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KIDNEY STONE PDF Print E-mail
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Wednesday, 17 August 2011 10:43

KIDNEY STONES

Our kidneys and urinary tract are located in lower abdominal cavity. Both the kidneys are made of blood side and a urine side. The urine side of both the kidneys lead on to a urine collecting system of tubes which join together to form the ureters. The ureters, of both sides, join to the urinary bladder and from the bladder another tube like structure called urethra communicates to the external urethral opening. Urine is formed from the blood in the kidney and tracts through this urinary system to outside. Urine contains various chemicals and minerals like calcium, oxalate, phosphorus, uric acid and cholesterol. These chemicals sometimes precipitate and form small particles which later on grow to become large particles. These are called kidney stones (renal stones). Kidney stones are solid materials formed in the urinary tract. These stones are of various size and shapes and they may be located at any point in the urinary tract (Fig 1).  

 Why do kidney stones form?

Factors predisposing to kidney stone formation include:

  1. Decreased water intake- This leads to decrease in the urine formation and decrease flushing out of the minerals from the urinary tract. The stone forming minerals accumulate in the tract and achieve high concentrations.
  2. Infection – Infection of urine tract provides a basic nucleus over which the minerals deposit and build up into stones.
  3. Urinary tract disease- If the urinary tract is affected by other morphological diseases which alter its walls and passages it leads to stasis of urine i.e. the urinary flow become less and turbulent. This also contributes to deposition of minerals and stone formation.
  4. Diet- Diets rich in stone forming minerals may contribute to increase incidence of stones. But this is not true for all cases.
  5. Medical illness- A variety of medical illness, which have effect on various organs of body, may present as kidney stones and are often overlooked if effort are not made to diagnose them and just the stone is treated.

 I have stone. What is the treatment?

Treatment for stone disease is in two parts. One is to see whether we need to remove the stone or not and if we have to remove then by what method. Second is that why is stone forming and treat any cause which may be leading to stone formation. We need to remove stones which are causing persistent pain, blood in urine or infections, are of larger size or obstructing the urine passage.

 Stones can be removed by:

Lithotripsy – Ultrasonic waves directed towards the stone from the body surface, will break down the stones into small particles and they will come out through the urine. By this method small stone pieces and gravel are still left in the urinary tract and have to come out from the urethra.(Figure 2)

 Endoscopic surgery- A ureteroscope is passed through the urethra into the ureters through which the stone can be seen, broken by laser and removed.

 PCNL- (Percutaneous Nephrolithotomy). It is an operation done under general anesthesia in which a small tube is passed from the back directly into the kidney and an endoscope is passed through that to see the stone, break it and take it out. (Figure 3)

 Open Surgery- This, now a days, is restricted only to very specific situations and generally not needed.

Do all stones need operation?

All kidney stones do not need operation. The need for operation is decided mainly on stone size and location. Stones of less then 4mm in size generally pass out by themselves. Stones more than 7mm in size generally need operative intervention. In case of other sizes if the stone is causing problem in form of infection, bleeding in urine, pain then they should be operated upon. Otherwise they may pass out by themselves over time.

I have stone. What are warning signs to meet my Doctor?

In case you are suffering from kidney stone and your doctor has not adviced you any operative intervention to remove the stone then you should be watchful for fever, burning sensation in urine, blood in urine, severe abdomen pain needing injectable pain killers and blood test showing progressive kidney failure or active urine infection. If any of these problem is there you should meet your doctor immediately.

Do dietary changes help?

Patient’s are very curious about dietary changes in kidney disease. In general, adequate water intake (greater than 3 litre/day) and avoiding non-vegetarian diet are the two major dietary modifications which help in decreasing stone formation. Other specific dietary measures can be undertaken if there is any mineral problem in blood or urine testing. This could include high calcium in urine where we need to decrease dietary calcium by avoiding milk products and calcium supplements. There can be high uric acid in which case we need to avoid green leaf vegetables and uric acid rich products. Inspite of all dietary changes benefit may be extended only to 20-30% patients rest of the patients may not benefit from dietary changes.

 

If the stone is not causing any problems then why should we treat it?

We should understand that any stone in the urinary tract can later lead on to complications. These include obstructive nephropathy leading to kidney failure, severe urinary infections, urinary bleeding and abdominal pain. To avoid these complications a patient with kidney stone should be on regular follow up of a doctor.

 

I had stones. They have been removed but will they recur?

Commonly, once the stone is removed patient forgets about the illness and so does a doctor but we should understand that 60% of these patients will again have stones in the next 10 years. Therefore, all efforts should be directed to find out the cause of kidney stones which would include blood and urine testing, ultrasound or any other investigation suitable as per case history. By these measures stone reformation can be prevented in around 30% of patients.

            Kidney and Urinary tract stone disease is a common problem in the community, correct knowledge about the disease is important to avoid delayed treatment and associated complications. With a plethora of modern treatment modalities available to treat the condition, choice of therapy should be best left with the treating doctor.

  Fig 1. Urinary tract with stones.

 Fig 2. Lithotripsy

 Figure 3. PCNL with Laser

 

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