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Nephrolithiasis – Kidney Stones

What is Nephrolithiasis?

Nephrolithiasis, commonly known as kidney stones, is a medical condition characterized by the formation of hard deposits of minerals and salts inside the kidneys or anywhere along the urinary tract.

These stones, also called renal calculi, can range in size from tiny grains of sand to larger, more substantial structures.

Formation and Composition

Kidney stones form when there is an imbalance in the substances present in the urine. When the concentration of certain minerals and salts (like calcium, oxalate, uric acid, and cystine) becomes too high, they crystallize and aggregate.

The main types of kidney stones include:

  • Calcium Stones: The most common type, usually made of calcium oxalate.
  • Uric Acid Stones: Often associated with gout, high-protein diets, or chronic diarrhea.
  • Struvite Stones: Less common, typically form in response to a urinary tract infection (UTI).
  • Cystine Stones: Caused by the rare genetic disorder cystinuria.

Main Signs & Symptoms

While small stones may pass unnoticed, larger stones can cause severe symptoms, often referred to as renal colic, when they travel down the ureter (the tube connecting the kidney to the bladder):

  • Severe Pain: Intense, cramping, sharp pain in the side and back, often below the ribs.
  • Radiating Pain: The pain may move to the lower abdomen and groin as the stone moves.
  • Hematuria: Blood in the urine (which may appear pink, red, or brown).
  • Urinary Issues: A persistent need to urinate, pain while urinating (dysuria), or only passing small amounts of urine.
  • Nausea and Vomiting: Common due to shared nerve connections between the kidneys and the digestive tract.

Common Causes

Nephrolithiasis, or kidney stones, typically occur when there is an imbalance of substances in the urine, causing crystal-forming minerals and salts to clump together and form a hard deposit.

The causes and risk factors are often a combination of dietary, lifestyle, and medical factors.

Primary Causes and Risk Factors

The main factors that contribute to stone formation include:

  • Low Urine Volume/Dehydration: This is a major risk factor. Not drinking enough water concentrates the urine, making it easier for salts and minerals to crystallize.
  • Diet:
    • High Sodium (Salt) Intake: Too much sodium increases the amount of calcium the kidneys excrete into the urine, raising the risk of calcium stones.
    • High Animal Protein Intake: Eating a lot of meat, poultry, and fish can increase acid levels in the body and urine, raising the risk of both uric acid and calcium stones.
    • High Oxalate Intake: For Calcium Oxalate stones (the most common type), a diet high in oxalate-rich foods (like spinach, nuts, and chocolate) can increase risk, especially if calcium intake is too low.
    • High Sugar Intake: Diets high in added sugar, including high-fructose corn syrup, may increase risk.
  • Family/Personal History:
    • Having a family member with kidney stones increases your own risk.
    • If you have already had one kidney stone, you are at a higher risk of getting another.

Underlying Medical Conditions

Certain health issues can alter urine chemistry and increase the risk of stones:

  • Obesity/High Body Weight: This is linked to changes in urine acid levels that favor stone formation.
  • Digestive Diseases and Surgery: Conditions like inflammatory bowel disease (Crohn’s, Ulcerative Colitis) or gastric bypass surgery can lead to chronic diarrhea and affect how the body absorbs water and calcium, increasing stone-forming substances in the urine.
  • Hyperparathyroidism: Causes overproduction of the parathyroid hormone, leading to high calcium levels in the blood and urine.
  • Gout: Causes high levels of uric acid in the blood, which can lead to Uric Acid stones.
  • Repeated Urinary Tract Infections (UTIs): Chronic UTIs can cause Struvite stones (infection stones).
  • Renal Tubular Acidosis: A condition where the kidneys fail to excrete acids, raising the risk of Calcium Phosphate stones.
  • Genetic Disorders: Rare inherited conditions like Cystinuria (excess cystine in the urine) or Primary Hyperoxaluria (excess oxalate made by the liver) cause specific types of stones.

Medications and Supplements

Some medications and supplements are associated with an increased risk:

  • Vitamin C supplements (taken in large doses)
  • Calcium-based Antacids
  • Certain Diuretics
  • Some medications for migraines, depression, or seizures
  • Overuse of Laxatives