Kidney Stone

Kidney stones, also known as renal calculi or nephrolithiasis, are a relatively common health issue affecting millions of people worldwide. They can cause severe pain and discomfort, and in some cases, may lead to complications. This comprehensive guide will provide you with detailed information about kidney stones, including their causes, symptoms, diagnosis, treatment options, and prevention strategies.

Kidney stones are hard, solid masses formed from crystals that separate from urine within the urinary tract. These stones can vary in size from tiny grains to larger stones that can block the flow of urine. They typically develop in the kidneys and can travel down the ureters to the bladder. If a stone becomes lodged in the ureter, it can cause severe pain and obstruct the flow of urine.

Kidney stones affect a significant portion of the population. Their prevalence in India stands at around 12%, however, the rate of recurrence is high and stands at over 50% within five years of the initial episode. 

There are several types of kidney stones, each composed of different minerals:

• Calcium stones: These are the most common type, typically made of calcium oxalate.
• Uric acid kidney stones: These form when urine is too acidic and are more common in people with gout or who eat a high-purine diet.
• Struvite stones: These are less common and often associated with urinary tract infections.
• Cystine stones: These are rare and occur due to a genetic disorder called cystinuria.

Let's see the factors contributing to kidney stone formation:

Dehydration

Urine contains various substances that can crystallize and form stones. When you're dehydrated, your urine becomes more concentrated, increasing the chances of these substances binding together and forming stones. This is particularly true in hotter climates or with strenuous exercise where fluid loss is higher.

Diet

• Oxalates: Foods high in oxalate (like spinach, rhubarb, nuts, and chocolate) can increase the risk of calcium oxalate stones, the most common type. Oxalate binds with calcium in the urine to form crystals.
• Sodium: A high-sodium diet increases calcium excretion in urine, which can contribute to stone formation.
• Animal Protein: A diet high in animal protein (meat, poultry, fish) can increase uric acid levels in the urine, promoting the formation of uric acid stones. It can also decrease citrate levels, which normally help prevent stones.

Medical Conditions

• Gout: This condition is another reason for kidney stone formation. It causes a buildup of uric acid in the blood, increasing the risk of uric acid stones.
• Hyperparathyroidism: This condition causes the parathyroid glands to produce too much parathyroid hormone, leading to high calcium levels in the blood and urine, increasing the risk of calcium stones.
• Inflammatory Bowel Disease: Conditions like Crohn's disease and ulcerative colitis can affect the absorption of nutrients and increase the risk of certain types of stones.
• Urinary Tract Infections (UTIs): Some bacteria can create an environment in the urinary tract that promotes the formation of struvite stones.

Medications

• Diuretics: These medications increase urination, which can lead to dehydration if fluid intake isn't increased accordingly.
• Antacids: Some antacids contain calcium, which can contribute to stone formation.
• Certain Anti-seizure Medications: These can increase the risk of kidney stones.

Small kidney stones may pass through the urinary tract without causing any symptoms. However, larger stones can cause:

• Severe pain: This is often felt in the side, back, or lower abdomen and can radiate to the groin.
• Blood in urine (haematuria): The urine may appear pink, red, or brown.
• Frequent urination: A strong urge to urinate, even when the bladder is not full.
• Painful urination: Burning or pain during urination.
• Nausea and vomiting: May accompany severe pain.
• Fever and chills: If an infection is present.

Diagnosing kidney stones involves a multi-faceted approach to accurately identify the type and location of the stones:

Detailed Medical History

Your doctor will ask about your symptoms, dietary habits, fluid intake, family history of kidney stones, any existing medical conditions, and medications you are taking.

Physical Examination

This may include checking for tenderness in the abdomen or back.

Urine Tests

• Urinalysis: This checks for blood in the urine (hematuria), which can indicate a stone, as well as signs of infection.
• 24-Hour Urine Collection: This test analyzes the urine collected over 24 hours to measure the levels of substances that contribute to stone formation, such as calcium, oxalate, uric acid, citrate, and creatinine. This helps identify the type of stone and potential causes.

Imaging Tests

• CT Scan (without contrast): This is often the preferred imaging test for kidney stones as it provides detailed images of the kidneys, ureters, and bladder, allowing for accurate detection of stones and their location.
• Ultrasound: This can be used to identify stones in the kidneys and bladder. It's particularly useful for pregnant women or those who should avoid radiation.
• X-ray (KUB): A plain abdominal X-ray can sometimes detect calcium stones but may miss smaller stones or those composed of other materials.

