Know About Kidney Stones
"Even if one has not experienced the pain caused by urinary stones, it is unlikely that they have not heard about them. Among the patients who come to the emergency departments of hospitals with severe abdominal pain, a significant proportion will be suffering from urinary stones. The truth is that, even though it is a very common condition, many of these patients do not receive the proper treatment. Many seek treatment when the pain arises, and after the pain subsides temporarily, they tend to become indifferent to it. However, such negligence could potentially cost one their own kidney, as through proper examinations, the cause behind most stones can be identified and preventive measures and treatments can be taken to prevent further stone formation. When treatment stops after the pain subsides, the chance of addressing the issue is lost.
How and why do stones form?
Many substances in the body, in amounts greater than necessary, are excreted through urine by the kidneys. Urine is a liquid containing many salts. It contains elements that can dissolve easily in water and those that cannot. Substances that dissolve easily are expelled quickly without clumping along the pathways of urine. However, substances that are difficult to dissolve, though more slowly, are still expelled by the kidneys. The kidneys know how to protect themselves from the tendency of such substances to clump together by including certain salts, like citrate, that prevent such clumping.
If the kidneys do not have enough urine to properly dissolve all salts, the concentration of the urine increases significantly. For example, have you noticed how urine turns dark yellow during hot weather? If one does not drink enough water, fewer substances will dissolve in the urine, causing it to concentrate and darken. In such conditions, there is a much greater chance of salts clumping along the urinary pathways. Over a long period, these clumped salts, along with dead cells, can form into stones. This is why people with urinary stones are often asked to drink a lot of water.
Now, even if there is sufficient urine volume, there are other factors that contribute to stone formation. For example, if someone passes 2.5 to 3 liters of urine, but due to certain illnesses, the amount of salts in the urine is still higher than normal, it actually creates a condition where there is less urine volume. Though the volume might be normal, the concentration will still be higher. Some of these conditions are inherited, while others are caused by other diseases or lifestyle factors. The kidneys use citrate to prevent stone formation, but in some people, the level of citrate in urine is low from birth, which increases the likelihood of stone formation. Recognizing such conditions is key in stone treatment. Unfortunately, many patients fail to get this recognition.
Where can stones be found?
Most stones form inside the kidneys. These stones can then travel down the urinary tract and may stay in the ureter, which is the tube connecting the kidneys to the bladder. Stones can also form inside the bladder. Sometimes, bladder stones can grow to surprising sizes, with stones up to 17 cm having been removed from the bladder.
Different types of urinary stones:
Calcium stones: 75 to 85% of stones are made from various calcium salts, primarily calcium phosphate and calcium oxalate, sometimes a combination of both. Calcium stones form due to several reasons, with the most common being a hereditary condition known as idiopathic hypercalciuria, where the amount of calcium expelled by the kidneys is higher than usual. However, the body has excellent systems to keep calcium levels in the blood normal, so the blood calcium levels will remain normal in these individuals. Adjustments in diet are important for such individuals, and although calcium in food should not be reduced, additional calcium in the form of supplements should be avoided. Reducing the intake of proteins and salt helps in preventing these stones. Medications that reduce the amount of calcium excreted through urine can also be used to treat these stones.
Parathyroid gland issues can lead to excess calcium in the blood, causing an increased amount of calcium to be expelled through urine, leading to stone formation. The treatment in such cases is surgery to remove the tumor in the parathyroid.
Calcium oxalate stones are often caused by a high intake of oxalates in food, genetic disorders, or certain gastrointestinal surgeries. Foods high in oxalates, such as chocolate, spinach, and certain nuts, should be avoided by individuals prone to these stones. Treatment depends on the underlying cause.
Uric acid stones are another significant type of stone, often caused by excessive intake of protein. Certain cancers, cancer treatments, and genetic diseases can also contribute to the formation of uric acid stones. Medications that reduce uric acid levels are available and can help prevent stone formation.
Cystine stones: These are rare and are caused by increased cystine levels in urine, which is a genetic condition. To prevent cystine stones, one must reduce salt intake, increase urine pH by using medications, and ensure a high fluid intake.
Struvite stones: These stones are commonly seen in individuals with persistent urinary tract infections. They can grow to an enormous size and, if left untreated, may completely damage the kidney. Surgery is often required to remove these stones.
What are the symptoms of urinary stones?
Stones in the kidneys may not show any symptoms. However, when the stones travel through the urinary tract, they can cause significant pain, usually starting slowly and then intensifying. The pain may decrease after some time, only to return more intensely. Occasionally, there may be blood in the urine, and pain may radiate to the groin or genital area. Some individuals may also experience discomfort even after urination and frequent urges to urinate.
How is it diagnosed?
The location and severity of the pain, along with other symptoms, can help suspect the presence of urinary stones, but confirmation requires tests. Initially, X-rays of the abdomen were widely used, but some types of stones do not appear on X-rays, particularly small ones. With the advent of ultrasound, X-rays are less commonly used now. Most stones can be detected by ultrasound, but small stones may still go unnoticed. CT scans are more accurate but may not be available in all hospitals, so ultrasound is still more commonly used. However, CT scans are necessary for pre-surgical or lithotripsy procedures.
Treatment:
Drinking enough water to pass 3 to 3.5 liters of urine is the most effective method to prevent stones and expel existing stones. Stones up to 5mm in size can easily pass with adequate hydration. For stones in the ureter, there are medications available to help them pass more quickly. For larger stones, other procedures may be required.
When is surgery necessary?
Surgery is required in cases of severe pain that doesn't respond to medication, obstruction of urine flow, infections, or significant bleeding.
With modern treatment options, there is no longer a need for major open surgeries to remove stones. Today, there are minimally invasive methods, such as:
1. PCNL (Percutaneous nephrolithotomy): A small incision is made on the skin, and a tube is inserted into the kidney to break up the stones using laser or sound waves. A small tube may also be placed temporarily in the urinary tract to facilitate urine flow.
2. ESWL (Extracorporeal shock wave lithotripsy): High-energy sound waves are used to break the stones into smaller pieces that will naturally pass through the urine.
3. Ureteroscopic removal: A tube