WHAT CAUSES KIDNEY STONES?

Urolithiasis is a final manifestation of a broad range of etiologies and pathogenesis. The formation of kidney stones is a complicated process and is manifestation of a broad range of etiologies & pathogenesis. It needs to be evaluated & treated with due considerations. It is a disease itself and can cause many others diseases. Advanced medical science have discovered many factors for the formation of stones but still many causes are hidden, many secrets unfolded and many questions unanswered. Some of the known factors are

1-Low urine output or concentrated urine
Kidney stone is a hard solid mass, formed by the aggregations of microscopic crystals that are present in the urine. Therefore, if there is excretion of less quantity or concentrated urine in the kidney, the chances of stones formation will increase, as the stone forming crystals will come closer with more chances of union and formation of stones.
On the other hand if urine is dilute & in adequate amount, the crystals will remain apart from each other and there would be fewer chances for their aggregation & stone formation.
Low urine out put or concentrated urine may be due to many reasons, such as drinking less water habitually, hot climate, excessive sweating, less thirst, less vigor to drink water due to stress, over work or depression, psychosis, out door activities and non availability of water at hand. Intestinal disorders causing diarrhea, loose motions and dysentry will cause loss of fluids & electrolytes with disability to absorb water.

2- Diet
Although, diet plays some role in formation of stones, but not in every stone and also not so significantly as is stressed commonly. There are so many reasons of stone formation and restriction of diet in every case is not advisable. Some specific stones are formed due to dietary imbalance like uric acid stones, ( due to intake of excessive proteins), but in general, no direct relationship has been discovered between diet & stone formation. We live in the same environment, under the same roof top, eat same food stuff & drink same water & fluids. One member of the family develops kidney stone disease while others do not. This shows that diet is not the sole major factor involved in the formation of stones and the restriction & selection of diet in every case is not so important. Generally, with few exceptions, the best advise for stone formers is to eat all kinds of food adequately, and don't over eat or restrict any particular food item.

Many stones have Calcium component, which is present in milk & dairy products ( yogurt, cheese, sweets, custard, pudding. milk shakes) , beans, wall nuts, oat, bran, cabbage, rice, fish, shrimps, baking powder, zuiki (Dar cheeni dried), Red peppers, sparrow, black tea, noodles, Sudachi (mitha), olive, egg yolk, Basil (podina, ?), thyme (zeera?), corn, mushrooms, cheese, corn cream soup, brown sugar, Hijiki(algi), peas, tomatoes ,Soya bean, cinnamon, clove, turnip pickle, biscuits, garlic, poppy seed, sesame seed ect. According to recent research, it is advised, not to restrict calcium in diet as a prophylaxis to restrict the calcium stone reformation, rather to increase the intake of calcium in adequate amount. So, the restriction of calcium containing diet is not advisable in calcium containing stones.
Some stones contain Oxalate, which is present in coffee, cola, tea, chocolate, spinach, green veggies, peanut, sweet potatoes, bear, oranges, berries, cranberries, tofu, beets, beans, rhubarb and adequate amount of these is allowed, but excess of every thing is bad.
More over, in Calcium oxalate stones, the relative amount of calcium & oxalate in gut affects the absorption of oxalate from intestines and disproportionate excess of one component affects the absorption of other stone forming component with resultant increase chances of stone formation.
Some stones have uric acid component and excess of proteins i.e. red meat, fish , poultry & eggs are restricted from their diet.
Further more, the excessive use of sodium salts, vitamins (C&D), alkaline & acidic drinks & juices may also effect the formation of stones.
In remote under developed areas, with poor hygiene, week health & low protein diet may formation of urinary bladder stones is common, especially in children.
Briefly, many research articles still find the role of diet in stone formation, inconclusive.

3- INFECTION
If there is urinary tract infection, especially with urea splitting organisms, it changes the PH of the urine to alkaline, which create favorable environment for stag horn or triple phosphate stones formation, spreading quickly in whole of the collecting system of kidneys.

4-OBSTRUCTION (NARROWING & DISTORTION OF INTRA & EXTRA RENAL COLLECTING SYSTEM) WITH COLLECTION OF URINE IN KIDNEYS
Normally, there is free flow of urine from kidneys, through ureteral tubes into urinary bladder. If this free flow is interrupted due to blockage or narrowing of ducts, urine collects in kidneys and its stasis causes infection & formation of stones by providing more favorable environment for stone forming elements to come closer & stay together. This blockage could be intra renal (Calyces & PUJ narrowing) or extra renal (Ureter). This blockage may be distal to urinary bladder (urethral stricture, stenosis & enlarged prostate), which favors formation of stones in urinary bladder.
There are various reasons for this distortion, stenosis and obstruction, which may be congenital or acquired. The congenital causes include polycystic kidneys, horse shoe kidneys, mal rotated kidneys, duplex system etc. The acquired causes include injuries including surgical & endoscopic trauma, tumors, infections, post infective fibrosis, strictures & distortions etc,

5-ELEVATED LEVELS OF STONE FORMING ELEMENTS IN BLOOD
For instance elevated levels of calcium, oxalate, uric acid in blood

6-EXCESSIVE EXCRETION OF STONE FORMING ELEMENTS IN URINE
For instance excessive amount of calcium, oxalate, uric acid in urine

7-CHANGES IN THE PH LEVEL OF URINE
This will change the amount of acids and alkali in urine helping in the formation of different kinds of stones.

8-OVER ACTIVITY OF PARATHYROID HARMONE
The parathyroid glands, present in neck, control the level of calcium in blood. Any abnormality, which causes over activity of this gland will result in elevated levels of calcium in blood with resultant formation of multiple kidney stones in both sides, even in children.

9-INHERITED TENDENCY
Stone disease may run in families and many members of the same family may suffer from this disease, without any apparent cause.

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