Renal Stones

renal stones Renal stones?

The main reason for kidney stone formation is not known. Pain is the main presentation. People who have a history of kidney stone formation have an increased tendency for further stone formation. Drinking plenty of water each day may prevent a recurrence.

What are kidneys?

The urine in human body is formed in the kidneys from where the ureters (tubing connecting kidneys to urinary bladder) drain it into the urinary bladder. Stone could be formed anywhere in these structures. The size varies from tiny microscopic crystals to stones as large as potatoes.About 3 in 20 men and 1 in 20 women are likely to develop a kidney stone. Urine is composed of waste chemicals, which are to be discarded from the body; these chemicals sometimes clump together to from stones.

How do they present?

A lot of times kidney stones are asymptomatic. If symptoms do occur, they include one or more of the following:

  • Pain from a kidney, called as renal colic, is a severe pain that comes and goes and is caused by a stone passing into the ureter (the tube that leads from the kidney to the bladder), where if it gets stuck, the ureter squeezes the stone towards the bladder causing intense pain in the side of your abdomen or groin. It can make a person sweat or feel sick.
  • Blood in the urine (urine turns red) is caused by a stone rubbing against the inside of your ureter.
  • Urinary infections are common and can cause fever, pain on passing urine and increased frequency of passing urine.

In most cases, there is no known reason for a stone formation, but a person who generally has concentrated urine is more likely to have stone formation. Sometimes an underlying condition, though uncommon, would result in high levels of chemicals like calcium, oxalates, cysteine or uric acid, which then further would result in stone formation. There are also medicines like diuretics, chemotherapy medicines for cancer and some medicines used for HIV, which would also result in stone formation.

b>Who are prone to have kidney stones?

People more prone to kidney stones are:

  • Recurrent urine or kidney infections.
  • A kidney with scars or cysts on it.
  • A close relative who has had a kidney stone.
What tests are to be done?

Tests to confirm the presence of a kidney stones include, X-rays or scans of the kidneys and ureters . These test detect the stone in the urinary pathway.

Tests to rule out or confirm an underlying cause include:

  • A blood test to check that the kidneys are working properly.
  • Blood tests to check the level of certain chemicals such as calcium and uric acid.
  • Urine tests to check for infection and for certain crystals.
  • An analysis of the stone if you pass it out. To catch a stone, pass urine through gauze, a tea strainer or a filter such as a coffee filter.
What complications can occur?

The main complications of kidney stones are uncommon (although the pain at the time can be severe). Sometimes a large stone can completely block the passage of urine down one ureter, which may lead to infection and damage to the kidney.

How do you treat it?

Treatment of kidney stones include drinking of lots of fluids and symptomatic treatment of pain. Generally no other treatment is required. However , in some cases, stones become stuck in a ureter or kidney and cause persistent symptoms or problems. In these cases, the pain usually becomes severe and you may need to be admitted to hospital. The treatment options for them include the following:

  • Extracorporeal shock wave lithotripsy (ESWL). This uses high-energy shock waves, which are focused on to the stones from a machine outside the body to break up stones. The crushed stone then passes out when urine is passed.
  • Percutaneous nephrolithotomy (PCNL) is used for stones not suitable for ESWL. A nephroscope (a thin telescope-like instrument) is passed through the skin and into the kidney. The stone is broken up and the fragments of stone are removed via the nephroscope. This procedure is usually done under general anaesthetic.
  • Ureteroscopy is another treatment that may be used. In this procedure, a thin telescope is passed up into the ureter via the urethra and bladder. Once the stone is seen, a laser (or other form of energy) is used to break up the stone. This technique is suitable for most types of stone.
  • Stone removal can be done by a traditional operation where the skin has to be cut to allow access to the ureter and kidney. This is only needed in a very small number of cases where the above, newer techniques have not worked or are not possible. It may be done if you have a very large stone in your kidney.
  • Another option for a stone made purely from uric acid (about 1 in 20 stones) is to dissolve the stone. This can be done by drinking plenty of fluids and making the urine alkaline with medication.
How do you prevent it?

For prevention of kidney stone formation:

  • Have plenty of water. Main aim should be to drink between two and three litres a day (unless your doctor advises otherwise if you have other medical problems).
  • For the few people who have a high level of certain chemicals in the body, further specific advice may be given. For example:
    • A dietitian may advise people with calcium oxalate stones to reduce the oxalate content of their diet. This may include reducing rhubarb, coffee and spinach.
    • Uric acid stones can be prevented with a medicine.

Other advice from a specialist may be appropriate for rarer conditions.

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