Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Back to the kidney. Kidneys can fail for mechanical reasons
as well. Blood clots or a dissection (a tear in the wall) of
the main artery supplying the kidney can cut off its blood
supply, as can trauma. We already discussed low blood
pressure as a cause.
After the kidney there can be mechanical reasons as well.
Let's discuss one: kidney stones. Stones can form in the
kidney from many sources -- parathyroid malfunction leading
to calcium stones, uric acid stones from gout, and it seems
that some people just have a tendency to them. Vitamin C
excess can also cause stones.
Stones are very painful and can be sudden. They can cause
frank bleeding in the urine, but usually they cause bleeding
that is invisible to the eye but visible in the urinalysis.
When they are at rest they may be painless, but movement of
the stone causes pain flares that often are so strong they
need narcotics. NSAIDS -- the class of drugs that include
ibuprofen and Naproxen - - are very effective too. Fluids do
not change the situation, the body shifts them to the other
kidney. Most stones do not block. 85 percent will drop into
the bladder without any problem, but if they are bigger than
5 mm. they will need some help being removed. We now measure
by CT scan, which replaced a dye study called an IVP.
Ultrasound is a cheaper test that may not see the stones but
will tell us if the kidney is blocked. Blood tests of the
kidney enzymes are also helpful.
We do two things in Israel for big stones. We can do
rissuk -- that is smashing them with a well- placed
water jet to the back, or nephrostomy -- a tube that drains
the urine from the kidney until the stone can be dealt with.
Surgery to remove the stone is also an option.
Two unrelated notes before we close. Those who have been
following this column have heard of my question about Dr.
Dena Zimmerman. Turns out my wife works in the town where she
lives and indeed, she is the same physician who was one year
behind me at Einstein Medical School.
Also I received a letter about cholesterol-lowering drugs. My
only comment is that all families of drugs have one that
turned out not to be safe. Extensive experience with a
medication is of course necessary, and before one jumps on to
the new, improved version, one should be sure that it is safe
and really shows improvement over the standard one. In the
case of Baycol, Bayer may have suppressed information that
led to the improper approval of this drug. The lawyers will
determine this, but it is not a reason to reject other safe
drugs in this class. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. A tried
and true standard is Ventolin in asthma therapy. It relaxes
the air tubes and makes breathing much easier for asthmatics
and people with allergies. As a physician I use it often --
for my patients and for myself as well.
