Kidney Stones treatment in south Delhi by Laser Surgery at MASSH Hospital South Delhi

About Kidney Stones

Kidney stones, also known as renal calculi or nephrolithiasis, are hard deposits made of minerals and salts that form inside the kidneys. They develop when substances like calcium, oxalate, uric acid, or phosphate in the urine become highly concentrated, allowing crystals to form and gradually build into stones. These stones can vary in size from as small as a grain of sand to as large as a golf ball and may remain in the kidney or travel through the urinary tract, potentially causing significant discomfort.

Types of Kidney Stones

There are several types of kidney stones, classified based on their composition:

• Calcium Stones: The most common type, making up about 80% of cases. They are typically calcium oxalate (formed from excess oxalate in the diet or body) or calcium phosphate (linked to metabolic conditions or high urine pH).
• Uric Acid Stones: These form when urine is too acidic, often due to a high-protein diet, dehydration, or conditions like gout. They account for about 10% of kidney stones.
• Struvite Stones: Less common, these are caused by urinary tract infections (UTIs) involving bacteria that produce ammonia. They can grow quickly and become large, sometimes forming "staghorn" stones.
• Cystine Stones: Rare, these occur in people with a hereditary condition called cystinuria, where the kidneys excrete excessive amounts of the amino acid cystine.

Kidney Stones Signs and Symptoms

Kidney stones may not cause symptoms until they move within the kidney or pass into the ureter (the tube connecting the kidney to the bladder). When symptoms occur, they can include:

• Severe Pain: Sharp or cramping pain in the lower back, side, abdomen, or groin, often described as one of the most intense pains a person can experience. The pain may come in waves and shift as the stone moves.
• Blood in Urine (Hematuria): Urine may appear pink, red, or brown due to irritation or damage to the urinary tract.
• Nausea and Vomiting: Caused by the intense pain or a blockage affecting kidney function.
• Frequent Urination or Urgency: A sensation of needing to urinate more often, sometimes with only small amounts passed.
• Painful Urination: Burning or discomfort when urinating, especially if the stone is near the bladder.
• Fever and Chills: If an infection develops alongside the stone, indicating a potentially serious complication.

Small stones may pass unnoticed, but larger ones can cause blockages, leading to swelling of the kidney (hydronephrosis) or infection.

Kidney Stones Causes

• Dehydration: Insufficient water intake is a primary driver of kidney stone formation. When you’re dehydrated, your body produces less urine, and what’s produced becomes highly concentrated. This lack of fluid reduces the urine’s ability to keep minerals like calcium, oxalate, and uric acid dissolved, allowing them to bind together and crystallize. For example, people living in hot climates or those who sweat heavily without replacing fluids are especially prone to this. Chronic dehydration compounds the risk, as it creates a persistent environment where stone-forming substances can accumulate.
• Metabolic Imbalances: Kidney stones can result from imbalances in the body’s mineral processing. An example is hypercalciuria, where too much calcium enters the urine due to overactive parathyroid glands responsible for calcium control. Another case involves uric acid stones, which may form when uric acid levels are high, often related to gout or purine breakdown, especially in acidic urine environments.
• Urinary Stasis: Anything that slows or blocks urine flow can contribute to stones. Conditions like an enlarged prostate, kidney abnormalities (e.g., horseshoe kidney), or urinary tract obstructions allow minerals to settle and crystallize instead of being flushed out.
• Infections: Certain urinary tract infections, particularly those caused by bacteria like Proteus or Klebsiella, can lead to struvite stones. These infections make urine more alkaline, promoting the precipitation of magnesium, ammonium, and phosphate into stones. These are often called "infection stones" and can grow rapidly.

