Dr Mohammed Mamdouh Hefzy, Specialist Nephrologist
Can kidney stones lead to chronic kidney disease or end stage renal disease or renal failure?
Kidney stones causing chronic kidney disease is rare considering advances in imaging and treatment allow for early detection. However, chronic kidney disease can happen due to kidney stones if the stones block the passage of urine, causing back pressure on the kidney, which if not treated early can be damaging and lead to chronic kidney disease and kidney failure.
What does the current treatment landscape for kidney stones look like in the UAE?
Management of stones differs according to the size, site and density of the stones and its effect on the kidney, and general condition of individual patients.
Small stones that don’t cause pain do not require treatment, drinking between 2.5-3 litres of water daily should work, followed by a scan six months after diagnosis. Ensure you visit the hospital in case of pain in the flank. With bigger stones, or in the case of renal colic, we suggest medical treatment to dissolve the stones, and if this fails, we will try ESWL ( Extra-corporeal Shock wave lithotripsy). However, if the stones are causing obstruction or back pressure we will need to conduct endoscopic and laser treatment to remove the stones. The stones also need to be shared for lab analysis to know its components, to help prevent stone formation again.
What other types of medical conditions may affect kidneys, and when should one consult a specialist?
Chronic kidney disease occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over months or years. Diseases and conditions that cause chronic kidney disease include high blood pressure, diabetes, glomerulonephritis (inflammation of the kidney’s filtering units), interstitial nephritis (inflammation of the kidney’s tubules and surrounding structures), polycystic kidney disease, other inherited kidney diseases, etc.
Chronic kidney disease symptoms develop over time if kidney damage progresses slowly. Loss of kidney function can cause a build-up of fluid or body waste or electrolyte problems. Depending on its severity, loss of kidney function can cause nausea, vomiting, loss of appetite and sleep, fatigue, urinating more or less, decreased mental sharpness, muscle cramps, swelling of feet and ankles, itchy skin, high blood pressure (hypertension) that’s difficult to control, shortness of breath, if fluid builds up in the lungs, and chest pain, if fluid builds up around the lining of the heart. Visit your doctor if you spot these signs, as early detection could help prevent kidney disease from progressing to kidney failure.
How has the Covid-19 pandemic affected kidney care?
The pandemic affected our kidneys badly, especially diabetics and patients with low immunity, and renal transplant patients who are on immunosuppressive medication because of septicemia, associated with Covid-19 and hypotension. In certain severe cases in the ICU, some patients developed acute renal failure and started hemodialysis, which was reversible in some cases. In some chronic kidney disease patients kidney functions deteriorated more but with good management and close monitoring, kidney functions returned to its basal levels.
What initiatives have Medcare undertaken to create awareness on kidney health?
Medcare has raised community awareness on kidney disease and protection through TV and radio interviews as well as virtual and physical lectures. The Group also offers reasonably priced packages to encourage patient visits for regular kidney health check-ups.
Dr Moamen Amin Abdelrahim, Consultant Urologist
What new surgical procedures in nephro-urology are being provided by Medcare?
Urinary stones are common, with one-fifth of men experiencing it at least once in their lifetime. The treatment depends on both size and location and the treatments are many. At Medcare Hospital Sharjah, we provide up-todate technology and minimally invasive procedures including shock wave therapy, flexible endoscopy and laser fragmentation of stones, as well as percutaneous nephrolithotomy, conducted as key hole for large kidney stones.
Other options for renal surgeries include laparoscopic and minimally invasive procedures for urological tumours, reconstructive urological surgery for congenital anomalies in adults and children, upto-date minimally invasive procedures for managing enlarged prostate by Rezum (steam ablation), and green laser vaporisation.
The Hospital also provides treatment for female urinary incontinence, and affordable treatment packages for erectile dysfunction and male infertility.
Prof. Dr Ahmed Elshenoufy, Consultant Urology
Kidneys, essentially help improve body performance by getting rid of waste products to keep our body healthy. Renal stones are solid deposits that can form in the body due to various factors - excessive excretion of crystals forming stones (calcium, oxalates, or uric acid); genetic reasons (especially with a family history); nutritional factors, as well as those related to physical factors such as the narrowing in a part of the urinary system involving the ureters (narrowest part of the urinaryexcretory system). These stones especially if they are obstructing the natural outflow of urine, can cause serious damage to renal cells if neglected.
Laboratory tests such as urine analysis and kidney function tests, and simple imaging modalities such as ultrasound, X-rays and computed tomography scans (CT) provide easy and efficient avenues for diagnosis.
Urinary stones can be managed in a variety of ways starting from medical treatment, stone fragmentation from outside the body (shockwave Lithotripsy), endoscopic treatment involving laser, and laparoscopy, as well as open surgeries, which are rarely required due to medical advances.
A meticulous follow up on full recovery and metabolic assessment especially in multiple or recurrent stones are important to try and decrease the rate of stone formation in future. Patient education is also integral to treatment including teaching the importance of water intake, required diet adjustments and understanding symptoms that warrant a doctor visit such as pain in the loin (flank), painful urination or change in urine colour.
