The kidneys, two in number are bean – shaped organs located in the lower part of the back of the abdomen . They move upwards and downwards in tune with inspiration and expiration, and are held in position by the structures that supply blood to them . The two kidneys are enveloped in masses of fat that is more abundant in young women. Drastic measures taken by some women to lose weight might shrink the layers of fat and cause kidney damage ,even before any significant weight loss is achieved. Urine made in the kidney comes through an opening situated in the lower part and enters a long funnel shaped tube that conveys it down to the urinary bladder ,from where it is gathered until the urge to urinate is experienced.
In males, semen and urine share a common passage in the penis, which measures approximately 11 cm , but in females the urethra through which urine exits is shorter, measuring approximately 4.5cm and situated close to both the clitoris and the vaginal opening. This anatomical arrangement puts women at risks of developing recurrent genitor urinary tract infections and frequent ascending urinary tract infections in turn create the environment for the formation of kidney stones.
Five to ten years ago, there were more deaths due to kidney failure in developed countries ,compared with the underdeveloped and developing others. Twenty to fifty percent of these deaths were related to kidney stones, and individual as well as environmental factors have been considered to be responsible for the morbidity and mortality statistics associated with stone related cases of end stage renal failure.
The kidneys help carry out the important function of regulating the amount of substances the body can safely accommodate at different times in accordance with it’s temperature ,and in relation to the many different activities the body can undertake . These substances include water, acids, alkali, protein, various salts , poisons and chemicals. The kidneys also participate in the production of the very important compound hemoglobin, and so conditions which directly cause damage to the kidneys such as kidney stones will indirectly cause anemia ,more kidney poisoning resulting in further stone formation ,the cycle continuing until the kidney fails.
Kidney stones are more common in countries with long dry seasons. The prevalence is variable from 5% in West Africa and elsewhere in the temperate regions to as high as 50% in places like Sahel , and in Latin America. Though prevalence of kidney stones remains higher in developed communities, the gap in prevalence and incidence compared with the developing world has begun to narrow , as climate change seems to be creating environmental conditions where people the world over lose water rapidly . In addition, many Africans are now adapting the life style and dietary habits of persons from the industrialized world , ignoring the hard fact that the sophisticated and expensive diagnostic and treatment facilities needed for disease conditions of the kidney are available to them over there and are not common here. In many developing countries including Nigeria, deaths due to kidney failure is becoming very frequent . A major problem is that unlike the situation in these industrialized countries, there is a significant level of underreporting of cases for a number of reasons:
Awareness about the general and specific factors that can lead to kidney diseases and renal failure is still very low. Many people don’t even know where the kidneys are located
Unregulated advertisement of herbal preparations is another serious problem that has continued to negatively impact on the illness behavior of many seriously ill patients ,either drawing them away from appropriate Specialist care, or contributing to the problem of late presentation of these cases at points in their illness spectra or disease continuum, where they can no longer be saved ; Particularly for kidney stones, fibroids and enlarged prostate ,there seems to be ‘no scarcity of herbal medicines” capable of melting fibroids, dissolving prostatic growths and crushing kidneys stones. In many towns and villages, there are loud public address systems asking people to visit herbal homes for permanent solutions to all diseases. Ignorance about the anatomical location of organs and the consequent inability to link symptoms to organ disease creates fear and uncertainty, resulting either in indecision, late presentation , or no action until death .
Some Churches and prayer squads have also contributed to the problem by giving kidney patients false hope ,reinforced by occasions where a stone probably causing flesh tearing pain in the bladder, descends through the ureter with agonizing pain felt from loin to groin, in the testes, vulva , vagina, anus and then finally appears in the urethral opening, the movement taking place as people prayed in loud voices and spoke in tongues. The gratifying results ,measurable by complete cessation of pain often go on to strengthen the wrong impression that these stones simply can not form all by themselves without some external demonic influences being remotely involved.
Any meaningful approach to problems arising from kidney stone must take into consideration a number of variables, as here under;
Current health status , and comprehensive past medical history of any individual with a stone or stones in the kidney, with emphasis on past history of spontaneous passage of stone or surgical removal. Family history of stone formation (genetics), age, sex, gender, ethnic group, religion, occupation, dietary habits, food preferences, hobbies, type of stone formed, the anatomical location of the stone(s).
Age
Kidney stones can occur in persons of any age, but is commoner in individuals aged 25-50, and within this age bracket, the risk increases with advancing age . This is because aging as a physiological process is destructive to tissues, not constructive . Young people are extremely mobile and the resulting loss of water even in small amounts cause the kidneys to adjust it’s salt and electrolyte composition as best it can until a critical level is reached where the capacity for additional ions to crystallize out exceeds that which makes them go into solution , and so they attach and begin to form stones. Moreover, the capacity of various water holding tissues of the body to maintain their hydration status decreases with age , by as much as 40%. This is one of the reasons, adults are advised to ensure they ingest up to 3 liters of water per day to keep the kidneys safe .
