Kidney stone

Kidney stones vary in size. While tiny stones are less likely to get stuck in the kidneys or other parts of the urinary tract, larger stones can cause sharp, cramping pain in the back and sides. This pain often radiates to the lower abdomen or groin. The discomfort may be intermittent or persistent, but it can be quite intense.

Symptoms of kidney stones include:

• Pink, red, or brown blood in urine (hematuria)
• Pain during urination
• Cloudy or foul-smelling urine
• A constant urge to urinate
• Chills
• Fever
• For men, pain at the tip of the penis
• Persistent vague pain or stomach ache
• Nausea
• Vomiting

Kidney stones are caused when the levels of minerals like calcium, oxalate, and phosphorus rise in the urine. Other factors that contribute to the development of kidney stones include:

• Dehydration
• Obesity
• Diet (high in oxalate or uric acid)
• Excessive salt or sugar intake
• Lack of exercise
• Highly concentrated urine
• Imbalance of pH in urine
• Regular constipation
• Genetic disorders

Risk Factors Of Kidney Stones

Age and Sex

Kidney stones are most likely to occur in people between the ages of 20 and 50 years. Men are significantly more likely to develop these stones than women.

Family or Personal History

• Individuals with a family history of kidney stones are more likely to develop them than those without.
• The risk of developing kidney stones is three times higher in individuals with a personal history of kidney stones.

Diet

• A diet high in sodium, protein, and sugar can increase the risk of certain types of kidney stones.
• Inadequate calcium intake is a major risk factor for kidney stone development. Low calcium diets can increase urinary oxalate excretion, leading to greater stone formation and potentially a negative calcium balance.

Dehydration

Dehydration is the most common cause of kidney stones and may result from excessive fluid loss due to exercise, work, or living in hot conditions.

Obesity

Obesity can alter the acid levels in urine, contributing to stone formation. A high body mass index (BMI), large waist size, and weight gain are associated with an increased risk of both initial and recurrent kidney stones.

Urinary Tract Infections

In patients with chronic urinary tract infections, larger stones may form in the kidneys, commonly referred to as struvite or infection stones.

Medical Conditions

Certain medical conditions increase the risk of kidney stones:

• Abnormal growth of one or more parathyroid glands, which regulate calcium metabolism, can lead to elevated calcium levels in the blood and urine.
• Distal renal tubular acidosis, a condition characterized by acid accumulation in the body, can raise the risk of calcium phosphate kidney stones.

Medications

Some medications and supplements, such as calcium and vitamin C, may increase the risk of stone formation. These include:

• Certain antibiotics, including ciprofloxacin and sulfa antibiotics
• Certain diuretics, like triamterene, used to treat high blood pressure
• Decongestants, such as ephedrine or guaifenesin
• Protease inhibitors, like indinavir
• Anticonvulsants, including felbamate, topiramate, and zonisamide

Medical history and physical examination

A healthcare practitioner will collect information regarding a person’s history of health conditions, family history of kidney stones, and the diet that may contribute to the development of kidney stones. The physical examination includes:

• General examination: In classical descriptions, a patient with renal colic (pain felt when kidney stones block the urinary tract) is continuously moving and twisting, unable to find a comfortable position. This is a common finding but not universal.
• Vital signs: Kidney stones can induce a fast heart rate and elevate blood pressure. They generally do not cause fevers unless associated with a urinary tract infection.
• Abdominal and flank examination: The doctor will physically examine the abdominal area.

Lab tests

Urologists often recommend several diagnostic tests to confirm the presence of kidney stones. These tests include:

• Urinalysis: Urine tests can show whether the urine contains high levels of minerals that form kidney stones. It also shows white blood cells and bacteria in the urine that may indicate a urinary tract infection.
• Blood tests: These tests are done to check the functioning of the kidneys and the levels of substances that could contribute to the formation of kidney stones, such as calcium, phosphorus, uric acid, and serum electrolytes. Blood urea nitrogen (BUN) and creatinine tests help identify any abnormal kidney function by determining the amount of nitrogen in the blood that comes from the waste product urea.

Imaging tests

These tests may help diagnose any issues that caused a kidney stone to form, such as a blockage in the urinary tract or any birth defects. These tests include:

• Abdominal X-ray: An abdominal X-ray uses low levels of radiation to create a picture of the abdomen. These X-rays can show the location of kidney stones in the urinary tract, but not all stones are visible in an abdominal X-ray.
• Intravenous pyelogram (IVP): IVP is the gold standard for kidney stone detection. This test uses an X-ray and dye to visualize the kidneys, bladder, and ureters.
• Abdominal Computed Tomography (CT) scan: If the stone is blocking the urinary tract, the CT scan can be used to assess the exact size and location of a kidney stone.
• Abdominal ultrasound: An abdominal ultrasound scan offers moderate sensitivity and specificity to diagnose kidney stones, although it is lower than a CT scan.
• Abdominal magnetic resonance imaging (MRI): This test allows doctors to examine soft tissues without bones obstructing the view. It is a safer alternative to a CT scan.
• Nuclear functional renal scan: A renal scan involves the use of nuclear radioactive material to examine the kidneys and assess their function.
• Noncontrast computed tomography: This type of CT scan offers high sensitivity and specificity for the detection of kidney stones.

