Can Kidney Stones lead to Chronic Kidney Disease?

Kidney Stones and Chronic Kidney Disease

Have you ever wondered, can kidney stones lead to chronic kidney diseases? Some people might take it lightly and brush it off, but in this article, it will shed some light on everything you need to know about kidney stones.

What are kidney stones?

Kidney stones are hard deposits of salt and minerals that are often made up of calcium or uric acid. This is due to a chemical imbalance in the body. Kidney stones are also known as urinary stones. They are formed inside the kidneys and are able to travel to other parts of the body – the urinary tract. They are a common urological problem as they will crystallise in the urine and that may cause discomfort and pain during urination.

Kidney stones or renal stone disease is a very common condition around the world. It is estimated to affect 2-3 percent of the general population. In affluent countries like Singapore, it is linked to obesity and a high dietary intake of salt, protein and oxalate-rich foods. Kidney stones usually occur in patients aged above 40 years and affect men more often than women.

In many cases, these kidney stones are formed when there is too much of certain minerals which have accumulated in your urine or your body is not well hydrated. There is also a higher risk of developing a kidney stone if you are overweight and regularly consume too much food and beverages that are high in sodium and oxalates. If you are not well hydrated, your urine also becomes more concentrated with higher levels of certain minerals – that is when it is more likely that a kidney stone will form.

Symptoms of kidney stones

A kidney stone is not always symptomatic at an early stage. Pain and other symptoms of a kidney stone may show up only when the stone has grown larger in size and moves down the ureter, the tube that connects the kidney to the bladder. This will block the flow of urine or when it is being passed, in which it will cause pain and discomfort to the person. Other symptoms include:

1. Blood in the urine

It is the most common symptom in people with urinary tract stones. It is also known as hematuria. The blood can be red, pink, or brown. Sometimes, the blood cells are too small to see without a microscope (microscopic hematuria) but your doctor can test for this symptom.

2. Cloudy or smelly urine

Healthy urine is clear and does not have a strong odour. Cloudy or foul-smelling urine could be a sign of an infection in your kidneys or another part of your urinary tract. The cloudiness is a sign of pus in the urine and the smell can come from the bacteria that cause urinary tract infections. An odour may also come from urine that is more concentrated than normal.

3. Pain or burning during urination

Once the stone reaches the junction between the ureter and bladder, you will start to feel pain when you urinate. This is also called dysuria. The pain may feel sharp or burning as you are passing urine.

4. Abdominal pain

This will happen as the kidney stone moves in the narrow ureter and causes a blockage, which causes pressure to build up in the kidney. This then activates the nerve fibres that transmit pain signals to the brain. The pain often starts suddenly. As the stone moves, the pain changes location and intensity. The pain often comes and goes, which is made worse by the ureters contracting as they try to push the stone out. Each time the pain comes, it may last for a few minutes, disappear and then come back again.

Other than feeling the pain in the abdominal area, you might feel it first along your side and back then down to the abdominal area as the stone moves down through your urinary tract.

5. Nausea and vomiting

It is common for people with a kidney stone to have nausea and vomiting. These happen because of the shared nerve connections between the kidneys and GI tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The organs that make up the GI tract are the mouth, oesophagus, stomach, small intestine, large intestine and anus. Stones in the kidneys can trigger nerves in the GI tract, setting off an upset stomach. It can also be your body’s way of responding to the intense pain caused by a kidney stone.

Treatment options

It is usually done by evaluating a 24-hour collection of urine or by examining a stone after it has been passed. There are several methods of kidney stone removal; many do not require surgery.

With plenty of water, most of the small kidney stones (< 5mm) will pass out of the body spontaneously without the need for surgery. For larger or impacted stones, the treatment objectives are to eliminate the stone and relieve obstruction to promote the recovery of kidney function. The treatments for larger kidney stones include:

1. Extracorporeal shock wave lithotripsy (ESWL)

This is a popular treatment in which shockwaves are sent directly to the kidney stone to break it down. It does not require a hospital stay or surgery, it is performed as an outpatient procedure and involves the patient lying on a specifically constructed treatment platform. Shockwaves of varying intensities are created outside the body and transmitted through the skin and body tissues to converge on these stones. It is broken down into smaller particles that pass easily through the urinary tract in the urine. Recovery time for this treatment is relatively short and most people can resume normal activities in a few days. The side effects include bruising and pain around the treated kidney; downstream blockage of stone fragments in the lower ureter and incomplete stone clearance requiring multiple treatment sessions.

2. Percutaneous Nephrolithotomy

This treatment is for larger kidney stones (> 2cm) that are occupying a significant part of the kidney. This procedure is performed under general anaesthesia, usually with the patient lying prone on the surgical table. Under x-ray or ultrasound guidance, the urologist makes a tiny incision in the back and creates a tunnel directly into the relevant chamber of the kidney. A small nephrostomy tube is left in the kidney for a few days till the residual bleeding clears up after removing the shattered stones.

3. Ureteroscopy (URS)

This treatment is for smaller kidney stones (< 2cm) that are located in the lower ureter, which is located with specially constructed small-calibre endoscopes, under x-ray guidance, aided by guide-wires. The stones are then shattered using a Holmium laser probe under direct vision and the fragments are retrieved out of the ureter using special stone baskets. This is usually performed as an outpatient procedure under general anaesthesia.

The pain after URS treatment usually resolves after 2-3 days, although blood in the urine will take slightly longer to clear up.

Prevention

Changes in your lifestyle are required, especially eating and exercising habits that can help people in avoiding or preventing kidney stones. Keep hydrated with about 2.5 litres of water a day to keep your urine light and clear, to keep your urine light and clear. Follow a diet that is low in salt, animal protein and oxalate-rich foods, for example, nuts, tea, chocolate, sodas and soy products. Reduce excess salt from your diet as it increases urinary calcium excretion and potassium along with citrate, which is enough to result in a change of urinary pH value that will eventually increase the risk of kidney stone formation.

At the end of the day, remember that if a kidney stone is left untreated, it may cause more damage to the kidneys and may even lead to the end stage of kidney failure. One with a past history of kidney stones is advised to have regular screenings done as the recurrence rate is high and you may be at a higher risk for chronic kidney disease. Be sure to talk to your doctor about ways to prevent kidney stones from coming back and how to keep your kidneys healthy.

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