Kidney / Renal Stones

Kidney or ureteric stones means presence of small stones in these areas of urinary tract causing symptoms.

Symptoms:

Kidney stones can cause very sudden and severe pain especially if the stone drops into the ureter (kidney pipe). This can be a medical emergency, with severe pain in the loin (and sometimes groin) often accompanied with nausea and vomiting, and sometimes with blood in the urine. Stones in the kidney itself cause less sudden symptoms, with the patient experiencing anything between aches and pains in the loin, urine infections, blood in the urine, or sometimes no symptoms.

Causes:

The lifetime risk of forming a kidney or ureteric (kidney pipe) stone is increasing, both in India and internationally. This may be due to changes in diet and lifestyle. The age of first forming a kidney stone may be anywhere during a persons lifetime, though the majority of new patients we see are between 20 and 60 year old. Risk factors for stone formation include dehydration (often related to a warm workplace or lack of fluid intake), hot climates (we believe stones are more likely to form in summer months or during periods of overseas travel), obesity, and up to a quarter of patients have a family history of stone formation.

Specific dietary factors are important, and these can depend both on patient factors, and the type of stone formed, for example some stones are related to a high animal protein diet.Other medical conditions can be linked with kidney stone formation, including hypercalcaemia (a high calcium), which is occasionally related to an overactive parathyroid gland, or gout (which causes high uric acid levels, seen in some stones).

Treatment:

Treatment of a stone is determined by the size, site (kidney, ureter or bladder), nature (calcium oxalate or uric acid) and whether it causing any blockage to the drainage of urine. Management should be aimed at both treating and preventing stones. Stones blocking the ureter (kidney pipe) should be assessed and diagnosed urgently, though thankfully up to two thirds may pass through without requiring an operation.

Treatment of kidney stones is varied, and depends on patient factor, and the stone’s size, composition and location. Small stones in the kidney that do not cause symptoms are often monitored with periodic radiological imaging such as ultrasound scans or X-rays. Many patients can be reassured that the stone is not significant, and further surveillance can be reduced or stopped. Larger, or symptomatic stones can be treated with Shock wave Lithotripsy (ESWL), which is a machine that gently breaks down stones using energy waves. One of the advantages of ESWL is that it is not an operation, and does not require an anaesthetic. Some stones cannot or should not be broken with ESWL, and require an operation. This involves inserting a fexible telescope (Flexi-URS) into the kidney and breaking the stones using specialist lasers.

If there is an infection along with a blockage, this can lead to a life- threatening emergency and has to be dealt with urgently.