Nephrolithiasis (Kidney Stone Disease)
Types of kidney stones
- Calcium Oxalate Stones are most common
- Calcium Phosphate
- Uric Acid
- Struvite
- Cystine
ASSOCIATED MEDICAL CONDITIONS
Several conditions predispose to stone formation, including
- Gastrointestinal malabsorption (e.g., crohn’s disease, gastric bypass surgery)
- Primary hyperparathyroidism
- Obesity
- Type 2 diabetes mellitus
- Distal renal tubular acidosis
- Hypertension
- Gout
- cardiovascular disease
- Cholelithiasis
- Reduced bone mineral density
- Chronic kidney disease.
PATHOGENESIS
A clinically useful concept is supersaturation (the point at which the concentration product exceeds the solubility product). Urine in most individuals is supersaturated with respect to one or more types of crystals, the presence of inhibitors of crystallization prevents from stones forming. inhibitor of calcium-containing stones is urine citrate.
Supersaturation→Nucleation→ Crystallization→Renal Calculi
CAUSES
- Low Urine Volumes
- High Ambient Temperatures,
- Low Fluid Intake
- High Protein- Higher intake of animal protein may lead to increased excretion of calcium and uric acid as well as to decreased urinary excretion of citrate, all of which increase the risk of stone formation.
- High Sodium- Higher sodium and sucrose intake increases calcium excretion independent of calcium intake.
- Low Calcium
- High Sodium Excretion
- High Oxalate Excretion
- High Urate Excretion
- Low Citrate Excretion
- Sugar-sweetened beverage consumption may increase risk
- Vitamin C supplements are associated with an increased risk of calcium oxalate stone formation in men, possibly because of raised levels of oxalate in urine.
PREVENTION OF RENAL STONE
Diet Fluid At least 3-4 litres
Sodium Restrict intake
Protein Moderate,not high
Calcium Plenty in diet (because calcium forms an insoluble salt with dietary oxalate lowering oxalate absorption and excretion)
Avoid supplements away from meals(increase calcium excretion without reducing oxalate excretion)
Avoid foods that are rich in oxalate (spinach,rhubarb)
SYMPTOMS
Stones in the renal pelvis may be asymptomatic
Pain abdomen-Obstruction related to the passing of a stone leads to severe pain, often radiating to the groin
Nausea
Vomiting
Diaphoresis
Light-headedness
Hematuria
Pyuria
Urinary tract infection (UTI)
INVESTIGATIONS
Blood
Complete blood count
Sugar
Lipid profile
Urea
Creatinine
Uric acid
Sodium
Calcium
Potassium
Parathyroid hormone (PTH)
25-hydroxy vitamin D
Urine
Red and white blood cells
Sediment
Casts
Creatinine
Urea
Albumin
Sugar
Crystals
IMAGING
Ultrasound abdomen
CT abdomen
Treatment
Homeopathy medicine