Confirmation Of The Diagnosis
The diagnosis of urinary tract calculi begins with a focused history. Key elements include past or family history of calculi, duration and evolution of symptoms, and signs or symptoms of sepsis. The physical examination is often more valuable for ruling out nonurologic disease.
Urinalysis should be performed in all patients with suspected calculi. Aside from the typical microhematuria, important findings to note are the urine pH and the presence of crystals, which may help to identify the stone composition. Patients with uric acid stones usually present with an acidic urine, and those with stone formation resulting from infection have an alkaline urine. Identification of bacteria is important in planning therapy, and a urine culture should be routinely performed. Limited pyuria is a fairly common response to irritation caused by a stone and, in absence of bacteriuria, is not generally indicative of coexistent urinary tract infection.
Because of the various presentations of renal colic and its broad differential diagnosis, an organized diagnostic approach is useful . Symptomatic stones essentially present as abdominal pain. Renal colic may be suspected based on the history and physical examination, but diagnostic imaging is essential to confirm or exclude the presence of urinary calculi. Several imaging modalities are available, and each has advantages and limitations .
How Do Health Care Professionals Diagnose Kidney Stones
Health care professionals use your medical history, a physical exam, and lab and imaging tests to diagnose kidney stones.
A health care professional will ask if you have a history of health conditions that make you more likely to develop kidney stones. The health care professional also may ask if you have a family history of kidney stones and about what you typically eat. During a physical exam, the health care professional usually examines your body. The health care professional will ask you about your symptoms.
Ckd In Rare Hereditary Stone Formers
Patients with rare hereditary forms of kidney stones that cause marked excretion of minerals important in stone formation, including primary hyperoxaluria, cystinuria, Dent disease, and adenine phosphoribosyltransferase deficiency, are an important subgroup of stone formers. Patients with these disorders experience recurring stones often starting in childhood and are at high risk for CKD. ESRD is common in primary hyperoxaluria, Dent disease, and APRT deficiency, with usually less aggressive CKD in cystinuria. Cystinuria is also the most common of the rare hereditary kidney stone diseases.
Patients with primary hyperoxaluria have deficiencies of hepatic enzymes important in the metabolic pathways for detoxification of glyoxylate. Deficiency of either alanine glyoxylate aminotransferase or glyoxylate hydroxypyruvate reductase results in marked overproduction of oxalate by the liver. Recently, a third genetic cause of primary hyperoxaluria was also identified, although the mechanism of oxalate overproduction in this subgroup has not yet been elucidated . Among patients with primary hyperoxaluria, urine oxalate excretion rates are typically two to eight times the upper limit of normal, such that the urine is markedly supersaturated for calcium oxalate. ESRD may occur as early as the first 6 months of life or may not occur until mid-adulthood. By the sixth decade of life, 90% of those with type 1 primary hyperoxaluria will have reached ESRD .
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Why Do Doctors Examine The Contents Of The Stone
There are four types of stones. Studying the stone can help understand why you have it and how to reduce the risk of further stones. The most common type of stone contains calcium. Calcium is a normal part of a healthy diet. The kidney usually removes extra calcium that the body doesn’t need. Often people with stones keep too much calcium. This calcium combines with waste products like oxalate to form a stone. The most common combination is called calcium oxalate.
Less common types of stones are: Infection-related stones, containing magnesium and ammonia called struvite stones and stones formed from monosodium urate crystals, called uric acid stones, which might be related to obesity and dietary factors. The rarest type of stone is a cvstine stone that tends to run in families.
For People At Increased Risk Of Kidney Cancer
People who have certain inherited conditions, such as von Hippel-Lindau disease, have a higher risk of kidney cancer. Doctors often recommend that these people get regular imaging tests such as CT, MRI, or ultrasound scans at younger ages, to look for kidney tumors. Kidney cancers that are found early with these tests can often be cured.
It is important to tell your doctor if any of your family members has or had kidney cancer, especially at a younger age, or if they have been diagnosed with an inherited condition linked to this cancer, such as von Hippel-Lindau disease. Your doctor may recommend that you consider genetic counseling and testing to see if you have the condition.
