Definition of Renal calculi Definition of Renal calculi Causes of a Heart Attack Slideshow Renal calculi: Kidney stones . A common cause of blood in the urine and pain in the abdomen, flank, or groin. Occurs in 1 in 20 people at some time in their life. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, urate, cystine, xanthine, and phosphate. The stones form in the urine collecting area (the pelvis) of the kidney and may range in size from tiny to staghorn stones the size of the renal pelvis itself . The pain is usually of sudden onset, very severe and colicky (intermittent), not improved by changes in position, radiating from the back, down the flank, and into the groin. Nausea and vomiting are common. Predisposing factors may include recent reduction in fluid intake, increased exercise with dehydration , medications that cause hyperuricemia (high uric acid) and a history of gout . Treatment includes relief of pain, hydration and, if there is concurrent urinary infection, antibiotics. The majority of stones pass spontaneously within 48 hours.

However, some stones may not. There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy , and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. If a stone does not pass, urologic intervention may be needed. The process of stone formation is also called nephrolithiasis or urolithiasis. "Nephrolithiasis" is derived from the Greek nephros- (kidney) + lithos (stone) = kidney stone "Urolithiasis" is from the French word "urine" which, in turn, stems from the Latin "urina" and the Greek "ouron" meaning urine = urine stone. Last Editorial Review: 5/13/2016 Kidney stone | Define Kidney stone at Dictionary.com kidney stone an abnormal stone, or concretion, composed primarily of oxalates and phosphates, found in the kidney. Expand Examples from the Web for kidney stone Expand Contemporary Examples British Dictionary definitions for kidney stone Expand noun 1.

(pathol) Also called renal calculus. a hard mass formed in the kidney, usually composed of oxalates, phosphates, and carbonates 2. (mineralogy) another name for nephrite Collins English Dictionary - Complete & Unabridged 2012 Digital Edition © William Collins Sons & Co. Ltd. 1979, 1986 © HarperCollins Publishers 1998, 2000, 2003, 2005, 2006, 2007, 2009, 2012 Expand kidney stone n. A small hard mass in the kidney that forms from deposits chiefly of phosphates and urates. Also called nephrolith. The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company. Expand kidney stone A calculus that originates in the kidney and is usually composed of calcium salts, uric acid, cystine, and other compounds.

Kidney stones cause extreme pain and bleeding if they obstruct the passage of urine in the kidney or in the ureter. They can often be treated with lithotripsy . The American Heritage® Science Dictionary Copyright © 2002. Published by Houghton Mifflin. All rights reserved. People invent new words all the time, but which ones actually make it? Word of the Day Renal Calculi - National Library of Medicine - PubMed Health Increased water intake may help reduce the risk of recurrence of kidney stones but more studies are needed Kidney stones (also known as calculi) are masses of crystals and protein and are common causes of urinary tract obstruction in adults. For a long time, increased water intake has been the main preventive measure for the disease and its recurrence. In this review only one study was found that looked at the effect of increase water intake on recurrence and time to recurrence. Increased water intake decreased the chance of recurrence and increased the time to recurrence. Further studies are needed. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones Stones in the urinary tract are a common medical problem.

Half of patients with previous urinary stones have a recurrence within 10 years. Kidney stones can cause pain, blood in the urine, infection, decreased kidney function, and kidney failure. The treatment is to remove the stones from kidney. Extracorporeal shock wave lithotripsy (ESWL) disintegrates stones using shock waves and is a minimally invasive technique. Other minimally invasive methods (percutaneous nephrolithotomy (PCNL)) and retrograde intrarenal surgery (RIRS)) are widely used for kidney stones management because ESWL had limited success rate. This review aimed to compare the effectiveness and complications between ESWL and stones removing using the nephroscopy through the skin at kidney level (PCNL) or ureteroscope through the bladder and ureter to the kidney (RIRS). Five small randomised studies (338 patients) were included. Four studies compared ESWL with PCNL and one study compared ESWL with RIRS. Patients with kidney stones who undergo PCNL have a higher success rate than ESWL whereas RIRS was not significantly different from ESWL. However, ESWL patients spent less time in hospital, duration of treatment was shorter and there were fewer complications.

Pharmacological interventions for preventing complications in idiopathic hypercalciuria Idiopathic hypercalciuria is an inherited metabolic abnormality characterised by excessive amounts of calcium excreted into the urine in patients with normal serum levels of calcium. The main complications of this disease in adults are the formation of kidney stones and bone loss. In children, hypercalciuria can cause recurrent haematuria (blood in the urine), frequency‐dysuria syndrome (frequent painful or difficult urination), urinary tract infection and abdominal and back pain. The aim of this review was to evaluate the benefits and harms of drug treatments for preventing the complications of idiopathic hypercalciuria. We identified four studies comparing thiazides (diuretics) with either standard treatment of clinical follow‐up and increased water intake or specific dietary recommendations and one study comparing thiazides plus a potassium salt. There was a decrease in the number of new stones in the group receiving thiazides as well as an increase in the time taken for new stone formation. The addition of potassium salts to thiazide treatment significantly reduced the amount of calcium excreted in the urine.

No studies in children were identified and there were no studies investigating the use of drug treatment for those with hypercalciuria but were symptom free. Treating kidney stones Small kidney stones often pass on their own and don't need treatment as long as they don't cause any severe pain or complications. Larger kidney stones usually need to be removed. Depending on how large the kidney stones are and where they're located, they can be destroyed, removed using endoscopy or operated on.Kidney stones with a diameter of less than 5 millimeters pass on their own 70% of the time, and stones that are between 5 and 10 millimeters are flushed out in about 50% of cases. The amount of time this takes varies greatly. Small kidney stones are often passed in your urine after one or two weeks.If a stone is expected to be flushed out with your urine without any treatment, it's usual to simply wait. Anti-inflammatory painkillers like diclofenac can provide relief if the kidney stone causes pain as it travels through the ureter.Larger stones will usually have to be broken up or surgically removed.

This needs to be done in the following instances:The kidney stone isn't passed within four weeks.There are complications.It causes severe renal colic.The stone is larger than 10 mm in diameter.Uric acid stones can sometimes be dissolved using medication. Increased water intake may help reduce the risk of recurrence of kidney stones but more studies are needed Kidney stones (also known as calculi) are masses of crystals and protein and are common causes of urinary tract obstruction in adults. For a long time, increased water intake has been the main preventive measure for the disease and its recurrence. In this review only one study was found that looked at the effect of increase water intake on recurrence and time to recurrence. Increased water intake decreased the chance of recurrence and increased the time to recurrence. Further studies are needed. Kidney stones: Overview Kidney stones are very common, especially in people between the ages of 20 and 40. These small, hard deposits form in the renal pelvis and can enter a ureter. Larger stones can be painful and often have to be surgically removed. There are several options for treatment and prevention.

Kidney stone | definition of kidney stone by Medical dictionary Kidney stone | definition of kidney stone by Medical dictionary Related to kidney stone: kidney infection kidney [kid´ne] either of the two bean-shaped organs in the lumbar region that filter the blood, excreting the end-products of body metabolism in the form of urine, and regulating the concentrations of hydrogen, sodium, potassium, phosphate, and other ions in the extracellular fluid. Physiology. In an average adult each kidney is about 10 cm long, 5 cm wide, and 2.5 cm thick, and weighs 120 to 175 g. In this small area the kidney contains over a million microscopic filtering units, the nephrons . Blood arrives at the kidney by way of the renal artery, and is distributed through arterioles into many millions of capillaries which lead into the nephrons. Fluids and dissolved salts in the blood pass through the walls of the capillaries and are collected within the malpighian capsule , the central capsule of each nephron.

