Conditions of the Kidney
Kidney stones
Kidney stones are common and can cause significant discomfort. This guide is designed to provide you with essential information about kidney stones, including their causes, symptoms, risk factors, and potential treatment options.
What are Kidney Stones?
Kidney stones are solid deposits that form in the kidneys from substances in urine. They can vary in size and composition, and their presence can lead to pain and other urinary symptoms.
Common Causes for Kidney Stones
- Dehydration: Insufficient fluid intake can concentrate minerals in urine, promoting stone formation.
- Dietary Factors: High intake of certain foods (e.g., salt, oxalate, calcium) can contribute to stone development.
- Medical Conditions: Conditions like gout or urinary tract infections can increase the risk.
- Genetics: Family history of kidney stones may predispose individuals to develop them.
Symptoms of Kidney Stones
- Severe Pain: Sharp, stabbing pain in the back or lower abdomen as stones move through the urinary tract.
- Haematuria: Blood in the urine, visible as pink, red, or brown discoloration.
- Urinary Changes: Frequent urination, urgency, and discomfort during urination.
- Nausea and Vomiting: Some individuals may experience nausea or vomiting.
Risk Factors
- Age and Gender: Men are more likely to develop kidney stones, and the risk increases with age.
- Family History: A genetic predisposition can contribute to stone formation.
- Medical History: Conditions that impair gut absorption of calcium and minerals (e.g. Inflammatory bowel disease) can predispose to kidney stones.
- Dietary Habits: High intake of sodium, protein, or oxalate-rich foods.
- Obesity: Increased body weight may elevate the risk of kidney stones.
Diagnostic Tools
Staging is a critical aspect of understanding and managing bladder cancer. It helps determine the extent of the disease and guides the selection of appropriate treatments.
Treatment Options
Medical Expulsion Therapy
Medications that relax the muscles, aiding stone passage. This is part of conservative management.
Conservative Management
Opting for Conservative Management: Important Considerations
Choosing conservative management for kidney stones involves essential considerations that patients should be aware of:
Painless Passage Through the Urethra:
Contrary to common perception, the passage of a stone through the urethra is rarely painful. Most individuals may not even notice it due to the wider calibre of the urethra compared to the ureter. If the stone has reached the bladder, it will easily flush out with urine. It is crucial to sift urine during this process to ensure awareness of the stone passing.
Persistence of Stone Presence:
The absence of pain does not necessarily indicate that the stone is no longer present. Silent or painless obstruction from an unnoticed stone can lead to gradual kidney failure. Follow-up imaging is imperative to confirm the complete passage of the stone if it hasn't been observed in the urine.
Consider Intervention
When to Consider Intervention:
Ongoing pain, failure to pass the stone after approximately two weeks, reduced kidney function, having a single kidney, or signs of infection are compelling reasons to reconsider conservative management. In such cases, intervention to remove or dissolve the stone becomes necessary.
Tailored Treatment Approaches:
Once the decision is made to actively treat the stone, various options are available, contingent on the stone type, size, and location. Your urologist will guide you through the most suitable course of action for your specific situation, ensuring a personalised and effective approach to managing kidney stones.
Interventional Procedures:
For larger stones, procedures like ureteroscopy and laser lithotripsy or extracorporeal shock wave lithotripsy (ESWL) may be recommended. For stones larger than 2cm, patients may need to undergo a larger procedure known as a Percutaneous Nephrolithotomy (PCNL).
Strategies to Prevent further Stone formation
For individuals experiencing their first urinary kidney stone, a comprehensive evaluation begins with a basic metabolic analysis. This involves blood and urine tests, along with an examination of the stone composition if feasible. While many patients won't show any detectable abnormalities, approximately half of them won't experience further stone formation in the short term. In such cases, no specific treatment or additional investigations are typically recommended.
To minimise the risk of stone recurrence, the following fundamental advice is provided:
For patients experiencing recurrent kidney stones despite adopting the above measures, a more thorough metabolic analysis can be conducted. Additionally, regular medication may be prescribed to decrease the concentration of substances prone to stone formation in the urine. This tailored approach ensures a comprehensive strategy for managing recurrent kidney stones and promotes long-term urinary health.
When to seek medical attention
If you experience severe pain, persistent urinary symptoms, or suspect kidney stones, consult with our urology team promptly. Early intervention can alleviate discomfort and prevent complications.