HealthEast Kidney Stone Institute

Diagnosing kidney stones

Most people are diagnosed with kidney stones after experiencing unforgettable pain. This severe pain occurs when the stone drops into the ureter (the narrow duct that drains urine from the kidney to the bladder) and blocks the drainage of urine from the kidney. This is also known as "renal colic." The pain may begin in the lower back and may move to the side or groin. Stones in the kidney which do not obstruct urine flow may cause a chronic dull ache.

Other kidney stone symptoms include:

• Side pain that is not affected by activity
• Blood in the urine
• Frequent or persistent urinary tract infections
• Urinary urgency or frequency
• Nausea

For many people, kidney stones cause no symptoms and are detected when microscopic amounts of blood are found in the urine. They may also be detected during x-ray tests for other medical problems.

When should I call a doctor?
It's important to consult a doctor to determine if symptoms are caused by a stone or by another medical problem. Unfortunately, the severity of symptoms is not a good indicator of the stone's size, location or if it will pass on its own. Radiology tests are the only reliable way to view kidney stones.

Should I go to the ER?
Many people with kidney stones go to the emergency room (ER) with severe pain. In the ER at St. Joseph 's, we specialize in treating patients with kidney stones. We focus on quickly reducing pain, making an accurate diagnosis and pairing patients with urologists who specialize in treating kidney stones.

A visit to the emergency room should be considered if you have:

• Fever and stone pain (may be a sign of a serious infection)
• Pain that is not helped by home medications
• Severe nausea or vomiting that prevents drinking fluids
• Previous difficult stone episodes

How do I find out if I have a kidney stone?
A CT scan of the abdomen and pelvis is the best way for your doctor to determine if you have a kidney stone. A CT scan is a specialized x-ray test that allows your doctor to look inside your body. It is usually done after a clinical examination by your doctor or a doctor in the emergency room. On the CT scan, stones are easily recognized. They look similar to bones but are outside of the skeleton. Unfortunately, plain x-rays and ultrasounds tend to miss many stones.

The scan is quick and painless and can help determine:

• If you have a kidney stone
• The location, size and number of kidney stones
• How much obstruction the stone is causing
• The density of the kidney stone
• The best treatment for your kidney stone

What other information can be found using a CT scan?
The CT scan gives information about all abdominal organs, so it may help to determine causes of abdominal pain that aren't related to a kidney stone. These can include appendicitis, gall bladder disease, abdominal aneurysms, bowel disease and hernias.

Follow-up after control of initial symptoms
We offer early follow-up to all patients discharged from our emergency room.

There should be adequate information to predict a patient's chances for spontaneous passage of stone from a proper CT scan.

We strongly believe that all patients should be evaluated with a CT scan to determine the size and location of their stone or whether there is even a stone present. Until this basic information is achieved no appropriate decisions can be made. Unfortunately, patients' symptoms are often misleading and larger more problematic stones do have a tendency to cause fewer problems than small "inconsequential" stones.

Managing pain

The pain associated with kidney stones is usually described as "the worst pain I have ever had."

Kidney stones cause severe pain when they drop into the ureter (the narrow duct that drains urine from the kidney to the bladder) and block urine from draining into the bladder. This is known as "renal colic."

Controlling pain and symptoms
We want to get your pain and nausea under control as quickly as possible. Pain can usually be treated at home, although in some cases, medications must be administered by IV (intravenously) in the emergency room. The most severe cases of pain require hospitalization and surgery.

Your doctor will determine the best pain medication for you. The following are common medications to relieve pain and nausea.

• Morphine-based medications (narcotics) are usually the most effective for pain control. Depending on the situation, they may be taken orally or by IV.
  
  
  
• Non-steroidal anti-inflammatories (aspirin-like drugs such as ibuprofen) may also be suggested by your doctor. In addition to relieving pain, they may also decrease the spasms of the smooth muscle of the ureter.
  
  
  
• Anti-emetics - Renal colic is often accompanied by tremendous nausea and vomiting. In addition to IV fluids for rehydration, oral or IV anti-nausea drugs provide relief of symptoms.

Recognition of emergencies

Fever and a stone
This can be a life-threatening emergency. The kidney is essentially a blood filter. If it becomes obstructed and there are bacteria in the kidney, these bacteria can quickly move into the blood stream. The first signs are fever or an elevated white blood count. The next signs, particularly in frail individuals, can be severe whole body sepsis and even death. If an obstructing stone is associated with fever this is a true emergency and urgent drainage by either a ureteral stent or a nephrostomy tube is necessary.

No urine
Occasionally a person may have stones blocking both kidneys at the same time or may only have one kidney that works. In this case, there is a significant risk of build-up of waste products in the blood which normally would have been excreted by the kidneys. In this situation, urgent drainage is required.

Need for hospital admission

The vast majority of patients with kidney stones do not need to be admitted to the hospital. Some reasons that hospital care may be necessary include:

Pain
For the rare patient who's pain cannot be controlled in the emergency room, admission to the hospital for continuous intravenous narcotic administration may be required. If pain does not settle within a brief periods of time, surgical procedures may be indicated depending on stone size and location.

Nausea
Similarly, patients who cannot keep fluids down cannot be allowed to leave the emergency room. Admission to the hospital and administration of IV fluids and potent anti-emetics is usually satisfactory.

An admission to the hospital does not necessarily mean that an offending stone should be immediately treated. Many small stones will still pass on their own and larger more complex stones may be better managed electively after the current crisis resolves.