Kidney Stone

TEN FACTS ABOUT KIDNEY STONES</h3

• There is an escalation of incidence of stone disease worldwide.
• Stone formation can affect people of any age group but the highest incidence is noted in people between 40-60 years age.
• Men are 2-3 times more likely to form stones than women.
• Highest prevalence of stone disease is found in hot, arid or dry climates such as mountain, desert or tropical areas.
• Heat exposure and dehydration are two most important risk factors for stone formation- people working as cooks, engineering room personnel, steel workers, individuals in sedentary occupations have more incidence of stone formation.
• Obesity is associated with higher prevalence of calcium oxalate and uric acid stones.
• First time stone formers have a 50% risk of stone recurrence in the next 5 years.
• Calcium is the major constituent in 75% calculi. Calcium oxalate stones are noted in 60%, uric acid stones in 10%,
  struvite stones in 10%.
• Approximately 10-20% of individuals with stone disease has a metabolic disorder predisposing to stone disease and this needs to be identified and corrected to prevent recurrent stone formation.
• Liberal water intake remains a key strategy in prevention of stone formation as well as expulsion of small renal and ureteric stones.

A close look at your kidney stone

Every kidney stone is different. Some are as small as a grain of sand, others as large as a pearl, and others are even larger than that, up to several inches in size. Some are smooth, others jagged. Some stones stay in the kidney, while others travel down the urinary tract. Explore how a kidney stone forms, what it’s made out of and where it goes – all factors your doctor will consider when determining your treatment plan.

Common Types

Calcium stones-The most common type of kidney stone forms in two primary ways: calcium combining with oxalate in your urine (calcium oxalate) or a high amount of calcium plus in creased pH levels in your urine (calcium phosphate).

Uric acid stones-If you eat a high-protein diet, are obese, or suffer from gout, you may have an increased level of uric acid in your urine. If uric acid becomes too concentrated, which may occur when the urine pH becomes abnormally low, or if uric acid combines with calci um, it can form a stone.

Struvite stones-If your kidney or urinary tract becomes infected, you may develop struvite stones, which can grow rapidly and become very large in size. Left untreated, they can cause chronic infection and seriously damage your kidney.

Cystine stones-These rarer stones are due to a genetic disorder that causes the amino acid cystine to leak into urine from your kidneys, forming crystals that may accumulate into stones.

Location

The location of your stone is critical. After a stone forms, it may stay in your kidney or travel down your urinary tract. Often, small stones will pass through the body without causing much pain. However, larger stones can get stuck somewhere along the path – your kidney, urinary tract, bladder, or ureter – blocking the flow of urine and triggering severe pain.

CAUSES AND RISK FACTORS

Why you may be more (or less) likely to get a kidney stone:

While anyone can get a kidney stone, some people are more at risk. Stones are more common in men than women. Some ethnicities – such as non-Hispanic Caucasians – are af fected at a higher rate. If you are overweight or obese, you are more likely to develop a stone. Diet and lifestyle may play a big role in the cause of your kidney stone as well. These are all key considerations when discussing your symptoms and diagnosis.

Causes

A kidney stone forms when substances in your urine become highly concentrated – which makes fluid intake one of the biggest contributing factors. If you do not drink enough water, you may put yourself at a higher risk for developing a stone.

Other possible causes include:

• Exercise (too much or too little)
• Family or personal history of kidney stones
• Food with too much salt or sugar
• Infections
• Medications
• Obesity
• Weight-loss surgery

Risk Factors

You may be at an increased risk to develop a kidney stone if you have:

• Blockage of your urinary tract
• Chronic inflammation of your bowel
• Cystic kidney disease – Disorder that causes fluid-filled sacs to form on your kidneys
• Cystinuria – Condition in which your urine contains high levels of the amino acid cystine
• Family history of kidney stones
• Gout – Disorder that causes painful swelling of your joints
• History of gastrointestinal tract surgery
• Hypercalciuria – Genetic condition in which your urine contains high levels of calcium
• Hyperoxaluria – Condition in which your urine contains high levels of oxalate
• Hyperparathyroidism – Condition in which the parathyroid glands in your neck release
  too many hormones, generating extra calcium in your blood
• Hyperuricosuria – Condition in which your urine contains high levels of uric acid
• Renal tubular acidosis – Disease in which your kidneys fail to excrete acids into urine, causing your blood to remain too acidic and the urine to be too alkaline

