Kidney stone

Symptoms Of Kidney Stones 

Kidney stones vary in size. While tiny stones are less likely to get stuck in the kidneys or other parts of the urinary tract, bigger stones can cause sharp, cramping pain in the back and the sides. This feeling often moves to the lower abdomen or groin.

The pain may last for a short or long time or come and go but can be quite intense.

Symptoms of kidney stones include:

• Pink, red, or brown blood in your urine, also called hematuria

• Pain during urination

• Cloudy or bad-smelling urine

• A constant need to urinate

• Chills 

• Fever

• For men, pain at the tip of the penis

• Vague pain or stomach ache that doesn't go away

• Nausea

• Vomiting

Causes Of Kidney Stones 

Kidney stones are caused when the levels of minerals like calcium, oxalate, and phosphorus rise in the urine. Other factors that cause the development of kidney stones in the body include:

• Dehydration

• Obesity

• Diet (high in oxalate or uric acid)

• Eating an excess of salt or sugar

• Lack of exercise

• High concentrated urine

• Imbalance of pH in urine

• Regular constipation

• Genetic disorders

Types Of Kidney Stones 

Kidney stones are made of different types of substances. They are discussed as follow:

Calcium oxalate and calcium phosphate stones (80 percent of stones)

Calcium stones are the most common type of kidney stones comprising about 80% of all urinary calculi. The main constituent of calcium stones is brushite (calcium hydrogen phosphate) or hydroxyapatite. The main portion of these stones may account for pure calcium oxalate (CaOx) (50%), calcium phosphate (CaP, termed as apatite) (5%), and a mixture of both (45%).

Struvite or magnesium ammonium phosphate stones (10 percent of stones)

Struvite stones are referred to as infection or triple phosphate stones. They are composed of magnesium ammonium phosphate and form in alkaline urine. They occur among patients with chronic urinary tract infections.

Uric acid stones (5-10 percent of stones)

Diets high in purines, especially those containing animal proteins such as meat and fish, result in excessive amounts of uric acid in the urine, low urine volume, and low urinary pH, increasing the chances of uric acid stone formation.

Cystine stones (less than 1 percent of stones)

About 1 in 7,000 people worldwide get cystine kidney stones. It is a genetic disorder that results in impaired absorption of cystine or leaking of cystine into the urine.

Drug-induced stones (less than 1 percent)

Drugs, such as guaifenesin, triamterene, atazanavir, and sulfa drugs, induce the formation of these stones. These drugs may induce calculi formation by interfering with calcium oxalate or purine metabolisms.

Risk Factors Of Kidney Stones

Age and sex

Kidney stones are most likely to occur in people between the ages of 20 and 50 years. It has been found that men are much more likely to develop these stones than women.

Family or personal history

Someone with a family history of kidney stones is more likely to develop the stones than someone without a family history. 

The risk of the development of kidney stones is also three times higher in a person with a personal history of kidney stones.

Diet 

• Diet that is high in sodium, protein and sugar can increase the risk of certain types of kidney stones.

• Inadequate amount of calcium in the diet is a major risk factor for the development of kidney stones. Low calcium diets increase urinary oxalate excretion, which may result in more stone formation and possibly a negative calcium balance.

Dehydration

This is the most common cause and may come from the loss of body fluids due to excessive exercise, working, or living in a hot place.

Obesity

Obesity may change the acid levels in the urine, leading to stone formation. High body mass index (BMI), large waist size, and weight gain have all been associated with an increased risk of both a single episode and recurrent episodes of kidney stones.

What is body mass index? Learn more about it and how to calculate it.
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Urinary tract infections

In patients with chronic urinary tract infections, larger stones may form in the kidney. These are commonly called a struvite or infection stones.

Medical conditions 

Some medical conditions have an increased risk of kidney stones. Abnormal growth of one or more parathyroid glands, which control calcium metabolism, can cause high calcium levels in the blood and urine. 

Another condition called distal renal tubular acidosis, in which there is acid build-up in the body can raise the risk of calcium phosphate kidney stones.

