Dr. K.Dastur

A kidney stone is a hard, crystalline mineral development, which forms within the kidney or the urinary tract. It is called nephrolithiasis in medical terms. Kidney stones occur due to the decrease in urine volume or due to an excess of substances in the urine which are stone-forming in nature. Dehydration is considered to be a primary risk factor for kidney stones too.

Causes of kidney stones:Kidney stones develop when the urine contains increased amounts of crystal forming substances. They include calcium, oxalate and uric acid in amounts which the fluid in the urine cannot dilute. Your urine may also lack the substances which help in prevention of crystals from sticking to each other, thereby enhancing the conditions for kidney stones to form.

The balance of your urine can change due to several factors:

1. Not drinking sufficient amount of water makes the salts, minerals and other substances present in the urine to stick together, which may lead to the formation of a stone.
2. The normal urine balance may get disrupted due to several health conditions, which lead to kidney stone formation. Diseases such as gout or certain inflammatory bowel diseases can also cause kidney stones.
3. Many cases of kidney stones are hereditary and run in families, affecting family members over many generations.
4. A rare cause of kidney stone formation is the overproduction of hormones by the parathyroid glands, which results in increased levels of calcium leading to calcium kidney stones.

Types of kidney stones
Kidney stones are of different types, which occur due to several, different causes. They are as follows:

1. Calcium stones: Calcium stones account for being the most common form of kidney stones. They occur due to excessive calcium in the urine. This may happen due to an inherited condition known as hypercalciuria, the overreaction of the parathyroid gland, kidney diseases, several cancers or from a condition known as sarcoidosis. The stones may be large and smooth or rough and spiky.
2. Struvite stones: These stones are caused due to infections. And they usually occur after a urinary tract infection. This form of kidney stone is more common in women though.
3. Uric acid stones: These stones occur due to large amounts of uric acid in the urine. It may occur from having a high protein diet, from a health condition called gout or from a hereditary condition where the amount of uric acid in urine increases.
4. Cystine stones: These are rare kidney stones and occur due to a hereditary health condition known as cystinuria.

Kidney stones occur due to the change in balance of water, salts and minerals, which are present in the urine. Insufficient water consumption is often the most common cause of kidney stones. So make sure you drink lots of water to keep stone formation at bay. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

Polycystic Ovary Syndrome (PCOS) is a condition, which is born due to an imbalance of hormones within the female body. When this happens, the female body faces anumber of problems as far as her periods or menstrual cycles goes, besides finding it difficult to conceive naturally and easily. Let us find out more about this condition.

PCOS and hormones
To begin with, let us understand what hormones are. These are chemical impulses that send messages to various parts of the brain and rest of the body to signal the release of other kinds of hormones that may be vital for various functions. In PCOS, it is normally seen that the sex hormones are thrown out of balance, due to which the ovaries start producing a small dose of some male hormones. This creates problems as far as ovulation is concerned and also, it gives rise to the growth of facial hair, acne and changes in the overall appearance of the patient. Insulin resistance is another cause that may also trigger PCOS. It is also an inherited issue in many cases.

Symptoms
From irregular periods to an increase in acne and facial hair, there are many symptoms that may point at the existence of this condition. Fertility problems and issues related to normal ovulation are also often seen in women who are suffering from this condition due to the irregular periods. Additionally, depression may be seen in many patients who are suffering from this condition on a chronic basis. Thinning of hair and excess weight gain with difficulty in losing extra pounds may also be indicative of PCOS.

Diagnosis
The diagnosis of PCOS is usually done with the help of a physical examination as well as a blood test that will primarily help in determining the sugar levels and insulin. The doctor will also conduct other hormone tests so as to understand which hormones are not in balance and which ones may be triggering changes in the body. Apart from all this, the doctor will also study the body mass index (BMI) of the patient to find out if there has been a sudden and drastic change on the weight of the patient. During the lab tests, where the blood and urine are examined, the doctor will also seek to rule out any anomalies in the thyroid gland. An ultrasound of the ovaries will also be conducted.

Treatment
Weight loss programs as well as diet tweaks that remove excess dairy and meat may be recommended by the doctor. Further, the doctor may also put the patient on birth control pills so as to bring better balance of hormones. Moreover, moderate exercise will be required for the patient so that the normal production of hormones may be resumed eventually. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Many children all over the world are affected by urinary tract infections or UTIs that can be resolved with simple antibiotics, but might also lead to complications at times. Most often, kids under 2 years of age are affected by it, and either the bladder or the kidney might be infected leading to cystitis or pyelonephritis , in smaller children kidneys are presumed to be infected unless proved otherwise.

Causes of UTIs

Though bacterial infections are the most common cause, viral or fungal infections might occur in some cases as well. Most UTI in infants are caused by structural abnormalities of urinary tract. Uncircumcised male infants or children with poor toilet habits, or female children with poor toilet hygiene are susceptible to this disease. Children suffering from a weak immune system might also be at a risk.

Symptoms and signs

Symptoms of UTI are very difficult to differentiate from any other illness in small kids under 2 years of age, symptoms include high fever, diarrhea vomiting, and dehydration. Basically any fever for which no cause is apparent must be evaluated for UTI. UTIs in older children beyond 5 years of age come with different signs including pain during urinating (dysuria), frequent urination, abnormal urge for urination, or bedwetting. Sometimes, fever, abdominal pain, blood in urine or vomiting might be signs as well.

Which doctor to consult?

In most cases, UTIs in children are treated by pediatricians, but if kidney function is troubled then a pediatric nephrologist needs to be contacted immediately. Pediatric Nephrologist to be consulted once the fever is over to look for cause of UTI.

1. Tests carried out: To understand the underlying cause of the infection and any anatomical or functional risk factors, several examinations or tests are carried out. Vital signs like blood pressure, body temperature, and breathing rate are checked. The abdomen is palpated to find tenderness near the kidneys. Genital areas are also examined for signs of trauma, redness, discharge and such. Urine cultures are essential for diagnosing UTIs finally and this helps in assessing the antibiotic sensitivity profile too.
2. Good to know: Right after an antibiotic is administered, UTI in children starts getting resolved. But recurrent UTIs might lead to urinary tract abnormalities like kidney malformation. Also note that UTI is not contagious, and cannot be passed on if children share a bath or if you sit on an infected toilet seat.

Treatment

In most cases, UTIs respond well to oral antibiotics, though Pyelonephritis may require hospitalization and intravenous drip. Some studies are also carried out to check if the child is susceptible to renal scarring or kidney failure. These are as below:

1. Renal ultrasound: Defines the location of the kidneys and their size and shape clearly.
2. Voiding cysto-urethrogram: The bladder is filled with a dye through a catheter in this method. Then the catheter is removed to study if the bladder is getting emptied without any reflux or obstruction.
3. Renal scan: To test the functioning of the kidneys and the risk of renal scarring, a bit of radioactive material is used.
4. Intravenous pyelogram: Though rarely used, in this method, a dye is injected into the bloodstream and X-ray images are obtained.

Prevention

1. Maintaining proper hygiene: Girls should wipe from front to back and uncircumcised boys should be able to gently retract the foreskin to reveal the urethral opening.
2. Complete voiding of bladder: Encourage kids to urinate every two to three hours, since they often ignore a full bladder to carry on playing.
3. Consumption of fluids: Drink plenty of fluids and avoid constipation. If you wish to discuss about any specific problem, you can consult a Pediatrician.