Nephrolithiasis refers to the development of renal calculi in the urinary tract, which results in an obstruction that causes flank pain.
Nephrolithiasis, also known as renal lithiasis, renal calculi or kidney stone, is a case in which tiny, hard particles of minerals and acidic salts, available in the urine, called calculus, is formed in the kidneys.
These stones or pebbles develop as a result of urine, getting concentrated in the organ.
Kidney stones occur when urine becomes too concentrated, and the substances in it crystallize and form pebbles (calculi).
Symptoms arise when calculi travel through the ureter and cause severe pain. Kidney stones can develop in the pelvis, kidney vessels, or ureter.
The human body usually can flush Kidney stones out of the system without leaving any symptoms or health problem.
However, when it increases from its regular size, it might get blocked in the bladder or ureter. This may lead to dilation of kidney causing improper functioning of it.
Usually taking painkillers and drinking lots of water helps in flushing out stones from the kidney. However, in some cases, if symptoms still prevail, it needs the immediate consultation of your physician.
The kidney stones are common. Some types are hereditary. They often occur in premature babies.
There are different types of kidney stones. The cause of the problem depends on the kind of calculus.
Calculi can develop when urine has a high content of certain substances that form crystals. These crystals can become calculi over weeks or months.
Calcium stones are the most common. They occur most often in men between 20 and 30 years of age. Calcium can be combined with other substances to form the calculus.
Oxalate is the most common of these. Oxalate is present in certain foods such as spinach. We can also find it in vitamin C supplements. Diseases of the small intestine increase the risk of formation of these stones.
Calcium calculi can also be formed from the combination with phosphate or carbonate.
Other types of calculi include:
- Cystine stones, which can affect people with cystinuria. This condition is hereditary. It affects both men and women.
- Struvite stones are found mainly in women who have a urinary tract infection. These stones can grow a lot and clog the kidney, ureters, or bladder.
- Uric acid stones are more common in men than in women. They can occur with gout and chemotherapy.
Other substances such as certain medicines can also form calculi.
Symptoms
The usual symptom of nephrolithiasis is that of pain, which may vary in intensity, from lower back up to the genitals and thighs.
Followed by this symptom, there are a few more signs that might help you get a better idea about kidney stones:
- Nausea
- Fever
- Vomiting
- Pain while urinating
- Blood in urine
- Restlessness
You may not have symptoms until the calculi go down the tubes (ureters) through which the urine empties into your bladder. When this happens, stones can block the flow of urine from the kidneys.
The primary symptom is the intense pain that suddenly begins, disappears, and later reappears:
The pain can be felt in the abdominal area or on the side of the back.
Pain may radiate to the groin area (inguinal pain) or the testicles (testicular pain).
Other symptoms may include:
- Abnormal color of urine
- Blood in the urine
- Shaking chills
- Fever
- Nausea and vomiting
Diagnosis
Although it is not easy to know about the calculus in the kidney, unless you had previous encounters with it, you can still look out for the signs or consult a doctor to deal with the issue.
A doctor can make a diagnosis by the following means:
- Family and medical history
- Ultrasound
- Urinalysis
- Blood Test
- Radiographic studies
An expert can see calculi or obstructions through:
- CT scan of the abdomen
- Magnetic Resonance of the Abdomen / Kidney
- X-ray of the abdomen
- Intravenous pyelogram (IVP)
- Ultrasound of the kidney
- Retrograde pelvis
Tests and exams.
The health care provider will perform a physical examination. The back or ventral area (abdomen) may feel sore.
Tests may include:
- Blood test to evaluate calcium levels of phosphorus, uric acid, and electrolytes
- Renal function tests
- Urine test to see crystals and look for red blood cells in the urine
Treatment
In case of treating kidney stones, the size of the obstruction and symptoms may differ and so does the procedure.
Medications, lithotripsy, expulsion therapy or surgery are some of the ways to treat kidney stones.
Besides, you need to restrict your diet and lifestyle accordingly. It is always considered a better idea to consult your physician.
The treatment depends on the type of calculus and the severity of the symptoms.
Small kidney stones often pass through the urinary tract on their own.
Urine must be shed so that the medical staff can analyze the calculus.
Take at least 6 to 8 glasses of water per day to produce a significant amount of urine. This will help to eliminate the calculus.
The pain can be intense.
OTC analgesics (e.g., ibuprofen and naproxen), either alone or together with narcotics, can be very useful.
Some people with severe pain due to kidney stones need hospitalization. You may need fluids through a vein.
For some types of calculi, your provider may prescribe medications to prevent their formation or help break down and eliminate the material that is causing it. These medications may be:
- Allopurinol (for uric acid stones)
- Antibiotics (for struvite stones)
- Diuretics (water pills)
- Phosphate Solutions
- Baking soda or sodium citrate
- Water pills (thiazide diuretics)
- Tamsulosin to relax the ureter and help the calculus pass
Surgery is often needed if:
- The calculus is too large to get out on its own
- The calculi are growing
- The stones are blocking the flow of urine and causing infection or
- kidney damage
- The pain is uncontrollable
At present, most treatments are much less invasive than in the past.
Lithotripsy is used to remove stones slightly smaller than half an inch located near the kidney or ureter. This method uses sound waves or shock waves to break the calculi.
Then, the stones leave the body in the urine. Also called extracorporeal shock wave lithotripsy (ESWL).
Several doctors perform procedures to pass particular instruments through a small surgical incision in the skin or into the kidney or ureters are used for large stones, or when the organs or surrounding areas took damage from the calculi.
The calculus is extracted with a probe (endoscope). Ureteroscopy can be used for calculi in the lower urinary tract.
Rarely, open surgery (nephrolithotomy) may be needed if other methods do not work or are not possible.
