Kidney Stones Treatment
What are Kidney Stones?
Kidney stones, also known as renal calculi or nephrolithiasis, are hard deposits of minerals and salts that form in the kidneys. Our kidneys filter out the toxic waste from the body via urine. However, when the concentration of toxic waste in urine exceeds the amount of water, it leads to the formation of the stones.
While kidney stones are common in all age groups, men in their 30s or 40s have a high high of being diagnosed with kidney stones. In some cases, prolonged or repeated UTIs can lead to the formation of staghorn calculus. Staghorn calculus refers to the large branching of stones in the kidneys that block the urine from leaving the kidneys and cause serious health problems.
Kidney stones vary in size and shape. While small stones can pass through the urinary tract without causing much pain, larger stones may cause significant discomfort and require medical intervention. Contact Artemis Hospitals, to schedule an appointment with some of the best urologists in Gurgaon for instant relief from kidney stone pain.
What are the Different Types of Kidney Stones?
Kidney stones are classified into different types based on their chemical composition. Each type requires different management approaches, and understanding the type is essential for effective treatment.
Calcium-Oxalate and Calcium Phosphate Stones
The most common types of kidney stones, calcium oxalate stones, are formed when calcium combines with oxalate. Calcium phosphate stones occur when calcium combines with phosphate. Both types can be caused by high levels of calcium or oxalate in the urine, often due to dietary choices or certain metabolic conditions.
Uric acid stones develop when there is too much uric acid in the urine, often resulting from dehydration, high-protein diets, or certain medical conditions like gout. These stones are often associated with a diet rich in purine-heavy foods such as red meat and shellfish.
Struvite stones are less common but are typically formed due to urinary tract infections (UTIs). The bacteria responsible for these infections can produce ammonia, which combines with magnesium and phosphate in the urine to form struvite stones.
Cystine stones are rare and occur in people with a genetic disorder called cystinuria, which causes high levels of cystine (an amino acid) in the urine. These stones are often large and can form at an early age.
What are the Symptoms of Kidney Stones?
Kidney stones can cause a range of symptoms, depending on their size and location within the urinary tract. One of the most common symptoms is sharp pain in the back which can radiate to the side or lower abdomen. Kidney stones symptoms in women can sometimes be confused with gynecological issues like urinary tract infections or ovarian cysts. Here are some common symptoms which can indicate stones in the kidneys:
What Causes Kidney Stones (Nephrolithiasis)?
Kidney stones occur as a result of increased concentration of toxic waste in the urine. Several factors contribute to the formation of stones which can be classified based on their location, size and composition. Additionally, certain risk factors such as obesity, dietary factors, age, family history of kidney stones, certain medications, chronic kidney diseases, etc. can also progress the formation of stones. Common kidney stone causes include:
Insufficient water intake leads to more concentrated urine, promoting stone formation.
Excess calcium in the urine can contribute to the formation of calcium-based kidney stones.
Foods rich in oxalate, such as spinach, beets, and chocolate, can increase the risk of calcium oxalate stone formation.
Certain conditions like hyperparathyroidism, gout, and inflammatory bowel disease can increase the risk of kidney stones.
When to Consult the Doctor for Kidney Stone Treatment?
Get in touch with the urologist or a uro-surgeon for your kidney stone treatment if the pain becomes very intense that it hinders your everyday work. Patients who are having difficulty passing the stone on their own, experiencing recurrent kidney stones, or if the medications are ineffective in treating the stone, must visit the doctor to prevent risk of complications.
Additionally, if the stones are large, located in areas that are difficult to reach, and may cause complications, medical intervention is necessary. A doctor can recommend the most appropriate treatment plan based on the size, location, and type of stone, ensuring the best possible outcome for your health and well-being.
How are Kidney Stones (Nephrolithiasis) Diagnosed?
Kidney stones diagnosis involve a combination of physical examination and symptom analysis. Kidney stones symptoms are usually silent and may remain undetected for a long time. However, comprehensive investigation of the kidneys and blood can reveal the presence of stones along with their location, size, number and composition. The urologist may recommend the following tests in case of suspicion of kidney stones:
X-ray (KUB – Kidney, Ureter, Bladder)
A basic X-ray can help identify larger kidney stones, though it may miss smaller ones.
