Kidney Stones

1 What are Kidney Stones?

Kidney stones are the solid pieces or pebbles of salt or minerals which develop when substances that are normally found in the urine become highly concentrated. A stone may stay in the kidney or travel down the urinary tract depending upon the size of the stone. 

Kidney stones vary greatly in size. A small stone may pass on its own, causing little or no pain whereas, a larger stone may get stuck in the urinary tract and can block the flow of urine, causing severe pain or bleeding. 

Kidney stones

Mostly, increased water intake removes stone with the flow of water but if this does not help one has to opt for a surgery. At times, simple changes in diet and nutrition may prevent the occurrence of the problem.

2 Symptoms

Kidney stones often don’t show any symptoms while in the kidney and can go undiagnosed. But it can cause immense pain while it travels from the kidney to the bladder through the ureter (tube connecting kidney and bladder) and may block the flow of urine. This blockage due to stone causes the kidney to swell and result in severe aches.

Common symptoms of kidney stones are:

  • A sharp, crushing pain in the back and side, often moving to the lower abdomen or the groin. The pain often starts suddenly and occurs frequently. 
  • An intense pain or burning sensation while urinating.
  • Frequent urination.
  • Urine can be dark or reddish in colour due to blood and may also give off a foul smell sometimes. 

Sometimes the urine has only small amounts of red blood cells that can’t be seen with the naked eyes.

  • Nausea and vomiting.
  • Men may experience pain at the tip of the penis.
  • Fever and chills are experienced if the infection is present.
  • The severity of pain may increase or decrease as the stone shifts its positions inside urinary tract.

Refer a physician immediately if you experience any of the mentioned symptoms.

3 Causes

Kidney stones often have no definite cause, although several factors may increase the risk of their development. The urine contains many dissolved minerals and salts. When the levels of these minerals and salts (calcium, oxalate, and uric acid) in the urine become high, development of kidney stones occur.

At the same time, your urine may lack substances that prevent crystals from sticking together thus creating an ideal environment for the development of kidney stones. The different types of kidney stones include:

1. Calcium stones: These are the most common types of kidney stones. They can be of two types: calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common one. Some people have a very high concentration of calcium in their urine which increases the risk of calcium stones. 

Oxalate is a naturally occurring substance found in food items like some fruits and vegetables, nuts and chocolate. Your liver also produces oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. 

2. Struvite stones: Struvite stones are rare but can grow quickly and become quite large, sometimes with very few symptoms or little warning. 

People who get chronic UTIs like those with long-term tubes in their kidneys or bladders or who have poor bladder emptying ability due to neurologic disorders (paralysis, multiple sclerosis, and spina bifida) are at the highest risk of these type of stones. 

3. Uric acid stones: Uric acid stones could develop in people who don't drink enough fluids or who lose too much fluid and who eat a high-protein diet, and those who have gout disease. Certain genetic factors may also increase the risk of uric acid stones. 

4. Cystine stones: Cystine is an amino acid (the building blocks of protein) that is present in certain foods. Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder.

It is when the kidney does not reabsorb cystine from the urine. This results in high amounts of cystine in the urine leading to the formation of stones, which often starts at childhood.

4 Making a Diagnosis

Usually, kidney stones get diagnosed due to a sudden pain which may occur while the stone is passing through the ureter. “Silent” kidney stones are the kidney stones with no symptoms. They can be diagnosed by:

  • Urinalysis: Urinalysis is the testing of a urine sample. The urine sample is collected in a special container at the health care provider’s office or commercial facility and can be tested in the same location or sent to a lab for analysis.  Urinalysis can show whether the person has an infection or the urine contains substances that form stones.
  • Blood test: A blood test involves drawing blood at a health care provider’s office or commercial facility and sending the sample to a lab for analysis. The blood test can indicate biochemical problems that can lead to kidney stones.
  • X- ray: An abdominal x-ray is an image created using radiation and is recorded on film or on a computer. The amount of radiation used is small. An x-ray is performed at a hospital or outpatient centre by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging.  \Anaesthesia is not needed. The person is asked to lie on a table or to stand during the x-ray. The x-ray machine is positioned over the abdominal area. The person will hold his or her breath as the picture is taken so that the picture will not be blurry. The person may be asked to change position for additional pictures. The x rays can show the location of stones in the kidney or urinary tract.
  • CT scans: CT scans use a combination of x rays and computer technology to create three-dimensional (3-D) images. A CT scan may include the injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or hospital by an x-ray technician, and the images are interpreted by a radiologist. Anaesthesia is not needed. CT scans can show stone locations and conditions that may have caused the stone to form.

5 Treatment

The treatment procedure for kidney stones varies with the type, size and cause of the stones. 

The various types of treatment procedures which could be adopted for treating small stones with minimal symptoms include:

  • Flushing with water: Usually, small stones with minimal symptoms won’t require invasive treatment. Cleansing drinks especially water can help passing the kidney stones. So it is highly recommended to drink more and more water to produce clear or nearly clear urine unless your doctor tells otherwise. 
  • Pain relievers: Passing a small stone can cause some discomfort and pain. So, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve). 
  • Medical therapy: If cleansing fluids are not very effective your doctor may give you the medication to help pass your kidney stone. This type of medication known as an alpha-blocker eases flushing the stones by relaxing the muscles of the ureter. 

