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Kidney stones - Introduction

Description

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

Alternative Names

Calcium stones; Nephrolithiasis

Introduction:

Kidney stones are hard, solid particles that form in the urinary tract. In many cases, the stones are very small and can pass out of the body without any problems. However, if a stone (even a small one) blocks the flow of urine, excruciating pain may result, and prompt medical treatment may be needed.

The process of urination begins in the kidneys. The kidneys filter out fluids and waste from the body, producing urine. As the urine passes through the kidneys, it becomes more concentrated. From the kidneys, urine flows from through thin tubes called ureters into the bladder. The bladder's stretchy walls expand to store the incoming urine until it leaves the body through a tube called the urethra.

The two kidneys are located deep behind the abdominal organs, below the ribs and toward the middle of the back.

The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulating red blood cell production.
Kidney anatomy



Click the icon to see an image of the urinary tract.

Types of Kidney Stones

Occasionally, various salts build up on the inside surfaces of the kidney and form crystals. Eventually these crystals become large enough to form stones in the kidney, a condition called nephrolithiasis. Kidney stones (renal calculi) may also form in the ureter or the bladder. Combinations of minerals and other chemicals, some derived from a person's diet, make up the salts in these stones.



Click the icon to see an image of the kidney stones.

Calcium Stones. About 70 - 90% of all kidney stones are made of calcium, usually combined with oxalate, or oxalic acid. A number of common vegetables, fruits, and grains contain oxalate.

About 6% of calcium stones are made of calcium phosphate (called brushite).

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. Uric acid enters the bloodstream, and then passes primarily into the kidneys. From the kidneys, uric acid leaves the body in the urine. Often, uric acid stones occur with calcium stones.

Struvite Stones. Struvite stones are made of magnesium ammonium phosphate. They are almost always associated with certain urinary tract infections. Worldwide, they make up to 30% of all kidney stones. In the United States, however, fewer than 15% of all stones are struvite. Most struvite stones occur in women. The rate of these stones may be declining in America, perhaps because of better control of urinary tract infections.

Cystine Stones. A build-up of the amino acid cystine, a building block of protein, causes 1% of kidney stones in adults and up to 8% of stones in children. The tendency to form these stones is inherited. Cystine stones are marked by rapid growth and recurrence, which, if not treated promptly, can eventually lead to kidney failure.

Xanthine Stones. Other kidney stones are composed of xanthine, a nitrogen compound. These stones are extremely uncommon and usually occur as a result of a rare genetic disorder.


Kidney stones
Click the icon to see an animation about kidney stones.

Resources

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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