Also known as Nephrolihiasis or Renal Lithiasis, Kidney Stones are small & hard mineral deposits which form inside kidneys. Generally made up of minerals & acid salts, development of kidney stones have several causes & can affect any portion of the urinary tract, from kidneys to the bladder. Kidney stones are often formed when urine becomes concentrated, thereby allowing minerals to crystallize & stick together. Nevertheless, passing kidney stones can be very painful, but they usually cause no permanent damage. However, depending upon the situation, many kidney stone patients need do nothing more than take prescribed pain medications & consume plenty of water to pass these stones. In other cases where surgery may be needed when stones are lodged within the urinary tract & cause complications. Urologists often recommend preventive treatment for kidney stones so as to reduce risk of recurrent kidney stones for patients who are at an increased risk of developing them once again.
Signs & Symptoms of Kidney Stones
Kidney stones usually do not cause any symptoms until they move around within kidneys or pass into the ureter tube connecting the bladder with kidneys. Patients may experience the following symptoms at this point of time.
- Severe pain in back & side below the ribs.
- Pain on urination.
- Pain which comes in waves with fluctuating intensity.
- Pain which spreads into groin & lower abdomen.
- Urine is pink, red or brown in color.
- Foul-smelling or cloudy urine.
- Small amounts of urine.
- Urinating more often than normal.
- Persisting need to urinate.
- Nausea & vomiting.
- Fever & chills when infection is present.
Pain caused by kidney stones may change. Quite often pain may shift to another location or increase in intensity as they move along the urinary tract.
Seek an Appointment with Doctor
It is recommended that patients seek an appointment with the doctor if they experience any worrying signs & symptoms. Immediate medical attention may also be required when patients experience the following conditions.
- Severe pain when patients cannot sit still or find any comfortable position.
- Pain accompanied by vomiting & nausea.
- Pain accompanied by chills & fever.
- Appearance of blood in urine.
- Difficulty in passing urine.
Causes of Kidney Stones
Kidney stones do not have any definite or single cause to develop, although several factors may come together to increase risk of its formation. Kidney stones are usually formed when urine contains more crystal-forming substances like oxalate, calcium & uric acid than the amount of fluid in urine which can effectively dilute presence of these minerals. Urine may at the same time lack substances which prevent crystals from sticking together & thereby creating an environment which is conducive for kidney stone formation.
Types of Kidney Stones
Knowing which type of kidney stone has formed will help determine the underlying cause & provide clues on how best to reduce risk of developing more kidney stones. Some types of kidney stones are listed below.
- Calcium Kidney Stones – Most cases of kidney stones are calcium stones & are usually in the form of calcium oxalate, where oxalate is a naturally occurring substance commonly found in food. Quite a few products including vegetables, fruits, chocolates & nuts in fact have high levels of oxalate. Our liver is also found to produce oxalate. Many dietary factors including high dosage of vitamin D & several metabolic disorders & intestinal bypass surgery eventually increase concentrations of oxalate or calcium in urine. Some calcium stones also occur as calcium phosphate in kidney stone patients.
- Struvite Kidney Stones – These are formed in response to infections pertaining to the urinary tract. Struvite kidney stones can grow very quickly & quite large & sometimes with fewer symptoms or little warning.
- Uric Acid Kidney Stones – These kidney stones are generally formed among people who do not consume enough liquids, or those who lose more fluid, or eat high-protein diet, or those who are having gout. Certain genetic factors may also be responsible & may increase risk of individuals developing uric acid kidney stones.
- Cystine Kidney Stones – This type of kidney stone is usually formed among people with a hereditary disorder causing kidneys to excrete more of certain amino acids like cystinuria.
- Other Kidney Stones – This includes many other rare types of kidney stones which can also occur in patients.
Risk Factors for Kidney Stones
Factors which increase risk of developing kidney stones include the following.
- Dehydration – People who do not drink enough water each day are at increased risk of developing kidney stones. Especially those people who are living in warm climates & those who sweat a lot are at higher risk of developing kidney stones than others.
- Certain Diets – Consuming diets which are rich in sodium, protein & sugar may also increase risk of people developing some types of kidney stones. This is particularly true with individuals consuming high-sodium diets. Large quantities of sodium in diet are found to increase amount of calcium, which kidneys must effectively filter. This will however significantly increase risk of developing kidney stones.
- Personal or Family History – In case someone in the family is having kidney stones, others too are at risk of developing stones. And for such people who already have one or more kidney stones, they are at increased risk of developing another.
- Being Obese – High BMI (Body Mass Index) including large waist size & weight gain have also been linked to people having increased risk of developing kidney stones.
- Digestive Disease & Gastric Surgery – Chronic diarrhea, inflammatory bowel disease & people who have undergone gastric bypass surgery are most likely to experience changes in digestive process which invariably affect absorption of water & calcium. As a result it will result in increasing levels of stone-forming substances within urine.
- Other Medical Conditions – Some diseases & conditions like hyperparathyroidism, cystinuria, renal tubular acidosis, certain medications & some urinary tract infections increase risk of developing kidney stones.
