Nephrolithiasis : Quick guide for a critical and prevalent disease

Nephrolithiasis, commonly known as kidney stones, is a medical condition characterized by the formation of solid mineral and salt deposits within the kidneys. These stones can vary in size and may cause significant pain and complications if not addressed.

Causes

Kidney stones can form due to various factors, including:

  1. Dehydration: Insufficient fluid intake can lead to concentrated urine, facilitating stone formation.
  2. Diet: High intake of salt, protein, and oxalate-rich foods (such as spinach and nuts) can contribute to stone development.
  3. Obesity: Increased body weight is associated with a higher risk of developing kidney stones.
  4. Medical Conditions: Conditions like hyperparathyroidism, diabetes, and certain urinary tract infections can influence the formation of stones.
  5. Family History: A genetic predisposition can increase an individual’s likelihood of developing kidney stones.

Symptoms

The symptoms of nephrolithiasis can vary depending on the size and location of the stone. Common symptoms include:

  • Severe Pain: Often described as sharp or cramping pain in the lower back, side, or abdomen, which may radiate to the groin.
  • Hematuria: Blood in the urine, which may appear pink, red, or brown.
  • Nausea and Vomiting: These symptoms often accompany the pain.
  • Frequent Urination: An increased urge to urinate, especially if the stone is located near the bladder.
  • Cloudy or Foul-Smelling Urine: This can indicate an infection or other underlying issues.

Signs

During a physical examination, the following signs may be observed:

  • Costovertebral Angle Tenderness: Tenderness when pressure is applied to the back where the kidneys are located.
  • Abdominal Distension: Swelling of the abdomen may occur if there is a blockage in the urinary tract.
  • Signs of Dehydration: Dry mouth, decreased skin turgor, or rapid heartbeat could indicate dehydration, often associated with stone formation.

Investigations

To diagnose nephrolithiasis, healthcare providers may use several investigative methods:

  1. Urinalysis: This test checks for the presence of blood, crystals, and signs of infection in the urine.
  2. Imaging Studies:
    • X-rays: Can help identify some types of stones.
    • Ultrasound: Useful for detecting larger stones and assessing kidney health.
    • CT Scan: A non-contrast CT scan is highly effective in identifying stones and their locations.
  3. Blood Tests: These can assess kidney function and check for conditions that may contribute to stone formation, such as high calcium levels.

Treatment

Treatment for nephrolithiasis depends on the size and type of stone, as well as the severity of symptoms:

  1. Hydration: Increasing fluid intake helps flush out smaller stones and prevents new ones from forming.
  2. Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) or stronger pain medications may be prescribed to relieve pain.
  3. Medical Expulsive Therapy: Medications such as alpha-blockers may facilitate the passage of stones.
  4. Extracorporeal Shock Wave Lithotripsy (ESWL): A non-invasive procedure that uses sound waves to break stones into smaller pieces, making them easier to pass.
  5. Ureteroscopy: A minimally invasive procedure that involves using a thin tube to remove or break up stones.
  6. Surgery: In cases of very large stones or complications, surgical intervention may be necessary.

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