URINARY CALCULI

General Information

DEFINITION--Small, solid particles that form in one or both kidneys and sometimes travel into the ureter (slender muscular tubes that carry urine from the kidneys to the urinary bladder) or to the bladder. Stones vary from the size of a grain of sand to a golf ball and there may be one or several.

BODY PARTS INVOLVED--Kidney, bladder, urethra.

SEX OR AGE MOST AFFECTED--Adults over 30 of both sexes, but more often occurs in men.

SIGNS & SYMPTOMS

• Painful urination; frequent urge to urinate, even if only small amounts of urine pass.
• Episodes of severe, colicky (intermittent) pain every few minutes. The pain usually appears first in the back, just below the ribs. Over several hours or days, the pain follows the stone's course through the ureter toward the groin. Pain stops when the stone passes.
• Frequent nausea.
• Traces of blood in the urine. Urine may appear cloudy or dark.

CAUSES

• Excess calcium in the urine caused by disturbance in the parathyroid gland, which upsets calcium metabolism; or excess calcium or vitamin-D intake.
• Gout (uric-acid stones).
• Blockage of urine from any cause.

RISK INCREASES WITH

• Decreased volume of urine due to dehydration or hot, dry weather.
• Family history of kidney stones; high animal protein diet; sedentary lifestyle.

HOW TO PREVENT

• Drink 3 quarts of fluid, mostly purified water, every day.
• Avoid milk and milk products if you have had a calcium or phosphorus kidney stone.
• Avoid excessive sweating.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Diagnostic tests may include urinalysis and urine culture, x-ray of the abdomen, kidney ultrasound, CT scan, intravenous urography (See Glossary for both).

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Small stone, uncomplicated by obstruction or infection may need no specific treatment.
• Treatment to remove larger stones, if they don't pass spontaneously and are causing complications, infection or severe pain.
• Stones due to excess calcium in the body may require surgical removal of abnormal parathyroid tissue.

POSSIBLE COMPLICATIONS--Urinary-tract infection; damage to the kidney, necessitating surgical removal; recurrence of stones.

PROBABLE OUTCOME--Large stones usually remain in the kidney without symptoms, although they can damage the kidney. Small stones pass easily into the ureter through the urine. Stones that are big enough to pass but not small enough to pass with ease cause excruciating pain. These usually pass in a few days. If the stone stops and blocks urine, it must be removed to prevent further kidney damage.

How To Treat

GENERAL MEASURES--

• If you are waiting for the stone to pass, watch for it when you urinate. To trap it, urinate each time through a piece of gauze. The stone may pass without discomfort. When it passes, take it to your doctor's office for analysis.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Pain relievers and antispasmodics to relax the ureter muscles and help the stone pass.
• Depending on the type of stone, medication may be prescribed that will stop the growth of existing stones or new stones

ACTIVITY--

• If you know you have calculi, avoid situations in which a sudden pain might cause danger, such as climbing ladders.
• During a calculi episode, stay as active as possible. Don't go to bed. Activity may help the stone pass.

DIET--

• Drink at least 13 glasses of fluid daily. Most of the fluid should be purified water.
• Low animal fat diet.
• Increase fiber in the diet (especially bran).
• Other dietary restrictions will depend upon type of stone formed. Ask your doctor.

Call Your Doctor If

• Temperature rises to 101F (38.3C).
• Symptoms of a kidney infection develop (stinging, burning on urination or a frequent urge to urinate).
• New, unexplained symptoms develop.