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Phoenicians Left Deep Genetic Mark, Study Shows

The New York Times, October 31, 2008, by John Noble Wilford – The Phoenicians, enigmatic people from the eastern shores of the Mediterranean, stamped their mark on maritime history, and now research has revealed that they also left a lasting genetic imprint.

Scientists reported Thursday that as many as 1 in 17 men living today on the coasts of North Africa and southern Europe may have a Phoenician direct male-line ancestor.

These men were found to retain identifiable genetic signatures from the nearly 1,000 years the Phoenicians were a dominant seafaring commercial power in the Mediterranean basin, until their conquest by Rome in the 2nd century B.C.

The Phoenicians who founded Carthage, a great city that rivaled Rome. They introduced the alphabet to writing systems, exported cedars of Lebanon for shipbuilding and marketed the regal purple dye made from the murex shell. The name Phoenica, for their base in what is present-day Lebanon and southern Syria, means “land of purple.”

Then the Phoenicians, their fortunes in sharp decline after defeat in the Punic Wars, disappeared as a distinct culture. The monumental ruins of Carthage, at modern Tunis, are about the only visible reminders of their former greatness.

The scientists who conducted the new research said this was the first application of a new analytic method for detecting especially subtle genetic influences of historical population migrations. Such investigations, supplementing the traditional stones-and-bones work of archaeology, are contributing to a deeper understanding of human mobility over time.

The study was directed by the Genographic Project, a partnership of the National Geographic Society and IBM Corporation, with additional support from the Waitt Family Foundation. The international team described the findings in the current American Journal of Human Genetics.

“When we started, we knew nothing about the genetics of the Phoenicians,” Chris Tyler-Smith, a geneticist at the Wellcome Trust Sanger Institute in Cambridge, England, said in an announcement. “All we had to guide us was history: we knew where they had and hadn’t settled.”

It proved to be enough, Dr. Tyler-Smith and Spencer Wells, a geneticist who directs the Genographic Project, said in telephone interviews.

Samples of the male Y-chromosome were collected from 1,330 men now living at six sites known to have been settled in antiquity as colonies and trading outposts of the Phoenicians. The sites were in Cyprus, Malta, Morocco, the West Bank, , Syria and Tunisia.

Each participant, whose inner cheek was swabbed for the samples, had at least three generations of indigenous ancestry at the site. To this was added data already available from Lebanon and previously published chromosome findings from nearly 6,000 men at 56 sites throughout the Mediterranean region. The data were then compared with similar research from neighboring communities having no link to Phoenician settlers.

From the research emerged a distinctive Phoenician genetic signature, in contrast to genetic traces spread by other migrations, like those of late Stone-Age farmers, Greek colonists and the Jewish Diaspora. The scientists thus concluded that, for example, one boy in each school class from Cyprus to Tunis may be a descendant of Phoenician traders.

“We were lucky in one respect,” Pierre A. Zalloua, a geneticist at Lebanese American University in Beirut who was a principal author of the journal report, said in an interview. “So many Phoenician settlement sites were geographically close to non-Phoenician sites, making it easier to distinguish differences in genetic patterns.”

In the journal article, the researchers wrote that the work “underscores the effectiveness of Y-chromosomal variability” in tracing human migrations. “Our methodology,” they concluded, “can be applied to any historically documented expansion in which contact and noncontact sites can be identified.”

Dr. Zalloua said that with further research it might be possible to refine genetic patterns to reveal phases of the Phoenician expansion over time — “first to Cyprus, then Malta and Africa, all the way to Spain.” Perhaps, he added, the genes may hold clues to which Phoenician cities — Byblos, Tyre or Sidon — settled certain colonies.

Dr. Wells, a specialist in applying genetics to migration studies who is also an explorer-in-residence at the National Geographic Society, suggested that similar projects in the future could investigate the genetic imprint from the Celtic expansion across the European continent, the Inca through South America, Alexander’s march through central and south Asia and multicultural traffic on the Silk Road.

