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Location of calculi in the urinary tract

Renal Calculi (Uroliths or Kidney stones)

ICD-9: 592.0

Description

Renal calculi are the most common cause of urinary obstruction. A renal calculus is a concentration of various mineral salts in the renal pelvis or the cuplike extension of the renal pelvis called the calyx of the kidney or elsewhere in the urinary tract. They can be small like a grain of sand or very large. Most stones develop in the kidney and are formed from calcium salts, uric acid, cystine, and struvite in descending order of frequency.

Renal Calculi

Etiology

Renal calculi form as a result of a disturbance in the kidney’s delicate balancing act of preventing water loss while at the same time eliminating watersoluble mineral wastes. Many factors, such as prolonged dehydration or immobilization, can upset this balance. The balance also may be upset by underlying diseases, such as gout, hyperparathyroidism (disease caused by oversecretion of the parathyroid glands), Cushing syndrome, or urinary tract infections and neoplasms. A person may develop renal calculi because of an excessive intake of vitamin D or dietary calcium. The condition appears to be genetic for certain types of stones, with men much more commonly affected than women. In many instances, no specific cause can be pinpointed.

Location of calculi in the urinary tract

FIGURE. Location of calculi in the urinary tract.

Signs and Symptoms

A person having renal calculi may remain asymptomatic for long periods. If a stone or calculus fragment lodges in a ureter, however, the individual may complain of intense flank pain and urinary urgency. Classic ureteral colicky pain is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. If calculi are in the renal pelvis and calyces, the pain is duller and more constant. Back pain and severe abdominal pain may occur. Other presenting symptoms include nausea, vomiting, chills and fever, hematuria, and abdominal distention.

Diagnostic Procedures

The history may reveal a familial tendency toward the formation of kidney stones. A urinalysis may be ordered to detect elevated levels of RBCs or WBCs in the urine or to check for the presence of protein, pus, and bacteria. CT scan and abdominal x-ray (or KUB) may be ordered to determine the locations of calculus formation. A noncontrast spiral CT scan of the ureters and kidneys is the preferred test for kidney stones. In this test, the scanner moves in a circle as the client moves through the machine. This test takes less time than a standard CT scan and provides better images of the kidneys and ureters. Blood testing may be helpful in confirming imbalances of minerals or the existence of other metabolic disorders.

Treatment

Treatment is directed at clearing obstructive stones and preventing the formation of new ones. Increased fluid intake (greater than 3 L/day) may enhance elimination of stones in some cases, but large stones may require surgical intervention, especially if renal function is threatened. Ureteroscopic removal with the use of fluoroscopic guidance may be used to dilate the ureter to grasp and remove the stone. Techniques such as ultrasonic percutaneous lithotripsy and extracorporeal shock wave lithotripsy pulverize stones in place, allowing them to be passed in the urine or removed by suction. Lithotripsy via a ureteroscope can also be used to remove urethral stones. Antibiotics may be prescribed if it is determined that the calculus buildup is due to bacterial infection. Analgesics may be necessary for the relief of intense pain.

Complementary Therapy

Complementary practitioners recommend drinking 8 or more glasses of water per day and eating a diet high in fiber and low in fat, with reduction of red meat consumption. Vitamins and minerals may be helpful especially when coordinated with the primary care provider. Relaxation techniques may be beneficial to deal with the pain.

Client communication

Stress the importance of proper diet and completing any medicinal therapy. Explain any diagnostic or surgical procedures to clients. Encourage increased fluid intake.

Prognosis

The prognosis is good if urinary tract obstruction is prevented and underlying disorders are promptly treated. However, about 60% of people who have a calcium stone have further stone formation later.

Prevention

An adequate daily fluid intake is the best way to minimize the chance of stone formation, especially among individuals at risk. Fruit juices, especially unsweetened cranberry and blueberry juice, help acidify urine and may help prevent the formation of renal calculi.

Video: How Do Kidney Stones Form? How Can We Prevent Them?

Kidney Stones

What are kidney stones?

Kidney stones, or renal calculi, are solid masses made of crystals. Kidney stones usually originate in your kidneys. However, they can develop anywhere along your urinary tract, which consists of these parts:

  • kidneys
  • ureters
  • bladder
  • urethra

Kidney stones are one of the most painful medical conditions. The causes of kidney stones vary according to the type of stone.

Types of kidney stones

Not all kidney stones are made up of the same crystals. The different types of kidney stones include:

Calcium

Calcium stones are the most common. They’re often made of calcium oxalate (though they can consist of calcium phosphate or maleate). Eating fewer oxalate-rich foods can reduce your risk of developing this type of stone. High-oxalate foods include:

  • potato chips
  • peanuts
  • chocolate
  • beets
  • spinach

However, even though some kidney stones are made of calcium, getting enough calcium in your diet can prevent stones from forming.

