Kidney stones

Medical specialist	Internal disease
Symptoms	Stones pass when urinating, pain when urinating, lower back pain, abdominal pain, discomfort lying down, frequent urination, nausea, blood in the urine
risk factor	Age over 35 years, male, dehydrated, high protein consumption, high purine, high sodium, family history of kidney stones, obesity, certain medical conditions, consumption of certain supplements
Cara diagnosis	The complete interview, physical examination, complete blood count, urine examination, ultrasound examination, x-ray, CT scan, and IVP
Treatment	ESWL, Ureteroscopy, PCNL, Surgery
Drug	Drink at least 8 glasses of water per day. Pain relievers, alpha-blockers
Complications	Blockage of the ureter, permanent kidney damage, infection of the urinary tract and kidneys
When to see a doctor?	Pain when urinating, stones coming out of the urine, bloody urine

Definition

Kidney stone disease or nephrolithiasis is a condition when hard material resembling stones forms in the kidneys.

This material is formed from waste substances in the blood that are filtered by the kidneys, then precipitates and gradually crystallize.

Precipitation usually occurs because you don’t consume water as recommended, are taking certain medications, or have a medical condition that can affect the levels of certain compounds in the urine.

Based on the type, kidney stones are divided into four, namely calcium stones, uric acid stones, struvite stones, and cystine stones. Different types of kidney stones will affect treatment and prevention measures.

Kidney stone disease is quite common in people aged 30-60 years and can affect both men and women.

However, men have a higher risk than women. From the research that has been done, this is thought to be related to obstruction of the male urinary tract.

Risk Factors

There are several factors that can increase a person’s risk of developing kidney stones, namely:

• 35–45 years old
• Male gender
• Not getting enough body fluids or experiencing dehydration
• Eat foods that are high in protein, high in purines, sodium (salt), or sugar
• Have a history of kidney stones in the family
• Experiencing indigestion
• Suffer from obesity
• Have undergone surgery on the digestive organs
• Suffer from certain medical conditions, such as urinary tract infections, hyperparathyroidism or diabetes
• Taking certain supplements or medications, such as food supplements, migraine medications, or vitamin C in excessive amounts

Symptoms

Usually, if the size of the kidney stone is very small, you will not feel any symptoms. The kidney stone will naturally come out through the ureter (the tube that connects the kidney to the bladder).

You will only feel something if the size of the stone is larger than the ureter. When going to urinate, the stone will rub against the wall of the ureter, causing irritation or even injury. This is why urine looks like blood.

Stones can also block the ureters or urethra (the final channel for excreting urine out of the body) so that urine output is obstructed.

Other symptoms of kidney stones can include:

• Prolonged lower back pain, sometimes felt up to the groin. In male patients, pain is also felt in the testicles and scrotum
• Side abdominal pain of varying duration, from minutes to hours
• Nervous
• Unable to lie down quietly because it is difficult to find a comfortable position
• Nauseous
• More frequent urination than usual
• Pain when urinating
• There is blood in the urine

When a kidney stone blocks the ureter, there will be a buildup of bacteria that can cause a kidney infection.

The symptoms of a kidney infection are similar to the symptoms of kidney stones, but usually, sufferers will also experience:

•  High fever
• Shivering
• Fatigue
• Diarrhea
• The color of the urine is cloudy and has an unpleasant smell

Diagnosis

To find out and diagnose kidney stones, generally doctors will carry out a series of the following tests.

1. Medical History Interview

In diagnosing kidney stones, initially the doctor will collect information about the symptoms experienced by the patient.

The doctor will also ask if there are family members who have the same disease, their daily diet, whether the patient is consuming anything that can trigger the formation of kidney stones.

2. Urine Test and Blood Test

Then, the doctor will carry out a series of examinations, including laboratory tests in the form of urine tests and blood tests.

A urine test is needed to check whether an infection has occurred. If the urine sample contains fragments of kidney stones, the doctor will use them to identify the type of kidney stone you are suffering from so that it can be handled properly.

Meanwhile, blood tests are needed to find out whether the kidneys are still functioning normally or not, as well as to check the levels of certain substances that have the potential to cause kidney stones to form.

3. Checking with Image Images 

After that, the doctor will carry out an examination through images that will help confirm the diagnosis and ensure the accurate position of kidney stones.

The types of image examinations that may be performed are CT scans, X-rays, ultrasound scans, and intravenous urogram (IVU) or intravenous pyelogram (IVP).

Currently, a CT scan is the main examination option in diagnosing kidney stone disease because the results are more accurate than other examination methods.

Treatment

Therapy and how to treat kidney stones depend on the size of the stone. For small stones that can still pass through the urinary tract, the doctor will only advise you to consume water as recommended. The hope is that the stone can come out on its own along with the urine.

If the pain that you feel is quite disturbing, the doctor will give you pain relievers, such as ibuprofen or non-steroidal anti-inflammatory drugs. To relieve the symptoms of nausea and vomiting, the doctor will give antiemetic drugs.

If the kidney stone has moved from the kidney to the ureter and causes severe pain, you will be referred for treatment at the hospital.

Generally, this is done for patients who only have one kidney, are pregnant, are dehydrated, or are over 60 years old.

If the size of the kidney stone is too large (minimum diameter of 6-7 mm) to be removed naturally, the doctor will recommend special therapy to remove it.

The type of treatment depends on the size and location of the kidney stones. Procedures for dealing with large kidney stones are:

1. Extracorporeal Shock Wave Lithotripsy (ESWL)

This procedure uses high-frequency sound waves to crush kidney stones into small pieces.

It is hoped that these flakes can be removed easily naturally. You will feel a little uncomfortable and afterwards the doctor will usually give you pain relievers.

The ESWL method is 99 percent effective for kidney stones with a maximum diameter of 20 mm.

2. Ureteroscopy

The doctor will use an instrument called a ureteroscope. The tool will be inserted into the ureter to see the location of the blockage.

Once the location of the stone is known, the stone will be destroyed using other tools or with the help of a laser.

You will be under general anesthesia during this procedure. Ureteroscopy is effective for kidney stones up to 15 mm in diameter.

3. Percutaneous Nephrolithotomy (PCNL) 

This procedure is usually performed when the ESWL procedure is not possible, for example, a patient who is  obese .

The doctor will make a small incision on the surface of the skin near the kidney, then insert a nephroscope which will crush and remove the kidney stone fragments.

The PCNL procedure is effective for stones 21-30 mm in diameter.

4. Open Operation 

Open surgery is rarely done, this procedure is done when kidney stones are very large and have an abnormal shape that cannot be treated by other methods.

Prevention

Kidney stone disease does have a tendency to recur, but its prevention is very easy. You should pay attention to the following two things:

• Consume water according to body needs. If you drink enough water, your urine will appear light in color
• Watch your diet. If your kidney stone is a type of calcium stone, then avoid foods that contain lots of oxalates

Oxalate will block the absorption of calcium. Reduce foods that cause high uric acid. However, consult with your doctor before changing your diet

• Lose weight
• Do not consume excessive calcium such as milk and its derivative processed products
• Limit salt intake

Complications

Complications can occur if the size of kidney stones is very large. This condition can block the flow of urine and permanently damage the kidneys.

In addition, kidney stones can also cause infections in the urinary tract and kidneys.