Kidney stones (nephrolithiasis) is the term used to describe a urinary tract or kidney disease in which small to larger crystalline stones form during the course of the disease and can only be excreted with great pain. Typical first signs are strong pain in the groin area or lower abdomen. At the beginning of a kidney stone disease, however, the affected person does not yet feel any discomfort, because the kidney stones are usually still small.
What are kidney stones?
Schematic diagram showing the anatomy and structure of the kidney in kidney stones. Click to enlarge. Kidney stones are solid structures that form in the kidney and in the urinary tract (bladder, ureter) in kidney stone disease (nephrolithiasis). Mostly kidney stones consist of calcium salts, but can also be composed of uric acid, cystine or magnesium ammonium phosphate. The peak incidence is in adults who are 30 to 60 years old. It affects men about twice as often as women. The size of the kidney stones formed can vary greatly. They range from a few millimeters (about the size of a grain of rice) to many centimeters (so-called renal pelvic effusion stones, which can completely fill the renal pelvis). In about 80 of the cases, these deposits occur on one side.
Causes
Kidney stones form due to an increased concentration of certain substances in the urine. There are many causes, ranging from dietary factors and from insufficient fluid intake to lack of exercise, certain metabolic diseases and genetic factors. In the majority of people affected by kidney stones, the causes remain unexplained. The substances involved in the formation of kidney stones are components of urine, which are normally excreted dissolved through the kidneys. These substances include calcium, phosphate, uric acid, cystine and oxalate. When they are so abundant in the urine and cannot be dissolved, they crystallize. Consequently, with the appropriate concentration of urine, new layers of substances continue to attach to the crystals that have formed, resulting in the formation of ever-growing onion–skin-like kidney stones.
Symptoms, complaints and signs
In kidney stones, there is a disease of the kidneys, which is associated with typical and fairly clear symptoms. In the early stages, no pain or signs are noticeable because the kidney stones are simply still too small. However, when they increase in size and weight, the first pain in the groin area is to be expected. Sporadically, there is also cramping in the lower abdomen. As a further symptom, pain and a burning sensation can occur during urination. This symptom occurs in both men and women. Another and at the same time very typical symptom associated with kidney stones is severe nausea. The nausea simultaneously triggers a general malaise and loss of appetite, so that affected persons are considerably restricted in their everyday life. Those who leave existing kidney stones without any treatment must expect a significant worsening of the symptoms that occur. Only if affected persons consult a doctor immediately, then a quick improvement and cure can be achieved. Otherwise, especially the pain during urination will increase.
Course of the disease
If kidney stones are treated nowadays, a favorable course can almost always be expected. Depending on the therapy method, the affected person is usually relieved of the symptoms after a short time. Nevertheless, complications can also arise if, for example, the kidney stones block the urinary tract and the urine or urine cannot be excreted. As a result, bacteria can enter the renal pelvis more easily and cause inflammation. If the kidney stones are not treated at all, the typical pain during urination becomes increasingly severe. In addition, there may be other symptoms, such as severe back pain, fever and chills. In rare cases, complete failure of kidney function may even occur. The resulting blood poisoning can then lead to life-threatening symptoms.
Complications
Due to a favorable course, complications of kidney stones rarely occur. Thus, more than 80 percent of the stones are excreted from the body again with the urine. How long this process takes depends on the size of the kidney stones.Nevertheless, secondary symptoms are possible if the outflow of urine is obstructed due to the stones. One of the most unpleasant complications of kidney stones is renal colic. It is characterized by sudden onset of severe pain, which manifests itself as seizures and cramps. It is localized in the area of the kidneys, but can also radiate to the groin, thigh or genitals. Many sufferers also experience restlessness, anxiety, nausea and vomiting. The duration of renal colic ranges from a few minutes to several hours. To prevent permanent damage to the kidneys and urinary tract, medical therapy must be provided. If the urinary tract is blocked by the kidney stones, pathogens such as bacteria can penetrate the organism more easily and cause urinary tract infections such as urocystitis. Not infrequently, the kidneys are also affected by interstitial nephritis. In this case, affected individuals suffer from discomfort during urination, fever, chills and severe back pain in the kidney region. Urosepsis is a feared complication of kidney stones. It occurs when bacteria are washed into the bloodstream. It can sometimes assume life-threatening proportions.
Treatment and therapy
Acute renal colic and kidney stones are primarily helped by appropriate pain management and the removal of any urinary retention. In most cases, kidney stones pass on their own with urine. The affected person can probably support such a spontaneous passing of the stones himself by drinking plenty of fluids, taking antispasmodic medication and exercising a lot. If spontaneous passage is not the case, the kidney stone can be removed in various ways. In extracorporeal shock wave lithotripsy (ESWL), the doctor shatters the kidney stones from the outside using shock wave therapy under ultrasound or X-ray guidance. The resulting stone fragments then usually pass away on their own with urine over the following 3 months. Percutaneous nephrolitholapaxy (PCNL) is used primarily for larger stones. In this procedure, an endoscope is inserted through a tiny incision in the skin, through which the stone is then crushed and removed. Snare extraction is performed exclusively for kidney stones located in the lower third of the ureter. In this procedure, the physician inserts a special snare into the ureter via a cystoscopy, with the help of which the kidney stone is extracted. Nowadays, kidney stones are only removed surgically (by laparoscopy or open surgery) in less than 5% of those affected. Some kidney stones (uric acid and cystine stones) may be dissolved by drug therapy (known as chemolitholysis). In addition, uric acid levels can be lowered with the help of the drug allopurinol.
