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CKD and Kidney Stones: Recognize before it’s too late

Kidneys, bean shaped organs, are located just below the rib cage, one on each side of the spine. Kidneys have significance in body functionality by keeping the composition or makeup of the blood stable. They (a) prevent the buildup of wastes and extra fluid in the body (b) keep levels of electrolytes stable, such as sodium, potassium, and phosphate (c) make hormones that help

  • regulate blood pressure
  • make red blood cells
  • bones stay strong

 

CKD (Chronic Kidney Diseases) is sometimes called a “silent disease.” Patients rarely feel sick until their kidney disease is advanced. Symptoms may include:

 

  • Fatigue
  • Trouble concentrating
  • Poor appetite
  • Trouble sleeping
  • Muscle cramping at night
  • Swollen feet and ankles
  • Puffiness around eyes, especially in the morning
  • Dry, itchy skin
  • More often urination, especially at night

 

Black and south Asian people are three to five times more likely to have kidney failure than white people, but many are unaware of the condition.

 

Kidney Stones & Chronic Kidney Diseases:

 Causes of kidney stones are as follows.

  • Calcium
  • Ammonia
  • Oxalate
  • Uric Acid (a waste product produced when the body breaks down food to use as energy)
  • Cysteine (an amino acid that helps build protein)

 

Certain medical conditions can lead to an unusually high level of these substances in urine. Kidney stones are more likely to develop if the fluid intake is low.

Kidney stones and Chronic Kidney Diseases affect 5% and 13% of the population respectively. Infection stones (struvite) may lead to an obstructive nephropathy with staghorn calculi and are the leading cause of ESRD (End Stage Renal Disease) attributed to nephrolithiasis. Kidney stones could be considered a contributing factor in developing and progression of CKD (Chronic Kidney Diseases). One of the roles of the kidney is to excrete metabolic wastes such as calcium and oxalate at supersaturated concentrations yet prevent precipitation of crystals. Thus, stone formation could be considered an imbalance between the substances which are dissolvers of crystal and promoters by and large. This leads to kidney diseases.

There is evidence that the risk for CKD varies by stone type, but more studies are required. Population based studies often lack the granular detailed data to characterize stone type because many stone formers never have their stones analyzed or urine chemistries evaluated, and, even if so, this information often is not available in the databases available for study. Informal researches indicate that 70% of the stones are Calcium Oxalates.

Kidney Stones & Diet:

Diet plays an important role in the pathogenesis of kidney stones. Because the metabolism of many dietary factors, such as calcium, may change with age, the relation between diet and kidney stones may be different in older adults. Uncertainty remains about the association between many dietary factors, such as vitamin C, magnesium, and animal protein, and the risk of kidney stone formation. Importance of individual dietary factors in the development of symptomatic kidney stones is high. Foods that are high in calcium, potassium, and magnesium should be evaluated as part of a diet to reduce the risk of kidney stone recurrence. Although vitamin C intake is associated with an increased risk of stones, the high amount of potassium in vitamin C–rich foods suggests that limiting the intake of dietary vitamin C in men with calcium oxalate nephrolithiasis is unwarranted.

References:

Rule, A., Krambeck, A. and Lieske, C., 2011. Chronic Kidney Disease in Kidney Stone Formers. Clinical Journal of the American Society of Nephrology, 6, pp. 2069-2075.

Rule, A., Bergstralh, E., Melton, L., Xujian, L., Weaver, A. and Lieske, J., 2009. Kidney Stones and the Risk for Chronic Kidney Disease. Clinical Journal of the American Society of Nephrology, [Online] Available at: <http://cjasn.asnjournals.org/content/4/4/804.full.pdf+html>

NHS, 2015, Black and south Asian kidney health. [Online] Available at: <http://www.nhs.uk/Livewell/Kidneyhealth/Pages/BlackandAsiankidneyhealth.aspx>

Curhan, G., Willett, W., Speizer, F. and Stampfer, M., 1999, Intake of Vitamins B6 and C and the Risk of Kidney Stones in Women. Journal of the American Society of Nephrology, 10, pp. 840-845.

Taylor, E., Stampfer, M. and Churan, G., 2004, Dietary Factors and the Risk of Incident Kidney Stones in Men: New Insights after 14 Years of Follow-up. Journal of the American Society of Nephrology, 15, pp. 3225–3232.

