Kidney, Kidney stone, its Classification,

Diagnosis, Treatment and its Prevention.

By

Anab Shaheen (G.L)

Maryam Faryal

Rafia

Zakia Bibi

Shahida Bibi

Department Of Chemistry
University Of Science and Technology
Bannu,
Pakistan

1
(2019-2023)

2
IN THE NAME OF ALLAH THE MOST BENEFICENT AND

MERCIFUL

3
 A Thesis entitled

Introduction of kidney, kidney stone, its classification, Diagnosis,

Treatment and its preventions.

A dissertation submitted in partial fulfillment of the requirement for the

degree of

Bachelor of Studies
In
Chemistry

Submitted By:
Anab shaheen
Maryam faryal
Rafia
Zakia bibi
Shahida bibi

Supervised By:
Ms. Kausar Rehman

Department of Chemistry, University of Science and Technology

Bannu, Pakistan (2023)

4
 Declaration
This is to certify that this dissertation entitled “kidney Stone, its Classification, Diagnosis,
Treatment and Preventions” by Anab shaheen, Maryam faryal, Zakia bibi, Rafia and
Shahida bibi is accepted in its present form by the Department of Chemistry, University of
Science and Technology, Bannu, Pakistan as satisfying the dissertation requirements for the
degree of Bachelor of Studies in Chemistry.

External Examiner:

Supervisor:

Kausar Rehman
Department of Chemistry,
GGDC Lakki Marwat

Head of Department:
Shagufta Saad
Department of Chemistry,
GGDC Lakki Marwat

BS Coordinator:
Shaheen
Department of Chemistry,
GGDC Lakki Marwat

Principal:

Fatima
Department of Chemistry,
GGDC Lakki Marwat)
5
 This Work is dedicated to
“My family”

Especially my

Dad

Who had always believed in me

and My Mom

The unseen power behind my every achievement.

They are my life. I have done nothing and will not be able to do anything even
in future without having them on my back.

6
 Acknowledgement

I owe my profound thanks and deepest sense of gratitude to ALLAH ALMIGHTY, Creator of
the universe, and Worthy of all praises, the Merciful, Who blessed us with determination,
potential and ability to complete this research work. This is His extreme blessing and grace on us
for which we cannot adequately thanks. We offer our humblest and sincere thanks to the HOLY
PROPHET MUHAMMAD (PBUH) who is the source of knowledge and guidance, for the entire
world forever and exhorted his followers to seek knowledge from cradle to grave. We wish to
express vehement sense of thankfulness to our supervisor, prof. Kausar Rehman, Department
of Chemistry, GGDC Lakki Marwat, for his enthusiastic interest and keen supervision. Her
inspiring guidance, deep analytic remarks, invigorating encouragement, generous help, good and
co-operative manners and friendly discussion enabled me to complete the BS research work
efficiently. We are highly indebted to pay cordial thanks to Prof. Shagufta Saad, HOD,
Department of Chemistry, for her immense help, cooperation and providing Lab facilities during
research work.
We would like to acknowledge our seniors and colleagues. We owe our deepest sense of
gratitude to our parents and siblings, but no words could be a substitute of their efforts,
sacrifices, lots of prayers and love. Last but not the least; we are deeply indebted to my esteemed
teacher, prof. Rahman Ullah Khan, whose unwavering support and invaluable assistance
during the arduous process of crafting this thesis deserves the utmost admiration and praise. His
guiding presence illuminated our path and elevated this endeavor to new heights, making this
journey an unforgettable and cherished experience.

Anab shaheen
Maryam faryal
Zakia bibi
Rafia
Shahida bib
(GGDC Lakki Marwat)

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 Table of contents

1. ABSTRACT.......................................................................................................................10
2. INTRODUCTION TO KIDNEY...........................................................................................11
3. LOCATION OF KIDNEY.................................................................................................... 11
4. ANOTOMY OF KIDNEY.................................................................................................... 12
4.1. External anatomy..........................................................................................................12

4.2. Internal anatomy..........................................................................................................13

4.2.1. Renal cortex..................................................................................................................13

4.2.2. Renal medulla................................................................................................................ 14

4.2.3. Renal pelvis...................................................................................................................14

5. NEPHRON..................................................................................................................... 14

6. STRUCTURE OF NEOHRON...........................................................................................14

6.1. Renal corpuscle............................................................................................................15

6.1.1. Bowman capsule.........................................................................................................16

6.1.2. Glomerulus................................................................................................................. 16

6.2 Renal tubule.............................................................................................................. 17

6.2.1. Proximal convoluted tubule........................................................................................17

6.2.2. Distal convoluted tubule............................................................................................17

6.2.3. Loop of Henle............................................................................................................ 18

6.2.3.1. Thin ascending limb....................................................................................................18

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6.2.3.2. Thick ascending limb................................................................................................... 18

6.2.3.3. Thin descending limb................................................................................................. 18

6.2.4. Collecting duct............................................................................................................ 19

7. TYPES OF NEPHRON................................................................................................... 19

7.1. cortical nephron.........................................................................................................20

7.2. Juxtamedullary nephron.............................................................................................20

8. FUNCTION OF THE KIDNEY........................................................................................20

9. BLOOD SUPPLY TO KIDNEY.......................................................................................21

10. KIDNEY STONE.........................................................................................................22

