Antibiotics Tied to Higher Kidney Stone Risk

Alan Mozes wrote . . . . . . . .

If you or your child is taking an antibiotic, new research suggests you might want to watch closely for signs that kidney stones might be developing.

“We found that five classes of commonly prescribed antibiotics were associated with an increased risk of kidney stones,” explained study author Dr. Gregory Tasian.

That increased risk appeared to linger for three to five years, and pediatric patients were the most vulnerable to developing the painful condition.

The findings echoed those of prior studies, “although we did not know which specific classes of antibiotics would be associated with an increased risk of stones and which ones would not,” Tasian added.

Tasian is an assistant professor of urology and epidemiology with the University of Pennsylvania Perelman School of Medicine.

The five antibiotic classes newly linked to kidney stone risk included sulfas (Bactrim, Gantanol); cephalosporins (Keflex); fluoroquinolones (Cipro); nitrofurantoin/methenamine (Macrobid, Hiprex); and broad-spectrum penicillins. No risk was observed among seven other classes of oral antibiotics.

Tasian stressed that this doesn’t mean people should avoid antibiotics when they’re truly needed.

“Antibiotics have saved millions of lives and are needed to prevent death and serious harm from infections,” he said. “The benefits outweigh the potential harms. These results don’t suggest that antibiotics should not be prescribed when indicated.”

However, they do support “the judicious and appropriate use of antibiotics, and reducing inappropriate use of antibiotics,” Tasian noted.

One kidney expert agreed that the proper use of the drugs is a balancing act.

“This study is another reminder that physicians have to be mindful of potential adverse effects of antibiotics and need to promote appropriate antibiotic stewardship. This is especially true since many antibiotics may be unwarranted,” said Dr. Maria DeVita, training program director for nephrology at Lenox Hill Hospital in New York City.

According to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, kidney stones arise following mineral build-up in a patient’s urine.

In some cases, small solid pebbles pass through the urinary tract without symptoms, while other people experience blood in the urine alongside sharp pain in the back, side, lower abdomen or groin.

Tasian noted that over the last three decades kidney stone incidence has skyrocketed by 70 percent, largely among children and adolescents.

Experts are unclear as to why. But prior research has cited a possible association with disturbances in the bacterial makeup (microbiome) of the intestinal and urinary tracts, which is often sparked by antibiotics.

And antibiotic prescriptions are increasingly common. As the researchers noted, in 2011, American doctors prescribed 262 million courses of antibiotics, with women and children forming the largest pool of recipients.

With that in mind, investigators used British health care data to isolate kidney stone cases among millions of patients treated by 641 general health care practitioners between 1994 and 2015. Roughly 26,000 kidney stone patients were identified.

The team then examined whether or not any of these patients had been prescribed any of 12 different classes of oral antibiotics in the three to 12 months leading up to their kidney stone.

This lengthy time frame was chosen because kidney stones can take weeks or even months to form.

The risk for kidney stones was greatest within three to six months following an antibiotic regimen, before ratcheting down over the ensuing three to five years.

Specifically taking sulfa antibiotics, cephalosporins, fluoroquinolones, nitrofurantoin/methenamine, and broad-spectrum penicillins were linked to a 1.3 to 2.3 times greater risk for kidney stones, the investigators noted.

But the study did not prove that these drugs caused kidney stones.

“For those five classes of antibiotics, the greatest risk was found among younger patients,” said Tasian. “However, the increased risk was still significant across all ages, including for older adults with the exception of broad-spectrum penicillins, which were not associated with an increased risk of kidney stones among patients over 75 years of age.

“At this time, we do not have any ways to limit the risk associated with antibiotics,” Tasian said. But he added that his work may eventually “provide additional insight into how, ultimately, we might be able to restore a healthy microbiome, or mitigate the adverse changes that exposure to certain antibiotics cause.”

The findings were published online in the Journal of the American Society of Nephrology.

Source: HealthDay


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Opinion: Too Many Almonds May Be Dangerous To Your Health!

Evan Levine, M.D. wrote . . . . . . . .

I remember it quite clearly. When it hit me, it was as sharp and as sudden as a bullet from a gun. Just a day before I had noticed that my urine looked a bit amber and now I had this sudden, sharp pain in my flank: “You fool,” I told myself, “you have a kidney stone.” I was pretty sure that’s what it was, but to make sure, I had my wife drive me to the ER where a CAT scan clearly showed a rather large and calcified stone in my right kidney.