YOU MAY ALSO HAVE AN ELEVATED RISK OF KIDNEY STONES IF YOU TAKE CERTAIN MEDICATIONS, SUCH AS:

• Calcium-based antacids
• Diuretics – Medication that helps kidneys remove fluid from your body
• Indinavir (CrixivanTMM) – Protease inhibitor used to treat HIV infection
• Topiramate (TopamaxTMM) – Anti-seizure medication

Symptoms

How to know if you have a kidney stone

Kidney stones are mostly associated with one palpable symptom: pain. Yet, while many people experience severe pain with a kidney stone, others feel only vague discomfort or no pain at all. Your symptoms depend on the characteristics of your stone – its size, shape, and location in your body – all of which will help to confirm your doctor’s diagnosis and, ulti mately, your treatment plan

If you have a kidney stone, you may experience:

• Sharp pain in your back or lower abdomen
• Vague discomfort or dull pain, like a stomachache that doesn’t go away
• Pain while urinating or blood in your urine
• Pain in your groin or thigh (if you have a ureteral stone)
• Pain in your testicles
• Nausea and occasional vomiting
• Fever and chills
• Cloudy or foul-smelling urine

If your stone creates an irritation or blockage, your pain may ramp up rapidly. Most stones pass without causing damage – but usually not without causing pain. While pain relievers may be the only treatment needed for small stones, your doctor may recommend other treatment options if you are in danger of further complications.

Severe Pain (Renal Colic)

If a stone blocks the normal urine flow through your ureter, you may experience a condition known as renal colic – sharp, severe pain on the side of your body caused by a sudden in crease of pressure in your urinary tract and ureteral wall. The pain comes in waves and has
been described as one of the most painful experiences, similar to childbirth.

Renal colic can be an emergency situation and you should contact your doctor or visit a hospital. If the pain is accompanied by a high fever, seek medical help immediately.

No Pain or Symptoms

Some kidney stones do not cause any discomfort, pain or symptoms of any kind. These as ymptomatic stones are often small and located in places within the kidney where they do not block the flow of urine. Asymptomatic stones are typically found during an imaging scan or X-ray for other conditions.

Diagnosis

If you are experiencing any of the symptoms above and have not yet seen your doctor for a diagnosis, now is the time. At your appointment, your doctor will perform a physical exam and take a medical history, including questions about your family history of kidney stones, your diet and any gastrointestinal problems.

To complete your kidney stone diagnosis, your doctor may also perform:

• Blood test to reveal any biochemical problems that can lead to kidney stones
• An imaging test such as an X-ray, ultrasound or CT scan to find your stone’s location and show any conditions that may have caused it to form
• Urinalysis to determine whether you have an infection or if your urine contains substances that may form stones

Prevention

How to prevent another kidney stone:

Once you develop a kidney stone, you are at increased risk of developing another kidney stone in the coming years. Stones also increase your risk of developing chronic kidney disease, which means keeping future stones at bay is a vital part of staying healthy. When talking to your doctor about your treatment plan, make sure prevention is part of the discussion.

Hydration

Drinking plenty of fluids is the best way to keep a kidney stone from forming. Your doctor may recommend you drink two to three liters of water (or other pH-neutral drinks) every day. Try to drink evenly throughout the day, monitor how much you urinate, and make sure your urine is light in color. If you live in a hot climate or exercise a lot, drink more to help bal ance fluid loss.

Other suggested steps for kidney stone prevention

• Adapt your diet to include more vegetables, fibers and fruits while limiting animal pro teins and reducing your sodium intake
• Maintain a healthy weight
• Adopt a healthier lifestyle by exercising two or three times per week and avoiding stress
• Take medicine to reduce your risk, if your doctor advises it
• Try to catch any stone you passed by yourself & bring for stone analysis. This test helps to detect the chemical composition of the stone & thereby guide specific prevention measures
• Stone Analysis Test is also performed if stone was surgically removed & you should follow any specific instructions provided based on this
• Schedule follow-up visits as advised by your doctor for Metabolic Evaluation, follow-up imaging, kidney function test and urine tests
• If you inherit a genetic disorder predisposing to kidney stone formation, ask your family members to attend for medical evaluation.