11. TYPES OF KIDNEY STONE........................................................................................23

12. CALCUIM STONE.....................................................................................................23

12.1. Calcium oxalate stone...........................................................................................24

12.1.1. Risk factor...............................................................................................................24

12.1.2. Prevention.............................................................................................................. 24

12.2. Calcium phosphate stone......................................................................................24

13. STRUVITE STONE..................................................................................................25

13.1. Symptoms............................................................................................................26

13.2. Diagnosis............................................................................................................. 26

13.3. Treatment............................................................................................................27

14. URIC ACID STONE.................................................................................................27

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14.1. Symptoms............................................................................................................... 28

14.2. Causes...................................................................................................................... 28

14.3. Treatment................................................................................................................ 28

15. CYSTINE STONE.........................................................................................................28

15.1. Causes...................................................................................................................... 29

15.2. Cystinuria................................................................................................................. 29

15.3. Symptoms of cystinuria............................................................................................30

15.4. Treatment of cystinuria............................................................................................31

16. SYMPTOMS OF KIDNEY STONE.................................................................................31

17. CAUSES OF KIDNEY STONE........................................................................................32

18. EXAM AND TEST FOR KIDNEY STONE.......................................................................33

19. TREATEMENT OF KDNEY STONE..............................................................................33

19.1. Treatment of small kidney stone..............................................................................33

19.2. Treatment of large kidney stone.............................................................................38

20. PREVENTION OF KIDNEY STONE..............................................................................38

20.1. Prevention of kidney stone by life style changes....................................................39

20.2. Prevention of kidney stone by medication.............................................................41

21. CONCLUSION...........................................................................................................42

22. REFRENCES............................................................................................................. 44

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1. ABSRACT

This review covers almost each and every aspect of the kidney location, anatomy, structural and
functional unit and function of the kidney and introduction, types, causes prevention, risk factor
and treatment etc of the kidney stone. Locations, anatomy, structural and functional unit,
function of the Kidney stones. The prevalence and incidence of kidney stones is rising
worldwide. It is an increasing urological disorder of human health, affecting about 12% of the
world population. It has been associated with an increased risk of end-stage renal failure; with a
lifetime risk of passing a kidney stone of about 8-10%.Increased incidence of kidney stones in
the industrialized world is associated with improved standards of living and is strongly
associated with race or ethnicity and region of residence. A seasonal variation is also seen, with
high urinary calcium oxalate saturation in men during summer and in women during early
winter. Stones form twice as often in men as women. The peakage in men is 30 years; women
have a bimodal age distribution, with peaks at 35 and 55 years. Once a kidney stone forms,
the probability that a second stone will within five to seven years is approximately 50%

11
2. INTRODUCTION TO KIDNEY

Kidney is two reddish bean shaped organ found in vertebrate [1]. Their internal structure is
revealed by anatomical studies using light and electron microscopy [2]. It is one of the most
important organs of our body, due its role in the filtration, metabolism, and excretion of
compounds All the blood which is present in our body passes through the kidney just for
filtration When the kidneys malfunction, or if they stop working (kidney failure) it may lead to
various complications such as, hyperkalemia or increased potassium levels in the blood, anemia,
heart disease, and pericard it is among other.

3. Location of kidney

The kidney is located on either side of spine, in the retroperitoneal space. The right kidney is
little lower and also smaller than the left one, because of the liver on the right side of the
abdominal cavity, above the right kidney [3].

They are located retroperitoneal on the posterior abdominal wall and are found between the
transverse processes of T12 and L3 [4].

FIG 1 Shows location of kidney

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4. Anatomy of kidney
The kidneys are bean-shaped organs, weighing anywhere from 150 to 200 g in males and about
120g to 135 g in females. The dimensions are usually a length of 10cm to 12 cm, a width of 5cm
to 7 cm, and a thickness of 3cm to 5 cm. Each kidney is about the size of a closed fist [5].

4.1. External anatomy

Kidney are bean shaped dark red in colour one side bulges outward (convex) and the other side
indented (concave).The indented or concave section is known as the helium. This is where the
renal vein, the renal artery and the ureter enter and exit the kidney. Each kidney is enclosed in a
semi transparent membrane called as the renal capsule. It is the container or sac in which the
other component of the internal anatomy of the kidney stored. The renal capsule also protects the
kidney against infection and trauma [6].

FIG 2 shows external anatomy of kidney

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4.2. Internal anatomy
Internally each kidney is made up three layers renal cortex, renal medulla and renal pelvis.

4.2.1. Renal cortex

The kidney is surrounding by renal cortex, a layer of tissue that is also covered by the renal
capsule. The renal cortex is granular due to presence of nephrone. The cortex provides space for
arteriole and venules from renal artery and vein, as well as the glomerular capillaries, to perfuse
the nephrone of the kidney. Erythropoietin, a hormone necessary for the synthesis of new red
blood cells, is also produced in the renal cortex. The renal cortex is also known as the kidney
cortex. The renal cortex is brownish-red in color. It’s the outside part of the kidney. It covers the
renal medulla, the inside part of the kidney [7].

FIG 3 shows internal anatomy of kidney

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4.2.2. Renal medulla

The medulla is the inner region of the kidney. The medulla consists of the multiple pyramidal
tissue masses, called the renal pyramids, which are triangular structures that contain a dense
network of nephron. The pyramids consist mainly of tubules that transport urine from the
cortical, or outer, part of the kidney, where urine is produced, to the calyces some animals, such
as rats and rabbits, have a kidney composed of only one renal pyramid. In humans each kidney
has a dozen or more pyramid.

