Kidney stones are an agonizing condition affecting millions globally. They are mineral deposits that can crystallize in the urinary tract when there is an excess of certain substances in the urine and cause severe discomfort, urinary complications, and probable kidney damage if left untreated. Fortunately, by understanding their causes and implementing certain lifestyle changes, we can hinder their formation and mitigate existing ones. This comprehensive guide serves to provide valuable insights and practical tips on preventing and managing kidney stones.
Firstly, it is essential to understand that kidney stones can form, travel through, and be present in several locations within the urinary tract, such as the inside of the kidneys, inside the ureter (tube connecting kidney to bladder), the inside of the bladder, and lastly inside the urethra, through which they are naturally and typically expelled from the body. Stones inside the kidney are not usually painful, and the pain tends to start when they begin passing through the ureter. Muscular contractions occur and the pain tends to come and go abruptly. This is referred to as “colicky pain” in medical science. Vomiting tendency is a common symptom at this stage. Depending on the size of the stone, the flow of urine can get blocked, which further disrupts the functioning of the kidney and increases the level of pain.
Secondly, it is important to recognise the various types of kidney stones by their chemical composition. They are, in descending order of frequency: –
- Calcium Oxalate Stones: Most prevalent type, accounting for approximately 70-80% of cases. They form when calcium combines with oxalate in the urine. A high intake of oxalate-rich foods, calcium-rich foods, and not drinking enough fluids contribute to their formation.
- Struvite Stones: AKA infection stones, they constitute around 10-15% of cases. They form under the presence of certain bacterial infections (mainly Proteus mirabilis and Proteus vulgaris, & some strains/species of Klebsiella & Pseudomonas) in the urinary tract. They produce an enzyme called urease, which breaks down urea into ammonia and carbon dioxide. The increased ammonia levels in the urine raise the pH and create an alkaline environment conducive to the formation of struvite. They are dangerous as they can grow rapidly and become rather large. Prompt treatment of the underlying infection is crucial to prevent their recurrence.
- Calcium Phosphate Stones: AKA apatite stones, account for 5-10% of cases. They form due to an excess of calcium and phosphate in the urine, leading to crystalline deposits in the kidneys. Factors such as hypercalciuria, hyperphosphaturia, alkaline urine pH, metabolic disorders, and genetics contribute to their development. Unlike other kidney stones, calcium phosphate stones are typically radiolucent and require alternative imaging for diagnosis. Treatment involves dietary adjustments, increased fluid intake, medications for underlying metabolic issues, and sometimes surgical intervention or lithotripsy for larger stones. Prevention strategies include lifestyle changes and ongoing medical management to reduce the risk of recurrence.
- Uric Acid Stones: Comprise 5-10% of cases. They occur when the urine is overly acidic, and is associated with conditions like gout, certain genetic factors, or a diet rich in purines {found in organ meats like chicken/mutton/beef liver & kidney, shellfish like prawns & crab, and some fish like anchovies, sardines, etc.}
- Cystine Stones: Rare (account for less than 1% of cases) and occur in individuals with a genetic disorder called cystinuria, which affects the reabsorption of cystine, an amino acid, in the kidneys, leading to the formation of cystine stones.
It is important to note that some kidney stones may be composed of a combination of minerals. Determining the specific type of kidney stone is important for treatment and prevention strategies as each type has its own considerations. When they form, their common indicators (symptoms) include immense pain in the back, side, or lower abdomen, having to urinate frequently, the presence of blood in the urine, the urine giving off a pungent odor, nausea, and vomiting.
