Diseases of the Urinary System
In the last two newsletters, we explored both the anatomy of the urinary system and the physiology of the urinary system. In this issue, we'll examine what can go wrong. My intent here is not to explore the details of diseases of the urinary system, but rather, to explore their actual impact on the system.
Quite simply, if we understand what degrades the tissue and functions of the different parts of the urinary system, we have a chance to do something about it -- to either prevent those things from happening in the first place, or reverse them after the fact -- rather than merely managing symptoms. In other words, I intend to explore the diseases of the urinary system from the alternative health perspective that disease is the final manifestation of a series of events and choices rather than the medical perspective that disease is an isolated event unto itself. (Note: although kidney and bladder cancer kill some 28,000 people a year in the US,1,2 we will not discuss them at this time but save them for a future discussion when we explore the anatomy and physiology of cancer itself.)
With the above perspective in mind, we're now going to examine the relationship of the following disease states to the urinary system:
- High blood pressure
- Low blood pressure
- Infection (bacterial and yeast)
- Interstitial cystitis
- Kidney stones
- Kidney Sludge
Diabetes is not a disease of the kidneys; but as we discussed in our exploration of the endocrine system, it is a disease of the pancreas. But that said, diabetes nevertheless has a huge impact on the health of your kidneys. The basics in terms of diabetes and the kidneys are simple. As we explained last newsletter, any excretion of glucose in the urine is abnormal. As a result of a simple filtration process, 100% of the sugar molecules in the blood are removed in the glomerulus and deposited in the urine filtrate. However, in a normal, healthy person, all of those sugar molecules (every single one of them) are then returned to the blood in the nephronic tubules. None of it remains in the final urine. People suffering from diabetes, however, produce more glucose than the tubules can handle; what can't be reabsorbed is excreted in the urine. In addition, the excess sugar in the urine creates an osmotic load that pulls water from the body into the urine leading to dehydration, along with diabetes and copious sweet urine. The brain picks up the information that we've lost too much fluid and it triggers dry mouth to encourage us to drink more water. Theoretically, if you drink enough water to compensate, all should be well and good. No harm; no foul. Unfortunately, diabetes presents two other problems for the kidneys that are not so easily resolved.
As just mentioned, too much sugar in the blood leads to increased thirst in the body's attempt to get rid of the extra sugar. And as explained in Diabetes -- the Echo Effect, this leads to increased urination and starts putting an extra burden on your kidneys. But it doesn't stop there. Too much sugar causes the small blood vessels throughout the body to narrow as your body tries to abate the damage caused to organs by minimizing the ability of the excess sugar to reach them. The higher the blood sugar level, then, the more the small blood vessels narrow. The blood vessels thus carry less blood, and circulation to the kidneys (as well as everywhere else in your body) is impaired and restricted. But this is only the beginning of your problems because sugar also directly attacks your kidney tissue.
So what kind of damage does sugar cause to kidney tissue?
Pretty much the same damage that sugar causes to all protein tissue -- only more so because your entire blood supply circulates through your kidneys upwards of 47 times a day. That's a lot of contact for the sugar in your blood to be making with your kidney tissue, thereby allowing it to continually attack that tissue 24/7. The culprit is protein glycation, or advanced glycosylation end-products (AGEs). Glycation is the uncontrolled reaction of sugars with proteins. It's kind of like what happens to sugars when you heat them and they caramelize. In effect, glycation is what happens when excess sugars caramelize the proteins in your body. AGEs can directly alter protein function or activate specific receptors with resultant changes in gene expression. AGEs also stimulate production of reactive oxygen species (a specific type of free radicals), which are common culprits in vascular pathology. Protein glycation is a major factor in the aging process and is particularly devastating to diabetics and their kidneys.
The damage primarily occurs in the tiny blood vessels of the glomeruli. High blood sugar steadily degrades these tiny blood vessels. When this happens, it is called diabetic kidney disease (or diabetic nephropathy). And as you may remember from our previous newsletters, you only have so many nephrons in your kidneys when you're born. That's it. They cannot be replaced. Once kidney tissue is destroyed, it can't be fixed. If diabetic kidney disease is not treated early, it can lead to kidney failure. There is no cure for kidney failure. If you have kidney failure, you will need dialysis or a kidney transplant to live. The good news is that diabetic kidney disease does not happen quickly. Sometimes it takes many years. This means you have time to help stop the damage from progressing and save your remaining kidney tissue -- if you act now.
