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Wednesday, January 12, 2011

RENAL STONES ( KIDNEY STONES ), Causes Of Kidney Stones, Signs And Symptoms,Diagnosis, Treatment And Preventions Of Kidney Stones.

Tubular and interstitial Nephrocalcinosis AND Nephrolithiasis
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.

The condition of having kidney stones is termed nephrolithiasis.

Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.

Stones in Kidney, Ureter and Bladder


Kidney stones form when there is a decrease in urine  volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium  in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.

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. In this regard, climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation.

Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.

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

  •     Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid stones.
  •    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.
  • 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 <a href=>diabetes</a> and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
  •      People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.
  •      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.
  •     Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual's risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.
Types of kidney stones (percentage in chronological order)
Calcium (Oxalate or Phosphate)   70-80 percent of all stones
The most common kidney stone type contains calcium in combination with either oxalate or phosphate. These are called calcium oxalate stones or calcium phosphate kidney stones, respectively.
Struvite  10 percent of all stones
A struvite stone, also known as an infection stone, may form after there is an infection in the urinary system.
Uric acid   5-10 percent of all stones
A uric acid stone may form when there is too much acid in the urine.
Cystine   Less than 1 percent
Cystine is one of the building blocks that make up muscles, nerves, and other parts of the body.

  • Severe Cramping pain in lower back, groin and abdomen ( characteristics of renal cholic )
  • Blood in urine ( Haematuria)
  • nausea
Pain in Lumber region - Typical hallmark of Kidney stone pain
  • Vomiting
  • Fever and Chills
Sometimes symptoms are :
  •   Urinary retention
  • Urinary urgency
  • Penile and Testicular Pain




3.X -RAY


Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine  (Adalat, Procardia, Afeditab, Nifediac)
and alpha blockers such as tamsulosin  (Flomax).
These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.
For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.

Open Surgery to Treat Kidney Stones  

Surgical intervention may be warranted for stones that are resistant to conservative therapy, large stones, obstructing stones, or for patients with anatomic abnormalities of their urinary tract that may prevent the passage of even small stones.

Renal Stones surgically removed from a 17 years old F.Sc student in Benazir Bhutto Hospital

Depending on the cause of the kidney stones and an individual's medical history, dietary changes or medications are sometimes recommended to decrease the likelihood of developing further kidney stones. If one has passed a stone, it can be particularly helpful to have it analyzed in a laboratory to determine the precise type of stone so specific prevention measures can be considered.
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