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Kidney Stones : Causes, Symptoms, Treatment and Prevention

Kidney stone disease or nephrolithiasis is the formation of hard rock-like material derived from minerals and salts in the kidney. Kidney stones can occur along the urinary tract, from the kidneys, ureters (urinary tract carrying urine from the kidneys to the bladder), bladder, and urethra (the urinary tract that carries urine outside the body).

Kidney stones are formed from waste in the blood that forms crystals and builds up in the kidneys. Over time, the material gets harder and resembles the shape of a stone.

Kidney stone

Causes of Kidney Stone

Kidney stones are formed when urine contains more crystalline substances than fluids in urine. The formation of kidney stones can also occur when the body lacks substances that can prevent stones from sticking together. This condition is a conducive environment for the formation of kidney stones.

Some medical conditions can increase the risk of kidney stones, namely:

  • Taking a little fluid increases the risk of getting kidney stones, as does the population living in hot temperatures.
  • Carry out certain eating patterns. Eating foods that are loaded with protein, salt, or sugar increases the risk of kidney stones. This makes the kidneys work harder in filtering, thus increasing the risk of kidney stones.
  • History of kidney stones in the family or have had kidney stones before.
  • Having digestive problems or postoperative digestive organs. Chronic diarrheal disorders, inflammatory bowel disease, or post-gastrointestinal surgery for weight loss (gastric bypass) are some examples of conditions that interfere with the absorption of fluids in the body, thereby increasing the levels of substances that form stones in the blood.
  • Having a large body mass index with a large waist size is associated with an increased risk of kidney stones.
  • Have certain medical conditions, such as hyperparathyroidism or urinary tract infections.

Based on the type, kidney stones can be divided into:

  • Calcium stones. Kidney stones that are formed due to high levels of calcium in the blood are the most common types of kidney stones. Besides being produced naturally by the liver, calcium can also be obtained from food intake, such as vegetables, fruit, nuts, or chocolate. In addition to being associated with a diet that is loaded with calcium oxalate, vitamin D levels that are too high and side effects of surgery can also trigger the formation of calcium stones. Besides the consumption of migraine drugs or anticonvulsant drugs is also related to calcium stone formation.
  • Gout stone. This stone is formed due to high levels of uric acid in the blood, which is caused by foods containing high purine, lack of fluid intake, and a history of gout.
  • Struvit stone. This is a type of kidney stone that can form and expand rapidly, and the cause is a long-lasting infection, such as a urinary tract infection. Stuvite stones are more common in women than men.
  • Cystine stone. This kidney stone is the most rare type, and the cause is cystinuria. This hereditary disease makes the kidneys emit too many amino acids.

Diagnosis of Kidney Stone

In diagnosing kidney stones, the doctor will initially collect information about the symptoms experienced by the patient. The doctor will also ask if there are family members who have the same disease, daily diet, whether the patient is consuming something that can trigger the formation of kidney stones.




Then, the doctor will conduct a series of examinations, including laboratory tests in the form of urine tests and blood tests. In addition there are also various scans such as ultrasound, x-rays, and intravenous pyelogram (IVP).

A urine test is needed to check if an infection has occurred. If in the urine sample there are fragments of kidney stones, the doctor will use it to identify the type of kidney stone that is suffered so that the treatment is right.

While a blood test is needed to find out whether the kidney is still functioning normally or not, and to check the levels of certain substances that have the potential to cause kidney stones to form.

After that, the doctor will do an examination through an image that will help confirm the diagnosis and ensure the position of kidney stones accurately. Possible types of image examinations are CT scans, X-rays, ultrasound scans, and intravenous urogram (IVU) or intravenous pyelogram (IVP).

Nowadays, CT scans are the main screening option in diagnosing kidney stone because the results are more accurate than other examination methods.

Symptoms of Kidney Stone

Usually, if the size of kidney stones is very small, you will not feel any symptoms. The kidney stone will come out naturally through the ureter (the channel that connects the kidney to the bladder).

You will only feel something if the size of the stone is bigger than the ureter. When going to urinate, the stone will rub against the ureteral wall, causing irritation or even injury. This is why blood appears in urine. Stones can also clog the ureter or urethra (the end of the drainage of urine outside the body) so that urine output is blocked.

