1. How do kidney stones form?
2. Are there different kinds of kidney stones?
- Calcium stones, which include two subtypes: calcium oxalate and calcium phosphate stones. Calcium stones, especially calcium oxalate stones, are by far the most common type of kidney stone. Oxalate is a natural substance found in many foods, including spinach, beets, almonds, and soy products. When there is too much waste in the body and too little liquid to flush it out, it can combine with the calcium in the urine to form stones.
The calcium phosphate stone is what it sounds like—it combines calcium with phosphate, an electrolyte (or electrically charged mineral). While most people get more phosphate than they need from their diet, some of these stones are related to renal tubular acidosis, a metabolic condition that results when the kidneys aren’t performing their function of removing acids from the blood into the urine.
- Uric acid stones can form when there is too much acid in the urine, which can result from eating too much fish, shellfish, poultry, pork, and meat (especially liver and other organ meats), which have high levels of purines, a common natural chemical compound. Too many purines can cause uric acid in the kidneys to crystallize and harden. Drinking enough water, cutting down on high-purine foods, and maintaining a healthy diet, in general, can help with avoiding uric acid stones.
- Struvite stones (also known as “infection stones”) are associated with urinary tract infections (UTIs). Bacteria from the infection produces ammonia, which makes the urine more alkaline, leading to the formation of struvite—a combination of ammonium, magnesium, and phosphate. Struvite stones can form suddenly and quickly grow too large to pass. Surgery is often necessary to remove them.
- Cystine stones. A rare, inherited disease called cystinuria causes an amino acid (cysteine) to leak from the kidneys to the urine, where it may cause stones to form. Cystinuria is a lifelong condition and most people with it have recurring stones, so it’s especially important for them to drink enough water, follow a recommended diet, and, in some cases, take medication to control the level of cysteine in their urine to prevent stones from forming. If a large stone forms, it may require surgical treatment.
3. How can you prevent kidney stones?
4. How are kidney stones diagnosed?
5. How are kidney stones treated?
- Wait for the stone to pass. If the stone is small, it may pass without your experiencing any pain or knowing you had it. If you already know you have a stone—either because it was diagnosed after you reported symptoms or it was identified during imaging for another condition—a doctor can use imaging to measure it and determine how far it has moved along the urinary tract. “There are people who pass large stones without an issue, and there are people who have a really hard time passing smaller ones; it depends on the person’s anatomy and pain tolerance,” Dr. Motamedinia says. Taking over-the-counter pain medication as recommended and, occasionally, prescription medications that can dilate the urinary tract help to manage the pain and facilitate the passing of the stone, adds Dr. Motamedinia. “As always, maintaining hydration is imperative,” he says.
- Shockwave lithotripsy. This is a common, noninvasive kidney stone treatment that uses a machine to administer sound wave energy from outside the body to crush the stone into pieces that can be passed. “Choosing the right stone and the right patient are important. A stone that is too large or too hard is not ideal. And, in certain cases, the patient’s size, if they are pregnant, or if they use blood thinners may indicate the need for an alternative treatment,” says Dr. Motamedinia. “However, in many cases, shockwave lithotripsy works quite well.”
- Ureteroscopy. This is an endoscopic approach and the most commonly used method to remove kidney stones. A small, flexible camera is inserted into the urinary tract, where it is used to visualize the stone. The stone is broken into manageable pieces with a laser, and pieces are retrieved using a tiny basket—or they are turned into a fine powder that can be passed easily. The procedure can take 20 minutes to an hour and a half, depending on the size and location of the stone, among other factors. “The considerations mentioned above that would preclude the use of shockwave lithotripsy are less of a concern for ureteroscopy, making it a more versatile option,” says Dr. Motamedinia.
- Percutaneous nephrolithotomy. Used for large stones unsuitable for other treatment options, this is a minimally invasive surgery performed through an incision in the back for direct access to the kidney. Instruments are inserted and used to pulverize the stone and suck it out. The procedure can take three hours.
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