The Painful Nature of Kidney Stones: Causes, Symptoms, and Treatment

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Kidney stones, one of the most painful of the urologic disorders, are not a product of modern life. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to healthcare providers and more than half a million people go to emergency rooms for kidney stone problems. With the right medical care, kidney stones can be prevented and treated.

Kidney stones, hard mineral deposits that form in the kidney, affect about 1 in 10 people. Often causing severe and sharp pain, kidney stones require professional treatments to help the body pass them safely, quickly, and with reduced pain. Kidney stones’ global prevalence is expected to grow over the next few years, especially in the United States. This is due to dietary changes and genetic factors. It is estimated that the prevalence of kidney stones will be around 1 in 7 by 2050. In this article, we will discuss the symptoms, causes, and treatment for kidney stones.

Overview of Kidney Stones

Kidney stones can form for a number of reasons and due to a variety of contributing factors. Over the course of normal kidney function, many substances can be crystallized from the urine, forming the necessary nidus for the development of stones. The most common substance in kidney stones is calcium oxalate. When the concentration of calcium and oxalate is increased beyond the regular kidney’s ability to excrete the excess, then crystals can form. The exceptionally unusual finding of high urine oxalate can also lead to the development of calcium oxalate stones, and in some cases, dietary oxalate is responsible for quite an exuberant amount of oxalate in the urine, also contributing to a stone. The genetic disorder called primary hyperoxaluria represents a challenging case for those who have it; their kidneys often fail due to their kidneys’ resistance to increased dietary oxalate.

Anatomy and Function of the Kidneys

The kidneys are attached to our outer back muscles (the muscles we feel when we rub our fingers along our lower back). Our internal organs are protected by a “cage” made of the bones of the back and chest. This is called our ribcage. Blood vessels, called renal arteries, enter the kidneys. Blood vessels, called renal veins, leave the kidneys. The kidneys look a bit like fists and are about the size of adult fists in children. The head of each kidney is called the renal cortex. The middle region looks striped and is called the renal medulla. The inner point of each kidney is called the renal pelvis, which is the point into which the urine collection tubes enter.

The kidneys are two organs located on either side of the backbone in the lower abdomen, near the back. Each kidney is about the size of a fist. Its main function is to clean the body’s blood. All the blood in our bodies travels through the kidneys many times each day. The kidneys remove wastes, control the body’s fluid balance, and keep the right levels of electrolytes. The waste and extra water become urine. The urine flows to the bladder through the two long tubes called the ureters. The muscles of your bladder push the urine out when it becomes full.

Structure of the Kidneys

In the nephrons, the blood is then cleaned and the waste products and the excess salts and water convert into urine. The urine then moves into the large collecting ducts, which are funnel-shaped digestive organs, through nephrons where further filtrations occur. These structures, known as tubes, collect the final urine and drive them out of the kidneys. Meanwhile, the remaining much cleaner blood returns through the veins to the body. In summary, the kidneys perform two critical functions – filter the waste materials, toxins, and the excessive fluids from the blood and convert them into urine, thereby regulating the balance of necessary ions, such as sodium, potassium, phosphate, and calcium and also regulating the body’s fluid and acidity levels; and release hormones for a number of essential physiological problems, including regulating the red blood cells, adjusting blood pressure, and aiding in calcium digestion.

Located just below the ribcage, externally each kidney measures about 2 inches in width and is 4 inches in length, and has the shape of a kidney bean. Internally, the kidney is composed of three regions – the renal cortex, medulla, and the renal pelvis. The renal cortex forms the outer area of the kidney and the renal pelvis the inner region. Separating the inner region from the outer area is the medulla. Together, the kidney has more than a million small units working in its outer region, that is the functional units called the nephrons. Blood comes from the arteries of the body into the kidneys and moving from here into the nephrons. Small waste products and excess salts and water are transferred from the blood into the kidneys through millions of glomerular capillaries. These substances are then squeezed into the nephrons through a ball of blood vessels that form the glomerulus in a process known as filtration.

Formation of Kidney Stones

The loop of Henle returns fluid via a countercurrent ion-exchange mechanism. The ascending limb pumps sodium and potassium ions from the urine; this concentrates the urine. The secretion of hydrogen ions acts to restore sodium reabsorption by a countercurrent action, which multiplies sodium excretion. It is this multiplication mechanism which is responsible for the final abnormal situation: kidney stones. The final urine, secreted into the pelvis of the kidneys, contains both mineral-precipitating substances and substances that prevent nucleation and growth of crystals. Normal urine also contains substances that reduce the effects of the precipitating substances.

The journey of kidney stones starts with the formation within the tubifical of the nephron. The tubifical consists of three general parts: the proximal, loop of Henle, and the distal. This structure is also found within the human brain, where it works to reabsorb the cerebro-spinal fluid. Each part of the tubifical serves a different function and plays a role in processing the urine. Although not all the parts of the tubifical are found in the brain, it helps in understanding the working of the brain micromachine.

Types of Kidney Stones

Calcium phosphate stones can form from a high amount of calcium in the urine and combine with other substances including calcium oxalate or female sebum. Calcium phosphate stones can also occur due to an alkaline urine.

Other types of kidney stones are cystine stones, protein arranged in abnormal ways, and calcium phosphate stones. Urease-splitting organisms (Proteus species, for example) can cause cystine and struvite stones. These kidney stones are also called infection stones.

Uric acid stones form as a result of urine that is too acidic and can erode the kidneys and the bladder. Patients living in warm climates are especially at risk for developing uric acid kidney stones.

