| Kidney Stones
		
			| Topic OverviewWhat are kidney stones? Kidney stones are made of
			 salts and minerals in the urine that stick together to form small "pebbles."
			 They can be as small as grains of sand or as large as golf balls. They may stay
			 in your
			 kidneys or travel out of your body through the
			 urinary tract. The urinary tract is the system that makes urine and carries it
			 out of your body. It is made up of the kidneys, the tubes that connect the
			 kidneys to the bladder (the
			 ureters), the bladder, and the tube that leads from
			 the bladder out of the body (the
			 urethra). When a stone travels through a ureter, it usually causes pain and other
			 symptoms. What causes kidney stones?Kidney stones form when
			 a change occurs in the normal balance of water, salts, minerals, and other
			 things found in urine. The most common cause of kidney stones is not drinking
			 enough water. Try to drink enough water, enough  so that your urine is light yellow or clear like water (about 8 to 10
			 glasses a day). Some people are more likely to get kidney stones
			 because of a medical condition, such as gout.  Kidney stones
			 may also be an inherited disease. If other people in your family have had
			 kidney stones, you may have them too.  What are the symptoms?Kidney stones often cause
			 no pain while they are in the kidneys. But they can cause sudden, severe pain
			 as they travel from the kidneys to the bladder.  Call a doctor
			 right away if you think you have kidney stones. Watch for severe pain in your
			 side, belly, or groin or for urine that looks pink or red. You may also feel
			 sick to your stomach (nausea) and may vomit. How are kidney stones diagnosed? You may first
			 find out that you have kidney stones when you see your doctor or go to an
			 emergency room with pain in your belly or side. Your doctor will ask you
			 questions about your pain and lifestyle. He or she will examine you and may do
			 imaging tests such as
			 a CT scan or an  ultrasound to look at your kidneys and urinary tract.
			   You may need more tests if you have more than one stone or have
			 a family history of stones. To find out the cause of your kidney stones, your
			 doctor may order a blood test and ask you to collect your urine for 24 hours.
			 This can help your doctor find out if you are likely to have more stones in the
			 future. Kidney stones may not cause any pain. If this is the case,
			 you may learn you have them when your doctor finds them during a test for
			 another disease.  How are they treated?For most stones, your doctor
			 will suggest that  you take care of yourself at home. You may need to take pain
			 medicine. You'll need to drink enough water and other fluids so you don't get
			 dehydrated. Your doctor may give you a medicine to
			 help the stone pass.  If a stone is too large to pass on its own,
			 or if it gets stuck in the urinary tract, you may need more treatment.   The most common treatment is
			 extracorporeal shock wave lithotripsy (ESWL). ESWL uses shock waves to break a
			 kidney stone into small pieces. The bits can pass out of your body in your
			 urine. Other times, a doctor will need to remove the stone or place a small
			 flexible plastic tube (called a
			 stent) in the ureter to keep it open while stones
			 pass. How can you prevent kidney stones? After you have
			 had kidney stones, you are more likely to have them again. You can help prevent
			 them by drinking plenty of water, enough  so that your urine is light yellow or clear like water, about 8 to 10 glasses
			 of water a day. You may have to eat less of certain foods. Your doctor may also
			 give you medicine that helps prevent stones from forming. Frequently Asked Questions| Learning about kidney stones: |  |  | Being diagnosed: |  |  | Getting treatment: |  |  | Living with kidney stones: |  | 
CauseKidney stones
		  may form when the normal balance of water, salts, minerals, and other
		  substances found in urine changes. How this balance changes determines the type
		  of kidney stone you have. Most kidney stones are
		  calcium-type-they form when the
		  calcium levels in your urine change.  
		  Things that change your urine balance include: Not drinking enough water. When you
			 don't drink enough water, the salts, minerals, and other substances in the
			 urine can stick together and form a stone. This is the most common cause of
			 kidney stones.Medical conditions. Many medical conditions can
			 affect the normal balance and cause stones to form. Examples include
			 gout and inflammatory bowel disease, such as Crohn's disease.
 More commonly, kidney stones can run in families, as stones
		  often occur in family members over several generations.  In rare
		  cases, a person forms kidney stones because the
		  parathyroid glands produce too much of a hormone. This leads to higher calcium levels and possibly calcium kidney stones.
		  SymptomsKidney stones
		  form in the kidney. If they stay in the kidney, they typically do not cause
		  pain. When they travel out of the body through the tubes of the
		  urinary tract (including the
		  ureters, which connect the kidney to the bladder, or
		  the
		  urethra, which leads outside the body), their movement
		  may cause: No symptoms, if the stone is small enough.Sudden, severe pain that gets worse in waves. Stones may cause
			 intense pain in the back, side, abdomen, groin, or genitals. People who have
			 had a kidney stone often describe the pain as "the worst pain I've ever had."
