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Definition

Kidney stones are crystals that collect in the kidney and may pass into the ureter and block it.

Types

• Calcium oxalate, the commonest
• Uric acid (with gout)
• Struvite (with certain bacterial infections)
• Cystine (inherited and rare)

Risk factors

Low water intake, hot climate, excess salt and animal protein, family history.

Symptoms

• Severe renal colic in the flank radiating to the groin; the patient cannot get comfortable
• Blood in the urine
• Nausea and vomiting
• Fever with a stone means infection behind an obstruction, an emergency

Diagnosis

Non-contrast CT for stones, urinalysis, and ultrasound in pregnancy and children.

Treatment

• Analgesia; NSAIDs work very well for colic
• Fluids, and tamsulosin to help passage
• Large stones: shock-wave lithotripsy or ureteroscopy

Nursing care

• Strain the urine to catch the stone for analysis
• Encourage fluids for 2–2.5 litres of urine a day

Exam point

Stones under 5 mm usually pass on their own.