Kidney stones also called renal lithiasis and ureteral stones (kidney stones that have moved to the ureters) are both a type of stone disease, otherwise known as urolithiasis. Stone disease is the most common type of urological disorder and is believed to be the most painful. 

Kidney and ureteral stones are formed from dissolved substances in the urine. They concentrate in the urine to form solid crystals that can lead to stones when materials in the urine build up around them. This is buildup is known as cystolithiasis. Most kidney stones are made up of calcium oxalate or calcium phosphate, but they can also contain cysteine, uric acid, or struvite.

Possible Causes of Kidney and Ureteral Stones

Kidney and ureteral stones can form when the healthy balance of substances in the urine, like water, minerals, and salts, is disturbed. There are different types of stones, but the most common type, the calcium type, forms when there is a change in the calcium levels in urine.

Although the cause of stones may be difficult to determine, there are some factors that can increase the risk of stones. 

  • Lack of fluid Intake: If you don’t drink enough water, substances in the urine are more likely to stick together and form stones. If you’re at risk for stone disease or have a history of kidney stones, you should drink 2 to 3 liters of water every day. Ask your doctor if it’s okay for you to drink fluids other than water to reach your fluid intake.
  • A diet high in protein, sodium, and oxalate-rich foods: If you are susceptible to stones, you may want to reduce sodium and animal protein. Eat plenty of calcium and avoid high-oxalate foods, like spinach, kale, and nuts.
  • Medical conditions: Medical conditions, like inflammatory bowel disease and gout, can affect the normal balance of urine.
  • Weight: If you are overweight, you’re at risk for both insulin resistance and increased calcium in your urine, and both things can lead to kidney stones.
  • Hormonal imbalance: Rarely, an increase in the hormones produced by the parathyroid glands can lead to hypercalcemia (excess calcium), which can cause stones to form.
  • Excess vitamin D could be a risk factor for kidney and urinary stones.

Heredity is an important predictor of the development of kidney stones. If someone in your immediate family has had kidney stones, you are more likely to develop them as well.

Signs and Symptoms of Kidney and Ureteral Stones

Just having kidney stones may not cause any symptoms, but when they begin to move or pass into your ureter (ureteral stones), you will likely experience symptoms.

Signs and symptoms of kidney and ureteral stones may include:

  • Pain in the back and side, often just below the ribs
  • Pain that changes, for example:
  • Pain spreads to the lower abdomen and possibly the groin
  • Pain comes in waves
  • Pain changes in intensity
  • Pain shifts locations
  • Pain with urination
  • Nausea and/or vomiting
  • More frequent urination
  • Urine that is cloudy or has a strong, foul smell
  • Blood in the urine

You may also have a fever and/or chills if you have an infection along with your stones. Consult the Doctor If you have any of the above signs or symptoms of kidney or ureteral stones.

Seek immediate medical advice if you have the following symptoms:

  • Pain that is accompanied by nausea and vomiting, fever, or chills
  • Severe pain that makes finding a comfortable position difficult
  • Blood in your urine
  • Difficulty urinating

Diagnosing Kidney and Ureteral Stones 

Our Consultant Urologist at t Westminster Ortho Med Clinic may suspect kidney or ureteral stones based on your symptoms alone; however, tests are usually required to make an official diagnosis. 

Diagnostic tests for kidney and ureteral stones include:

  • Imaging tests – X-rays can help diagnose some stones, but they may miss smaller stones. CT scans of the urinary tract are often used to help diagnose kidney and ureteral stones. An ultrasound can sometimes help diagnose stones as well.
  • Blood tests – Blood tests cannot tell whether you have stones, but they can reveal high levels of calcium and uric acid in the blood, which can aid in diagnosis. Blood tests can also help our Urologist to monitor how healthy your kidneys are.
  • Urine tests – Urine tests can help find stone-forming particles in your urine and may also reveal if you have too few substances that help prevent stones.

Treating Kidney and Ureteral Stones 

The treatment of kidney or ureteral stones will depend on how large the stones are, how severe the symptoms are, type and the cause of the stones . 

Most kidney stones can be managed with fluid intake and pain relievers. Some will require medication to help pass the stones quickly and with less pain. Most people who have stones will not require surgery or medical procedures to remove or destroy the stones.

