Kidney stones (urolithiasis): Treatment, symptoms, advice & help

About kidney stones (urolithiasis)

Kidneys are bean-shaped paired abdominal organs which carry out vital functions of the body. The kidneys are responsible for removing waste and toxins from blood, and subsequently concentrating the remaining fluid to be excreted as urine. Sometimes, the waste products may form crystals which in turn, may accumulate to form hard stone like material. These hard crystalline aggregations when found in kidney, are termed as kidney stones or nephrolithiasis. Occurrence of these stones anywhere in the urinary tract (kidney, ureters, urinary bladder) is termed as ‘urolithiasis’. Kidney stones can be of different types depending upon the underlying causative factors.

Kidney stones (urolithiasis): Incidence, age and sex

Kidney stones are frequently encountered in the general population and may affect individuals at any age. However they are more frequently encountered in individuals between the ages of 30 and 60 years. Men are three times more commonly affected than women.

Signs and symptoms of kidney stones (urolithiasis): Diagnosis

Kidney stones are characterised by the sudden onset of intense pain in the flanks or belly which may be transmitted to the groin. The pain usually has a sudden ‘on and off’ nature. The affected individual with kidney stones is usually asymptomatic and experiences pain only when the stone travels through the ureter. The condition is commonly associated with passage of blood in urine (haematuria). The affected individual may also experience fever, nausea or vomiting.

The characteristic nature of pain is itself quite conclusive of the diagnosis of kidney stones. Urine analysis may be performed to confirm the presence of red blood cells in urine. Individuals with uric acid stones may reveal a high uric acid level in blood. Imaging modalities like MRI or CT scan of kidneys or intravenous pyelogram may be done to establish the diagnosis in cases of blockage of ureters by stone.

Causes and prevention of kidney stones (urolithiasis)

Several kinds of kidney stones can be formed like calcium stones, phosphate stones, oxalate stones, struvite stones or uric acid stones, depending upon the underlying causative factors. A significant decrease in urine volume in cases of dehydration may also predispose individuals to stone formation. Individuals with gout are quite susceptible to uric acid stones. Likewise formation of calcium, phosphate or oxalate stones are commonly associated with hyperparathyroidism, inflammatory bowel disease or excessive supplements of vitamin D. Individuals suffering from gout are susceptible to uric acid stone formation in the kidneys. Moreover, struvite stone formation is seen in individuals with a history of frequent urinary tract infections. Sometimes the stone formation may run in families.

It is important to drink plenty of fluids in order to prevent dehydration which is one of the main factors leading to kidney stones. Management of underlying causes of stone formation may effectively help in preventing kidney stone formation.

Kidney stones (urolithiasis): Complications

Persistent or recurrent stone formation may predispose individuals to kidney scarring and damage. Large stone may obstruct the ureters leading to obstructive uropathy. Frequent stone formation in individuals may also lead to urinary tract infection.

Kidney stones (urolithiasis): Treatment

The first and foremost step in the management of kidney stones is taking plenty of fluids either orally or intravenously and subsequently wait and watch for the stone to pass on its own. Meanwhile, pain relief can be obtained by analgesic medications like ibuprofen. In most individuals, the stone is small enough to pass on its own by the help of added push by ample fluid intake. However, a larger stone may not be able to pass on its own and may require other techniques like ‘shock wave lithotripsy’ or ‘percutaneous nephrolithotomy’. Lithotripsy uses shock waves to break up larger stone into smaller pieces which can then easily pass on their own. Percutaneous nephrolithotomy is an invasive procedure to remove stones which are placed close to the kidneys. Another invasive procedure called ureteroscopy, may be performed for removal of stones in the lower urinary tract. Kidney stones carry a good prognosis since they either pass on their own, or can be removed by other procedures. However, they have a high tendency of recurrence.