Kidney Stones – Solid mass made up of small crystals

Kidney Stones is one of the most agonizing of the urologic disorders that have plagued humans for ages. Kidney Stones have been found in a 7,000-year-old Egyptian Mummy.  It is one of the most common forms of urinary tract disorders. Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery.

Urinary Tract

Urinary Tract

The Urinary Tract System consists of the kidneys, ureters, bladder, and urethra.  Two bean-shaped organs are positioned below the ribs toward the middle of the back, one on each side of the spine. The kidneys eliminate spare water and wastes from the blood, producing urine. They also keep an even equilibrium of salts and other materials in the blood. The kidneys make hormones that help construct strong bones and form red blood cells. Thin tubes called ureters take urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. The bladder’s elastic walls stretch and expand to store urine like a balloon.

Kidney Stones

Kidney Stones

A Kidney Stone is a solid mass made up of small crystals, formed in the kidneys from dietary minerals in the urine.  A Kidney Stone is also known as a renal calculus (from the Latin ren, “kidney” and calculus, “pebble“). One or more stones can be in the kidney or ureter at the same time. Urinary stones are normally classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds).

Causes of Kidney Stones

75% of kidney stones are calcium stones; few other chemical compounds that can form stones in the urinary tract include uric acid, magnesium ammonium phosphate and the amino acid cystine. The major causes of Kidney Stone formation are as follows:-

  • Dehydration from decreased fluid intake or exhausting exercise without adequate fluid replacement increases the risk of kidney stones. Dwellers of hot and dry regions are more apt to become dehydrated and prone to stone formation.

    Kidney stone
    Kidney stone (Photo credit: Wikipedia)
  • Hindrance to the flow of urine can also lead to stone formation.
  • Infection in the urinary tract can also cause Kidney Stones; these Kidney Stones are known as struvite or infection stones.
  • Metabolic abnormalities can also cause Kidney Stones
  • Dietary factors and practices may amplify the danger of stone formation in vulnerable individuals; this includes a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive eating of oxalate-containing foods such as spinach. Low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and tend to form oxalate stones.
  • Risk of Kidney Stones is also increased by medications. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor.
  • Heredity. Some people are more vulnerable to forming of Kidney Stones, heredity may be responsible.
  •  Few persistent illnesses are linked with Kidney Stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
  • Geographic predisposition i.e. where a person lives may influence them to develop Kidney Stones.

Symptoms of Kidney Stones

  • The first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine.  A person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Pain may spread to the groin.
  • Nausea and vomiting may occur sometimes.
  • If the stone is too large to pass effortlessly, pain persists as the muscles in the wall of the slender ureter try to squeeze the stone into the bladder. As the stone moves and the body try to push it out, blood may become visible in the urine, making the urine pink.
  • As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
  • If fever and chills accompany any of these symptoms, an infection may be present.

Diagnosis of Kidney Stones

Previously, X-ray or ultrasound was carried out, now CT Scan is preferred to diagnose the disease. CT Scan is very superior at showing the size of the stone and where it is positioned. This is essential because it facilitates doctors to decide how and when the stone should be removed. Following tests may also be carried out for diagnosis:-

  • Blood Tests to confirm that your kidneys are functioning properly and to check the levels of substances that could cause kidney stones, such as calcium
  • Urine Tests to verify for infections and pieces of stones
  • Assessment of any stones that passed in your urine

Treatment of Kidney Stones

Small Kidney Stones usually pass at its own within 48 hours, with ample fluid intake. The urine is strained, when the stone passes, this stone can be saved and tested. Drink at least 6 – 8 glasses of water per day to produce a large amount of urine. Doctor will prescribe medicine depending on the type of stone, in order to reduce stone formation or facilitate break down and remove the material that is causing the stone. Medications can include:-

  • Allopurinol (for uric acid stones)
  • Antibiotics (for struvite stones)
  • Diuretics
  • Phosphate solutions
  • Sodium bicarbonate or sodium citrate
  • Water pills (thiazide diuretics)

Surgery is usually needed if:

  • The stone is too large to pass on its own
  • The stone is growing
  • The stone is blocking urine flow and causing an infection or kidney damage
  • The pain cannot be controlled

Other treatments are as follows:-

  • If the stone is high up in the ureter, near the kidney, and is large,the doctor may recommend Lithotripsy to remove stones slightly smaller than a half an inch.  Lithotripsy uses sound or shock waves to break up stones and then these stones leave the body in the urine.
  • Ureteroscopy is used when Lithotripsy is not practical, in this procedure; instruments are threaded into the ureter and can allow the physician to place a stent (a thin hollow tube) through the urethra, past the bladder, and into the ureter to bypass the obstructing stone. This stent may be left in place for a longer period of time. Rarely, the urologist may be able to use instruments to grab the stone and remove it.
  • Percutaneous Nephrolithotomy. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL. In Percutaneous Nephrolithotomy, the surgeon makes a tiny cut in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe-ultrasonic or electrohydraulic may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

 

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