What is a kidney stone?
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.
The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.
Who is at risk for kidney stones?
Anyone may develop a kidney stone, but people with certain diseases and conditions (see below) or those who are taking certain medications are more susceptible to their development. It is estimated that one out of every 10 people in the U.S. will develop stones in the urinary tract at some point in their lives. Most urinary stones develop in people 20-49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life.
In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. Urinary tract stones are about three times more common in males than in females. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. A Caucasian male has a one in eight chance of developing a kidney stone by age 70. People who have already had more than one kidney stone are prone to developing further stones.
A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood.
A small number of pregnant women (about one out of every 1,500-3,000 pregnancies) develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus. Healthy pregnant women also have a mild increase in their urinary calcium excretion. However, it remains unclear whether the changes of pregnancy are directly responsible for kidney stone formation or if these women have another underlying factor that predisposes them to kidney stone formation.
What causes kidney stones?
Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.
Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. In this regard, climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation.
Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.
A number of different medical conditions can lead to an increased risk for developing kidney stones:
Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid stones.
Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions, including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.
Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.
Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual's risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.
The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.
Who is at risk for kidney stones?
Anyone may develop a kidney stone, but people with certain diseases and conditions (see below) or those who are taking certain medications are more susceptible to their development. It is estimated that one out of every 10 people in the U.S. will develop stones in the urinary tract at some point in their lives. Most urinary stones develop in people 20-49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life.
In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. Urinary tract stones are about three times more common in males than in females. The prevalence of kidney stones begins to rise when men reach their 40s, and it continues to climb into their 70s. A Caucasian male has a one in eight chance of developing a kidney stone by age 70. People who have already had more than one kidney stone are prone to developing further stones.
A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood.
A small number of pregnant women (about one out of every 1,500-3,000 pregnancies) develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus. Healthy pregnant women also have a mild increase in their urinary calcium excretion. However, it remains unclear whether the changes of pregnancy are directly responsible for kidney stone formation or if these women have another underlying factor that predisposes them to kidney stone formation.
What causes kidney stones?
Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.
Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. In this regard, climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation.
Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones.
A number of different medical conditions can lead to an increased risk for developing kidney stones:
Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid stones.
Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and some inherited metabolic conditions, including cystinuria and hyperoxaluria. Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
People with inflammatory bowel disease or who have had an intestinal bypass or ostomy surgery are also more likely to develop kidney stones.
Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.
Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual's risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.
TYPES OF RENAL CALCULUS
? OXALATE CALCULUS (CALCIUM OXALATE )The commonest type of stone, called as mulberry calculi. Irregular in shape, covered with sharp projections which tends to cause bleeding. Produces haematuria very early, resulting in deposition of blood over the stone giving a dark colour to it. Hard and single, occurs in infected urine. Can be visualized radiologically.
? PHOSPHATE CALCULUS (usually CALCIUM PHOSPHATE or rarely as MAGNESIUM AMMONIUM PHOSPHATE or STRUVITE) Smooth, round, dirty white to yellow in colour. Commonly occurs in renal pelvis & tend to grow in alkaline urine especially when proteus organisms are present. As it enlarges in the pelvis, it grows & fills the major & minor calyces & slowly forms a STAG HORN CALCULUS. This produces recurrent urinary infections & haematuria. As they are large, they are usually easy to see on radiographs.
? URIC ACID CALCULUS Multiple, small, hexagonal, multifaceted. Colour varies from yellow to reddish brown. Occur in acidic urine. Pure urate stones are radiolucent, unless contaminated with calcium salts.
? CYSTINE CALCULUS They appear in the urinary tract of patients with a congenital error of metabolism that leads to cystinuria or due to decreased resorption of cystine from renal tubules. They are hexagonal, multiple, pink or yellow. Occur in acidic urine. Seen in young girls at puberty. They are radio opaque due to sulphur content.
