A kidney stone or stones are indicated by back or side pain, blood in the urine, and nausea or vomiting in addition to the pain. Although kidney stones typically range in size from a chickpea to a golf ball, they can also be as little as a grain of sand. While smaller stones can pass through your urinary tract, bigger ones may require surgery.
OVERVIEW
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What’s a kidney stone?
An irregularly formed solid mass or crystal, such as a kidney stone, can range in size from a grain of sand to a golf ball. You might not even be aware that you have a kidney stone (or stones), depending on their size. Even little stones can be quite painful as they pass through your urinary tract and leave your body. Drinking fluids could speed up the procedure, which could take three weeks.You could develop a huge kidney stone in your ureter (the tube that drains urine from your kidney down to your bladder). The stone may then start bleeding and prevent urine from leaving your body. For a stone that can't pass on its own, surgery might be necessary.
How common are kidney stones?
According to research, almost one in ten people will have kidney stones at some point in their lives. Kidney stones are much less prevalent in children than in adults, but they nevertheless happen for the same reasons. Children with asthma are four times more likely than children without asthma to experience them.
Who’s most likely to get kidney stones? What are the risk factors?
Kidney stones are most common in males in their 30s and 40s. However, kidney stones can occur in anyone.
There are several risk factors for developing kidney stones. These include:
- not taking in enough fluids.
- having a diet that contains the ingredients that cause stones (phosphate, for example, is in meat, fish, beans and other protein-rich foods).
- a history of kidney stones running in one's family.
- having an obstruction in your urinary system.
- Hypercalciuria (high calcium levels in your urine).
- High blood pressure.
- Diabetes.
- Obesity.
- Osteoporosis.
- Gout and cystic fibrosis.
- Kidney cysts.
- Parathyroid disease.
- Inflammatory bowel disease and chronic diarrhea.
- Some surgical procedures, including weight loss surgery or other stomach or intestine surgeries.
- Diuretics (water pills).
- Calcium-based antacids (used to treat osteoporosis).
- Crixivan® (used to treat HIV infections).
- Topamax® and Dilantin® (used to treat seizures).
- Cipro® (ciprofloxacin, an antibiotic).
- Ceftriaxone (an antibiotic).
- Meats and poultry (animal proteins).
- Sodium (diets high in salt).
- Sugars (fructose, sucrose and corn syrup).
Are kidney stones genetic (hereditary)?
What’s the urinary tract? How does it work?
- Kidneys: Your fist-sized, bean-shaped kidneys are located on either side of your spine, below your rib cage. Each day they filter 120 to 150 quarts of your blood to remove waste and balance fluids. Your kidneys make one to two quarts of urine every day.
- Ureters: After your kidney creates urine, the liquid travels through the tube-shaped ureter to the bladder. There is one ureter per kidney. Kidney stones can pass through the ureters or, if they’re too big, get stuck in them. You may require surgery if the stone is too large.
- Bladder: Between your hip bones is your bladder, an organ that stores urine. It stretches to hold about one and a half to two cups.
- Urethra: Like a ureter, your urethra is a tube through which urine passes. It’s the final stop of the urinary tract where your urine (and a kidney stone) leaves your body. This is called urination.
How long does it take a kidney stone to form?
Kidney stones can exist for years without the sufferer being aware of them. You won't experience any pain as long as the stones are in your kidney. A kidney stone's pain usually begins as it passes through your kidney. Occasionally, a stone might form more quickly in a matter of months.
Discuss your risk factors with your healthcare physician. To determine how rapidly you produce stones, they may perform a 24-hour urine test.
What are the most common types of kidney stones?
A calcium oxalate stone is the most typical kind of kidney stone. This kind develops when your urine contains both calcium and oxalate. It can occur if you have high oxalate levels, poor calcium levels, and insufficient fluid intake.
Uric acid can also cause stones, which is pretty common. These are derived from a naturally occurring compound termed purine, a byproduct of animal proteins (meat, chicken and fish).
If I have multiple kidney stones, are they all made of the same substances?
The materials that make up a kidney stone can be different. You could develop a calcium oxalate stone and one made of uric acid.
What are the symptoms of kidney stones?
You can have a stone in your kidney for years and not know it’s there. But, when it starts to move or becomes very large, you may have symptoms. Symptoms of a kidney stone include:
- Feeling pain in your lower back or side of your body. This pain can start as a dull ache that may come and go. It can also become severe and result in a trip to the emergency room.
- Having nausea and/or vomiting with the pain.
- Seeing blood in your urine.
- Feeling pain when urinating.
- Being unable to urinate.
- Feeling the need to urinate more often.
- Fever or chills.
- Having urine that smells bad or looks cloudy.
Smaller kidney stones may not cause pain or other symptoms. These “silent stones” pass out of your body in your urine.
