KIDNEY STONES

Kidney stones (also called renal calculi, nephrolithiasis, or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys.

Kidney stones can affect any part of your urinary tract from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.

SYMPTOMS

You can have a stone in your kidney for years and not know it’s there. But, when it starts to move or becomes very large, and lodged in the ureters, it may block the flow of urine and cause the kidney to swell and the ureter to spasm, which can be very painful. Symptoms of a kidney stone include:

• Feeling pain in your lower back or side of your body. This pain can start as a dull ache that may come and go. It can also become severe.
• Having nausea and/or vomiting with the pain.
• Seeing blood in your urine.
• Feeling pain when urinating.
• Being unable to urinate.
• Feeling the need to urinate more often.
• Fever or chills if an infection is present.
• Having urine that smells bad or looks cloudy.

Smaller kidney stones may not cause pain or other symptoms. These stones can pass out of your body in your urine.

Common types of kidney stones

The most common type of kidney stone is a calcium oxalate stone.

This type happens when calcium and oxalate combine in your urine.

It can happen when you have high quantities of oxalate, low amounts of calcium, and aren’t drinking enough fluids.

Stones caused by uric acid are also fairly common. These come from a natural substance called purine, which is a by product of animal proteins (meat, chicken, and fish).

Also, the materials that make up a kidney stone can be different. You could develop a calcium oxalate stone and one made of uric acid.

RISK FACTORS

Anyone can develop kidney stones.

There are several risk factors for developing kidney stones. These include:

• Not drinking enough liquids.
• Having a diet that includes the substances that form the stones (phosphate, for example, is in meat, fish, beans, and other protein-rich foods).
• Having a family history of kidney stones.
• Having a blockage in your urinary tract.

Certain medical conditions and some medications you are taking can also increase your risk of developing stones. These conditions can include:

• Hypercalciuria (high calcium levels in your urine).
• High blood pressure.
• Diabetes.
• High blood pressure.
• Osteoporosis.
• Gout and cystic fibrosis.
• Kidney cysts.
• Parathyroid disease.
• Inflammatory bowel disease and chronic diarrhea..
• Diuretics (water pills)
• Calcium-based antacids (used to treat osteoporosis
• Crixivan(used to treat HIV infections).
• Topiramate and Phenytoin (used to treat seizures).
• Ciprofloxacin, an antibiotic).
• Ceftriaxone(an antibiotic).

Certain foods can also place you at risk of a kidney stone. These foods include:

• Meats and poultry (animal proteins).
• Sodium (diets high in salt).
• Sugars (fructose, sucrose, and corn syrup).

DIAGNOSIS

If your healthcare provider  suspects that you have a kidney stone by assessing your signs and symptoms and history, you may have diagnostic tests and procedures, such as:

• Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
• Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
• Imaging tests may show kidney stones in your urinary tract. Ultrasound, a noninvasive test that is quick and easy to perform, is another imaging option to diagnose kidney stones.
• Computerized tomography (CT) may reveal even tiny stones.
• Simple abdominal X-rays are used less frequently because this kind of imaging test can miss small kidney stones.
• Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your healthcare provider uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.

Treatment

Treatment for kidney stones varies, depending on the type of stone and the cause.

Small stones with minimal symptoms:

• Drinking water. Drinking as much as fluid a day will keep your urine dilute and may prevent stones from forming. Unless your doctor tells you otherwise, drink enough fluid ideally mostly water to produce clear or nearly clear urine.
• Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen, naproxen, etc.
• Medical therapy. Your doctor may give you medication to help pass your kidney stone. This type of medication, known as an alpha blocker(tamsulosin ) relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms :

Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or ongoing urinary tract infections may require more extensive treatment. Procedures may include:

• Surgery to remove very large stones in the kidney.A procedure called percutaneous nephrolithotomy.
• Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL). The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
• Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. You may need general or local anesthesia during this procedure.

PREVENTION

There are several ways to decrease your risk of kidney stones, including:

• Drink water- Staying hydrated helps you urinate more often, which helps to prevent the build-up of the substances that cause kidney stones. If you sweat a lot, be sure to drink even more.
• Limit salt. Eat less sodium.
• Lose weight. If you’re overweight, try to lose weight and maintain an ideal BMI.

OUTLOOK

• Kidney stones can be painful to pass, but if detected early, they usually do not cause permanent damage.
• Your healthcare provider may recommend preventive treatment to reduce your risk of recurrent kidney stones if you’re at increased risk of developing them again.
• Don’t skip your prescriptions, drink lots of water, and follow the dietary guidelines.