The existence of kidney stones has been recorded since the beginning
of civilization and lithotomy for the removal of stones is one
of the earliest known surgical procedures. In 1901, a stone
was discovered in the pelvis of an ancient Egyptian mummy, and
was dated to 4,800 BC. Medical text from ancient Mesopotamia,
India, China, Persia, Greece and Rome all mentioned calculous
disease. Kidney stones results from stones or renal calculi
in the ureter. The stones are solid concretions or calculi (crystal
aggregations) formed in the kidneys from dissolved urinary minerals.
Nephrolithiasis refers to the condition of having kidney stones.
Urolithiasis refers to the condition of having calculi in the
urinary tract (which also includes the kidneys), which may form
or pass into the urinary bladder. Ureterolithiasis is the condition
of having a calculus in the ureter, the tube connecting the
kidneys and the bladder. The term bladder stones usually apply
to urolithiasis of the bladder.
Nephrolithiasis occurs in all parts of the world, with a lower
lifetime risk of 2-5% in Asia, 8-15% in the West, and 20% in
Saudi Arabia. Men are affected approximately 4 times more often
than women. Female patients have a higher incidence of infected
hydronephrosis. The prevalence of kidney stones begins to rise
when men reach their 40s, and it continues to climb into their
70s. Nephrolithiasis in children is rare. Recent evidence has
shown an increase in pediatric cases. One in every 20 people
develops a kidney stone at some point in their life. Approximately
80-85% of stones pass spontaneously. Approximately 20% of patients
require hospital admission because of unrelenting pain, inability
to retain ureteral fluids, proximal urinary tract infection
(UTI), or inability to pass the stone. A ureteral stone associated
with obstruction and upper UTI is a true urologic emergency.
Causes of kidney stones:
Most calculi arise in the kidney when urine becomes supersaturated
with a salt that is capable of forming solid crystals. Symptoms
arise as these calculi become impacted within the ureter as
they pass toward the urinary bladder. The formation of the 4
basic chemical types of renal calculi is associated with various
underlying etiologies. Stone analysis, together with serum and
24-hour urine metabolic evaluation, can identify an etiology
in more than 95% of patients. Kidney stones form when there
is a decrease in urine volume and/or an excess of stone-forming
substances in the urine. The most common type of kidney stone
contains calcium in combination with either oxalate or phosphate.
Other chemical compounds that can form stones in the urinary
tract include uric acid and the amino acid cystine.
· Dehydration from reduced fluid intake or strenuous
exercise without adequate fluid replacement increases the risk
of kidney stones. Obstruction to the flow of urine can also
lead to stone formation. Kidney stones can also result from
infection in the urinary tract; these are known as struvite
or infection stones.
· People who have already had more than one kidney stone
are prone to develop more stones. A family history of kidney
stones is also a risk factor for developing kidney stones.
· There has been some evidence that water fluoridation
may increase the risk of kidney stone formation. In one study,
patients with symptoms of skeletal fluorosis were 4.6 times
as likely to develop kidney stones. However, fluoride may also
be an inhibitor of urinary stone formation.
· A number of medical conditions can lead to an increased
risk for developing kidney stones: e.g. Gout can lead to the
formation of uric acid stones. Hypercalciuria causes stones
in more than half of cases.
· Other conditions associated with an increased risk
of kidney stones include hyperparathyroidism, metabolic kidney
diseases such as renal tubular acidosis, medullary sponge kidney,
and some inherited metabolic conditions including cystinuria
and hyperoxaluria. Chronic diseases such as diabetes and hypertension;
people with inflammatory bowel disease or who have had an intestinal
bypass or ostomy surgery are also more likely to develop kidney
Symptoms of Kidney stones:
While some kidney stones may not produce symptoms (known as
“silent” stones), people who have kidney stones
often report the sudden onset of excruciating, cramping pain
in their low back and/or side, groin, or abdomen. Changes in
body position do not relieve this pain. The pain typically waxes
and wanes in severity, characteristic of colicky pain. The signs
and symptoms whichever develops in kidney stones are mainly
due to obstruction in urinary tract caused by the stone. Most
calculi originate within the kidney and proceed distally, creating
various degrees of urinary obstruction as they become lodged
in narrow areas, including the ureteropelvic junction, pelvic
brim, and ureterovesical junction. The obstruction by a stone
may cause dilation or stretching of the upper ureter and renal
pelvis (the part of the kidney where the urine collects before
entering the ureter) as well as muscle spasm of the ureter,
trying to move the stone. Calculi that have entered the bladder
are usually asymptomatic and are passed relatively easily during
Symptoms of Obstruction:
· Renal colic: The pain is most commonly felt in the
flank, lower abdomen and groin. Renal colic can be associated
with intense nausea with or without vomiting.
