Kidney Stones Causes Symptoms Diagnosis and Treatment

Kidney stones are a frequent medical condition that causes pain and affects millions of people around the world. Learning the causes, early warning signs and when to get medical attention are important steps in caring for the condition and preventing it from occurring again.

What Are Kidney Stones?

Kidney stones are little rock-like deposits that can form in one or both kidneys. They are formed when minerals and salts in the urine become very concentrated and crystallize together. The stones can be as small as grains of sand, or large enough to block the flow of urine.

Small stones may sometimes pass naturally through the urinary tract and may stay in the kidney without causing any symptoms. Larger stones can fall into the ureter, the thin tube that carries urine from the kidney to the bladder, causing obstruction and severe kidney stone pain.

A stone can also irritate the urinary tract, or increase the risk of infection. Many stones do not cause permanent damage to the kidneys if treated properly, but prolonged obstruction or infection can be serious.

Kidney Stones Causes and Risk Factors

Learning causes of kidney stones may help reduce your chances of getting them again. Stones form when the urine contains too much of one or more substances that form crystals and not enough fluid to dilute them, or both.

Common kidney stones causes

• Dehydration: If you don't drink enough water your urine becomes more concentrated and minerals crystallize more readily.
• High salt intake: Too much sodium can cause more calcium to be passed in the urine, increasing the risk of stones that contain calcium.
• Dietary factors: A high intake of animal protein, refined foods or some high-oxalate foods may contribute to susceptible individuals.
• Family history: Having a close relative with stones may put you at increased risk.
• Stones in the past: Having had one stone puts you at risk of having another.
• Obesity and metabolic diseases Obesity and some metabolic alterations are related to stone formation.
• Medical conditions such as hyperparathyroidism, gout, recurrent urinary infections, inflammatory bowel disease and certain intestinal conditions may increase the risk.
• Urinary tract problems: Obstructions or anatomical issues can affect urine flow.
• Medications: Certain medications and supplements can raise the risk for certain types of stones.
• Genetic conditions: Rare disorders such as cystinuria can cause recurrent stones.

Types of kidney stones

• Calcium stones are the most common type and are usually composed of either calcium oxalate or calcium phosphate.
• Uric acid stones: These are more common when the urine is chronically acidic and may be associated with gout or a high-purine diet.
• Struvite stones: Commonly associated with some forms of urinary tract infections.
• Cystine stones: These are rare stones caused by an inherited metabolic disorder.

Don't eliminate calcium from your diet without medical advice. If you get enough dietary calcium, it may help bind oxalate in the gut, but extra calcium supplements could affect the risk of stones in some people. Your stones and urine analysis should inform your diet recommendations.

Kidney Stones Symptoms

The kidney stones symptoms you will experience will depend on the stone’s size, location, whether it is moving, and whether it is causing obstruction or infection. Other stones do not cause any symptoms and are found during an ultrasound or scan for another reason.

Common Symptoms of kidney stones

The most common kidney stone signs include:

• Sharp or cramping pain in the side, back or beneath the ribs.
• Pain that goes to the lower belly or groin.
• Pain comes in waves & changes in intensity.
• Blood in urine, which may be pink, red or brown.
• Pain or burning when you urinate.
• Constant or urgent urge to pee.
• Passing small amounts of urine only.
• Cloudy or foul smelling urine.
• Nausea and vomiting.
• Restlessness due to severe pain.

The classic kidney stone pain symptoms are often called renal colic. This pain may start in the flank and radiate toward the groin as the stone moves down the ureter. However, not all flank or back pain is caused by a stone. Proper evaluation is important because urinary infection, appendicitis, gallbladder disease, muscle injury and other conditions can present with similar symptoms.

Kidney stones: when to seek emergency care

If you need urgent medical help, you should see a doctor immediately.

• Severe or unremitting kidney stone pain.
• Feeling feverish, having chills or feeling hot and shivery.
• Vomiting that prevents you from keeping fluids down.
• Difficulty or inability to urinate.
• Worsening symptoms, blood in the urine.
• Known kidney disease, only one kidney working, or pregnancy.
• Severe weakness, confusion or signs of infection.

If the urinary system is blocked and infected, this can be dangerous and may require urgent drainage and medical treatment. If you have severe pain with a fever or chills, do not wait for a stone to pass at home.Kidney Stone Diagnosis .