Kidney Stones In Children
Not very common, but when present can very quickly lead to death, because it will occur in combination with and be masked by other child hood diseases. As the affected child cries uncontrollably, refusing to be comforted , parents quickly become confused as to what to do or think . Mistakes are often made at this point and God only knows how disasters are averted. Children fed on artificial milk instead of breast milk are at increased risk of developing kidney stones; the higher proteome and salt composition in artificial feeds readily promote formation of crystals and nucleation
Children introduced too early(first week of life) to rice and corn meals are also at risk as the extremes of malnutrition which favour deficiencies of calcium and vitamin D ,promote formation of kidney stones
For children suffering frequent episodes of diarrhea, there is increased tendency to form stones and the addition of Zinc to the drug regimen places the child who is vomiting and at the same time has diarrhea at risk of kidney failure from renal papillary necrosis, complicating the metabolic derangement. It is particularly common in children who have problems with absorption of food and vitamins either at the level of the stomach, upper intestine or the lower portion of the small intestine
Recurrent infections in children may occur as a result of poor sanitation, ignorance and poverty. Infections may also occur as a result of variant anatomy of the respiratory ,cardiovascular and gastrointestinal system.
Genetically inherited abnormalities of the blood elements by way genetic polymorphism or mutation may also give rise to variant alleles that produce defective proteins that make up the different layers of the body’s natural immune defense system. The final common pathway is the inability of an affected child to fight off the common infections of child hood that usually emerge after the protective guard mounted by mothers immunity will have waned ,which usually occurs six months after birth and normally contingent or convergent with the period children are exposed to these infections. For children that are exclusively breast fed and fully immunized, the possibility of developing kidney stones does not disappear completely but will definitely be much more lower. Infections of the intestine ,liver, and blood involving parasitic worms apart from sucking blood and depriving the victims of nutrients, cause damage to the structures they invade . They also leave toxins that affect the Ph of the fluid in the urogenital milieu, paving way for stones to form, anchor and grow in the affected parts of the different portions of the kidney . This can be understood from the fact that, like other endothelia in the body, the urothelium is actually an organ capable of forming compounds with certain chemical compounds and salts via adhesion molecules. In general, stones in children are more likely to be found in the lower parts of the kidney and in the bladder, the opposite being the case for stones in adult kidneys.
Congenital abnormalities of the bowel, kidneys(horse shoe), the spine(scoliosis) and the heart(septal defects, pentallogy of Cantrell, etc ), may occur in combination or singly to put a child on the difficult road to stone formation. They are common in developing countries but underreported because mothers prefer to take affected children to Prayer houses ,and indeed, facilities for diagnosing these conditions are very few and located in the city centers, where only 20% of the population have access to fairly good hospital facilities.
Sex
By this is meant, the anatomical considerations that identify and classify an individual as a male or female. Tissue for tissue , irrespective of race and assuming many other variables being controlled for , a man is larger and has more mass , compared with a woman of his age. By the age of 14, and 15 years, the long bones of the upper and lower extremities of a woman contain more bone remodeling cells(osteoclasts) than the bone laying cells(osteoblasts). This in response to the female hormones, particularly oestrogen , receptors of which are present in large quantities in the osteoblasts of premenopausal women. Unlike females however, epiphysis of long bones remain open in boys up to the age of 17 and 18 years, in some young male adults. For these and many other reasons, several processes in males require higher levels of work or thermodynamics and the kidneys of males are more prone to dissipate more energy and create more super saturation versus solubility challenges culminating in relatively higher tendency to develop stones. This used to be the thinking in the recent past. Current thinking however is that the on the average more males than females develop kidney stones, but this difference is not statistically significant and as will be discussed later depends on the type of stone, and the anatomical location. It has been observed that in recent times, the activity profiles of women are now no more significantly different from those customarily undertaken by males. It is sufficient albeit to note that conclusions from ongoing research will provide additional insight into the matter, at least for the Caucasians; but for the Nigerian African, there are indeed many more unsettled issues.
As concerns gender, cultural and religious practices that place women at greater risks of developing kidney stones are very common in African societies; they can be seen to be at the ends of a triangle of jeopardy;
in the South South and south eastern parts of the country, a woman as part of the requirements for marriage is made to go on a diet of animal protein and fat laden food with little or no vegetables and fruits to generate alkali that will take care of the large amounts of acids that will be produced from the fats, triglycerides and cholesterol. The dietary composition in this preparation includes ingestion of large amounts of fish and other sea creatures. The young lady invariably develops both the apple type(truncal), as well as the gyenoid type(pear ) obesity. Whereas with time, the lady involved may be able to lose some fat cells from the trunk, the obesity involving the thighs and legs are very difficult to get rid of. Both types of obesity ,but more seriously the one involving the trunk will provide the ingredients for not only the kidneys , but also the gall bladder to form dangerous stones.
Then there are other religious cum cultural practices that place women in the inner rooms of houses for months with little or no access to sunlight, and then to further prepare the kidneys for stone formation, they are covered in several clothing leaving only slits for the eyes . When fasting is added to this condition, the foundation is laid for kidney stones, obstruction of the kidneys and eventually renal failure and death.
To be continued
