Kidney Stones

Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, are among the many causes of kidney stones.

What Are Kidney Stones

Urine contains many dissolved minerals and salts. When your urine has high levels of these minerals and salts, you can form stones. Kidney stones can start small but can grow larger in size, even filling the inner hollow structures of the kidney. Some stones stay in the kidney, and do not cause any problems. Sometimes, the kidney stone can travel down the ureter, the tube between the kidney and the bladder. If the stone reaches the bladder, it can be passed out of the body in urine. If the stone becomes lodged in the ureter, it blocks the urine flow from that kidney and causes pain.

Kidney stones form in the kidney. Some stones move from the kidney into the ureter. The ureters are tubes leading from the kidneys to the bladder. If a stone leaves the kidney and gets stuck in the ureter, it is called a ureteral stone.

What Are Kidney Stones Made Of

Kidney stones come in many different types and colors. How you treat them and stop new stones from forming depends on what type of stone you have.

Calcium stones (80% of stones)

Calcium stones are the most common type of kidney stone. There are two types of calcium stones: calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common type of calcium stone. Some people have too much calcium in their urine, raising their risk of calcium stones. Even with normal amounts of calcium in the urine, calcium stones may form for other reasons.

Uric acid stones (5-10 % of stones)

Uric acid is a waste product that comes from chemical changes in the body. Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Having acidic urine may come from:

  • Being overweight
  • Chronic diarrhea
  • Type 2 diabetes (high blood sugar)
  • Gout
  • A diet that is high in animal protein and low in fruits and vegetables
Struvite/infection stones (10% of stones)

Struvite stones are an uncommon type of stone. These stones are often related to chronic urinary tract infections (UTIs). Some bacteria make the urine less acidic and more basic or alkaline. Magnesium ammonium phosphate (struvite) stones form in alkaline urine. These stones are often large, with branches, and they often grow very fast.

People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders (paralysis, multiple sclerosis, and spina bifida) are at the highest risk for developing these stones.

Cystine stones (less than 1% of stones)

Cystine is an amino acid that is in certain foods; it is one of the building blocks of protein. Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. It is when the kidneys do not reabsorb cystine from the urine. When high amounts of cystine are in the urine, it causes stones to form. Cystine stones often start to form in childhood.

Symptoms

Common symptoms of kidney stones include a sharp, cramping pain in the back and side. This feeling often moves to the lower abdomen or groin. The pain often starts suddenly and comes in waves. It can come and go as the body tries to get rid of the stone.

Other signs of a kidney stone include:

    • A feeling of intense need to urinate.
    • Urinating more often or a burning feeling during urination.
    • Urine that is dark or red due to blood. Sometimes urine has only small amounts of red blood cells that can’t be seen with the naked eye.
    • Nausea and vomiting.
    • For men, you may feel pain at the tip of the penis.

Causes

Low Urine Volume

A major risk factor for kidney stones is constant low urine volume. Low urine volume may come from dehydration (loss of body fluids) from hard exercise, working or living in a hot place, or not drinking enough fluids. 

When urine volume is low, urine is concentrated and dark in color. Concentrated urine means there is less fluid to keep salts dissolved. Increasing fluid intake will dilute the salts in your urine. By doing this, you may reduce your risk of stones forming.

Adults who form stones should drink enough fluid to make at least 2.5 liters (⅔ gallon) of urine every day. On average, this will take about 3 liters (100 ounces) of fluid intake per day. While water is likely the best fluid to drink, what matters most is getting enough fluid.

Diet

Diet can also affect the chance of forming a stone. One of the more common causes of calcium kidney stones is high levels of calcium in the urine. High urine calcium levels may be due to the way your body handles calcium. It is not always due to how much calcium you eat. Lowering the amount of calcium in your diet rarely stops stones from forming. Studies have shown that restricting dietary calcium can be bad for bone health and may increase kidney stone risk. Health care providers usually do not tell people to limit dietary calcium in order to lower urine calcium. But calcium intake should not be too high.

Instead of lowering dietary calcium intake, your health care provider may try to reduce your urine calcium level by decreasing your sodium (salt) intake. Too much salt in the diet is a risk factor for calcium stones. This is because too much salt is passing into the urine, keeping calcium from being reabsorbed from the urine and into the blood. Reducing salt in the diet lowers urine calcium, making it less likely for calcium stones to form.

Because oxalate is a component of the most common type of kidney stone (calcium oxalate), eating foods rich in oxalate can raise your risk of forming these stones.

