Urolithiasis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 24, 2016
StartDiseasesUrolithiasis

Urolithiasis, better known as kidney stones, is one of the most common and painful medical problems in the world. It is caused by a variety of both genetic factors and environmental factors, and while it is painful, it is also relatively easy to treat.

Contents

Definition & Facts

Urolithiasis occurs when a stone forms somewhere in the patient's urinary tract. These stones are usually made of calcium, although stones that are made of uric acid or struvite occur in a minority of cases.

Some of the stones pass out of the body while they are relatively small and go unnoticed, but larger stones can cause blockages in the urinary tract. These blockages can lead to a variety of symptoms, and sometimes lead to hospitalization or even death.

Symptoms & Complaints

Pain in the area around the kidneys and pelvis is the distinguishing symptom of urolithiasis. Many sources claim that it is one of the most extreme forms of pain that humans can experience.

The pain is usually intermittent, and is caused by the body's efforts to get rid of the stone. It usually lasts for between twenty minutes and one hour at a time, and most patients feel only minimal discomfort between the waves of agony.

In addition to the pain, urolithiasis can block the flow of urine through the body. This can lead to difficulty urinating, which can develop into more serious medical conditions over time. Urinary tract infections are the most common of those problems, and they can lead to additional pain even after the stone has been removed.

When the patient is able to urinate, doing so is usually quite painful, and the urine often contains blood (hematuria). Finally, many patients find that the pain and discomfort of the disease causes them to vomit, especially during the bouts of pain that come from the body's attempts to purge the stone.

All of these symptoms persist until the stone has been removed, either through medical intervention or through the body's efforts, and their intensity rarely changes over time.

Causes

Several different factors contribute to the formation of stones. Genetic factors control much of a person's susceptibility to the disease, which is one of the primary reasons that people who have had a kidney stone in the past are very likely to develop another stone later in life.

However, environmental factors can contribute to the condition. Consumption of excessive amounts of calcium, purine, fructose, and animal protein can contribute to the development of stones.

Additionally, diseases such as Crohn's disease that can inhibit the body's ability to absorb those nutrients will also contribute urolithiasis. Dehydration is another major cause of the disease. While it does not have a significant impact on the formation of stones, dehydrated people urinate less than others, which means they have a reduced chance of getting rid of stones while they are too small to cause problems. 

Diagnosis & Tests

Urolithiasis is a common disease with very distinctive symptoms, so most doctors can diagnose it based on the patient's complaints, with pain around the kidneys and pelvis as the main criterion for diagnosis. Doctors can confirm their diagnosis through a variety of techniques. Physical examination is the most common, with signs of fever and tenderness in the area around the kidneys as the confirming data.

If the doctor feels that the diagnosis is still questionable, imaging studies can be used to provide additional information. Stones will show up on a computed tomography (CT) scan, which can also be used to assess the severity of the problem to help choose between treatment methods. If the stones do not show up on a CT scan, an ultrasound can help to confirm their presence by showing any obstructions in the flow of urine through the patient's body.

Finally, a variety of laboratory tests are available that can provide additional information. Examining a patient's urine under a microscope can reveal small crystals and trace chemicals that are signs of urolithiasis. Blood tests can reveal which compounds are likely to be developing into stones.

The collection of stones that have passed through the system is the best and most conclusive sign of urolithiasis, and it can also definitively demonstrate what type of stones are forming.

Treatment & Therapy

Most stones pass on their own within four weeks. Larger stones are an exception to that trend, and doctors treat the disease by removing them. Chemical methods are available that make them easier to pass naturally, but surgery is necessary in the most extreme cases, or for patients that are already suffering from kidney problems.

Surgical procedures are used as a last resort, and are unlikely for patients who are otherwise healthy. A technique called lithotripsy, which uses ultrasound devices to break stones into smaller pieces, can be used in some cases as an alternative to surgery.

In cases where the doctor chooses to wait for the stone to leave naturally, patients usually receive medication to help control the pain while they wait for the stone to pass. Patients who have previously formed stones are usually given more intensive treatment that those who have not, and they are usually directed to make lifestyle changes to prevent future problems.

Prevention & Prophylaxis

There are several measures that can prevent stones from forming. The most effective approach is dietary change. Patients are advised to increase their fluid intake in order to encourage urination and purge stones while they are small.

Consuming additional citric drinks while consuming less calcium, phosphoric acid, animal protein, and sodium can also help. Some doctors give their patients medicine that makes their urine more basic to dissolve stones as they form, especially if the patient suffers from uric acid stones. Diuretics are also used to increase urination.