Renal stones (nephrolithiasis) are much more common than I would have guessed. In the United States in 2000, almost 2 million outpatient visits resulted in a primary diagnosis of kidney stones. While there are several types of stones, the majority of them, over 80 percent, are made up of calcium combined with oxalate.

After a week of waxing and waning pain; pain that many women who have had kidney stones have compared to their labor pains, and an $8,000 dollar visit to an ER (a future story), my urologist decided we should blast the thing out of my kidney by using focused sound beams. And so a few more thousand dollars later, with the use of the technique known as lithotripsy, my stone was broken into several sharp sliver like pieces that would pass, like, I suppose, real slivers of glass would, from me over the course of about a week.

For the few moments I had no pain, I began to wonder why I got these stones and if there was a way to prevent them. This was something I wasn’t hoping to have again. I wondered if there was some correlation, or association, between the foods I ate and why I formed this kidney stone. And so, when I had the strength to do so, I began searching through the medical literature. I found out that most stones are made up of calcium and oxalate but that the dietary Oxalate intake was far more important in causing these calcium oxalate stones. I might be a physician but I hadn’t the foggiest notion that calcium kidney stones were actually a combination of calcium and oxalate, and then it hit me like a ton of bricks, or better still, that kidney stone: I ate tons of almonds. OK, I ate ounces of almonds almost every single day, often as many as three small bags of roasted non-salted almonds. Could it be that I was loading myself up with oxalates when I was munching on almonds?

I ran to my computer, did the standard Google search, and came up with what I had expected; almonds are loaded with oxalates (just below Rhubarb and Spinach), and eating too much of them, like I did, was potentially the reason why I got that kidney stone. And not only were almonds loaded with oxalates but the oxalates in almonds appeared to be better absorbed, according to a one study published in the Journal of Urology, into our body when compared to other sources of dietary oxalate.

I had always thought that eating almonds, instead of the usual snacks, would be good for me. Almonds after all were loaded with fiber, might help lower your cholesterol, and had antioxidants. Even Dr. Oz seems to believe that almonds are good for you championing them as “The best snack of all.” “Because nuts are high in fiber and protein, they’ll satiate you so you’ll never be hungry. Because of my Turkish culture, I grew up eating almonds that have been soaked in water first. I still do that. It makes them taste completely different—very sweet,” Dr. Oz says.

What could go wrong? But as I read the Almond Board of California site (almost all the almonds grown in the states are grown in California) I wondered why they suggested everyone have a handful of almonds a day? Why not just say eat almonds and eat lots of them? Was this a carefully vetted statement?

Here is just one of several statements made on their site:

Of all the things to love about almonds, this one should really get your heart pumping: Just a handful of almonds a day may help you maintain healthy cholesterol levels. And that’s good news for just about everyone as cardiovascular disease holds its spot as the leading cause of death among men and women in the U.S.

California Almonds are cholesterol-free and low in saturated fat, making them a deliciously tempting option for smarter meals and snacks. And research is now showing they may also help maintain a healthy heart. In 2003, the U.S. Food and Drug Administration released a health claim recognizing that California Almonds can help you maintain a healthy cholesterol level. And no, you’re not dreaming.

Why do they keep saying a handful and why do they limit it to that amount? Do the almond growers know that eating too many almonds could be dangerous to your health? Are they afraid that perhaps the FDA would mandate that warnings be placed on foods loaded with oxalates, like almonds, because these foods might have some relationship or might even be causing thousands of us to form kidney stones and perhaps even worse, kidney failure?

I researched the topic even further. Eager to learn more I decided to see if the prevalence of kidney stones, the amount of people who had kidney stones in a given time, had increased over the past several years. What I learned is that the prevalence, in the United States, as well as most other nations, had about doubled in less than ten years: the incidence is about 1 in 11 people in the USA now.

Many experts, from what I read, seem to blame this epidemic of kidney stones with the increase in obesity and diabetes, which doctors say is associated with stones, while some even blame global warming; more sweating means more dehydration, higher concentration of calcium and oxalate in the urine and an increase chance for stones to form. No one seemed to consider that an increase in almond consumption (or other foods high in oxalates) may be the culprit.

I dug in more and took a look to see if almond consumption was up in the US. I found that the USDA calculates that almond consumption had doubled since 1994 and tripled since the 1970’s; with most people not eating almonds directly as I did, but in cereals, baked products and health bars. In other words many people are eating almonds and don’t even know they are.

