Urinary Stone Disease
by Julie Chacko, M.D.
• Definition: Stone(s) in the kidney.
• Overview:
· Kidney stones are slightly more common in men than in women. …..
• Types:
Calcium containing stones
Uric Acid Stones
Infection related stones
Cystine stones
Matrix stones
medication related stones
• Symptoms:
· May be asymptomatic (without symptoms) if the stone remains in the kidney.
· The symptoms usually occur when the stone tries to pass or blocks a portion of the kidney.
· Classic symptoms of stone passage include:
· flank pain
· nausea
· vomiting
· blood in the urine
• Etiologies:
· The causes of kidney stones are varied
· Over 90% of stone-forming patients can be found to have a clear etiology when work-up is performed.
· Urinary factors include low urinary volumes, high urinary calcium, low urinary citrate, high urinary oxalate, high urinary uric acid levels, and others.
· Other causes of kidney stones include hyperparathyroidism, cancer that has spread to the bones, treatment for cancers with chemotherapy, sedentary lifestyle (wheelchair or bed-bound patients), certain medications, urinary obstruction, hereditary causes, bowel diseases, and congenital abnormalities of the kidneys.
• Complications:
· Kidney infection can cause a serious condition known as obstructive pyelonephritis.
· Calyceal rupture can occur and is more common with small stones.
• Clinical Findings/signs:
· Blood is usually present in the urine, microscopically or sometimes visibly.
· Tenderness of the involved flank on examination.
· CT scan, ultrasound, or plain x-ray may be ordered to confirm the diagnosis.
• Treatment:
· Lifestyle: Modifications in diet can help modify the risk of recurrent stones. The work-up can be complicated and the recommendations are generally made based upon the findings of urine collection. General recommendations for calcium stone forming patients include increase in fluid intake to approximate 2-3 liters of urine a day, decreasing salt intake, and decreasing animal protein intake. Low oxalate diets may be recommended for certain patients.
· Medications used include: potassium citrate, thiazide diuretics, allopurinol, magnesium
Posted on April 16, 2009
