Renal Stones
Kidney stones, or renal stones develop when minerals and various substances in your urinary tract crystallize into clusters. While many stones exit the body naturally through urine, the process can be excruciating as they traverse. If a stone fails to pass independently or obstructs the tract, surgical intervention such as fragmentation or removal may be necessary.
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What are Renal Stones?
Renal stones, also known as kidney stones, are solid formations or crystals that develop from various substances such as minerals, acids, and salts within the kidneys. They range in size from as small as a grain of sand to, on rare occasions, larger than a golf ball.
The presence of kidney stones may go unnoticed depending on their size. Tiny stones can traverse the urinary tract without causing symptoms, being eliminated through urine. However, larger stones risk becoming lodged in the ureter, obstructing the flow of urine from the kidney to the bladder. This blockage can lead to urinary backup, impairing the kidney's waste filtration process and potentially causing bleeding.
Natural passage of kidney stones through the urinary tract may take up to three weeks, during which they can induce severe pain. In cases where stones are too large to pass independently, surgical intervention may be necessary to break them up or remove them altogether.
Symptoms and Causes
What are the symptoms of kidney stones?
The primary symptoms of kidney stones is discomfort in the lower back, abdomen, or side (flank pain). This sensation may radiate from the loin to the side, ranging from a dull ache to intense sharp pain. Sometimes referred to as colicky pain, it can fluctuate in intensity.
Additional symptoms of kidney stones include:
- Nausea and vomiting.
- Presence of blood in urine.
- Pain during urination.
- Difficulty urinating.
- Frequent urge to urinate.
- Presence of fever or chills.
- Urine appearing cloudy or having a foul odor.
Smaller kidney stones might not elicit pain or other symptoms.
What causes to the formation of kidney stones?
The composition of your urine includes minerals, acids, and various substances such as calcium, sodium, oxalate, and uric acid. When there's an imbalance with an excess of these particles and insufficient fluid, they can aggregate and crystallize, eventually forming stones. The process of kidney stone formation can occur gradually over months or even years.
Different kinds of kidney stones
Kidney stones are categorized based on the crystals they consist of:
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Calcium-based stones: These include calcium-oxalate and calcium phosphate stones, which often form due to factors like a diet high in oxalates or low in calcium, coupled with inadequate fluid intake. Among these, calcium-oxalate stones are the most prevalent.
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Uric acid stones: Consumption of animal meat can contribute to the development of uric acid stones.
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Struvite stones: These stones are linked to bacterial infections. Persistent infections may result in the formation of staghorn calculi, exceptionally large kidney stones often necessitating surgical intervention.
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Cystine stones: Caused by an inherited condition known as cystinuria, these stones form due to an excess of cystine, a compound composed of two cysteine amino acids bound together.
What factors increase the risk of developing kidney stones?
Individuals may face a higher risk of kidney stone formation if they:
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Have inadequate fluid intake.
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Consume a diet rich in meat and other protein sources.
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Consume foods high in sodium or sugars, such as sucrose and fructose.
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Take vitamin C supplements.
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Have a family history of kidney stones.
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Experience urinary tract blockages.
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Undergo stomach or intestinal surgeries, including gastric bypass procedures.
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Use certain medications, including some diuretics, calcium-based antacids, and specific antiseizure drugs.
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Have certain medical conditions.
Medical conditions that increase the likelihood of kidney stone formation
Several medical conditions predispose individuals to an increased risk of developing kidney stones. These conditions encompass:
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1. Cystic fibrosis.
2. Cystinuria, an inherited disorder leading to cystine accumulation.
3. Diabetes.
4. Gout.
5. Hypertension (high blood pressure).
6. Hypercalciuria, characterized by elevated calcium levels in urine.
7. Inflammatory bowel disease (IBD).
8. Renal cysts.
9. Obesity.
10. Osteoporosis.
11. Parathyroid disorders.
12. Primary hyperoxaluria.
13. Hemiplegia or paraplegia (forms of paralysis).
What complications can arise from kidney stones?
Kidney stones may lead to:
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1. Obstructions causing urine backup into the kidney, resulting in swelling (hydronephrosis).