Before having genetic tests, its important to talk with a genetic counselor so that you understand what the tests can and cant tell you, and what any results would mean. Genetic tests look for the gene mutations that cause these conditions in your DNA. They are used to diagnose these inherited conditions, not kidney cancer itself. Your risk may be increased if you have one of these conditions, but it does not mean that you have kidney cancer. For more information on genetic testing, see Genetics and Cancer.
Some doctors also recommend that people with kidney diseases treated by long-term dialysis or those who have had radiation to their kidney in the past have regular tests to look for kidney cancer.
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Inhibitors Of Stone Formation
Normal urine contains chelating agents, such as citrate, that inhibit the nucleation, growth, and aggregation of calcium-containing crystals. Other endogenous inhibitors include calgranulin , TammHorsfall protein, glycosaminoglycans, uropontin , nephrocalcin , prothrombin F1 peptide, and bikunin . The biochemical mechanisms of action of these substances have not yet been thoroughly elucidated. However, when these substances fall below their normal proportions, stones can form from an aggregation of crystals.
Sufficient dietary intake of magnesium and citrate inhibits the formation of calcium oxalate and calcium phosphate stones; in addition, magnesium and citrate operate synergistically to inhibit kidney stones. Magnesium’s efficacy in subduing stone formation and growth is dose-dependent.
Computed Tomography Scan For Kidney Stones
A;CT scan;for kidney stones can detect tiny pieces that other imaging tests might miss. Doctors may choose a CT scan in an emergency because it allows them to make a quick decision.;A CT scan uses x-ray beams to capture images from different angles. A computer processes the information and produces three-dimensional pictures of the area scanned.
During a CT scan, youll lie on an exam table that enters a tube-like scanning machine. A scanner will rotate around your body and send x-rays to the part being studied. The x-ray data is then sent to a computer and processed.
Your doctor can look for kidney stones as they examine the CT scan images. They can also look for kidney tumors, lesions or other conditions.
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Who Is At Risk For Kidney Stones
Anyone may develop a kidney stone, but people with certain diseases and conditions 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 .
Blocked Ureter And Kidney Infection
A kidney stone that blocks the ureter can lead to a kidney infection. This is because waste products are unable to pass the blockage, which may cause a build-up of bacteria.
The;symptoms of a kidney infection;are similar to symptoms of;kidney stones, but may also include:
- a high temperature of 38C or over
- chills and shivering
Kidney stones are usually formed following a build-up of certain chemicals in the body.
This build-up;may be any of the following:
- calcium
- ammonia
- uric acid; a waste product produced when the body breaks down food to use as energy
- cysteine; an amino acid that helps to build protein
Certain medical conditions can lead to an unusually high level of these substances in your urine.
You’re also;more likely to develop kidney stones if you don’t drink enough fluids.
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Recognizing Signs And Symptoms
Checking For Kidney Stones In The Emergency Department
First, the emergency doctor will give you medicine to help stop your pain. The medicine may be given by mouth. Or, it may be given through an intravenous needle placed in a vein in your arm. You may also be given medicine to help stop your nausea and vomiting. If you are dehydrated from vomiting, you may be given liquids through an IV tube.
Next, the emergency doctor will talk with you about your symptoms and medical history. If the emergency doctor thinks you might have a kidney stone, several tests may be done.
These may include:
- Urine Tests: To check for blood or mineral crystals in your urine or for signs of infection.
- Blood Tests: To check the health of your kidneys and for signs of a kidney or blood infection.
- Imaging Tests: To check for kidney stones in your urinary tract . Imaging tests may include a CT scan or an ultrasound.
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How Do Health Care Professionals Treat Kidney Stones
Health care professionals usually treat kidney stones based on their size, location, and what type they are.
Small kidney stones may pass through your urinary tract without treatment. If youre able to pass a kidney stone, a health care professional may ask you to catch the kidney stone in a special container. A health care professional will send the kidney stone to a lab to find out what type it is. A health care professional may advise you to drink plenty of liquids if you are able to help move a kidney stone along. The health care professional also may prescribe pain medicine.
Larger kidney stones or kidney stones that block your urinary tract or cause great pain may need urgent treatment. If you are vomiting and dehydrated, you may need to go to the hospital and get fluids through an IV.
Diagnosis: Too Much Calcium In The Urine
Possible treatments:
Thiazide diuretics
These drugs help to decrease urine calcium excretion. They also help to keep calcium in the bones, reducing the risk for osteoporosis. The most common side effect of thiazide diuretics is potassium loss, so in many cases your doctor will prescribe a potassium supplement to go along with the thiazide diuretic.
