GASTROENTEROHEPATOLOGY SYSTEM

2014
INTERNATIONAL CLASS

RESEARCH AND METHODOLOGY

NAME

NURUL NABILAH AZRA BINTI NOR AZLAN

NIM

C 111 12 863

GROUP

PROFESSORS NAME

DR. dr. GATOT S. LAWRENCE

MEDICAL FACULTY
HASANUDDIN UNIVERSITY
MAKASSAR
2014

I.
II.
III.

RESEARCH QUESTION
How does water consumption helps to prevent urolithiasis?
TITTLE OF RESEARCH
The Influence of Water Consumption in Preventing Urolithiasis
VARIABLES
Independent variable
:
Dependent variable
:
Confounding variables
:
Geographical
Kidney Abnormalities, Ethnicity
Controlled variable
:

The amount of water intake

Urolithiasis
Age, Gender, Lifestyle,
differences,
Gender, Age

Age
Gender
Lifestyle
The amount of
water intake

Urolithiasis
Ethnicity
Geographical Differences
Kidney Abnormalities

V.

FACTORS AFFECTING UROLITHIASIS

VI.

LION AND FOX PHENOMENON

Lion : Gender, Age
Fox : Kidney Abnormalities, Lifestyle, Ethnicity, Geographical
Differences
STUDY DESIGN
Using cross-sectional study design, gather the data concerning those who
are suffering from urolithiasis. Taking the variable (water consumption)
into account, other data related such as the amount of water consumed
in a day, the type of beverages consumed and drugs usage, are also
collected.
THEORETICAL FRAMEWORK

of water
intake [1],
[3], [4], [5]

Inadequate
intake

Concentration of
salt increases

differences
[11]

Higher
temperature

Dehydratio
n

Ethnicity [7]
Gender

Lifestyle [6],
[13] [14]

Age[10]

Crystallizatio
n of dissolved
salts

Caucasians

High intake
of salt
(oxalate,
citrate)
Male: 30-50 years
old
Female:

Gender [9]

Kidney
abnormalities

Anatomical
structures
difference

Males
urethra is
longer than
female

Genetic
defects

Horseshoe
Kidney [2]

Stagnation
and
accumulation
of urine
Urine
obstruction

UROLITHIASIS [4], [12], [13]

IV.

VII.

CONCEPTUAL FRAMEWORK

The amount of water Inadequate

intake
intake
Concentration of salt increases
Crystallization of dissolved saltsUrolithiasis

VIII.

EXPALANATION
Urolithiasis
Urolithiasis or kidney stone are solid particles in the urinary system. Pain,
nausea, vomiting, hematuria and, possibly chills and fever are symptoms
due to secondary infections (Preminger, 2011) [12]. In the United States,
5-10 % people suffer this diseases and based worldly statistics 1- 12 %
suffer kidney stones. Alongside urinary tract infections (UTIs) and benign
prostate hypertrophy (BPH), Urolithiasis make up the three most common
cases in urology department. Epidemiologically, the factors contributing
toward the formation of Urolithiasis can be divided into two: a) Intrinsic
factors (hereditary, age, gender) and b) Extrinsic factors (geographical
differences, climate and temperature, water consumption, diet and
activity or occupation) (Purnomo, 2012) [13]. The mechanism that
triggers the events that lead to urolithiasis is super saturation in which
the dissolved salts are condensed into solid particles. Super saturation is
usually approximated to the ratio of the concentration of salts in urine
and their solubility in it. In ratio of lesser than 1, the salts usually dissolve
and any greater than 1 would result in crystallizations (Coe, Evan &
Worcester, 2005) [4].
The amount of fluid intake
According to Purnomo (2011), little intake of fluid and a high mineral
(calcium) concentration in the fluid intake can increase the incidence of
urolithiasis [13]. The mechanism that triggers the events that lead to
urolithiasis is super saturation in which the dissolved salts are condensed
into solid particles. Super saturation is usually approximated to the ratio

