Kidney stones (also known as renal lithiasis) form from substances that are part of the urine and that the kidney itself eliminates. They can be as small as a grain of sand or several centimetres and the reasons why they occur are various. Genetic, environmental factors and eating habits influence its appearance. The stones are composed of different minerals such as calcium, oxalate, uric acid, and others.
The treatment of kidney stones comprises three different aspects:
1) The treatment of acute renal colic.
2) The removal of the stone.
3) The actions to prevent recurrences since in 50-70% of cases patients can re-experience new episodes.
Treatment of renal colic
Kidney colic is a very intense pain situation that requires emergency treatment. Doctors hydrate parenterally with dextrose solution and apply anti-inflammatory drugs (ibuprofen, ketoprofen) and antispasmodics intravenously. In addition, local heat and/or hot tub baths are advised. Most of the patients are relieved by these measures. However, when pain persists, it is advisable to administer an opiate such as Demerol and hospitalization to better manage the situation.
When we eliminate the stone spontaneously or instrumentally, you get to feel totally healthy with the disappearance of all the symptoms of intoxication and pain.
Removal of the stone
To extract stones we now have the following therapeutic measures: observation, oral dissolution, open surgery, endoscopic extraction, and extracorporeal lithotripsy.
Observation and medical treatment
Stones less than 0.4 cm, especially ureteral stones, usually come out spontaneously over a period of hours to weeks. After treating renal colic, hydration, administration of antispasmodics and oral anti-inflammatories are indicated continuously every 8 or 12 hours. If after around 15 days there are no positive results, other methods may be prescribed. In addition, light exercises and the intake of vegetables and fruit rich in citrates are recommended to raise the urinary pH.
The long-standing hope of being able to dissolve urinary stones through oral medications has been successfully achieved in uric acid lithiasis.
Dissolution of uric stones can be achieved in almost all cases, in any location. The dissolution of other types of stones has not been possible until today.
All kidney stones can be extracted through open surgery. However, these have been replaced by modern endoscopic surgery and / or extracorporeal lithotripsy treatments. Today, only about 10% of stones with an indication of extraction are operated, and it is reserved for large stones.
Endoscopic surgery and/or endourology
The principle is to concentrate mechanical and ultrasonic waves at a point in space that must correspond to the location of the stone to be treated. The stones are disintegrated with this method and the produced tiny stones are eliminated naturally. This system is quite efficient.
It can be used first as a system to solve very intense renal colic and not manageable with medical methods. It is also used in certain complicated cases caused by the obstruction of ureteral lithiasis.
The prevention treatments
It depends on the composition of the stones:
Calcium: Consists of a diet low in sodium and protein, normal in calcium and without supplements. In specific cases, potassium citrate is recommended.
Uric acid: Diet low in proteins and with allopurinol if necessary and alkalizing the urine with sodium bicarbonate or citrate supplement.
As a general measure to avoid new episodes of kidney stones, we insist on changing eating habits. Patients must drink more than two litres of water daily. The diet must be specially balanced (eating abundant vegetables and citric fruits).
You might also want to read: Urethrotomy
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