Kidney stones

Understanding

Kidney stone or nephrolithiasis is a condition when a hard material resembling a stone is formed inside the kidney. This material is formed from the waste of substances in the blood filtered by the kidneys, then settles and gradually crystallizes.

Precipitation usually occurs because you do not consume water as recommended, are taking certain drugs, or have medical conditions that can affect certain levels of compounds in urine.

Based on the type, kidney stones are divided into four: calcium stones, uric acid stones, struvite stones, and cystine stones. Different types of kidney stones will affect treatment and prevention measures.

Kidney stone disease is quite common in people aged 30-60 years, and can be suffered by men and women. However, men have a higher risk than women. From research that has been done, it is suspected to be related to male urinary tract blockage.

 Diagnosis

In diagnosing kidney stones, the doctor initially collects information about the symptoms experienced by the patient. The doctor will also ask if there are family members who have the same disease, daily diet, whether the patient is consuming something that can trigger the formation of kidney stones.

Then, the doctor will conduct a series of examinations, including laboratory tests in the form of urine tests and blood tests. In addition there are various scans such as ultrasound, X-rays, and intravenous pyelogram (IVP).

A urine test is needed to check whether an infection has occurred. If there is a flake of kidney stone in a urine sample, the doctor will use it to identify the type of kidney stone that is being suffered so that the treatment is correct.

While blood tests are needed to find out whether the kidneys are still functioning normally or not, and to check the levels of certain substances that have the potential to cause kidney stone formation.

After that, the doctor will perform an examination through image images that will help confirm the diagnosis and ensure the position of kidney stones accurately. The types of image image checks that may be performed are CT scans, X-rays, ultrasound scans, and intravenous urograms (IVU) or intravenous pyelogram (IVP).

Today, CT scans are the main screening option in diagnosing kidney stones because the results are more accurate than other examination methods.

Symptoms

Usually, if the size of the kidney stone is very small, you will not feel any symptoms. The kidney stone will come out naturally through the ureter (the channel that connects the kidney to the bladder).

You will feel something if the size of the stone is larger than the ureter. When you are going to urinate, the stone will rub against the ureteral wall, causing irritation or even injury. This is why blood is seen in urine. Stones can also clog the ureter or urethra (the final drainage of the urine out of the body) so that urine output is blocked.

Other symptoms of kidney stones can include:

• Prolonged lower back pain, sometimes feels up to the groin. In male patients, pain is also felt in the testes and scrotum.
• Side stomach pain varies in duration, ranging from minutes to hours.
• Restless.
• Can't lie down calmly because it's difficult to find a comfortable position.
• Nausea.
• More frequent urination than usual.
• Pain when urinating.

There is blood in the urine — which is caused by friction of the kidney stone against the kidney or ureter. When kidney stones block the ureter there will be a buildup of bacteria that can cause kidney infection. Symptoms of kidney infection are similar to symptoms of kidney stones, but usually patients will also feel:

• High fever.
• Shivering.
• Fatigue.
• Diarrhea.
• The color of urine is cloudy and smells bad.

Treatment

Treatment of kidney stones depends on the size of the stone. For a small stone that can still pass through the urinary tract, the doctor will only advise you to consume water as recommended. The hope is that the stone can come out alone along with the discharge of urine.

If the pain that you feel is disturbing enough, the doctor will provide painkillers, such as ibuprofen or nonsteroidal anti-inflammatory drugs. To relieve symptoms of nausea and vomiting, the doctor will give antiemetic drugs.

If the kidney stone has moved from the kidney to the ureter and caused severe pain, you will be referred to hospital treatment. Generally, this is done for patients who have only one kidney, are pregnant, are dehydrated, or are over 60 years old.

If the size of the kidney stone is too large (a minimum diameter of 6-7 mm) to be removed naturally, the doctor will recommend special therapy to remove it. The type of treatment depends on the size and location of kidney stones. The procedures for handling large kidney stones are:

- Extracorporeal Shock Wave Lithotripsy (ESWL)
    This procedure uses high frequency sound waves to destroy kidney stones into small pieces. These flakes are expected to be easily removed naturally. You will feel a little less comfortable and after that the doctor will usually give painkillers. ESWL 99% effective for kidney stones with a maximum diameter of 20 mm.

- Ureteroscopy

    The doctor will use a device called a uteroscope. The device will be inserted into the ureter to see the location of the blockage. Once the location of the stone is known, the stone will be destroyed using other tools or with the help of a laser. You will be totally sedated when you are going through this procedure. Ureteroscopy is effective for kidney stones with a maximum diameter of 15 mm.

- Percutaneous Nephrolithotomy (PCNL)

This procedure is usually done if the ESWL procedure is not possible, for example the patient is obese. The doctor will make a small incision on the surface of the skin near the kidney, then insert a nephroscope that will destroy and remove kidney stones. PCNL is effective for stones with a diameter of 21-30 mm.
 

Prevention

Kidney stones do have a recurring tendency, but prevention is very easy. You must pay attention to the following two things:

• Water consumption according to body needs. If you consume enough water, the color of urine will look bright.
• Pay attention to diet. If your kidney stone is a type of calcium stone, then avoid foods that contain lots of oxalate. Oxalate will block the absorption of calcium. However, first consult with a doctor before changing your diet.