Overview
The primary symptom of kidney stones is severe pain in the lower back, abdomen, or side, often radiating and intensifying in waves. Sometimes kidney stones may cause repeated urinary tract infections also.
What are Kidney Stones?
Kidney stones are solid masses or crystals that form from substances like minerals, acids, and salts in your kidneys. They vary in size from a grain of sand to, in rare cases, as large as a golf ball. Known as renal calculi or nephrolithiasis, these stones can sometimes go unnoticed if small. However, larger stones can obstruct the ureter, causing urine to back up, leading to kidney pain, functional impairment and potential bleeding.
While small stones can pass naturally over two to three weeks, this process can be extremely painful. If a stone is too large to pass, medical intervention may be necessary to break it up or remove it.
How Common are Kidney Stones?
Approximately 12% people will develop a kidney stone during their lifetime. The highest prevalence is among individuals assigned male at birth in their 30s and 40s. This incidence rises to 15 % in North India.
Symptoms and Causes
What are the Symptoms of Kidney Stones?
The most common symptom is intense pain in the lower back, abdomen, or side, which may extend from the groin to the side. This pain can be dull or sharp, often worsening in waves (colicky pain). Other symptoms include:
- Nausea and vomiting
- Bloody urine
- Pain during urination
- Difficulty urinating
- Frequent urge to urinate
- Fever or chills
- Cloudy or foul-smelling urine
Smaller stones may not cause noticeable symptoms.
What Causes Kidney Stones?
Kidney stones form when your urine contains high concentrations of minerals, acids, and other substances like calcium, sodium, oxalate, and uric acid, combined with insufficient fluid. These substances can crystallize over time, forming stones.
Types of Kidney Stones
Kidney stones are categorized by their crystal composition:
- Calcium-Oxalate and Calcium Phosphate Stones: Formed from diets high in oxalate or low in calcium and inadequate fluid intake. Calcium-oxalate stones are the most common type.
- Uric Acid Stones: Result from high consumption of animal proteins like beef, poultry, pork, eggs, and fish.
- Struvite Stones: Caused by bacterial infections, potentially leading to large staghorn calculi that typically require surgical removal.
- Cystine Stones: Result from the genetic disorder cystinuria, leading to cystine buildup.
Risk Factors for Kidney Stones
Increased risk factors include:
- Inadequate fluid intake
- High-protein diet
- High-sodium or high-sugar foods
- Vitamin C supplements
- Family history of kidney stones
- Urinary tract blockages
- Stomach or intestine surgeries, including gastric bypass
- Certain medications, such as diuretics, calcium-based antacids, and antiseizure drugs
- Specific medical conditions
Medical Conditions Increasing Kidney Stone Risk
Conditions that elevate risk include:
- Cystic fibrosis
- Cystinuria
- Diabetes
- Gout
- High blood pressure
- Hypercalciuria
- Inflammatory bowel disease (IBD)
- Kidney cysts
- Obesity
- Osteoporosis
- Parathyroid disease
- Primary hyperoxaluria
- Hemiplegia or paraplegia
Complications of Kidney Stones
Kidney stones can lead to:
- Hydronephrosis (kidney swelling due to urine backup)
- Kidney infection (pyelonephritis)
- Acute kidney injury, derangement in kidney function
- Frequent urinary tract infections (UTIs)
- Chronic kidney disease (CKD), Kidney failure
Diagnosis and Tests
How are Kidney Stones Diagnosed?
Diagnosis involves imaging, blood, and urine tests:
- Urine Test: Detects blood, crystals, and infection signs.
- Imaging: X-rays, CT scans, and ultrasound visualize the size, shape, location, and number of stones.
- Blood Tests: Assess kidney function, detect infections, and check for high calcium levels or other conditions that may lead to stone formation.
Management and Treatment
Kidney Stone Treatment Options
For small stones likely to pass naturally, monitoring symptoms and prescribing medications can facilitate passage. Larger stones or those causing complications require treatment, which may include:
- Medications: To relax the ureter, manage nausea and vomiting, and relieve pain.
- Shockwave Lithotripsy: Uses shockwaves to break stones into smaller pieces.
- Ureteroscopy: Inserting a scope through the urethra to break up and remove stones.
- Percutaneous Nephrolithotomy: Inserting a tube directly into the kidney to break up and remove stones.
- Laparoscopic Surgery: Making a small incision to remove the stone, sometimes requiring open surgery.
Prevention
Can Kidney Stones be Prevented?
Diet and hydration play a crucial role in preventing kidney stones. Recommendations include:
- Drinking plenty of liquids. Try to maintain a urine output of 2 litres per day, if you are an adult.
- Limiting animal proteins.
- Reducing intake of high-sugar and high-sodium foods
- Avoiding high-oxalate foods if prone to calcium oxalate stones
- Maintaining a healthy weight
- Consuming foods high in calcium (but not supplements)
- Using prescription medications if dietary changes are insufficient
Outlook / Prognosis
What Can you expect if you have Kidney Stones?
Most small stones (under 6 mm) pass on their own, while larger stones may require procedures. Those who have had kidney stones are likely to develop them again, necessitating preventive measures.
Living with Kidney Stones
Kidney stones shouldn’t drastically affect your daily life. Treatment options ensure they are not a permanent problem. However, having kidney stones increases the risk of chronic kidney disease.
When to See a Urologist
Seek medical attention if you experience symptoms of kidney stones. Emergency care is needed for unbearable pain. Questions for your urologist may include:
- Do I have a kidney stone?
- What type and size is it?
- How many stones do I have?
- Do I need treatment or will it pass naturally?
- Should I be tested for kidney disease?
- What dietary changes should I make?
- What procedures are available?
Kidney stones are an unfortunate reality in today’s times. But it does not mean a death sentence. It just needs you to stay alert, adopt good dietary practices and lifestyle changes, that would render the chances of repeated stones, very minimal.