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Nephrolithiasis / Kidney stones : Types, Clinical features, Diagnosis and Treatment (Hindi)

Introduction
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Nephrolithiasis refers to the formation of urinary calculi in the kidney, which can occur throughout the urogenital tract, from the renal pelvis to the urethra. This condition is influenced by various risk factors, including low fluid intake and diets high in sodium, purine, and low in potassium. These dietary choices can elevate urine levels of calcium, uric acid, and oxalate, facilitating stone formation. The most prevalent type of urinary stones comprises calcium oxalate, but less common types include uric acid, struvite (associated with urease-producing bacterial infections), calcium phosphate, or cystine.

Clinical Presentation
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Nephrolithiasis typically manifests as sudden-onset colicky flank pain, which may radiate to the groin, testes, or labia. This condition is commonly referred to as renal or ureteric colic and is often accompanied by hematuria.

Diagnosis
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Diagnostics for nephrolithiasis include:

Spiral CT without Contrast: Used to detect the presence and location of stones.
Ultrasound of the Abdomen and Pelvis: Another imaging option for stone detection.
Urinalysis: To assess for concomitant urinary tract infection (UTI).
Serum BUN and Creatinine: These tests evaluate kidney function.

Management
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For small stones that do not require immediate urological intervention, the approach involves symptomatic treatment and a trial of medical expulsive therapy to encourage spontaneous passage. If spontaneous passage seems unlikely or fails due to stone size or location, first-line urological interventions include:

Shock Wave Lithotripsy: Using shock waves to break the stones into smaller pieces.

Ureterorenoscopy: A minimally invasive procedure to remove or fragment stones.

Percutaneous Nephrolithotomy: Reserved for patients with large kidney stones, involving a surgical incision to access and remove the stone.

Prevention
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The most crucial preventive measure for nephrolithiasis is ensuring adequate hydration. Additionally, analyzing passed stones can offer insights for dietary modifications and medical therapy (e.g., thiazide diuretics, urine alkalinization) to prevent future stone formation.

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