Various approaches to kidney stone diet

Kidney stones form when the urine becomes so saturated with a certain mineral that no more of it can dissolve into the urine. The undissolved portion of the mineral forms crystals that then clump together and grow into hard stones. This condition is medically known as urolithiasis or nephrolithiasis. It is important for the physician to determine the stone's mineral content and to identify any medical conditions that may have contributed to stone formation. About 80% of all kidney stones are composed of calcium and other minerals, usually a combination of calcium and oxalate.

• Doctors used to prescribe a low calcium diet for preventing kidney stones. Changing the amount of calcium in the diet causes very little change in the blood level of calcium. Blood calcium level kept steady by balancing the absorption of calcium from diet and taking calcium from bones when it is needed. The kidney filters substances from the blood; so changing the dietary intake of calcium does not change the amount of calcium that is filtered by the kidneys.

• Citric acid can protect against kidney stone formation. Citric acid in its natural form, such as from citrus fruits, citric acid does not alkalinize the urine as citrate does. It prevents small stones from becoming “problem stones” by coating them and preventing other material from attaching and building onto the stones. Moreover it inhibits stone formation and breaks up small stones that are beginning to form. It is for this reason, that citrus fruit, especially lemons should be plentiful on the kidney stone diet. The exception to this rule is grapefruit juice.

• Another approach to prevent kidney stones in adults is to eat calcium rich foods and avoid foods rich in oxalates. Calcium and oxalate always have a tendency to bind in the intestine). If oxalate rich foods (Chocolate Tea Spinach Beet tops Peanuts Almonds) are restricted in the diet, taht can bve solved and chances of formation of stones can be reduced.
  

• Insoluble fiber (found in wheat, rye, barley, and rice) that may help to reduce calcium in the urine. It combines with calcium in the intestines, so the calcium is excreted with the stool instead of through the kidneys. Moreover insoluble fiber also speeds up movement of substances through the intestine, so there will be less time for calcium to be absorbed.

• Potassium reduces urinary calcium excretion, which in turn lowers the risk of kidney stone formation. So foods rich in potassium should be included in the diet.

• Protein rich foods increase urinary calcium and should be reduced in the kidney stone diet.

• It is believed that sugar can increase urinary oxalate and urinary calcium.

References

kidney stone diet

http://www.medindia.net/patients/patientinfo/diet-kidney-stones.htm

Citric acid and kidney stones

Physical characteristics and abnormal constituents of urine part1

Appearance: Small quantity of blood in urine is often undetectable by inspection, but it gives the urine a smoky appearance. Large quantities of blood make the urine brownish or red. Colour variation from dark red -brown-black occurs due to presence of large amount of heamoglobin from lysed red blood cells, after mismatched blood transfusion or in black water fever. Drugs like tetracyclines, anthraquinonepurgatives, desferrioxamine, pheninedione, nitrofurantoin and nitridazole rifampacin, may discolour urine. Cloudiness of urine may be due to the presence of red or white blood cells, pus from bladder or kidney infection, bacteria, mucous and chyle. Phosphates and pus make freshly passed urine cloudy.

Odour: Foul smelling urine is a common symptom of urinary tract infection. Fruity odour is associated with diabetes mellitus, starvation, dehydration or ketone body formation. Patients with maple syrup urine diseases and phenyl ketonuria may present with distinctive odour of the urine.

Specific gravity: Low specific gravity (below 1.005) associated with diabetes insipidus, acute tubular necrosis, nephrogenic diabetes insipidus and pyelonephritis. High specific gravity (above 1.035) occurs in patients who are in shock or who suffer from nephritic syndrome, dehydration, and acute glomerulo nephritis.

PH: Ranges between 4.6 -8.0.High protein diets increase the acidity of urine; vegetarian diets increase the alkalinity. (Normal fresh urine is nearly always slightly acidic, except after a meal.) Value greater than 7 may be due to metabolic/ respiratory alkalosis, Fanconi’s syndrome. Ph value below 7 may be due to fever, phenyl ketonurea, alkaptonurea and acidosis.