Within the capsule is a tuft of capillaries called the glomerulus that acts as a semipermeable membrane permitting a protein-free ultrafiltrate of plasma to pass through. This filtrate is forced into the renal tubules , hairpin-shaped collecting channels in the nephrons. Capillaries in the walls of the tubules reabsorb the water and the salts required by the body and deliver them to a system of small kidney veins which, in turn, carry them into the renal vein and return them to the general circulation. Excess water and other waste materials remain in the tubules as urine . The urine contains, besides water, a quantity of urea , uric acid , yellow pigments, amino acids, and trace metals. The urine moves through a system of ducts into the funnel-shaped renal pelvis in each kidney, through which it is led into the two ureters . Filtering Capacity. About 1500 ml of urine are excreted daily by the average adult. The efficiency of the normal kidney is one of the most remarkable aspects of the body.

Ordinarily it draws off from the blood about 164 liters of fluid daily, and usually returns 98 to 99 per cent of the water plus the useful dissolved salts, according to the body's changing needs. Maintaining Acid-Base Balance . The kidneys help control the body's acidity by reabsorbing filtered bicarbonate ions in exchange for chloride and by secreting hydrogen ions. When there is alkalosis, the kidney compensates by reabsorbing less bicarbonate ions and more hydrogen ions. Regulation of Sodium-Water Balance. Normal osmolality and volume of body fluids are preserved by the normally functioning kidney. It does this by actively reabsorbing sodium and, by osmosis , reabsorbing more water, thus varying the urine concentration. The regulation of the sodium level in the blood is influenced by aldosterone , which increases sodium reabsorption; it is secreted by the adrenal gland in response to low serum sodium levels and the presence of angiotensin II. The reabsorption of water is affected not only by the reabsorption of sodium but also by antidiuretic hormone, which is secreted by the pituitary gland in response to high serum osmolality.

Endocrine Functions. In response to renal ischemia the kidneys regulate blood pressure by the renin-angiotensin-aldosterone system . Also, when kidney cells become hypoxic they release a hormone called erythropoietin , which stimulates the maturation of oxygen-bearing red blood cells in the bone marrow. The kidneys also are involved in the conversion of inactive vitamin D to the active form, which increases calcium absorption in the intestine and calcium uptake by the bones. Disorders of the Kidneys. Disorders of the kidney include inflammation, infection, obstruction, structural defects, injuries, calculus formation, and tumors. Specific disorders include types of glomerulonephritis , nephritis , nephropathy , and pyelitis ; kidney stones ; polycystic kidney disease ; and nephroptosis . See also renal failure . Details of structure of the kidney. amyloid kidney one with amyloidosis ; called also waxy kidney . artificial kidney popular name for an extracorporeal hemodialyzer , a device used as a substitute for nonfunctioning kidneys.

Ask-Upmark kidney a hypoplastic kidney with fewer lobules than usual and fissures on its surface; most affected persons have severe hypertension, sometimes with hypertensive encephalopathy and retinopathy . The condition may be either congenital or secondary to vesicoureteral reflux with pyelonephritis . cake kidney a solid, irregularly lobed organ of bizarre shape, formed by fusion of the two renal anlagen; called also lump kidney . cicatricial kidney a shriveled, irregular, and scarred kidney due to suppurative pyelonephritis. fatty kidney one with fatty degeneration . flea-bitten kidney one with small, randomly scattered petechiae on its surface. floating kidney nephroptosis . fused kidney a single anomalous organ developed as a result of fusion of the renal anlagen. horseshoe kidney an anomaly in which the right and left kidneys are linked at one end by a band of tissue as a result of fusion of the poles of the renal anlagen. lump kidney cake kidney .

medullary sponge kidney a usually asymptomatic congenital condition in which multiple small cystic dilatations of the collecting tubules of the medullary portion of the renal pyramids give the organ a spongy, porous feeling and appearance. Called also sponge kidney . myeloma kidney renal changes seen in multiple myeloma , due to filtration of large amounts of Bence Jones protein; they include tubular atrophy with intraluminal casts and multinucleate giant cells in tubular walls and interstitium, resulting in renal failure. sponge kidney medullary sponge kidney . kidney stone a calculus in the kidney, composed of crystals precipitated from the urine on a matrix of organic matter. Called also nephrolith and renal calculus . About 80 per cent of kidney stones are composed of calcium salts, which precipitate out of their normally soluble form in urine, usually because the patient has an inherited tendency to excrete excessive amounts of calcium ( idiopathic hypercalcemia ). A very small percentage of kidney stones are associated with a parathyroid tumor that increases production of parathyroid hormone and thus raises the serum calcium level.

Persons with intestinal absorption problems, including those who have had intestinal bypass surgery for obesity, sometimes develop calcium stones because of excessive absorption of dietary oxalate, which is eventually excreted by the kidneys. Since vitamin C is converted by the body into oxalate, large doses of the vitamin can predispose one to stone formation. The most common type of stones is the oxalate calculi, hard ones consisting of calcium oxalate ; some have sharp spines that can abrade the renal pelvic epithelium, and others are smooth. Another common type is the phosphate calculi, which contain calcium phosphate in a mineral form such as brushite or whitlockite; they may be hard, soft, or friable and range from small to so large that they fill the renal pelvis. Struvite stones are composed of the salt magnesium ammonium phosphate and form in alkaline urine such as that produced in urinary tract infections . Uric acid stones form when there is an increased excretion of uric acid , as in gout or certain malignancies. An acid urine favors their formation. Cystine stones are associated with cystinuria , a hereditary kidney disorder in which there is excessive excretion of cystine .

“Staghorn stones” are ones that have extended from the renal pelvis into the calyces, giving them sharp protrusions like the antlers of a stag. Prevention. No matter what the type of kidney stone, an essential preventive measure is high fluid intake to prevent urinary stasis. In order to dilute the urine sufficiently, an adult must put out almost 4000 ml of urine every 24 hours. A continuous flow of adequate amounts of urine has both a mechanical and a chemical effect. The fluids flush the urinary tract and remove substances essential to stone formation. Also, the urine itself contains substances that bind with potential precipitates, making them more soluble and less able to form a mass. Additional preventive measures include avoidance or prompt treatment of urinary tract infections , changing the urinary pH in cases in which acidity or alkalinity predisposes to stone formation, treatment of underlying pathologies such as parathyroid tumor, and careful long-term follow-up of patients who have had intestinal bypass surgery or a history of intestinal malabsorption. Uric acid stones can be prevented by administering the drug allopurinol , which inhibits the formation of uric acid, and by keeping the urine relatively alkaline.

An alkaline urine and high intake are effective means of preventing cystine stones. If these measures fail, however, the drug penicillamine may be prescribed. A specific strategy for prevention of stone formation in an individual patient requires chemical analysis of the stones, urine, and blood to determine the type of stone being formed. Symptoms. Kidney stones do not always produce symptoms. However, they can lead to infections and inflammations that do produce symptoms. A definitive diagnosis is established by examination of the urine for hematuria , an abdominal x-ray (which can detect stones of calcium salts), or an intravenous or retrograde pyelogram using a radiopaque dye. The pyelogram will not show the stone itself but there will be a gap in the stream of dye as it courses down the ureter. The classic symptoms of renal colic occur when a small calculus is dislodged from the renal pelvis and begins to travel down the ureter. Many stones have sharp spicules or spikes on their surfaces; as they roll along the ureter they can scrape the lining, causing excruciating pain and bleeding. The pain is typically felt in the flank over the affected kidney and ureter and radiates downward toward the genitalia and inner thigh.

