Urinary Stone Disease (USD)
Last updated date: 13-May-2023
Originally Written in English
Urinary stone disease
Urinary stone disease is also known as renal calculi, kidney stones, urolithiasis, or nephrolithiasis. A stone in the kidney refers to hard solid masses made of salts and minerals that normally form in the kidneys. Apart from the kidneys, stones can form along the urinary tract in the ureters, urethra, and bladder areas.
Based on the size of the urinary stone(s), you might not even know that you have it. Passing these stones, even the small ones, can be painful. However, they don’t cause any permanent damage if detected on time. Although the small stones may exit through the urinary tract, surgery might be necessary for the larger stones.
Types of Urinary Stone Disease
Urinary stones are made up of different crystals. The various categories of kidney stones are:
- Calcium stones
These are common and typically in calcium oxalate and can sometimes contain calcium phosphate and maleate. One can lower the risk of getting this urinary stone disease by eating foods low in oxalate. Examples of foods rich in oxalate are peanuts, potato chips, chocolate, spinach, and beets.
While certain urinary stone diseases are made of calcium, consuming adequate calcium helps prevents stone formation.
- Struvite stone
Struvite stone is common in women who have urinary tract infections and can also occur due to a kidney infection. These stones tend to grow bigger and can lead to urinary obstruction. However, with effective treatment of the underlying infection, the development of struvite stones can be prevented.
- Uric acid stone
This is more prevalent in men, unlike women. It can develop in individuals who have gout or in those undergoing chemotherapy.
Uric acid stones occur due to too much acid in the urine. Also, a diet with plenty of purine tends to raise the level of acidic urine. Purine is typically a colorless content present in animal protein foods such as fish, meats, and shellfish. Genetic factors can sometimes contribute to the development of uric acid stones.
- Cystine stone
Cystine stones are uncommon but can develop in men and women with a hereditary disorder known as cystinuria. Cystine refers to the naturally occurring acid present in the body. Cystine tends to seep out from the kidneys and into the urine with this kind of kidney stone.
Signs and Symptoms of Urinary Stone Disease
A stone may be present in the kidney for several years even without you knowing it. However, if it begins to move or grows large, you may experience kidney stone early symptoms. With time, they can be severe. Such a kidney stone can cause the following symptoms:
- Experiencing kidney stone pain symptoms in the lower back or on one side of the body. Such pain may begin as a slight ache that appears and disappears. It could also worsen and necessitate emergency treatment.
- Experiencing nausea and vomiting along with the pain
- Detection of blood in the urine.
- experiencing pain when urinating
- Inability to urinate.
- Feeling the urge to urinate frequently.
- Fever or chills
- Urine that appears cloudy and has a bad smell
Small kidney stones might not be painful or cause other symptoms. Instead, they exit the body when urinating.
Causes of Urinary Stone Disease
Urinary stones form as a result of substances present in the urine. Normally, the substances combining to form stones pass through the urinary tract. But when they fail to pass, then it’s due to urine volume insufficiency. This causes the substances to get extremely concentrated and crystallize. This is usually caused by not taking sufficient water.
Risk factors of Urinary Stone Disease
The following risk factors can contribute to the formation of kidney stones or increase the chances of developing them:
Dehydration: Not consuming plenty of fluids, especially water, daily increases the chances of getting urinary stones. Individuals residing in warm and dry areas and those sweating a lot have increased risks of developing kidney stones.
Diet: Consuming foods rich in protein, sugar, and sodium (or salt) increases the chances of developing urinary stone disease. High sodium in a routine diet increases the level of calcium that the kidneys have to filter. Significantly, this puts you at an increased risk of urinary stones.
Family or personal history: The chances of getting the urinary stone disease increases if you have a family history of stones, either a sibling or parent. Also, if you’ve had a urinary stone disease in the past, the chances of developing another are high.
Supplements and medications: Certain types of medication used in treating migraines and depression, diet supplements, vitamin C, calcium-based antacids, and excessive use of laxatives increase the chances of developing urinary stones.
