Kidney stones are clusters of crystals that accumulate in the urine. By accumulating there, they can form stones or stones that can reach a size of a few millimeters to several centimeters. Then these stones formed in the kidneys can then move and move down into the ureters and bladder.

Epidemiology

Urinary stones are common and affect around one in ten people in India. However, this frequency varies by country, mainly due to dietary habits.

Types of calculations

There are several types of urinary stones, the most common being calcium oxalate stones and uric acid stones.

How are the calculations manifested?

The best known and most painful manifestation of stones is the attack of renal colic. Thus, this crisis, sometimes extremely painful, is due to the migration of a kidney stone into the ureter. As a result, there is obstruction and tensioning of the ureter by urine under pressure. It is this obstruction and the resulting distention that causes the pain.

Some kidney stones cause no pain. Consequently, they are sometimes discovered fortuitously during radiological or ultrasound examinations carried out for another reason: abdominal ultrasound, scanner, X-ray of the abdomen.

What causes kidney stones?

The  lithiasic disease  responsible for their formation is  favored by insufficient water intake  (less than 1.5 to 2 liters per day),  certain trades or climates exposing them to dehydration.

Diet also plays a role, especially  excess animal protein, salt or, conversely, insufficient calcium intake.

Symptoms of Kidney Stones

Kidney stones do not always cause symptoms or pain in the kidneys. Moreover, many people are carriers without knowing it. On the other hand, when the stone migrates and becomes blocked in the urinary tract, the pain is very sharp.

Other symptoms may also occur:

  • The presence of blood in the urine (visible to the naked eye, the urine being red from the beginning to the end of urination, or detected during a Cyto-Bacteriological Examination of Urine ECBU );
  • A urinary tract infection responsible for cystitis , pyelonephritis or even sepsis ;
  • A discreet or frank, violent lumbar pain , typical of an attack of renal colic, so intense that one does not know what position to take to calm it;
  • Very rarely anuria : this exceptional total absence of urine can be observed, in a patient with a single kidney, if the calculation involves a complete obstacle of a ureter or even more rarely in the event of simultaneous migration of calculations in the two ureters.

Fever is an unusual symptom that should lead to urgent consultation.

What are the risk factors?

Kidney stones can be very different in nature. However, there are some risk factors:

  • Insufficient hydration: urinary salts increase, which promotes their crystallization;
  • A diet too rich in salt and/or protein;
  • A diet that is too low in calcium;
  • Sedentary lifestyle: calcium is released in too low a quantity due to a decrease in bone quantity linked to a lack of physical activity;
  • Taking certain medications.

What exams are performed?

Imaging exams

The imaging examinations most often requested are renal ultrasound, abdominal X-ray without preparation ( ASP ) and uroscanner.

Ultrasound and ASP are often requested in first intention or in emergency or during monitoring after an intervention.

Uroscanner can be performed with or without intravenous injection of contrast product. In fact, it is today the most accurate examination to assess the size, location and impact of a urinary stone.

Biological examinations

The most frequently requested biological tests are:

  • The ECBU, cytobacteriological examination of urine, which is used to look for a possible urinary tract infection.
  • The study of renal function (creatinine, MDRD or CKD-EPI) in particular before a CT scan with intravenous injection of contrast product.
  • Analysis of the calculus or its fragments after spontaneous elimination or surgical removal. Indeed, this analysis is very useful because it makes it possible to know precisely the chemical nature of the stone and to draw practical consequences from it to avoid recurrences.
  • The biological assessment, in search of a phospho-calcic anomaly, a hormonal imbalance (parathormone) which can explain the formation of kidney stones.

Kidney stone treatments

Once past the crisis, it remains to eliminate the stone, which occurs spontaneously in more than 60% of cases when the stone is less than or equal to 6 mm.

In other cases, it is necessary to carry out an intervention to destroy or extract the calculation. Finally, some stones can be dissolved (see below).

Medical treatments

Medical treatments include treatments used during renal colic attack, such as anti-inflammatories.

On the other hand, when it comes to uric acid stones, one can use the property that these stones have of being soluble in an alkaline medium. These stones can thus be dissolved by alkalizing the urine. The alkalinization of the urine can be obtained by drinking Vichy water or by taking a medicine based on citric acid. However, this alkalinization acts slowly and it often takes several weeks to completely dissolve a stone. But the result is sometimes surprising, since it is possible to completely dissolve certain uric acid stones of more than one centimeter. Unfortunately, this does not work in 100% of cases.

Surgical treatments

The majority of stones that do not pass on their own can be removed or destroyed using minimally invasive techniques. These include extracorporeal lithotripsy, ureteroscopy (flexible or rigid, with or without the use of a laser) or percutaneous surgery.

Dr. Pawan has at his clinic all the technologies indicated above and in particular:

  • An extracorporeal lithotripsy device (a device used to break up stones from outside the body, using shock waves, formerly called a “bathtub”). This machine is permanently present at the Archette clinic, which allows rapid care and treatment of stones.
  • A latest generation laser to break certain stones in the ureter or kidney by endoscopic means, called flexible ureteroscopy (flexible camera introduced into the urinary tract).

However, the choice of the technique to use depends on the characteristics of the calculation to be treated and not on the availability or not of one technique or another.

Prevention of kidney stones

In all types of stones, diet measures are the basis of preventive treatments for kidney stones.

The main recommended elements are:

  • increasing fluid intake (drinking more water),
  • reduced
  • consumption of certain foods (salt, foods rich in oxalates, foods rich in calcium).

This prevention is as far as possible adapted according to the type of calculation in question. The analysis of stones or their fragments is therefore desirable, at least during a first episode.