			 Feeling sick to the stomach (nausea) and
			 vomiting.Blood in the urine (hematuria), which can occur either
			 with stones that stay in the kidney or with those that travel through the
			 ureters.Frequent and painful urination, which may occur when the
			 stone is in the ureter or after the stone has left the bladder and is in the
			 urethra. Painful urination may occur when a
			 urinary tract infection is also present.
 Conditions with similar symptoms
			 include
			 appendicitis,
			 hernias,
			 ectopic pregnancy, and
			 prostatitis.What HappensA
		  kidney stone begins as a tiny piece of crystal in the
		  kidney. When the urine leaves the kidney, it may carry the crystal out, or the
		  crystal may stay in the kidney. If the crystal stays in the kidney, over time
		  more small crystals join it and form a larger kidney stone. Most
		  stones leave the kidney and travel through the
		  urinary tract when they are still small enough to pass easily out of the body.
		  No treatment is needed for these stones. Larger stones may become stuck
		  in the tubes that carry urine from the kidney to the bladder (ureters). This can cause pain and possibly block the
		  urine from flowing to the bladder and out of the body. The pain often becomes
		  worse over 15 to 60 minutes until it is severe. The pain may ease when the
		  stone no longer blocks the flow of urine. And the pain often goes away when the stone
		  passes into the bladder. Medical treatment is often needed for larger
		  stones. Problems that may occur with kidney stones include: An increased risk of
			 urinary tract infection, or making an existing urinary
			 tract infection worse. Kidney damage, if stones block the flow of
			 urine out of both kidneys (or out of one kidney, for people who have a single
			 kidney). For most people with healthy kidneys, kidney stones do not cause
			 serious damage until they completely block the urinary tract for 2 weeks or
			 longer.
 Kidney stones are more serious for people who have a single
		  kidney or an
		  impaired immune system or have had a kidney
		  transplant. Stones in pregnant womenWhen stones occur during
			 pregnancy, an
			 obstetrician and
			 urologist should determine whether you need treatment.
			 Treatment will depend on your trimester of pregnancy.What Increases Your RiskSeveral risk factors (things that put you at risk) for kidney stones make it more
		  likely that you will get
		  them. Some of these things you can control, and
		  others you cannot. Risk factors you can controlThings  you can control include: How much fluid you drink. 
				The most common cause of kidney stones is
					 not drinking enough water. Try to drink enough water to keep your urine light yellow or clear like water
					 (about 8 to 10 glasses of water a day).Your diet. Diets high in protein, sodium, and
					 oxalate-rich foods, such as dark green vegetables,
					 increase your risk for kidney stones. If you think that your diet may be a
				problem, schedule an appointment with a
				dietitian and review your food choices. 
				Kidney Stones: Preventing Kidney Stones Through Diet
Being overweight. This can cause both
				insulin resistance and increased calcium in the urine,
				which can result in a greater risk for kidney stones.Medicine. Some
				medicines, such as acetazolamide (Diamox) and indinavir (Crixivan), can cause
				kidney stones to form.
 Risk factors you cannot controlThings you can't control include: Age and gender.Men between the ages of 30 and 50 are
					 most likely to get kidney stones.Postmenopausal
					 women with low
					 estrogen levels have an increased risk for kidney stones. Women who have had their ovaries removed are also at increased
					 risk.
A family history of kidney
				stones.A personal history of frequent
				urinary tract infections.Other diseases
				or conditions, such as
				Crohn's disease, hyperparathyroidism, or gout.Intestinal surgery or gastric bypass surgery.Insulin resistance, which can occur because of
				diabetes or
				obesity.
When To Call a DoctorCall a doctor immediately if you have symptoms that suggest you have a
		  kidney stone, such as: Severe pain in your side, abdomen, groin, or
			 genitals. It may get worse in waves.Blood in your
			 urine.Signs of a
			 urinary tract infection, such as pain or burning when you urinate.
 Call your doctor if you have been diagnosed with a kidney
		  stone and have another problem, such as: Severe nausea or vomiting.Fever
			 and chills.Severe pain in your side in the area of your kidney
			 (flank pain).
 Call your doctor to find out if you need an exam when
		  you: Have been diagnosed with a kidney stone, and
			 you need a stronger pain medicine.Pass a stone, even if there was
			 little or no pain. Save the stone, and ask your doctor whether it should be
			 tested.