Outlook and prognosis
Kidney stones offer a variable prognosis. Four-fifths of all kidney stones pass on their own with urine, without further action. Patients are usually symptom-free after the kidney stones pass and also do not require further medical examination or treatment. However, kidney stones can also cause serious complications. As a result of kidney stones, for example, blood poisoning in the urinary tract, narrowing in the urinary tract or severe inflammation of the renal pelvis can develop. In the worst case, kidney stones trigger acute kidney failure. In about 50 percent of cases, kidney stones recur after successful treatment. Comprehensive preventive care lowers the recurrence rate and thus improves the prospect of a symptom-free life. The prognosis for kidney stones is determined by the specialist. The size and number of kidney stones must be taken into account. In addition, any concomitant diseases and the patient’s general state of health are part of the prognosis. The medical professional evaluates the course of the disease in terms of the health of the kidneys and the preventive measures that the patient takes. Usually, the prognosis is adjusted as part of the regular checkups that must be done after a patient has been diagnosed with kidney stones.
Prevention
The most important preventive measures against kidney stones include, first and foremost, adequate fluid intake (about 3 liters daily). This dilutes the urine and prevents its supersaturation with stone-forming substances.Drinking should be spread evenly throughout the day, because the concentration of stone-forming substances can also be increased at night. The risk of kidney stones can also be reduced by regular exercise, prevention of obesity or by losing excess pounds. The positive effects are supported thanks to a balanced diet rich in fiber.
Aftercare
Since new kidney stones often form again, it is important to analyze this cycle individually and, above all, to break it. To prevent the formation of new stones, the risk should be significantly reduced, especially through changes in drinking and diet. The amount of water drunk by those affected should allow the body to produce at least two liters of urine. In addition, a balanced diet, the reduction of excess weight, moderate physical exercise and, above all, sufficient and regular drinking are recommended. Affected individuals should favor fruits and vegetables in their diet, and citrus fruits in particular are considered helpful. Patients should also avoid oxalate-rich foods, such as spinach, rhubarb, coffee, black tea, chocolate, cola and nuts. Attention should also be paid to adequate calcium intake. Whereas the amount of salt in the diet should be significantly reduced. The consumption of animal proteins should also be reduced. As a diagnostic measure after the removal of kidney stones, a qualitative urinary stone analysis is recommended. Patients are advised to maintain an increased drinking quantity of four to six liters per day and night. The goal here is a light urine color. In addition, supplemental medication is usually necessary.
When should you see a doctor?
If kidney pain, reddish urine, or decreased urine flow are noticed, kidney stones may be the underlying cause. A doctor should be consulted if the symptoms persist over a long period of time or are associated with serious discomfort. Thus, medical advice must be sought with blood in the urine or urinary retention. Severe pain that affects well-being also requires clarification by a physician. If the condition is not treated, it can lead to serious complications, for example urethral injuries or infections. Therefore, an appointment with the family doctor should be made at the latest when stabbing pain occurs. People who already suffer from chronic kidney disease are best advised to speak to the internist responsible. Patients at risk, such as people who lead an unhealthy lifestyle and eat a particularly high-fat diet, should speak to a nutritionist to accompany symptomatic treatment. If the symptoms do not improve despite taking medication and other remedies, it is best to consult a urologist. Then a special colic medication can be prescribed to dissolve the kidney stones. In addition to the urologist, a nephrologist or gastroenterologist may be consulted. Women consult the gynecologist if kidney stones are suspected. With children, if the symptoms are mentioned, they should first go to the pediatrician, who can clarify the symptoms and initiate treatment.
This is what you can do yourself
If the diagnosis is “kidney stones”, it depends on the size and location of the stones in terms of healing. If the stones are small or the kidney gravel, herbal preparations can be helpful. A lot of water, bladder and kidney teas or teas of herbal preparations such as dandelion or hawthorn root with a diuretic effect in combination with a lot of exercise can already cause the stones or kidney gravel to pass. In the resting state heat is helpful. If necessary, the doctor will prescribe medication. To control the success, urination through a fine sieve is recommended. The result can be shown to the attending physician at the next visit. If a kidney stone does not dissolve, the urinary tract is blocked and an infection develops, the doctor will decide in what way the kidney stone will be removed. In 90 percent of cases, kidney stones are crushed and pass out of the urinary tract with the urine. In stubborn cases, the stone is removed by minor surgery. To counteract the formation of new kidney stones, it is still important to drink plenty of fluids, i.e. at least 2.5 to 3 liters per day. Plenty of exercise and a healthy diet are helpful in any case.The doctor or a dietitian will know which foods should be avoided to prevent recurrence.
