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About Kidney Stone

Kidney stones, or in medical term known as nephrolithiasis, is made up from excess minerals from the kidney where the urine is formed. Kidney stones can also form in other parts of the urinary tract: ureters, bladder, and urethra. Stones form when there is an imbalance among water, minerals, and salt processed in the kidneys.
There are various minerals that precipitate in kidney stone formation. These are the types of kidney stones:

Calcium – most common type of nephrolithiasis are formed from calcium oxalate, which is commonly found in cocoa, chocolate, tea, nuts, seeds, grains, fruits, and vegetables.
Uric Acid – this is found in animal proteins such as meats, fish, and shellfish. They contain purines that increase the acidity level of urine. Uric acid forms when urine is highly acidic. This commonly affects men than women.
Struvite – this type of stone forms as a result of an infection in the urinary tract, and treatment of the infection can prevent its occurrence. The formation of struvite stone is common in females.
Cystine – a rare type of stone due to a genetic disorder cystinuria. Amino acid cystine develops into stone instead of going back into the circulation. This type of stone reappears; medication is prescribed for pain and prevention of stone formation.

Sign and Symptoms

An individual with kidney stone can manifest the following signs and symptoms:

  • Severe pain in the back, belly or side
  • Blood in the urine
  • Nausea
  • Vomiting
  • Dark-colored urine
  • Fever
  • Chills
  • Urinary frequency
  • Passing out small amounts of urine

Treatment Options For Kidney Stones

Kidney stone treatment that can be used for nephrolithiasis:

  • Medication
    • Potassium citrate – increases the citrate levels in urine and making urine less acidic
    • Diuretics – increase the amount of salt and water to be urinated.
    • Allopurinol – decreases uric acid production thus preventing formation of kidney stones
    • Antibiotics – kills microbial growth, treating the infection.
    • Calcium channel blockers or alpha-blockers – relaxes ureters to allow kidney stones to pass through with urine.

Non surgical treatment option for kidney stone removal:

  • Lithotripsy- this kidney stone treatment involves crushing the kidney stones, and then a person can pass out the broken stones through urination.
    • Extracorporeal shock wave lithotripsy (ESWL) – uses shock wave to crush the kidney stone
    • Flexible ureteroscopy and laser lithotripsy (FURSL) – urologists use ureteroscope for visualization and kidney stone laser treatment is used to break the stones.

SURGICAL TREATMENT OPTIONS FOR KIDNEY STONE REMOVAL:

  • Ureteroscopy – a kidney stone treatment procedure that uses a thin lighted scope-ureteroscope, to visualize the ureters and kidneys. Once the stone is located, a small long instrument (stone extractor) is inserted through the ureteroscope that traps the stone for removal.
  • Percutaneous Nephrolithotomy (PCNL) – a kidney stone treatment that uses minimally invasive surgery which involves a small incision at the back of the patient until the doctor reaches the kidney. Nephroscope will be used to locate the stone and small instruments are inserted through the scope to remove the stone.
  • Open Nephrolithotomy – an open surgery used as a kidney stone treatment with incision done at the flank area to fully visualize the affected kidney and its adjacent organs that might have been affected. This is usually done to take out very large stones that may have caused injury to the kidney.

RETROGRADE INTRARENAL SURGERY (RIRS)

Retrograde intrarenal surgery (RIRS) is done using a fiberoptic endoscope. It will be inserted to th urethra of the patient going to the bladder, ureters until it reaches the inner portion of the kidney to locate the kidney stone. The kidney stone will be broken using an ultrasound probe or evaporated using a laser probe. Broken stones will be retrieved using a stone extractor.

Advantages Of RETROGRADE INTRARENAL SURGERY (RIRS)

  • No skin and tissue incisions
  • Low-risk procedure
  • Elimination of prolonged pain after surgery
  • Shorter operating time
  • Faster recovery
  • Shorter hospital stay

Risks And Complications

Risks for developing kidney stones:

  • Hereditary
  • Male gender
  • Dehydration
  • High protein, sodium, sugar diets
  • Obesity
  • Colorectal diseases and surgery

Complications that may arise would depend on the treatment used, the size of the kidney stone and its location. Complications of a kidney stone include:

  • Injury to the ureters during stone removal surgery
  • Obstruction of stone in the urinary tract
  • Recurrence of kidney stone
  • Sepsis after removal/ treatment of large kidney stone
  • Bleeding during or after the stone removal surgery
  • Severe pain
  • Urinary tract infection

FAQs

How are kidney stones diagnosed?

• Physical examination
• Blood tests: high levels of minerals such as uric acid, calcium
• Urine tests- checks for infection and presence of blood
• Imaging tests: X-rays, CT scan, Ultrasound

How painful are kidney stones?

Kidney stones are one of the most severe types of pain that can be comparable to childbirth. Pain brought about by kidney stones is called renal colic. Renal colic happens when the stone obstructs a narrow part in the urinary tract, especially the ureters. Intense pain can be felt in the back, side, or belly.

Can kidney stones cause kidney failure?

In most cases, kidney stones appear in one kidney. If kidney stone treatment is not given, it could aggravate infection and bleeding to the kidney causing damage. Kidney failure could happen if both kidneys have stones and left untreated, this may cause damage to both kidneys; or if a person has one kidney and has a stone in it and is left untreated, this could damage the remaining kidney.

What is the treatment for kidney stones?

• Medication- Calcium channel blockers or alpha-blockers, potassium or sodium citrate, diuretics, allopurinol, antibiotics
• Lithotripsy- Extracorporeal Shockwave and Kidney stone laser treatment
• Ureteroscopy
• Percutaneous Nephrolithotomy/ PCNL
• Open Nephrolithotomy
• Retrograde Intrarenal Surgery

What is the best surgery to remove kidney stones in India?

There are various surgeries to remove kidney stones available in India, such as:
• Extracorporeal shockwave lithotripsy (ESWL)
• Retrograde Intrarenal Surgery (RIRS)
• Percutaneous Nephrolithotripsy

Are kidney stones genetic?

Yes, specifically the cystine stones because it is formed due to a genetic disorder Cystinuria, wherein amino acids cystine forms into stone instead of going back to the bloodstream. Cystinuria is directly inherited from parents.

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