Kidney Stones

Also known as Renal/Kidney Calculi/ Renal Stones/ Nephrolithiasis.
About Common worldwide especially hot climates.
Seen in 10% population. Males > Females 2:1

Etiology

  1. Chemicals come out of solution.

  2. High urinary calcium (High PTH, Sarcoid, Vitamin D).

  3. High urinary oxalates, cystine.

  4. Infection, renal tubular acidosis, polycystic kidneys.

  5. Medullary sponge kidney.

  6. Uric acid stones with ileostomies due to loss of bicarbonate.

Stone types

  1. Calcium oxalate/phosphate 65%.

  2. Calcium phosphate alone 15%.

  3. Magnesium ammonium phosphate 10%.

  4. Uric acid 5% and Cystine 2%.

Clinical

  • Concentrated urine in dry environment.

  • Renal stones, renal colic.

  • UTIs, urinary tract obstruction.

Complications

  • Ureteric obstruction.

  • Pyonephrosis.

  • Sepsis.

  • Hematuria.

  • Nephrocalcinosis.

  • Renal/Ureteric colic.

Investigations

  • U&E, LFTS, Ca, PO4, PTH, Urate.

  • MSSU for culture.

  • CXR, ACEI if sarcoid suspected.

  • Plain AXR (KUB).

  • Renal USS.

  • CT Renal if acute stones.

  • Chemical analysis of the stone.

Management


Good hydration to encourage diuresis. If not causing any issues incidental stones can be ignored or monitored with X-rays. Analgesia for colic: Diclofenac 75 mg IV infusion.
After renal/ureteric it would be unusual to have urgent surgery unless associated renal infection – Pyonephrosis. This would mean a nephrostomy or a ureteric stent to drain an obstructed kidney.

Treatment will vary according to the size and position of the stone or stones, and the facilities available locally. If the stone is small and in the lower ureter Medical Expulsive Therapy (MET) is used. Either Tamsulosin once a day) or occasionally calcium antagonists.

Ureteroscopy is the most frequently used surgical treatment for stones in the ureter that have not passed, or are not likely to pass, by themselves. The stones can be broken up. Often a stent is left in the ureter at the end of ureteroscopy, though this will be avoided if possible. Stents are temporary plastic tubes that keep the kidney draining. They can cause symptoms of cystitis, and sometimes discomfort in the kidney while you are passing urine. They need to be removed at a later stage, usually by using a fine telescope into the bladder to grasp the stent and slide it out.

Sometimes lithotripsy (ESWL) is used for ureteric stones. When the stone is in the kidney, the options are ureteroscopy (usually for stones up to 1-2cm, but sometimes larger), and may include flexible ureteroscopy, keyhole surgery or lithotripsy (ESWL). Keyhole surgery – percutaneous nephrolithotomy (PCNL) tends to be reserved for larger or harder-to-reach stones.

ESWL works best for smaller stones that are sited in the upper parts of the kidney, though it can work for virtually any stone. The procedure is carried out with analgesia. A ‘shock head’ is placed on the side of the abdomen or back, next to the kidney. The stone is then hit by focused sound waves, usually once or twice a second for up to about 3000 pulses per session. This breaks the stone into pieces that are small enough to be passed spontaneously with the urine. ESWL often needs to be repeated after a few days or weeks.


KIDNEY STONES: AYURVEDIC REMEDIES FOR PREVENTION AND TREATMENT


The signs and symptoms of kidney stones are similar to Ashmari described in Ayurveda. Following measures should be followed for prevention and management of kidney stones:
-Adequate fluid intake throughout the day like lukewarm water, coconut water, butter milk etc. Limit tea and coffee intake.
Salt intake should be limited along with packaged and bakery food items
-Limited consumption of animal-based protein diet like eggs, fish, chicken, red meat, paneer etc.
-Vegetables like trapus (kheera), ervaruka (kakdi), kushmanda (kaddu), shigru (sahijan), patola (parval) should be consumed. Limit intake of green leafy vegetables like spinach.
-Kulatha (Horse gram) is beneficial for kidney stones. It can be consumed as soup etc. Yava (Barley) is another important cereal for kidney stone patients.
-Ayurvedic herbs like Gokshura, Punarnava, Varuna, Pashanabheda, Shigru and formulations like Trinapanchamoola kwatha, Varunadi kwatha, Chandraprabha vati, Gokshuradi guggulu, Sweta parpati, Hajrulyahud bhasma etc. are advised for the management of kidney stones.

*Note: These medicines must be taken under the supervision of Ayurvedic physician only.