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In this Health Hub article, we explore the symptoms, methods of prevention, and treatments of kidney stones.

Kidney Stones


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Kidney Stones

Kidney Stones

In this Health Hub article, we explore the symptoms, methods of prevention, and treatments of kidney stones.

What are Kidney Stones?

Kidney stones, clinically known as “nephrolithiasis”, are little stone-like formations that can develop in one or both of the kidneys. Waste products in the blood can occasionally form crystals that collect inside the kidneys. Over time, the crystals may build up to form a hard stone-like lump.

After a kidney stone has formed, your body will try to pass it out when you go to the toilet (in the urine). This means it will often travel through the urinary system (the kidneys, kidney tubes, and bladder).


Facts & Figures

  • In the United States, overall kidney stone prevalence has doubled since 1964–1972 time. This can be attributed to agricultural modernisation and the increase in starchy foods alongside associated obesity levels.
  • Around half of people who have had kidney stones will experience them again within the following 10 years.


Signs & Symptoms of Kidney Stones

Kidney stones can go undetected particularly if they are small and passed through the urine painlessly. While small stones may be passed out in the urine, it is fairly common for a stone to block part of the urinary system, such as the ureter or the urethra. If this happens, it can cause severe pain in the abdomen or groin. A blockage in the urinary system can also lead to infection, kidney damage and kidney failure.

The main symptoms of kidney stones are:

  • a persistent ache in the lower back, which is sometimes also felt in the groin – men may have pain in their testicles and scrotum
  • periods of intense pain in the back or side of your abdomen, or occasionally in your groin, which may last for minutes or hours
  • feeling restless and unable to lie still
  • nausea (feeling sick)
  • needing to urinate more often than normal
  • pain when you urinate (dysuria)
  • blood in your urine (haematuria)


Types of Kidney Stones

Kidney stones come in a variety of sizes, shapes, and colours. Some are like grains of sand, while in rare cases others can grow to the size of a golf ball.

The four main types of kidney stones are:

  • calcium stones
  • struvite stones – contain magnesium and ammonia; often horn-shaped and quite large
  • uric acid stones – usually smooth, brown and softer than other types of kidney stones
  • cystine stones – often yellow and resemble crystals rather than stones

Medications & Treatments Available

The majority of small stones will pass in the urine with relatively few problems. Bed rest, painkillers (such as paracetamol or ibuprofen) and good fluid intake will help.

If deemed necessary, there are several procedures to remove, or break down, larger kidney stones. Depending on the size and location of the stone this may require surgical removal through a special type of endoscope (a telescopic instrument inserted through the urethra and bladder up into the ureter). The stones may be crushed and removed through this tube. Other stones may be suitable for treatment by extracorporeal shock wave lithotripsy, where the stones are disintegrated by focusing shock waves on them from outside the body.

If an underlying metabolic disorder (such as gout) is detected, medical treatment and a special diet may be initiated to prevent recurrence of stones. However, no metabolic disturbance is detected in the majority of cases.


Prevention of Kidney Stones

Kidney stones are more likely to happen if you don't drink enough fluids, if you're taking some types of medication, or if you have a medical condition that raises the levels of certain substances in your urine. Water intake, diet, and medications are the three main methods of preventing kidney stones which are described further below:


  • Water intake


To avoid getting kidney stones, make sure that you drink plenty of water each day to avoid becoming dehydrated. It is very important to keep your urine diluted to avoid waste products forming into kidney stones. You can tell how diluted your urine is by looking at its colour. The darker your urine is, the more concentrated it is. Your urine is usually a dark yellow colour in the morning because it contains a build-up of waste products that your body has produced overnight.

Normally, you should drink at least six to eight glasses (about 1.2 litres) of water each day. However, people who have had a kidney stone before are encouraged to increase their fluid intake to two to three litres each day in order to 'flush out' waste products that can cause stones to develop.

