Kidney stone is one of the most common diseases of urology. The symptom of kidney stones is pain and is seen as flank pain in the kidney area.
Considering all age groups, approximately 15% of kidney stones are seen, that is, they are present in about 1 in 7 people.
If it is obstructed in the kidney, it causes severe pain, nausea and vomiting, and treatment may require urgency.
It is much more common in those living in hot climates. It is less common in western society then it is in eastern society. However, it is likely that there will be more kidney stone disease in the future due to changes in the western diet and lifestyle in western society.
It is 3 times more common in men than in women.
What are Kidney Stones?
It is a hard solid mass formed in the collecting system of the kidneys. Although kidney stone is one of the oldest known diseases, its cause is not known exactly.
There are minerals and acid salts in the urine and these are in equilibrium. This may occur due to the breakdown of balance.
How Does Kidney Stone Fall?
Most of the kidney stones formed can be excreted in the urine. However, sometimes it remains in the kidney and grows to form kidney stones.
What are the Causes of Kidney Stones?
As we said above, the exact cause of kidney stones is still unknown. However, many factors are held responsible. Every individual can develop kidney stones during their lifetime.
If there is an imbalance in the way your body produces urine, stones can form. This may depend on how much water you drink and whether our urine is substances that initiate stone growth.
Other factors are held responsible for the development of stones. Stones in the family, urinary tract infections, congenital or acquired strictures in the ureter, renal outlet obstruction of the ureter, obstruction of the urinary bladder, medullary sponge kidney, vesicoureteral reflux, ureterocele, horseshoe kidney, polycystic kidney may be responsible for stone formation.
In addition, hyperparathyroidism, sarcoidosis, gastrointestinal diseases are the causes of stone formation.
What are the Symptoms of Kidney Stone Disease?
The symptom of kidney stones is pain and usually manifests itself in the form of flank pain in the kidney area.
If the stone does not cause any obstruction in the kidney and there is no infection, it can grow without any symptoms.
When it obstructs the urinary system, then both the infection starts and causes severe pain. There may be additional symptoms such as nausea, vomiting, fever, bleeding in the urine, burning.
In order to make a diagnosis, first of all, a medical history including diseases, surgeries, and additional diseases is taken and a detailed physical examination is performed.
Then, tests such as urine-blood analysis, ultrasound, x-ray computed tomography are performed for the cause of the symptoms. At the end of all these evaluations, kidney stones are diagnosed and the treatment method is determined. The presence of bleeding or inflammation in the urinalysis gives us a clue in terms of stone disease.
Most stones can be seen on x-ray, but some stones are not. Ultrasonography is important both in terms of evaluating the damage to the kidney and determining the size of the stone.
Computed tomography is very important in terms of both the stones and their location and their relationship with neighboring organs and has the highest diagnostic value.
The disadvantage is that it involves radiation, so we try not to have tomography under the age of 40 if it is not necessary as much as possible.
Which Patients Should Be Performed Stone Analysis?
If the stone formed in the kidney is single, small, and is detected for the first time, stone analysis may not be required after treatment or reduction.
In this case, increasing the daily amount of fluid can delay or prevent the formation of stones. However, in case of recurrence of stones, having more than one stone, identifying stones in both kidneys, and having stones in pediatric patients, it is necessary to determine the type of stone if we have stones.
Recurrence of stones can be prevented by giving necessary treatments according to the type. In addition, if there are conditions such as underlying kidney disease, metabolic disease, hyperparathyroidism, it must be detected and treated.
Since blood and urine calcium are high in hyperparathyroidism, stone formation increases. In addition to stone analysis, metabolic evaluation should be done in these patients. 24-hour urine analysis, blood calcium, parathyroid hormone, oxalate in urine, calcium, creatinine, etc. should be checked.
How are Kidney Stones Treated?
If kidney stones are detected, the size, location, number, type, and even the age of the patient will cause us to decide how to approach this stone.
Stones larger than 1 cm are difficult to fall off spontaneously and should be treated if the age of the patient is appropriate when detected.
While performing kidney stone treatment, the main purpose is to leave the patient stone-free and then, most importantly, to prevent the formation of new stones.
If the stones are small, that is, below 5 mm, there is no obstruction in any part of the urinary tract, it is a correct method to increase fluid intake and wait for the stones to fall within 4-6 weeks.
If the stones are between 5-10 mm, they can be reduced by increasing fluid and drug therapy, but they may exit the kidney and block any level of the urinary tract. In this case, surgery may be required.
Therefore, it should be followed closely. If the stones are over 1 cm, surgical treatment or stone breaking with shock waves (ESWL) is required.
If the stones are over 2 cm, the stones can be finished only by surgical treatment. If the stones are between 1-2 cm, ESWL (Extracorporeal shock wave littripsy), flexibl ureterorenoscopy (RS), and wig nephrolithotomy (PNL) are preferred respectively.
If the stones are over 2 cm, PNL should be the first choice. Open surgery has been abandoned in the last decade. However, it can be applied rarely in selected patients. Laparoscopic stone treatment can also be performed in selected patients.
What Should Be Done To Prevent Stone Recurrence?
Some patients with kidney stones may develop more stones in the future. After the stone has been dropped or removed, it should be determined whether there is a risk of recurrence. To do this, it is necessary to analyze the stone. If the risk of recurrence is low, general lifestyle changes will be sufficient to reduce the risk of forming another stone.
If you have a high risk of recurrence, a series of specific blood and urine tests called metabolic assessment are performed for kidney stones. Depending on the test results, preventive measures or further testing are recommended. These are;
1.More Fluid Intake
- 5 to 3 liters of water should be consumed evenly throughout the day.
- pH neutral beverages such as water or milk should be chosen.
- There should be 2 to 2.5 liters of urine output every day.
- Urine color should be light yellow
- If living in a hot climate or heavy exercise, the fluid lost should be balanced.
2.Adjusting the Diet
- Depending on the individual situation of the people, he may recommend diet adjustments.
- Balanced and varied diets,
- Excessive consumption of vitamin supplements should be avoided,
- Lots of vegetables, fiber and fruits (especially citrus fruits) should be eaten,
- Eat foods low in oxalate such as eggs, lentils, white rice, peeled apples, grapes, cauliflower, zucchini,
-Adequate calcium should be kept in the diet (approximately 1000 milligrams per day). However, it is worth paying attention to calcium supplements.
-Reduce the amount of salt in your diet (3 to 5 grams per day)
-Too much animal protein, especially meat from young animals should not be eaten. Instead, for example
-More vegetable protein found in avocados, cauliflower or peas should be eaten.
-Lose a healthy weight (body mass index should be between 18-25 kg / m2)
It is always a good idea to adopt a healthy lifestyle.
– Exercise should be done 2 or 3 times a week.
– Stress should be avoided