Renal lithiasis or kidney stones: symptoms, treatments and prevention

It is estimated that approximately 12% of the world's population suffers from kidney stones at some point in their lives. This figure may be higher in certain geographic areas, such as the "stone belt" in the southeastern United States, where prevalence can be as high as 20%.

It is important to note that the incidence of kidney stones has been increasing in recent decades, possibly due to changes in diet and lifestyle. In addition, kidney stones can affect people of all ages, although they are more common in young adults.

What is renal lithiasis?

Kidney stones, also known as renal calculi or kidney stones, are solid formations that develop in the kidneys from substances present in the urine. These substances may include calcium, oxalate, uric acid, phosphate and other compounds.

When the concentration of these substances in the urine is high, they can crystallize and form small solid deposits in the kidneys. Over time, these deposits can grow into larger kidney stones. These stones can range in size from grains of sand to larger stones the size of a golf ball.

Kidney stones can cause severe pain and other symptoms when they move from the kidneys into the ureters, the tubes that connect the kidneys to the bladder. Depending on the size and location of the stones, they can cause partial or complete obstruction of urine flow, resulting in symptoms such as lower back or abdominal pain, blood in the urine, frequent and painful urination, nausea and vomiting.

Treatment of kidney stones can vary depending on the size and location of the stones. In some cases, small stones may pass on their own with the help of hydration and medications to control pain. For larger stones or stones that cannot be removed naturally, additional treatments may be necessary, such as extracorporeal shock wave lithotripsy (ESWL), ureteroscopy or open surgery.

Causes of renal lithiasis. Risk factors for kidney stones.

The formation of kidney stones, or renal lithiasis, can be caused by a variety of factors. The chemical composition of the stones can vary, which influences the underlying causes. Some of the most common causes are listed here:

  1. Imbalances in the concentration of substances in the urine: Kidney stones can form when there are imbalances in the concentration of certain substances in the urine, such as calcium, oxalate, uric acid or phosphate. If these substances are found in high levels, they can crystallize and form kidney stones.
  2. Dietary factors: Diet plays an important role in the formation of kidney stones. Excessive consumption of oxalate-rich foods, such as spinach, beets, chocolate, nuts, and some fruits, may increase the risk of developing calcium oxalate stones. In addition, a diet high in sodium and low in fluids may contribute to stone formation.
  3. Genetic factors: There is evidence that genetic predisposition may increase the likelihood of developing kidney stones. Some people may inherit a greater tendency to produce substances that crystallize and form stones in the kidneys.
  4. Underlying medical conditions: Some medical conditions may increase the risk of developing kidney stones. These include hyperparathyroidism, chronic kidney disease, obesity, gout, inflammatory bowel diseases and certain urinary tract diseases that interfere with the normal flow of urine.
  5. Environmental and lifestyle factors: Chronic dehydration, hot weather, and lack of adequate fluid intake can contribute to kidney stone formation. Also, certain medications, such as diuretics and antiretrovirals, may increase the risk of developing kidney stones in some people.

It is important to note that each case of renal lithiasis may be unique and influenced by a combination of factors.

Symptoms of lithiasis renal or kidney stones

Symptoms of kidney stones can vary in intensity and presentation, depending on the size and location of the stones, as well as each person's individual response. Some of the most common symptoms include:

  1. Intense pain in the back or side: The most characteristic symptom of kidney stones is sharp, stabbing pain experienced in the back or side, in the area where the kidneys are located. This pain, known as renal colic, can be very intense and fluctuate in intensity. It may radiate to the abdomen or groin.
  2. Changes in urination: Kidney stones may cause changes in urination, such as increased urinary frequency or urgent need to urinate. In addition, blood may be present in the urine (hematuria), which may give it a pink, reddish or brownish color.
  3. General discomfort: Some people with kidney stones may experience general discomfort, nausea or vomiting.
  4. Difficulty finding a comfortable position: Severe pain caused by kidney stones can make it difficult to find a comfortable position. Some people may feel the need to move constantly to relieve the pain.

It is important to note that not all people experience obvious symptoms. Some smaller stones may go unnoticed and pass without causing significant symptoms. If fever or chills appear, there may be an associated infection so it is vitally important to contact your urologist immediately or go to the emergency room as there is a risk of bringing the patient to a serious clinical situation.

It should be noted that the symptoms of renal lithiasis can be similar to those of other medical conditions, such as urinary tract infections or appendicitis, so the assessment of a specialist is essential to reach a correct diagnosis.

How is cholelithiasis diagnosed?

