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Kidney Stone: Diagnosis & Treatment
Posted On: February 17, 2017
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.
“Nephrolithiasis” is the medical terms for kidney stones .One in every 20 people develop kidney stones at some point in their life. Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. Dehydration is a major risk factor for kidney stone formation.
Symptoms of a kidney stone include flank pain (the pain can be quite severe) and blood in the urine (hematuria).
People with certain medical conditions, such as gout, and those who take certain medications or supplements are at risk for kidney stones.
Diet and hereditary factors are also related to stone formation.
Diagnosis of kidney stones is best accomplished using an ultrasound, intravenous paleography (IVP), or a CT scan.
Most kidney stones will pass through the ureter to the bladder on its own, with passage of time.
Treatment includes pain-control medications and, in some cases, medications to facilitate the passage of urine.
If needed, lithotripsy or surgical techniques may be used for stones which do not pass through the ureter to the bladder on its own.
Treatment for kidney stones varies, depending on the type of stone and the cause.
Small stones with minimal symptoms:
Most kidney stones won't require invasive treatment. You may be able to pass a small stone by:
Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers, acetaminophen.
Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.
Large stones and those that cause symptoms:
- Kidney stones that can't be treated with conservative measures — either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more extensive treatment. Procedures may include:
- Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called Extracorporeal Shock Wave Lithotripsy (ESWL).
- ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed through your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
To remove very large stones in the kidney, a procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.
Using a scope to remove stones:
- To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (Ureteroscope) equipped with a camera through your urethra and bladder to your ureter.
- Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
Use of Laser in stone disease: Larger stones are broken into smaller pieces with the help of lasers which is the latest technique for managing stone disease.
Seek urgent medical attention, if:
- You have a high temperature (fever) of 38°C (100.4°F) or over
- You have an episode of shivering or shaking
- The pain gets worse, particularly if it is a sudden, severe pain
- If you experience any of the above symptoms, contact your GP immediately for advice
Prevention of kidney stones may include a combination of lifestyle changes and medications
- Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.5 liters of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water.
- If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.
Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose non animal protein sources, such as legumes. Consider using a salt substitute.
Dr. Rajesh K. Patel
Shalby Hospital, Jabalpur