Kidney Stones

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Kidney stones, medically termed renal calculi, are accumulations of mineral salts, such as calcium, uric acid, struvite, and cystine. Human urine normally contains minute particles of minerals and other solid substances suspended in solution. If a certain critical mass is reached, they can begin to crystallize, ultimately forming stones that can begin lodge anywhere in the urinary tract. About 80 % of all kidney stones are composed of calcium from the intestines that in turn increases calcium in the urine. The excess calcium can crystallize to form stones, which can range in size from an unnoticeable speck to a troublesome half-inch.

There are many factors that can predispose a person to forming stones. High humidity and temperature, high sodium intake, low fluid intake, and low fiber intake are all thought to be risk factors for stone-forming individuals. A lack of dietary fiber in particular can increase the level of calcium in the urine because it slows the passage of food through the intestines, allowing more calcium to be absorbed into the bloodstream, and also because it results in a lack of sufficient fiber to bind to calcium in the gastrointestinal (GI) tract. A sedentary lifestyle seems to increase the possibility of stone formation, too. More important seems to be the degree of concentration and the level of acidity of the urine. Heredity also plays a role. For example, only specific types of individuals, designated type II hypercalciuric seem to benefit at all from lowering their calcium intake to avoid stone formation.

If you ever have a kidney stone, it is likely you will never forget the sensation. The pain is usually severe, beginning suddenly and specifically in the flank region. Nausea and vomiting may follow, as may chills and fever, and there may be pus and blood in the urine. It is usually difficult to stay still, unlike in other acute abdominal problems, which make it hurt to move at all. The pain moves with the stone, and stone size does not seem to have any relationship to the degree of pain. Urinary urgency may occur if the stone lodges at the junction of the bladder and ureter.

Your doctor may wish to know the chemical composition of the stone, and ask you to urinate through a screen to catch the stone if it is passed. It may be worthwhile to have a twenty-four hour urine sample taken to see whether you have some defect in urinary volume or the excretion of calcium, phosphate, uric acid, oxalate, or citrate. A standard urinalysis will usually show the presence of some blood and will determine the relative acidity of the urine, which is an important clue to the type of stone that is causing the problem.

Most stones can be found using standard x-ray films and ultrasound. If any uncertainty remains, a doctor may order an intravenous pyelogram (IVP). In this test, a dye is introduced to the bloodstream using a small intravenous line, and then x-ray are taken to see how the dye flows through the kidney. This test is usually reserved for more severe kidney disease, however, as the dye has been known to cause both allergic reactions and acute kidney failure in some cases.

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