Kidney stones
Kidney stones form when deposits from the components of the urine form in the tubules of the kidney or renal pelvis. There, or in the urinary tract, minerals can accumulate and form solid structures.
What are kidney stones?
Kidney stones are caused by mineral deposits from urine in the kidney and urinary tract. Men are more likely to develop kidney stones than women, and they tend to be more common with age.
If the kidney stones remain small and can be flushed out with the urine, no major symptoms develop and the stones may even go unnoticed. However, the kidney stones can become larger as a result of further deposits and so there is no longer the possibility of simply rinsing them out with the urine.
If renal colic occurs, a doctor’s visit is necessary. Sometimes drinking a lot can help flush out the kidney stone. This is supported by antispasmodic medication prescribed by the doctor and possibly an accompanying movement therapy.
If it is not possible to remove the stone in this way, a stone crushing can be carried out under certain circumstances. This is done by sound waves that destroy the stone.
Whether this procedure is appropriate or whether other measures are suitable to remove the stone is at the discretion of the doctor and varies greatly from person to person.
causes
The task of the urine is to flush the various degradation products and salts out of the body. These are water-soluble substances. Changing conditions can cause the salt concentration to become too high, causing some substances to crystallize.Such small crystals are the basis for the formation of kidney stones. Whenever the concentration of calcium salts in the urine becomes too high due to insufficient fluid intake, there is a risk of stone formation.
That is why it is very important, even on hot days or at extremely hot workplaces, to always ensure that the kidneys are supplied with an appropriate amount of liquid so that the concentration of salts does not become too high.
But the causes of the formation of kidney stones are not only due to drinking too little. Chronic urinary tract infections or intestinal diseases, parathyroid diseases, a diet that is too salty or long-term use of painkillers can also cause kidney stones.
symptoms and course
If the kidney stone cannot be flushed out with urination, it migrates towards the urethra, which causes considerable pain. These are the so-called renal colics . The pain can last for days and require medical intervention.
Depending on the location of the kidney stone in the body, there may be stabbing and cramping pain in the back or in the area of the lateral lower abdomen. If the ureteral stones are deep enough, the pain can even reach the groin and genital area.
It can also cause nausea and vomiting . The amount of urine is noticeably reduced when urinating and inflammation of the renal pelvis could be a result. In about a third of those affected, blood is visible in the urine or blood in the stool . This is caused by kidney stones that injure the lining of the urinary tract.
Diagnose
The patient’s medical history already confirms the suspicion of kidney stones. A diagnosis can be made with the help of imaging techniques. Already an ultrasound examination of the urogenital tract and an X-ray examination of the bladder, ureters and kidneys can confirm the diagnosis.
Another diagnostic option is excretory urography of the kidneys and the urinary tract using an X-ray contrast agent. Contrast agent administration is problematic in patients with impaired renal function or a contrast agent allergy. Extensive protective measures are required during the investigation. Therefore, a spiral CT (without contrast agent) is usually used, which is an adequate alternative to urography.
Another diagnostic option is a cystoscopy with an X-ray of the urinary tract. Likewise, a scintigraphy can provide informative results for the determination of kidney stones.
Suspicion of kidney disease usually requires additional examinations. Blood or signs of infection in the urine as well as chemical changes are informative in the diagnosis. Urine should be collected at least once every 24 hours. In this way, the daily excretion of certain substances can be determined in the laboratory. It is important to use the results of the blood tests to assess the kidney function and the accompanying inflammation in order to identify existing and causal metabolic diseases.
When urinating, it is recommended to use a strainer to catch stones. Examination of the deposits can clarify the cause of the kidney stones, an important step for targeted treatment.
complications
Kidney stones can cause various complications. When the nephroliths block the ureters, renal colic can occur. Severe cramping pain occurs in the kidney area, which can radiate into the intimate area and buttocks. This is accompanied by nausea and vomiting as well as nervousness and fearful thoughts.
