Kidney stone

Abnormal collection of mineral salts in the kidneys which often form stones. These eventually move through the ureters to the bladder. The movements of these stones cause severe pain in the lower back. It is often accompanied by nausea and vomiting. Bloody urine (hematuria) is the most common feature.

Causes:

The list is extensive but some of the causes are as follows.

• Idiopathic (about 80% cases) - here the cause is not known.
• Metabolic disorders
• Infection
• Urinary diversion as after an operation.
• Drugs such as indanavir
• Sarcoidosis

Types of stones:

• Calcium Oxalate stones- 70% cases
• Calcium phosphate stones- 10% cases
• Sturvite- 15% cases (follow infection with urease producing bacteria such as proteus)
• Uric acid stones- 5% cases
• Cystine stones -1% cases. These occur in cystinuria, a metabolic disorder.

Symptoms:

Usually the patient presents in the emergency with severe pain which commonly radiates from the loin to the groin and is associated with nausea and or vomiting. Sometimes blood may be present in the urine .

Diagnosis:

Usually made by a plain X-ray. Other investigative modalities used are ultrasound and intravenous urography (a dye injected in the patients veins is excreted by the kidneys and thus helps viualise the urinary tract).

Treatment:

Small stones usually pass by themselves and no treatment specific to the stone disease is needed. However bigger stones need to be dealt with. Various modalities are available.

• Extracorporeal Shockwave lithotripsy (ESWL)
• Percutaneous nephrolithotomy(for very large stones which cannot be handled by other modalities)
• Ureteroscopy and extraction with a dormia basket
• Laparoscopic and open surgical techniques. The latter is largely obsolete.

Compiled by: Shelly Gill , Last updated: 02.12.07 © Medhospital Foundation

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