Kidney Stones Disease

BASICS

DESCRIPTION

Kidney stones, also called urolithiasis or renal colic, are the formation of hard mineral deposits called calculi within the urinary system.

SIGNS AND SYMPTOMS

Usually sudden onset
Severe agonizing pain, which may be felt from the rib cage to the groin, depending on the location of the stone
Patient is unable to obtain relief from discomfort
Nausea with or without vomiting
Sweating
Rapid heartbeat
Abdominal distension
Tenderness to deep abdominal examination
Frequent, urgent, or difficult urination
Fever
Blood or pus in the urine
May be asymptomatic if stone stays within kidney

CAUSES

Kidney stones may be caused by a wide range of factors related to the body's water and mineral balance.

RISK FACTORS

Family history
Hot climate
Work in hot environment
Inadequate fluid intake
Diet high in minerals and vitamins
Cancer
Gout
Use of diuretics (water pills)
Bowel or kidney disease

DIAGNOSIS

WHAT THE DOCTOR LOOKS FOR

Other medical disorders, such as kidney disease, diabetes, infection, intestinal conditions, or gynecological problems

TESTS AND PROCEDURES

Urinalysis and culture
Blood tests for electrolytes, chemistry, and hormones
Stone may be analyzed to determine its chemical composition
Urinary system may be assessed by x-rays or ultrasound
A special procedure called intravenous pyelogram (IVP) may be performed to evaluate the urinary system

TREATMENT

GENERAL MEASURES

Most stones pass within 24 hours
About 80% of individuals with kidney stones are managed as outpatients
About 20% require hospitalization and treatment by a specialist
The doctor should provide reassurance to the patient
Patient should be instructed to strain urine to recover stone for analysis
It is important to maintain adequate fluid intake
Doctor should make sure pain is controlled appropriately
The patient may be seen by a specialist for intractable pain, obstruction of the urinary tract, stones of large size, infection, or other complicated conditions
Surgical measures include:
- Extracorporeal shock wave lithotripsy, which uses sound waves to shatter kidney stones
- Urethroscopy, in which a stone is crushed and removed through an instrument inserted into the bladder
- Minimally invasive techniques
- Open surgery, which is performed on less than 5% of patients

ACTIVITY

Bed rest during acute phase if necessary. No restrictions after stone passes.

DIET

Normal diet
Drink 8 oz. water every 1 hour while awake, and, if possible, every 2 hours during sleep hours
If stones consist of uric acid, eat less protein and take sodium bicarbonate to alkalinize urine

FOLLOW UP

PREVENTION/AVOIDANCE

Maintain adequate water intake to produce more than 2 liters of urine a day, including one trip to
the bathroom at night. Keep dietary calcium below 1 gram per day.

POSSIBLE COMPLICATIONS

Acute therapy
- Pain control: meperidine (Demerol) or morphine or buprenorphine (Buprenex), etc.
- 3-day supply pain control: oxycodone-acetaminophen (Percocet), pentazocine (Talwin), hydrocodone-acetaminophen (Vicodin), etc.
- Uric acid stones: potassium citrate (Urocit-K)
- Cystine stones: penicillamine (Cuprimine, Depen)
- Infected stones: antibiotics
Maintenance therapy
- Hypercalciuria: sodium cellulose phosphate, hydrochlorothiazide (HCTZ), K-citrate
- Uric acid: allopurinol (Zyloprim), K-citrate
- Cystine: K-citrate, penicillamine

WHAT TO EXPECT

In about 80% of cases, stones pass within 48–72 hours with outpatient therapy
About 60% of persons have no recurrence of kidney stones at 10 years

MISCELLANEOUS

PREGNANCY

Pregnant women with kidney stones should be seen by a urology specialist.

OTHER NOTES

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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