Kidney Stones – Diagnosis and Treatment
Diagnosis
Doctors use a few different steps to check for kidney stones and figure out where they’re hiding in your urinary system. First, a healthcare professional will ask about your symptoms—things like pain, blood in your urine, or changes in how often you go.
You might feel a strong urge to pee, or maybe you’ve noticed your urine looks dark or reddish. A physical exam usually comes first. The doctor presses on your abdomen and back to see if anything hurts or feels tender.
Depending on what they find, they might order more tests.
Blood Tests
Doctors draw blood to see if you have high levels of calcium or uric acid. If these numbers are up, it could point toward certain types of stones—maybe calcium oxalate or uric acid stones.
Blood tests also show how well your kidneys are working and flag other possible issues.
Urine Testing
Often, doctors ask you to collect your urine for 24 hours. This checks for high amounts of minerals—like calcium, oxalate, or uric acid—that can cause stones. It also looks for low levels of things that usually help prevent stones.
Sometimes, they’ll also do a urinalysis or a urine culture if you might have a urinary tract infection.
Imaging Studies
To actually see the stones and figure out their size and location, doctors use imaging:
| Test Type | What it Checks For |
|---|---|
| CT Scan | Finds small and large stones in the urinary tract |
| Ultrasound | Picks up stones and signs like hydronephrosis |
| Abdomen X-ray | Used less; may miss small or certain types of stones |
A CT scan gives a really clear view and can spot even tiny stones, including uric acid ones. Ultrasound works well too and doesn’t use radiation, so it’s a good pick for kids or pregnant people.
Stone Analysis
If you pass a stone, the doctor will usually send it to a lab to find out what it’s made of. This tells them if it’s a calcium stone, struvite stone, cystine stone, or something else.
Knowing the type helps them pick the best way to treat and prevent future stones.
Genetic Testing
If you have a family history of stones or keep getting them, sometimes genetic testing comes into play—especially for rare conditions like cystinuria.
This can uncover risks for special stone types, like cystine stones or issues like primary hyperoxaluria, which causes calcium oxalate stones.
Doctors pull together all these results to diagnose nephrolithiasis or urolithiasis and come up with a plan to treat and prevent more stones.
Treatment
Managing Smaller Stones With Mild or No Symptoms
If you have a smaller kidney stone and not a lot of symptoms, you probably won’t need anything too fancy. Most of the time, you can pass these stones naturally.
- Fluid Intake: Drinking plenty of water is key. Most people should aim for about 2 to 3 quarts (1.8 to 3.6 liters) a day. Keeping your urine clear or almost clear helps flush out minerals and lowers the risk of new stones.
- Pain Control: Passing a stone hurts—a lot. Over-the-counter painkillers like ibuprofen or naproxen sodium are common choices for mild pain. If the pain is worse, the doctor might give you something stronger at the clinic.
- Medication to Promote Stone Passage: Sometimes, doctors prescribe alpha blockers. These meds relax the muscles in your ureter (the tube from kidney to bladder), making it easier—and less painful—for stones to move out.
| Approach | What It Does |
|---|---|
| Fluid intake | Dilutes urine, helps move stones along |
| Pain relievers (NSAIDs) | Cut down on discomfort during passage |
| Alpha blockers | Help the ureter muscles relax, reduce pain |
Always check with your healthcare provider before starting or changing any treatment.
Therapies for Larger Stones or Troublesome Symptoms
If your stone is big, blocking things up, causing pain that won’t quit, or leading to infections or bleeding, you’ll need more serious treatment. Doctors have a few options, depending on the size and spot of the stone.
| Treatment Option | Use/Indication | Method | Anesthesia | Recovery |
|---|---|---|---|---|
| Shock wave lithotripsy (ESWL) | Medium to large stones | External sound waves | Sometimes needed | Same day |
| Ureteroscopy | Stones in ureter or kidney | Thin scope through urine tract | Local or general | Short stay |
| Percutaneous nephrolithotomy | Very large kidney stones | Surgical removal via back | General | 1-3 days in hospital |
| Parathyroid gland surgery | Stones from high calcium | Remove gland(s) | General | Varies |
Shock Wave Lithotripsy
Extracorporeal shock wave lithotripsy (ESWL) uses sound waves to smash stones into smaller pieces. You’ll lie down while a machine sends shock waves from outside your body toward the stone.
