05-04-2021 / Kidney and Nephrology

Kidney Stone - Diagnosis and Treatment

In India, 12% of the overall population suffers from kidney stone disease, and 50% of them get subsequent renal damage. Here is some essential information on symptoms and treatment details on Kidney Stones

Kidney Stone - Diagnosis and Treatment
Mazia AhmedMazia Ahmed

Mazia Ahmed

MSc Nutrition Science, Ph.D. Scholar

Table of Content

Introduction

  • Kidney stone disease is a common medical condition occurring throughout the world. The number of patients with kidney stones in their urinary tract is continuously increasing globally. In India, 12% of the overall population suffers from kidney stone disease, and 50% of them get subsequent renal damage. Common areas with most of these cases in India include Madhya Pradesh, Haryana, Punjab, Delhi, West Bengal, and Bihar.

  • The kidney is an essential organ in the human body which performs multiple health activities. It is responsible for maintaining an accurate percentage of fluids in the body and removing waste materials. Thus, keeping this organ in good health is crucial; however, multiple lifestyle choices cause kidney stones.

  • The given graph shows the state-centric concentration of kidney stone cases in India. Statistically, around 15% of the North Indians are prone to this condition than South Indian citizens. 

Percentage of Kidney stones patient India
  • To know how to prevent urinary stone growth or reoccurrence, it is crucial to understand the cause. This article details data about kidney stones, the common symptoms, and treatment plans. 

What are kidney stones?

  • Kidney stones are hardened salt and mineral deposits inside the kidney. Other names include renal calculi, urolithiasis, or nephrolithiasis. The stones can originate anywhere in the urinary tract, i.e., the bladder or the kidney. Common causes include particular medical conditions, obesity, certain dietary choices, and usage of some medications and supplements. The urine concentration in one area results in crystallization and accumulation of minerals into stones. 

  • Kidney stones passing through the system are uncomfortable and can often cause severe kidney stone pain. The latter is a leading symptom of kidney stone disease; 5% of this condition reports renal pain as the prime diagnosis sign. 

  • However, quicker diagnosis and medication would relieve you from any lasting damage. Generally, a patient with KSD should drink high quantities of water and particular prescribed medicines. In case the affected person has a urinary infection, lodged stones inside the urinary tract, or other complications, doctors can prescribe a surgical procedure.

How are Kidney stones formed?

  • Multiple waste materials are present in the urine. A high concentration of crystal-forming substances like uric acid and calcium can trigger the formation of crystals. Usually, the fluid present in the urine dilutes these substances. The crystals that do not pass through start forming a harder mass by joining with other elements. 

  • This process is known as crystal aggregation, and reports show that all CaOx urolithiasis models agree that this process causes crystal retention inside the kidneys. In healthy bodies, the kidney's liquid washes the crystals and chemicals out of the system via urine before stones form. 

  • Other natural stone-forming chemicals include cystine, phosphate, oxalate, and xanthine. The average size of these stones is six or lower millimeters, and the common types of kidney stones include uric acid, calcium, cystine, and struvite. After completing their development, the stones transfer to the ureter via the urinary tract or remain in the kidney. 

Kidney Stone Infographic for India

7 Risk Factors of Kidney Stones

Often, there are no absolute kidney stones causes. Particular risk factors do increase the likelihood of getting this condition. The factors include:

1. Dehydration

Patients are at a higher risk of kidney stone disease if they do not consume enough water quantity every day. The climate in India is comparatively dry and warm in particular areas. The inhabitants of these regions have a higher risk of kidney stone disease. One 2015-2016 hospital-based study in Ujjain, India, showed 70% of participating children having severe dehydration symptoms. Plus, people with a high sweating predisposition are also at a higher risk. 

2. History of KSD in the family

Having kidney stone patients in a family increases the possibility of this disease appearing in other direct relatives. Also, patients who previously developed kidney stones can get this condition again. 

3. Weight gain

Another risk factor for kidney stones is having a high BMI count, sudden weight gain, or a broader waist size.

4. Dietary changes

Some Indian diet options are common causes of kidney stones in the region. Indian diet generally consists of high amounts of sodium (salt), protein, calcium, and oxalate-rich food. Calcium constitutes 80-90% of the urinary stone content; people with high calcium consumption are at higher risk. Also, an increase in sugar consumption can develop stones in the kidneys. 

5. Digestion issues/surgery

Conditions like chronic diarrhea and inflammatory bowel disease can change the natural digestive process. Also, prior surgeries like gastric bypass surgery enhance the water and calcium absorption ratio in people. 

6. Specific medications and supplements

These include dietary supplements, vitamin-C supplements, calcium-based antacids, excessive laxative usage, and medications for depression/migraine (particular options).