Nausea and vomiting can occur as a result of the severe pain. If an infection is present the patient experiences fever and chills. Treatment. Stones that are less than 5 mm can usually be eliminated with the normal passage of urine; this is the most desirable method of treatment. Adequate medication is given to relieve pain and relax the muscular walls of the ureter, thus easing passage of the stone. Fluids are given orally or intravenously to aid mechanical flushing. During this period the urine is strained in order to determine whether the stone is passed and, if it is, to collect it for laboratory analysis. If the stone is not passed, the traditional treatment has been surgical intervention to remove it via ureteroscopy . A newer noninvasive technique is lithotripsy , which involves crushing the stone into fragments small enough to be passed in the urine; this is done using any of a variety of techniques, the most common being ultrasound. Patient Care. Prevention of kidney stones requires a knowledge of patients most at risk. Males are much more at risk than females for development of calcium stones; also at high risk are those of either sex who have a family history of stone formation.

Other persons at risk are those who are immobilized for any reason, have a urinary tract infection, or have a history of intestinal bypass or malabsorption. Analgesics should be administered promptly to provide relief of pain and facilitate passage of the stone. Fluid intake and output are measured; the intake is encouraged to be 4000 ml every 24 hours. Characteristics of the urine are noted, and all urine is strained until the stone is either passed or removed surgically. Dietary restrictions and recommendations to alter urinary pH and the reason for increased fluid intake are explained to the patient and family members as appropriate. The patient also is taught to take prescribed medications faithfully and to report symptoms of urinary tract infection promptly. Synonym(s): kidney stone . Kidney stone A hard mass that forms in the urinary tract and which can cause pain, bleeding, obstruction, or infection. Stones are primarily made up of calcium. Mentioned in: Lithotripsy Patient discussion about kidney stone Q. Why do i get kidney stones? I am 38 and have had three stones pass so far. Is it the coffee, the meat, the stress, or the damned DNA?!

My uncle is in his 50s and has passed over 30 stones! A. Kidney stones are very common and even without the genetic or familial background people tend to get them. Of course, the more family predisposition you have, the higher are your chances of developing them, which is probably why you did. Also, a diet rich with dairy and calcium can cause your body to store excess calcium, that tends to calcify and create stones. Not drinking enough fluid is also one of the reasons. Q. Would kidney stones affect a PSA reading? Would drinking lots of grapefruit juice affect a PSA reading? My husband's PSA reading jumped from a 4.2 to a 17 in @ 2 years' time. How can that be? This man takes all sorts of supplements and really watches his diet. He also takes good care of his body, and does NOT look or act 68. A. You should get your parathyroid gland checked out. Your calcium level might be causing the kidney stones. Q. How can i overcome kidney ache? in the morning it appears.after wake up. A. First of all, it is important to distinguish kidney ache from lower back ache.

If you have ever suffered from kidney problems or infections, it might be advisable to see a doctor, and rule out an infection. However, if you are otherwise healthy, and have been experiencing back pain after you wake up, it is very much possible your pain is not from the kidneys, but from the muscles of your back. In this case, some exercise on a daily basis to help strengthen your lower back can very much ease the pain you're experiencing. Nephrolithiasis Treatment & Management: Approach Considerations, Emergency Management of Renal Colic, Surgical Care Emergency Management of Renal Colic Treatment Approach Considerations Treatment of nephrolithiasis involves emergency management of renal (ureteral) colic, including surgical interventions where indicated, and medical therapy for stone disease. In emergency settings where concern exists about possible renal failure, the focus of treatment should be on correcting dehydration, treating urinary infections, preventing scarring, identifying patients with a solitary functional kidney, and reducing risks of acute kidney injury from contrast nephrotoxicity, particularly in patients with preexisting azotemia (creatinine >2 mg/dL), diabetes, dehydration, or multiple myeloma.

Adequate intravenous (IV) hydration is essential to minimize the nephrotoxic effects of IV contrast agents. Most small stones in patients with relatively mild hydronephrosis can be treated with observation and acetaminophen. More serious cases with intractable pain may require drainage with a stent or percutaneous nephrostomy. The internal ureteral stent is usually preferred in these situations because of decreased morbidity. Acetaminophen can be used in pregnancy for mild-to-moderate pain. Opioid drugs, such as morphine and meperidine, are pregnancy category C medications, which means they can be used but they cross the placental barrier. Opioids can cause respiratory depression in the fetus; therefore, they should not be used near delivery or when other medications are adequate. A chemical composition analysis of the stone should be performed whenever possible, and information should be provided to motivated patients about possible 24-hour urine testing for long-term nephrolithiasis prophylaxis. This is particularly important in patients with only a single functioning kidney, those with medical risk factors, and children.

However, any strongly motivated patients can benefit from a prevention analysis and prophylactic treatment if they are willing to pursue long-term therapy. The size of the stone is an important predictor of spontaneous passage. A stone less than 4 mm in diameter has an 80% chance of spontaneous passage; this falls to 20% for stones larger than 8 mm in diameter. However, stone passage also depends on the exact shape and location of the stone and the specific anatomy of the upper urinary tract in the particular individual. For example, the presence of a ureteropelvic junction (UPJ) obstruction or a ureteral stricture could make passing even very small stones difficult or impossible. Most experienced emergency department (ED) physicians and urologists have observed very large stones passing and some very small stones that do not move. Aggressive medical therapy has shown promise in increasing the spontaneous stone passage rate and relieving discomfort while minimizing narcotic usage. Aggressive treatment of any proximal urinary infection is important to avoid potentially dangerous pyonephrosis and urosepsis. In these cases, consider percutaneous nephrostomy drainage rather than retrograde endoscopy, especially in very ill patients.

Medical therapy for stone disease takes both short- and long-term forms. The former includes measures to dissolve the stone (possible only with noncalcium stones) or to facilitate stone passage, and the latter includes treatment to prevent further stone formation. Stone prevention should be considered most strongly in patients who have risk factors for increased stone activity, including stone formation before age 30 years, family history of stones, multiple stones at presentation, and residual stones after surgical treatment. In 2016, the American Urological Association/Endourological Society issued general management guidelines for the various presentations of stones that can be managed conservatively. The guidelines state that observation with or without medical expulsive therapy (MET) should be offered to patients with uncomplicated distal ureteral stones that are 10 mm or less in diameter. The guidelines also state that active surveillance can be offered for asymptomatic, non-obstructing caliceal stones. [ 35 ] In the case of pediatric patients with uncomplicated ureteral stones ≤10 mm or asymptomatic non-obstructing renal stones, active surveillance with periodic ultrasonography can be offered. Pregnant patients with ureteral/renal stones with well-controlled symptoms can also be observed.

[ 35 ] Indications for hospitalization The decision to hospitalize a patient with a stone is usually made based on clinical grounds rather than on any specific finding on a radiograph. Generally, hospitalization for an acute renal colic attack is now officially termed an observation because most patients recover sufficiently to go home within 24 hours. The admission rate for patients with acute renal colic is approximately 20%. Hospital admission is clearly necessary when any of the following is present: Oral analgesics are insufficient to manage the pain. Ureteral obstruction from a stone occurs in a solitary or transplanted kidney. Ureteral obstruction from a stone occurs in the presence of a urinary tract infection (UTI), fever, sepsis, or pyonephrosis. Infected hydronephrosis, defined as urinary tract infection (UTI) proximal to an obstructing stone, mandates hospital admission for antibiotics and prompt drainage. Midstream urine culture and sensitivity was a poor predictor of infected hydronephrosis in one series, being positive in only 30% of cases. [ 36 ] The clinical presentation of infected hydronephrosis is variable.

