Kidney Stones

Humans have been affected by kidney stones since millennia, in fact, bladder and kidney stones have even been found in Egyptian mummies. Acute renal colic due to stones in the urinary tract is one of the most excruciating pains a person can endure.

Approx 1.2 million people each year are affected and accounts for approx 1% of hospital admissions. Stone disease incorporates both renal and ureteric stones.

What are the symptoms of stones?

Classic complaint is sudden onset of very severe pain (renal colic) originating in the flank and radiating to the groin. One can also have blood in urine, nausea and vomiting. Stones can be asymptomatic. Other symptoms include increased frequency of urination/ pain while passing urine/ urgency/ pain in lower abdomen.

What are the potential risks of renal stone disease?

There is a high risk of infections ranging from urinary tract infection to pyelonephritis (infection of the kidney) or urosepsis (infection spreading to the whole body). In patients with preexisting kidney injury, single functioning kidney, there is a risk of additional renal damage and renal failure due to stone disease. Diabetes, staghorn calculus, hereditary diseases. spinal cord injuries, functional/structural urologic diseases can also predispose patients to stone formation and increased risk of kidney injury. There is a very high possibility of recurrence of stone after an initial episode.

What are the investigations done to evaluate a patient with stone disease?

A battery of tests can be done depending on the individual clinical situation. The tests broadly include Urine examination – to look for urine pH, presence or absence of RBC/WBC/Crystals & culture. Blood tests include urea, creatinine, electrolytes, calcium, phosphorus, uric acid, bicarbonate & parathyroid hormone. 24 hr urine profile including volume, creatinine, calcium, oxalate, uric acid, sodium, citrate, cysteine, phosphorus & magnesium. Imaging modalities include ultrasound, plain X - Ray, CT scan and nuclear scans.

What is the incidence of stone recurrence?

Multiple studies worldwide have documented varying rate of recurrence in different population groups. On an average it is approx 50% within 5 years and 70% in 10 years

What are risk factors predisposing recurrence?

Certain groups of people are predisposed to recurrent stone formation. These include those with multiple stones, family or personal history of previous stones, first stone at a young age (<30 yrs), persistence of residual stone after treatment & presence of concomitant renal failure.

What are the various treatment options available?

Management can be divided into treatment of acute pain and long term care which is based on prevention of repeat stone formation. During an acute pain attack treatment includes IV hydration with fluids & pain relief measures. Need or option of surgery can be explored depending on clinical condition.

What can one do to prevent recurrence?

• Prevention modalities include Dietary/ lifestyle modifications & medication.
• Maintain a high fluid intake and a thereby high urine volume ~ 2 ltr/day.
• Avoidance of excessive salt and protein in diet.
• Moderation of dietary calcium and oxalate intake. In case of calcium, restriction beyond normal daily intake can be counterproductive.
• Metabolic testing and appropriate treatment, if any. e.g. Allopurinol for uric acid stones, D-penicillamine for cysteine stones.
• Alkalization of urine

Disclaimer: Please consult your doctor to find out what suits best for you.