Kidney Stones

Stones in the kidney are medically referred to as a nephrolith or renal calculi. They are also called urinary stones. Kidney stones may be found in one or both kidneys, and are best described as small, stone-like structures. They are usually composed of certain minerals and can vary in size and colour. Most kidney stones, especially those that are smaller, pass through the urine and resolve without treatment. Some may get lodged or stuck on the way, causing pain and bleeding. 

Over the past decades, the incidence of kidney stones among people has been increasing. While it is seen more commonly in men than in women, the number of women affected by kidney stones is also rising at present.

Kidney stones can be of different kinds, depending on how they look, their composition and location. Stones may sometimes be as small as a particle of sand, while the larger ones may be pea-sized. In some rare cases, they may grow to the size of golf balls or obstruct half the kidney. The colour of these stones usually ranges from pale yellow to darkish brown. Kidney stones are often round and smooth, except for some that may be irregular and jagged. The most common types of kidney stones by composition include:

• Calcium stones
  Calcium is essential for the teeth and bones. The body’s natural mechanism is to flush out all the extra calcium, which is not being used by the body. When there is an excess of calcium or hindrance in calcium metabolism, calcium tends to fuse with other waste products and form stones. The most commonly occurring kidney stones are calcium phosphate and calcium oxalate stones.
• Uric acid stones
  When there is an unusually high uric acid level in the blood, it also starts getting excreted in large amounts in the urine and there is a higher tendency for uric acid stones to form. Among others, a diet rich in meat and fish, which are high in protein, contributes to high uric acid levels.
• Struvite stones
  These stones are usually the result of a severe urinary tract infection and occur after or during the ailment. This is because the urine becomes alkaline in nature due to the infection. As a result, magnesium ammonium phosphate is formed, which accumulates in the kidneys in the form of stones. They have a tendency to increase in size very rapidly.
• Cystine stones
  A hereditary condition called cystinuria is responsible for these kinds of stones. In this condition, amino acids, especially cystine start to leak from the kidneys and pass into the urine, causing the formation of these stones.

Kidney stones, especially in the initial stages, do not really present many symptoms. It is only later when the stone either starts to move around or goes through into the ureter that obvious discomfort and symptoms start to appear. Some of the symptoms are:

• Discolouration of the urine to a red, pink or dark brown colour.
• Intense urge to pass urine every now and then.
• Peculiar odour in urine.
• Passing only small amounts of urine each time.
• Pain experienced in the urethra while urinating. (Read more - Painful urination causes)
• Nausea and vomiting.
• Pain in the lower back and sides.
• Pain in the groin region and lower belly.

Pain can sometimes be felt in spurts or waves, and the location of the pain may also change as the stone travels from one part of the urinary system to the other. Severe, continuous pain is a medical emergency and should be immediately attended to. 

Causes

Urine comprises several minerals including calcium, phosphorus and oxalate. These are routinely eliminated from the body and are usually found only in small quantities. When levels exceed what the body is capable of passing out, these residual minerals usually come together, crystallise and form stones in the kidneys.

Risk Factors

Numerous factors place an individual at the risk of developing kidney stones. In most cases, it is a combination of two or more factors that may rise to kidney stones. Some risk factors include:

• Medical conditions
  There are several medical conditions, which can increase the risk of developing kidney stones, such as:
  • Cystic kidney disease
    A disease that is characterised by the formation of fluid-filled sacs in the kidneys. These may hinder efficient filtration by the kidneys.
  • Cystinuria
    A genetic condition where the excess of an amino acid called cystine is passed in the urine.
  • Surgery
    A gastrointestinal surgery due to digestive disorders may hamper calcium absorption.
  • Disorders of the digestive system
    Irritable bowel syndrome or other chronic bowel-related disorders.
  • Recurrent urinary tract infections
    Recurrent infections of the urinary tract reduce the acidity of the urine and prevent the dissolution of salts in water.
  • Hyperparathyroidism  
    A disorder of parathyroid glands hampers calcium metabolism and leads to excessive calcium level in the blood.
  • Blockage in the urinary tract
    Certain birth defects of the urinary bladder or kidney may hamper the passing of urine.
  • Gout
    Gout is a condition characterized by excess uric acid levels in the blood.
  • Hypercalciuria  
    Elevated calcium levels found in urine.
  • Hyperoxaluria  
    Elevated oxalate levels in the urine.
  • Hyperuricosuria  
    Elevation of uric acid levels in the urine.
  • Renal tubular acidosis  
    A tendency of the urine to remain acidic because kidneys can’t remove the excess acids.
• Medications
  Certain medications may also aid in the formation of kidney stones.
  • Antacids, which are calcium based.
  • Anti-seizure medication.
  • Some medications that are used to treat HIV infection.
  • Diuretics (medications that excrete excess water from the body)
• Others
  There may also be more generalised factors, which place an individual at greater risk. These are:
  • A family history of kidney stones or high uric acid levels.
  • Diet high in sugar, protein and salt.
  • Obesity.
  • Dehydration.

The key to preventing kidney stones lies in making simple dietary and lifestyle changes. Different kinds of precautions need to be exercised for different types of kidney stones. However, there are some general rules that can aid in the prevention of kidney stones. These are:

• Drink plenty of water (2-3 litres) unless you are suffering from a kidney disorder.
• Avoiding nuts, spinach and rhubarb if you are prone to developing oxalate stones.
• If you have a history of having uric acid stones, reduce the intake of protein-rich foods, which produce uric acid on breakdown e.g., meat, fishes, pulses, dairy, fermented foods and others.
• Lowering the intake of salt and processed foods.

Diagnostic tests for kidney stones are fairly simple and begin with a consultation to help the doctor understand the nature of the problem and symptoms, and also the medical history. After checking for the role of heredity and a physical examination, some simple tests may be advised, such as:

• Blood samples to check for the levels of minerals and salts in the body.
• Urine tests may show the presence of blood in the urine along with the levels of minerals and uric acid. Urine samples also help reveal the presence of bacteria and levels of white blood cells, which indicate infections.
• X-ray of the abdomen usually helps to determine the location of the stones; however, all stones may not show up on an X-ray.
• CT scans are more accurate in revealing the location, size and impression of kidney stones. They also help reveal how the stones impact other organs.

The course of treatment for kidney stones differs based on how large and impacting the stone is. Most doctors prefer adopting a more conservative approach, allowing the stones to be passed naturally in the urine. The treatment options employed for kidney stones are:

For small kidney stones

These are much easier to eliminate. Doctors usually suggest drinking plenty of fluids to help the stones get flushed out in the urine. They may aid the process by prescribing a mild painkiller to suppress the pain, or a muscle relaxant to help the stone pass more effortlessly.

For larger stones

Some medical procedures may be required to treat larger kidney stones:

• Medications
  Medication is suggested depending on the nature of the stone formed and the severity of the condition. These medications help in dissolving the salts of the stone and reduce its size. Over a period of time, the stone may get small enough to be easily passed in the urine.
• Surgery
  Using small telescopic instruments called laparoscopes that are inserted into the kidneys through the back, doctors surgically remove kidney stones after administering anaesthesia to the person undergoing surgery. This procedure, called percutaneous nephrolithotomy, requires admission and stay in the hospital for a few days.
• Scopes
  These are used when the stones are lodged in the kidney or ureter. A thin lit tube is passed through the urethra to the ureter to locate the stone, which may then either be removed or broken down. Most procedures of this nature use local anaesthesia and are performed as outpatient procedures.
• Shock-wave therapy
  Shock waves are sometimes passed through the skin to break down or fragment the kidney stones so that they may then be flushed out in the urine. This is a procedure that lasts for about an hour and can cause some pain. Following the procedure, there may also be some discomfort, bruising or bleeding.

Doctors usually recommend collecting the stone that has been passed to examine its nature. It also helps decide the next course of treatment and take lifestyle measures that help prevent them from forming again.

Lifestyle management

The harsh reality about kidney stones is that the chances of them recurring are unusually high. This means that not only is treatment crucial, but also the time when it is sought and the choices we make following the episode. In managing and maintaining a lifestyle following recovery, here are some things that you will need to factor in:

• Consumption of plenty of fluids, chiefly water.
• Modification of diet to avoid foods that contribute to the development of the kind of kidney stones previously formed.
• Managing and maintaining weight appropriate for height and age.
• Regular health and blood check-ups to watch the mineral and uric acid levels in the blood and urine.
• Being health conscious and maintaining personal hygiene to prevent UTIs, which may be contracted more easily once you have had kidney stones.

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Prognosis

When given timely and proper attention, kidney stones can be treated effectively without causing too much trouble or complication. The prognosis of kidney stones is mostly good, however, it is unpredictable in certain cases and usually involves:

• A tendency of the kidney stone to relapse. However, given the peculiarity of the discomfort and pain experienced, it becomes easy for the patient to identify and seek treatment almost immediately.
• In those who have a family history of kidney stones, the chances of occurrence are much higher. Watching for signs and taking more preventive measures can be useful.

Complications

Although it seems like a relatively harmless and less damaging condition, there are several complications that can arise because of kidney stones, such as

• Recurring episodes of stones in the kidney or urethra.
• Increased chances of contracting UTI.
• Blockages in the ureter, which may lead to obstruction and bleeding that may also be seen in the urine.
• Kidney scarring or damage caused due to compromised functioning.