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Nephrolithiasis

Kidney stone disease
Synonyms urolithiasis, kidney stone, renal calculus, nephrolith, kidney stone disease,
A color photograph of a kidney stone, 8 millimetres in length.
A kidney stone, 8 millimeters (0.3 in) in diameter
Classification and external resources
Specialty Urology, nephrology
ICD-10 N20.0N20.9
ICD-9-CM 592.0594.9
OMIM 167030
DiseasesDB 11346
MedlinePlus 000458
eMedicine med/1600
Patient UK Kidney stone disease
MeSH D052878
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Kidney stone disease, also known as urolithiasis, is when a solid piece of material (kidney stone) occurs in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms. If a stone grows to more than 5 millimeters (0.2 in) it can cause blockage of the ureter resulting in severe pain in the lower back or abdomen. A stone may also result in blood in the urine, vomiting, or painful urination. About half of people will have another stone within ten years.

Most stones form due to a combination of genetics and environmental factors. Risk factors include high urine calcium levels, obesity, certain foods, some medications, calcium supplements, hyperparathyroidism, gout and not drinking enough fluids. Stones form in the kidney when minerals in urine are at high concentration. The diagnosis is usually based on symptoms, urine testing, and medical imaging. Blood tests may also be useful. Stones are typically classified by their location: nephrolithiasis (in the kidney), ureterolithiasis (in the ureter), cystolithiasis (in the bladder), or by what they are made of (calcium, uric acid, struvite, cystine).

In those who have had stones, prevention is by drinking fluids such that more than two liters of urine is produced per day. If this is not effective enough, thiazide diuretic, citrate, or allopurinol may be taken. It is recommended that soft drinks containing phosphoric acid (typically colas) be avoided. When a stone causes no symptoms, no treatment is needed. Otherwise pain control is usually the first measure, using medications such as nonsteroidal anti-inflammatory drugs or opioids. Larger stones may be helped to pass with the medication tamsulosin or may require procedures such as extracorporeal shock wave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy.


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