A diet high in animal protein, such as beef, fish, chicken and pork, can raise the acid levels in the body and in the urine. High acid levels make it easier for calcium oxalate and uric acid stones to form. The breakdown of meat into uric acid also raises the chance that both calcium and uric acid stones will form.

Bowel Conditions

Certain bowel conditions that cause diarrhea (such as Crohn’s Disease or ulcerative colitis) or surgeries  (such as gastric bypass surgery) can raise the risk of forming calcium oxalate kidney stones. Diarrhea may result in loss of large amounts of fluid from the body, lowering urine volume. 

Obesity

Obesity is a risk factor for stones. Obesity may change the acid levels in the urine, leading to stone formation.

Medical Conditions

Some medical conditions have an increased risk of kidney stones. Abnormal growth of one or more of the parathyroid glands, which control calcium metabolism, can cause high calcium levels in the blood and urine. This can lead to kidney stones.

Some rare, inherited disorders can also make certain types of stones more likely. Examples include cystinuria, which is too much of the amino acid cystine in the urine, and primary hyperoxaluria, in which the liver makes too much oxalate.

Medication

Some medications, and calcium and vitamin C supplements, may increase your risk of forming stones. Be sure to tell your health care provider all the medications and supplements you take, as these could affect your risk of stone formation. Do not stop taking any of these unless your health care provider tells you to do so.

Family History

The chance of having kidney stones is much higher if you have a family history of stones, such as a parent or sibling.

Treatment

Treatment depends on the type of stone, how bad it is and the length of time you have had symptoms. 

Wait for the stone to pass by itself

Often you can simply wait for the stone to pass. Smaller stones are more likely than larger stones to pass on their own.

Waiting up to four to six weeks for the stone to pass is safe as long as the pain is bearable, there are no signs of infection, the kidney is not completely blocked and the stone is small enough that it is likely to pass.

Certain medications may speed up the stone passage process.
The most common medication prescribed for this reason is tamsulosin. 
Tamsulosin (Flomax) relaxes the ureter, sometimes making it easier for the stone to pass.
Surgery may be needed to remove a stone from the ureter or kidney if:
  • The stone fails to pass.
  • The pain is too great to wait for the stone to pass.
  • The stone is affecting kidney function. Small stones in the kidney may be left alone if they are not causing pain or infection. Some people choose to have their small stones removed. They do this because they are afraid the stone will unexpectedly start to pass and cause pain.

Kidney stones should be removed by surgery if they cause repeated infections in the urine or because they are blocking the flow of urine from the kidney. Today, surgery usually involves small or no incisions (cuts), minor pain and minimal time off work.

Shock Wave Lithotripsy (SWL) is used to treat stones in the kidney and ureter. Shock waves are focused on the stone using X-rays or ultrasound to pinpoint the stone. Repeated firing of shock waves on the stone usually causes the stone to break into small pieces. These smaller pieces of stones pass out in the urine over a few weeks

Because of possible discomfort caused by the shock waves and the need to control breathing during the procedure, anesthesia is needed. 

With SWL, you will home the same day as the procedure. 

Although SWL is widely used and considered very safe, it can still cause side effects. You may have blood in your urine after treatment. Most stone pieces pass painlessly. Larger pieces may get stuck in the ureter, causing pain and needing other removal procedures.

Ureteroscopy (URS) is used to treat stones in the kidney and ureter. URS involves passing a very small telescope, called an ureteroscope, into the bladder, up the ureter and into the kidney. 

The ureteroscope lets the urologist see the stone without making an incision (cuts). General anesthesia keeps you comfortable during the URS procedure. Once the urologist sees the stone with the ureteroscope, a small, basket-like device grabs smaller stones and removes them. If a stone is too large to remove in one piece, it can be broken into smaller pieces with a laser or other stone-breaking tools.

Once the stone has been removed whole or in pieces, a temporary stent is placed in the ureter. A stent is a tiny, rigid plastic tube that helps hold the ureter open so that urine can drain from the kidney into the bladder. This tube is completely within the body and does not require an external bag to collect urine.

You generally go home the same day as the URS. If your urologist places a stent, he or she will remove it later in the office. Occasionally, a string is left on the end of the stent so you can remove it on your own. It is very important that the stent is removed when advised. Leaving the stent in for long periods can cause an infection and loss of kidney function.

Percutaneous Lithotripsy (PCNL) is a treatment for large stones in the kidney. General anesthesia is needed to do a PCNL. PCNL involves making a half-inch incision (cut) in the back or side, just large enough to allow a rigid telescope (nephroscope) to be passed into the hollow center part of the kidney where the stone is located.

The ability to suction pieces makes PCNL the best treatment choice for large stones.

