Kidney stones (the medical term is renal calculi) are small hard stones that form in the kidney when the salts in the urine become solid. They can vary in size and location and can eventually grow over time to become quite large. Stones can lodge anywhere in the urinary tract and cause severe pain. There can be one or more stones present at any one time and anyone can get a kidney stone, though most occur between the ages of 20 and 60. Some people keep getting kidney stones throughout their lives. 

Are there high incidence of Stone formation in the Middle Eastern Gulf States?

The world average life time prevalence of stone disease in men is 10%. It is greater than 20% in Gulf states, the highest in the world. The reason is due to a combination of dietary and environmental factors such as:

1. Higher consumption of animal protein.
2. High salt intake
3. Higher consumption of oxalate rich food
4. Excessive excretion of uric acid in urine
5. Lower calcium intake.
6. Lower urine volumes, due to the hot, dry climate of the region
7. Lower excretions of citratein urine
8. Reduced water intake
9. Weight gain
10. Diabetic patients have lower urine pH, which may increase the risk for uric acid calculi

What are the symptoms? 

You may feel a strong gripping pain in the back below the ribs, and you may also have pain in your side, groin and thigh.

Other symptoms may include:
• blood in your urine
• nausea and vomiting
• sweating, fever and shivers.
Some “silent stones” may be totally asymptomatic, which are discovered only on routine check up.

How do we find if we are having renal stones?
• A urine test to look for infection, blood and crystals 
• A blood test to look at the salts in your blood and how well your kidneys are working 
• An ultrasound scan of abdomenor CT scan to see whether there is a stone and check the status of the urinary tract

Recurrent stone formers
These group of patients need blood tests and 24 hour urine tests to find out the causative factor for stone formation and treatment accordingly, to prevent further stone formation.

What happens if the stones of urinary tract are not treated?
The stones, if untreated and remaining in the urinary tract or kidney, can eventually increase in size. This can lead to recurrent urinary tract infections and passage of blood in urine. 

How do we treat the stones stuck up in the ureter?

 Ureteroscopic Laser lithotripsy
Currently, most patients with ureteric stones that require intervention will have Ureteroscopic laser lithotripsy. Ureteroscopic laser lithotripsyoffers the definitive management of ureteric stones at any level.

This method is one of the safest and least morbid intervention for stone located in the entire length of ureter. In this method of treatment , there is no need of puncturing or cutting any part of body.

How can we prevent formation of Stones?

1. Drink the right amount of fluids every day.

It is very important to drink plenty of liquids. Your goal should be 10-18 glasses a day, depending on your exposure to heat. This recommendation is not applicable to patients who have diseases causing fluid overload, such as heart failures or poorly functioning kidney or liver.

2. Calcium-rich dietof minimum 1 Grams/day

Eating high calcium foods as high oxalate food is helpful; for example have low fat cheese with a spinach salad or yogurt with berries. If you take a calcium supplement, calcium citrate is the preferred form.

3. Higher consumption of citrus fruits such as lemon

You may also want to consider drinking lemonade. Research suggests that lemonade may be helpful in reducing the risk of calcium oxalate stone formation

4. Oxalate-controlled diet

Reduce amount of:

• Spinach
• Bran flakes
• Rhubarb
• Beets
• Potato chips
• French fries
• Nuts and nut butters
• Reduce salt intake

Reduce the amount of sodium in your diet to 2-3 grams per day. Limit eating processed high salt containing foods.

5. Reduce animal protein
Eating large amounts of protein may increase the risk of kidney stone formation. Your daily protein needs can usually be met with 2-3 servings a day, or 4 to 6 ounces. Eating more than this if you are at risk at kidney stones is unnecessary.

6. Tests to detect cause of stone formation in recurrent stone former’s
Visit your consultant and have a check up to find out what the real reason of stone formation, especially if you are having recurrent stone formation and initiate treatment early.

• Treatment of urinary tract infections

– Prompt treatment of urinary tract infections can prevent stone formation, especially “Struvite” stones.

Dr. Ginson V George, MBBS, MS MCh (Urology) works as Urology Specialist at Abeer Hospital, Muscat.