Kidney stones (renal lithiasis, nephrolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.
Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they’re recognized in a timely fashion.
A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, you may experience these signs and symptoms:
- Severe pain in the side and back, below the ribs.Pain that radiates to the lower abdomen and groin- PAIN – located posteriorly in the renal angle or anteriorly in the hypochondrium in costal margin or in both. It may be worse on movement, particularly on climbing stairs. It is described as FIXED RENAL PAIN or COSTOVERTEBRAL PAIN.
- Pain that comes in waves and fluctuates in intensity.Pain on urination- When the stone is impacted in the pelvi-ureteric junction or anywhere in the ureter, it results in severe colicky pain radiating from the loin to the groin. It may also extend to the testicles, vulva & medial side of the thigh. This may be associated with strangury, the painful passage of a few drops of urine, with pallor, sweating & vomiting & he groans in agony.
- Pink, red or brown urine–) HAEMATURIA – is common with oxalate stones. The quantity of blood loss is small, but it is fresh blood.
- Cloudy or foul-smelling urine
- Nausea and vomiting
- Persistent need to urinate
- Urinating more often than usual
- Fever and chills if an infection is present– fever with chills & rigors, pyuria, burning micturition & increased frequency of micturition may occur. In severe cases, even septicaemia can quickly develop.
- Urinating small amounts
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.
CAUSES OF RENAL STONES
The leading cause of kidney stones is a lack of water in the body.
Stones are more commonly found in individuals who drink less than the recommended eight to ten glasses of water a day.
When there is not enough water to dilute the uric acid, a component of urine, the urine becomes more acidic.
An excessively acidic environment in urine can lead to the formation of kidney stones.
Kidney stones often have no definite, single cause, although several factors may increase your risk.
Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.
TYPES OF RENAL STONES
Knowing the type of kidney stone helps determine the cause and may give clues on how to reduce your risk of getting more kidney stones. If possible, try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis.
Types of kidney stones include:
- Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food and is also made daily by your liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content.
Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.
Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain migraine headaches or with taking certain seizure medications, such as topiramate (Topamax).
- Struvite stones. Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning.
- Uric acid stones. Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones.
- Cystine stones. These stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).
Factors that increase your risk of developing kidney stones include:
- Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones, too. And if you’ve already had one or more kidney stones, you’re at increased risk of developing another.
- Not drinking enough water each day can increase your risk of kidney stones. People who live in warm climates and those who sweat a lot may be at higher risk than others.
- Certain diets. Eating a diet that’s high in protein, sodium (salt) and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much salt in your diet increases the amount of calcium your kidneys must filter and significantly increases your risk of kidney stones.
- Being obese. High body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
- Digestive diseases and surgery. Gastric bypass surgery, inflammatory bowel disease or chronic diarrhea can cause changes in the digestive process that affect your absorption of calcium and water, increasing the levels of stone-forming substances in your urine.
- Other medical conditions. Diseases and conditions that may increase your risk of kidney stones include renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications, and some urinary tract infections.
If your doctor suspects you have a kidney stone, you may have diagnostic tests and procedures, such as:
- Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
- Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
- Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to high-speed or dual energy computerized tomography (CT) that may reveal even tiny stones.
Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.
- Analysis of passed stones.You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.
Renal colic < left side. Stitching, cutting pain from left kidney following course of the ureter into bladder & urethra. Burning & soreness in region of kidneys. Pain in small of back, very sensitive to touch in renal region
Constant urging to urinate, passing but a few drops at a time, which is mixed with blood. Intolerable urging before, during & after urination. Violent paroxysms of cutting & burning in the whole renal region. Violent tenesmus & strangury. Urine scalds him & is passed drop by drop. Membranous scales looking like bran in water. Urine jelly-like, shredy. Pain raw, sore, burning in every part, internally & externally. Oversensitiveness of all parts.
Renal colic, right side. Pain shooting across the lower abdomen from right to left. Pain in back relieved by urinating. Urine slow in coming must strain. Retention. Polyuria during the night. Red sand in urine. Uric acid diathesis. The child cries before urinating. Pains drawing, aching < 4-8 pm. The upper part of the body emaciated, lower part semi-dropsical. Ailments from fright, anger, mortification, reserved displeasure
Passage of small calculi or gravel, renal colic, stone in the bladder. Excruciating pains from right kidney downwards. Severe almost unbearable pain at conclusion of urination. Urine bloody, scanty, slimy, flaky, sandy, copious, passed without sensation, deposits white sand. Painful distension & tenderness in the bladder, urine dribbles while sitting, pass freely when standing. Air passes from the urethra, child screams before & while passing urine.
Renal colic, violent spasmodic pains along ureter, left side. With deathly nausea & vomiting. Vomiting violent, with cold sweat, on least motion, with faintness > open air. Nausea incessant as if seasick > in fresh cold air. Vertigo, death-like pallor, on opening the eyes. Face pale, blue, pinched, sunken, collapsed. Terrible, faint, sinking feeling at the pit of the stomach. Icy coldness of surfaces.
Renal colic, right-sided. The pain extends to the right thigh & to the genitals. Frequent ineffectual urge for urination with dribbling of urine. Haematuria, strangury. While urinating, itching in urethra & pain in the neck of the bladder. Backache, must sit up or turn over in bed. Adapted to thin, irritable, zealous, nervous, literary, studious, responsible persons. Bad effects of coffee, tobacco, alcohol, highly spiced food, overeating, long-continued mental exertion. Over sensitiveness to all external impressions. Frequent ineffectual urging for stool.