A kidney stone is a solid mass formed from substances in the urine. These substances are normally found in the urine, but become highly concentrated when there are not enough liquids to flush them out of the body in the urine. These stone-forming substances are:
These and other chemicals are the “waste products” that must exit the body.
Kidney stones usually range in size from as small as a grain of sand to a pearl. Although rare, some stones can be as large as golf balls. Smaller stones can pass through the urinary tract on their own without any pain or notice. Larger stones can get trapped in the kidney or lodged in the ureters. When this happens, the stones keep urine from exiting the body. Blocking the flow of urine causes severe pain or bleeding. Stones that can’t pass on their own are treated with medications or surgery. The decision is based on stone size/shape, location, type, and number of stones.
Risks for developing kidney stones include:
Signs and symptoms include:
Smaller kidney stones may not cause pain or other symptoms and are able to pass on their own.
Diagnosis starts with a physical exam and review of your medical history. Other tests include:
Two types of X-rays are used: a standard X-ray of the urinary tract or a special type of X-ray called an intravenous pyelogram (IVP). If an IVP is ordered, you receive an injection of a dye in your vein before the X-ray is taken. The dye is used to get a sharper image of problems in the kidneys, ureters, and bladder resulting from urine being blocked.
A CT scan of the abdomen is an imaging test that creates a three-dimensional view of the organs within the abdominal cavity. It is used with or without the injection of a dye in your vein. This test shows the stone size and location and conditions that may have caused the stone to form. In addition, the other organs within this area of the body can be evaluated.
An ultrasound of the urinary tract uses sound waves to detect kidney stones and indirect signs of kidney stones, such as changes in the kidney’s size and shape.
Treatment options include:
No treatment: Depending on the size and location of the kidney stone, sometimes stones can pass through urine on their own. Drinking plenty of liquids helps the kidney stones travel through the urinary tract. Passing the stone may take up to three weeks.
Medications: Severe pain, requiring an emergency room visit, can be managed with IV narcotics, IV anti-inflammatory drugs, and IV drugs to manage nausea/vomiting. Stones causing less pain can be managed with an anti-inflammatory drug such as ibuprofen. (Caution: Ask your doctor before taking ibuprofen. This drug can increase the risk of kidney failure if taken while having an acute attack of kidney stones – especially in those who have a history of kidney disease and associated illnesses such as diabetes, hypertension, and obesity.) Other medications may be given to relax the ureter such as tamsulosin (Flomax®) or nifedipine (Adamant®, Procardia®) so that the stones can pass on their own.
Procedures: There are three types of minimally invasive surgery – ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy:
In this procedure, a tube is inserted directly into the kidney through a small incision made in your back. If the stones are large, an ultrasound probe and/or laser are inserted and deliver shock waves to the stones to break them apart. Fragments of stones are either suctioned out (so you do not have to pass them through your urine) or removed through a tube (called a nephrostomy) that has been inserted through the skin and into the kidney. This tube drains urine, as well as any small pieces of stone, into a urine collection bag. This procedure requires a short hospital stay (2 to 3 days).
Open stone surgery. Open stone surgery, a major surgical procedure, is rarely performed. It is currently only done in 0.3 to 0.7% of cases.
Ways to decrease your risk of kidney stones include:
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition.
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