Normally, the waste product from the blood isfiltered through the kidneys, but when it over accumulates, it may producekidney stones. Kidney Stones are small, solid pebbles that are made of mineralsand salts that form within your kidneys, and it may become painful. There couldmany reasons for the formation of kidney stones because it implicatesenvironmental and metabolic risk factors. Kidney stones mostly happen toadults, but children and teenagers can get them, too. There are several treatments; how to treat itwill depend on the type, the size and the location of the stones either in thekidneys or the urinary tract.Kidney stones affect about 5% of the worldpopulation. The peak age for kidney stones is between 20 years old and 50 yearsold. Furthermore, the probability of having it is more in men than in women(Figure 1).
Family history may also increase the risk of getting kidney stones.(University of Wisconsin Hospitals and Clinics Authority, 2013)Figure 1 UnitedStates kidney stone prevalence by age and sexNote 1Reprinted from Kidney Stones: A Global Picture of Prevalence, Incidence, andAssociated Risk Factors, V. Romero, 2010, retrieved from https://www.ncbi.nlm.
nih.gov/pmc/articles/PMC2931286/Copyright © 2010 by MedReviews, LLCKidney stones occur in the urinary system. Theurinary system is made of different organs, such as the kidney, ureters,urinary bladder, and urethra. The urinary system aids the body to get rid ofwaste, like urea. It also keeps chemicals, such as potassium and sodium, andwater in check. The excretory system is conformed of otherdifferent systems: urinary system, respiratory system, biliary system, andintegumentary system. The main job of the excretory system is to eliminate allwaste the body produces that would otherwise interfere with cellular function;it also regulates the content of the body’s fluid by limiting what and how muchcan go out.
In other words, the body seeks to be in homeostasis to prevent anydamage. To make it simple, without the mechanisms that allow the human systemto eliminate wastes, humans would die of intoxication, as is the case when thekidneys or the liver stop working. A clear example of the excretory in actionis when cellular respiration produces carbon dioxide and it is removed from oursystem by an effective circulatory system and respiratory system, which arepart of the excretory system.There are several organs and structures that areinvolved in the excretory system: kidneys, ureter, urinary bladder, urethra,lungs, skin, some glands, etc. But the ones affected by kidney stones are onlyin the urinary system: kidneys, ureter, bladder, prostate, urethra. “Thekidneys are two bean-shaped organs, which are about the size of a fist” (NIDDK,2014).
Arguably, the kidneys are the most important organs of this system. Theydo three essential things that help to balance the body: purifying the blood(table 1.1), regulating blood pressure and the amount of water in the body, andsynthesizing hormones, like erythropoietin which controls red blood cellproduction. Once the kidneys have separated all waste, the urine goes from thekidneys to the bladder through the ureter which are muscular tubes that areabout 28 centimetres long.
Next, urine ends up in the bladder where it isstored allowing it to be occasional. Finally, the urethra, the tube thatconnects the bladder with the meatus, leads the final part of the urinarysystem. The urine leaves the body through it.
Table 1 NormalBlood Value Ranges in the bodyNote. Reprinted from why are kidneys so important? The kidney Foundationof Canada. Retrieved from https://www.kidney.
ca/why-kidneys-are-importantCopyright 2017 by The Kidney Foundation of Canada Kidneys are vey effective in eliminating wastefrom the blood. Nevertheless, under certain circumstances, such as chronicdehydration, some waste may accumulate in the kidney. As theses microscopiccrystals (waste) stick to each other, they become a larger and larger,reaching, in some extreme cases, more than 10centimetres wide. For example,according to the Guinness World Records (n.d) a kidney stone was removed, inIndia, at the Urological research institute and it was 13 centimetres wide.Certainly, there are different kind of kidneystones. In other words, they can be made of different substances.
There iscalcium, struvite, uric acid, and cystines stones. The most common ones are thecalcium stones, made mainly of calcium oxalate & calcium phosphate. About 80% of all stones are made of calcium(Sakhaee, Maalou & Sinnott, 2012).
