Kidney stones are solid masses made up of tiny crystals. Kidney stones (renal calculi or nephrolithiasis) are hard deposits made of minerals and salt that form inside your kidneys. They are hard, pebble-like pieces of material that form in one or both of your kidneys. The development of a kidney stone is due to decreased urine output or increased formation of stone-forming components. Stones can range in size from as small as a grain of sand to the size of a pearl.
It most often affects people aged 30 to 60. It is estimated that 1 in 10 people will have a kidney stone at some time in their lives. Each year, more than half a million people go to emergency rooms for kidney stone problems. Kidney stones are usually found in the kidneys or in the ureter (the ureter is the tube that connects the kidneys to the urinary bladder).
Kidney stones are known to cause severe pain. If left untreated they can lead to urinary tract infections (UTI) or can lead to poor kidney function.
Kidney Stones Symptoms
Very small kidney stones are unlikely to cause many symptoms. They may even go undetected and pass out painlessly when you pee. Big or large Kidney stones are very painful and can cause symptoms. A kidney stone may not cause symptoms until it moves around within your kidney or passes or move down into the ureter (the tube that connects kidneys to the urinary bladder)
Early Symptoms are as follows
- Sharp, cramping pain at the lower back or sides of the body, often moving to the lower abdomen or groin. The pattern of pain is important in kidney stones. Kidney stone pain can start as a dull ache that may come and go; this pain can become suddenly so severe that can result in a trip to an emergency room.
- Nausea or vomiting with the pain
- Pain on urination (sometimes burning sensation during urination)
- Unable to urinate.
- Red-brown or cola color urine
- Blood in the urine
- Cloudy or foul-smelling urine
- Urge to do urine more than usual (frequent urination)
- Fever with chills if urinary tract infection present
- Small crystal or substances in urine (sometimes)
Kidney Stones Causes
Kidney stones have no definitive single cause, although several factors may increase your risk of having kidney stones. Following are the causes for the development of kidney stones.
- The most important cause is dehydration i.e., not drinking enough water or decreased fluid intake
- Exercise (too much or too little)
- Weight loss surgery ( bariatric surgery or gastric bypass surgery)
- Family history
- Repeated urinary tract infections
- Blockage in the urinary tract
- Certain medications such as aspirin, antacids, certain diuretics, certain antibiotics, certain antiretroviral drugs for HIV, certain antiepileptic drugs (Topiramate), etc.
- Certain foods are rich in oxalate such as tea, chocolate, spinach, beets, nuts, etc. cola is rich in phosphate.
- Eating a high protein, low fiber diet
- Eating too much fructose correlates with an increased risk of developing a kidney stone. Fructose can be found in table sugar and high fructose corn syrup
So, drink enough water in a day almost 8 glasses and make a habit of moderate exercise.
Kidney Stones Types
A kidney stone is a hard object that is made from chemicals in the urine. Kidney stones are of different types. Depending upon the type of stone; treatment guidelines can be different. Try to save the stone if you pass in your pee and bring it to your doctor for further analysis. Knowing the type of kidney stone helps in determining the cause and also helps to further reduce the risk of developing stones in the future. Kidney stones are of the following types:
a. Calcium Stones
Most kidney stones are calcium stones. Calcium stones are of two types
- Calcium oxalate
- Calcium phosphate
1. Calcium Oxalate:
The most common type of stone is calcium oxalate stones which are created when calcium combines with oxalate in the urine. Oxalate is a naturally occurring substance in many foods and also made by the liver of the human body every day. Oxalate is naturally found in vegetables and fruits, nuts and seeds, grains, legumes, and even chocolate and tea. Oxalate-rich foods are peanuts, chocolate, dark green vegetables (such as spinach), sweet potatoes, beans, berries, cranberries, beets, coffee, etc.
Dehydration from not drinking enough fluid, dietary factors, obesity, gastric bypass surgeries, high doses of vitamin D can increase the concentration of calcium or oxalate in the urine and can lead to calcium oxalate stone formation.
2. Calcium Phosphate:
Calcium phosphate stones are more common in metabolic conditions like renal tubular acidosis. It may be associated with certain antiepileptic medication (such as Topiramate) which is used to treat seizures.
b. Uric Acid Stones
Uric acid stones are common in people who are taking high protein diet, having gout, having certain metabolic conditions, not drinking enough water or fluid or who lose too much fluid. Genetic factor also increases the risk of uric acid crystals
c. Cystine Stones
Cystine stones are caused by a rare disorder called “cystinuria”. The disorder causes a natural substance called cystine to leak into your urine. When there is too much cystine in the urine, kidney stones can form.
d. Struvite Stones
Struvite stones are a type of hard mineral deposit that can form in your kidneys. These stones form in response to an infection, like urinary tract infection,. Struvite is a mineral that is produced by bacteria in your urinary tract; these stones can grow quickly and becomes quite large with only few symptoms.
