Kidney Stone: Diagnosis & Treatment

What are kidney stones?

The medical term for kidney stones is renal calculi. The human urine may consist of many different kinds of salts and minerals, and when the concentration of these substances is large, the stone formation can occur. Several crystals combine to form the mass of kidney stones. While these stones often originate within the kidneys, they may also develop at other parts or areas of the urinary tract. Therefore, apart from kidneys, a stone may even start to develop in the urethra, ureter, and the bladder. While some stones stay inside the kidney and do not cause any problems, others can block urine flow. The cause of this painful medical condition depends on the stone’s type.

A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney Stones develop 1 in every 20 people 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.

Types of kidney stones:

Different kinds of kidney stones may be found in humans such as:

Calcium stones- it is the commonest variety of kidney stones and is made of oxalate and calcium or calcium and phosphate combination.

Cystine stones- cystine is an amino acid formed naturally by the human body. Cystine stones get formed in individuals naturally and can form stones in the urinary tract in cases when it accidentally leaks from the kidneys to reach to the urine. It is a kind of genetic disorder and occurs rarely.

Struvite stones-occur in conditions when a bacterium infects the urinary tract. These stones are made up of phosphate, ammonium, and magnesium.

Uric acid stones- are found in individuals who face the problem of acidic urine. The uric acid may get either alone or in combination with calcium.

The size of a kidney stone may vary from the size of sand gravel to the size of a pearl. The stone can also block the flow of urine by blocking the urinary tract or may travel through the urethra and ureters to be excreted through urine. The condition can be painful in all cases.

Risk factors for kidney stones:

While all people are susceptible to kidney stones, some are more prone to them. Men are more prone to have kidney stones as compared to women. A person is more prone to have a kidney stone, if he/she:

• Had a kidney stone before as well.
• Has a family history of Kidney Stones.
• Does not drink ample water regularly
• Has a diet with high sugar, sodium, and/or protein content
• Is Obese or Overweight
• Has a medical condition that causes irritation/swelling in the joints or bowels
• Is on medicines, including diuretics or the antacids containing calcium
• Has undergone some intestinal surgery or has acquired polycystic kidney disease.
• Suffers from a medical condition due to which his/her urine contains high amounts of calcium, uric acid, oxalate, or cystine.

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 the 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.

The line of treatment chosen by a urologist for treating the condition of kidney stones may depend on factors including:

• Stone’s size
• Substance the stone is composed of
• Whether there is an occurrence of pain
• Whether the urinary tract is blocked by the stone

For better diagnosis, the patient may be required to undergo a blood test, urine test, x-ray examination, and/or a CT scan.

When the stone is small, the patient may be advised to drink more fluids and water so that the stone can be pushed through the urinary tract and excreted via the urine. Additional treatment measures are required for stones that are blocking the urinary tract or are large.

Lithotripsy uses shock waves for breaking up the stones in smaller fragments so that they can pass through the urine easily and excrete. The treatment procedure may not last for more than 45 minutes, and the patient is also administered general anesthesia so that the feeling of pain is absent.

Ureteroscopy is another treatment option. A long tube is used for locating and removing the stone, and a general anesthetic is also used. For larger stones, a laser may be used as well.

Surgery may be required (in rare cases) for removing kidney stones. Known by the name percutaneous nephrolithotomy, the surgery involves the insertion of a tube directly inside the kidney, so that the stone can be removed. The patient will be hospitalized for a period of 2 or 3 days for the surgery.

Small stones with minimal symptoms:

Most kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

Drinking Water:

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.

Pain Relievers:

Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers, acetaminophen.

Medical Therapy:

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.

Surgery:

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 a tone disease.

Seek urgent medical attention, if:

• You have a high temperature (fever) of 38°C (100.4°F) or more
• 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

Lifestyle changes:

• 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

Urologist

Shalby Hospital, Jabalpur

+91 9575801200