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Kidney Stones

The kidney acts as a filter for blood, removing waste products from the body and making urine. It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney through a narrow tube called the ureter into the bladder. When the bladder fills and there is an urge to urinate, the bladder empties to the outside through the urethra, a much wider tube than the ureter. In some people, Chemicals crystallize in the urine and form the beginning, or nidus, of a kidney stone. Theses stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time an inch or larger. Urolithiasis is the term that refers to the presence of stones in the urinary tract, while Nephrolithiasis refers to kidney stones and Ureterolithiasis refers to stones lodged in the ureter. The size of the stone does not matter as much as where it is located and whether it obstructs or prevents urine from draining. When the stone sits in the kidney, it rarely causes problems, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.
Types of kidney stones
Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. Types of kidney stones include:
Calcium stones:
Most kidney stones are calcium stones, usually in the form of calcium Oxalate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolates have high oxalate levels. 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. Calcium stones may also occur in the form of calcium phosphate.
Struvite Stones:
Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
Uric acid stones:
Uric acid stones can form in people who do not drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
Cystine stones:
These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (Cystinuria).
Other stones:
Other, rarer types of kidney stones also can occur.
Signs and symptoms:
A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter - the tube connecting the kidney and bladder. at that point, you may experience these signs and symptoms:
  • severe pain in the side and back, below the ribs
  • pain that spreads to the lower abdomen and groin
  • pain that comes in waves and fluctuates in intensity
  • pain on urination
  • pink, red or brown urine
  • cloudy or foul-smelling urine
  • nausea and vomiting
  • persistent need to urinate
  • urinating more often than usual
  • fever and chills if an infection is present
  • urinating small amounts of urine
Pain caused by a kidney stone may change - for instance, shifting to a different location or increasing in intensity -as the stone moves through your urinary tract.
RISK FACTORS:
Factors that increase your risk of developing kidney stones include:
Family or personal history:
If someone in your family has kidney stones, you are more likely to develop stones, too. And if you have already had one or more kidney stones, you are at increased risk of developing another.
Factors that increase your risk of developing kidney stones include:
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 higher risk than others.
Certain Diets:
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 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.
TESTS:
If your doctor suspects you have a kidney stone, you may have diagnostic tests and procedures, such as:
  • Blood testing. Blood tests may reveal too much calcium or uric acid in your Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
  • Imaging.Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to high-speed or dual energy computerized tomography (CT) that may reveal even tiny stones.
  • Other imaging options .include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.
  • Analysis of passed stones.You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what's causing your kidney stones and to form a plan to prevent more kidney stones.
  • TREATMENT:
    Treatment for kidney stones varies, depending on the type of stone and the cause.

    Small stones with minimal symptoms

    Most kidney stones won't require invasive treatment. You may be able to pass a small stone by:
    • Drinking water .. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid - mostly water - to produce clear or nearly clear urine.
    • Pain relievers .Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
    • Medical therapy .Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.
    Large stones and those that cause symptoms
    Kidney stones that can't be treated with conservative measures - either because they're too large to pass on their own or because they cause bleeding, kidney damage or on-going urinary tract infections - may require more extensive treatment. Procedures may include:
    TREATMENT:
    It is done using sound waves to break up stones. For certain kidney stones depending on size and location, your doctor may recommend a procedure called Extracorporeal Shock Wave Lithotripsy (ESWL). ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anaesthesia to make you comfortable. ESWL 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.
    PCNL
    Surgery to remove very large stones in the kidney. A procedure called Percutaneous Nephrolithotomy (PCNL) involves surgically 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 be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.
    Using a scope to remove stones
    To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anaesthesia during this procedure.
    Parathyroid Gland Surgery
    Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam's apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result. Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that's causing your parathyroid gland to overproduce the hormone.

    To know more please contact :

    Dr. Gautam Banga

    MBBS,MS,M.Ch (Urology)
    Urologist, Andrologist and Genito -Urinary Reconstructive Surgeon
    Contact no. : 91- 9886624303 | +91-9999062316
    Email:- info@urethraandpenilesurgery.com