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Genitourinary Conditions / Kidney Stones

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Substances in urine (uric acid and calcium in particular) can crystallize within the kidney and form rocklike particles (calculi) called stones. The medical term for this condition is nephrolithiasis, or renal stone disease. Kidney stones may be as small as a grain of sand or larger than a golf ball. They may be smooth, round, jagged, spiky, or asymmetrical, depending on their composition. Most stones are yellow or brown in color, but variations in chemical composition can produce stones that are tan, gold, or black.

Some stones stay in the kidney and produce no symptoms. Other stones break loose and travel down the urinary tract. The smallest, smoothest stones may pass out of the body with little resistance, and the patient may experience minimal discomfort. Large, irregularly shaped stones can become lodged in a ureter (tube that carries urine from the kidney to the bladder), the bladder, or the urethra (tube that carries urine from the bladder out of the body) and cause intense pain.

A lodged stone can block the flow of urine, causing waste and pressure to build up in the kidneys. Such a condition must be corrected swiftly to prevent serious kidney damage and other medical problems. The stone can be removed surgically, or can be broken up and then passed naturally out of the body.



Types of Kidney Stones

Different chemical imbalances in the urine produce stones with different chemical compositions and shapes. The four most common types of stones are made of calcium salts, struvite, uric acid, and cystine.

  • Calcium Stones

About 70% to 80% of all kidney stones are composed of hard crystals of calcium oxalate, insoluble phosphate salt, or both. They occur in patients with hypercalciuria (excessive calcium in the urine). Excess calcium normally is removed from the blood by the kidneys and excreted in the urine. Patients with hypercalciuria build up excess calcium in the kidneys, where it combines with other waste products to form a stone.

In about 40% of patients who develop calcium stones, this build up is caused by an inherited metabolic disorder. In rare cases, a tumor on the parathyroid gland may trigger an overproduction of parathyroid hormone, the chemical that regulates calcium metabolism. The diuretic furosemide, antacids, and steroids can produce hypercalciuria. Intestinal disease, excessive amounts of vitamin A or D, and a diet too high in purine (associated with meat, fish, and poultry consumption) also can cause hypercalciuria.

Calcium oxalate stones are commonly associated with vitamin B deficiency or an excess of vitamin C in the diet.

  • Struvite Stones

Struvite stones (also called infection stones) account for up to 20% of all kidney stones. They are made of crystallized magnesium and ammonia, common acidic by-products of the bacterial breakdown of urea. This often occurs in patients who develop urinary tract infections. Struvite stones are more common in women because they generally suffer more urinary tract infections than men. This type of kidney stone typically develops as a jagged or branched structure called a "staghorn."

  • Cystine Stones

Cystine is an amino acid is found in nerves, muscles, and other body tissues. Cystinuria, a rare genetic defect, can cause excessive cystine build up in the urine and lead to the development of cystine stones. This type of stone occurs in about 1% to 2% of patients with kidney stone disease. The condition often runs in families.

  • Uric Acid Stones

Uric acid is produced by the body when it breaks down protein. Some people, particularly men, build up excessive uric acid concentration in their kidneys or joints. In the joints, this can cause gout, an inherited disorder with painful arthritic symptoms. If uric acid builds up in the kidneys, uric acid stones may form.

An estimated 5% to 13% of patients with kidney stone disease develop uric acid stones. Genetics may be a factor in uric acid stone propensity. Patients prone to developing uric acid stones are advised to reduce their consumption of high-protein foods, especially meat.

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