Kidney Diseases and Urinary Track

The production, transport, storage, and discharge of most liquid wastes by the human body are accomplished by the marvelously engineered, highly complex and integrated urinary system that includes several vital organs. The kidneys and ureters operate together, with delicately controlled cellular mechanisms in each kidney, giving finesse to the passage of urine through a muscular contraction called peristalsis, ending finally with the act of urination.

Each kidney weighs less than a pound, yet contains over two million microscopic filtration units. These nephrons, if stretched out end-toend, would be fifty miles long! Every day our kidney tubules perform the amazing feat of removing about 300 pints of water from the blood, All but around three to six pints of this filtered water is returned (98-99%), purified of waste and mineral-balanced to perfect accuracy.

Proper treatment of urinary problems requires an understanding of the physiology of this process, making possible most methodical analysis, then guiding medical practitioners to an accurate diagnosis. This in actuality, is usually derived from the history of the illness, together with certain physical findings; and most simply the examination of the urine.

A patient may develop a life-threatening disease in the genitourinary tract with few, if any symptoms. However, the following symptoms at least suggest urinary tract disease. Nocturia is the awakening at night to void, usually unnecessary for the ordinary person. Nighttime urination may be caused by bladder dysfunction, infection, or the presence of stones.

Metabolic disorders, such as diabetes, congestive heart failure, or the intake of some drug can also produce these symptoms. Usually, though, it results from excessive water intake, drinking particularly late in the day. Frequency: The normal person voids three to four times a day.

Increased urinary frequency may be due to several causes. Polyuria means larger than normal total urine volume. This is characteristic of metabolic disorders such as diabetes, as well as inordinate fluid intake. Diminished urine volume is called oliguria. At times complete suppression of urine formation occurs. This is termed anuria.

The sudden desire to void, called urgency makes control difficult, even impossible at times. Occasionally this is associated with pain or discomfort on urination, called dysuria. When it is severe, bladder spasm may follow voiding, and usually indicates the presence of an irritated or infected bladder.

Hesitancy denotes undue delay and difficulty in initiating the voiding process. With infection blood may be present in the urine (hematuria), or pus may appear (pyuria). A kidney or bladder stone may be passed occasionally. Incontinence is another distressing symptom, where involuntary loss of urine occurs.

The stress of coughing or straining may cause this, or it may occur in association with urgency. Pain from a kidney disorder may vary from dull aching discomfort in the flank to very sharp flank pain radiating into the lower abdomen or buttocks. Renal pain may be episodic or persistent.

Often it is associated with loss of appetite, nausea, or vomiting. When a stone is passing through the ureter, pain is quite excruciating, causing the patient to move about restlessly, holding the area of discomfort, often by grasping the flank between his thumb and forefingers.

Kidney pain tends to radiate into the lower abdomen and genitalia. A stone lodging in the junction between the ureter and bladder may also cause frequency, urgency, and pain on urination. Individual cases may present with severe or mild symptoms, and the diagnosis may be immediately apparent or thoroughly obscure.

A careful examination of the affected area and scrutiny of the urine, both with light illumination and, when possible the microscope, is of considerable help in establishing numerous causes.

Urinary Stones

Stones in the kidney or ureters may occur at any age, but are more common in the third and fourth decades. These calculi may be single or multiple, firmly lodged or free. Kidney stones often cause pain, produce blood in the urine, and symptoms of vague abdominal distress.

Occasionally, even when large, stones may occur without symptoms, while causing serious and insidious kidney damage. Characteristically, as mentioned above, renal calculi cause severe, sharp flank pain, which is often acute in onset and present intermittently.

A small stone being passed in the ureter creates painful colic and the patient usually moves about restlessly, vainly seeking relief. Blood is frequently present in the urine, but at times requires the microscope for its detection.

Physical findings may be entirely normal, although tenderness, muscle spasm, or even a lump may be felt in the location. It is important to search for the original cause of the stone, then attempt to correct it.

Most stones after bladder passage can be analyzed to determine their composition. Some are composed of calcium salts; others of oxalate crystals, and less commonly uric acid or cystine may precipitate to form stones.

Each of these causes needs to be ascertained in order to correct the diet, avoiding future recurrence. One of the commonest situations that sets the environment for an attack of colic is inadequate fluid intake. Normally our kidneys require at least one and a half to two quarts of fluid a day!

That will maintain urine volume at diluted concentrations, to avoid the precipitation of these salts. A high consumption of milk may result in calcium precipitation and the formation of a stone. Ice cream, cheese, and soft drinks such as cola beverages, and foods high in oxalic acid may provide the situation where stones begin to crystallize.

Uric acid stones usually result from a high intake of purines, found in meats, particularly sweetbreads, and other flesh foods obtained from animal organs. Uric acid calculi are usually seen in combination with other symptoms of gout, a metabolic disease traditionally associated with indulgence in rich foods and alcohol.

A discriminating, well-balanced diet associated with adequate fluid will usually bring relief to patients who form uric acid stones frequently. The treatment of colic in the urinary tract usually begins at home. Drink a high intake of water, at least one glass of liquid hourly, and begin immediately. Urinary acidifying agents are helpful to deter stones of calcium or oxalate composition, while for uric acid stones the urine should be alkalinized.

Vitamin C and cranberry juice are both good acidifying agents for the urine, and are also helpful in treating urinary infections. Diuretic herbs, such as Buchu tea may also be helpful, when combined with a high volume of fluids. Relief of acute urinary pain can be obtained in a hot tub bath, or with intensely hot fomentations applied to the flank and hip region.

At times when flank pain is severe, the treatments will not only modify the pain, but through reflex pathways may help to relax the ureter and alleviate the spasm. Most often the smaller stones (calculi) will pass down into the bladder, where they are then excreted.

Since obstruction in the urinary tract can progressively damage the kidney, as well as be painfully disabling, any urinary stones that do not resolve promptly should be evaluated be a competent physician. Newer diagnostic techniques using x-ray contrast, and cystoscopic basket stone retrieval, water immersion shock (sound) wave lithotripsy, and other types of surgery may be necessary to save the kidneys from permanent harm.