Renal Stone Disease (Kidney & Ureteral stones)
A. A stone is a hard, solid mass that can form in various organs with a lumen like the gallbladder, bladder, and kidneys.
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A. Each stone has a different molecular composition. Stones can happen due to an underlying pathology. Kidney and ureteral stones develop in the kidney and either stay there or move to the ureter. Kidney stones form when minerals or acid salts in your urine form crystals which later become stones.
Most stones leave your body while you urinate. However, sometimes stones get stuck in the ureter, block the normal flow of urine, and cause symptoms. Stones can also be too big to leave the kidney. In both cases, you may need treatment to remove the stone.
A. Stones are often associated with pain. However, symptoms can vary from severe pain to no pain at all, depending on stone characteristics – such as the size, shape, and location of the stone in the urinary tract.
Severe pain (renal colic)
If the stone blocks the normal urine flow through the ureter you will experience severe pain, known as renal colic. This is a sharp pain in the loin and the flank (the side of your abdomen, from the ribs to the hip)
If the stone is not in your kidney but in your ureter, you may feel pain in the groin. Men can even have pain in their testicles.
Renal colic is caused by a sudden increase of pressure in the urinary tract and the ureteral wall. The pain comes in waves and does not decrease if you change positions. It is described as one of the most painful experiences, similar to giving birth.
Other symptoms that may accompany renal colic are:
Renal colic is an emergency situation and you should contact your family doctor or nearest hospital to relieve the pain. In case of high fever, you must seek immediate medical help
Dull pain
Stones that do not block the ureter completely can cause a recurrent, dull pain in the flank. This kind of pain may also point to other diseases, so you will need to take medical tests to find out if you have kidney or ureteral stones.
No symptoms
Some stones do not cause any discomfort or clinical problems. These are called asymptomatic stones and are usually small. They do not block the flow of urine. In general, asymptomatic stones are found during x-ray, ultrasound or in any other imaging procedures for other conditions. Discuss your individual circumstances with your doctor and what would be the best possible treatment for you.
A. The diagnosis is based on history, physical examination and imaging tests
Imaging techniques
You will get an ultrasonography (also known as ultrasound) which uses high-frequency sounds to create an image. The doctor can see whether the stone causes an obstruction by checking if the urinary collecting system is enlarged. In addition to ultrasonography, you may
need an x-ray of the urinary tract.
A non-contrast- enhanced computed tomography (NCCT) or a low-dose CT may also be done. This scan can clearly show the size, shape, and density of the stone. In some situations, your doctor may decide to do a contrast- enhanced CT-scan or an intravenous urography. These images give additional information about your kidney function and your anatomy.
Blood and Urine Tests
The doctor may prescribe urine routine/microscopy and kidney function tests to rule out infection and kidney damage.
Stone Analysis/ metabolic evaluation
If you have a high risk of forming more stones in future, you will get additional tests known as metabolic evaluation to understand the composition of urine for preventive measures
A. A Not all stones require treatment. You need treatment if your stone causes discomfort and does not pass naturally with urine. Your doctor may also advise treatment if you have pre-existing medical conditions. There are different treatment methods for emergency and non-emergency situations.
If you have a kidney or ureteral stone which does not cause discomfort, you will generally not receive treatment. Your doctor will give you a time schedule for regular control visits to make sure your condition does not get worse.
A. It is a shared decision making process. The decision will depend on:
A. If your stone is likely to pass with urine, your doctor can prescribe drugs to ease this process. This is called conservative treatment.
If your stone continues to grow or causes frequent and severe pain, you will get active treatment.
A. Most kidney or ureteral stones will leave your body while you urinate. However, depending on the size and location of the stone, it will take you some time to pass the stone. You may suffer from renal colic when the stone moves.
If you have a very small stone with a very high chance you may pass the stone within a couple of weeks.
In general, you can keep this in mind:
There are 2 common conservative treatment options:
A. Kidney or ureteral stones should be treated if they cause symptoms. There are 3 common ways to remove stones:
A. Which active treatment option is best for you depends on many aspects. The most important factor is the symptoms the stone causes. Based on whether the stone is in your kidney or your ureter, the doctor may recommend different treatment options.
If you don’t have symptoms you may still get treatment in case:
Your doctor will recommend removing a stone in the ureter if:
A. Anyone may develop a kidney stone during his or her lifetime. The most common cause of urinary stones is the imbalance in the composition of urine. This may be connected to how much you drink and whether there are substances in your urine which trigger stone formation or deficiency of some substances which prevents stone formation.
However, there are other causes as well, such as urinary tract infection and obstructive pathologies of the urinary tract.
These are high risk factors:
These are some of the congenital conditions which may increase your risk of having stones:
These are some of the generalised disorders which may increase your risk of having stones:
A. Stones are classified based on the mineral composition:
Calcium-oxalate stones
After you have had a calcium-oxalate stone you should:
If the metabolic evaluation shows that you have a high risk of forming more stones you will get medication to reduce the risk of recurrence.
Calcium-phosphate stones
Uric acid stones
If you had a uric acid stone you have a high risk of forming more stones.
Ammonium urate stones
Cystine stones
Other stones
A. Some patients who have had kidney or ureteral stones may form more stones in the future. After your stone passes or is removed, your doctor will determine if you are at high risk of recurrence. To do so, he or she will need to analyse the stone. In addition, the doctor will consult the results of your blood and urine tests which were done before treatment.
If your risk of recurrence is low, general lifestyle changes will be enough to cut the risk of forming another stone.
If you have a high risk of recurrence, the doctor will run a series of specific blood and urine tests called metabolic evaluation. Depending on the test results, the doctor will recommend preventive measures or further tests.
General lifestyle advice to prevent stones
Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes. These measures reduce the risk of you getting another stone and improve your health in general. Depending on your individual situation, your doctor may recommend that you adapt your diet. The following drinking and diet suggestions are for adult patients with any stone type, but it is important to discuss them with the doctor first:
Drink more:
Healthy habits
A. Acute renal colic: Renal colic is an acute, painful situation caused by a stone that blocks the ureter. Go to the family doctor or the nearest emergency room as soon as possible to relieve the pain.
Pain is usually relieved with NSAIDs (non-steroidal anti-inflammatory drugs), which you can take as a tablet. If this first step of treatment does not help, you will get stronger painkillers called opioids. Usually, they are injected directly into the vein. The disadvantage of opioids is that they can make you nauseous.
On a rare occasion, drugs do not work. In this case, the doctor may need to drain urine from your kidney. This is called decompression.
There are two methods of decompression:
Both methods are equally effective.
Obstructed and infected kidney: If you have renal colic together with a fever or if you feel
unusually tired, you should go to the closest urological department at once. You will get blood and urine tests to check if you have an infected and/or obstructed kidney.
If you have an infected, obstructed kidney, you need immediate decompression to relieve the pressure in your kidney. After the decompression you will get antibiotics to clear the infection.
Usually, you can only be treated to have your stone removed after the infection is gone.