Kidney Stones (Nephrolithiasis) Treatment in Delhi, India

Kidney stones refer to solid masses made up of tiny crystals. There can be one or more stones in the kidney or ureter at the same time. Kidney stones typically leave the body in the urine stream, and a small stone may pass without causing symptoms. If stones grow to sufficient size (usually at least 3 millimetres (0.12 in), they can cause blockage of the ureter. This leads to pain, most commonly beginning in the flank or lower back and often radiating to the groin. This pain is often known as renal colic and typically comes in waves lasting 20 to 60 minutes.

Kidney stones come in four primary types:

1. Calcium stones: The most prevalent type, calcium stones can be categorised into two subgroups, depending on the specific molecules they are composed of:

• Calcium oxalate
• Calcium phosphate

2. Uric acid stones: Another common type of kidney stone, which forms when there's an excess of uric acid in the urine.

3. Struvite stones: Also known as triple phosphate or magnesium ammonium phosphate stones, they tend to develop due to urinary tract infections.

4. Cystine stones: These rare stones occur due to a genetic condition where the kidneys excrete too much cystine, an amino acid.

The development of kidney stones can be influenced by a variety of causes and risk factors, such as:

• Diet: High consumption of oxalate-rich foods (such as spinach, beets, and nuts), high-sodium diets, and diets low in calcium can increase the risk of kidney stones.
• Dehydration: Insufficient fluid intake can lead to concentrated urine, increasing the risk of stone formation.
• Family history: A family history of kidney stones can increase an individual's susceptibility to developing them.
• Age and gender: Kidney stones are more common in people between the ages of 30 and 60, and they are more prevalent in men than women.
• Obesity: Obesity is a risk factor for kidney stones because it can lead to higher levels of certain substances in the urine that promote stone formation.
• Urinary tract abnormalities: Structural abnormalities in the urinary tract, such as blockages or congenital conditions, can hinder the normal flow of urine and contribute to stone formation.
• Medical conditions: Certain medical conditions, such as gout, hyperparathyroidism, and cystinuria, can increase the risk of kidney stone development due to abnormal levels of substances in the urine.
• Medications: Some medications, such as diuretics and antacids, can increase the risk of kidney stone formation by affecting urine composition.
• Inactivity: Lack of physical activity can reduce calcium excretion, potentially increasing the risk of stone formation.
• Previous history of kidney stones: Individuals with kidney stones are at a higher risk of developing them again.

Kidney stones often manifest with a variety of symptoms, which can include:

• Hematuria (blood in the urine): Kidney stones can cause bleeding in the urinary tract, leading to blood in the urine. This may give the urine a pink, red, or brownish tint.
• Fever: In some cases, kidney stones can lead to infection or inflammation, resulting in a fever. Fever can be a sign of a more serious condition and should be evaluated promptly.
• Nausea and vomiting: Kidney stone pain can be severe enough to cause nausea and vomiting in some individuals.
• Abnormal urine colour: Along with blood in the urine, kidney stones may cause urine to appear cloudy, foul-smelling, or discoloured.
• Abdominal Pain: The discomfort caused by kidney stones can also lead to generalised abdominal pain.

Kidney stones can lead to severe complications, which include:

• Urinary Tract Infections (UTIs): Kidney stones can serve as a focus for bacterial growth, leading to urinary tract infections.
• Obstruction of urinary flow: Larger stones or stones that become lodged in the urinary tract can block the flow of urine, potentially leading to severe pain and kidney damage.
• Hydronephrosis: When urine is obstructed due to kidney stones, it can cause kidney swelling, a condition known as hydronephrosis.
• Sepsis: In rare cases, kidney stones can lead to systemic infection, known as sepsis, which is a life-threatening condition.
• Kidney damage: Repeated or prolonged blockages can harm the kidneys and impair their function.
• Chronic kidney disease: Recurrent kidney stones may contribute to the development of chronic kidney disease over time.

When diagnosing kidney stones, doctors typically use a combination of clinical evaluation, laboratory tests, and imaging studies.

Clinical Evaluation 

• Assessment of symptoms:A healthcare provider will ask about symptoms, which may include severe pain in the back or side, pain during urination, cloudy or odorous urine, nausea and vomiting, and a persistent urge to urinate.
• Evaluation of medical history: Information on personal and family medical history, dietary habits, fluid intake, and previous kidney stones is collected.

Laboratory Tests 

• Urine testing: A 24-hour urine collection test may reveal too much calcium or uric acid in the urine. A urine sample may also be tested for infection or pieces of stones.
• Blood testing: Blood tests can reveal biochemical problems that can lead to kidney stones, such as high calcium or uric acid levels.