What are the symptoms of kidney stones in children?
- Severe colicky pain.
- Inability to urinate (when a stone blocks the urinary tract).
- Nausea/vomiting.
- Cloudy, foul-smelling urine, fever, chills or weakness which might be a sign of a serious infection.
- Blood in the urine.
CAUSES AND RISK FACTORS
What causes kidney stones?
Your urine contains elements that can cause kidney stones to develop. Normally, the ingredients that combine to form kidney stones flow through your urine system. When they don't, it's because not enough urine is produced, which leads to the compounds becoming crystallised and extremely concentrated. Usually, not getting enough water leads to this.The stone-forming substances are:
- Calcium.
- Oxalate.
- Uric acid.
- Phosphate.
- Cystine (rare).
- Xanthine (rare).
These and other chemicals are some of the waste products that exit your body.
DIAGNOSIS AND TESTS
How are kidney stones diagnosed?
Your healthcare provider will discuss your medical history and possibly order some tests. These tests include:
- Imaging tests: An X-ray, CT scan and ultrasound will help your healthcare provider see the size, shape, location and number of your kidney stones. These tests help your provider decide what treatment you need.
- Blood test: A blood test will reveal how well your kidneys are functioning, check for infection and look for biochemical problems that may lead to kidney stones.
- Urine test: This test also looks for signs of infection and examines the levels of the substances that form kidney stones.
MANAGEMENT AND TREATMENT
How are kidney stones treated?
Once diagnosed, your healthcare provider will first determine if you even need treatment. Some smaller kidney stones may leave your system when you urinate. This can be very painful. If your provider decides that you do need treatment, your options include medications and surgery.
Medications. Medications may be prescribed to:
- Decrease pain. Your healthcare provider may recommend that you take an over-the-counter medication like ibuprofen or, if you’re in the emergency room, an IV narcotic.
- Manage nausea/vomiting.
- Relax your ureter so that the stones pass. Commonly prescribed medicines include tamsulosin (Flomax®) and nifedipine (Adamant® or Procardia®).
Surgery. There are four types of surgeries used to treat kidney stones. The first three are minimally invasive, meaning that the surgeon enters your body through a natural opening (like your urethra), or makes a small incision.
- Ureteroscopy: To perform this procedure, a small instrument called an ureteroscope is inserted in your urethra, through your bladder and into a ureter. This instrument shows the kidney stones and then retrieves them in a surgical “basket,” or breaks them apart using a laser. These smaller pieces of the kidney stones are then easily able to exit your body through your urinary tract.
- Shockwave lithotripsy: In this procedure, you’re placed on a special type of surgical table or tub. High-energy shockwaves are sent through water to the stone(s). The shockwaves break apart the stones, which are then more easily able to exit your body.
- Percutaneous nephrolithotomy: When kidney stones can’t be treated by the other procedures — either because there are too many stones, the stones are too large or heavy or because of their location — percutaneous nephrolithotomy is considered. In this procedure, a tube is inserted directly into your kidney through a small incision in your back. Stones are then disintegrated by an ultrasound probe and suctioned out so that you don’t have to pass any fragments. A urethral stent is placed after the procedure (an internal tube from the kidney to the bladder which is removed one week later). Patients are typically kept overnight for observation.
- Open stone surgery: A longer cut is used during this surgery. Compared to minimally invasive procedures, it’s rarely performed (0.3% to 0.7% of cases).
How are children treated for kidney stones?
How long does it take to pass a kidney stone?
The amount of time it can take for you to pass a kidney stone is different from another’s. A stone that’s smaller than 4 mm (millimeters) may pass within one to two weeks. A stone that’s larger than 4 mm could take about two to three weeks to completely pass.
Once the stone reaches the bladder, it typically passes within a few days, but may take longer, especially in an older man with a large prostate. However, pain may subside even if the stone is still in the ureter, so it’s important to follow up with your healthcare provider if you don’t pass the stone within four to six weeks.
Are there any foods or drinks that help treat kidney stones? Are there any home remedies?
There are three liquids rumored to help with kidney stones:
- Cranberry juice. Although cranberry juice can help prevent urinary tract infections (UTIs), it doesn’t help with kidney stones.
- Apple cider vinegar. Vinegar is acidic and it can sometimes create changes to your urine, which helps with kidney stones. But, this doesn’t always help. Talk to your healthcare provider about the use of vinegar.
- Lemon juice. Lemon juice is rich in citrate, which can help prevent kidney stones from forming. Citrates are found in several citrus fruits including lemons, limes, oranges and melons.
- Coffee. Studies show that coffee may decrease your risk of developing kidney stones.
PREVENTION
How can I prevent kidney stones?
