Kidney diseases are becoming one of the major public health concerns in India. The prevalence of kidney-related conditions is steadily increasing, especially among individuals aged 15 years and above. If statistics are to be believed, a significant number of children and adolescents are also affected, with studies showing that around 4.9% experience impaired kidney function. This makes it essential to understand and identify the risk factors that contribute to kidney disease. One of the most common conditions under this category is kidney stones.

What are Kidney Stones?

Kidney stones are solid crystal formations that develop in the urinary tract, a condition medically referred to as nephrolithiasis or urolithiasis. Nephrolithiasis specifically refers to stones within the kidneys, whereas urolithiasis encompasses stones that may be found anywhere along the urinary tract, including the kidneys, ureters, bladder, or urethra.

These stones, also known as renal calculi, are composed of various crystalline substances like calcium, uric acid, oxalate, struvite, cystine, or combinations thereof. They vary in size and color depending on their composition, ranging from as small as pebbles to as large as golf balls.

What can be the reasons for Kidney Stones Formation?

The most common reason for kidney stones development is dehydration or inadequate fluid intake. Urine contains minerals and substances like calcium, sodium, oxalate, and uric acid. When these substances become overly concentrated due to low water content in the urine, they can begin to crystallize, gradually forming stones over months or even years.

Additional risk factors include:

• Family History of kidney diseases
• Systemic conditions such as diabetes, cardiovascular disease, bone disorders, and
  chronic kidney conditions
• Dietary factors, including high salt or protein intake and very low dairy consumption. A
  diet rich in fruits and vegetables is considered a preventive measure for kidney stones.
• Urinary Tract Infections (UTIs) and other urinary disorders
• Medications, such as triamterene diuretics, anti-seizure drugs, and calcium-based
  antacids

Symptoms and Signs of Kidney Stones

The most common symptom of Kidney Stones is sudden, sharp, cramping pain in the lower back or side. This pain may radiate to the lower abdomen or groin and often comes in waves as the body attempts to expel the stone. The pain can often be an early sign of kidney stones. Apart from kidney stone pain, other symptoms include fever, chills, nausea, vomiting, frequent and urgent urination, burning sensation during urination, and cloudy or foul-smelling urine.

In some cases, the urine may appear red or brown due to the presence of blood. Even when not visible to the naked eye, microscopic traces of blood (red blood cells) may be detected in laboratory tests. Men may also experience pain at the tip of the penis.

Diagnosis of Kidney Stones

Diagnosis begins with a thorough review of the patient's medical history, physical examination, and appropriate laboratory and imaging tests. Sometimes, kidney stones are discovered by chance during routine check-ups and cause no symptoms. These are referred to as "silent kidney stones".

A physical examination may reveal tenderness in the lower back or abdomen. The physician may also assess the nature and location of the pain to help determine the stone’s size and position. For recurrent cases, a metabolic evaluation might be conducted to assess urinary pH and the levels of calcium, oxalate, and citrate.

Laboratory tests include:

• Urinalysis to detect blood, white blood cells, bacteria, and high mineral levels
• Blood tests to assess mineral imbalances or markers that may promote stone formation
  Imaging tests include:
• Abdominal X-ray, which can identify the presence of some types of stones, though not
  all are visible
• Ultrasound and CT scan (without contrast), which are more reliable in detecting stone
  size, location, and associated blockages
• Intravenous Pyelogram (IVP), a contrast dye study used to examine urinary flow and
  visualize stones
• Stone Analysis, involving laboratory testing of passed or surgically removed stones to
  understand their composition

Treatment for Kidney Stones

The choice of treatment depends on the type, size, location of the stone, the level of pain, and whether there are any complications.

Watchful Waiting

The doctor may recommend waiting for it to pass naturally if the stone is small and not causing serious symptoms. During this time, drinking plenty of fluids is advisable. As long as the pain is bearable, there is no infection, and the kidney is not obstructed, waiting up to four to six weeks is often considered safe.

Medication

Certain medications can help facilitate the passage of the stone or manage symptoms. The most commonly prescribed drug is Tamsulosin (Flomax), which relaxes the ureter muscles to allow the stone to pass more easily. Over-the-counter NSAIDs and other pain relievers may be used alongside anti-nausea medications and, in case of infection, antibiotics may be prescribed.

Surgery

Surgical options are considered when:

• The stone does not pass on its own
• Pain is unmanageable
• The stone is impairing kidney function not to work properly or have repeated infections
• The stone is blocking urine flow

Nowadays, the surgical interventions are minimally invasive and involve little downtime. These include:

Shock Wave Lithotripsy (SWL)

This procedure uses high-energy sound waves to break the stone into smaller fragments that can be passed in the urine. It is most effective for smaller, softer stones. The procedure is done as a day procedure, and patients can return home the same day and patients typically resume normal activities within two to three days. It is widely used and considered safe however, it can cause some side effects.It is common for patients to notice blood in their urine for several days following the procedure.

Ureteroscopy (URS)

In this method, a small telescope called a ureteroscope is inserted into the urinary tract to visualize and remove or break down stones using laser energy. Stones in the lower ureter near the bladder are generally managed using rigid telescopes, whereas flexible telescopes are preferred for stones situated in the upper ureter and renal pelvis. A temporary stent may be placed to facilitate urine flow post-procedure. Recovery usually takes a few days.

Percutaneous Nephrolithotomy (PCNL)

This is recommended for larger kidney stones. A small incision is made in the back to allow direct access to the kidney, where the stone is fragmented and removed. Patients typically stay in the hospital overnight, and recovery takes one to two weeks. It is the best treatment choice for large stones as it suctions out stone pieces completely.

Open, Laparoscopic, or Robotic Surgery

These are rarely performed and reserved for cases where less invasive methods are ineffective or inappropriate.

How Long Does It Take to Pass a Stone?

Smaller stones may pass on their own within one to two weeks without treatment. Larger stones can take up to three weeks. Stones that remain in the body longer than four weeks without movement typically require medical intervention.

Complications of Kidney Stones

Kidney stones can cause serious complications if not managed properly, including:

• Hydronephrosis - swelling of the kidney due to urine backup
• Pyelonephritis- a kidney infection that may be life-threatening
• Acute Kidney Injury - a sudden decline in kidney function
• Frequent UTIs resulting from partial obstructions
• Chronic Kidney Disease (CKD), if recurrent or untreated

Final Takeaway

Kidney stones, while painful, are largely preventable. Some lifestyle modifications such as staying hydrated all the time, consuming a diet rich in fruits and vegetables, and limiting salt and animal protein can significantly reduce the risk. Maintaining a healthy weight and seeking timely medical attention at the first sign of symptoms can also help prevent complications. With proper care and awareness, kidney stones do not have to become a long-term burden.