STONE IN THE KIDNEY

What is a kidney stone?

The formation and periodic passage of crystal particles is known as kidney stones. This is a common urological disease also known as nephrolithiasis or urolithiasis. Calcium oxalate is the major component of most kidney stones. Other elements that can form a kidney stone include calcium phosphate, uric acid, struvite (formed from magnesium ammonium phosphate), and cystine. Kidney stones are considered risk factors for systemic diseases such as chronic kidney disease, bone fractures, cardiovascular disease and diabetes.

Signs and symptoms

• abdominal and flank pain radiating to the back. This occurs during the transit of the stone from the kidney to the bladder.

• Haematuria

• Nausea and vomiting

• Fever and chills.

• Feeling weak, uneasy and tired.

Management of kidney stones

Dietary modification and pharmacological therapy specific to the type of kidney stone is essential in the management and prevention of recurrence of kidney stone

Dietary management

High salt and animal protein diet are risk factors of kidney stone formation, while increased fluid and vegetable intake are of good benefit on the incidence of kidney stone.

Increasing water intake is a globally known intervention for reducing the risk of kidney stones. At least 2.5L of fluid is recommended daily. While adequate hydration is recommended in the prevention of kidney stone formation, some beverages have been associated with the risk of kidney stone formation. Tea, wine, coffee, alcoholic beverages and orange juice have a lower risk compared to sugar-sweetened beverages and carbonated drinks, particularly those containing phosphoric acid.

Supplemental calcium has been linked to increased calcium stone formation in contrast to dietary calcium. It is recommended to have dietary calcium in a normal range (1.0-1.2g per day)

pharmacological management

Diuretics are used in the management of calcium phosphate and calcium oxalate stone formation.

Potassium citrate might be considered for the management of calcium phosphate stone formers with low citrate levels due to its ability to bind with calcium, thereby inhibiting calcium crystallisation. It can also be used in the management of uric acid and cystine stones.

The use of cystine-binding thiol medication might be considered if dietary modifications are ineffective for the management of cystine stones.

Urease inhibitors are of good benefit in the management of struvite stones. Struvite stones are caused by urease-producing organisms, which are present in urinary tract infections.

References

Khan, S. R., Pearle, M. S., Robertson, W. G., Gambaro, G., Canales, B. K., Doizi, S., ... & Tiselius, H. G. (2016). Kidney stones. Nature reviews Disease primers, 2(1), 1-23.

Stamatelou, K., & Goldfarb, D. S. (2023, February). Epidemiology of kidney stones. In Healthcare (Vol. 11, No. 3, p. 424). MDPI.

Pearle, M. S., Goldfarb, D. S., Assimos, D. G., Curhan, G., Denu-Ciocca, C. J., Matlaga, B. R., ... & White, J. R. (2014). Medical management of kidney stones: AUA guideline. The Journal of urology, 192(2), 316-324.

Fontenelle, L. F., & Sarti, T. D. (2019). Kidney stones: treatment and prevention. American family physician, 99(8), 490-496.

Khan, S. R., Pearle, M. S., Robertson, W. G., Gambaro, G., Canales, B. K., Doizi, S., ... & Tiselius, H. G. (2016). Kidney stones. Nature reviews Disease primers, 2(1), 1-23.

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