2. Kidney infection (pyelonephritis).
3. Acute kidney injury, a reversible form of kidney failure.
4. Recurrent urinary tract infections (UTIs).
5. Development of chronic kidney disease (CKD).
Diagnosis and Testing
How are kidney stones identified?
Healthcare professional employ a combination of imaging techniques, blood analyses, and urine tests to diagnose kidney stones. If there is suspicion of kidney stones based on symptoms and a physical examination, one or more of the following tests may be necessary:
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Urine analysis: This involves examining urine for the presence of blood, crystals that form stones, and indications of infection.
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Imaging: X-rays, CT scans (computed tomography scans), and ultrasound are utilized to provide a clear view of the size, shape, location, and quantity of stones.
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Blood tests: These tests are conducted to assess kidney function, identify infections, and detect elevated levels of calcium or other factors predisposing to stone formation.
Management and Treatment
What are the treatment options for kidney stones?
For small stones expected to pass naturally, Our Urologist will advise monitoring symptoms until the stone exits through urine. They may also prescribe medications to alleviate discomfort and aid in the stone's passage.
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Larger stones require tailored treatment based on their size, position, potential for infection or symptoms, and additional considerations. If you have a substantial stone or obstruction, or if a stone fails to pass naturally within a few weeks, your provider will suggest procedures to fragment or extract it.​
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Procedures for Kidney Stones
When a kidney stone becomes too large to pass naturally or obstructs the urinary tract, your healthcare provider will suggest a procedure to either break it up or remove it. The choice of procedure depends on various factors, such as the size and location of the stone. These procedures include:
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Shockwave Cystolithotripsy: This technique involves using shockwaves externally to fragment the stones, making it easier for them to pass through the urinary tract and out of the body.
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Ureteroscopy (URSL/RIRS): A scope is inserted through the urethra, bladder, and into the ureter. Instruments passed through the scope can then break up and remove the stone, facilitating the passage of smaller fragments through the urinary tract.
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Percutaneous Nephrolithotomy: When other methods are ineffective, this procedure may be recommended. It involves inserting a tube directly into the kidney through a small incision in the back. An ultrasound probe is then used to fragment and remove the stones.
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Laparoscopic Surgery: In this approach, a small incision is made to remove the stone. In rare instances, open surgery with a larger incision may be necessary instead of laparoscopy.
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If you suspect a kidney stone, seek evaluation from our Urologist to rule out blockages or complications. Timely follow-up is crucial if the stone doesn't pass within four to six weeks.
Prevention
Is it possible to prevent kidney stones?
Your dietary choices significantly influence your susceptibility to kidney stones. Consult with our Urologist or a dietitian to explore strategies for reducing your risk. They may suggest:
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1. Hydrating adequately by drinking plenty of water.
2. Restricting intake of animal proteins.
3. Reducing consumption of foods high in sugar and sodium.
4. Managing intake of foods high in oxalates; for instance, if you have calcium oxalate stones, your provider might advise avoiding foods like spinach, rhubarb, wheat bran, tree nuts, and peanuts.
5. Maintaining a healthy weight.
6. Incorporating calcium-rich foods into your diet. Surprisingly, foods with high calcium content can aid in kidney stone prevention, unlike calcium supplements or antacids containing calcium, which can heighten the risk of stones.
7. Considering prescription medications. If dietary modifications fail to yield results, your provider may prescribe medications tailored to prevent kidney stones, depending on the type of stones you tend to develop.
What is the best way to eliminate kidney stones?
If our Urologist believes your kidney stone can pass naturally, ensure ample hydration to aid its expulsion. Adhere to prescribed medications and follow our Urologist's guidance on dietary and fluid intake, including any restrictions.
When should I consult a doctor?
If you're experiencing symptoms of kidney stones, it's crucial to promptly seek medical attention. Identifying the location and size of the stone is vital for effective treatment and to avert potential complications.
A Message from NU Urology and Andrology Clinics
Dealing with kidney stones ranges from frustrating to excruciatingly painful. Seeking evaluation from our Urologist promptly is crucial to prevent worsening. Severe pain may require surgical intervention. Ensure to adhere to prescribed medications, stay well-hydrated, and follow dietary recommendations. Keep in mind, kidney stones are temporary; they won't trouble you indefinitely.