Blood and tissue cells: Red blood cells in the urine can be due to vigorous exercise or exposure to toxic chemicals. High number of white blood cells in the urine is usually a symptom of urinary tract infection. Certain other causes of haematurea are bacterial infections, parasitic infections including malaria, obstructions in the urinary tract, scurvy, sub acute bacterial endocarditis, traumatic injuries, and tumors. A large number of cells from tissue lining can indicate damage to the small tubes that carry material into and out of the kidneys.(In females, one should make sure that the urine sample was not contaminated with menstrual blood from vagina.)

Casts: They are small fibrous objects that are formed when protein and other materials settle in the kidney tubules and collecting ducts. Large number of casts in urine specimen is a sign of kidney disease.

Sources

Hutchison’s clinical method

Davidson's Principles and practice of medicine

Haematurea

Medical inventions and Discoveries

Stethoscope - Laennec (1819)

Chemotherapy - Ehrlich (1909)

Pace maker - Zoll (1952)

Hearing aid - Sonotone Corporation, USA (1952).

Heart –lung machine - Dr. John H. Gibbon. (1953)

Artificial heart - Willem kolff (1957)

LASER - Gould (1957)

MRI -Damadian (1971)

Cloning DNA - Boyer, Cohen (1973)

CT Scan - Hounsfield (1973)

HIV -M.Cockerell. (1984)

Microscope

Compound - Z.Janssen (1590)

Electron -Ruska knoll (1931)

Hepatitis markers and its usual significance

• HBsAg

Virus is present.

• Anti-HBs (surface antibody)

Virus is usually cleared and Patient is immune.

(Presence of hepatitis B surface antigen (HBsAg) signifies the infection with the virus.It doesnot give the information regarding infectivity and the ongoing liver damage.When the virus is cleared from the infected person,antibody to hepatitis B surface antigen (anti-HBs)develops.It gives immunity to further virus infection.)

• HBeAg*

Active viral replication ,ongoing liver disease ,patient infectious.

• Anti-HBe*

Viral replication reduced ,inactive liver disease (usually),Less infectious.

(HBeAg usually represents that , there is an active viral replication. The disappearance of HBeAg and appearance of anti Hbe usually means that the level of viral replication and the associated liver disease has lessened.The individual is less capable of infecting others.)

• HBV-DNA
  

Active viral replication and on going liver disease,patient infectious.

(HBeAg and/or HBV-DNA should be measured , if active viral replication is present.)

• HBcAg

Never detectable in serum

• Anti-HBc (core antibody)

(Hepatitis B core antigen (HbcAg) never appears freely in blood. The corresponding antibody (anti-HBc) appears in the blood at about the same time as HBsAg and usually remains for life.It implies that Patient has come into contact with hepatitis B and may or may not still be infected with the virus. Anti HBc does not signify immunity)

IgM anti-HBc Signifies recent contact with hepatitis B

* except for pre-core mutant strains of HBV(the mutant strain of HBV (pre-core mutant) in which the virus cannot manufacture HBeAg and thus the only marker for the presence of the virus core is HBV-DNA.)

Links

Approach to the management of incidentally detected HBsAg carrier

hepatitis markers

Concept of Polypill and the criticism

A polypill is a medication, which contains a combination of five life-saving drugs called “polypill” that promises to reduce the risk of heart attack and stroke in healthy people. It was actually conceived, developed and clinically tested in Bangalore,India.

The pill is a result of a three-year study conducted by three doctors from St. John’s Medical College, Bangalore along with a team of experts from McMaster University, Hamilton, Canada.

The combination

The "polypill" would contain 3 blood pressure medications at low dose:

a diuretic, such as bendroflumethiazide,a beta-blocker such as atenolol,
an ACE inhibitor such as enalapril.

This is combined with

a statin such as simvastatin,aspirin at a dose of 75 mg and

Follic acid(Follic acid has been shown to reduce the level of homocysteine in the blood which is another risk factor for heart disease).

