Renal stone the silent killer

localization and symptoms of kidney stone pain

• Colicky pain: "loin to groin". Often described as "the worst pain [...] ever experienced". This can also occur in the lower back.
• Nausea/vomiting: embryological link with intestine- stimulates the vomiting center.
• Hematuria: blood in the urine, due to minor damage to inside wall of kidney, ureter and/or urethra.
• Pyuria: pus in the urine.
• Dysuria: burning on urination when passing stones (rare). More typical of infection.
• Oliguria: reduced urinary volume caused by obstruction of the bladder or urethra by stone, or extremely rarely, simultaneous obstruction of both ureters by a stone.
• Postrenal azotemia: the blockage of urine flow through a ureter.
• Hydronephrosis:[6] the distension and dilation of the renal pelvis and calyces.

Causes

Staghorn Calculus

Kidney stones can be due to underlying metabolic conditions, such as renal tubular acidosis Dent's disease,hyperparathyroidism, primary hyperoxaluria and medullary sponge kidney. Kidney stones are also more common in patients with Crohn's disease. Patients with recurrent kidney stones should be screened for these disorders. This is typically done with a 24 hour urine collection that is chemically analyzed for deficiencies and excesses that promote stone formation.

Uric acid (urate)

Calcium oxalate stones

Other types

Other types of kidney stones are composed of struvite (magnesium, ammonium and phosphate); calcium phosphate; and cystine.

Prevention

Preventive strategies include dietary modifications and sometimes also taking drugs with the goal of reducing excretory load on the kidneys:

• Drinking enough water to make 2 to 2.5 liters of urine per day.
• A diet low in protein, nitrogen and sodium intake.
• Restriction of oxalate-rich foods, such as chocolate, nuts, soybeans, rhubarb and spinach,plus maintenance of an adequate intake of dietary calcium. There is equivocal evidence that calcium supplements increase the risk of stone formation, though calcium citrate appears to carry the lowest, if any, risk.
• Taking drugs such as thiazides, potassium citrate, magnesium citrate and allopurinol, depending on the cause of stone formation.
• Some fruit juices, such as orange, blackcurrant, and cranberry, may be useful for lowering the risk factors for specific types of stones. Orange juice may help prevent calcium oxalate stone formation, black currant may help prevent uric acid stones, and cranberry may help with UTI-caused stones.
• Limit intake of caffeinated beverages, such as coffee.
• Avoidance of cola beverages.
• Avoiding large doses of vitamin C.

For those patients interested in optimizing their kidney stone prevention options, a 24 hour urine test can be a useful diagnostic.

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