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Unveiled in 1960, the birth control pill revolutionized contraception. Yet despite an abundance of birth control options today, almost half the pregnancies in this country are unintended, according to the Centers for Disease Control and Prevention, more than in any other developed nation. What’s the reason?

The New York Times, October 31, 2008, by Leslie Berger – The issue is not technology. But economics and human behavior are another story. Nearly a third of women who start a new type of birth control stop within a year, according to one recent study, largely because of changes in their insurance coverage. All methods have some side effects. And the current crop of intrauterine devices, or IUDs, despite having a nearly perfect efficacy rate, have been slow to catch on, experts say, partly because more doctors need to be trained in inserting them.

Adherence is a huge issue, said Dr. Nancy Padian, an epidemiologist at the University of California, San Francisco, who specializes in reproductive health and H.I.V. prevention. To have a significant effect you have to use a product very consistently.

As a result, whether to promote their particular brand or to encourage better compliance, many birth control manufacturers and doctors are promoting the non-contraceptive benefits of contraception. Whether it’s reducing the risk of cancer, improving the health of mothers-to-be, easing cramps or enhancing complexion, it’s nice to have a medical excuse for using birth control.

Hormonal contraceptive methods use manufactured estrogen and progestin in different combinations and deliver them in a variety of ways — through pills, shots, skin patches, implants, IUDs and vaginal rings. Studies have shown that all those methods reduce the risk of ovarian and endometrial cancer. Some may also help protect against osteoporosis.

Using contraception can also give women a chance to get healthy before they conceive — to stop smoking, lose weight or lower their blood sugar.

If a diabetic woman gets pregnant unexpectedly, there’s a risk of major anomalies — heart problems, neurological problems — in the baby, said Dr. Anita L. Nelson, director of women’s reproductive health at the Harbor-U.C.L.A. Medical Center in Los Angeles. Very young mothers are also at greater risk for pre-eclampsia and premature births.

Early prenatal care is not good enough anymore, Dr. Nelson said. We could do so much better if we got moms into really good health before they got pregnant.

If those reasons aren’t enough, ads for pills like Yaz cite beautiful skin and relief from premenstrual bloating and mood swings. Loestrin 24 Fe includes an iron supplement. The oral contraceptives Seasonale and Seasonique reduce menstrual cycles to three and four times a year. And Lybrel is supposed to eliminate menstruation altogether, a potential boon to women who suffer from severe cramping and bleeding, anemia, mood swings and migraines that can worsen with menses.

The no-bleed pills aren’t exactly new, of course, but a refinement of the pill introduced 47 years ago. By suppressing ovulation, the pill — or any hormonal method — automatically stops menstruation, because if no egg has been deposited, the uterus has no reason to shed its lining.

But the pill was such a radical departure that its inventors decided to include a week of placebos in the 28-day pack to create a fake period, or withdrawal bleed. The cycle of 21 days on, 7 days off was pure marketing, designed to make the pill more acceptable to the public. Many women have been controlling their periods for years by skipping the placebos in their packs and taking the real pills continuously.

Today’s marketing of the no-bleed or c0-extended regimen pills, all variations on the original pill, plays down the breakthrough bleeding that can occur, according to some skeptics. And while some advocates argue that these newer contraceptive techniques are likely to cause no long-term problems since, historically, women spent most of their reproductive years either pregnant or nursing so had far fewer menstrual periods than women today, the health effects of going for months or even years without a period remain unknown.

In the clinical trials that led to Lybrel’s approval by the Food and Drug Administration, for example, many women dropped out because of breakthrough bleeding, and nearly 40 percent of the participants still had breakthrough bleeding after a year of use. Lybrel’s manufacturer, Wyeth, is also recommending that users take a monthly pregnancy test because the absence of a regular menstrual period makes it harder to tell whether conception has occurred.

Is it really worth it if you have to put up with all that? asked Barbara Seaman, a feminist health writer, several months before her death earlier this year.

