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Nephrolithiasis: urinary stones in the kidney
Depending on the size, type and position, kidney stones can go unnoticed for a long time or can lead to a violent and very painful renal colic. If the stones migrate into the lower urinary tract, there are usually similar complaints. The causes are not fully understood, but beneficial factors such as certain foods with harmful nutrients and metabolic disorders are undisputed potential triggers. Conventional measures consist in crushing and removing the kidney stones, while naturopathy in particular tries to prevent stone suffering by changing the diet.
A brief overview
Those who have already suffered from kidney stones are likely to develop urinary stones in the kidney again and again without preventive measures. While the article below provides worth knowing, detailed information, the following short summary provides a first quick overview of this common kidney disease.
- definition: Kidney stones are crystalline deposits of urine components that form in the kidney pelvis or in the kidney cups. They have different sizes, shapes and compositions. If the urinary stones are located in the lower urinary tract (e.g. due to migration), they are named according to their position.
- Symptoms: Typical complaints include severe renal colic and severe flank pain on the corresponding side, which can radiate to neighboring regions of the body. This can also cause nausea and vomiting, as well as blood in the urine. If there are accompanying infections or other complications, further complaints may arise.
- causes: In addition to certain basic diseases of the metabolism and hormone balance, the previously known causes also include a lack of fluids (dehydration), unfavorable diets and an overall unhealthy lifestyle with little exercise.
- diagnosis: In the vast majority of cases, ultrasound examinations or other imaging, radiological, endoscopic or nuclear medical procedures are used in the diagnosis. Urine, blood and stone samples are often analyzed to find the exact causes.
- treatment: In lighter cases, conservative methods can facilitate the passage of stones and alleviate the pain by increasing hydration, changing the diet and heat treatment. In the case of more serious diseases and if there are impending complications, various techniques are used to actively break up and remove the kidney stones.
- Naturopathic treatment: Preventive and symptom-relieving, an additional alternative treatment method is said to be a particularly effective change of diet (for example to a vegetarian-basic diet). Potassium citrate, the potassium salt of citric acid, has also proven to be recommendable. Drinking lemon juice is considered a good measure against kidney stones.
Definition
Kidney stones (from the Greek: nephroliths) are crystalline deposits that are formed from components of the urine and are located in the kidney pelvis or in the kidney cups. If the deposits are not in the kidney, but elsewhere in the urinary tract, the so-called urinary stones are also called ureteral stones, bladder stones or urethral stones depending on their location. A cluster of many smaller kidney stones is called kidney semolina.
Basically, the deposits differ in their size, external shape and composition. Because of these characteristics, there are different types of kidney stones. The most common shapes include coral stones, deer antler stones, valve stones and pouring stones. Looking at the chemical components, the following classification, which is related to the causes, is often chosen:
- Calcium stones: About seventy to eighty percent are calcium-related deposits, the most common of which are calcium oxalate stones.
- Uric acid stones: About fifteen percent are nutritional and so-called urate stones.
- Struvite stones: About ten percent consist of magnesium ammonium phosphate and typically form in urinary tract infections (infection stones).
- Cystine stones and Xanthine stones: A very small number of kidney stones (approximately two percent) is due to rare inheritable metabolic diseases (cystinuria, xanthinuria).
Kidney stones are the most common kidney disease and are now considered a widespread common disease. In total, stone disease in Germany occurs in around five percent of the total population. Kidney stone disease (nephrolithiasis) is particularly common between the ages of thirty and fifty, with men being affected more often than women. Repeated stone formation occurs in more than fifty percent of the cases.
Symptoms
Smaller kidney stones (between 5 and 10 millimeters) and kidney semolina are often only discovered by accident and usually go away on their own without causing major complaints. Flushing with urine can lead to (slight) discomfort when urinating (dysuria).
However, if there are larger urinary stones in the kidney, symptoms usually arise that require treatment and removal of the stones. The typical symptom is the so-called renal colic. These very strong and cramp-like pains arise when the urinary stones move through the lower urinary tract (ureter colic). The muscle contractions that occur in episodes and the overuse of the ureters trigger intense pain or colic, which are among the most severe types of pain. In this context, an increased urge to move as well as nausea and vomiting can occur.
