28 Oct 2016


The Renal Boulders!

All about kidney stones

 What is a Kidney Stone?
Lodgement of a concretius mass in the renal tract, is known as a kidney stone. The mass is compared to a stone, for its physical equivalence with the stone. It is hard, grating, and doesn't usually dissolve with water, thus making this condition, painful.


How are they formed?
  Kidney stones are usually  masses of calcium and phosphate deposits. They're usually seen when there is deranged metabolism in a susceptible individual. This includes conditions wherein blood calcium is elevated, as seen in hyper parathyroidism. Increased blood calcium is finally filtered off in the kidney and thus excreted in urine. The kidney is an effective pump for calcium excretion but it has it’s own threshold. Excess calcium from the blood fails to be filtered off and thus results in stone formation in the kidney. 

How does it present?
-       Pain leading to the side and the back
-       Pain radiating to the abdomen
-       Pain in the groin
-       Pain in sitting position
-       Pain which increases and decreases in intensity
-       Urine can be red in colour, which is due to blood.
-       There can be associated fever with chills
-       In severe cases, there's a chance of development of urinary tract infections
-       There can be associated testicular pain too,in males.

 Why is there such exacerbating pain?
These are the typical features seen in a patient with kidney stones. Many other non specific symptoms such as nausea, vomiting, etc can be seen too. They can be associated with many other conditions have no great clinical significance. Typically, the patient has pain while micturating and complaints of decreasing micturation frequency.
The symptoms are due to obstruct of urine flow. The obstruction can be at the level of
-       Kidney
-       Ureter
-       Bladder
-       Urethra

Why do women suffer less ?
Urethral obstruction is rather uncommon in women due to shorter length of the urethra as compared to men's. The obstruction causes impairment in urine flow.

How do you treat this condition?
 If the stone is smaller in size it may be dislodged and may even break in tiny pieces and drain off on the urine. Excess water consumption is advocated in such cases. Pain killers are advocated to counter act the pain caused by their lysis. Alpha blockers is a commonly used class of drugs which relates urethric muscles and allows easy flow of the stones with the urine.

Bigger stones are much difficult to lyse and may need surgical intervention. To name some are
-       Extracorporeal shock wave lithotripsy
-       Scopic removal of the stone.
-       Percutaneous removal of the stone
-       Parathyroidectomy in cases of hyper Parathyroidism

Even after surgery the patient is advised to drink plenty of fluids to prevent recurrence. Kidney stones presents as one of the most painful symptoms and thus needs immediate medical attention.