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Kidney Stones—Adult

(Renal Colic; Renal Lithiasis; Nephrolithiasis; Renal Calculi)

Definition

Kidney stones are pieces of a stone or crystal-like material. These stones form inside the kidneys or other parts of the urinary tract. The kidneys remove waste from the body. They also balance the water and electrolyte content in the blood by filtering salt and water.
There are several types of kidney stones:
  • Calcium oxalate
  • Calcium phosphate
  • Struvite
  • Uric acid
  • Cystine
Kidney Stone
IMAGE
Copyright © Nucleus Medical Media, Inc.

Causes

The cause of your kidney stone may be depend on the type of stone that you have. Calcium stones are the most common type.
  • Calcium oxalate or phosphorus stones—These kidney stones form when the concentration of calcium or other minerals in the urine becomes too high or when minerals that prevent stone formation are too low.
  • Struvite stones—These stones develop as a result of a urinary tract infection. The stones are composed of ammonium, magnesium, and phosphate salts.
  • Uric acid stones—These stones form when urine is acidic. This may also occur in people with gout or those who are on chemotherapy.
  • Cystine stones—These stones form due to a rare genetic disorder that causes the kidneys to build up excess amounts of cystine. Cystine is one of the amino acids that make up proteins.

Risk Factors

Factors that may increase your risk of kidney stones include:
  • White adult male under 50 years old
  • Personal history of kidney stones
  • Family history of kidney stones
Other factors that increase your risk of kidney stones include:
Calcium oxalate or phosphorus stones:
  • Excess dietary sodium and oxalate. Oxalate can be found in green, leafy vegetables, chocolate, nuts, or tea.
  • Low fluid intake, especially during warmer weather, which can lead to dehydration
  • Overactive parathyroid gland
  • Chronic bowel disorders such as Crohn’s disease or ulcerative colitis
  • Some diuretics
  • Calcium-based antacids
Struvite stones:
  • History of urinary infection
  • More common in women
Uric acid stones:
  • Excess dietary red meat or poultry
  • Gout
A rare genetic disorder increases the risk of cystine stones.

Symptoms

In many people, kidney stones do not cause symptoms and pass during urination. Other people may have symptoms, including:
  • Sharp, stabbing pain in the mid-back that may occur every few minutes and last from 20 minutes to one hour
  • Pain in the lower abdomen, groin, or genital areas
  • Nausea and vomiting
  • Blood in the urine
  • Frequent urge to urinate
  • Burning pain during urination
  • Fever

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
  • Urine tests and cultures
  • Blood tests
Images may be taken of your kidneys and urinary system. This can be done with:

Treatment

Treatment depends on the size and location of the kidney stone. Treatment may include one or more of the following:

Water

For small kidney stones, drinking at least two or three quarts of water a day helps the body pass the stones during urination. You may be given a special cup to catch the stone when it passes so it can be analyzed. If you are having a hard time keeping fluids down, you may need to be hospitalized to receive IV fluids.

Medications

You may be advised to take pain medication. You may also be prescribed medications that may help you pass your kidney stones during urination.

Surgery

Surgery may be needed if the stones are:
  • Very large or growing larger
  • Causing bleeding or damage to the kidney
  • Causing infection
  • Blocking the flow of urine
  • Unable to pass
Ureteroscopy
Ureteroscopy uses a small camera to locate the stones located in the ureter or kidney. Once found, a small basket is used to capture and remove the stones. Larger stones can be broken up into small pieces with a laser.
Percutaneous nephrolithotomy (PNL)
PNL is used to treat large stones located in the kidney. A small incision is made in the lower back. A nephroscope is passed through a tube so the kidney stones can be seen. The stones are broken into smaller pieces and removed. A temporary drain may be left in the incision site.
Lithotomy
Lithotomy is an open surgery used to remove stones. This is rarely used because of the less invasive options available.

Extracorporeal Shock Wave Lithotripsy (ESWL)

ESWL uses a device called a lithotripter that is applied to the skin. The lithotripter sends shock waves into the body. The impact of the shock waves breaks up the larger stones so they can be passed during urination.

Prevention

Once you have formed a kidney stone, you are more likely to form another. Here are some steps to prevent this condition:
  • Drink plenty of fluids, especially water.
  • Talk to your doctor about what diet is right for you. Depending on the type of stone you have, you may have to avoid certain food or drinks.
  • Depending on what type of stone you have, certain medications may be prescribed to keep stones from forming again.

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases http://niddk.nih.gov

Urology Care Foundation http://www.urologyhealth.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

The Kidney Foundation of Canada http://www.kidney.ca

References

Borghi L, Meschi T, et al. Dietary therapy in idiopathic nephrolithiasis. Nutr Rev. 2006;64:301-312.

Clinical Guidelines: Ureteral Calculi (’07). American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=uc. Accessed March 3, 2014.

Coe FL, Evan A, Worcester E. Kidney stone disease. J Clin Invest. 2005;115:2598-2608.

Delvecchio FC, Preminger GM. Medical management of stone disease. Curr Opin Urol. 2003 May; 13(3):229-33.

Kang DE, Sur RL, et al. Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol. 2007;177:1358-1362.

Kidney and uretral stones. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=148. Updated April 2013. Accessed March 3, 2014.

Kidney stones in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/stonesadults/index.htm. Updated January 28, 2013. Accessed March 3, 2014.

Martini LA, Wood RJ. Should dietary calcium and protein be restricted in patients with nephrolithiasis? Nutr Rev. 2000;58:111-117.

Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 17, 2014. Accessed March 3, 2014.

Pearle MS, Lingemann JE, et al. Prospective, randomized controlled trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol. 2005;173:2005-2009.

Vitamin C. EBSCO Natural and Alternative Treatments website. EBSCO Health Library website. Available at: http://www.ebscohost.com/academic/natural-alternative-treatments. Updated August 2013. Accessed March 3, 2014.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006;368:1171-1179.

1/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mora B, Giorni E, Dobrovits M, et al. Transcutaneous electrical nerve stimulation: an effective treatment for pain caused by renal colic in emergency care. J Urol. 2006;175:1737-1741; discussion 1741.

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