Pyuria (>5 white blood cells [WBCs] per high-power field [hpf]) is almost always present but is not diagnostic of proximal infection. In one small series of 23 patients with infected hydronephrosis, the temperature was higher than 38°C in 15 patients, the peripheral WBC count was more than 10 × 109/L in 13 patients, and the creatinine level was greater than 1.3 mg/dL in 12 patients. [ 37 ] Renal ultrasonography or CT may distinguish pyonephrosis from simple hydronephrosis by demonstrating a fluid-fluid level in the renal pelvis (urine on top of purulent debris). In two small studies, ultrasonographic sensitivity for pyonephrosis was found to be 62-67%. CT sensitivity for pyonephrosis has not been reliably determined. [ 38 , 39 ] The emergency physician must maintain a high index of suspicion. [ 40 ] Antibiotics should cover Escherichia coli and Staphylococcus, Enterobacter, Proteus, and Klebsiella species.

In another small study of 38 patients with hydronephrosis, 16 had infected hydronephrosis and 22 had sterile hydronephrosis. Ultrasonography alone detected 6 of 16 cases of pyonephrosis, a sensitivity of 38%. Using a cutoff value of 3 mg/dL for C-reactive protein and 100 mm/h for erythrocyte sedimentation rate, the diagnostic accuracy of detecting infected hydronephrosis and pyonephrosis increased to 97%. [ 41 ] Relative indications to consider for a possible admission include comorbid conditions (eg, diabetes), dehydration requiring prolonged IV fluid therapy, renal failure, or any immunocompromised state. Patients with complete obstruction, perinephric urine extravasation, a solitary kidney, or pregnancy, and those with a poor social support system, also should be considered for admission, especially if rapid urologic follow-up is not reliably available. Larger stones (ie, ≥7 mm) that are unlikely to pass spontaneously require some type of surgical procedure. In some cases, hospitalizing a patient with a large stone to facilitate surgical stone intervention is reasonable.

However, most patients with acute renal colic can be treated on an ambulatory basis. About 15-20% of patients require invasive intervention due to stone size, continued obstruction, infection, or intractable pain. Techniques available to the urologist when the stone fails to pass spontaneously include the following [ 42 ] : Stent placement Next: Emergency Management of Renal Colic Initial treatment of a renal colic patient in the ED starts with obtaining IV access to allow fluid, analgesic, and antiemetic medications to be administered. Many of these patients are dehydrated from poor oral intake and vomiting. Although the role of supranormal hydration in the management of renal (ureteral) colic is controversial (see below), patients who are dehydrated or ill need adequate restoration of circulating volume. After diagnosing renal (ureteral) colic, determine the presence or absence of obstruction or infection. Obstruction in the absence of infection can be initially managed with analgesics and with other medical measures to facilitate passage of the stone. Infection in the absence of obstruction can be initially managed with antimicrobial therapy. In either case, promptly refer the patient to a urologist.

If neither obstruction nor infection is present, analgesics and other medical measures to facilitate passage of the stone (see below) can be initiated with the expectation that the stone will likely pass from the upper urinary tract if its diameter is smaller than 10 mm (larger stones are more likely to require surgical measures). If both obstruction and infection are present, emergency decompression of the upper urinary collecting system is required (see Surgical Care). In addition, immediately consult with a urologist for patients whose pain fails to respond to ED management. Pain relief The cornerstone of ureteral colic management is analgesia, which can be achieved most expediently with parenteral narcotics or nonsteroidal anti-inflammatory drugs (NSAIDs). If oral intake is tolerated, the combination of oral narcotics (eg, codeine, oxycodone, hydrocodone, usually in a combination form with acetaminophen), NSAIDs, and antiemetics, as needed, is a potent outpatient management approach for renal (ureteral) colic. Parenteral narcotics are the mainstay of analgesia for patients with acute renal colic. They work primarily on the central nervous system (CNS) to reduce the perception of pain.

They are inexpensive and quite effective. When considering a medication and dosage range, remember that acute renal colic is probably the most painful malady to affect humans. Adverse effects of narcotic analgesics include respiratory depression, sedation, constipation, a potential for addiction, nausea, and vomiting. Choosing any particular agent tends to be somewhat arbitrary. Morphine, meperidine, and butorphanol are the most commonly used. Morphine is a potent narcotic analgesic that controls severe pain primarily through a CNS mechanism via specific receptor site interactions. The usual dosage is 10 mg/70 kg body weight intramuscularly (IM) or subcutaneously (SC) every 4 hours. The actual dosage required varies according to each individual patient’s tolerance and severity of discomfort. For more rapid results, morphine sulfate can be administered IV in doses of 4-10 mg, but this must be done slowly or in small increments to avoid excessive adverse effects. Adverse effects of morphine include respiratory depression, drowsiness, mood changes, nausea, vomiting, increases in the cerebrospinal fluid pressure, and cough reflex depression.

The most bothersome is respiratory depression caused by a direct effect on the brain stem respiratory center. This effect is most severe in patients who are elderly, debilitated, or both. Meperidine is a potent parenteral narcotic analgesic that is very similar in overall effect to morphine sulfate. A 60-80 mg dose of meperidine is roughly equivalent to 10 mg of morphine. Meperidine offers a slightly more rapid onset of action and slightly shorter duration of analgesic activity than morphine sulfate. Some evidence suggests that meperidine may have slightly fewer adverse effects than morphine. The dosage range is usually 50-150 mg IM or SC every 3-4 hours; it is reduced by at least 50% with IV administration. The actual effective dosage varies according to the source of the pain and the individual’s tolerance. As with morphine sulfate, IV administration should be performed slowly. Meperidine is contraindicated in patients taking monoamine oxidase inhibitors. Butorphanol has some theoretical advantages based on studies that suggest it causes less smooth muscle spasm and respiratory depression than either morphine or meperidine.

Butorphanol costs approximately $10/mg, compared with approximately $0.05/mg for meperidine. Because 1 mg of butorphanol is roughly equivalent in pain relieving efficacy to 20 mg of meperidine, butorphanol effectively is about 10 times as costly. Naloxone (0.4 mg or 1 mL) is a specific narcotic antagonist for both meperidine and morphine sulfate that can be administered to counteract inadvertent narcotic overdosage or unusual opioid sensitivity. Naloxone has no analgesic properties. Nalbuphine is a potent parenteral analgesic that is partly antagonistic to narcotics. Its overall effectiveness in relieving pain is equivalent to the opioids. The usual starting dose is 0.5 mg IV or 1-1.5 mg IM every 4-6 hours as needed. Of the NSAIDs, the only one approved by the US Food and Drug Administration (FDA) for parenteral use is ketorolac. Ketorolac works at the peripheral site of pain production rather than on the CNS.

It has been proven in multiple studies to be as effective as opioid analgesics, with fewer adverse effects. [ 43 , 44 ] The dosage is 30-60 mg IM or 30 mg IV initially followed by 30 mg IV or IM every 6-8 hours. A dose of 15 mg is recommended in patients older than 65 years. In more severe cases, ketorolac is particularly effective when used together with narcotic analgesics. Oral ketorolac is available in 10-mg pills, but the efficacy of this form in persons with acute renal colic is less clear. Some practitioners use parenteral ketorolac in the hospital but recommend either ibuprofen or oral cyclooxygenase-2 inhibitors (eg, celecoxib or meloxicam) for pain management in outpatients. An intranasal ketorolac preparation is now available for moderate-to-severe pain and may be particularly useful for outpatient use in patients unable to take oral medication. A maximum of 5 days of ketorolac therapy is recommended.

