Know about symptoms, diagnosis and treatment of kidney stones/calculi

• Kidney stones or otherwise called renal calculi or nephrolithiasis are deposits of combination of various minerals inside the kidney.
• The constituents of these stones are normally excreted into the urine.
• Excess concentration of these minerals in the urine leads its crystallization and further stone formation.
• Various reasons of stone formation include less water intake, dietary factors, excessive calcium level in blood due to Vitamin D deficiency or hormonal imbalance, excess body weight, urinary infections, certain drugs intake etc.
• Kidney stones are often diagnosed with ultrasound or CT scan test and its management depends on various factors.

Symptoms

• Dull aching Flank or back pain
• Radiating pain to lower abdomen
• Pain while passing urine
• Colicky pain (pain that comes and go in intervals or waves)
• Blood in urine
• Passing cloudy urine
• Fever
• Nausea/vomiting

Diagnosis

• Combination of various tests are done.
• Blood tests – Tests to look for elevated calcium or uric acid, Vitamin D deficiency, Parathyroid hormone.
• Urine tests- Urine tests are done to look for active infection. Recurrent infections lead to stone formation. Also 24 hour urine test is done to find the cause of recurrent stone formation.
• Imaging – Imaging in form of Ultrasound, IVP or CT scan is often used to look for the exact number of stones, its size, location inside kidney, hardness of stone. It also helps the doctor in deciding the treatment to be undertaken for stones.

Treatment

• Small kidney stones do not require any surgical treatment and kept on surveillance. General mesures such as plenty of oral fluids, painkillers and alkalizers are often used.
• Large kidney stones are treated with one or other surgical therapy. These include-
• ESWL – Extracorporeal shock wave therapy uses various kind of shock waves to break the stone by vibration. Doctor chooses which stone to be treated with this therapy. Patient is placed on machine and stone is focused on machine and sound waves then break the stone. Procedure last for about 30-40 min. Small broken stones then passes in urine in following days.

• PCNL (Per – cutaneous Nephro-lithotomy) – In this surgery used for large stone, small endoscope is passed through the the cut (<1cm) given in back of the patient. Small instruments passes through this endoscope such as laser and other to break the stone and then these small broken pieces are removed with other instrument. Surgeon may also stent at the end of surgery.  

• RIRS (Retrograde Intra Renal Surgery) – This surgery involves passing the small endoscope (ureteroscope) is passed through the urethra up into the kidney and subsequently the stone is broken with laser machine. This laser breaks and convert the stone into sand particles which gets flushed in urine in following days. Doctor may place a stent in this surgery.  

• Parathyroid gland/adenoma removal – Sometimes the cause of recurrent stone formation lies in parathyroid gland which becomes overactive. It is situated in the front of neck behind thyroid gland. This involves either complete removal of parathyroid gland removal or removal of a small part of it. 

Prevention of stone disease

• Drink plenty of oral fluids to maintain urine output of about 1.5-2.0 litre/day.
• Take low salt diet.
• Cut down the animal protein intake.
• Cut down oxalate rich diet such as rhubarb, beets, okra, spinach, sweet potatoes, nuts, tea, chocolate and soy products. Calcium rich diet can be safely taken and not avoided.
• Recurrent calcium stone formers may be prescribed by doctor with certain medicines such as thiazide or potassium citrate.
• Uric acid stone formers may be given with Allopurinol or oral alkalizer is given.
• Infection stone former may be treated with antibiotic to keep the urine free of infection.