Kidney

What is Kidney?

The kidney is a bean shape organ about of a size of fist of a person. Our body has two kidneys they are located back of the abdomen just below the rib cage on either side of spine. Function of the kidney is to remove waste products from the blood by the way of filtration; Waste products are in the form of urea and creatinine. Size of the kidney is about 9cm X 4.5cm x 2.5cm (LxWxD) each kidney has one million nephrons ( Filters) for the process of filtration.

When Kidney fails due to the reasons like stone, infection, fever like malaria, Tuberculosis or drugs like pain killers kidney function affected and kidney gradually stops working. So it is not able to remove waste products like urea and creatinine from the blood and make urine. So in kidney failure patients waste products starts collecting in the blood.

In healthy person every moment by the process of filtration waste products and water are continuously removed from the blood and urine formation occurs with the combination of waste products and water. Any moment if we measure the level of creatinine in the blood ( Serum creatinine level) it is around 1.0 – 1.3 mg%. In kidney failure patients due to continuous collection of creatinine and blood urea in the blood the level of S. Creatinine and Blood urea increases if it goes about 3mg% and patient starts developing symptoms like swelling of eyes, feet, nausea and vomiting, headache, weakness, loss of appetite then dialysis is require.

Failed kidneys do not work properly to remove waste products from the blood. So with help of haemodialysis machine we remove waste product from the blood. One can not to do haemodialysis more than 4 hours otherwise patient become haemodynamically unstable.

Myth: Once dialysis done lifetime repeated dialysis is require.

Fact: There are two types of kidney failure:

  • Temporary (Acute) kidney (Renal) failure (ARF)
  • Permanent (chronic) kidney(renal) failure ( CRF)

In fever like malaria Acute kidney failure occurs so kidney temporarily stops working. In that case 2-3 haemodialysis require to support the kidney to start its work again. In chronic failure both kidneys are permanently damaged and size of both kidney are reduced (small sized kidney). So in that case lifetime repeated dialysis requires.

If they want to get read off dialysis than they should go for kidney transplantation.

Urinary System

  • Urine flows from kidney to ureter
  • Bladder stores urine
  • When bladder becomes full a person goes to washroom to empty the bladder through urethra.
  • In man urethra is 20 cm long in woman urethra is 4 cm short.

Cause of Kidney Stone

  • Obstruction to urinary tract e.g. Enlarged prostate, Stricture in ureter, P.U.J. obstruction
  • Infection in urinary tract
  • Parathyroid Hyperactivity (Hyperparathyroidism)
  • Gout – Uric acid stone forms
  • Metabolic disorders like Hypercalciuria, Cystinuria
  • Diabetes
  • Inflammatory Bowel diseases E.g. Crohn’s disease
  • Intestinal Bypass surgery or ostomy surgery
  • Vitamin A deficiency

Types of kidney stone

  1. Calcium Stones:Calcium stones are the most common type of kidneyStone.Calcium stone is formed when there is too much calcium in the urine. High amount of calcium could be due to:
    • High level of vitamin D
    • Overactive hypothyroid gland
    • due to kidney diseases
  2. Uric acid stones:Uric acid stone is in gout patients. In gout there is high amount of uric acid that forms the stone.
  3. Cystine stones:Cystine stones particularly seen in the person talking high amount of non vegetarian diet. It is also seen in patient having cystinuria.
  4. Struvite stones:These stones are caused by urinary tract infection and are more common in women.

Complications of Kidney Stones

  1. Urinary tract infection
  2. Kidney stops working gradually and become non functioning. Due to stone urine collect in kidney called hydronephrosis. Stone causes infection in the urine so infected urine becomes pus in the kidney. So hydronephrosis converted into pyonephrosis and kidney becomes non functioning due to pyonephrosis

Prevention of kidney stones

  1. Drink plenty of water every day to prevent kidney stone formation. Drink at least 12-15 glass of water daily. More you drink water more urine become diluted so it is very easy for kidney to remove the calcium and waste products out in the kidney. Amount of water or fluid intake should be increase when there is summer or you do exercise.
  2. Diet to reduce:
    • Stone is composed of calcium and oxalate. Oxalate prevents calcium absorption in the intestine, so more calcium accumulated in the kidney to form the stone.
    • Food one should avoid which contain high amount of oxylate like Chocolate,Tea/coffee,Ice cream,Milk products,Almond, pea nuts and cashew nuts,Soya Products,Beat root,Green leafy vegetables
    • One should not reduce the amount of calcium diet unless your family doctor recommends it. This is because calcium is require for healthy bone and teeth.
  3. Diet restriction which contain uric acid like Non Vegetarian diet like meat and fish
  4. Medicines:
    • By the research now most of the pharma company had started manufacturing medicine for prevention of stone.This drug contains Potassium citrate, Magnesium Citrate and Vitamin B6 oral solution to reduce the stone formation.
    • Drugs is taken in the form of tablet and injection for pain relief and infection

Risk Factor for Stone

  • People drinking hard water. In hard water TDS are 1500 to 1700. Tube well water is hard water contains high calcium. Hard water is in North Gujarat and saurashtra so stone formation is high in people living in these region. These area called “Stone belt area”
  • Inadequate fluid intake
  • People working in hot climate e. g. farmers, Labourers, sales persons
  • Persons taking high oxalate e.g. green leafy vegetables (methi, palak etc) tomatoes, tea, coffee, chocolates
  • Long bed ridden patients
  • Reccurent urinary tract infection

Symptoms of Kidney Stones

  1. Pain in the side of abdomen (loin). Sometimes pain is so severe that patient literally ___ in the bed.
  2. Pain sometimes radiate downwards towards the pelvis.
  3. Severe pain causes nausea and vomiting.
  4. Burning while passing urine or burning at the tip of the urethra.
  5. Blood passes in the urine
  6. When infection due to stone occurs patient suffers from fever with rigor
  7. When kidney fails due to kidney stone patient having oedema on both feet, decrease amount of urine, weakness, body becomes pale, loss of appetite.

