Updated by admin on
Sunday, August 10, 2014 03:18 PM IST
Madurai:
URINARY SYSTEMS – Kidney stones
In the era of advanced ultrasound scanning, most renal stones (kidney stones) are diagnosed without any symptom. Nowadays, renal stone disease is a significant health problem. Formation of stones in the urinary tract is called urolithiasis and in kidney is termed nephrolithiasis. This causes an acute painful condition called renal colic. It strikes without warning at any time and the pain is often described as worse than labour pain.
Incidence – Men are affected by renal stones more commonly than women. The male-to-female ratio is approximately 3:1. It occurs commonly between 30-50 years of age. It is mostly found in persons whose diet is low in vitamins. Approximately 80-85 per cent of stones pass spontaneously without any mortality. Its recurrence is likely to occur if it is left without treatment.
Causes and pre-disposing factors – Stones occur due to abnormal and excessive accumulation of substances such as calcium, oxalate, uric acid and cystine in the urine. Usually, these substances are dissolved in the urine by the presence of substances like citrate and pyrophosphates. The formation of stones (renal calculi) is a complex process and depends on the various factors which include:
1) Changes in urinary PH in diseases like renal sepsis, renal ischemia and renal tumours
2) Increased urinary concentration due to dehydration – Most stones arise in the kidney when urine becomes supersaturated with salts and crystals that are capable of forming stones. Factors of crystallisation play a major role in stone formation – like citrate, magnesium and pyrophosphate.
3) Urinary inadequate drainage – slow obstructive urine flow will encourage salt precipitation due to stagnation
4) Hyperparathyroidism may also lead to hyper calcuria (increased calcium in urine)
5) Vitamin A deficiency
6) Increased intake of vitamin D, calcium, protein, tea or fruit juice
7) Prolonged immobility where stone formation is due to hypercalcuria
8) Metabolic disorder (e.g., hypercalcemia or hyperparathyroidism)
9) Hereditary disease (e.g., cystinuria)
10) Underlying disease of the small bowel
11) Urinary tract infection
Symptoms: Many stones are asymptomatic until they begin to move down the ureter, causing pain due to obstruction. The main symptoms of renal colic are:
1) Pain – The most common symptom of kidney stone is severe back or abdominal pain. The colicky-type of pain is the sudden onset of very severe pain sub costally and it radiates interiorly and anteriorly towards the groin. The pain generated by renal colic is primarily caused by the dilation, stretching and spasm caused by the acute ureteral obstruction. As the stone moves lower, the pain may be felt in the genitals, especially the testicles in men and the labia in women. In infants, stone pain is often confused with colicky abdominal pain. Most of the calculi are originating within the kidney and proceed distally, creating various degrees of urinary obstruction as they become lodged in narrow areas, including the ureteropelvic junction, pelvic brim, and ureterovesical junction. Location and quality of pain are related to the position of the stone within the urinary tract.
The severity of the pain depends on the degree and site of the obstruction and not on the size of the stone. Pain also varies in intensity with the presence of ureteral spasm and infection a) If stones block in the ureteropelvic junction – pain will be severe with a deep back pain without radiation to the groin and due to distension of the renal capsule. b) If stones block the upper urethra and renal pelvis – Pain will radiate from back to front misguiding to gall stones on right and peptic ulcer in left. c) If stones block the middle urethra – pain will radiate anteriorly and suprapubically. This mid urethral pain usually misguides to appendicitis on the right. d) If stones block the distal urethra – pain will radiate into the groin or testicle in the male or labia majora in the female. If a stone is lodged in the intramural urethra, symptoms may appear similar to cystitis or urethritis. These symptoms include suprapubic pain, urinary frequency, urgency, dysuria, stranguria, and pain at the tip of the penis. e) If stones enter the bladder, pain is often switched off and stone gets circular or oval shape as it rolls inside the bladder and is passed easily during urination.
2) Nausea and vomiting with excessive sweating – This is due to the common nerve supply by vagus nerve to renal pelvis and bowels. This may also misguide the patients that it these are bowel disorders.
3) Urinary tract infection – Symptoms may include fever, chills, sweats and pain with urination. Kidney stones and urinary tract infection can cause block with urine retentions. Red blood cells and pus cells will be found in the urine. Also albumin, hyaline casts and crystals will be seen.
4) Fever – It is not a part of the presentation of uncomplicated nephrolithiasis. If fever is present, rule out hydronephrosis, pyonephrosis, or perinephric abscess. Such a condition is potentially life-threatening and should be treated as a surgical emergency.
Stone analysis – Stones which are passed spontaneously should be saved for analysis of its type and composition. Chemical analysis of a calculus passed in the urine or removed surgically is very helpful in identifying the underlying causative factor and aid in getting relief from recurrences. But in case of lithotripsy, renal stones get fragmented, and a whole stone is not available for analysis. According to composition, stone types are:
Calcium oxalate: 75 per cent
Calcium phosphate: 15 per cent
Uric acid: 8 per cent
Other types are rare which include Cystine: 1 per cent and Xanthine: 1 per cent
Stones can also be classified:
Primary stones are stones which are formed through the tendencies. For example-oxalate and uric acid and urate stones. Secondary stones are stones that occur after infection. For ex-formation of magnesium, ammonium and phosphate stones. These stones are formed in the alkaline urine. The stones formed due to vitamin A deficiency also come under this category.