CT Scan (Computed Tomography)
A non-contrast CT scan is the most accurate test for detecting kidney stones, providing detailed images of the kidneys, ureters, and bladder.
This non-invasive test uses sound waves to create images of the kidneys and is often used to detect kidney stones, especially in pregnant women or children.
Intravenous Pyelogram (IVP)
Involves injecting a contrast dye into a vein, which then highlights the urinary tract in X-ray images to help detect stones.
A urine sample may be analyzed for the presence of blood, minerals, or infections, which can indicate kidney stones or other urinary issues.
Blood tests can measure kidney function and check for elevated levels of substances like calcium, uric acid, or creatinine, which may indicate the presence of kidney stones.
MRI (Magnetic Resonance Imaging)
Although not commonly used for kidney stones, MRI can be used in certain cases to provide clear images of the kidneys and urinary tract without using radiation.
What are the Different Types of Kidney Stone (Nephrolithiasis) Treatment?
Patients with extreme pain in the abdomen due to kidney stones are immediately taken to the ER for surgery. Depending on the size, number and location of the stones, the doctor may recommend surgical and non-surgical methods.
For small stones causing mild to moderate symptoms, the urologist may prescribe medications, suggest dietary changes, and recommend drinking excess water to flush out the stones via urine. However, for severe symptoms or large stones which are immune to medications and non-surgical methods, surgical intervention becomes necessary.
There are multiple treatment options for kidney stones depending on the size, location, and number. Below are some common treatment methods:
Non-Surgical Methods for Kidney Stone Removal
Non-surgical methods are typically used for smaller kidney stones that are less than 4mm to 5mm in size or when the stone can pass through the urinary tract on its own. These methods include prescription of medicines, dietary changes, and lifestyle modifications.
Medications
Certain medications can help facilitate the passage of small kidney stones by relaxing the muscles in the urinary tract and reducing the pain associated with stone movement. Some of the medicines prescribed by the doctor include:
Pain Relief Medications: Over-the-counter pain relievers can help manage pain during the passage of the stone.
Alpha-Blockers: These medications help relax the muscles in the ureter (the tube connecting the kidney to the bladder), making it easier for stones to pass. These drugs can be particularly helpful in preventing pain during the stone’s passage.
Potassium Citrate: This medication helps make the urine less acidic, which may help prevent the formation of certain types of kidney stones, such as uric acid stones, and may also help dissolve small stones.
Dietary Changes
Dietary changes play a crucial role in both the prevention and managing kidney stones symptoms. The following modifications in the diet can help reduce the risk of stone formation:
Staying Hydrated: Drinking plenty of water (almost 8-10 glasses a day) is crucial to prevent and flush out kidney stones. Proper hydration helps dilute the substances that lead to stone formation.
Limit Oxalate-Rich Foods: Foods high in oxalates, such as spinach, beets, and chocolate, can contribute to the formation of calcium oxalate stones. Reducing these in your diet may help prevent stone formation.
Reduce Sodium Intake: High sodium levels in the diet can increase the amount of calcium in urine, raising the risk of calcium-based kidney stones. Limiting salt intake is key to prevention.
Limit Animal Protein: High-protein diets, particularly those rich in animal protein (e.g., red meat, poultry, and seafood), can increase uric acid levels and promote the formation of uric acid stones.
Increase Citrus Foods: Citrus fruits, such as lemons and oranges, contain citrate, a substance that helps prevent stone formation by binding with calcium.
Lifestyle Modifications
In addition to dietary restriction, certain lifestyle modifications are recommended to manage symptoms of kidney stones and prevent the progression of stone:
Maintain a Healthy Weight: Obesity is a known risk factor for kidney stones, so maintaining a healthy body weight through regular exercise and a balanced diet is important.
Avoid Dehydration: Make sure to drink water consistently throughout the day, especially in warmer climates or after physical activity, to prevent the urine from becoming concentrated.
Exercise Regularly: Physical activity can help maintain healthy kidney function and reduce the likelihood of developing stones by promoting proper hydration and circulation.