Medications

Some medications, calcium and vitamin C supplements, may increase your risk of forming stones. These include:

• Certain antibiotics, including ciprofloxacin and sulfa antibiotics
• Certain diuretics, like triamterene, which are used to treat high blood pressure 
• Decongestants, like ephedrine or guaifenesin
• Protease inhibitors, like indinavir
• Anticonvulsants, like felbamate, topiramate, and zonisamide

Diagnosis Of Kidney Stones 

 

Medical history and physical examination

A healthcare practitioner will collect information regarding a person’s history of health conditions, family history of kidney stones, and the diet that is likely to aid in developing kidney stones. The physical examination includes:

1. General examination: In classical descriptions, a patient with renal colic (pain felt when kidney stones block the urinary tract) is continuously moving and twisting, unable to find a comfortable position. This is a common finding but not universal.

2. Vital signs: Kidney stones can induce a fast heart rate and elevate blood pressure. They generally do not cause fevers unless associated with a urinary tract infection.

3. Abdominal and flank examination: The doctor will physically examine the abdominal area.

Lab tests 

Urologists often recommend several diagnostic tests to confirm the presence of kidney stones. These tests include:

1. Urinalysis: Urine tests can show whether the urine contains high levels of minerals that form kidney stones or not. It also shows white blood cells and bacteria in the urine that may indicate a urinary tract infection.

2. Blood tests: These tests are done to check the functioning of kidneys and the levels of substances that could cause progressions of kidney stones, such as calcium, phosphorus, uric acid, and serum electrolytes. 

Blood urea nitrogen (BUN) and creatinine test help in identifying any abnormal functioning in kidneys by determining the amount of nitrogen in the blood that comes from the waste product urea. 

Imaging tests

These tests may help to diagnose any issues that caused a kidney stone to form, such as a blockage in the urinary tract or any birth defects. These tests include:

1. Abdominal X-ray: An abdominal x-ray uses low levels of radiation to create a picture of the abdomen. These x-rays can show the location of kidney stones in the urinary tract but not all stones are visible in an abdominal x-ray.

2. Intravenous pyelogram (IVP): IVP is a gold standard for kidney stone detection. This test uses an X-ray and dye to visualize the images of kidneys, bladder, and ureters.

3. Abdominal Computed Tomography (CT) scan: If the stone is blocking the urinary tract, the CT scan can be used to assess the exact size and location of a kidney stone.

4. Abdominal ultrasound: An abdominal ultrasound scan offers moderate sensitivity specificity to diagnose kidney stones, although it is lower than a CT scan.

5. Abdominal magnetic resonance imaging (MRI): This test allows doctors to examine soft tissues without bones obstructing the view. This test is a safer alternative to a CT scan.

6. Nuclear functional renal scan: A renal scan involves the use of nuclear radioactive material to examine kidneys and assess their function.

7. Noncontrast computed tomography: This type of CT scan offers high sensitivity and specificity for the detection of kidney stones.

Stone analysis

If a person passes a stone or a stone is removed by surgery, testing the stone will determine its type. This information helps the healthcare provider to decide the best way to treat or prevent future stones.

Prevention Of Kidney Stones 

Drink enough fluids

A simple and most important lifestyle change to prevent stones is to drink more water and fluids. It's best to drink mostly no-calorie or low-calorie drinks and limit sugary and alcoholic drinks.

Reduce the amount of sodium in your diet

It is advisable to restrict salt intake ( ≤ 50 mmol/day of sodium chloride). A high sodium intake boosts stone risk by reducing calcium reabsorption in the kidneys and increasing urinary calcium. 

Eat the recommended amount of calcium

• People having calcium stones are recommended to avoid dairy products and other foods with high calcium content unless advised otherwise.

• A reduced intake of calcium can also lead to increased intestinal absorption of oxalate, which itself accounts for an increased risk of stone formation. 

• Hence, it is advised to eat the right recommended amount of calcium in diet or supplements. 

Eat plenty of fruits and vegetables

• To prevent the formation of calcium oxalate, cystine, and uric acid stones, alkalize the urine by eating a diet high in fruits and vegetables, taking supplemental citrate, or drinking alkaline mineral waters. 
• Eating at least five servings of fruits and vegetables rich in potassium, fiber, magnesium, antioxidants, phytate, and citrate may help prevent stone formation.