4.2.3. Renal pelvis

The renal pelvis contains the helium. The helium is the concave part of the bean shaped where
blood vessels and nerves enter and exit the kidney; it is also the point of exit for the ureters. The
renal pelvis connects the kidney to the rest of the body [8].The renal pelvis is triangular in shape,
lies posteriorly in the renal helium surrounded by fat and vessels. Its function pathway for fluid
on its way to the bladder [9].The renal pelvis or pelvis of the kidney is the funnel-like dilated
part of the ureter in the kidney [10].

4.2.4. Calyces

The first part of the renal pelvis contains the calyces. These are small cup-shaped spaces that
collect fluid before it moves into the bladder. This is also where extra fluid and waste become
urine

5. Nephron

Nephron is the structural and functional unit of kidney. In each adult human kidney there are one
million of nephron, but the number of nephron in the kidney changes from one organism to
another in a mouse, there are about twelve thousand five hundred nephron only. It is composed
of a renal corpuscle and a renal tubule [11].

6. Structure of nephron

A nephron is made of two parts:

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  A renal corpuscle, which is the initial filtering component.
 A renal tubule that processes and carries away the filtered fluid [12].

FIG 4 structure of nephron

6.1. Renal corpuscle

It consists of a knot of capillaries (glomerulus) surrounded by a double-walled capsule
(Bowman’s capsule) that opens into a tubule The renal corpuscle consists of a glomerulus
surrounded by a Bowman’s capsule. The glomerulus arises from an afferent arteriole and empties
into an efferent arteriole. The afferent arteriole has a broader diameter than the efferent arteriole.
The smaller diameter of an efferent arteriole helps to maintain high blood pressure in the
glomerulus. It is where the vascular system and urinary system meet.

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 FIG 5 Structure of renal corpuscle

6.1.1. Bowman capsule

Bowman’s capsule is the second structure of the renal corpuscle. It is ultimately the structure that
connects the renal corpuscle to the renal tubule; the second part of the nephron. Bowman’s
capsule (is a cup-like sac at the beginning of the tubular component of a nephron in the
mammalian kidney that performs the first step in the filtration of blood to form urine. It encloses
a glomerulus. Fluids from blood in the glomerulus are collected in the Bowman's capsule [13]
.Bowman’s capsule is located in the renal cortex, part of your kidney. Bowman’s capsule
Bowman’s capsule encloses a space called “Bowman’s space Bowman’s capsule also has a
structural function and creates a urinary space through which filtrate can enter the nephron and
pass to the proximal convoluted tubule [14].

6.1.2. Glomerulus
The glomerulus is a network of small blood vessels (capillaries) located at the beginning of
a nephron in the kidney [16].Clinically, the glomerulus is considered to be the most important
part of the kidney mainly because most of the disorders that affect the kidney involve the
glomerulus. The glomerulus receives its blood supply from an afferent arteriole of the renal
arterial
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circulation [18].The main function of the glomerulus is to filter plasma to produce glomerular
filtrate, which passes down the length of the nephron tubule to form urine [19].

6.2. Renal Tubule

The renal tubule is a U-shaped structure where the filtrate from the renal corpuscle enters. The
beginning and end of the U are the proximal and distal convoluted tubules, while the curved
portion of the U is the loop of Henle As the filtrate travels through the renal tubule, some content
is reabsorbed back into the vasculature while other substances are secreted into the tubule, and
whatever remains in the tubule is eventually excreted as urine [20].The renal tubule is a long and
convoluted structure that emerges from the glomerulus and can be divided into three parts based
on function. The major function of tubules is reabsorption and the process can either be
through active transport or passive transport. In addition, secretions by tubules help in the urine
formation without affecting the electrolyte balance of the body [21].

6.2.1. Proximal convoluted

The proximal convoluted tubule (PCT) is a segment of the renal tubule responsible for the
reabsorption and secretion of various solutes and water. The PCT is located in the renal cortex,
the outer part of the kidney, and is the first segment of the renal tubule, where it receives the
filtrate from the renal corpuscle. The proximal tubule is the region where reabsorption of
essential substance like glucose, protein, amino acid, a major portion of electrolyte takes.
[22].The proximal convoluted tubule (PCT) has a high capacity for reabsorption, hence it has
specialized features to aid with this. It is lined with simple cuboidal epithelial cells which have a
brush border to increase surface area on the apical side. In addition to solute reabsorption and
secretion, the proximal tubule is also a metabolic organ. For example, within the proximal
tubule, 25-hydroxy-vitamin D is converted to 1,25-dihydroxy-vitamin D, a hormone that
increases blood Ca2+ levels [23].

6.2.2. Distal convoluted tube

The distal convoluted tubule (DCT) is a portion of kidney nephron between the loop of Henle
and the collecting duct system. It is partly responsible for the regulation of potassium, sodium,
calcium, and pH. It is the primary site for the kidneys' hormone based regulation of calcium

18
(Ca).

19
Although the DCT is the shortest segment of the nephron it plays a critical role in a variety of
homeostatic processes, including sodium chloride reabsorption, potassium secretion, and calcium
and magnesium handling [24]. It also participates in calcium regulation by reabsorbing Ca2+ in
response to parathyroid hormone [25].