Uric acid

This type of kidney stone is more common in men than in women. They can occur in people with gout or those going through chemotherapy. This type of stone develops when urine is too acidic. A diet rich in purines can increase urine’s acidic level. Purine is a colorless substance in animal proteins, such as fish, shellfish, and meats.

Struvite

This type of stone is found mostly in women with urinary tract infections (UTIs). These stones can be large and cause urinary obstruction. They result from a kidney infection. Treating an underlying infection can prevent the development of struvite stones.

Cystine

Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria. With this type of stone, cystine — an acid that occurs naturally in the body — leaks from the kidneys into the urine.

Risk factors for kidney stones

The greatest risk factor for kidney stones is making less than one liter of urine per day. This is why kidney stones are common in premature infants who have kidney problems. However, kidney stones are most likely to occur in people between the ages of 20 and 50.

Different factors can increase your risk of developing a stone. Typically, Caucasians are more likely to have kidney stones than those of African descent.

Sex also plays a role. More men than women develop kidney stones, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

A history of kidney stones can increase your risk. So does a family history of kidney stones.

Other risk factors include:

  • dehydration
  • obesity
  • a diet with high levels of protein, salt, or glucose
  • hyperparathyroid condition
  • gastric bypass surgery
  • inflammatory bowel diseases that increase calcium absorption
  • taking medications such as diuretics, antiseizure drugs, and calcium-based antacids

Recognizing the symptoms and signs of a kidney stone

Kidney stones are known to cause severe pain. Symptoms of kidney stones may not occur until the stone begins to move down the ureters. This severe pain is called renal colic. You may have pain on one side of your back or abdomen.

In men, pain may radiate to the groin area. The pain of renal colic comes and goes, but can be intense. People with renal colic tend to be restless.

Other symptoms of kidney stones can include:

  • blood in the urine (red, pink, or brown urine)
  • vomiting
  • nausea
  • discolored or foul-smelling urine
  • chills
  • fever
  • frequent need to urinate
  • urinating small amounts of urine

In the case of a small kidney stone, you may not have any pain or symptoms as the stone passes through your urinary tract.

Why kidney stones can be a problem

Stones don’t always stay in the kidney. Sometimes they pass from the kidney into the ureters. Ureters are small and delicate, and the stones may be too large to pass smoothly down the ureter to the bladder. Passage of stones down the ureter can cause spasms and irritation of the ureters as they pass. This causes blood to appear in the urine.

Sometimes stones block the flow of urine. This is called a urinary obstruction. Urinary obstructions can lead to kidney infection and kidney damage.

Testing for and diagnosing kidney stones

Diagnosis of kidney stones requires a complete health history assessment and a physical exam. Other tests include:

  • blood tests for calcium, phosphorus, uric acid, and electrolytes
  • blood urea nitrogen (BUN) and creatinine to assess kidney functioning
  • urinalysis to check for crystals, bacteria, blood, and white cells
  • examination of passed stones to determine their type

The following tests can rule out obstruction:

  • abdominal X-rays
  • intravenous pyelogram (IVP)
  • retrograde pyelogram
  • ultrasound of the kidney (the preferred study)
  • MRI scan of the abdomen and kidneys
  • abdominal CT scan

The contrast dye used in the CT scan and the IVP can affect kidney function. However, in people with normal kidney function, this isn’t a concern.

There are some medications that can increase the potential for kidney damage in conjunction with the dye. Make sure your radiologist knows about any medications you’re taking.

9 Ways to Prevent Kidney Stones

Kidney stone prevention

Kidney stones are hard mineral deposits that form inside your kidneys. They cause excruciating pain when they pass through your urinary tract.

Up to 12 percent of Americans are affected by kidney stones. And once you’ve had one kidney stone, you’re 50 percent more likely to get another within the next 10 years.

There’s no one sure way to prevent kidney stones, especially if you have a family history of the condition. A combination of diet and lifestyle changes, as well as some medications, may help reduce your risk.

How to prevent kidney stones naturally

Making small adjustments to your current diet and nutrition plan may go a long way toward preventing kidney stones.

1. Stay hydrated

Drinking more water is the best way to prevent kidney stones. If you don’t drink enough, your urine output will be low. Low urine output means your urine is more concentrated and less likely to dissolve urine salts that cause stones.

Lemonade and orange juice are also good options. They both contain citrate, which may prevent stones from forming.

Try to drink around eight glasses of fluids daily, or enough to pass two liters of urine. If you exercise or sweat a lot, or if you have a history of cystine stones, you’ll need additional fluids.

You can tell whether you’re hydrated by looking at the color of your urine — it should be clear or pale yellow. If it’s dark, you need to drink more.

