Kidney stones

Text A
Kidney stones can develop in 1 or both kidneys and most often affect
people aged 30 to 60. They’re quite common, with more than 1 in 10
people affected. Kidney stones are usually found in the kidneys or in the
ureter, the tube that connects the kidneys to your bladder. They can be
extremely painful, and can lead to kidney infections or the kidney not
working properly if left untreated. Very small kidney stones are unlikely

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to cause many symptoms. They may even go undetected and pass out
painlessly when you pee.

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1.Larger kidney stones can cause symptoms, including:
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• Pain in the side of your tummy (abdomen) or groin – men may have
pain in their testicles
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• A high temperature
• Feeling sweaty
W

• Severe pain that comes and goes

• Feeling sick or vomiting
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• Blood in your urine

• Urine infection
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2.Blocked ureter and kidney infection

A kidney stone that blocks the ureter, the tube that connects your kidney
to your bladder, can cause a kidney infection. This is because waste
products are unable to pass the blockage, which may cause a build-up of
bacteria.
The symptoms of a kidney infection are similar to symptoms of kidney
stones, but may also include:

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 • A high temperature
• Chills and shivering
• Feeling very weak or tired
• Diarrhoea
3.Cloudy and bad-smelling urine
Kidney stones are usually formed following a build-up of certain
chemicals in the body. Certain medical conditions can lead to an
unusually high level of these chemicals in urine.

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4.Medicines :Certain medicines may increase your risk of developing
recurrent kidney stones. These include:

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•
•
Aspirin
Antacids ee
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• Diuretics (used to reduce fluid build-up)
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• Certain antibiotics
• Certain antiretroviral medicines (used to treat HIV)
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• Certain anti-epileptic medicines

Text B
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Types of kidney stones

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Kidney stones come in a variety of sizes, shapes and colours. Some are
like grains of sand, while in rare cases others can grow to the size of a
golf ball.
The main types of kidney stones are:
• Calcium stones, the most common type of stone
• Struvite stones, usually caused by an infection, like a urine infection
• Uric acid stones, usually caused by a large amount of acid in your
urine

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Recurrent kidney stones
People who keep getting kidney stones include those who:
• Eat a high-protein, low-fibre diet
• Are inactive or bed-bound
• Have a family history of kidney stones
• Have had several kidney or urinary infections
• Have had a kidney stone before, particularly if it was before they
were 25 years old

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Diagnosis

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You may be given tests, including:

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✓ Urine tests to check for infections and pieces of stones.
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✓ Blood tests to check that your kidneys are working properly and
also check the levels of substances that could cause kidney stones,
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such as calcium
✓ You may be given equipment to collect a kidney stone. Having a
W

kidney stone to analyse will make a diagnosis easier, and may help
to determine which treatment method will be of most benefit to
ET

you.
If you have severe pain that could be caused by kidney stones, your GP
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should refer you to hospital for an urgent scan:

✓ Adults should be offered a CT scan
✓ Pregnant women should be offered an ultrasound scan
✓ Children and younger people under 16 should be offered a scan –
if the ultrasound does not find anything, a low-dose non-contrast
CT scan may be considered

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Text C
Prevention and Management
Most kidney stones are small enough to be passed out in your pee and
can probably be treated at home. But even small kidney stones can be
painful, although the pain usually only lasts a couple of days and
disappears when these stones have cleared.
To ease your symptoms, measures include:

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• Drinking plenty of fluids throughout the day
• Painkillers, like ibuprofen

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• Anti-sickness medicine
•
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Alpha-blockers (medicines to help stones pass)
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Treating large kidney stones
If your kidney stones are too big to be passed naturally, they’re usually
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removed by surgery. Your type of surgery will depend on the size and
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location of your stone

Shock wave SWL involves using ultrasound (high-frequency sound
ET

lithotripsy (SWL) waves) to pinpoint where a kidney stone is.

