Kidney Stone for Patient Beyond Basics

8/22/2019 Kidney Stone for Patient Beyond Basics

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The content on the UpToDate website is not intended nor recommended as a substitute for medicaladvice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified healthcare professional regarding any medical questions or conditions. The use of this website is governed bythe UpToDate Terms of Use (click here) 2012 UpToDate, Inc.Patient information: Kidney stones in adults (Beyond the Basics)AuthorsGlenn M Preminger, MDGary C Curhan, MD, ScDSection EditorsStanley Goldfarb, MDMichael P O'Leary, MD, MPHDeputy EditorJohn P Forman, MD, MScDisclosuresAll topics are updated as new evidence becomes available and our peer review process is complete.Literature review current through: Apr 2012. | This topic last updated: Nov 14, 2011.

KIDNEY STONES OVERVIEW Kidney stones (also called nephrolithiasis or urolithiasis) affect

approximately 12 percent of men and 5 percent of women by age 70. Fortunately, treatment is available

to effectively manage most stones. In addition, you can take steps to prevent kidney stones from

recurring.

A detailed review of kidney stones in children is available separately. (See "Patient information: Kidneystones in children (Beyond the Basics)".) More detailed information about kidney stones is available by

subscription. (See "Diagnosis and acute management of suspected nephrolithiasis in adults".)

HOW KIDNEY STONES DEVELOP A kidney stone can form when substances such as calcium,

oxalate, cystine, or uric acid are at high levels in the urine. Stones can also form if these substances

are at normal levels, especially if the amount of urine made each day is low. The substances form

crystals, which become anchored in the kidney and gradually increase in size, forming a kidney stone.

Typically, the stone will move through the urinary tract (figure 1) and is passed out of the body in the

urine. A stone may cause pain if it becomes stuck and blocks the flow of urine. Large stones do not

always pass on their own and sometimes require a procedure or surgery to remove them.

KIDNEY STONE RISK FACTORS Certain diseases and habits can increase your risk of developing

kidney stones (table 1).


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KIDNEY STONE SYMPTOMS

Pain Pain is the most common symptom of kidney stones. Pain can range from a mild and barely

noticeable ache to discomfort that is so intense it requires treatment in the hospital. Typically, the pain

gets worse and better, but does not go away completely. Waves of severe pain, known as renal colic,usually last 20 to 60 minutes. Pain can occur in the flank (the side, between the ribs and the hip) or the

lower abdomen (figure 1).

Blood in the urine Most people with kidney stones will have blood in the urine (hematuria). The

urine may be pink or reddish, or the blood may be visible only with urine dipstick testing or microscopic

examination of the urine. (See "Patient information: Blood in the urine (hematuria) in adults (Beyond the

Basics)".)

Gravel You may pass "gravel" or small stones in your urine.

Other symptoms Other kidney stone symptoms include nausea or vomiting, pain with urination, and

an urgent need to urinate.

Asymptomatic kidney stones Many people with kidney stones have no symptoms (asymptomatic

means without symptoms). These kidney stones are usually found when an imaging study (such as an

ultrasound, x-ray or CT scan) is performed is done for other purposes. Stones can remain in the

kidneys for many years without ever causing symptoms. (See "The first kidney stone and asymptomatic

nephrolithiasis in adults".)

KIDNEY STONE DIAGNOSIS Kidney stones are usually diagnosed based upon your symptoms, a

physical examination, and imaging studies.

Computed tomography (CT) scan A CT scan creates a three dimensional image of structures

within the body. A particular type of CT scan (called noncontrast helical CT) is often recommended if

kidney stones are suspected.

Ultrasound An ultrasound can also be used to detect kidney stones, although small stones or

stones in the ureters may be missed. However, ultrasound is the procedure of choice for people who

should avoid radiation, including pregnant women.


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KIDNEY STONE TREATMENT Treatment of kidney stones depends upon the size and location of

your stone, as well as your pain and ability to keep down fluids. If your stone is likely to pass, your pain

is tolerable, and you are able to eat and drink, you can be treated at home.

If you have severe pain or nausea, you will need to be treated with stronger pain medications and IVfluids, which are often given in the hospital. (See "Options in the management of renal and ureteral

stones in adults".)

Home treatment You can take non-prescription pain medication until the stone passes. This

includes nonsteroidal antiinflammatory drugs such as ibuprofen (Advil, Motrin) or naproxen (Aleve).

Other medications, such as tamsulosin (Flomax), may also be recommended to speed the passage of

stones.