Stone analysis

If a person passes a stone or a stone is removed by surgery, testing the stone will determine its type. This information helps the healthcare provider decide the best way to treat or prevent future stones.

Drink enough fluids

• A simple and important lifestyle change to prevent stones is to drink more water and fluids. It's best to drink mostly no-calorie or low-calorie drinks and limit sugary and alcoholic drinks.

Reduce the amount of sodium in your diet

• It is advisable to restrict salt intake (≤ 50 mmol/day of sodium chloride). A high sodium intake boosts stone risk by reducing calcium reabsorption in the kidneys and increasing urinary calcium.

Eat the recommended amount of calcium

• Individuals with calcium stones are recommended to avoid dairy products and other foods with high calcium content unless advised otherwise.
• A reduced intake of calcium can lead to increased intestinal absorption of oxalate, which accounts for an increased risk of stone formation.
• Hence, it is advised to consume the recommended amount of calcium through diet or supplements.

Eat plenty of fruits and vegetables

• To prevent the formation of calcium oxalate, cystine, and uric acid stones, alkalize the urine by eating a diet high in fruits and vegetables, taking supplemental citrate, or drinking alkaline mineral waters.
• Eating at least five servings of fruits and vegetables rich in potassium, fiber, magnesium, antioxidants, phytate, and citrate may help prevent stone formation.

Eat less meat

• Restriction of animal proteins (≤ 52 g/day) is encouraged since animal proteins provide an increased acid load due to their high sulfur-containing amino acids content.
• Therefore, in cases of acidic urine output, it is recommended to eat less meat, fish, and poultry.

Increase magnesium intake

• Magnesium is an important mineral that helps prevent calcium oxalate kidney stone formation. The reference daily intake (RDI) for magnesium is 420 mg per day.
• Dietary magnesium intake can be increased by consuming bananas, avocados, legumes, and tofu.

Eat foods with low oxalate levels

• Limit the consumption of foods high in oxalate, such as peanuts, spinach, beetroots, chocolate, and sweet potatoes.
• It is not necessary to completely stop eating foods that contain oxalate; however, the level of oxalate intake should be decreased.

Small kidney stones

These stones are typically excreted from the body on their own without considerable treatment. Intake of sufficient amounts of water (4-5 liters a day) may help flush out the stone via urine. Different medications that can assist in the removal of these stones include:

• Medications
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Used to relieve pain caused by stone movement. Examples include:
  • Aspirin
  • Diclofenac
  • Ketoprofen
• Anti-sickness medicine: Used in cases of nausea and vomiting, including:
  • Cinnarizine
  • Hyoscine
  • Chlorpromazine
• Alpha-blockers: Help relax the muscles of the ureter and facilitate the passage of stones. These drugs include:
  • Tamsulosin
  • Alfuzosin
  • Nifedipine
  • Doxazosin
  • Terazosin
• Diuretics: Increase urine flow and may help flush out stones smaller than 5 mm. Examples include:
  • Bumetanide
  • Ethacrynic acid
  • Furosemide
  • Torsemide

Large kidney stones

If the kidney stones are too large to be passed naturally, they are usually removed by surgery.

• Surgery
• Shock wave lithotripsy (SWL): The only non-invasive method for stone removal, SWL uses ultrasound (high-frequency sound waves) to locate a kidney stone and break it into smaller pieces. This method may require more than one session to successfully treat kidney stones.
• Ureteroscopy (URS): Used for stones in the ureter, especially those closest to the bladder. It involves passing a long, thin telescope called a ureteroscope through the urethra and into the bladder. URS is preferred for treating small to medium-sized kidney stones located anywhere in the urinary tract.
• Percutaneous nephrolithotomy (PCNL): Often used when kidney stones are too difficult to reach, too large, too numerous, or too dense for SWL or URS. PCNL is considered the first-choice treatment for renal stones larger than 2 cm.

