Kidney Stones Treatment

When minerals, acids, and salts accumulate in the kidneys, they create solid masses or crystals referred to as kidney stones. These can take different sizes, from little grains of sand to some having as big as a golf ball. They are also known as renal calculi or nephrolithiasis. They may be unnoticed sometimes while passing through the urinary tract. But larger ones would obstruct the ureter and create urine backup, resulting in kidney failure, along with bleeding.

Kidney stones can cause distinctive symptoms, indicating their presence in the urinary tract. Common signs include:

1. Severe Pain: Intense, stabbing pain in the back or lower abdomen is a hallmark symptom. The pain often radiates to the groin and fluctuates in intensity as the stone moves within the urinary tract.

2. Hematuria (Blood in Urine): Kidney stones can cause microscopic or visible blood in the urine. Hematuria may give the urine a pink, red, or brown color, signaling potential stone-related irritation or damage to the urinary tract.

3. Frequent Urination: Individuals with kidney stones may experience an increased urge to urinate. However, the passage of urine may be minimal or accompanied by pain.

4. Cloudy or Foul-Smelling Urine: Discoloration, cloudiness, or an unpleasant odor in the urine may occur due to the presence of infection or mineral buildup associated with kidney stones.

5. Nausea and Vomiting: The pain and discomfort caused by kidney stones can induce nausea and vomiting. These symptoms may be accompanied by a general feeling of discomfort or restlessness.

Types of Kidney Stones

Stones are named according to the type of crystals they possess. Here is a breakdown of the major categories:-   

• Calcium Stones: These stones constitute a major part of stones that are composed of either calcium oxalate or calcium phosphate. However, their formation is determined by increased intake of vitamin D, leading to diet, among other factors causing metabolic disorders.

• Struvite Stones: The rapid formations of very large stones containing magnesium, ammonium, and phosphate result from a urinary tract infection. 

• Uric acid stones: These are Urinary calculi that are a result of excessive uric acid in urine because of several causes such as increased protein consumption, dehydration, gout, or genetics.

• Cystine stones: These are rare and occur among those with the hereditary disease known as cystinuria, which increases the excretion of cystine in the urine.  

What Causes Kidney Stones

High concentrations in urine permit the minerals calcium, oxalate, uric acid, and cystine to crystallize and clump together, forming kidney stones. Several factors may cause this process, such as:  

• Low urine volume: When you're dehydrated, your urine is much more concentrated, which makes it easy for minerals to crystallize.  

• Diet: Some eating habits such as high sodium intake, protein, especially animal protein, oxalate-rich foods, and sugar increase calcium and uric acid levels.

• Family history: Those whose family has a history of kidney stones have an increased risk of developing them.

• Medical conditions: Kidney stones are known to result from hyperparathyroidism, gout, inflammatory bowel disease, renal tubular acidosis, urinary tract infections, and cystinuria.

• Obesity: Overweight or obese people usually have increased chances of developing kidney stones.

• Certain medications: Some medications increase the risk of developing kidney stones.

Diagnosing Kidney Stones

Diagnosis of kidney stones involves a comprehensive assessment of medical history and a physical examination in conjunction with various tests. Here is a short outline discussing the common methods of diagnosis:

1. Medical History and Physical Examination: During evaluation, the doctors will inquire about the symptoms, sites of pain, severity of pain, the personal and family history of kidney stones, dietary habits, and any pre-existing medical condition.

2. Urine Tests: Urinalysis is a test performed on urine to check for blood, crystals, and infection. A 24-hour urine collection for testing is useful to check the volume containing stone-forming substances and determine the stone type and risk of making stones in the future. 

3. Blood Tests: Blood tests reveal increased calcium or uric acid levels in the blood and evaluate kidney function.

4. Imaging Tests: CT scans are the best way to catch kidney stones. X-rays can catch the stones but are not as sensitive as CTs. Ultrasounds employ sound waves to visualize the kidneys and urinary tract, which is especially useful in pregnant women and children. 

5. Stone Analysis: If you find that you've passed a kidney stone, your doctor likely will request that you save the stone for further analysis. This analysis helps determine the composition of the stone, which can further assist in determining the appropriate treatment and prevention methods. 