6.2.3. Loop of Henle

Loop of Henle, long U-shaped portion of the tubule that conducts urine within each nephron of
the kidney of reptiles, birds, and mammals. Anatomically, the loop of Henle can be divided into
three main segments: the thin descending limb, the thin ascending limb, and the thick ascending
limb (sometimes also called the diluting segment).The ascending limb have a thin and a thick
segment. The ascending limb drains urine into the distal convoluted tubule. The thin ascending
limb is found in the medulla of the kidney, and the thick ascending limb can be divided into a
part that is in the renal medulla and a part that is in the renal cortex. The ascending limb drains
urine into the distal convoluted tubule [26].

6.2.3.1. Thin ascending limb

The thin ascending limb is impermeable to water; but is permeable to ions allowing for some
sodium reabsorption [27]. The thin limbs (descending and ascending) are lined by simple
squamous epithelium.

6.2.3.2. Thick ascending limb

The thick ascending limb is composed of simple cuboidal epithelium. Thick ascending limb
remains impermeable to water. Sodium, potassium (K+) and chloride (Cl-) ions are reabsorbed
by active transport this drains into the distal convoluted tubule (DCT)

6.2.3.3. Thin descending limb of loop of Henle

Within the nephron of the kidney, the descending limb of loop of Henle is the portion of
the renal tubule constituting the first part of the loop of Henle [28].The descending portion of the
loop of Henle is extremely permeable to water and is less permeable to ions, therefore water is
easily reabsorbed here and solutes are not readily reabsorbed [29].

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6.2.4. Collecting duct

It is also called renal collecting tubule. The last part of a long, twisting tube that collects urine
from the nephrons and moves it into the renal pelvis and ureters. It participates in electrolyte and
fluid balance through reabsorption and excretion, processes regulated by
the hormones aldosterone and antidiuretic hormone. In humans, the system accounts for 4–5% of
the kidney's reabsorption of sodium and 5% of the kidney's reabsorption of water. At times of
extreme dehydration, over 24% of the filtered water may be reabsorbed in the collecting duct
system. [30].It is found in both the renal cortex and the renal medulla [31].

7. Types of nephron

Nephron is of two types on the basis of location and function [32]

 Cortical nephron
 Juxtamedullary nephron

FIG 6 Shows structure of cortical and juxtamedullary nephron

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7.1. Cortical Nephron
The majority of nephrons start from the cortex. These nephrons are having short loop of Henle.
The short loop of Henle is not penetrating into the medulla. And hence they are called as cortical
nephrons [33]. Their main function is the reabsorption of water and small molecules from the
filtrate into the blood and secretion of waste from blood to urine. The major part of the
regulatory and excretory functions of the human body is carried out by them [34].

7.2. Juxtamedullary Nephron

The juxtamedullary nephrons are the type of nephrons that can only be found in the birds and
mammals. They have a long loop of Henle which is penetrating deep into the renal medulla.
Animals such as birds that live in terrestrial environments have more juxtamedullary nephrons
than cortical nephron [35]. About 15% of all nephrons in the human kidney are juxtamedullary.
The juxtamedullary nephrons concentrate or dilute urine. Depending on the quantity of water,
absorbed by the vase recta the produced urine is more concentrated or diluted [36].

8. Function of the kidney

The kidneys excrete a variety of waste products produced by metabolism into the urine. The
microscopic structural and functional unit of the kidney is the nephron [37]. It processes the
blood supplied to it via filtration, reabsorption and excretion; the consequence of those processes
is the production of urine. These include the nitrogenous wastes urea, from protein catabolism,
and uric acid, from nucleic acid metabolism [38].

 Filtration

Filtration, which takes place at the renal corpuscle, is the process by which cells and large
proteins are retained while materials of smaller molecular weights are filtered from the blood to
make an ultrafiltrate that eventually becomes urine [39]. The adult human kidney generates
approximately 180 liters of filtrate a day [40].

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  Reabsorption

Reabsorption is the transport of molecules from this ultrafiltrate and into the peritubular capillary
[41]. Water is 55% reabsorbed in the proximal tubule. Glucose at normal plasma levels is
completely reabsorbed in the proximal tubule [42].

 Excretion
The last step in the processing of the ultrafiltrate is excretion: the ultrafiltrate passes out of the
nephron and travels through a tube called the collecting duct and then to the ureters where it is
renamed urine. In addition to transporting the ultrafiltrate, the collecting duct also takes part in
reabsorption [43].

 Hormone secretion

The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin [44].

 Regulation of osmolality
The kidneys help maintain the water and salt level of the body. Any significant rise in plasma
osmolality is detected by the hypothalamus, which communicates directly with the posterior
pituitary gland[45].An increase in osmolality causes the gland to secrete antidiuretic
hormone (ADH), resulting in water reabsorption by the kidney and an increase in urine
concentration. The two factors work together to return the plasma osmolality to its normal levels
[46].

9. Blood supply to kidney

The renal arteries are large system. They carry large amounts of blood from the aorta (the heart’s
main artery) to the kidneys. Approximately 1/2 cup of blood passes through your kidneys from
the renal arteries every minute. There are two renal arteries. The right renal artery supplies blood
to the right kidney, while the left artery sends blood to the left kidney [47].

