Every year, ten million people apply to hospitals because of kidney stones. It can be said that kidney stones are more common in men than women. In general, the first symptoms begin to appear around the age of 30. Other diseases such as obesity, diabetes and high blood pressure predispose to the formation of kidney stones.
Stones can be of different types and sizes, depending on the content of salt and minerals and the reason for their formation. Kidney stones can be seen unilaterally or bilaterally. For the treatment of kidney stones, it is necessary to apply to the urology department.
What Are the Symptoms of Kidney Stones?
Kidney stones may not cause any symptoms for a long time. However, pain in the back and abdomen that starts suddenly is one of the biggest indicators of kidney stones. When the stones move towards the urinary tract, in some cases, they can be removed from the body without symptoms or with very few symptoms. However, the presence of larger stones can lead to urine accumulation in the kidney, ureter, bladder, or urethra. At this point, the kidney stone presents itself with the aforementioned pain.
In advanced cases, more serious complications may occur if the stones obstruct the urinary tract. Common symptoms of kidney stones can be listed as follows:
Pain in the lower part of the ribs in the back
Pain radiating to the lower abdomen
Burning and pain in urination
Nausea
Vomiting
Change in the structure, color, and density of urine (cloudy, foul-smelling urine)
blood in the urine
In the presence of infection, fever and chills may accompany these symptoms.
Kidney stones are mostly excreted through the urine without causing any damage to the body. However, treatment may be required for recurrent stones that cannot be passed through urine.
What are the Causes of Kidney Stones?
There are many different wastes in the urine. If these wastes condense in a small amount of liquid, the wastes gradually crystallize, which can lead to the formation of kidney stones. Mostly, these wastes are excreted together with the urine and stone formation does not occur. However, in the presence of risk factors and in cases where fluid intake is less than necessary, the formation of kidney stones accelerates and the stones may reach sizes that cannot pass through the urinary tract after a certain point and even block the urinary tract. The chemicals that make up these stones are calcium, oxalate, urea, cystine, xanthine and phosphate.
Many factors such as diet, metabolic disorders, insufficient fluid intake or fluid loss, and some medications can cause kidney stones.
Apart from these factors, among the factors that cause kidney stone formation,
family health history
Prolonged administration of high protein diets
insufficient fluid intake
Obesity
Other kidney diseases or kidney anomalies
Bowel surgeries
Stomach surgeries for weight loss
High salt and sugar consumption
Heavy use of laxatives
Some migraine and depression medications
metabolic syndromes
Some supplements (vitamin D, calcium, etc.)
Gout
insufficient physical activity
Factors such as urinary tract infections are also involved.
What Are the Types of Kidney Stones?
Kidney stones are divided into four different categories according to their content and formation. The stones can be the size of a grain of sand or the size of a pebble.
Calcium Oxalate Stones: Calcium stones are the most common type of kidney stone. It is formed as a result of the combination of calcium and oxalate in the urine. In the formation of these stones, which are seen as a result of insufficient fluid and excessive calcium intake, other risk factors often accompany these causes.
Cystine Stones: Cystine stones, which are formed as a result of an inherited disorder, are the rarest type of kidney stones. These stones can form before the age of 25 and are a frequent recurring disorder. Therefore, it can cause weakening of kidney functions and kidney failure.
Uric Acid Stones: Factors such as long-term use of high protein diets, gout, and low fluid consumption increase the amount of uric acid and cause the formation of uric acid stones. Offal and shellfish can also cause high levels of uric acid to form in the urine. Uric acid stones are a type of kidney stone that can also be inherited.
Citruvite Stones: These stones, also called infection stones, are formed as a result of recurrent urinary tract infections. It is more common in women.
How Are Kidney Stones Diagnosed?
Patients presenting with kidney pain are first subjected to a physical examination and it is investigated whether there is a history of kidney stones in the family. Afterwards, a definitive diagnosis is made by using some imaging techniques along with blood and urine analysis. It is tried to understand whether there is any damage to the kidneys through blood and urinalysis. Calcium, phosphorus and uric acid levels are checked in the blood. From time to time, 24-hour urine collection may be requested from the patient.