Moreover, it is vital to follow a diet that helps to prevent kidney stones from their initiation, as prevention is better than management. It is essential to always be adequately hydrated. Drink enough water (recommended intake is about 2-3 litres) daily. It is also ideal to consume beverages made from citrus fruits like orange juice and lemonade in moderation as they contain citrate, an acidic, organic chemical compound that helps inhibit stone formation. For some individuals, limiting sodium (a major component of salt) intake helps in preventing kidney stones from forming. Also, while generally perceived as healthy, do not excessively eat oxalate-rich foods like spinach and beetroot. Restrict animal-based protein consumption (meat/fish, eggs, dairy products like milk, butter, ghee, yoghurt, cheese, etc.) Limit intake of purine-rich foods, found especially in organ meats to prevent uric-acid stone formation. It is good to restrict sugary drinks (juices with added sugar, artificial sweeteners & preservatives) and drinks containing high-fructose corn syrup (found especially in carbonated soft drinks like Coca-Cola, Pepsi etc.) Also limit coffee and other caffeinated beverages and energy drinks such as Redbull. Certain protein powders, used especially by gym-goers, have been linked to causing kidney stones, so be mindful of intake. Maintaining a healthy body weight through a balanced diet and regular exercise is also crucial. Avoid resorting to extreme crash diets and rapid weight loss programs, as they can increase the risk of stone formation. If necessary, discuss with a healthcare professional regarding medications that can help prevent kidney stones, like thiazide diuretics and citrate supplements.
Despite following the prevention tips mentioned above, we can still find ourselves with stones forming, so this next segment will provide valuable information on managing and passing kidney stones. Over-the-counter painkillers like Ibuprofen, Acelofenac, Tramadol, Ketorolac, etc. can help in pain reduction. Applying heat (like a hot water bag) to the affected area can provide temporary relief by increasing blood circulation and relaxing the surrounding muscles.
Important Info: If a stone does not pass through the urethra within a few days or causes severe symptoms, get immediate medical help. Depending on the size and location of the stone, treatment options may include:
- Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock waves to break up the stone into smaller fragments, making them easier to pass through urine.
- Ureteroscopy: In this procedure, a thin tube (ureteroscope) is inserted through the urinary tract to locate and remove or break up the stone.
- Percutaneous Nephrolithotomy (PCNL): This surgical procedure involves accessing the kidney through a small incision and removing the stone using specialized instruments.
The appropriate treatment method depends on factors such as stone size, location, and individual circumstances. Consult with a urologist (doctor specialising in kidney stones and other urinary issues) to determine the best course of action for your specific situation.
Straining Urine: When passing kidney stones, your doctor/medical professional may recommend straining your urine. This allows for the collection and analysis of stones, which can aid in determining their composition and guide further treatment or preventive measures.
Follow-Up Care: Once you have passed a kidney stone, it is important to follow up with your doctor for further evaluation and guidance. They may recommend further tests to identify the underlying cause of stone formation and develop a preventive plan to reduce the risk of future stones.
Remember, passing kidney stones can take time and patience. If you experience severe pain, persistent symptoms, or are unable to pass the stone, seek urgent medical attention. A medical professional can provide appropriate guidance and interventions to help you manage and pass stones effectively.
Other lifestyle changes & additional tips: Schedule routine check-ups with a healthcare professional to monitor kidney health. Undergo periodic urine and blood tests to identify any underlying conditions or risk factors. Quit smoking and limit alcohol consumption. Regularly exercise to maintain optimal kidney health.
In summary, kidney stones are a common condition that can cause significant pain and discomfort. They typically form in the kidneys when certain substances in the urine become overly concentrated and crystallize. While the exact causes of kidney stones can vary, factors such as dehydration, dietary choices, certain medical conditions, medications, and genetic predispositions can contribute to their formation. Understanding the symptoms, risk factors, and treatment options for kidney stones is essential for early detection and management. If you suspect you may have kidney stones or are experiencing persistent urinary symptoms, it is crucial to consult with your doctor for proper diagnosis and guidance. With proper medical care, lifestyle modifications, and preventive measures, individuals can effectively manage kidney stones and reduce the likelihood of future occurrences.
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Article Credits
Dr. Anoop Lal, Medical Director, CareMithra
Rohan Panicker, Content Writer, CareMithra