Make an Appointment
Talk to DoctorOverview
Kidney stones, also referred to as renal calculi, nephrolithiasis, or urolithiasis, are solid masses or crystals that come in irregular shapes and can vary in size from as small as a grain of sand to as large as a golf ball. They are formed by the accumulation of minerals and salts within the kidneys, often resulting from the concentration of urine, which leads to the solidification and binding together of these substances.
Kidney stones can harm any area of the urinary tract, including the kidneys and bladder. Depending on the size of the kidney stone, it can go unnoticed. However, even little stones can cause severe pain as they pass through the urinary tract. Although kidney stones can cause discomfort when passing, they typically do not cause permanent damage if detected and treated early.
The causes of kidney stones are diet, excess body weight, certain medical disorders, and certain supplements and drugs. Depending on the size of the stone, consuming fluids and taking pain reliever may aid the healing process, which usually take up to three weeks.
In some cases, a big kidney stone might become lodged in the ureter. The ureter is the tube that drains urine from the kidney down to the bladder. When this occurs, the stone can cause bleeding and prevent urine from exiting the body. A stone that won’t pass on its own may necessitate surgery. In cases where individuals are at a high risk of experiencing a recurrence of kidney stones, preventive treatment may be recommended.
Types of kidney stones
There are several types of kidney stones that can form in the body. The patient may choose to save the pass kidney stone for laboratory analysis. Understanding what kind of kidney stone a person has aids in determining its cause and may provide information on how to lower the risk of developing more kidney stones in the future.
The types of kidney stones are:
- Calcium stones: When calcium and oxalate mix in the urine, this type of kidney stone forms. A calcium oxalate stone is the most common form of kidney stone. This occurs when the person has a lot of oxalates, low amounts of calcium, and are not well hydrated.
Oxalate is a chemical that the liver produces on a daily basis or is absorbed through diet. Fruits, vegetables, nuts, and chocolate are among the foods that contain high levels of oxalate. Calcium and oxalate concentrations in urine can be increased by dietary variables, high vitamin D doses, intestinal bypass surgery, and a variety of metabolic diseases.
Calcium phosphate stones are another type of calcium stone. It may be linked to certain migraine or seizure drugs, such as topiramate. This form of stone occurs more frequently in metabolic circumstances such as renal tubular acidosis.
- Struvite stones: These stones can develop rapidly and become large, with minimal signs or symptoms. These stones are caused by an infection in the urinary tract.
- Uric acid stones: Uric acid stones are also relatively prevalent. Those who lose too much fluid due to chronic diarrhea or malabsorption, those who eat a high protein diet, and those with diabetes or metabolic syndrome are at risk of developing uric acid stones. Some genetic factors may also enhance the chances of developing uric acid stones.
- Cystine stones: People who are diagnosed with cystinuria often develop these stones. Cystinuria is a hereditary condition in which the kidneys discharge an excessive amount of a certain amino acid.
Symptoms
When a kidney stone becomes lodged in the ureters, it can block the normal flow of urine, resulting in enlargement of the kidney and contraction of the ureter, which can cause intense pain. As the stone moves through the urinary tract, the pain it causes may vary, such as by shifting to a different area or increasing in severity.
A kidney stone normally does not produce symptoms until it moves around within the kidney or enters one of the ureters. If this happens, one may experience the following symptoms:
- Intense pain in the lower back or side of the body
- Pain that spreads from the lower abdomen and groin
- Pain that occurs intermittently and varies in strength
- Pain when urinating
Additional indications and symptoms could be:
- Blood in the urine
- Having urine that smells bad or looks cloudy
- Frequent need to urinate
- Fever and chills
- Nausea and vomiting
If any of the symptoms of kidney stones persist, it is advisable to seek medical advice from a healthcare provider. In cases where the pain becomes severe and is accompanied by a fever and chills, urgent medical attention may be necessary, as these may indicate an infection. Obtaining an accurate diagnosis can aid in receiving appropriate treatment and avoiding potential complications.
If a person experiences intense pain that causes difficulty in finding a comfortable position, nausea, or vomiting, immediate medical attention may be necessary. Difficulty in urinating or the presence of blood in the urine are also signs that should be promptly addressed.
Causes
The development of kidney stones is often the result of the presence of certain chemicals in the urine. Typically, these substances flow through the urinary system without issue. However, when there is insufficient urine volume, these chemicals can become highly concentrated and form crystals, ultimately leading to the formation of stones. This lack of urine volume is frequently the result of inadequate water intake.
The urine may lack chemicals that keep crystals from sticking together, producing an ideal environment for kidney stones to grow. Stone-forming chemicals include calcium, oxalate, uric acid, phosphate and rarely, cystine and xanthine. These and other substances are among the waste products produced by the body.
Risk factors
Although anyone can develop kidney stones, several factors can significantly contribute to one’s risk of getting it, such as:
- Family or personal history: A person is more likely to get another kidney stone if he or she already had one or more before. Having a family member with kidney stones also increases the chance of having them as well.
- Dehydration: Individuals who live in hot, dry areas or who excessively sweat may be more vulnerable than others. Generally, not drinking adequate water makes a person susceptible to developing kidney stones.
- Specific diets: Having a diet that includes the substances that form the stones such as phosphate in meat, fish, beans, and other protein-rich food can increase the risk of developing kidney stones. In addition, too much salt in the diet also increases the quantity of calcium the kidneys must filter, increasing the risk of kidney stones dramatically. The same is true to high-sugar diet.
- Obesity: Individuals who have excessive weight gain or a high BMI are more prone to kidney stones.
