NEPHROLITHIASIS

The process of forming a kidney stone, a stone in the kidney (or lower down in the urinary tract). Kidney stones are a common cause of blood in the urine and pain in the abdomen, flank, or groin. Kidney stones occur in 1 in 10 people at some time in their life.The development of the stones is typically related to increased excretion of stone-forming components such as calcium, oxalate, urate or cystine.

The pain with kidney stones is usually of sudden onset, very severe and colicky (intermittent), not improved by changes in position, radiating from the back, down the flank, and into the groin. Nausea and vomiting are common.Treatment includes relief of pain, hydration and, if there is concurrent urinary infection, antibiotics.

Kidney stones are small masses of salts and minerals that form inside the kidneys and may travel down the urinary tract. Kidney stones range in size from just a speck to as large as a ping pong ball. Signs and symptoms of kidney stones include blood in the urine, and pain in the abdomen, groin, or flank. About 5% of people develop a kidney stone in their lifetime.

The rate of people who develop kidney stones is increasing in the U.S. The reasons for the trend are unknown. The prevalence of kidney stones was 3.8% in the late 1970s. In the late 1980s and early 1990s, the number rose to 5.2%. Caucasian ethnicity and male gender are associated with higher rates of kidney stones. Men tend to develop kidney stones in their 40s through 70s; rates increase with age. Women are most likely to experience kidney stones in their 50s. A person who has suffered from one kidney stone is likely to develop others.

Many kidney stones are painless until they travel from the kidney, down the ureter, and into the bladder. Depending on the size of the stone, movement of the stone through the urinary tract can cause severe pain with sudden onset. People who have kidney stones often describe the pain as excruciating. The lower back, abdomen, and sides are frequent sites of pain and cramping. Those who have kidney stones may see blood in their urine. Fever and chills are present when there is an infection. Seek prompt medical treatment in the event of these symptoms.

Kidney stones are diagnosed by excluding other possible causes of abdominal pain and associated symptoms. Imaging tests including an X-ray called a KUB view (kidney, ureter, bladder), or a helical CT scan are often used to confirm the diagnosis of kidney stones. Although the amount of radiation exposure associated with these tests are minimal, pregnant women and others may need to avoid even these low levels of radiation. In these cases, an ultrasound may be used to diagnose the kidney stone.

Most people with kidney stones are able to pass them on their own within 48 hours by drinking plenty of fluids. Pain medication can ease the discomfort. The smaller the stone, the more likely it is to pass without intervention. Other factors that influence the ability to pass a stone include pregnancy, prostate size, and patient size.

Stones that are 9 mm or larger usually do not pass on their own and require intervention. Stones that are 5 mm in size have a 20% chance of passing on their own while 80% of stones that are 4 mm in size have a chance of passing without treatment.

Lithotripsy is a procedure that uses shock waves to break a kidney stone into smaller pieces that can be more easily expelled from the body. The device used for this procedure is called a Lithotripter. Kidney stones can also be removed surgically. A percutaneous nephrolithotomy is a procedure in which a kidney stone is removed via a small incision in the skin.

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David Paul

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Journal of Clinical Nephrology and Research