Diagnosis
If your doctor suspects you have a kidney stone, you may have diagnostic tests and procedures, such as:
• Blood testing. Blood tests may reveal too much calcium or uric acid in your blood. Blood test results help monitor the health of your kidneys and may lead your doctor to check for other medical conditions.
• Urine testing. The 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. For this test, your doctor may request that you perform two urine collections over two consecutive days.
• Imaging. Imaging tests may show kidney stones in your urinary tract. Options range from simple abdominal X-rays, which can miss small kidney stones, to high-speed or dual energy computerized tomography (CT) that may reveal even tiny stones.
Other imaging options include an ultrasound, a noninvasive test, and intravenous urography, which involves injecting dye into an arm vein and taking X-rays (intravenous pyelogram) or obtaining CT images (CT urogram) as the dye travels through your kidneys and bladder.
• Analysis of passed stones. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the makeup of your kidney stones. Your doctor uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.

Treatment
Treatment for kidney stones varies, depending on the type of stone and the cause.
Small stones with minimal symptoms
Most small kidney stones won’t require invasive treatment. You may be able to pass a small stone by:
• Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
• Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
• Medical therapy. Your doctor may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain.

Large stones and those that cause symptoms

Parathyroid glands
Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more-extensive treatment. Procedures may include:
• Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).
ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.
ESWL can cause blood in the urine, bruising on the back or abdomen, bleeding around the kidney and other adjacent organs, and discomfort as the stone fragments pass through the urinary tract.
• Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back.
You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.
• Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter.
Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
• Parathyroid gland surgery. Some calcium phosphate stones are caused by overactive parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. When these glands produce too much parathyroid hormone (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result.
Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or your doctor may recommend treatment of the condition that’s causing your parathyroid gland to overproduce the hormone.

Prevention
• Prevention of kidney stones may include a combination of lifestyle changes and medications.
• Lifestyle changes
You may reduce your risk of kidney stones if you:
• Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you’re drinking enough water.
If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.
• Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper and soy products.
• Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes. Consider using a salt substitute, such as Mrs. Dash.
• Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn’t have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise.
• Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.
• Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

Medications
Medications can control the amount of minerals and salts in your urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:
• Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
• Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
• Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
• Cystine stones. Cystine stones can be difficult to treat. Your doctor may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn’t help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine.
• Clinical trials
Liva Consulting studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.
Preparing for your appointment
Small kidney stones that don’t block your kidney or cause other problems can be treated by your family doctor. But if you have a large kidney stone and experience severe pain or kidney problems, your doctor may refer you to a doctor who treats problems in the urinary tract (urologist or nephrologist).

What you can do:

To prepare for your appointment:
• Ask if there’s anything you need to do before your appointment, such as limit your diet.
• Write down your symptoms, including any that seem unrelated to kidney stones.
• Keep track of how much you drink and urinate during a 24-hour period.
• Make a list of all medications, vitamins or other supplements that you take.
• Take a family member or friend along, if possible, to help you remember what you discuss with your doctor.
• Write down questions to ask your doctor.
For kidney stones, some basic questions include:
• Do I have a kidney stone?
• What size is the kidney stone?
• Where is the kidney stone located?
• What type of kidney stone do I have?
• Will I need medication to treat my condition?
• Will I need surgery or another procedure?
• What’s the chance that I’ll develop another kidney stone?
• How can I prevent kidney stones in the future?
• I have other health conditions. How can I best manage them together?
• Do I need to follow any restrictions?
• Should I see a specialist? If so, does insurance typically cover the services of a specialist?
• Is there a generic alternative to the medicine you’re prescribing?
• Do you have any educational material that I can take with me? What websites do you recommend?
• Do I need a follow-up visit?
Besides the questions you prepare in advance, don’t hesitate to ask any other questions during your appointment as they occur to you.
What to expect from your doctor.
Your doctor is likely to ask you a number of questions, such as:
• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Has anyone else in your family had kidney stones?