Original Editors - Suzanne Shelburne from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Introduction[edit | edit source]
Kidney stones (also termed urolithiasis, nephrolithiasis) are hardened deposits of minerals that form in the kidneys and can cause pain as they pass through the urinary tract. Kidney stones do not usually cause permanent damage if recognized early and treated appropriately.
Epidemiolgy[edit | edit source]
Most patients tend to present between 30-60 years of age. Lifetime incidence of renal stones is high: approx. 5% of women and 12% of males.
- By far the most common stone is calcium oxalate, however, the exact distribution of stones depends on the population and associated metabolic abnormalities.
- 17% of all the population will have kidney stones in his or her life.
- People who have had kidney stones previously are at an increased risk to have a second episode of kidney stones.
Clinical Presentation[edit | edit source]
Kidney Stones can be one of the most painful urologic disorders and kidney stone have been increasing in the population over the past 30 years. This fact is attributed to the increasing incidence of obesity due to poor dietary habits and lack of physical activity.
Although some renal stones remain asymptomatic, most will result in pain.
- The common symptoms associated with kidney stones, including acute pain radiating to the groin, occurs once the stone begins descending the ureters from the kidneys. Described as dull, colicky, sharp, and severe pain. The pain is often associated with nausea and vomiting due to the severity of pain.
- Hematuria, although common, may be absent in approximately 15% of patients.
- If the stone becomes infected, patients may develop fever, chills, or other signs of worsening systemic signs of infection (i.e., shock).
Risk Factors[edit | edit source]
Kidney stones often have no single, definable cause. Multiple factors can contribute, some of which are controllable and others of which are not
- Personal history of prior kidney stones increases the risk of kidney stones by 15% within the first year, and 50% within the next ten years.
- A family history of kidney stones increases the risk by 2.5 times.
- Hyperoxaluria: high dietary oxalate (vegetarians); low gut absorption of calcium, leading to increased absorption of oxalate; low dietary intake of calcium; malabsorption / ileal disease (e.g. Crohn disease)
- Urinary tract infections altering urinary pH in the setting of urease-producing bacteria, producing struvite crystals
- Dehydration is a major contributing factor to all types of kidney stones. Inadequate fluids increase the concentration of compounds in the urine, some of which can crystallize and form into hardened masses.
- Diet can also play a part, including the high intake of animal proteins, sodium, and sugars.
- Others are caused by genetic conditions passed from parent to child. Diabetes and obesity can also contribute.
Diagnosis[edit | edit source]
If a kidney stone is suspected the doctor will review clients symptoms and medical history and gently palpate the affected area.
- Laboratory tests to assess renal function, including either a basic or comprehensive metabolic panel, may be used. Additionally, a urinalysis, urine electrolytes, and urine pH can help direct towards a specific type of stone.
- Stone Analysis: Any passed stones will be sent to the lab for analysis. Determining the composition and cause of the stone helps in management.
Systemic Involvement[edit | edit source]
Kidney Stones are usually not a medical emergency and will pass with normal flow of the urine, therefore does not have major systemic involvement with the rest of the body.  However, kidney stone have been linked to several disorders such as connective tissue disorders, gastric disorders, metabolic syndrome disorder, immunologic disorders and eating disorders.
- Sarcoidosis: Raised serum calcium level in 2-63% of sarcoidosis patients due to overproduction of vitamin D by sarcoid granulomas, which can lead to kidney stones as a result of abnormal calcium metabolism."
- Crohn's disease The incidence of kidney stones is increased in Crohn's disease because of malabsorption of fat and bile salts. Patients who have Crohn's disease are likely to form calcium oxalate stones due to the unabsorbed long-chain fatty acids that bind calcium in the kidney. 
- Metabolic Syndrome: Patients with metabolic syndrome have a highly acidic urine, which can cause formation of uric acid kidney stones, which can be hard to detect because these kind of stones will not shoe up on a regular abdominal x-ray, often leading to increased growth of the stone. 
- Anorexia & Bulimia: Patients that have a eating disorder such as anorexia or bulimia usually will develop kidney stones during their life. "Fasting, repeated cycle of vomiting and the use of laxative will result in a loss of fluid and crucial electrolytes from the body. Chronic dehydration and low potassium level can lead to kidney stones and even kidney failure." 
Medical Management[edit | edit source]
If the stones are too large to pass naturally or is blocking the flow of urine then other methods need to be explored. The first option is usually medication but if this proves unsuccessful then surgery may be considered.
Indications for surgical management include:
- larger stones, typically those above 5 mm in size
- extended duration of symptoms
- location of the stone, with proximal calculi less likely to spontaneously pass
- infection or septic features
- certain professions (airline pilot, truck driver) due to the risk of renal colic during work
- solitary kidney
- failed conservative management
Physiotherapy[edit | edit source]
Kidney Stones are managed medically but physical therapist can play an important role in screening patients for kidney stones and helping these patient seek proper medically attention. However, kidney stones can present as a musculoskeletal problem therefore therapist should be aware of some of the key questions and evaluation techniques to screen for kidney stones.
Below is a 1.16 minute video on Kidney stones.
References[edit | edit source]
- Radiopedia Urolithiasis Available:https://radiopaedia.org/articles/urolithiasis?lang=us (accessed 1.4.2022)
- Very well health What Are Kidney Stones? Available:https://www.verywellhealth.com/kidney-stones-5212960 (accessed 1.4.2022)
- MayoClinic Website. Kidney Stones. Available at http://www.mayoclinic.com/health/kidney-stones/DS00282. Accesses on February 17, 2010.
- National Kidney and Urologic Disease Information Clearinghouse. Adult Kidney Stones. Available at http://kidney.niddk.nih.gov/Kudiseases/pubs/stonesadults/. Accessed on February 17, 2010.
- Nojaba L, Guzman N. Nephrolithiasis. InStatPearls [Internet] 2020 Aug 10. StatPearls Publishing. Available: https://www.ncbi.nlm.nih.gov/books/NBK559227/(accessed 1.4.2022)
- DermNet NZ: Sarcoidosis. Available at http://dermnetnz.org/dermal-infiltrative/sarcoidosis.html. Accessed March 27, 2010
- Inflammatory Bowel Disease: Sarvotham Kini, MD; Medical University of South Carolina, Updated November 20, 2009. Available at http://emedicine.medscape.com/article/774566-overview. Accessed on March 27, 2010
- Nutrition Health Review: The Consumer's Medical Journal 2007; Metabolic Syndrome Link to An increase Risk of Kidney Stones. Available at http://www.britannica.com/bps/additionalcontent/18/36406884/Metabolic-Syndrome-Linked-to-An-Increased-Risk-of-Kidney-Stones. Accessed on March 27, 2010
- Anorexia and Bulimia; Serious Consequences. Available at http://www.allaboutlifechallenges.org/anorexia-bulimia.htm. Accessed on March 27, 2010