They say it is the worst pain you can experience. That’s hard to prove, but the pain I’ve had from kidney stones on several occasions has certainly been the worst for me.
As a small-town general practitioner, I had seen and treated dozens of cases before I had my first attack, which happened during a night shift when I was covering emergencies over a wide area centred on North Oxfordshire. I felt a niggle in my left flank which wouldn’t go away, no matter which way I turned. I got up and moved around, but it kept on getting worse. I started sweating and was sick a couple of times. Finally I had to wake the driver and get a peacefully sleeping colleague out of bed to give me a shot of pethidine and replace me at 3 a.m. The shame felt as strong as the pain.
A couple of days later, a tiny piece of black grit appeared in the tea-strainer I was peeing through. It consisted of calcium phosphate and oxalate. The size of the stone bears little relation to the amount of pain, which is caused by intense spasm in the ureter, the little tube which leads from the kidney down to the bladder. Once it has reached the wide open spaces of the bladder and urethra, the stone passes through painlessly. These little enemies have reappeared to floor me every 3-5 years, always at highly inconvenient times and locations.
Can citrates prevent kidney stones?
A new Cochrane review of citrate salts for preventing kidney stones in adults has a nice clear introduction. “Kidney stones affect people worldwide and have a high The speed or frequency of occurrence of an event, usually expressed with respect to time. For instance, a mortality rate might be the number of deaths per year, per 100,000 people. of recurrence even with Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes.. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher The number of new occurrences of something in a population over a particular period of time, e.g. the number of cases of a disease in a country over one year. of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. of calcium oxalate stones, the evidence to support its clinical The extent to which an intervention (for example a drug, surgery, or exercise), produces a beneficial result under ideal conditions. remains uncertain.”
Adding citrates to your diet
Nothing could be easier and cheaper than taking extra citric acid or citrates. You can take them as citrus fruit, lemon barley water or a vile-tasting liquid called Mist Pot Cit (Potassium Citrate Mixture), which used to be given to most patients on urology wards in days gone by. I guess I take most of my citrate as fresh citrus fruit, or the delicious mixtures of fresh raw fish and lemon and lime juice devised by the Peruvians and known as ceviche. The Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. used packets of citrate salts.
We need better information on which citrate sources work
The review states that “the quality of reported literature remains moderate to poor; hence a well-designed statistically The power of a trial is the chance that it will correctly detect a real effect of an intervention being tested (for example a drug, surgery, or exercise). Studies with more participants will have greater power. multi-centre A trial in which the people taking part are randomly divided into groups. A group (the intervention group) is given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). is needed in order to answer relevant questions concerning the The extent to which an intervention (for example a drug, surgery, or exercise), produces a beneficial result under ideal conditions. of citrate salts.” So we need better information on which sources actually work. The strange thing about having an intensely painful condition that only recurs every few years is that you tend to forget about it, so compliance is going to be a problem (as it was in these past Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known.), however harmless and even palatable the A treatment, procedure or programme of health care that has the potential to change the course of events of a healthcare condition. Examples include a drug, surgery, exercise or counselling. . But I’d be very happy to be enrolled in a new, well-designed RCT of citrates to prevent kidney stones, especially if there was a chance of being randomised to ceviche.
Stones, groans and citrates by Richard Lehman is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Based on a work at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010057.pub2/abstract.
Permissions beyond the scope of this license may be available at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010057.pub2/abstract.
Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2015, Issue 10. Art. No.: CD010057. DOI: 10.1002/14651858.CD010057.pub2.