In addition, high glucose can activate and up-regulate the Protein Kinase C enzymes, which leads to vascular dysfunction, nephropathy, retinopathy, and at least some forms of neuropathy.3 And finally, excessive blood levels of glucose stimulate flux through the sorbitol pathway that ultimately decreases sodium-potassium ATPase activity,4 but that is probably more a factor in the onset of diabetic cataracts than kidney disease.5
Sugar is not the only problem associated with diabetes. Excess insulin is also a kidney killer.6 Insulin is the master hormone of your metabolism. When it is out of balance and your insulin levels are consistently elevated, a long list of deadly complications are created. An elevated insulin level, hyperinsulinemia, is directly implicated in the damage done to the arterial endothelium.7 This leads to both inflammation and plaque buildup in arterial tissue. Although the capillaries that are inside the glomerulus and around the tubules are not subject to plaque buildup and atherosclerosis, the arterioles entering and leaving the glomerulus are. And although they are not as narrow as the capillaries, they are remarkably narrow as blood vessels go and easily narrowed and clogged. The bottom line is that excessive insulin in the blood, by virtue of the inflammation and damage it can do to the blood supply feeding the nephrons, can steadily shut down and "kill" large sections of the kidney over time, leading to kidney atrophy.
High blood pressure
Chronic high blood pressure permanently damages the nephron capillaries and prevents the kidneys from working properly. The damage worsens as long as blood pressure remains elevated. As continued hypertension increases the damage to kidneys, the ability of the kidneys to filter blood diminishes. The kidneys also lose the ability to maintain proper blood volume, thus further increasing blood pressure in a negative spiral. As damage to these capillaries worsens, kidneys eventually lose their ability to function properly, and eventually kidney failure develops. This is known as hypertensive nephropathy -- defined as damage to the vasculature of the kidneys as a direct result of high blood pressure.
In addition, high blood pressure can cause proteins to leak into the kidney inappropriately so that protein (albumin) ends up in the urine (called proteinuria). Long-term proteinuria damages the filtering component of the kidney, which can rapidly lead to acute kidney injury. High blood pressure can also lead to a condition called arteriolar nephrosclerosis, wherein the leaked pressures get into the walls of the kidney's blood vessels, decreasing their ability to do their job. And finally, very high blood pressure negatively impacts blood composition by eliminating useful components to the urinary system.
Hypertension is particularly insidious in terms of kidney function. The problem is that it's not only a direct cause of kidney disease, but as you may remember from our last newsletter, the kidneys play a direct role in regulating blood pressure by regulating fluid levels in the blood. That means that not only does hypertension compromise the ability of the kidneys to function, but that compromised function then raises blood pressure even more, thus leading to an echo effect. In other words, as hypertensive nephropathy progresses, physical changes in the kidneys lead to even higher blood pressure. Therefore, a dangerous spiral, involving rising blood pressure and factors that raise blood pressure, occurs. Early detection and treatment of even mild hypertension is essential.
Hypertension causes one quarter of all kidney failures and is the number two cause of all kidney failure according to the American Kidney Fund.8 In summary, regardless of other factors such as age, race or cause of kidney disease, hypertension worsens and accelerates kidney damage. And as the American Association of Kidney Patients says, "Study after study has shown better blood pressure control slows progression of CKD [chronic kidney disease]."9
Low blood pressure
Low blood pressure also is damaging to the kidneys. Low blood pressure decreases the blood flow to the kidneys, and since, as you will remember from the last newsletter, the kidney's function depends on adequate blood flow and sufficient blood pressure in the glomerulus, the nephrons may not be able to function effectively if the pressure is sufficiently reduced. Consequently, the glomerular filtration rate (GFR), a measure of kidney function, may drop; a low GFR is one measure of kidney injury. If the low blood pressure persists, not only does kidney function decrease, but the kidneys can actually become damaged. Low blood flow can lead to inadequate oxygen delivery to the kidney, which can cause the cells of the kidney to fall apart, die, and leak fluid. We're not talking about slightly low blood pressure here, as can be found in trained athletes and is actually beneficial. We're talking about low blood pressure as the result of injury to the kidneys or as the result of chronic disease or severe trauma.