2. Eat more calcium-rich foods

The most common type of kidney stone is the calcium oxalate stone, leading many people to believe they should avoid eating calcium. The opposite is true. Low-calcium diets may increase your kidney stone risk and your risk of osteoporosis.

Calcium supplements, however, may increase your risk of stones. Taking calcium supplements with a meal may help reduce that risk.

Low-fat milk, low-fat cheese, and low-fat yogurt are all good calcium-rich food options.

3. Eat less sodium

A high-salt diet increases your risk of calcium kidney stones. According to the Urology Care Foundation, too much salt in the urine prevents calcium from being reabsorbed from the urine to the blood. This causes high urine calcium, which may lead to kidney stones.

Eating less salt helps keep urine calcium levels lower. The lower the urine calcium, the lower the risk of developing kidney stones.

To reduce your sodium intake, read food labels carefully.

Foods notorious for being high in sodium include:

  • processed foods, such as chips and crackers
  • canned soups
  • canned vegetables
  • lunch meat
  • condiments
  • foods that contain monosodium glutamate
  • foods that contain sodium nitrate
  • foods that contain sodium bicarbonate (baking soda)

To flavor foods without using salt, try fresh herbs or a salt-free, herbal seasoning blend.

4. Eat fewer oxalate-rich foods

Some kidney stones are made of oxalate, a natural compound found in foods that binds with calcium in the urine to form kidney stones. Limiting oxalate-rich foods may help prevent the stones from forming.

Foods high in oxalates are:

  • spinach
  • chocolate
  • sweet potatoes
  • coffee
  • beets
  • peanuts
  • rhubarb
  • soy products
  • wheat bran

Oxalate and calcium bind together in the digestive tract before reaching the kidneys, so it’s harder for stones to form if you eat high-oxalate foods and calcium-rich foods at the same time.

5. Eat less animal protein

Foods high in animal protein are acidic and may increase urine acid. High urine acid may cause both uric acid and calcium oxalate kidney stones.

You should try to limit or avoid:

  • beef
  • poultry
  • fish
  • pork

6. Avoid vitamin C supplements

Vitamin C (ascorbic acid) supplementation may cause kidney stones, especially in men.

According to one 2013 study, men who took high doses of vitamin C supplements doubled their risk of forming a kidney stone. Researchers don’t believe vitamin C from food carries the same risk.

7. Explore herbal remedies

Chanca Piedra, also known as the “stone breaker,” is a popular herbal folk remedy for kidney stones. The herb is thought to help prevent calcium-oxalate stones from forming. It’s also believed to reduce the size of existing stones.

Use herbal remedies with caution. They’re not well-regulated or well-researched for the prevention or treatment of kidney stones.

How to prevent kidney stones with medication

In some cases, switching up your dietary choices may not be enough to prevent kidney stones from forming. If you have recurrent stones, talk to your doctor about what role medication can play in your prevention plan.

8. Talk to your doctor about the medications you’re currently taking

Taking certain prescriptions or over-the-counter medications can result in kidney stones.

Some of these medications are:

  • decongestants
  • diuretics
  • protease inhibitors
  • anticonvulsants
  • steroids
  • chemotherapy drugs
  • uricosuric drugs

The longer you take these drugs, the higher your risk of kidney stones. If you’re taking any of these medications, talk to your doctor about other medication options. You shouldn’t stop taking any prescribed medications without your doctor’s approval.

9. Talk to your doctor about preventative medications

If you’re prone to certain types of kidney stones, certain medications can help control the amount of that material present in your urine. The type of medication prescribed will depend on the type of stones you usually get.

For example:

  • If you get calcium stones, a thiazide diuretic or phosphate may be beneficial.
  • If you get uric acid stones, allopurinol (Zyloprim) can help reduce uric acid in your blood or urine.
  • If you get struvite stones, long-term antibiotics may be used to help reduce the amount of bacteria present in your urine
  • If you get cystine stones, capoten (Captopril) may help reduce the level of cystine in your urine

The bottom line

Kidney stones are common. There’s no guarantee that prevention methods will work, but they may reduce your risk. Your best bet for preventing kidney stones is staying hydrated and making certain dietary changes.

If you have a condition that increases your risk of kidney stones, such as inflammatory bowel disease, persistent urinary tract infection, or obesity, talk to your doctor about ways to manage it to decrease your kidney stone risk.

If you’ve passed a kidney stone before, ask your doctor to have it tested. Once you know what type of stone you’ve had, you can take targeted steps to prevent new ones from forming.

8 Signs and Symptoms of Kidney Stones

What are kidney stones?

Kidney stones are hard collections of salt and minerals often made up of calcium or uric acid. They form inside the kidney and can travel to other parts of the urinary tract.

