Pain, Causes, Treatment & Passing

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Kidney Stone Treatment

Most kidney stones eventually pass from the kidney through the ureter and bladder and finally through the urethra on their own. However, treatment is often required for pain control from kidney stones as they pass. The consumption of ample fluids helps facilitate the passage of kidney stones, but even with plentiful fluid intake, most people require some type of medications for pain control.

X-ray of kidney stones.

A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.Source: MedicineNet

A doctor discusses causes of a patient's kidney stone by viewing his X-ray.

A family history of kidney stones is also a risk factor for developing kidney stones.Source: Getty Images

Who is at risk for kidney stones?

Anyone may develop a kidney stone, but people with certain diseases and conditions (see below) or those who are taking certain medications are more susceptible to their development. Urinary tract stones are more common in men than in women. Most urinary stones develop in people 20 to 49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life. People who have already had more than one kidney stone are prone to developing further stones.

In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. People who live in the southern or southwestern regions of the U.S. have a higher rate of kidney stone formation, possibly due to inadequate water intake leading to dehydration than those living in other areas. Over the last few decades, the percentage of people with kidney stones in the U.S. has been increasing, most likely related to the obesity epidemic.

A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.

Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood (hyperuricemia).

A small number of pregnant women develop kidney stones, and there is some evidence that pregnancy-related changes may increase the risk of stone formation. Factors that may contribute to the stone formation during pregnancy include a slowing of the passage of urine due to increased progesterone levels and diminished fluid intake due to a decreasing bladder capacity from the enlarging uterus. Healthy pregnant women also have a mild increase in their urinary calcium excretion. However, it remains unclear whether the changes of pregnancy are directly responsible for kidney stone formation or if these women have another underlying factor that predisposes them to kidney stone formation.

Chart showing types and causes of kidney stones.

Types of kidney stones include calcium oxalate, calcium phosphate, uric acid, struvite, and cysteine.Source: N/A



SLIDESHOW


Kidney Stones: Symptoms, Causes, and Treatment
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Additional risks for causes of kidney stones include gout, diabetes, high blood pressure and certain medications.

A number of different medical conditions can lead to an increased risk for developing kidney stones include gout, hypercalciuria, other conditions, and more.Source: iStock

Other medical conditions which cause kidney stones

A number of different medical conditions can lead to an increased risk for developing kidney stones:

  • Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid kidney stones.
  • Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate kidney stones.
  • Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and other inherited metabolic conditions, including cystinuria and hyperoxaluria.
  • Chronic diseases such as diabetes and high blood pressure (hypertension) are also associated with an increased risk of developing kidney stones.
  • People with inflammatory bowel disease are also more likely to develop kidney stones.
  • Those who have undergone intestinal bypass or ostomy surgery are also at increased risk for kidney stones.
  • Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.
  • Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual’s risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.
  • Hyperoxaluria as an inherited condition is uncommon and is known as primary hyperoxaluria. The elevated levels of oxalate in the urine increase the risk of stone formation. Primary hyperoxaluria is much less common than hyperoxaluria due to dietary factors as mentioned above.

A woman experiencing discomfort from kidney stones in her lower back and side.

The early signs and symptoms of kidney stones inclu de abdominal, groin, and/or back pain.Source: iStock



SLIDESHOW


Kidney Stones: Symptoms, Causes, and Treatment
See Slideshow

Lithotripsy is a procedure often used for kidney stones that do not pass on their own.

Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones.Source: N/A

What is the treatment for kidney stones? How long does it take to pass a kidney stone?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the-counter pain control medications are not effective. Toradol, aspirin, and NSAIDs must be avoided if lithotripsy is to be done because of the increased risk of bleeding or if there is impaired kidney function. Intravenous pain medications can be given when nausea and vomiting are present.

Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones. Since most kidney stones, given time, will pass through the ureter to the bladder on their own, treatment is directed toward control of symptoms. Home care in this case includes the consumption of plenty of fluids. Acetaminophen (Tylenol) may be used as pain medication if there is no contraindication to its use. If further pain medication is needed, stronger narcotic pain medications may be recommended.

There are several factors that influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9 mm to 10 mm rarely pass without specific treatment.

Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine (Adalat, Procardia, Afeditab, Nifediac) and alpha-blockers such as tamsulosin (Flomax). These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.

For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.

Surgical techniques have also been developed to remove kidney stones when other treatment methods are not effective. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument is known as a ureteroscope passed through the urethra and bladder up into the ureter.

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A woman drinking a glass of water.

People who have a tendency to form calcium oxalate kidney stones may be advised to limit their consumption of foods high in oxalates, such as spinach, rhubarb, Swiss chard, beets, wheat germ, and peanuts.Source: iStock

Medically Reviewed on 2/11/2021

References

Medically reviewed by John A. Daller, MD; American Board of Surgery with subspecialty certification in surgical critical care

REFERENCES:

“Kidney Stones in Adults.” National Kidney & Urologic Diseases Information Clearinghouse. Sept. 2, 2010. <http://kidney.niddk.nih.gov/Kudiseases/pubs/stonesadults/>

Shekarriz, Bijan. “Hyperoxaluria.” Medscape.com. Apr. 5, 2013. <http://emedicine.medscape.com/article/444683-overview>.

Wolf Jr., J. Stuart. “Nephrolithiasis.” Medscape.com. September 26, 2015. <http://emedicine.medscape.com/article/437096-overview>



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