Kidney Stones

Introduction

Kidney stones are stone-like lumps that can develop in one or both of the
kidneys. Kidney stones are quite common and, in the UK, they will affect
around 3 in 20 men, and 1 in 20 women at some point.

How do the kidneys work?

The kidneys are two, bean-shaped organs that are roughly four inches in
length and located towards the back of the abdomen, on either side of the
spine.
Kidneys work by removing waste products from the blood. The waste
products are transferred into the ureter (the tube that attaches each kidney
to the bladder) with excess fluids, where it is disposed of as urine. The
clean blood is then transferred back into the body.

What is a kidney stone?

There are four main types of kidney stone which are outlined below.
_ Calcium stones - are made from calcium and phosphate, or calcium
and oxalate.
_ Struvite stones - contain magnesium and ammonia, and are often
'horn-shaped' and quite large.
_ Uric acid stones - are usually smooth, brown, and softer than other
forms of kidney stones.
_ Cystine stones - are often yellow and resemble crystals rather than
stones.
Kidney stones come in a variety of shapes, sizes, and colours. Some
resemble grains of sand, while, in rare cases, others can grow to the size
of a golf ball.

How does a kidney stone form?

The waste products are usually dissolved in the fluids that form urine but,
occasionally, they can form crystals which collect around the inside of the
kidney. The crystals may gather over time to form a hard stone-like lump.
This is a kidney stone.
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After a kidney stone has formed, it will often travel through the urinary
system as it tries to be 'passed' in urine. However, it is fairly common for
a stone to block part of the urinary system, such as the ureter, or urethra
(the tube that carries urine from the bladder to the outside of the body). If
this happens, you may experience severe pain in your abdomen or groin.
A blockage in the urinary system can also lead to infection, kidney
damage or, sometimes, kidney failure.

Symptoms
If you have a kidney stone that is very small, it is unlikely to cause many
symptoms. It may even go undetected you may pass it painlessly when
you urinate. This type of kidney stone is known as 'silent' because they
are discreet.
Symptoms usually occur if the kidney stone gets stuck in your kidney, if
it starts to travel down the ureter, or causes an infection. As the ureter is a
narrow tube, you will experience pain if the kidney stone tries to pass
through it.
Common symptoms of kidney stones include;
_ intense pain in the back, or side, of your abdomen, or occasionally in
your groin,
_ nausea,
_ blood in your urine which is often caused by the stone scratching the
ureter,
_ cloudy, or smelly urine,
_ a burning sensation during urination, and
_ fever (a temperature of 38 C or 100.4 F, or higher).
If you have kidney stones, you may also feel like you need to urinate
more often even if you do not need to.

Blocked ureter
The ureter is a muscular tube that carries waste products from your
kidneys to your bladder. If the ureter becomes blocked by a kidney stone,
it may swell up (hydroureter), and cause the muscles to spasm (renal
colic). The spasms can be very painful.
If the ureter does swell, you may experience symptoms such as:
_ nausea and vomiting,
_ feeling like you need to urinate all the time, and
_ pain when you urinate.
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A blocked ureter can also cause an infection in the kidney because waste
products cannot
pass, and this may cause a build up of bacteria. Symptoms of an infected
kidney include:
_ pain in the lower side of your back,
_ fever (a temperature of 38 C or 100.4 F, or higher),
_ shivering,
_ nausea and vomiting,
_ diarrhoea,
_ cloudy and bad smelling urine,
_ needing to urinate more often than normal, and
_ pain when you urinate.

