Stone disease: Treatment, symptoms, advice and help
About stone disease
The stones are solid concretions or crystal aggregations formed in the kidneys from dissolved urinary minerals. Urolithiasis refers to the condition of having calculi in the urinary tract (which also includes the kidneys), which may form or pass into the urinary bladder.
Urinary calculi consist of aggregates of crystals containing small amounts of proteins and glycoprotein. In Europe, 80% of renal stones contain crystals of calcium, 15% contain magnesium ammonium phosphate and a small number are pure cystine or uric acid stones.
Stone disease: Incidence, age and sex
In developing countries, bladder stones are common, particularly in children .In developed countries. Renal stones in adults are more common. Overall, about 12% of men and 5% of women experience a renal stone by the age of 70 years.
Signs & symptoms of stone disease: Diagnosis
When a stone become impacted in the ureter, an attack of renal colic develops. The patient is suddenly aware of pain in the loin, which radiates round the flank to the groin. There is pallor, sweating and often vomiting. Frequency, dysuria and haematuria may occur.
Causes and prevention of stone disease
Stones may be caused by environmental and dietary factors such as low fluid intake or diet with high protein or high sodium. The acquired causes include hypercalcaemia of any cause and ileal disease or resection (leads to increased oxalate absorption and urinary excretion)Congenital and inherited causes include familial hypercalciuria, medullary sponge kidney, cystinuria, renal tubular acidosis type I (distal) and primary hyperoxaluria. About 5–10% of all stones are formed from uric acid. Uric acid stones form in association with conditions that cause hyperuricosuria with or without hyperuricemia. About 90% of stones are seen on a plan abdominal X-ray. Spiral CT gives the most accurate assessment and will identify non-opaque stone (e.g. uric acid). Ultrasound may show dilation of the ureter if the stone is obstructing urine flow.
Measures to prevent calcium stone formation are as follows.
- Diet : Fluid intake of at least 3 – 4 liters per day and at least 2 litres of output per day, restricted intake of sodium and protein ,avoiding foods that are rich in oxalate (e.g. rhubarb) and taking plenty of calcium in diet (because calcium forms an insoluble salt with dietary oxalate, lowering oxalate absorption and excretion).
- Drugs which help are: Thiazide diuretics which reduce calcium excretion and allopurinol, if urate excretion is high. Avoid vitamin D supplements as they increase calcium absorption and excretion.
Stone disease: Complications
Possible complications include decrease or loss of function in the affected kidney, kidney damage, scarring, obstruction of the ureter (acute unilateral obstructive uropathy), recurrence of stones and urinary tract infections.
Stone disease: Treatment
The immediate treatment of renal colic is bed rest, application of warmth to the site of pain and a powerful analgesic. e.g. morphine, pethidine intramuscularly or diclofenac as a suppository. Patients are advised to drink 2 litres of water per day. Around 90% of stones less than 4 mm in diameter will pass spontaneously. Bigger stones can now be fragmented by extracorporeal shock wave lithotripsy. Endoscopic surgery may be required for stones, but open surgery is now almost never needed except for large bladder stones. All stones are potentially infected and surgery should be covered with appropriate antibiotics.