After the PCNL, a tube is usually left in the kidney to drain urine into a bag outside of the body. This will allow for drainage of urine and stop any bleeding. The tube is left in overnight or for a few days. You may have to stay in the hospital overnight after this operation.

Why You Get Stones

Part of preventing stones is finding out why you get them. Your health care provider will perform tests to find out what is causing this.

Blood and Urine Tests

Blood tests can help find if a medical problem is causing your stones. Your urine can be tested to see if you have a urinary tract infection or crystals that are typical of different stone types.

A 24-hour urine collection can be done. This test will reveal the levels of different stone-forming substances in your urine. The results of this test can help your health care provider recommend make specific diet and medications to prevent future stones.

Imaging Tests

When a health care provider sees you for the first time and you have had stones before, he or she may want to see recent X-rays or order a new X-ray. They will do this to see if there are any stones in your urinary tract. Imaging tests may be repeated over time to check for stone growth. You may also need this test if you are having pain, hematuria (blood in your urine) or recurrent infections.

Stone Analysis

If you pass a stone or a stone is removed by surgery, your health care provider will want to test it. Testing the stone will determine what type of stone it is. This information helps your health care provider decide the best way to prevent future stones.

Prevention of Future Stones

Once your health care provider finds out why you are forming stones, he or she will give you tips on how to prevent them.

Diet Changes

Drink enough fluids each day.

This is a great way to lower your risk of forming new stones. Remember to drink more to replace fluids lost when you sweat from exercise or in hot weather. All fluids count toward your fluid intake. But it’s best to drink mostly no-calorie or low-calorie drinks. This may mean limiting sugar-sweetened or alcoholic drinks.

Reduce the amount of salt in your diet.

This tip is for people with high sodium intake and high urine calcium or cystine. Sodium can cause both urine calcium and cystine to be too high.

The following foods are high in salt and should be eaten in moderation:

  • Cheese (all types)
  • Most frozen foods and meats, including salty cured meats, deli meats (cold cuts), hot dogs, bratwurst and sausages
  • Canned soups and vegetables
  • Breads, bagels, rolls and baked goods
  • Salty snacks, like chips and pretzels
  • Bottled salad dressings and certain breakfast cereals
  • Pickles and olives
  • Casseroles, other “mixed” foods, pizza and lasagna
  • Canned and bottled sauces
  • Certain condiments, table salt and some spice blends

Eat the recommended amount of calcium.

If you take calcium supplements, make sure you aren’t getting too much calcium. On the other hand make sure you aren’t getting too little calcium either.

Good sources of calcium to choose from often are those low in salt. Eating calcium-rich foods or beverages with meals every day is a good habit. There are many non-dairy sources of calcium, such as calcium-fortified non-dairy milks. There are good choices, especially if you avoid dairy.

You can usually get enough calcium from your diet without supplements if you eat three-to-four servings of calcium-rich food. Many foods and beverages have calcium in them. Some foods and beverages that might be easy to include on a daily basis with meals are:

Eat plenty of fruits and vegetables.

Eating at least five servings of fruits and vegetables daily is recommended for all people who form kidney stones. Eating fruits and vegetables give you potassium, fiber, magnesium, antioxidants, phytate and citrate, all of which may help keep stones from forming.

Eat foods with low oxalate levels.

This recommendation is for patients with high urine oxalate. Eating calcium-rich foods (see table above) with meals can often control the oxalate level in your urine. Urinary oxalate is controlled because eating calcium lowers the oxalate level in your body.

Nearly all plant foods have oxalate, but a few foods contain a lot of it. These include spinach, rhubarb and almonds. It is usually not necessary to completely stop eating foods that contain oxalate.

Eat less meat.

If you make cystine or calcium oxalate stones and your urine uric acid is high, your health care provider may tell you to eat less animal protein.

If your health care provider thinks your diet is increasing your risk for stones, he or she will tell you to eat less meat, fish, seafood, poultry, pork, lamb, mutton and game meat than you eat now. This might mean eating these foods once or twice rather than two or three times a day, fewer times during the week, or eating smaller portions when you do eat them.

Medications

Changing your diet and increasing fluids may not be enough to prevent stones from forming. Your health care provider may give you medications to take to help with this. The type of stone and the urine abnormalities you have will help your health care provider decide if you need medicine and which medicine is best.

Potassium citrate

is for patients with calcium stones and low urinary citrate, and for those with uric acid and cystine stones. Potassium citrate makes the urine less acidic or more alkaline (basic). This helps prevent cystine and uric acid stones. It also raises the citrate level in the urine, helping to prevent calcium stones.

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