Kidney Stones And Its Management

Kidney stones are small, hard pebble like deposits which develop in the kidneys or in the ureters (the tube joining the kidney with the bladder). These deposits are made up of certain chemicals present in the urine. Kidney stones are very common-1 in every 10 people develop kidney stones at least once in their life.

When there is right amount of water in the body, the urine washes out all the waste chemicals from the body. When the urine is too concentrated, certain chemicals start forming crystals. These crystals attract other chemicals and eventually, become bigger in size. The chemicals which form stones include calcium, oxalate, urate, cystine, xanthine, and phosphate.

Kidney stones may cause severe pain but can be managed without any complications if diagnosed early.

Causes:

Kidney stones do not have a definite cause, but some factors do increase your risk:

• Dietary factors: Low fiber high protein diet can increase the risk of developing kidney stones. Meat, poultry, sugary and salty foods can increase risk of kidney stones.
• Medications: Medications such as aspirin, antacids, diuretics, certain antibiotics can increase your risk.
• Disease conditions: High blood pressure, diabetes, obesity, hyperparathyroidism, osteoporosis, inflammatory bowel disease can increase the amount of chemicals that form kidney stones.
• Surgery: Certain stomach and intestinal surgeries and weight loss surgeries can increase risk of kidney stones.

Symptoms

Kidney stones usually do not cause any symptoms initially. Only when the stone gets lodged in the ureter does a patient experience severe pain. When this happens, you may experience:

• Stabbing pain below the ribs at the sides and back
• Radiating pain in the lower abdomen and groin
• Burning pain while urinating
• Foul smelling urine
• Nausea and vomiting
• Blood in urine
• Fever with chills

If you have unbearable pain (as described above) accompanied with fever, blood in urine, and/ or nausea and vomiting, you must see a doctor.

Diagnosis:

If your symptoms are suggestive of kidney stones, your doctor may prescribe the following tests:

1. Urine tests: To check for the levels of chemicals which form kidney stones. Also, to check for infection.
2. Blood tests: To check for calcium and uric acid levels and to check if your kidneys are functioning properly.
3. Imaging tests: To check for the presence, location, size, shape and number of kidney stones. CT scans can help detect even small kidney stones.

Management

The management of kidney stones depend on the size of the stone:

If the kidney stones are small and cause minimal symptoms

Your doctor would ask you to take the following measures to help pass the stones in urine:

1. Increase fluid intake: Drink 2-4 liters of water a day. This will help to pass the stones in urine. Plus, it also prevents formation of additional stones. In addition to water, juices, tea, coffee can also be taken. However, fizzy drinks should be avoided.
2. Take painkillers: Passing a small stone can be painful. Your doctor may prescribe painkillers like NSAIDs to relieve pain.
3. Take medicine to wash out stones: Your doctor may ask you to take certain medications (alpha blockers) which helps to relax the smooth muscles of the ureter and thus, helps the stones to pass through the ureter easily.

If the kidney stones are large and painful

When the stones cannot be passes through urine and one of the following invasive interventions may be required:

1. Shockwave lithotripsy: This procedure uses ultrasonic waves to break down a large kidney stone to smaller pieces which can then pass through urine. This procedure takes around 40-60 minutes and can be slightly painful. You may be given a sedative or a mild anesthetic before the procedure.
2. Ureteroscopy: In this procedure, a ureteroscope, which is a small tube with a camera at its tip, is inserted into the urethra and passed into the ureter through the bladder. This scope helps to locate the stones and tiny surgical instruments, or laser can be used to break the stone into smaller pieces. This procedure is usually done under general anesthesia.
3. Percutaneous nephrolithotomy: In this procedure, a small incision is made in the back. A small telescopic instrument called a nephroscope is inserted into the incision and passed into the kidney. The stone is then pulled out or broken down into pieces using tiny surgical instruments. This procedure is always done under general anesthesia.

Prevention of kidney stones:

Kidney stones increase the likelihood of conditions like chronic kidney disease. Moreover, if you have developed a kidney stone once, there are 50% chances that you develop another one within 5-7 years.

You could take the following measures to prevent kidney stones:

• Drink atleast 2 liters of water per day. Drink more if you live in hot climates and/ or engage in intense workout.
• Limit intake of foods such as nuts, tea, black pepper, okra, soy as they are rich in oxalates.
• Opt for plant based proteins in diet (such as legumes) rather than animal protein.
• Limit salt intake
• Maintain a healthy weight

Dr Muruganandham K

MBBS, MS, DNB, MCh, FMAS

HOD and Senior Consultant

Department of Urology & Renal Transplantation