Managing kidney disease is already a complex problem to solve. Combine that with kidney stones, and things get more complicated, particularly for patients on dialysis. Dialysis patients often have to navigate additional challenges for stone management and treatment. Stones can be quite bothersome and, if poorly managed, could lead to other complications.
Having consulted many patients in chronic kidney disease stages 4 and 5 on dialysis, we intend to share why stones can still happen, what warning signs indicate their presence, and what the safest management strategies are, aside from prevention. As a start, we’d like to introduce Dr. Deepanshu Gupta, a renowned urology specialist, with a unique clinical skill in tackling complex stone disease.
Can Dialysis Patients Get Kidney Stones?
That is still possible. It’s worth noting, however, that patients with very low residual kidney function (often associated with near-zero urine output) are the ones who start on dialysis. Yet, there are cases of patients with bladder outlets who still retain some capability of voiding small amounts of urine. That will inevitably expose them to a risk of developing stones.
Even in the situation where someone doesn’t pass any urine, stones can still occur due to lapsed accumulation of minerals or changes to the body’s chemical makeup. Having dialysis does eliminate the risk of crystalline material forming in the kidneys.
What Causes Kidney Stones in Dialysis Patients?
Unlike those with sufficient renal function, the causes in dialysis patients might differ:
1. Mineral Disorders
Calcium, phosphate, and uric acid levels are disturbed in dialysis patients. These disturbances can crystallize minerals within the kidneys, leading to stones.
2. Calcium-Containing Phosphate Bindings
These binders can control phosphate levels, but also cause an increase in calcium and therefore, increase the chances of calcium stones.
3. Infections
Stones such as struvite can develop as a result of bacterial enzymatic activity in patients on peritoneal dialysis and in those with a history of UTIs.
4. Low to No Urine Volume
A low level of urine means different minerals that are considered waste aren’t removed adequately, which greatly increases the chance of stone development, particularly in patients with some renal function.
Common Symptoms to Look for
Symptoms may not be very straightforward in dialysis patients. These might include:
– Side or mid-back discomfort.
– Feverish sensations or chills.
– Blood in the urine, if there is some urine output.
– Vomiting or constant nausea.
– General feeling of tiredness or lethargy without any primary reason.
In patients with no urine output, diagnosis relies heavily on imaging. Other symptoms like blood in the urine, also known as hematuria, are not very common.
How are Kidney Stones Diagnosed?
In order to safely determine which treatment is best, accurately diagnosing the issue is essential first. These are common ways to do so:
- Ultrasound: Often the first line imaging tool, gentle with kidney patients.
- Non-contrast CT Scan: Useful to check the stones magnitude, density and position.
- Blood Tests: Need to check the patient’s calcium, phosphate and uric acid levels.
- Urine Tests: Very helpful to assess the substances that cause kidney stones for patients that still pass urine.
Kidney Stone Treatments for Dialysis Patients
Treatment varies depending on the type of stone, location, size, and the urinary habits of the patient. Available choices include:
1. Medication
For asymptomatic stones or uncomplicated small stones, medications might relief inflammation or pain. Even so, this is rarely the case because medication is not effective long-term.
2. RIRS (Retrograde Intrarenal Surgery)
RIRS entails passing a slender scope through the urinary tract (also referred to as the scope and grab technique aided by laser). Strong lasers break stones into fragments and clean them out. This is useful for patients with working ureters. Working ureters permits removal of small to moderate stones.
3. Ureteroscopy (URS)
URS involves passing a thin, telescope-like device into the ureter and the kidney to grab or pulverize stones. Patients need to have their urinary system and need some degree of open surgery along with a scope without large cuts.
4. Percutaneous Nephrolithotomy (PCNL)
PCNL involves making a small cut in the back to allow access to the kidney to take out large or complex stones straight from the kidney. This is one of the highly chosen ways to assist dialysis patients who have large stones, especially those who do not pass urine.
5. Extracorporeal Shock Wave Lithotripsy (ESWL)
Patients undergoing ESWL have stones that can be broken into smaller pieces using shock waves. It is unlikely to be the first choice of treatment for patients who are on dialysis and have limited kidney function.
6. Placement Of Catheters Or Stents
In emergency situations, stents can be placed to provide short term relief from infection and urinary blockage.
Is There Any Possibility For A Patient To Prevent Kidney Stones?
Even dialysis patients would benefit from prevention methods. The following are primary approaches:
Consistent Monitoring Of Blood Levels
To avoid the formation of stones, urinary calcium, phosphate, and uric acid levels should be kept in check, and regular blood tests are crucial for this.
Fluid Management
Proper hydration under the guidance of a nephrologist for patients still excreting urine can reduce the stone forming minerals from crystallizing.
Changing Food Intake
Renal dietitians can assist in cutting down high sodium and oxalate foods. Following a kidney friendly diet would reduce the possibility of mineral build up and improve kidney health.
Calcium-Based Dietary Supplements
These should be avoided unless absolutely necessary. Patients taking phosphate binders with calcium need to consult their doctor for alterations.
Regular Ultrasounds/Imaging
Routine scans would help in early detection of stones thereby avoiding symptoms or complications.
Closing Thoughts: Talk To Our Expert Urologist
Kidney stones for patients undergoing dialysis are a complex issue requiring specific care. Without appropriate treatment, these patients whose health is already fragile can develop more infections, obstructions, or other devastating complications with the remaining kidney.
Personalized strategies from skilled healthcare professionals such as urologists will provide the best results when combined with early diagnosis. For example, Dr. Deepanshu Gupta is a distinguished urologist with a specialization in complicated and advanced cases of kidney stones. He adopts a contemporary attitude towards the specialty and manages to protect the majority of his patients, especially those on dialysis, with experience-driven care using RIRS and PCNL techniques.
Those who have family members on dialysis and are suffering from kidney stones should consider consulting with experts such as Dr. Deepanshu Gupta. He treats all his patients with empathy and compassion despite the challenging situations they are going through.
Book a consultation to know more!