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10. KIDNEY STONE
Kidney stones affect up to 5% of the population, with a lifetime risk of passing a kidney stone
of about 8-10% [48]. Increased incidence of kidney stones in the industrialized world is
associated with improved standards of living and is strongly associated with race or ethnicity and
region of residence. A seasonal variation is also seen, with high urinary calcium oxalate
saturation in men during summer and in women during early winter. Stones form twice as often
in men as women [49]. The peak age in men is 30 years; women have a bimodal age distribution,
with peaks at 35 and 55 years. Once a kidney stone forms, the probability that a second stone
will form within five to seven years is approximately 50% [50]. Kidney stones (calculi) are
mineral concretions in the renal calyces and pelvis that are found free or attached to the renal
papillae. By contrast, diffuse renal parenchymal calcification is called nephrocalcinosis [51].
Stones that develop in the urinary tract (known as nephrolithiasis or urolithiasis) form when the
urine becomes excessively supersaturated with respect to a mineral, leading to crystal formation,
growth, aggregation and retention within the kidneys. . Kidney stones are associated with chronic
kidney disease [52].

FIG 7 shows stone in kidney

24
11. Types of Kidney Stones
The chemical composition of kidney stones depends on the abnormalities in urine composition of
various chemicals. Stones differ in size, shape, and chemical compositions (mineralogy).Based
on variations in mineral composition and pathogenesis, kidney stones are commonly classified
into four types as follows.

 Calcium stone

 uric acid stone

 Struvite stone

 Cystine stone

12. Calcium Stones: Calcium Oxalate and Calcium Phosphate

Calcium stones are predominant renal stones comprising about 80% of all urinary calculi [53].

FIG 8 shows Calcium stone

25
12.1. Calcium oxalate stone

Calcium oxalate is found in the majority of kidney stones and exists in the form of CaOx
monohydrate (COM, termed as mineral names: whewellite, CaC 2O4·H2O), and CaOx dihydrate
(COD, weddellite, CaC2O4·2H2O), or as a combination of both which accounts for greater than
60%. COM is the most thermodynamically stable form of stone. COM is more frequently
observed than COD in clinical stones Mostly; urinary pH of 5.0 to 6.5 promotes CaOx stones,
whereas calcium phosphate stones occur when pH is greater than 7.

Oxalate is one type of substance that can form crystals in the urine. This can happen if there is
too much oxalate, too little liquid, and the oxalate “sticks” to calcium while urine is being made
[54].

12.1.1. Risk factors

 Dehydration from not drinking

 A diet too high in protein and oxalate
 Obesity
 Hyperparathyroidism (a very high amount of a type of hormone called parathyroid
hormone in the blood that causes a loss of calcium. Calcium is needed to bind with
oxalate and leave the body)

12.1.2 Prevention of calcium oxalate stone

 Drink enough fluid

 Avoid eating too much protein
 Eat less oxalate rich food

12.2. Calcium phosphate

Calcium phosphate stones are less common than calcium oxalate stones [55]. Causes include
hyperparathyroidism (when the body produces too much parathyroid hormone), renal tubular

26
acidosis (a kidney condition that causes a buildup of acid in the body), and urinary tract
infections

13. Struvite or Magnesium Ammonium Phosphate Stones

Struvite stones are a common type of urinary or kidney stones that are made of magnesium ammonium
phosphate (MgNHPO4·H2O). They make up around 10 to 15 percent of all kidney stones.

Struvite stones are also called infection stones because they are associated with urinary tract
infections [56].

FIG 9 shows struvite stone

If Struvite stones aren’t removed in time, they can grow rapidly and cause a variety of health
conditions.

Struvite stones are created when bacteria, such as Proteus or Klebsiella, enter your body and break
down the urea in your urine into ammonia, creating Struvite. This will raise the pH of your urine.

27
These bacteria get inside you when you eat foods that aren’t cooked or put instruments into
your bladder [57]. They are more likely to infect women since women have shorter urethra,
which makes entry easier.

13.1. Symptoms

If you have Struvite kidney stones, you may have the following symptoms:

 Urinary tract infection

 Kidney injury, since Struvite kidney stones can get very large and fill up your
kidneys. The bacteria responsible for Struvite stones can also infect other types of
calcium kidney stones to produce mixed stones to create more injuries

 Sharp, severe pain below your ribs, in your side and back

 Burning sensation or pain when urinate

 Pain that can spread to your groin and lower abdomen

 Red, pink, or brown urine

 Urinating in small amounts at a time or more than usual

 Chills and fever

 Pain caused by a Struvite stone may change in intensity or location as it moves

through your urinary tract [58]. If you’re experiencing any of the above symptoms,
talk to your doctor to get a proper diagnosis.

13.2. Diagnosis

Your doctor may order the following tests to find out if you have struvite stones and what’s
causing them:

 X-rays, computerized tomography (CT) scans, and ultrasounds

28
13.3. Treatment

Struvite stones should be treated as soon as possible. If they’re not treated in time, they can become
very large and damage your kidney, leading to fatal infections. Since Struvite stones are caused
by bacteria, doctors may use a mixture of antibiotics and surgery to remove the stones and kill the
bacteria creating them [59]

Surgical methods include shock wave lithotripsy (SWL) or percutaneous nephrolithotomy or

nephrolithotripsy.

Doctors may prescribe the following to prevent Struvite stones from forming:

 Pyrophosphat
 Trisodium citrate
 Disodium EDTA

14. Uric acid stone

A uric acid stone is a type of kidney stone, which is a hard object that is made from chemicals in
the urine [60].This accounts approximately for 3–10% of all stone types after formation, the
stone may stay in the kidney or travel down the urinary tract into the ureter. Stones that don't
move may cause significant pain, urinary outflow obstruction, infection, or other health
problems.

