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Kidney Stones

Kidney stones are solid masses occurring in the kidneys and ureter made from tiny crystals that coalesce into a crystal that cannot pass through the ureter to the bladder. It usually forms when too much of a given substance is located in the kidney and exceeds the amount necessary to precipitate out crystals. The biggest risk factor for having kidney stones is being dehydrated. There may be no symptoms at all if the kidney stone occurs in the kidney itself but when it breaks off and tries to exit via the narrow ureter, it can be extremely painful. When there is pain, it is located in the flank and is often severe.

Kidney stones can occur at any age and are common in preterm babies. Certain types of kidney stones are hereditary and run in families. Some kinds of kidney stones are associated with bowel disease, obesity surgery with an ileal bypass and tubule damage to the kidneys.

The most common type of stone is a calcium-based stone. Men get them more commonly than women, especially between the ages of 20 and 30 years. They are likely to be recurrent. Calcium is often combined with carbonate, oxalate or phosphate. Oxalate stones can happen with a diet high in oxalates or a person has a disease of the small intestine. On the other hand cystine stones occur primarily in women and Struvite stones are also more common in women as well. They are found in women with a urinary tract infection. Men tend to get uric acid stones as part of having hyperuricemia and gout.

Symptoms of urinary tract stones include pain in the abdomen or on the side of the back (flank). There is pain in the groin area as it spreads down from the flank area. The urine is pink or red from blood in the urine, there is nausea and vomiting, and fever and chills from secondary infection. Tests can be done to see what type of stone it is once it has passed. The uric acid level can help with uric acid stones. Crystals can be seen in the urine and red blood cells can be seen in the urine.

You can see blockage of the ureter on the abdominal CT scan or plain films of the abdomen. An MRI examination can be done to show blockage of the ureter and the stone, if it is big enough. An ultrasound of the kidney can show dilatation of the calyces. An IVP or intravenous pyelogram is a dye study that outlines the urinary tract and can show where the blockage is occurring. Blood tests can show high levels of calcium, oxylate or uric acid in the urine or the blood.

The treatment of kidney stones includes treating the pain until the stone passes and pushing fluids so that there can be an increased pressure behind the stone and can push the stone past the blockage. The treatment can be different depending on the type of stone which is involved in the kidney stone. This is why it is so important to test the stone at the time the stone passes. People are given a strainer to strain the urine and look for the stone.

Allopurinol can be given for uric acid stones in order to prevent recurrences. Antibiotics are given for Struvite stones, phosphate solutions can be helpful if given by IV, diuretics push the urine out of the body and push the stone away from its blockage. Sodium citrate and sodium bicarbonate are given to alkalinize the urine so that the stones dissolve better.

Surgery is used in the most severe cases, when the kidney stone does not pass or remains in the kidney. Certain stones outline the entire inside of the urinary tract in the kidney and are called stag horn calculi because of the way they look. If the blockage is complete, then a shock wave lithotripsy is used to remove the stones that are located near the kidney and are smaller than half of an inch in diameter.

The prognosis of kidney stones is good but, if the kidney stones are completely blocking the ureter for a period of time, there can be kidney damage. Kidney stones have a way of recurring at a later date.

Complications of kidney stones can be a decrease in function of the affected kidney, scarring of the affected kidney, blockage of the ureter, recurrence of the stones, and a secondary bladder infection and kidney infection.

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