Nephrolithiasis (Kidney Stones)

Urine contains many dissolved minerals and salts. Stones can form when these minerals and salts in the urine are at high levels. Kidney stones can be small but can grow in size. These stones reach the bladder through the ureters (the tubes connecting the kidneys and the bladder) and are excreted in the urine, but sometimes it can get stuck and this causes pain.

Signs / Symptoms

What's common signs of kidney stones?

  • 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

 

Other signs and symptoms may include:

  • 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
  • Fever and chills if an infection is present

Common causes

What's common causes of kidney stones?

Kidney stones often have no definite, single cause, although several factors may increase your risk.

Risk Factors – Influenced by certain diseases, habits, composition of urine.

  • Personal history of prior kidney stones increases the risk of kidney stones by 15% within the first year, and 50% within the next ten years.
  • A family history of kidney stones increases the risk by 2.5 times.
  • Increased enteric oxalate absorption, typically due to malabsorption, leads to increased formation of calcium oxalate crystals.
  • Urinary tract infections altering urinary pH in the setting of urease-producing bacteria, producing struvite crystals
  • Low fluid intake
  • History of diabetes, obesity, gout, and hypertension
  • Acidic urine (pH< 5.5), which promotes uric acid formation in the setting of chronic diarrhea and gout

Departments & Emergency

The following may be signs of kidney stones that need a doctor’s help:

  • Extreme pain in your back or side that will not go away
  • Blood in your urine
  • Fever and chills
  • Vomiting
  • Urine that smells bad or looks cloudy
  • A burning feeling when you urinate

Diagnosis

The following can be done for diagnosis:

  • Pelvic exam
  • Blood test
  • Urine test
  • Imaging tests

Treatment

If you have a stone that won’t pass on its own, you may need treatment. It can be done with shock waves; with a scope inserted through the tube that carries urine out of the body, called the urethra; or with surgery.

 

Treatment depends on the size of the stone:

< 5 mm: often pass spontaneously
< 10 mm: likelihood of spontaneous passage increases with alpha-blocker or CCB therapy.
> 10 mm: often require shock wave lithotripsy or ureterorenoscopy
> 20 mm: percutaneous nephrolithotomy

Your doctor will decide on the most appropriate treatment for you or surgical intervention when necessary.

FAQ

What can I do to prevent kidney stones?

The best way to prevent kidney stones is to make sure you drink plenty of water each day to avoid becoming dehydrated.

To prevent stones returning, you should aim to drink up to 3 liters (5.2 pints) of fluid throughout the day, every day. Keeping your urine clear helps to stop waste products getting too concentrated and forming stones. You can tell how dilated your urine is by looking at its color. The darker your urine is, the more concentrated it is. Your urine is usually a dark yellow color in the morning because it contains a build-up of waste products that your body’s produced overnight.

You’re advised to:

  • drink water, but drinks like tea and coffee also count
  • add fresh lemon juice to your water
  • avoid fizzy drinks
  • do not eat too much salt

 

Is there a difference between bladder stones and kidney stones?

Bladder stones are similar to kidney stones. Kidney stones form in the kidneys and then travel through the urinary system to reach the bladder.

References

  1. Mayo Clinic. (2020, May 5). Nephrolithiasis. Retrieved February 21, 2022, from
    https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755#:~:text=Kidney%20stones%20
  2. Nojaba L.; Guzman N. (Last Update: August 11, 2021.) Nephrolithiasis. StatPearls Publishing. Retrieved April 10, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK559227/
  3. Kocvara R, Plasgura P, Petrík A, Louzenský G, Bartonícková K, Dvorácek J. A prospective study of nonmedical prophylaxis after a first kidney stone. BJU Int. 1999 Sep;84(4):393-8.
  4. Lotan Y, Antonelli J, Jiménez IB, Gharbi H, Herring R, Beaver A, Dennis A, Von Merveldt D, Carter S, Cohen A, Poindexter J, Moe OW, Pearle MS. The kidney stone and increased water intake trial in steel workers: results from a pilot study. Urolithiasis. 2017 Apr;45(2):177-183.
  5. Abate N, Chandalia M, Cabo-Chan AV, Moe OW, Sakhaee K. The metabolic syndrome and uric acid nephrolithiasis: novel features of renal manifestation of insulin resistance. Kidney Int. 2004 Feb;65(2):386-92.
  6. National Kidney Foundation. Nephrolithiasis. Retrieved February 21, 2022, from https://www.kidney.org/atoz/content/kidneystones
  7. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of Kidney Stones. (Last Reviewed May 2017) Retrieved February 21, 2022, from https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/diagnosis
  8. MedlinePlus. Kidney Stones. Retrieved February 21, 2022, from https://medlineplus.gov/kidneystones.html
  9. Amboss. Nephrolithiasis. (Last updated: November 29, 2021). Retrieved February 21, 2022, from https://www.amboss.com/us/knowledge/Nephrolithiasis/
  10. NHS. Kidney stones. (Page last reviewed: 30 April 2019). Retrieved February 21, 2022, from https://www.nhs.uk/conditions/kidney-stones/prevention/
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