Dr. Susan Wood, a professor of public health at George Washington University, has called for long-term safety studies of these newer contraceptive techniques. Dr. Wood resigned from her post as the Food and Drug Administration’s assistant commissioner for women’s health over the delayed approval of Plan B, the emergency contraception pill that is now available over the counter for women and men 18 and older. (Those younger than 18 still need a doctor’s prescription.)

With more potent doses of hormones than daily birth control pills, Plan B is designed to prevent conception if taken within three days of unprotected intercourse. Even without a noncontraceptive benefit, sales of Plan B are booming, according to the health research company IMS Health.

While all these new products are just variations on an old theme, novel approaches like a long-awaited male pill or a method for women that would prevent both pregnancy and sexually transmitted diseases like AIDS remain elusive. Several experts said that the cost of developing an entirely new contraceptive method outweighed prospective profits, and that research financing from pharmaceutical companies had dried up.

The holy grail is a drug that would specifically target the ovaries and testes that would have no effect on any other organ system, so they would be side-effect free, said Dr. James Strauss, who was co-chairman of a national committee on contraception research and is now dean of the medical school at Virginia Commonwealth University. That would be based on the discovery of genes only present in those reproductive tissues. We know a significant number of those genes today, and that’s the fruit of 20 years of research. Unfortunately, that knowledge has yet to be translated into a product.

The New York Times, by Tara Parker-Pope – For years, scientists have shown a link between stress and poor health. But a new study highlights how in women, chronic daily stress may be far more damaging than major stressful events like divorce or job loss.

Researchers at Fox Chase Cancer Center in Philadelphia studied how stress affects the body’s ability to fight off the human papillomavirus, or H.P.V. The virus is spread during sexual intercourse, and while most infections disappear over time, common subtypes of H.P.V. can sometimes lead to cervical cancer.

“H.P.V. infection alone is not sufficient to cause cervical cancer,” explained lead author Carolyn Y. Fang. “An effective immune response against H.P.V. can lead to viral clearance and resolution of H.P.V. infection. But some women are less able to mount an effective immune response to H.P.V.”

In a study published this month in the Annals of Behavioral Medicine, Dr. Fang and her colleagues studied how stress affects the body’s ability to clear H.P.V. They asked 74 women with precancerous cervical lesions to answer questionnaires about their perceived stress in the past month and about major stressful life events like divorce, death of a close family member or loss of a job.

No significant associations were found among women who reported major stressful events. But women who perceived their daily lives to be stressful were more likely to have an impaired immune response to H.P.V.

“That means women who report feeling more stressed could be at greater risk of developing cervical cancer, because their immune system can’t fight off one of the most common viruses that cause it,” said Dr. Fang.

The New York Times, October 31, 2008, by Tara Parker-Pope – Older adults appear to be more affected by stress than younger people, a new study suggests.

The research, to be published in the journal Psychological Science, used laboratory studies of adult behavior to measure the effect stress can have on decision making. It involved 45 adults between the ages of 18 and 33, and 40 adults between the ages of 65 and 89.

The tests began by exposing some of the study subjects to the laboratory equivalent of a stressful event, which involved holding a hand in ice-cold water for three minutes. That test has been shown to raise levels of cortisol, a stress hormone. A control group was not subjected to the ice water.

After being subjected to the icy water, participants played a driving game in which they had to decide whether to drive through a yellow light. They won points for driving when the light was yellow but lost points if they drove through a red light.

Among those in the control group, who had not been subjected to the ice stress, the older adults were actually better drivers than the younger adults and scored higher on the game. But when subjected to the icy water stress, the older adults did far worse. They were more cautious but also became more nervous, braking and restarting almost three times as often as their calmer peers.

“People haven’t looked at how stress affects decision making, even though so many of our decisions are made under stress,” said Mara Mather of the University of Southern California, Davis School of Gerontology, lead author of the study. “There’s very little information about this whole topic, and when you get to age differences, there’s even less.”

