Kidney stones have been afflicting humans since the time of the Egyptian pharaohs. They have been found in a 7,000-year-old mummy. Kidney stones are the most painful of the urologic disorders and one of the most common diseases of the urinary tract. Patients who complain of kidney stone problems to their doctor number in millions every year. Hundreds of thousands, on the other hand, are sent to the emergency rooms. More men than women tend to get affected.
Most of the time kidney stones pass out of the body without medical intervention. There are also nonsurgical techniques available for stones that cause lasting symptoms or other complications. The many factors that affect stone formation have been the focus of many studies to better understand this disease.
Urinary System 101
The urinary system is made up of the kidneys, ureters, bladder, and urethra.
The kidneys, which are bean-shaped organs found below the ribs and toward the middle of the back, convert extra water and wastes from the blood into urine. The balance of salts and other substances in the blood are kept stable by the kidneys. They also produce hormones that help in bone formation and red blood cell formation.
Urine from the kidneys is carried by the ureters, which are narrow tubes, to the bladder, an oval-shaped chamber. The bladder has elastic walls which stretch and expand to store urine. The walls flatten when urine is emptied through the urethra.
Kidney Stone
Crystals sometimes form and build up on the inner surfaces of the kidney. These develop into a hard mass, the kidney stone. The urine normally has chemicals that inhibit the formation of crystals. When these inhibitors fail, stones are formed. The crystals may be small enough to travel through the urinary tract and out of the body in the urine without causing harm.
The chemicals in the stone determine its type. The most common contains calcium combined with either oxalate or phosphate. These chemicals can also be found in bones and muscles and are a part of a person’s normal diet.
The other type is less common and is caused by urinary tract infection. It’s called a struvite or infection stone. Less common types of stone are the uric acid stone and the rarer cystine stones.
The occurrence of stones in the urinary tract is called urolithiasis. It is also known as urinary tract disease or nephrolithiasis. The location of the stone in the urinary tract also determines the type of stone. In the ureter, the stone is called the ureteral stone (ureterolithiasis). The term “kidney stones” is used to refer to any type to simplify things.
Gall stones, which form in a different area of the body, are different and do not lead to the development of kidney stones.
Who are susceptible?
In the US, the number of people with kidney stones has been increasing over the past 30 years. Between White Americans and African Americans, the latter are more prone to develop kidney stones. More men than women are infected. As men get older, the prevalence of kidney stones also increases. For men, the increase in prevalence starts in their 40s. For women, it peaks in their 50s. A person with more than one stone is very likely to develop more.
What Causes Kidney Stones?
There is no known specific cause of stone formation. Eating certain foods does not cause stones to form in people who are not susceptible, but these foods may promote formation in people who are susceptible.
Stone formation have also been linked to a heredity, urinary tract infections, kidney disorder, and some metabolic disorders like hyperparathyroidism. A rare hereditary disease called renal tubular acidosis is also a culprit.
There are other conditions and inherited metabolic disorders that cause kidney stones.
* Cystinuria causes too much of the amino acid cystine in the urine. Cystine does not dissolve in the urine and forms stones made of cystine.
* Hyperoxaluria is the production of too much of the salt oxalate. Too much oxalate than can be dissolved in the urine also forms stones.
* Hypercalciuria occurs when too much calcium is absorbed from food and is lost into the urine. Crystals of calcium oxalate or calcium phosphate then form in the kidneys or urinary tract.
* Hyperuricosuria which is a disorder of uric acid metabolism.
* Gout
* Too much Vitamin D
* Certain diuretics which are calcium-based antacids increases the amount of calcium in the urine, which risks stone formation.
* People with chronic bowel inflammation or who have had intestinal bypass operation are likely to develop calcium oxalate stones.
* People with HIV who take the protease inhibitor indinavir also risk stone formation.
Kidney Stones Symptoms
* A sharp, cramping pain in the area of the kidney (the back and side) or in the lower abdomen. This occurs when a stone moves in the urinary tract which causes irritation and blocks the flow of urine.
* Nausea and vomiting.
* The pain spreads to the groin area.
* Blood in the urine. If the stone is too large to pass in the urine, the ureter tries to squeeze it into the bladder.
* The need to urinate more often or a burning sensation during urination. This occurs as the stone moves down the ureter closer to and pressing into the bladder.
* Fever and chills. In this case, see a doctor right away.
Diagnosis
* Asymptomatic stones or silent stones are sometimes detected on x-rays taken during a routine medical exam.
* An x-ray or sonogram can detect kidney stones in someone who complains of blood in the urine or pain like the ones described above. Size and location of the stone can also be determined.
* Blood and urine tests can detect abnormal substances that contribute to stone formation.
* A scan of the urinary system using a CT (computer tomography) scan or IVP (intravenous pyelogram).