Kidney stones that can't be treated using conservative measures either because they're too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections require more extensive treatment. These treatment procedures may include: 

  • Using sound waves to break up stones: Depending on the size and location the stones, your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL). ESWL uses sound waves to create strong vibrations (shock waves) that break down the stones into minute pieces that can be passed in your urine. The procedure may last for about 45 to 60 minutes. As ESMW procedure can cause moderate pain, your doctor may give you sedatives or light anaesthesia to make you comfortable. Although the procedure effective, it can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract. 
  • Percutaneous Nephrolithotomy: Percutaneous nephrolithotomy is a surgical procedure which involves removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. You will receive general anaesthesia during the surgery and have to stay in the hospital for 2 or more days, till recovery. This surgery could be recommended if ESWL turns out to be unsuccessful. 
  • Ureteroscopy: This procedure involves passing a thin lighted tube (known as ureteroscope) equipped with a camera through your urethra and bladder to your ureter for locating and removing small stones in your ureter or kidney.  Once the stone is located, special tools can snare the stone into pieces which can easily pass in your urine. Your doctor may then place a small tube called stent in the ureter to relieve swelling and promote healing. As the procedure can be painful, you may need general or local anaesthesia. 
  • Parathyroid gland surgery: Some calcium phosphate stones result due to overactive parathyroid glands. These glands are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone (known as hyperparathyroidism), your body’s calcium levels gets elevated which may result in the development of calcium stones. Hyperparathyroidism occurs due to the development of conditions like a tumor in one of your parathyroid glands that lead to the production of high amounts of parathyroid hormone. So the doctor may suggest a treatment for this condition or alternatively surgical removal of the abnormal growth in the gland.

6 Prevention

Kidney stone prevention

Kidney stones can be prevented by following methods: 

Diet

A slight change in the diet can help in preventing kidney stones:

  • For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 litres) of urine a day. So drink fluids as much as you can. Though water is the best option, other fluids such as citrus drinks may also help prevent kidney stones.
  • Consider using a salt substitute but consult your doctor first.
  • Continue eating calcium-rich foods, but be cautious with calcium supplements until your doctor advises otherwise.
  • Limit oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates (rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products) 

Medication

Certain medications can control a number of minerals and acid in your urine and thus are very helpful in people who are prone to the development of stones. The choice of medication depends on the type of kidney stones you have.

  • Calcium stones: To prevent the development of calcium stones your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation and will restrict intake of sodium, animal protein (meat, eggs, and fish), calcium supplements and foods rich in  oxalates, such as spinach, rhubarb, nuts, and wheat bran.
  • Uric acid stones: Your doctor may prescribe allopurinol (zyloprim, aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones. 
  • Struvite stones: To prevent struvite stones, your doctor may recommend strategies to keep your urine free from bacteria that causes infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones. 
  • Cystine stones: Cystine stones can be difficult to treat. Your doctor may recommend you to drink more fluids so as to increase the frequency of urination. If that alone doesn't help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine.

7 Alternative and Homeopathic Remedies

There are many alternative remedies for kidney stone:

  • Ayurvedic Medicine for Kidney Stones: 
  1. Typically, kidney stone treatments involve dietary changes and herbal therapies. 
  2. Uva Ursi is a common folk remedy for kidney stones. Not only will it help to fight off infection in the kidneys, but it may also help reduce pain and cleanse the urinary tract. 500mg three times a day is recommended for kidney stones.
  • If one has kidney stones, try taking one teaspoon each of basil juice with raw honey daily for up to six months. It’s believed that folk remedies with pure basil juice can help induce stone expulsion from the urinary tract.
  • Celery in vegetable form and celery seed are great urine-promoters and kidney tonics. Regular use of celery seed, as a spice or as a tea, may prevent kidney stone formation.
  • Bodywork for kidney Stones: Reflexology is just one form of bodywork that can stimulate the organs and regulate bodily functions. Treatment can focus on the reflexes of the pituitary gland, thyroid and parathyroid glands, spleen, and kidney, among others.
  • Homeopathy for kidney stones: Common remedies can include berberis, magnesia phosphorica, and sarsaparilla.
  • Hydrotherapy for kidney stones: Treatments such as warm sitz baths can be used to relieve the pain of kidney stones.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with kidney stones.

During kidney stone drinking as much as 2 to 3 quarters (1.9 to 2.8 litres) a day may help flush out your urinary system.

Unless your doctor tells you otherwise, drink enough fluids (best is to drink plenty of water) to produce clear or nearly clear urine. In severe cases consult your doctor immediately.

9 Risks and Complications

Factors that increase the risk of developing kidney stones include: 

  • Family or personal history: If someone in your family has kidney stones, you're more likely to develop stones, too. And if you've already had one or more kidney stones, you're at increased risk of recurrence of kidney stones. 
  • Dehydration: Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at a higher risk than others. 
  • Certain diets: Eating a diet that's high in protein, sodium and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium in your diet increases the amount of calcium your kidneys which must be filtered and significantly increases your risk of kidney stones. 
  • Obesity: High body mass index (BMI) i.e. 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 diarrhoea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
  • Other medical conditions: Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.
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