Kidney Stones - More Information

The pain begins as an ache in the back and side (the flank). Then it becomes constant and severe as the urinary system tries to rid itself of the stone. Sometimes there is burning during urination, blood in the urine, or a frequent urge to urinate. Nausea and vomiting may occur, and the lower abdomen or flank may be painful if touched.

(Back Pain from Kidney Stones Can Be on Right or Left Back and Side)

All these symptoms are hallmarks of kidney stones, a condition that may affect up to 10% of Americans in their lifetimes. More than half a million people will develop kidney stones this year, and over one third of these patients will be hospitalized.

The economic costs of kidney stones are enormous. In the United States, 7 to 10 of every 1,000 hospital admissions are due to kidney stones. Stones tend to develop in the middle years of life when family and work commitments - and the economic effects of time lost to illness - are at their peaks.

The purpose of this section of the site is to shed light on kidney stones: what causes kidney stones, who gets them, what kinds of treatments are available, and how kidney stones can be prevented.

The urinary system includes two kidneys, two tube-like ureters that connect the kidneys to the bladder, and another tube, the urethra, that connects the bladder to the outside of the body. The parts of the urinary system are shown below.

Front Interior View of Urinary System [Male or Female]

Each kidney is bean-shaped and about the size of an adult's fist. The kidneys are located below the ribs and toward the back. They contain nearly 40 miles of tubes, most of them tiny, that process some 100 gallons of blood each day. The kidneys filter and clean the blood, and they produce urine from excess water and dissolved solids.

The ureters carry waste, as urine, from the kidneys to the bladder. The bladder, located in the lower abdomen, is a balloon-like organ that stores urine. A bladder can hold over a pint of urine. During urination, the urethra carries urine from the bottom of the bladder out of the body.

What Causes Kidney Stones?

Kidney stones are hardened crystal clumps that can develop in the urinary system. They usually form because there is a breakdown in the balance of liquids and dissolved solids in the urine. The kidneys must keep the right amount of water in the body while they remove materials that the body cannot use. If this balance is disturbed, the urine can become overloaded with substances (usually small crystals) that won't dissolve in water. Crystals begin to stick together and slowly add layer upon layer to form a stone. A kidney stone may grow for months or even years before it causes a problem.

What Does a Kidney Stone Look Like?

Kidney stones don't all look the same. The color depends on what chemicals are in it. Most are yellow or brown, but they can be tan, gold, or black. Stones can be round, jagged, or even have branches. They vary in size from specks to pebbles to stones as big as golf balls.

Kidney Stones Vary in Size, Shape, and Color

Can Kidney Stones Damage The Kidney?

Kidney stones can cause kidney damage. Whether there is damage and, if so, how much there is depends on the location of the stone in the urinary system. To avoid or minimize damage, it is important to eliminate stones that form and to prevent new ones from developing. Therefore, your family doctor may refer you to a urologist, a doctor who specializes in urinary diseases. But click here to get this report first, which could save you thousands of dollars.

Who Gets Kidney Stones?

Anyone can get kidney stones, but some people are more likely to develop stones than others. Typically, a person with a kidney stone is a man 20 to 60 years old. Although four out of five kidney stone sufferers are men, women also get kidney stones. Often, there is a family history of kidney stones. Chronic dehydration (lack of body water) can lead to kidney stones. Very hot weather, heavy sweating, or too little fluid intake contribute to the formation of kidney stones. People who work outdoors in hot weather and who do not drink enough fluids may increase their risk of getting stones.

Some physicians believe that our rich diet in the U.S. may promote the development of kidney stones. Experts note that the incidence of kidney stones has tripled in Japan since World War II - at the same time the Japanese diet has become more like our own.

A variety of other conditions are linked with kidney stone development. These include urinary tract blockage, urinary infections that recur, bowel disease, and certain inherited disorders. People who are paralyzed or who have to rest in bed for long periods of time are also at increased risk for kidney stones, as are men and women who fly long space missions.

