The kidney acts as a filter for blood, making urine and removing waste products from the body. It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney into the bladder through a narrow tube called the ureter. When the bladder fills and there is an urge to urinate, the bladder empties through the urethra, a much wider tube than the ureter.
In some people, chemicals crystallize in the urine and form the beginning, or nidus, of a kidney stone. These stones are very tiny when they form, smaller than a grain of sand, but gradually can grow over time to a 1/10 of an inch or larger.
When the stone sits in the kidney, it rarely causes problems, but when it falls into the ureter, it acts like a dam. As the kidney continues to function and make urine, pressure builds up behind the stone and causes the kidney to swell. This pressure is what causes the pain of a kidney stone, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms of a kidney stone are resolved.
Kidney Stones Causes
There is no consensus as to why kidney stones form.
Heredity: Some people are more susceptible to forming kidney stones, and heredity may play a role.
Geographical location : The hot climate and poor fluid intake may cause people to be relatively dehydrated, with their urine becoming more concentrated and allowing chemicals to come in closer contact to form the nidus, or beginning, of a stone.
Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in calcium may increase the risk; however, if a person isn't susceptible to forming stones, diet will not change that risk.
Study have suggested that person who consumes excess or High protein diet are at risk of stone formation.
Medications: People taking diuretics (or "water pills") and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones.
Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.
Kidney Stones Symptoms and Signs
When a tubular structure is blocked in the body, pain is generated in waves as the body tries to unblock the obstruction. These waves of pain are called colic. This is opposed to non-colicky type pain, like appendicitis or pancreatitis, in which movement causes increased pain and affected people hold very still.
•Renal colic (renal is the medical term for things related to the kidney) has a classic presentation when a kidney stone is being passed.•The pain is intense and comes on suddenly. It may wax and wane, but there is usually a significant underlying ache between the acute spasms of pain.
•It is usually located in the flank or the side of the mid back and radiates to the groin.
•Those affected cannot find a comfortable position, and many writhe in pain.
•Sweating, nausea, and vomiting are common.
•Blood in urine (haematuria) Urinalysis with a microscope may detect blood even if it is not appreciated by the naked eye.
Exams and Tests
The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone.
Physical examination is often not helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness.
Urinalysis
A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.
Blood tests are usually not indicated, unless the health-care provider has concerns about the diagnosis or is worried about kidney stone complications.
Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to obtain the images, and therefore, it may not always be available.
X-ray KUB: X-ray may revel the site and the size of the stone An intravenous pyelogram (IVP) is an x-ray examination of the kidneys, ureters and urinary bladder that uses iodinated contrast material injected into veins.An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Imaging with x-rays involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.When a contrast material is injected into a vein in the patient's arm, it travels through the blood stream and collects in the kidneys and urinary tract, turning these areas bright white. An IVP allows the radiologist to view and assess the anatomy and function of the kidneys, ureters and the bladder.
Computerized tomography (CT) scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney. The CT can also evaluate many other organs in the abdomen, including the appendix, gallbladder, liver, pancreas, aorta, and bowel. However, since no contrast material is used, there are some limitations to the detail that can be observed in the images of the scan.
Kidney Stones Treatment
Self-Care at Home
Prevention is always the preferable way to treat kidney stones. Remaining well hydrated and keeping the urine dilute will help prevent kidney stones from forming.
Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do at home to control the debilitating pain and vomiting that can occur with a kidney stone other than to seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a health-care provider to confirm the diagnosis.
For those who have a history of stones, home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed toward symptom control. The patient should be instructed to consume oral fluids. Ibuprofen may be used as an antiinflammatory medication if there is no contraindication to its use. If further pain medication is needed, the primary-care provider may be willing to prescribe stronger narcotic pain medications.
Please note, if a fever is associated with the symptoms of a kidney stone, this becomes an emergency, and medical care should be accessed immediately. Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.
Because of their size or location, some stones may not be able to be passed without help. If the stone is high up in the ureter, near the kidney, and is large, then a urologist may need to consider using lithotripsy, or shock wave therapy (EWSL),
Extracorporeal shock wave Lithotrispy (ESWL)
Usually renal stone less than 15 mm are opted for these modality, only after confirming on IVU that passage of stone inside the kidney is open. Extracorporeal shock wave Lithotrispy (ESWL) uses highly focused sound waves projected from outside the body to crush kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like particles that can be passed in the patient's urine. Large stones may require more than one ESWL sessions. The procedure should not be done for pregnant women. It can be used for patients of all age groups and those who have heart and breathing problems. ESWL by 4th generation LITHOTRIPTOR with Ultrasound attachment helps to treat even Radioluscent stones, which are not visible in normal fluoroscopy Lithotriptors.
ESWL is done on the Out door patient procedure. ESWL requires no anaesthesia hence patient can walk home within few hours of ESWL.
PerCutaneous Nephrolithotomy (Also Known as Keyhole surgery, Tunnel surgery for Kidneystone)
PCNL is usually performed for the kidney stone which are large enough which cannot be treated by ESWL. PCNL is done under Epidural or Spinal anaesthesia. In this technique the stone is removed by making a small tunnel into the kidney from the back. A fine needle is used to puncture the renal collecting system with the aid of X-ray and/or Ultrasonograpy, and a guide wire is led into the kidney through the needle. This tract is dilated over the guide wire and a Nephroscope (kidney telescope) is inserted into the pelvis of the kidney. The stones are visualized, fragmented using Lithoclast and extracted using fine forceps, allowing the kidney to become free of stones at the end of the operation, in the vast majority patients. This is of course an operation, needing full general anesthesia, average 90 minutes of operation time, 3 -4 day hospitalization, Patient returns to light work in 5-7 days time. Nevertheless the operation is safe, for both the patients and the kidney.
Follow-up
For the first-time kidney stone patient, there should be an attempt to catch the stone by straining the urine, so that it can be sent for analysis. The stone may be so tiny that it may not be recognized. While most stones are made of calcium oxalate, stones can also consist of other chemicals. It may be possible to prevent future stone formation by taking medications. For those whose stone disease is recurrent and the kind of stone is known, this instruction is often omitted.
Drinking plenty of water will help push the stone down the ureter to the bladder and hasten its elimination.
A follow-up visit with a urologist may be arranged one to two weeks after the initial visit, allowing the stone to pass on its own.
Patients should call their physician or return to the emergency department if the pain medication is not working to control the pain, if there is persistent vomiting, or if a fever occurs.
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