? XANTHINE CALCULUS Extremely rare. They are smooth and round, brick red in colour and show lamellation on cross section.CONDITIONS ASSOCIATED WITH HYPERCALCIURIA High dietary intake of calcium, chronic pyelonephritis, hyperparathyroidism, vitamin D poisoning, sarcoidosis, cushing?s syndrome, myelomatosis, renal tubular acidosis, prolonged immobilization, idiopathic hypercalciuria ? a) excessive absorption of calcium from gut. b) reduced renal tubular absorption of filtered calcium.
? PHOSPHATE CALCULUS (usually CALCIUM PHOSPHATE or rarely as MAGNESIUM AMMONIUM PHOSPHATE or STRUVITE) Smooth, round, dirty white to yellow in colour. Commonly occurs in renal pelvis & tend to grow in alkaline urine especially when proteus organisms are present. As it enlarges in the pelvis, it grows & fills the major & minor calyces & slowly forms a STAG HORN CALCULUS. This produces recurrent urinary infections & haematuria. As they are large, they are usually easy to see on radiographs.
? URIC ACID CALCULUS Multiple, small, hexagonal, multifaceted. Colour varies from yellow to reddish brown. Occur in acidic urine. Pure urate stones are radiolucent, unless contaminated with calcium salts.
? CYSTINE CALCULUS They appear in the urinary tract of patients with a congenital error of metabolism that leads to cystinuria or due to decreased resorption of cystine from renal tubules. They are hexagonal, multiple, pink or yellow. Occur in acidic urine. Seen in young girls at puberty. They are radio opaque due to sulphur content.
? XANTHINE CALCULUS Extremely rare. They are smooth and round, brick red in colour and show lamellation on cross section.CONDITIONS ASSOCIATED WITH HYPERCALCIURIA High dietary intake of calcium, chronic pyelonephritis, hyperparathyroidism, vitamin D poisoning, sarcoidosis, cushing?s syndrome, myelomatosis, renal tubular acidosis, prolonged immobilization, idiopathic hypercalciuria ? a) excessive absorption of calcium from gut. b) reduced renal tubular absorption of filtered calcium.
CONDITIONS ASSOCIATED WITH HYPEROXALURIA
High dietary intake of oxalates ? fruits, vegetables, strawberries, plums, spinach, rhubarb, asparagus, tomatoes etc. Increased absorption of oxalates from gut ? a) ileal diseases b) low calcium diet
CONDITIONS ASSOCIATED WITH HYPERURICOSURIA
Metabolic disorders like gout, myeloproliferative disorders, high dietary intake of urates ? red meat, fish rich in purines, offal.
The leading symptoms in 75% of people include ?
1) RENAL PAIN ? located posteriorly in the renal angle or anteriorly in the hypochondrium in costal margin or in both. It may be worse on movement, particularly on climbing stairs. It is described as FIXED RENAL PAIN or COSTOVERTEBRAL PAIN.
) URETERIC COLIC ? When the stone is impacted in the pelviureteric junction or anywhere in the ureter, it results in severe colicky pain radiating from the loin to the groin. It may also extend to the testicles, vulva & medial side of thigh. This may be associated with strangury, the painful passage of a few drops of urine, with pallor, sweating & vomiting & he groans in agony.
3) HAEMATURIA ? is common with oxalate stones. The quantity of blood lost is small, but it is fresh blood.
4) URINARY TRACT INFECTION ? fever with chills & rigors, pyuria, burning micturition & increased frequency of micturition may occur. In severe cases, even septicaemia can quickly develop.
5) RIGIDITY & GUARDING ? abdominal examination during an attack reveals rigidity of the lateral abdominal muscles & of the rectus abdominis. Percussion over the kidney produces a stab of pain & there may be tenderness on gentle deep palpation.
COMPLICATIONS
? CALCULOUS HYDRONEPHROSIS ? occurs due to back pressure producing renal enlargement. Due to the stretching of the renal capsule, it results in pain in the loin & an associated palpable kidney mass suggests hydronephrosis.
? CALCULOUS PYONEPHROSIS ? The kidney is converted into a bag of pus when hydronephrosis becomes infected.