Diagnosis of kidney stones starts with your symptoms, medical history, physical exam, and laboratory or imaging tests. Your doctor may ask about your diet, fluid intake, urinary symptoms, medical conditions, family history, medicines, and previous stones.

Tests for Kidney Stones Diagnosis

Urine test: It may show blood, infection, crystals, acidity, or other clues.

Blood tests: Can measure kidney function and levels of calcium, uric acid and electrolytes.

Ultrasound: Can see many stones and swelling of kidney without radiation. The first test is often useful, especially in pregnancy and children.

CT scan A CT scan without contrast can show the stone’s size, location, density and effect on urine flow. It is often used when symptoms are severe or the diagnosis is uncertain.

X-ray: May see some stones that have calcium but may not see all types.

Stone analysis. If you pass a stone or have one removed, laboratory analysis may be able to determine its composition.

24-hour urine testing: This may be recommended in recurrent or high-risk stone formers to detect avoidable chemical abnormalities.

Imaging is used in current urological guidance to determine whether a stone is obstructing the urinary tract and to guide an appropriate treatment. Ultrasound may be preferable in selected cases. CT provides more detailed information in symptomatic patients when clinically indicated.

Kidney Stone Treatment

The kidney stone treatment depends on many factors such as:

• Type and size of stone.
• Site in kidney or ureter.
• Degree of obstruction .
• Intensity and duration of pain.
• Proof of infection.
• Kidney function
• Pregnancy, age and other health problems.
• Chances of the stone passing naturally.

1. Expectant management and medical therapy

Little stones that are not causing a serious blockage or infection may pass on their own. Your doctor may suggest:

• Adequate fluid intake unless restricted because of kidney or heart or other medical problems.
• Pain-killing medicines.
• Medicines to help with nausea.
• Select medicines to relax the ureter and may facilitate passage in appropriate patients.
• Imaging follow-up to confirm passage of stone or resolution of obstruction.

Do not drink large quantities of water during acute painful episodes without medical advice. Drinking too much can make you feel worse if your urine flow is blocked.

2. ESWL (Extracorporeal shock wave lithotripsy)

One called extracorporeal shock wave lithotripsy, or ESWL, sends focused shock waves to break a stone into smaller pieces. The fragments then can be passed out in the urine.

ESWL is used for some stones in the kidney or upper ureter. How well it works depends on the stone’s size, location, and hardness, your body’s anatomy, and whether your urinary tract is clear.

3. Laser Treatment and Ureteroscopy

Ureteroscopy A thin scope is passed up the urinary tract into the ureter or kidney. The urologist can either remove the stone with specialized instruments or use laser energy to break it into pieces

Ureteroscopy is often used for stones that are unlikely to pass, cause ongoing symptoms or are not good candidates for ESWL. They may place a temporary stent to help hold open the drainage of urine after the procedure.

4. Retrograde intrarenal endoscopic surgery

RIRS (retrograde intrarenal surgery) is a procedure where a flexible scope is used to reach stones inside the kidney. The stone can be broken up with a laser and the pieces can be removed or allowed to pass.

This minimally invasive option may be considered for selected stones depending upon their size, location, number and composition.

5. Percutaneous nephrolithostomy

PCNL is typically done for larger or more complex stones. The urologist makes a small cut in the back and takes out or breaks up the stone in the kidney.

This procedure may be the preferred option for large stone burdens, staghorn stones, or stones that are unlikely to be cleared effectively by less invasive methods. Stones may need to be actively removed if there is a persistent blockage, uncontrolled pain, reduced kidney function or other complications.

What is kidney stones removal?

Kidney stones removal can involve natural passage, or removed via ESWL, ureteroscopy, RIRS or PCNL. There is no one procedure that is best for every patient. Once the imaging, urine tests, kidney function and overall health are taken into account, a urologist selects the safest and most effective method.

If there is an association of infection and obstruction with stone, urgent drainage may be required prior to definitive stone therapy. Sometimes infected urine cannot drain properly, and antibiotics alone may not be enough.

Recovery & Prevention

Follow the instructions your urologist gives you after kidney stones treatment. You may need more imaging, urine tests, or analysis of the stone.

