Kidney stones, also known as renal calculi, nephrolithiasis, or urolithiasis, originate from the Greek words nephros, meaning kidney, uro-, meaning urinary, and lithos, meaning stone. These stones are hard deposits made of chemicals (minerals and salts, such as calcium oxalate, uric acid, magnesium, ammonia, and cysteine) in the urine. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together, and they get larger over time when they do not pass out of the body with the urine.
Signs and symptoms
Kidney stones typically do not cause any symptoms, unless they move around within the kidney or pass into one of the ureters, which are tubes connecting the kidneys and the bladder. If a kidney stone gets stuck in the ureters, it can block the urine flow, leading to the swelling of the kidney and spasms in the ureter. At that point, several symptoms may persist:
- Severe, sharp pain in the side and back, below the ribs
- Pain that radiates to the lower abdomen and groin
- Pain that comes in waves and fluctuates in intensity
- Pain or burning sensation while urinating
Other signs and symptoms may include:
- Blood in urine (Pink, red, or brown urine)
- Cloudy or foul-smelling urine
- Urinating more often than usual
- Urinating in small amounts
- Nausea and vomiting
- Fever and chills if an infection is present
Types of kidney stones
There are four main types of kidney stones: calcium oxalate, uric acid, struvite, and cystine. Understanding these different types can be beneficial for preventing and treating kidney stone conditions.
Calcium oxalate stones
Calcium oxalate stones are the most common type of kidney stones. They form when calcium combines with oxalate in the urine. The main risk factors that may cause calcium oxalate stones are dehydration from not drinking enough fluid and an imbalanced diet: A diet too high in protein, oxalate, or sodium.
Besides the dietary factors, obesity, certain medical conditions, Inflammatory Bowel Disease, gastric bypass surgery, and several metabolic disorders can increase the concentration of calcium or oxalate in urine. These conditions will affect fat absorption. When fat is not absorbed the right way, the fat binds to calcium and leaves oxalate to be absorbed and taken to the kidney, causing higher levels of oxalate in the urinary tract. The build-up of oxalate can form crystals, which can form kidney stones.
To lower the chances of forming calcium oxalate stones, it is advisable to:
- Drink enough fluids, like water.
- Avoid eating too much protein.
- Eat less salt (sodium).
- Eat less oxalate-rich foods (nuts, rhubarb, beets, miso, sesame seeds, Swiss chard, etc).
Uric acid stone
Uric acid stone is a prevalent type of kidney stone that forms when the levels of uric acid in the urine are excessively high, and/or the urine is consistently too acidic. The primary risk factor for this type of kidney stone is a high intake of purine. Purines are a natural chemical compound found in foods such as organ meats and shellfish. When consumed in large amounts, they lead to the production of monosodium urate, which can form stones in the kidneys under certain conditions. People with a family history of kidney stones are more likely to develop uric acid kidney stones.
To prevent uric acid stones, it is advisable to:
- Drink enough water every day.
- Cut down on high-purine foods such as red meat, organ meats, beer/alcoholic beverages, meat-based gravies, sardines, anchovies and shellfish.
- Limit sugar-sweetened foods and drinks, especially those that have high fructose corn syrup.
- Decreasing animal-based protein and eating more fruits and vegetables.
Struvite stones
Struvite stones are less common than other types of kidney stones. It is formed due to an upper urinary tract infection (UTI) caused by bacteria. The bacteria produce ammonia, which can render the urine less acidic and more alkaline. When the urine becomes more alkaline, struvite stones can form. Struvite (magnesium ammonium phosphate) and calcium carbon-apatite are the primary chemicals present in a struvite stone. These stones can grow rapidly and become quite large without any early symptoms or warning signs. In many cases, the stone is too large to pass through, and surgical procedures are needed to break down larger stones or remove them.
To prevent future struvite stones, your doctor may prescribe certain medicines.
- Acetohydroxamic acid (AHA) is used to stop the bacteria from making ammonia, which can cause struvite stones to grow.
- Antibiotics are used to stop a bacterial infection causing a UTI after a stone is removed.
- Drinking enough fluids to make at least two liters of urine per day may be recommended.
Cystine stones
Cystine stones are caused by a rare, inherited disorder called “cystinuria”, which leads to the leakage of the natural substance cystine into the urine. Excessive cystine in the urine can lead to the formation of kidney stones, which may become lodged in the kidneys, bladder, or anywhere in the urinary tract. Individuals with cystinuria often experience recurring stones. This condition is lifelong and can be managed but not cured.
The main solutions are to keep stones from forming:
- increasing water intake
- reducing salt intake
- consuming less meat
If these steps are not enough, certain prescription medicines may be necessary to prevent stone formation. If a stone is very large and painful, or if it blocks the flow of urine, you may need surgery to remove it.
Tips to reduce the formation of kidney stone
Drinking enough water every day is crucial to prevent the formation of kidney stones. Studies indicate that consuming at least 2500 mL of water and producing at least 2 liters of urine per day can significantly reduce the risk of developing kidney stones.
Avoid sugar-sweetened beverages. Frequent consumption of sugar-sweetened soda beverages increases the risk of developing high blood glucose (hyperglycemia) and kidney stones. Drinking more sugar-sweetened non-cola or cola beverages is associated with a higher risk of developing kidney stones. Drinking more than one serving of sugar-sweetened soda per day raises the risk of stone formation by 23–33% compared to drinking less than one serving per week.
Increase the amount of dietary fiber you consume. A higher intake of total dietary fiber, fruits, and vegetables is linked to a reduced risk of developing kidney stones. However, juicing may not be as helpful because the process removes or destroys many of the dietary fibers and certain nutrients.
Consume calcium-rich foods in moderation and consult your doctor before taking calcium supplements. Reducing the consumption of calcium sources was historically recommended to prevent calcium stones. However, consuming calcium from food does not affect the risk of developing kidney stones. It is generally safe to continue consuming calcium-rich foods unless your doctor advises against it.
Limit your intake of high-oxalate foods. Oxalate is an important dietary consideration for preventing stone formation. For people who are prone to developing calcium oxalate stones, limiting the consumption of foods that are high in oxalates may be beneficial. Such foods include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate, black pepper, and soy products.
Decrease your sodium intake. High sodium intake increases urinary calcium excretion, so a low-sodium diet is generally recommended for patients with kidney stones. Decreased urinary sodium and the resulting reduction in urinary calcium are also considered beneficial for maintaining bone density.
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References
- Stamatelou, K., & Goldfarb, D. S. (2023). Epidemiology of Kidney Stones. Healthcare (Basel, Switzerland), 11(3), 424. https://doi.org/10.3390/healthcare11030424
- Mayo clinic, (2022). Kidney stones. Available from: https://www.mayoclinic.org/diseases-conditions/kidney-stones/symptoms-causes/syc-20355755
- National Kidney Foundation, (n.d.). Kidney stones. Avaialble from https://www.kidney.org/atoz/content/kidneystones
- Xu, H.-J & Liu, Chunhua & Xue, Y. & Xue, C.-H & Wang, Yu-ming. (2011). The effect of dietary sea cucumber saponin on hyperuricemia in mice. Chinese Pharmacological Bulletin. 27. 1064-1067. 10.3969/j.issn.1001-1978.2011.08.008.
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