ACP Health & Medical Nephrolithiasis Discussion Responses

Response to these classmates forum posts
classmate 1: Bre
Primary literature regarding nephrolithiasis
I found a 5-year randomized prospective study. The aim of the study was to see how much of a risk urine volume factors in patients nephrolithiasis was. They took 199 patients who had already had one idiopathic calcium stone. They randomly split the participants into two groups and followed them for five years. One group was a controlled group and the other was involved in a high intake of water. The patients were evaluated every year for five years. They concluded from their study that increasing your urine volume can decrease the prevalence of kidney stones. They also believe that taking in more water should be the first line therapy in preventing future occurrences. In the 5-year time frame 12 participants in the experimental group had another episode involving kidney stones. The control group had 27 participants who had another kidney stone. I would like to see the study done with much more participants in each group, which I think could be possible. It is an easy study to replicate and doesn’t involve much risk to the participants. It makes sense from a physiology standpoint that more water intake would help with preventing kidney stones. Drinking more water ultimately dilutes the substances in your urine that could cause a stone. I also think dietary changes should be involved with the increase in water intake, an example would be to cut out things that could dehydrate the body, such as caffeine.
Reference:
Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini A. Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study. J Urol. 1996 Mar;155(3):839-43.
Secondary literature regarding nephrolithiasis
The article I found while researching was very insightful. Kidney stones are rising in the United States every year and is already affecting a little over five percent of adults in America. Out of all the chronic kidney conditions nephrolithiasis is 2nd most common under hypertension. Something I found interesting was that kidney stones are more common in men than in woman. Since I have been married to my wife, she has had kidney stones twice, and it was tough to see her go through it. I know of multiple woman in her family who also are prone to getting kidney stones. This has been my only exposure to kidney stones, personally so it came as a surprise that it is more prevalent in men than woman, because I have only had women in my life experience them. The article also went into the difference between the stones in woman and men because there is a difference in the composition of the two. The composition also differs in children.
Classmate 2: Sha
Primary Literature – I found a prospective study which included the health professional follow-up study (HPFS), nurse’s health study (NHS1), nurse’s health study (NHS2). The study explored the association between history of kidney stones and risk of coronary heart disease. The study was conducted between 1986-2010 with 242,105 people: men(45,748), women(196,357). The men were followed for 24 years and the women for 18 years. At the conclusion of the study, 19,678 people reported kidney stones. The study showed no significance association in the men. However, in the female group a history of kidney stones did show an increased risk of coronary artery disease.
JAMA. 2013 Jul 24; 310(4): 408–415.  doi: 10.1001/jama.2013.8780 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC40199…
Secondary Literature – I found a meta-analysis and systematic review of cohort studies that measured kidney disease and its association with diabetes, obesity, waist circumference, BMI, and physicial activity. The review searched PumMed and Embase up until 4/22/2018 for the studies and it consisted of cohorts with specific relationships. BMI and kidney stones (8 cohorts); waist circumference and kidney stones (5 cohorts); weight gain and kidney stones (3 cohorts); diabetes and kidney stones (10 cohorts); physical activity and kidney stones (4 cohorts). The review observed as of lately kidney, stones have been associated with heart disease. Since heart disease is associated with obesity and diabetes it makes sense to explore the possible connection that kidney stones could have the same risk factors. The study found that several reports of increased body mass index, greater waist circumference, weight gain and diabetes were associated with kidney stones.  Eur J Epidemiol. 2018;33(11): 1033-1047
references: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC62089… 
Tertiary Literature – I found a newsletter (reviewed by Univ of Illinois-Chicago, School of Medicine) from Medical News Today entitled, “How do you get kidney stones?”. Kidney stones are caused by calcification and build-up of certain materials inside the kidneys. Kidney stones form as a result of low water intake. When we don’t drink enough water to sufficiently dilute the urine, the urine becomes very acidic and form kidney stones. The newsletter reports that more men than women suffer from kidney stones and the average age is 30-50 in both. If you have a family history of kidney stones, you have a greater risk to develop kidney stones. To me, the newsletter echoes the same sentiment as the primary and secondary literature I read regarding certain risk factors. People who eat high protein and high sodium foods, have very little physical activity, are obese, and have hypertension are at much high risk to have kidney stones. https://www.medicalnewstoday.com/articles/154193.p…
classmate 3 zeAccording to several articles, kidney stones are most commonly described as minerals and salts that form into hard deposits in your kidneys. There are several types of kidney stones calcium stones, cysteine stones, struvite stones and uric acid stones. 
Calcium stones are the most common type of kidney stone and they have been linked to consuming foods with high oxalate content, metabolic conditions, medications such as topiramate and high doses of vitamin d.  Cystine stones are the least common type of kidney stones, they are formed by too much cystine in the urine.  Struvite stones are typically linked to people that get chronic urinary tract infections. The last type of stones are uric acid stones. Having a diet high in animal protein, being overweight, having gout and being  diabetic may result in Uric acid stones. 
One of the biggest risk factors for all types of kidney stones is dehydration. Having concentrated urine makes it more likely for stones to form. Increasing your fluid intake will dilate the urine and help keep salts dissolved. 
The following medications have been known to help patients with kidney stones –thiazide diuretics, allopurinol, potassium citrate, acetohydroxamic acid and cysteine binding drugs. 
Most kidney stones are passed without any type of treatment, however depending on the severity of the stone surgery may be necessary.

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