In addition, according to research published in the Journal of the American Society of Nephrology, for patients with even moderate kidney disease, the risk of stroke is increased with low blood pressure even when compared to chronic kidney disease patients with slightly higher blood pressure.10
Infection, interstitial cystitis, and yeast infection
We've already explored infections and cystitis when detailing the anatomy of the urinary system. At that time we learned that although bacterial infection can occur throughout the urinary system, it is found most often in the bladder, as opposed to the kidneys. And the primary reason for this is that although infections can happen spontaneously in the kidneys or be brought there through the bloodstream, the primary route, overwhelmingly, is upwards -- through the vagina and penis, and then into the urethra. That makes the bladder the first stop. Women have the disadvantage of a shorter urethra and closer proximity to the anus, which makes it easier for bacteria to make their way into the system. Men have the disadvantage, as they age, of an enlarging prostate, which squeezes the urethra and prevents full voiding of the bladder, which gives it more time to acquire an infection and serve as a medium for growth. All of that said, if an infection does reach your kidneys and is not treated properly, it can permanently damage your kidneys or spread to your bloodstream and cause a life-threatening infection. The medical term for an infection of the kidneys is pyelonephritis. As discussed, this can happen with bacteria making their way from the bloodstream into the kidneys, or if reflux into the ureters is so bad that infected urine is refluxed all the way to the kidney.
As for interstitial cystitis (IC), that too was covered in the anatomy of the urinary system. Its actual cause is unknown, but it is understood that it is different from urinary tract infections, which are caused by bacteria and can be treated with antibiotics. In fact, studies have shown that antibiotics are not useful for treating IC. Because its symptoms and severity vary so much, current thinking is that it's not actually one disease but several. One theory being studied is that IC is an autoimmune response following a bladder infection. Yet another theory is that there are substances in urine which are irritating to people with IC. And still other theories are being studied.
Protocols for treating both bacterial infection and IC can be found in the Anatomy of the Urinary System.
It is estimated that three quarters of all women will have a vaginal, Candida-yeast infection at some point in their lives. Confusingly, however, because the symptoms are so similar, people are often not sure whether they have a bacterial bladder infection or a yeast infection. On the other hand, they are connected by the fact that vaginal yeast infection can actually lead to bladder infection. Symptoms for both types of infection can include: pain and burning during urination, the feeling that you need to urinate often but not much urine is produced, pressure in the abdomen or lower back, and even fever.
The infection can travel into the bladder and, in some cases, even into the kidneys. However, knowing what you have is important before getting any treatment, as the treatments for the two types of infection are somewhat mutually exclusive. Doctors will usually prescribe antibiotics to eliminate a bacterial infection, but antibiotics have no effect on fungi and, instead, can actually cause their levels to increase. How?
Vaginal yeast infections occur when new yeast is introduced into the vaginal area, or when there is an increase in the quantity of yeast already present in the vagina relative to the quantity of normal beneficial bacteria -- in other words, a state of dysbiosis. One of the primary ways this happens is when protective beneficial bacteria are eradicated by a round of antibiotics. A diet heavy in antibiotic laden meat and dairy can also contribute to the problem. And chlorinated water is also unhelpful in this regard as it tends to kill off all beneficial bacteria. This allows the yeast to multiply, invade tissues, and cause irritation of the lining of the vagina (vaginitis). From there, the yeast infection, like a bacterial infection, can migrate upwards to the bladder, the kidneys, and even the adrenals. Likewise, the use of douches or perfumed vaginal hygiene sprays, by similarly eradicating beneficial bacteria, can increase a woman's risk of developing a vaginal yeast infection.
And finally, anything that compromises the immune system can promote the overgrowth of yeast and, thus, a yeast infection. This includes diabetes, the use of oral contraceptives, cortisone- or prednisone- based medications, and, of course, chemotherapy. Other obvious problems include the use of immunosuppressant drugs or diseases such as AIDS that directly compromise your immune system.
As for men, yeast infections are even rarer than bacterial infections, but still possible, and can affect not only the bladder, but also the prostate.
Getting rid of a yeast infection
Antifungal creams can clear an infection over about a week, but they have two limitations.