Depending on the position of the kidney stones, the symptoms appear on the corresponding flank and may radiate to neighboring regions (back and abdomen). Ureteral stones cause pain in the pubic area and in the groin (groin pain), which can radiate up to the legs. The symptoms persist until the kidney stone gets into the bladder. Sometimes a urinary stone is pinched, so the process can take a long time. In these cases, there is an increased risk of prolonged urine build-up (kidney build-up), which can damage the kidney. Bacterial growth can also be promoted, so that in addition to a urinary tract infection or even kidney inflammation (pyelonephritis), accompanied by fever and other possible complaints. A serious possible complication in this case is urosepsis, a general bacterial inflammation of the body (sepsis) originating from the urinary tract.
In most cases, minor injuries to the ureter mucous membranes occur during natural removal, so that blood is visible in the urine (macrohematuria) or can be demonstrated in laboratory tests (microhematuria).
Other possible accompanying symptoms are an increased urge to urinate, which requires frequent urination, and beginning intestinal paralysis. In rare, severe courses, massive complications such as (unilateral) acute kidney failure or uremia (urine poisoning from “urine in the blood”) can occur without appropriate treatment.
Chronic kidney stones can be very large and grow into so-called pouring stones that fill the entire kidney basin. In this case, migration to the lower urinary tract is not possible. There are fewer complaints, however. Sufferers complain of mild, dull or oppressive pain in the area of the kidneys and back. Complications usually arise from bacterial infections or a shrinking kidney that is associated with the destruction of kidney tissue.
Causes
In medical jargon, the process of developing urinary stones in the kidneys and urinary tract is called nephrolithiasis or urolithiasis. A solid mass is formed from previously dissolved substances, which leads to crystalline deposition (concretion).
The exact metabolic processes have not yet been fully understood. Before stone formation occurs, there are increased concentrations of certain components in the blood and urine. From an expert point of view, various causes can lead to such an imbalance, such as lack of fluids (dehydration) but also various diseases that are associated with an increased urine concentration. These include, among others, the purine metabolic disease known as gout or a hormone-related disruption of the calcium metabolism (parathyroid hyperfunction).
In general, kidney stones are also considered a disease of affluence, whereby a rather unhealthy lifestyle is assumed to be the cause. Reasons are seen in a protein-rich diet, overeating, lack of exercise and the associated obesity (obesity). Taking certain medications (e.g. antibiotics) is also associated with increased stone formation.
Diagnosis
In addition to the typical renal colic and other information that can be determined by a normal patient survey (medical history) and the associated clinical examination, diagnostic procedures are mainly used to confirm the diagnosis. In most cases, urine samples are taken and evaluated in the laboratory, and ultrasound examinations of the kidneys, ureters and bladder are carried out.
Under certain circumstances, X-rays can also supplement the diagnosis using contrast media to create a pyelogram (urography), although this diagnostic method is used less and less. Nowadays, other imaging methods such as computer tomography (CT) and magnetic resonance imaging (MRI) are also used. Depending on the size and the respective components, not all urinary stones can be made visible using these methods.
In more difficult cases and if the diagnosis is not clear, further endoscopic or nuclear medical examinations can also be considered. To investigate the cause, those affected can also be advised to use a sieve when urinating and to store the stones that have been excreted for certain analysis procedures.
Treatment
In principle, therapy is only necessary if the kidney stones do not go away on their own or if symptoms arise that require treatment, which can also lead to complications. Treatment does not mean active removal of the stones.
Conservative treatment
In many cases, conservative measures are initially recommended to facilitate and accelerate the natural finish. Above all, this includes an increased fluid intake of about two to three liters (low-sodium) water per day, moderate exercise and a low-salt and low-meat diet. In the case of accompanying pain, conventional medicine often uses the well-tried home remedy of heat therapy (warm bath, warm body wrap or hot water bottle). Pain relievers are also prescribed for severe symptoms. In all cases, the stone exit should be monitored to prevent possible complications in the further course.
Treatment using active removal and dissolution
If there is a medical indication to actively intervene, this can be done using various methods, depending on the location and type of stone. The urinary stones are either dissolved with medication (litholysis) or broken and removed using various techniques.
The crushing of urinary and gallstones is called lithotripsy. Known methods use, for example, mechanical pressure waves from the outside (extracorporeal shock wave lithotripsy), laser (laser lithotripsy) or a special instrument that is inserted through an artificial channel to the position of the stone (percutaneous nephrolitholapaxy).
