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Renal Calculi or Kidney Stones

Updated: Apr 30, 2022

Renal calculi or Kidney stones is a very common condition frequently encountered in our day-to-day life.Anyone who has had pain due to kidney stones know how agonising the condition is.How are these stones formed?Who are at risk?How are they treated?

Let us have a look.

How are kidney stones formed?

Kidney stones are hard deposits of minerals and salts that form inside the kidney.Though broadly termed as kidney stones,they can occur anywhere along the urinary tract from the kidneys to the bladder or beyond.Stones can occur in the presence of infection or due to metabolic causes or when it becomes concentrated.

PC: What are the causes behind stone formation?

Simply put,stones form urine contains more crystal-forming substances(calcium,uric acid,oxalate etc) than the liquid in urine can dilute.Infections can worsen the scenario as well.

  1. Dietary habits: A diet rich in protein,salt or sugar can facilitate stone formation.Intake of large amounts of red meat and/or alcohol can lead to uric acid stones.

  2. Dehydration: it is a well-known fact that stones form more when there is inadequate water intake.

  3. Obesity.

  4. Supplements and medications: Notorious are calcium supplements and certain laxatives and other added nutrients.

  5. Digestive diseases and surgery: Conditions such as inflammatory bowel disease and surgeries like Gastric bypass surgeries can interfere with the intestinal absorption of calcium and water.

  6. Personal history of stone disease: increases the risk compared to normal population.

  7. Family history: significant in some type of stones.

  8. Medical conditions: Certain metabolic states such as hyperparathyroidism(a condition wherein the hormone involved in calcium metabolism is excess) can predispose an individual to renal stones.

  9. Drug induced: Some medications used to treat migraine or seizures can sometimes precipitate stone formation.

Are all the stones the same?

Absolutely Not!!

Though calcium stones are the most common,there are other types as well.The various types of kidney stones commonly found are:

  • Calcium stones: a majority of these are calcium oxalate stones.Nuts,chocolates,certain fruits and vegetables like tomatoes have high oxalate content.

  • Uric acid stones: Particularly seen in people having high protein diet and also in diabetic individuals.

  • Struvite stones or phosphate stones: these occur at the backdrop of infections.

How do kidney stones present?

Be informed that the size of stones may have no relation to the symptoms they manifest!The symptoms mainly depend upon the location of stones.Commonest symptoms are:

  • Severe pain over the flanks often spreading down to the groin

  • Nausea and vomiting

  • Reddish urine

  • Fever,sometimes with chills

  • Pain while urinating

  • Increased frequency to urinate

  • Difficulty in urinating.

Whom should I visit for my renal stone?

A Urologist is the correct choice when you are suffering from kidney stones.

What are the tests I should undergo?

Imaging studies are the fastest ways of diagnosis of kidney stones.This can be an Ultrasonography or a Computerized Tomography scan(CT).While Ultrasound is non-invasive,accurate diagnosis may not be always possible with it.However,CT scan can pinpoint the exact size,location and hardness of stones while helping in deciding the apt treatment strategy in each case.Urine analysis can help to unmask concurrent urinary infection.

How do I get rid of these kidney stones?

Small stones do not usually need treatment unless they obstruct or produce severe pain.Drinking enough water would usually help in flushing out the tiny stones.Treatment can be medical or surgical.

Medical If the stone is small and has a high chance of passage, especially if the patient is a frequent stone passer.Your doctor would take the call if medical management is applicable in your case and if so,a medication cocktail would be prescribed.But if medical management is not feasible,one or the other interventional methods would be adopted.

Surgical This is the era of endoscopic interventions which being less invasive are highly recommended when personal comfort is taken into account.The type of intervention adopted depends on the stone size and it's location within the urinary tract.These are as follows:

1) ESWL(Extracorporeal Shock Wave Lithotripsy): uses sound waves to create vibrations which break the stones into tiny fragments which would eventually be passed in urine.Bleeding can occur at times and hence is not suited for people with bleeding disorders,pregnancy etc.

2) PCNL(Percutaneous Nephrolithotomy): Stones are fragmented through a small incision made over the flank particularly useful in large stones.

3) URS(Ureterorenoscopy)and Laser Lithotripsy: stone fragmentation with laser is done through a scope introduced into the tract via the urethra(tubal structure for passage of urine from the bladder outside).

4) Open surgeries are not done these days as in the past after the advent of laser,as there are higher chances of morbidity with these.

Stone analysis A stone analysis is of prime importance because it helps in understanding the composition of the stone which in turn helps in identifying possible causes of stones as well their prevention.

Can I prevent renal stones? A combination of lifestyle modifications and some medications can help in keeping renal stones under check:

Adequate water intake. Diet low in salts and animal proteins. Cut down oxalate rich foods such as spinach,sweet potatoes,rhubarb,beetroot, chocolates etc. Ensure adequate amount of normal calcium rich foods but be cautious regarding calcium supplements as some of these can precipitate stone formation. Specific medications which might help in the control of uric acid stones and calcium stones might be prescribed by your doctor if you are at high risk for stone formation.

So,if you are in pain and there is sonological evidence to substantiate kidney stones,get evaluated by your urologist in a timely manner to avoid complications.I have seen many patients presenting in acute kidney failure after inadvertent use of natural and herbal medications after stone diagnosis.Kindly ensure that you adhere to the instructions of your Urologist and safeguard your kidneys!

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