The urinary systemcomprises of the
kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs
located below the ribs toward the middle of the back. The kidneys remove extra
water and wastes from the blood, converting it to urine. They also keep a
stable balance of salts and other substances in the blood. The kidneys produce
hormones that help build strong bones and help form red blood cells.Narrow
tubes called ureters carry urine from the kidneys to the bladder, an
oval-shaped chamber in the lower abdomen. Like a balloon, the bladder's elastic
walls stretch and expand to store urine. They flatten together when urine is
emptied through the urethra to outside the body.
A kidney stone is a hard mass
developed from crystals that separate from the urine and build up on the inner
surfaces of the kidney. Normally, urine contains chemicals that prevent or
inhibit the crystals from forming. These inhibitors do not seem to work for
everyone, however, so some people form stones. If the crystals remain tiny
enough, they will travel through the urinary tract and pass out of the body in
the urine without being noticed.Kidney stones may contain various combinations
of chemicals. The most common type of stone contains calcium in combination
with either oxalate or phosphate. These chemicals are part of a person's normal
diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is
caused by infection in the urinary tract. This type of stone is called a
struvite or infection stone. A bit less common is the uric acid stone. Cysteine
stones are rare.
Urolithiasis is the medical term
used to describe stones occurring in the urinary tract. Other frequently used
terms are urinary tract stone disease and nephrolithiasis. Doctors also use
terms that describe the location of the stone in the urinary tract. For
example, a urethral stone (or ureterolithiasis) is a kidney stone found in the
ureter. To keep things simple, however, the term "kidney stones" is
used throughout this fact sheet.
Gallstones and kidney stones are not
related. They form in different areas of the body. If you have a gallstone, you
are not necessarily more likely to develop kidney stones.
For
unknown reasons, the number of people in the United States with kidney stones
has been increasing over the past 30 years. The prevalence of stone-forming
disease rose from 3.8 percent in the late 1970s to 5.2 percent in the late
1980s and early 1990s. White Americans are more prone to develop kidney stones
than African Americans. Stones occur more frequently in men. The prevalence of
kidney stones rises dramatically as men enter their 40s and continues to rise
into their 70s. For women, the prevalence of kidney stones peaks in their 50s.
Once a person gets more than one stone, others are likely to develop.Doctors do
not always know what causes a stone to form. While certain foods may promote
stone formation in people who are susceptible, scientists do not believe that
eating any specific food causes stones to form in people who are not susceptible.A
person with a family history of kidney stones may be more likely to develop
stones. Urinary tract infections, kidney disorders such as cystic kidney
diseases, and certain metabolic disorders such as hyperparathyroidism are also
linked to stone formation.In addition, more than 70 percent of people with a
rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two
other rare, inherited metabolic disorders that often cause kidney stones. In
cystinuria, too much of the amino acid cystine, which does not dissolve in
urine, is voided. This can lead to the formation of stones made of cystine. In
patients with hyperoxaluria, the body produces too much of the salt oxalate.
When there is more oxalate than can be dissolved in the urine, the crystals
settle out and form stones.
Shapesof various stones. Sizes are usually
smaller than shown here.
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Hypercalciuria is inherited. It is
the cause of stones in more than half of patients. Calcium is absorbed from
food in excess and is lost into the urine. This high level of calcium in the
urine causes crystals of calcium oxalate or calcium phosphate to form in the
kidneys or urinary tract.
Other causes of kidney stones are
hyperuricosuria which is a disorder of uric acid metabolism, gout, excess
intake of vitamin D, urinary tract infections, and blockage of the urinary
tract. Certain diuretics which are commonly called water pills or calcium-based
antacids may increase the risk of forming kidney stones by increasing the amount
of calcium in the urine.
Calcium oxalate stones may also form
in people who have a chronic inflammation of the bowel or who have had an
intestinal bypass operation, or ostomy surgery. As mentioned above, struvite
stones can form in people who have had a urinary tract infection. People who
take the protease inhibitor indinavir, a drug used to treat HIV infection, are
at risk of developing kidney stones.
