Understanding kidney stones
[6 MIN READ]
In this article:
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Kidney stones affect one million people every year. They are solid, pebble-like calcifications that range in size from as tiny as a grain of sand to as large as a golf ball.
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Most kidney stones are caused by inadequate fluid intake. However, a family history of kidney stones or eating excessive salt, animal proteins and certain high-oxalate foods (e.g., beets, rhubarb and chocolate) can also cause kidney stones to form.
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A urology expert at Providence explains how kidney stones form, outlines treatment options and shares tips to prevent this common condition from affecting your health.
Understanding kidney stones
Despite the many sayings and jokes to the contrary, having a kidney stone doesn’t actually make you a rock star. Passing one is not the same as giving birth, and kidney stones are not your body’s way of starting its own geology collection.
Kidney stones are a common condition, affecting one million people every year, according to the American Medical Association. Although roughly one in 10 people will experience kidney stones at least once in their lifetime, the condition is often misunderstood and frequently ignored. And that can hurt your health.
We talked to Joshua Gottlieb, D.O., a urologist at PMI Urology Alameda, to learn more about the warning signs of kidney stones, treatment options and how to prevent them from forming. Here’s what he shared.
What are kidney stones?
Kidney stones are solid, pebble-like calcifications that form in your kidneys when your urine contains more crystal-forming substances than it can dilute. Over time, those crystals can develop into stones, explains Dr. Gottlieb.
Kidney stones vary in shape and size. They may be as small as a grain of sand or, in rare cases, larger stones can be the size of a golf ball. They can be jagged or smooth and are typically brown or yellow.
There are several different types of kidney stones. Their cause depends on the type of stone.
- Calcium oxalate stones are the most common type of kidney stones. They develop when the extra calcium that isn’t needed remains in your kidneys and joins with other waste products to form a kidney stone. Aside from chronic dehydration, these stones can form for multiple reasons.
- Cystine stones are the result of a disorder called cystinuria. The condition causes the amino acid cystine to leak from your kidneys into your flow of urine.
- Struvite stones typically form after repeated urinary tract infections. If left untreated, they may grow into large stones.
- Uric acid stones form when your urine contains excessive uric acid, or when the pH of the urine is too acidic. They are more common in men than in women and may occur with diabetes, gout, or after chemotherapy.
Symptoms of kidney stones
Many people do not experience symptoms until the kidney stone becomes stuck in the small tube that carries urine into their bladder, called the ureter. If this happens, the stone can prevent your kidneys from expelling the urine, causing a blockage, severe pain and potentially infection. An obstructed and/or infected kidney can cause stress to your kidney function.
Severe pain that starts and stops suddenly is the most common sign of kidney stones, according to the National Institutes of Health. The pain typically begins in your back, flank or belly. It may move to the groin area and cause testicle or vaginal pain.
Other symptoms of kidney stones include:
- Abnormal urine color
- Blood in the urine
- Chills
- Fever
- Nausea and vomiting
What are the causes of kidney stones?
"Most kidney stones are due to chronic dehydration from not drinking enough fluids,” says Dr. Gottlieb.
Other contributing factors include:
- High salt diet
- Eating excessive amounts of animal protein
- High oxalate foods, such as beets, spinach, rhubarb, almonds, nuts and chocolate
- Family history of kidney stones
Some medical conditions can also increase the risk of kidney stones, including:
- Diabetes
- Obesity
- Metabolic syndrome
- Gout
- Chronic diarrhea
- Intestinal malabsorption
- Chronic urinary tract infections
When are kidney stones dangerous?
“If you have an active urinary tract infection while having a kidney stone episode, this is a dangerous situation, and you should proceed to the emergency room,” says Dr. Gottlieb. Symptoms can include dysuria (burning with urination), bladder pain or fevers (temperature >100.4 degrees Fahrenheit). The most concerning symptom is fever.
If infected urine remains blocked in the kidney, you can develop sepsis very quickly, Dr. Gottlieb explains. This situation often requires an urgent minor procedure called cystoscopy with ureteral stent placement to prevent infected urine from being blocked behind the obstructing stone.
During this procedure, a small camera is placed in the bladder, and a soft tube (ureteral stent) is passed into the ureter and kidney. This helps prevent you from getting sicker and also prevents pain episodes due to the obstructing stone. Once the infection has been fully treated, the procedure to remove the stone is usually performed at least two weeks later.
Preventing kidney stones
There are several strategies you can use to lower your risk of kidney stones, according to Dr. Gottlieb. The most important one is getting enough fluids.
“Hydration is the best prevention for kidney stones. Patients who have already had kidney stones should be drinking two to three liters of water every day. Adding lemon juice to your water can also help by increasing the citrate in your urine,” he explains. “Preventing obesity, diabetes and metabolic syndrome will also reduce the risk factors that can lead to kidney stones.”
Kidney stone treatment
Treatment options for kidney stones depend on the severity of your symptoms and the type of kidney stone.
“It is reasonable to attempt passing small kidney stones when the stone is less than one centimeter, there is no urinary tract infection, the pain is manageable with oral medications and there is not excessive strain on the kidney,” says Dr. Gottlieb.
“If the kidney stone is too large or simply is not passing on its own, it can be necessary for a urologist to perform a procedure to break up or remove the stone,” he continues. "Stones in the kidney that are not causing any blockage of urine, urinary tract infection or severe pain can be monitored and removed electively.”
“For patients who have already made kidney stones, we typically recommend a special test to collect urine for 24 hours. The urine test is done at home. It gives a specific breakdown of the components in your diet and urine that are leading to kidney stone formation. This test is also quite useful in determining how to prevent future kidney stones,” says Dr. Gottlieb.
Common treatment options for kidney stones include:
- Ureteroscopy with laser lithotripsy: A tiny camera is placed into your bladder, ureter and/or kidney. The camera is used to visualize the kidney stone, and the laser breaks the stone into dust or small fragments that are easily removed. The procedure requires general anesthesia, and you will typically go home the same day.
- Extracorporeal shock wave lithotripsy (EWSL): External shock waves are directed through your body over the stone’s location to break it into smaller pieces that are easier to pass on their own. You will typically go home the same day.
- Percutaneous nephrolithotomy (PCNL): A direct channel is created from the skin on your back to the kidney. Special tools are then used to break apart, suction and remove large stones from your body. The procedure is typically used on kidney stones two centimeters or larger and commonly requires an overnight stay in the hospital.
“Our expert team at Providence Urology offers every available surgical intervention to treat kidney stones,” says Dr. Gottlieb.
Contributing caregiver
Joshua Gottlieb, D.O., is a fellowship-trained urologist at PMI Urology Alameda. Dr. Gottlieb has also served as an investigator on several research projects and presented at multiple national medical conferences. His work has appeared in over 15 peer-reviewed publications.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
