Kidney stones

As Kidney stones (nephrolithiasis) is a disease of the urinary tract or kidneys, in which small to larger crystalline stones form, which can only be eliminated with great pain. Typical first signs are severe pain in the groin or lower abdomen. At the beginning of kidney stone disease, however, those affected do not feel any symptoms, as the kidney stones are usually still small.

What are kidney stones?

Kidney stones are solid structures that arise in kidney stone disease (nephrolithiasis) in the kidneys and in the urinary tract (urinary bladder, ureter). Most kidney stones are made up of calcium salts, but can also consist of uric acid, cystine or magnesium ammonium phosphate.

The frequency peak is in adults who are 30 to 60 years old. It affects men about twice as often as women. The size of the kidney stones formed can vary widely. It ranges from a few millimeters (about the size of a grain of rice) to many centimeters (so-called renal pelvis pouring stones, which can completely fill the renal pelvis). In about 80 of the cases these deposits occur on one side.

causes

Kidney stones are formed by an increased concentration of certain substances in the urine. The causes for this are varied and range from nutritional factors and insufficient fluid intake to a lack of exercise to certain metabolic diseases and genetic factors. The causes of the majority of kidney stone sufferers remain unexplained.

The substances that contribute to the formation of kidney stones are components of the urine that are normally excreted in dissolved form via the kidneys. These substances include calcium, phosphate, uric acid, cystine and oxalate. When they are so abundant in the urine and can no longer dissolve, they crystallize out. If the urine concentration is appropriate, new layers of material will accumulate on the crystals that have formed, so that constantly growing onion skin-like kidney stones are formed.

Symptoms, ailments & signs

Kidney stones are a disease of the kidneys with typical and fairly clear symptoms. In the early stages there are no signs of pain or pain as the kidney stones are simply too small. However, if these increase in size and weight, the first pain in the groin area can be expected.

Occasionally there are also cramps in the lower abdomen. Another symptom may be pain and a burning sensation when urinating. This symptom occurs in both men and women. Another and at the same time very typical symptom associated with kidney stones is severe nausea. The nausea dissolves a general malaise and loss of appetite at the same time, so that affected people are considerably restricted in everyday life.

If you leave existing kidney stones without any treatment, you have to expect a significant worsening of the symptoms. A quick improvement and healing can only be achieved if affected persons consult a doctor immediately. Otherwise, the painful urination in particular will increase.

Course of disease

Become Kidney stones treated today, a favorable course can almost always be expected. Depending on the therapy method, the affected person is usually relieved of the symptoms after a short time. However, complications can also arise if, for example, the kidney stones block the urinary tract and the urine or urine cannot be excreted. As a result, bacteria can penetrate the renal pelvis more easily and cause inflammation.

If the kidney stones are not treated at all, the typical pain when urinating increases. There may also be other symptoms, such as severe back pain, fever and chills. In rare cases, the kidneys can even fail completely. The resulting blood poisoning can then lead to life-threatening symptoms.

Complications

Due to a favorable course, complications with kidney stones rarely occur. More than 80 percent of the stones are eliminated from the body with the urine. How long this process takes depends on the size of the kidney stones. However, sequelae are possible if the urine is obstructed by the stones.

Renal colic is one of the most unpleasant complications of kidney stones. It makes itself noticeable through sudden onset of severe pain, which shows up like attacks and cramps. They are localized in the kidney area, but they can also radiate into the groin, thighs or genitals. Many sufferers also experience restlessness, fear, nausea and vomiting.

Renal colic lasts from a few minutes to several hours. In order to avoid permanent damage to the kidneys and urinary tract, medical therapy must be given. If the urinary tract is blocked by kidney stones, pathogens such as bacteria can penetrate the organism more easily and cause urinary tract infections such as urocystitis.

It is not uncommon for the kidneys to be affected by interstitial nephritis. The affected people suffer from urination problems, fever, chills and severe back pain in the kidney region. A dreaded complication of kidney stones is urosepsis. It occurs when bacteria are washed into the bloodstream. It can sometimes be life-threatening.

Treatment & Therapy

Against acute Renal colic and Kidney stones Above all, appropriate pain therapy and the elimination of any urinary obstruction help. Most of the time, kidney stones go off by themselves in the urine. The person affected can probably support such a spontaneous loss of stones by drinking plenty of fluids, taking anticonvulsant medication and exercising a lot. If the spontaneous exit is not the case, the kidney stone can be removed in different ways.

In extracorporeal shock wave lithotripsy (ESWL), the doctor smashes the kidney stones from the outside using shock wave therapy under ultrasound or X-ray control. The resulting stone fragments then normally go off by themselves with the urine in the following 3 months.

Percutaneous nephrolitholapaxy (PCNL) is mainly used for larger stones. An endoscope is inserted through a tiny incision in the skin, through which the stone is then broken up and removed.

The loop extraction is only carried out for kidney stones that are located in the lower third of the ureter. The doctor inserts a special loop into the ureter via a cystoscopy, with the help of which the kidney stone is pulled out.

Nowadays, kidney stones are only removed surgically (through a laparoscopy or open surgery) in less than 5% of those affected.

Some kidney stones (uric acid and cystine stones) can be resolved by drug therapy (so-called chemolitholysis). In addition, the uric acid level can be lowered with the help of the drug allopurinol.

Outlook & forecast

Kidney stones offer a varying prognosis. Four fifths of all kidney stones go away with the urine on their own without further action. After the kidney stones have passed, the patients are usually symptom-free and do not require any further medical examination or treatment.

However, kidney stones can also cause serious complications. As a result of kidney stones, for example, blood poisoning in the urinary tract, constrictions in the urinary tract or severe inflammation of the renal pelvis can develop. In the worst case, the kidney stones trigger acute kidney failure. In about 50 percent of cases, kidney stones recur after successful treatment. Comprehensive preventive care reduces the relapse rate and thereby improves the prospect of a symptom-free life. The prognosis for kidney stones is made by the specialist.

The size and number of kidney stones must be taken into account. Any co-morbidities and the general health of the patient are also part of the prognosis. The medical professional assesses the progress of the disease in terms of kidney health and the preventive measures the patient is taking. As a rule, the prognosis is adjusted as part of the regular check-ups that must be carried out after an illness with kidney stones.

prevention

Among the main preventive measures against Kidney stones First and foremost, you should drink enough fluids (around 3 liters per day). This dilutes the urine and prevents it from becoming oversaturated with stone-forming substances. Drinking should be evenly distributed throughout the day because the concentration of stone-forming substances can also be increased at night.

The risk of kidney stones can also be reduced through regular exercise, preventing obesity or shedding excess pounds. The positive effects are supported thanks to a balanced diet rich in fiber.

Aftercare

Since new kidney stones often form again, this cycle needs to be analyzed individually and, above all, broken. So that stone formation does not occur again, the risk should be significantly reduced, above all by changing drinking and eating habits. The amount of water the person affected should drink should enable the body to produce at least two liters of urine.

A balanced diet, the reduction of obesity, moderate physical activity and, above all, sufficient and regular drinking are also recommended. Those affected should prefer fruits and vegetables in their diet, citrus fruits in particular are considered helpful. Patients should also avoid foods rich in oxalates, such as spinach, rhubarb, coffee, black tea, chocolate, cola, and nuts.

Care should also be taken to ensure an adequate supply of calcium. Whereas the amount of salt in food should be significantly reduced.The consumption of animal proteins should also be reduced. A qualitative urinary stone analysis is recommended as a diagnostic measure after the kidney stones have been removed.

Patients are recommended to drink more than four to six liters per day and night. The goal is a light urine color. In addition, supplementary medication is usually necessary.

When should you go to the doctor?

If you notice kidney pain, reddish urine, or decreased urine flow, you may have kidney stones. A doctor should be consulted if the symptoms persist for a long period of time or are associated with serious complaints. Medical advice must be sought if there is blood in the urine or urinary retention. Even severe pain that affects your well-being needs to be clarified by a doctor. If left untreated, it can lead to serious complications, such as urethral injuries or infections. Therefore, an appointment should be made with the family doctor at the latest when stabbing pain occurs. People who already suffer from chronic kidney disease are best advised to speak to the internist in charge.

High-risk patients, such as people who lead an unhealthy lifestyle and eat a particularly high-fat diet, should speak to a nutritionist to accompany the symptomatic treatment. If the symptoms do not improve despite taking medication and other means, it is best to see a urologist. A special colic medication can then be prescribed to dissolve the kidney stones. In addition to the urologist, a nephrologist or a gastroenterologist can be consulted. Women see a gynecologist if they suspect kidney stones. If you have children with the above symptoms, you should first go to the pediatrician, who can clarify the symptoms and initiate treatment.

You can do that yourself

If the diagnosis is "kidney stones", the size and location of the stones are important for healing. Herbal supplements can be helpful for small stones or kidney gravel. A lot of water, bladder and kidney teas or teas made from herbal preparations such as dandelion or grouse root with a diuretic effect in connection with a lot of exercise can already cause the removal of stones or kidney gravel. Warmth is helpful when resting. The doctor will prescribe medication if necessary.

To control the success, urinating through a fine sieve is recommended. The result can be shown to the attending physician at the next visit. If a kidney stone does not go away, the urinary tract is blocked and an infection develops, the doctor will decide how the kidney stone is removed. In 90 percent of cases, kidney stones are smashed and get out of the urinary tract with the urine. In stubborn cases, the stone is removed by a small operation.

To counteract the formation of new kidney stones, you should still drink a lot, i.e. at least 2.5 to 3 liters per day. Lots of exercise and a healthy diet are definitely helpful. The doctor or nutritionist will know which foods should be avoided to avoid recurrence.