Description

Kidney stones are hard objects made of minerals and salts in the urine. It is formed in the interior of the kidneys. You can listen to the health professionals refer to the stones of the kidney as a kidney stone, nephrolithiasis or urolithiasis.

Kidney stones have many causes. These include the diet, excess body weight, some health conditions, and some supplements and medications. Kidney stones can affect any of the organs that produce urine, or remove it from the body — from the kidneys to the bladder. Often, stones form when the urine has less water. This allows the mineral crystals form and stick together.

Passing kidney stones can be quite painful. But prompt treatment usually helps to prevent permanent damage. Sometimes, the only treatment needed to pass a kidney stone is to take pain medication and drink lots of water. Other times, surgery or other treatments may be necessary. Depends on the size, location and the type of stone you have.

If you've had more than one kidney stone, a health care professional can show you ways to prevent more. This may involve making changes in the diet, taking medication, or both.

Symptoms

A kidney stone usually does not cause symptoms until it moves within the kidney or passes into one of the ureters. The ureters are the tubes that connect the kidneys and the bladder.

If a kidney stone is stuck in one of the ureters, it can block the flow of urine and cause the kidney to swell, and the ureter to spasm. That can be very painful. At that point, you may have these symptoms:

  • Severe, acute pain in the side and back, below the ribs.
  • Pain that spreads to the lower abdomen and groin.
  • The pain that comes in waves and varies in how intense it feels.
  • Pain or burning sensation when urinating.

Other symptoms may include:

  • Pink, red, or brown urine.
  • Cloudy or foul-smelling urine.
  • A constant need to urinate, urinating more often than usual, or in the urine in small amounts.
  • Upset stomach and vomiting.
  • Fever and chills if an infection is present.

The pain caused by a kidney stone may change as the stone moves through your urinary tract. For example, the pain may switch to a different part of the body or of the ever more intense.

When to see a doctor

Make an appointment with your health care professional if you have any symptoms that worry you.

Get a health check at once if you have:

  • The pain is so bad that it can't sit still or find a comfortable position.
  • The pain along with stomach upset and vomiting.
  • The pain along with fever and chills.
  • Blood in the urine.
  • Difficulty urinating.

Causes

Kidney stones often have no definite, single cause. But many factors can increase the risk.

Kidney stones develop when the urine contains more crystal-forming substances that the fluid in your urine can dilute. These substances include calcium oxalate, calcium phosphate and uric acid. At the same time, your urine may lack substances that prevent crystals from sticking together. That creates an ideal environment for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone you have helps your healthcare provider figure out your cause and the right treatment for you. This information can also give clues about how to prevent kidney stones. If you can, try to save the stone in the kidney if you pass one. Then take it to your health care professional, which you can check on what type of kidney stone is.

Types of kidney stones include:

  • Calcium stones.The majority of kidney stones are calcium stones. Usually they are made of chemical compounds of calcium oxalate. The oxalate is a substance that is made daily by the liver or absorbed from the diet. Some fruits and vegetables, as well as nuts and chocolate, have high amounts of oxalate. Dietary factors, high doses of vitamin D, intestinal bypass surgery and many conditions that affect the metabolism can make calcium oxalate or more concentrated in the urine. Calcium stones may also be made of calcium phosphate. This type of stone is more common in metabolic diseases such as renal tubular acidosis. It can also be linked with some medications for migraines or seizures, such as topiramate (Topamax, Trokendi XR, others).
  • Uric acid stones. Uric acid stones can form in people who lose too much fluid because of ongoing diarrhea or people who have problems absorbing nutrients from the food; they eat a high-protein diet or lots of organ meats or shellfish; and those with diabetes mellitus or metabolic syndrome. Some of the genetic factors also may increase the risk of uric acid stones.
  • Struvite stones. Struvite stones form in response to an infection of the urinary tract. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
  • Cystine stones. These stones form in people with a rare genetic condition called cystinuria which causes the kidneys to leak too much of a protein building block called cystine.

Calcium stones. The majority of kidney stones are calcium stones. Usually they are made of chemical compounds of calcium oxalate. The oxalate is a substance that is made daily by the liver or absorbed from the diet. Some fruits and vegetables, as well as nuts and chocolate, have high amounts of oxalate.

Dietary factors, high doses of vitamin D, intestinal bypass surgery and many conditions that affect the metabolism can make calcium oxalate or more concentrated in the urine.

Calcium stones may also be made of calcium phosphate. This type of stone is more common in metabolic diseases such as renal tubular acidosis. It can also be linked with some medications for migraines or seizures, such as topiramate (Topamax, Trokendi XR, others).

