I’ll never forget a patient, let’s call him Tom, a strapping fellow in his late 30s, who came into the clinic doubled over. “Doc,” he gasped, “it’s like a hot poker in my back, and it comes in waves.” He was pale, sweating, and clearly in agony. That kind of sudden, severe flank pain? It often points to one culprit: kidney stones. These little troublemakers can cause some of the worst pain imaginable, something I’ve seen bring even the toughest folks to their knees.
So, What Exactly Are Kidney Stones?
Alright, let’s break this down. Kidney stones, or renal calculi as we sometimes call them (or nephrolithiasis if we’re being fancy), are solid little masses. Think of them like tiny, hard crystals that form inside your kidneys. Your kidneys, those amazing bean-shaped organs, filter waste from your blood to make urine. Sometimes, certain substances in your urine – things like minerals, acids, and salts – get too concentrated. When there’s too much of this stuff and not enough liquid to dilute it, these particles can stick together and, well, form a stone.
These stones can be tiny, like a grain of sand, and you might pass one without ever knowing it. But sometimes, they can grow much larger. Rarely, and I mean rarely, they can be bigger than a golf ball! If a stone is small enough, it might just travel through your urinary tract (that’s the plumbing system: kidneys, ureters, bladder, urethra) and come out in your pee without much fuss. But a larger stone? That’s where the trouble starts. It can get stuck in the ureter, the narrow tube that carries urine from your kidney down to your bladder. This can cause urine to back up, which isn’t good for your kidneys and can hurt. Plus, it can cause some bleeding.
It’s pretty common. About 1 in 10 people will experience a kidney stone at some point. We tend to see it a bit more in men, especially in their 30s and 40s.
Tell-Tale Signs: How Do I Know If I Have Kidney Stones?
The classic symptom, like Tom experienced, is that awful pain. It often starts in your lower back, belly, or your side (we call this flank pain). It can feel like it’s shooting down towards your groin. Sometimes it’s a dull ache, but often it’s sharp, intense, and comes in waves – what we call colicky pain.
But that’s not all. You might also notice:
- Feeling sick to your stomach, maybe even vomiting.
- Seeing blood in your pee (hematuria). It might look pink, red, or brown.
- Pain when you pee (dysuria).
- Feeling like you can’t pee, or only a little comes out.
- I need to pee all the time.
- Fever or chills, which could mean an infection is brewing.
- Your pee lis ooking cloudy or smelling unusually bad.
Of course, if you have a very small kidney stone, you might not have any symptoms at all. Lucky you, if that’s the case!
What’s Behind These Pesky Stones?
As I mentioned, it’s all about the concentration of certain substances in your urine. When there’s an imbalance – too many particles like calcium, sodium, oxalate, or uric acid, and not enough fluid – they crystallize. This process can take months, even years.
There are different kinds of stones, named after the crystals they’re made of:
- Calcium-oxalate and calcium phosphate stones: These are the most common. They can form if you’re eating a lot of high-oxalate foods (like spinach or nuts), not getting enough calcium in your diet (sounds counterintuitive, but it’s true!), or, crucially, not drinking enough fluids.
- Uric acid stones: These can pop up if you eat a lot of animal proteins – think red meat, poultry, and fish.
- Struvite stones: These are often linked to bacterial infections, like recurrent urinary tract infections (UTIs). Sometimes, these can grow into very large stones called staghorn calculi, which usually need surgery.
- Cystine stones: These are less common and are due to an inherited condition called cystinuria, where an amino acid called cystine builds up.
Are Some People More Likely to Get Kidney Stones?
Yes, certain things can make you more prone to developing kidney stones. We call these risk factors:
- Not drinking enough water or fluids. This is a big one!
- A diet high in animal protein, sodium, or sugars (like sucrose and fructose).
- Taking high doses of vitamin C supplements.
- Having a family history of kidney stones. If your mom or dad had them, your chances are higher.
- Any blockage in your urinary tract?
- Previous stomach or intestinal surgery, like gastric bypass surgery.
- Certain medications, including some diuretics (water pills), calcium-based antacids, and some anti-seizure drugs.
- Specific medical conditions can also increase your risk. Things like:
- Cystic fibrosis
- Diabetes
- Gout
- High blood pressure
- Hypercalciuria (too much calcium in your urine)
- Inflammatory bowel disease (IBD)
- Kidney cysts
- Obesity
- Osteoporosis
- Parathyroid disease (your parathyroid glands control calcium)
- Primary hyperoxaluria (a rare genetic disorder)
- Certain types of paralysis
Kidney stones, if not managed, can lead to some complications too, like a blockage causing kidney swelling (hydronephrosis), kidney infection (pyelonephritis), temporary kidney damage (acute kidney injury), frequent UTIs, or even chronic kidney disease (CKD) down the line.