Treating small stones with mild symptoms:

Our Consultant Urologist may recommend the following to treat small stones without many symptoms:

  • Drinking water – It is important to drink plenty of fluids when you have kidney or ureteral stones. Most doctors recommend about 2 to 3 liters of water per day. This is meant to flush your urinary tract system. Talk to our Urologist about how much fluid you should be drinking and whether any of that fluid can be in a form other than plain water.
  • Taking pain relievers – Because passing even small stones can cause pain, our doctor may recommend over-the-counter pain relievers to help you manage the pain and discomfort.
  • Taking medications to help you pass the stones – Our Urologist may recommend a medication called an alpha-blocker to help you pass your kidney stones. It helps relax the muscles in your ureter, which should reduce pain and help you pass the stone more quickly.

Treating larger stones or stones with more severe symptoms or risks of complications:

If the stones are large with severe symptoms, or the type of stone puts you at higher risk for complications, you may need to have a medical or surgical procedure. 

Those procedures include:

  • SHOCK WAVE LITHOTRIPSY (SWL)

This procedure, also known as extracorporeal shock wave lithotripsy or ESWL, uses a machine called a lithotripter to break up stones. The machine delivers ultrasonic waves through the skin to the stones to break them up. 

  • PERCUTANEOUS NEPHROLITHOTOMY (PNL)

This is a surgery to remove large kidney stones. It is done under general anesthesia in the hospital. Nephrolithotomy, also known as endoscopic removal of kidney stones, is done using a tiny, lighted telescope and instruments that are inserted through an incision on your back.

  • URETEROSCOPY (URS)

This procedure uses a ureteroscope (a thin tube with a light on it) to locate a stone in the kidney or ureter. During the procedure, the surgeon will insert the ureteroscope into your urethra and through the urinary tract until the stone is located. Once the surgeon can see your stone, he can use a tool to either grab the stone and remove it or to break it into tiny pieces you will be able to pass when you urinate. 

  • SURGERY TO REMOVE PARATHYROID TUMORS

Some kidney stones are caused by a condition called hyperparathyroidism, which is overactive parathyroid glands. The parathyroid glands produce parathyroid hormone, but when they produce too much, calcium levels in the body can increase. When you have too much calcium in your body, kidney stones may form. Sometimes, hyperparathyroidism is caused by small, non-cancerous tumors that form on the parathyroid glands. These tumors often lead to an overproduction of parathyroid hormone. In this case, removing the tumor from the gland should stop the overproduction of the hormones and in turn reduce calcium levels in the body.

Preventing Kidney and Ureteral Stones 

The most important thing you can do to prevent kidney and ureteral stones is to drink lots of fluids. Drinking fluids helps you pass more urine, which is important in preventing stones. Most doctors will recommend that you pass about 2.5 liters of urine every day to keep your urinary tract flushed. The amount of fluid you’ll need to drink to pass that much urine depends on factors such as how hot and dry the climate is and how much you exercise. 

For most people, drinking 2 to 3 liters of fluid every day should be enough. If you’re at high risk of forming stones, Our Doctor may recommend you measure your urine output for a while to make sure you’re making enough. The color of your urine should help you know whether you’re drinking enough fluids. Urine should be light and clear. If your urine is dark or cloudy, you probably need to increase your fluids.

The lifestyle changes you can make to reduce your risk of developing stones are:

  • Reduce oxalate-rich foods: If you have had calcium oxalate stones (which are the most common form), limiting or eliminating certain foods can help reduce your risk for stone formation. Some of those foods are spinach, Swiss chard, rhubarb, nuts, wheat germ, soy products, sweet potatoes, beets, chocolate, and tea.
  • Eat less animal protein: Cut down on animal protein, such as meat, eggs, and fish, and increase your intake of non-animal protein, such as beans and legumes.
  • Reduce sodium intake: A diet low in sodium can help you reduce your risk of forming stones. Most processed foods have a lot of sodium, so limiting those can help.
  • Eat calcium-rich foods, but limit calcium supplements: It’s important to eat calcium-rich foods unless your doctor tells you not to. But ask your doctor before taking calcium supplements. If you need supplemental calcium, be sure to take it with food.
  • Control your weight: Since being overweight is a risk factor for stone disease, take steps to keep your weight at an optimal level. If you are overweight, talk to our doctors about healthy ways to lose weight.

If you have any signs or symptoms of kidney or ureteral stones, contact our Clinic to Consult our Urologist to set up an appointment to discuss your treatment choices.

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