Wednesday 21 March 2018

Ask the GP: Understanding kidney stones and treating lazy eyes

Dr Nina Byrnes
Dr Nina Byrnes

Nina Byrnes

Our GP advises on treatments for kidney stones and lazy eye.

Question: My husband was admitted to hospital recently with severe stomach pain.  Investigations showed he has kidney stones. The doctors gave him painkillers and IV fluids but once he felt better, he was allowed home. There doesn't seem to be any other treatment planned. Is there anything we should do?

Dr Nina replies: Kidney stones are small, hard mineral deposits that form inside the kidneys.

They can be quite common, occurring in up to one-in-10 adults. The majority of these kidney stones are really small, often amounting to no more than small pieces of gravel. Stones that become larger and start to pass out of the kidneys can become symptomatic - causing infection, pain or, rarely, obstruction along their path out of the body.

There are several types of kidney stones. Calcium stones are the most common accounting for 60-80pc of cases. Struvite stones may occur in association with repeated urinary tract infections.

Uric acid stones may occur on those who don't drink enough fluids, eat a very high protein diet or have gout. Genetic factors may also increase the risk of these. Another genetic condition can lead to cystine stones.

Kidney stones may run in families. They are three times more common in men than women and occur most commonly in those aged 30 to 50. Dehydration increases the risk. It is important to produce more than one litre of urine daily to flush the kidneys through. Obesity, digestive disease and surgery may also increase the risk.

Kidney stones are associated with bouts of severe abdominal pain. This usually comes in waves and is referred to as renal colic. The pain usually starts in the side and back and may radiate down into the groin. Other symptoms include urinary infection, blood in the urine, nausea and vomiting, a constant need to pass urine and fevers and chills.

Those who are passing larger stones will usually end up presenting to an emergency department due to the severity of the pain. If symptoms are milder, you may end up with your GP. Most calcium-containing stones will show on X-ray, so this basic test may help diagnose the problem. A specialised CT scan is usually required to confirm the presence and location of stones in the urinary tract.

Stone may pass themselves and the usual treatment is lots of fluids (either intravenous or by mouth) and painkillers. If a single stone is present and this passes, further treatment may not be required.

If stones are large or multiple, or there is any obstruction along the tract, further treatment may be required. Lithotripsy is external beam shock therapy that delivers pulses of energy to the stones breaking them into pieces small enough to pass. Surgery is more rarely required.

In order to reduce the risk of further stones, it is important to drink plenty fluids: upwards of two litres daily. Calcium and vitamin D supplement should be avoided in those with a history of kidney stones.

Question: My daughter is six-months-old and I think she has a lazy eye. It's not there all the time but I have noticed it on and off and it appears obvious in some photos. Will it need to be treated?

Dr Nina replies: Lazy eye is the term used to describe strabismus or squint. There are six muscles that control movement of the eye. These normally work together to align the eyes when they are looking at something sending a clear, uniform message to the brain.

If these muscles don't work as a team, the eyes look in different directions. The brain gets sent two different messages at a time and may be confused. The brain may start to ignore the message from the weaker or lazy eye and this can lead to poor vision on that side.

Squints are common, occurring in up to one-in-20 children. In the majority of cases, the cause is unknown. More rarely, a squint may occur due to a disorder of the eye itself, the brain or the muscles and nerves associated with it. It is common enough to notice a squint in infants up to three months of age.

Babies may appear to have these at times, especially if they are tired. Squints that are permanent or increasing should be reviewed by a specialist. If your child covers one eye to look at you, or looks at you sideways, this may also suggest they have blurred or double vision.

Squints should be treated as early as possible. If the resulting poor vision isn't corrected by the time the child is seven or eight, it may be permanent.

The main treatment for squint is to restrict the use of the good eye. This forces the "lazy eye" to work harder. Patching is most commonly used.

It may take weeks to months for patching to work. If vision is short or far-sighted, glasses may also be required.

Surgery is often used to improve the appearance of the squint. More than one operation may be required.

Surgery is normally performed as a day case. It will require general anaesthetic but your child can go home with you the same day.

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