Kidney Stones

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Kidney Stones

Kidney stones are solid granule-like hard pieces ranging in size from a salt grain to a ping pong ball. The stones are usually formed when there is high level of certain minerals in the urine.

Our kidneys filter blood.  The waste substance removed from the blood may become crystals or stones in the kidneys if the person does not drink enough water. The kidney stones can move and travel from kidneys to the urinary tract or bladder. During the movement of the stone, some patient feel intense pain.

Small kidney stones may pass through the urine un-noticed (without even causing any pain), while the large stones may get stuck and block the flow of urine, causing severe pain.

Kidney stones could be formed in one or both kidneys.

More men are found to develop kidney stones than women. People with family history of kidney problems have higher risk of developing kidney stones.

Kidney stones could be of many different shapes and sizes. They may be rough from the edges or smooth and are usually brown or yellow in color.

Specific treatment is recommended with respect to the size, number and type of the stones.
Mainly, there are four types of kidney stones (see causes and risk factors).

It is estimated that almost half of the people who have had kidney stones will again experience them within the following five years.

Kidney stones symptoms

Usually, small kidney stones do not cause any symptoms or problems. Symptoms usually occur when stones get stuck or move.  If symptoms occur, they include one or more of the following

  • Intense pain in the back, side, lower abdomen and groin
  • Pain in passing urine
  • Passing small amount of urine or inability to pass urine
  • Blood in urine (brown, pink or red colour urine) refer as hematuria
  • Pain which comes in waves and fluctuates in intensity
  • Severe pain that makes sitting and movement difficult
  • Felling to urinate more frequently
  • Nausea and vomiting

Kidney stone may result in developing infection due to blockage of urine passage, the patient may also experience

  • Bad smelling or cloudy urine
  • Fever

The patient should make an appointment with the doctor if the signs and symptoms persist. In case of severe pain, immediate medical attention should be obtained.

In most cases, kidney stones do not have one specific cause.  There are multiple factors that when occur together may lead to the development of kidney stones.

Risk factors that increase the possibility of developing kidney stones include:

  • People with family history of kidney stones
  • People who consume high salt and protein diet
  • Not enough fluid or water is consumed
  • Medicines - regular intake of some medicines increase the risk of developing kidney stones such as Aspirin, Antacids (acid reflux medicines), and some antibiotics
  • High levels of waste material in urine such as calcium, oxalate and phosphorous also form crystals. Overtime these crystals clump together to form stone
  • Unknown Cause

In some cases, there is no specific reason of formation of kidney stones. The amount of other chemicals, calcium, phosphate and oxalate in the blood or urine is normal.

Mainly, kidney stones are formed when urine is concentrated. It may occur when the patient is dehydrated because of losing more water as sweat than urine. This may happen when the person does regular intense exercise, working in hot environment or living in warm climate.

Types of Kidney Stones

Mainly, there are four types of kidney stones.
Treatment and prevention for developing future kidney stones depend on the type of kidney stone.

  • Calcium Stones
    Calcium stones are the most common type, they are usually in the form of calcium oxalate and calcium phosphate. Calcium oxalate stones are more common. Oxalate is naturally present in many vegetables and fruits. Liver also produce oxalate.
  • Struvite Stones
    These stones are formed due to infection in kidneys or urinary tract. These stones grow in size quickly and can become quite large. They show less symptoms.
  • Uric acid Stones
    These stones are formed in people who either lose too much fluid or drink very less amount of water. People who eat a high protein diet and those who have disease named gout are at increased risk of developing uric acid stones.
  • Cystine Stones

  These stones occur in people who have natural tendency to excrete too much cysteine amino acid in       urine. It is referred as cystinuria, which is a genetic disorder.

Most cases of kidney stones are diagnosed by reviewing the signs & symptoms, personal history and physical examination of the patient. The doctor may also order some lab tests to confirm the diagnosis.

Testing may include:

Urine analysis - to look for blood or minerals that may have caused the stone

Blood tests – Kidney function tests and and to test for certain minerals in blood

Ultrasound, X-Ray and CT Scan (mostly preferred) are usually required to precisely identify the location, size and type of stone.

Kidney stones treatment

Specific treatment is recommended with respect to the size, number and type of the stone.

Most cases of small stones pass through urine without causing any trouble. Usually, large intake of water is recommended to help getting rid of smaller stones. Small stones may be treated at home with medication.

Patients are also asked to collect the stone by urinating through the supplied sieve or filter. The collected stone is then tested in lab to determine its type. Knowing the stone type, doctor advises specific precautions in diet and life-style to prevent future stone development.

Larger stones that cause pain, block urine flow, blood in urine and may damage kidney or the duct are required urgent treatment at the hospital. Patient who have large stone feels intense pain and may show in hospital emergency. Based on the diagnostic test results, doctor decides the best approach for the treatment. Meanwhile, patients are given pain killers to control the pain.

Larger stones may need to be broken down with the help of ultrasound waves or laser energy.  Untreated kidney stones when very large in size may lead to kidney failure.

Following treatment options may be utilized for larger kidney stones

Extracorporeal Shock Wave Lithotripsy (ESWL)
The procedure in short is called lithotripsy. It does not require any cut in the skin. In this procedure, high frequency sound waves are applied through the skin to break the large stones into smaller pieces. The procedure is carried out in hospital under light to general anesthesia.

This procedure is performed under general anesthesia. It is carried out when the stone is stuck in the ureter. A thin tube fitted with camera is inserted through the urethra to examine and locate the stone. The stone can be removed through specialized instrument.

Percutaneous Nephrolithotomy (PNCL)
In this procedure, the stone is removed using a thin telescopic tube that is inserted by making a small incision in the skin. The patient is given general anesthesia to avoid pain and discomfort.

For preventing kidney stones

  • Drink plenty of water (8 – 12 glass) depending on the season and nature of work
  • Reduce in-take of salt in diet
  • Do not consume high protein diet on regular basis
  • Patients who had kidney stones should reduce eating fruits and vegetables that have high oxalate and calcium content such as tomato, leafy vegetables, beet root and okra (lady finger).
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