· Stones obstructing the ureteropelvic junction may present
with mild-to-severe deep flank pain without radiation to the
groin, due to distension of the renal capsule.
· Stones impacted within the ureter cause abrupt, severe,
colicky pain in the flank and ipsilateral lower abdomen with
radiation to the testicles or the vulvar area.
· Stones lodged at the ureterovesical junction also may
cause irritative voiding symptoms, such as urinary frequency
· Rarely, a patient reports positional urinary retention
(obstruction precipitated by standing, relieved by recumbency),
which is due to the ball-valve effect of a large stone located
at the bladder outlet.
· Colic: The classic patient with renal colic is writhing
in pain, pacing about, and unable to lie still, in contrast
to a patient with peritoneal irritation, remains motionless
to minimize discomfort. Pains are most commonly felt in the
flank, lower abdomen and groin with nausea and vomiting.
· Tenderness: The most common finding in ureterolithiasis
is flank tenderness due to the dilation and spasm of the ureter
from transient obstruction as the stone passes from the kidney
to the bladder.
· Haematuria: There can be blood in the urine, visible
with the naked eye or under the microscope (macroscopic or microscopic
haematuria) due to damage to the lining of the urinary tract.
· Oliguria: Reduced urinary volume caused by obstruction
of the bladder or urethra by stone.
· Fever: It is not part of the presentation of uncomplicated
nephrolithiasis. If present, suspect infected hydronephrosis,
pyonephrosis, or perinephric abscess.
· Abdominal examination: Usually is unremarkable. Bowel
sounds may be hypoactive, a reflection of mild ileus, which
is not uncommon in patients with severe, acute pain.
· Testicles may be painful but should not be very tender
and should appear normal.
· Older patients: In patients older than 60 years with
no prior history of renal stones, the physician should look
carefully for physical signs of Abdominal Aortic Aneurism.
Diagnosis of Renal Stones:
The diagnosis of kidney stones is suspected by the typical pattern
of symptoms when other possible causes of the abdominal or flank
pain are excluded. Clinical diagnosis is usually made on the
basis of the location and severity of the pain, which is typically
colicky in nature (comes and goes in spasmodic waves).Imaging
is used to confirm the diagnosis and a number of other tests
can be undertaken to help establish both the possible cause
and consequences of the stone
CT scan: A helical CT scan without contrast material is considered
the gold-standard diagnostic test for the detection of kidney
stones or obstruction within the urinary tract and almost all
stones are detectable by CT scan. This gives a clearer idea
of the exact size and shape of the stone as well as its surgical
X-rays: The relatively dense calcium renders these stones radio-opaque
(90% cases) and they can be detected by a traditional X-ray
of the abdomen that includes the Kidneys, Ureters and Bladder.
About 10% of stones do not have enough calcium to be seen on
standard x-rays (radiolucent stones).
Intravenous Pyelogram (IVP) or IntraVenous Urogram (IVU): The
test requires about 50 ml of a special dye to be injected into
the bloodstream that is excreted by the kidneys and by its density
helps outline any stone on a repeated X-ray.
Retrograde pyelogram: The stones can also be detected by a retrograde
pyelogram where similar “dye” is injected directly
into the urethral opening in the bladder by a surgeon, usually
Ultrasound: It is useful to detect stones in a pregnant woman
where x-ray exposure or CT scan is usually avoided.
Urine examination: Microscopic study of urine, which may show
proteins, red blood cells, bacteria, cellular casts and crystals.
24 hour urine collection to measure total daily urinary volume,
magnesium, sodium, uric acid, calcium, citrate, oxalate and
Blood tests: Full blood count for the presence of a raised white
cell count (Neutrophilia) suggestive of infection, a check of
renal function and to look for abnormally high blood calcium
blood levels (hypercalcaemia).
Management and Prevention of Renal Stones:
About 90% of stones 4 mm or less in size usually will pass
spontaneously; however 9% of stones larger than 6 mm or
a staghorn impacted stone will require some form of intervention.
