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When stones form in the kidney, they can cause pain in the loins and damage the kidneys if they progress into the ureter and get stuck. Who tends to be afflicted with the condition of urinary stones? About 5-7% of the population are afflicted with urinary stones. It is more common in males than in females, occurring at a 3:1 ratio and is most prevalent within the ages of 30-50 years. Because of its genetic link, there is usually a high risk of recurrence. However dietary discretion can moderate the risk of stone recurrence. The best advice if you are a urinary stone former is to drink lots of water; enough to produce clear urine. What happens when kidney stones form and how do they affect the patient? Stones are formed in the kidney. Some stones (uric acid, cystine stones) form primarily from supersaturation of constituent compounds while the formation of calcium stones is more complex. Generally speaking, there is a genetic basis for stone formation. Stones in the kidney do not cause much trouble. It is when they drop into the ureter that trouble starts. When that happens, how much trouble stones cause depends on their size. If they are less than 4mm in diameter, they can generally pass through the ureter without causing too much pain. If they are more than 7mm, they are likely to get stuck in the ureter and block the flow of urine. It can be dangerous as back pressure can cause permanent kidney damage. Stones that are between 4-7mm have a fair chance of passing out on their own, though often with significant pain. What’s the difference between a stone in the kidney and a stone in the ureter? Kidney stones are often asymptomatic, but can grow to fill the whole collecting system of the kidney. Generally speaking, kidney stones larger than 7mm are recommended for treatment. Stones smaller than 5mm can be monitored for growth. Patients with stones 5-7mm can opt for elective treatment if they are concerned about pain if the stone dislodges into the ureter. Ureteric stones are those which have dropped from the kidney into the ureter and often cause obstruction and pain. They may also block the flow of urine from the same side kidney into the bladder. What are the treatment options for urinary stones? Treatment options vary widely from chemical dissolution with oral medication; and non-invasive ESWL (Extracorporeal Shockwave Lithotripsy) which involves sending shockwaves generated outside the body through the body and focused on the stone to break it up; to minimally invasive methods such as PCNL (Percutaneous Nephrolithotomy) which involves inserting a scope into the kidney to locate and fragment a stone; and endoscopic lithotripsy, which involves inserting a scope into the ureter to reach the stone and fragment it. At the other end of the spectrum, we have open surgery to remove badly damaged kidneys. The choice of treatment depends on the site and size of the stone, urgency to clear the stone, degree of kidney damage and type of stone. Under what circumstances can kidney stones pose a danger? Emergencies caused by stones are generally uncommon. However when both ureters are blocked by stones at the same time, it can lead to acute renal failure. The warning sign is when you pass little urine within a 12 hour period. If that happens, do not take things lightly because it can make you very sick and the situation will become grave if there is no urine after 24 hours. The other dangerous situation is when bacteria get into the urine pool and cause infection. When that happens, the patient may experience high fever, chills and rigors, and pain in the loin on the affected side. In both these situations, emergency treatment is necessary. What symptoms does one experience with ureteric stones? Pain is the commonest complaint. The pain can be excruciating and likened to labour pains. The pain is often felt in the flanks or may move in the direction of the loin to the groin. The pain often occurs suddenly at night or in the early hours of the morning and may be accompanied by nausea and vomiting. While most ureteric stones are painful, there are some patients who experience only aches. Such ‘silent’ obstructing ureteric stones can destroy the kidneys without the patient realising it. If ignored, it could lead to complete kidney failure. It is very sad because with all the new technology available, treating stones today is not an issue. Advice to prevent such a tragedy from happening? Go for annual checkups once you discover that you are a ‘stone-former’. Do not ignore any aches in the loins. Seek professional medical advice if you suspect something is up.
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