Imaging Studies 

• Non-contrast helical (spiral) CT scan: This imaging test is commonly used as it is the most sensitive method for detecting stones, including tiny ones, and doesn't require any contrast material.
• Ultrasound: A non-invasive test that can detect stones and may be used as a first-line imaging technique, especially in pregnant women and children.
• Intravenous Pyelography (IVP): Less commonly used, this involves injecting a dye into a vein in the arm and taking X-rays (or obtaining a CT scan) as the dye travels through the kidneys and bladder.
• Abdominal x-rays (KUB - Kidney, Ureter, Bladder): Can detect larger stones, but this test is less detailed and can miss smaller stones or stones that do not block X-rays.

Other Diagnostic Tools

• Stone analysis: If a stone is passed, analysing its composition can help in determining the cause and preventing recurrence.

Depending on the type of stone, the kidney stone doctor may prescribe medicines to decrease stone formation or help break down and remove the material that is causing the stones.

1. Allopurinol (for uric acid stones)
2. Antibiotics (for struvite stones)
3. Diuretics
4. Phosphate solutions
5. Sodium bicarbonate or sodium citrate
6. Water pills (thiazide diuretics)

Kidney stone surgery is required if:

1. The stone is too large to pass on its own
2. The stone is growing
3. The stone is blocking urine flow and causing an infection or kidney damage
4. The pain cannot be controlled

The kidney stone operation depends on the type of stone and the severity of symptoms. Here's a comprehensive approach to reducing the risk of kidney stones:

Hydration

• Fluid intake:The best way to prevent kidney stones is to drink 6–8 glasses of water to produce a large amount of urine.
• Variety of fluids: While water is best, incorporating fluids like lemonade and other citrus beverages can help due to their natural citrate content.

Dietary Adjustments 

• Calcium intake: Consume the right amount of dietary calcium. Calcium supplements should be discussed with a healthcare provider as they can increase the risk of stone formation in some people.
• Reduce oxalates: Limit foods high in oxalates like spinach, rhubarb, nuts, and wheat bran if you are prone to calcium oxalate stones.
• Limit salt: High sodium intake can trigger kidney stones because it increases the amount of calcium in the urine.
• Protein consumption: Reduce the amount of animal protein you eat, as too much can raise the risk of kidney stones.
• Fruits and vegetables: A diet rich in fruits and vegetables can help prevent stones by making the urine less acidic.
• Balanced diet: Avoid crash diets for weight loss, as they can increase the risk of stone formation.

What is ureteroscopy? 

Ureteroscopy is a minimally invasive procedure that uses a small scope to examine and treat problems in the ureter.

How is ureteroscopy performed?

Ureteroscopy is a procedure performed using a small scope that is inserted through the urethra and bladder into the ureter.

Can ureteroscopy be used to remove kidney stones? 

Yes, ureteroscopy can be used to remove ureteric or kidney stones from the ureter or kidney through flexible ureteroscope. 

What is percutaneous nephrolithotomy? 

A minimally invasive procedure, percutaneous nephrolithotomy involves the use of a small incision to remove kidney stones.

How is percutaneous nephrolithotomy performed? 

Percutaneous nephrolithotomy is performed using a small incision in the back, through which a scope is inserted to remove the kidney stone.

What are the risks of percutaneous nephrolithotomy?

The risks of percutaneous nephrolithotomy include bleeding, infection, and damage to surrounding tissue.

Can percutaneous nephrolithotomy be used to treat all types of kidney stones?

Percutaneous nephrolithotomy is effective for most kidney stones, although some larger or more complex stones may require combined procedures like flexible ureteroscopy and rarely open surgery. 

What is a ureteral stent? 

A ureteral stent is a small and flexible tube that is inserted into the ureter to help urine flow from the kidney to the bladder and it dilates the ureter as well. 

Should I seek a second opinion before undergoing a kidney stone operation?

If you are searching for the best kidney stone doctor in Delhi, consider Max Healthcare for getting a cure for kidney stones. Max Hospital is well known for its best kidney stone treatment facilities. Book an appointment now and follow all kidney stones prevention to keep safe & healthy. We have got all possible armamentarium including different types of Laser for stone management. 

Why is a ureteral stent needed? 

A ureteral stent may be needed to help relieve symptoms of a kidney stone, such as pain or obstruction of the passage. 

What are the risks of a ureteral stent? 

The risks of a ureteral stent include discomfort or pain, infection, and blockage.

Why is it essential to follow up with a kidney stone specialist about kidney stones? 

Following up with a kidney stone specialist is essential, as they can monitor the size and location of kidney stones, provide guidance on treatment options, and help prevent future stone formation through dietary and lifestyle recommendations.

How do I manage my kidney stones along with my other health problems, such as diabetes and a heart disorder? 

Managing kidney stones along with other health conditions calls for close coordination with consulting doctors. Ensure your medications and dietary choices consider all your health issues. Consult with specialists in each area for personalised guidance.

Reviewed by Dr. Waheed Zaman - Director - Urology & Renal Transplantation, Kidney Transplant, Robotic Surgery on 19-Jan-2024.

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