Kidney Stones

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Definition/Description

Nephrolithiasis also known as kidney stones "are hard masses developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemical that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, and stone can start to form. If crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed. If the stones are unable to pass with the urine, further medical attension is needed." 

Prevalence

• 17% of all the population will have kidney stones in his or her life.
• If affects both males and females. 12% of males and 5% of females are likely to experience kidney stones within their lifetime. 
• Average onset of kidney stones is over the age or 30 years old.
• People who have had kidney stones previously are at an increased risk to have a second episode of kidney stones.

 

Characteristics/Clinical Presentation

Kidney Stones can be one of the most painful of the urologic disorders and kidney stone have been increasing in the population over the past 30 years. "In the 1970s, less than 4 percent of the populations had stone-forming disease. By the early 1990s, the portion of the population with this disease has increased more than 5 percent."  Doctors are uncertain why these stones form is particular people but not others. Kidney stones usually do not have one defined cause, some common theories are that certain foods may cause stones to form, family history of kidney stones, infection, other kidney disorders and some metabolic disorders. .

Common Signs and Symptoms:

• "Severe pain in the side or back that will not go away"
• Pain that spreads to the lower abdomen/groin
• Pain with urination
• Pink, red, brown or cloudy urine
• Nausea and vomiting
• Persisten urge to urinate
• Fever and chills
• Urine that smells bad
  

Stones usually will begin causing these common signs and symptoms once the stone is blocking the outflow of the urine from the kidney into the bladder. 

Associated Co-morbidities

• As of now, not enough research has been completed on kidney stones to link any co-morbidities to this disorder. Research is currently being analysis to see if there is a connection between a history of kidney stones and Chronic Kidney Disease. 

• Risk Factors for Kidney Stones: (MayoClinic)
• <uFamily History/personal history
• Being over the age of 30 years old
• Male
• Dehydration
• Diet
• Digestive disease
• History of digestive surgeries
• Rental Tubular Acidosis
• Cystinuria
• Hyperparathyroidism
• Urinary Tract Infections
  
  <u

Medications

Medication is often not needed when dealing with a kidney stone. Doctors will commonly prescribe pain medication for a kidney stone because passing a small stone can be very painful. The doctor usually orders the patient to drink "2 to 3 quarts of water a day" to help pass the stone through the urinary system.  If the patient is unable to pass the stone naturally surgical intervention may be needed.

Things to consider before Surgery:

1. The stone does not pass after a considerable amount of time

2. The stone is too large to pass

3. Does the stone block urine flow?

4. Is the stone causing an ongoing infection in the urinary tract?

5. Is the stone causing damage to the tissue or constant bleeding

6. Has the stone grown larger?

Surgical Inventions:

• Extracorporeal Shock Wave Lithotripsy
• Percutaneous Nephrolithotomy
• Ureteroscopic Stone Removal
• Open Surgery

Diagnostic Tests/Lab Tests/Lab Values

• Blood Tests: 

Blood tests are one of the first lab tests that will be performed if kidney stones are thought to be present. Blood tests can help the doctor to check the function of the kidneys, check for infection, calcium or uric acid levels and can also check for other medical conditions. , 

• Urine Tests:

Urine can be sent for a urinalysis and culture to check for infection within the urinary tract.

• Imaging Tests:

X-rays are often performed of the abdomen to see if a calcification in the area of the kidneys or ureters can be seen to be as an obstructing stone. This is very simple, painless, cost affective way to diagnosis kidney stones. 

• Ultrasound:

• Analysis of passes stones:
  

When people are thought to have kidney stones, often they will be given a strainer to catch stones that may pass with urine. This is a good way to analysis what kind of stone was formed and maybe what caused the stone to form in the first place. Since there is an increased risk for people that have had stone before knowing what caused their formation of their first stone is the primary way of preventing future stones from forming. (Mayoclinic)

Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

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