Renal Stones / Kidney Stones

Kidney stones are one of the most common disorders of the urinary tract. Kidney stones or renal stones are gravel-like collections of chemicals that may appear in any area of the urinary system, from the kidney to the bladder. They may be small or large, single or multiple. One in every 20 people develops a kidney stone at some point in their life.

The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis.

Types of stones

Calcium oxalate stones
The most common type of kidney stone is composed of calcium oxalate crystals, occurring in about 80% of cases and the factors that promote the precipitation of crystals in the urine are associated with the development of these stones.

Common cause is increased consumption of calcium in diet. However, current evidence suggests that the consumption of low-calcium diets is actually associated with a higher overall risk for the development of kidney stones. This is perhaps related to the role of calcium in binding ingested oxalate in the gastrointestinal tract. As the amount of calcium intake decreases, the amount of oxalate available for absorption into the bloodstream increases; this oxalate is then excreted in greater amounts into the urine by the kidneys. In the urine, oxalate is a very strong promoter of calcium oxalate precipitation, about 15 times stronger than calcium.

Uric acid (urate)
Multiple kidney stones composed of uric acid and a small amount of calcium oxalate.
About 5-10% of all stones are formed from uric acid. This might be occurring when fluid intake is less. They may occur when uric acid excretion is increased in urine. This is often found with gout and chemotherapy.

Other types
Other types of kidney stones are composed of struvite (magnesium, ammonium and phosphate); calcium phosphate; and cystine.
The formation of struvite stones is associated with the presence of urea-splitting bacteria, most commonly Proteus mirabilis (but also Klebsiella, Serratia, Providencia species). These organisms are capable of splitting urea into ammonia, decreasing the acidity of the urine and resulting in favorable conditions for the formation of struvite stones. Struvite stones are always associated with urinary tract infections.

Cause-

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine.

Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the urinary tract.

A number of different medical conditions can lead to an increased risk for developing kidney stones:

1. Gout results in an increased amount of uric acid in the urine and can lead to the formation of uric acid stones.
2. Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
3. Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
4. People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.
5. Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.

Predisposing factors

Environmental and dietary factors-

• Low urine volumes.
• High ambient temperatures.
• Low fluid intake.
• Diet.
• High protein intake.
• High sodium.
• Low calcium.
• High sodium excretion.
• High oxalate excretion.
• High urate excretion.
• Low citrate excretion.

Symptoms

Most calculi originate within the kidney and proceed distally, creating various degrees of urinary obstruction as they become lodged in narrow areas, including the ureteropelvic junction, pelvic brim, and ureterovesical junction. Location and quality of pain are related to position of the stone within the urinary tract. Severity of pain is related to the degree of obstruction, presence of ureteral spasm, and presence of any associated infection. So the symptomatic presentation of renal calculi has been described below:-

• Flank pain or back pain, which may be:

• on one or both sides
• progressive
• severe
• colicky (spasm-like)
• may radiate or move to lower in flank, pelvis, groin, genitals

• Nausea, vomiting
• Painful urination
• Urinary frequency or urgency is increased (persistent urge to urinate)
• Blood in the urine
• Fever with chills

Rarely, a patient reports positional urinary retention (obstruction precipitated by standing, relieved by recumbency), which is due to the ball-valve effect of a large stone located at the bladder outlet.

Investigations

1. Complete blood count.
2. Urine analysis- routine and culture
3. Serum Calcium, uric acid.
4. Imaging: X-ray of KUB region / Ultrasonography of KUB region.
5. Intra-venous pyelogram

Treatment

Kidney stone treatment depends on the size and location of the stone(s). Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Pain medications are used for symptom relief.

Avoidance of milk, cheese and great deal of calcium should be advised.

Patients with hyperuricemia should avoid red meats, offal and fish, which are rich in purines, and should receive treatment with allopurinol.

Role of Homoeopathy

Homeopathic medicines are highly effective in treating acute as well as chronic cases of renal or kidney stones (renal calculi). Homeopathy takes care of the acute pain as well as facilitates and hastens the passage of stone/s in the urine.

For those who suffer from recurrent kidney stones, homeopathic treatment can be very effective and a safe alternative to any kind of surgical intervention.

What is the best cure for kidney stones in Bangalore without surgery ?

What is the best cure for renal calculi in Bangalore without surgery ?

What is the best cure for renal stones in Bangalore without surgery ?

What is the best cure for kidney stones without surgery in Bangalore ?

What is the best cure for renal calculi without surgery in Bangalore ?

What is the best cure for renal stones without surgery in Bangalore ?

What is the best cure for renal stones without surgery in Bangalore ?

What is the best kidney stones treatment in Bangalore without surgery ?

What is the best renal calculi treatment in Bangalore without surgery ?

What is the best renal stones treatment in Bangalore without surgery ?

What is the best kidney stones treatment without surgery in Bangalore ?

What is the best renal calculi treatment without surgery in Bangalore ?

What is the best renal stones treatment without surgery in Bangalore ?

Please E-mail dr_ramanand@rediffmail.com for any questions/treatment