Kidney stone

Summary

Generally

The urine contains various salts. If the concentration of salt becomes too high, for example, if you drink too little, crystals can form. They can then grow into and form so-called kidney stones.

If the stones are really small, they are flushed out with urine and do not cause any problems. However, if the stones are larger, they can get stuck in the ureter and stop the flow of urine. Stones can also remain in the renal pelvis, which is the first part of the urinary tract , and cause other problems such as recurrent  urinary tract infections , pain or  blood in the urine .

A stone that prevents the urine from passing freely down to the bladder causes the renal pelvis to be stretched. The pressure increases and it starts to hurt. If it lasts a long time, the increase in pressure can damage the kidney. If you have a urinary tract infection at the same time, there may be a risk of  sepsis, also called blood poisoning . 

Every other person who has had kidney stones gets a new stone within ten years.

symptoms

Common kidney stone symptoms:

  • You can have an intense pain that feels worst on the side or the back on the side where the stone sits. The pain can radiate down to the abdomen or groin.
  • The pain is usually cutting but can also be dull. It often comes in intervals.
  • You can feel bloated in the stomach, often in combination with nausea.

A kidney stone attack can cause a fever up to 38 ° without an infection. However, high fever can be a sign of a serious infection with the risk of sepsis, also called blood poisoning.

Treatment

If you have had kidney stone problems before and recognize the symptoms, you can try to relieve the problems yourself with non-prescription painkillers. If it does not help or if you get a fever, you should seek care.

Small stones, less than five millimeters, often come out of themselves after a time of kissing. Most often, an  x-ray is made  when seeking care and then another within a few weeks to see that the stone is gone. If the stone does not come out by itself it must be treated.

The most common is that you get so-called shockwave treatment that is found in some hospitals. This means that the stone is crushed by means of an apparatus that emits pressure waves. After that, you can usually pee out the remains.

If the stone cannot be crushed, it usually needs to be treated differently, with so-called peephole surgery or with laser.

When to seek care?

If you have kidney stone pain, you should seek care at a health center or on-call reception . If you have a fever at the same time, it is very important to seek immediate medical attention at the nearest hospital emergency room.

What happens in the body?

Common disease

At kidney stones, stones are formed that can follow the urine down the ureter. There, they can obstruct the flow of urine and cause severe pain. If you have a kidney stone attack, it is common for you to have several seizures later in life as well. Usually the kidney is not damaged, but if the stone obstructs the urine flow and increases the pressure in the urinary tract for two, three weeks, the kidney can be damaged.

Most common in men

Kidney stones are most common in the 20-50 age group and affect men more often than women. Every fifth to ten times you get the disease at some point in your life. You may have a hereditary risk of getting kidney stones more easily.

The kidneys purify the blood

The human has two kidneys that lie above the waist on either side of the spine. The kidneys have a curved shape and are 10–12 centimeters long. The part of the kidney that bends in is called the kidney port and here the ureter exits the kidney. The first part of the ureter is shaped like a funnel and is called the renal pelvis. The kidney port also contains blood vessels that go to and from the kidney.

The kidneys and urinary tract are needed for the body to cleanse the blood and dispose of residual products from the metabolism. Each day, the kidneys produce 1.5–2 liters of urine, which is mostly water. The rest are various residues such as urea and gall colorants, but also foreign substances that have entered the body, such as certain drugs. The urine is transported through the ureters, is temporarily collected in the bladder and leaves the body via the urethra.

The kidneys regulate the volume, salinity and acidity of the urine. How much urine is formed depends, among other things, on how much fluid is in the body.

Read more about kidneys and urinary tract .

Kidney stones can prevent the flow of urine

Initially, the kidney stones are small like grains of sand and easily follow the urine out of the body. Larger stones may get stuck, either in the renal pelvis or in the ureters. The stones can be several centimeters in size and fill the entire renal pelvis.

When the normal flow of urine from the kidneys is hindered by one or more stones, the renal pelvis is stretched. Then it hurts, because the kidneys are surrounded by a tight capsule that does not give. The kidneys may eventually stop working because the tissue cannot withstand high pressure for any length of time. Also the ureter before the stopping stone becomes stretched. Contractions in the walls of the ureter try to push the urine further, but when it is not possible you can get hurt. This is why the pain often comes in intervals.

Several reasons

The urine contains various salts. If the concentration of the salts becomes too high or if the balance between the salts is disturbed, the salt can be precipitated into crystals and stones formed. The concentration of salts is too high either because more salt is excreted in the urine or because the urine becomes too concentrated. This can happen if you do not drink enough or if you lose large amounts of fluid, for example in diarrhea.

The most common type of kidney stone contains lime (calcium salt). Both too much and too little calcium in the diet has been shown to increase the risk of kidney stones. Therefore, the best advice is to eat a varied diet and to drink a little extra if you know that you have the risk of forming kidney stones.

Rarely, kidney stones are caused by the parathyroid glands forming too much of a hormone that regulates the amount of calcium and phosphate in the blood and urine. As a result, you get too much calcium in your blood and urine.

The urine may contain too much of substances other than calcium. This includes uric acid, oxalate and cystine, all of which can form stones.

Kidney stones are also more easily formed if the urine acidity is changed. The change can either be due to a congenital injury or caused by an infection.

Symptoms and diagnosis

Pain most common trouble

Kidney stones usually cause severe pain periodically. The pain feels worst on the side or back on the side where the stone sits, and radiates down to the abdomen and groin on the same side. The pains are usually cutting and spasmodic, but can also be more dull. The cutting and spasmodic pain comes and goes with pain-free periods in between. They can be so powerful that you become cold sweaty and feel unwell. As a result of the pain, the intestines can also be affected so that you feel bloated in the stomach. During a kidney stone attack, you prefer not to be still. You like to rock back and forth or twist if you lie down. Between the bouts of pain one can be completely pain free, often for shorter periods of an hour.

