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Kidney stones or renal calculi are hard stone-like structures that get formed in the kidneys due to the accumulation of certain minerals that are otherwise excreted through the urine.
The kidney stones may vary in,
• Number: can be single or numerous
• Size: can be few millimeters in size to several centimeters
• Surface: smooth or rough & sharp
The kidney stone usually does not cause any symptoms until it obstructs the drainage pathway of urine. This happens when the stone passes down from the kidney to the urinary outlet (urethra) and tries to come out via urine.
Many a times the stone may be small enough (few millimeters in size) to cause no symptoms or minimal symptoms when it passes down. It may be large enough (several millimeters to centimeters in size) to cause a complete or partial obstruction in the flow of urine. This in turn may lead to the development of backpressure, pain, and other symptoms.
A pain that is located in the loin region (ie pain localized on the back on one side) could indicate a pain caused by an obstructed stone especially if a person has personal or family history of kidney stones.
Some of the stones may cause obstruction for a long time (often several years) leading to a condition called obstructive nephropathy where the kidney becomes less or non-functioning. This is a permanent condition that can’t be treated. However, acute obstruction of stone can be treated medically or surgically.
Kidney stones are quite a common problem which affects about 12% of the world population at some stage of their life. It is the commonest disease of the urinary tract which affects all ages, sexes, and races.
It is problem that has been dated as old as 4000 B.C. and has been on rise in last decades.
The rise in cases of kidney stone has been attributed to the lifestyle changes of modern times with
• Lack of physical activity
• Changes in dietary habits such as high sodium and animal protein, high packaged food consumption
• Global warming
In India, about 12% of the population is expected to develop kidney stones and about half of them are expected to lose functioning of the kidneys.
The chances of developing kidney stones is higher in northern states of India where about 15% people are expected to develop them.
The following states are considered to part of the stone belt in India where people are more prone to develop kidney stones.
• Personal history: a person with a history of kidney stones is more prone to develop stones again in life. It is estimated that if a person doesn’t take precautions he has a tendency to form stones again with a likelihood of 10–23% per year, 50% in 5–10 years, and 75% in 20 years.
• Family history: a person is 2 times more likely to develop kidney stones if any family member has a history of kidney stones.
• Sex: men are about 2 times more likely to develop kidney stones than women.
• Lack of fluids: lack of water/fluid tends (less than 1 L/day) to precipitate accumulation of minerals leading to the formation of stones. It also tends to make the urine more acidic which can further lead to the formation of stones. People who live in warm areas or people who sweat a lot are considered to be more prone to develop stones due to reduced levels of fluids.
• Dietary factors: diet rich in the following contents make a person more prone to develop kidney stones:
– High salt (sodium) in food items such as processed and packaged food and others. This occurs due to increased exertion of calcium in the urine.
– High sugar content as seen in soft drinks.
– High animal protein such as beef, chicken, pork, eggs, fish, and others. These food items have high sulfur content which makes the urine more acidic, increases excretion of calcium, and oxalate in urine resulting in stone formation.
– Low calcium in diet causes increased oxalate absorption in the gut and excretion in urine, predisposing to the formation of calcium oxalate stones.
– Calcium and vitamin D, intake in the form of supplements can increase the risk of calcium stone disease.
• Certain diseases and conditions: repeated UTIs, horseshoe kidneys, renal tubular acidosis, cystinuria, diabetes mellitus, gout, hyperparathyroidism, hypercalciuria, hyperoxaluria, chronic diarrhea, IBD, gastric bypass surgery and others.
• Some medicines: tends to increase chances of the stone formation such as
– Diuretics medicines are taken to increase urine formation, which help rid your body of water
– Antacids which are calcium-based
– Topiramate taken for seizures
Following signs and symptoms may indicate you have a kidney stone:
• Pain: sharp shooting pain in the back on one side, lower abdomen, or groin region. Pain may come in waves increasing decreasing cyclically called renal colic pain. Pain may change in intensity and location as it moves through the urinary tract.
• Blood in urine (hematuria): urine may appear pink, red, or brown in color due to the presence of blood
• Dysuria: discomfort or pain felt while urinating
• Increased frequency and urge to urinate. This along with dysuria may occur when the stone has reached in the lower ureter.
• Inability to pass urine or pass only a small amount of urine
• Bad smelling or cloudy urine
• Associated symptoms: along with pain there may be accompanying symptoms such as nausea, vomiting, and sometimes fever. Individually, without pain, these symptoms don’t indicate kidney stones.
You must consult a doctor immediately in case of any of the above symptoms. These symptoms usually direct towards a kidney stone or any other significant problem.
Health care professionals may use lab or imaging tests to diagnose kidney stones.
These tests check for abnormality in urine which may indicate the presence of blood, infection, or stone forming minerals.
The treatment of kidney stones depends upon the size, location, and associated symptoms.
Small to medium sized stones are generally managed with conservative treatments such as pain killers, increased water intake and medicines, etc.
Large-sized stone or stones are generally treated with procedures like Extracorporeal shock wave lithotripsy (ESWL), Cystoscopy and ureteroscopy and Percutaneous nephrolithotomy (PCNL).
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