Causes and risk factors:
Though particular reason for kidney stones is not established however concentration of urine, presence of low fluid or urine volume in kidney with certain dietary factors predisposed to formation of stones. Excessive intake of dietary protein or sodium, uric acid rich food, excessive calcium supplements predispose to formation of stones. Infection of urinary system, inability to pass the urine freely, prolonged immobilization due to certain diseases like paraplegia can also cause renal calculi. Dehydration causes alteration in the concentration of solutes which presicipate and form calculi Deficiency of vitamin A and low intake of water, Grape juice apple juice is the contributing factor of renal calculi. Renal calculi is more common in people suffering from hyperparathyroidism, Crohns diseases, dents diseases etc.Certain geographical regions have high prevalence of kidney stone occurrence known as ‘stone belts ‘ my be probably due to high mineral content in water.
Clinical presentations:
Generally patients presents with acute severe colicky , sharp, stabbing pain in lumbar region often radiating to the groins or lower abdomen associated with bouts of vomiting. In some cases stones in kidney do not produce any symptoms these are called as silent calculus.it is only when the stones relocate or float in the kidneys or find the passage out through the ureters( Tubes connecting kidneys to bladder) present with pain. It may be associated with blood ting urine (Hematuria) or high colored concentrated urine. Fever may be present only due to infection. Chronic untreated calculi usually give the feeling of heaviness in the lumbar or back region affected due to stagnation of urine in kidneys (Hydronephrosis a common complication)Similarly impacted large stones in the lumen of ureter (obstructive uropathy) often presents with debilitating acute symptoms.
Diagnosis and investigations:
In cases of renal calculi along with the symptoms narrated by the patient and the physical examination carried out by the doctor, like localized tenderness at renal angle or lumbar region helps in aid of diagnosis. Certain sets of investigations are advised to confirm the diagnosis. Routine blood test, urine test, Cultures for detection of the causative agents can be advised. Radiography like plain X ray of abdomen (KUB) a specilised Xrays with dye contrast like IVP (Intravenous pylegraphy) CT Scan along with renal scans are done to evaluate chronic stones to plan the treatment mode.Ultrasound sonography is routine inn noninvasive investigations carried out in every case of suspected renal calculi.
Treatment:
Acute episodes of pain called renal colic/ ureteric colic are treated with antispasmodic analgesic (inject able, oral, anti emenitics with IV transfusion. Dietary modification needs to be implemented; it includes adequate intake of water. Intake of animal protein in diet should be limited. Diets suspected to be cause of stones formation like high uric acid high sodium intake should be avoided. Diuretics, ureteric dilators, medications are suggested. Surgical methods like lithotripsy ESWL, PCNL, SCOPY are done to remove the stones impacted. Gone are the days when open surgery were advised for removal of stones.
Other Modes of treatment
The other modes of treatment can also be effective in treating renal calculi. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms and dissolving the small stones similarly the ayurvedic system of medicine which uses herbal medicines and clean the efficacy of certain herbs in dissolving and expulsion the herb are also found to be effective in treating calculi.
Recent updates:
American Society of Nephrology has designed a new tool which uses 11 questions to accurately calculate the probability that a patient will have another symptomatic kidney stone at 2, 5, or 10 years after the first stone.
International Union of Crystallography has designed a new crystallographic technique to ensure that they receive the most correct and effective treatment.