There are various measures that can be used to encourage the
passage of a stone. These can include increased hydration, medication
for treating infection and reducing pain, and to encourage urine
flow and prevent further stone formation. Caution should be
exercised in eating certain foods, such as star fruit, with
high concentrations of oxalate which may precipitate acute renal
failure in patients with chronic renal disease.
Preventive strategies include dietary modifications reducing
excretory load on the kidneys. In most cases, a smaller stone
that is not symptomatic is often given up to four weeks to move
or pass before consideration is given to any surgical intervention
as it has been found that waiting longer tends to lead to additional
complications. Immediate treatment and even surgical intervention
may be required in certain situations such as in people with
only one working kidney, bilateral obstructing stones, and intractable
pain or in the presence of an infected kidney blocked by a stone
which can cause sepsis where the life of the patient is at risk.
Water intake: Drinking enough water to make 2 to 2.5 liters
of urine per day.
Beverages: Avoidance of cola beverages.
Vitamin: Avoiding large doses of vitamin C.
Intake of calcium: Calcium plays a vital role in body chemistry
so limiting calcium may be unhealthy. Since calcium in the intestinal
tract will bind with available oxalate, thereby preventing its
absorption into the blood stream, some nephrologists and urologists
recommend chewing calcium tablets during meals containing oxalate
Oxalate food: Restriction of oxalate-rich foods, such as chocolate,
nuts, soybeans, rhubarb and spinach, plus maintenance of an
adequate intake of dietary calcium.
Decreased protein diet: A diet low in protein, nitrogen and
sodium intake is usually advised.
Fruit juice: Some fruit juices, such as orange, blackcurrant,
and cranberry, may be useful for lowering the risk factors for
specific types of stones. Orange juice may help prevent calcium
oxalate stone formation, black currant may help prevent uric
acid stones, and cranberry may help with UTI-caused stones.
Homoeopathic Medicines for Renal Stones:
Homoeopathic medicines have great role in the treatment of renal
stone and to prevent its recurrence. Besides treating the cases
with homoeopathic potency, I have also prescribed some mother
tinctures as per the indications in the case. Application of
mother tincture in such cases greatly relieves the pains and
helps in easy expulsion of the stone from urinary tract. In
Homoeopathic Materia Medica we have a considerable number of
medicines which are very useful in such cases of kidney stones.
The anti-miasmatic constitutional treatment in a case of kidney
stone prevents the recurrent tendency of the stone and provides
the patient a pain free normal life.
Kidney stones typically leave the body by passage in the urine
stream, and many stones are formed and passed without causing
symptoms. If stones grow to sufficient size before passage on
the order of at least 2-3 millimeters they can cause obstruction
of the ureter. The resulting obstruction causes dilation or
stretching of the upper ureter and renal pelvis as well as muscle
spasm of the ureter, trying to move the stone. Sometimes, symptoms
such as difficulty in urinating, urinary urgency, penile pain,
or testicular pain may occur due to kidney stones. Surgical
techniques have also been developed to remove kidney stones
when other treatment methods are not effective especially in
cases of larger stone or impacted staghorn stones. In most of
the cases the above mentioned homoeopathic medicines are successfully
used to relieve pain, to drain out the stones and preventing
1. Allen, H. C.: Keynote Materia Medica;
B. Jain Publishers (P) Ltd.; New Delhi; Reprint Edition; 1998.
2. Bailey & Love: Short Practice of Surgery;
Arnold Publication, London; 24th Edition; 2004.
3. Boericke, W.: Homoeopathic Materia Medica
and Repertory; B. Jain Publishers (P) Ltd.; New Delhi; Reprint
4. Das, S.: A Concise Text Book of Surgery,
Dr. Das Publication; Kolkata; 3rd Edition; 2001.
5. Hering, C.: The Guiding symptoms of our
Materia Medica; B. Jain Publishers (P) Ltd.; New Delhi; Reprint
6. Hughes, R.: The Principles and Practice
of Homoeopathy; B. Jain Publishers (P) Ltd.; New Delhi; Reprint
7. Kent, J. T.: Repertory of the Homoeopathic
Materia Medica; B. Jain Publishers (P) Ltd.; New Delhi; Reprint
8. Schroyens, Fr.: Synthesis Repertory; B.
Jain Publishers (P) Ltd.; New Delhi; 8.1 Edition; 2002.