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Credit: Technology Review

Research in mice suggests that it might be possible to delete specific painful memories

MIT Technology Review, October 29, 2008, by Lauren Gravitz – Amping up a chemical in the mouse brain and then triggering the animal’s recall can cause erasure of those, and only those, specific memories, according to research in the most recent issue of the journal Neuron. While the study was done in mice that were genetically modified to react to the chemical, the results suggest that it might one day be possible to develop a drug for eliminating specific, long-term memories, something that could be a boon for those suffering from debilitating phobias or post-traumatic stress disorder.

For more than two decades, researchers have been studying the chemical–a protein called alpha-CaM kinase II–for its role in learning and memory consolidation. To better understand the protein, a few years ago, Joe Tsien, a neurobiologist at the Medical College of Georgia, in Augusta created a mouse in which he could activate or inhibit sensitivity to alpha-CaM kinase II.

In the most recent results, Tsien found that when the mice recalled long-term memories while the protein was overexpressed in their brains, the combination appeared to selectively delete those memories. He and his collaborators first put the mice in a chamber where the animals heard a tone, then followed up the tone with a mild shock. The resulting associations: the chamber is a very bad place, and the tone foretells miserable things.

Then, a month later–enough time to ensure that the mice’s long-term memory had been consolidated–the researchers placed the animals in a totally different chamber, overexpressed the protein, and played the tone. The mice showed no fear of the shock-associated sound. But these same mice, when placed in the original shock chamber, showed a classic fear response. Tsien had, in effect, erased one part of the memory (the one associated with the tone recall) while leaving the other intact.

“One thing that we’re really intrigued by is that this is a selective erasure,” Tsien says. “We know that erasure occurred very quickly, and was initiated by the recall itself.”

Tsien notes that while the current methods can’t be translated into the clinical setting, the work does identify a potential therapeutic approach. “Our work demonstrates that it’s feasible to inducibly, selectively erase a memory,” he says.

“The study is quite interesting from a number of points of view,” says Mark Mayford, who studies the molecular basis of memory at the Scripps Research Institute, in La Jolla, CA. He notes that current treatments for memory “extinction” consist of very long-term therapy, in which patients are asked to recall fearful memories in safe situations, with the hope that the connection between the fear and the memory will gradually weaken.

“But people are very interested in devising a way where you could come up with a drug to expedite a way to do that,” he says. That kind of treatment could change a memory by scrambling things up just in the neurons that are active during the specific act of the specific recollection. “That would be a very powerful thing,” Mayford says.

But the puzzle is an incredibly complex one, and getting to that point will take a vast amount of additional research. “Human memory is so complicated, and we are just barely at the foot of the mountain,” Tsien says.

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Yarek Waszul

The New York Times, October 29, 2008, by Kate Murphy – After nearly a decade of planning, researchers will begin recruiting pregnant women in January for an ambitious nationwide study that will follow more than 100,000 children from before birth until age 21.

The goal of the federally financed project, the National Children’s Study, is to gain a better understanding of the effects of a wide array of factors on children’s health.

“What we are doing is bold and needs to be bold in order to answer some pressing questions,” said the study’s director, Dr. Peter C. Scheidt, a pediatrician on the staff of the child-health division of the National Institutes of Health.

Investigators hope to find explanations for the rising rates of premature births, childhood obesity, cancer, autism, endocrine disorders and behavioral problems. To that end, they will examine factors like genetics and child rearing, geography, exposure to chemicals, nutrition and pollution.

While few quarrel with the goal, some experts worry that the expansive project will take resources away from smaller and more focused perinatal and pediatric research, particularly when budgets are certain to be strained by the financial crisis. The total cost is estimated to be $2.7 billion.

Participating mothers and children (fathers will be encouraged but not required to take part) will be given periodic interviews and questionnaires. They will further be asked to submit samples of blood, urine and hair. Air, water and dust from their environments will also be sampled and tested.

“Something like this has never been done in this country,” said a principal investigator for the study, Dr. Philip J. Landrigan, professor and chairman of community and preventive medicine at Mount Sinai School of Medicine in Manhattan. “It’s past time for us to do this.”

Studies of comparable size and scope are under way in Britain, Denmark and Norway.

