Kidney stones – treatment

Kidney Stones: Prevent

It is best, of course, if you prevent the formation of kidney stones, so it does not even come to a treatment. To prevent (new) kidney stones, patients should drink enough, two to three liters daily. Especially in the evening, sufficient fluid should be taken in order to avoid a high concentration of urine at night. Alcohol, coffee and tea should be consumed only in moderation. If you have a tendency to calcium-containing stones, it is best to use low-calcium water.

An important point is also the diet of kidney stones. The following recommendations apply here:

• Pay attention to low-salt and low-fat diets.
• Limit intake of animal protein.
• Prefer vegetable foods (such as vegetables, fruits) because they make the urine more alkaline and contain substances that inhibit kidney stone formation.
• Purine-rich foods (offal, some fish such as herring, mackerel, anchovies, etc.) avoid, because purines are degraded to uric acid and thus promote the formation of uric acid stones.
• For increased risk of oxalic acid stones (oxalate stones), avoid high-oxalic foods such as cocoa (chocolate!), Rhubarb, beetroot, spinach, black tea and nuts.
• Ensure adequate calcium intake, as this may, paradoxically, reduce the formation of calcium oxalate stones. However, this only applies to the calcium in the diet – calcium-containing supplements on the other hand promote the formation of stones.

These recommendations are especially for people who already had kidney stones. Because the rate of relapse is high – half of all patients get renal calculi again within ten years. Here, a consistent dietary change and, if necessary, additional medication prevention are necessary.

Drugs for kidney stone prevention

Depending on the composition of the previous kidney stones, the urine is made more basic or acidified by medication, or thiazides, allopurinol or minerals are given. All of these chemical changes are designed to ensure that kidney-excreted metabolites do not precipitate as crystals and pool together.

With consistent stone prophylaxis, renal calculi form again in only about five percent of cases.

Kidney stones: treatment options

There are basically two approaches: One waits for the spontaneous departure of a kidney stone or actively intervenes. In the decision, the doctor considers various factors, such as the nature and severity of the symptoms, any imminent complications (such as blood poisoning) as well as any comorbidities.

Kidney stones: Treatment by conservative route

The conservative treatment of kidney stones mainly includes the following measures:

• Plenty of fluid intake (2.5 to 3 liters per day), but preferably no caffeinated coffee, black tea and no sugary sodas and cola drinks and no alcoholic drinks
• Heat applications (hot water bottle, heating pad, warm / hot baths etc.)
• A lot of physical activity like climbing stairs, dancing, squats
• Low purine foods (offal, some fish such as mackerel), because purines are broken down to uric acid (uric acid rocks!)
• Restrain meat consumption (five to seven servings per week, never eat meat twice a day!)
• Low salt diet
• Eat lots of vegetables and fruits
• Normal to calcium-rich diet (800 mg calcium per day from milk and dairy products)
• Remove obesity
• Anticonvulsant and analgesic drugs in renal colic

In severe renal colic pain, diclofenac is usually prescribed for normal renal function. Only when this does not work, other painkillers are used.

The effect of the conservative treatment is regularly checked by means of ultrasound and / or X-ray examinations. It can be determined whether the kidney stone continues to migrate or not and if it causes complications (such as urinary retention).

Kidney stones: Treatment by active stone removal

If a spontaneous discharge of the kidney stone is not possible (usually for stones over seven millimeters in diameter), the pain under the painkillers does not subside or threatens kidney damage, one of the following therapies is performed. The choice of therapy depends, among other things, on the composition, location and size of the kidney stone. It is particularly important to distinguish whether the stone is still in the renal pelvis or is already in the ureter.

Litholyse

Special substances can in some cases dissolve kidney stones and kidney stones. They are either ingested (oral intake) or delivered via a catheter.

Extracorporeal shockwave lithotripsy (ESWL)

Here, the kidney stones are first located by means of ultrasound or fluoroscopy. Then targeted external pressure waves (shock waves) are directed to penetrate the body tissue and shatter the kidney stones. The resulting fragments can go off spontaneously.

Percutaneous nephrolitholapaxy (PCNL)

A puncture needle is used to drill a thin canal from the outside to the kidney. Through the canal an optical instrument is introduced, the kidney stones are smashed and removed.

Ureterorenoscopy (URS)

This kidney stone surgery is used on ureteral stones – kidney stones that have slid into the urethra. A semi-rigid or flexible thin tube is inserted via the urethra into the bladder and further into the ureter using an optical instrument (similar to a bladder mirror).

Through the working channel of the optical instrument different devices (special probes and pliers) are introduced, with the aid of which the kidney stone can be smashed and removed. Sometimes a catheter as a placeholder (stent) is left in the ureter for a few days to facilitate the natural discharge of other stone fragments.

loop extraction

In this method, the doctor inserts a sling over the ureter and tries to extract the kidney stone with it. Because of the high risk of injury, this form of treatment is used today only in exceptional cases.

Open surgery or laparoscopy

A Kidney Stones Treatment By open surgery today is only rarely necessary, such as very large stones that complete the hollow system of the kidney completely.