Kidney stones- What causes them and what are the treatment options

 

What are Kidney stones?

According to the Kenya Renal Association, kidney diseases and ailments have become the most common non-communicable disease in the country after diabetes.

 

Symptoms

Kidney stones do usually not cause any symptoms unless they start to be passed down the urinary tract. Some of the symptoms include:

• Excruciating pain in the back or side


• Vomiting


• Fever and chills


• blood in the urine (red, pink, or brown urine)


• Nausea


• discolored or foul-smelling urine


• frequent need to urinate


• urinating small amounts of urine

 

What different kinds of stones can one find?

• Calcium oxalate stones are the most common kidney stones encountered. They are caused by many different mechanisms which include kidney function abnormalities, genetic issues and high serum calcium levels.


• Struvite stones are more commonly found in females and are generally caused by urinary tract infections. These stones can be very big and can harm the kidney affected.


• Uric acid stones contain the breakdown products of animal proteins and may be caused by eating too much animal protein, drinking alcohol which interferes with the excretion of uric acid, kidney issues or, rarely, be inherited.


• Cystine stones are very rare and are caused by an inherited kidney disease, cystinuria.

 

What causes them?

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine.  Factors that may cause this can be-

• 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.


• Metabolic abnormalities, including inherited disorders of metabolism, can alter the composition of the urine and increase an individual's risk of stone formation.

 

Treatment

Treatment depends on the type of stone, how bad it is and the length of time you have had symptoms. There are different treatments to choose from. It is important to talk to your health care provider about what is best for you.

1. Wait for the stone to pass by itself - Often you can simply wait for the stone to pass. Smaller stones are more likely than larger stones to pass on their own.Waiting up to four to six weeks for the stone to pass is safe as long as the pain is bearable, there are no signs of infection, the kidney is not completely blocked and the stone is small enough that it is likely to pass. While waiting for the stone to pass, you should drink normal amounts of water. You may need pain medication when there is discomfort.


2. Medication-  Certain medications have been shown to improve the chance that a stone will pass. The most common medication prescribed for this reason is tamsulosin. Tamsulosin (Flomax) relaxes the ureter, making it easier for the stone to pass. You may also need pain and anti-nausea medicine as you wait to pass the stone.


3. Surgery-  Surgery may be needed to remove a stone from the ureter or kidney if:

•  The stone fails to pass.


• The pain is too great to wait for the stone to pass.


•  The stone is affecting kidney function. Small stones in the kidney may be left alone if they are not causing pain or infection.

Kidney stones should be removed by surgery if they cause repeated infections in the urine or because they are blocking the flow of urine from the kidney. Today, surgery usually involves small or no incisions (cuts), minor pain and minimal time off work.

 

 

Facts about Kidney stones

• Kidney stones are found in 2-3% of people and 0.5% of people present each year with an acute episode of pain due to stones. These rates have been rising steadily since the start of the 20th century


• Men are more commonly affected than women. After the age of 50 when the sex distribution becomes equal


• At the age of 70, you have a lifetime risk of 1 in 8 for forming a stone


• Stones are responsible for more than 12,000 hospital admissions each year


• Stone formation is governed by both intrinsic (heredity, age & sex) and extrinsic factors (geography, climate, water intake & diet)


• Poor fluid intake combined with a low-roughage, high protein diet containing a lot of refined sugar increases the risk of forming stones


• There is an association with the “metabolic syndrome”


• Recurrence rates for stones are high (20% at 5 years, 35% at 10 years & 70% at 20 years)

 

 

Steps take by Kenyan Government to enhance access to nephrology services

The aim of conference  “Toward excellence in renal care and Education in developing countries which is the First Joint Conference of the East Africa Centres’ of Excellence (EACE) bringing together renal experts from the region  is to contribute to the advancement of knowledge and enhance efforts for prevention, control and management of Kidney diseases in Kenya and the region. Right now there are a total of 74  facilities in the country, both in government and  private sector said the Cabinet Secretary for Health, during the official opening of the 14th Annual Scientific Conference of the Kenya Renal Association and the launch of nephrology programme  in Mombasa .

He mentioned that the Government is aware of the country’s dire need to improve all aspects of nephrology services alongside other allied disciplines such as urology, anesthesia and nutrition and assured that they have taken steps to bridge the gap and fight the kidney diseases and its negative effects on health and the economy. To complement the expansion and physical facilities, the government is addressing the need to improve skills for nephrology services among health workers and increase the numbers handling patients with Kidney diseases. In addition they have asked all the training institutions in the Country, the Universities, the middle level colleges and the teaching hospitals for collaborating to launch and develop additional courses in nephrology, urology and allied disciplines.