 Watchful waitingWatchful waiting is a wait-and-see approach. If
			 you get better on your own, you won't need medical treatment. If you get worse,
			 you and your doctor will decide what to do next.  If you are
			 passing a kidney stone under your doctor's advice, you may be able to pass the
			 stone without medical treatment if you: Can control your pain with medicine.Know how to look for and collect kidney stones you
				pass.Do not have signs of infection, such as fever and
				chills.Are able to drink plenty of fluids.Do not have
				severe nausea or vomiting.
 Who to seeIf you need immediate help because of pain from kidney
			 stones, you may see an
			 emergency medicine specialist.  Health professionals who can diagnose and treat
			 nonurgent
			 kidney stones include: To prepare for your appointment, see the topic Making the Most of Your Appointment.Exams and TestsYour first diagnosis of
		  kidney stones often occurs when you see your doctor or
		  go to an emergency room because you are in great pain. Your doctor or an
		  emergency medicine specialist will ask you questions and
		   examine you. After you pass a
		  stone, your doctor may give you another exam to find out whether you are likely
		  to get kidney stones again.  Tests to diagnose kidney stonesYour doctor may do
			 one or more of the following tests to help diagnose kidney stones, see where they are
			 located, and find out if they are causing or may cause damage to the
			 urinary tract. Tests to find out the type of stoneFinding out the
			 type of your kidney stone will help with treatment
			 decisions and measures to prevent stones from forming again. Tests you may have include: A
				medical history and physical exam.Stone analysis. Your doctor may ask you
				to collect stones by straining your urine through a fine-mesh strainer or fine
				gauze. He or she will then determine what type of stone it
				is.Blood chemistry screen, to measure kidney function,
				levels of calcium, uric acid, phosphorus, electrolytes, and other substances
				that may have caused the stone to form. Urine collection for 24 hours, to measure volume, pH, calcium, oxalate, uric
				acid, and other substances that may have caused the stone to form. This is a test you may do at home.
Treatment OverviewFor  small stones, most people don't need any treatment other than taking pain medicine
		  and drinking enough fluids.  Treatment for your first stoneIf your doctor
			 thinks the stone can pass on its own, and if you feel you can deal with the pain,
			 he or she may suggest home treatment, including: Using pain medicine. Nonprescription medicine, such as
				nonsteroidal anti-inflammatory drugs (NSAIDs), may relieve
				your pain. Be safe with medicines. Read and follow all instructions on the label. Your doctor can prescribe stronger pain medicine if
				needed.Drinking enough fluids. You'll need to keep drinking water
				and other fluids when you are passing a kidney stone. 
 Your doctor may prescribe medicine to help your body pass
			 the stone.
			 To learn more, see Medications. If your pain is too
			 severe, if the stones are blocking the
			 urinary tract, or if you also have an infection, your doctor will probably
			 suggest a medical procedure, such as lithotripsy, or surgery to deal with the stone. For more information, see Other Treatment and Surgery. Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?
 Preventing future stonesAfter you have had a
			 kidney stone, you are more likely to have one again. You may be able to prevent
			 getting more kidney stones by drinking more fluids and making changes in your
			 diet. Talk with your doctor or a dietitian if you need help with your diet. If you have risk factors (things that put you at risk) for having more stones, such as a family history
			 of stones, your doctor may suggest medicines that help prevent stones from
			 forming. Kidney Stones: Preventing Kidney Stones Through Diet
 What to think about You
			 may need more treatment for your kidney stones if you have continuing
			 problems and:  A lot of urinary tract
				infections.Decreased kidney function.A single
				kidney.An
				impaired immune system.Have had a kidney
				transplant.
PreventionAfter you have had a kidney stone, you are more likely to have stones again. But you can take
		  steps to help prevent them: Drink more fluids. Try to drink enough water to
			 keep your urine light yellow or clear like water, about 8 to 10 glasses of water a day. Slowly increase
			 how much you drink, perhaps adding one more glass of water a day until you are
			 drinking 8 to 10 glasses a day. This slow increase will give your body time to
			 adjust to the extra fluids. If your urine is dark yellow, you are not drinking enough
			 fluids. If you have kidney, heart, or liver disease and have fluid
			 restrictions, talk with your doctor before increasing how much you
			 drink.Change your diet. This may be helpful, but it depends on
			 what is causing your kidney stones. Your doctor may do more tests before
			 deciding whether changing your diet will help reduce your risk for getting
			 another stone.