Kidney Stones Risk Factors

• Sodium: Excessive salt intake (think processed foods, salty snacks, or heavy seasoning) increases calcium excretion in the urine. More calcium in the urine means a higher chance it’ll bind with oxalate or phosphate to form stones.
• Animal Protein: Diets heavy in meat, poultry, or fish (rich in purines) boost uric acid production and acidify the urine, creating a double whammy for stone formation. Protein also increases calcium and oxalate levels in urine while reducing citrate, a natural stone inhibitor.
• Oxalate-Rich Foods: Foods like spinach, rhubarb, beets, nuts, chocolate, and even tea contain high levels of oxalate. When oxalate combines with calcium in the urine, it forms calcium oxalate stones, the most common type. People who over consume these foods without balancing them with adequate hydration or calcium from other sources (like dairy) are at greater risk.
• Low Fluid Intake: Tied to dehydration, consistently drinking too little water (less than 2-3 liters daily for most people) is a major risk factor. Urine output below 1 liter per day significantly raises stone risk, as there’s simply not enough liquid to flush out stone-forming substances.
• Family or Personal History: Genetics play a role. If your parents or siblings have had kidney stones, your odds go up—possibly due to inherited metabolic tendencies like hypercalciuria or low citrate production. A past stone also makes recurrence more likely, especially without lifestyle changes.
• Obesity: Excess body weight alters urine chemistry, increasing calcium, oxalate, and uric acid levels while decreasing pH (making urine more acidic). Studies show obese individuals have a higher incidence of stones, partly due to insulin resistance affecting mineral metabolism.
• Medical Conditions: Certain diseases amplify risk. Gout increases uric acid stones. Inflammatory bowel diseases (like Crohn’s) or gastric bypass surgery disrupt oxalate absorption, flooding the urine with it. Type 2 diabetes, hypertension, and chronic kidney disease also tweak urine composition in stone-friendly ways.
• Medications and Supplements: Overuse of vitamin C supplements (which convert to oxalate), laxatives, or calcium-based antacids can tip the scales toward stone formation. Some diuretics or protease inhibitors (used in HIV treatment) also contribute.
• Climate and Lifestyle: Living in hot, dry regions or working in jobs with heavy sweating like construction ups the risk of fluid intake doesn’t match output. Sedentary lifestyles may also indirectly contribute by slowing metabolism and urine flow.

Kidney Stone Diagnosis

Medical History Review:

• The doctor asks about symptoms (e.g., pain, urination issues), past stone history, diet, and family history of kidney stones.

Physical Examination:

• Checks for pain in the back, sides, or abdomen; assesses general health to rule out other conditions.

Urinalysis:

• Urine sample tested for blood, crystals, infection, or abnormal levels of stone-forming substances (e.g., calcium, uric acid).

Blood Tests:

• Measures levels of calcium, uric acid, or other markers to identify underlying metabolic issues or kidney function.

Imaging Tests:

• Ultrasound: Non-invasive, uses sound waves to detect stones in the kidneys or urinary tract.
• CT Scan: Detailed imaging to locate stones, determine size, and assess blockages (most common and accurate).
• X-ray (KUB): Visualizes stones containing calcium; less effective for uric acid stones.

Stone Analysis (if passed):

• Examines a passed stone’s composition (e.g., calcium oxalate, uric acid) to guide treatment and prevention.

Kidney Stone Removal Procedure

Kidney stone Size Chart (in mm)

Treatment depends on the stone’s size, type, location, and severity of symptoms. Options include:

Kidney Stone Conservative Management:

• Hydration: Drinking plenty of water (8-12 cups daily) to help small stones (less than 4-6 mm) pass naturally.
• Pain Relief: Over-the-counter medications like ibuprofen or prescription drugs to manage discomfort.
• Medical Expulsive Therapy (MET): Medications like tamsulosin to relax the ureter and facilitate stone passage.

Minimally Invasive Procedures for Kidney Stone:

• RIRS surgery: This is done using a thin, flexible ureteroscope that is inserted through the urethra and bladder to reach the kidney or the ureter.
• Ureteroscopy: A thin scope is inserted through the urethra to locate and break up stones with a laser. Fragments are removed or passed naturally.
• Percutaneous Nephrolithotomy (PCNL): For larger stones (>2 cm), a small incision is made in the back, and a scope is used to remove or break up the stone. Requires a short hospital stay.
• MiniPERC (Minimally Invasive Percutaneous Nephrolithotomy):MiniPerc, also called Minimally Invasive Percutaneous Nephrolithotomy, is a technique in which kidney stones are removed via a small incision made in the skin, through which specialized instruments are inserted to access the kidney. This technique uses smaller instruments and a smaller incision than traditional PCNL, resulting in less trauma to the body, faster recovery times, and fewer complications.

Surgical Intervention for Kidney Stone:

• Open Surgery: Rarely used today, reserved for very large or complex stones when other methods fail. It involves a larger incision and longer recovery.

Remember Note: After treatment, dietary changes (e.g., reducing sodium, animal protein, or oxalate-rich foods) and medications (e.g., thiazide diuretics for calcium stones or allopurinol for uric acid stones) may be recommended to prevent recurrence.