Kidney stones are one of the most painful urological disorders globally.
Prevalence: About 11% of men and 6% of women experience kidney stones.
Age Group: Most common among men aged 30-60.
Impact: Renal colic, the intense pain from kidney stones, affects approximately 10-20% of men and 3-5% of women.
In India, around 12% of the population may develop urinary stones, with nearly 50% at risk of kidney loss or permanent renal damage.
Factors Contributing to Kidney Stone Formation
Influences include age, gender, family history, diet, comorbidities, environmental factors, and genetics.
Recurrent Nature: Approximately 98% of patients face a recurrence within 25 years of the first occurrence.
Types: Calcium oxalate (CaOx) stones are the most common, accounting for 60% of all cases.
Mechanisms Behind Calcium Oxalate Stone Formation
Intratubular Formation
Occurs within the kidney's tubular lumens, where crystalline salts supersaturate, crystallize, and grow.
Both urease-producing and non-urease-producing bacteria contribute to the process.
Renal Interstitium Formation
Calcium phosphate crystals, known as Randall plaques, form in the renal interstitium.
These plaques can extend into the kidney’s collecting system, serving as a foundation for calcium oxalate crystals.
Symptoms of Kidney Stones
Severe flank or lower abdominal pain (renal colic).
Accompanied by nausea, vomiting, hematuria (blood in urine), and sometimes fever.
Some patients may be asymptomatic, with diagnosis often occurring through imaging or upon stone passage.
Diagnostic Approaches
Initial steps include a medical history review, physical exam, and imaging tests.
Primary diagnostic tools:
Renal ultrasound: 70% sensitivity and 94% specificity.
High-resolution CT scans and KUB X-rays (Kidney-Ureter-Bladder X-rays) are also used, especially to assess treatment suitability for shock wave therapy.
Preventive Strategies for Kidney Stones
Hydration
Dehydration is a major risk factor, so increased fluid intake is essential to reduce urinary concentration.
Diet and Weight Management
Obesity links to higher risk; maintaining a healthy BMI is recommended.
A Mediterranean-style diet focusing on plant-based foods, monounsaturated fats, and limited red meat intake may lower risk.
Metabolic Abnormalities
Conditions like hypercalciuria, hyperoxaluria, and hypocitraturia contribute to stone formation.
Dietary adjustments can help address these metabolic issues, reducing the risk of recurrence.
Treatment Options
Surgical Methods:
Extracorporeal Shock Wave Lithotripsy (ESWL)
Ureteroscopy
Percutaneous Nephrolithotomy
Choice of treatment depends on stone size, type, and location.
Pain Management for Kidney Stones
Initial management with NSAIDs, unless contraindicated.
For inadequate relief, opioids or intravenous acetaminophen may be used.
Oral Dissolution Therapy:
Effective for uric acid stones; involves urine pH adjustments and medications like allopurinol or febuxostat.