of the concentration of salts in urine and their solubility in it. In ratio of

lesser than 1, the salts usually dissolve and any greater than 1 would
result in crystallizations (Coe, Evan & Worcester, 2005) [4]. Specific
clinical scenarios have existed that an increased fluid intake may prevent
kidney diseases but no clinical trials have been conducted to examine
fluid intake in the progression of kidney diseases. A study conducted by
Dr. Clark and colleagues have shown an association between fluid intake
and incident of kidney diseases and eGFR progression. The study
conducted by using urine volume as a surrogate marker for fluid intake
and have shown and supported the fact that a higher fluid intake as a
preventative measure in GFR loss among individuals with eGFR 60
ml/min per 1.73 m2 (Chang & Kramer, 2011) [3].In addition to that,
according to Anastasio et. al (2002) acute changes in the level of
hydration influence GFR and urinary Na excretion under fasting
conditions. An individual on a low hydration regimen has a higher GFR
value and a lower urinary Na values. Plus, after a protein-rich meal,
hydration play a major role in influencing renal response [1]. Even so, the
type of fluid or beverages consumed need to be taken into account as the
composition may either increase or decrease the risk of urolithiasis
(Ferraro et. al, 2013) [5].
Age
The risk of kidney stones increases in men in their 40s and continues to
rise until age 70.In children, the cases are mostly due to genetic factors.
For women, the incidence only peaks in the 50s and younger women
during the late stage of pregnancy (Kidney Stones, 2005) [10].
Gender
The study results showed that male expose to renal stone formation than
female, this finding is similar to other studies, and they found that most
of the patients with renal stones were males. This could be due to
anatomical differences in urinary tract between males and females, as in
male the urethra is longer than in female which may cause accumulation
and stagnation of urine in the bladder for longer times (Muhbes, 2012)
[9].
Ethnicity
The highest incidence of kidney stones occurs in Caucasians, followed by
Mexican Americans. African-Americans have the lowest risk. (Kidney
Stones, 2005) [10]. Idiopathic stone disease occurs more frequently in
white Caucasians than in Blacks, irrespective of the geographic area
concerned. In the USA and Brazil, the same 4 to 1 Caucasian-to-Black
ratio between stone formers was reported (Lopez and Hope, 2010) [8].
Geographical Differences
According to Purnomo (2012) [13] , the prevalence of kidney stones are
higher in certain areas than others, to a degree in which the said area
would be known as stone belt area, meanwhile in the Bantu region of
South Africa, the incidences are so rare to none. Ambient temperature
and sunlight exposure can be associated to the prevalence of kidney
stones. In warmer climate, dehydration occur from inadequate fluid

intake, increases the pH of urine, making it easier for the formation of

urolithiasis. A proposal that show that there might be a link between
sunlight exposure and urolithiasis based on the observation a higher
urinary calcium in soldiers transferred to warmer climates than those to
colder climates (Soucie, Coates, McClellen, Austin & Thun, 1996) [11].
Lifestyle
Lifestyle is composed of dietary habits, occupations and activities. The
risk of developing kidney stones increases in those who lead sedentary
lives than those who lead active lives (Purnomo, 2012) [13]. Diet
influences the formation of renal stones, which can be explained by two
factors: a) urine composition factors and b) renal morph anatomy factors.
For example: Oxalate-rich foods may be a risk factor for formation of
calcium oxalate monohydrate papillary calculi (Grases, Costa-Bauza &
Prieto, 2006) [6]. High intakes of purines, oxalates and calcium make it
easier for kidney stones to form (Purnomo, 2012) [13]. Intakes of vitamin
C is also limited in patients with calcium oxalate stones (Taylor, Stampfer
& Curhan, 2004) [14].
Kidney Abnormalities
Some anatomical abnormalities to the kidneys may causes the formation
of kidney stones. Horseshoe kidney is one of the more common birth
defects, occurring in approximately one of every 400 births. Although it
often goes unnoticed, it is associated with a higher risk of kidney disease
and kidney stones. In individuals with normal anatomy, there are two
separate kidneys, located in the back, which are protected by abdominal
muscles and ribs. With a horseshoe kidney, the two kidneys are actually
fused together, giving it a horseshoe-like appearance. Increased stone
incidence in individuals with a horseshoe kidney is due mainly to its
unusual blood supply, the problematic placement of the ureters into the
kidney and the prevalence of urinary tract obstruction associated with
horseshoe kidney. Tubular Ectasia is common in patients with calcium
containing stones (UW Health, n.d) [2].
IX.

CONCLUSION
In order to prevent urolithiasis, the amount water intake is essential to
ensure that the concentration of salt within our body do not become
escalated and thus leading to saturation. Super saturation, a term that
can be evaluated by the concentration of salts in urine and their solubility
in it. If its too high or the ratio >1 , crystallization would occur and
urolithiasis formed. An adequate water intake ensures that concentration
of salt accumulated does not get high and does preventing urolithiasis.

X.

REFFERENCES
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