Treatment For Kidney Stones
If the stones are small enough, two to three quarts of water a day can help the stones pass through the urinary system. This can be done at home. Pain medication can be taken if needed. The stones can be collected for testing by catching it in a cup or strainer.
Kidney Stones Prevention
Prevention is important especially if you’ve already had more than one kidney stone. The cause of the formation should be determined by your doctor. Laboratory tests will be done and information about your medical history, occupation, and eating habits taken. Lab tests should be done on stones that have been removed or passed to determine their composition and plan proper treatment.
To determine the cause of the stone, urine examination should also be done 24 hours after you’ve passed a stone. The urine should be tested for the volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and, creatinine. To determine if the treatment is working, another urine exam may be needed 48 hours after passing the stone.
Change Your Lifestyle
* Drink plenty of fluids, especially water. If you are susceptible, you should drink enough fluids to produce at least 2 quarts of urine in one day.
* With calcium stones, studies have shown that intake of calcium-rich foods may help prevent stone formation. Calcium supplements (pills) are more risky.
* If you are susceptible, try to avoid food with added Vitamin D and antacids that have a calcium base.
* If your urine is acidic, eat less meat, fish, and poultry.
* For cystine stones, drinking more than a gallon of water every 24 hours may be needed to dilute the cystine concentration in the urine. A third of this should be drunk at night.
* People with excess calcium oxalate in their urine should cut back on the following: beets, chocolate, coffee, cola, nuts, rhubarb, spinach, strawberries, tea, wheat bran.
Always talk to your doctor first. These foods do not have to be completely avoided but only eaten in limited amounts.
Kidney Stones Therapy
Conventional Medicine
* Medications may be prescribed to control the amount of acid or alkali in the urine and prevent calcium and uric acid stones.
* Diuretics are prescribed to prevent calcium stones. The calcium is retained in the bones instead of being released into the urine. Sodium intake should be low for this to be effective.
* The drug sodium cellulose phosphate also prevents calcium stones by binding calcium in the intestines and prevents it from leaking into the urine.
* The amount of cystine in the urine can be reduced by drugs like Thiola and Cuprimine.
* If struvite stones have been removed, the urine should be kept free of bacteria to avoid infection. The urine should be tested regularly.
* For struvite stones that cannot be removed, AHA (acetohydroxamic acid) used with antibiotics can prevent infection.
* Hyperparathyroidism increases the risk of calcium stone formation. Surgical removal of the parathyroid glands cures the patient’s problem and removes the risk.
Natural Remedies
Natural and holistic approach can also help the stones formation and reduce the pain associated with the symptoms of kidney stones. Natural kidney stones treatment addresses the overall needs of the individual’s well being, and with no harmful side effects.
Recommended natural remedies:
* BladderWell – Homeopathic remedy that relieves burning sensations, frequent urination and improves bladder health.
* UTI-Clear – Supports bladder and urinary tract functioning, plus complete urinary system health.
* UTI-Tonic – Homeopathic remedy temporarily relieves bladder irritation, urinary burning and frequent urination.
Surgery
Surgical removal of the kidney stone should be done for these conditions:
* The stone does not pass after a reasonable period of time and causes constant pain.
* The stone is too large to pass or is trapped.
* The stone is blocking urine flow.
* The stone is causing infection.
* The stone is damaging the kidney or is causing bleeding.
* The stone has grown larger.
Nonsurgical treatment options:
* Extracorporeal Shockwave Lithotripsy (ESWL)
With this procedure, shockwaves are generated, travel through the skin and tissues, and break down the stones into sand-like particles that can be easily passed in the urine. Complications from this procedure include: bloody urine, bruising and minor discomfort in the back or abdomen, or discomfort while the shattered stone particles pass through the urinary tract. ESWL is not recommended for very large stones.
* Percutaneous Nephrolithotomy
This procedure is recommended when a stone is too large or is in a difficult location for ESWL. With this procedure, an incision is made in the back and a nephroscope is inserted directly into the kidney to remove the stone. Large stones may be broken into smaller pieces by an energy probe before they can be taken out.
* Ureteroscopic Stone Removal
This procedure is for stones that are located in the middle and lower part of the ureter. A ureteroscope is inserted through the urethra and bladder into the ureter, and the surgeon locates the stone. It is then either removed or broken into smaller pieces first with an instrument that produces shock wave.
Continuing Kidney Stones Research
The treatment of kidney stones have been greatly improved by new drugs and the growing field of lithotripsy. But a lot of questions still need answers and drugs with fewer side effects developed.
Important Points to Remember:
* Heredity and a pre-existing condition increase risk of developing more stones.
* Drink plenty of liquids.
* Blood and urine tests are important to reduce risk of stone formation in susceptible people.
* People with other health conditions that make them susceptible will need to take additional medication to prevent stone formation.
* If stones are causing infection, these should be removed immediately and regular follow up is important to avoid re-infection.
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