Kidney Stone Management: Prevention Through Precautions

Kidney stones affect about 1 in 11 people in India, it is the condition in which stones are formed in urinary tract due to inadequate hydration, Imbalance in urinary pH, urinary tract deformity, Dietary factors, Urinary tract infections, medications or even genetic factors.

Fortunately, almost 80-90% of renal calculi pass spontaneously and only about 3% of patients need medical supervision. A few patients may develop urinary tract obstruction and an upper urinary tract infection, this can result in serious conditions like urosepsis or pyelonephritis which will require a medical procedure for stone removal.

Individuals with ongoing malignancy or metabolic problems are at a higher risk for recurrence. The recurrence rate for renal calculi has been reported to be about 50% within 5 years, which is pretty high, this calls for proper precautions to avoid reoccurrence of kidney stones.

Smaller stones (less than 5 mm) have a greater chance (90%) of passing on their own with medical expulsion therapy. The key for all patients with renal calculi is to stay hydrated; without hydration no medical therapy is successful.

Management of small stones with minimal symptoms

Most small kidney stones won’t require invasive treatment. You may be able to pass a small stone by:

• Drinking water: Drinking as many as 1.8 to 3.6 liters a day can dilute the urine and can avoid the development of stones. Unless your doctor tells you otherwise, drink plenty of fluid, ideally mostly water, to make urine clear, or almost clear.
• Pain relievers: Passing even tiny stones may induce a certain discomfort. Your doctor can prescribe pain relievers to help alleviate or moderate pain.
• Medical therapy: Your doctor may prescribe you medication to help the remove kidney stone. These medications are known as an alpha-blocker, it relaxes the ureter muscles and allows kidney stones to move quicker causing lesser discomfort.

Management of Large stones that causes severe symptoms

Kidney stones that are too large to pass on their own can cause bleeding, kidney damage, or ongoing urinary tract infections. They may require more extensive treatment which may include:

• Using sound waves to break up stones: Doctors at the best kidney hospital in NCR can prescribe a treatment called extracorporeal shock wave lithotripsy (ESWL) for some kidney stones — based on their size and position. ESWL uses sound waves to produce powerful vibrations (shock waves) and break down the stones into tiny pieces that can be passed through your urine. The treatment takes around 45 to 60 minutes and may induce mild discomfort, so it may be done under sedation or light anesthetic.
• Surgery to remove very large stones in the kidney: A technique called percutaneous nephrolithotomy includes the surgical removal of a kidney stone utilizing miniature lenses and tools that are implanted through the back through a slight incision. During the surgery, you can receive general anesthesia and remain in the hospital for one or two days while you recover. If ESWL is ineffective or is not recommended, your doctor may advise this operation.
• Using a scope to remove stones: Your doctor may transfer a thin light tube (ureteroscope) fitted with a camera through your urethra and bladder to your ureter to extract a smaller stone in your ureter or kidney. Unique tools will capture the stone or smash it into bits that move through your urine.
• Parathyroid gland surgery: Any calcium phosphate stones are triggered by overactive parathyroid glands found just below your Adam’s apple at the four corners of your thyroid gland. When such glands release too much parathyroid hormone (hyperparathyroidism), the calcium levels can become too high, which can result in the development of kidney stones.
• Dissolution therapy: Dissolution therapy does not work for calcium stones but it may be used to manage uric acid and cystine stones. Uric acids can be dissolved by making the urine less acidic with sodium bicarbonate.

Emergency intervention

Pyonephrosis or obstructive pyelonephritis is a condition with a obstructing stone causing urinary tract infection, fever or sepsis and requires urgent surgical decompression by urology or interventional radiology), Its symptoms include:

• Nausea or pain uncontrolled with outpatient management.
• An obstructing stone in a solitary kidney.
• Any degree of simultaneous bilateral obstruction which can easily lead to renal failure.
• Any degree of obstruction with a rising creatinine.

Prevention of Kidney Stones  

The preventive steps involved are slightly different for different types of stones. Proper diagnosis can help assess the probability before advising the patients. Prevention of kidney stones may include a combination of lifestyle changes and medications.

Lifestyle changes

You may reduce your risk of kidney stones if you:

• Drink water throughout the day: For people with a history of kidney stones, doctors usually recommend drinking enough fluids to pass about 2 liters of urine a day. Your doctor may ask that you measure your urine output to make sure that you’re drinking enough water.
• If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.
• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper, and soy products.
• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose no animal protein sources, such as legumes. Consider using a salt substitute, such as Mrs. Dash.
• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn’t affect your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.
• Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.
• Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

Medications for Kidney Stones

Medications can control the amount of minerals and salts in the urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:

• Medication for Calcium stones: To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
• Medication for Uric acid stones: Your doctor may prescribe allopurinol to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
• Medication for Struvite stones: To prevent Struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection, including drinking fluids to maintain good urine flow and frequent voiding. In rare cases, long-term use of antibiotics in small or intermittent doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
• Medication for Cystine stones: Along with suggesting a diet lower in salt and protein, your doctor may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn’t help, your doctor may also prescribe a medication that increases the solubility of cystine in your urine.

Precautions are better than cure, it is better to make small lifestyle changes and prevent disease and discomfort rather than undergoing medical procedures. However, in case of any suspicion of a disease or continuous discomfort medical advice should be sought.

At metro hospitals we believe in education people to prevent the occurrence of any medical emergency and in case such a situation arises, we are always here to care for you. Stay Healthy Stay Safe.

By,

Dr. Ashutosh Singh

Consultant, Urology

Metro Hospitals & Heart Institute, Noida Sector-11, UP
Metro Hospital & Cancer Institute, Preet Vihar, Delhi

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