- They only help with vaginal infections. They can't reach into the bladder or the kidneys.
- They destroy all beneficial bacteria, which means you are totally unprotected after using them -- at least until you rebuild the protective layer of beneficial bacteria that they clean out -- thus making a recurrence of the infection more likely.
For a more natural approach, you will want to attack the infection from low and high -- from externally and internally.
Douching with apple cider vinegar (ACV), oil of oregano, tea tree oil, or garlic can help. Dilute the ACV 50/50 with water. Just a few drops of oil of oregano or tea tree oil or the juice from 3-5 crushed garlic cloves are all that's needed in the douching water. Repeat several times a day until the infection is gone -- and then continue for three days longer.
Internally, you will want to supplement with a good probiotics formula, particularly one that contains live acidophilus. This is not a quick solution as it takes time for the probiotics to migrate over to the vaginal tract. You will also want to supplement with an immune boosting formula so that your immune system can help keep things under control -- as it's designed to do.
You should also use a powerful anti-pathogenic formula that contains things like garlic, oil of oregano, olive leaf extract, and liquid zinc. A good formula is not only useful against viruses and bacteria; it's also effective against yeast. Use a lot. If you use something like the formula described in the link, you will want to use at least an ounce a day (diluted in juice or water) until all visible signs of the infection are gone -- then for several days after to be sure all traces are gone. The virtue of taking the formula internally is that it makes its way into the bloodstream, then to the kidneys, and finally into the urinary tract from top to bottom.
Kidney stones and sludge
Everybody knows about kidney stones. They are one of the most painful things that can happen to you. Doctors equate them with labor pains, but worse because you don't know when it will end and there's no reward to look forward to. In fact, when severe, no amount of morphine can help with the pain from kidney stones. But kidney stones are only the visible manifestation of the problem. Kidney sludge is a far bigger problem because it affects just about everyone, and as it shuts down more and more nephrons, it causes inflammation of kidney tissue. Unfortunately, sludge is asymptomatic until it is too late. You become aware of the problem only after you develop kidney stones -- or even worse, you start to lose kidney function.
Kidney sludge and stones are the result of the accumulated crystallized minerals that sometimes obstruct the flow of urine and damage the kidneys. If the minerals accumulate to a sufficient degree, the sludge coalesces, most likely in the renal papilla,11 into rough surfaced stones that rip and tear at the ureters on their way out of the kidneys. Although everyone focuses on kidney stones because of the pain involved, it's important to remember that a kidney stone is only the extreme manifestation of sludge. Just because you don't suffer from kidney stones doesn't mean you don't have a problem. Kidney sludge may not be painful like a stone, but it is nevertheless deadly over time as it slowly chokes off kidney function nephron by nephron.
How extensive is the problem? Virtually, every living person has some degree of sludge build-up and some loss of kidney function over time. The only question is how much. Does it reach the point where it causes painful kidney stones to form or the point where it chokes off a critical mass of kidney tissue, ultimately leading to kidney failure? Kidney failure is the ultimate expression of this choking off process. It occurs when so much function has been lost that the kidneys are no longer able to keep the blood balanced. In acute kidney failure, symptoms include swelling, drowsiness, and irregular heartbeat. In chronic kidney failure, symptoms include fatigue, loss of appetite, headaches, cramps, and thirst.
One final note on kidney stones: there are four types.
- Calcium stones are composed of calcium that is chemically bound to oxalate12 (calcium oxalate) or phosphate (calcium phosphate).
- Uric acid stones are formed when the acid level in the urine is high or too much acid is excreted. This means that the uric acid may not dissolve and uric acid stones may form.
- Struvite, or infection stones,13 develop when a urinary tract infection alters the chemical balance of the urine causing stones to form from ammonium, magnesium, and phosphate.
- Some people inherit a rare condition that results in large amounts of cystine in the urine, which causes the formation of cystine stones that are difficult to treat.
The important thing to understand is that although all of the above types of stones have different chemical compositions, most of them can be dissolved by the right combination of herbs in a single formula. Look for a formula that contains herbs like chanca piedra, gravel root, and hydrangea root. If the formula is any good, it can start to help in as little as a couple of hours. How can it work so quickly? That's all it takes for a liquid herbal medicine to be absorbed into the bloodstream and then make its way to the kidneys. And as we've learned over this series, that can happen quickly…and repeatedly.