The criticism

Although several group of physicians accept the rational combination of proven life-saving drugs in easily administered and cost-saving formulations, especially for the secondary prevention of Cardio vascular diseases, they expresses their concern over, proclaiming polypill as the principal pathway to primary prevention of Cardio vascular disease.

Several scientific questions currently remain, especially with respect to primary prevention. How will this drug combination alter with behaviour change involving healthy diets, regular exercise, and smoking cessation?

Critics also worry that the promised protection of a polypill may work against people giving up unhealthy habits like smoking or bad diet.

Another criticism is that,a person would be subjected to different drugs unnecessarily even if he had one ailment.


Links

Can polypill replace poly-policy for heart health

SWINE FLU

Swine influenza (also swine flu) refers to influenza caused by any strain of the influenza virus endemic in pigs (swine). Swine influenza is known to be caused by influenza A subtypes H1N1, H1N2, H3N1, H3N2, H2N3.

Epidemiology: Earlier,many cases in swine (2007 Philippines) & in humans(The "Spanish" influenza pandemic of 1918–19 infected one third of the world's population and US outbreak in 1976)were reported.

The new strain of influenza involved in the 2009 swine flu outbreak is a combination of several strains of influenza A virus subtype H1N1 that are separately endemic in humans and in swine.

In response to the intensifying outbreak, the World Health Organization raised the worldwide pandemic alert level to Phase 4alert.

Who are at risk? Swine flu is common in swine and rare in humans. People who work with swine, people with intense exposures ,are at risk of catching swine influenza. Rarely these strains are able to pass from human to human.Swine flu cannot be spread by pork products, since the virus is not transmitted through food.

Infectivity: The swine flu in humans is most contagious during the first five days of the illness.Although some people, most commonly children, can remain contagious for up to ten days.

Clinical features: In humans, the symptoms of swine flu are similar to those of influenza.Symptoms include ,chills, fever, sore throat, muscle pains, severe headache, coughing, weakness and general discomfort. According to Centers for Disease Control and Prevention (CDC) advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the 7 days preceding their illness onset."

Diagnosis: A diagnosis of confirmed swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab)

Prevention:Experts agree that hand-washing can help to prevent viral infections, a surprisingly effective way to prevent all sorts of diseases, including ordinary influenza and the new swine flu virus.Frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public.Anyone with flu-like symptoms such as a sudden fever, cough or muscle aches should stay away from work or public transportation and should see a doctor to be tested.

Further reading: Swine flu

Nail as a diagnostic tool PART 2

Splinter hemorrhage under the nail may result from trauma,psoriasis,rheumatoid arthritis other collagen vascular diseases and bacterial endocarditis. Bacterial endocarditis is the most common systemic disease associated with splinter hemorrhages. These hemorrhages are more common in subacute variety rather than acute variety.Although splinter hemorrhages in subacute bacterial endocarditis have been described as proximally located,no suitable evidence available to confirm this

Leukonychia. These marks are common, nonuniform, white lines found in differing spots on one or more nails. It should not be confused with Mees line(due to arsenic poisoning)and Muehrcke's line which are parallel to the lanula across the entire nail bed and occur in more than one nail.

Beau's lines. This condition presents as a transverse depressions in the nail that result from trauma, exposure to cold, Raynaud's disease, or any episodic disease condition serious enough to disrupt the normal nail growth

Raynauds phenomenon can lead to thinning and longitudinal ridging of nail plate

Muehrcke's line demonstrates as a transverse white bands parallel to the lanula. These bands usually occur in pairs and extend all the way across the nail.

Half and half nail with a white proximal and red or brown distal half is occasionally seen in patient with chronic renal failure

Whitening of nail plates may be related to hypoalbuminaemia as in cirrhosis of the liver

Nail fold erythema is a useful physical sign in dermatomyositis, systemic sclerosis and SLE


References :

Huchisons clinical method

Davidson’s Principles and practice of medicine

Nail disorder index

PART 1