Calcium stones – Of the four main types of urinary stones, calcium stones are the most common. The calcium may combine with other substances such as oxalate, phosphate or carbonate to form the stone. Any increased levels of calcium and oxalates will increase the tendency to stone formation. Small intestine disorders and defective kidney disorders may allow too much calcium in the urine. The risk
of calcium stone formation is increased in condition of hyperparathyroidism and metabolic disorders. This type of stone is extremely hard with surface rough with spicules. It is dark in colour, usually single and radio-opaque. It usually arises in acid urine.
Oxalate stones – The toxicity of oxalate in humans results from the extreme insolubility of its calcium salt or calcium oxalate, which may precipitate in the renal parenchyma or renal tract, causing either nephrocalcinosis or stones. Diseases of the small intestine increase the tendency to form calcium oxalate stones. These stones are dark brown in colour.
Uric acid stones – It is the second most common type of stone. Uric acid stones occur because of too much uric acid in the urine. They might occur due to dehydration after strenuous exercise or during an illness. Uric acid stones are common in people who have got a disease that causes high uric acid levels in the blood. For example gout patients often suffer from uric acid stones. Reduced urine volume with dehydration, hyperuricaemia, and a urinary PH that is consistently less than 6 are the important factors that influence uric acid stone formation. These types of stones are usually multiple, moderately hard, easily broken and not radio-opaque. They are brownish white in colour and usually occur in acid urine.
Phosphates stones – These types of stones are smooth and chalky with tendency to easily break. It is dirty white in colour and radio-opaque. It usually arises in alkaline urine which is favourable for infectious diseases. In this alkaline condition it grows enormously and takes the form of pelvic calyceal system assuming the shape of stag-horn. Stones are frequently diagnosed in children and women who have recurrent urinary tract infection. They can grow very large and obstruct the kidney, urethra, or bladder. A urine PH greater than 7 suggests presence of urea-splitting organisms, such as Proteus, Pseudomonas, or Klebsiella species, and struvite stone.
Cystine stones – This is a rare type of kidney stone that occurs in children of all ages due to genetic condition. Urine becomes supersaturated with cystine resulting in crystal deposition. All cystine calculi are radio-opaque. Cystine stones are pink or yellow in colour and are soft stones.
Xanthine stones occur in the rare condition of Xanthinuria which is also an inherited genetic condition. Xanthine is usually converted into uric acid. So, its diagnosis is made by low-level of uric acid. It is smooth, round, brick red/orange sediment in the urine of children.
Investigations:
Urinalysis will identify PH, and microscopy will identify cystine crystals, haematuria, pyuria and bacteria. Also culture and sensitivity tests of urine will guide on the treatment to be followed. A 24-hour urine collection is necessary in evaluating renal stones. Microscopic haematuria is present in over 90 per cent of cases with stones.
Kidney ultrasound – Ultrasound is more sensitive in detecting nephrocalcinosis and may detect radiolucent stones. Ultrasound cannot be used to find small stones (less than 3 mm).
Abdominal X-rays – Small stones may not be detected by this method and plain abdominal radiography should be performed if the suspicion of stones is high.
Intravenous pyelogram – Various reactions have been attributed to intravenous contrast agents including nausea, vomiting, urticaria, bronchospasm and cardiac arrhythmias.
Abdominal CT scan and abdominal/kidney MRI will also give a clear picture about the disease condition.
Complications:
1) Infection
2) Kidney damage – affected kidney will become functionless with hydronephrosis.
3) Recurrence of stones
Preventive measures:
Prevention with dietary changes
Drink – Plenty of water should be taken – at least 3 litres of water or an intake to make a volume of 2 litres of urine a day should be taken. After doing strenuous exercises or when passing yellowish urine, additional water should be administered. Taking tender coconut daily is good for the kidney function and also prevents stone formation.
Eat – Low-fat diet with increased natural foods and plenty of fruits should be taken. Good protein diet from vegetarian sources, such as beans is a good intake.
Avoid: Consumption of animal protein from meat, dairy, cheese, poultry, or fish should be avoided in the case of patients having calcium stones.Calcium supplements should be avoided. Ice creams, chocolates, tea, soft drinks and drinks which are rich in calcium should be avoided. Consumption of spinach, greens, vegetables, black pepper, almonds and peanuts should be avoided for patients suffering from oxalate stones. Citrus fruits, apples, tomato, orange, lemon and strawberries should be avoided in the case of patients suffering from uric acid stones but for patients with calcium stones, it is allowed. A sedentary lifestyle should be followed since physical activity, especially walking and jogging, can bring the stone down.
Restrict – Salt should be restricted
Prevention with controlling urinary tract infections
Long intervals between urinating should be avoided.
More water intake should be made.
