Kidney Stone's Complete Information

Kidney stone is urinary stones (urolithiasis), it had been known since Babylon era and ancient Egypt with the discovery of stones in the mummy bladder. Urinary tract stones can be found in the urinary tract; the kidney Calix system, pielum, ureters, bladder and urethra. These stones may form in the kidneys and then travel to the lower urinary tract or it can be formed in the lower urinary tract due to stasis of urine movement such as bladder stones due to prostatic hyperplasia or urethra stones in the urethra diverticula condition.

Kidney Stone

Urinary tract stone disease spreads throughout the world with distinction in many developing countries found a stone in inner urinary tracts, while in developed countries is more common in upper urinary tract stones, this difference is influenced by the nutritional status and activities daily living. The average prevalence rate in worldwide is about 1-12% of the population suffer from urinary tract stones.

Definition of Kidney Stone

Kidney stone is a condition where the hard material block the urinary tract or kidney itself. The material comes from residual substances in the blood, its residual substances become hard and crystal in time. Sedimentary stone in the kidneys can be caused by many things such as food or other health problems. Based on the types of kidney stones, these conditions can be divided into four main types, the differences are only in stone substance; calcium stones, uric acid stones, struvite stones and cystine stones.

Kidney stone is a condition where there is accumulation of minerals in the kidneys. The minerals that accumulate become solid and its components are from urine concentrate or waste product. Kidney stone is usually called nephrolithiasis.

A human has two kidney in the body, its position lies behind the stomach and in front of the spine. Human kidney is like a bean-shaped and it has 4 inches size. To know more about kidney function, you may click here.

Kidney's function is like an organ that responsible for the disposal of residual substances from the blood or body fluid, in general the kidney will make the blood becomes clean and then flows out from the body. The last product of the substances form urine and it will excrete out the body.

So, when kidney stones are formed, inside the kidney there will be a small or large lump that formed stone. The condition occurs due to the deposition of substances such as uric acid and calcium, which should not remain in the body. This condition will make renal colic occurs when the kidney stone that is in the body, it will be so painful for the patients.

Kidney stone is usually found around 30 to 60 years old. The problem will appear if the stone blocked the urinary tracts. If the condition is not serious, kidney stones can be excreted without pain and not even felt at all when urinating. Not only that, the serious condition of kidney stones will block the urinary system, especially the ureter, renal channel, and the bladder. Urethra or urine tubes which are like a pathways will be blocked. On any part of blockage, the patient will always feel serious pain in the abdomen, it leads to urinary tract infections.

In addition, residual substances that form kidney stones will be hard accumulate little by little and become kidney stones. This condition can occur because of the habit, such as like lack of drinking water. However, if you are taking certain types of drugs, the drugs have also the potential to increase the levels of chemicals accumulation in the urine and it will contribute kidney stones formation.

Basically human immune system will naturally recognize kidney stones as foreign bodies that live inside the body. Consequently, when a kidney stone is forced to come out of the urinary tract. When the size of kidney stones are too large, the patients need X-ray or ultrasound to break the stone into smaller size pieces, and the result is small kidney stone formed and it is easy to excrete. Treatment of kidney stones is often still have a percentage of failure that still had to do kidney stone surgery.

Unfortunately, once the patients are suffering from kidney stones, then it has a high recurrence after recovered from kidney stone.

Etiology

The cause or etiology of kidney stones is definitely unknown. In many cases it probably due to hyperparatirodisme which can cause the occurrence of hypercalciuria. Sometimes it can be caused by a bacterial infection such as Proteus, pseudomonas, staphylococcus alba and several types coli.

Causes the formation of urinary tract stones associated with urinary tract disorders, metabolic disorders, urinary tract infections, dehydration and other circumstances that remain unclear (idiopathic).

Epidemiologically, there are several factors that facilitate the occurrence of urinary tract stones, those are distinguished into two factors; intrinsic and extrinsic factors.

Intrinsic Factors are:

1. Hereditary; it maybe from closest relatives from generation to generation.
2. Age; it is most often obtained at the age about 30-50 years.
3. Sex; the number men suffering with this disease is 3 times more than women patients.

Extrinsic Factors include:

1. Geography; in certain areas have a higher incidence than other areas.
2. Climate and temperature.
3. Fluid intake; lack of water intake and high levels of mineral calcium may increase the incidence of urinary tract stones.
4. Diet; a diet that is high ingredient of purine, oxalate and calcium will facilitate the occurrence of urinary tract stones.
5. Occupation; This disease is often found in people who work a lot of sitting or lack of physical activity (sedentary lifestyle).