Struvite stones (magnesium ammonium phosphate or ammonium magnesium phosphate) are primarily found in women and are typically associated with urinary tract infections and indwelling bladder catheters. Struvite kidney stones form rapidly and are among the largest stones found in the kidney.

The two most common groups of kidney stones are calcium oxalate stones and uric acid stones. Although calcium oxalate could indicate a mixture of calcium oxalate, ideally it is more specifically calcium oxalate monohydrate or calcium oxalate dihydrate, two distinct crystalline forms of the compound. Stones of one component or another can be more common, and some practice guidelines for managing these patients recommend different approaches based on the stone type.

Symptoms and Diagnosis

An accurate diagnosis is important for getting the proper treatment instead of treating a wrong disease, whereas time is a big factor. In view of the large number of possible other sources of urine problems, diagnosis can be a real challenge, and a doctor who is experienced in these matters is crucial. Personal and family medical history, as well as a physical exam, are conducted. Afterward, lab tests including blood tests and a urine test are used to determine whether there is an infection or obstruction. The physical exam will detect the swelling and tenderness in the kidney area, and the doctor may also feel the stone at the entrance of the groin. If it is too large, if it moves to the bladder without being noticed, or if it moves to the bladder and is expelled before or while the symptoms appear, kidney stones become less of a medical issue.

A person with a kidney stone usually feels intense and sudden painful spasms in the back or side, or in the lower abdomen or groin, that go on for long or short periods of time. They may also experience bleeding in the urine, increased need to urinate, urgency in passing urine, and other symptoms including nausea, vomiting, chills, fever, and cloudy urine. It is important to note that a person might not have all these symptoms. Sometimes the stone damages the tissue along the urinary tract, which might cause severe pain and may lead to blood in the urine. Afterwards, while the stone moves from the bladder to the urethra, it causes a pressing need to urinate. In some cases, at that phase, urination helps in relieving the symptoms.

Common Symptoms

The causes of kidney stones are varied. The most common ones include reduced fluid intake as a result of sweat in the summertime, bowel problems like constipation, getting less fiber than you should, a low-calcium diet, a high-salt diet, and certain professions such as construction where outdoor work is required. Although poor living habits, bad diets, and lack of hygiene are to blame for the rapid increase in chronic diseases in the twenty-first century, kidney stones are just the opposite. These sharp crystals growing in certain organs are characterized as a shortage of living essentials, especially hydration. This is the painful nature of kidney stones. Unlike carbohydrates, protein, and healthy fats, we often neglect to consume enough water. A recent study showed that people who drink soda and have a high salt intake have a 30 to 40 percent greater chance of having stones, and regular exercise is also a factor in the formation of stones. You should consult your doctor immediately if you think you have a kidney stone so that they can provide you with the treatment you need. Small kidney stones form due to crystallization.

You may experience renal colic with sudden, severe pain or without any pain. If a stone moves into the ureter, it can cause difficulty in urination and additional pain. Burning, tingling, chills, fever, discharge, frequent urination, and the need to urinate overnight should be checked out. If you are in the presence of one or more of these symptoms, you need to consult your doctor. Small stones and foreign substances can be passed at home within a few days, but larger stones may require surgical intervention, depending on how painful they are.

Kidney stone symptoms are variable. In their early stages, you may have no symptoms. If a stone becomes larger as a result of reducing hydration, it may block the kidney, ureter, or bladder. These are some of the common symptoms of a kidney stone.

Treatment Options

Treatment options: Some of the treatments for kidney stones include potassium (K) citrate and allopurinol. These medications can help prevent the formation of crystals that lead to kidney stones. A low-sodium diet can also increase citrate levels in the urine. Time and plenty of fluids are important for kidney stone elimination, as faster elimination can reduce pain. Over-the-counter diuretics can be used to increase urine flow. Pain medication and anti-inflammatory drugs can provide relief and should be taken under the guidance of a healthcare professional. Severe kidney stones require medical attention, as the body cannot absorb or reverse them. In cases of infection or fever, antibiotics may be necessary. Intravenous fluids may be given to those with kidney stones, and surgery may be required if the stones are too large to pass easily, cause bleeding, or are difficult to eliminate.

Medical Management

In patients receiving a diagnosis of an acute stone, opioids and a nonsteroidal anti-inflammatory drug (NSAID) used in combination are ideal treatment for pain. NSAIDs have the additional benefit of causing ureteral smooth muscle relaxation, which may facilitate stone expulsions. In patients receiving a diagnosis of an acute symptomatic stone where non-opioid therapy is contraindicated, a short course of an alpha blocker can augment stone passage. Large stones, end organ compromise in the setting of obstruction, severe infection, or intractable pain represent the only primary indications for immediate surgical intervention. Large numbers of clinical trials suggest that alpha blockers enhance stone passage. High-quality and cost-effective interventions for personnel with well-complicated proximal ureteral stones should be considered, particularly when the expert is dealing with care issues.

Kidney stones can cause severe pain and complications, especially when they are large. Evaluation of stone composition and type, as well as assessment of urinary characteristics, is necessary in the treatment of these patients. Many minerals are important in the formation of kidney stones, but the traditional distinction between calcium and uric acid stone formation dictates that a specific approach be adopted. Prevention of stone recurrence requires long-term treatment with medication, in addition to diet and fluid counsel. The approach to stone therapy includes stone detection and size determination as well as evaluation of the patient’s ability to pass a stone unassisted. The risks of stone passage and complications must be assessed, and intervention only considered when necessary. Fortunately, many minimally invasive options exist for the treatment of symptomatic stones when they require management.

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