Chemically, ketorolac is similar to aspirin and may increase the prothrombin time when administered with anticoagulants. Ketorolac can increase methotrexate toxicity and phenytoin levels. It is potentiated by probenecid and should be avoided in patients with peptic ulcer disease, renal failure, or recent gastrointestinal (GI) bleeding. Antiemetic therapy Because nausea and vomiting frequently accompany acute renal colic, antiemetics often play a role in renal colic therapy. Several antiemetics have a sedating effect that is often helpful. Metoclopramide is the only antiemetic that has been specifically studied in the treatment of renal colic. In 2 double-blinded studies, it apparently provided pain relief equivalent to narcotic analgesics in addition to relieving nausea. Its antiemetic effect stems from its dopaminergic receptor blockage in the CNS. It has no anxiolytic activity and is less sedating than other centrally acting dopamine antagonists. The effect of metoclopramide begins within 3 minutes of an IV injection, but it may not take effect for as long as 15 minutes if administered IM.

The usual dose in adults is 10 mg IV or IM every 4-6 hours as needed. Metoclopramide is not available as a suppository. Other medications commonly used as antiemetics include promethazine, prochlorperazine, and hydroxyzine. The author usually recommends antiemetics when patients with renal colic have been vomiting actively or report nausea sufficient to interfere with oral therapy. They also may be useful as anxiolytics in some cases. Whereas metoclopramide is the antiemetic of choice in the hospital or ED setting, a suppository formulation such as promethazine or prochlorperazine is recommended for outpatient use. Antidiuretic therapy Several studies have now demonstrated that desmopressin (DDAVP), a potent antidiuretic that is essentially an antidiuretic hormone, can dramatically reduce the pain of acute renal colic in many patients. It acts quickly, has no apparent adverse effects, reduces the need for supplemental analgesic medications, and may be the only immediate therapy necessary for some patients.

It is available as a nasal spray (usual dose of 40 mcg, with 10 mcg per spray) and as an IV injection (4 mcg/mL, with 1 mL the usual dose). Generally, only 1 dose is administered. Animal studies have demonstrated a significant reduction in mean intraureteral pressure after an acute obstruction in subjects administered desmopressin compared with controls. In human studies, approximately 50% of 126 patients tested had complete relief of their acute renal colic pain within 30 minutes after the administration of intranasal desmopressin without any analgesic medication. For patients in whom desmopressin therapy failed, suitable analgesics were administered. No adverse effects from the antidiuretic medication occurred. Although desmopressin is thought to work by reducing the intraureteral pressure, it may also have some direct relaxing effect on the renal pelvic and ureteral musculature. A central analgesic effect through the release of hypothalamic beta-endorphins has been proposed but remains unproved. Whether this therapy significantly affects eventual stone passage is unknown.

While some of the human studies lack adequate controls and further studies must be conducted, desmopressin therapy currently appears to be a promising alternative or adjunct to analgesic medications in patients with acute renal colic, especially in patients in whom narcotics cannot be used or in whom the pain is unusually resistant to standard medical treatment. Antibiotic therapy Antibiotic use in patients with kidney stones remains controversial. Overuse of the more effective agents leaves only highly resistant bacteria, but failure to adequately treat a UTI complicated by an obstructing calculus can result in potentially life-threatening urosepsis and pyonephrosis. Use antibiotics if a kidney stone or ureteral obstruction has been diagnosed and the patient has clinical evidence of a UTI. Evidence of a possible UTI includes an abnormal finding upon microscopic urinalysis, showing pyuria of 10 WBCs/hpf (or more WBCs than RBCs), bacteriuria, fever, or unexplained leukocytosis. Perform a urine culture in these cases because a culture cannot be performed reliably later should the infection prove resistant to the prescribed antibiotic. Approximately 3% of patients being treated for renal colic are reported to develop a newly acquired UTI.

While case numbers are not high, such an infection can dramatically complicate the clinical outcome for that patient. Base selection of the antibiotic on the patient’s presentation, reserving the most effective parenteral antibiotics for patients with frank sepsis or other high-risk characteristics. The author’s preference for initial medical therapy for pain in patients with acute renal colic is to use IV or IM ketorolac for pain with metoclopramide for nausea. If this therapy is unsuccessful or if the case is deemed more severe, a narcotic such as morphine sulfate or meperidine is added as needed to control pain. An antibiotic is administered if any question of potential infection exists. An oral antibiotic is always used if the patient is able to return home. Active medical expulsive therapy The traditional outpatient treatment approach detailed above has recently been improved with the application of a more aggressive treatment approach known as active medical expulsive therapy (MET). Many randomized trials have confirmed the efficacy of MET in reducing the pain of stone passage, increasing the frequency of stone passage, and reducing the need for surgery.

[ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ] MET should be considered in any patient with a reasonable probability of stone passage. Given that stones smaller than 3 mm are already associated with an 85% chance of spontaneous passage, MET is probably most useful for stones 3-10 mm in size. Overall, MET is associated with a 65% greater likelihood of stone passage. [ 53 ] The original rationale for MET was based on the possible causes of failure to spontaneously pass a stone, including ureteral stricture, muscle spasm, local edema, inflammation, and infection. Various common drugs were considered that would potentially benefit these problems, improve spontaneous stone passage, and alleviate renal colic discomfort. Although NSAIDs have ureteral-relaxing effects and, as such, can be considered a form of MET, patient outcomes have been significantly improved only with the use of more potent (off-label) medications.

The initially popularized regimens for MET included corticosteroids such as prednisone, as in the following example: Ketorolac at 10 mg orally every 6 hours for 5 days Nifedipine XL at 30 mg/d PO for 7 days Prednisone 20 mg PO twice a day for 5 days Trimethoprim/sulfamethoxazole DS once a day for 7 days Acetaminophen 2 tablets 4 times a day for 7 days An oral opioid pain medication (oxycodone-acetaminophen) as needed for breakthrough pain Prochlorperazine suppository as needed for control of nausea Although corticosteroids are effective, concerns about their side effects (admittedly not supported by randomized data) limited the acceptance of MET. More recently, randomized studies have demonstrated great efficacy of the following individual agents, sparing the corticosteroid component. The calcium channel blocker nifedipine is indicated for angina, migraine headaches, Raynaud disease, and hypertension, but it can also reduce muscle spasms in the ureter, which helps reduce pain and facilitate stone passage.

Ureteral smooth muscle uses an active calcium pump to produce contractions, so a calcium channel blocker such as nifedipine would be expected to relax ureteral muscle spasms. The alpha-blockers, such as terazosin, and the alpha-1 selective blockers, such as tamsulosin, also relax the musculature of the ureter and lower urinary tract, markedly facilitating passage of ureteral stones. Some literature suggests that the alpha-blockers are more effective in this setting than the calcium channel blockers, and most practitioners currently use alpha-blockers preferentially over calcium channel blockers. Multiple prospective randomized controlled studies in the urology literature have demonstrated that patients treated with oral alpha-blockers have an increased rate of spontaneous stone passage and a decreased time to stone passage. [ 46 , 47 , 48 ] The best studied of these is tamsulosin, 0.4 mg administered daily. A systematic review by Singh et al found that MET using either alpha antagonists or calcium channel blockers augmented the stone expulsion rate for moderately sized distal ureteral stones.