7. Pre-existing medical conditions

Patients with conditions like cystinuria, renal tubular acidosis, urinary tract infections (multiple), and hyperparathyroidism have higher odds of getting kidney stones. 

11 Symptoms of Kidney Stones

The size of the kidney stones can influence the symptoms in the affected person. Particular stones are minuscule, and others are pebble-sized. Rare cases involve golf-ball-sized stones. The smallest types barely show any symptoms, and the biggest ones are very noticeable. 

The first signs of kidney stones appear when the particles transport to the uterus or move inside the kidney. Blockage in the ureters causes urine flow blockage, which inflates the kidney. The ureter spasms induce the pain. Reports show that the severe pain symptom (renal colic) affects approximately 3-5% of females and 10-20% of males.

Kidney Stones Infographic

The common signs of kidney stones in the early stages include the following:

1. Pain originating in the groin and lower abdomen region 

2. Sharp, sudden pain in the back and the sides, mainly under the ribs

3. Pain that comes in surges, and the intensity shifts continuously

4. A burning feeling or pain during urination 

5. Foul smell in the urine 

6 Cloudy appearance of urine 

7 Brown, red, or pink urine color

8. Vomiting or nausea 

9. Small spurts of urination  

10. Frequent or persistent urge to urinate 

11. In cases of infections, patients may experience chills and fever 

The position and intensity of the pain wave as the stones move through the internal system. 

Particular symptoms imply that the condition is severe and requires professional medical attention. It is essential to make a doctor's appointment in case the following signs appear:

  • Pain as well as chills and fever symptoms 

  • Pain as well as frequent vomiting and nausea 

  • Highly intense pain or discomfort; the patient finds it difficult to sit in a straight position. 

  • The patient cannot pass urine 

  • Blood deposits in the urine 

Seek quick medical counsel if the signs increase in intensity and quantity. 

Diagnosis of Kidney Stones

For diagnosis, specialized and general physicians would order a blood test, urine test, CT scan, or X-ray. For severe cases, multiple tests are applicable. 

To note, the CT scan may include contrast dye usage. Patients with an issue with this component must inform the doctor beforehand for accurate preventive measures. Doctors usually conduct the evaluation and tests at the clinic. However, most treatments occur in the patients' homes or at the operating theatre. 

Depending on the test results, the health professionals prescribe the appropriate treatment.

Kidney Stone Ultrasound

4 Medical Treatments of Kidney Stones

Doctors prescribe similar treatment plans for both younger and older patients with kidney stones. Statistically, most cases of this condition among Indians occur in the 30-50 year age bracket.

The conditions that determine the treatment plan include:

  • Size of the kidney stone 

  • The composition of the stone 

  • If the stone is causing a blockage in the urinary tract 

  • Symptom of pain (intensity)

Here are the common medical treatments: 

1. Lifestyle changes

Small kidney stones do not require complex medical treatment plans. Doctors generally prescribe particular pain medications and suggest lifestyle changes like regular exercise. Also, professionals recommend increasing water consumption; the fluid supports easier removal of kidney stones through the bladder. 

2. Shock wave therapy

During shock wave therapy or shock wave lithotripsy, sound waves break down the kidney stones. Here, sound waves are applied from the outside of the patient's body around the affected region. While the stones pass, the waves break them down into tiny pieces.  Later, the smaller pieces travel out of the body with urine. The approximate duration of this treatment lasts between 45 to 60 minutes. Also, patients are put under general anesthesia during the procedure. For most patients, this treatment method is painless and quick. 

3. Percutaneous surgery

Doctors perform percutaneous surgery if the kidney stone's size is more than 1.5 centimeters or has a hard consistency. This is an additional surgery after initial surgical treatment. Here, the doctor makes a small incision in the patient's back and puts a tube to reach the kidney. Then, the doctor surgically breaks the stones into small fragments and removes them through the attached tube. Afterward, they keep a stent in place to hold the channel open. 

4. Ureteroscopy 

Doctors put the patient under general anesthesia in the operating room. They use a scope to view inside the ureter and use a laser fiber to break the kidney stone pieces. Then, the specialists take each piece out of the body. 

The general time limit for this procedure lasts between 20 minutes to multiple hours based on the number of stones present inside. During post-surgery, a stent is put in place so that the ureter does not close. It remains for 3-10 days, and the remaining pieces pass out throughout this period. 

After these treatments for kidney stones, professionals work on another ultrasound or X-ray diagnosis after 30 days. This confirms if the kidney stones are completely gone or the patient requires additional medical care. 

Word of Wisdom

Overall, kidney stones are common in a lot of Indians. Professionals prescribe treatments based on the diagnosis of the stone size and the health condition of the patient. While there are no preventive medications available, keeping aware of the risk factors can decrease our kidney stones chance. 

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