Brief Overview of the Disease
Kidney stone disease is a condition in which stones formed from urinary salts develop in the kidneys and urinary tract. The disease may remain asymptomatic for a long time, but when a stone moves, it often causes sharp pain and renal colic. Early detection of the condition and properly selected treatment help prevent severe complications and the need for surgical intervention.
Main Symptoms of Kidney Stone Disease
- pain in the lower back, side, or lower abdomen
- attack of sharp pain – renal colic
- frequent or painful urination
- appearance of blood in the urine
- nausea and vomiting associated with pain
- elevated body temperature when inflammation develops
- feeling of incomplete bladder emptying
When to Seek Medical Attention Urgently
- sudden severe pain that does not decrease over time
- pain accompanied by nausea or repeated vomiting
- fever and chills
- visible blood in the urine
- difficulty or absence of urination
- recurrent episodes of renal colic
These conditions require urgent diagnostic evaluation and medical care.
Kidney stone disease (urolithiasis) is a chronic condition associated with metabolic disorders that lead to the formation of stones from urinary components in the urinary tract. It is one of the most common diseases of the kidneys and urinary system. According to urological practice, kidney stone disease accounts for up to 32–40% of all urological pathology and ranks second after infectious and inflammatory diseases.
The disease can occur at any age; however, it is most often diagnosed in people of working age – between 20 and 55 years. In men, kidney stone disease occurs approximately three times more often than in women, while staghorn stones are predominantly detected in women. In most cases, stones form in one kidney, but in 9–17% of cases the disease affects both kidneys.
Understanding the causes of kidney stone disease makes it possible not only to treat the condition but also to reduce the risk of its recurrence.
Kidney Stone Disease. Causes
What Most Commonly Triggers Kidney Stone Disease
In clinical practice, the development of kidney stone disease is most often associated not with a single cause but with a combination of several factors. Their simultaneous effect creates favorable conditions for stone formation in the kidneys and urinary tract.
- insufficient fluid intake
- excessive consumption of salt and animal protein
- urinary tract infections
- metabolic disorders
- sedentary lifestyle
- genetic predisposition
Under the influence of these factors, the concentration of salts in the urine increases, which over time leads to their crystallization and gradual stone growth.
At present, there is no single theory that fully explains the causes of urolithiasis. Kidney stone disease is a multifactorial condition with complex mechanisms of formation that depend on both metabolic processes and external factors. An important role is played by congenital metabolic disorders that result in the formation of poorly soluble salts. However, even in the presence of genetic predisposition, the disease usually develops only when additional factors are present.
According to their chemical composition, urinary stones are classified as oxalate, phosphate, urate, and carbonate stones. Less commonly, cystine, xanthine, protein, and cholesterol stones are found. Typically, a stone consists of several mineral components and has a layered structure. Stones may be single or multiple.
The Formation of Urinary Stones Is Based on the Following Metabolic Disorders:
- hyperuricemia – elevated uric acid levels in the blood
- hyperuricosuria – increased uric acid excretion in the urine
- hyperoxaluria – increased oxalate concentration in the urine
- hypercalciuria – excessive excretion of calcium salts in the urine
- hyperphosphaturia – increased phosphate concentration
- changes in urine acidity
The development of these metabolic disorders may be related to both external influences and internal characteristics of the body. In practice, their combination is most often observed.
Exogenous Causes of Urolithiasis:
- urinary tract infections and foci of chronic infection outside the urinary system
- metabolic disorders – gout, hyperparathyroidism
- deficiency or hyperactivity of certain enzymes
- severe injuries and diseases accompanied by prolonged immobilization
- diseases of the gastrointestinal tract, liver, and biliary system
- genetic predisposition
- sex and age – the disease occurs more often in men than in women
Additional importance is attributed to local changes in the urinary tract – congenital anomalies, strictures, and vascular structural features that impair urine outflow and contribute to stone formation.
Kidney stones may be single or multiple; in some cases, their number reaches several thousand. The size of calculi ranges from a few millimeters to giant formations exceeding 10 cm in diameter and weighing up to 1000 g.
The disease may remain asymptomatic for a long time or manifest as pain of varying intensity in the lower back, as well as episodes of renal colic.
Kidney Stone Disease. Symptoms
Lower Back Pain
Pain in kidney stone disease may be constant or intermittent, dull or sharp. Its intensity, localization, and radiation depend on the size and location of the stone, the degree of urinary outflow obstruction, and individual anatomical features of the urinary tract.