? RENAL FAILURE ? Bilateral staghorn calculi may be asymptomatic until they present with uraemia.
TREATMENT
GENERAL MANAGEMENT
DIETARY ADVICE ? They should drink plenty to keep their urine dilute. Fluid intake should be therefore 3 litres per day, more if the climate or patient?s occupation causes much sweating. In persons with hypercalciuria, intake of milk, cheese & other dairy products should be avoided. Persons with oxalate stones should avoid spinach, rhubarb, strawberries, plums & asparagus. Persons with hyperuricaemia should avoid redmeats, offal & fish rich in purines. Eggs, meat & fish are high in sulphur containing proteins & should be restricted in those with cystinuria
Homoeopathic Management
Most people think that getting rid of an existing stone is the end of the problem but they are not aware that the stone formation can happen again, and again Homeopathy is useful in all stages of renal lithiasis. It can be used to speedily expel an existent stone, and is extremely helpful in preventing recurrence of the stones in those prone to getting repeated renal lithiasis. Homeopathy is also useful in treating secondary infections of the urinary tract arising after injury from the moving stone.Most commonly used medicines to help in renal calculi are.
Lycopodium- Renal colic, right sided. Pain shooting across lower abdomen from right to left. Pain in back relieved by urinating. Urine slow in coming, must strain. Retension. Polyuria during night. Red sand in urine. Uric acid diathesis. Child cries before urinating. Pains drawing, aching <> warm food & drinks.
Tabacccum - Renal colic, violent spasmodic pains along ureter, left side. With deathly nausea & vomiting. Vomiting violent, with cold sweat, on least motion, with faintness > open air. Nausea incessant as if seasick > in fresh cold air. Vertigo, death like pallor, on opening the eyes. Face pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of stomach. Icy coldness of surfaces
Sarsaparilla- Passage of small calculi or gravel, renal colic, stone in the bladder. Excruciating pains from right kidney downwards. Severe almost unbearable pain at conclusion of urination. Urine bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Painful distension & tenderness in bladder, urine dribbles while sitting, passes freely when standing. Air passes from urethra, child screams before & while passing urine
Cantharis.- Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in whole renal region. Violent tenesmus & strangury. Urine scalds him & is passed drop by drop. Membranous scales looking like bran in water. Urine jelly like, shredy. Pain raw, sore, burning in every part, internally & externally. Over sensitiveness of all parts. Drinking even small quantities of water increases pain in bladder.
Beberris.vulg - Renal colic < left side. Stitching, cutting pain from left kidney following course of ureter into bladder & urethra. Burning & soreness in region of kidneys. Pain in small of back, very sensitive to touch in renal region
OCIMUM CANUM - Renal colic, right sided. Uric acid diathesis. Red sand in urine. High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody, brick dust red or yellow sediment. Odour of musk. Pain in ureters, cramps in kidneys
OCIMUM CANUM - Renal colic, right sided. Uric acid diathesis. Red sand in urine. High acidity, formation of spike crystals of uric acid. Turbid, thick, purulent, bloody, brick dust red or yellow sediment. Odour of musk. Pain in ureters, cramps in kidneys
HYDRANGEA - Renal calculi, gravel, profuse deposit of white amorphous salts in urine. Renal colic, sharp pain in loins, especially left. Burning in urethra & frequent desire. Urine hard to start. Bloody urine, heavy deposit of mucus. Great thirst with abdominal symptoms & enlarged prostate.
PAREIRA BRAVA - Renal colic, pain going down the thighs. Neuralgic pain in the anterior crural region. Constant urging, great straining. Can emit urine only when he goes on his knees, pressing head firmly against floor. Black, bloody, thick mucus urine. Dribbling after micturition. Urethritis, prostatitis
In my own experience I have given Hydrangea Q (mother tincture) for hard stones, it is a stone breaking medicine. If the stone is at the verge of coming out then give Silicea 30 1 hourly.
NATRUM PHOS 6X should be taken thrice daily after stone removal to avoid formation of stone again.