Risk factors

Factors that increase your risk of kidney stones include:

  • A personal or family history. If someone in your family has had kidney stones, you are more likely to develop stones, too. If you have already had one or more kidney stones, you are at greater risk of developing another.
  • The dehydration. Not drinking enough water each day can increase the risk of kidney stones. The people who live in hot, dry climates and those who sweat a lot may be at higher risk than others.
  • Some diets. Eating a diet that is high in oxalate, protein, sodium, and sugar can increase the risk of some types of kidney stones. This is especially true with a high sodium content of the diet. Too much sodium increases the amount of calcium in the kidneys to be filtered out. And that greatly increases the risk of kidney stones.
  • Obesity. This complex disease involves having too much body fat and has been linked with an increased risk of kidney stones.
  • Digestive diseases and surgery. The gastric bypass surgery, inflammatory bowel disease or ongoing diarrhea can cause changes in the digestive process. These changes affect how the body absorbs the calcium and water. That, in turn, increases the amount of stone-forming substances in the urine.
  • Other health conditions such as renal tubular acidosis, cystinuria, hyperparathyroidism, and repeated urinary tract infections can also increase the risk of kidney stones. A rare genetic condition called primary hyperoxaluria, increases the risk of calcium oxalate stones.
  • Some supplements and medications. These include vitamin C, dietary supplements, excessive use of laxatives, calcium-based antacids, and some medications for migraine or depression.

Prevention

The prevention of kidney stones may include a combination of lifestyle changes and medications.

Lifestyle changes

You can reduce your risk of kidney stones if you:

  • Drink water throughout the day.This is the most important lifestyle change you can make. If you have had kidney stones before your doctor may tell you to drink enough fluids to pass around 2.1 quarts (2 liters) of urine a day or more. You may be asked to measure the amount of urine to make sure you are drinking enough water. If you live in a hot and dry climate or exercise often, you may need to drink more water to produce enough urine. If your urine is light and clear, the more likely it is to drink enough water.
  • Eat less oxalate-rich foods. If you have a tendency to form calcium oxalate stones, your health care professional may recommend limiting the consumption of foods rich in oxalates. These include rhubarb, beets, okra, spinach, swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper, sesame seeds or tahini products, and soy products. Review your diet with a nutritionist with experience in kidney stones is usually helpful.
  • Choose a diet low in sodium and animal protein. Reduce the amount of sodium that you eat. And choose protein sources that do not come from meat or fish, such as legumes. Consider using a salt substitute to give flavor to the food.
  • Eat calcium-rich foods, but use caution with calcium supplements.Calcium in food does not have an effect on the risk of kidney stones. Eat calcium-rich foods unless your health care professional recommends otherwise. Ask your health care professional before taking calcium supplements. These have been linked with an increased risk of kidney stones. You can reduce the risk by taking supplements with meals. Diets low in calcium can make kidney stones more likely to form on some people.

Drink water throughout the day. This is the most important lifestyle change you can make. If you have had kidney stones before your doctor may tell you to drink enough fluids to pass around 2.1 quarts (2 liters) of urine a day or more. You may be asked to measure the amount of urine to make sure you are drinking enough water.

If you live in a hot and dry climate or exercise often, you may need to drink more water to produce enough urine. If your urine is light and clear, the more likely it is to drink enough water.

Eat calcium-rich foods, but use caution with calcium supplements. Calcium in food does not have an effect on the risk of kidney stones. Eat calcium-rich foods unless your health care professional recommends otherwise.

Ask your health care professional before taking calcium supplements. These have been linked with an increased risk of kidney stones. You can reduce the risk by taking supplements with meals. Diets low in calcium can make kidney stones more likely to form on some people.

Ask your health care professional to refer you to a dietitian. The dietitian can help you make an eating plan that reduces the risk of kidney stones.

Drugs

Medications can control the amount of salts and minerals in the urine. They may be helpful in people who are certain types of stones. The type of medicine that your healthcare provider prescribes depends on the type of kidney stones you have. Here are some examples:

  • Calcium stones. To help prevent the formation of calcium stones, your healthcare provider may prescribe a thiazide diuretic or potassium citrate. If you have calcium oxalate stones due to the rare genetic condition in primary hyperoxaluria, you may need other treatments to reduce the amount of oxalate in the blood. Your health care professional may recommend that you take vitamin B6, also called pyridoxine. Or you may need prescription medications, such as lumasiran (Oxlumo) or nedosiran (Rivfloza).
  • Uric acid stones. Your health care professional may prescribe allopurinol (Zyloprim, Aloprim, other) to lower the levels of uric acid in the blood and in the urine. You may also be prescribed potassium citrate. Sometimes, these medications can dissolve existing uric acid stones.
  • Struvite stones. To prevent struvite stones, your health care professional may recommend ways to keep your urine free of bacteria that cause the infection. For example, you may urinate more often and to drink fluids to maintain the flow of the urine good. Rarely, long-term use of antibiotics in small and occasional doses can help to achieve this goal. For example, your health care professional may suggest that you take an antibiotic prior to and during a period of time after surgery for the treatment of kidney stones. Medicines called acetohydroxamic acid may also help to prevent struvite stones.
  • Cystine stones. A diet that is low in sodium and protein can help to prevent cystine stones. Your healthcare provider may also recommend that you drink more fluids so that you urinate more. If the changes alone don't help, medications called thiol drugs or other new drugs may also be prescribed. Could do crystals less likely to form.

