Nephrolithiasis

GENERAL INFORMATION:

What is it? Nephrolithiasis (nef-roh-li-THI-ah-sis) is also called renal calculi or "kidney stones". Kidney stones are rock-like pieces that can form in the urinary system, usually in the kidneys. They may be very small, or may grow to the size of a small pebble or larger. You may have one or more kidney stones at one time. Small kidney stones often leave the body without a person even knowing about them. While larger stones may get stuck in one of the two ureters, causing pain and sometimes blocking urine flow. Anyone can get kidney stones, but they are most common in men aged 20 to 60 years.

What is the urinary system? The urinary system is made up of the kidneys, bladder, ureters, and urethra. The kidneys are bean-shaped organs that remove unwanted chemicals and waste from your blood. These wastes are turned into urine by the kidneys. The kidneys are located one on each side in the back of your abdomen. The ureters are tubes that carry urine from the kidneys to the bladder. The bladder is a hollow, round organ that holds urine. Urine leaves the bladder and goes out of the body through a tube called the urethra.

What causes kidney stones? Kidney stones are usually caused when water and waste in the urine are out of balance. When this happens, certain types of waste crystals separate from the urine. Instead of going out of the body in the urine, the crystals build up. Examples of these crystals are uric acid, calcium, phosphate, and oxalate. As the crystals build up, they form clumps, or kidney stones. You may be at higher risk of having kidney stones if:

• You do not drink enough liquids (especially water) each day.
  
  
• You have urinary tract infections often.
  
  
• You eat a certain type of diet. For example, people who eat a diet high in meat or salt may be at higher risk of developing kidney stones. People who eat foods high in oxalate (found in nuts, chocolate, coffee, tea, and green leafy vegetables) may also be at higher risk.
  
  
• You take certain medicines. These include some diuretics, steroids and antacids.
  
  
• Someone else in your family has had kidney stones.
  
  
• You were born with a kidney or bowel disorder, or you have other medical problems such as gout.

What are the signs and symptoms of kidney stones? The most common sign of kidney stones is pain in the middle of your back that moves across to your side. The pain may continue down toward your groin (area between your legs). The pain may come and go and can be very severe (bad). You may also have one or more of the following:

• Fever and chills. You may have these if your stone has caused an infection.
  
  
• Nausea (feel sick to your stomach) and vomiting (throwing up).
  
  
• Problems with urination. You may feel like you need to urinate very often. You may feel burning when you urinate. You may have blood in your urine, which may look pink or red.
  
  
• Tenderness in your lower back, side, or stomach.

How are kidney stones diagnosed? Your caregiver will do a medical exam and ask you questions about your health, diet, and lifestyle. The caregiver may send you to see a specially-trained caregiver called a urologist. You may need certain tests. Tests can help caregivers know about the type of kidney stones you have (what crystals they are made of). They may show the size of your kidney stones and where they are located in your urinary system. You may have one or more of the following:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Cystoscopy: A cystoscopy allows caregivers to look for problems inside your bladder. A cystoscope is put into your bladder through your urethra. The urethra is the tube that urine flows through when you urinate. The cystoscope is a long tube with a lens and a light on the end. The scope may be hooked to a camera or monitor, and pictures may be taken. A tissue sample may also be taken during your cystoscopy. During this test, small tumors may be removed or bleeding may be stopped.
  
  
• IVP: This is also called an intravenous pyelogram. An IVP is an x-ray of the kidneys, bladder, and ureters (tubes that carry urine). Dye is put into your IV, which makes these organs show up better in x-ray pictures. You may need to have more than one x-ray over short periods of time during your IVP. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or other medicines.
  
  
• KUB x-ray: An x-ray machine takes pictures of your kidneys (K), ureters (U), and bladder (B). The ureters are tiny tubes that carry urine from your kidneys to your bladder. The bladder is where the urine is stored before leaving your body. Caregivers use these pictures to check for problems with your intestines , kidneys, or abdomen.
  
  
• Noncontrast helical CT scan: This test is also called a "CAT" scan. A special x-ray machine uses a computer to take pictures of your kidneys. Your caregivers look at the pictures to see if there are kidney stones or other problems.
  
  
• Abdominal ultrasound: An abdominal ultrasound is a test that is done to see inside your abdomen. Sound waves are used to show pictures of your abdomen on a TV-like screen.

How are kidney stones treated?

• Your caregiver may tell you to drink at least two to three quarts (eight to twelve cups) of liquids each day. This may help the kidney stone to "pass" (come out) on its own during urination. You will urinate into a special cup or strainer each time you go to the bathroom. The cup or strainer will help catch any kidney stones that you pass. Kidney stones that pass will be sent to the lab to help caregivers learn what type of stones you have. You may be given pain medicine to take while you are waiting for your stone to pass. You may also need a KUB x-ray every one to two weeks until the stone is gone.
  
  
• If the stone does not pass, you may need a procedure or surgery to remove it. One common procedure is called lithotripsy. With lithotripsy, shock waves are used to break up kidney stones so they can be passed in the urine. Other types of procedures or surgery can be done. Your treatment will depend on the size and location of your kidney stone. You may need to take medicine, change your diet, and drink plenty of liquids to help prevent more kidney stones.

For information and support:

• National Kidney and Urologic Diseases Information Clearinghouse
  3 Information Way
  Bethesda, MD 20892-3580
  Phone: 1-800-891-5390
  Web Address: http://kidney.niddk.nih.gov/
  

• National Kidney Foundation
  30 East 33rd Street
  New York, NY 10016
  Phone: 1-212-889-2210
  Phone: 1-800-622-9010
  Web Address: http://www.kidney.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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