Kidney Stones

KIDNEY STONES

The urine contains many dissolved minerals and salts. Kidney stones may form when urine has high levels of some of these minerals and salts. These stones at the onset may be small and not cause any issues initially. Except that kidney stones can grow larger in size, and can even fill the inner hollow structures of the kidney. It is also possible for some stones to remain in the kidney, and never cause any problems.

Some of the times, kidney stones can travel down the tube between the kidney and the bladder (The ureter). If the stone reaches the bladder, it can be passed out of the body through urine. However, if the stone becomes lodged in the ureter, it will block urine flow from that kidney, and this may be painful.

The Kidneys and Urinary System

The kidneys are fist-size organs that regulates the body's fluid and chemical levels. Most people have two kidneys, one on each side of the spine behind the liver, stomach, pancreas and intestines. When they are healthy, kidneys clean waste from the blood and remove it in the urine. When the kidneys are healthy, they also properly control the levels of sodium, potassium and calcium in the blood.

The kidneys, ureters and bladder are part of the urinary tract. The urinary tract makes, moves, and also stores urine. Kidneys make urine from water and the body's waste. The urine then travels down the ureters into the bladder, where it is stored. Urine leaves the body through the urethra.

Kidney stones form in the kidney. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone.

TYPES OF KIDNEY STONES

Kidney stones come in many different types and colors. The way kidney stones will be treated depends on the type of stone that may be present. The path to prevent new stones from forming will also depend on the type of stone.

• Calcium stones

The most common type of kidney stone is calcium stones. There are two types of calcium stones:

• Calcium phosphate and
• Calcium oxalate

Calcium oxalate is by far the most common of calcium stones. Certain people have too much calcium in their urine, raising their risk of calcium stones. Even with normal amounts of calcium in the urine, calcium stones may form due to other reasons.

• Uric acid stones

Uric acid is a waste product that comes as a result of chemical changes in the body. Uric acid crystals do not dissolve the right way in acidic urine. This will end up causing uric acid stones.

Having acidic urine may come from:

• Type 2 diabetes (high blood sugar)
• A diet that is low in fruits and vegetables, but rather high in animal protein
• Being overweight
• Chronic diarrhea
• Gout

• Cystine Stones

Cystine is an amino acid that is found in certain foods. It is one of the building blocks of protein. When the kidneys do not reabsorb cystine from the urine it leaves too much cystine in the urine (Cystinuria), this is a rare, inherited metabolic disorder. When high amounts of cystine are in the urine, it causes stones to form.

Cystine stones often begin to form in childhood.

• Struvite Stones

Struvite stones are found mostly in women with urinary tract infections (UTIs). These stones can be quite large and cause urinary obstructions. They actually result from a kidney infection. The treatment of an underlying infection can prevent the development of struvite stones.

CAUSES

The leading cause of kidney stones is lack of water in the body. Stones are commonly found among individuals who drink less than the recommended eight to ten glasses of water a day.

When there is not enough water to dilute the uric acid component in urine, the urine becomes more acidic. The excessively acidic environment in urine can lead to the formation of kidney stones.

On the other hand, medical conditions such as Crohn's disease, urinary tract infections, renal tubular acidosis, hyperparathyroidism, medullary sponge kidney, and Dent's disease increase the risk of kidney stones.

SYMPTOMS OF KIDNEY STONES

Usually, a kidney stone will not cause symptoms until it moves around within the kidney or passes into the tubes connecting the kidneys and the bladder (ureters). It may block the flow of urine and cause the kidney to swell and the ureter to spasm, if it becomes lodged in the ureters, this can be very painful.

At the point of blocking urine, one may experience these signs and symptoms:

• Pain that emanates from lower abdomen and groin
• Pain or burning sensation during urination
• Severe pain at the side and back, below the ribs
• Pain that comes in waves and fluctuates even in intensity

Some other signs and symptoms may include:

• A constant pressure to urinate, urinating more frequently than usual or urinating in small amounts
• Fever and chills if there is an infection
• Pink, red or brown colored urine
• Cloudy and/or foul-smelling urine
• Nausea and vomiting

Pain caused by a kidney stone may change (E.g. shifting to a different location or increasing in intensity), as the stone moves through the urinary tract.

WHY KIDNEY STONES CAN BE A PROBLEM

Kidney stones do not always stay in the kidney. Sometimes they pass from the kidney into the ureters, which are small and delicate, and the stones may be too large to pass smoothly down the ureter to the bladder.

Passage of stones down the ureter can cause spasms and some irritation of the ureters. This sometimes causes blood to appear in the urine.

Sometimes stones cause urinary obstruction by blocking urine. Such obstructions can lead to kidney infection and kidney damage.

WHEN TO SEE A DOCTOR

People must make appointments with their doctors if they have any signs and symptoms that may be worrying.

