Kidney stones

Diagnosis

When diagnosing kidney stones, healthcare professionals typically begin by discussing the patient’s symptoms and reviewing their medical history. In addition to this, doctors may require one or more tests to confirm the diagnosis. These tests may include:

• Blood testing: A blood test will show how well the kidneys are working, examine for infection, and search for biochemical issues that could contribute to kidney stones such as an excess of calcium or uric acid in the blood. The results may prompt the doctor for the next step or to look for other medical concerns.
• Urine testing: This test checks for signs of infection as well as the level of the chemicals that cause kidney stones. The doctor may require two urine samples on two consecutive days for this test. The 24-hour urine sample test may reveal whether the body is excreting excessive amounts of stone-forming minerals or insufficient amounts of stone-preventing chemicals.
• Imaging: The doctor will be able to see the size, shape, position, and quantity of kidney stones using an X-ray, CT scan, and ultrasound. These tests will help in determining what treatment will be required. Small stones can be detected using high-speed or dual-energy computerized tomography (CT).

Another imaging technique for diagnosing kidney stones is ultrasound, which is a noninvasive, rapid, and easy examination. Basic abdominal X-rays are not commonly used for diagnosing kidney stones, as they may not be able to detect very small stones.

• Analysis of passed stones: The composition of the kidney stones will be revealed by laboratory analysis. The result can be used to establish what is causing the kidney stones and to devise a plan to avoid future kidney stones. To catch stones, patients may be requested to urinate through a strainer.

Treatment

The result of the diagnosis will determine the appropriate treatment for kidney stones. It often differs on the type of kidney stone the person has as well as the underlying cause. The treatment can range from medication to surgery.

Smaller kidney stones with minor symptoms

When diagnosing kidney stones, the healthcare provider will evaluate whether treatment is necessary. In many cases, small stones can pass through the urinary system naturally with urination, although this may be a painful process. In such cases, the healthcare provider may recommend the following:

• Drinking water: The doctor may suggest consuming 1.8 to 3.6 liters of water per day to dilute the pee and keep stones from developing. The goal is to create clear or almost clear urine. It is recommended to seek consultation if the passing of stone is not successful within four to six weeks.
• Pain relievers: Patients may be prescribed to take an over-the-counter medication to alleviate pain associated with passing small kidney stones. Common pain relievers are ibuprofen and naproxen sodium.
• Medical therapy: Tamsulosin and the medication combination dutasteride and tamsulosin are examples of alpha blockers that may be prescribed to assist the patient in passing the kidney stone. An alpha blocker is a drug that calms the muscles in the ureter, allowing patients to pass the kidney stone more rapidly and with less pain.

Large stones and those that cause symptoms

Most surgeries used to treat kidney stones are minimally invasive. Surgery is usually recommended for larger stones that can cause bleeding, kidney damage, or recurring urinary tract infections. The following minimally invasive surgical treatments are commonly used for kidney stones:

• Extracorporeal shock wave lithotripsy (ESWL): This procedure breaks up stones by using high-energy shock waves. Smaller kidney stones can then pass more smoothly through the urine canal. The operation takes about 45 to 60 minutes and can be painful. It is typically done under local anesthesia.

Shock wave lithotripsy may help lessen the symptoms and avoid more invasive kidney stone removal operations. However, blood in the urine, bruises on the back or abdomen, bleeding around the kidney and other nearby organs, and discomfort as stone pieces move through the urinary tract are to be expected with ESWL procedure. Most children with kidney stones are treated with ESWL.

• Percutaneous nephrolithotomy: During this procedure, a tube is introduced straight into the kidney through a small incision in the back. Stones are then dissolved using an ultrasonic probe and suctioned out so that no fragments are passed. The patient will be anesthetized throughout the procedure and will stay in the hospital for one to two days to recover.

Percutaneous nephrolithotomy is often recommended when other procedures cannot treat kidney stones, either because there are too many stones, the stones are too large or heavy, or because of their location.

• Ureteroscopy: A small instrument called a ureteroscope is introduced into the urethra, past the bladder, and into the ureter to execute this surgery. Once the stone has been identified, special tools such as a surgical basket can catch it or break it up into fragments with a laser. These smaller bits of kidney stones can then readily exit the body via the urine tract. After that, the doctor may insert a stent into the ureter to reduce swelling and facilitate recovery. During this operation, patients may require general or local anesthetic.
• Parathyroid gland surgery: Hyperparathyroidism can occur when a small, benign tumor grows in one of the parathyroid glands or when there is an underlying illness that causes these glands to generate extra parathyroid hormone. Parathyroid glands are found on the four corners of the thyroid gland below the Adam’s apple.

Hyperactive parathyroid glands can cause an excess production of parathyroid hormone, resulting in high levels of calcium and the development of kidney stones, particularly specific calcium phosphate stones. To prevent the formation of kidney stones, surgical removal of the growth from the gland may be necessary. Alternatively, the healthcare provider may recommend treating the underlying cause of the hyperparathyroidism.