Today’s fast paced life drags us through the turmoil of ‘less time and more work schedule’ which prompts many of us to have self-medication with least botheration about our internal organs though keen on the physical fitness. Dr.Anandam Gopinath turns you towards your kidney which is having a high market value outside and a ‘quintessential’ status inside.

Kidney stone  is  a cause of obstruction to the flow of urine. They are solid pieces of material that forms in a kidney out of susubstance in the urine. It can be as small as grain of sand or as large as a pearl. At times some are seen bigger. Anyways, these stones may be present inside the kidneys or ureters (tubes which carry urine from the kidney to the bladder) or in the bladder itself.

A small stone can grow large enough to occupy a considerable part of one kidney. A large stone in the kidney can take the shape of deer horn and is called a stag horn calculus then. The size and shape of the stones vary according to their composition. The size varies from those of sand particles to pebble size as stated already. There may be a shower of crystals following excessive intake of straw berries or rhubarb.

Causes

Renal stones are commonly seen in the 30-50 age groups, men being more commonly affected. The following conditions may be associated with stone formation:

1. Living and working under conditions where excessive loss of fluid by sweating occurs. This causes the salts in urine to be precipitated due to the high concentration.
2. Repeated urinary tract infections.
3. Disorders like gout (due to increased level of uric acid in the blood).
4. Faulty diet consisting of excessive spinach, straw berries etc.
5. Bed-ridden patients are more prone to this condition.
6. The predisposition to high levels of calcium in the urine may be passed on from           generation to generation.
7. People taking diuretics (water pills) and those who consume excess calcium-containing antacids can increase the amount of calcium in their urine and potentially increase their risk of forming stones. Taking excess amounts of vitamins A and D are also associated with higher levels of calcium in the urine. Patients with HIV positive who take the medication Indinavir (Crixivan) can form stones. Other commonly prescribed medications associated with stone formation include dilantin and antibiotics like Cefriaxone (Rocephin) and Ciprofloxacin (Cipro).

The size and shape of the stones vary according to their composition. The size varies from those of sand particles to pebble size as stated already. There may be a shower of crystals following excessive intake of straw berries or rhubar.

In some patients even if the stones are larger there may be no symptoms – while others with a small stone may suffer a lot. In some, there is dull pain in the back along the sides which is aggravated by movement or a sudden jolt. If the stone passes into the ureter it may produce a severe colic. This is a severe, sudden pain which starts at the side and back on the affected side and moves forwards towards the lower abdomen and inner thigh. It is a severe cramp, making the patient restless. The pain increases in intensity and may be accompanied by vomiting, sweating and passing of blood-stained urine.

Diagnosis

Urine analysis with a microscope can detect blood even if it is not appreciated by the naked eye. Sometimes, if the stone causes complete diagnosis

CT scanning of the abdomen without oral or intravenous contrast dye is the most commonly used diagnostic test. The scan will demonstrate the anatomy of the kidneys, ureter, and bladder and can detect a stone, its location, its size, and whether it is causing dilation of the ureter and inflammation of the kidney

Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant). Ultrasound requires a specially trained person to obtain the images, and therefore, it may not always be available.

In those patients who already have the diagnosis of a kidney stone, plain abdominal x-rays may be used to track its movement down the ureter toward the bladder

Treatment

If fever is associated with the symptoms of a kidney stone, this becomes an emergency, and medical care should be accessed immediately.

Urinary tract infections associated with a kidney stone often require urgent assessment and may need intervention by a urologist to remove or bypass the stone.

A person who has had an attack of renal colic may get repeated attacks when the stone moves. He is advised rest and warm compresses. Strong pain killers are given to reduce the pain. The most important part of the treatment is adequate intake of fluid. Enough fluid is to be taken to ensure a minimum urinary output of 3 liters per day. Small stones are passed spontaneously while larger ones are removed by surgery. Recently, laser treatment has been used to dissolve the stones.

Once a stone has been successfully treated further attacks can be prevented. A person who had renal colic once is advised by his surgeon to have approximately four liters of water daily. This is to be increased during the hot summer months.