|
Kidney Stones
Kidney stones (nephrolithiasis) represent a significant percentage of hospital admissions, approximately 1 in 1,000. Kidney stones result from the formation of crystals INSIDE the kidney. The crystals may remain within the kidney (and grow) or they may fragment and pass down the ureter (thin tube connecting the kidney to the bladder) to the bladder. The relative size of the stone determines the degree of pain that will be associated with its passage. In the majority of cases, kidney stones measuring UNDER 6 millimeters will pass through without surgical assistance from the doctor. Those stones over 6 millimeters have a greater chance of requiring surgical retrieval. Once the stones reach the bladder they may fragment or be passed out in the urine (at this point with much less pain). Kidney stones are clinically significant for their painful presentation and the possibility of obstructing the ureter. A ureteral obstruction will block urine flow from the kidney on the affected side. This can result in damage to the kidney if the problem is not rectified. Some patients with high calcium or uric acid in their blood stream are predisposed to stone formation. Patients with prior stones have a increased risk of repeat stones. Males are more commonly affected than females. The early morning seems to be the most common time for the onset of pain. Exertion with dehydration can predispose to kidney stone formation. Kidney stones can also result in urinary tract infection (UTI). Common symptoms of a kidney stone (renal colic) include the SUDDEN onset of a sharp, agonizing pain that generally starts in the back (on one side) and wraps around the flank down to the groin. This may be accompanied by a red or pink tinge to the urine (indicating the presence of blood). Nausea with vomiting is seen in some cases.
Evaluation will include history and physical examination. Urinalysis will show blood in the urine. Blood tests such as blood counts and renal profile will be done. Intravenous pyelography (IVP) can reveal the stone's location, size, and possible obstruction of the ureter. Patients allergic to the iodinated contrast dye used in the IVP will have a kidney ultrasound performed. Treatment will include IV fluids and pain medications in the hope of encouraging the stone to pass. The IVP itself also encourages the stone to move. Patients with intractable pain, infection, compromised kidney function, or obstruction will require admission to the hospital. Special instrumentation using cystoscopy may allow the physician to retrieve larger stones. Patients with resolution of symptoms may be sent home to strain (a fine mesh strainer) their urine for stones. The Urologist is the expert in the management of this problem.
|