Initial Appointment for Kidney Stone Treatment
Small kidney stones which do not block kidneys or cause any problem can be generally treated by the family doctor. But when patients have large kidney stones & often experience severe pain or kidney problems must Book an appointment with a urinary tract specialist which is either a urologist or nephrologist.
Preparing for the Initial Appointment
- Patients can check if there is anything they need to do prior to appointment, like limiting diet.
- Jot down symptoms including those which seem unrelated to presence of kidney stones.
- Keep account of the quantity of fluid intake & urine during the last 24 hour period.
- List all medications currently used, including vitamins & supplements.
- Another family member or friend accompanying for initial appointment will be helpful in remembering all that was discussed with the doctor.
- Make a list of questions to ask the doctor.
Basic Questions Which Patients Ask Doctors on Kidney Stones
- Am I having kidney stones?
- What is the size of my kidney stone?
- Where is my kidney stone located?
- What kind of kidney stone do I have?
- Do I need medication to treat my kidney stone?
- Do I need surgery or any other procedure to treat my kidney stone?
- What are my chances of developing another kidney stone?
- How can I prevent formation of kidney stones in future?
- How can I best mange other health conditions together with my kidney stones?
- Do I have to follow any restrictions?
- Should I see any specialist?
- Are there any generic alternatives to medications you are prescribing/
- Can you provide me with any printed educational material on kidney stones?
- What websites would you recommend I refer to?
- Do I need to schedule any follow-up visits?
Never hesitate to ask any other questions to doctors as they occur during initial appointment.
Doctors Normally Ask the Following Questions to Patients
- When did you first notice these symptoms?
- Have these symptoms been occasional or continuous?
- How severe are these symptoms?
- What is there, if anything, that seems to improve symptoms?
- What is there, if anything, which appears to worsen symptoms?
- Did anyone in the family ever have had kidney stones?
Tests & Diagnosis for Kidney Stones
Patients suspected of having kidney stones must prepare to undergo the following diagnostic tests & procedures.
- Urine Testing – A 24 hour urine collection test is required to show that patient is excreting too many stone forming minerals or very little stone preventing substances. For this purpose doctors often suggest patients perform 2 urine collection sessions spread over 2 consecutive days.
- Blood Testing – Blood tests can also reveal if too much uric acid or calcium is in the patient’s blood. Blood test results can also help monitor health of kidneys & effectively lead doctors to look for other medical conditions.
- Imaging Tests – A variety of imaging tests can effectively show presence of kidney stones within the patient’s urinary tract. Wide range of imaging tests options include, simple abdominal X-rays that can miss smaller kidney stones to dual energy or high-speed CT (Computerized Tomography) scans which can reveal the tiniest kidney stone. Other available imaging options include ultrasound which is a noninvasive procedure & intravenous urography involving injecting dye into vein in arm & subsequently obtaining CT Urogram images or Intravenous Pyelogram X-rays as dye travels through kidneys & bladder.
- Analysis of Stones Passed – Patients may be asked to urinate through a strainer for this test in order to catch kidney stones which they pass. Lab analysis can later reveal the make-up of these kidney stones. Doctors will subsequently use this information in order to determine the cause of kidney stones & to format a treatment plan so as to prevent development of more kidney stones.
Treatment Procedures for Kidney Stones
Treatments for kidney stones vary & normally depend upon the type & cause of stone. Small stones with minimal symptoms will not require any invasive treatment. Small stones can be easily passed by taking the following steps.
- Drinking Water – Drinking plenty of water, as much as 1.9 – 2.8 liters (2 – 3 quarts) every day may effectively help flush-out the urinary system. Drink large amounts of fluid, mostly water so as to produce clear or nearly-clear urine. Pay heed when the doctor tells otherwise.
- Pain Relievers – Sometimes, passing a small stone may also cause discomfort. Doctors may in such situations prescribe pain relievers like naproxen sodium, acetaminophen or ibuprofen so as to ease mild pain.
- Medical Therapy – Doctors may also prescribe medications so as to help pass kidney stones. These types of medications are commonly known as alpha blockers & which relax muscles in the ureter. This will eventually help patients pass kidney stones more quickly & with lesser pain.
Large Stones with Specific Symptoms
Most large kidney stones cannot be treated with conservative measures. They are either too large to pass on their own or they are prone to cause kidney damage, bleeding or ongoing urinary tract infections & may therefore require more extensive treatment procedures like the ones listed below.
- ESWL Sound Waves to Break Up Stones – Certain kidney stones depending upon the size & location may require this procedure called ESWL or Extracorporeal Shock Wave Lithotripsy. ESWL typically uses sound waves so as to create strong vibrations which break up kidney stones into tiny pieces which can comfortably be passed in urine. ESWL generally lasts for about 45 – 60 minutes & will only cause moderate pain. Kidney stone patients conveniently undergo this procedure by availing sedation or light anesthesia. ESWL can however cause bruising on abdomen or back, bleeding around kidneys & other adjacent organs, blood in urine & general discomfort when fragments of kidney stones pass through the urinary tract.
