What is Nephrolithiasis?
Nephrolithiasis is characterized by the formation of crystalline material in the kidney and the urinary tract. Nephrolithiasis is also known as kidney stones and is formed as a result of a decrease in the volume of urine or an increase in the substances in urine that can form stones in the kidney or in the urinary tract. Nephrolithiasis is also called renal calculi and the stone formations often results in blood in the urine. Severe pain in the abdomen, flank or groin is also included in the manifestation of renal calculi.
Nephrolithiasis mainly affects the general population without racial predilection. It occurs more commonly in male gender that in the female gender. The incidence can occur between the ages of 20 to 49 years with peak onset in the age of 35 to 45 years although the disease can also affect people from all age groups including children. Nephrolithiasis on the other hand is far more common in Asians and to those living in hot and dry areas. The prognosis is generally good as most cases of kidney stone spontaneously pass through the urine. Morbidity of kidney stones are those associated with urinary tract obstruction and upper urinary tract infection.
The symptoms of Nephrolithiasis usually occur when the stones move within the kidney and passes through the ureter. Kidney stones generally originate from the kidney and extend distally and lodge in narrow areas adjacent to the kidney. When symptoms occur this may include the following:
Pain is the most common and initial symptom of kidney stones. The onset of pain is characterized as rapid and excruciating. The pain may be felt in the lower back and radiates to the sides, groin and the abdomen. The pain is also characterized as colicky pain which cannot be relieved with a change in the body position. The location and quality of pain are relative to the position on of the stone within the urinary tract while the severity is dependent on the degree of obstruction brought by the formation of kidney stones.
Nausea and vomiting usually accompany the rapid and excruciating pain.
Painful urination is also experienced and is accompanied by a blood in the urine.
Frequent urge to urinate is also noted and the urine while the characteristic of the urine can be noted with foul smells and cloudy appearance.
Fever and chills may occur if infection is present during the process of kidney stones.
The pain in kidney stones goes through different phases. The first phase is onset of pain that normally attacks early in the morning or during at night time that can disturb the sleep of an affected individual. The constant phase of pain is the second phase where the pain has reached the maximum intensity where it will linger until treatment or medical intervention has been applied. Abatement or relief phase is the third and last phase of pain characterized by spontaneous relief anytime following the initial onset. The relief of pain usually lasts for an hour and a half to 3 hours after the patient has awakened following administration of analgesic.
Nephrolithiasis has no single cause and the stone formation results when the urine has more stone forming substances than fluid composition that the urine can dilute. Several risk factors on the other hand are considered to result in the formation of kidney stones.
There are different types of kidney stones that can form within the kidney and this includes the following:
Calcium stones are the most common type of kidney stone that usually develop as a result of high intake or consumption of certain substances such as salt. Calcium stones are usually in the form of oxalate which is a substance that is naturally occurring in the food.
Struvite stones commonly form in women suffering from urinary tract infection. The struvite stones grow rapidly and become large and manifested with few symptoms.
Uric acid stones
Uric acid stones potentially occur to individuals suffering from gout or went through chemotherapy. This is also potential for individuals who take in an insufficient amount of fluid and loses large amounts of fluid. This is also potential for individuals who include high protein in their diet.
Cystine stones can develop in people with cystinuria or an inherited disorder marked by an elevation in the formation of stones in the bladder, kidney and the ureter.
Risk factors predisposing an individual to kidney stones include the following:
Dehydration from decreased fluid intake or from strenuous activities without sufficient fluid replacement can put one at risk for kidney stone formation. People living in hot and dry climates are also at high risk for developing Nephrolithiasis due to the risk of dehydration.
Diet can also affect or influenced the incidence of Nephrolithiasis. Diet that includes high protein, sugar and sodium potentially increases the risk for kidney stone formation.
Digestive disorders including surgery is a potential risk for Nephrolithiasis due to changes in the digestive process that can affect the absorption of calcium and water and thus increasing the levels of stone forming substances in the urine.
This is potential for uric acid stone formation as the condition is generally the consequence of an increase in the amount of uric acid in the blood and urine.
This increases the risk for kidney stones including personal history of previously suffered from kidney stones.
How is Nephrolithiasis diagnosed?
Suspicion of kidney stones or Nephrolithiasis is diagnosed with the onset of the pattern of symptoms. Diagnostic test procedures are the following:
Urinalysis or Urine test requires a 24-hour urine collection for evaluation of stone forming minerals and a decreased in the levels of substances that inhibits the formation of stones.
This is done to evaluate for calcium or uric acid content in the blood which can reveal an elevation in the levels of these substances.
Imaging tests are done to confirm the formation of kidney stones. A helical CT scan is the imaging test of choice that is usually done without contrast materials. This imaging test can identify stones and obstruction within the urinary tract.
Most kidney stones usually resolve within 48 hours with sufficient amount of fluid intake to help wash away the stone through the urine. Small stones that have minimal symptoms can be treated with the following:
- Increase fluid intake
- Pain relieving medications
- Alpha blocker medication facilitates the passing of stone rapidly as the medication act by relaxing the muscles of the ureter
A large stone formation that leads to manifestation of symptoms can be treated with the following:
- Extracorporeal shock wave lithotripsy is a procedure that utilizes sound waves to break the stones.
- Percutaneous nephrolithotomy is a surgical removal procedure recommended for large stone formation.