FIG 10 shows uric acid stone

29
14.1 Symptoms
 Blood in the urine
 Nausea or vomiting
 Fever and chills
 Urine that smells bad or looks cloudy

14.2. Causes

Foods such as beef, poultry, pork, fish, and particularly organ meats such as liver, have high
amounts of a natural chemical compound known as purines. Uric acid can result from a diet high
in purines. High purines intake leads to a higher production of monosodium urate, which, under
the right conditions, may form uric acid stones in the kidneys [61]. Uric acid stones form when
the levels of uric acid in the urine are too high, and/or the urine is too acidic on a regular basis.

14.3. Treatment

At first, drinking more water may be recommended. Medications can also be used either for pain
or to help the stone pass. Medications can include can include allopurinol to reduce uric acid
levels in the blood. Other medicines can include citrate to make urine less acidic (or more
alkaline). Other medications can include thiazide diuretics (water pills) or tamsulosin (to relax
the ureter and help the stone pass).

If these treatments do not work, or if the stone is too large to pass through, then surgical
procedures may be needed to break down larger stones or remove them.

 Shock wave lithotripsy

 Percutaneous nephrolithotomy

15. Cystine stones

A cystine stone is a type of kidney stone Cystine stones tend to reoccur and are typically larger
than other kidney stones [62]. These stones comprise less than 2% of all stone types. It is a
genetic disorder of the transport of an amino acid and cystine.
30
 FIG 11 shows cystine stone

15. Causes

Cystine stones are caused by a rare disorder called “cystinuria.” The disorder causes a natural
substance called “cystine” to leak into your urine. When there is too much cystine in the urine,
kidney stones can form. These stones can get stuck in the kidneys, bladder, or anywhere in the
urinary tract

15.1. Cystinuria

A mutation in the SLC3A1 or SLC7A9 gene causes cystinuria. The SLC3A1 and SLC7A9 genes
provide instructions for making the two parts (subunits) of a protein complex that is primarily
found in the kidneys. Normally this protein complex controls the reabsorption of certain amino
acids, including cystine, into the blood from the filtered fluid that will become urine. Mutations
in either the SLC3A1 gene or SLC7A9 gene disrupt the ability of the protein complex to
reabsorb amino acids, which causes the amino acids to become concentrated in the urine. As the
levels of cystine in the urine increase, the crystals typical of cystinuria form [63]. The other

31
amino acids that are reabsorbed by the protein complex do not create crystals when they
accumulate in the urine.

15.2. Symptoms of cystinuria

Cystinuria only causes symptoms if you have a stone Symptoms may include:

 Pain while urinating

 Blood in the urine
 Sharp pain in the side or the back (almost always on one side)
 Pain near the groin, pelvis, or abdomen
 Nausea and vomiting

15.3. Treatment for cystinuria

Treatment starts with doing things to keep stones from forming. For adults and children, this
means drinking more water, reducing salt, and eating less meat. If these steps are not enough,
you may also need to take special medicine to help keep stones from forming.

 Drinking more water

Drinking lots of water will lower the ability for the cystine to form stones in the urine. Changing
your diet. Cystine stones are less able to form in urine that is less acidic. Eating more fruits and
vegetables can make the urine less acidic. Eating meat produces urine that has more acid, which
can increase your risk for cystine stones.

 Reducing salt
Eating less salt can help keep cystine stones from forming. Try not to eat salty foods, including
potato chips, French fries, sandwich meats, canned soups, and packaged meals [64].

32
  Medicine
Some people may also need to take prescription medicine to help keep stones from forming.
Different medicines work in different ways. Some types help to keep your urine less acidic.
Other types help keep cystine stones from forming by not allowing crystals to come together.
Your healthcare provider can explain these different options and help you find the right medicine
for you.

15.4. Cystine stone treatment

His goal of treatment is to help keep stones from forming by reducing the amount of cystine in
your urine. With less cystine in your urine, stones are less likely to form. It is important to work
with your healthcare provider to reach this goal. Kidney stones can cause a lot of pain. You
may need to take pain relievers while you wait for the stone to pass out of your body.

If a stone is very large and painful, or if it blocks the flow of urine, you may need surgery to
remove it. There are a few different types of surgeries to help get rid of the stones. These
include:

 Percutaneous nephrostolithotomy
 Ureteroscopy
 Extracorporeal shock wave lithotripsy

16. SYMPTOMS OF KIDNEY STONE

A kidney stone usually will not cause symptoms until it moves around within the kidney or
passes into one of the ureters. The ureters are the tubes that connect the kidneys and bladder
[65].

