Nephrologist

Nephrologists are specialists who specialize in diagnosing and treating diseases related to the kidney. They are trained to mange kidney disorders too. Pediatric nephrologists treat the same conditions in infants, children, and young adults. Nephrologists should complete medical school and then complete three years in internal medicine and further specialize for two years in the field of nephrology. Pediatric nephrologists have to further take special certification to qualify as pediatric Nephrologist. Nephrologists also termed as renal physicians treat diseases related to the kidney, any malfunctioning in the kidney can affect other organs of the body.

• Conditions that can lead to kidney disorders such as hypertension and diabetes mellitus.
  
• Check the functioning of the kidney.
  
• They treat Polycystic kidney diseases.
  
• Prescribe medications for kidney disorders.
  
• Support kidney transplantation.
  
• Treat patients who have kidney failure also called as renal failure / uremia.
  
• Treat patients with kidney stones.
  
• Removes sample from the tissues of the kidney for biopsy purposes.
  

Antacids

One of the common stomach disorders encountered is gastro esophageal reflux also known as heartburn. The stomach contains hydrochloric acid which helps in digestion of the food and subsequently killing ingested microorganisms. The acidity of the gastric HCl is 2M and any increase in the acidity leads to reflux, in which the gastric HCl travels through the cardiac sphincter muscle to the esophagus causing burning sensation and discomfort. Antacids are common choice of drugs which are administered in these conditions as they reduce the acid reflux and peptic ulcer.

Antacids act locally in the stomach region to neutralize the effect of the gastric HCl in order to prevent the onset of peptic ulcer. Most antacids are not absorbed and they are easily excreted in the stool. The predominant forms of chemicals used in the preparation of antacids include sodium bicarbonate, potassium bicarbonate, aluminum hydroxide, aluminum carbonate, magnesium carbonate, magnesium oxide and calcium carbonate. The natural forms of antacids include ginger, bananas, aloe vera, chamomile (used along with tea), carrots and turmeric. The action of antacids on the stomach is carried out throughout the wall to prevent ulcer formation.

Types of antacids

Antacids are recommended depending upon the intensity of the gastric disorder. In normal or mild conditions of acidity, non systemic antacids are recommended as they do not cause much damage. Prolonged administration of systemic antacids may lead to a condition called alkalosis in which the PH of the blood is raised leading to renal failure. Some of the common types of antacids used in the treatment of reflux and peptic ulcers are:

Sodium bicarbonate: It is recommended by many doctors to treat acid reflux and also reduce the acidity of urine and blood. Antacids which contain sodium bicarbonate also contain baking soda and hence it is not recommended for patients having congestive heart failure, hypertension, kidney disorders and gastrointestinal bleeding. Antacids containing sodium bicarbonate should be taken only after meals on a partially full stomach. The side effects include nausea, flatulence, weakness, increased thirst, black stools and irritability.

Aluminum hydroxide: Aluminum hydroxide is widely used as a non-systemic antacid and in most cases is available without prescription. The side effects of aluminum hydroxide include constipation and abdominal discomfort. In order to avoid constipation and abdominal stress, aluminum hydroxide is given in combination with magnesium hydroxide which has laxative properties along with antacid effects The combination of two such compatible antacids helps in sustained action in relieving peptic ulcers and protecting the wall of the stomach.

Calcium Carbonate: These antacids are mainly used in the treatment of indigestion, flatulence along with acidity and more commonly used as it is less expensive than other types of antacids. They are mostly recommended for children below the age of 12. In patients who have a previous history of osteoporosis or any other type of calcium deficiencies, the intake of calcium carbonate in case of acidity also helps in balancing the calcium requirement. If patients have a history of renal calculi or any other allergic reaction, calcium carbonate antacids should be avoided. The major side effect of this antacid is that it interacts with cardiac drugs. Calcium carbonate based antacids usually disintegrate and dissolute in forty minutes.

Drug side effects

Antacids react with many medications; digoxin, isoniazid, quinidine, pseudoephedrine and tetracycline. The potency and absorption of the drug reduces when the antacids interact with the corresponding drugs.

Kidney Stone

A kidney stone or renal calculus is a crystal concentration formed in the kidneys. Nephrolithiasis is formed from the minerals consumed in the diet and is largely composed of calcium. 75% of kidney stones are calcium stones. While Struvite stones are more commonly noticed in women, Uric acid stone can occur in men and women. Typically men are more affected by kidney stones than women. In most cases, the kidney stones are expelled by the body in the urine and no symptoms are noticed. But as the kidney stone grows in size, it can lead to pain and other symptoms. This is because of the obstruction to the ureters. A person suffering kidney stones feels pain in the area between the ribs and hip or lower abdomen and groin. Intermittent pain or renal colic is felt in spasms. It is sometimes accompanied by fever, blood and pus in the urine and pain on urination. There might be nausea and vomiting. There might be abnormal color of the urine.

Some foods that might increase the risk of kidney stone formation are refined sugars, sodium, vast quantities of animal protein and cola. Inadequate consumption of water adds to the risk factors. Those taking calcium supplements might also notice higher incidences of renal stone formation. This does not happen with high consumption of dietary calcium. Sodium, Uric acid and sulfurous amino acids also contribute to the formation of kidney stones. On the other hand, magnesium and potassium reduce urinary crystal formation by excreting citrate. Those with a family history of kidney stones are at higher risk of renal stones. Persons suffering kidney disorders, UTI and cystic kidney disease are also susceptible to kidney stones. Hyperoxaluria is a condition where the body produces too much oxalate. When this quantity is too large to be dissolved in urine, it leads to the formation of renal stones.

Ultrasound is done to confirm the presence of kidney stones. X-rays and IVP (intravenous pyelogram) aid in imaging the renal stone. Kidney function test and blood tests are also done. The size of kidney stones can range from a small grain of sand to a pearl. It can be smooth or jagged. Over time, renal stones can cause irreversible kidney damage. Most small stones in the kidney do not need treatment or removal. But if the kidney stones cause urine blockage, bleeding, infection or keep growing in size, they need to be removed. Some kidney stones, especially those consisting of uric acid or cystine can be treated with medicines. Else endoscopic removal of kidney stones with a uterescope is done. Lithotripsy is often used to break the stone into smaller pieces so that they can be flushed with the urine.

Burst Wave Lithotripsy : A recent feasibility study published in The Journal of Urology highlights a novel approach that may alleviate the pain associated with the treatment of renal calculus (Kidney stones) . This new technique combines two ultrasound technologies and offers an alternative to the current standard procedure - shock wave lithotripsy, which requires sedation.

This new approach involves the use of a handheld transducer placed on the skin to direct ultrasound waves towards the stone. The ultrasound can then be used in two ways. First, ultrasound propulsion can be utilized to move and reposition the stones, thereby facilitating their passage. Second, burst wave lithotripsy (BWL) can be employed to break up the stone into smaller fragments.

Notably, this technology has the advantage of being minimally invasive and painless, and it does not require anesthesia. This makes it a desirable option for patients who may not be able to tolerate sedation or anesthesia.

Kidney stones can be extremely painful and are known to afflict about 10 % of Americans. While patients with these stones are typically advised to wait for the stones to pass on their own, this can be a lengthy process.

Actually we may owe NASA for this technique to zapping kidney stones, because several years ago, NASA forked out funds for a study primarily intended to break up or move the kidney stones without anesthesia for Astronauts on long space flights where their physical movement will be restricted for longer duration - susceptible to the formation of stones due to factors such as microgravity and fluid shifts. When the study reported that BWL could shift or fracture the stones with ease, it came into general usage.