Ultrasound shock waves are then sent to the stone
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from a machine to break it into smaller pieces so it can

be passed in your urine.
Ureteroscopy Ureteroscopy involves passing a long, thin telescope
called a ureteroscope through the tube urine passes
through on its way out of the body (the urethra) and
into your bladder.
It’s then passed up into your ureter, which connects
your bladder to your kidney. The surgeon may either
try to gently remove the stone using another
instrument, or they may use laser energy to break it

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 up into small pieces so it can be passed naturally in
your urine. Ureteroscopy is carried out under general
anaesthesia.
Percutaneous PCNL involves using a thin telescopic instrument called
nephrolithotomy a nephroscope. A small cut (incision) is made in your
(PCNL) back and the nephroscope is passed through it and
into your kidney. The stone is either pulled out or
broken into smaller pieces using a laser or pneumatic
energy. PCNL is always carried out under general
anaesthesia.

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Text D

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Complications can occur after the treatment of large kidney stones.

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Possible complications will depend on the type of treatment you have
and the size and position of your stones.
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Complications could include:
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▪ Sepsis, an infection that spreads through the blood, causing

symptoms throughout the whole body
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▪ A blocked ureter caused by stone fragments (the ureter is the tube

that attaches the kidney to the bladder)
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▪ An injury to the ureter

▪ A urinary tract infection (UTI)
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▪ Bleeding during surgery

▪ Pain
Prevention
The best way to prevent kidney stones is to make sure you drink plenty
of water each day to avoid becoming dehydrated. To prevent stones
returning, you should aim to drink up to 3 litres (5.2 pints) of fluid
throughout the day, every day.
▪ Drinks like tea and coffee also count but water is the healthiest
option and is best for preventing kidney stones developing.

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▪ Add fresh lemon juice to your water
▪ Avoid fizzy drinks
▪ Do not eat too much salt
▪ Keeping your urine clear helps to stop waste products getting too
concentrated and forming stones.

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Time: 15 minutes
• Look at the four texts, A-D, in the separate Text Booklet.
• For each question,1-20,look through the texts, A-D, to find in this
Question Paper
• Answer all the questions within the 15 Minute time limit
• Your answers should be correctly spelt.

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Kidney stones :Questions
Questions 1-7

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For each question, 1-7, decide which text (A,B,C or D) the
Information comes from. You may use any letter more than
N
once. In which text can you can find information about.
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1.Avoid carbonated drink…………

2.Pain usually only lasts a couple of days and disappears when……..
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3.Sedentary lifestyle may cause

4.Use of laser energy to break stones in…………….
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5.Clear urine helps to stop accumulation of waste products………..

6.Build-up of certain chemicals in the body causes…..
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7.Kidney stones are quite common………

Questions 8- 14
Answer the questions,8-14,with a word or short phrase from one of the
texts. Each answer may include words, numbers or both.
8.Which is the most common type of kidney stone - - - - - - - - - - - - - - - -?
9.Which group of medication uses to clear the kidney stones - - - - - - - -?
10.Who will be the most common population get affected by kidney
stones ------------------------------------?

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11.What is an example for differential diagnosis of kidney stone
---------------------------------------?
12. Which viral infection medications may cause kidney stones - - - - - -?
13.Which type of dietary patterns may be risk for the formation of kidney
stones - - - - - - - - - - - - - - - - - - - - - - - - - - - -?
14.Which kidney stones will be developed as a result of infections--------
----------------------- - - - -?

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Questions 15-20
Complete each of the sentences, 15-20, with a word or short phrase

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from one of the texts. Each answer may include words, numbers or
both.
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15.Serological studies evaluate the levels of substances that could cause
kidney stones, such as - - - - - - - - - - - - - - - -?
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16.----------------------------------- stones, usually caused due to increased

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level of acid in urine?

17.Children and younger people should be offered a - - - - - - - - - - - - - - -
ET

if the ultrasound does not find anything?

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18.----------------------------- involves using high-frequency sound waves to

break the renal stones into smaller pieces so it can be passed in your
urine?
19.Some kidney stones are like - - - - - - - - - - - - - - - - while in rare cases
others can grow to the size of - - - - - - - - - - - - - - - - -?
20.To prevent stones returning, you should drink - - - - - - - - - - - - - - - -
of fluid throughout the day, every day.
End of Part A
Proceed to Part B & C