Pregnancy

How pregnancy impacts kidney stone development and treatment:

If the idea of passing a kidney stone during pregnancy sounds unpleasant, here’s some good news: It’s estimated that stone formation only happens in one out of every 1,500 pregnan cies. Some physiological changes that occur while pregnant may increase your chances of developing a stone, yet others decrease the likelihood. All in all, it is thought that pregnant women are at no higher risk for stone formation than non-pregnant women.

Physiological Changes

Changes during pregnancy that impact stone formation include:

• A rise in your cardiovascular system output
• Increased filtration activity in your kidneys
• More calcium released into your urine and absorbed by your intestines
• An increase in other urinary substances that help prevent stones, such as citrate
• Dilation of your upper urinary tract (including your kidneys and ureters) due to compres sion from the uterus and effects of hormones

Symptoms

Common symptoms of kidney stone during pregnancy include:

• Nausea and occasional vomiting
• Blood in your urine
• Pain in your sides, lower back or abdomen If you are pregnant and think you have a stone, talk to your doctor or seek medical care.

Diagnosis and Treatment

Because of the need to limit X-ray radiation to your growing baby, diagnosing a kidney stone during pregnancy is a challenge and may lead to a less certain treatment plan. Your doctor may also be concerned about the potential health risks of stone surgery, if that is the recom mended option.

That’s why prevention may really be your best medicine. Make sure to maintain a high intake of water. Drinking a lot of fluids will dilute your urine and make it less likely for a stone to form.

Stone Treatment Options

Passing the Stone Naturally

Depending on the size, type, location and cause of your kidney stone, your doctor may just recommend waiting for a ureteral stone to pass naturally – without any medical or surgical intervention – for four to six weeks. During this time, periodic assessments are necessary to re-evaluate your treatment plan and determine if you can safely continue with observation or if you should have an intervention performed.

Medical Expulsive Therapy (MET)

Your doctor may recommend MET (medicines that help relax the lower ureter) if you have a small stone in your ureter. The medication may help you pass the stone spontaneously

Shock Wave Lithotripsy (SWL)

Your doctor may recommend SWL if you have a medium-sized stone in your kidney or ureter. SWL typically takes one hour and can be done as an outpatient procedure. You should be able to resume normal activities in two to three days.

Ureteral Stents

Ureteral stents (Double J Stents, DJ stents) are thin flexible tubes in serted into the ureter while performing different kidney stone treat ments. It helps the flow of urine from the kidney to the bladder. These stents will need to be removed. The length of time the stent will remain inside your ureter is decided by your doctor based on your clinical condition. You can continue your normal activities with a stent but may experience pain, discomfort, blood in urine, urinary frequency.

Ureteroscopy (URS)

Your doctor may recommend URS surgery if you have a large stone in your kidney or ureter. The surgery typically takes 30 minutes to two hours and can be done as day-surgery procedure or one-night stay. You should be able to resume normal activities in two to three days.

Percutaneous Nephrolithotomy (PCNL)

Your doctor may recommend PCNL surgery if you have a large, multiple or complex stones. The surgery lasts one to three hours and typically requires a hospital stay of one to two nights. You should be able to resume normal activities in one to two weeks.

Laparoscopy

Your doctor may recommend Laparoscopy if you have a very large stone or complex anato my that hinders satisfactory stone treatment by the previous methods. The surgery usually take three to five hours and a hospital stay of three to four nights. You should be able to resume normal activities in two to three weeks.

Recurrent Stone Formation: Role Of Stone Analysis & Metabolic Evaluation

The lifetime risk of stone formation in an individual is 5-10%. About 50% of them will develop second stone within 5 years and 80-90% suffer from recurrent stones within 10 years. Stone analysis is a very important test to know the stone type and guide prevention strategies. Metabolic evaluation (detailed 24-hour urine tests and blood tests) may help in identifying risk factors and help in stone prevention. Your doctor will suggest these tests based on your assessment and current medical guidelines. Below is a list of common oxalate rich foods that should be avoided in recurrent calcium oxalate stone formers (the common est stone overall!!!). Dietary modifications vary for different stone types and your doctor will provide relevant information.

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