What do doctors do when things go wrong?
Standard medical approaches for dealing with kidney issues include diuretics, dialysis, alpha-blockers, and lithotripsy.
A diuretic is anything that causes urine to flow in large amounts. They are commonly used to control blood pressure. Diuretics lower blood pressure by lowering the volume of fluid in the "tank" so to speak. There are three general types of diuretics:
- Osmotic diuretics use direct osmotic pressure to create short-term urine flow (dieresis). This includes most of your blood pressure medications -- and sugar, for that matter.
- Caffeine decreases sodium reabsorption, causing diuresis through osmosis.
- Lasix (fuosemide) works in the loop of Henle to produce massive diuresis. It also increases blood flow to the kidney, which can be useful in its own right. It works too effectively to be used as a blood pressure medication as it can remove liters or even gallons of urine in a day. It tends to be prescribed in emergency situations.
Dialysis is the last stop before a kidney transplant. It makes use of a mechanical osmotic pump that mimics the glomerulus, thus filtering a patient's blood externally to replace damaged or destroyed kidneys. It takes about two hours for a complete treatment, the benefits of which can last two to four days. Although it is inconvenient and results in the patient feeling "off" as those two to four days wind down, it nevertheless can allow patients to lead otherwise quasi-normal lives -- either while waiting for a transplant, or for an extended period of time, if necessary. Side effects can include muscle cramps, infection, low blood pressure, and sexual dysfunction. If nothing else, from a medical point of view, we can safely say that it's better than the alternative.
For most people, kidney stones are passed through the body without the need for surgery. In fact, in most cases they are so small that you never even know that you had them. Sometimes they are large enough and linger just long enough to cause a patient intense pain, and they can potentially lead to other complications. A doctor's first option is to prescribe an alpha-blocker such as Flomax to relax the smooth muscles of the ureter, particularly where it passes through the prostate, to help a patient pass the stone more swiftly.14 If that doesn't do the trick, surgery is required to pulverize and extract the kidney stones. Surgery, in this case, refers to lithotripsy, a non-invasive surgical technique.15 Note: the use of the word surgery in this case does not involve cutting someone open. It merely refers to "manual" or "operative" procedures, as opposed to using drugs to treat a disease or condition. In this case, lithotripsy uses sound waves to shatter the stones -- like a medical Weirding Module from the movie, "Dune."
Lithotripsy is hardly a cure all. It only works on stones, not on sludge -- and it's not always effective at that. It also merely treats the stones on hand and does nothing to prevent the appearance of new stones down the line. In addition, it's very expensive ($5,000-7,000 a treatment in the U.S.). But most important of all, a study out of the Mayo Clinic found that its use comes at a high "medical" cost. According to the study, the use of lithotripsy is associated with a "significant" increase in the risk of subsequent diabetes and high blood pressure.16
Conclusion - more natural approaches
There are alternatives to the medical approach. Specifically:
- First and foremost, drink enough water. There's a lot of debate on this in the medical community, but pay no attention. And really, why would you listen to the medical community when it comes to diet and nutrition anyway. Medical crises "yes;" diet and nutrition, "no.") Think about this for a moment. You lose 2-4 quarts of fluid a day in your urine, plus what you lose in your sweat, your stools, and in water vapor as you breathe. And of course, if you drink diuretics like coffee, energy drinks, colas, or regular tea, that number is even higher. You really want to drink in the neighborhood of 8 glasses of water (2 quarts/liters) a day. Yes, diluted juices and non-diuretic herbal teas can contribute to that amount, but colas, energy drinks and coffee do not. If the drink contains either caffeine or sugar it is counterproductive in that they cause you to pee out anything you're drinking. In addition, they force your kidneys to work overtime to filter out all of the additives and artificial flavors they contain.
- Everyone should use a good kidney flush formula twice a year -- more often if you have a problem. Remember, it's not just a question of kidney stones. You also want to help your body flush sludge before it can block nephrons, and you also want to nip any kidney infection in the bud -- not to mention reduce any inflammation. And if nothing else, use a good proteolytic enzyme formula on a daily basis to help control systemic inflammation.
- Cut sugar from your diet and incorporate a sugar metabolic enhancement formula to reduce stress on your kidneys.