The waves break up the stone so you can pass it on your own. It usually takes about 45 to 60 minutes. Some folks need pain meds or sedation to get through it. You might see blood in your urine or feel sore or bruised where the waves hit.
Ureteroscopy
If the stone’s in your ureter or kidney, doctors use a thin scope (ureteroscope) through your urethra and bladder up to the stone. Once they find it, they break it up and pull out the pieces.
They might leave a stent (a tiny tube) in your ureter to keep it open and help it heal. You’ll need anesthesia for this one.
Percutaneous Nephrolithotomy
For really big or hard-to-reach stones, doctors do surgery. They use tiny telescopes and tools through a small cut in your back or side.
You’ll need general anesthesia and probably stay in the hospital for a few days.
Parathyroid Gland Surgery
If an overactive parathyroid gland is to blame, doctors may remove the gland. This fixes the hormone problem and can stop more stones from forming.
Medication to Reduce Stone Formation
Doctors sometimes prescribe medicines like alkalinizing agents or uric acid–lowering medication, especially if you’ve had certain types of stones before. These help prevent new stones by changing your urine chemistry.
General Advice for Stone Management
- Drink More Water: Stay hydrated every day.
- Watch for Symptoms: If you get pain, infection, or blood in your urine, get checked out.
- Follow Your Doctor’s Advice: Some folks need ongoing meds or changes to their diet to lower the risk of more stones.
Getting Ready for Your Visit
Getting organized before your kidney stone appointment makes things easier. Jot down all your symptoms—even ones you think might not matter. This could be pain, vomiting, chills, fever, or any really bad pain.
If your pain comes and goes, mention that. If you’re having renal colic (that sharp, cramping pain in your back or side), note how bad it gets, how long it lasts, and when it happens.
Keep track of your fluids. Write down how much water you drink and how often you pee for at least a day before your appointment. If your urine looks weird or you feel pain when you go, note that.
If you’re peeing less than usual or see blood in your urine, make sure to write that down.
Make a list of all your medicines, vitamins, and supplements from the last month. Include prescription meds and anything you picked up over the counter, even if it seems minor. If you take meds for other conditions, mention those too.
Also, write out your medical history, including past kidney problems or other illnesses—a clear record helps your doctor see the big picture.
It’s easy to forget stuff during your visit. If you can, bring a trusted friend or family member. They can help you remember important things and support you, especially if you’re feeling rough.
Write down your questions and concerns ahead of time. A simple list like this can help:
| Key Questions to Consider |
|---|
| Do I have a kidney stone? |
| What type and size is the stone? |
| Where is the stone located? |
| Do I need medicine or surgery? |
| What steps can I take to avoid more stones? |
| Should I see a kidney specialist? |
| How do I manage other health issues with this? |
| Are my symptoms caused by the stones or something else? |
| Does my family history make my risk higher? |
| Can I get reading materials or website links for more info? |
If you have severe symptoms like vomiting, fever, chills, or extreme pain, let your provider know right away—either at your visit or by phone if you can’t wait. These could mean an infection or something serious that needs fast attention.
If your family has a history of kidney stones, write that down too. This might help your doctor decide if you need genetic testing or other steps.
What the Healthcare Provider May Ask
During your visit, the provider will ask questions to figure out your symptoms and medical history:
- When did your symptoms start?
- Are they constant or do they come and go?
- How strong is the pain, and where exactly do you feel it?
- Have you had vomiting, chills, fever, or blood in your urine?
- Is the pain getting better or worse?
- Has anything helped, like drinking more water?
- Have you noticed anything that makes things worse, like certain foods or activities?
They’ll probably ask about your past medical problems and medicines to see if there’s a link to kidney stones. You might talk about your family’s health, especially if relatives have had kidney stones or similar issues.
If anyone in your family has had kidney or urinary problems, mention that. Be ready to talk about whether you’ve had kidney stones before, and if you’ve had surgery or procedures for them.
The doctor may also want to know if you’ve had fever and chills or signs of infection, since that can change your treatment plan.
The doctor might ask how kidney stones are affecting your life. If pain keeps you from working, going to school, sleeping, or eating, let them know.
Bringing all this info helps the doctor treat you faster and give advice that fits your situation.
