Kidney stones can affect a number of individuals especially men. In addition to affecting the kidney, these stones can affect other parts of the urinary system and can present in a number of different ways.
What are kidney stones?
Kidney stones (renal lithiasis) are hard deposits that form inside the kidneys. The stones are made of mineral and acid salts.They can be as small as grains of sand or as large as tennis balls.Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.Kidney stones are most common in adults age 40 and older, though they may occur at any age.
Types of kidney stones
There are several types of kidney stones. They include calcium stones, uric acid stones and cysteine stones.
Risk factors for kidney stones
There is no one single cause of getting kidney stones. Several factors can increase your chances of developing kidney stones.
Factors that increase your risk of developing kidney stones include:
• Family or personal history. If someone in your family has kidney stones, you are more likely to develop stones too. If you have already had one or more kidney stones, you are at increased risk of developing another.
• Being a man. Men are more likely to develop kidney stones, although an increasing number of women are developing kidney stones.
• Dehydration. Not drinking enough water each day can increase your risk of kidney stones.
• Certain diets.Eating a diet that is high in protein, sodium and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet.
• Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
• Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhoea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
• Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections.
What are the symptoms of kidney stones?
You might have kidney stones and do not have any symptoms at all. In some cases a stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur:
• Severe pain in the side and back, below the ribs
• Pain on passing urine
• Pain that spreads to the lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Blood in your urine ( urine pink or red in colour)
• Cloudy or foul-smelling urine
• Nausea and vomiting
• Persistent urge to urinate
• Urinating more often than usual
• Fever and chills if an infection is present
Making the diagnosis
In some cases your doctor can easily make the diagnosis of kidney stones from a clinical history and medical examination and only needs some tests and other investigations to confirm the diagnosis. In other cases the diagnosis might not be so straight forward and various imaging tests, like high-speed computerized tomography (CT), might be needed. Other imaging options include an ultrasound and intravenous pyelography.
Treatment
Treatment for kidney stones varies, depending on the type of stone and the cause. Some small stones with minimal symptoms do not require invasive treatment and can be passed by drinking lots of water (as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system.
Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.
Large stones that cause severe symptoms cannot be treated with the above measures either because they are too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections. These stones require more invasive treatment. Procedures may include:using sound waves to break up stones and surgery to remove very large stones in the kidney.
How to prevent kidney stones?
Prevention of kidney stones may include a combination of lifestyle changes and medications.
Lifestyle changes
You may reduce your risk of kidney stones by doing the following:
• Drink water throughout the day.Individuals with a history of kidney stones are encouraged to drink lots of water throughout the day.
• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include beets, okra, spinach, sweet potatoes, nuts, tea, chocolate and soy products.
• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources such as legumes.
• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food does not have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals.
Medications
Various medications can control the amount of minerals and acid in your urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have.
Conclusion
Kidney stones can occur at any age but tend to be more frequent in individuals over the age of forty and are more common in men. They might not have any symptoms but the pain produced by stones passing down the ureter can be extremely severe. Treatment options will depend on the size and type of kidney stones. Two out of ten cases of kidney stones usually pass with conservative measures while the others require more invasive treatment.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over twenty nine years in clinical practice. Dr Hodge has a medical practice in the Johnson Building in The Valley.
