4 Stages of Passing A Kidney Stone From Your Body

Kidney stones are solid mineral formations in the kidneys that can lead to significant discomfort and health issues. Affecting approximately 10% of people at some point, understanding the stages of passing a kidney stone is crucial for effective management and prevention. This journey starts in the nephron, where crystals form, and progresses through the urinary system, including the ureter and bladder, often resulting in painful episodes known as renal colic. By familiarizing yourself with the four stages of kidney stones, you can better navigate this challenging process and work closely with your urologist to maintain optimal renal health.

The Science Behind Kidney Stone Formation

Kidney stones, or renal lithiasis, are hard mineral and salt deposits in the kidneys. Understanding their formation is key to prevention and treatment.

Crystallization: The Starting Point

Kidney stone formation begins with the crystallization of minerals in urine. Normally, urine contains dissolved substances that prevent crystals from sticking together. When these substances become concentrated (supersaturation), crystals form and can aggregate to create a stone nucleus.

Mineral Buildup and Supersaturation

Concentrated urine increases the likelihood of stone formation. Dehydration and conditions like hypercalciuria (excess calcium in urine) elevate mineral concentrations, especially for calcium oxalate stones.

Types of Kidney Stones

Understanding the types of kidney stones is crucial for effective prevention and treatment. The four primary types include:

• Calcium Oxalate Stones
  

Calcium oxalate stones are the most common type, accounting for 80% of all stones. They form when calcium combines with oxalate in the urine, with high calcium levels (hypercalciuria) and oxalate-rich foods increasing the risk. They typically form in slightly acidic to neutral urine.

• Uric Acid Stones
  

Formed from uric acid, these stones are more common in individuals with high-protein diets or certain metabolic disorders. Acidic urine promotes crystallization, and conditions like gout can elevate the risk.

• Struvite Stones
  

Known as infection stones, struvite stones develop in response to urinary tract infections caused by urease-producing bacteria. These stones can grow rapidly and may fill the renal pelvis.

• Cystine Stones
  

Rare stones result from cystinuria, a genetic disorder that causes high levels of cystine in urine. They form even in slightly acidic environments and often require specific management due to their recurrence.

Factors Influencing Kidney Stone Formation

Several factors influence how kidney stones form, including:

• Urine Concentration and Volume: Low fluid intake leads to concentrated urine, increasing the risk of supersaturation and crystal formation.

• Dietary Habits: High intake of salt, protein, and oxalate-rich foods can elevate the levels of stone-forming minerals in urine.

• Genetic Predisposition: A family history of kidney stones increases susceptibility due to inherited metabolic disorders.

• Urinary pH: The acidity or alkalinity of urine affects the solubility of different minerals, influencing the type of stone that forms.

• Underlying Health Conditions: Diseases like hyperparathyroidism, gout, and certain kidney disorders can disrupt normal mineral metabolism, promoting stone formation.

The Role of the Nephron and Ureter

The nephron, the kidney’s functional unit, filters blood and maintains mineral balance. When mineral concentrations exceed their solubility, crystals can form in the nephron and migrate to the ureter, causing renal colic, which is characterized by severe pain. Disorders like hypercalciuria, hyperoxaluria, and hypocitraturia disrupt this balance, increasing the risk of kidney stones. Understanding these processes allows for preventive measures such as staying hydrated, adjusting dietary intake, and managing metabolic disorders with healthcare professionals. Regular monitoring can help prevent the progression from crystals to larger stones.

Risk Factors and Genetic Predisposition

Kidney stones can affect anyone, but several risk factors significantly increase the likelihood of their development. Understanding how genetics, diet, lifestyle, and health conditions contribute to this risk can help with prevention.

• Genetic Predisposition
  

Family history is a major predictor of kidney stone risk. Individuals with relatives who have experienced stones are more susceptible due to shared genetic traits. Conditions like cystinuria and hyperoxaluria can further elevate this risk by increasing certain substances in the urine.

• Dietary Habits

Diet plays a crucial role in stone formation. Key dietary factors include:

1. High Sodium Intake: Excess sodium can increase calcium excretion in urine, raising the risk of calcium oxalate stones.
2. High Protein Diet: High animal protein consumption raises uric acid levels and lowers urinary pH, promoting uric acid stones.
3. Oxalate-Rich Foods: Foods like spinach and nuts can contribute to calcium oxalate stone formation, especially for those with genetic predispositions.