Large renal pelvic stones and staghorn kidney stones are usually immobile and cause dull, often persistent pain in the lower back. Kidney stone disease is characterized by increased pain during movement, shaking, driving, or physical exertion.
Renal Colic
Renal colic is an episode of sudden, intense pain in the lower back that occurs due to obstruction of the upper urinary tract. In most cases, colic is associated with the migration of a stone from the renal calyx or pelvis into the ureter.
The mechanism of renal colic development is related to impaired urine outflow. As a result, intrapelvic pressure increases, microcirculation in the kidney deteriorates, venous congestion develops, and pain receptors of the renal hilum and fibrous capsule are irritated. These processes lead to the characteristic pain attack.
More detailed information about symptoms and first aid for renal colic can be found in the article Renal Colic.
Cases of Renal Colic Not Associated With Kidney Stone Disease
It should be noted that approximately 13% of renal colic cases are not related to kidney stone disease but to other conditions of the kidneys and ureters – tumors, tuberculosis, hydronephrosis, ureterovascular conflict, and retroperitoneal fibrosis. In such situations, pain may be caused by the passage of blood clots, pus, or mucus that obstruct the urinary tract lumen.
Renal colic associated with kidney pathology is among the most severe pain syndromes and requires timely first aid, urgent diagnostic evaluation, and treatment.
Other Associated Signs
General symptoms of kidney stone disease include signs of intoxication – nausea and vomiting, which usually do not bring relief. Due to reflex intestinal paresis, difficulty in gas passage may occur.
Depending on the level of obstruction, false urges to urinate or defecate may develop. In some cases, subfebrile body temperature within the range of 37,1–37,5 ℃ is observed, along with moderate changes in heart rate and blood pressure.
When the ureteral wall or renal cavity is damaged by a stone, urine may acquire a pinkish or reddish tint. Pain often persists for several hours or even days, periodically subsiding.
Kidney Stone Disease. Diagnosis
Manifestations of kidney stone disease often resemble symptoms of other conditions affecting the abdominal organs and retroperitoneal space. Therefore, during the initial examination, the urologist must exclude so-called “acute abdomen” conditions – acute appendicitis, gallstone disease, peptic ulcer disease, and in women, uterine and ectopic pregnancy. In some cases, the involvement of physicians from other specialties is required.
For this reason, the diagnosis of kidney stone disease may be carried out in stages and include several complementary examination methods.
1. Examination by a Urologist and Medical History Collection. At this stage, the characteristics of disease progression and risk factors are clarified, which helps to understand the causes of stone formation and plan relapse prevention. The physician pays attention to:
- occupation and lifestyle
- time of symptom onset and disease course characteristics
- previous treatment
- family history
- dietary habits and fluid intake
- history of Crohn’s disease, intestinal surgery, or metabolic disorders
- medication use
- presence of sarcoidosis
- presence and course of urinary tract infection
- congenital anomalies of the genitourinary system and previous surgeries
- history of injuries and periods of prolonged immobilization
2. Stone Visualization. Instrumental methods are used to detect stones and assess their location:
- ultrasound examination of the kidneys and urinary tract
Image. Stone in the lower third of the right ureter
Image. Stone in the upper third of the ureter
- plain and excretory urography or spiral computed tomography
Image. Plain urography – stone in the right kidney
Excretory urography – calculus in the upper third of the left ureter, obstructed left kidney
Image. Bilateral nephrolithiasis.
3. Laboratory Tests, including complete blood and urine analysis, urine pH measurement, as well as biochemical analysis of blood and urine.
4. Urine culture to identify microflora and determine sensitivity to antibacterial drugs.
5. If necessary, calcium load tests are performed for differential diagnosis of hypercalciuria, as well as ammonium chloride tests to detect renal tubular acidosis and assessment of parathyroid hormone levels.
6. Stone composition analysis – when a passed or removed calculus is available.
7. Biochemical and radioisotope studies of kidney function.
8. Retrograde ureteropyelography, ureteropyeloscopy, and pneumopyelography – used according to indications to clarify the level and nature of obstruction.
Image. Antegrade ureteropyelography – calculus of the left pyeloureteral segment.
9. Stone Density Assessment by Tomography, which is used to predict the effectiveness of lithotripsy and reduce the risk of possible complications.
