Kidney stone, also known as renal stone, is a common cause of abdominal pain requiring hospital visit or admission in Nigeria. It is more common in men compared to women. It is also a very common cause of emergency presentation in the emergency department.
What is Kidney Stone?
Kidney stone is the presence of a stone, medically called precipitated solutes within the kidney(s). Imagine when you add salt/sugar (solute) to a cup of water (solvent). The more you add the solute to the solvent; it will reach the saturation point when it crystallizes out. However when more solvent is added, the solute will dissolve. This is the same principle that works in the human body. The kidney does that admirable function of removing waste materials from the body. This it does by carrying them in a liquid conduit. The stone could be caused by various salts, the most common being calcium containing salts.
Signs and Symptoms of Kidney Stone:
- Asymptomatic: Here the stone does not cause any symptom. It is found incidentally when patient does investigations for an unrelated illness.
- Abdominal pain: Pain is more in the loins and the affected individual may feel that the pain moves to the groin on the same side. It may also be felt to affect the testicles in males and the labia in females. Usually the individual cannot find a comfortable position in order to get relief from the pain.
- Nausea and vomiting
- Haematuria: passage of blood in the urine
- Anuria: failure to pass urine is seen in those with bilateral disease or a single functioning kidney.
- Fever: occurs when infection sets in.
Causes and Risk Factors of Kidney Stone:
- Age: peak incidence age 20-50yrs.
- Male gender
- Past history of kidney stone
- Positive family history of kidney stone
- Low fluid intake
- Low urinary volume
- Increased urinary pH
- Diet: especially high intake of animal protein and Vitamin A deficiency
- Infection: within the urinary tract
- Prolonged immobilization
- Hyperparathyroidism
- Hyperuricosuria
- Hyperoxaluria
- Hypomagnesuria
- Stasis: obstruction to urine flow. May result from a congenital obstruction to the urinary tract or a nearby cancer blocking the urinary tract.
When to Seek Help:
The presence of the symptoms discussed earlier should prompt immediate review by a Medical Doctor. This is not the time for self-medication. It is also necessary to seek help on time to prevent complications from kidney stone occurring or complications from other diseases that may present like that of kidney stones.
Complications:
The presence of kidney stones could predispose to infection which may be restricted to the urinary tract and in severe cases could progress to sepsis. In individuals with bilateral kidney stones or affectation of the single functioning kidney it may result in the development of kidney failure which if not addressed immediately would result in need for dialysis or kidney transplant in future. These complications in severe cases could also result in death of the individual if not treated on time.
Treatment for Kidney Stone:
- The attending doctor takes relevant history (asks questions about the illness. Don’t feel tired or irritated about the questions. They are for your good) and does a physical examination.
- Relevant investigations to help confirm the diagnosis, rule out other differential diagnosis and to also check the extent of the disease and complications are also carried out.
- Relief of pain with appropriate analgesic. ‘Appropriate’ is the term as the use of a particular medication in one individual may be contraindicated in another due to some other underlying pathology.
- With features suggestive of infection, antibiotics are also given. Where infection is confirmed on urine M/C/S, the appropriate antibiotic is administered.
- Further treatment depends on the size of the stone, the location of the stone, the function of the affected kidney and the number of kidneys the patient has. It may shock you to know that in rare cases, individuals may be born with just one kidney only coming to their attention when there is a problem requiring investigation.
- Treatment could either be conservative or surgical in nature
- Conservative management involves watchful waiting, advice on regular and adequate intake of fluids, analgesics and antibiotics when appropriate.
- Where conservative management fails or in cases where conservative management is contraindicated, surgery is indicated. Surgery could be via extracorporeal shockwave lithotripsy, use of endoscopes or laparoscopes, or an open procedure.
Prevention:
Adequate hydration is advised. In regions with a tropical climate like Nigeria, it is usually advised to take more than three litres (3 ltr) of fluid a day. However this may be inadequate when the weather is hot and humid and perspiration is high. The colour of the urine passed is a very good marker to know if you have taken adequate amounts of water. It should be colourless (just like water).
In conclusion…
Kidney stone is one disease that can be overcome when the right thing is done and on time. Are you having symptoms suggestive of kidney stone or suffering from kidney stone? Speak to doctor today.
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