- Use an anti-pathogenic formula as described above at least once a week to help minimize the risk of any infection getting established.
- Use a good probiotic supplement to keep the urethra, bladder, and ureters lined with beneficial bacteria to reduce the risk of any bad bacteria or yeast establishing a beachhead.
- And do Kegel exercises regularly to prevent the onset of incontinence as you age.
In our last newsletter, I promised you that we would discuss an unusual therapy based on urine that some alternative healers swear by. Let's now conclude our discussion of the urinary system by discussing urine therapy. Now that you understand how urine is made and what it is, this program may not sound quite so outlandish.
Quite simply, urine therapy refers to the drinking of one's own urine as a natural medicine. As we've thoroughly discussed, there's nothing toxic in urine. In healthy urine, there should be no bacteria, no viruses -- just water electrolytes and some biochemicals that your body no longer needs such as urea and creatinine. Maybe the word urea bothers you, but keep in mind that urea is a common ingredient in high end skin care products. And keep in mind that the amniotic fluid that surrounds you in the womb is mostly urine. It has been speculated that one of the reasons a baby's skin is so soft is because of all the months it's been soaking in a urea solution. Even better, while in the womb, urine filled amniotic fluid continually circulates in your lungs. The bottom line: get over it. There really is no yuck factor involved with urine therapy. It doesn't even taste that bad. The only question is: does it work?
And there are those in the medical community, no less, who believe it does. For example:
"The efficacy of hypertonic urea solution for lowering intracranial pressure in man was demonstrated in 1936 by Irvine, but the data were not reported until many years later (Irvine, 1960). It was not until after the relatively recent work of Smythe, Smythe & Settlage (1950) and the clinical trials by Javid (1958), Javid & Settlage (1955, 1956), and Javid, Settlage & Monfore (1956) that hypertonic urea solution was widely accepted as an agent for the reduction of cerebral volume and c.s.f. [cerebrospinal fluid] pressure."19
"It was found that many physical illnesses were relieved, such as multiple sclerosis, colitis, hypertension, lupus, rheumatoid arthritis, hepatitis, hyperactivity, pancreatic insufficiency, psoriasis and eczema, diabetes, herpes zoster, and mononucleosis."20
So, how does it work?
No one knows for sure, but suffice it to say for now that urine is not waste. It is one of the most complex of all body fluids. It is literally extracted from your blood. It contains virtually all of the constituents found in your blood -- and its biochemical make-up is specific to your body. Your urine is unique to you. In effect, it is a mirror of the state of your body at any moment in time and, thus, provides biochemical clues as to exactly what your body needs to know to self-regulate itself. It seems that your body can make use of those clues if you ingest small amounts of it on a daily basis.
If you're interested in learning more about urine therapy, check out "Your Own Perfect Medicine" by Martha Christy.24
And that concludes our series on the urinary system.
If you're interested in learning about kidney function from a more technical point of view, check out George Tanner's chapter on kidney function from "Medical Physiology."25
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- 2. "SEER Stat Fact Sheets: Bladder." NCI. (Accessed 26 March 2012.) <http://seer.cancer.gov/statfacts/html/urinb.html>
- 3. Eli A Friedman, MD. "Protein kinase C and the vascular complications of diabetes mellitus." Wolters Kluwer Health. 23 Feb 2012. (Accessed 26 March 2012.) <http://www.uptodate.com/contents/protein-kinase-c-and-the-vascular-complications-of-diabetes-mellitus>
- 4. "Polyol pathway." Wikipedia. (Accessed 26 March 2012.) <http://en.wikipedia.org/wiki/Polyol_pathway>