There are several factors that couldproduce these type of stone; for example, many foods have oxalate, such as nutsand chocolate. High quantities of vitamin D may also contribute to calciumstones. Struvite stones often form only due to an infection. The problem withthese stones is their fast grow rate and its often lack of symptoms. Uric acidstones are normally present in people who don’t drink enough liquids and/or eatfood with high levels of proteins. Furthermore, there certain genetic factorthat may influence the formation of them. Lastly, cystine stones formexclusively in people with certain hereditary issues that provoke the kidney tomake an excessive amount of specific amino acids that produce them.
Usually, a kidney stone doesn’t show any symptomsuntil it is moving because it is formed of many microscopic crystals that maycut tissue as it moves through the urinary system. The most common symptoms,according to Mayo Clinic (2017), are:· Severe pain in the side and back, below the ribs· Pain that radiates to the lower abdomen and groin· Pain that comes in waves and fluctuates inintensity· Pain on urination· Pink, red or brown urine· Cloudy or foul-smelling urine· Nausea and vomiting· Persistent need to urinate· Urinating more often than usual· Fever and chills if an infection is present· Urinating small amounts This information brings a very interestingquestion: where do kidney stones form? Kidney calcium stones usually form onplaque, which is a deposit of calcium phosphate that forms within tissues, morespecifically in the Loops of Henle’s walls.There are several factors that boost theprobabilities of having kidney stones: genetics, dehydration, obesity, certainsurgeries. First, family history of the disease increases the chances of havingit. Dehydration play an important role in kidney stone formation; people wholive in warm and humid environments tend to have more risk of it. There is acorrelation between obesity and kidney stones. Although, symptoms can provide enough informationto set the basis, they cannot deliver enough data to discern what type ofstones is, until a full diagnosis have been done.
Several diagnosis can bemade: · Ultrasound scan · Computed tomography · Blood test· Urine test · Analysis of passes stones · Medical history Simple x-ray is not recommended because onlycalcium stones are easy to identify. Struvite stones are harder to find, anduric acid stones do not appear at all. With that being said, x-ray is useful tofigure out how favorable a treatment for calcium stones was.Usually, small stones pass through the urinarysystem, but when there are bigger stones, treatment is necessary. The kind oftreatment depends on several factors: size, composition, location of the stone,as well as symptoms and medical history. There are invasive and non-invasivetreatments. The are many types of treatments from drinking plenty of fluids to Nephrolithotomy.The most common treatments are: medication, shock wave therapy, ureteroscopy,nephrolithotomy,and nutritional therapy.
When the stone is smaller than five millimetres, aconservative management is used. This consists in a high fluid intake, as wellas a good and healthy diet, such as orange juice and oxalate restrictions.According to Bogi, et al. (1996),studies have shown that drinking 2.5 litres of water is related with reducing levels of Calcium oxalate.
Whenthe stone is between five and ten millimetres or the stone has been stuck forfour week or more after observation, medication is required. Normally, theseare the most common medications: thiazide diuretic, potassium citrate,allopurinol, and muscle-relaxing medications. Thiazidediuretics and potassium citrate are used to reduce the excretion of calcium. Allopurinolis used in patients who have uric acid stones. It reduces the levels of uricacid. Muscle- relaxing medication, such as Tamsulosin, helps, as its name says,with the relaxation of the muscle, making easier for the stones to pass trough.This type of medication is for the most part used in patients whose stone isthe ureter.
Finally, if the stone is bigger than ten millimetres or it has beenstuck even though medication has been given, surgery is required. There arethree main surgical options: Extracorporeal Shock Wave Lithotripsy, Ureteroscopy,Percutaneous Nephrostolithotomy or Nephrolithotomy. ESWL, also known as shockwave therapy, uses sound waves, thus creating vibrations, to shatter bigstones. This is the most used technique to treat kidney stones in the UnitedStates (National Kidney Foundation, 2017). Percutaneous Nephrolithotomy: anexpert makes a small incision, about one centimetre, and a nephroscope isinserted and the stones is removed. This is technique is used when the stone istoo big, in which case it has to first be broken up.
Finally, when the stone isin the ureter, it is commonly removed by ureteroscopy, in which an urologist insertsureteroscope trough the urethra, the bladder, and the ureter and the stone isremoved. Prevention is a