Surgical Methods for Kidney Stone Removal
Surgical treatments are generally recommended for larger stones that cause persistent pain or blockage. If the stone fails to pass through the urinary tract with the help of medications or lifestyle changes, patients often have to undergo more aggressive treatment methods. Advanced surgical methods for kidney stone removal involve:
Extracorporeal Shock Wave Lithotripsy (ESWL)
ESWL is a non-invasive procedure that uses high-energy shock waves to break kidney stones into smaller fragments. These fragments can then pass more easily through the urinary tract. During the procedure, the patient lies on a water-filled cushion, and shock waves are directed toward the kidney stones using X-ray or ultrasound imaging to locate the stones.
ESWL is typically effective for stone sizes up to 7mm in size. It is less effective for larger stones or those located in difficult-to-reach areas of the kidney. The procedure usually takes 30-45 minutes, and can be done in multiple sittings depending on the size and number of stones.
Benefits:
Non-invasive and requires no incisions.
Minimal recovery time.
Often effective for stones that are smaller than 2 cm in diameter.
Can be done on an outpatient basis.
Ureteroscopy involves passing a thin, flexible scope through the urethra and bladder into the ureter (the tube between the kidney and bladder). In some cases, a laser is used to break the stone into smaller fragments. If the stone is too large, it may be removed using special baskets.
URSL is typically used for stones that are less than 10mm in size and procedure usually takes about 30-60 minutes.. Larger stones may require other methods like RIRS or PCNL.
Benefits:
Ideal for stones located in the ureter or renal pelvis.
No need for large incisions or long recovery periods.
Effective for stones in difficult-to-reach areas.
Retrograde Intrarenal Surgery (RIRS)
RIRS is a minimally invasive procedure in which a small fiber-optic scope (ureteroscope) is passed through the urethra and bladder into the kidney. Once inside the kidney, a laser is used to break the stone into smaller pieces, which are then either removed or flushed out with irrigation.
RIRS is suitable for stones sizes ranging between 10 mm to 20mm in size. It is effective for both single and multiple stones. RIRS typically takes 45 minutes to 1 hour to complete, depending on the complexity of the procedure.
Benefits:
Minimally invasive, requiring only a small incision (or none in some cases).
Effective for stones in the renal pelvis or calyces (the chambers inside the kidney).
Can be performed under general or local anesthesia.
Lower risk of complications compared to more invasive surgeries.
Percutaneous Nephrolithotomy (PCNL)
PCNL is a more invasive procedure that is used for large kidney stones or stones that have not responded to other treatments. The procedure involves making a small incision in the back, through which a nephroscope is inserted directly into the kidney. The stones are then broken up using a laser or ultrasonic probe and subsequently removed using suction or forceps.
PCNL is generally recommended for stones larger than 2 cm in size or stones that are causing severe pain, obstruction, or infection. PCNL typically takes 1-2 hours to perform depending on the location and number of stones.
Benefits:
Highly effective for larger stones (greater than 2 cm) or stones that are difficult to remove with ESWL or URSL.
Can remove multiple stones in one session.
Suitable for stones located in the renal pelvis or calyces.
Complications of Untreated Kidney Stones (Nephrolithiasis):
Untreated kidney stones can lead to several serious complications, some of which may require emergency medical intervention. Early diagnosis and treatment are essential to avoid these risks and preserve kidney function. Here are some of the potential complications:
Urinary Tract Infection (UTI)
A kidney stone can obstruct the flow of urine, creating a breeding ground for bacteria. This can lead to a urinary tract infection, which may cause symptoms like fever, chills, pain during urination, and cloudy or foul-smelling urine. If left untreated, a UTI can escalate to a more severe infection, like pyelonephritis (kidney infection).
When a kidney stone causes a blockage in the urinary tract, it can lead to hydronephrosis, a condition where urine backs up into the kidney, causing it to swell. This can impair kidney function and, if prolonged, may lead to kidney damage or even kidney failure.
Repeated kidney stone formation, along with any ongoing obstruction, can lead to chronic kidney disease (CKD). Over time, damage to the kidney tissue from blocked urine flow or infection can result in a gradual decline in kidney function.
Kidney Damage or Permanent Loss of Kidney Function
If a large stone remains in the kidney or ureter for an extended period, it can cause irreparable damage. The prolonged pressure or infection caused by the stone can lead to the permanent loss of kidney function, potentially requiring dialysis or a kidney transplant.
In rare but severe cases, if an untreated kidney stone leads to an infection, it can spread throughout the body, resulting in sepsis. Sepsis is a life-threatening condition that causes widespread inflammation and can lead to organ failure.