An often used surgical method for ureter stones is also ureterorenoscopy (ureter and kidney mirroring). This endoscopic examination of the ureter and the renal pelvis makes it possible to introduce further instruments for breaking and removing the stone via the working channel of the inserted optical device (intracorporeal lithotripsy). So-called loop extraction is rarely used these days due to the increased risk of injury.
In most cases, a catheter or stent (also called a ureteral splint) is left in the ureter for a few days after the procedure to ensure that any residues of the deposits can subsequently drain away more easily.
A completely different approach was postulated some time ago by two US osteopaths. With their Ig Nobel Prize (2018), they showed a spectacular study: Rides on the roller coaster help against kidney stones.
Prevention
If kidney stones have been formed more than once, there is a very high probability that those affected will continue to develop urinary stones. In any case, the respective cause is the decisive factor in order to be able to take the right preventive measures. To determine the cause, the personal life and professional history, possible previous illnesses and analysis results of blood, urine and stone samples are used.
In any case, it is recommended to increase the fluid intake to two to three liters (low sodium) of water, especially at night. This keeps the concentration of stone-forming substances in the urine as low as possible. Furthermore, nutrition is of great importance. Depending on the composition of the kidney stones, various dietary changes can help prevent new formation.
Most sufferers tend to calcium oxalate stones, the formation of which can be explained either by an increased oxalate intake or an increased calcium breakdown. In this case, it is advised to ensure an adequate calcium intake in the diet. Calcium binds the oxalate in the intestine, causing it to be excreted and no longer available for stone formation. In addition, correspondingly little oxalate should be ingested through food. The best way to ensure this is to avoid foods with a high proportion of oxalate acid. These include coffee, black (and green) tea, cola, chocolate, strawberries, rhubarb, spinach and Swiss chard.
If people are more likely to form uric acid stones, the consumption of meat (poultry) and fish should be reduced, since these foods contain high amounts of purines. The uric acid formed from these substances (as a breakdown product) lowers the pH value of the urine and leads to an increased uric acid level. If this is the case, the organism tries to neutralize the high acid concentration with calcium from the bones. In the worst case, this can lead to osteoporosis. Sometimes drug treatment is also necessary in this context.
It is believed that too much stress reduces the formation of substances that are more likely to inhibit stone formation, such as magnesium. Accordingly, stress reduction and magnesium-containing foods can help to counteract the (re) formation of stones. Convenient and magnesium-rich foods include brewer's yeast, soy flour, wheat germ or wheat bran, almonds, bananas, kohlrabi and celery.
Naturopathic treatment
According to the preventive measures, a further change in diet and life can prevent the development of kidney stones. A healthy, salt, fat and protein reduced diet, combined with sufficient exercise, lowers the general risk of urinary stones. For example, a vegetarian-basic diet (or a base treatment) can help prevent kidney stones and reduce the corresponding complaints. A basic diet can especially reduce the appearance of the so-called cystine stones.
Potassium citrate, the potassium salt of citric acid, has also been shown to be particularly effective. So it happens that to protect against kidney stones drinking fresh lemon juice or even a lemon juice cure are recommended. (jvs, cs)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
Swell:
- Strehlow, Wighard: Hildegard medicine from A-Z, Droemer Knaur; 11th edition: 11, 2000
- Pschyrembel, Willibald: Pschyrembel naturopathy and alternative healing methods, De Gruyter, 4th edition, 2011
- Bierbach, Elvira (ed.): Naturopathic practice today: Textbook and Atlas, Urban & Fischer Verlag / Elsevier GmbH, 5th edition, 2013
- Institute for Quality and Efficiency in Health Care (IQWiG): Kidney stones and ureter stones (accessed: June 25, 2019), gesundheitsinformation.de
- Professor Moe, Orson W .: Kidney stones: pathophysiology and medical management, The Lancet, 2006, thelancet.com
- German Society for Urology (DGU): S2k guidelines for diagnosis, therapy and metaphylaxis of urolithiasis, as of March 2015, detailed view of guidelines
- European Association of Urology (EAU): Urolithiasis (accessed: June 25, 2019), uroweb.org
- Herold, Gerd: Internal Medicine 2019, self-published, 2018
- Professional Association of German Internists: Kidney Stones (accessed: June 25, 2019), internisten-im-netz.de
ICD codes for this disease: N20ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.