The bladder should be emptied after intercourse as a preventive measure.
Treatment – Treatment goals include relief of symptoms and prevention of further symptoms. Treatment varies depending on the type of stone and the extent of symptoms and complications. Also, it 1) Depends on the size – Most of the small stones with relatively mild hydronephrosis can be treated with observation and medicines. If the stone is 4 mm or smaller, the stone is easily passed in 90 per cent of the cases. Stones of 5-7 mm have a 50 per cent chance of passing spontaneously. Calculi larger than 7 mm are unlikely to pass unassisted. In general, smaller stones are more likely to pass spontaneously. But a stone may take days or weeks or even months to pass.
2) Location of the stone – Passing of the stone also depends on the exact shape and location of the stone and the specific anatomy of the upper urinary tract in that particular individual. For example, the presence of an ureteropelvic junction (UPJ) obstruction or a ureteral stricture could make it difficult or impossible for even very small stones to pass.
3) Number of stones blocking the flow of urine out of the kidney
4) Whether it is involved on one or both sides
5) Infection – In the acute phase, intermittent pain usually lasts for 1 day to 2 days. The urinary tract does not resolve until the stone is removed entirely.
Medication – In Allopathy, the first line of treatment for a renal colic patient starts with obtaining intravenous (IV) fluids, analgesic, and antiemetic medications since many of these patients are dehydrated from nausea and vomiting.
Also most of the patients are prescribed Ayurvedic or Siddha preparation such as calcurin or cystone, etc. But getting recurrence of stones once in a year or two is very common.
Surgical option – If the stone is not passed spontaneously, surgical removal of the stone may be required. Lithotripsy may be an alternative to surgery. In this extra-corporeal shockwave lithotripsy, ultrasonic waves or shockwaves are used to break up stones so that they may be expelled in the urine or removed with an endoscope. The stones, once broken, pass out as fine sand particles.
Stones are also removed using cystoscopy or ureteoscopy or percutaneous surgery.
In the case of large stones impacted in the kidneys, open surgery may be required – Pyelolithotomy – to remove stones in pelvis of kidney; Nephrolithotomy – to remove large stones in renal parenchyma without opening pelvis; Ureterolithotomy – to remove stones in the ureter that are not amenable to other treatment; and Nephrectomy – partial or the whole kidney is removed depending upon the extent of damage.
Prognosis – Kidney stones are usually excreted without causing permanent damage. But they tend to recur, especially if the underlying cause is not found and treated. Prognosis depends on the extent of the damage caused to the kidney. If it is involved in a single kidney, the prognosis is good.
Homoeopathic approach: The first medicine is water, without this even right medicine cannot work. The second one is surely Homoeopathy medicine which can stop the tendency to form stones. When patients suffer constantly from certain disease conditions which are untreated or not properly treated, then they become tendencies. Mostly patients who suffer from renal stones will constantly suffer from its tendencies. These types of patients can be cured permanently in Homoeopathy. Surgery can be avoided in many cases of kidney stones but in advanced conditions, surgery is the only way.
By acting in a natural way, Homeopathy increases the immune power and also removes tendencies and thus helps mankind to live in a modern polluted world.
Tricks and tips to expel stone
1) Take fluids in abundance: Drink lots of liquids so that kidney stones usually pass on their own. It increases the speed of the movement of a stone through the urinary tract. If nausea and vomiting is there, IV fluids can be given. Usually, when IV fluids are administered (3 pints) at a fast rate, it accounts for 1,350 ml of fluid. But drinking one litre of water at a time is well and good. The principle is to take a lot of fluids at a time to flush the stone out.
2) Pass the urine forcibly and speedily after getting the bladder filled up so that the stone in the pathway may get down faster with suction force and turbulence. The early you treat, you get speedier and complete cure. In all natural way of healing, the immune power is increased against diseases so that recurrences are avoided. When the cure is not in the proper way, the disease often recurs. There are many drugs in Homoeopathy which relieve pain, to expel stones, to break stones, and for its associated complaints. Some of those are Beri beri
vulgaris, Ocimum canum, Lycopodium, Sarasaparilla, Pareira Brava, Calc carb, Urtica urens, Nat phos, Terebinth, Belladona, Dioscorea, Cantharis, Hydrangea, Millefolium, Uva ursi etc., Depending upon the symptoms present in the patient, drug selection differs.
These Homoeopathy medicines not only relieve pain but also treat the condition permanently. The homoeopathic approach is a natural way to help the body by supporting the body’s own process of healing. In recent days, people are aware of Homeopathy’s miraculous cure which is permanent and safe. This is the right time for the wise to get rid of their complaints without any torture (like injections or surgeries) and live healthily.
(Disclaimer: The contents of this column are for informational purpose only. The content is not intended to be a substitute for professional healthcare advice, diagnosis, or treatment. Always seek the advice of healthcare professional for any health problem or medical condition.)
Dr. S. Chidambaranathan
Laxmi Homeo Clinic
24-E, New Mahalipatti Road,
Madurai – 625001
Tamilnadu
India
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