Medications

Certain medications are prescribed alongside surgeries for larger stones, depending on the type of stone:

• Calcium stones: Thiazide diuretics (often called water pills) are used for patients with calcium stones. Potassium citrate is another salt that helps inhibit the formation of calcium stones.
• Uric acid stones: Also known as hyperuricemia or hyperuricosuria. Allopurinol, frequently prescribed for gout, lowers uric acid levels in the blood and urine.
• Struvite stones: Acetohydroxamic acid (AHA) is used for patients with struvite infection, diluting the urine and making it less favorable for struvite stone formation.
• Cystine stones: Cystine-binding thiol drugs are used for patients with cystine stones. Medications such as d-penicillamine or tiopronin bind to cystine in the urine, forming a compound less likely to crystallize.

Hyperparathyroidism surgery

Individuals with hyperparathyroidism, a condition that results in excess calcium in the blood, may develop calcium stones. Removing the parathyroid gland can cure hyperparathyroidism and help prevent kidney stones. Symptoms of hyperparathyroidism can include unexplained weight loss.

Here are a few home remedies that can help in managing kidney stones:

• Lemon juice (Nimbu): Lemons contain citrate, which is a chemical that prevents calcium stones from forming. Citrate can also break up small stones, allowing them to pass more easily. Consumption of half a cup of lemon juice per day will increase citrates in the urine.
• Water consumption: Drinking water helps speed up the process of passing a stone. Drink at least 12 glasses of water if you are trying to pass a kidney stone.
• Green tea: Green tea is rich in antioxidants and possesses a protective effect against the development of calcium stones in the kidneys.
• Kidney beans (Rajma): High levels of fiber in kidney beans and broth from cooked kidney beans help improve overall urinary and kidney health. It also helps dissolve and flush out kidney stones.
• Celery: It has antispasmodic properties and also helps in cleansing the toxins from the body.
• Dandelion: Organic dandelion roots help cleanse the kidneys and support normal kidney functioning. Taking 500 mg of dried dandelion extract or drinking dandelion tea may help ease the symptoms and prevent the formation of kidney stones.
• Wheatgrass: It is a rich source of many vital nutrients. A glass of wheatgrass juice with lemon extract is a perfect way to sort out kidney stones.
• Pomegranate juice (Anar): This juice acts as a natural detoxifying agent that helps get rid of kidney stones causing impurities. Try to consume fresh pomegranate juice each day without added sugar.
• Raspberry: This fruit is capable of expelling stones from the urinary tract. The prophylactic effect of raspberry has been reported on calcium oxalate renal stone formation.
• Fenugreek seeds (Methi dana): It has been usually seen that fenugreek seeds significantly reduce calcification in the kidneys and help prevent kidney stones.
• Black cumin seed (Jeera): This herb significantly reduces the formation of calcium oxalate stones.
• Radish (Mooli): Roots of the radish plant are highly effective in breaking kidney stones.
• Tamarind pulp (Imli): Tamarind has shown beneficial effects in inhibiting spontaneous crystallization during the formation of kidney stones.
• Baking soda: It helps in maintaining an alkaline environment in the body. The stones get enhanced in an acidic environment and baking soda aids in their removal. Mix half a teaspoon of baking soda with apple cider vinegar and consume the solution twice a day.

Ayurveda

• Asparagus (Shatavari): Leaves of this plant are useful in expelling stones from the urinary tract and inhibiting the formation of calcium oxalate stones.
• Crataeva nurvala (Varuna): The part of the plant used is the roots. Its pharmacological properties include being a lubricant, diuretic, and lithotriptic.
• Tribulus Terrestris (Gokshura): This herb is commonly used in India to treat urinary tract diseases.
• Hogweed (Punarnava): This Indian weed is used to help expel kidney stones.
• Hibiscus (Gudhal): Drinking a cup of tea made from this herb significantly increases the excretion of uric acid and the clearance of kidney stones through urine.
• Indian nightshade (Kantakari): A widely used edible medicinal plant in India, known as the yellow berried nightshade plant. This plant is used as a remedy for various renal diseases, including kidney stones.
• Horse gram (Kulthi): A nutritional and medicinal plant native to India. Its seeds are used to prepare soup, which decreases the formation and recurrence of calcium oxalate stones.
• Indian madder (Manjistha): A flowering plant in the coffee family, used as a natural food colorant. The roots of manjistha are beneficial in reducing the risk of kidney stones by lowering the levels of calcium and oxalate in the kidneys and inhibiting the growth of urinary stones.

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Smaller kidney stones may not cause significant problems and can be managed with certain simple lifestyle modifications. Here are some tips to consider when living with kidney stones:

• Always stay hydrated
• Watch your diet
• Maintain a healthy weight
• Consult your doctor if symptoms affect your daily activities
• Add magnesium supplements to your diet
• Take your medications as prescribed
• Follow up as recommended by your doctor

Here are some daily food habits you should follow if you have or are prone to developing kidney stones.