General Info about Renal Stones 

The Times whereat you often in a day have the Urinary Excretion performed with Ease, are times which invite you very frequently to lift up your Hearts unto God with such an Acknowledgment as This; O, My most merciful God, I bless thee, that the grinding Torments of the Stone, are not now grinding of me. 
                                           -Cotton Mather, 1724 


Kidney stones or renal stones are gravel-like collections of chemicals that may appear in any area of the urinary system, from the kidney to the bladder. They may be small or large, single or multiple. 

What are the causes of Renal Stones ? 

Of the four main types of urinary stones, calcium stones are the most common. Almost 95% of all kidney stones are calcium stones. They occur when there is too much calcium in the urine. Defective kidney function may allow too much calcium in the urine, or excessive calcium may be absorbed from the stomach and intestines. Some calcium stones are caused by an excess of a chemical called oxalate, present in many foods, which binds easily with calcium to form a stone. The risk of calcium stone formation is increased if you have certain medical diseases; for example, hyperparathyroidism and inflammatory bowel disease. 

A second type of kidney stone is made of uric acid. These stones are much less common than calcium stones. Uric acid stones occur because you have too much uric acid in your urine. They might occur if you have become dehydrated; for example, during strenuous exercise on a hot day or perhaps during an illness. Uric acid stones are common in people who have gout, a disease that causes high uric acid levels in the blood. 

A third type, struvite stones, are not quite so well understood. It is thought that these stones form as a result of an interaction between protein-breakdown products and infection-causing bacteria in the urine. 

Finally, a rare type of kidney stone is a cystine stone. It occurs if you have the genetic disease called cystinuria. This disease results from a birth defect that causes the kidney to allow too much cystine into the urine. This type of stone formation is almost always diagnosed during childhood. 


What are the symptoms of Renal Stones ? 

The most common symptom of kidney stones is severe back or abdominal pain. This may be accompanied by nausea and vomiting. If you have a urinary tract infection as well, your symptoms may include fever, chills, sweats, and pain with urination. 

Kidney stones and urinary tract infection can cause blood  in the urine. Usually the blood is seen only with a microscope, but occasionally it is more obvious. 

Some people have no kidney stone symptoms until they pass gravel-like stones in their urine. Others never have any symptoms, and their stones are found incidentally during testing for other problems. 


How can we diagnose Renal Stones ? 

Your doctor may suspect you have kidney stones if you have severe abdominal or back pain with no other likely causes. He or she will look for blood in your urine. 

Sometimes the pattern of pain over time is helpful in the diagnosis. The pain may move from the upper to the lower abdomen over a few hours. As the stone moves lower, the pain may be felt in the genitals, especially the testicles in men and the labia in women. 

The diagnosis may be confirmed with a plain x-ray of the abdomen. However , not all kidney stones show up on regular x-rays. A special x-ray called an IVP (intravenous pyelogram) may be done. Contrast is injected into a vein, and the contrast becomes concentrated by the kidneys. The IVP gives a helpful picture of the urinary system, including both kidneys. A stone that does not show up on a regular x-ray may be seen on an IVP x-ray.


How can Renal Stones be treated ? 

Kidney stone treatment depends on the size and location of the stone(s), whether one or more stones are blocking the flow of urine out of the kidney, and whether there is evidence of infection. The phase of acute, intermittent pain usually lasts hours to 1 to 2 days. A stone, however, may take days or even weeks to pass. Sometimes weekly x-rays will be necessary to track the progress of the stone down the urinary tract. If the stone has not passed after a month or so, it may need to be surgically removed. 

Fluids in Abundance: You may be treated at home by drinking lots of liquids and taking pain medication. Kidney stones usually pass on their own. Your doctor will ask you to strain all urine until the stone is passed. This allows the stone to be identified with lab tests. 

If you are vomiting too much to drink liquids, you may need to be hospitalized. A stay in the hospital may also be necessary if you have signs of urinary infection, a kidney abnormality, or a large stone requiring surgery. 

ESWL: A stone located I kidney that is less than 2 cms in size is usually treatable as an out-patient procedure using a special machine that produces high intensity sound waves called shock-waves called "Extra-corporeal Shockwave Lithotripsy". This machine has revolutionized the treatment of stone disease from a previously open operation to a minimal interventional procedure. The stones once broken pass out of urine as fine sand particles. Almost 90% of all kidney stones can be treated by this method.

Cystoscopy or ureteoscopy: If you have a stone in the lower urinary tract that requires surgery, it may be removed, under anesthesia, through a cystoscope. This instrument is a slim, lighted, flexible, fiberoptic telescope, which is passed through the urethral opening into the urinary tract. Tiny tools can be passed through the cystoscope and used to trap and remove the stone. 

A stone that is too high or too large may require open abdominal surgery for removal. However, a new method for removal is being used in some centers: Higher or larger stones are removed through a type of operating telescope (a ureteroscope). The ureteroscope is inserted via the bladder. 

Percutaneous Surgery or Open Surgery: This is reserved for large bulky stones in the kidneys. Less than 3 to 4 % of the patients require this form of major interventional surgery. 


More Valuable information about Renal Stones ... 

The phase of acute, intermittent pain usually lasts hours to 1 to 2 days. A stone, however, may take days or even weeks to pass. Sometimes weekly x-rays will be necessary to track the progress of the stone down the urinary tract. If the stone has not passed after a month or so, it may need to be surgically removed. 



Frequently asked questions about Renal Stones... 

Which specialist should I see if I have Renal or Kidney stones?

You should see a Urologist and rule it out.

How can I take care of myself?

Follow your doctor's instructions.
Make sure you drink enough liquids.
Watch for signs of kidney infection, such as fever, chills, sweats and worsening back or abdominal pain.
Get help, if you need it, with the straining of your urine.
Take the pain medicine prescribed by your doctor.
Make sure you tell your doctor if any difficulties or questions arise.

What can be done to help prevent kidney stones?

If you do not have any underlying health problems, the most important thing is to drink plenty of water daily. The goal should be to urinate from 2 to 4 liters per day. Make sure you avoid getting dehydrated.

There are no specific dietary recommendations until a stone from your system has been analyzed. After analysis you diet can be evaluated and any changes recommended.

Because kidney stones are associated with a number of metabolic diseases, it is important to be under the care of a physician for the stones. Any underlying causes can then be identified and treated. In this way complications besides kidney stones can be prevented. 

Kidney stones have known to trouble mankind from time immemorial. Many remedies have been prescribed over the centuries. However the availability of ESWL over the past 25 years has truly revolutionized treatment of stone disease. 

Glossary 

Kidney Stones / Renal Stones/ Renal Calculi - Gravel - Like collections of chemicals that may appear in any area of the urinary system. 

Hyperparathyroidism - Over activity of the parathyroid gland 

Inflammatory bowel disease - Inflammation of the bowel 

Cystine - Amino acid in the blood 

Ureteroscope - Operating telescope