If a kidney stone becomes lodged in the ureters, it may block the flow of urine and cause the
kidney to swell and the ureter to spasm, which can be very painful. At that point, you may
experience these symptoms:

 Severe, sharp pain in the side and back, below the ribs

33
 Pain that radiates to the lower abdomen and groin

34
  Pain that comes in waves and fluctuates in intensity

 Pain or burning sensation while urinating

 Other signs and symptoms may include:

 Pink, red or brown urine

 Cloudy or foul-smelling urine

 A persistent need to urinate, urinating more often than usual or urinating in small
amounts

 Nausea and vomiting

 Fever and chills if an infection is present

 in the urine

 Chills

 Fever

 Nausea Blood and vomiting

17. Causes of the kidney stone

Kidney stones are common. Some types run in families. They often occur in premature infants.
There are different types of kidney stones. The cause of the problem depends on the type of
stone. Stones can form when urine contains too much of certain substances that form crystals.
These crystals can develop into stones over weeks or months.
 Calcium stones are most common. They are most likely to occur in men between ages 20
to 30. Calcium can combine with other substances to form the stone [66]. Calcium stones
can also form from combining with phosphate or carbonate
 Oxalate is the most common of these. Oxalate is present in certain foods such as spinach.
It is also found in vitamin C supplements. Diseases of the small intestine increase your
risk for these stones.
Other types of stones include:

35
  Cystine stones can form in people who have cystinuria. This disorder runs in families. It
affects both men and women.
 Struvite stones are mostly found in men or women who have repeated urinary tract
infections. These stones can grow very large and can block the kidney, ureter, or bladder.
 Uric acid stones are more common in men than in women. They can occur with gout or
chemotherapy.

Other substances, such as certain medicines, also can form stones. The biggest risk factor for
kidney stones is not drinking enough fluids. Kidney stones are more likely to occur if you make
less than 1 liter (32 ounces) of urine a day [67].

18. Exams and Tests

The health care provider will perform a physical exam. The belly area (abdomen) or back might
feel sore.

Tests that may be done include:

 Blood tests to check calcium, phosphorus, uric acid, and electrolyte levels

 Kidney function tests

 Examination of the stone to determine the type

 Stones or a blockage can be seen on:

 Abdominal CT scan

 Abdominal x-rays

 Kidney ultrasound

 Retrograde pyelogram

19. Treatment of kidney stone

Treatment for kidney stones varies, depending on the type of stone and the cause.

36
19.1. Treatment of small stone

Most small kidney stones won't require invasive treatment. You may be able to pass a small
stone by:

 Drinking water

Drinking as much as 2 to 3 quarts (1.8 to 3.6 liters) a day will keep your urine dilute and may
prevent stones from forming. Unless your doctor tells you otherwise, drink enough fluid —
ideally mostly water — to produce clear or nearly clear urine.

 Pain relievers
Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may
recommend pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium
(Aleve).

 Medical therapy.
Your doctor may give you a medication to help pass your kidney stone. This type of medication,
known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone
more quickly and with less pain. Examples of alpha blockers include tamsulosin (Flomax) and
the drug combination dutasteride and tamsulosin (Jalyn) [68].

19.2. Treatment of large kidney large stones

Kidney stones that are too large to pass on their own or cause bleeding, kidney damage or
ongoing urinary tract infections may require more-extensive treatment. Procedures may include:

 Using sound waves to break up stones:

For certain kidney stones — depending on size and location — your doctor may recommend a
procedure called extracorporeal shock wave lithotripsy (ESWL).

37
ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny
pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause
moderate pain, so you may be under sedation or light anesthesia to make you comfortable
[69].ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the
kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary
tract.

FIG 12 Shows ESWL to treat the kidney

 Surgery to remove very large stones in the kidney:

A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone

using small telescopes and instruments inserted through a small incision in your back.

A passageway is created on the skin on the back and carried to the kidney and using special
instruments the stones are removed from the kidney [70].

These procedures are generally recommended used to treat large (more than 5-cm sized stones)
or irregularly shaped kidney stones which can’t pass on their own and which cannot be removed
with lesser invasive procedures. Percutaneous nephrolithotomy is also recommended in staghorn

38
kidney stones, where the large kidney stones block more than one branch of the collecting
system of the kidney.

You will receive general anesthesia during the surgery and be in the hospital for one to two days
while you recover. Your doctor may recommend this surgery if ESWL is unsuccessful [71].

FIG 13 shows percutaneous nephrolithotripsy procedure to treat the kidney stone

 Using a Kidney Stenting

Kidney stenting allows passages of painful kidney stones through the ureters and out of the
body.

FIG 14 Shows structure of stent

39
These urethral stents are thin, flexible tubes that hold the ureters open that allows for free flow
of urine. These stents may be required due to urethral obstructions caused by kidney stones [72].

FIG 15 Shows Ureteric stent in the kidney

 Using a scope to remove stones

To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube
(ureteroscope) equip with a camera through your urethra and bladder to your ureter.

Once the stone is located, special tools can snare the stone or break it into pieces that will pass in
your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and
promote healing. You may need general or local anesthesia during this procedure [73].

40
 FIG 16 Shows a Ureteroscopic procedure for kidney stone treatment

 Parathyroid gland surgery

Some calcium phosphate stones are caused by overactive parathyroid glands, which are located
on the four corners of your thyroid gland, just below your Adam's apple. When these glands
produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become
too high and kidney stones may form as a result.

Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your
parathyroid glands or you develop another condition that leads these glands to produce more
parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones.
Or your doctor may recommend treatment of the condition that's causing your parathyroid gl and
to overproduce the hormone [74].

20. Prevention of kidney stone

Prevention of kidney stones may include a combination of lifestyle changes and medications.

41
 20.1. Lifestyle changes:

 Staying hydrated helps prevent kidney stones

The number one natural way to prevent kidney stones is to drink more water. If you are not
hydrated, you will not produce enough urine. This can increase the chances of kidney stones
because low urine output means the urine is concentrated and less likely to dissolve urine salts
that cause kidney stone.

