DIAGNOSIS
The diagnosis of kidney stones is suspected when the typical pattern of symptoms is noted and when other possible causes of the abdominal or flank pain are excluded. Kidney stones are rarely diagnosed before they begin causing pain. This pain is often severe enough to send patients to the ER, where a variety of tests can uncover the stones. These may include:
- Blood testing. Blood tests may reveal too much calcium or uric acid in your blood.
- Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances.
- Imaging. Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays to high-speed or dual energy computerized tomography (CT).
Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.
- Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.
RECOMMENDED MEDICATIONS
Treatment for kidney stones varies, depending on the type of stone and the cause.
Small stones with minimal symptoms
Most kidney stones won’t require invasive treatment. You may be able to pass a small stone by:
- Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system.
- Pain relievers. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
- Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.
Large stones and those that cause symptoms
Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more extensive treatment. Procedures may include:
- Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).
ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine.
- Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.
- Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter.
- Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple.