KİDNEY STONE

DR.MEHMET UMUT ÖZBAY DR.KÜRŞAD AKÇAKALE

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney.

What are kidney stones?

Kidney stones are made of salts and minerals in the urine that stick together, creating small "pebbles" formed within the kidney or urinary tract. They can be as small as grains of sand or as large as golf balls. Kidney stones are a common cause of blood in the urine and often severe pain in the abdomen, flank, or groin. One in every 20 people develops a kidney stone at some point in their life.

WHAT ARE THE TYPES OF KİDNEY STONES?

• THERE ARE FOUR MAİN TYPES OF KİDNEY STONES.

• CALCİUM STONES

• URİC ACİD STONES

• STRUVİTE STONES

• CYSTİNE STONES

CALCİUM STONES ?

• Most kidney stones are madeof calcium compounds, especially calciumoxalate.

• Calcium phosphate and other minerals also may be present.

• Oxalate is a naturally occurring substance found in food(Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels).

• Your liver also produces oxalate.

• Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.

• Conditions that cause high calcium levels in the body, such as hyperparathyroidism, increase the risk of calcium stones.

• Certain medicines may prevent calcium stones.

• Population: 80 %

• Circumstances:when urine is alkaline (ph>5.5)

URİC ACİD STONES ?

• Some kidney stones are made of uric acid, a waste product normally passed out of the body in the urine

• You are more likely to have uric acid stones if you have: -Low urine output.

-A diet high in animal protein, such as red meat.-An increase in how much alcohol you drink.-Gout.- Inflammatory bowel disease

• Uric acid stones can form in people who don't drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout.

• Certain medicines may prevent or dissolve uric acid stones.

• Population: 5–10%

• Circumstances: when urine is persistently acidic

STRUVİTE STONES ?• Some kidney stones are struvite stones.

• They can also be called infection stones if they occur with kidney or urinary tract infections (UTIs).

• These types of kidney stones sometimes are also called staghorn calculi if they grow large enough.

• Struvite stones can be serious, because they are often large stones and may occur with an infection.

• Medical treatment, including antibiotics and removal of the stone, is usually needed for struvite stones.

• Women are affected more than men because of their higher risk of urinary tract infections

• These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.

• Population: 10–15%

• Circumstances: infections in the kidney

CYSTİNE STONES ?

• Less common are kidney stones made of a chemical called cystine.

• These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).

• Cystine stones may be prevented or dissolved with medicine. But this may be difficult and not very effective.

• If a stone causes blockage in the urinary tract or is too large, then it will need to be removed.

• Population: 1–2%

• Circumstances: rare genetic disorder

The most common cause of kidney stones is not drinking enough water.

What causes kidney stones?• Kidney stones form when a change occurs in the

normal balance of water, salts, minerals, and other substances found in urine

• Other chemical compounds that can form stones in the urinary tract include uric acid and the amino acid cystine.

• Dehydration through reduced fluid intake and strenuous exercise without adequate fluid replacement increase the risk of kidney stones.

• Some people are more likely to get kidney stones because of a medical condition or family history, as the tendency to form kidney stones may also be inherited.

• If other people in your family have had them, you may have them too

Symptoms and signs of a kidney stone include excruciating, cramping pain in the lower back and/or side, groin, or abdomen as well as blood in the urine.

• What are symptoms of kidney stones?

• Kidney stones often cause no pain while they are in the kidneys, but they can cause sudden, severe pain as they travel from the kidneys to the bladder

• Symptoms and signs include excruciating, cramping pain in the lower back and/or side, groin, or abdomen as well as blood in the urine

• . If infection is present in the urinary tract along with the stones, there may be fever and chills.

• Also occur: Pain on urination, pink, red or brown urine, Cloudy or foul-smelling urine

How are kidney stones diagnosed?

• THERE ARE FOUR MAİN TYPES OF KİDNEY STONES DİAGNOSED

1-)PHYSİCAL EXAMİNATİON

2-) BLOOD TEST

3-) URİNE TEST

4-) İMANGİNG TEST

2-)BLOOD TEST

• Uric acid

• Calcium

• Phosphate

• Creatine

• 3-)URİNE TEST

• To determine whether bleeding in the urine

• Sodium

• Calcium

• Phosphate

• Erythrocyte

4-)İMANGİNG TEST

• X-RAY(we cant see all stones in x-ray)

• ULTRASOUND(its good methods to diognes stone, we can see stone region , stone size and kidney size but we cantsee urethra stones in ultrasound.Also its good methods forpregran women)

• CT(we can see all stones in ct)

KİDNEY STONES TREATMENT ?

• Drink enough fluids

• Drugs(pain drugs:nonsteroidal anti inflammotary, acetaminophen , naproxen sodium.For calciumstone:Orthophosphat, Potassium citrate, Thiazides , for uric acid stone: Allopurinol, Potassium citrate, Sodium bicarbonate , for cystine stone:Penicillamine, Potassium citrate, Tiopronin and for strutivestone:need surgery to remove stone

• Surgery(Remove kidney stone this include :extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, percutaneous nephrolithotomy (PCNL), open surgery

Extracorporeal shock wave lithotripsy (ESWL)

• ESWL is the most common way of treating kidney stones that cannot be passed in the urine.

• It involves using X-rays (high-energy radiation) or ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is

• A machine then sends shock waves of energy to the stone to break it into smaller pieces so it can be passed in your urine.

• ESWL can be an uncomfortable form of treatment, so it is usually performed after giving painkilling medication.

• You may need more than one session of ESWL to treat your kidney stones successfully.

• ESWL is up to 99% effective for stones that are up to 20mm (0.8in) in diameter.

Ureterorenoscopy• If a kidney stone is stuck in your ureter (tube that carries waste products

from your kidneys to your bladder), you may need to have ureterorenoscopy.

• Ureterorenoscopy is also sometimes known as retrograde intrarenalsurgery (RIRS)

• It involves passing a long, thin telescope called a ureteroscope through your urethra (the tube urine passes through out of the body) and into your bladder.

• It is then passed up into your ureter to where the stone is stuck.

• The surgeon may either try to gently remove the stone using another instrument, or they may use laser energy to break the stone up into small pieces so that it can be passed naturally in your urine.

• Ureterorenoscopy is performed under general anaesthetic, so you should not drive or operate machinery for up to 48 hours after the procedure

• For stones up to 15mm (0.6in), an ureterorenoscopy is effective in 50-80% of cases.

• You may need a plastic tube called a stent to be inserted inside you temporarily to allow the stone fragments to drain into the bladder.

Percutaneous nephrolithotomy (PCNL)• PCNL is an alternative procedure that may be used for larger

stones.

• It may also be used if ESWL is not suitable (for example, because the person being treated is obese).

• PCNL involves using a thin telescopic instrument called a nephroscope.

• An incision (cut) is made in your back. The nephroscope is passed through the incision and into your kidney

• The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy.

• It is always performed under general anaesthetic (you are put to sleep), which means that you should not drive or operate machinery for up to 48 hours after the procedure.

• PCNL is 86% effective for stones that are 21-30mm (0.8-1.2in) in diameter.

Open surgery

• If you have a uric acid stone, you may be advised to drink around three litres of water each day to try to dissolve it.

• Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if they are exposed to alkaline fluids.

• You may need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve.

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