Stones vary in size. Some are as small as the period at the end of this sentence — a fraction of an inch. Others can grow to a few inches across. Some kidney stones can become so large they take up the entire kidney.

A kidney stone forms when too much of certain minerals in your body accumulate in your urine. When you aren’t well hydrated, your urine becomes more concentrated with higher levels of certain minerals. When mineral levels are higher, it’s more likely that a kidney stone will form.

About 1 out of every 11 people in the United States will get a kidney stone. Stones are more common in men, people who are obese, and those who have diabetes

Smaller kidney stones that remain in the kidney often don’t cause any symptoms. You might not notice anything is amiss until the stone moves into your ureter — the tube that urine travels through to get from your kidney to your bladder.

Kidney stones are typically very painful. Most stones will pass on their own without treatment. However, you may need a procedure to break up or remove stones that don’t pass.

Here are eight signs and symptoms that you may have kidney stones.

1. Pain in the back, belly, or side

Kidney stone pain — also known as renal colic — is one of the most severe types of pain imaginable. Some people who’ve experienced kidney stones compare the pain to childbirth or getting stabbed with a knife.

The pain is intense enough to account for more than 1 million visits to emergency rooms each year.

Usually the pain starts when a stone moves into the narrow ureter. This causes a blockage, which makes pressure build up in the kidney.

The pressure activates nerve fibers that transmit pain signals to the brain.

Kidney stone pain often starts suddenly. As the stone moves, the pain changes location and intensity.

Pain often comes and goes in waves, which is made worse by the ureters contracting as they try to push the stone out. Each wave may last for a few minutes, disappear, and then come back again.

You’ll feel the pain along your side and back, below your ribs. It may radiate to your belly and groin area as the stone moves down through your urinary tract.

Large stones can be more painful than small ones, but the severity of pain doesn’t necessarily relate to the size of the stone. Even a little stone can be painful as it moves or causes a blockage.

 2. Pain or burning during urination

Once the stone reaches the junction between the ureter and bladder, you’ll start to feel pain when you urinate. Your doctor might call this dysuria.

The pain can feel sharp or burning. If you don’t know you have a kidney stone, you might mistake it for a urinary tract infection. Sometimes you can have an infection along with the stone.

3. Urgent need to go

Needing to go to the bathroom more urgently or frequently than usual is another sign that the stone has moved into the lower part of your urinary tract. You may find yourself running to the bathroom, or needing to go constantly throughout the day and night.

Urinary urgency can also mimic a urinary tract infection symptom.

4. Blood in the urine

Blood in the urine is a common symptom in people with urinary tract stones. This symptom is also called hematuria.

The blood can be red, pink, or brown. Sometimes the blood cells are too small to see without a microscope (called microscopic hematuria), but your doctor can test for this symptom.

5. Cloudy or smelly urine

Healthy urine is clear and doesn’t have a strong odor. Cloudy or foul-smelling urine could be a sign of an infection in your kidneys or another part of your urinary tract.

One study found that about 8 percent of people with acute kidney stones had a urinary tract infection.

Cloudiness is a sign of pus in the urine, or pyuria. The smell can come from the bacteria that cause urinary tract infections. An odor may also come from urine that’s more concentrated than normal.

6. Going a small amount at a time

Large kidney stones sometimes get stuck in a ureter. This blockage can slow or stop the flow of urine.

If you have a blockage, you may only urinate a little bit each time you go. Urine flow that stops entirely is a medical emergency.

7. Nausea and vomiting

It’s common for people with a kidney stone to have nausea and vomiting.

These symptoms happen because of shared nerve connections between the kidneys and GI tract. Stones in the kidneys can trigger nerves in the GI tract, setting off an upset stomach.

The nausea and vomiting can also be your body’s way of responding to intense pain.

8. Fever and chills

Fever and chills are signs that you have an infection in your kidney or another part of your urinary tract. This can be a serious complication to a kidney stone. It can also be a sign of other serious problems besides kidney stones. Any fever with pain requires urgent medical attention.

Fevers that occur with an infection are usually high — 100.4˚F (38˚C) or more. Chills or shivering often occur along with the fever.

The bottom line

Kidney stones are hard collections of salt and minerals that form in your kidneys and can travel to other parts of your urinary system.

Stones cause symptoms like pain, trouble urinating, cloudy or smelly urine, nausea and vomiting.

Some stones will pass on their own. Others need treatment with sound waves or surgery to break them up or remove them.

Call your doctor if you have any symptoms of kidney stones. Get medical help right away if you have these symptoms, which could indicate that you have an infection or other serious complication:

  • pain so severe that you can’t get comfortable
  • nausea, vomiting, fever, or chills with the pain
  • blood in your urine
  • trouble urinating