- Percutaneous Nephrolithotomy Surgery to Remove Large Stones in Kidney – This is a surgical procedure which involves removal of kidney stones using instruments & small telescope through a small incision made in the patient’s back. Performed under general anesthesia, patients will have to stay at the hospital for a day or two in order to recover. Doctors often recommend this surgical procedure when ESWL has failed to yield successful results.
- Ureteroscope to Remove Kidney Stones – Smaller stones are generally removed from kidneys or ureter through this procedure. Ureteroscope consists of a thin lighted tube equipped with a camera which surgeons pass through urethra & bladder into the ureter. These special tools can snare the stone or break it in pieces when located & which can eventually pass in urine. Surgeons will subsequently place a stent, which is a small tube, within the ureter so as to relieve swelling & promote healing. Patients may either need local or general anesthesia during the Ureteroscope procedure.
- Parathyroid Gland Surgery – Calcium phosphate kidney stones are sometimes caused by overactive parathyroid glands which are typically located along the four corners of thyroid gland right below the Adam’s apple. Hyperparathyroidism is a condition where these glands produce too much parathyroid hormone. This will eventually result in calcium levels of patients to become too high & result in formation of kidney stones. Hyperparathyroidism at times occurs when a small benign tumor forms in any one of the parathyroid glands or when patients develop another condition which leads them to produce excessive quantities of parathyroid hormone. Removal of tumor growth from the parathyroid gland effectively stops formation of kidney stones. Doctors sometimes also recommend treatment of this specific condition which is causing the patient’s parathyroid gland to overproduce parathyroid hormone.
Preventive Measures of Kidney Stones
Preventive measures of kidney stones will include an selective combination of medications & lifestyle changes.
Medications to Prevent Kidney Stones
Medications are generally able to control the amount of acids & minerals in urine & which may be helpful in people who are prone to forming certain kinds of kidney stones. However, the type of medication which the doctor will prescribe invariably depends upon the kind of kidney stone patients have.
- Calcium Stones – Doctors will either prescribe a phosphate containing preparation or a thiazide diuretic so as to help prevent formation of calcium stones in patients.
- Uric Acid Stones – Doctors usually prescribe allopurinol to reduce levels of uric acid in blood & urine along with another medication to keep urine alkaline. In some cases allopurinol & alkalizing agent in combination may also be able to dissolve uric acid kidney stones.
- Struvite Stones – Doctors generally recommend strategies in order to keep urine free of bacteria causing infection so as to prevent formation of struvite kidney stones in patients. Long-term antibiotics usage in small doses also helps achieve this goal. Doctors also often recommend an antibiotic prior to & for a while after surgical intervention as treatment for kidney stones.
- Cystine Stones – These stones are difficult to treat. Doctors may often recommend that patients consume more fluids so that they produce more urine. In case this alone does not help, doctors may prescribe medications which help decrease amount of cystine in urine.
Lifestyle Changes to Avoid Kidney Stones
- Drinking Water Throughout the Day – Doctors usually recommend passing about 2.5 liters (2.6 quarts) of urine everyday for people with history of kidney stones. Patients are also asked to measure the urine output so as to make sure that they are consuming enough quantity of water. Patients who frequently exercise or live in hot & dry climate will need to drink even more water so as to produce enough urine. Only when the urine is light & clear will it mean that the patient is consuming enough water.
- Consume Fewer Oxalate-Rich Foods – Doctors often recommend restricting foods rich in oxalates in patients having a tendency to form calcium oxalate stones. These foods could include soy products, chocolates, tea, nuts, sweet potatoes, Swiss chard, spinach, okra, beats & rhubarb.
- Choose Low Salt & Low Animal Protein Diet – Kidney stone patients should reduce the amount of salt consumption & choose to consume non-animal sources of protein like legumes. They should also consider using a substitute for salt.
- Eat Calcium-Rich Foods but Avoid Calcium Supplements – Calcium content in food does not seem to have any effect on person’s risk of developing kidney stones. Patients therefore can continue consuming calcium-rich foods unless the doctor has advised otherwise. However, patients should check with the doctor before taking calcium supplements as they have been linked to increased risk of developing kidney stones. As diets low in calcium also increase formation of kidney stones in some people, they may however reduce risks by combining calcium supplements with meals. Patients can also seek doctor’s referral to a dietitian who can help develop an ideal eating plan which reduces risk of kidney stone formation.
Treatment for Kidney Stone Removal in India
Although anyone can get kidney stones, some are however more likely to get than others. Moreover, it is men who are more affected than women. Kidney stones are also more common in non-Hispanic white people than in Mexican Americans & black people. Obese & overweight people are more likely to get kidney stones than people are of normal weight. India is an excellent medical tourism destination providing high quality of affordable healthcare solutions including urology treatments & surgery for kidney stones for people from all around the world. Healthcare facilities & expert surgeons in India are some of the most reputed. IndianMedTrip, which is one of the fastest growing medical tourism companies in South Asia, is associated with the best healthcare facilities in the country. Seamless services offered by IndianMedTrip begin with the first telephonic conversation & go on to include assistance in obtaining medical visa, online consultation with doctors, warm welcome at the airport, convenient travel & comfortable accommodation, scheduled treatments & surgery without any waiting period, exotic recuperative holidays, follow-up checks & a successful farewell.