Kidney stone: Signs you should never ignore

Monday August 23 2021

Kidney stones can be small, like a grain of sand, but are often much larger. PHOTO / COURTESY

By Joan Salmon

Often, we believe pain is a passing episode and a few painkillers will help. However, David Simba, who experienced pain just below the lower right side of his stomach later came to understand that pain medication is not always a solution.
“I could barely sit or even stand upright that I had to visit a health facility. Test results showed I had a urinary tract infection for which I was given treatment. However, four weeks later, the pain resumed,” he says.
An ultrasound scan was carried out and the results showed the genesis of kidney stone formation.
“I was advised to up my fluid intake; no less than two litres a day coupled with medication, which helped ease the pain,” he says, adding that a month later, an unbearable pain returned that even these painkillers did not help.
After a series of ultra sound scans showed the stone had increased in size, Simba was advised to visit an urologist who after other scans recommended stone extraction via operation. With the solution on the table, Simba asked about the cost implication which seemed staggering then.
“Unwilling to have an operation because of lack of money source, I asked if there were any other treatment options and a drug usually used to gradually reduce the stone to a size where it could pass out through urination was recommended,” he says.
Simba shares that apparently, his kidney stones were bigger than 5mm thus could not be naturally be passed in the urine, so the drug, if it worked, was his way out.
The only downside though was that Simba would be on the medication for months, and there was a possibility that the drugs would not reduce the stone.
“I still decided to take the medicine and was on it for months. Thankfully, it did not have any noticeable side effects and I did not have the pain as often. However, when it (pain) re-surfaced, which was usually when I had not hydrated enough, it would be severe, unresponsive to painkillers, make me feel nauseated and sometimes even throw up. Owing to the pain, sometimes, I would have to go to hospital where I would get drip. I also frequently got UTIs, something the doctors said is expected and that caused more problems,” Simba remembers.
The fundraisers
Just like UTIs, he suffered another medical condition but the attending doctor advised that they  deal with the stones first before anything to avoid other severe problems that could come because of the stone.
“He recommended a medical centre and urologist that specialised in this area, and once again, we got a scary bill for the operation procedure so we embarked on a fundraising drive,” he says.
After a few months, they raised the funds through family.
Simba had three theatre visits because at first, they were unable to extract.
 “I was told my ureters were too small thus the need to insert a stent which I carried for three weeks. Thereafter, doctors were able to take out the stone,” he smiles.
Thinking of those theatre visits, Simba says each time necessitated that he spend the day after at the clinic for monitoring and was given a catheter urine passage.
“It was a very painful experience using it and also when it was taken out. After the operation, they left in another stent for three weeks. Having it taken out was a quick process, though it involved lots of pain in spite the anaesthesia but thankfully, I left right after,” he shares. For some time, Simba had a bit of pain in the area where the stone and stent were but he says it was nothing compared to what the stone caused.
 The experience caused him to take his lifestyle regarding diet and hydration more seriously.
“Simple things such as taking sufficient water, eating fruits and the right foods at the right time can and will surely save you a lot of money and pain. We ought to be intentional about taking care of our bodies,” he says.
Dr Frank Asiimwe, an urologist says what Simba suffered is a condition referred to as ureteric stones, essentially kidney stones that have moved into the urethra (tubes that carry urine from the kidneys to the bladder).
“These stones are formed from excess concentrations of minerals and salts in the urine which crystallise to forming stones. Most of these are calcium- based,” he explains
Some of the causative factors include:
Stagnation or blockage downstream: When urine is not flowing normally, crystallising of minerals within the kidneys will cause stones to form.
“This could be due to a urinary tract infection,” Dr Asiimwe says.
Genetics: Some people are susceptible to stone disease owing to family history.
“If someone in your family has ever suffered from kidney stones, there is a high possibility that you could also get them,” he says.
Dehydration: If one does not drink enough water, minerals in their urine are likely to come together, forming stones (like how the more you boil salty foods, you end up having salt left in the saucepan, because the concentration of the salts increases as the water is evaporated.).
 “If you are susceptible to ureteric stone disease, dehydration makes you even more prone to getting them,” Dr Franklin Wasswa, a general practitioner shares.
When stones are small, they will pass through the urine, causing no problems. However, when they are larger, they will block the urethra and Dr Asiimwe says they cause the following signs:
Severe intermittent (on and off) pain in the back, under the lower ribs and could spread to the lower abdomen.
“Among men, it is the groin area (scrotum) while for the women, it is in the vulva,” he shares.
Obstruction to urine flow leads to eventual death of the affected kidney. “When there is obstruction, you get a back flow of urine to the kidneys, which will start expanding like a balloon because of the backlog of urine,” Dr Wasswa shares.
One will also have pain on the inner side of their thighs
Urinary tract infections are also common when one has these stones.
They will also suffer with nausea and vomiting.
When one is suspected of having these stones, tests are done to verify and these include:
Ultrasound scan: While it might be helpful if the stones are still the kidneys, once they descend into the urethra, it has a very low sensitivity for detecting ureteric stones.
Additionally, the smaller stones are harder to see.
“Nonetheless, it’s very cheap and safest of all other options so it should be considered first,” Dr Wasswa shares.
Plain Abdominal x-ray: Dr Wasswa explains that this option only sees one type of stone; calcium which though is the most common, there are other types such as uric acid, and cystine stones.
“The other issue is it exposes the patient to radiation hence can only come after ultrasound. That said, with xray, you can put a dye in the urine and see how much it flows, where the blockage is, and the amount of damage on the kidney,” he explains.
CT scan: A CT scan of the urinary tract will help to find out if one has ureteric stones, as even the smaller ones will be clearly seen. “CT scan is 10 time an xray so we only use it to see more information, such as size, location of the stone and also to evaluate the damage to the kidney from urine backlog,” he clarifies.
Urine test: This will help in finding out if one’s urine has stone-forming particles.
While Dr Ssekitooleko says once a stone-former, always a stone-former, he says there are practices that can reduce the frequency of the formation and these include:
Drinking lots of water: This helps one pass more urine, which avoids (more of diluting) substance build-up. The necessary amount of water is dependent on several factors such as temperature, how much one exercises.
Eating less sodium-rich foods- Lots of sodium in one’s body aids in the creation of ureteric stones. Most processed foods as well as fuzzy drinks are rich in it therefore, limiting them is important.
Exercising more- when you get into the habit of exercising, you are able to control your weight. That is because being overweight is a risk factor regarding ureteric stones.
Early infection treatment: UTIs are known to be a causative factor of ureteric stones as they could cause a blockage in the urethra. Therefore, in case of an infection, it is advisable you treat it early.
Reducing animal proteins
Stones smaller than 5mm will most likely come out using medical expulsive therapies (drugs) thus no need for surgery. However, bigger ones will require to be removed surgically.

People at risk
While anyone can get these stones, Dr Badru Ssekitooleko, an urologist, says some people are at a higher risk. These include:
Men, more so those between 30 and 50 years of age are more susceptible that women.
People with a family history of ureteric stones
Persons who have a personal history of UTIs
People with diseases such as hyperthyroidism, and gout
Women who are in their menopause or have had their ovaries removed.
Congenital defects of the genital urinary system
Diet such as animal proteins
Drugs such as magnesium trisilicate