Kidney stone attacks often come back. Therefore, once you have suffered, you may have recurring pain attacks.

Kidney stones need not cause any problems. In such cases, the stones are discovered more by chance if you undergo an X-ray or ultrasound examination for other reasons.

This is how they are investigated

At the doctor you can tell about their complaints, how long you have had them and how it feels. It is important to describe the problems as comprehensively as possible. The doctor also examines the stomach by feeling and listening to it. If the doctor strikes easily with his clenched fist where the kidneys are located, it is usually very tender on the side where the kidney stone is located.

You have to have a blood test showing how the kidneys work and how much calcium is in the blood and urine. There is no blood test that specifically shows that you have kidney stones.

To confirm the suspicion that it is a kidney stone, one is x-rayed. They are examined with computerized X-ray, so-called computed tomography. The study shows if there are any stones. You can also go through a contrast x-ray, so-called urography. The study shows whether there are stones and whether the kidney has done any damage to them.

Care and treatment

Treatment necessary

Severe pain without obvious, natural explanation and that does not go away by itself should always be taken seriously.

Often, you can squeeze out smaller stones without getting stuck. The kidney then does no harm. Larger stones get stuck more easily, which can lead to kidney damage if the urine flow is blocked for two, three weeks. The risk of permanent kidney damage increases if you have a urinary tract infection at the same time.

Serious complications

If you have kidney stone pain and also have a fever, it can indicate that you have had a closed kidney pelvic inflammation, called pyelonephritis. A renal pelvic infection that closes in because a stone in the ureter blocks the flow of urine is a life-threatening condition. This requires care in hospitals and, among other things, treatment with antibiotics. Since the flow of urine from the kidney is prevented, the kidney is stretched by the accumulated urine and the increased pressure leads to damage to the kidney tissue. The increased urine pressure leads to bacteria being pushed into the bloodstream with sepsis, also called blood poisoningas a result. The kidney must be relieved by creating another way for the urine to leave the kidney. One can get something called a nephropyelostomy, which means that a thin plastic tube is inserted through the skin of the back and placed in the renal pelvis to direct the urine that way.

Where to turn?

If you experience sudden and intense pain in the side, you should seek help at a health center or emergency room.

If it does not hurt or if the pain develops gradually over a longer period, it may be more appropriate to contact a doctor at the health care center. If necessary, the doctor writes a referral to a specialist in a hospital or a private specialist clinic. The rules that apply for referral vary between different county councils. There are also private specialists who you can contact yourself without referral. If you feel insecure, you can first call the medical advice for advice.

The continued investigation is usually done where care was sought, either at the health center or at the emergency room hospital. If the stone is so small that the doctor expects to be able to urinate it yourself, the same doctor can follow up the treatment and, if necessary, renew prescriptions for analgesics.

Relieve the trouble yourself

If you have had kidney stone problems before and recognize the symptoms, you can relieve the problems yourself. It can be done with painkillers that have been prescribed by their doctor, or with non-prescription medicines. Sometimes it can feel nice to put something warm on your stomach.

If the problems go over, you do not need to seek care. If, on the other hand, you fail to get rid of the pain with the help of painkillers, you should seek care again.

If you have pain from your stone, you should not drink extra fluid to rinse the stone, as the fluid presses and causes you to get more pain.

Drug treatment in the first place

Kidney stones are primarily treated with painkillers, either as a tablet, suppository or syringe. Often, anti-inflammatory drugs are used from that group of cox inhibitors, also called NSAIDs, such as Diclofenac or Voltaren. Sometimes stronger, morphine-like medicines are needed. If you do not become pain-free despite the treatment, you need to be hospitalized.

If you have also got an infection in the kidney you get antibiotics.

After a while you are usually called to your doctor for a follow-up check. At that doctor’s visit, you are allowed to leave a urine sample and perform a kidney function test. In addition, the doctor will decide whether additional X-rays are needed.

The stone can be crushed

If the kidney stone is large, it must be removed. The most common treatment involves crushing the stone with the help of shock wave treatment, called ESVL. The equipment used in the stone crushing is not available in all hospitals and therefore you may need a referral to a larger hospital.

X-rays or ultrasound are used to find the stone. The shockwave treatment itself takes about an hour and usually does not hurt very much. You always get some pain-relieving and soothing medicine before treatment.

Afterwards you have to pee the crushed stone chips. It can hurt quite a bit and you can then get pain relief medication. The treatment is done in an outpatient setting, which means that you can go home the same day.

Complications are rare

Crushing is a safe method of treatment and serious consequences of the treatment are rare. It is common to have blood in the urine a few days after treatment. Often a couple of treatments are needed for the stone to be crushed to such small fragments that they can pass the ureter.

Operation may be necessary

Sometimes the location of the stone can make it difficult to access it with shockwave treatment. It can also be so large that crushing is inappropriate. Then it may be necessary to remove the stone instead.

The operation is almost always a so-called peephole operation when a tubular instrument is inserted through the skin or the urethra. Through the instrument, the stone is either crushed by laser or ultrasound, and then the fragments can be sucked or picked out with special tools.

Preventive treatment

About half of all those who have had kidney stones are affected again within ten years. To prevent kidney stones, one should drink plenty of fluid, at least two liters per day. Then the urine becomes more diluted and the risk of crystals forming decreases. It is also possible to obtain drug treatment for preventive purposes after examination by a specialist.

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