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Kidney stones

Definition


Disease: Kidney stones Kidney stones
Category: Dermatological diseases

Disease Definition:

Small, hard deposits of mineral and acid salts on the inner surfaces of the kidneys are called renal lithiasis or kidney stones. Typically, the substances that make up kidney stones are diluted in the urine. However, when the urine is concentrated, the minerals could crystallize, stick together and solidify, resulting in a kidney stone. Calcium is contained in most kidney stones.

 

Passing kidney stones could be an excruciating experience. Usually, the pain will start in the person’s side or back, just below the ribs, and radiate to the groin and lower abdomen.

 

Usually, kidney stones don't cause any permanent damage despite the fact that they are quite painful. In most cases, medical intervention is not necessary except for pain medication.

 

Finding out what type of kidney stones a person has and why it developed is important. In order to prevent new stones from forming, some of the underlying causes of kidney stones could be treated. Someone could avoid additional kidney stones by drinking more water and making a few dietary changes in case there is no specific treatment for his/her condition.
 

Work Group:


Symptoms, Causes

Symptoms:

Someone may not know that he/she has a kidney stone until it moves into the ureter, which is the tube that connects the kidney and bladder. When the kidney stone does move to there, the person may experience some of these signs and symptoms:

 

  • Pain on urination
  • Persistent urge to urinate
  • Nausea and vomiting
  • Pain waves that radiate from the side and back to the lower abdomen and groin
  • Pain in the side and back, below the ribs
  • Fever and chills in case an infection is present
  • Bloody, cloudy or foul-smelling urine
  • Fluctuations in pain intensity, with periods of pain that last between 20 to 60 minutes.

 

When someone seeks medical care for other problems including urinary tract infections or blood in your urine, the kidney stones that don't cause these signs and symptoms could show up on the X-rays.
 

Causes:

Located in the back of the abdomen on each side of the spine, the kidneys are two bean-shaped organs, each about the size of a fist. Removing excess fluid, unneeded electrolytes and wastes from the blood in the form of urine is the main function of the kidneys. Until urine is eliminated from the body, it is stored in the bladder. Urine is carried from the kidneys to the bladder through the ureters.

 

When the components of urine, fluid, in addition to various minerals and acids, are out of balance, kidney stones form. When this happens, the urine contains more crystal-forming substances than the available fluid can dilute, including uric acid and calcium. The urine could also be short of substances that keep crystals from sticking together and becoming stones. In highly acidic or highly alkaline urine, kidney stones are also prone to develop.

 

The conditions that allow kidney stones to form are created by problems in the way a person’s system absorbs and eliminates calcium and other substances. Some specific types of kidney stones are promoted by inflammatory bowel disease, gout and some drugs, such as those used in treating heart failure and high blood pressure called furosemide, an anti-seizure drug called topiramate, in addition to those used in treating human immunodeficiency virus, which is the cause of AIDS, called indinavir .

 

Commonly, kidney stones don't have a definite, single cause. The conditions that allow susceptible people to develop kidney stones are usually due to a number of factors, often in combination.

 

Crystals of more than one type are usually contained in most kidney stones. In order to help identify the underlying cause, the type that makes up the bulk of the stone should be determined which is usually a combination of calcium compounds. After the first kidney stone, the best preventive approach will depend partly on the composition of the stone.

Calcium stones:

Approximately four out of five kidney stones are calcium stones, mostly in the form of calcium oxalate. The liver produces most of the body's oxalate supply, which is also found in some fruits and vegetables. The concentration of calcium or oxalate in the urine could be increased by dietary factors, several different metabolic disorders, intestinal bypass surgery and high doses of vitamin D.

Struvite stones:

Almost always, urinary tract infection is the cause of struvite stones, which are found more often in women. These stones could be large enough that they fill most of a kidney's urine-collecting space, and form a characteristic stag's-horn shape.

Uric acid stones:

A byproduct of protein metabolism called uric acid form these stones. Someone’s chances of developing uric acid stones are greater if he/she eats a high-protein diet. Another reason for the development of uric acid stones is gout. Someone could be predisposed to the condition due to certain genetic factors and disorders of the blood-producing tissues.

Cystine stones:

Only a small percentage of kidney stones are cystine stones. People with a hereditary disorder that causes the kidneys to excrete excessive amounts of certain amino acids (cystinuria) usually develop cystine stones.
 

Complications

Complications:

Usually, problems aren't caused by a stone that stays inside one of the kidneys, unless it becomes so large that it blocks the flow of urine. In addition to the risk of kidney damage, infection and bleeding, this could cause pressure and pain. Smaller stones, which partially block the thin tubes connecting each kidney to the bladder or the outlet from the bladder itself, could cause ongoing urinary tract infections if left untreated, or kidney damage.

 

Treatments:

Based on the type of the kidney stone and its cause, treatment could vary. By drinking plenty of water, as much as 1.9 to 2.8 liters (2 to 3 quarts) a day, and by staying physically active, a person could move a stone through his/her urinary tract.

 

Professional treatment may be needed in case the stones cannot be treated with more conservative measures, either because they cause bleeding, ongoing urinary tract infections or kidney damage,or because they are too large to pass on their own.
Some of these professional procedures include:

ESWL (extracorporeal shock wave lithotripsy):

This procedure, in which shock waves are used to break the stones into tiny pieces that are then passed in the urine, is commonly used. Sometimes, during this procedure, the patient may be partially submerged in a tub of water. Other times, the patient may lie on a soft cushion. Because of the moderate pain that is caused by the shock waves, light anesthesia or sedation will be needed. During this procedure, the patient should wear earphones to protect his/her hearing because a loud noise is produced each time a shock wave is generated.
In order to help determine the position of the stone and monitor the status of the stone during treatment, X-rays or ultrasound will be used.

 

Blood in the urine, bleeding around the kidney and other adjacent organs, bruising on the back or abdomen and discomfort as the stone fragments pass through the urinary tract are some of the complications that could occur with ESWL. However, a person may need a second round of ESWL or ureteroscopic stone removal in case the stone doesn't shatter completely. It could take months after the treatment for all the stone fragments to pass.

Percutaneous nephrolithotomy:

Using an instrument called a nephroscope a kidney stone may be removed through a small incision in the patient’s back in case ESWL is not effective, or if the stone is very large.

Parathyroid surgery:

Overactive parathyroid glands that are located on the four corners of the thyroid gland just below the Adam's apple could be the cause of some of the calcium stones. The body's level of calcium could become too high when these glands produce too much parathyroid hormone, causing excessive excretion of calcium in the urine. Most of the time, the cause of this is a small benign tumor in one of the four parathyroid glands. The tumor could be surgically removed.

Ureteroscopic stone removal:

When a stone is lodged in a ureter, this procedure could be used. The stone will be snared with a small instrument called a ureteroscope, which will pass into the ureter through the bladder. In order to shatter the stone, ultrasound or laser energy could also be directed through the scope. In case a person’s stones are in the lower part of the ureter, these methods work especially well.
 

Prognosis:

Not available

Expert's opinion

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