Kidney Stones

What Are Kidney Stones?

Kidney stones are a common problem in primary care and also a common cause of abdominal and flank pain in patients presenting to the emergency department. A kidney stone is formed when the body has too much of certain materials and these materials become concentrated in the urine.  Typically, the stone is passed out of the body in the urine and only causes pain if it becomes stuck and blocks the flow of urine. The pain associated with the kidney can be very severe and it has been compared with that of childbirth.

What is the epidemiology of Kidney Stones?

In the United States, the prevalence of kidney stones has risen from 5.2% to 8.8% over the span of 6 years. In 2010, approximately 2 million outpatient visits are kidney stone related. The prevalence is 10.6% in men and 7.1% in women and there is increase prevalence in other developed countries as well. Obesity and diabetes have been strongly associated with kidney stones and carry high rates of recurrences

What are the risk factors for developing Kidney Stones?

  • Insufficient fluid intake
  • Use of calcium supplements 
  • Diet with high levels of animal protein 
  • High sodium diet 
  • Primary hyperparathyroidism 
  • Gout 
  • Diabetes mellitus 
  • Obesity 

What types of Kidney Stones are there?

  • calcium oxalate and calcium phosphate accounts for 80% of the kidney stone
  • Uric acid stones account for 10%
  • Struvite/infections account for 10%

What are the symptoms of Kidney Stones?

  • Pain: Most common symptoms 
  • Painful urination
  • Blood in the urine
  • Sharp pain in the back or lower abdomen
  • Nausea and vomiting

How to diagnose Kidney Stones?

Medical history and physical examination based upon a patient’s symptoms is crucial in the diagnosis of kidney stone. Lab tests to rule out infections are also required for a full diagnosis work-up. A computed tomography (CT) scan is often recommended to visualize and confirm the presence of kidney stones. Ultrasound is also an alternative imagine modality for people who should avoid radiation exposure, including pregnant women and children tests.

How to treat Kidney Stones?

  • Spontaneous passing of the stone: It is recommended to wait for the stones to pass through the urine if there is no sign of obstruction or infection as the pain is bearable. Drinking a lot of water may aid in the passing of the stone
  • Medication: Pain medication such as NSAID and anti-nausea is an important treatment regimen. Tamsulosin may be prescribed to improve the chance of passing the stone. It works by relaxing the ureter and making it easier for the stone to pass

Large stones or stones that do not pass spontaneously will required procedures to break and remove the stones. The procedures include:

  • Shock wave lithotripsy: This procedure involves directing shock waves toward the stone and causes the stone to break into fragments that can be more easily passed in the urine.
  • Ureteroscopy: A thin telescope is passed through the urethra into the ureter and kidney. The scope is then used to break the stone into smaller pieces to allow easy passage. 
  • Percutaneous nephrolithotomy: This is a minimally invasive surgical procedure use for large stones or stones that do not respond to shock wave lithotripsy. A small telescope is passed through the skin of the back and into the kidney to remove the stone.

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