Kidney stones

Kidney stones are hard, pebble-like mineral and salt deposits that form inside your kidneys. They can range in size from a grain of sand to as large as a pearl or golf ball. Most stones are small enough to pass on their own through the urinary tract, but some may become lodged, causing severe pain and potentially blocking the flow of urine. 

Signs and symptoms

Many kidney stones, especially smaller ones, do not cause symptoms while they are in the kidney. Pain and other symptoms often begin when a stone moves into the ureter, the narrow tube connecting the kidney and the bladder. 

Common symptoms of a kidney stone include:

  • Severe pain: This pain, often called renal colic, is typically sharp and cramping. It may be felt in your side, back, or lower abdomen and can come in waves.

  • Pain while urinating: You may feel a burning sensation or experience pain while urinating as the stone passes through the urinary tract.

  • Blood in the urine: You may notice pink, red, or brown-colored urine from the stone scratching the ureter, a condition known as hematuria.

  • Other urinary changes: These can include a persistent need to urinate, frequent urination, or passing only small amounts of urine at a time. The urine may also appear cloudy or have a foul odor.

  • Nausea and vomiting: Severe pain can trigger nausea and vomiting.

  • Fever and chills: If an infection is present, a fever and chills can develop. 

Diagnosis

To confirm the presence of kidney stones, a doctor will take a medical history and perform a physical exam.

  • Imaging tests: Imaging tests are the most common way to confirm a diagnosis. A CT scan is often used to get a detailed image of the kidneys and urinary tract. Ultrasounds can also be used, especially in situations where radiation should be limited, such as during pregnancy.

  • Urine tests: A doctor will analyze a urine sample for blood, signs of infection, and crystals.

  • Blood tests: A blood test can reveal high levels of calcium or uric acid in your blood, which are common causes of stone formation.

  • Stone analysis: If a stone is passed or removed, it can be sent to a lab to determine its chemical makeup. This information is crucial for developing a prevention plan. 

Treatment

Treatment for kidney stones depends on their size, type, and location. 

For small stones

Small stones (under 5 millimeters) often pass on their own. The goal of treatment is to manage pain and help the stone pass.

  • Stay hydrated: Drinking plenty of water helps flush the stone out of the urinary system.

  • Pain medication: Your doctor may recommend over-the-counter pain relievers or stronger prescription medication for pain management.

  • Alpha blockers: Prescription medications like tamsulosin (Flomax) can relax the muscles in your ureter to help the stone pass more easily. 

For large stones or complicated cases

If a stone is too large to pass, is blocking the urinary tract, or is causing an infection, a procedure may be necessary.

  • Shock wave lithotripsy (SWL): This noninvasive procedure uses high-energy sound waves to break the stone into tiny pieces, which can then be passed in the urine.

  • Ureteroscopy: A thin, flexible scope is inserted through the urethra and bladder into the ureter to locate the stone. A laser can then be used to break the stone into smaller pieces that are passed naturally or removed by the surgeon.

  • Percutaneous nephrolithotomy (PCNL): For very large or complex stones, a surgeon may make a small incision in the back to directly access and remove the stone from the kidney. 

Prevention

After having a kidney stone, you are at a higher risk of developing another one. Preventive measures often include:

  • Staying well-hydrated: Aim for enough fluid intake to produce clear or nearly clear urine throughout the day.

  • Dietary changes: Depending on the stone type, your doctor may recommend limiting certain foods, such as those high in sodium, oxalate, or animal protein.

  • Medications: Some medications can be used to control the levels of minerals in your urine that cause stones to form.

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