RENAL STONES-CAUSES AND TREATMENT

The most important reasons for formation of kidney stones are not taking enough water. Kidney stones are more common in summers especially, because most of the water we consume is excreted through sweat, so urine becomes concentrated. When urine becomes concentrated, the substance like calcium, oxalate, uric acid which normally in soluble form in urine gets crystallized and lead to stone formation.

Let’s hear from Dr.KVR Prasad, what causes kidney stones? What are the symptoms? And what is the treatment for kidney stones?
BODY METABOLISM:

In some people, underlying metabolic condition like Hypercalcaemia, hyperuricaemia, hypothyroidism may get recurrent kidney stones. So, in people with recurrent renal stones metabolic evaluation plays an important role in preventing stone formation.

ROLE OF DIET:

People with uric acid stones needs to stop eating animal protein or non-vegetarian food. Those with calcium stones have to cut down milk and cheese.

SYMPTOMS:

When the stone blocks the ureter or the tube which transports which transports urine from kidney to bladder, the person can have severe pain in the loin which can radiate down to the front. Patient may have vomiting along with this pain. It’s typically called as “Renal colic”. There may be blood in the urine, pain and frequency of urination if the stone is close to the bladder. Fever indicates setting of infection in the kidney which means immediate intervention is required.

DIAGNOSIS:

Ultrasound of the abdomen will show where the stone is located in the KUB area (kidney-ureter-bladder), size of the stone and if there is any swelling of the stone-which is called hydronephrosis.

CT scan maybe required sometimes, if USG does not show a stone situated in ureter.

TREATMENT:

Medical Expulsion Therapy:

Small stones in the ureter can be flushed out by consuming more water and taking certain medication. If the stone is big or there is swelling of kidney, stone needs to be removed by endoscopy using laser energy to break the stone.

In modern Urology, it is not necessary to do open surgery to remove kidney stones.

SURGICAL TREATMENT FOR RENAL STONES

Surgery may be needed to remove a kidney stone if it:-

  • Does not pass after reasonable period of time and causes constant pain.
  • Is too large to pass on it’s own or is caught in a different place.
  • Blocks the flow of urine.
  • Causes an ongoing UTI.
  • Damages kidney tissues or causes constant bleeding.
  • Has grown larger as seen on follow up X- rays.
SURGERIES:

Ureteroscopy for kidney stones:

This procedure can be used to remove or break up (fragment) stones located in the ureter. The fragments are then passed by the patient. Ureteroscopy is performed under general or regional anesthesia on an outpatient basis.


Extracorporeal shock wave lithotripsy (ESWL):

uses highly focused impulses projected and focused from outside the body to pulverize kidney stones anywhere in the urinary system. The stone usually is reduced to sand-like granules that can be passed in the patient's urine. Large stones may require several ESWL treatments. The procedure should not generally be used for struvite stones, stones over 1 inch in diameter, or in pregnant women.


Percutaneous Nephrostolithotomy (PCN) to Treat Kidney Stones:

This surgical procedure is performed under local anesthesia and intravenous sedation. Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy) is accomplished through the most direct route to stones through the kidney.


Ureteroscopic Kidney Stone Removal:

This procedure is performed under general anesthesia to treat stones located in the middle and lower ureter. Small stones are removed and large stones are fragmented using a laser or similar device. A small tube (or stent) may be left in the ureter for a few days after treatment to promote healing and prevent blockage from fragments, swelling or spasm.