- Kidney stones are the solid crystal of salts of the minerals and the acids which deposit on the inner surfaces of the kidney.
- We can have one or more than one stone in the kidney or the ureter at the same time.
What is a Kidney stone?
- It is also known as renal calculi or urolithiasis or nephrolithiasis.
- Kidney stones are the solid crystal of salts of the minerals and the acids which deposit on the inner surfaces of the kidney.
- It may be formed on the kidney, ureter, urinary bladder, and urethra.
- Kidney stones are minute. These stones grow in size and can cause the blockage of the uterus.
- Kidney stones cause unbearable suffering and extreme pain. But, if a kidney stone is treated by the health care professional, it rarely causes permanent damage.
How many kidney stones can you have?
- We can have one or more than one stone in the kidney or the ureter at the same time.
Who develops kidney stones?
- 8.8% of the Americans
- The risk of developing kidney stones is more in men than women
- Associated with diabetes, obesity, and hypertension.
- More common in the Southeastern United States because the temperature is warmer there and there are higher rates of dehydration.
Types of kidney stones :
The types of kidney stones are :
i. Calcium oxalate stone:
- 80% of the stones are calcium oxalate stone.
- These stones are visible on the X-ray.
- They happen when there is increased urine calcium or oxalate and decreased urine volume or citrate.
ii. Calcium phosphate stone
- Less than 5% of the stones are calcium phosphate stones.
- These stones are not visible on X-ray
- They happen when there is increased urine calcium or urine pH.
- Associated with hyperparathyroidism, distal Renal Tubal Acidosis, alkalinization treatment.
iii. Uric acid stone :
- 10% of the stones are uric acid stones.
- These stones are not visible X-ray.
- They happen when there is increased urine uric acid and decreased urine pH and volume.
- Uric acid stone is associated with gout.
- It’s a possibility to have Staghorn with this stone.
iv. Struvite stone:
- 10% of the stones are struvite stone.
- These stones are visible on the X-ray.
- They happen when there is increased urine pH and urease-positive UTI.
v. Cystine stone
- Less than 1% of the stones are cystine stones.
- They are faintly visible on x-ray.
- They happen when there is increased urine cystine.
- Staghorn is common with this stone.
Symptoms of kidney stone
The symptoms of the kidney depend on the sizes of the stones. For the small kidney stones, the symptoms may be mild.
Renal stone symptoms
- Flank pain
- Blood in the urine.
Ureteral stone symptoms
- Acute colicky flank pain
- Sharp pain in the back and side
- Lower abdominal pain radiating to the groin
- Pain on the urination
- Nausea and vomiting
- Fatigue
- After stones get infected you can have a fever
- Obstruction in oliguria and anuria
- Hematuria
- Hydronephrosis
Obstructing Stone Warning Symptoms
- Fever, chills, signs of sepsis
- In traceable vomiting
- Uncontrolled pain
- Acute kidney injury
- Bilateral obstruction or obstruction of a solitary kidney.
Bladder stone symptoms
- Blood in urine
- Incomplete bladder emptying
- Associated with BPH or neurogenic bladder.
Causes of kidney stones
- Highly concentrated urine is the key to the formation of stone in the kidney.
- Imbalance of the Ph level in the urine
- Gout
- Inflammatory bowel disease
- Dehydration
- Urinary tract infections
- Crystal aggregation.
Risk factors of kidney stones
- Dehydration
- Family history
- Obesity
- High mineral concentration in the drinking water
- People living in warm climates due to the risk of fluid loss
- High dietary intake of animal protein
Diagnosis of kidney stones
- Renal ultrasound
- An X-ray called KUB (A kidney, ureter, and bladder )
- CT –scan in abdomen and pelvis without contrast
- Intravenous pyelography
- Retrograde pyelogram
- Cystoscopy
- Blood analysis
- Urine analysis
Treatment of kidney stones
Asymptomatic non-obstructing stone
- Observation
- Serial imaging
- Await symptoms or increased size, before pursuing treatment.
Parenchymal stone
- No need for treatment or surveillance.
Once the stone starts to go down to the ureter and you start to feel pain. All of you don’t need to do surgery. Stones can pass easier with the help of the medicines :
Trial passage
- Tamsulosin (Flomax): Relaxes the ureter, Used in BPH
- Hydration
- Pain control: NSAIDs
- Anti-nausea medication
- Strain urine to collect stone for analysis.
Emergent surgery for warning symptoms
Ureteral Stent to un obstruct kidney
- Relieve pressure/hydronephrosis to improve pain/nausea
- Allow drainage of UTI/pus
- Improve renal function
Extracorporeal Shockwave Lithotripsy
- The stone must be visible on X-ray
• Bowl preparation - The stone must be less than 2 m
- If not, will require a ureteral stent.
Some cautions:
The patient:
- can
- not be anticoagulation,
- should not be pregnant,
- should not have severe obesity,
- skeletal malformation,
- distal obstruction, or
- renal artery aneurysm.
Ureteroscopy with laser lithotripsy
- Rigid or flexible ureteroscopy
- Ureteral stent after
Percutaneous Nephrolithotomy (PCNL)
Two-stage processes
• For staghorn stones, especially greater than or equal to 2 cm, Calyceal diverticulum stone, and Narrow infundibulum
1. Access
- Interventional radiology
- Place nephrostomy
- Days before PCNL.
2. Surgery
Cystoscopy and laser lithotripsy of bladder stone
If too large, open bladder to cut out stone.
Uric acid stone can be dissolved
- Urinary alkalinization
- Uric acid is 10 more dissolvable at pH than pH 5
- Potassium citrate, sodium bicarbonate, sodium citrate
Prevention of kidney stones
Dietary intake :
- Low protein intake
- Low calcium intake
- Avoiding eating of the foods containing oxalate eg. Tea, peanuts
- Limit sodium intake
Hydration
- Drinking lots of the water 3 liters of the water per day
Exercise and physical activity
- Avoidance of physical activities and exercise that may lead to changes in the environmental conditions which may cause dehydration and excessive sweating.
Others :
- Drink plenty of the coconut and barely water regularly.
- Avoid eating meat products, poultry, and fish
- Have fresh ripe apples, melons, and grapes.
- Avoid foods with vitamin D, antacids, and calcium base.
Medications of kidney stones
- Potassium citrate
- Hydrochlorothiazide
- Acetohydroxamic acid
- Alpha- mercapto propionyl glycine
- Repeat 24hours urine collection to assess response to dietary or medication changes.
Frequently Asked Questions (FAQs)
Can you have multiple kidney stones at once?
Kidney stones are the solid crystal of salts of the minerals and the acids which deposit on the inner surfaces of the kidney. We can have one or more than one stone in the kidney or the ureter at the same time.
Where do you hurt with kidney stones?
The symptoms of the kidney depend on the sizes of the stones. For the small kidney stones, the symptoms may be mild. You will have :
Acute colicky flank pain
Sharp pain in the back and side
Lower abdominal pain radiating to the groin
Pain on the urination
What is the fastest way to relieve kidney stone pain at home?
Drink plenty of the coconut and barely water regularly, Avoid eating meat products, poultry, and fish, Have fresh ripe apples, melons, and grapes and Avoid foods with vitamin D, antacids, and calcium base.
How much water should I drink a day with kidney stones?
We should drink 3 liters of water per day and drink plenty of coconuts and barely water regularly.
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