What to Do If You Think You Have a Kidney Stone?

Kidney stones that are small may be passed with just lots of fluids and rest, but larger, painful ones that make it difficult to eat or drink need medical attention.

Kidney stones (nephrolithiasis or urolithiasis) are hard objects formed from substances in the urine. Waste products usually dissolve in urine, but sometimes if there is excess waste and insufficient liquid, crystals can form into solids that grow. Small stones may be passed out of the body in the urine, but larger stones too big to pass can block urine flow in the kidney, ureter, bladder, or urethra, causing the pain of kidney stones. 

There are four types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. 

Kidney stones are common, affecting 19 percent of men and 9 percent of women by the time they turn 70. 

Kidney stones may not cause any symptoms. When symptoms do occur, they can include: 

• Pain 
  • Varies from a mild ache to pain so intense it requires hospitalization
  • Waves of severe pain (renal colic) that can last 20 to an hour
  • Occurs in the flank (the side, between the ribs and the hip) or the lower abdomen, and can move toward the groin
  • Pain can also be vague or feel like a stomach ache that doesn’t go away
• Blood in the urine (hematuria)
  • Urine may appear pink or reddish
  • Blood may not be visible but is seen when urine is examined under a microscope
• Gravel 
  • Passage of “gravel” or “sand,” which are multiple small stones in the urine
• Pain with urination
• Urinary urgency
• Nausea 
• Vomiting
• Fever 
• Chills
• Urine that smells bad 
• Cloudy appearance to urine

If you think you have a kidney stone, see a doctor right away. Drinking additional fluids to try to flush a stone out in the urine may be recommended. If a stone does pass, it is helpful to strain it and bring it to your doctor to determine what kind of stone it is. 

Causes of kidney stones include:

• Diet 
  • Not drinking enough fluids
  • Eating foods with excess salt or sugar (especially fructose, like table sugar and high fructose corn syrup)
  • Diets low in calcium
  • Use of calcium supplements 
  • Diets high in animal proteins
  • Diet with low levels of phytate (found in wheat, rice, rye, barley, and bean products)
  • Frequent spinach consumption
• Too much or too little exercise 
• Obesity
• Weight loss surgery
• Infections 
• Family history of kidney stones
• Certain medical conditions
  • Primary hyperparathyroidism
  • Crohn's disease
  • Gout
  • Diabetes mellitus

Kidney stones are diagnosed based upon a patient’s symptoms and physical examination, along with testing to confirm a stone or rule out other conditions.

Tests used to diagnose kidney stones include: 

• Imaging tests
  • Computed tomography (CT) scan 
  • KUB x-ray (kidney-ureter-bladder X-ray)
  • Ultrasound 
• Blood tests 
  • Basic metabolic profile (BMP) which includes kidney function tests blood urea nitrogen (BUN) and creatinine
  • Calcium
  • Phosphorus 
  • Uric acid
  • Pregnancy test
• Urine tests
  • Urinalysis
  • 24-hour urine test

After the stone comes out of the body, either on its own or following surgical removal, it can be analyzed to determine the type of stone and treatment. 

Treatment of a kidney stone depends on the size and location of the stone, the type of stone, and the patient’s pain levels. 

Home treatment may be suggested if the stone is believed to be small enough to pass, the patient’s pain is tolerable, and they can eat and drink.

Home treatment for kidney stones includes: 

• Pain management 
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
• Medications to facilitate stone passage  
  • Tamsulosin (Flomax)
• Straining urine to retrieve the stone for testing once it passes
  • Knowing the type of stone you have helps determine treatment to prevent future stones

Medical treatments for larger stones or severe symptoms include: 

• Stronger prescription pain medications 
• Intravenous (IV) fluids given in the hospital
• Stones larger than 9 or 10 millimeters usually do not pass on their own so a procedure is needed to break up or remove the stone
  • Ureteroscopy uses a thin telescope passed through the urethra and bladder into the ureter and kidney to remove the stone or to break it into smaller pieces that can pass more easily
  • Shock wave lithotripsy (SWL) directs high-energy shock waves toward the stone causing the stone to fragment and be more easily passed in the urine
  • Percutaneous nephrolithotomy (PNL) is a minimally invasive surgical procedure in which a small telescope is passed through the skin of the back and into the kidney to remove the stone

Complications of kidney stones include:

• Recurrent kidney stones
• Increased risk of developing chronic kidney disease
• Infection of the kidney (pyelonephritis)

Kidney stones commonly recur. To help prevent future stones certain measures can be taken, such as:

• Increasing fluid intake 
  • Water is best 
  • Avoid sugar-sweetened beverages (such as soda and sports drinks) which can increase the risk of developing kidney stones
• Dietary changes
  • Recommendations are based on the type of kidney stone that is found 
  • Reduce excess salt (sodium) in the diet, which includes processed foods
  • Eat more fruits and vegetables to reduce urine acidity
  • Eat less animal protein which increases urine acidity 
• Lose weight if you are overweight but avoid a high-protein diet or crash diets
• Preventive medications may be prescribed to reduce the risk of developing future stones