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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.

There are several types of kidney stones:

  • Calcium oxalate
  • Calcium phosphate
  • Struvite
  • Uric acid
  • Cystine

Kidney Stone

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Causes    TOP

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—form when there are high amounts of calcium or other minerals in the urine or when minerals that stop stones from forming are too low.
  • Struvite stones—These stones develop because of a urinary tract infection.
  • 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—due to a rare genetic disorder that causes the kidneys to build up too much cystine.

Risk Factors    TOP

Caucasian men under 50 years old are at increased risk.

Factors that may increase your chance of kidney stones include:

  • Personal history of kidney stones
  • Family history of kidney stones

Other factors that increase your risk of kidney stones include:

For calcium oxalate or phosphorus stones:

  • High amount of sodium (salt) and oxalate in your diet. Oxalate can be found in green, leafy vegetables, chocolate, nuts, or tea.
  • Not drinking enough fluids and dehydration.
  • Overactive parathyroid gland.
  • Chronic bowel disorders such as Crohn’s disease or ulcerative colitis.
  • Certain medications called diuretics
  • Calcium-based antacids.

Struvite stones:

  • History of urinary infection
  • More common in women

Uric acid stones:

  • Excess dietary red meat or poultry
  • Gout

Symptoms    TOP

In many people, kidney stones do not cause symptoms and pass with urine. 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    TOP

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    TOP

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 2-3 quarts of water per day can help the body pass the stone out with urine. You may be given a special cup to catch the stone when it passes. The doctor may want to test the stone to see what type it is. IV fluids may be needed in a hospital if you are vomiting.

Medications

Pain medication may help with discomfort until the stone passes. You may also be given medication to help pass the stone.

Surgery    TOP

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

A small tube is passed up through the urinary tract to the ureter. A small camera is passed through the tube so that the doctor can see the stone. The stone can then be removed. General or spinal anesthesia may be needed.

Percutaneous nephrolithotomy

Percutaneous nephrolithotomy is used to treat large stones located in the kidney. A small incision is made in the lower back. A scope is passed through a tube so the kidney stones can be seen. The stones are then broken into smaller pieces and removed.

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)    TOP

ESWL sends shock waves into the body. The impact of the shock waves breaks up the larger stones so they can pass in urine.

Prevention    TOP

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:

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.
Coe FL, Evan A, et al. Kidney stone disease. J Clin Invest. 2005;115:2598-2608.
Delvecchio FC, Preminger GM. Medical management of stone disease. Curr Opin Urol. 2003;13(3):229-233.
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. Urology Care Foundation website. Available at:
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Updated March 7, 2016.
Kidney stones in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
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Updated February 2013. Accessed March 7, 2016.
Management of ureteral calculi: EAU/AUA nephrolithiasis panel (2007). American Urological Association website.
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Accessed March 7, 2016.
Martini LA, Wood RJ. Should dietary calcium and protein be restricted in patients with nephrolithiasis? Nutr Rev. 2000;58:111-117.
Nephrolithiasis. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Updated June 30, 2016. Accessed September 28, 2016.
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:
...(Click grey area to select URL)
Updated December 2015. Accessed March 7, 2016.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis: Hollingsworth JM, Rogers MA, et al. Medical therapy to facilitate urinary stone passage: A meta-analysis. Lancet. 2006;368:1171-1179.
1/4/2011 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis: Mora B, Giorni E, 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.
Last reviewed March 2017 by EBSCO Medical Review BoardAdrienne Carmack, MD
Last Updated: 2/1/2018

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