A complete blockage of the ureter can cause damage to the kidney tissue and also increases the risk of infection. In the short term, so-called urosepsis can occur, in which bacteria enter the bloodstream and lead to blood poisoning.
In the long term, atrophic kidneys can develop, which is associated with permanent destruction of the kidney tissue. Kidney stones can also lead to injuries to the ureter and urethra.
In individual cases, the kidneys themselves can also be damaged, which is accompanied by bleeding and severe pain. Kidney stones can also develop into a chronic disease. This significantly reduces the patient’s quality of life and increases the risk of developing mental health problems.
treatment and therapy
Medical therapy
Kidney stones up to a size of about 4 mm can pass spontaneously through the urine without drug therapy. However, this process can be supported by the patient by drinking plenty of fluids. Furthermore, kidney stones can be spontaneously transported back to the outside by movement, for example by jumping.
It must be decided on a case-by-case basis whether a stone can be passed from the ureter or kidneys without drug therapy.
An alpha-blocker, tamsulosin, can accelerate the passing of stones by acting on the lining of the urogenital tract. Whether a kidney stone can be treated with medication or not usually depends on the type of stone.
Stones composed primarily of uric acid respond well to treatment with the drug allopurinol to help the stone pass. However, patients can also do a lot by changing their diet to lower the uric acid level in the blood and thus accelerate the passage of uric acid-containing kidney stones.
In addition, the doctor can also prescribe medication that makes the urine alkaline with an ideal pH value of 6.2-6.8 for spontaneous dissolution of kidney and ureter stones.
Extracorporale Stoßwellenlithotripsie (ESWL)
The proven procedure of extracorporeal shock wave lithotripsy uses external acoustic pressure waves to shatter certain types of kidney stones directly in the body.
Exposure to these shock waves can break up a kidney stone into tiny fragments, making it easier for these stones to pass.
After the therapy, the shattered fragments are usually excreted spontaneously via the ureter. Especially individual but also small kidney stones are usually well suited for ESWL therapy.
Ureterorenoskopie (URS)
Ureterorenoscopy, URS, is an endoscopic procedure for examining the kidneys and ureter. If only the ureters are examined, the procedure is called ureteroscopy. Both interventions can be used to diagnose and treat stones in the kidneys or urinary tract. The minimally invasive urological procedure is performed with the patient in the supine position with the knees bent.
The endoscopes work with light optics and can be either semi-flexible or rigid. The working channel of the endoscope allows the doctor to insert various instruments to break up the stone during the procedure. Depending on the indication, the URS can also be used to remove the stones using grasping forceps or laser application.
Perkutane Nephrolitholapaxie (PCNL)
Larger kidney stones can also be removed with the minimally invasive procedure of percutaneous nephrolitholapaxy, PCNL. The nephroscope is inserted percutaneously via a precisely defined punctured area of skin.The medical indication for PCNL therapy is given when kidney stones with a diameter of at least 2.5 cm are found. So-called urinary tract obstructions are also an indication for carrying out PCNL treatment.
If there are cast stones, this procedure is also combined with ESWL therapy. During the practical implementation, the puncture channel is first widened, after the subsequent introduction of the nephroscope, the kidney stone is broken up and removed.
prevention
In order to prevent the formation of kidney stones, it is extremely important to drink enough fluids. The kidneys must always be able to flush the resulting salts out of the body in dissolved form. This means drinking at least two liters of water, tea or juice, especially on hot days.
But liquid intake is also very important in the case of vigorous sporting or professional activity, which results in a high level of sweating . Since the feeling of thirst decreases in older people, regular drinking throughout the day and also at night is of great importance, especially in old age.
A low-salt diet, hardly any rhubarb, spinach, tomatoes and less milk and dairy products can prevent kidney stone formation. This is especially true for people who have had problems with kidney stones.
Without appropriate prophylactic measures, the symptoms reappear in about 50 percent of those affected. This risk can only be reduced by changing your diet and possibly by taking preventive medication.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.