Lower sodium intake
The human body carefully regulates its sodium levels. When excess sodium is excreted in the urine, calcium is also excreted proportionally. In other words, the more sodium you consume, the more calcium that will be in your urine. Your goal should be to reduce your sodium intake so that you consume less than 2 grams of sodium per day. Watch out for silent sources of salt, such as fast foods, packaged or canned foods, softened water and sports drinks.
Normal calcium diet
People who form stones sometimes think that because there is too much calcium in their urine, they should restrict their calcium intake. There is no research that supports this practice. Your body needs dietary calcium to support the skeleton. You should be encouraged to consume two servings of dairy or other calcium-rich foods to maintain bone stores of calcium.
Increase fluid intake
No matter what your diagnosis, you should drink enough water to produce at least 2 liters of urine per day.
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Prevention Of Future Stones
Once your health care provider finds out why you are forming stones, he or she will give you tips on how to prevent them. This may include changing your diet and taking certain medications. There is no “one-size-fits-all” diet for preventing kidney stones. Everyone is different. Your diet may not be causing your stones to form. But there are dietary changes that you can make to stop stones from continuing to form.
Diet Changes
Drink enough fluids each day.
If you are not producing enough urine, your health care provider will recommend you drink at least 3 liters of liquid each day. This equals about 3 quarts . This is a great way to lower your risk of forming new stones. Remember to drink more to replace fluids lost when you sweat from exercise or in hot weather. All fluids count toward your fluid intake. But it’s best to drink mostly no-calorie or low-calorie drinks. This may mean limiting sugar-sweetened or alcoholic drinks.
Knowing how much you drink during the day can help you understand how much you need to drink to produce 2.5 liters of urine. Use a household measuring cup to measure how much liquid you drink for a day or two. Drink from bottles or cans with the fluid ounces listed on the label. Keep a log, and add up the ounces at the end of the day or 24-hour period. Use this total to be sure you are reaching your daily target urine amount of at least 85 ounces of urine daily.
Reduce the amount of salt in your diet.
Eat the recommended amount of calcium.
When Is It Ordered
Kidney stone analysis is ordered when you have passed a kidney stone and it has been filtered out of the urine or when a stone has been removed from your urinary tract.
Sometimes, your healthcare practitioner may;suspect that you have a kidney stone and will search for a stone either in voided urine or within your body using imaging tests when you have signs and symptoms such as:
- Severe pain in the side of the back that may move to the groin
- Abdominal pain
- Uric acid
- Struvite stones associated with a bacterial infection
These four types make up about 95% to 99% of kidney stones, with calcium oxalate stones being the most common.
Less common stones include:
- Cystinestones associated with an inherited excess of cystine excretion
- Drug-relatedstones that are associated with drugs such as guaifenesin, indinavir, triamterene, atazanavir, and sulfa drugs
However, stone analysis does not give the reason that the stone formed.
You may have an underlying disease or condition that may produce and/or release an excess of a specific chemical into the urine. Not drinking enough fluids and/or having urine with a high or low pH can contribute to your risk of forming stones. Preventing kidney stones from developing again depends upon identifying and addressing the cause of stone formation.
In general, if you have;a:
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Tips For Seeing Your Doctor About A Kidney Stone
If you suspect you have a kidney stone, here are some ways to prepare for your doctors appointment:
- Write down your symptoms and questions you want to ask your doctor.
- Be prepared to talk about any underlying medical conditions you have, as well as your medical history and medication youre taking, says Shidham.
- Keep track of how much you drink throughout the day, says Daniel Marchalik, MD, a urologist and director of ambulatory urologic surgery at MedStar Washington Hospital Center in Washington, DC.
- Share information about your dietary habits, which can raise of lower your risk of kidney stones, adds Dr. Marchalik.
- Send or bring prior medical reports, including results of imaging tests and laboratory work, says Prakash N. Maniam, MD, a urologist at Poinciana Medical Center in Kissimmee, Florida.
- Drink some water so youre ready to give urine sample for your doctor to examine, says Dr. Maniam.
- If you pass a kidney stone, keep it and bring it to the appointment so doctors can analyze it and identify what kind it is, says Marchalik.