Kidney stone

This one patient of age around 40 was brought with a complaint of abdominal pain in RL quadrant, nausea and vomiting. Tenderness could be felt by palpation of his lower right back. The doctor guessed it might be appendicitis but when the CT result arrived it turned out to be a kidney stoneon his right kidney. The stone was 4.8 mm diameter and the stone was down the ureter. The kidney could be stranded and there was already an inflmmation on his right kidney. His lactic acid level was going up, meaning that his bowel was not getting enough oxygen. If his urehtra would be clogged up then it would block the bladder. In that scenario his urine would back up and damage his kidney. He was advised to have a stent inserted but it was eventually decided for the stone to flush itself out.



Kidney stones, also known as nephrolithiases, urolithiases or renal calculi, are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. They vary in size from as small as a grain of sand to as large as a golf ball. Kidney stones typically leave the body in the urine stream; if they grow relatively large before passing (on the order of millimeters), obstruction of a ureter and distention with urine can cause severe pain most commonly felt in the flank, lower abdomen and groin. Kidney stones are unrelated to gallstones.

Symptoms

Kidney stones are usually asymptomatic until they obstruct the flow of urine. Symptoms can include acute flank pain (renal colic), nausea and vomiting, restlessness, dull pain, hematuria, and possibly fever if infection is present. Acute renal colic is described as one of the worst types of pain that a patient can suffer. Note that the pain is generally due to the stone's presence in the ureter, and not—as is commonly believed—the urethra and lower genitals.

Some patients have no symptoms until their urine turns bloody—this may be the first symptom of a kidney stone. The amount of blood may not be sufficient to be seen, and thus the first warning can be microscopic hematuria, when red blood cells are found in the microscopic study of a urine sample, during a routine medical test.

Treatment

Stones less than 5 mm in size usually will pass spontaneously, with diclofenac usually providing effective pain management. For those patients requiring alternative treatment, Toradol or opioid analgesics (such as pethidine^[1]) are indicated. However the majority of stones greater than 6 mm will require some form of intervention, especially so if the stone is stuck causing obstruction and infection of the urinary tract.

In many cases non-invasive Extracorporeal Shock Wave Lithotripsy may be used. Otherwise some form of invasive procedure is required; with approaches including ureteroscopic basket extraction, retrograde ureteral, percutaneous nephrolithotomy or open surgery, and using laser, ultrasonic and mechanical (pneumatic, shock-wave) forms of energy to fragment stones.

A single study at the Mayo Clinic has suggested that Lithotripsy may increase subsequent incidence of diabetes and hypertension,^[2] but it has not been felt warranted to change clinical practice at the clinic.^[3]

A hot bath may also bring relief during an attack, as this relaxes the muscles where the stone is.