Kidney Stones Treatments and Outcome

Kidney stones treatments depend upon numerous factors, including, but not necessarily limited to:  the hospital you go to, the Urologist you see, and the availability of services. Uncomplicated renal stones are often managed supportively. Management is focused on relieving the symptoms, such as, giving pain relievers and muscle relaxants for pain, and the prevention of the complications like pyelonephritis and UTI.  Antibiotics must be given to suspected cases of renal stones. Most of the time, stones just pass through the urinary tract and in the urine. However, larger stones sometimes require a more invasive approach, such as, surgery.

Timeliness in treatment may play a role in the outcome of care.  For example, kidney stones in the presence of other renal conditions, such as, a kidney infection, may signify the need for prompter action when compared to waiting for stones to pass. A kidney infection may be life threatening. Timely attention may reduce the risk of a life threatening condition.  Another example. If an ultrasound suggests kidney stones, but,  in truth is an alternative condition, such as UPJ Obstruction and a Kidney Infection, then the possible waiting time associated with commencing 2nd line  treatment may result in a more serious or life threatening condition. There are benefits and risks associated with all treatment options. A meaningful Q and A with Your Doctor may assist in making a well-educated decision and following your instincts to seek out a second opinion when necessary may be beneficial in select circumstances.

Renal Stones Complication Risks

Renal stones seldom lead to complications because most of these stones are eventually washed away in the urine. However, there are times when these stones persist and may cause complications.  Renal stones may cause partial or complete obstruction in the urinary tract. The accumulation of urine in the tract will promote growth of pathogenic organisms, such as, Escherichia coli and candida albicans.  That is the reason why most people with renal stones may tend to have recurrent urinary tract infection. A more fatal complication of renal stones is the damage that they cause in the kidneys, causing glomerulonephritis and eventually leading to renal failure. When a kidney stone diagnosis is established and a kidney infection is present, there may be other life threatening risks. Timely advanced medical intervention may reduce additional  risks.

Monitoring Kidney Function

Creatinine clearance should be one of the parameters to be checked in patients with nephrolithiasis. A decreased Creatinine clearance means that there is a decrease in kidney function.

Preventing Risks and Medical Intervention

Renal calculi that are less than 5mm with tolerable pain and do not produce other symptoms are eventually washed off in the urine. Management of small renal stones is supportive and is focused on relieving the pain. However, in stones that are more than 5mm or stones that cause intolerable pain not relieved by analgesics and pain relievers, medical intervention is indicated.

Medical Expulsive Therapy

Medical expulsive therapy is often commonly used initial management for symptomatic renal stones. Drugs that promote expulsion are given. Nifedipine and Prednisolone are the 2 most common drugs used for promoting expulsion of stones. Ideally, stones pass through the urine within 48 hours after therapy.

Shockwave Lithotripsy

Another method of destroying renal stones is the Shockwave lithotripsy. Shockwaves are fired to the stones present within the kidneys. The waves will breakdown the stones into smaller pieces, allowing them to get washed off in the urine. However, a percentage of patients who received shockwave therapy for renal stones suffered renal injury.

Percutatneous Nephrolithotomy

Percutatneous nephrolithotomy is a surgical procedure for renal stone removal. The procedure is also known as the keyhole stone extraction. Open surgery for the management of renal stones is rare and is done only in desperate situation, where there is severe and extensive renal damage with complications.

Other Surgical Options

In the presence of other kidney conditions and/or questionable diagnosis and to prevent untimely treatment that may cause a complication(s), select Urologists may perform variations in surgery to better identify and treat the condition.      

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