11725 Health Library | Health and Wellness | Wellmont Health System
  • Kidney Stones—Adult

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

    Definition

    Kidney stones are pieces of a stone or crystal-like material in the urine. These stones form inside the kidneys or other parts of the urinary tract. The kidneys remove waste (in the form of urine) 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:
    • The most common type has mostly calcium along with oxalate or phosphate.
    • Others types contain uric acid, struvite, and/or cystine.
    Kidney Stone
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Some of the known causes include:
    • Chemotherapy (that is, uric acid stone)
    • Too much oxalate in urine (hyperoxaluria)
    • Too little magnesium in urine (hypomagnesemia)
    • Too much calcium in the urine (hypercalciuria)
    • Too much calcium in the blood (hypercalcemia)
    • Too little citrate in the urine (hypocitraturia)
    • Bacteria around which a stone can form
    • Too much uric acid in the urine (hyperuricuria, gout)
    • Bacteria that produce enzymes that increase the amount of ammonia and struvite in the urine
    • Inherited abnormality in the way the body handles cystine
    • Certain medications (such as indinavir)
    • Foreign bodies in the urinary tract, such as stents or catheters
    • Retention of urine

    Risk Factors

    Risk factors that can increase your chance of developing kidney stones include:

    Symptoms

    Occasionally, kidney stones do not cause symptoms. They leave the body in the urine. The condition, though, can cause severe pain.
    Symptoms include:
    • 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 and groin area, labia, or testicles
    • Nausea, vomiting, or diarrhea
    • Blood in the urine
    • Frequent urge to urinate
    • Burning pain during urination
    • Fever
    • Urinary tract infection

    Diagnosis

    The doctor will ask about your symptoms and medical history, and perform a physical exam.
    Tests may include:
      Your doctor may order tests to gather information about your urine such as:
      • Urinalysis
      • 24-hour urine
      • Urine culture
    • Blood tests
    • Your doctor may need detailed pictures of your kidneys and urinary system. These can be made with:

    Treatment

    Treatment depends on the size and location of the kidney stone. Treatment may include:

    Water

    For small kidney stones, drinking at least two or three quarts of water a day helps the body pass the stone in the urine. The doctor may provide 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 fluids in your vein.

    Medications and Nerve Stimulation

    Your doctor may recommend that you take pain medication. You may need medication that is given in the vein or in the muscles.
    Certain medicine used to treat high blood pressure (such as, calcium channel blockers and alpha blockers) may help your body pass kidney stones.

    Surgery

    Surgery may be needed if the stone is:
    • Very large or growing larger
    • Causing bleeding or damage to the kidney
    • Causing infection
    • Blocking the flow of urine
    • Unable to pass on its own
    Types of surgery include:
    • Stent placement—used to allow urine to pass
    • Ureteroscopy and stone basketing or laser lithotripsy—a camera is used to locate the stone
      • Stone basketing—a tiny basket is used to remove the stone
      • Laser lithotripsy—the stone is broken into smaller pieces with a laser if it is too large to remove
    • Extracorporeal shock wave lithotripsy (ESWL)—uses shock waves to break up stones that are too large to pass
    • Percutaneous nephrolithotomy—uses a scope placed through a small tube in the back to remove a large stone
    • Lithotomy—open surgery to remove a stone (rarely used now)
    If you are diagnosed as having kidney stones, follow your doctor's instructions.
    If you are diagnosed as having kidney stones, follow your doctor's instructions.

    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 be told to:
      • Avoid apple and grapefruit juices.
      • Drink more cranberry juice.
      • Avoid foods high in oxalate, such as spinach.
      • Eat less meat, fish, and poultry. These foods increase urine acidity.
      • Decrease your sodium intake (especially if you have calcium stones).
      • Increase your intake of magnesium.
      • Drink lemonade daily.
      • Increase your fiber intake.
      • Lose weight.
    • If you have an enlarged parathyroid gland, you may need to have it removed surgically.
    • Medicines may include:
      • Drugs that control the amount of acid in the urine
      • Allopurinol or sodium cellulose phosphate—to treat urine high in calcium
      • Hydrochlorothiazide (a diuretic)—to treat urine high in calcium
      • Thiola—to reduce the amount of cystine in the urine

    RESOURCES

    American Urological Association Foundation http://www.urologyhealth.org

    National Institute of Diabetes and Digestive and Kidney Diseases http://www2.niddk.nih.gov

    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.

    Calcium. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary. Updated July 2012. Accessed November 1, 2012.

    Campell MF, Wein AJ, et al, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders, Elsevier; 2007.

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

    Clinical Guidelines: Ureteral Calculi (’07). American Urological Association. http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=uc. Accessed November 1, 2012.

    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 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 June 29, 2012. Accessed November 1, 2012.

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

    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. Available at: http://www.ebscohost.com/healthLibrary. Updated July 2012. Accessed November 1, 2012.

    1/4/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: 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 https://dynamed.ebscohost.com/about/about-us: 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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