Kidney stones often do not cause any
symptoms. Usually, the first symptom of a kidney stone is extreme pain, which
occurs when a stone acutely blocks the flow of urine. The pain often begins
suddenly when a stone moves in the urinary tract, causing irritation or
blockage. Typically, a person feels a sharp, cramping pain in the back and side
in the area of the kidney or in the lower abdomen. Sometimes nausea and
vomiting occur. Later, pain may spread to the groin.If the stone is too large
to pass easily, pain continues as the muscles in the wall of the tiny ureter
try to squeeze the stone along into the bladder. As a stone grows or moves,
blood may appear in the urine. As the stone moves down the ureter closer to the
bladder, you may feel the need to urinate more often or feel a burning
sensation during urination.
If fever and chills accompany any of
these symptoms, an infection may be present. In this case, you should contact a
doctor immediately.
How
are kidney stones diagnosed?
Sometimes "silent"
stones—those that do not cause symptoms—are found on x rays taken during a
general health exam. If they are small, these stones would likely pass out of
the body unnoticed.
More often, kidney stones are found
on an x ray or sonogram taken on someone who complains of blood in the urine or
sudden pain. These diagnostic images give the doctor valuable information about
the stone's size and location. Blood and urine tests help detect any abnormal
substance that might promote stone formation.
The doctor may decide to scan the
urinary system using a special test called a CT (computed tomography) scan or
an IVP (intravenous pyelogram). The results of all these tests help determine
the proper treatment.
How
are kidney stones treated?
Fortunately, surgery is not usually
necessary. Most kidney stones can pass through the urinary system with plenty
of water (2 to 3 quarts a day) to help move the stone along. Often, you can
stay home during this process, drinking fluids and taking pain medication as
needed. The doctor usually asks you to save the passed stone(s) for testing.
(You can catch it in a cup or tea strainer used only for this purpose.)
The
First Step: Prevention
If you've had more than one kidney
stone, you are likely to form another; so prevention is very important. To
prevent stones from forming, your doctor must determine their cause. He or she
will order laboratory tests, including urine and blood tests. Your doctor will
also ask about your medical history, occupation, and eating habits. If a stone
has been removed, or if you've passed a stone and saved it, the laboratory
should analyze it because its composition helps in planning treatment.
You may be asked to collect your
urine for 24 hours after a stone has passed or been removed. The sample is used
to measure urine volume and levels of acidity, calcium, sodium, uric acid,
oxalate, citrate, and creatinine (a product of muscle metabolism). Your doctor
will use this information to determine the cause of the stone. A second 24-hour
urine collection may be needed to determine whether the prescribed treatment is
working.
Lifestyle
Changes
A simple and most important
lifestyle change to prevent stones is to drink more liquids—water is best. If
you tend to form stones, you should try to drink enough liquids throughout the
day to produce at least 2 quarts of urine in every 24-hour period.
People who form calcium stones used
to be told to avoid dairy products and other foods with high calcium content.
But recent studies have shown that foods high in calcium, including dairy
products, may help prevent calcium stones. Taking calcium in pill form,
however, may increase the risk of developing stones.
You may be told to avoid food with
added vitamin D and certain types of antacids that have a calcium base. If you
have very acidic urine, you may need to eat less meat, fish, and poultry. These
foods increase the amount of acid in the urine.
To prevent cystine stones, you
should drink enough water each day to dilute the concentration of cystine that
escapes into the urine, which may be difficult. More than a gallon of water may
be needed every 24 hours, and a third of that must be drunk during the night.
Foods and Drinks Containing Oxalate
People prone to
forming calcium oxalate stones may be asked by their doctor to cut back on
certain foods if their urine contains an excess of oxalate:
People should not give
up or avoid eating these foods without talking to their doctor first. In most
cases, these foods can be eaten in limited amounts.
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Medical
Therapy
The doctor may prescribe certain medications
to prevent calcium and uric acid stones. These drugs control the amount of acid
or alkali in the urine, key factors in crystal formation. The drug allopurinol
may also be useful in some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria,
and thus prevent calcium stones, by prescribing certain diuretics, such as
hydrochlorothiazide. These drugs decrease the amount of calcium released by the
kidneys into the urine by favoring calcium retention in bone. They work best
when sodium intake is low.
Very rarely, patients with
hypercalciuria may be given the drug sodium cellulose phosphate, which binds
calcium in the intestines and prevents it from leaking into the urine.