Adverse effects were noted in 4% of those taking alpha antagonists and in 15.2% of those taking calcium channel blockers. [ 54 ] A systematic review by Beach et al found that MET with alpha antagonists for 28 days increased the rate of stone passage, decreased the time to stone passage, and decreased the rates of hospitalization and ureteroscopy, with minimal adverse effects. [ 55 ] Not all data support MET. A randomized study of 77 ED patients with ureterolithiasis found no benefit to a 14-day course of tamsulosin, though the study group was small and the average stone size was 3.6 mm, making spontaneous passage without MET highly likely. [ 56 ] Similarly, a prospective, placebo-controlled trial by Pickard et al in 1167 adults with ureteral stones found that neither tamsulosin nor nifedipine decreased the need for further treatment to achieve stone clearance in 4 weeks.

[ 57 ] However, Hollingsworth et al propose that the findings of Pickard et al may be largely due to the high rate of spontaneous stone passage in the control group, perhaps because a large proportion of patients had smaller stones. In a systematic review and meta-analysis, these authors concluded that alpha-blockers help facilitate the passage of larger ureteric stones. They recommend considering a course of an alpha-blocker for patients with ureteral colic, unless it is medically contraindicated. [ 58 ] Hollingsworth et al found that overall, passage of larger stones was 57% more likely in patients treated with an alpha-blocker compared with controls (risk ratio 1.57); the likelihood of stone passage increased by 9.8% with every 1 mm increase in stone size. The effect of alpha-blockers was independent of stone location within the ureter. They estimated that four patients would need treatment for one patient to realize benefit from alpha-blockers. Adverse effects associated with alpha-blocker use were relatively infrequent and were not severe.

[ 57 ] MET with calcium channel blockers and alpha-blockers also appears to improve the results of ESWL (see Surgical Care) inasmuch as the stone fragments resulting from treatment appear to clear the system more effectively. Analgesic therapy combined with MET dramatically improves the passage of stones, addresses pain, and reduces the need for surgical treatment. Ibuprofen can be substituted for the ketorolac tablets recommended in the original studies. Fewer complications with ibuprofen occur while maintaining efficacy for pain relief. An oral narcotic (eg, oxycodone/acetaminophen) is used as needed to control breakthrough pain. A typical regimen for this aggressive therapy is as follows: 1-2 oral narcotic/acetaminophen tablets every 4 hours as needed for pain 600-800 mg ibuprofen every 8 hours MET with 30 mg nifedipine extended-release tablet once daily, 0.4 mg tamsulosin once daily, or 4 mg of terazosin once daily Limit MET to a 10- to 14-day course, as most stones that pass during this regimen do so in that time frame.

If outpatient treatment fails, promptly consult a urologist. Future studies may identify a subgroup of patients such as those with larger stones or history of inability to pass stones that would benefit from MET. Intravenous hydration IV hydration in the setting of acute renal colic is controversial. Whereas some authorities believe that IV fluids hasten passage of the stone through the urogenital system, others express concern that additional hydrostatic pressure exacerbates the pain of renal colic. One small study of 43 ED patients found no difference in pain score or rate of stone passage in patients who received 2 L of saline over 2 hours versus those who received 20 mL of saline per hour. [ 59 ] IV hydration should be given to patients with clinical signs of dehydration or to those with a borderline serum creatinine level who must undergo intravenous pyelography (IVP). Straining urine for stones Collecting any passed kidney stones is extremely important in the evaluation of a patient with nephrolithiasis for stone-preventive therapy. Yet, in a busy ED, the simple instruction to strain all the urine for stones can be easily overlooked. Knowing when a stone is going to pass is impossible regardless of its size or location.

Even after a stone has passed, residual swelling and spasms can cause continuing discomfort for some time. Be certain that all urine is actually strained for any possible stones. An aquarium net makes an excellent urinary stone strainer for home use because of its tight nylon weave, convenient handle, and collapsible nature, making it very portable; it easily fits into a pocket or purse. Previous Next: Surgical Care In general, stones that are 4 mm in diameter or smaller will probably pass spontaneously, and stones that are larger than 8 mm are unlikely to pass without surgical intervention. With MET, stones 5-8 mm in size often pass, especially if located in the distal ureter. The larger the stone, the lower the possibility of spontaneous passage (and thus the greater the possibility that surgery will be required), although many other factors determine what happens with a particular stone. Indications and contraindications The primary indications for surgical treatment include pain, infection, and obstruction. Infection combined with urinary tract obstruction is an extremely dangerous situation, with significant risk of urosepsis and death, and must be treated emergently in virtually all cases.

The 2016 American Urological Association (AUA)/Endourological Society guidelines provide more specific indications for surgical treatment. The guidelines recommend surgery in the following scenarios [ 35 ] : Ureteral stones >10 mm Uncomplicated distal ureteral stones ≤10 mm that have not passed after 4-6 weeks of observation, with or without MET Symptomatic renal stones in patients without any other etiology for pain Pediatric patients with ureteral stones that are unlikely to pass or in whom MET has failed Pregnant patients with ureteral or renal stones in whom failed observation has failed General contraindications to definitive stone manipulation include the following: Active, untreated UTI Medical Therapy for Stone Disease Dissolution of calculi Urinary calculi composed predominantly of calcium cannot be dissolved with current medical therapy; however, medical therapy is important in the long-term chemoprophylaxis of further calculus growth or formation. Uric acid and cystine calculi can be dissolved with medical therapy. Patients with uric acid stones who do not require urgent surgical intervention for reasons of pain, obstruction, or infection can often have their stones dissolved with alkalization of the urine.

Sodium bicarbonate can be used as the alkalizing agent, but potassium citrate is usually preferred because of the availability of slow-release tablets and the avoidance of a high sodium load. In patients with recurrent calcium stones and low urinary citrate levels, potassium citrate therapy should be offered. The dosage of the alkalizing agent should be adjusted to maintain the urinary pH between 6.5 and 7.0. Urinary pH of more than 7.5 should be avoided because of the potential deposition of calcium phosphate around the uric acid calculus, which would make it undissolvable. Both uric acid and cystine calculi form in acidic environments. Even very large uric acid calculi can be dissolved in patients who comply with therapy. Roughly 1 cm per month dissolution can be achieved. Practical ability to alkalinize the urine significantly limits the ability to dissolve cystine calculi. Chemoprophylaxis Prophylactic therapy might include limitation of dietary components, addition of stone-formation inhibitors or intestinal calcium binders, and, most importantly, augmentation of fluid intake.

(See Dietary Measures and Prevention of Nephrolithiasis.) Besides advising patients to avoid excessive salt and protein intake and to increase fluid intake, base medical therapy for long-term chemoprophylaxis of urinary calculi on the results of a 24-hour urinalysis for chemical constituents. In patients with high urine calcium levels and recurrent calcium stones, thiazide diuretics are recommended. If a patient suffers from recurrent calcium stones but metabolic abnormalities are absent or controlled with treatment, thiazides, potassium citrate, or both should be offered. [ 81 ] Chemoprophylaxis of uric acid and cystine calculi consists primarily of long-term alkalinization of urine with potassium citrate. If hyperuricosuria or hyperuricemia is documented in patients with pure uric acid stones (present in only a relative minority), allopurinol (300 mg qd) is recommended because it reduces uric acid excretion. Allopurinol should also be offered to patients with recurrent calcium oxalate stones who have hyperuricosuria and normal urinary calcium levels.

