How kidney stones are treated

If you would like to know about the symptoms and diagnosis of kidney stones, and about kidney stones treatment, the following information will interest you.

Kidney stones, known in the medical world as renal calculi, are small, hard lumps that form in the kidneys. A kidney stone can range in size from a grain of sand to as large as a grapefruit.

This article on kidney stone symptoms and treatment is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Normally, waste in the urine exists in very tiny amounts, completely dissolved into the liquid. But sometimes it can accumulate to form crystals on the inner surface of the kidney. Over time, these crystals form into a small ‘stone’. They can be smooth or jagged, and are yellow or brown in colour.

Once a stone has formed in the kidney it may travel down into other parts of the urinary system, causing infection, kidney damage, or even kidney failure. It can also cause intense pain as the stone moves from the kidneys to the bladder.

Causes

The most common kind of kidney stone arises spontaneously and is made of calcium oxalate crystals. Conventional wisdom suggests that consuming too much calcium can promote the development of kidney stones. But in fact, evidence suggests that a low-calcium diet may increase the overall risk of kidney stones forming.

Certain medications such as steroids, antacids, and vitamin D supplements can cause kidney stones to form. You may also be prone if you suffer from recurrent urine or kidney infections, only have one kidney, or have close relatives who’ve had kidney stones in the past.

Very rarely, a kidney stone may arise as a consequence of underlying conditions such as renal tubular acidosis, Dent’s disease, and medullary sponge kidney.

Symptoms

Sometimes kidney stones can cause no problems or symptoms at all and go undetected for years. Alternatively, they can give rise to one or more of the following kidney stone symptoms:

1. severe colicky pain in the abdomen or groin
2. blood in the urine
3. painful urination when passing stones
4. lack of urine production due to a blockage in the urethra
5. nausea or vomiting

Diagnosis

A clinical diagnosis is made based on the location and severity of the pain, which usually comes and goes in spasmodic waves. Three main types of imaging techniques can be used to confirm the diagnosis. These are:

X-ray of the abdomen - may be combined with a special intravenous dye injected into the bloodstream and excreted by the kidneys. This will reveal any stones present in the kidneys, ureter, or bladder.

CT or CAT scan, (Computed Tomography) - a specialised X-ray that’s the most effective (but expensive) test for detecting kidney stones. It does not require any intravenous dye and can detect almost any kind of stone.

Ultrasound scanning - can detect hydronephrosis, or swelling of the kidney, which suggests a kidney stone could be blocking the outflow of urine. It is also used to detect stones containing less calcium, and for pregnant women.

Treatment

Small Stones

Many kidney stones are small – less than 4mm in width – and will pass naturally in the urine. Painkillers are recommended to ease the pain until the stone is passed, and hospitalisation may be needed if the pain is severe. Stones that form and stick in the kidney do not cause any symptoms and can be left untreated.

Larger Stones

However, larger stones – more than 6mm in width – will usually require some form of intervention. The pain is managed with an intravenous painkiller, such as morphine, Demerol, or Dilaudid, which relax the ureter to facilitate the passing of smaller stones within two days. Hydrocodone may also be prescribed so the patient can return home to pass more stones and avoid unnecessary trips back to the emergency room.

Alternatively, a non-invasive kidney stones treatment called Extracorporeal Shock Wave Lithotripsy (ESWL) may be used, where high-energy shock waves break down the stones from outside the body. Otherwise, invasive therapies like laser, ultrasonic or mechanical forms of energy are used to fragment the stones. This involves passing thin wires through the skin or up the urethra, in order to break down the stones directly.

Surgical removal of kidney stones is a last resort, but is necessitated by certain situations, such as patients with only one working kidney, intractable pain, or an infected kidney that’s blocked by a stone (which can rapidly result in severe sepsis and toxic shock).