Causes
The exact cause of kidney stones is unknown. They are usually formed
following a build up of a substance in the body, such as calcium,
ammonia, uric acid, or cystine.
Certain medical conditions, such as cancer, or kidney disease can also
increase your risk of developing kidney stones. This is usually due to the
treatment for these conditions.
You are also at a greater risk of developing kidney stones if:
_ you are dehydrated, or do not drink enough fluids,
_ you eat a high-protein, low-fibre diet,
_ you are inactive, or bed-bound,
_ kidney stones run in your family,
_ you have had several kidney, or urinary infections,
_ you have had a kidney stone previously,
_ only one kidney works, and
_ if you have had an intestinal bypass, or a disease of the small intestine,
such as Crohn's disease (inflammation of the gut).
There is also evidence that certain medication, such as aspirin, antacids,
calcium, and vitamin D supplements may increase your risk of
developing a kidney stone.
Kidney stones can develop as the result of a number of different factors.
The causes of the four main types of kidney stone are outlined below
Calcium stones
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The most common type of kidney stone is a calcium stone. These are
caused when there is too much calcium in the urine.
High amounts of calcium could be due to factors such as:
_ high levels of vitamin D,
_ an overactive parathyroid gland,
_ kidney disease,
_ sarcoidosis (a condition which causes inflammation of the lymph nodes
and other organs), and
_ some cancers.
Calcium stones are usually either large and smooth, or 'spiky' and rough.

Struvite stones
Struvite stones are often caused by infections, most commonly occurring
after a urinary tract
infection that has lasted a long time. Struvite stones are more common in
women than men.

Uric acid stones

Uric acid stones often form when there is a high amount of acid in your
urine. Uric acid stones may be caused by:
_ eating a high protein diet, that includes lots of meat,
_ a condition that prevents the body breaking down chemicals, such as
gout,
_ an inherited condition that encourages higher levels of acid in the body,
or
_ chemotherapy.
Cystine stones
Cystine stones are the rarest form of kidney stone. They are caused by an
inherited condition called cystinuria which affects the amount of acid that
is passed in your urine.

Diagnosis
Your GP will usually be able to diagnose a kidney stone from your
symptoms. However, a number of different diagnostic techniques may be
used to help confirm the diagnosis, or to identify precisely where a
kidney stone is. These include:
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_ an X-ray,
_ ultrasound,
_ computerised tomography (CT) scan, or
_ an intravenous urogram (IVU), (also known as an intravenous
pyelogram (IVP)).
An IVU is a technique that involves injecting a dye into a vein in your
arm and watching the
kidneys filter it out into urine. The dye shows up on an X-ray, which will
highlight any points in the filtration process that are blocked.
Other tests that may be performed if you have kidney stones include:
_ blood tests - to check that your kidneys are working properly, and to
check the levels of
chemicals that could cause kidney stones, such as calcium,
_ urine tests - to check for infections and pieces of stones, and
_ examination of any stones that you pass in your urine.
You can catch a kidney stone by urinating through some gauze, or a
stocking. Having a stone to analyse will make diagnosis easier, it will
enable your GP to determine which method of treatment will benefit you
most.

Treatment
If you have a kidney stone the type of treatment that you will need will
depend on the type of kidney stone that you have.
Small kidney stones
Most kidney stones will be small enough to be passed in your urine.
However, this may still cause pain which may need to be treated using
painkillers. If you experience severe pain, you may need to have stronger
painkillers and be treated at hospital.
The pain from smaller kidney stones usually lasts a couple of days and
goes when the stone has been passed.

