Kidney stones, also known as nephrolithiasis or urolithiasis, are prevalent worldwide.
In India, the incidence is about 12-13%.
Recurrence:
Around 50% of patients experience a recurrence within five years of treatment.
Kidney stones are mineral deposits that form in concentrated urine within the kidneys and urinary tract.
Causes of Kidney Stones
Common mineral compositions: Calcium oxalate or uric acid.
Non-infectious causes:
Low fluid intake.
Hot climates.
Genetics.
Co-morbidities like diabetes, gout, unhealthy lifestyles, sedentary habits, and high sodium consumption.
Symptoms of Kidney Stones
Common Symptoms:
Severe abdominal pain (often memorable for a lifetime).
Vomiting.
Blood in urine.
Fever with chills and rigors due to infections.
Asymptomatic Cases:
Large stones may go unnoticed and are detected incidentally during routine ultrasound.
Rare Symptoms:
Retention of urine caused by stones in the lower ureter or urethra.
Diagnosis of Kidney Stones
1. Clinical Examination:
Focus on pain severity and co-morbid conditions.
2. Primary Diagnostic Tools:
Ultrasound: Initial investigation in India.
CT Scan: Gold standard with 99.9% diagnostic accuracy and 99% specificity.
3. Blood Investigations:
Assess renal function (serum creatinine, blood urea) to check for renal failure due to obstruction.
Evaluate blood sugar levels for diabetes.
Treatment Strategies
1. Conservative Management:
Medical expulsion therapy for smaller stones.
Pain relief with medications and alpha-blockers to facilitate stone passage.
2. Surgical and Minimally Invasive Interventions:
ESWL (Extracorporeal Shock Wave Lithotripsy):
Uses sound waves to disintegrate stones.
Less popular today due to advances in safer methods.
Ureteroscopy (URS) and Retrograde Internal Surgery (RIRS):
Involves inserting a scope through the bladder to the ureter or kidney.
Stones are fragmented using lasers (holmium or TFL) and removed via suction or stents.
PCNL (Percutaneous Nephrolithotomy):
For large stones (>2 cm).
Punctures the kidney to remove stones with a nephroscope.
Highly effective with minimal complications.
Preventive Strategies for Recurrence
1. Addressing Metabolic Abnormalities:
Manage hypercalciuria, high oxalates, or uric acid levels through medications.
2. Dietary Recommendations:
Reduce salt intake (WHO standard: 5 grams/day).
Limit foods rich in oxalates, like dairy and green leafy vegetables.
Maintain hydration: Aim for 3.5–5 liters of water daily, ensuring urine remains clear.
1. Lifestyle Adjustments:
Encourage regular exercise.
Avoid obesity and manage diabetes effectively.
2. Monitoring and Follow-Up:
Routine ultrasounds:
Every 3-6 months initially.
Annual exams if stone-free.
Include stone chemical analysis and metabolic evaluations.
Conclusion
Urolithiasis is a common problem with varied presentations, from severe pain to asymptomatic cases detected via routine scans.
CT scans remain the cornerstone of diagnosis.
Treatments range from conservative management for small stones to advanced interventions for larger stones.
Preventive care, dietary advice, and lifestyle modifications are essential to reduce recurrence and improve patient outcomes.
