stones arise in the kidney when urine becomes supersaturated with salts and crystals that are capable of forming stones. Factors of crystallisation play a major role in stone formation – like citrate, magnesium and pyrophosphate.
Metabolic disorder (e.g., hypercalcemia or hyperparathyroidism)
Many stones are asymptomatic until they begin to move down the ureter, causing pain due to obstruction. The main symptoms of renal colic are:
1) Pain – The most common symptom of kidney stone is severe back or abdominal pain. The colicky-type of pain is the sudden onset of very severe pain sub costally and it radiates interiorly and anteriorly towards the groin. The pain generated by renal colic is primarily caused by the dilation, stretching and spasm caused by the acute ureteral obstruction. As the stone moves lower, the pain may be felt in the genitals, especially the testicles in men and the labia in women. In infants, stone pain is often confused with colicky abdominal pain. Most of the calculi are originating within the kidney and proceed distally, creating various degrees of urinary obstruction as they become lodged in narrow areas, including the ureteropelvic junction, pelvic brim, and ureterovesical junction. Location and quality of pain are related to the position of the stone within the urinary tract. The severity of the pain depends on the degree and site of the obstruction and not on the size of the stone. Pain also varies in intensity with the presence of ureteral spasm and infection
3) Urinary tract infection – Symptoms may include fever, chills, sweats and pain with urination. Kidney stones and urinary tract infection can cause block with urine retentions. Red blood cells and pus cells will be found in the urine. Also albumin, hyaline casts and crystals will be seen.
4) Fever – It is not a part of the presentation of uncomplicated nephrolithiasis. If fever is present, rule out hydronephrosis, pyonephrosis, or perinephric abscess. Such a condition is potentially life-threatening and should be treated as a surgical emergency.
Calcium oxalate: 75 per cent
Calcium phosphate: 15 per cent
Uric acid: 8 per cent
Other types are rare which include Cystine: 1 per cent and Xanthine: 1 per cent
are stones which are formed through the tendencies. For example-oxalate and uric acid and urate stones. Secondary stones are stones that occur after infection. For ex-formation of magnesium, ammonium and phosphate stones. These stones are formed in the alkaline urine. The stones formed due to vitamin A deficiency also come under this category.
Urinalysis will identify PH, and microscopy will identify cystine crystals, haematuria, pyuria and bacteria. Also culture and sensitivity tests of urine will guide on the treatment to be followed. A 24-hour urine collection is necessary in evaluating renal stones. Microscopic haematuria is present in over 90 per cent of cases with stones.
Prevention with dietary changes
Drink – Plenty of water should be taken – at least 3 litres of water or an intake to make a volume of 2 litres of urine a day should be taken. After doing strenuous exercises or when passing yellowish urine, additional water should be administered. Taking tender coconut daily is good for the kidney function and also prevents stone formation.
Eat – Low-fat diet with increased natural foods and plenty of fruits should be taken. Good protein diet from vegetarian sources, such as beans is a good intake.
Restrict – Salt should be restricted
Long intervals between urinating should be avoided.
More water intake should be made.
The bladder should be emptied after intercourse as a preventive measure.
Treatment – Treatment goals include relief of symptoms and prevention of further symptoms. Treatment varies depending on the type of stone and the extent of symptoms and complications. Also, it
1) Depends on the size – Most of the small stones with relatively mild hydronephrosis can be treated with observation and medicines. If the stone is 4 mm or smaller, the stone is easily passed in 90 per cent of the cases. Stones of 5-7 mm have a 50 per cent chance of passing spontaneously. Calculi larger than 7 mm are unlikely to pass unassisted. In general, smaller stones are more likely to pass spontaneously. But a stone may take days or weeks or even months to pass.
2) Location of the stone – Passing of the stone also depends on the exact shape and location of the stone and the specific anatomy of the upper urinary tract in that particular individual. For example, the presence of an ureteropelvic junction (UPJ) obstruction or a ureteral stricture could make it difficult or impossible for even very small stones to pass.
3) Number of stones blocking the flow of urine out of the kidney
4) Whether it is involved on one or both sides
5) Infection – In the acute phase, intermittent pain usually lasts for 1 day to 2 days. The urinary tract does not resolve until the stone is removed entirely.
Also most of the patients are prescribed Ayurvedic or Siddha preparation such as calcurin or cystone, etc. But getting recurrence of stones once in a year or two is very common.
Prognosis – Kidney stones are usually excreted without causing permanent damage. But they tend to recur, especially if the underlying cause is not found and treated. Prognosis depends on the extent of the damage caused to the kidney. If it is involved in a single kidney, the prognosis is good.
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