Computed tomography (CT) is one of the imaging methods used in the diagnosis of kidney stones. Also, for diagnosis kidney, ureter
r and bladder region x-ray may also be requested. In this way, the size of the stone and its location are displayed and it is decided what kind of treatment plan should be followed for existing stones.
However, since the radiation exposure rate in computed tomography is high, it is necessary to be careful about the use of this method in pregnant women and young people. For this reason, ultrasound is often used in pregnant women.
In some cases, doctors can also diagnose kidney stones by looking at an X-ray taken using the coloring method called IVP (Intravenous Pyelography). However, since IVP causes toxicity (poisoning) in some patients and the diagnosis time is prolonged due to processes such as dye injection, it can be said that this method is no longer preferred.
Different imaging and diagnostic methods may be required for each case. Therefore, it would be best for the doctor to decide which imaging method to use based on the patient’s condition and disease history.
What Can Be Done to Prevent Kidney Stones?
Increasing fluid intake, especially water, is one of the things that should be done to prevent kidney stones. Under normal conditions, urine should be light yellow. Instead of tea, coffee, fruit juices and acidic beverages, water consumption should be increased. Because some of these drinks can cause dehydration (loss of fluid) or invite other problems due to the sugar in them. It should not be forgotten that people who do sports, outdoors and do intense physical work should drink more water.
Consumption of plenty of vegetables and fruits is also very important. Vegetables and fruits reduce the amount of acid in the urine. For this reason, vegetables should be consumed together with animal foods that have the risk of increasing the uric acid ratio.
Reducing salt and sugar is another method that can be used to prevent kidney stones. In addition, since the amount of salt and sugar in packaged foods cannot be controlled, it is recommended that people at risk consume less packaged foods.
Since obesity is also a risk factor for kidney stone formation, losing weight is recommended for reducing or preventing kidney stones. However, caution should be exercised before resorting to methods such as weight loss surgeries or fast weight loss high protein diets.
Blood and urine tests can also be done to prevent kidney stone formation. Since blood and urine tests often give an idea about what needs to be changed in nutrition, a suitable nutrition plan can be prepared for people at risk as a result of these tests.
How Are Kidney Stones Treated?
90% of stones smaller than 4 mm will fall out on their own without any intervention. It can be said that half of the stones between 4-7 mm and stones larger than 8 mm rarely fall spontaneously.
If the kidney stone has started to move in the urinary tract and is too small to require intervention, patients are advised to consume plenty of water and move around. It is aimed to reduce the problems that can be experienced during the falling of the stone with painkillers. However, it may be necessary to intervene and consult a doctor in stones larger than 5 mm.
The urologist decides on the necessary intervention according to the location and size of the stone, the patient’s health status and age. It can be said that similar treatment methods are used in children and adults.
Medication
In the presence of kidney stones, some painkillers can be given to patients to reduce pain and eliminate discomfort. Especially ibuprofen-style pain relievers are preferred. In some cases, doctors may also prescribe some medications to help pass the stone. At the beginning of these drugs are alpha blockers. These drugs, which are given to relax the muscles in the ureter, facilitate the process of removing the stone from the body.
In cases where there is an excess of uric acid in the body, drug therapy can also be applied to reduce the acidity of the urine.
Non-operative interventions
ESWL (Extracorporeal Shockwave Lithotripsy) method is one of the methods used in the treatment of kidney stones and does not require surgery. In the ESWL method, which can be defined as the process of breaking the stone with shock waves given outside the body, computerized tomography is taken again after the procedure and it is checked whether the procedure is successful or not.
In cases where all other interventions and procedures are insufficient, or in the presence of other diseases or anomalies accompanying the condition of the patients, or if the stones are very large, surgical intervention is used in the treatment of kidney stones.
surgical interventions
Percutaneous nephrolithotomy (PNL) is the name given to kidney stone surgery. This surgery is also called closed kidney stone surgery. It is an intervention that allows the removal of kidney stones through a small incision on the back and with the help of telescope-like tools. It is done under general anaesthesia. The patient may need to stay in the hospital for several days.
Ureteroscopy is used to surgically remove kidney stones from the body.