If cystine stones cannot be
controlled by drinking more fluids, your doctor may prescribe drugs such as
Thiola and Cuprimine, which help reduce the amount of cystine in the urine.For
struvite stones that have been totally removed, the first line of prevention is
to keep the urine free of bacteria that can cause infection. Your urine will be
tested regularly to be sure that no bacteria are present.
If struvite stones cannot be
removed, your doctor may prescribe a drug called acetohydroxamic acid (AHA).
AHA is used with long-term antibiotic drugs to prevent the infection that leads
to stone growth.
People with hyperparathyroidism
sometimes develop calcium stones. Treatment in these cases is usually surgery
to remove the parathyroid glands (located in the neck). In most cases, only one
of the glands is enlarged. Removing the glands cures the patient's problem with
hyperparathyroidism and with kidney stones as well.
Surgical
Treatment
Surgery should be reserved as an
option for cases where other approaches have failed. Surgery may be needed to
remove a kidney stone if it
- does not pass after a reasonable period of time and
causes constant pain
- is too large to pass on its own or is caught in a
difficult place
- blocks the flow of urine
- causes ongoing urinary tract infection
- damages kidney tissue or causes constant bleeding
- has grown larger (as seen on followup x ray studies).
Until 20 years ago, surgery was
necessary to remove a stone. It was very painful and required a recovery time
of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and
many options do not require major surgery.
Extracorporeal
Shockwave Lithotripsy
Extracorporeal shockwave lithotripsy
(ESWL) is the most frequently used procedure for the treatment of kidney
stones. In ESWL, shock waves that are created outside the body travel through
the skin and body tissues until they hit the denser stones. The stones break
down into sand-like particles and are easily passed through the urinary tract
in the urine.
In most cases, ESWL may be done on
an outpatient basis. Recovery time is short, and most people can resume normal
activities in a few days.
Complications may occur with ESWL.
Most patients have blood in their urine for a few days after treatment.
Bruising and minor discomfort in the back or abdomen from the shock waves are
also common. To reduce the risk of complications, doctors usually tell patients
to avoid taking aspirin and other drugs that affect blood clotting for several
weeks before treatment.
Another complication may occur if
the shattered stone particles cause discomfort as they pass through the urinary
tract. In some cases, the doctor will insert a small tube called a stent
through the bladder into the ureter to help the fragments pass. Sometimes the
stone is not completely shattered with one treatment, and additional treatments
may be needed. ESWL is not ideal for very large stones.
Percutaneous
Nephrolithotomy
Sometimes a procedure called
percutaneous nephrolithotomy is recommended to remove a stone. This treatment
is often used when the stone is quite large or in a location that does not
allow effective use of ESWL.
I
One advantage of percutaneous
nephrolithotomy over ESWL is that the surgeon removes the stone fragments
instead of relying on their natural passage from the kidney.
Ureteroscopic
Stone Removal
Although some kidney stones in the
ureters can be treated with ESWL, ureteroscopy may be needed for mid- and
lower-ureter stones. No incision is made in this procedure. Instead, the
surgeon passes a small fiber optic instrument called stereoscope through the
urethra and bladder into the ureter. The surgeon then locates the stone and
either removes it with a cage-like device or shatters it with a special
instrument that produces a form of shock wave. A small tube or stent may be
left in the ureter for a few days to help the lining of the ureter heal. Before
fiber optics made ureteroscopy possible, physicians used a similar "blind
basket" extraction method. But this outdated technique should not be used
because it may damage the ureters.
Hope
Through Research
CIDPUSA has done research to provide
you with herbal and homeopathic remedy that will remove all stones at home. Try
this at home today . People who had surgeons tell them that they were at
surgical risk have been helped by cidpusa protocol of herbs at home.
Prevention
Points to Remember
- If you have a family history of stones or have had more
than one stone, you are likely to develop more stones.
- A good first step to prevent the formation of any type
of stone is to drink plenty of liquids—water is best.
- If you are at risk for developing stones, your doctor
may perform certain blood and urine tests to determine which factors can
best be altered to reduce that risk.
- Some people will need medicines to prevent stones from
forming.
- People with chronic urinary tract infections and stones
will often need the stone removed if the doctor determines that the
infection results from the stone's presence. Patients must receive careful
followup to be sure that the infection has cleared.
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