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Today in Health & Wellness
HEALTH CONDITIONS

Nephrolithiasis

Overview
Symptoms
Risk Factors
Commonly Prescribed Drugs
Treatment and Management
Home Remedies
Doctors to Consult
Overview

Common name/Other name

Kidney stones; urinary calculi; renal calculi; renal lithiasis (Eng.)

Nephrolithiasis is a condition of the urinary system that manifests with insoluble stones known as kidney stones. The urine naturally contains crystals of salt. Certain conditions cause these crystals to precipitate and solidify forming kidney stones. The crystals usually contain calcium oxalate, uric acid, and calcium phosphate. Kidney stones form inside the kidneys and can affect any part of the urinary tract. Most kidney stones do not present any symptoms. However, when a kidney stone blocks a narrow passage like the ureter, intense pain is felt by the patient. Some of the conditions that cause the precipitation of crystals include ingestion of excess calcium, low water intake, abnormal pH of the urine, and overactive parathyroid glands.

 

Types of Kidney Stones:

  • Calcium stones are the most common kidney stones. The usual composition of calcium stones is calcium oxalate. Oxalate is produced by the liver daily. It is also common in food like fruits, vegetables, nuts, and chocolates. Another possible composition of calcium stones is calcium phosphate. Conditions that affect metabolism, migraine headaches, and taking seizure medications increase the risk of forming stones of calcium phosphate.
  • Struvite stones or infection stones form when there is an infection in the urinary system. It can suddenly increase in size without warning signs.
  • Uric acid stones are common in people with low fluid intake or lose too much fluid. People on a high protein diet or have gouty arthritis are also prone to uric acid stone formation.
  • Cysteine stones form in people with cystinuria wherein the kidneys excrete the amino acid cysteine in excess.

Some cases of kidney stones are diagnosed during radiographic tests for another condition. Some cases are diagnosed when the physician orders diagnostic tests upon the appearance of signs and symptoms. Blood testing indicates the levels of calcium and uric acid in the blood. Urine testing measures the amount of stone-forming minerals or stone-preventing substances present in the urine. Radiographic imaging tests can show the kidney stones in the urinary tract.

 

Symptoms
  • Severe pain in the side and back, below the ribs
  • Pain reaches the lower abdomen and groin
  • Pain comes in waves and fluctuates in intensity
  • Pain on urination
  • Pink, red or brown urine
  • Cloudy or foul-smelling urine
  • Nausea, vomiting
  • Frequent urination
  • Urinating in small amounts
  • Fever and chills (infection is present)
Risk Factors
  • Family history of kidney stones
  • Personal history of kidney stones. Presence of one or more kidney stone increases risk in developing another
  • Dehydration. Also, people living in warm climates or who sweat a lot
  • Certain diets. High protein, high salt, and high sugar diet
  • Obesity
  • Disease and surgery of digestive system. Digestive process involved in calcium and water absorption might be affected
  • Other medical conditions. Include renal tubular acidosis, cystinuria, hyperparathyroidism, UTI
Commonly Prescribed Drugs
  • Pain relievers are given when passing of a small stone causes discomfort and pain. Mild pain is usually relieved by ibuprofen, paracetamol, and naproxen.
  • Alpha blockers or calcium channel blockers can be given to relax the muscles of the ureter when passing kidney stones. A relaxed ureter allows the kidney stones to pass more quickly and with less pain.
  • Potassium citrate or sodium citrate are given to dissolve uric acid stones.

 

Treatment and Management
  • Small kidney stones with minimal symptoms usually do not require invasive treatments. Drinking 1.9 to 2.8 liters of water per day help in excreting the kidney stones with the urine.
  • Kidney stones that become too large or cause bleeding might require a more intensive or an invasive treatment. Stones that have not passed into the urine within 6 to 8 weeks may require surgical removal.
  • Extracorporeal shock wave lithotripsy (ESWL) uses shock waves that cause strong vibrations to break a large kidney stone into tiny pieces. These fragments can now pass into the urine. The procedure takes around 45 to 60 minutes and causes moderate pain. The procedure can also cause passing of blood in the urine, bruising on the back, and bleeding around the kidneys.
  • Percutaneous nephrolithotomy is the surgical removal of kidney stones by inserting instruments through a small back incision. This surgical procedure is usually recommended if the ESWL fails to remove the stones.
  • An uteroscope can be used to locate the kidney stones in the urinary tract. Special instruments are used to trap or break the stone into smaller fragments which can pass into the urine. A small stent is placed in the ureter to minimize swelling and to hasten healing.
  • Endoscopic surgery is done to remove infection stones. The urinary tract infection will not be resolved until the stones are removed.
  • Passing of large volumes of urine per day (2.5 liters) is encouraged especially in patients with a history of kidney stones. People who live in a hot region or exercise frequently should have an increased water intake.
  • Restrict intake of oxalate-rich food if you are at risk of forming calcium stones. Oxalate-rich foods include beets, okra, spinach, sweet potatoes, nuts, tea, chocolate, and soy products.
  • Eat a diet low in sodium. Consider non-animal protein sources such as legumes.
  • Take calcium supplements with caution as these might increase the risk of kidney stone formation. However, calcium from diet does not affect the risk of forming kidney stones.
Home Remedies
  • Lemon juice or adding freshly squeezed lemon into the drinking water helps prevent the formation of calcium stones. Lemons contain citrate which is a stone-preventing substance. It can also break down stones into smaller fragments for easier passing.
  • Fresh or dried basil leaves can be used to make tea. It contains acetic acid which lowers uric acid levels and breaks down stones into smaller pieces. Do not drink basil tea for more than 6 weeks.
  • Two tablespoons of apple cider vinegar can be mixed with 6 to 8 ounces of drinking water. The citric acid in this mixture helps dissolve kidney stones and minimize pain when passing stones into the urine. Do not consume more than 8 ounces of the apple cider vinegar mixture in a day. Do not drink this mixture when taking insulin, digoxin, and diuretic drugs.
  • Wheatgrass juice increases urine flow which helps in passing stones into the urine. The recommended daily consumption of wheatgrass juice is 2 to 8 ounces
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