Risk Factors For Kidney Stones  

Kidney stones are a common and painful condition, and several factors may increase your chance of developing them. The following highlights the important risk factors:  

• Dehydration: Drinking little amounts of fluid increases risk as it concentrates the urine, which helps in crystallizing minerals.  

• Diet: Consuming foods high in sodium, protein (particularly animal protein), oxalate, and sugar contributes to the formation of kidney stones. 

• Obesity: Increased body weight (BMI) along with a bigger waist size increases the risk.

• Family history: If kidney stones run in the family, you may be more prone.  

• Urinary tract infection (UTIs): UTIs can give rise to struvite stones.

• Hyperparathyroidism: Leads to excessive calcium deposition in blood and urine.  

• Gout: Elevated levels of uric acid.  

• Inflammatory bowel disease (IBD): May compromise calcium and water absorption.  

• Renal tubular acidosis: Impairs the kidney's regulation of acid-base equilibrium.   

• Cystinuria: A hereditary disease, more cystine in urine.   

• Diabetes: Metabolic syndrome.  

• Medication: Some drugs can make you more susceptible. Excessive vitamin D or calcium supplementation may also be a risk.  

• Age and sex: Stone formation is more prevalent in men and adults.

Knowing these factors can help patients the chances of being affected.

Complications of Kidney Stones

When either untreated or when stones are too large to pass, kidney stones may lead to complications. Those are severe pain (renal colic from blockage of urine flow), UTI due to obstruction of urine flow, kidney infection (pyelonephritis) due to ascending UTI infection, kidney damage, hydronephrosis by obstructing urine flow, sepsis from severe infection, and obstructing the ureter causing kidney injury. Therefore, if manifestations such as acute pain, fever, or blood in urine arise, it would be wise to seek medical assistance to curb their effects on health. 

Prevention

Preventing kidney stones can be achieved through lifestyle changes, medication, and these specific guidelines:

• Stay Hydrated: Drink at least 2 to 3 liters of fluids, preferably water; monitor urine color; increase intake in hot weather or physical activity.
• Dietary Adjustment: Restrict sodium intake; moderate protein use; pay attention to oxalate; maintain calcium levels; and avoid sugary drinks.
• Maintain Healthy Weight: Stay fit with diet and exercise to minimize obesity-related risks.
• Medical Management: Take prescribed medications, control associated disease, and arrange for check-ups.

Kidney stones treatment involves a combination of pain management, lifestyle modifications, and medical interventions tailored to the stone's size and composition. Here's an overview of the treatment procedure in six key points:

1. Pain Management: Severe pain is a hallmark symptom of kidney stones. Over-the-counter or prescription pain medications are often prescribed to alleviate discomfort during the passage of stones. Intravenous pain medications may be administered in more severe cases.

2. Hydration and Diet Modification: Increasing fluid intake is crucial for flushing out stones and preventing their formation. Dietary changes may involve reducing salt, oxalate, and animal protein intake to minimize the risk of stone recurrence.

3. Medication: Depending on the stone's composition, medications like alpha-blockers or citrate may be prescribed to relax the muscles in the ureter or inhibit crystal formation, facilitating stone passage and preventing new stone development.

4. Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure employs shock waves to break larger stones into smaller fragments, making them easier to pass. ESWL is commonly used for stones located in the kidneys or upper urinary tract.

5. Ureteroscopy: For stones that don't respond to ESWL, ureteroscopy involves the insertion of a thin tube through the urethra and bladder to directly access and remove or break down stones in the ureter or kidney.

6. Surgical Interventions: In cases of large or complex stones, surgical procedures like percutaneous nephrolithotomy (PNL) may be necessary. Percutaneous Nephrolithotomy (PCNL) is performed for large or complex kidney stones and involves making an incision in the back, through which a tube is inserted directly into the kidney. Instruments are used to crush and extract the stone under general anesthesia and inpatient care. 

7. Laparoscopic: Laparoscopic surgery will have a small incision for the removal, although open surgery may be required in rare cases.

The physician will pick the procedure based on stone characteristics and the patient's health. Alpha blockers and other medications may facilitate stone passage by relaxing ureteral muscles.