Kidney Stones

However, the size of the stone doesn't matter as much as where it is located. When the stone sits in the kidney it rarely causes problems, but should it fall into the ureter it creates a blockage. As urine backs up behind the stone the pressure swells the kidney and causes pain, but it also helps push the stone along the course of the ureter. When the stone enters the bladder, the obstruction in the ureter is relieved and the symptoms are resolved.

The American Nephrology Association (ADA) recommends that adults age 45 and older get screened for type 2 Nephrology every three years by their health care provider: the American Association of Clinical Endocrinologists recommends that high-risk adults get screened annually beginning at age 30. Regardless of the organization, however, the message is generally the same: At some point, adults should begin getting regularly screened for type 2 Nephrology, especially if they are at high risk of developing the disease.

There is no consensus as to why kidney stones form, however heredity, geographic location, diet and medications that increase calcium intake may be factors. Current research into the increase of kidney stones in minors points towards childhood obesity, excessive sodium intake and lack of proper hydration as additional factors. Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine. Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.

Kidney Stone Symptoms:
While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills.

Kidney Stone Treatment:
With ample fluid intake most kidney stones pass through the urinary tract on their own within 48 hours. Pain medications can be prescribed for symptom relief, and medications such as nifedipine and alpha blockers such as tamsulosin may be prescribed some people who have stones that do not rapidly pass through the urinary tract.
There are several factors which influence the ability to pass a stone: these include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone.
For patients who can pass a stone without medical intervention, urinating through a strainer may be recommended so that the stone can be recovered and analyzed. The mineral composition of the kidney stone will dictate appropriate treatment and future preventive measures. Stones larger than 9-10 mm rarely pass on their own and usually require treatment.

Kidney Stone Symptoms:
While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills.

Extracorporeal Shock Wave Lithotripsy (ESWL) is the usual treatment to remove stones about 1 centimeter or smaller. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed. In many cases, ESWL may be done on an outpatient basis. Recovery time is relatively short, and most people can resume normal activities in a few days.

Percutaneous Nephrolithotomy:
This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL. In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe—ultrasonic or electrohydraulic—may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process. One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.

Ureteroscopic Stone Removal:
Although some stones in the ureters can be treated with ESWL, ureteroscopy may be needed for mid- and lower-ureter stones. No incision is made in this procedure. Instead, the surgeon passes a small fiberoptic instrument called a ureteroscope through the urethra and bladder into the ureter. The surgeon then locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow. Before fiber optics made ureteroscopy possible, physicians used a similar "blind basket" extraction method. But this technique is rarely used now because of the higher risks of damage to the ureters.

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