- Digestive diseases and surgery: Conditions include gastric bypass surgery, inflammatory bowel disease, or chronic diarrhea can affect the body’s digestive process. These conditions might impair calcium and water absorption, raising the levels of chemicals in the urine which can lead to kidney stones.
- Other medical conditions: increase the risk of developing stones, such as renal tubular acidosis, cystinuria, hyperparathyroidism and repeated urinary tract infections.
- Certain supplements and medications: increase the risk of kidney stones. These include diuretics, calcium-based antacids, dietary supplements, laxatives, excessive vitamin C, and other drugs used to treat HIV infections, seizures, migraines or depression, and some antibiotics.
Diagnosis
When diagnosing kidney stones, healthcare professionals typically begin by discussing the patient’s symptoms and reviewing their medical history. In addition to this, doctors may require one or more tests to confirm the diagnosis. These tests may include:
- Blood testing: A blood test will show how well the kidneys are working, examine for infection, and search for biochemical issues that could contribute to kidney stones such as an excess of calcium or uric acid in the blood. The results may prompt the doctor for the next step or to look for other medical concerns.
- Urine testing: This test checks for signs of infection as well as the level of the chemicals that cause kidney stones. The doctor may require two urine samples on two consecutive days for this test. The 24-hour urine sample test may reveal whether the body is excreting excessive amounts of stone-forming minerals or insufficient amounts of stone-preventing chemicals.
- Imaging: The doctor will be able to see the size, shape, position, and quantity of kidney stones using an X-ray, CT scan, and ultrasound. These tests will help in determining what treatment will be required. Small stones can be detected using high-speed or dual-energy computerized tomography (CT).
Another imaging technique for diagnosing kidney stones is ultrasound, which is a noninvasive, rapid, and easy examination. Basic abdominal X-rays are not commonly used for diagnosing kidney stones, as they may not be able to detect very small stones.
- Analysis of passed stones: The composition of the kidney stones will be revealed by laboratory analysis. The result can be used to establish what is causing the kidney stones and to devise a plan to avoid future kidney stones. To catch stones, patients may be requested to urinate through a strainer.
Treatment
The result of the diagnosis will determine the appropriate treatment for kidney stones. It often differs on the type of kidney stone the person has as well as the underlying cause. The treatment can range from medication to surgery.
Smaller kidney stones with minor symptoms
When diagnosing kidney stones, the healthcare provider will evaluate whether treatment is necessary. In many cases, small stones can pass through the urinary system naturally with urination, although this may be a painful process. In such cases, the healthcare provider may recommend the following:
- Drinking water: The doctor may suggest consuming 1.8 to 3.6 liters of water per day to dilute the pee and keep stones from developing. The goal is to create clear or almost clear urine. It is recommended to seek consultation if the passing of stone is not successful within four to six weeks.
- Pain relievers: Patients may be prescribed to take an over-the-counter medication to alleviate pain associated with passing small kidney stones. Common pain relievers are ibuprofen and naproxen sodium.
- Medical therapy: Tamsulosin and the medication combination dutasteride and tamsulosin are examples of alpha blockers that may be prescribed to assist the patient in passing the kidney stone. An alpha blocker is a drug that calms the muscles in the ureter, allowing patients to pass the kidney stone more rapidly and with less pain.
Large stones and those that cause symptoms
Most surgeries used to treat kidney stones are minimally invasive. Surgery is usually recommended for larger stones that can cause bleeding, kidney damage, or recurring urinary tract infections. The following minimally invasive surgical treatments are commonly used for kidney stones:
- Extracorporeal shock wave lithotripsy (ESWL): This procedure breaks up stones by using high-energy shock waves. Smaller kidney stones can then pass more smoothly through the urine canal. The operation takes about 45 to 60 minutes and can be painful. It is typically done under local anesthesia.
Shock wave lithotripsy may help lessen the symptoms and avoid more invasive kidney stone removal operations. However, blood in the urine, bruises on the back or abdomen, bleeding around the kidney and other nearby organs, and discomfort as stone pieces move through the urinary tract are to be expected with ESWL procedure. Most children with kidney stones are treated with ESWL.
- Percutaneous nephrolithotomy: During this procedure, a tube is introduced straight into the kidney through a small incision in the back. Stones are then dissolved using an ultrasonic probe and suctioned out so that no fragments are passed. The patient will be anesthetized throughout the procedure and will stay in the hospital for one to two days to recover.
Percutaneous nephrolithotomy is often recommended when other procedures cannot treat kidney stones, either because there are too many stones, the stones are too large or heavy, or because of their location.
- Ureteroscopy: A small instrument called a ureteroscope is introduced into the urethra, past the bladder, and into the ureter to execute this surgery. Once the stone has been identified, special tools such as a surgical basket can catch it or break it up into fragments with a laser. These smaller bits of kidney stones can then readily exit the body via the urine tract. After that, the doctor may insert a stent into the ureter to reduce swelling and facilitate recovery. During this operation, patients may require general or local anesthetic.
- Parathyroid gland surgery: Hyperparathyroidism can occur when a small, benign tumor grows in one of the parathyroid glands or when there is an underlying illness that causes these glands to generate extra parathyroid hormone. Parathyroid glands are found on the four corners of the thyroid gland below the Adam’s apple.
Hyperactive parathyroid glands can cause an excess production of parathyroid hormone, resulting in high levels of calcium and the development of kidney stones, particularly specific calcium phosphate stones. To prevent the formation of kidney stones, surgical removal of the growth from the gland may be necessary. Alternatively, the healthcare provider may recommend treating the underlying cause of the hyperparathyroidism.