Figuring It Out: How We Diagnose Kidney Stones
If you come in with symptoms that make me suspect kidney stones, we’ll need to do a bit of detective work. This usually involves:
- Urine test: We’ll check your pee for blood, any crystals that might point to stone formation, and signs of infection.
- Imaging tests: These help us see the stones. We might use:
- X-rays
- CT scans (computed tomography scans): These are very good at showing stones.
- Ultrasound: Another good way to visualize them, especially if we want to avoid radiation.
These images tell us the size, shape, location, and number of stones.
- Blood tests: These can check your kidney function, look for infection, and see if you have high levels of calcium or other substances that could be forming stones.
Getting Rid of Them: Treatment for Kidney Stones
Treatment depends on the stone – its size, where it is, if it’s causing an infection or bad symptoms.
If you have a small stone that we think is likely to pass on its own (and many do!), we’ll often advise you to manage it at home. This usually means drinking plenty of water to help flush it out. We might also prescribe:
- Medications to help relax your ureter, making it easier for the stone to pass. Common ones are tamsulosin (Flomax®) or nifedipine.
- Something to help with nausea and vomiting.
- Pain relief. Let’s be honest, even small stones can be incredibly painful. We might suggest over-the-counter options or prescribe something stronger. A word of caution: it’s best to ask us before taking ibuprofen during an acute kidney stone attack, as it can sometimes affect kidney function, especially if you have other health issues.
For larger stones, or stones that are causing a blockage or just won’t pass after a few weeks, we’ll likely recommend a procedure to break them up or remove them. Options include:
- Shockwave lithotripsy (SWL): This uses sound waves from outside your body to break the stone into smaller, passable pieces.
- Ureteroscopy: We insert a very thin scope (a tiny camera) up through your urethra and bladder into the ureter. Through this scope, we can use tiny instruments or a laser to break up the stone and remove the fragments.
- Percutaneous nephrolithotomy (PCNL): For very large or awkwardly placed stones, this might be needed. It involves making a small incision in your back, directly into the kidney. We then use a probe to break up and remove the stone.
- Laparoscopic surgery: Rarely, for very complex situations, a surgeon might make a few small incisions to remove the stone. Open surgery with a larger cut is very uncommon these days.
Most kidney stones (around 80%) do pass on their own. A small one (less than 4mm) might pass in a week or two. A larger one could take two to three weeks. Once it reaches your bladder, it usually passes out within a few days. But it’s always important to get checked out if you think you have one, just to make sure there’s no blockage or complication. If it hasn’t passed in about four to six weeks, you need to follow up with us.
Looking Ahead: What to Expect
The good news is that about 90% of small stones (under 6mm) and even 60% of larger ones (over 6mm) can pass without needing a procedure. If you do need a procedure, they are generally very effective.
One thing to know is that if you’ve had one kidney stone, you’re unfortunately more likely to get another one in the future. So, we’ll work with you on ways to prevent that.
Can We Stop Kidney Stones From Forming?
Yes, there’s a lot you can do! Your diet and lifestyle play a big role. We, or a dietitian, might suggest:
- Drink plenty of water! This is key. Aim for clear or pale yellow urine.
- Limit animal proteins.
- Cut back on foods high in sugar and sodium.
- Be mindful of high-oxalate foods if you’re prone to calcium oxalate stones. These include things like spinach, rhubarb, nuts, and wheat bran. We can give you a more detailed list.
- Maintain a weight that’s healthy for you.
- Eat foods rich in calcium. Interestingly, getting enough calcium from your food can help prevent stones. Calcium supplements or calcium-containing antacids, however, can sometimes increase the risk, so talk to us about those.
- Sometimes, if diet changes aren’t enough, we might prescribe medications to help prevent stones, depending on the type you form.
Take-Home Message: Key Things to Remember About Kidney Stones
Living with the risk of kidney stones can be worrying, but here’s what I want you to remember:
- Sudden, severe pain in your back, side, or groin, especially with nausea or bloody urine, could be a kidney stone. Don’t ignore it.
- Most stones are small and pass on their own, but always get checked out.
- Staying well-hydrated is your best friend in preventing kidney stones.
- Dietary changes can make a huge difference in preventing future stones.
- If you’ve had one, you’re at higher risk for more, but we can work together on a prevention plan.
- Modern treatments are very effective if a stone doesn’t pass on its own.
You don’t have to just live with kidney stones. With the right approach, you can manage them and often prevent them from coming back.
When to Reach Out
If you’re experiencing any of those symptoms we talked about, please don’t hesitate to give us a call. We need to figure out what’s going on. And if the pain is truly unbearable, head to the emergency department. They can help manage severe pain and any immediate complications.