Kidney Stones

What is Kidney Stones?

Kidney stones is a common problem in North India. It is one of the most common cause for kidneys becoming non functional and development of chronic kidney failure. Kidney stone are also called Renal Calculi/ Nephrolithiasis. These are hard deposits of salt and minerals inside the kidneys of one person.

Kidney Stones are caused by various factors like diet, obesity, some medical problems and medications. The stones most commonly form by crystallisation of salts in urinary tract when the urine becomes concentrated. Kidney stones can cause variety of problems in the urinary tract starting from kidney upto the urethra.

Pain is often the most common symptom of the stone disease. The utmost important thing in stone disease is to timely treatment of the problem before it can cause further damage to the kidneys or body. The treatment of stone disease vary from medical expulsive therapy to various endourological surgeries.

Causes & Types of Kidney Stones

There are 4 different type of stones most commonly found in urinary tract, Different kind of kidney stones have their own unique causative factors. Following are the different kind of kidney stones:

• Calcium stones. It is the most common kidney stone found in the north India. Most kidney stones are calcium oxalate stones, usually in the form of calcium oxalate monohydrate and dihydrate. Oxalate is a substance made daily by liver or absorbed from diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
  Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
  Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain medications used to treat migraines or seizures, such as topiramate.
• Struvite stones. Struvite stones form in response to a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning. These stones often are large stones along with very mild symptoms of dull aching flank pain.
• Uric acid stones. Uric acid stones are commonly found in people who lose too much fluid because of chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.
• Cystine stones. These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid.

Kidney Stones Risk Factors

There are several risk factors associated with kidney stones:

• Family or personal history. Stones in urinary tract are more common in family members. It is also more common if one is already having single or multiple stones then formation of another stone is also very common.
• Dehydration. It is single most important risk factor. As people living in North India are often exposed to high temperatures and sweat a lot which increases the risk of having kidney stones. Also decreased fluid intake along with dehydration will increase the risk of developing kidney stones.
• Certain diets. Diet which is high in protein, sodium (salt) and sugar increases the risk of developing kidney stones. Too much salt in diet increases the excretion of calcium in urine and hence increases the chances of developing kidney stones.
• Obesity. High body mass index (BMI), large waist size and weight gain are associated with increased risk of stones.
• Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhoea leads to disturbances in absorption of calcium and water along with increase in stone forming agents in urine.
• Other medical conditions such as renal tubular acidosis, cystinuria, hyperparathyroidism and repeated urinary tract infections are rare ailments associated increased risk of urinary stone formation.
• Certain supplements and medications, such as vitamin C, dietary supplements, laxatives (when used excessively), calcium-based antacids, and certain medications used to treat migraines or depression, are also associated with increased risk of urinary stones.

Kidney Stones Symptoms

Kidney stones mostly become symptomatic when it moves in the kidneys or starts passing down the ureters (passage from kidney to bladder). Any stone passing in the ureter may block the flow of urine from kidney to the bladder and cause severe pain and may permanently damage the affected kidney if not treated timely. The most common symptoms of the stone disease are

• Severe, excruciating pain in the flank and back
• The pain often radiated to groin and lower abdomen
• Pain is generally colicky with fluctuating intensity
• There may be severe burning sensation during urination
• Red or pink color urine
• Constant urge to urinate with small amount of urine
• Nausea and vomiting
• High grade fever with chills and rigour if there is concomitant kidney infection

Seek immediate medical attention if you experience:

• Pain so severe that you can't sit still or find a comfortable position
• Pain accompanied by nausea and vomiting
• Pain accompanied by fever and chills
• Blood in your urine
• Difficulty passing urine

Kidney Stones Diagnosis

Kidney stones are primary diagnosed on following investigations:

Ultrasound KUB - It is the non invasive modality of choice and is quick and easy to perform. It is primary modality for screening on outdoor basis.

Functional Imaging

These generally comprises of contrast based imaging modality to find out the functionality of the affected kidney and the opposite kidney. These are primarily Intravenous Pyelography/ IVP or CT Urography.

Blood Investigations:

Kidney function test, Serum Calcium, Serum Phosphorus, Serum Magnesium, Parathyroid Hormone Levels, Serum Uric acid levels are done to identify functioning of kidney as well as the various risk factors for formation of kidney stones.

Kidney Stones Treatment

The treatment of kidney stones depend upon the size of the stones. Very small stones of size less than 5mm are often the initial conditions in the kidney and treated medically with increase in food intake as well as urine alkaliser solutions. The larger stones in the kidney which are symptomatic are often treated with various endourological procedures.

1. RIRS (Retrograde internal surgery) - This is the latest technique involving flexible scope and use of holmium laser in breaking a stones. This is a scarless surgery where the entire procedure is done through the urinary tract of the patient.
2. Mini PCNL - This is the novel technique of removing kidney stones and is the modification of conventional Pcnl surgery. Here the stone is removed using very small incision via the latest endourological equipment and it leads to very minimal or no scar. It is often done as a single day procedure.
3. PCNL - This is the proven endoscopic surgery where the kidney stone is removed by making a small hole in the body. It is now a days used in removing larger stones (>20 mm size)
4. Supine PCNL - This is another modification of PCNL where the procedure is done in supine position. It has several advantages in specific group of patients. Guru Jambheshwar Multispeciality Hospital is the first hospital in entire Hisar, Fatehabad and Sirsa region where it was done,
5. Laparoscopic Pyelolithotomy - This is another minimally invasive surgery where using laparoscopy the kidney stones of size > 20 mm are removed from the kidney via abdominal approach.

ALL THESE TECHNIQUES ARE AVAILABLE AT GJMH, AGROHA. DR KSHITIJ BISHNOI HAS AN EXPERIENCE OF MORE THAN 2000 KIDNEY STONE SURGERIES.