[ 81 ] Pharmaceuticals that can bind free cystine in the urine (eg, D-penicillamine, 2-alpha-mercaptopropionyl-glycine) help reduce stone formation in cystinuria. Therapy should also include long-term urinary alkalinization and aggressive fluid intake. Captopril has been shown to be effective in some trials, although, again, strong data are lacking. Routine use should be avoided but such agents can be added in patients who have difficulty in dissolving and preventing cystine stones. Previous Next: Dietary Measures In almost all patients in whom stones form, an increase in fluid intake and, therefore, an increase in urine output is recommended. This is likely the single most important aspect of stone prophylaxis. Patients with recurrent nephrolithiasis traditionally have been instructed to drink 8 glasses of fluid daily to maintain adequate hydration and decrease chance of urinary supersaturation with stone-forming salts. The goal is a total urine volume in 24 hours in excess of 2.5 liters. The only other general dietary guidelines are to avoid excessive salt and protein intake.

Moderation of calcium and oxalate intake is also reasonable, but great care must be taken not to indiscriminantly instruct the patient to reduce calcium intake. Patients with calcium stones and relatively low urinary citrate should increase their intake of fruits and vegetables. Dietary calcium should not be restricted beyond normal unless specifically indicated on the basis of on 24-hour urinalysis findings. Urinary calcium levels are normal in many patients with calcium stones. Reducing dietary calcium in these patients may actually worsen their stone disease, because more oxalate is absorbed from the GI tract in the absence of sufficient intestinal calcium to bind with it. This results in a net increase in oxalate absorption and hyperoxaluria, which tends to increase new kidney stone formation in patients with calcium oxalate calculi. An empiric restriction of dietary calcium may also adversely affect bone mineralization and may have osteoporosis implications, especially in women. This practice should be condemned unless indicated based on a metabolic evaluation. As a rule, dietary calcium should be restricted to 1000-1200 mg/d in patients with diet-responsive hypercalciuria who form calcium stones. This is roughly equivalent to a single high-calcium or dairy meal per day.

Previous Next: Prevention of Nephrolithiasis The most common causes of kidney stones are hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia, and low urinary volume. Each of these major factors can be measured easily with a 24-hour urine sample using one of several commercial laboratory packages now available. Kidney stone preventive therapy consists of dietary adjustments, nutritional supplements, medications, or combinations of these. Strongly encourage patients who have a stone at a young age (ie, < 25 y), multiple recurrences, a solitary functioning kidney, or a history of prior kidney stone surgery to obtain a 24-hour urine collection for stone prevention analysis, especially if they are motivated to comply with a long-term stone prevention program. These 24-hour urine collection kits can be obtained from a number of commercial medical laboratories. Previous Next: Consultations Consultation with a urologist is required when immediate ED management of renal (ureteral) colic fails. Referral to a urologist is necessary for all stones that prove refractory to outpatient management or that fail to pass spontaneously. Consult a urologist immediately in cases of ureterolithiasis with proximal UTI.

Infected hydronephrosis is a true urologic emergency and requires hospital admission, IV fluids, IV antibiotics, and immediate drainage of the infected hydronephrosis via percutaneous nephrostomy or ureteral stent placement. Urologic consultation is also appropriate in patients with unusually large stones, high-risk medical conditions, inability to tolerate oral fluids and medications, unrelenting pain, renal failure, renal transplant, a solitary functioning kidney, or a history of prior stones that required invasive intervention. Patients who are pregnant require a consultation with an obstetrician-gynecologist, and those with a history of severe cardiac disease or congestive heart failure may benefit from involvement of an internal medicine specialist or cardiologist. Patients with strong motivation to prevent all future stones, those with multiple recurrences or single functioning kidneys, and all children younger than 16 years with nephrolithiasis should be referred to a specialist in nephrolithiasis prevention. A medical expert in metabolic stone prevention testing, interpretation, and prophylactic therapy is available in most communities. Previous Next: Long-Term Monitoring Patients who do not meet admission criteria may be discharged from the ED in anticipation that the stone will pass spontaneously at home.

Arrangements should be made for follow-up with a urologist in 2-3 days. Patients should be told to return immediately for fever, uncontrolled pain, or vomiting. Patients should be discharged with a urine strainer and encouraged to submit any recovered calculi to a urologist for chemical analysis. Follow-up for patients with first-time incidence of stones should consist of stone analysis and abbreviated metabolic evaluation to rule out hyperparathyroidism, renal tubular acidosis, and chronic infection with urea-splitting bacteria. Patients with recurrent ureterolithiasis should undergo a more thorough metabolic evaluation. Patients with recurrent stones who undergo thorough metabolic evaluation and specific therapy enjoy a remission rate in excess of 80% and can decrease the rate of stone formation by 90%. A stone chemical analysis together with serum and appropriate 24-hour urine metabolic tests can identify the etiology in more than 95% of patients. A typical 24-hour urine determination should include urinary volume, pH, specific gravity, calcium, citrate, magnesium, oxalate, phosphate, and uric acid.

Most common findings are hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia, and low urinary volume. Therefore, the emergency physician should encourage urologic follow-up. Postsurgical follow-up After surgical treatment of urinary tract calculi, the major issues include infection, ureteral obstruction, and hemorrhage. The postoperative course of minimally invasive stone-removal modalities is generally characterized by short-lived discomfort easily managed with oral medications. Continued or severe pain should prompt evaluation for complications. Repeat urine cultures and imaging studies should be performed to assess for ureteral obstruction and perforation, and the degree of circulating blood volume should be evaluated for ongoing hemorrhage. A follow-up examination that includes abdominal radiography is often adequate after an uncomplicated stone-removal procedure. Further imaging is often unnecessary in a patient with a previous radiopaque stone who has no further symptoms.

Imaging that includes assessment of renal drainage (eg, IVP, ultrasonography, CT scanning) is usually indicated in the following cases: Stones with unusual characteristics Author Chirag Dave, MD Resident Physician, Department of Surgery (Urology), William Beaumont Health System Chirag Dave, MD is a member of the following medical societies: American Academy of Family Physicians , American College of Physicians , American Urological Association Disclosure: Nothing to disclose. Coauthor(s) Sugandh Shetty, MD, FRCS Associate Professor of Urology, Oakland University William Beaumont School of Medicine; Attending Physician, Department of Urology, William Beaumont Hospital Sugandh Shetty, MD, FRCS is a member of the following medical societies: American Urological Association Disclosure: Nothing to disclose. Kassem Faraj Oakland University William Beaumont School of Medicine Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Disclosure: Nothing to disclose. Chief Editor Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine Disclosure: Nothing to disclose. Additional Contributors David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of Emergency Medicine, University of Chicago, University of Chicago, The Pritzker School of Medicine David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine , American College of Emergency Physicians , Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center Richard H Sinert, DO is a member of the following medical societies: American College of Physicians , Society for Academic Emergency Medicine Disclosure: Nothing to disclose.

Sandy Craig, MD Residency Program Director, Carolinas Medical Center; Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine Sandy Craig, MD is a member of the following medical societies: Alpha Omega Alpha , Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Stephen W Leslie, MD, FACS Founder and Medical Director, Lorain Kidney Stone Research Center; Associate Professor of Surgery, Creighton University School of Medicine, Chief of Urology, Creighton University Medical Center Stephen W Leslie, MD, FACS is a member of the following medical societies: American College of Surgeons , American Urological Association , National Kidney Foundation , Ohio State Medical Association Disclosure: Nothing to disclose. J Stuart Wolf, Jr, MD, FACS David A Bloom Professor of Urology, Associate Chair for Urologic Surgical Services, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School Kidney stones: MedlinePlus Medical Encyclopedia Watch this video about: Kidney stones Kidney stones are common. Some types run in families. They often occur in premature infants. There are different types of kidney stones. The cause of the problem depends on the type of stone.