Diagnosis

The diagnosis consists of the steps that your health professional needs to find out if you have kidney stones. The diagnosis may also include tests to find the cause and the chemical composition of kidney stones. Your health care professional begins by giving you a physical exam. You may also need tests such as:

  • Blood tests. Blood tests may reveal too much calcium or uric acid in the blood. Blood test results can help you track the health of their kidneys. These results may also lead to your health care professional to detect other health conditions.
  • The analysis of urine. Your health care professional may ask you to collect a sample of urine for 24 hours. The 24-hour urine collection test may show that your body is releasing too many stone-forming minerals or too few substances that prevent the stones. Follow your healthcare provider's instructions carefully. The collection of the urine properly is the key to making changes in your plan of treatment to prevent the formation of new stones.
  • The projection image.Imaging tests such as ct scans can show kidney stones in your urinary tract. Advanced analysis known as the high-speed or dual-energy computed tomography can help to find the small stones of uric acid. Simple x-rays of the area of the stomach, also called the abdomen, which are used less frequently. This is because this type of imaging test can miss small stones in the kidney. Ultrasound is another imaging option to diagnose kidney stones.
  • Analysis of passing the stones. You may be asked to urinate through a strainer to catch the stone that passes. Then, a laboratory examines the chemical composition of kidney stones. Your health care professional uses this information to figure out what the cause of the kidney stones and to form a plan to prevent more kidney stones.
  • The genetic testing. Some rare conditions that are passed on from parents to children to make kidney stones more likely. For example, counting with cystinuria increases the risk of cystine stones. Primary hyperoxaluria, increases the risk of calcium oxalate stones. If your healthcare provider thinks you might have this condition, your health care professional may recommend genetic testing to find out for sure.

The projection image. Imaging tests such as ct scans can show kidney stones in your urinary tract. Advanced analysis known as the high-speed or dual-energy computed tomography can help to find the small stones of uric acid. Simple x-rays of the area of the stomach, also called the abdomen, which are used less frequently. This is because this type of imaging test can miss small stones in the kidney.

Ultrasound is another imaging option to diagnose kidney stones.

Treatment

The treatment for kidney stones varies. Depends on the type of stone and the cause.

Small stones with minimal symptoms

Most of the small stones in the kidney do not require invasive treatment such as surgery. You may be able to pass a small stone by:

  • Drinking water. Drink 2 to 3 quarts (1.8 to 3.6 liters) per day is likely to keep the urine diluted and can prevent the formation of stones. Unless your healthcare professional tells you otherwise, drink enough fluid. The ideal is to mainly drink water to produce clear or nearly clear urine.
  • Pain relievers. Passing a small stone can cause mild to severe discomfort. To relieve mild pain, your healthcare provider may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). For serious pain, other treatments in the emergency room may be necessary.
  • Other medications. Your health care professional may give you a medication to help pass your kidney stone. This type of medicine is known as an alpha blocker. It relaxes the muscles in the ureter. This will help you pass the kidney stone more quickly and with less pain. Examples of alpha blockers include tamsulosin (Flomax), and the combination of drugs dutasteride and tamsulosin (Jalyn).

The stones are large and cause symptoms

Kidney stones that are too large to pass through your account may need more extensive treatment. You can, therefore, stones that they cause bleeding, kidney damage or ongoing urinary tract infections. Treatments may include:

  • The use of sound waves to break up stones.For some stones in the kidney, your health care professional may recommend a treatment called extracorporeal shock wave lithotripsy. This is also known as ESWL. But it depends on the size and location of the stones. ESWL uses sound waves to create strong vibrations called shock waves to break the stones into small pieces that can pass in the urine. The treatment takes around 45 to 60 minutes. Can cause moderate pain, so that you may receive medicine to prevent pain or to help you relax. ESWL can cause blood in the urine and bruises on the back or the stomach area. It can also cause bleeding around the kidney and around other organs nearby. It can cause discomfort as the stone fragments pass through the urinary tract too.
  • Surgery to remove very large stones in the kidney.A surgery called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) is the removal of a kidney stone using small telescopes and tools inserted through a small incision in the back or side. Receives drug called general anesthesia which avoids the pain and puts you in a state similar to sleep during the surgery. It is likely to recover in the hospital for 1 to 3 days after. Your health care professional may recommend this surgery if ESWL does not help enough.
  • Using a scope to remove stones.To remove a smaller stone in your ureter or kidney, the surgeon may use a thin, lighted tube called a ureteroscope. This instrument is equipped with a camera. The surgeon places the uteroscope through the urethra and the bladder to the ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in the urine. Then, the surgeon may place a small tube called a stent into the ureter to relieve the swelling and support healing. You may need local or general anesthesia during this procedure.
  • Surgery of the parathyroid gland.Some calculations of calcium phosphate are caused by the hyperactivity of the parathyroid glands. These glands are found in the four corners of the thyroid gland, just below the Adam's apple. When these glands produce too much parathyroid hormone, which is a condition known as hyperparathyroidism. The condition can cause calcium levels to become too high, and kidney stones may form as a result. Hyperparathyroidism sometimes happens when a small tumor that is not cancer forms in one of the parathyroid glands. Or hyperparathyroidism can happen if you develop another condition that leads these glands to produce more parathyroid hormone. The removal of the tumor of the gland stops the formation of kidney stones. Or your health care professional may recommend to treat the condition that causes the parathyroid gland to make too much of the hormone.

The use of sound waves to break up stones. For some stones in the kidney, your health care professional may recommend a treatment called extracorporeal shock wave lithotripsy. This is also known as ESWL. But it depends on the size and location of the stones.

ESWL uses sound waves to create strong vibrations called shock waves to break the stones into small pieces that can pass in the urine. The treatment takes around 45 to 60 minutes. Can cause moderate pain, so that you may receive medicine to prevent pain or to help you relax.

ESWL can cause blood in the urine and bruises on the back or the stomach area. It can also cause bleeding around the kidney and around other organs nearby. It can cause discomfort as the stone fragments pass through the urinary tract too.

Surgery to remove very large stones in the kidney. A surgery called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) is the removal of a kidney stone using small telescopes and tools inserted through a small incision in the back or side.

Receives drug called general anesthesia which avoids the pain and puts you in a state similar to sleep during the surgery. It is likely to recover in the hospital for 1 to 3 days after. Your health care professional may recommend this surgery if ESWL does not help enough.

Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, the surgeon may use a thin, lighted tube called a ureteroscope. This instrument is equipped with a camera. The surgeon places the uteroscope through the urethra and the bladder to the ureter.

Once the stone is located, special tools can snare the stone or break it into pieces that will pass in the urine. Then, the surgeon may place a small tube called a stent into the ureter to relieve the swelling and support healing. You may need local or general anesthesia during this procedure.

Surgery of the parathyroid gland. Some calculations of calcium phosphate are caused by the hyperactivity of the parathyroid glands. These glands are found in the four corners of the thyroid gland, just below the Adam's apple. When these glands produce too much parathyroid hormone, which is a condition known as hyperparathyroidism. The condition can cause calcium levels to become too high, and kidney stones may form as a result.

Hyperparathyroidism sometimes happens when a small tumor that is not cancer forms in one of the parathyroid glands. Or hyperparathyroidism can happen if you develop another condition that leads these glands to produce more parathyroid hormone. The removal of the tumor of the gland stops the formation of kidney stones. Or your health care professional may recommend to treat the condition that causes the parathyroid gland to make too much of the hormone.

Preparing for your appointment

Small stones in the kidney that are not blocked by your kidneys or cause other health problems can be treated by your primary healthcare professional. But if you have a large stone in the kidney and have severe pain or kidney problems, you may need to see a specialist. Your health care professional may refer you to a doctor called a urologist or nephrologist who treats conditions of the urinary tract.

What you can do

To prepare for your appointment:

  • Ask if there is something that you need to do before your appointment, such as a limit to your diet.
  • Write down your symptoms, including those that do not seem to be related to kidney stones.
  • Keep track of how much you drink and urinate during a period of 24 hours.
  • Make a list of all medications, vitamins or supplements you take.
  • Have a friend or family member, if possible, to help you remember what you talk with your health care professional.
  • Write questions to ask their health professional.

For kidney stones, some basic questions include:

  • I have a kidney stone? If so, what size and type of stone it is, and where in my urinary tract is?
  • I'm going to need a medication to treat my condition?
  • I'm going to need a surgery or other procedure?
  • What is the probability that I'm going to develop another stone in the kidney? How can I prevent kidney stones in the future?
  • I have other health conditions. How can I best manage them together?
  • You should see a specialist? If so, does the insurance usually covers the services of a specialist?
  • Do you have any educational material that I can take with me? What sites do you recommend?

Feel free to ask any other questions during your appointment.

What to expect from your doctor

Your healthcare provider will likely ask questions such as:

  • When did the symptoms begin?
  • The symptoms been constant or to make that happen once in a while?
  • How bad are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • Has someone in your family has ever had kidney stones?
The symptoms and treatment of Kidney stones