Ref: CHB/HB/029/15                                                                            

CHB NEWS BULLETIN

KIDNEY STONES

Kidney stones come in many sizes, shapes and colors. They can be as small as a speck of sand or as large as a golf ball. Some look like smooth, round pebbles and others have rough edges, depending on the chemicals in them.

The picture on the left shows - 3 stone fragments that were removed during percutaneous surgery in a patient.

How do you get kidney stones?

The kidneys are fist-size organs that handle the body's fluid and chemical levels. There are two kidneys, one on each side of the spine behind the liver, stomach, pancreas and intestines. The kidney acts as a filter for blood, removing waste products from the body and making urine. It also helps regulate electrolyte levels that are important for body function. Urine drains from the kidney through a narrow tube called the ureter into the bladder. When the bladder fills and there is an urge to urinate, the bladder empties to the outside through the urethra, a much wider tube than the ureter.

Kidney stones are solid masses made of crystals formed from salts concentrated in the urine. 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.

What are the symptoms of kidney stones?

Sometimes stones do not cause any symptoms and they are never diagnosed. Stones in the kidney that don't block the flow of urine often go unnoticed because they usually don't cause pain. When a person does have symptoms, they may include:- 

  • Sharp, cramping pain in the back and side, often moving to the lower abdomen or groin. The pain often begins suddenly and comes in waves. It can come and go as the body tries to get rid of the stone. 
  • A feeling of intense need to urinate. 
  • Urinating more often or feeling a burning sensation during urination
  • Urine that is dark or red due to blood. 
  • Sometimes the urine has only microscopic red blood cells that can't be seen with the naked eye. 
  • Nausea and vomiting. 
  • For men, pain in the tip of the penis.

What causes kidney stones?

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine.

Low urine volume 
One of the main reasons kidney stones form is constant low urine volume. This can be due to dehydration (loss of body fluids) from hard exercise, working or living in a hot place, or not drinking enough fluids. When urine volume is low, urine is concentrated and dark in color. Concentrated urine means there is less fluid to keep salts dissolved. This raises the chance that crystals will form from mineral salts in the urine.

Heredity: Heredity may play a role. The majority of kidney stones are made of calcium, and hypercalciuria (high levels of calcium in the urine) is a risk factor. The predisposition to high levels of calcium in the urine may be passed on from generation to generation.

Diet: Diet may or may not be an issue. If a person is susceptible to forming stones, then foods high in animal protiens and salt may increase the risk.

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. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine.

Underlying illnesses: Some chronic illnesses are associated with kidney stone formation, including cystic fibrosis, renal tubular acidosis, and inflammatory bowel disease.

How are kidney stones diagnosed?
When a person has hematuria (blood in the urine) or sudden abdominal or side pain, X-rays or asonogram may find a stone. An X-ray can help the doctor know how big the stone is and where it is.

Computerized tomography (CT) scanning of the abdomen 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.

A urinalysis may detect blood in the urine. It is also done to look for evidence of infection, a complication of kidney stone disease.

How are kidney stones treated?

  • Wait for the stone to pass by itself.
  • Medication to control pain and vomiting.
  • Surgery -if there is a need to relieve the obstruction emergently.
  • Shock Wave Lithotripsy (SWL) -Breaks the stone up into smaller fragments to allow those small pieces to pass more easily into the bladder. Shock waves work by vibrating the urine surrounding the stone and causing the stone to break up. 

How can kidney stones be prevented?

· Hydrate yourself: While kidney stones and renal colic cannot always be prevented, the risk of forming a stone can be minimized by avoidingdehydration. Keeping the urine dilute will not allow the chemical crystals to come out of solution and form the beginning of a stone. Making certain that the urine remains clear and not concentrated (dark yellow) will help minimize stone formation

· Get less salt in your diet. A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine.

· Continue eating calcium-rich foods, but use caution with calcium supplements. 
Calcium in food doesn't have an effect on your risk of kidney stones. Calcium supplements have been linked to increased risk of kidney stones.

· Drink plenty of water. The most common cause of kidney stones is not drinking enough fluids, especially water.

· Eat plenty of fruits and vegetables. 

· Limit 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.

· Avoid stone-forming foods: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, and colas are rich in phosphate, both of which can contribute to kidney stones. If you suffer from stones.

Kidney Stone Prognosis

Once a patient has passed a stone, there is a great likelihood that another stone will be passed in his or her lifetime. This means you’ll always have to take care of yourself to prevent the stones from recurring again.

Reference:- http://www.urologyhealth.org/urology/index.cfm?article=148#KSTitle 
http://www.emedicinehealth.com/kidney_stones/article_em.htm#kidney_stones_overview

 

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