Drinks such as tea, coffee, and fruit juice can count towards your fluid intake, but water is the healthiest option and is best for preventing kidney stones developing. You should also make sure that you drink more than the recommended daily amount when it is hot, or when you are exercising, in order to replenish fluids that are lost through sweating.


  • Diet


If your kidney stone is caused by an excess of calcium, you may be advised to reduce the amount of oxalates in your diet. Oxalates prevent calcium from being absorbed by your body and can accumulate in your kidney to form a stone.

Foods that contain oxalates include:

  • beetroot
  • asparagus
  • rhubarb
  • chocolate
  • berries
  • leeks
  • parsley
  • celery
  • almonds, peanuts, and cashew nuts
  • soy products
  • grains, such as oatmeal, wheat germ and wholewheat

You should not reduce the amount of calcium in your diet unless your GP recommends it. Calcium is very important for maintaining healthy bones and teeth.

To avoid developing a uric acid stone, you should reduce the amount of meat, poultry, and fish in your diet.


  • Medicines


The type of medication that your GP prescribes will depend on the type of kidney stone that you have. For example, if you have previously had a struvite stone, you may need to take antibiotics. Antibiotics will help to prevent bacteria from causing a urinary tract infection (UTI), which will infect your kidney and may create a stone. To avoid uric acid stone formation, you may be prescribed medication to change the levels of acid, or alkaline, in your urine e.g. Allopurinol.


Treatments

Treatment can help most people with epilepsy have fewer seizures or stop having seizures completely.

Treatments include:

  • medicines called anti-epileptic drugs – these are the main treatment
  • surgery to remove a small part of the brain that's causing the seizures
  • a procedure to put a small electrical device inside the body that can help control seizures
  • a special diet (ketogenic diet) that can help control seizures

Some people need treatment for life. But you might be able to stop treatment if your seizures disappear over time.


Medications

The objective of treatment is to prevent the occurrence of seizures by maintaining an effective dose of one or more antiepileptic drugs. Anti-epileptic drugs are selected based on the presenting epilepsy syndrome, concomitant medication, other conditions, and sex.

Common antiepileptic medications include:


TABLE


Side Effects of Medications

Side effects are common when starting treatment with antiepileptic medications. Some may appear soon after starting treatment and pass in a few days or weeks, while others may not appear for a few weeks.

For information about the side effects of your medicine, check the information leaflet that comes with it. General common side effects include:

  • drowsiness
  • a lack of energy
  • agitation
  • headaches
  • tremor
  • hair loss or unwanted hair growth
  • swollen gums
  • rashes – contact your GP or specialist if you get a rash, as it might mean you're having a serious reaction to your medicine

Contact your GP or specialist if you experience symptoms similar to being drunk, such as unsteadiness, poor concentration and vomiting. This could mean your dose is too high.

Always discuss with your doctor if you are thinking of having a baby. Some of these medicines can harm your unborn baby, particularly sodium valproate. Your doctor may suggest switching to another medication if there’s risk to your baby.


Free Medicines

In Ireland, if you have been diagnosed with Epilepsy you are entitled to get the medications used to treat this condition, free of charge. The scheme under which these medications are dispensed is the Long-Term Illness scheme (LTI) and you must apply and have an LTI number to be allowed get medicines free. The application needs to be filled out by your GP and your pharmacy before being returned to your local community health organisation.


Advice From The Pharmacist

  • Call 999 for an ambulance if you suspect someone is experiencing a fit for the first time, or if it lasts for more than 5 minutes, or is having serious breathing issues.
  • If you are diagnosed with epilepsy you are entitled to free anti-epileptic medications through the Long-term illness scheme.
  • If you experience a seizure or are diagnosed as epileptic, it is your responsibility to tell the National Driver License Service (NDLS) and your insurance provider of any long-term or permanent injury or illness that may affect your ability to drive safely.
  • If you are female taking antiepileptic medications and are thinking of becoming pregnant discuss with your pharmacist or doctor.


Supports Available In Ireland


References