Types of Stones and Their Causes

Calcium oxalate and phosphate stones. Calcium oxalate and phosphate stones are made up of a hard crystal compound. These stones have become more common in recent years with about 70% to 80% of all kidney stones currently made up of calcium oxalate and phosphate. Calcium oxalate is often mixed with phosphate, but either pure calcium oxalate or calcium phosphate stones may occur.

Hypercalciuria (too much calcium in the urine) often causes calcium oxalate stones to develop. Almost 40% of patients with calcium oxalate stones have an inherited metabolic disorder that causes a build-up of calcium in the urine. Certain drugs, such as furosemide (a diuretic), antacids, and steroids, also may cause an overload of calcium in the urine. Other factors associated with hypercalciuria include overactive parathyroid glands, too much vitamin A or D, and a diet high in purine from meat, fish, and poultry.

Another cause of calcium oxalate stones is too much oxalate in the urine. This can result from too much oxalate production by the body or not enough calcium in your diet. Large doses of vitamin C or not enough vitamin B can also lead to excess oxalate in the urine.

• Struvite (or infection) stones. About 10% to 28% of all stones are associated with bacterial urinary infections. Such stones are called struvite stones, and like urinary infections, are more common in women. In patients with struvite stones, it is important not only to remove the stone but also to prevent recurrence of the urinary infection.

• Uric acid stones. About 5% to 13% fo kidney stones contain uric acid, which arises when the body breaks down certain foods, especially meats. These stones are more common among men and develop when there is too much uric acid in the urine. Patients with gout, a metabolic disorder associated with high uric acid levels, are especially prone to uric acid stones.

• Cystine stones. Another inherited condition can cause too much cystine (produced by the breakdown of protein from your diet) to collect in the urine. The cystine tends to form crystals that develop into cystine stones. These stones are relatively rare, accounting for only about 1% to 3% of all kidney stones.

• Rare stones. Other rare stones (xanthine, silicate) may occur.

   

Five Common Types of Kidney Stones

• Calcium oxalate

• Calcium phosphate (can be mixed with Calcium oxalate)

• Struvite (infection)

• Uric acid

• Cystine

During

People with kidney stones usually see their doctors because of back pain or blood in their urine. If your doctor thinks that you have a stone, its location, size, and type need to be determined for proper treatment to occur. Your doctor will start by asking you questions about your medical and family history and by doing a physical examination. Analyses of your blood and urine will help determine whether there is an infection or whether high levels of stone-forming substances are present.

Kidney stones can become stuck in any part of the urinary system. To begin to locate a stone, doctors may perform an x-ray or ultrasound study. This gives a good idea of the stone's size and where it is located. Many patients also receive an intravenous pyelogram (IVP). For an IVP, a special dye is injected into the patient's vein. The dye eventually collects in the urinary system. There, it produces a white contrast when an x-ray is taken. The dye allows the doctor to precisely locate the stone and to determine the condition of the kidneys, ureters, and bladder.

It is very important that the stone, if passed, be saved, so that it can be sent to a laboratory for evaluation. Long-term treatment and prevention plans depend on the type of stone. Between 70% and 80% of stones pass on their own in the urine, usually within 48 hours of the start of the symptoms. To catch a stone, patients are asked to urinate into a strainer, a cup with mesh in the bottom. All pieces of stone, no matter how small, should be collected and given to the doctor. If one stone is analyzed, more may not be needed, since most people develop just one type of stone.

Treatment

Although kidney stones, especially calcium stones, are very hard, most of the 20% to 30% that do not pass out of the body on their own can be eliminated without surgery. A process called lithotripsy (from the Greek word for "stone crushing") breaks into tiny fragments most stones that are less than three-quarters of an inch acress. (Lithotripsy also is called extra-corporeal shock wave lithotripsy.)