• Dehydration 

Dehydration is a preventable risk factor. Insufficient fluid intake concentrates urine, increasing the likelihood of crystallization. Drinking water and citrate-rich beverages can help dilute urine and inhibit stone formation.

• Sedentary Lifestyle and Obesity

Sedentary behavior and obesity are linked to higher kidney stone risk. Obesity affects metabolism, raising uric acid and calcium levels. Regular physical activity promotes healthy weight management and improves urinary function, reducing the risk of stone formation.

Underlying Health Conditions: Metabolic Disorders and Kidney Stone Risk

Certain underlying health conditions elevate the risk of kidney stones, particularly those that affect mineral metabolism or urinary pH. These conditions include:

• Hyperparathyroidism 

This condition causes overproduction of parathyroid hormone, leading to elevated calcium levels in the blood and urine. High urinary calcium increases the likelihood of calcium oxalate stones.

• Gout 

Gout is characterized by elevated levels of uric acid in the blood, which can lead to the formation of uric acid stones. Managing uric acid levels through dietary changes and medication is essential for individuals with gout to reduce the risk of kidney stones.

• Diabetes 

People with diabetes often have higher levels of calcium and uric acid in their urine, which can promote stone formation. Additionally, insulin resistance can affect the kidneys’ ability to regulate calcium, further increasing the risk.

• Citrate Deficiency (Hypocitraturia) 

Citrate deficiency is another metabolic disorder that increases the risk of kidney stones. Citrate binds with calcium in the urine, preventing it from forming crystals. A lack of citrate allows more calcium to crystallize and form stones. Citrate supplements and dietary changes that increase citrate intake, such as consuming more citrus fruits, can help prevent stone formation.

Early Symptoms Before the Stone Moves

Before a kidney stone begins its journey through the urinary tract, subtle symptoms often serve as early warning signs of its presence. These symptoms can be vague and may go unnoticed until the stone shifts or grows larger. Common early symptoms include lower back pain, blood in urine, and changes in urinary habits.

• Lower Back Pain (Flank Pain) 

Lower back pain, or flank pain, is often one of the first signs of a kidney stone. This discomfort, located on one side below the ribs, can range from a dull ache to sharp pain. It often worsens as the stone obstructs urine flow, with initial mild soreness escalating to severe cramping.

• Blood in Urine (Hematuria) 

Blood in the urine, known as hematuria, can occur due to irritation from kidney stones. This may manifest as pink, red, or brown urine, or it could only be detectable through testing. Not everyone will notice visible blood, but it is a key symptom to watch for.

• Frequent Urination and Urinary Changes 

Changes in urination patterns, such as increased frequency and urgency, can signal kidney stones. Irritation in the urinary tract may cause the need to urinate more often, sometimes accompanied by painful urination (dysuria) or a burning sensation.

• Nausea and Vomiting 

Nausea and vomiting may arise as the body reacts to kidney stone pain. While more common when the stone moves, some individuals may experience these symptoms early on. Nausea can worsen with movement, and vomiting may occur in response to severe discomfort.

Ureter Passage: The Most Painful Stage

The passage of a kidney stone through the ureter is often the most painful phase of kidney stone formation, characterized by severe pain known as renal colic. This pain occurs as the stone moves from the kidney into the ureter, triggered by spasms and contractions. Even small stones can block urine flow, leading to hydronephrosis, which increases pressure and sharp pain. Symptoms typically include sharp flank pain radiating to the abdomen and groin, and the phase can last hours or days, depending on the stone’s size and movement. Stones smaller than 5 mm in diameter have an 80% chance of passing naturally without medical intervention, while stones larger than 10 mm have less than a 20% chance of passing on their own. 

To manage the pain, individuals can use over-the-counter medications like ibuprofen or acetaminophen, and stay hydrated to help move the stone along. Medical interventions, such as ureteroscopy or shock wave lithotripsy, may be necessary for larger stones. Heat therapy can relax the ureter muscles, while alpha-blockers like tamsulosin can aid in easing stone passage. Although passing through the ureterovesical junction (UVJ) is often the most painful part, pain typically decreases significantly once the stone enters the bladder, and it is usually passed during urination with little discomfort.