There are several ways to decrease your risk of kidney stones, including:
- Drink water. Drink at least six to eight 8-ounce glasses every day (about 64 ounces). Staying hydrated helps you urinate more often, which helps “flush away” the buildup of the substances that cause kidney stones. If you sweat a lot, be sure to drink even more.
- Limit salt. Eat less sodium. You may want to connect with a dietician for help with planning what foods you eat.
- Lose weight. If you’re overweight, try to lose some pounds. Talk to your healthcare provider about an ideal weight.
- Take prescriptions. Your healthcare provider may prescribe some medications that help prevent kidney stones. The type of medication may depend on the type of stones you get.
Should I cut calcium out of my diet if I develop calcium oxalate kidney stones?
If you develop kidney stones composed of calcium, you may be tempted to stop eating foods that include calcium. However, this is the opposite of what you should do. If you have calcium oxalate stones, the most common type, it’s recommended that you have a diet higher in calcium and lower in oxalate.
Foods that are high in calcium include:
- Cow’s milk.
- Yogurt.
- Cheese.
- Broccoli.
- Kale.
- Calcium-fortified juices.
- Dried beans.
- Salmon.
- Calcium-fortified hot cereal.
Foods that are high in oxalates include (reduce these in your diet):
- Spinach.
- Rhubarb.
- Strawberries.
- Tea.
- Dried peas and beans.
- Nuts and nut butters.
- Wheat bran.
It’s also important to drink plenty of fluids to dilute the substances in your urine.
OUTLOOK / PROGNOSIS
What’s the outlook for kidney stones?
The outlook for kidney stones is very positive, although there is a risk of recurrence (the stones coming back). Many kidney stones pass on their own over time without needing treatment. Medications and surgical treatments to remove larger kidney stones are generally very successful and involve little recovery time.
It’s possible to get kidney stones multiple times throughout your life. If you keep developing kidney stones, your healthcare provider may work with you to discover why the stones happen. Once the cause is found, you may be able to make dietary changes to prevent future stones.
Can a large kidney stone cause an injury?
Your risk of injury from a kidney stone can go up based on the size and location of the stone. A larger stone could get stuck in a ureter, causing pressure to build up. This can lead to renal failure and, in the worst-case (but rare) scenario, you could lose your kidney. The chance of passing a 1 cm stone is less than 10%, and stones larger than 1 cm typically don’t pass.
How long does the pain last after you pass a kidney stone?
Pain from a stone can persist for a few days after completely passing. But, if the pain persists beyond a week, a repeated imaging test (usually an ultrasound) is done to see if any further blockage is present (sometimes due to a remaining stone fragment).
LIVING WITH
Can I live a normal life with kidney stones?
Kidney stones shouldn’t stop you from going about your daily activities, or drastically reduce your quality of life. Thanks to passing them while you urinate, and thanks to treatment options, kidney stones are not permanent.
Do kidney stones cause kidney disease?
If you’ve had kidney stones, you’re at a higher risk for more kidney stones and chronic kidney disease.
Are kidney stones deadly?
No. Kidney stones do not cause death.
When should I see my healthcare provider?
Don’t hesitate to see your healthcare provider if you’re experiencing symptoms of kidney stones. If you have a kidney stone, you’ll need to know where it’s located and what size it is so that you can get treatment and prevent complications.
When should I go to the emergency department?
Go to the emergency department if the pain is unbearable. You may be prescribed medication for your pain and any nausea/vomiting.
What questions should I ask my healthcare provider?
- Do I have a kidney stone or is there another reason for my symptoms?
- What type of kidney stone do I have?
- What size is my kidney stone?
- Where is my kidney stone located?
- How many kidney stones do I have?
- Do I need treatment or will I be able to pass the kidney stone?
- Should I be tested for kidney disease?
- What changes should I make to my diet?
- What type of procedure should I have to get rid of the stones?
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Kidney stones can be frustrating at best and agonizingly painful at the worst. To stop your situation from getting worse, you should be evaluated by a healthcare provider as soon as possible. The pain can get severe, and surgery might be necessary. Remember: don’t skip your prescriptions, drink lots of water and follow any dietary guidelines. Also, remember that kidney stones are a temporary condition. They won’t bother you forever.
References
- Urology Care Foundation. What are Kidney Stones? (https://www.urologyhealth.org/urologic-conditions/kidney-stones)
- Merck Manual, Consumer Version. Stones in the Urinary Tract. (https://www.merckmanuals.com/home/kidney-and-urinary-tract-disorders/stones-in-the-urinary-tract/stones-in-the-urinary-tract)
- National Institute of Diabetes and Digestive and Kidney Diseases. The Urinary Tract & How it Works. (https://www.niddk.nih.gov/health-information/urologic-diseases/urinary-tract-how-it-works)
- US National Library of Medicine, Genetics Home Reference. Kidney Stones. (https://ghr.nlm.nih.gov/condition/kidney-stones)
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