 I am Dr. Tarun Jaloka, I am a consultant in the Head of Department of Nephrology, Manipala Hospital. Today I will talk about kidney stones. You know kidney stones are quite common, about 10% of adults suffer from kidney stones. And life time risk in meals is about 20% and in fitness is 9%. So it makes sense to talk about kidney stones. And I will tell you about 5 step management of kidney stones in any adult. Step 1 is diagnosis. So first you have to confirm if you really have kidney stones. And that depends upon clinical history, where patient presents with flight pain. Maybe they may have blood in your head, some increased frequency. These are classical symptoms of kidney stones pain. And we do resort to imaging, for example sonography or CT scan depending upon requirement. And that's how we confirm diagnosis of kidney stones. The second step of management is initial treatment. So when these patients come to emergency or to OPD, they are in extreme pain. So what we do is we give pain medicines first. And we hydrate them as well. Because many times this hydration itself can flush down the kidney stones down the track outside. The third step in kidney stone management is subsequent management. So after the initial management, we advise the patient to take plenty of water either orally. Or sometimes we give intravenous fluids as well. And pain medicines as per their requirement. Apart from this, we give some medicines which facilitate the stone passage. And one of the example which is well known is alpha receptor blocker, CO2C. That helps in expulsion of stones. Let me remind you here that most of these stones do not require surgical intervention. Only 10 to 20% of stones actually require surgical intervention. And rest all can be managed by medical management. And the fourth step in my management is surgical intervention. So when do these patients require surgeries? One, in the conservative treatment phase, even after 3 or 4 weeks of trial. Number two, if there are bilateral obstruction or there is co-existing infection. Or if there is acute kidney injury. So in any of these scenarios, it's better to go for an intervention. And also I will remind you that in 99% of cases there are no cuts which are required. Most of these stones can be intervened into endoscopy day. So in such cases, we send it to a gyrologist who intervenes and takes out the stone. This was the fourth step. Up to here, people know everything. But my final stage is to prevent recurrence. You know 50% of these patients may have recurrence of stones. And that is where we come into picture how to prevent recurrence of these stones. And we have two or three different steps how to prevent it. Number one is get a metabolic profile there. Which in my experience 99% of people do not do it. But it is essential part of management of kidney stones. If you do a metabolic profile, 3 out of 4 patients will identify what is the metabolic abnormality. Which actually is leading to stone formation and recurrence of stone. And by identifying that, we can take care of treat those metabolic abnormality. And hence prevent the recurrence of these stones. For example, if somebody is high-obscleting brain. We can advise certain steps by which this can be taken care of. If there is high uric acid in urine. If there is high calcium in urine. If somebody has got high PTH. All these are metabolic abnormalities. Which can be very well treated. And hence we can prevent the recurrence of these stones. Apart from this metabolic workup and this specific management. Very important part of management of kidney stones. Or prevention of recurrence of kidney stones is dietary management. Now dietary management is not very difficult. So in general what I advise to my patients is take plenty of water. Take fruits which contains potassium and phytates. So these are stone inhibitors. They inhibit the formation of stones. Avoid animal proteins. And also avoid excess of salt. So in general anyone can follow this. And that is how we can prevent recurrence of stone formation. Apart from this, as per the metabolic profile. If somebody has high obstetrics. You can advise diet according to that. So these 5 steps can take care of most of my patients. Regarding acute pain during stone. And subsequent management of stone. As well as recurrence of stone. So guys I think this would be helpful for you. In management of kidney stones. If you have any other questions. You can drop it into our OPD. And we will discuss this in the community. Thank you so much.