Kidney Stone Formation

1. The formation of urinary stone have three theories, those are:
2. Nucleation theory: stones formed in the urine tract because of stone belt (nucleus). Particles that are too thick solution will settle in the nucleus, then it will form stones immediately. This stone belt can be crystal or foreign objects in urinary tract.
3. Matrix theory: organic matrix such as like urinary proteins (albumin, globulin and mucoprotein) are as a framework for formation of stone.
4. Crystallization inhibitor theory: Urine normally contains the crystal-forming inhibitors, those are magnesium, citrate, pyrophosphate, mucoprotein and peptides. If the levels of one or more of these substances is decrease in the body, it will help the formation of stones in the urinary tract.

Type of Kidney Stones

In general, the kidney stones contain elements such as calcium oxalate, calcium phosphate, uric acid, magnesium-ammonium-phosphate (MAP), xanthine and cysteine. Good information about this composition is important in the prevention of the possibility of recurrent kidney stones.

Calcium stones

Calcium stones (calcium oxalate or calcium phosphate) are most commonly found in kidney stone around 75-80%. Factors that lead to calcium stone formation are:

1. Hypercalsiuria: urine calcium level is over 250-300 mg / 24 hours, it may occur because of increased calcium absorption in the intestine (absorptive hypercalciuria), in a condition such as like inability calcium reabsorption in the renal tubules (renal hypercalciuria) and an increase in bone resorption (hypercalciuria resoptif) as the primary hiperparatiridisme or parathyroid tumors.
2. Hyperoxaluria: Urine oxalate excretion is over 45 g / 24 hours, this circumstance is found in patients with post-surgical gastro intestinal and consumption of oxalate-rich foods such as tea, instant coffee, soft drinks, cocoa, strawberry, lemon and green vegetables, especially spinach.
3. Hyperuricosuria: urine uric acid levels is over 850 mg / 24 hours. Uric acid in the urine can be an indicator for formation of calcium oxalate stones. Uric acid in the urine can come from the  rich purine foods or derived from endogenous metabolism.
4. Hypocytraturia: In urine, citrate reacts with calcium to form calcium citrate, thus blocking the binding of calcium with oxalate or phosphate. Hypocitraturia circumstances can occur in renal tubule acidosis disease, malabsorption syndrome or the use of thiazide diuretics in the long term consumption.
5. Hypomagnesiuria: just like citrate, magnesium reaction is as an inhibitor of calcium stones because urine magnesium will react with oxalate into magnesium oxalate, then it will prevent calcium oxalate bond.

Struvite Stones

Struvite stones is also known as infection stones, the stone formation is triggered by a urinary tract infection. Germs that cause these infections are breaking urea group bacterial (urea splitter such as Proteus spp., Klebsiella, Serratia, Enterobacteria, Pseudomonas and staphylococci). These bacteria produce the enzyme urease and transform urine into alkaline by hydrolysis of urea into ammonia. It facilitates alkaline salts of magnesium, ammonium, phosphate and magnesium ammonium carbonate to form  magnesium-ammonium-phosphate (MAP) and carbonate.

Uric Acid Stones

Uric acid stone is about 5-10% of all urinary tract stones, this uric acid substance may be got by patients with gout, myeloproliferative diseases, patient with drug cytostatic and uricosuria (sulfinpyrazone, thiazide and salicylate), obesity, alcoholism and high-protein diets have a high risk for having this disease. Factors that contribute the formation of uric acid stones are: urine is too acidic (pH <6, urine volume <2 liters / day or dehydration and hyperuricosuria.

Kidney Stone Sign and Symptoms

The most common sing and symptoms that is felt by the patient are low back pain, decrease urine output, urine retention, fever if there is an infection in the urinary tracts, nausea, vomit, hematuria or blood in urine, abdomen distention, and anuria bilateral obstruction.

According to Smeltzer in his book (perioperative nursing care) describes the patients complaints are depends on the location and the size of the stones. On physical examination there may be a pain in the urinary system area, kidney can be touched as the result of hydronephrosis, renal failure signs, urinary retention and infection can be obtained if the kidney stone is accompanied by fever.

Here is some of the clinical picture of nephrolithiasis:

1. Stone, especially the small ones in ureter, it may not cause symptoms.
2. Stone in the bladder can cause pain in the lower abdomen. Stones that obstruct the ureter, renal pelvis or renal tubules can cause back pain or renal colic (severe colicky pain). Renal colic is like intermittent pain and it is usually in the area between the ribs and hips, abdomen, pubic area, and inner thighs.
3. Symptoms are nausea and vomiting, abdominal distention, fever, and blood in the urine. Patients always want to urinate, especially when stones pass through the ureter.
4. Stones in the urinary tract can cause urinary tract infections. If the stones blocked the urine flow, microorganism will trapped in urinary tract, so the infection will occur. If the blockage is remain there in long time, the urine will flow back into the channel in the kidney, it will lead to hydronephrosis and it could damage the kidneys or kidney failure.

