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Kidney Stones

  • What are kidney stones?

    Kidney stones

    Kidney stones occur when salt or chemicals in the urine form crystals. These crystals grow and coalesce to form stones that can block the flow of urine and can lead to serious complications including infection, kidney damage or even kidney failure. Kidney stones are made of various types of chemicals including calcium, phosphate and oxalate. This urinary disorder affects more men than women between the ages of 20 and 40.

    Types of kidney stones

    Different types of kidney stones are made of different chemicals, and these include:

    • Calcium oxalate stones or calcium phosphate stones – Kidney stones are mostly calcium stones, which occur in the form of calcium oxalate and, less commonly, calcium phosphate. Oxalate is a substance made by the liver or absorbed from your diet daily, such as fruits, vegetables, nuts, and chocolates. Calcium phosphate stones, on the other hand, are commonly found in people with metabolic conditions, such as renal tubular acidosis.
    • Cystine stones – These are made of cystine, which is an amino acid found in digestive enzymes. These very rare stones form in people with a genetic disorder that causes the kidneys to excrete too much cystine into the urine.
    • Struvite stones – These develop when you have a urinary tract infection. The bacteria makes ammonia that builds up in the urine.
    • Uric acid stones – These stones form when your urine is often too acidic, and uric acid can form stones by itself or with calcium. Uric acid stones are common in people who are losing too much fluid because of chronic diarrhoea or from eating a high purine diet. People with diabetes or metabolic syndrome are also prone to have uric acid stones.
  • A kidney stone occurs when:

    • The urine has little or none of the substances that usually prevent these minerals from becoming crystals.
    • The urine contains more minerals (calcium, oxalate, phosphate, uric acid or cystine) than it can dilute.
    • There is the presence of other conditions like cystic kidney diseases, urinary tract infections, and metabolic disorders.

    Risk factors for kidney stones

    Risk factors that can increase the chances of developing kidney stones include:

    • Dietary factors including low intake of fluid and high intake of salts, oxalate-rich foods (eg. peanuts, almonds, strawberries, tea and coffee) and purine-rich foods (eg. organ meats, shellfish)
    • Environmental factors like living in a hot climate which causes excessive sweating, and having a low fluid intake, which leads to reduced urine volume and increased levels of minerals in the urine
    • Genetic factors including a family history of kidney stones

    Preventing kidney stones

    You can reduce your risk for kidney stones by drinking sufficient amount of water daily. Likewise, choosing a diet low in salt and animal protein and eating fewer oxalate-rich foods can help prevent the formation of kidney stones.

    If you are at a higher risk of developing kidney stones, ask your doctor for dietary recommendations.

  • The symptoms of kidney stones include:

    • Blood in the urine
    • Difficulty urinating (if the stone is too large)
    • Nausea and vomiting
    • Pain when passing urine
    • Severe pain in the back and flanks of the abdomen, radiating towards the front and the groin area
    • No symptoms. Some stones, especially if they occur within the substance of the kidney, may not result in any symptoms.

    Ask for medical attention immediately if you experience having pain that is so severe you can't find a comfortable position or sit still, and is accompanied by nausea, vomiting, fever and chills, blood in your urine, and difficulty passing urine.

  • After checking your symptoms and medical history, your doctor will require you to undergo several tests including:

    Blood tests

    Blood tests are important to check the levels of uric acid or calcium in your blood. The results of your blood test help monitor the health of your kidneys and can help your doctor check other medical conditions.

    Urine test

    This may reveal if you are excreting too few stone-preventing substances or too many stone-forming minerals.

    Imaging tests

    An ultrasound or a computerised tomography (CT) will help detect kidney stones. An ultrasound is a noninvasive procedure that is a common imaging option used to diagnose kidney stones, while a CT scan can detect very small kidney stones.

    Evaluation of passed stones

    You may be asked to urinate through a lab strainer to catch stones that you pass. The stones will be examined in the laboratory and the composition of your kidney stones will be determined. The information will be helpful in finding out the cause of the kidney stones and developing a plan to prevent more kidney stones from forming.

  • There are different treatment options available to treat kidney stones. Your doctor will assess your condition and suggest the appropriate treatment for you, depending on the size and type of your kidney stone(s).

    If your kidney stones are small:

    • No treatment is needed. With plenty of water, the stones may eventually pass out in the urine
    • Painkillers may be prescribed to ease any pain during the passing of the stones

    If your kidney stones are too large to pass on their own, your doctor may suggest a few options for kidney stones removal. These options include:

    Extracorporeal shock wave lithotripsy

    This is a non-invasive procedure where shock waves are sent into the body to break down the kidney stones into smaller pieces, which are then passed out in the urine over the next few days.

    Medication

    You will be given medicines that help to expel or prevent the recurrence of certain stones. Specific type of medication depends on the type of kidney stones.

    Percutaneous nephrolithotripsy

    This is a surgical procedure that involves making a small cut in the back to allow a special instrument to locate and remove the stones.

    Ureterorenoscopy

    This is a surgical procedure where an endoscope (thin, flexible tube with a camera at the end) is inserted through the urethra, into the bladder and to the kidney to where the stone is located. The stones are then broken down and removed.

    Speak to a specialist to find out the best treatment option for you.

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  • If left untreated, kidney stones may lead to more serious health complications and diseases, including:

    Kidney failure and loss of kidney function

    Kidney failure occurs when the kidneys lose their function to sufficiently filter waste from the blood. The body will be overloaded with toxins if the kidneys fail to do their job, which can be life-threatening.

    Infection

    A kidney stone increases the risk of urinary infection by causing disruption to urine flow and stasis. Infection of a closed and infected urinary system is an emergency and needs to be promptly corrected.

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