 

 

By

Dr. Sameeh J. Khan

Nephrologist- KIH

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World Heart Day: A Healthy Heart… A Healthy Life

Cardiovascular Disease (CVD) is the world’s leading cause of death which kills 17.3 million people every year. 80% of these deaths occur in developing and under developed countries. In Pakistan, 200,000 people die of CVD every year which is 40% of total deaths occur. Being a trendsetter in healthcare sector and a renowned cardiac center, Kulsum International Hospital celebrated World Health Day with a slogan “A healthy Heart… A Healthy Life”.

Patients, attendants and all the community was encouraged to adopt a healthy lifestyle and communicated about the risk factors attributed to CVD. Our CSR (Corporate Social Responsibility) activities like these will be continued for the well-being of the community.

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KIH Nursing Care

Nurses take care of patients and they are involved in stability of a patient’s life. Nursing is considered one of the challenging professions. It is a continuous business which never ends.

Nursing Department at KIH is known for its exceptional care and it strives to maintain standards. To assure the quality, adequate nurse patient ratio is maintained, infection prevention & control practices are promoted, safe medical administration is practiced, pressure ulcer is kept to minimal level and capacity building of staff is kept on priority. Under the guidance of Ms. Salimah Jalal Baig (Chief of Nursing Services, KIH) trainings were conducted for the staff which include BLS (Basic Life Support) Certification, 12 leads ECG course and ACLS Mega Code.

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Renewal of IBTA License

Inspection team of Islamabad Blood Transfusion Authority (IBTA) has visited KIH Blood Bank lately for the renewal of license for next year 2015-2016. KIH Blood Bank was initially licensed on 1st April, 2014.

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Diet and Nutrition Clinic

KIH introduces Diet and Nutrition Clinic to provide services to the patients needing food and nutrition advice. Ms. Afsheen Hasan (HOD Clinical Nutrition & FNSD) runs the clinic. She is a member of Pakistan Nutrition & Dietetic Society (PNDS). For appointments, call our helpline 051-8446666 or visit www.kih.com.pk

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World Blood Donor Day – Thanks for Saving My Life

The theme of this year’s World Blood Donor Day was “Thank you for saving my life”. It was focused on thanking blood donors who save lives every day through their blood donations and strongly encouraging more people all over the world to donate blood voluntarily and regularly. To promote this life saving act, Kulsum International Hospital in collaboration with Pakistan Red Crescent Society celebrated World Blood Donation Day on 14th June, 2015 at KIH. Patients and attendants visited the kiosk to learn more about the significance of blood donation. Learning material was also distributed among all the visitors. Many visitors voluntarily gave blood to KIH Blood Bank.

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Hypertension – An enemy inside you:

An awareness session was conducted at Kulsum International Hospital on Hypertension with the theme “Hypertension, An enemy inside you”. Dr. Hamid Iqbal (Cardiologist) presented particulars to patients and visitors about the life style and factors which promote hypertension. Audience was provided with education material which helps in making them understand causes, effects and complications of hypertensive life style.

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Percutaneous Vertebroplasty

Services for Percutaneous Vertebroplasty have been introduced at Kulsum International Hospital with an aim of providing this treatment modality to the patients. Vertebroplasty is a minimally invasive, image guided therapy used in relieving the pain from a vertebral body fracture. Percutaneous Vertebroplasty involves percutaneous injection of cement called Polymethylmethacrylate in to the vertebral bodies.

A patient was brought for a treatment with history of trauma having TH12 collapse vertebral body and painful spine. Pain was radiating to the ribs. Dr. Umair Rashid Chaudhry, Consultant Neuro-Radiologist at KIH, conducted the procedure using local anesthesia under Fluoroscopy. The procedure had excellent results.

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Another Milestone Achieved

KIH Laboratory achieves another milestone by attaining ISO 15189:2012 accreditation. Pakistan National Accreditation Council (PNAC), Ministry of Science and Technology awards this accreditation. KIH Laboratory is the 6th Pathological Laboratory of Pakistan to achieve this status. Certificate was formally handed over in the ceremony held on 26th May 2015 at Kulsum International Hospital. This ceremony was attended by Ms. Ismat Gul Khattak (Director General, PNAC) Mr. Ateeq Memon (Deputy Director General, PNAC), Mrs. Hoor Yousafzai (Director, Saif Group), Dr. Muhammad Saleem Khan (CEO, Saif Healthcare Limited), Dr. Syed Muntazir Mehdi Zaidi (Head of Operations and Administration, Saif Healthcare Limited), Dr. Haroon Khan (Head, KIH Laboratory), Mr. Asim Ansari (Manager, KIH Laboratory) and Mr. Sikandar Zaman (Manager Marketing, Saif Healthcare Limited). All the participants discussed important aspects and valuable long term impacts of accreditations on the healthcare industry of Pakistan.

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