Eat less meat

Restriction of animal proteins ( ≤ 52 g/day) is also encouraged since animal proteins provide an increased acid load because of their high sulfur-containing amino acids content. Therefore, in case of acidic urine output, it is recommended to eat less meat, fish, and poultry.

Increase magnesium intake

Magnesium is an important mineral that helps in preventing calcium oxalate kidney stone formation. The reference daily intake (RDI) for magnesium is 420 mg per day. Dietary magnesium intake can be increased by taking bananas, avocados, legumes, and tofu.

Eat foods with low oxalate levels

• Limit the consumption of foods high in oxalate. These food items include peanuts, spinach, beetroots, chocolate, and sweet potatoes.

• It is not necessary to completely stop eating foods that contain oxalate; however, the level of oxalate intake should be decreased.

Specialist To Visit

Doctors that can help with kidney stones include: 

• General physician

• Nephrologist

• Urologist

A nephrologist specializes in kidney diseases and their functions. A urologist specializes in urinary tract disease.

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Treatment Of Kidney Stones

 

Small kidney stones

These stones are typically excreted out from the body on their own without considerable treatment. Intake of sufficient amounts of water (4-5 liters a day) may help flush out the stone via the urine. Different medications that can be used for assistance during the removal of these stones are:

Medications

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are used to relieve the pain caused by the stone movement. A few examples include:

1. Aspirin 

2. Diclofenac

3. Ketoprofen
   
   

• Anti-sickness medicine: These drugs are used in case of nausea and vomiting. They include:

1. Cinnarizine

2. Hyoscine

3. Chlorpromazine
   
   

• Alpha-blockers : They help in relaxing the muscles of the ureter and facilitate the passage of stones from the kidney. These drugs are:

1. Tamsulosin 

2. Alfuzosin

3. Nifedipine

4. Doxazosin

5. Terazosin
   
   

• Diuretics: These drugs increase the urine flow, and may also flush out the stone of <5 mm in size. Examples of a few diuretics are:

1. Bumetanide 

2. Ethacrynic acid 

3. Furosemide 

4. Torsemide 

Large kidney stones

If the kidney stones are too big to be passed naturally, they're usually removed by surgery.

Surgery

• Shock wave lithotripsy (SWL): This is the only non-invasive method for stone removal. SWL involves the usage of ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is, and the ultrasound waves break the stone into smaller pieces. SWL needs more than one session to successfully treat kidney stones.
• Ureteroscopy (URS): This method is used for stones in the ureter, especially for stones closest to the bladder, in the lower half of the ureter. It involves passing a long, thin telescope, called a ureteroscope, through the tube urine passes through on its way out of the body (the urethra) and into your bladder. URS is a preferred method for the treatment of small to medium-sized kidney stones located in any part of the urinary tract.
• Percutaneous nephrolithotomy (PCNL): PCNL is used most often when kidney stones are too difficult to reach, too large, too numerous, or too dense to be treated by shock wave lithotripsy or ureteroscopy. PCNL is considered the first-choice treatment for renal stones >2 cm.

Medications 

Certain medications are also prescribed along with surgeries for larger stones, depending on the type of stone:

• Calcium stones: Thiazide diuretics (often called water pills, which help rid your body of water) are used for patients with calcium stones. Another salt used to inhibit the formation of calcium stones is potassium citrate.
• Uric acid stones: This condition is also called hyperuricemia or hyperuricosuria. Allopurinol, which is frequently prescribed for gout, is also used to lower the level of uric acid in the blood and urine.
• Struvite stones: Acetohydroxamic acid (AHA) is used for patients with struvite infection. AHA can dilute the urine and make it unfavorable for the formation of struvite stones. 
• Cystine stones: Cystine-binding thiol drugs are used only for patients in whom cystine stones are formed. These medications (d-penicillamine or tiopronin) bind to cystine in the urine and form a compound that is less likely to crystallize than cystine.

Hyperparathyroidism surgery

People with hyperparathyroidism, a condition that results in too much calcium in the blood, sometimes develop calcium stones. Removing the parathyroid gland cures hyperparathyroidism and can prevent kidney stones. 