Kidney Stones Diagnosis
In case of suspicion of kidney stones following tests are conducted to make a diagnosis.
1. Imaging Tests
Diagnosis of kidney stone is best accomplished using an
- A “KUB X-ray”( kidney -ureter – bladder X-RAY)
- A high resolution computerized tomography (CT) scan (it can detect very tiny stones)
Or thorough an
- Intravenous pyelography (IVP)
2. Blood Test
Blood tests help in the detection of uric acid, calcium and phosphorus level in your blood. It also helps to know the kidney function. The health of your kidneys is evaluated by blood tests.
3. Analysis of Passed Stone
Your doctor will also want to find the cause and type of stone. The stone will be analyzed after it comes out of your body.
4. Urine Test
The doctor may tell you to collect 24 hour of your urine. The 24 hour urine collection test may show you that you are excreting too many stone forming mineral like Calcium or Uric acid.
Kidney Stones Treatment
The treatment of kidney stone is similar for all ages (for children and adults)
1. Simple Measures
Most kidney stones can pass through urine on their own depending on the size and location. Drink plenty of fluids (especially water), it helps the kidney stone travel through the urinary tract. Your doctor may advise you to drink plenty of water to excrete kidney stones on its own. Normally the majority of tiny stones passed on their own with no treatment needed. Passing of stone may take up to three weeks.
a. Pain Relievers
Your doctor may prescribe you some medication to relieve the pain of kidney stones. Severe pain requires an emergency room visit which can be managed with intravenous drugs. To relieve mild pain your doctor may prescribe you anti-inflammatory drug such as ibuprofen, acetaminophen, or naproxen sodium.
CAUTION (ask your doctor before taking anti-inflammatory drug if you have associated illnesses such as diabetes mellitus, hypertension, obesity etc.)
b. Medical Therapy
Other medications may be given to relax the muscles of ureter such as tamsulosin or nifedipine,it helps you passing the kidney stone quickly and with less pain.
a. Shock-wave Lithotripsy
It is a non -invasive procedure that uses high energy sound waves to break the stones into small fragments, which are than more easily able to exit the body through the urinary tract.
b. Percutaneous nephrolithotomy:
In this a kidney stone is surgically removed using small telescopes and instruments inserted through a small incision at the back of the body. General anesthesia is given in this procedure.
You may be given local or general anesthesia for this procedure. In this procedure a small instrument called an ureteroscope, is inserted in the urethra, through the bladder, and into the ureter. This instrument allows stones to be seen and then retrieved in a surgical “basket” or broken by using laser. The smaller stones are easy to pass through the body. Your doctor may then place a small tube (called stent) in ureter to relieve the swelling & promote healing.
Kidney Stones PREVENTION
Kidney stones can be prevented by a combination of lifestyle changes and medication. Following measures can be adopted to reduce the risk of occurrence of renal stones.
- Drink plenty of fluids especially water. Stay well hydrated it helps your kidneys to flush away the substances that cause stone formation. You must drink 8 to 12 cups of water. In case you are working in hot weather or you are exercising and sweating a lot you need to increase the intake of liquids especially water. The purpose of increased fluid intake (especially water) is to make the urine less concentrated.
- Limit the type of food that helps lead to the development of a specific type of stones. Eat a healthy diet having more vegetables and fruits. for example, if you have a history of calcium oxalate stones, your doctor may advise you to avoid oxalate-rich foods especially nuts, beets, green leafy vegetables especially spinach, colas, etc. In the case of uric acid, stones avoid animal protein and food rich in purines such as red meat, organ meat, shellfish, spinach, green peas, etc.
- Reduce weight if you are overweight or obese. Obesity increase the risk of the formation of kidney stones
- Reduce salt in the diet.
- Calcium in food such as dairy products does not have any effect on the risk of formation of kidney stones. Continue calcium-containing products in food. Caution is to ask your doctor before taking calcium supplements.
Sometimes your doctor may prescribe you certain medications depending on your specific stone type or if you have any health problem (that may you lead to more stone formation) to less the risk of formation of stones. Below are some examples
- In order to prevent Calcium stones formation you doctor may prescribe you a thiazide diuretic or phosphate containing preparation
- In case of Uric acid stones you doctor may prescribe you allopurinol (a xanthine oxidase inhibitor) to decrease the level of uric acid in your body. Sometimes an alkalizing agent also added to make urine less acidic.
- In case of Struvite stones your doctor may prescribe you medications to keep you urine free of bacteria that causes infection.
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