diease

Kidney Stone


OVERVIEW OF Kidney Stone :

A kidney stone is a solid, pebble-like piece of material that can form in one or both of your kidneys when high levels of certain minerals are in your urine


STRUCTURE of Kidney Stone :

The nephrons are the functional unit of the kidney. The kidney consists of proximal convoluted kidney, distal convoluted kidney, collecting duct.  A nephron consists of the two parts namely the corpuscles and tubules. The tubules aids the kidney in monitoring the passages of fluids and chemicals. The tubules includes the distal convoluted tubule, proximal convoluted tubule, loop of henle and the collecting duct. The cortex is the outer covering structure of the kidney. It leads to medulla where the renal pyramids are located. The renal pyramids consists of collecting ducts.

 


CAUSES :

Kidney stones happens when the urine concentration shows higher amounts of minerals and other substances such as calcium, oxalate, uric acid and these together makes the crystals. Stone formation happens when the urine is devoid of enough fluid and other substances to keep them from happening. Since the size of the kidney stone is very minute that it resembles the grain of sand the person can pass the stone in the urine without knowing it. But the bigger one can cause severe pain.

Lack of water and dehydration

Oversweating

Diet:  The kidney stones happens when calcium nad oxalate stick together in process of urine making by the kidney. Avoid taking caffeine, tomato, milk products

Salt

Packaged food items

Gut problems: This includes inflammatory bowl disease like crohns’s disease and ulcerative colitis

obesity

Many diseases can play a role in one or more types of kidney stones to form.

Medullary sponge kidney of birth defect

Type 2 diabetes mellitus

Gout

Hyperparathyroidism

Renal tubular acidosis


PATHOPHYSIOLOGY :

Types of Kidney Stones

The different types of stones are made of different types of substances. It's important to know the type of stone you have, so you can know what may have caused it and how to prevent it. 

If you pass a kidney stone, you should take it to your doctor so they can send it to the lab and find out what kind it is:

Calcium stones:  Most kidney stones are made from calcium, in the form of calcium oxalate. There are two kinds of calcium stones:

  Calcium oxalate: Oxalate is a substance made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, are high in it. Your body absorbs the substance when you eat these foods. Other things that can make the concentration of calcium or oxalate in your urine to rise are taking high doses of vitamin D, intestinal bypass surgery and certain metabolic disorders.

Calcium phosphate: This type of stone happens more often in people with metabolic conditions, like renal tubular acidosis (where your kidneys aren’t able to help maintain proper acid balance in your blood) or with people who take medications to treat migraines or seizures.

Struvite stones: These can form from a urinary tract infection (UTI). The bacteria that cause the infection make ammonia build up in your urine. This leads to formation of the stones. The stones can get large very quickly.

Uric acid stonesThese form in people who lose too much fluid because of chronic diarrhea or malabsorption; eating a high-protein diet; or having diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones.

Cystine stones: This rare type of stone forms because the kidneys leak too much of a specific amino acid called cystine into the urine. They occur in people with a genetic disorder called cystinuria.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

fever

abdomen pain

pain during micturition

oliguria(small amount of urine in the increased time of interval)

loss of apetite

constipation.

burning with urination

bloody urine

cloudy urine

urine that looks like cola or teaurine that has a strong odour

pelvic pain in women

rectal pain in men

 


DIAGNOSTIC :

Urinanalysis: The urine analysis includes the red blood cell count,white blood cell count.T

Ultrasound: The ultrasound which reveals the inflammation the ureter,renal,urethra. And provides the information about the renal calculi,hydronephrosis and obstruction.

Temperature: an increase in temperature increase greater than 38 degree indicates the infection

Urine dipstick:

     Leukocyte esterase and nitrites if tends to be positive then go for the urinary culture.

Micturating cystography:

During cystography, contrast dye is injected into the bladder. Contrat dyes are placed in the  body that causes the particular organ or tissue under study to be seen more clearly. X-rays are taken of the bladder, and fluoroscopy may be used to study the bladder emptying while a person urinates (voiding cystography). Cystography may indicate how well the bladder emties the urine and whether any urine backs correctly (vesicoureteral reflux).

 

DMSA scintigraphy(dimercaptosuccinic acid):

It is a radionucleoside  scanning that reveals the morphology of renal morphology,structure and function.

Radioactive technetium-99m is combined with DMSA and injected into a patient, followed by imaging with a gamma camera after 2-3 hours.

CT scan:

The CT scan involves the slicing of the kidney and detecting the abnormalities.

Magnetic Resonance Imaging:

A MRI scan uses the combination of the magnetic and radiowave frequency to view the abnormal tissues.

An dye is injected in the vein or the patient is asked to swallow the dye and the results are observed.

Ultrasound:

A sound waves to create the picture of the internal organs to find out if the cancer is spread or not.

Abdominal ultrasound:  with the patient symptoms it can be used to view the pancreas. But it cannot reveal the spread of pancreas.

Endoscopic ultrasound: in this method the doctor uses an ultrasound probe, and with the guidance of endoscope it is passed in to the small intestine and then into the pancreas to view the structures.


TREATMENT AND PROGNOSIS :

Shock wave Lithotripsy:  The sound waves are used to break the kidney stones. When the wave is given outside it is called as extracorporeal shock wave therapy.

Ureteroscopy:

The physician uses thin light tube into the ureter and helps to break the kidney stones.

Percutaneous nephrolithotomy or percutaneous nephrolithotripsyThese similar surgical procedures are options if your stone is large or if other procedures fail to break them down enough. Your doctor uses a thin tube inserted through your skin to reach the stone and them removes (nephrolithotomy) or breaks (nephrolithotripsy) it.

You will be given drugs so you won’t be awake or feel pain. You'll likely have to stay in the hospital for 1-2 days.

Open surgery:

If the kidney stone is oversized then the physician open and operate i


PROGNOSIS :

The prognosis is excellent when the kidney stone is of small size. When it is larger then open surgery is indicated.


PREVENTION :

Takes larger amount of water intake

Take citrus since it can breaks the stone.

Avoid calcium diet

Take lots of plantain juice

Avoid packaged food items

Avoid salt in the diet

Avoid obesity


Medicines used in the Treatment :

The doctor might put you in the observation phase for 2-3 weeks. During this period intake of lots of water and other home remedy measures such as intake of large amount of plantain juice might dissolves the stone.

To relieve from the pain acetaminophen or ibuprofen can be used.

Potassium citrate or sodium citrate breaks the formation of the kidney stones.

Calcium channel blocker such as verapamil, nifedipine and amlodipine can relax the ureter

Alpha blocker such as the phenoxybenzamine, ergotamine, Phentolamine and prazosin can be used to relax the ureter.

Surgeries:


REFERENCE :

https://www.webmd.com/kidney-stones/understanding-kidney-stones-prevent

https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755

https://www.medicinenet.com/kidney_stones/article.htm

https://www.kidney.org/atoz/content/kidneystones