Hyperparathyroidism can cause many symptoms in the body, including unexplained weight loss. Watch this video to know more

 

Home-care For Kidney Stones 

Here are a few home remedies that can help in managing kidney stones: 

• Lemon juice (Nimbu): Lemons contain citrate, which is a chemical that prevents calcium stones from forming. Citrate can also break up small stones, allowing them to pass more easily. Consumption of half cup of lemon juice per day will increase citrates in the urine.

• Water consumption: Drinking water helps speed up the process of passing a stone. Drink at least 12 glasses of water if you are trying to pass a kidney stone. 

• Green tea: Green tea is rich in antioxidants and possesses a protective effect against the development of calcium stones in the kidneys.

• Kidney beans (Rajma): High levels of fiber in kidney beans and broth from cooked kidney beans help improve overall urinary and kidney health. It also helps dissolve and flush out kidney stones. 

• Celery: It has antispasmodic (that suppresses muscle spasms) properties and also helps in cleansing the toxins from the body.

• Dandelion: Organic dandelion roots help cleanse the kidneys and support normal kidney functioning. Taking 500 mg of dried dandelion extract or drinking dandelion tea may help ease the symptoms and prevent the formation of kidney stones.

• Wheatgrass: It is a rich source of many vital nutrients. A glass of wheatgrass juice with lemon extract is a perfect way to sort out kidney stones.

• Pomegranate juice (Anar): This juice acts as a natural detoxifying agent that helps get rid of kidney stones causing impurities. Try to consume fresh pomegranate juice each day without added sugar. 

• Raspberry: This fruit is capable of expelling stones from the urinary tract. The prophylactic effect of raspberry has been reported on calcium oxalate renal stone formation.

• Fenugreek seeds (Methi dana): It has been usually seen that fenugreek seeds significantly reduce calcification in the kidneys and help prevent kidney stones.

• Black cumin seed (Jeera): This herb significantly reduces the formation of calcium oxalate stones.

• Radish (Mooli): Roots of radish plant are highly effective in breaking kidney stones.

• Tamarind pulp (Imli): Tamarind has shown beneficial effect in inhibiting spontaneous crystallization during the formation of kidney stones.

• Baking soda: It helps in maintaining an alkaline environment in the body. The stones get enhanced in an acidic environment and baking soda aids in their removal. Mix half a teaspoon of the baking soda with apple cider vinegar and consume the solution twice a day. 

Read more about effective natural remedies that can help in getting rid of kidney stones.
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Alternate Treatment For Kidney Stones 

Ayurveda

1. Asparagus (Shatavari): Leaves of this plant are useful in expelling stones from the urinary tract and inhibiting the formation of calcium oxalate stones.

2. Crataeva nurvala (Varuna): The part of the plant used is the roots. Its pharmacological properties include being a lubricant, diuretic, and lithotriptic.

3. Tribulus Terrestris (Gokshura): This herb is commonly used in India to treat urinary tract diseases. 

4. Hogweed (Punarnava): This Indian weed is used to help expel kidney stones.

5. Hibiscus (Gudhal): Drinking a cup of tea made from this herb significantly increases the excretion of uric acid and the clearance of kidney stones by urine.

6. Indian nightshade (Kantakari): It is a widely used edible medicinal plant in India, and is also known as the yellow berried nightshade plant. This plant is used as a remedy for the treatment of various renal diseases, including kidney stones.

7. Horse gram (Kulthi): It is a nutritional and medicinal plant native to India. Its seeds are used to prepare soup which decreases the formation and recurrence of calcium oxalate stones.

8. Indian madder (Manjistha): This is a species of flowering plant in the coffee family, and is used as a natural food colorant. The roots of manjistha are beneficial in reducing the risk of kidney stones. They work by reducing the level of calcium and oxalate in kidneys and inhibiting the growth of urinary stones.

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Living With Kidney Stones 

Smaller kidney stones may not cause much problems and can be managed with certain simple lifestyle modifications. Here are some of the tips to apply when living with kidney stones:

• Always stay hydrated
• Watch your diet
• Maintain a healthy weight
• Talk to your doctor if the symptoms are affecting your daily activities
• Add magnesium supplements to your diet
• Take your medications as advised
• Follow up as advised by the doctor

Here are some daily food habits you should follow if you have or are prone to developing kidney stones.
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