Kidney Stones

Overview:

Are you experiencing pain in your side or back? Are you noticing traces of blood in your urine? Are you experiencing nausea or vomiting along with the above symptoms? The root cause for all this might be a kidney stone.

Kidney stones are small crystal deposits that are formed from the chemicals present in urine. The growth and deposition of kidney stones might pave the way for the symptoms mentioned above. These stones (also known as Renal Calculi, Nephrolithiasis or Urolithiasis) are of four types: uric acid, calcium oxalate, cystine, and struvite.

But the question is what leads to the formation of these kidney stones. Urine generally consists of several waste materials. When the waste content of the urine goes up and the liquid intake level decreases, kidney stones crystallise. These newly-formed crystals then start attracting other waste elements in the urine, forming a solid mass in the kidney.

This solid mass will stay in the body and grow in size, unless it is passed out via urine or extracted. So, the size of the stone will vary based on the chemical deposition. These stones start at the size of a grain of sand and can grow to the size of a golf ball. Generally, kidney stones are around the size of a chickpea, and there is a chance the patient might just pass it off while urinating.

However, if the size of the stone is considerably large, it calls for a surgery. In case a small stone is detected, patients are advised to keep themselves thoroughy hydrated. Drinking enough water might help the patient get rid of the stone in around 3 to 4 weeks. Passing the stone can be pretty painful, but remember that they usually don't cause permanent damage, given that they are detected on time.

In case there’s a chance of relapse, the health practitioner might recommend preventive methods. Practising them religiously will reduce the risk of recurrent kidney stones.

When to Consult a Doctor?

A person must consult a licensed healthcare practitioner for kidney stones in case he/she experiences any signs or symptoms. To make things easier, here are some kidney stone symptoms one must keep an eye out for.

• Extreme difficulty passing urine
• Inability to sit still or comfortably due to intense pain 
• Nausea 
• Vomiting 
• Bloody urine (brown, red, or pink)
• Fever and chills 
• Pain growing towards the groin and lower abdomen
• Pain on the back, sides, and below the ribs 
• Fluctuating pain in terms of intensity

The position and intensity of the pain caused by a kidney stone might change based on the size of the stone and where in the urinary tract is it present. The location of this pain will keep changing as the stone moves through the urinary tract.

Diagnosis

To diagnose a kidney stone, doctors generally begin with a comprehensive medical history, followed by a thorough physical examination and a few necessary lab tests. By doing so, the doctor will determine the kidney stone's exact size and location. This is generally done with the help of a CT scan or an X-ray (KUB X-ray - Kidney Ureter Bladder X-ray).

Post-detection of the stone, the doctor will determine the suitable treatment method. To do so, he/she will first gauge the health of the patient’s kidneys via urine and blood tests.

Once the treatment method is decided and the stone is removed, doctors will try and find the cause behind the formation of the kidney stone. The doctor further analyses the stone once it is removed. The doctor will also check for the level of phosphorous, calcium, and uric acid present in the patient’s blood. A person might also need to submit urine for uric acid and calcium tests.

Diagnostic tests

Here are the diagnostic tests that are used to detect the presence of a kidney stone:

• Lab Tests

Lab tests for kidney stones are usually carried out using two primary testing samples, blood and urine. Firstly, doctors will ask the patient to take a blood test since it reveals the accurate calcium or uric acid content in the blood.

If uric acid or calcium levels in the blood are higher than normal, then the patient might have a kidney stone.
Furthermore, these blood tests also gauge kidney health, allowing doctors to check for other prevalent health conditions. Secondly, the doctor will also ask the patient to go for a complete urine examination.

A urine test will check for the presence of excessive stone-forming chemicals and elements in the urine. The doctor might ask the patient for two separate urine tests over a two-day window.

• Imaging Tests

Imaging tests can successfully detect the presence and location of the kidney stones. Doctors will either perform a CT scan (dual energy or high-speed computerised tomography) or a simple abdominal X-ray. Both these imaging tests differ in effectiveness.

A simple abdominal X-ray can detect small kidney stones; however, they might miss out on the very tiny ones. On the other hand, a CT scan is a lot more precise and can even detect minute kidney stones for early treatment.

Treatment

Here are some top treatment options one can adopt to get rid of kidney stones:

• Home Care

If the kidney stone is relatively small, doctors might ask the patient to take care of it at home and eventually pass it out via urine through medications. In this case, frequent and abundant hydration is the key. A medicine dosage will also accompany hydration to dilute the stone further.

