Awareness about a disease is important because it helps us in identifying the symptoms early in the course of the disease, helping us in taking timely treatment. Getting to know about the risk factors associated with the disease can help us in identifying early symptoms and if the risk factors are modifiable this awareness can help us in reducing the chances of getting the disease or reducing the severity of the disease or the chances of recurrence. The disease of kidney stones is very prevalent in India and knowing about the risk factors is of immense value for the Indian population so that they can reduce the chances of getting a kidney stone by modifying the modifiable risk factors.
Risk Factors of Kidney Stones
Here are the risk factors for forming kidney stones:
Family history or genetics
This is perhaps the most important risk factor. Your genetics or your chromosomes decide the chemistry of your body fluids including your urine. In a person who has kidney stone disease, the chemistry of urine is different from the person who does not form a kidney stone. The genetics can make your urine prone to kidney stone formation by leading to early precipitation of the salts which are excreted in the urine and are normally present in the dissolved state. In kidney stone formers the salts or chemicals which would usually remain in a dissolved state tend to precipitate in the form of crystals and eventually form a kidney stone.
Genetics is responsible for the tendency of urine but there are multiple other factors responsible for the final formation of the kidney stone. The acidic or alkaline content of urine is determined mostly by genetics. Your chromosomes also are a major deciding factor for the excretion of certain substances in the urine which are supposed to protect you from the formation of kidney stones like citrate and many other compounds. If you have a family history of stone formation, this points towards a genetic tendency of forming a kidney stone and you will be at a higher risk of getting a kidney stone as compared to a person who has no family history.
It has been found that people who are overweight have more acidic urine as compared to a normal weight person. An obese person also tends to excrete more uric acid and calcium in the urine which ultimately leads to the formation of kidney stones. So a person who is overweight has a higher risk of getting a kidney stone.
Researches have shown that patients with diabetes, specially with uncontrolled sugars have urine that is much more acidic as compared to non-diabetic patients. There are other mechanisms that could be contributing to this tendency like abnormal excretion of uric acid and abnormal handling of acid and alkaline load by the kidney.
The water content of your body is the most common and most important and modifiable risk factor for kidney stone formation. A dehydrated body produces very concentrated urine in which the excreted salts are present in concentrations much higher as compared to diluted urine in a normal person. This high concentration leads to the precipitation of these salts in the form of crystals which can grow in number and size and start making a kidney stone inside the kidney. As a person starts drinking more fluid the urine becomes dilute and the tendency of the salts to precipitate in the form of crystal reduces, thus reducing the risk of kidney stones formation. Also if the crystals have not come together in the form of a stone, dilution of urine leads to dissolution of these crystals which will pass in the urine through the normal urinary passage.
Indulgence in high-calorie high salt food has been found to be associated with a higher risk of kidney stone formation. If you are habitual of eating lots of junk food in your daily diet, especially food which is rich in salt and sugar, the risk of kidney stone formation goes up. Increased concentration of sugar and salt in your diet leads to higher excretion of salt forming chemicals in your urine and indirectly increases the chances of kidney stone formation.
Hormonal imbalance (hyperparathyroidism)
Near your thyroid gland, there is a gland called the parathyroid gland. The function of this parathyroid gland is to regulate the level of calcium in your blood. If there is some abnormality in this parathyroid gland the concentration of calcium in your blood goes up increasing the amount of calcium excretion in urine and in turn increases the risk of kidney stone formation. If you have a kidney stone and your blood calcium levels are high the probability is that it's probably your parathyroid gland which is hyper functioning.
For patients who have undergone surgery on their intestine or if they have undergone a bariatric surgery which is the surgical procedure done for reducing weight, it has been found that the chances of kidney stone formation are higher as compared to normal population. This results from altered absorption of the chemicals which are responsible for kidney stone formation. In normal population the major kidney stone-forming chemical known as oxalate which is present in the diet is excreted in the stools. But in patients who have undergone intestine surgery or bariatric surgery a higher amount of oxalate gets absorbed leading to a higher concentration of oxalate in blood and thus higher oxalate excretion in urine. This increases the risk of kidney stone formation.
A person suffering from chronic diarrhoea or malabsorption for years has a higher risk of forming kidney stone as compared to the normal population. This again happens because of abnormal absorption of stone forming chemicals like oxalates from the intestine which would otherwise get combined with the fatty acids and get excreted in the stools. But in a patient who has chronic diarrhoea absorption increases.
It has been found in medical research that the patients who have urinary tract infections, the chemical nature of urine changes as a result of bacterial interaction with the chemicals. Recurrent urinary tract infection can lead to long-standing altered chemical nature of urine which becomes more alkaline as compared to a normal person. This alkalinity is responsible for formation of special type of stones which are known as phosphate stones or infection stones.
Any anatomical and functional abnormality of urinary tract
A person who is having any kind of anatomical or structural abnormality in the urinary tract which leads to inadequate drainage of urine or pooling of urine in specific areas will have a higher risk of precipitation of salts in that stagnant urine. A similar thing happens if the expulsion of urine is impaired as a result of functional abnormality of the urinary tract. The common structural abnormalities which can lead to formation of stones are pelviureteric junction obstruction or PUJO, prostatic enlargement or stricture of urethra. The common functional abnormality which can lead to stone formation is known as neurogenic bladder which affects the contractility of the bladder.
These are the important risk factors which if present can increase the chances of formation of kidney stone in a person. If more than one risk factors are present the risk of forming a kidney stone will increase in that proportion. apart from these risk factors if a person has had the first kidney stone at an early age of teenage or childhood, or a person has multiple kidney stones or if the stones are present in both the kidneys the chances of forming recurrent stones are high. Awareness about these risk factors can definitely help us in reducing the chances of getting a kidney stone. Most of these risk factors are modifiable such as dietary habits, obesity and dehydration. Rest of the risk factors can be modified with some sort of treatment and are mostly correctable. The only unmodifiable risk factor seems to be genetics. So if you have any of these risk factors you must try to correct it so that your chances of getting a kidney stone become less. Getting rid of these risk factors will also reduce the chances of getting recurrent or repeat kidney stones.
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