Other symptoms of kidney stones can include:

  • Prolonged lower back pain, sometimes felt up to the groin. In male patients, pain is also felt in the testis and scrotum.
  • Side abdominal pain with varying duration, ranging from minutes to hours.
  • Restless.
  • Can not lie down quietly because it is difficult to find a comfortable position.
  • Nausea.
  • More frequent urination than usual.
  • Pain when urinating.

There is blood in the urine — caused by friction in kidney stones on the kidneys or ureters. When kidney stones block the ureter there will be a buildup of bacteria that can cause kidney infection. Symptoms of kidney infection are similar to symptoms of kidney stones, but usually sufferers will also feel:

  • High fever.
  • Shivering.
  • Fatigue.
  • Diarrhea.
  • The urine color is cloudy and smells bad.

Kidney Stone Treatment

Treatment of kidney stones depends on the size of the stone. For the size of small stones that can still pass through the urinary tract, the doctor will only advise you to consume water as recommended. The hope is that the stones can come out alone along with the discharge of urine.

If the pain you feel is quite disturbing, the doctor will give painkillers, such as ibuprofen or nonsteroidal anti-inflammatory drugs. To relieve symptoms of nausea and vomiting, the doctor will give antiemetic drugs.

If kidney stones have moved from the kidney to the ureter and cause severe pain, you will be referred to hospital treatment. Generally, this is done for patients who have only one kidney, are pregnant, are dehydrated, or are over 60 years old.

If the size of the kidney stone is too large (a minimum diameter of 6-7 mm) to be released naturally, the doctor will recommend special therapy to remove it. The type of treatment depends on the size and location of kidney stones. The procedures for dealing with large kidney stones are:

  • Extracorporeal Shock Wave Lithotripsy (ESWL)

This procedure uses high frequency sound waves to destroy kidney stones into small pieces. These flakes are expected to be easily removed naturally. You will feel a little uncomfortable and after that the doctor will usually give painkillers. ESWL 99% is effective for kidney stones with a maximum diameter of 20 mm.

  • Uretheroscopy

The doctor will use a device called a uteroscope. The device will be inserted into the ureter to see the location of the blockage. After the location of the stone is known, the stone will be destroyed using another tool or with the help of a laser. You will be totally sedated when going through this procedure. Ureteroscopy is effective for kidney stones with a maximum diameter of 15 mm.

  • Percutaneous Nephrolithotomy (PCNL)

This procedure is usually done if the ESWL procedure is not possible, for example, the patient is obese. The doctor will make a small incision on the surface of the skin near the kidney, then insert a nephroscope that will destroy and remove kidney stone debris. PCNL is effective for stones 21-30 mm in diameter.

  • Open surgery.

Open surgery is a rare procedure, and usually for kidney stones that are very large or have an abnormal shape.

Complications of Kidney Stones

Complications can arise when the size of kidney stones is so large that it blocks the flow of urine. This condition can trigger permanent kidney damage, as well as infection.

On the other hand, treatment for kidney stones themselves, especially large kidney stones, can also cause complications, namely:

  • Injury to ureter
  • Bleeding
  • Infection that spreads throughout the body through blood or bacteremia.

If the patient has had kidney stones, the risk of relapse is very large. Here are the factors that trigger kidney stone recurrence:

  • Eating too many foods containing protein and consuming too little fibrous foods
  • Only has one kidney that is still functioning
  • Have experienced several infections related to the kidney or urinary tract system.
  • Has a family history of kidney stone disease
  • Have had surgery on the digestive system
  • Regularly take supplements containing calcium.
  • Taking aspirin, antacids, diuretics, anticonvulsants, and drugs for HIV.

Prevention of Kidney Stones

Kidney stones do have a recurring tendency, but prevention is very easy. You must pay attention to the following two things:

  • Water consumption according to body needs. If you consume enough water, the color of urine will look bright.
  • Pay attention to your diet. If your kidney stone is a type of calcium stone, then avoid foods that contain lots of oxalate. Oxalate will block calcium absorption. However, consult with your doctor before changing your diet.

Nevertheless, consult your doctor first before carrying out any diet, to fit our health conditions.



References

References

1. Alelign, T, Petros, B. (2018). Kidney Stone Disease: An Update on Current Concepts. Advances in Urology.

2. Urology Care Foundation (2018). Kidney Stones.

3. Stephens, C. Healthline (2018). Kidney Stones. 


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Is a health and wellness enthusiast. In him free time, she loves to travel and taste different types of teas.

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