 Get enough calcium from a balanced diet

By increasing the amount of calcium-rich foods you eat, you may reduce your chance of the
most common type of kidney stone, a calcium-oxalate stone. Good calcium-rich options include
low-fat cheese, low-fat milk and low-fat yogurt.

If you already have an adequate calcium intake, this may not be helpful to reduce your chances
of stones. The amount of calcium you need depends on your age and gender While you may
think it would be helpful, taking calcium supplements does the opposite and may increase the
risk. If you need to take supplements, be sure to take them with a meal to try to reduce that
increased possibility of stones [75].

 Limit oxalate-rich foods

Oxalate is a natural compound found in food that binds with calcium in the urine and can lead to
kidney stones forming. By limiting these types of foods, you can help prevent kidney stones
from forming.

Oxalate and calcium bind together in the digestive tract before reaching the kidneys. If you
would like to eat foods that contain oxalate or the mineral calcium, it is best to consume them at
different times.

Foods to reduce or stay away from that are high in oxalates include:

 Chocolate.
 Coffee.
 Spinach.
 Sweet potatoes.

42
  Peanuts.
 Beets.
 Wheat bran.

 Reduce sodium intake

Sodium is a natural mineral found in some foods and also makes up 40% of table salt, with
chloride making up 60%. We get most of our sodium from table salt [76]. A person with a
history of kidney stones should consume less sodium/salt, because the salt in urine does not
allow the calcium to be reabsorbed into the blood. This can lead to urine with high levels of
calcium, which may lead to stones.

 Eat less animal protein

Animal protein can be high in acidity and lead to increased urine acid. This can lead to both
calcium-oxalate and uric-acid kidney stones.

Foods you should aim to limit or avoid are:

 Poultry.

 Beef.

 Pork.

 Fish.

 Eat plenty of fruits and vegetables

I recommend that all people who form kidney stones should have at least five servings of fruits
and vegetables daily. This will help by providing fiber, potassium, magnesium, phytate,
antioxidants and citrate, all of which can help keep stones from forming.

 Don’t take vitamin C supplements

Vitamin C supplements, also known as ascorbic acid, have been linked to kidney stones
especially in men.

43
20.2. Medications
Medications can control the amount of minerals and salts in the urine and may be helpful in
people who form certain kinds of stones. The type of medication your doctor prescribes will
depend on the kind of kidney stones you have. Here are some examples:

 Calcium stones.

To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a
phosphate-containing preparation [77].

 Uric acid stones.

Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your
blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an
alkalizing agent may dissolve the uric acid stones.

 Struvite stones.

To prevent Struvite stones, your doctor may recommend strategies to keep your urine free of
bacteria that cause infection, including drinking fluids to maintain good urine flow and frequent
voiding. In rare cases long-term use of antibiotics in small or intermittent doses may help achieve
this goal. For instance, your doctor may recommend an antibiotic before and for a while after
surgery to treat your kidney stones.

 Cystine stones.

Along with suggesting a diet lower in salt and protein, your doctor may recommend that you
drink more fluids so that you produce a lot more urine. If that alone doesn't help, your doctor
may also prescribe a medication that increases the solubility of cystine in your urine [78].

44
21. CONCLUSION

The prevalence and incidence of kidney stones is rising worldwide . It is an increasing urological
disorder of human health, affecting about 12% of the world population. It has been associated
with an increased risk of end-stage renal failure. Kidney stones are hard deposits of minerals
(calcium, oxalate and phosphate) which are formed from dissolved minerals in the urine and are
usually excreted in the urethra. Kidney stones are the third most common urinary tract problem
after urinary tract infections and prostate disorders. Kidney stones are classified into calcium
oxalate, calcium phosphate, uric acid, cystine, Struvite, and mixed stones types, depending on
the material of the stones. Calcium stones account for almost 70–80% of all kidney stones.
Risk factors related to kidney stones are different among different population groups and
environmental factors have a key role in their pathogenesis. Research on urological patients has
shown that the incidence of kidney stones can be associated with sex, race, geographic region,
occupation, hot climate, positive family history, unhealthy diet (excessive intake of caffeine, salt,
dairy products, animal proteins and fat) smoking, alcohol consumption, physical activity,
obesity, low fluid intake, dehydration socioeconomic status, education , water quality , high
intake of vitamins D and C, genetic background and comorbid metabolic disorders (diabetes
mellitus, hypertension, chronic kidney disease, and cardiovascular disease).
Epidemiologically, about 5% of women and 12% of men experience kidney stones during their
lives.
The recurrence rate of renal calculi has been reported to be about 50% within 5 years. The key
for all patients with renal calculi is to stay hydrated; no medical therapy is successful without
adequate hydration and sufficient urinary fluid output should generally avoid diets Patients high
in calcium while limiting excessive salt and meat animal protein intake. A low oxalate diet is
also recommended.
A kidney stone can be determined by kidney function test, abdominal ct scan, abdominal x rays
and kidney ultrasound
Smaller stones (less than 5 mm) have a greater chance (90%) of passing on their own with
medical expulsion therapy (usually tamsulosin, nifedipine, or alfuzosin). About 3% of patients
need admission because of pain, inability to pass the stone, or dehydration. A few patients may

45
develop urinary tract obstruction and an upper urinary tract infection. This can result in urosepsis
or pyelonephritis
Most of these patients require an urgent procedure to bypass the stone until the infection is
resolved, at which time an elective procedure can be performed to remove the stone

46
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