Conceived during the Clinton administration and authorized by the Children’s Health Act of 2000, the National Children’s Study is being led by a group of federal agencies. Besides the health institutes, they are the Department of Health and Human Services, the Centers for Disease Control and Prevention, the Environmental Protection Agency and the Department of Education.

Since 2000, more than 2,400 health care, environmental and technology professionals have met in panels for hundreds of hours to work out such details as sampling methodology, data collection and privacy protection.

Subjects will be chosen from 105 counties to achieve a representative mix of racial, ethnic, religious, social, cultural and geographic characteristics. Forty regional centers will administer the study — mostly well-known medical institutions like Mount Sinai, the University of North Carolina School of Medicine and the University of Texas Health Science Center-Houston.

Dr. Russ Hauser, a professor of environmental and occupational epidemiology at the Harvard School of Public Health who served on a National Academy of Sciences committee that reviewed the study’s design, said the study would be “worthy and feasible” as long as it was properly financed.

But other experts questioned whether it was worth the cost. “The question isn’t whether the goals can be accomplished,” said Dr. Arthur Reingold, professor of epidemiology at the School of Public Health at the University of California, Berkeley. “It’s more a question of is this the best use of almost $3 billion, particularly when it will inevitably take funding from other research, especially with the economy falling to pieces.”

Researchers involved in the study counter that it will more than pay for itself by leading researchers to the causes or contributing factors for so many childhood disorders. Dr. Landrigan said a “dress rehearsal” of the study, which began in 2001 with 1,500 subjects from New York and California, has already shown that pregnant women exposed to organophosphates in pesticides were more likely to have babies with small brains and impaired cognition.

Another concern is that the study’s advisory board — which is choosing the chemical exposures to be studied — includes scientists from 3M and Pfizer, who have apparent conflicts of interest.

But Richard Wiles, executive director of the nonprofit Environmental Working Group, said that since there were only 2 such scientists among the board’s 33 members, he hoped they would not have undue influence.

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Brendan Smialowski for The New York Times

YOUNG VICTIM Tessa Cesario, 11, developed a kidney stone in February. She has since cut back on salt and is drinking more water.

The New York Times, October 29, 2008, by Laurie Tarkan – To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.

While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.

“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”

Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”

In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.

The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.

Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.

Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.

Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.

Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.

“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.

The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.

“It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”

The median age of children with stones is about 10.

Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”

Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”

Dr. Pope, in Nashville, agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.

“There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.

Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”

There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.

A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.

Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.

One Saturday last February, 11-year-old Tessa Cesario of Frederick, Md., began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.

The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.

“I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.

“I thought older men get kidney stones, not kids,” Ms. Cesario said.

The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.

Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.

Tessa Cesario is taking a wait-and-see approach. Her stone is not budging, so her parents are putting off surgery until they can work it into her dance schedule. In the meantime, she has vastly reduced her salt intake by cutting back on sandwich meats, processed soups and chips.

And, her mother said, “she drinks a ton more water.”

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Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses.
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The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and the stimulation of red blood cell production.

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This is the typical appearance of the blood vessels (vasculature) and urine flow pattern in the kidney. The blood vessels are shown in red and the urine flow pattern in yellow

Kidney Stones – Alternative Names

Renal calculi; Nephrolithiasis; Stones – kidney

Causes

Kidney stones can form when the urine contains too much of certain substances. These substances can create small crystals that become stones. Kidney stones may not produce symptoms until they begin to move down the ureter, causing pain. The pain is usually severe and often starts in the flank region, then moves down to the groin.

Kidney stones are common. A person who has had kidney stones often gets them again in the future. Kidney stones often occur in premature infants.

Risk factors include renal tubular acidosis and resultant nephrocalcinosis.

Some types of stones tend to run in families. Certain kinds of stones can occur with bowel disease, ileal bypass for obesity, or renal tubule defects.