Diagnosis Test of Kidney Stone

1. Renal physiology test
2. Urine sediment test
3. X-ray to show the majority of kidney stones
4. Urography to confirm the diagnosis and determine the size and location of the kidney stone.
   Renal ultrasound to detect the changes of obstruction such as unilateral or bilateral hydronephrosis.
5. Laboratory examination
6. Routine laboratory tests that need to examine are:
   • Urine Sediment to determine erythrocytes, leukocytes, bacteria (nitrite), and the pH of urine.
   • Serum creatinine to determine kidney function.
   • C-reactive protein, leukocyte count of B cells, and urine culture is usually tested in fever.
   • Sodium and potassium are examined during vomiting.
   • Calcium and uric acid level to look for metabolic risk factors.

Treatment

Stones that make problems in the urinary tract should be removed as fast as it can, so the severe complication can be prevented. Indications to perform a treatment usually when the urinary tract stones have already blocked, infection, or social indications. Kidney stone can be removed with medical procedures, solved with ESWL, endourology treatment, laparoscopic surgery, or open surgery.

ESWL / Lithotripsy

ESWL is a non-invasive procedure that is used to destroy kidney stones. Once the stone is destructed into small pieces and it will getting smaller and smaller.

Endourology

Endourology method is a combination of radiology and urology to remove renal stones without major surgery.

Percutaneous Nephrostomy

Percutaneous nephrostomy is a tube installation through the skin into the renal pelvis. This procedure is performed for urine external drainage with a catheter, destroying kidney stones, dilate strictures. Ureterscopy includes visualization and ureter access by inserting an instrument through cystoscopy. Kidney stone can be destroyed using a laser, electrohydraulic lithotripsy, or ultrasound and then removed.

Kidney Stone Fluid .

After percutaneous nephrostomy is done, irrigate the warm fluid flowed continuously into the kidney stone. Irrigation fluid flows through the kidney ducts, ureter or nephrostomy tube.

Surgery

Nephrolithotomy.

Incision in the kidney to remove the stone. It can be done if the kidney stone located in the kidney.

Pielolitotomy.

It can be only done if the kidney stone located in the kidney, not in the ureter or bladder.

Drugs Treatment

1. Drugs treatment depend on types of kidney stone.
   Calcium stone: Paratirodectomy for hyperparathyroidism, limit milk and cheese consumption, potassium phosphate acid (3-6 grams per day) can reduce calcium level in urine, a diuretic (hydrochlorothiazide 50 mg for 2 times a day), or cranberry juice (200ml for 4 times a day) to acidify the urine and makes calcium level more soluble in urine.
2. Oxalate stone: limit the oxalate diet and calcium phosphate (3-5 grams of potassium phosphate acid every day), pyridoxine (100 mg, 3 times a day).
3. Metabolic stone: cysteine and uric acid precipitate in acidic urine (urine pH should be over than 7.5 by giving 4-8 ml of 50% nitric acid, 4 times a day) and tell the patient about right diet such as mineral alkaline diet, limit purine diet in patients with uric acid stones (prescribe 300mg allopurinol (zyloprin) once or twice a day). In patients sistienura, a low diet in methionine and penicillamine (4 grams per day).

Management of kidney stone treatment should be placed the patient in a room with adequate ventilation, pay attention to urine output, prevent the distension and bleeding and pay attention to the installation  location of drainage.

Kidney Stone Prevention
After the stone is removed, the most important things are to prevent a recurrence. Urinary tract stone recurrence is about 7% per year or 50% in 10 years. The prevention is based on the content of stone elements has been removed. In general, the prevention that need to be done are:

1. Avoid dehydration by drinking enough water, so the urine output will be enough about 2-3 liters per day
2. Limit the diet that lead to stone formation.
3. Exercise
4. Drugs prevention
5. Some diets are recommended for reducing recurrence are:
• Low protein, because protein will stimulate urinary calcium excretion and cause the urine to become more acid.
• Low oxalate diet.
• Low salt because natiuresis will lead to hypercalciuria.
• Low purine diet. This diet is recommended for the patients suffering from kidney disease and gout arthritis.
• Low calcium diet are not recommended except in type II absorptive hypercalciuria condition.