Stones can form when urine contains too much of certain substances that form crystals. These crystals can develop into stones over weeks or months. Calcium stones are most common. They are most likely to occur in men between ages 20 to 30. Calcium can combine with other substances to form the stone. Oxalate is the most common of these. Oxalate is present in certain foods such as spinach. It is also found in vitamin C supplements. Diseases of the small intestine increase your risk of these stones. Calcium stones can also form from combining with phosphate or carbonate. Other types of stones include: Cystine stones can form in people who have cystinuria . This disorder runs in families. It affects both men and women. Struvite stones are mostly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder. Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy. Other substances such as certain medicines also can form stones. The biggest risk factor for kidney stones is not drinking enough fluids.

Kidney stones are more likely to occur if you make less than 1 liter of urine a day. Symptoms You may not have symptoms until the stones move down the tubes (ureters) through which urine empties into your bladder. When this happens, the stones can block the flow of urine out of the kidneys. The main symptom is severe pain that starts and stops suddenly: Pain may be felt in the belly area or side of the back. Pain may move to groin area ( groin pain ) or testicles ( testicle pain ). Other symptoms can include: Treatment depends on the type of stone and the severity of your symptoms. Kidney stones that are small most often pass through your system on their own. Your urine should be strained so the stone can be saved and tested. Drink at least 6 to 8 glasses of water per day to produce a large amount of urine. This will help the stone pass . Pain can be very bad. Over-the-counter pain medicines (for example, ibuprofen and naproxen), either alone or along with narcotics, can be very effective. Some people with severe pain from kidney stones need to stay in the hospital. You may need to get fluids through a vein.

For some types of stones, your provider may prescribe medicine to prevent stones from forming or help break down and remove the material that is causing the stone. These medicines can include: Tamsulosin to relax the ureter and help the stone pass Surgery is often needed if: The stone is too large to pass on its own The stone is growing The stone is blocking urine flow and causing an infection or kidney damage The pain cannot be controlled Today, most treatments are much less invasive than in the past. Lithotripsy is used to remove stones slightly smaller than a half an inch that are located in the kidney or ureter. It uses sound or shock waves to break up stones. Then, the stone fragments leave the body in the urine. It is also called extracorporeal shock-wave lithotripsy or ESWL. Procedures performed by passing a special instrument through a small surgical cut in your skin and into your kidney or ureters are used for large stones, or when the kidneys or surrounding areas are incorrectly formed. The stone is removed with a tube (endoscope). Ureteroscopy may be used for stones in the lower urinary tract.

Rarely, open surgery (nephrolithotomy) may be needed if other methods do not work or are not possible. Talk to your provider about what treatment options may work for you. You will need to take self-care steps. Which steps you take depend on the type of stone you have, but they may include: Drinking extra water and other liquids Eating more of some foods and cutting back on other foods Taking medicines to help prevent stones Taking medicines to help you pass a stone (anti-inflammatory drugs, alpha-blockers) Outlook (Prognosis) Kidney stones are painful but most of the time can be removed from the body without causing lasting damage. Kidney stones often come back. This occurs more often if the cause is not found and treated. You are at risk for: Urinary tract infection Urine that smells bad or looks cloudy A burning feeling when you urinate If you have been diagnosed with blockage from a stone, passage must be confirmed either by capture in a strainer during urination or by follow-up x-ray. Prevention If you have a history of stones: Drink plenty of fluids (6 to 8 glasses of water per day) to produce enough urine.

You may need to take medicine or make changes to your diet for some types of stones. Your provider may want to do blood and urine tests to help determine the proper prevention steps. Alternative Names Renal calculi; Nephrolithiasis; Stones - kidney; Calcium oxalate - stones; Cystine - stones; Struvite - stones; Uric acid - stones; Urinary lithiasis Images Lithotripsy procedure References Bushinsky DA. Nephrolithiasis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 126. Fink HA, Wilt TJ, Eidman KE, et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med. 2013;158(7):535-543. PMID: 23546565 . Fink HA, Wilt TJ, Eidman KE, et al. Recurrent nephrolithiasis in adults: comparative effectiveness of preventive medical strategies [Internet].

Rockville, MD. Agency for Healthcare Research and Quality (US) 2012; Report No.: 12-EHC049-EF. PMID: 22896859 . Lipkin ME, Ferrandino MN, Preminger Glenn M. Evaluation and medical management of urinary lithiasis. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 52. Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2014;161(9):659-667. PMID: 25364887 .

Read More Renal calculus - RightDiagnosis.com Renal calculus Introduction: Renal calculus Description of Renal calculus Renal calculus (medical condition): Kidney stones are solid deposits of salts (e.g calcium) from the urine.... more » See also: Renal calculus as a Disease Renal calculus: Another name for Kidney stones (or close medical condition association).

» Treatments for Kidney stones Renal calculus: Related Diseases Renal calculus: Renal calculus is listed as a type of (or associated with) the following medical conditions in our database: See full list of 215 causes of Renal calculus (Kidney stones) Symptoms of Renal calculus (Kidney stones) Some of the symptoms of Renal calculus incude: See full list of 21 symptoms of Renal calculus (Kidney stones) Treatments for Renal calculus (Kidney stones) Treatments for Renal calculus (Kidney stones) include: No treatment - in mild cases; some kidney stones pass naturally in urine Treatment of Renal calculus: For more treatment information about Renal calculus, see treatment of Kidney stones (Renal calculus) Renal calculus: Article Excerpts about Kidney stones What Are Kidney Stones: NIDDK (Excerpt) A kidney stone is a solid piece of material that forms in the kidney out of substances in the urine. ...

(Source: excerpt from What Are Kidney Stones: NIDDK ) Your Urinary System and How It Works: NIDDK (Excerpt) Kidney stones is the term commonly used to refer to stones, or calculi, in the urinary system. Stones form in... (Source: excerpt from Your Urinary System and How It Works: NIDDK ) Renal calculus: Related Disease Topics These medical disease topics may be related to Renal calculus: renal stone Search to find out more about Renal calculus: Kidney stones - Mayo Clinic Kidney stones Kidney stones Kidney stones (renal lithiasis, nephrolithiasis) are small, hard mineral deposits that form inside your kidneys. The stones are made of mineral and acid salts. Kidney stones have many causes and can affect any part of your urinary tract — from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together. Passing kidney stones can be quite painful, but the stones usually cause no permanent damage. Depending on your situation, you may need nothing more than to take pain medication and drink lots of water to pass a kidney stone.

In other instances — for example, if stones become lodged in the urinary tract or cause complications — surgery may be needed. Your doctor may recommend preventive treatment to reduce your risk of recurrent kidney stones if you're at increased risk of developing them again. References Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. Accessed Dec. 10, 2014. Kidney stones in adults. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Dec. 10, 2014. Diet for kidney stone prevention. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Dec. 10, 2014. Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. Accessed Dec. 10, 2014. Curhan GC, et al. Diagnosis and acute management of suspected nephrolithiasis in adults. Accessed Dec. 10, 2014. Preminger GM, et al. The first kidney stone and asymptomatic nephrolithiasis in adults.

Accessed Dec. 10, 2014. Humphreys MR (expert opinion). Mayo Clinic, Phoenix/Scottsdale, Ariz. Jan. 21, 2015. Anderson CF (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 16, 2015. Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. Accessed Dec. 10, 2014. Signs and symptoms of parathyroid disease. The American Association of Endocrine Surgeons. Accessed Jan. 15, 2015. Cook AJ. Decision Support System. Mayo Clinic, Rochester, Minn. Oct. 8, 2014. Kidney stone treatment: Shock wave lithotripsy. National Kidney Foundation. Accessed Feb. 5, 2015. Products and Services

Question: In medicine, Renal Calculus is another term for what?
Answer: Kidney Stone