Kidney Stone Disease. Possible Complications
Prolonged presence of a stone in the urinary tract without a tendency to pass spontaneously leads to gradual impairment of urinary tract and kidney function. In advanced cases, this may result in irreversible damage to renal tissue and loss of organ function.
The Most Common Complications of Kidney Stone Disease Include:
- Chronic inflammatory process at the site of stone localization and in renal tissue – pyelonephritis and cystitis. Under unfavorable conditions, such as hypothermia or acute respiratory infections, inflammation may worsen.
- Acute pyelonephritis, which in severe cases may be complicated by paranephritis, formation of purulent foci in the kidney (apostematous pyelonephritis), development of a carbuncle or renal abscess. In rare but dangerous situations, sepsis may develop, requiring urgent surgical intervention.
- Pyonephrosis – a terminal stage of purulent-destructive pyelonephritis, in which the kidney undergoes purulent destruction and loses its function.
- Chronic pyelonephritis, leading to gradual development of chronic kidney failure and formation of nephrosclerosis.
- Acute renal failure, which is extremely rare and usually associated with complete urinary tract obstruction in a solitary kidney or bilateral ureteral stones.
- Anemia, developing as a result of prolonged blood loss due to hematuria and impaired hematopoietic kidney function.
Kidney Stone Disease. Treatment
Since the causes of kidney stone disease are not fully understood, removal of a stone from the kidney or urinary tract does not always mean complete recovery. Treatment is aimed not only at eliminating the calculus but also at correcting metabolic disorders that led to its formation.
In the treatment of kidney stone disease, two main approaches are distinguished – destruction or removal of the stone and prevention of recurrent stone formation. Additional measures include improving renal blood circulation, normalizing fluid intake, eliminating urinary tract infection, as well as diet therapy, physiotherapy, and spa treatment.
After establishing the diagnosis, determining the size and location of the stone, assessing urinary tract patency and kidney function, and taking into account comorbidities and previous treatment, the optimal therapy method is selected.
Methods of Stone Removal Include:
- conservative treatment promoting spontaneous passage of small stones
- symptomatic therapy used for renal colic
- medication-based and “local” litholysis
- instrumental removal of stones displaced into the ureter
- percutaneous removal of kidney stones with extraction or contact lithotripsy
- ureterolitholapaxy and contact ureterolithotripsy
- extracorporeal shock wave lithotripsy (ESWL)
- surgical removal of the stone or, in rare cases, removal of the kidney with the stone
The listed methods do not exclude each other and in some cases are used sequentially or in combination. A significant breakthrough in the treatment of kidney stone disease occurred with the introduction of extracorporeal lithotripsy and the development of endoscopic technologies, which made it possible to significantly reduce the number of open surgeries.
Modern minimally invasive and low-trauma techniques allow effective removal of stones regardless of their size and location. Even small, long-standing asymptomatic calculi require attention, as the risk of growth and development of chronic inflammation remains.
Currently, extracorporeal lithotripsy, percutaneous nephrolithotripsy, and ureterorenoscopy are most widely used. Thanks to these methods, the number of open surgeries has been reduced to a minimum, and in many clinics in Western Europe – almost to zero.
Kidney Stone Disease Treatment at Home
By “treatment at home,” patients most often mean the possibility of avoiding surgery or stone fragmentation. It is important to understand that kidney stone disease cannot be completely cured at home; however, in certain cases, measures may be allowed under medical supervision.
Home treatment may be considered only for small stones, in the absence of significant urinary tract obstruction or infection, and with preserved kidney function. In such situations, the main goal is not to “dissolve” the stone but to create conditions for its safe spontaneous passage and to prevent further growth.
Measures That May Be Applied at Home on a Doctor’s Recommendation Include:
- a strictly controlled fluid intake regimen to increase diuresis
- dietary restrictions based on the chemical composition of the stone
- use of medications prescribed by a physician to correct metabolic disorders
- symptomatic therapy to reduce pain and spasm
- dynamic follow-up with control tests and ultrasound examinations
It should be emphasized that attempts at self-treatment using “folk remedies,” herbal preparations, warming procedures, or uncontrolled medication intake may lead to stone migration, renal colic, inflammation, and other complications.
If increasing pain, fever, blood in the urine, or impaired urination occur during home management, immediate medical attention is required. In such situations, further treatment is carried out only in a medical facility.
