In this week’s health talk, The Pioneer’s Shikha Duggal speaks to a few medical experts to learn more about stone analysis and a deeper survey on silent kidney stones.
Clinical medicine still persists as an art — it’s a nod in the direction of humanitarianism. So, exploring the mantra of silent kidney stones this time, especially on why you get stones, we have some medical experts on board for stone analysis and a deeper survey on silent kidney stones.
Dr. Sohini Sengupta, the Medical Lab Director at Redcliffe Labs and also an MD and DNB in clinical biochemistry and an FNB in laboratory medicine, shared, “Kidney stones are a common disease affecting millions of people worldwide. These tiny, hard mineral deposits can cause pain and discomfort when obstructing the urinary tract. However, not all kidney stones show symptoms.
A lesser-known type of kidney stone silently forms within the kidneys, causing no apparent symptoms until discovered incidentally during routine health exams. These “silent” kidney stones can pose a unique threat to your renal health, highlighting the importance of timely diagnosis and treatment. Typically, kidney stones have symptoms like severe abdominal or back pain, blood in the urine, frequent urination, and a persistent urge to urinate.
However, “silent” kidney stones, often made of calcium oxalate or calcium phosphate, remain hidden until a routine X-ray or other imaging techniques are done. Such stones are usually small in size, ranging from a grain of sand to a pea, and do not cause obstruction or blockage within the urinary tract. It is estimated that around 20% of all kidney stones are silent, making their discovery an essential aspect of preventive healthcare.”
The doctor advised that it is essential to note that while silent kidney stones may not cause immediate symptoms or severe pain, they can still lead to complications if left untreated.
The doctor continued: “Over time, these stones can grow in size or number, increasing the risk of urinary tract obstruction, infection, or kidney damage. Therefore, regular check-ups and imaging studies are essential, as they can aid in the early detection of kidney stones and other underlying conditions.
Routine imaging tests are commonly suggested to screen for these stones. A radiologist can identify these stones’ presence, size, and location even in the absence of apparent symptoms.Once diagnosed, the treatment options for silent kidney stones may vary based on factors such as stone size, composition, and the patient’s overall health. It is advised to increase fluid intake to promote natural stone passage and prevent further stone formation.
Lifestyle modifications, including dietary changes to reduce the intake of oxalate-rich foods like spinach, rhubarb, and chocolate, are also recommended. Active treatment measures may be required for larger ‘silent’ kidney stones or those causing persistent discomfort.”
According to Dr. Sohini, Extracorporeal Shock Wave Lithotripsy is a commonly used procedure that uses shock waves to break down the stones into smaller fragments, allowing for their easier passage through the urinary tract.
“In other severe cases, ureteroscopy may also be performed to visualise and remove the stones directly. Still, prevention is crucial to managing symptomatic or silent kidney stones. We recommend regular health check-ups such as Kidney Function Tests, particularly for individuals with a higher risk of stone formation. A routine test assesses the effectiveness of the treatment plan and identifies any recurrent stone formations.
Furthermore, it is essential to monitor and manage any underlying medical conditions that may contribute to stone formation, such as hypercalciuria or hyperparathyroidism. By adopting a proactive approach, individuals can reduce the likelihood of future kidney stone episodes and preserve their kidney health in the long run,” she said.
These ninja stones can be really detrimental to your health. Studies of the natural history of stones have revealed that only 20% of patients yearly actually become symptomatic from a new stone, and one-half of those require surgical intervention at some point. The guidelines are well established for the treatment of symptomatic urolithiasis, and many investigators have extensively studied the management of silent kidney stones.
“Renal stones are one of the most common urological issues, affecting almost 5% of the world’s population. Few regions of the world have a stone incidence rate of around 10–15%, aptly called the stone belt of the world. This stone belt crosses the majority of North India, too. Renal stones can range from small, hard deposits to large stones completely occupying the kidney, known as staghorn calculus. Usually, the renal stones, when they pass through the ureter, cause significant pain, blood in the urine, and vomiting.
However, there is a subset of renal stones that pose a silent threat, akin to a ninja hovering in the shadows. Surprisingly, most of the time, the patient will be completely unaware of the stones that they harbour in the kidneys, since a non-obstructive stone will rarely produce any symptoms. Even certain kidney stones, which drop into the urine tube, may produce symptoms very briefly, and then they become completely silent. The danger of missing the silent stones is that they slowly enlarge in size and cause painless obstruction of the kidneys, gradually causing kidney damage and failure over months or a few years.
Such silent stones are nowadays easily diagnosed with the help of preventive health checks. Yet, a vast majority of people don’t undergo diagnostic screenings. Even small renal stones should be followed up to avoid major consequences like permanent kidney damage,” said Dr. Mathisekaran Thangarasu, M.S. (Gen Surg), DrNB (Uro), a consultant urologist at the Asian Institute of Nephrology and Urology. The most relevant account is that the duration of the presence of the kidney stone or its silence does not matter.
What matters is how much damage it has caused to the kidneys and what the necessary measures to remove it are! “The key to effectively managing silent or asymptomatic kidney stones is prevention. Adequate hydration is the foundation of prevention. Drinking plenty of water throughout the day dilutes urine and flushes out minerals that may contribute to stone formation. Aim for eight glasses of water per day, or more if you engage in strenuous physical activity or live in a hot climate.
Aside from hydration, dietary changes can significantly lower the risk of silent or asymptomatic kidney stones. Limit your consumption of oxalate-rich foods and sodium, both of which can contribute to stone formation. Instead, concentrate on incorporating calcium-rich foods into your diet, such as low-fat dairy products. In the intestines, calcium can bind to oxalate, preventing its absorption and lowering the risk of stone formation.
Maintaining a healthy weight and getting regular exercise are also crucial to avoiding kidney stones. Obesity and sedentary lifestyles raise the likelihood of stone formation. You can help keep silent stones at bay by eating a well-balanced diet and leading an active lifestyle,” concluded Dr. Vidyashankar P., Lead Consultant at Nephrology, Aster CMI Hospital.
Do you remember the case study of a 60-year-old farmer from Gajwel in Siddipet district who got a new lease on life when a surgery was performed to remove silent stones that had accumulated in both his kidneys? This report reports on the experience with silent ureteral stones and exposes their true influence on renal function.
Conclusion: Silent ureteral stones are associated with decreased kidney function present at the diagnosis! Hence, hydronephrosis-related procedures tend to diminish after stone removal, and kidney function remains unaltered.
