Kidney Stone (Risk Factors, Symptoms, Management)

Stone are the polycrystalline aggregates composed of varyinga mounts of crystalloids and organic matrix.

Risk factors.

1. Low volume water intake.
2. Higher incidence in dry and hot climaticregions.
3. Obesity, diabetes and metabolic syndrome.
4. Sedentary life style.
5. Abnormal kidney anatomy- obstruction to urine flow.
6. Recurrent UTI
7. Genetic.

Symptoms.

• Pain : -Deep ,dull aching pain ever back (kidney stone)
  Severe, sharp colicky flank pain radiating towards groin (Ureteric stone)
• Blood in urine.
• Recurrent UTI.
• Nausea and vomiting

Test to be done:-

1. Urine Routine examination.
2. Kidney function test.
3. Ultrasound of kidney, ureter and bladder region.
4. CT scan (Non-contrast) is the gold standard ofinvestigation.
5. Recurrent stone formers need metabolicevaluation and stone analysis.

How to manage: - Treatment options

1. Medical therapy
2. Pain management
3. Medical expulsive therapy for stones less than6mm in size.
4. Surgical management:-
5. Kidney stones:-
6. RIRS (Retrograde Intra-renal surgery): -

Use of flexible endoscope to reach in to the calyces of the kidney and toremove the stone with laser.

• PCNL and its modifications: -

Small puncture over patients back to create a track to reach the kidneystones and remove it.

• ESWL for favourable and soft stones.

• Stone in ureter
• Medical expulsive therapy for stones less than6mm.
• URSL: - Use of endoscope which passes throughthe patient’s urine pipe to reach the stone, fragment it and remove.
• Stone in urinary bladder
• Cystolitholapexy / Cystolithotripsy use ofendoscope to pass through the urine pipe, fragment the stone and remove it.
• Open cystolithotomy (open surgery)

Patient with large burden of stones in kidney may need opensurgery to remove them. Measures to avoid recurrent stone formation.

• Fluid intake of at least 2 liters per day.
• Avoid carbonated drinks.
• Encourage citrate juices ( Lemon / CRANBERRY)
• Reduce animal protein.
• Low salt intake.
• Avoid oxalate rich foods like spinach, beets,nuts, almonds.
• Healthy lifestyle with physical activities.