Extracorporeal Shock Wave Lithotripsy (ESWL)
The method of extracorporeal shock wave lithotripsy is based on the theory of the electrohydraulic effect developed by L.A. Yutkin in the 1960s. Shock waves are generated outside the body and focused on the stone, causing its fragmentation.
Under the action of high-intensity acoustic impulses, cracks form within the stone structure, leading to its fragmentation. X-ray and ultrasound methods are used for precise targeting.
Extracorporeal Lithotripsy is considered a minimally invasive method and in many cases can be performed on an outpatient basis. The effectiveness of the method and its advantages over open surgery and percutaneous interventions are confirmed by numerous clinical studies.
Percutaneous Nephrolitholapaxy (PNL)
Percutaneous nephrolitholapaxy is a minimally invasive surgical procedure for removing kidney stones. The technique is a low-trauma alternative to open surgery and is widely used in modern urology.
The operation is performed under general anesthesia and lasts from 40 minutes to 4 hours, depending on the size, location, and structure of the stone. Through a small incision in the lumbar region, a renal puncture is performed, after which a nephroscope is inserted to visualize the renal cavity and perform stone fragmentation and removal. If necessary, a nephrostomy tube or ureteral stent is placed.
Percutaneous Nephrolitholapaxy
After standard PNL, the patient usually remains hospitalized for 5–6 days. During this period, follow-up examinations are performed to exclude residual stones. If necessary, repeat nephroscopy is carried out. The effectiveness of the method exceeds 98% for kidney stones and about 88% for ureteral stones.
Ureterorenoscopy. Contact Lithotripsy
Ureterorenoscopy is an endoscopic diagnostic and treatment method in which instruments are introduced through the urethra, bladder, and ureter into the kidney cavity. Modern ureterorenoscopes have a small diameter, allowing procedures to be performed with minimal tissue trauma.
To facilitate advancement of the endoscope, a safety guidewire is used, and after the procedure, a ureteral stent may be placed if necessary. In most cases, the patient is discharged the next day, and in some cases treatment may be performed on an outpatient basis.
Conservative Treatment
Conservative therapy is aimed at preventing recurrences, slowing stone growth, and achieving medical dissolution of stones. If dietary measures are insufficiently effective, the physician selects appropriate medications. One course of treatment usually lasts about one month and is carried out under laboratory monitoring.
Uric Acid Stones. Medications that normalize purine metabolism and urine acidity are used – Allopurinol and Blemaren.
Calcium Oxalate Stones. Medications affecting calcium and oxalate metabolism are used – Pyridoxine, magnesium preparations, Hypothiazide, Blemaren.
Calcium Phosphate Stones. Treatment is aimed at correcting phosphate metabolism and eliminating inflammation. Antibacterial agents are prescribed in the presence of infection, along with magnesium preparations, Hypothiazide, herbal remedies, and Methionine.
Cystine Stones. Therapy is aimed at reducing cystine concentration in urine and normalizing amino acid metabolism. Penicillamine, Blemaren, and ascorbic acid preparations are used.
A comprehensive and individualized approach to the treatment of kidney stone disease under medical supervision helps reduce the risk of recurrence, slow the growth of calculi, and avoid surgical intervention.
Kidney Stone Disease. Prevention and Metaphylaxis
Prevention of kidney stone disease is aimed at correcting metabolic disorders and reducing the risk of recurrent stone formation. It is prescribed based on examination results and selected individually under medical and laboratory supervision. Without preventive measures, recurrence occurs in half of patients within five years after stone removal. Therefore, patient education and preventive measures are recommended to begin immediately after spontaneous passage or surgical removal of the stone.
- Lifestyle. Regular physical activity is an important part of prevention, especially in sedentary individuals. Excessive physical exertion should be avoided in untrained people. Frequent alcohol consumption and pronounced emotional stress are undesirable. In overweight patients, weight reduction through decreased caloric intake significantly lowers the risk of stone formation.
- Increased Fluid Intake. This is a mandatory measure for all patients with kidney stone disease. When urine specific gravity decreases below 1.015 g/L, the risk of stone formation is significantly reduced. Active diuresis promotes elimination of small fragments and sand. An optimal urine output of at least 2 liters per day is recommended.
- Calcium Intake. In calcium oxalate stones, adequate dietary calcium intake helps reduce urinary oxalate excretion, thereby lowering the risk of crystallization and formation of new stones.