Types of stones include:

* Calcium stones are most common. They occur more often in men than in women, and usually appear between ages 20 – 30. They are likely to come back. Calcium can combine with other substances, such as oxalate (the most common substance), phosphate, or carbonate to form the stone. Oxalate is present in certain foods. Diseases of the small intestine increase the risk of forming calcium oxalate stones.
* Cystine stones can form in people who have cystinuria. This disorder runs in families and affects both men and women.
* Struvite stones are mainly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder.
* Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy.

Other substances also can form stones.

Symptoms

* Abdominal pain
* Abnormal urine color
* Blood in the urine
* Chills
* Excess urination at night
* Fever
* Flank pain or back pain
o Colicky (spasm-like)
o May move lower in flank, pelvis, groin, genitals
o On one or both sides
o Progressive
o Severe
* Groin pain
* Nausea, vomiting
* Painful urination
* Testicle pain
* Urinary frequency/urgency
* Urinary hesitancy

Exams and Tests

Pain can be severe enough to need narcotic pain relievers. The abdomen or back might feel tender to the touch. If stones are severe, persistent, or come back again and again, there may be signs of kidney failure.

Tests for kidney stones include:

* Analysis of the stone to show what type of stone it is
* Straining the urine to catch urinary tract stones
* Uric acid level
* Urinalysis to see crystals and red blood cells in urine

Stones or a blockage of the ureter can be seen on:

* Abdominal CT scan
* Abdominal/kidney MRI
* Abdominal x-rays
* Intravenous pyelogram (IVP)
* Kidney ultrasound
* Retrograde pyelogram

Tests may show high levels of calcium, oxylate, or uric acid in the urine or blood.

Treatment

The goal of treatment is to relieve symptoms and prevent further symptoms. (Kidney stones usually pass on their own.) Treatment varies depending on the type of stone and how severe the symptoms are. People with severe symptoms might need to be hospitalized.

When the stone passes, the urine should be strained and the stone saved and tested to determine the type.

Drink at least 6 – 8 glasses of water per day to produce a large amount of urine. Some people might need to get fluids through a vein (intravenous).

Pain relievers can help control the pain of passing the stones (renal colic). For severe pain, you may need to take narcotic analgesics.

Depending on the type of stone, your doctor may prescribe medicine to decrease stone formation and/or help break down and remove the material that is causing the stone. Medications can include:

* Allopurinol (for uric acid stones)
* Antibiotics (for struvite stones)
* Diuretics
* Phosphate solutions
* Sodium bicarbonate or sodium citrate (which make the urine more alkaline)

Stones that don’t pass on their own might need to be removed with surgery. Lithotripsy may be an alternative to surgery. It uses ultrasonic waves or shock waves to break up stones. Then the stones can either exit the body in the urine (extracorporeal shock-wave lithotripsy) or be removed with an endoscope that is inserted into the kidney via a small opening (percutaneous nephrolithotomy).

You may need to change your diet to prevent some types of stones from coming back.

Kidney stones are painful but usually can be removed from the body without causing permanent damage. They tend to return, especially if the cause is not found and treated.

Possible Complications

* Decrease or loss of function in the affected kidney
* Kidney damage, scarring
* Obstruction of the ureter (acute unilateral obstructive uropathy)
* Recurrence of stones
* Urinary tract infection

When to Contact a Medical Professional

Call your health care provider if you have symptoms of a kidney stone.

Also call if symptoms return, urination becomes painful, urine output decreases, or other new symptoms develop.

Prevention

If you have a history of stones, drink plenty of fluids (6 – 8 glasses of water per day) to produce enough urine. Depending on the type of stone, you might need to take medications or other measures to prevent the stones from returning.

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In the procedure intravenous pyelogram (IVP), the patient is injected with radiopaque dye and X-rays are taken as the dye travels through the urinary tract. This procedure is performed to confirm the presence of kidney stones, although some stones may be too small to see.
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Extracorporeal shock wave lithotripsy (ESWL) is a procedure used to shatter simple stones in the kidney or upper urinary tract. Ultrasonic waves are passed through the body until they strike the dense stones. Pulses of sonic waves pulverize the stones, which are then more easily passed through the ureter and out of the body in the urine

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