Signs and Symptoms of Kidney Stones
Kidney stones are small mineral deposits that form within the kidneys. The medical term for kidney stones is nephrolithiasis. Approximately one in every twenty individuals will develop kidney stones at some time during their lifetime. Low fluid intake is one of the main risk factors for the formation of kidney stones, also called renal calculi. When a kidney stone moves around in the kidney or moves into the ureter, which is the tube connecting the kidney to the bladder, the patient may experience pain in the lower back radiating around to the lower abdomen and groin area. The pain can fluctuate and has been described as one of the most excruciating types of pain one can experience. It may be accompanied by nausea, vomiting, red discoloration of the urine (blood) and pain on urination.
Risk Factors
There are several types of kidney stones based on the composition of the stones. They can be comprised of calcium oxalate, calcium phosphate, uric acid, struvite or cysteine. Calcium oxalate is by far the most common type of kidney stone, accounting for 75 to 80% of all stones. Additional factors affecting one’s risk of having kidney stones include a family history of kidney stones, medications, diet, obesity, hyperparathyroidism, hypertension, gout, a history of urinary tract infections, intestinal bypass surgery, inflammatory bowel disease and certain inherited conditions. In the United States the highest incidence of kidney stones is seen in the South where there may be a higher content of minerals in the local water.
Diagnosis
Blood testing may reveal higher than normal levels of kidney stone forming minerals like uric acid and calcium and can also point to other medical conditions that predispose to stone formation. Urine testing may show blood in the urine. Analysis of the urine sediment can help identify the type of kidney stone which, in turn, will guide treatment and prevention strategies. Radiographic studies, the most basic of which is a simple x-ray of the abdominal area, may reveal the presence of a kidney stone. Other helpful imaging studies include CT scans, intravenous pyelogram and ultrasound.
Treatment and Prevention
Most kidney stones pass naturally. In fact, 80% of symptomatic kidney stones will pass within three days with appropriate hydration. Treatment of pain with NSAIDS and narcotic medications when necessary is usually all that is required. Use of alpha blockers, which relax the muscles in the wall of the ureter, have been shown to increase the rate of stone passage. Depending on the size and location of the stone, the patient’s symptoms and whether the stone passes spontaneously, additional treatment modalities may be necessary. Extracorporeal shock-wave lithotripsy (sound waves) may be used to break up the stones. Percutaneous nephrolithotomy or surgical removal of the stone through a small incision in the back is sometimes used to remove the stone. Additionally, a small stone may be removed using a scope through the urethra. Kidney stones tend to recur, so prevention strategies are important. Identifiable dietary and metabolic factors should be addressed and modified as indicated. By far the best preventive measure is consumption of more than two liters of fluid a day.