Complications During Kidney Stone Passage

Kidney stones can lead to serious complications during their passage through the urinary tract, especially if they cause prolonged obstruction or result in infections. While many stones pass without issues, complications can include urinary tract infections (UTIs), kidney damage, or life-threatening conditions like sepsis.

• Urinary Tract Infections (UTIs)
  

UTIs are common when a stone blocks the ureter, trapping urine and allowing bacteria to grow. This can lead to bacteriuria and, if untreated, spread to cause pyelonephritis, characterized by fever and severe back pain.

• Kidney Infection and Pyelonephritis
  

When bacteria from a UTI reach the kidneys, it can cause pyelonephritis, resulting in intense pain, fever, and nausea. Immediate medical intervention is crucial to prevent permanent kidney damage.

• Sepsis and Urosepsis
  

A severe infection from a kidney stone can enter the bloodstream, causing sepsis. Urosepsis is a life-threatening condition that requires prompt treatment with antibiotics and fluids to prevent septic shock.

• Prolonged Obstruction and Hydronephrosis
  

A stuck kidney stone can lead to urine backup and hydronephrosis, increasing kidney pressure. If untreated, this can cause acute kidney injury and potentially lead to kidney failure.

• Abscess Formation 

In rare cases, untreated infections from kidney stones can result in abscesses in the kidney, which require surgical drainage to prevent further comp

Medical Treatment Options: When to Seek Help

While many kidney stones pass naturally through the urinary system, some stones may become too large or cause severe complications that require medical intervention. Knowing when to seek help is critical to avoiding serious health issues like infection, kidney damage, or prolonged pain. Treatments range from non-invasive options like lithotripsy to more invasive surgical procedures. Here’s an overview of the medical treatments available and when they might be necessary.

When to Seek Medical Help

If you experience any of the following symptoms while trying to pass a kidney stone, it’s crucial to seek medical attention:

• Severe, unrelenting pain in the back or side
• Blood in the urine (hematuria)
• Fever or chills (which may indicate infection)
• Nausea and vomiting
• Difficulty urinating or a total blockage of urine flow

Additionally, if the stone hasn’t passed after several weeks or is too large to pass on its own, medical intervention is necessary.

Natural Remedies and Home Treatment for Passing a Kidney Stone

Passing a kidney stone can be a painful process, but small stones can often be managed and passed naturally with home remedies. Focusing on hydration, herbal treatments, and dietary adjustments can assist in alleviating discomfort while helping your body pass the stone.

• Hydration: The Key to Passing Kidney Stones 

Proper hydration is essential for passing kidney stones. Drinking 2-3 liters of water daily helps dilute substances in urine that form stones and encourages their elimination. Adding lemon juice can enhance the effect, as citrate in lemons may help break down calcium-based stones.

• Herbal Remedies for Kidney Stones
  

Several herbal remedies may aid in managing kidney stones. Dandelion root tea, consumed 2-3 times daily, can act as a diuretic and promote kidney health. Nettle leaf tea brewed up to 3 times a day, also helps keep urine flowing. Basil tea (1-2 times daily) may reduce pain and support kidney health. Apple cider vinegar, mixed with water, can help dissolve stones but should be consumed in moderation to avoid stomach discomfort.

• Dietary Adjustments 

Dietary changes can prevent stone formation. Foods high in potassium citrate, such as bananas, avocados, and cantaloupes, are beneficial. Reducing sodium intake (below 2,300 mg daily) and limiting animal protein can also help. Increasing citrate-rich foods, like lemons and limes, may prevent calcium stones by reducing crystallization.

Pain Management at Home and in the Hospital

Managing pain associated with kidney stones can be challenging, as it often ranges from mild discomfort to severe pain. Effective pain management is essential for improving the quality of life during the passage of stones. Here, we’ll explore pain relief methods, including over-the-counter medications, prescription drugs, and alternative techniques.