Stones can sometimes migrate, causing severe pain (renal colic) as they move through the urinary tract. If a stone moves from the kidney into the ureter (the tube between the kidney and bladder), it can cause intense, cramp-like pain, often referred to as one of the most severe types of pain.
What are Kidney Stone Prevention Tips?
Preventing kidney stones involves lifestyle changes that help reduce the risk of stone formation. Here are key tips for keeping your kidneys healthy:
Drinking plenty of water is the most effective way to prevent kidney stones. Aim for at least 8-10 glasses of water daily. Proper hydration dilutes the substances in urine that form stones, making it harder for crystals to develop.
Excessive salt in the diet can increase calcium in the urine, raising the risk of kidney stones. Limit sodium intake by avoiding processed foods, canned goods, and high-sodium snacks.
A diet high in fruits, vegetables, and fiber can help reduce stone risk. Limiting animal protein, which increases uric acid levels, and foods rich in oxalates (like spinach, nuts, and chocolate) may also help prevent calcium oxalate stones.
Foods high in citric acid, such as lemons and oranges, can help prevent stone formation by increasing the citrate levels in urine, which binds with calcium and prevents stone formation.
Maintain a Healthy Weight
Obesity is a risk factor for kidney stones. Regular physical activity and a balanced diet help maintain a healthy weight and lower the risk of developing stones.
Myths and Facts About Kidney Stones (Nephrolithiasis):
Myth 1: Drinking beer can help prevent kidney stones.
Fact: While it’s true that beer and other alcoholic beverages may increase urine output, which could theoretically help flush out small stones, beer does not actually prevent kidney stones. In fact, alcohol consumption can lead to dehydration, which is one of the key risk factors for developing kidney stones. Additionally, beer contains purines, which can increase uric acid levels in the urine, potentially promoting the formation of uric acid stones. For effective kidney stone prevention, it's essential to stay well-hydrated with water and maintain a balanced diet, rather than relying on alcohol.
Myth 2: Drinking more water won't help if you already have kidney stones.
Fact: Staying hydrated is crucial for preventing and managing kidney stones. Drinking adequate amounts of water helps dilute the substances in urine that contribute to stone formation, such as calcium and oxalate. For those with existing kidney stones, increasing fluid intake can help flush out smaller stones and prevent new ones from forming. It is generally recommended to drink at least 8-10 glasses of water daily.
Myth 3: Kidney stones are only caused by too much calcium.
Fact: While calcium is a key component of many kidney stones (especially calcium oxalate stones), high calcium intake does not necessarily cause kidney stones. In fact, calcium from dietary sources can help reduce the risk of kidney stones by binding to oxalates in the intestines and preventing their absorption. The main culprits for stone formation are often imbalances in calcium, oxalate, uric acid, or phosphate levels, not simply excess calcium intake.
Myth 4: Passing a kidney stone is always extremely painful.
Fact:Not all kidney stones cause intense pain. Small stones, particularly those under 5mm, may pass through the urinary tract with little to no pain, especially if they are adequately hydrated. The severity of pain depends on the stone's size, location, and whether it causes a blockage. Larger stones or stones that become lodged in the ureter can cause significant pain, often referred to as renal colic, which is severe and may require medical treatment.
Myth 5: Surgery is the only option for large kidney stones.
Fact: Surgery is not always required for large kidney stones. Many large stones can be treated with non-invasive procedures like extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to break the stones into smaller pieces. For stones that are not amenable to ESWL, other procedures like ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) can be performed. The treatment approach depends on the stone's size, type, location, and the patient's health condition.
ICD-10 Coding for Kidney Stones:
The ICD-10 code for kidney stones is N20, which includes several sub-categories such as:
N20.0 - Calculus in kidney
N20.1 - Calculus in the renal pelvis
N20.2 - Calculus in the ureter
N20.9 - Kidney stone, unspecified
Choose Artemis Hospitals for Laser Kidney Stone Removal Treatment in Gurgaon:
Kidney stone removal treatment depends on the size, location, and number of stones, as well as the patient's overall health. Non-surgical methods like medications, dietary changes, and lifestyle modifications are ideal for smaller stones, while surgical procedures such as ESWL, RIRS, URSL, and PCNL offer effective solutions for larger or more complex stones.