Lithotripsy has been used in the U.S. since 1984. It is performed using a machine called a lithotripter. There are different types of lithotripters, but all focus shock waves from outside the body on the kidney stone. Repeated shock waves cause the kidney stone to disintegrate into tiny particles. These particles pass easily out of the body in the urine.

CLICK HERE TO AVOID THIS COSTLY SURGERY

Before receiving lithotripsy, the patient's history is reviewed and the physical examination is completed. Laboratory tests also are performed, and the patient may be given some medication. Just before lithotripsy, most patients receive a sedative to help them relax. Occasionally, a patient is given anesthesia - either general anesthesia, which induces a sleep-like state, or a regional anesthesia, which numbs the lower body. The choice depends on physician and patient preference. Shock waves are then focused on the kidney stone for a total time of one-half hour to two hours. As the shock waves travel through body tissue, they may cause some mild bruising, which heals in a few days.

Lithotripsy alone doesn't work for all patients or for all kidney stones. In addition to lithotripsy, some patients may need to have a tube (catheter) inserted via a needle through the back muscles into the kidney to help drain the kidney. This tube may later be used to remove stones through a small telescopic device. Also, stones located in the lower portions of the urinary system may be removed with a small telescope inserted through the urethra. In fewer than 5% of cases, surgery through an incision may be required to remove kidney stones.

CLICK HERE TO AVOID THIS COSTLY SURGERY

After Can Kidney Stones Recur?

People who have had one kidney stone are prone to develop others. Without preventive treatment or changes in lifestyle, patients can develop a new stone within a year or two of the first one. About half of patients do develop a stone again within 5 to 10 years, and 80% do so sometime in their lives.

We have a Kidney Stone Prevention Report waiting for you that will help you avoid kidney stones for the rest of your life. However, if you do get another kidney stone, simply use this remedy again and the stones will turn into sludge/gravel and exit your body pain free.

What You Can Do to Prevent Future Kidney Stones

There definitely are things you can do to reduce your chances of developing another stone. One of the most important is simply getting into the life-long habit of drinking a lot of liquid - mainly water. Everyone who has had a kidney stone should drink at least 8 ounces of fluid at each meal, between each meal, before bed, and during the night if awakened to urinate. In other words, you should drink a minimum of 7, and preferably 10 to 12, large glasses of fluid in the course of each day. At least half of these should be glasses of water.

Your fluid intake should be spread out as evenly as possible throughout the day. This keeps the urine from becoming concentrated and reduces the chances that crystals - the building blocks of kidney stones - will form. Since the goal is to produce at least 2 quarts of urine a day, you should drink more fluid in very hot weather to make up for that lost by sweating.

A good way to judge whether you're drinking enough is to watch the color of your urine. If your urine is dark and yellow, drink more. It should be pale, almost watery. Urine has more color in the morning when it is most concentrated, but the rest of the time, the less color the better.

Drinking plenty of fluids also reduces the risk of urinary tract infections - a major cause of struvite stones. Any infections that do occur should be treated promptly and completely.

Depending on the kind of stone involved and the results of laboratory tests, your doctor may advise you to eat less of certain kinds of foods. For example, patients with calcium oxalate or uric acid stones may need to reduce the amount of meat products and table salt in their diets and increase the amount of fiber. You and your physician may work with a dietitian to develop a diet suited to your particular needs.

There are prescription medications that help some patients. Diuretics, such as hydrochlorothiazide, decrease calcium excretion. Potassium citrate binds calcium and helps to remove it safely. Allopurinol, which causes the body to produce less uric acid, is sometimes prescribed for patients with gout. It also reduces their risk of forming uric acid or calcium oxalate stones. Patients taking medications still need to drink at least ten 8-ounce glasses of fluid per day. When cystine stone formation can't be controlled by increased fluid levels alone, penicillamine or tiopronin may be prescribed to make it easier for the body to dissolve cystine. Other specific medications may be prescribed by your doctor.

This section of the site has answered some questions you may have about kidney stones. Please read our disclaimer before taking any further medical action.