Medical Hex

Kidney stones: Treatment and Prevention

To read part 1, click here.

Diagnosis

Correct diagnosis of a kidney stone has magnificent importance for the treatment and prevention of kidney stones; thus, lots of care is put into the process of diagnosing kidney stones.

Doctors benefit from these factors to diagnose a kidney stone:

  • Your medical history of having kidney stones.
  • A physical examination.
  • Diagnostic lab and imaging tests.

After asking about your previous medical history and running a physical examination, your doctor will use these Diagnostic tests and procedures to diagnose kidney stones:

  1. Blood testing: done especially for calcium and uric acid, a high concentration of these substances in the blood indicates the possible presence of stones.
  2. Urine testing: these tests can show whether your urine contains a high concentration of the substances that build up into stones.
  3. Imaging: these tests are useful in locating kidney stones. 3 imaging options exist to diagnose kidney stones:
    • CT scans: Ct scanning of the abdomen and pelvis is the standard imaging tool for stone diagnosis one advantage of CT scanning is that it can locate small-sized stones that are otherwise missed by X-rays.
    • x-ray: this option of imaging is not used frequently, nevertheless in certain cases, such as when ultrasound fails to find anything in children younger than 16 years this option may be considered.
    • Ultrasound: is also another option to diagnose kidney stones; this option of imaging diagnosis is mainly used to diagnose pregnant women.
  4. Analysis of passed stones.

Treatment of kidney stones

Choosing the right treatment for a patient's kidney stone varies and depends on:

  1. The size of the stone
  2. Type of the stone & its composition
  3. Whether the stone is causing pain
  4. Whether it is blocking the urinary tract.

To find a suitable treatment for each patient a correct diagnosis is quite necessary.

With these factors in mind and after a diagnosis, a doctor may choose one of the following treatments:

A. If the size of the stone is relatively small:

Stones less than 4-5 millimeters in diameter will usually pass out of the body on their own and they don't need invasive treatments. Your doctor may recommend:

  • Drinking large amounts of water and beverages to help speeding the process along, drinking large amounts of water will also dilute urine and prevent the stone from growing larger.
  • Taking painkillers such as ibuprofen (Advil, Motrin IB…etc) to relieve the mild pain that stone passage tends to cause.

B. If the stone is not large for surgery to be involved (Medium sized stones, relatively):

Stones which are slightly larger than 5 millimeters usually can't pass out on their own and require a few medical interventions, for the treatment of these kinds of stones your doctor may recommend:

1. Medications such as:

  • Alpha blockers to help relax the muscles in the ureter and therefore make it easier for the stone to pass out.
  • Another example of medications used in this situation is (tamsulosin 400 μg once daily, nifedipine 30 mg once daily). These two drugs had been thought to aid stone passage, especially for distal ureteral stones.
  • Another medication called potassium citrate can help to dissolve the stones by producing a less acidic urine. This type of medication uses an approach called chemolysis, this approach is effective for those stone types which are in principle amenable to dissolution by oral medications, Thus, it is important to mention that chemolysis is effective for only uric acid stones, which can be easily dissolved by alkalization of the urine, usually with potassium citrate.

2. Shock-wave lithotripsy:

another option is pulverizing stones with soundwaves. Extracorporeal shock wave lithotripsy uses high-intensity pulses of focused ultrasonic energy aimed directly at the stone. These pulses produce vibrations inside the stone itself and crush the stone into smaller pieces that can pass out of the body spontaneously.

But if the size of the stone is bigger than 10mms shock-wave lithotripsy won't be effective so more invasive treatments are necessary.

3. Using a ureteroscopy to remove stones:

this option includes using an endoscope is inserted through the ureter to remove the stone. Once the endoscope reaches the stone, special tools can catch the stone or break it into pieces. Afterwards A rigid small tube called a stent can be placed inside the ureter to relieve swelling and promote healing.

4. Using optical fibers:

Another treatment option is to use Optical fibers that can deliver laser pulses to break up the stone.

Surgery

Stones can also be surgically removed through an incision in the patients back or groin if the previous treatments have failed or for some reason don't seem fit to be tried.

Open stone surgery is a final resort when it comes to treating kidney stones, but it still has a place in the treatment of stone disease.

Your doctor may decide on open stone surgery when the previous treatments have failed or the previous treatments cannot be used due to anatomic reasons (e.g. pelviureteral junction [PUJ] obstruction) that Make it impossible to use the other minimally invasive methods.

Prevention of kidney stones

For those who get a kidney stone in their lifetime, chances are high that they will be diagnosed with another kidney stone in the future, thus prevention plays an important role in decreasing the chance of stone reoccurrence.

Doctors may recommend one of the following to prevent kidney stones:

  1. Drinking plenty of water: this helps by diluting the substances in urine that can eventually build up into stones.
  2. Limiting Foods: like potato chips, spinach, rhubard and beets because they are high in oxalate, so doctors might advise reducing or avoiding them.
  3. Eating foods which contain calcium: Even though calcium is often one of the substances that can build up into stones, calcium in foods and beverages can help prevent stones by binding to oxalate in the intestines before it can be absorbed into bloodstream and reach the kidneys. This binding decreases the concentration of oxalate in urine.
  4. Reducing sodium intake: current guidelines recommend not getting more than 2,300 mg of sodium per day, however in certain cases when sodium has a history of contributing to stones in the past, reducing to 1,500 mg per day is recommended.
  5. Limiting animal protein: such as meat, milk and eggs. This kind of limitation is especially recommended when we're dealing with uric acid stones.

Complications

If a stone gets big enough to actually block the flow of urine, it can create an infection or a back flow and damage the kidneys themselves.

If the kidney damage is permanent kidney stones will cause the initiation of chronic kidney disease.

If stones are left untreated, they can also cause urinary tract infections and acute kidney injury (traditionally called acute kidney failure).

References

1. Karl Skorecki, Glenn M. Chertow et al., Brenner & Rector's the Kidney, 10th edition, Philadelphia, United States of America, Elsevier, [2016]

2. John Feehally et al., Comprehensive Clinical Nephrology, 6th edition, Philadelphia, United States of America, Elsevier -Health Sciences Division, [2018]

3. Christopher S. Wilcom et. al., Therapy in Nephrology and Hypertension- A Companion to Brenner & Rector's the Kidney, 3rd Edition, Philadelphia, United States of America, Saunders/an imprint of Elsevier, [2008]

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