At Artemis Hospitals, we specialize in providing comprehensive, cutting-edge kidney stone treatment personalized to your needs. Our expert urologists are equipped with the latest diagnostic tools and advanced treatment options, from non-invasive procedures like shock wave lithotripsy (ESWL) to minimally invasive surgeries such as ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL). Artemis Hospitals offer the best in kidney stone treatment with the latest technology and expertise by some of the top urologists or kidney specialists in Gurgaon.
To book an appointment with top urologists at Artemis Hospitals, call our customer care at +91-124-451-1111 or WhatsApp us at +91 9599285476. You can also schedule an appointment through our online patient portal or download and register on the Artemis Personal Health Record mobile app, available for both iOS and Android devices.
Frequently Asked Questions:
What is the duration of the ESWL (Extracorporeal Shock Wave Lithotripsy) procedure?
The ESWL procedure typically takes about 30 to 45 minutes. It involves breaking the stone into smaller fragments using shock waves, which can then pass through the urinary tract.
How long does recovery take after ESWL?
Recovery time after ESWL is generally short. Most patients can resume normal activities within 1-2 days, though mild discomfort or blood in the urine may persist for a few days.
What is the pain level during the ESWL procedure?
The procedure is usually not painful as patients are given local anesthesia or mild sedation. Some discomfort may occur after the procedure due to stone fragments passing through the urinary tract.
What size of kidney stones can be treated with ESWL?
ESWL is typically used for stones that are 1-2 cm in size. It is less effective for larger stones or those located in difficult-to-reach areas of the kidney.
How long does the PCNL (Percutaneous Nephrolithotomy) surgery take?
PCNL surgery usually takes 1-2 hours, depending on the size and location of the kidney stone. This procedure involves making a small incision in the back to remove larger stones directly from the kidney.
What is the recovery time after PCNL surgery?
Recovery after PCNL takes longer than other treatments, typically 1-2 weeks. Patients may experience some pain and require a stay in the hospital for observation, especially if the stone was large.
What is the pain intensity like after PCNL surgery?
There is moderate to severe pain after PCNL surgery due to the incision made in the back. Pain management will be provided, and discomfort typically reduces over the first few days to weeks.
What size of kidney stones can be treated with PCNL?
PCNL is typically recommended for larger stones (greater than 2 cm in size) or those that are difficult to treat with other methods like ESWL.
How long does the RIRS (Retrograde Intrarenal Surgery) procedure take?
RIRS usually takes 1-2 hours. It is a minimally invasive procedure where a ureteroscope is inserted to break up and remove kidney stones using a laser.
What is the recovery time after RIRS?
The recovery time after RIRS is relatively quick, with most patients returning to normal activities within a few days. Mild discomfort or blood in the urine may persist for a short period, but it generally resolves quickly.
What is a staghorn calculus?
A staghorn calculus is a large, branching kidney stone that takes the shape of the renal pelvis and calyces, resembling a stag's horn. These stones often consist of struvite and can grow to fill the entire renal collecting system, leading to potential complications.
How is a staghorn calculus treated?
Staghorn calculus often requires more invasive treatment due to its size and location. Treatment options include percutaneous nephrolithotomy (PCNL), which involves surgically removing the stone through a small incision in the back, or shock wave lithotripsy (ESWL) for smaller stones.
What are the complications of untreated staghorn calculus?
If left untreated, staghorn calculus can cause severe complications like chronic infections, kidney damage, or even kidney failure. It may obstruct the urinary tract, leading to recurrent urinary tract infections (UTIs) and permanent kidney function loss.
How long does it take for a 5mm kidney stone to pass naturally?
A 5mm stone can typically pass within a few weeks with proper hydration and pain management, but it may require intervention if it causes severe pain or obstruction.
Is kidney stone surgery always necessary?
Surgery is only necessary if the stone is too large to pass naturally, causes severe symptoms, or leads to complications like infections or urinary blockage.
Can kidney stones recur?
Yes, kidney stones can recur, especially if you do not follow preventive measures like staying hydrated and reducing risk factors.
How do I know if I need surgery for my kidney stone?
If a stone is larger than 7mm to 8mm, it causes severe pain and can lead to complications, surgery may be necessary. Your doctor will advise you on the best course of action.