Drinking a minimum of 8-10 glasses of water to keep the stones from growing is essential. The key is to have more liquid in urine than chemicals so the existing stone can dissolve and pass.

Other liquids one must consume to get rid of a kidney stone are lemon juice, apple cider vinegar, wheatgrass juice, dandelion root juice and celery juice. Patients must also remember to manage their weight and stay away from caffeinated and sugary drinks.

• Medication

Kidney stone patients are given medications with the primary goal of managing pain. Also, doctors will prescribe antibiotics to keep them safe from infections. Some other reasons for using medications to tackle kidney stones are as follows:

1. Reduce and manage pain
2. Manage vomiting and nausea
3. Relax the ureter so that the prevalent kidney stones can easily pass via urine

To achieve this, doctors might prescribe the following medications:

1. Allopurinol: To get rid of uric acid stones 
2. Phosphorus solutions: To prevent the formation of calcium stones 
3. Ibuprofen: To manage pain  
4. Naproxen sodium: To manage pain  
5. Thiazide diuretics: To prevent the formation of calcium stones  
6. Sodium bicarbonate or sodium citrate: To reduce the acidity of urine

• Surgical Treatment

Surgical treatment for kidney stones involves three types of surgery, i.e. ureteroscopy, percutaneous nephrolithotomy, and open stone surgery.

First, let's talk about the ureteroscopy. A tiny instrument (ureteroscope) is inserted in the urethra. It then travels through the bladder and into the ureter. Doctors use this instrument to find kidney stones and retrieve them using a surgical basket. Sometimes doctors also break the stones using a laser head attached to the ureteroscope.

Moving on, a percutaneous nephrolithotomy is employed when no other method of kidney stone removal is working. This can be because the stone is considerably large, or too many in number.

A small incision is made on the patient’s back, through which a tube is inserted directly into his/her kidney. All the stones present in the urinary tract are then disintegrated with the help of an ultrasound probe. These remaining bits are then suctioned out, eliminating the need for the patient to pass the stones out.

Lastly, an open stone surgery essentially involves a larger incission. This is a doctor's last resort and is rarely ever performed.

• Alternative Management

Another non-surgical method to get rid of kidney stones is lithoscopy. In this case, the patient will be placed on a special surgical tub or table and then sound waves are used to break up the large stones. These smaller pieces of stones can then be passed via urine.

This procedure might get quite uncomfortable and require anaesthesia. Another risk associated with this treatment method is that it might bruise the abdomen, causing bleeding in all the organs surrounding the kidney.

Risks & Complications if Left Untreated

Here are some of the top risks and complications that can happen in case a kidney stone is left untreated.

• Severe pain: When a large stone enters the ureter, it can get quite painful. It might just get stuck there, leading to a blockage. This blockage can lead to severe pain.
• Increased risk of UTIs (Urinary Tract Infections): Since kidney stones block ureters, they can even cause them to narrow down. As a result, patients might experience a urine build-up, which increases the risk for a urine infection.
• Increased risk of kidney infection: If kidney stone is left untreated, one can develop serious infection which can affect the kidney functions. Proper and timely treatment can help avoid kidney infection.
• Can cause kidney failure: If the kidney stone is left untreated for very long, it will grow in size considerably. As a result, it can cause permanent damage to the kidneys, leading to renal failure. A kidney failure can occur without a single symptom. Hence, one must ensure the stone doesn't grow out of control.

Additional Information

Passing the kidney stone

The passing of a kidney stone doesn’t just happen overnight. In fact, a patient will pass a kidney stone in stages over a period of several weeks. Here are the four stages that entail the passing of a kidney stone:

• Stage 1: Once a kidney stone is formed in the urinary tract, one will start feeling spasms. These spasms are a result of the kidneys trying to shove the stone out. This might bring in waves of severe pain in back or sides.
• Stage 2: The stone has now entered the ureter, a tube that connects the bladder and the kidney. Here, pain intensity will vary based on the size and location of the kidney stone. 
• Stage 3: The kidney stone has now reached the bladder, taking most of the pain away from the equation. Although one might experience increased pressure while urinating, the frequency of urination will also increase. 
• Stage 4: The kidney stone has now reached the urethra. The patient should push hard while urinating and pass the stone out via the urethra.