Immediate medical attention must be sought if one experiences:

• Difficulty passing urine
• Pain that may be accompanied by fever and chills
• Pain so severe that they cannot sit still or find a comfortable position
• Pain that is accompanied by nausea and vomiting
• Blood in their urine

RISK FACTORS

Factors that increase the risk of developing kidney stones include:

• Family or personal history - If a family member or close relative has had kidney stones, one is more likely to develop stones, too. If the person has already had one or more kidney stones, he/she is at increased risk of developing another.
• Dehydration - Not drinking enough water each day can increase the risk of kidney stones. Additionally, people who live in warm, dry climates and those who sweat a lot may be at higher risk than others. Certain diets. Eating foods that are high in protein, salt and sugar may increase a person's risk of some types of kidney stones. Too much salt in a diet for instance increases the amount of calcium the kidneys must filter and significantly increases the risk of kidney stones.
• Obesity - High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
• Digestive diseases and surgery - Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that may affect the body's absorption of calcium and water. This will increase the amounts of stone-forming substances in the urine.
• Medical conditions - Such as renal tubular acidosis, cystinuria, hyperparathyroidism and repeated urinary tract infections also can increase a person's risk of kidney stones.
• Certain supplements and medications - Such as vitamin C, dietary supplements, laxatives, calcium-based antacids, and medications used to treat migraines or depression, can increase the risk of kidney stones.

DIAGNOSING KIDNEY STONES

The diagnosis of a kidney stone will begin with a medical history, physical examination, and imaging tests. The doctors will want to know the exact size and shape of the kidney stones. This can be done with the employment of a high resolution CT scan from the kidneys down to the bladder or an x-ray called a kidney-ureter-bladder x-ray (KUB x-ray) which has the ability to show the size of the stone and its position.

The KUB x-ray is often used by surgeons to determine if the stone is suitable for shock wave treatment. The KUB test may also be used to monitor the stone before and after treatment. However, the CT scan is usually preferred for diagnosis. Doctors will also in some cases, order an intravenous pyelogram or l.V.P. a special type of X- ray of the urinary system that is taken after injecting a dye.

The next will be for the doctors to decide how to treat the stone. The health of the patient's kidneys will be evaluated by blood tests and urine tests. The patient's overall health, and the size and location of the stone in question will be considered.

The doctor will then want to find the cause of the stone. Actually, the stone will be analyzed after it comes out of the body, and the doctor will test the blood for calcium, phosphorus and uric acid. The doctor may also ask that the patient collects their urine for 24 hours to be tested for calcium and uric acid.

Why the doctor needs to examine the contents of the stone

There are four types of stones. Studying the stone can help doctors to understand why the patient has it and how to reduce the risk of further stones.

The most common type of stone contains calcium, which is a normal part of a healthy diet. The kidney usually removes extra calcium that the body doesn't need. It is very common for the bodies of people with stones retain too much calcium. This calcium combines with waste products like oxalate to form a stone. The most common of these is called calcium oxalate.

Less common types of stones are:

• Stones that are Infection-related (containing magnesium and ammonia called struvite stones)
• Stones that are formed from monosodium Urate crystals, called uric acid stones, which might be related to obesity and dietary factors.
• The rarest type of stone is a Cystine stone which tends to run in families.

TREATMENT

Although the pain usually only lasts a couple of days and disappears when these stones have cleared, even small kidney stones can be painful.

To ease symptoms, the doctor might recommend:

• The use of painkillers, like ibuprofen
• Use of medicines to help stones pass (alpha-blockers)
• The drinking of plenty fluids throughout the day
• Use of anti-sickness medicine

The patient could be advised to drink up to 3 litres of fluid throughout the day, every day, until the stones clear.

To help the passage of the stones:

• Refrain from eating too much salt
• Drink water, although tea and coffee also would count
• Add fresh lemon juice to the water
• Avoid fizzy drinks

People must ensure to drink enough fluid. Dark urine means one is not drinking enough. Averagely, urine should be pale in color.

The patient could be advised to continue drinking this much of fluid to prevent new stones from forming.

TREATING LARGE KIDNEY STONES

Usually large kidney stones are removed by surgery because they are too big to be passed naturally.

The main types of surgery for removing kidney stones are:

• Percutaneous nephrolithotomy (PCNL) - A procedure used to remove kidney stones from the body when they can't pass on their own. A scope is inserted through a small incision in the back to remove the kidney stones.
• Shockwave lithotripsy (SWL) - A technique for treating stones in the kidney and ureter that does not require surgery. Instead, high energy shock waves are passed through the body and used to break stones into pieces as small as grains of sand. Because of their small size, these pieces can pass from the body along with the urine.
• Ureteroscopy - A procedure to treat kidney stones. It involves the passage of a small telescope, called a ureter scope, through the urethra and bladder and up the ureter to the point where the stone is located.

The type of surgery will depend on the size and location of the stones.

Percutaneous nephrolithotomy (PCNL)

PCNL employs a thin telescopic instrument called a nephroscope. A small cut (incision) is made in the back of the patient and the nephroscope is passed through it and into then kidney.

The stone is either pulled out or broken into smaller pieces with a laser or pneumatic energy. PCNL is always carried out under general anaesthetic.

Shock wave lithotripsy (SWL)

This procedure involves the use of ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is. Ultrasound shock waves are then sent to the stone from a machine to break it into smaller pieces so it can be passed in urine.

This is usually carried out after giving painkilling medication because SWL can be an uncomfortable form of treatment.

