Have you recently experienced sudden pain in the side of your back, the worst imaginable kind? Or did you notice any blood in your urine that was not painful? Beware, you might be a stone’s throw away from having a stone lodged in your urinary system that can get worse. A blockage or obstruction of the urinary tract can make one susceptible to infection and the formation of kidney stones, also called calculi.
How are Calculi formed?
Nephrolithiasis or urolithiasis, commonly referred to as a kidney stone, is the formation of calculi at any level of the urinary tract. It is observed in more males than females, and the 2nd and 3rd decade of life (your 'Stone-Age') are the target age groups for such development.
Kidney stones are formed by the crystallisation of calcium or any other nutrient deposits. Under typical conditions, urine citrate, an inhibitor of crystallisation, helps in preventing the formation of calcium stones.
Studies blame the infections or your genes for messing up the functioning of the body and forming these crystals. The formation happens long before the body starts showing any signs of being sick. Risk factors for the same include dietary modification like decreased calcium intake and genetic changes.
A few predisposing factors include obesity, hypertension, cardiovascular disease, gout and type 2 diabetes mellitus. Although rarely fatal, this condition is one of the worst pains a person can experience.
Types of Renal Calculi
The four main types of calculi are as follows:
Calcium: A majority of the stones in the urinary tract (about 75 percent) are made of calcium or a combination of calcium and other substances like oxalate or phosphate. These stones are usually small, hard, and tend to have a rough surface. People who have conditions that make their bodies absorb too much calcium or those with hyperparathyroidism are more likely to develop calcium stones. As the stone grows, crystals continue to stick to the focus or nidus. Decreased urine volume and increased pH levels in the urine are associated with the formation of stones.
Struvite: Magnesium-ammonium-phosphate stones, also referred to as triple phosphate calculi, are mixed stones formed due to infection by organisms like Proteus, Klebsiella and Enterobacter. They are soft and friable and may also resemble the kidney pelvis - the Staghorn Stone.
Uric acid: Such calculi are radiolucent, formed due to consumption of drugs like salicylate (aspirin), acidic pH and chemotherapy in patients suffering from leukaemia. As urine becomes more acidic, its solubility decreases, and crystallisation occurs. These stones are smooth, hard and multiple.
Cystine: Rare in occurrence, these calculi result from a genetic defect in the transport of cystine (an amino acid) across the membrane of the kidney tubules. An increasing amount of this amino acid leads to the formation of tiny, yellowish and waxy crystals.
Diagnosis and prevention
When a stone enters the ureter, it causes pain that intensifies rapidly. Accompanied by nausea and vomiting, the person may present with blood in the urine, fever, and chills. The gold standard for detecting renal calculi is Computed Tomography (CT), which helps determine stone burden. A kidney, ureter and bladder (KUB) X-Ray may also be used to minimise radiation exposure.
Prevention is cure: With a frequent recurrence rate, preventive measures are of utmost importance. Since diluted urine decreases the likelihood of crystallisation, total fluid intake should be enhanced. Drinking lots of water and juices can help the same. Restricting animal proteins like chicken and seafood can increase citrate, that inhibits crystallisation. Besides, excessive amount of salt can interfere with calcium excretion; hence, lower salt intake is recommended.
Silent stones often pass by themselves into the urine, but larger ones may need medical intervention. Hence, a visit to the urologist is advised.
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