Overweight: High body mass index, weight gain, and larger waist size have been associated with the increased possibility of developing urinary stones.
Digestive disorders and surgery: These can lead to changes in the digestive process and interfere with water and calcium absorption. Hence, this increases the stone forming content amount in the urine. Gastric bypass, chronic diarrhea, and inflammatory bowel disease are some of the examples.
Certain medical conditions: These include repeated urinary tract infections, renal tubular acidosis, cystinuria, and hyperparathyroidism. They increase the risk of developing urinary stones.
Urinary Stone Disease Diagnosis
Your medical provider or urologist can recommend the following diagnostic tests and procedures if he or she suspects kidney stones:
Urine analysis: The doctor can recommend a 24-hour urine collection testing to check if you are excreting either insufficient stone-preventing matter or a lot of stone-forming minerals. He or she can suggest collecting two urine samples for two consecutive days for this test.
Blood tests: These show if you have an excess of calcium or uric acid in the bloodstream. Blood test results enable your doctor to monitor the kidneys' health and prompt them to look for other health conditions.
Imaging tests: Urinary tract imaging tests may reveal the presence of kidney stones. Even small stones can be detected using high-speed or dual-energy CT scans. Since simple abdominal x-rays can miss the tiny kidney stones, they are not frequently used.
Examination of the passed kidney stones: Your doctor can ask you to urinate via a strainer to grab any stones that pass through. The composition of your stones will be revealed through laboratory analysis. This information enables the doctor to determine the cause of your kidney stones and to devise an effective plan to prevent future kidney stones.
Urinary Stone Disease Treatment
Urinary stone disease treatment varies according to the type of stone, size, the underlying cause, and kidney stone pain location.
Small kidney stones treatment:
The majority of the small kidney stones do not need invasive treatment. The urologist can recommend the following treatment options to help pass the small stone:
- Drinking enough water
Taking at least two to three quarts (6 to 8 glasses) of water per day helps keep urine diluted and can prevent the formation of stones. Therefore, you should drink plenty of fluids, preferably water, to create clear or almost clear urine, unless the doctor advises otherwise.
Your doctor can recommend certain medications to help ease kidney stone pain passing. A drug such as alpha-blocker assists in relaxing the ureter muscles. This makes it easy to pass stones faster and with reduced pain. These medications can also help manage nausea and vomiting associated with urinary stone disease.
Large kidney stones treatment:
Too large kidney stones are difficult to pass on their own and can even lead to bleeding and kidney damage. They can also cause recurrent urinary tract infections that may necessitate more extensive treatment.
In most cases, the urologist recommends surgical procedures for larger kidney stones. These may include the following:
This procedure involves inserting a small device known as a ureteroscope into the urethra, via the bladder, and into your ureter. This device displays the urinary stones before retrieving them in the surgical "basket" or breaking them separately with a laser. The smaller parts of the stones can then easily leave the body via the urinary system.
- Shockwave lithotripsy
This procedure involves placing you on a special surgical table or tub. It uses high-energy shockwaves, which are directed at the stone via water. These shockwaves crash the stones, allowing them to leave your body more easily.
- Percutaneous nephrolithotomy
When other procedures fail to treat kidney stones, either due to stones that are too big or heavy, many, or those in the wrong place, percutaneous nephrolithotomy is an option. The procedure is done by directly inserting a tube into the kidney via a small incision made at the back. Next, the stones are disintegrated using an ultrasound probe and suctioned out such that no fragments are passed.
Following the procedure, a urethral stent is implanted. The stent is an internal tube running from the kidney towards the bladder, often removed after one week. With this procedure, patients remain overnight in the hospital for observation.
The urinary stone disease can be aggravating at best and excruciatingly painful during the worst. You should consult a healthcare provider as soon as possible to prevent the condition from worsening. Sometimes, the pain can become severe, and surgery may be required.
Always ensure that you take your prescriptions on time, drink plenty of water, and adhere to a dietary guideline. Also, keep in mind that urinary stones are only a short-term condition. Hence, they will not bother you indefinitely.