Large kidney stones

If a kidney stone is too big to be passed naturally, you may need
treatment to remove it another way. This could include:
_ extracorporeal shock wave lithotripsy (ESWL),
_ percutaneous nephrolithotomy (PCNL),
_ ureteroscopy, or
_ surgery.
Extracorporeal shock wave lithotripsy (ESWL)
Extracorporeal shock wave lithotripsy (ESWL) is the most common way
of treating kidney stones that cannot be pass in the urine.
ESWL involves using X-rays, or ultrasound, to pin-point where a kidney
stone is. A machine then sends shock waves of energy to the stone to
break it in to smaller pieces so that it can be passed in your urine.
As ESWL can be an uncomfortable form of treatment, it is usually
performed under a local anaesthetic.
Percutaneous nephrolithotomy (PCNL)
Percutaneous nephrolithotomy (PCNL) involves using a thin telescopic
instrument, called a nephroscope, which is passed through an incision in
your back, leading to your kidney. The stone is then either pulled out or
broken into smaller pieces by a laser, or using ESWL.
PCNL is often performed under general anaesthetic, which means that
you should not drive or operate machinery for up to 48 hours after the
procedure.
Ureteroscopy
If a kidney stone is stuck in your ureter, you may need a ureteroscopy.
A ureteroscopy involves passing a long, thin telescope, called a
ureterscope, through your urethra, into your bladder, and up into your
ureter to where the stone is stuck.
The surgeon may either gently remove the stone using another
instrument, or they may use lasers, or ESWL, to break the stone up into
small pieces so that it can be passed naturally in your urine.
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As with PCNL, a ureteroscopy is also performed under general
anaesthetic. Since a general anaesthetic is used for this procedure, you
should not drive or operate machinery for up to 48 hours after the
procedure.

Surgery
If none of the other methods of removing your kidney stone are suitable,
it may need to be removed using traditional surgery. This will involve
making an incision in your back in order to gain access to both your
ureter and kidney so that your kidney stone can be removed.
Uric acid stones
If you have a uric acid stone, you may be advised to drink around three
litres of water each day to try to dissolve it. Uric acid stones are much
softer compared with other types of kidney stone, and they can be made
smaller if they are exposed to alkaline fluids. You may need to take some
medication to make your urine more alkaline before the uric acid stone
starts to dissolve.

Complications
Complications that develop as a result of kidney stones are rare because
in most cases kidney stones are identified and treated before problems
can occur. However, if a blockage does occur, there is a risk of an
infection developing and, in very rare cases, your kidney may be
damaged.

Prevention
Drink plenty of water
You can avoid getting kidney stones by making sure that you drink plenty
of water each day, and avoid getting dehydrated. It is very important to
keep your urine diluted to avoid waste products forming into kidney
stones.
You can tell how diluted your urine is by looking at the colour of it. The
darker it is, the more concentrated it is. Your urine is usually a dark
yellow colour in the morning because it contains a build up of waste
products that your body has produced overnight.
Normally, you should drink at least 6-8 glasses (about 1.2 litres) of water
each day. However, people who have had a kidney stone before are
encouraged to increase their fluid intake to 2-3 litres each day in order to
'flush out' that can cause stones to develop.
Drinks such as tea, coffee, and fruit juice can count towards your fluid
intake, but water is the healthiest option, and is best for preventing kidney
stones. You should also make sure that you drink more than the
recommended daily amount when it is hot, or when you are exercising, in
order to replenish fluids that are lost through sweating.

Diet
If your kidney stone is caused by an excess of calcium, you may be
advised to reduce the amount of oxalates in your diet. Oxalates prevent
calcium from being absorbed by your body, so it can accumulate in your
kidney and form a stone.
Foods that contain oxalates include:
_ beetroot,
_ asparagus,
_ rhubarb,
_ chocolate,
_ berries,
_ leeks,
_ parsley,
_ celery,
_ almonds, peanuts and cashew nuts,
_ soy products, and
_ grains, such as oatmeal, wheat germ, and whole wheat.
You should not reduce the amount of calcium in your diet unless your GP
recommends it.
To prevent developing a uric acid stone, you should reduce the amount of
meat, poultry and fish in your diet. You may also be prescribed
medication to change the levels of acid, or
alkaline, in your urine.
Medication
If you have a kidney stone, medication is usually prescribed for pain
relief, or to prevent infections from developing. However, some
medication may need to be reviewed by your GP if it is thought to be
causing your kidney stone.
The type of medication that your GP prescribes will depend on the type
of kidney stone that you have.
For example, if you have previously had a struvite stone, you may need to
take antibiotics to prevent bacteria from a urinary tract infection infecting
your kidney and creating a stone. Your GP will be able to give you more
advice about how to prevent urinary tract infections. See the 'related
articles' section for further information about urinary tract infections.