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Kidney stones - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of kidney stones.

Alternative Names

Calcium stones; Nephrolithiasis

Highlights:

Overview:

The kidneys filter out fluids and waste from the body, producing urine. The two kidneys are located deep behind the abdominal organs, below the ribs and toward the middle of the back.
Kidney stones are hard, solid particles that form in the urinary tract. If a stone (even a small one) blocks the flow of urine, excruciating pain may result, and prompt medical treatment may be needed.

Types of Stones:

Calcium Stones. About 70 - 90% of all kidney stones are made of calcium.
Uric Acid Stones. Uric acid is responsible for close to 10% of kidney stones. It is the breakdown product of purines, nitrogen compounds found in our bodies and in certain foods.
Struvite Stones. Struvite stones are almost always associated with certain urinary tract infections.
Cystine Stones. Cystine is an amino acid, a building block of proteins. The tendency to form these stones is inherited.
Xanthine Stones. These stones are extremely uncommon and usually occur as a result of a rare genetic disorder.

New Drug:

In 2009, the U.S. Food and Drug Administration approved febuxostat (Uloric) to treat gout. It is the first new treatment for gout in 40 years. Febuxostat lowers uric acid levels by inhibiting the same enzyme as allopurinol.

Treatment:

Treatments include:

In about 85% of patients, the kidney stones are small enough that they pass through normal urination, usually within 2 - 3 days.
If the stone has not passed in 2 - 3 days, the patient will need additional treatments. In some severe cases, hospitalization may be necessary.
Alpha blockers (such as tamsulosin) can relax muscles in the urinary tract, helping kidney stone pass.
Depending on the type of kidney stone, dietary changes, medicines, and other noninvasive treatments are available.
Surgery is usually needed if the stone is too large to pass on its own, if there are signs that the stone is growing, or if the stone is blocking the urine flow and causing a urinary tract infection or kidney damage.
Treatments for stones are much less invasive than in the past. Major surgery is performed in less than 2% of patient.

Resources

www.kidney.niddk.nih.gov -- National Kidney and Urologic Diseases Information Clearinghouse
www.urologyhealth.org -- American Urological Association
www.kidney.org -- National Kidney Foundation
www.ohf.org -- Oxalosis and Hyperoxaluria Foundation

References

Cameron MA, Maalouf NM, Adams-Huet B, Moe OW, Sakhaee K. Urine composition in type 2 diabetes: predisposition to uric Acid nephrolithiasis. J Am Soc Nephrol. 2006 May;17(5):1422-1428. Epub 2006 Apr 5.

Cameron MA, Sakhaee K. Uric acid nephrolithiasis. Urol Clin North Am. 2007;34(3):335-346.

Chandhoke PS. Evaluation of the recurrent stone former. Urol Clin North Am. 2007; 34(3):315-322.

Finkielstein VA. Strategies for preventing calcium oxalate stones. CMAJ. 2006;174(10):1407-1409.

Krambeck AE, Gettman MT, Rohlinger AL, Lohse CM, Patterson DE, Segura JW. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup. J Urol. 2006;175(5):1742-1747.

Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. In: Wein AJ, ed. Wein: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders; 2007:chap 44.

Miller NL, Evan AP, Lingeman JE. Pathogenesis of renal calculi. Urol Clin North Am. 2007; 34(3):295-313.

Monk RD, Bushinsky DA. Kidney Stones. In: Kronenberg HM, Shlomo M, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008.

Pietrow PK, Preminger GM. "Evaluation and Medical Management of Urinary Lithiasis." In: Wein AJ, Kavoussi LR, Novick AC, et al. (eds.) Wein: Campbell-Walsh Urology, 9th ed. Philadelphia, PA: Saunders; 2007.

Sinha MK, Collazo-Clavell ML, Rule A, et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney International. 2007;72:100-107.

Straub M, Hautmann RE. Developments in stone prevention. Curr Opin Urol. 2005;15(2):119-126.

Taylor EN, Stampfer MJ, Curhan GC. Fatty acid intake and incident nephrolithiasis. Am J Kidney Dis. 2005;45(2):267-274.

Taylor EN, Stampfer MJ, Curhan GC. Obesity, weight gain, and the risk of kidney stones. JAMA. 2005;293(4):455-462.

Taylor EN, Stampfer MJ, Curhan GC. Diabetes mellitus and the risk of nephrolithiasis. Kidney Int. 2005;68(3):1230-1235.

Wasserstein AG. Nephrolithiasis. American Journal of Kidney Diseases. 45(2);2005:422-428.

Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am. 2007;34(3):409-419.

Reviewed last on: 7/27/2009
Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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