Kidney stones are small hard deposits that are made inside the kidneys commonly consisting of calcium oxalate and occasionally from triple phosphates, urates etc. Around two percent of the Asian population is at risk of developing kidney stones and males are three times more affected than women.

Many causes have been attributed to it but they vary with each individual. Depending on the place of impaction Kidney stones can have an effect on any part of the urinary tract. Daily Mirror Life spoke to Dr.K.K.W.perera to gain some understanding of the disease.

What are the symptoms of kidney stones?

The stones may not cause any symptoms until they move around within the kidney and pass into the ureters(a muscular tube connecting the kidney to the bladder) at this point the symptoms and signs may occur:
Severe pain in the loin area that spreads to the groin and lower abdominal area which is colicky in nature.(some women claim it to be worst than labor pains)

Pain on urination.

Pink red or brownish colored urine.

Cloudy foul smelling urine.

Persistent urge to urinate.

Nausea and vomiting.

Fever and chills if an infection is present.  

 

What causes nephrolithiasis?

 

It is now thought to be a systemic disorder caused by an inborn problem in the metabolic pathways of the body while many things may act as risk factors. The supersaturation theory where the supersaturation of minerals causing crystal formation, the nidus theory in which an infective nucleus around which a stone formation takes place or the stagnation theory where urine stasis causes stone formation are theories that are still widely accredited but they are not applicable to all the scenarios.

 

 

What are the risk factors for stone formation?

 

Family history or past history- If someone in your family has kidney stones or if you’ve had kidney stones in the past then you’re at an increased risk of developing another.

 

Age- Although they may occur at any age, the risk increases with age.

Male sex- Men are three times more likely to develop kidney stones.

Coming from a hot humid climate or being dehydrated- Not drinking enough water can increase your risk of developing stones.

Diet- A diet high in protein, sodium, sugar, oxalic acid containing substances such as spinach may increase your risk of some types of kidney stones.

Obesity- A high BMI and a large waist size have been linked to an increased risk of stone formation.

Digestive diseases and surgery- Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affects your absorption of calcium and water, thereby increasing the level of stone forming substance in the urine.

Other medical conditions- Hormonal problems like hyperparathyroidism, urinary tract conditions like renal tubular acidosis, cystinuria can also precipitate kidney stone formation.

 

What tests are used to diagnose kidney stones?

 

Urine full report-The presence of blood cells in an elderly person might create some suspicion about the possibility of stones. At the same time urine stasis due to the stone may cause bacterial colonization higher up in the urinary tract giving rise to a field full of pus cells.

X-ray KUB- Around 90% of kidney stones are seen in an X-RAY KUB.

Other imaging tests- CT, ultra sound scans, intra venous urogram may catch small stones that the x-ray missed.

Cystoscopy- This can be used to visualize bladder stones although deemed a bit of an invasive procedure.

 

What are the treatment measures available for this condition?

 

The treatment measures vary according to the type and size of stone. Small stones with minimal symptoms won’t require any invasive procedures. Instead you may be able to pass a small stone by drinking as much as 2-3 liters of water a day to flush out the urinary system, or drink enough water until u produce clear urine.

Meanwhile your doctor may prescribe a type of drug called alpha blockers which will relax the muscles in the ureters helping to pass the stone more quickly. Since passing a stone can sometimes cause discomfort your doctor may also recommend a pain reliever. Large stones that can’t be passed on their own, can’t be treated with conservative management.

Therefore they have to be broken down by procedures such as extra corporeal shock wave lithotripsy which uses sound waves to create strong vibrations. The procedure takes about 45-60 minutes and can cause moderate pain so you need to be sedated or under light anesthesia.

Smaller stones in the ureters can also be removed by a ureteroscope where the stone is located and snared and broken in to tiny pieces, this too is done under general anesthesia.  Very large stones in the kidney that couldn’t be crushed by lithotripsy can be removed by surgery (per cutaneous nephrolithotomy)

 

How can we prevent the formation of kidney stones?

A combination of lifestyle changes can reduce your risk of kidney stones:

Drinking enough water throughout the day and staying well hydrated will curb your chances of developing stones. If you live in a hot dry climate or exercise frequently then you need to drink even more water.

Eat fewer oxalate rich foods, such as spinach, beet, sweet potatoes, tea, chocolate etc,while eating citric acid rich fruits such as oranges, lime/lemon juices.

Choose a diet low in sodium and animal protein instead choose non animal protein such as legumes.

Continue eating calcium rich foods as they have no effect on stone formation instead be cautious with calcium supplements.


 
 

 

 

(By Samurddhi Tillekeratne)