Urinary Stones (Urolithiasis, Nephrolithiasis)

Urinary stones (calculi) are hardened mineral deposits that form in the kidney. They originate as microscopic particles and develop into stones over time.

Urinary stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Much less common are the uric acid stone and the rare cystine stone.

Cause

Urinary stones usually arise because of the breakdown of a delicate balance. The kidneys must conserve water, but they must excrete materials that have a low solubility. These two opposing requirements must be balanced during adaptation to diet, climate, and activity. The problem is mitigated to some extent by the fact that urine contains substances that inhibit crystallisation of calcium salts and others that bind calcium in soluble complexes. These protective mechanisms are less than perfect. When the urine becomes supersaturated with insoluble materials, because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone.

Symptoms

The first symptom of a kidney stone is extreme pain. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side around the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur with this pain. Later, the pain may spread to the groin.

If the stone is too large to pass easily, the pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may be found in the urine. As the stone moves down the ureter closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.

If fever and chills accompany any of these symptoms, an infection may be present. In this case, a doctor should be contacted immediately.

Diagnoses

The urologist will order laboratory tests, including urine and blood tests. He or she will also ask about the patient’s medical history, occupation and dietary habits. If a stone has been removed, or if the patient has passed a stone and saved it, the lab can analyse the stone to determine its composition.

X-ray is the chief method used to diagnose kidney stones. Ultrasound can also be used to detect stones and urinary obstruction.

Your doctor might ask you to undertake a battery of tests to confirm that the stone disease is not the result of any primary disease.

Treatment

• • Conservative: In asymptomatic patients a wait-and-see course may be recommended by the doctor. Many stones will become symptomatic and produce acute renal colic while traveling down the ureter some time in the future. The stones may enlarge and then become more problematic and difficult to treat.
  • Pain control: The severe pain of renal colic needs to be controlled by potent pain killers. Don’t expect an aspirin to do the trick. Get yourself to a doctor or an emergency room. Also, the pain may be caused by some other problem needing immediate attention.
  • ESWL: stands for “extracorporeal shock wave lithotripsy” (shattering a stone with a shock wave produced outside the human body). There are several methods for producing an acoustical or ultrasonic “big bang” which is then focused from outside into the kidney and the kidney stone.
  • Open surgery