• Over-the-Counter Medications 

For mild to moderate pain, over-the-counter (OTC) medications like Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can provide relief. Ibuprofen (200-400 mg every 4-6 hours, up to 1,200 mg per day) and acetaminophen (500-1,000 mg every 4-6 hours, up to 3,000 mg per day) are effective options.

• Prescription Medications 

For severe pain, healthcare providers may prescribe opioids like hydrocodone or oxycodone for short-term relief. Antispasmodics, such as hyoscine butylbromide (Buscopan), can help relax urinary tract muscles and ease pain.

• Alternative Pain Management Techniques 

Heat therapy can alleviate pain by applying a hot compress to the lower back or abdomen for 15-20 minutes. Relaxation techniques, such as deep breathing and mindfulness, can also help manage pain. Staying well-hydrated by drinking 2-3 liters of water daily can facilitate stone passage and reduce discomfort.

Reaching the Bladder: The Final Stretch

As kidney stones travel through the urinary tract, the journey culminates in their entry into the bladder, marking a significant turning point in the passage of stones. This stage often brings a mix of relief and urgency as the body prepares to expel the stone.

• The Journey to the Bladder 

Upon reaching the bladder, where urine is stored, individuals typically feel relief from the intense pain of renal colic, as the stone is no longer causing ureter spasms.

• Relief and Urgency 

Although the initial pain diminishes, new sensations emerge. A sudden urge to urinate arises due to the stone’s presence, creating urgency as the bladder now accommodates a foreign object.

• Symptoms in the Bladder Stage 

Pain decreases but may linger. Urgency to urinate intensifies, and some individuals may experience dysuria, or painful urination, from irritation caused by the stone.

• The Final Expulsion 

The stone is expelled through the urethra during urination. This process can vary based on the stone’s size and shape.

• Stone Expulsion Process 

As the bladder contracts, the force aids in pushing the stone through the urethra. While relief is common after expulsion, some may still feel residual pain. It’s crucial to stay hydrated and monitor for complications, such as blood in the urine or persistent pain.

How Long Does It Take to Pass a Kidney Stone?

The duration it takes to pass a kidney stone varies by individual and depends on factors such as stone size, location, and overall health. Understanding these factors can help manage expectations during this painful process.

• Factors Affecting Passage Time 

Stone size is crucial: small stones (less than 5 mm) typically pass within days to a week, while medium stones (5 mm to 10 mm) may take one to three weeks. Large stones (over 10 mm) often require medical intervention and can take weeks to months to pass.

The stone’s location matters as well; those in the ureter can cause more pain and urgency than those in the kidney. A wider ureter can facilitate quicker passage. Individual anatomy, hydration levels, and overall health also influence how easily a stone can pass.

• Typical Passage Timeline 

Most small stones pass on their own within a week. Larger stones or those causing significant discomfort may require monitoring through imaging. If necessary, medical procedures like lithotripsy or ureteroscopy may be needed, altering the timeline for removal.

Recurrence Prevention and Long-Term Health Monitoring

Preventing kidney stones is essential for long-term health and avoiding discomfort. Effective strategies include dietary changes, hydration, and regular check-ups.

• Dietary Changes
  

Limit oxalate-rich foods like spinach and chocolate, and ensure a balanced calcium intake of 1,000 to 1,200 mg per day from food, not supplements. Moderate protein and sodium to reduce uric acid levels, and include citrate-rich foods like lemons to inhibit stone formation. Aim to produce at least 2.5 liters of urine daily by monitoring fluid intake.

• Staying Hydrated 

Stay well-hydrated by drinking water throughout the day, aiming for at least eight 8-ounce glasses. Electrolyte-rich beverages can help maintain hydration, especially during exercise.

• Regular Medical Check-Ups 

Schedule routine check-ups to monitor kidney health and discuss any stone history. If you pass a stone, ask for a stone analysis to tailor prevention strategies, and consider follow-up imaging if needed.

• Lifestyle Modifications 

Maintain a healthy weight through a balanced diet and regular physical activity. Limit sugary drinks like soda and fruit juices to reduce the risk of stone formation.

Frequently Asked Questions

– Disclaimer –
This blog is for informational & educational purposes only, and does not intend to substitute any professional medical advice or consultation. For any health related concerns, please consult with your physician, or call 911.