Kidney Stone: Causes, Symptoms, Diagnosis and Treatment

Kidney stone affected 3,915,700 Indian population

Kidney stones have many causes and can affect any part of your urinary tract; from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they're recognized in a timely fashion. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone. In other instances — for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications - surgery may be needed.

Female and Male urinary system: which includes the kidneys, ureters, bladder and urethra — is responsible for removing waste from human body through urine. Kidneys are located toward the back in your upper abdomen, produce urine by filtering waste and fluid from your blood. That urine then travels through your ureters to your bladder, where the urine is stored until you can eliminate it at an appropriate time.

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11 Sign and Symptoms of Kidney Stone -

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:

1. Severe pain in the side and back, below the ribs
2. Pain that radiates to the lower abdomen and groin
3. Pain that comes in waves and fluctuates in intensity
4. Pain on urination
5. Pink, red or brown urine
6. Cloudy or foul-smelling urine
7. Nausea and vomiting
8. Persistent need to urinate
9. Urinating more often than usual
10. Fever and chills if an infection is present
11. Urinating small amounts

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.

When to consult a doctor?

If you have any signs and symptoms mentioned above that worry you. Seek immediate medical attention if you are experiencing:

• Pain accompanied by fever and chills
• Pain accompanied by nausea and vomiting
• Blood in your urine
• Pain so severe that you can't sit still
• Difficulty passing urine

What causes kidney stones?

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

Types of kidney stones -

• Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food and is also made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
  
• 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. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain migraine headaches or with taking certain seizure medications.
  
• 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 don't 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).

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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're more likely to develop stones, too. And if you've already had one or more kidney stones, you're at increased risk of developing another.
• 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. Eating a diet that's high in protein, animal protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
• Limiting animal protein. Eating too much animal protein, such as 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 urinary citrate, the chemical in urine that helps prevent stones from forming.
• Being obese. 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 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.

Diagnosis 

If urologist 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. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.

• Urine testing. The 24-hour urine collection test may show that you're excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.

• Imaging Test. It 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

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Treatment

Certain medications have been shown to improve the chance that a stone will pass. The most common medication prescribed for this reason is tamsulosin. Tamsulosin (Flomax) relaxes the ureter, making it easier for the stone to pass. You may also need pain and anti-nausea medicine as you wait to pass the stone.

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 ongoing urinary tract infections — may require more-extensive treatment.

Surgery may be needed to remove a stone from the ureter or kidney if:

• The stone fails to pass.
• The pain is too great to wait for the stone to pass.
• The stone is affecting kidney function. Small stones in the kidney may be left alone if they are not causing pain or infection. Some people choose to have their small stones removed. They do this because they are afraid the stone will unexpectedly start to pass and cause pain.
  

Kidney stones should be removed by surgery if they cause repeated infections in the urine or because they are blocking the flow of urine from the kidney. Today, surgery usually involves small or no incisions (cuts), minor pain and minimal time off work. Surgeries to remove stones in the kidneys or ureters are:

• Shock wave lithotripsy (SWL): Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks.
• Ureteroscopy (URS): Ureteroscopy (URS) is used to treat stones in the kidney and ureter. URS involves passing a very small telescope, called an ureteroscope, into the bladder, up the ureter and into the kidney. Rigid telescopes are used for stones in the lower part of the ureter near the bladder. Flexible telescopes are used to treat stones in the upper ureter and kidney.
• Percutaneous nephrolithotomy (PCNL): Percutaneous Lithotripsy (PCNL) is the best treatment for large stones in the kidney. General anesthesia is needed to do a PCNL. PCNL involves making a half-inch incision (cut) in the back or side, just large enough to allow a rigid telescope (nephroscope) to be passed into the hollow center part of the kidney where the stone is located.
• Kidney Stone Laser Treatment: Laser treatment for kidney stones can be used for treating different stones that have different compositions. Laser treatment for kidney stones was over 95.8% success rate in most patients. More interestingly, when patients received a kidney stone laser treatment, the stone re-treatment was almost 5 to 6 times lower as compared to other treatment options.

If you have Kidney stone better to consult with Urologist before going for surgery or medication.

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