You will probably be asked to strain your urine to recover the stone; it can then be analyzed in a

laboratory to determine the content of the stone (eg, calcium, uric acid, etc). Knowing what type of

kidney stone you have is important in planning treatments to prevent future stones (see 'Kidney stone

prevention' below).

If the stone does not pass Stones larger than 9 or 10 millimeters rarely pass on their own and

generally require a procedure to break up or remove the stone. Some smaller stones also do not pass.

Several procedures are available.

Shock wave lithotripsy (SWL) Lithotripsy is the treatment of choice in many patients who need

help passing a stone. Lithotripsy is particularly good for stones in the kidney and upper ureter.

Lithotripsy may not be effective for treating large or hard stones. You may require medication to make

you sleepy and reduce pain during treatment, although this depends upon the type of lithotripsy

equipment used.

Lithotripsy is done by directing high-energy shock waves toward the stone. These pass through the skin

and bodily tissues and release energy at the stone surface. This energy causes the stone to break into

fragments that can be more easily passed.

Percutaneous nephrolithotomy (PNL) Extremely large or complex stones, or stones resistant to

shock wave lithotripsy, may require a minimally invasive surgical procedure to remove the stone. In this


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procedure, small instruments are passed through the skin (percutaneously) into the kidney to remove

the stone.

Ureteroscopy Ureteroscopy is a procedure that uses a thin scope, which is passed through the

urethra and bladder, into the ureter and kidney. This scope contains a camera and other instruments,which allows the physician to see the stone and remove it, or to break it up into smaller pieces that can

pass more easily. Ureteroscopy is often used to remove stones blocking the ureter, and sometimes for

stones in the kidney.

Treatment of asymptomatic stones If you have a kidney stone that is causing no symptoms, you

may or may not be treated. The decision is based upon the size and location of your stone, as well as

your ability to be treated quickly if symptoms were to develop. If there is a chance that you would not be

able to get treatment quickly (eg, if you travel frequently), you are more likely to be treated.

Regardless of the decision to treat or not, you should be evaluated for underlying health conditions that

can increase the risk of kidney stones (table 1).

KIDNEY STONE PREVENTION After you have a kidney stone, you should have blood and urine

tests to determine if you have certain health problems that increase the risk of kidney stones ( table 1).

If you passed and saved the stone, it should be analyzed to determine the type of stone. Based upon

these test results, one or more of the following may be recommended:

You may be given a medication to reduce the risk of future stones.

Drink more fluids to decrease the risk of another stone. The goal is to increase the amount of

urine that flows through your kidneys and also to lower the concentrations of substances that

promote stone formation. One expert recommends drinking enough fluid that you make about 2

liters of urine per day.

You may be advised to make changes in your diet; the changes recommended will depend

upon the type of kidney stone you have.

SUMMARY

A kidney stone can form when there are normal or high levels of certain substances in the urine.

These substances can form crystals. Crystals become attached to the kidney and gradually

increase in size, forming a stone.


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Eventually, the stone moves through the urinary tract and is passed in the urine. Or, the stone

can remain in the urinary tract, blocking urine flow, which can cause pain.

Certain diseases and habits can affect a person's risk for developing kidney stones. These

include a past history or family history of kidney stones, certain dietary habits, underlying

medical problems, certain medications, and dehydration (table 1) (see 'Kidney stone riskfactors' above).

The most common symptom of a kidney stone is pain; other symptoms include hematuria (blood

in the urine), passing small stones, nausea, vomiting, pain with urination, and an urgent need to

urinate. Many patients with kidney stones have no symptoms (see 'Kidney stone

symptoms' above).

Testing is usually needed to diagnose a kidney stone. Computed tomography (CT scan) is the

preferred test for most patients (see 'Kidney stone diagnosis' above).

Treatment usually includes pain medication and increased fluids (to drink) until the stone is

passed. Over the counter pain medication (eg, ibuprofen, Advil, Motrin) may be helpful. If the

pain is not controlled, a stronger medication (narcotic) may be needed (see 'Home

treatment' above).

Small stones (less than 5 millimeters) usually pass without treatment. Larger stones (greater

than 9 millimeters) rarely pass on their own. Treatment for larger stones is usually done in a

hospital (see 'If the stone does not pass' above).

Further testing is recommended for patients who have kidney stones several times in their life.

Tests help to determine if an illness is causing kidney stones to form. Medications may be

prescribed to prevent future stones. Drinking more fluids and changing the diet can help to

prevent future kidney stones (table 1) (see 'Kidney stone prevention' above).

Kidney Stone for Patient Beyond Basics

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