 Kidney Stones: Preventing Kidney Stones Through Diet
 MedicineIf you get more kidney stones despite
			 drinking more fluids and making changes to your diet, your doctor may give you
			 medicine to help dissolve your stones or to prevent new ones from forming.  For more
			 information, see Medications. Home TreatmentHome treatment-drinking more fluids and taking pain medicine-is often the only thing
		  you need to do when passing a
		  kidney stone.  Drink fluidsWhen you are
			 passing a kidney stone, you need to drink enough water to
			 keep your urine light yellow or clear like water, about 8 to 10 glasses of water a day. If you have kidney, heart, or liver disease and are on
			 fluid restrictions, talk with your doctor before drinking more fluids.  Use pain medicine Medicine you can buy without a
			 prescription, such as
			 nonsteroidal anti-inflammatory drugs (NSAIDs), may relieve
			 your pain. NSAIDs include aspirin and ibuprofen (such as Advil and Motrin).
			 Be safe with medicines. Read and follow all instructions on the label. Your doctor can prescribe stronger pain medicine if needed. MedicationsMedicine to help pass stones Medicine you can buy without a
		  prescription, such as
		  nonsteroidal anti-inflammatory drugs (NSAIDs), may relieve
		  your pain while you pass a stone. Your
		  doctor may also  prescribe medicine to help your body pass the stone, such as 
		  alpha-blockers.   Medicine to prevent stonesWhich medicine you take depends on the
		  type of stones you have. Calcium stonesCalcium stones are the most common kind of kidney stone. To prevent them, you may take: Orthophosphate.Potassium citrate.Thiazides.
 Uric acid stonesSome  kidney stones are made of uric acid, a waste product that normally exits
				the body in the urine. To prevent these types of stones, you may take: Allopurinol.Potassium citrate.Sodium bicarbonate.
 Cystine stonesA very small number of stones are made of a chemical called cystine. Medicines to prevent them include: Penicillamine.Potassium citrate.Tiopronin.
 Struvite stonesSome struvite stones (staghorn calculi) form because of
			 frequent
			 kidney infections. If you have a struvite stone, you
			 will most likely need antibiotics to cure the infection and help prevent new
			 stones from forming. You may need surgery to remove the
			 stone. Urease inhibitors may be used to prevent struvite stones.SurgerySurgery is rarely needed to treat kidney stones. Surgery is only needed when the kidney stone is very large, caused by an infection (staghorn calculi), blocking the flow of urine out of the kidney, or causing other problems like severe bleeding. If your kidney stones were caused by a problem with your parathyroid gland, your doctor may suggest surgery to
		  remove a parathyroid gland or glands (parathyroidectomy). This can help prevent future kidney stones.Other TreatmentOther treatments for kidney stones  are much more common than surgery. You may need one of these treatments if your pain is very bad, your stone is blocking the urinary tract, or you have an infection. Your options include: Whether these treatments will work for you will depend on the size of the stone, its location in the urinary tract,
		  and your overall health.  Kidney Stones: Should I Have Lithotripsy to Break Up the Stone?
Other Places To Get HelpOrganizationsNational Kidney and Urologic Diseases Information 		Clearinghouse (U.S.) www.kidney.niddk.nih.govNational Kidney Foundation (U.S.) www.kidney.orgReferencesOther Works ConsultedAgency for Healthcare Research and Quality (2012). Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies (AHRQ Publication No. 12-EHC049-EF). Rockville, MD: Agency for Healthcare Research and Quality. Also available online: http://effectivehealthcare.ahrq.gov/ehc/products/274/1035/kidney-stones-prevention-report-130409.pdf.American Urological Association and European Association of Urology (2007, reaffirmed 2010). Ureteral Calculi: 2007 Guideline for the Management of Ureteral Calculi. Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm?sub=uc.Ferrandino MN, et al. (2012). Evaluation and medical management of urinary lithiasis. In AJ Wein et al., eds., Campbell-Walsh Urology, 10th ed., vol. 2, pp. 1287-1323. Philadelphia: Saunders.Smith-Bindman R, et al. (2014). Ultrasonography versus computer tomography for suspected nephrolithiasis. New England Journal of Medicine, 371(12): 1100-1110. DOI: 10.1056/NEJMoa1404446. Accessed November 17, 2014.Stoller ML (2013). Urinary stone disease. In JW McAninch, TF Lue, eds., Smith and Tanagho's General Urology, 18th ed., pp. 249-279. New York: McGraw-Hill.Tseng TY, Preminger GM (2015). Kidney stones: Flexible ureteroscopy. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/2003/overview.html. Accessed April 14, 2016.
CreditsByHealthwise StaffPrimary Medical ReviewerE. Gregory Thompson, MD - Internal Medicine
 Adam Husney, MD - Family Medicine
 Kathleen Romito, MD - Family Medicine
 Specialist Medical ReviewerTushar J. Vachharajani, MD, FASN, FACP - Nephrology
Current as of:
                May 3, 2017 Last modified on: 8 September 2017  |  |