One patient may need more than 1 session of SWL to successfully treat kidney stones.

Ureteroscopy

Ureteroscopy involves passing a long, thin telescope called an ureterscope through the tube urine passes through on its way out of the body (the urethra) and into the bladder.

It is subsequently then passed up into the ureter, which connects the bladder to the kidney.

The surgeon may either try to remove the stone with another instrument, or may employ laser energy to break it up into small pieces so it can be passed naturally in urine. Ureteroscopy is carried out under general anaesthetic, when the patient has been put to sleep.

MEDICATIONS

Some medications can control the amount of minerals and salts in the urine and may be helpful to people whose system forms certain types of stones.

Here are some examples:

• Calcium stones

To help prevent calcium stones from forming, a doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.

• Uric acid stones

The doctor may prescribe allopurinol (e.g. Aloprim) to reduce uric acid levels in the blood and urine and another medicine to keep the urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.

• Struvite stones

The doctor may recommend strategies to keep the urine free of bacteria that cause infection in order to prevent struvite stones, this will likely include drinking fluids to maintain good urine flow and frequent voiding. In cases that may be rare, long-term use of antibiotics in small or intermittent doses may prove useful.

• Cystine stones

Apart from a diet lower in salt and protein, the doctor may recommend the drinking of more fluids so as to produce a lot more urine. If that fails to help, the doctor may also prescribe a medication that will increase the solubility of cystine in the urine.

POSSIBLE COMPLICATIONS OF TREATMENT

Complications can occur after the treatment of large kidney stones.

Possible complications will depend on the type of treatment regimen as against the size and position of the stones in question.

Complications could include:

• A blocked ureter caused by stone
• Bleeding during surgery
• Sepsis (an infection that spreads through the blood, causing symptoms throughout the whole body)
• An injury to the ureter
• A urinary tract infection (UTI)
• Pain

Home remedies

A few steps can be taken to reduce the impact of kidney stones and assist doctors in providing appropriate treatment.

• First would be drinking enough water to make the urine completely clear. A person can tell they are not consuming enough water if their urine is yellow or brown.
• A doctor may also request that a kidney stone is passed naturally though urinating. He would then ask that the patient retrieve the kidney stone from the urine by filtering it through a medium.

After studying the retrieved stone, the doctor will be able to determine what further treatment is required.

DIET

Several foods can have a positive impact on kidney health. These foods can help reduce both the risk and impact of kidney stones.

Kidney beans are one such option. The bean pods are boiled for around six hours, strain the liquid, and allow this liquid to cool.

People with kidney stones should consume this liquid every 2 hours over the course of 1 to 2 days.

Other foods that can protect the kidneys include:

• Apples - Apples are one of the most popular fruits. They're an exceptionally healthy fruit with many research-backed benefits.
• Pomegranates - Pomegranate has anti-oxidant, anti-viral and anti-tumor properties and is said to be a good source of vitamins, especially vitamin A, vitamin C.
• Basil - Basil is an herb in the mint family. It adds flavor to meals, and its nutrients may provide health benefits.
• Celery - Celery is a great source of important antioxidants. Antioxidants protect cells, blood vessels, and organs from oxidative damage.
• Grapes - Antioxidants in grapes, such as resveratrol, reduce inflammation and may help protect against cancer, heart disease and diabetes.

PREVENTING KIDNEY STONES

The following are five ways to help prevent kidney stones:

• Drink plenty of water: Drinking extra water will dilute the substances in urine that may lead to stones. People should strive to drink roughly eight standard 8-ounce cups of water or at least enough fluids to pass 2 liters of urine a day. It would be beneficial to include some citrus beverages, (e.g. lemonade and orange juice). The citrate in these beverages helps block stone formation.
• Limit animal protein: Eating too much red meat, poultry, eggs, and seafood, boosts the level of uric acid and could lead to kidney stones. A high-protein diet also reduces levels of the chemical in urine that helps prevent stones from forming (urinary citrate). This is also beneficial for a healthy heart.
• Reduce sodium Intake: A high-sodium diet can trigger kidney stones because it increases the amount of calcium in the urine. Therefore, a low-sodium diet is recommended for those prone to stones. This will also be good for blood pressure and heart management.
• Eat calcium rich foods: Dietary calcium binds to oxalate in the intestines, thus decreasing the amount of oxalate that gets absorbed into the bloodstream and then excreted by the kidney. This effectively lowers the concentration of oxalate in the urine, therefore the chances of binding to urinary calcium is greatly reduced. That leads to decreased risk of kidney stones.
• Avoid stone-forming foods: If a person suffers from stones, the doctor may advise that these foods be avoided or consume them in smaller amounts.
• Beets,
• Chocolate,
• Spinach,
• Rhubarb,
• Tea, and
• Most nuts

Are rich in oxalate, which can contribute to kidney stones.

Some studies have shown that people who take high doses of vitamin C in the form of supplements are at slightly higher risk of kidney stones. That may be because the body converts vitamin C into oxalate.

For everyone else, particular foods and drinks are unlikely to trigger kidney stones unless consumed in extremely high amounts.