- 5. Jedziniak JA, Chylack LT Jr, Cheng HM, Gillis MK, Kalustian AA, Tung WH. "The sorbitol pathway in the human lens: aldose reductase and polyol dehydrogenase." Invest Ophthalmol Vis Sci. 1981 Mar;20(3):314-26. <http://www.ncbi.nlm.nih.gov/pubmed/6782033>
- 6. Despres JP, Lamarche B, Mauriege P, et al.) "Hyperinsulinemia as an Independent risk factor for ischemic heart disease." I. 1996; 334:952-958. <http://www.nejm.org/doi/full/10.1056/NEJM199604113341504>
- 7. Sobel BE. "The potential influence of insulin and plasminogen activator inhibitor type 1 on the formation of vulnerable atherosclerotic plaques associated with type 2 diabetes." Proc Assoc Am Physicians. 1999;111:313-318. <http://www.ncbi.nlm.nih.gov/pubmed/10417739>
- 8. "High Blood Pressure." American Kidney Fund. December 2010. (Accessed 26 march 2012.) <http://www.kidneyfund.org/kidney-health/are-you-at-risk/high-blood-pressure.html>
- 9. Ronald Goldin, MD. "Hypertension and CKD." AAKP. March/April 2005. (Accesed 26 March 2012.) <http://www.aakp.org/aakp-library/hypertension-and-ckd/index.cfm>
- 10. Daniel E. Weiner, Hocine Tighiouart, Andrew S. Levey, et al. "Lowest Systolic Blood Pressure Is Associated with Stroke in Stages 3 to 4 Chronic Kidney Disease." JASN Mar 1, 2007 18: 960-966. <http://jasn.asnjournals.org/content/18/3/960.full>
- 11. Khashayar Sakhaee. "Recent advances in the pathophysiology of nephrolithiasis." Kidney Int. 2009 March; 75(6): 585--595. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3088505/>
- 12. "Food sources of oxilate." Georgetown University Hospital. (Accessed 2 Apr 2012.) <http://www.georgetownuniversityhospital.org/documents/Urology/Food_Souces_Oxalate.pdf>
- 13. "Struvite." Wikipedia. <http://en.wikipedia.org/wiki/Struvite>
- 14. Michael Lipkin, MD and Ojas Shah, MD. "The Use of Alpha-Blockers for the Treatment of Nephrolithiasis." Rev Urol. 2006; 8(Suppl 4): S35--S42. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1765041/>
- 15. "Lithotripsy." MedLine Plus. (Accessed 2 Apr 2012.) <http://www.nlm.nih.gov/medlineplus/ency/article/007113.htm>
- 16. Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. "Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup." J Urol. 2006 May;175(5):1742-7. <http://www.ncbi.nlm.nih.gov/pubmed/16600747>
- 17. "Pelvic Floor (Kegel) Exercises for Urinary Incontinence in Women." WebMD. (Accessed 5 Mar 2012.) <http://www.webmd.com/urinary-incontinence-oab/pelvic-floor-kegel-exercises-for-urinary-incontinence-in-women>
- 18. "Kegel Exercises: Treating Male Urinary Incontinence." WebMD. (Accessed 5 Mar 2012.) <http://men.webmd.com/kegel-exercises-treating-male-urinary-incontinence>
- 19. D. J. Reed, D. M. Woodbury. "Effect of Hypertonic Urea on Cerebrospinal Fluid Pressure and Brain Volume." J. Physiol. (1962), 164, pp. 252-264. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1359301/pdf/jphysiol01232-0064.pdf>
- 20. Dunne AP. "The use of injected and sublingual urine in the treatment of allergies." Irish Med Times 1981; 19: 24-6.
- 21. E. D. Danopoulos, G. A. Chilaris, I. E. Danopoulou, S. B. Liaricos. "Urea in the treatment of epibulbar malignancies." Brit. J. Ophthal. (1975) 59, 282. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1042617/pdf/brjopthal00257-0033.pdf>
- 22. Danopoulos ED, Danopoulou IE. "Eleven years experience of oral urea treatment in liver malignancies." Clin Oncol. 1981 Dec;7(4):281-9. <http://www.ncbi.nlm.nih.gov/6274553>
- 23. Danopoulos ED, Danopoulou IE. "Urea--treatment of liver metastases." Clin Oncol. 1981 Dec;7(4):385-7. <http://www.ncbi.nlm.nih.gov/pubmed/7318281>
- 24. Martha Christy. "Your Own Perfect Medicine." TriMedica, Inc., Scottsdale 1994. (Accessed 2 Apr 2012.) <http://www.scribd.com/doc/49307669/Your-Own-Perfect-Medicine-by-Martha-Christy>
- 25. Rhoades, Tanner. "Medical Phyiology." Lippincott Williams & Wilkins; Second edition (March 13, 2003). <http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9780781768528_Rhoades/samples/Rhoades_PT6-CH22.pdf>