Kidney stones

Symptoms

• Very severe pain in the side or back, coming in waves and often moving down toward the groin.
• Blood in the urine, visible or microscopic.
• Nausea and vomiting.
• Frequent or burning urination when the stone is near the bladder.

A stone that stays in the kidney without blocking it may cause no symptoms and is found incidentally on ultrasound.

How stones form and the types

Stones form when urine becomes concentrated and substances such as calcium, oxalate or uric acid crystallize. The most frequent are calcium (oxalate) stones, then uric acid stones, linked to acid urine and gout, struvite stones after infections (urinary infections) and cystine stones. Factors: low fluid intake, excess salt, a diet rich in animal protein, overweight, family history and some metabolic diseases.

Diagnosis and when a stone passes by itself

The doctor assesses the pain, urinalysis, creatinine and markers of infection. Kidney ultrasound shows larger stones and dilatation of the collecting system. Non-contrast computed tomography, which is not performed at our clinic, is recommended at another center when the diagnosis is uncertain or an intervention is planned. A stone up to about 5 mm in diameter usually passes by itself; a larger stone has lower chances and may require urological intervention. Size, location, infection and function determine the decision.

What to do during colic and how to prevent recurrence

Renal colic is one of the most severe pains, but in most cases the stone passes by itself and home care complements medical treatment. Pain is relieved with painkillers recommended by the doctor and with local warmth; stay mobile, because movement may help the stone descend. Drink fluids normally, not forcibly during severe pain. If the doctor suggests it, strain the urine through a fine sieve to catch the stone; analysis of its composition is very useful for prevention. After passage, keep the stone in a clean container and bring it to the visit.

The risk of recurrence after a first stone is considerable in the following years, so prevention has value. The aim is a urine volume of at least 2–2.5 liters a day, which usually requires drinking about 2.5–3 liters of fluids, mainly water, spread throughout the day and in the evening. Salt is limited to about 5 g a day, because sodium increases calcium excretion in the urine. Animal protein (red and processed meat) is moderated. Dietary calcium (milk, cheese) should not be avoided, because it binds oxalate in the gut and reduces its absorption; restricting it may raise risk. Foods very rich in oxalate (spinach, rhubarb, nuts, strong tea) are taken in moderation if you have oxalate stones. Lemon and other citrus raise urinary citrate, which inhibits crystallization. For uric acid stones, control of gout and a supportive diet are part of the plan.

Which tests and questions matter

After a first stone, the doctor usually requests blood tests (creatinine, calcium, uric acid) and urine tests; in recurrent stones, in children, in multiple stones or in those with coexisting disease, a fuller metabolic evaluation is done, including 24-hour urine, which shows the amounts of calcium, oxalate, citrate and uric acid. High blood calcium may indicate hyperparathyroidism, which requires separate treatment.

Periodic ultrasound follows any remaining stones in the kidney, because they may grow or descend. Useful questions: what is the composition of my stone; what is the risk of recurrence; are there coexisting diseases promoting it; what specific diet suits me; when should I return for a check. If you want follow-up, bring earlier ultrasound or CT reports.

Treatment and prevention

In colic, painkillers are used and, at the doctor’s discretion, medicines that ease passage; anti-inflammatories are used with caution in patients with kidney disease. Drinking fluids as advised by the doctor helps, but forcing fluids during severe pain does not speed passage. Lithotripsy, ureteroscopy and other procedures are performed by the urologist at specialized centers.

Prevention aims at dilute urine: enough fluids throughout the day, less salt, moderate animal protein and normal dietary calcium, without excessive restriction. Blood tests and 24-hour urine collection are used in recurrent stones. Reviews are every 6 months to a year, or sooner when the doctor considers it reasonable.

Care at Tirana Polyclinic: we offer nephrology consultation, abdominal ultrasound and interpretation of tests and of imaging performed elsewhere.