- Fiber Intake. Also recommended for calcium oxalate stones. The diet should include more vegetables and fruits while limiting foods high in oxalates.
- Vitamin C Intake. Vitamin C intake up to 4 g per day is acceptable without increasing the risk of stone formation. Exceeding recommended doses may lead to conversion of ascorbic acid to oxalic acid, increasing renal load and oxalate excretion.
- Protein Restriction. Excessive animal protein intake increases calcium and oxalate excretion, reduces citrate levels, and lowers urine pH. In calcium oxalate stones, protein intake should be limited to 1 g per 1 kg of body weight per day.
- Use of Thiazides. Prescribed in cases of hypercalciuria – increased urinary calcium excretion. Medications include Hypothiazide, Trichlorthiazide, and Indapamide. Possible side effects include masking of hyperparathyroidism, development of gout or diabetes mellitus, and erectile dysfunction.
- Use of Orthophosphates. Acidic and neutral forms exist that reduce calcium absorption and excretion while increasing pyrophosphate and citrate levels, enhancing the protective properties of urine. Orthophosphates are used in hypercalciuria but are not indicated in stones associated with infection. Possible side effects include diarrhea, abdominal cramps, and nausea.
- Alkaline Citrate. This agent reduces urine supersaturation with calcium oxalate and calcium phosphate, inhibits crystal growth and aggregation, and lowers uric acid concentration. It is prescribed for calcium stones and hypocitraturia.
- Magnesium. Indicated for calcium oxalate stones, especially in hypomagnesuria. Possible side effects include diarrhea, drowsiness, fatigue, and central nervous system disturbances. Magnesium preparations are used only in combination with citrates.
- Glycosaminoglycans. These substances inhibit calcium oxalate crystal growth and are used as an adjunctive preventive measure in calcium oxalate stones.
Frequently Asked Questions About Kidney Stone Disease
Can Kidney Stone Disease Resolve on Its Own?
Small stones may indeed pass spontaneously, especially with adequate fluid intake and in the absence of complications. However, this is not possible in all cases and depends on the size, composition, and location of the calculus. Even after spontaneous passage, medical consultation is important for follow-up and prevention of recurrence.
Is Surgery Always Required for Kidney Stone Disease?
Surgical treatment is not always required. In many cases, conservative methods or minimally invasive procedures such as extracorporeal or laser lithotripsy are used. The choice of method depends on stone size, location, symptoms, and the patient’s overall condition.
How Can You Tell That a Stone Has Started to Pass?
Most often, stone movement is accompanied by sudden severe pain in the lower back or side – renal colic. The pain may radiate to the groin and be accompanied by nausea, frequent urination, or blood in the urine. Medical attention is required if these symptoms occur.
Is It Possible to Treat Kidney Stone Disease Without Stone Fragmentation?
Yes, in some cases treatment without fragmentation is possible. This applies to small stones that may pass spontaneously, as well as situations where the primary focus is correction of metabolic disorders and prevention of stone growth. The decision is made by a physician based on examination findings.
What Stone Size Is Considered Dangerous?
Risk is determined not only by stone size but also by its location. Even small calculi can cause severe pain and impair urine outflow. Large stones, especially staghorn calculi, often remain asymptomatic for a long time but gradually damage the kidney and require active treatment.
What Should Be Done If a Stone Is Found Incidentally and There Is No Pain?
Even in the absence of symptoms, consultation with a urologist is recommended. The physician will assess the risk of stone growth, the likelihood of complications, and determine an appropriate strategy for observation or treatment. Ignoring asymptomatic stones may lead to inflammation or impaired kidney function.
Is It Possible to Prevent Recurrent Stone Formation?
It is not possible to completely eliminate the risk of recurrence; however, properly selected preventive measures significantly reduce it. Adherence to fluid intake recommendations, dietary modification, control of metabolic disorders, and regular medical follow-up help prevent recurrent stone formation.
Kidney Stone Disease Treatment at New Life Clinic
The capabilities of New Life Clinic allow kidney stone disease treatment to be performed at a modern medical level. We use methods aimed not only at stone removal but also at preserving kidney function and ensuring rapid patient recovery.
On an outpatient basis, extracorporeal shock wave lithotripsy is performed, as well as minimally traumatic laser lithotripsy of kidney and ureteral stones using fine endoscopic instruments. These methods allow effective stone fragmentation and removal without incisions, shorten recovery time, and enable a quick return to normal daily activities.