To prevent recurrence:

• Unless your doctor has told you to restrict fluids, drink enough water to produce a good amount of urine.
• Cut down on salt and processed foods.
• Eat a well-rounded diet, rather than one of an extreme high-protein plan.
• Maintain a healthy body weight and be physically active.
• Don’t remove normal dietary calcium without professional guidance.
• If your doctor confirms calcium oxalate risk, moderate foods high in oxalate.
• Used for gout, parathyroid disorders, recurrent infections and other conditions.
• Take preventive medicines as prescribed.
• If you have stones that keep coming back, attend follow-up appointments.

Prevention must be type of stone specific. A person with uric acid stones may need a different plan than a person with calcium oxalate stones or infection stones.

Kidney Stone Treatment

The kidney stone treatment depends on many factors such as:

• Type and size of stone.
• Site in kidney or ureter.
• Degree of obstruction .
• Intensity and duration of pain.
• Proof of infection.
• Kidney function
• Pregnancy, age and other health problems.
• Chances of the stone passing naturally.

1. Expectant management and medical therapy

Little stones that are not causing a serious blockage or infection may pass on their own. Your doctor may suggest:

• Adequate fluid intake unless restricted because of kidney or heart or other medical problems.
• Pain-killing medicines.
• Medicines to help with nausea.
• Select medicines to relax the ureter and may facilitate passage in appropriate patients.
• Imaging follow-up to confirm passage of stone or resolution of obstruction.

Do not drink large quantities of water during acute painful episodes without medical advice. Drinking too much can make you feel worse if your urine flow is blocked.

2. ESWL (Extracorporeal shock wave lithotripsy)

One called extracorporeal shock wave lithotripsy, or ESWL, sends focused shock waves to break a stone into smaller pieces. The fragments then can be passed out in the urine.

ESWL is used for some stones in the kidney or upper ureter. How well it works depends on the stone’s size, location, and hardness, your body’s anatomy, and whether your urinary tract is clear.

3. Laser Treatment and Ureteroscopy

Ureteroscopy A thin scope is passed up the urinary tract into the ureter or kidney. The urologist can either remove the stone with specialized instruments or use laser energy to break it into pieces.

Ureteroscopy is often used for stones that are unlikely to pass, cause ongoing symptoms or are not good candidates for ESWL. They may place a temporary stent to help hold open the drainage of urine after the procedure.

4. Retrograde intrarenal endoscopic surgery

RIRS (retrograde intrarenal surgery) is a procedure where a flexible scope is used to reach stones inside the kidney. The stone can be broken up with a laser and the pieces can be removed or allowed to pass.

This minimally invasive option may be considered for selected stones depending upon their size, location, number and composition.

5. Percutaneous nephrolithostomy

PCNL is typically done for larger or more complex stones. The urologist makes a small cut in the back and takes out or breaks up the stone in the kidney.

This procedure may be the preferred option for large stone burdens, staghorn stones, or stones that are unlikely to be cleared effectively by less invasive methods. Stones may need to be actively removed if there is a persistent blockage, uncontrolled pain, reduced kidney function or other complications.

Seek Urologist Help with the JVH E-Consult App

If you have kidney stones symptoms, have had previous stones, abnormal findings on urine tests or questions regarding kidney stone treatment, the JVH e-consult app can help you to get preliminary advice from the healthcare team of Jaipur Vatika Hospital.

You can discuss your symptoms, reports, ultrasound or CT findings, medicines and if you need to be seen in person by a urologist, all through an e-consultation. Jaipur Vatika Hospital is a 50 bedded multi specialty tertiary care hospital located at Thikariya, Ajmer Road, Jaipur and is backed by diagnostic services and 24/7 emergency.

If you have severe kidney stone pain, fever, chills, vomiting repeatedly, or are unable to pass urine, please use emergency medical services rather than waiting for an online consultation.

Conclusion

Kidney stones are silent deposits to painful stones that block the flow of urine or cause infection. Recognizing the signs of kidney stones, making a kidney stones diagnosis in a timely manner and choosing treatment appropriate to the size and location of the stone and the risk to health may help preserve kidney function.

Don’t ignore severe kidney stone pain, fever, blood in your urine or difficulty urinating. Early medical assessment will help determine if observation, medicines, kidney stone removal, or a minimally-invasive procedure is appropriate.