While this was by no means a cause and effect relationship, things began to look quite suspicious. I came down with a calcium oxalate stone and the only risk I could find was that I ate a lot of almonds. Almonds contain the most important ingredient needed to form the most common type of kidney stone — oxalate. The prevalence of kidney stones has doubled since 1994 just as the consumption of almonds has doubled.

I then looked at how prevalent kidney stones might be in a country where, according to Dr. Oz, people grow up eating almonds. What I found was shocking! According to a study published on kidney stone disease in Turkey (an updated epidemiological study. Eur Urol. 1991;20:200–203), the incidence of kidney stones in Turkey in 1989, was 11.8 %. This would suggest that the country which appears to embrace almond consumption from the earliest ages also has the highest rate of kidney stones.

So in conclusion, please consider that almonds are chock full of oxalates, the most important component of kidney stones. As the intake of almonds has increased in the United States, and several other countries, the prevalence of kidney stones has also increased. In Turkey, where it is customary for even young children to eat almonds, the prevalence of kidney stones may be the highest in the world. Dr. Oz and others, who claim to be experts on health and diet, should be cautious when they suggest that their listeners, especially those who have a history of kidney stones, consume almonds as an ideal snack. Taking their advice might do more harm than good.

One has to wonder if the multi-billion dollar almond industry is aware that by hyping their product as a health conscious food, and without any warning of its potential risk, this huge and global industry could be contributing to thousands, perhaps millions, of their consumers developing renal stones.

My advice is to limit the quantity of almonds you eat and completely avoid them and other foods high in oxalates, if you have a history of calcium oxalate Kidney Stones. If the industry won’t add warnings voluntarily, I believe that it would be prudent for the FDA to require that a warning label be placed on packages of almonds noting that “increased consumption of almonds and other foods high in oxalates may significantly increase your risk of developing kidney stones.”

Source: The Leftist Review

Natural Remedies for Kidney Stones

Nearly one in 11 Americans will develop a kidney stone during their lifetime, according to the American Urological Association, and for at least half of those afflicted, it isn’t just a one-time occurrence. Since the experience can be very painful, it’s important to know that there are steps you can take to prevent another attack.

Kidney stones form when the levels of minerals and salts normally present in urine—such as calcium and phosphate—are high and tiny particles of them stick together. The stones can then pass from the kidneys into the urinary tract. Symptoms include: sharp pain in your lower abdomen, back, side or groin; pain when you urinate; nausea and vomiting; and fever and chills.

If you have had a kidney stone, a lab analysis of the stone’s composition or of your urine can help provide information on the specific stone risk factor. About 80 percent of people with kidney stones have calcium stones. The good news is that there are some natural remedies for kidney stones.

What to Drink

Drinking 4 ounces of lemon juice daily (diluted in a half-gallon of water) over the course of each day may help prevent recurrence of two types of kidney stones—calcium oxalate and calcium phosphate. The lemon juice boosts levels of citrate in your urine, which discourages the formation of these stones.

This “lemonade therapy” may be a possible alternative to traditional citrate treatments, which are often recommended to prevent kidney stones, but can cause gastrointestinal symptoms. Don’t add sugar, though; sugar-sweetened beverages can boost stone risk by around 20 percent, according to Ramy Youssef Yaacoub, M.D., an assistant clinical professor of urology at the University of California, Irvine, School of Medicine.

If drinking lemon water daily doesn’t appeal to you, another natural remedy for kidney stones is drinking plenty of fluids in general. Drinking enough to essentially double your daily urine output is the cornerstone of any action plan to prevent kidney stones, says Yaacoub. This step can dilute your urine, which helps keep calcium and other compounds from clumping together. Plain water is a good choice, and coffee can also help, Yaacoub says. While there is research suggesting that sipping tea may also cut risk, Yaacoub advises against it; high oxalate levels in tea could increase stone risk for some people.

What to Eat

Natural remedies for kidney stones also include some dietary changes. If you’ve had a calcium stone, cutting back on sodium-heavy processed and fast foods can reduce your risk because a high-sodium diet increases calcium levels in your urine.

Don’t skimp on calcium-rich foods, though. Too little calcium in your diet can increase urine levels of oxalate, another factor in the formation of kidney stones. “Two to three servings of milk, yogurt, or other healthy calcium-rich dairy foods are recommended for people who’ve had calcium stones,” Yaacoub says. “Have it with a meal; that way the calcium will bind in your digestive system with oxalates from the other food you eat.”