The diagnosis of renal lithiasis is usually made by a combination of clinical evaluation, imaging tests and laboratory analysis. The most common methods used to diagnose renal lithiasis are:

  1. Medical history and physical exam: The physician will gather information about your symptoms, medical and family history, as well as perform a physical exam.
  2. Urinalysis: A urinalysis can help to identify the presence of blood in the urine (hematuria) and signs of urinary tract infection.
  3. Imaging tests:
    • Plain abdominal x-ray: X-rays can detect the presence of dense kidney stones in the renal area. However, some stones may not be visible on plain X-ray, especially those composed of uric acid.
    • Renal ultrasound: Ultrasound evaluates the kidneys, bladder and urinary tract. It can help identify the presence of kidney stones, although its ability to detect smaller stones or stones in the middle ureter is limited.
    • Computed Tomography (CT): CT is a more accurate and commonly used imaging technique to diagnose renal lithiasis. It allows detailed visualization of kidney stones, determination of their size, location, possible composition and quantity, as well as evaluation of possible associated complications.
  1. Chemical analysis of stones: If a kidney stone is removed, a chemical analysis can be performed to determine its chemical composition. This can help guide treatment and prevent future recurrences.

Treatments for lithiasis (Those performed at Ramirez Urology)

The treatment of kidney stones depends on several factors, such as the size and location of the stones, the severity of the symptoms, the presence of complications and the individual characteristics of the patient. Common treatments used for renal lithiasis are:

  1. Observation and conservative management: If the kidney stones are small and do not cause severe symptoms, a strategy of observation and conservative management may be chosen. This involves drinking plenty of water to promote spontaneous elimination of the stones through urine. Dietary changes and medication may be recommended to relieve symptoms and prevent the formation of new stones.
  2. Medications: Some medications may be prescribed to help treat kidney stones. For example, alpha-blocker medications can relax the muscles of the urinary tract and make it easier for stones to pass, or some drugs help change the pH of the urine to help dissolve some types of stones.
  3. Extracorporeal shock wave lithotripsy (ESWL): This non-invasive procedure uses high-energy shock waves to break kidney stones into smaller fragments, which can then be passed naturally through the urine. ESWL is usually performed under sedation and is used primarily for small to medium-sized stones.
  4. Both rigid and flexible ureteroscopy: Consists of access to the stone both at the level of the kidney and the ureter, through the natural urinary orifices, by means of an instrument called ureteroscope that can be rigid or flexible. Subsequently, the stone is extracted or fragmented with a laser.
  5. Percutaneous endoscopic nephrolithotomy: Through the creation of a path from the skin to the kidney, a nephroscope is introduced that allows us to fragment the lithiasis with laser and extract the lithiasic fragments.
  6. Surgery: In more complex cases or when other treatments are not feasible, surgical intervention may be necessary. Open surgery for kidney stones is less common today, but may still be necessary in certain cases.

How to prevent kidney stones?

To prevent the formation of kidney stones, you can take measures and adopt healthy habits. Here are some general recommendations for the prevention of kidney stones:

  1. Drinking enough water: Maintaining adequate hydration is essential to dilute the concentration of substances in the urine and prevent the formation of stones. It is recommended to drink at least 2-3 liters of water per day, unless there is a medical contraindication.
  2. Modify dietSome dietary changes may help prevent the formation of kidney stones, especially if the specific chemical composition of the stones has been identified. These recommendations may vary depending on the type of stone, but in general it is suggested:
    • Limit consumption of oxalate-rich foods, such as spinach, beets, chocolate, nuts and some fruits.
    • Moderate intake of salt and processed foods containing sodium.
    • Consume adequate amounts of calcium, preferably through food sources.
    • Limit consumption of animal proteins, especially high-purine animal proteins, which can increase uric acid levels in the urine.
  3. Maintain a healthy weight: Obesity is associated with an increased risk of developing kidney stones. Maintaining a healthy weight through a balanced diet and regular exercise can reduce the risk.
  4. Control underlying medical conditions: If you have medical conditions such as hyperparathyroidism, chronic kidney disease or gout, it is important to follow the indications and treatments recommended by the specialist to properly control these conditions and reduce the risk of stone formation.

Urology center specialized in renal lithiasis.

Our service specializes in the comprehensive treatment of kidney stones, providing a complete and personalized approach to help patients prevent the formation of kidney stones, as well as diagnose, treat and effectively manage this condition when it occurs.

Our team of highly trained and specialized urology and nephrology professionals has the experience and resources to offer advanced, evidence-based treatment options, ranging from lifestyle changes and dietary modifications to the use of innovative technologies, such as both flexible and rigid ureteroscopy.

Our goal is to improve our patients' quality of life, alleviate the symptoms associated with kidney stones, prevent recurrences and promote long-term kidney health.