Diagnosis

Diagnosis of kidney stone is carried out by:

  1. Blood reports
    • Complete blood
    • S.Creatinine
    • S.Potassium (S.K+) while S.Creatinine is high
  2. Urine Report
    • U R/M pus cells suggest infection
      • Red blood cells suggest infection
      • Crystal suggests present of stone
      • Albumium suggests presents of infection
    • Urine C/S
      • Urine culture & sensitivity report is indicated only when urine
      • R/M report suggests many pus cells or repeated infection in the Report
  3. Radiological Reports
    • Ultrasonography of KUB & Prostate: In our institute we are routinely doing bed side sonography to diagnosed kidney stone & effects on the kidney (Hydronephrosis due to kidney stone) . We can also see the pus in the kidney (Pyonephrosis). In pregnancy this is the best investigation to diagnsosed kidney stones.It is the safest radiological investigation to diagnosed any kidney Diseases like Kidney Stone.Kidney Cancer,Bladder Cancer,Prostate Cancer,Renal Cyst etc..
    • X-Ray Kidney Ureter & Bladder:Along with the sonography X-Ray KUB is must to diagnosed kidney ureter or bladder stone exact size & locationof stone is determined by X-Ray KUB. In pregnancy X-Ray KUB isnot advised as it harms the intra utera in child(Contraindicated).
    • CT IVP (Intravenous Pyelography):When X-ray KUB shows kidney stone. Next Investigation advised to the patient is CT IVP. CT IVP is the latest radiological investigation for kidney diseases like kidney stone all over the world. IN CT IVP we can exactly see the location of the stone, size of stone, function of kidney, blockage in ureter due to the stone. In short anatomy is very well visualized by CT IVP. By CT IVP we can avoid unnecessary operations because in normal IVP sometimes anatomy s not very well visualized so exact endourological management of kidney stone was not possible previously. CT IVP is the real blessings for the patiemt suffering from kidney stone.
    • DTPA Renal scan:When CT IVP shows mom functioning kidney.DTPA renal scan is required. If DTPA renal acan shows function of kidney > than 21% then we can save that kidney & we remove the stone only, but if the function is < 21% whole nonfunctioning kidney with kidney stone should be removed.

Treatment

  1. Lithotripsy (Extra Corporeal Shock wave lithotripsy-ESWL ) ESWL is highly effective for soft kidney stone of about 1cm most of the people understand lithotripsy as laser treatment but it is not laser treatment. But in ESWL shock waves are used to break the stones.Devasya Kidney hospital is having high lower direx lithotripsy machine. In ESWL patient is lied down on the table.Kidney stone is located with the X-Ray machine and exactly over the kidney stone shock waves are throwing from the generator of the Direx machine stone is fragmented and size of stone fragments becomes 4-5 mm and all these stone partical passes out with Urine.
  2. PCNL (Per cutaneous Nephrolithotomy) PCNL is a key whole surgery for removal of kidney stone. PCNL is done under general or spinal anesthesia while with the patient lying face down on their abdomen.A small skin incision on the back at the site of kidney is put. A treatment is made from skin to the kidney stone. Aplastic Amplatsz sheath is placed a nephroscope is passed to the sheath into the kidney upto the stone with laser, pneunometric and ultrasound devise stone is fragmented and fragments are taken out with the help of forcep. We are the pioneers in giving quality PCNL treatment in India since 1994. And we have over 10500 PCNL successful PCNL to our credit. Urologist from devasya have demonstrated different types of PCNL in national conferences of India. Till date we have given 95-100% success rate for treatment of kidney stone.
    • Benefits
      • A day care Procedure
      • Very less complication
      • Minimal Pain
      • No whole or incision on body
      • No blood is require
      • 95-100% success rate than lithotripsy ( Litho has 75% success rate)
  3. RIRS & Holmium Laser for kidney stone In this procedure the worlds thinnest 5 X 6.5 F flexible ureterorenoscope is passed per urethra to the bladder and ureter and into the Kidney and all the dialysis of kidney are visualized & stone is fragmented with high power holmium laser machine into dust which clears with the urine. After the procedure DJ Stent is put in the kidney. Till today we have perform more the 500 RIRS procedure in our institute

Ureteric Stones

Origin of ureteric stone occurs from the kidney .Intially stone forms in the kidney and free stone passes out with the urine & migrates into the uretr . Ureter is about 25 cm long diameter of upper part of ureter is 9-10 mm, Diameter of middle part of ureter is 5-6mm AND Diameter of lower part of ureter enters into the bladder is 2-3 mm. So 5-7 mm stone becomes impacted in lower part while bigger stone of about 1 cm becomes impacted in upper part of ureter. Sometimes even small size of stone impacts in upper ureter due to infection or stricture in the ureter.

  1. Symptoms:
    • Ureteric stones causes severe calicy pain like labour pain
    • Pain starts from the loin amd migrates into the groin.
    • Patient literally toses in the bed.
    • Due to severe pain patienty also develops Nausea and vomiting.
    • Because of friction of stone with the ureteric wall patient passes bloo din the urine
    • Due to infection of the stone patient develops buning in the urine
    • Sometimes patient develops fever with chill due to severe infection
  2. Investigations:
    • CBC
    • Urine R/M
    • S. Creatinine
    • X-Ray KUB
    • USG KUB
    • CT IVP