Overview
Kidney stones are hard deposits made of minerals and salts that form inside the kidneys. They can cause pain and discomfort, and may require medical attention if they block the flow of urine or cause complications. Kidney stones can be caused by various factors such as diet, excess body weight, medical conditions, and certain supplements and medications. They usually form when the urine becomes concentrated, allowing minerals to crystallize and stick together. Passing kidney stones can be painful, but they usually do not cause permanent damage if recognized in a timely fashion. Different types of kidney stones include calcium stones, struvite stones, and calcium phosphate stones, each with distinct causes and risk factors.
Understanding the disease
Symptoms
The symptoms of kidney stones may include: severe, sharp pain in the side and back, below the ribs; pain that radiates to the lower abdomen and groin; pain that comes in waves and fluctuates in intensity; pain or burning sensation while urinating; pink, red or brown urine; cloudy or foul-smelling urine; a persistent need to urinate, urinating more often than usual or urinating in small amounts; nausea and vomiting.
Risk Factors
The risk factors for developing kidney stones include:
- Dehydration: Not drinking enough water each day can increase your risk of kidney stones.
- Certain diets: Eating a high-protein, high-sodium, or high-sugar diet may increase the risk of some types of kidney stones.
- Obesity: High body mass index (BMI) and large waist size have been linked to an increased risk of kidney stones.
- Digestive diseases and surgery: Gastric bypass surgery, inflammatory bowel disease, chronic diarrhea, or certain digestive conditions can affect calcium and water absorption, increasing the risk of kidney stones.
- Struvite stones: These stones form in response to a urinary tract infection and can grow quickly, often with few symptoms.
- Uric acid stones: Uric acid stones can form in people with chronic diarrhea, high-protein diets, diabetes, or metabolic syndrome.
- Cystine stones: These stones form in people with the hereditary disorder cystinuria, which causes the kidneys to excrete too much of a specific amino acid.
- Family or personal history: If someone in your family has had kidney stones, you're more likely to develop stones, too. If you've had one or more kidney stones, you're at increased risk of developing another.
- Other medical conditions: Renal tubular acidosis, cystinuria, hyperparathyroidism, and repeated urinary tract infections can also increase the risk of kidney stones.
- Certain supplements and medications: Vitamin C, dietary supplements, laxatives, calcium-based antacids, and certain medications used to treat migraines or depression can increase the risk of kidney stones.
Development
Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They can be caused by a variety of factors, including diet, excess body weight, some medical conditions, and certain supplements and medications. Kidney stones can affect any part of your urinary tract, and they often form when the urine becomes concentrated, allowing minerals to crystallize and stick together. The various types of kidney stones include:
- Calcium stones: Most kidney stones are calcium stones, usually in the form of calcium oxalate. These stones can form due to dietary factors, high doses of vitamin D, intestinal bypass surgery, and several metabolic disorders that increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate, which is more common in metabolic conditions such as renal tubular acidosis or associated with certain medications like topiramate.
- Struvite stones: Struvite stones form in response to a urinary tract infection. They can grow quickly and become quite large, sometimes with few symptoms or little warning.
- Uric acid stones: Uric acid stones can form in people who lose too much fluid due to chronic diarrhea or malabsorption, those with a high-protein diet, diabetes, or metabolic syndrome. Certain genetic factors may also increase the risk of uric acid stones.
- Cystine stones: These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid. In summary, kidney stones develop due to various factors, including the presence of specific minerals and salts, urinary tract infections, metabolic disorders, diet, and genetic conditions.
Assessment and Diagnosis
Triage
You should see a doctor if you suspect kidney stones, especially if you experience any of the following symptoms:
- Severe, sharp pain in the side and back, below the ribs
- Pain that radiates to the lower abdomen and groin
- Pain that comes in waves and fluctuates in intensity
- Pain or burning sensation while urinating
- Pink, red or brown urine
- Cloudy or foul-smelling urine
- A persistent need to urinate, urinating more often than usual or urinating in small amounts
- Nausea and vomiting These symptoms may indicate that a kidney stone is blocking the flow of urine, causing kidney swelling and ureter spasms. It's important to seek medical attention for proper diagnosis and treatment.
Diagnosis
To diagnose kidney stones, doctors may use a combination of diagnostic tests and procedures, including:
- Blood testing: Blood tests can reveal high levels of calcium or uric acid in the blood, which may indicate the presence of kidney stones.
- Urine testing: A 24-hour urine collection test can show the presence of excess stone-forming minerals or insufficient stone-preventing substances in the urine.
- Imaging: Imaging tests like high-speed or dual energy computerized tomography (CT) scans, simple abdominal X-rays, or ultrasound can help identify the presence and location of kidney stones in the urinary tract.
