Kidney Stones

Overview
Diagnosis
Treatment

Causes and Symptoms of Kidney Stones

Kidney Stones Overview
Kidney stones are one of the most common disorders of the urinary tract, and one of the most painful. In the United States, approximately 1 million people suffer an attack of kidney stones every year.

Stones most typically affect people between the ages of 20 and 40, men more frequently than women. Risk also increases if there is a family history of kidney stones.

About the Kidneys
Kidney stones can develop when crystals form in urine and build up on the inner surface of the kidney. The kidneys are two bean-shaped organs in the lower back. Their main function is to remove waste from the body and to balance the water and mineral content of the blood by removing water. The waste and water are combined to form urine.

The kidneys filter the blood and remove liquid waste from the body in the form of urine. From the kidneys, urine flows down the ureters, two thin tubes that connect the kidneys to the bladder. The bladder stores urine until it is eliminated from the body through a tube called the urethra.

How Do Kidney Stones Form?
Kidney stones can develop when crystals form in the urine and build up on the inner surfaces of the kidney. Most stones are made of calcium and oxalate, a substance found in nuts, leafy greens, chocolate, and vitamin C. The stones may either remain in the kidney or travel down the ureter.

Most stones are so small that they pass through the urinary system unnoticed. However, when a larger stone moves into the ureter, it causes irritation or blockage.

Symptoms of Kidney Stones
Usually, the first symptom of a kidney stone is sudden, sharp, cramping pain in the area of the kidney or lower abdomen. As the stone travels down the ureter closer to the bladder, the need to urinate more often or a burning sensation during urination may occ ur. Blood may appear in the urine. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.

Diagnosing Kidney Stones

How Are Kidney Stones Diagnosed?
Kidney stones are diagnosed through a combination of the patient's symptoms, evaluation of the urine, and radiographic studies.

Intravenous Pyelogram (IVP) Treatment for Kidney Stones
One of the most common tests is the intravenous pyelogram (IVP), in which x-rays follow the progress of a contrast dye as it is filtered by the kidneys and travels through the urinary tract. Another common test is a CT scan, which takes cross-sectional pictur es of the body and can detect even small stones.

Kidney Stones Treatment

Next Steps After Diagnosis
Don't change your diet without consulting your doctor. Recommendations will be based on the type of stones you've had, and the results of your 24-hour urine tests. Be sure to ask your doctor for a list of the foods you should avoid, or meet with a dietician who can help you understand your dietary restrictions.

You may be advised to:

Drink plenty of fluids, especially water.
Avoid apple and grapefruit juices.
Increase intake of cranberry juice.
Eat foods high in calcium, such as dairy products. Recent studies have shown that dairy products do not promote stone formation.
Avoid calcium or vitamin D supplements or calcium-based antacids.
Avoid foods that have added vitamin D.
Avoid foods high in oxalate, such as spinach.
If tests show your urine is usually acidic, you may need to eat less meat, fish, and poultry. These foods increase urine acidity.
If you have calcium stones, you may be asked to decrease your sodium intake.
If you have an enlarged parathyroid gland, you can have it removed surgically.

Medications may include:

Drugs that control the amount of acid in the urine, such as Allopurinol; sodium cellulose phosphate for urine high in calcium; Hydrochlorothiazide (a diuretic) to reduce the amount of calcium released by the kidneys; or Thiola to reduce the amount of cystine in the urine.

Surgical intervention to treat kidney stones

Most kidney stones pass out of the body in the urine without any active medical intervention, but there are a variety of treatment options available when intervention is needed. Most do not involve major surgery. The options are:

Extracorporeal shock wave lithotripsy (ESWL)
This is the most common procedure to treat kidney stones. The procedure generates shock waves from outside the body and directs them through the skin to the stone. The stone breaks down into sand-like particles that pass easily through the urinary tract.
Ureteroscopy
Stones found in the ureter may be treated with ureteroscopy. A scope is sent up through the urethra and into the ureter. Th e stone is retrieved with a device called a basket and broken up into pieces that can easily pass through the urinary tract.
Holmium laser surgery
This is a minimally invasive procedure that focuses a powerful beam of energy to break up the stone.
Percutaneous nephrolithotomy
This is a procedure used when stones are larger or in a location not suitable for ESWL. The surgeon makes a tiny incision in the back and sends a scope up to the kidney to locate and remove the stone.

Kidney Stone Treatment at UPMC

The Department of Urology also provides specialty care for kidney stone disease over the long term. The Department is currently conducting exciting research into new and better ways to treat and manage advanced disease. For patient referral or consultations, contact the Department of Urology at 412-692-4100.