Kidney stones are hard deposits that form within the kidneys, composed of various minerals and salts. These formations are a common health concern, and while some individuals may experience no symptoms, others endure considerable discomfort. The ability to live with a kidney stone depends on its size, location, and the symptoms it causes, presenting a nuanced picture for affected individuals.
What Are Kidney Stones?
Kidney stones, also known as renal calculi or nephrolithiasis, are solid masses that develop from crystal-forming substances in urine. These substances, such as calcium, oxalate, uric acid, and phosphate, can become concentrated and crystallize if there is insufficient fluid in the urine.
The most common type of kidney stone is calcium oxalate, due to dietary, genetic, and medical factors. Uric acid stones, another type, are frequently associated with conditions like gout or diets high in animal protein. Struvite stones can form due to urinary tract infections, while cystine stones are linked to a rare genetic disorder called cystinuria. Stones can range in size from a grain of sand to larger formations, sometimes reaching significant sizes.
Symptoms and Diagnosis
Kidney stones often remain undetected until they begin to move within the kidney or enter the ureter, the narrow tube connecting the kidney to the bladder. This movement can cause severe pain, commonly known as renal colic, which typically manifests in the side and back, below the ribs, and may radiate to the lower abdomen. Other symptoms include blood in the urine, nausea, vomiting, a frequent urge to urinate, or a burning sensation during urination.
Diagnosis begins with a medical history and physical examination, followed by various tests. Urine tests can detect blood, stone-forming crystals, or signs of infection. Blood tests help assess kidney function and identify high levels of minerals that contribute to stone formation. Imaging tests, such as CT scans and ultrasounds, are important for determining the stone’s size, shape, location, and whether it is obstructing urine flow.
Approaches to Living with Kidney Stones
For very small kidney stones that do not cause significant pain or urinary obstruction, a “wait and see” approach is often an option. These smaller stones, typically under 5 millimeters, have a high chance of passing naturally through the urinary tract. During this period, medical guidance is important to manage symptoms and monitor stone progression.
Strategies for managing the process at home often involve increased fluid intake, especially water, to flush the stone. Over-the-counter pain relievers can alleviate discomfort, while prescription medications, such as alpha-blockers, are prescribed to relax the ureter and facilitate stone passage. Hydration and pain management are central to living with a small, passing kidney stone.
When Treatment Becomes Necessary
While some kidney stones pass on their own, medical intervention becomes necessary in several situations. These include persistent severe pain, complete obstruction of urine flow, signs of infection, or evidence of kidney damage. Stones that are too large to pass naturally, typically those greater than 10 millimeters, also require treatment.
Various treatments are available, depending on the stone’s size and location. Shock wave lithotripsy (SWL) uses high-frequency sound waves to break the stone into smaller fragments. Ureteroscopy involves inserting a thin, lighted scope through the urethra and bladder into the ureter to either remove the stone with a basket-like device or break it with a laser. For very large or complex stones, percutaneous nephrolithotomy (PCNL) is performed, where a small incision in the back allows direct access and removal.
Preventing Recurrence
Preventing future kidney stones involves a combination of lifestyle adjustments and, in some cases, medication. Adequate hydration is a primary recommendation, aiming for enough fluid intake to produce 2.5 liters of urine daily. Water is preferred, but citrus juices like lemonade and orange juice also contribute to prevention by increasing urinary citrate.
Dietary modifications are tailored to the stone type. For calcium oxalate stones, limiting sodium intake to less than 2,000 milligrams per day reduces calcium excretion. Reducing animal protein and consuming calcium-rich foods with oxalate-rich foods is also beneficial. Individuals prone to uric acid stones should limit purine-rich foods like red meat and shellfish, and reduce sugar-sweetened beverages. Medications like potassium citrate are prescribed to help prevent stone formation in some cases.