Management and Treatment
Complications
Potential complications of kidney stones include:
- Urinary tract infection (UTI): Kidney stones can cause urinary stasis, which can lead to bacterial infections in the urinary tract. UTIs can cause pain, fever, chills, and nausea.
- Kidney damage: In some cases, kidney stones can obstruct the flow of urine, leading to kidney damage due to decreased blood flow and increased pressure in the affected kidney.
- Recurrent stones: People who have had one kidney stone are at a higher risk of developing additional stones. Approximately 50% of people who have had one kidney stone will have another within 5 years.
- Obstruction and complications: Kidney stones that become lodged in the ureters or urethra can cause obstruction, leading to pain, infection, and potentially serious complications.
- Renal insufficiency: In rare cases, kidney stones can cause chronic kidney disease or renal insufficiency if they obstruct the urinary flow for a prolonged period.
- Embolism: In rare cases, a kidney stone may dislodge and cause an embolism, leading to life-threatening complications. It is essential to seek medical attention if you suspect a kidney stone to prevent potential complications and ensure proper management.
Prevention
There are ways to prevent kidney stones. Some preventive measures include:
- Drinking plenty of fluids, especially water, to dilute the concentration of minerals in your bladder. The appropriate amount of fluid can vary based on factors like age, size, health, and level of activity, so consult your doctor for personalized guidance.
- Avoiding dehydration, especially for individuals living in warm and dry climates or those who sweat a lot.
- Maintaining a healthy weight and managing obesity.
- Monitoring your diet to limit high-sodium, high-protein, and high-sugar intake. Reducing sodium intake can help lower the risk of calcium stone formation.
- Consulting your doctor about any underlying medical conditions, digestive diseases, or surgeries that may increase your risk of kidney stones. By following these tips and managing any underlying health conditions, you can reduce your chances of developing kidney stones.
Treatment
For kidney stones, treatments typically involve managing pain, facilitating stone passage, and addressing any underlying conditions. Here are some common treatments:
- Pain relief: Over-the-counter pain medications such as ibuprofen or acetaminophen can help alleviate pain caused by kidney stones. In some cases, prescription pain medications may be prescribed.
- Hydration: Drinking plenty of water helps to flush out the kidney stones. It is essential to stay adequately hydrated to aid in the passage of the stone.
- Medications: Your doctor may recommend certain medications to help facilitate the passage of the stone. These can include alpha-blockers to relax the ureter, making it easier for the stone to pass, or medications to reduce inflammation and pain.
- Shock wave lithotripsy (SWL): In this minimally invasive procedure, high-energy shock waves are used to break up the kidney stone into smaller fragments, making it easier to pass. The fragments can then be passed naturally with urine.
- Ureteroscopy and laser lithotripsy: If the stone is located in the ureter or is too large to pass on its own, this procedure involves using a small scope to access the ureter and break up the stone with a laser.
- Percutaneous nephrolithotomy (PCNL): This surgical procedure involves making a small incision in the back and removing the kidney stone through a tunnel created in the kidney. PCNL is typically reserved for larger or complex kidney stones that cannot be treated with other methods.
- Medical management of underlying conditions: If an underlying medical condition, such as renal tubular acidosis or cystinuria, is contributing to the formation of kidney stones, treatment will be focused on managing the underlying condition. It is essential to consult a healthcare professional for proper diagnosis and guidance on the most appropriate treatment plan, as each case is unique. For bladder stones, treatment options may include medications or surgery, depending on the size and severity of the stones. If the stones are small and causing no complications, they may pass on their own. However, if they cause symptoms or block the flow of urine
Preparing for medical consultation
To prepare for an appointment for kidney stones, you should:
- Ask if there are any preparations needed before the appointment, such as restricting your diet.
- Note down your symptoms, including any unrelated ones.
- Keep track of your fluid intake and urination patterns for a 24-hour period.
- Make a list of all medications, vitamins, or supplements you are taking.
- Bring a family member or friend to the appointment for support and to help remember important information.
- Write down questions to ask your doctor, such as:
- Do I have a kidney stone?
- What size is the kidney stone?
- Where is the kidney stone located?
- What type of kidney stone do I have?
- Will I need medication to treat my condition?
- Will I need surgery or another procedure?
- What's the chance that I'll develop another kidney stone?
- How can I prevent kidney stones in the future?
- Do I need to follow any restrictions?
- Should I see a specialist? If so, does insurance typically cover the services of a specialist?
- Is there a generic alternative to the medicine you're prescribing?
- Do you have any educational material that I can take with me? What websites do you recommend?
- Do I need a follow-up visit? Remember to speak up during the appointment and ask any additional questions that come up.