Stone Analysis

If you pass a stone, your doctor will likely send it to a lab for analysis. This helps determine its composition and guide prevention strategies.

Treatment for kidney stones is individualized based on the size, location, and type of stone, as well as the severity of symptoms:

Expectant Management 

Hydration

Increasing fluid intake is the best cure for kidney stones, especially when they are tiny. Fluids like water help small stones pass naturally. Your doctor might recommend drinking 2 to 3 liters of water per day.

Pain Management

Pain meds for kidney stones include over-the-counter pain relievers like ibuprofen or naproxen. Stronger medications may be prescribed by the doctor, if needed.

Urinary Alkalizers

These medications are used primarily for uric acid stones and sometimes for cystine stones. They make the urine less acidic, which helps dissolve these types of stones and prevent new ones from forming. Common alkalizers include 

• Disodium hydrogen citrate (Brands Available: Citralka, Cital, Alkasol)
• Citric acid + potassium (Brands Available: Uriliser)
• Sodium bicarbonate

Alpha-blockers

These medications can relax the muscles in the ureter, making it easier for the stone to pass.

Procedures (for Larger or Problematic Stones)

Shock Wave Lithotripsy (SWL)

This non-invasive procedure uses focused sound waves to break the stones into smaller pieces that can be passed in the urine.

Ureteroscopy

A thin scope is passed through the urethra and bladder into the ureter to locate and remove the stone. Small stones can be removed with a basket or forceps, while larger ones are addressed with laser treatment for kidney stones.   

Percutaneous Nephrolithotomy (PCNL)

This minimally invasive surgical procedure is used for larger stones or those that cannot be treated with SWL or ureteroscopy. A small incision is made in the back, and a nephroscope is inserted into the kidney to remove or break up the stone.

While there's limited scientific evidence to support their effectiveness, some alternative remedies are used to complement conventional treatment for kidney stones:

Increased Fluid Intake

This is the most important "remedy" and is often recommended by doctors as well. Water is best, but you can also include citrus juices like lemonade, which contain citrate that may help prevent stone formation.

Herbal Remedies

Always consult your doctor before using any herbal remedies, as they can interact with medications or have side effects.

• Chanca Piedra: This herb is traditionally used to break down stones and promote their passage.
• Hydrangea Root: Believed to help dissolve stones and reduce inflammation.
• Uva Ursi: May have antibacterial properties that could be helpful for stones associated with UTIs.
• Dandelion Root: A natural diuretic that may help increase urine flow.

Several factors can increase your risk of developing kidney stones, including:

• Dehydration
• Diet high in oxalate, sodium, and animal protein
• Family history of kidney stones
• Obesity
• Certain medical conditions
• Certain medications

Kidney stones can lead to complications such as:

• Urinary tract infections
• Kidney damage
• Recurrent stones

If you have kidney stones, these tips can help you manage the condition:

1. Drink plenty of water throughout the day to stay hydrated.

2. Follow your doctor's recommendations. Take medications as prescribed and follow dietary restrictions.

3. Use over-the-counter pain relievers or prescription medications (as prescribed) to manage pain.

4. Make lifestyle changes. Adopt a healthy lifestyle with regular exercise and a balanced diet.

Kidney stones are always painful.

Small stones may pass without causing any symptoms.

Kidney stones are caused by calcium supplements.

While calcium oxalate stones are common, calcium supplements do not increase the risk.

Once you have a kidney stone, you will always have them.

While recurrence is possible, lifestyle changes can reduce the risk.

Seek medical attention if you experience:

• Severe pain in your side, back, or lower abdomen
• Blood in your urine
• Difficulty urinating
• Fever and chills

• What type of kidney stone do I have?
• What is the best treatment option for me?
• What can I do to prevent future stones?
• Are there any dietary restrictions I should follow?

If someone you know has kidney stones, you can support them by:

• Offering to help with household chores or errands
• Providing emotional support and encouragement
• Encouraging them to stay hydrated and follow their doctor's recommendations

Kidney stones are a common condition that can cause significant pain and discomfort. However, with proper diagnosis, treatment, and preventive measures, most people can effectively manage the condition and reduce their risk of recurrence. If you experience symptoms of kidney stones, it is essential to seek medical attention promptly.