Kidney Stones

How are Kidney Stones Diagnosed?

Diagnosis of kidney stones involves several steps to confirm the presence, size, and location of stones, as well as to identify underlying causes. Early and accurate diagnosis guides the most effective treatment plan.

Physical Examination

A healthcare provider begins with a physical examination, checking the abdomen and back for areas of pain or tenderness that may indicate a kidney stone.

Blood Tests

Blood tests can detect elevated levels of minerals such as calcium or uric acid, which may contribute to stone formation. These tests also assess kidney function and screen for related health conditions.

Urine Analysis

Urine tests, sometimes collected over 24 hours, measure minerals and other substances that can promote or prevent stones. For individuals with recurrent stones, a detailed metabolic evaluation may be recommended to identify risk factors and guide long-term prevention. Following healthcare instructions ensures accurate results and supports a tailored prevention plan.

Imaging Studies

Imaging is a key part of diagnosis. Advanced techniques such as CT scans can detect even small stones, while ultrasound is often used as a radiation-free alternative. In some cases, an intravenous pyelogram (IVP) may be used to visualise the urinary tract, though this is less common today. X-rays are also used, but may not detect all stone types.

Stone Analysis

If a stone is passed, collection for laboratory analysis may be requested. Identifying the stone’s chemical composition helps guide targeted treatment and prevention strategies.

Treatment Options for Kidney Stones

Treatment varies based on the size, type, and symptoms caused by the kidney stones.

Managing Small Stones with Mild Symptoms

Most small kidney stones pass naturally without surgery. Treatment focuses on easing passage and preventing new stones.

• Hydration: Drinking 2 to 3 quarts (about 2 to 3 litres) of water daily dilutes urine and may help stones pass more easily. Water is preferred to maintain clear or nearly clear urine unless otherwise advised by your doctor.
• Pain Relief: Over-the-counter pain relievers like ibuprofen or naproxen sodium can help manage discomfort. Severe pain may require stronger medications or emergency care.
• Medications: Alpha blockers such as tamsulosin (Flomax) or combination drugs like dutasteride and tamsulosin (Jalyn) relax the ureter muscles, facilitating faster and less painful stone passage.

Treating Large or Complicated Stones

Large stones or those causing complications like bleeding, kidney damage, or infections often require advanced treatments.

• Extracorporeal Shock Wave Lithotripsy (ESWL): This non-invasive procedure uses shock waves to break stones into smaller fragments that pass more easily in urine. The session lasts 45–60 minutes and may involve pain relief or sedation. Side effects can include bruising, bleeding, and discomfort as fragments pass.
• Percutaneous Nephrolithotomy: For very large or resistant stones, surgeons remove stones through a small incision in the back using telescopes and specialised tools. General anaesthesia is administered, with a typical hospital stay of 1–3 days.
• Ureteroscopy: A thin, flexible scope with a camera is inserted through the urethra and bladder to reach and remove or fragment stones in the ureter or kidney. A stent may be placed to support healing. This procedure usually requires anaesthesia.
• Parathyroid Surgery: Some kidney stones result from hyperparathyroidism, an overactive parathyroid gland causing high calcium levels. Surgery to remove tumours or correct gland function may prevent recurrent stones.

Prevention and Long-Term Care

Prevention of kidney stones is an important part of ongoing care.

• Dietary changes: Limiting salt, animal protein, and foods high in oxalate (such as spinach, nuts, and chocolate) may be recommended.
• Medication: Potassium citrate, thiazide diuretics, or allopurinol (for uric acid stones) may be prescribed to reduce stone risk.
• Regular follow-up: Ongoing monitoring and metabolic evaluation help adjust the prevention plan and detect any new stones early.
• Lifestyle counselling: Maintaining adequate hydration and following dietary advice can significantly lower the risk of future stones.

Steps to Prepare

Before Your Visit:

• Check if you need to follow any dietary or fluid restrictions.
• Document your symptoms, including onset, duration, and triggers.
• Record your fluid intake and urine output over 24 hours.
• List all medications and supplements.
• Prepare questions to discuss with your doctor.

Questions You Might Ask:

• What type and size of kidney stone do I have?
• Will I need medication or surgery?
• How likely am I to develop stones again?
• How can I prevent future kidney stones?
• Should I see a specialist?
• Are there educational resources or websites you recommend?

What to Expect from Your Doctor

During your visit, your doctor will ask important questions to help diagnose your condition and recommend the best course of action. Expect questions such as:

• When did the pain or discomfort first occur?
• Are the symptoms constant, intermittent, or related to specific activities?
• Have you noticed blood in your urine or any changes in urine colour?
• Are there episodes of nausea, vomiting, or urinary urgency?
• Do you have a personal or family history of kidney stones or metabolic disorders?
• What is your typical diet and fluid intake?

These insights help your doctor create a personalised care plan designed to relieve your symptoms and prevent recurrence.

Advanced Kidney Stone Care at SJMC

At Subang Jaya Medical Centre (SJMC), we offer comprehensive and expert care for kidney stones, combining advanced diagnostics, minimally invasive treatments, and personalised management plans.

SJMC's multidisciplinary team includes experienced urologists and nephrologists who specialise in the diagnosis and treatment of kidney stones. Our specialists utilise state-of-the-art technology and evidence-based practices to provide effective care tailored to each patient's needs.

Reference

• Mayo Clinic: Kidney Stones – Diagnosis and Treatment
• NYU Langone Health: Kidney Stones – Diagnosis and Treatment
• Cleveland Clinic: Percutaneous Nephrolithotomy and Kidney Stone Treatments
• National Kidney Foundation: Kidney Stone Treatment
• Healthdirect Australia: Kidney Stones – Causes, Diagnosis and Treatment