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A kidney stone is a solid concretion or crystal aggregation formed in the kidneys from minerals in the urine. Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters (0.12 in)) they can cause blockage of the ureter. This leads to pain, most commonly beginning in the flank or lower back and often radiating to the groin or genitals. This pain is often known as renal colic and typically comes in waves lasting 20 to 60 minutes. Other associated symptoms include: nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination.
The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. Ultrasound examination and blood tests may also aid in the diagnosis.
Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). About 80% of those with kidney stones are men. Blockage of the ureter causes decreased kidney function and dilation of the kidney.
In those who have previously had stones, prevention is recommended 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, watchful waiting is a valid option. For stones which are causing symptoms, pain control is usually the first measure, using medications such as non-steroidal anti-inflammatory drugs or opioids. More severe cases may require procedures. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy. Some cases require more invasive procedures.
Examples of these are cystoscopic procedures such as laser lithotripsy or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms, as well as to prevent ureteral stricture after ureteroscopic stone removal.
The hallmark of a stone that obstructs the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the inner thigh. This pain, known as renal colic, is often described as one of the strongest pain sensations known. Renal colic caused by kidney stones is commonly accompanied by urinary urgency, restlessness, hematuria, sweating, nausea, and vomiting. It typically comes in waves lasting 20 to 60 minutes caused by peristaltic contractions of the ureter as it attempts to expel the stone.
The embryological link between the urinary tract, the genital system, and the gastrointestinal tract is the basis of the radiation of pain to the gonads, as well as the nausea and vomiting that are also common in urolithiasis. Postrenal azotemia and hydronephrosis can be observed following the obstruction of urine flow through one or both ureters. Pain in the lower left quadrant can sometimes be confused with diverticulitis because the sigmoid colon overlaps the ureter and the exact location of the pain may be difficult to isolate due to the close proximity of these two structures
Kidney stones can result from an underlying metabolic condition, such as distal renal tubular acidosis, Dent’s disease, hyperparathyroidism, primary hyperoxaluria, or medullary sponge kidney. 3–20% of people who form kidney stones have medullary sponge kidney. Kidney stones are more common in people with Crohn’s disease; Crohn’s disease is associated with hyperoxaluria and malabsorption of magnesium. A person with recurrent kidney stones may be screened for such disorders. This is typically done with a 24-hour urine collection. The urine is analyzed for features that promote stone formation.
Dehydration from low fluid intake is a major factor in stone formation. High dietary intake of animal protein, sodium, refined sugars, fructose, and high fructose corn syrup, oxalate, grapefruit juice, and apple juice etc. increase the risk of kidney stone formation.
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