Your doctor may also recommend cutting back on high-oxalate vegetables, such as beets, navy beans, rhubarb, and spinach. Be sure to eat plenty of other types of fruit and vegetables, though, and to rein in serving sizes of animal proteins (red meat, chicken, fish, pork)—a dietary one-two punch that helps keep citrate levels in urine high.

Check Your Medicines

Your doctor can also evaluate whether medications you take for other health conditions are causing stones to form, and may be able to adjust your dosage or switch you to another drug. These include laxatives, some antibiotics, potassium-sparing diuretics (used for high blood pressure), potassium channel blockers (used to control heart rhythm and for multiple sclerosis), and sulfonylureas (used to treat type 2 diabetes).

Source: Consumer Reports

Calcium Supplements Tied to Kidney Stone Risk in Study

But don’t stop on your own if doctor recommended them, experts say.

People with a history of kidney stones may have a higher risk of recurrence if they use calcium supplements, a new study finds.

The findings, based on records from more than 2,000 patients, add to evidence linking calcium supplements to kidney stone risk.

But researchers also said that people taking calcium under a doctor’s advice should not stop on their own.

“We’re definitely not advocating that people stop taking calcium supplements if their doctor prescribed them for their bone health,” said Christopher Loftus, the lead researcher on the study and an M.D. candidate at the Cleveland Clinic Lerner College of Medicine.

Loftus is scheduled to present his findings next month at the American Society of Nephrology’s annual meeting in San Diego. Data and conclusions presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

Kidney stones develop when high levels of crystal-forming substances — such as calcium, uric acid and a compound called oxalate — build up in the urine. Most kidney stones contain calcium.

Doctors used to advise people who are “stone formers” to cut down on their calcium intake, said Dr. Mathew Sorensen, an assistant professor of urology at the University of Washington in Seattle.

And while that “makes sense intuitively,” Sorensen said, research since the 1990s has indicated the opposite is true: People can help lower their risk of kidney stone recurrences by getting the recommended amount of calcium — if the calcium comes from food.

Calcium supplements, on the other hand, have been tied to an increased risk of kidney stones in some studies.

Loftus said supplements have been linked to higher odds of passing a large stone that causes painful symptoms. Often, though, small stones pass unnoticed, so Loftus and his colleagues looked at whether supplement users had a greater risk of forming stones at all based on CT scans.

The researchers looked at records for more than 2,060 people with a history of kidney stones who underwent two CT scans within two years. Almost 1,500 of those patients were on calcium supplements, while 417 took vitamin D only. The rest used no supplements.

While researchers only saw an association, they found that calcium users had a faster rate of new stone formation than either of the other two groups.

People may be confused by the finding, given that calcium in food helps prevent kidney stones, Loftus said.

“But there’s a difference between dietary calcium and supplements,” he said. “When people eat calcium-containing foods, they’re getting other nutrients at the same time.”

Many foods contain at least a small amount of the compound oxalate, for example. “The oxalate in food binds to calcium, and you excrete it,” Loftus said.

Still, some people might need supplemental calcium for the sake of their bone density.

So if a doctor has advised you to take calcium, do not simply stop on your own, Sorensen said.

“In general, it’s best to get your calcium from food,” Sorensen said. “But if you’re on a supplement that’s been prescribed to protect your bones, we usually recommend taking it along with a meal.”

Loftus agreed. He added, though, that stone formers who started using calcium supplements on their own might want to ask their doctor whether that’s really necessary.

The findings come in the wake of a study from New Zealand that concluded extra calcium — either in food or supplements — may not help aging bones at all. That study was published in the BMJ.

Sorensen offered some advice for people with a history of kidney stones: “The most important thing,” he said, “is to drink enough fluid every day.”

That keeps the urine diluted, and helps flush away materials that can form stones. Typically, stone formers should aim for 2 to 3 liters of water and other fluids each day, according to the U.S. National Institutes of Health.

Cutting back on sodium is also wise, Sorensen said, since sodium causes the kidneys to excrete more calcium into the urine.

Stone formers could also try limiting their intake of meat and other animal proteins, Sorensen said, since those foods might contribute to calcium stones by making the urine more acidic.

People who form another kind of kidney stone — uric acid stones — are often advised to limit their meat intake to 6 ounces per day, the NIH says.

Source: U.S. Department of Health and Human Services