Nephrolithiasis: Symptoms, Causes & Treatment

Nephrolithiasis is a type of stone that forms in the kidneys or urinary tract. It can cause symptoms such as severe lower back pain, burning or pain when urinating, and reddish urine.

Depending on where the stone is located, nephrolithiasis, also known as kidney stones, can be bilateral, right-sided, or left-sided. This condition may be caused by factors such as low fluid intake, urinary tract infections, or high salt intake.

If nephrolithiasis is suspected, it is important to see your primary care provider, a urologist, or a nephrologist (kidney doctor). They can confirm the diagnosis and recommend treatment, which may include medication, surgery, and dietary changes.

Common symptoms

The main symptoms of nephrolithiasis are:

• Sudden, severe lower back pain

• Pain that may spread to the abdomen, groin, or genital area

• Burning or pain when urinating (dysuria)

• Blood in the urine

• Frequent urge to urinate

• Nausea and vomiting

Pain from nephrolithiasis does not improve with rest or changes in position. It can vary in intensity and may come in waves lasting between 20 and 60 minutes.

However, symptoms of nephrolithiasis usually only appear when the stones become infected or cause some type of blockage in the kidneys, at the ureteropelvic junction, or in the ureter, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Confirming a diagnosis

Nephrolithiasis can be diagnosed by a primary care provider, urologist, or nephrologist through a physical exam and evaluation of the person’s health history.

To confirm the diagnosis, the provider may also order lab tests, such as a urine test to check for microorganisms or small stone fragments, and blood tests to assess uric acid, calcium, urea, and creatinine levels.

The provider will usually also order imaging tests, such as an ultrasound, abdominal X-ray, and, in some cases, a CT scan.

Where nephrolithiasis can occur

Nephrolithiasis can be classified by location as:

1. Bilateral nephrolithiasis

Bilateral nephrolithiasis is characterized by stones in both the right and left kidneys. It is diagnosed through imaging tests.

2. Right-sided nephrolithiasis

Right-sided nephrolithiasis refers to stones located only in the right kidney. This type can cause the same symptoms as other types of nephrolithiasis, such as lower back pain, burning or pain when urinating, and reddish urine.

3. Left-sided nephrolithiasis

Left-sided nephrolithiasis is identified through imaging tests, such as an X-ray or ultrasound, and means that stones are present only in the left kidney.

Main types

The main types of nephrolithiasis are:

• Calcium and calcium phosphate stones: may occur due to conditions such as hyperparathyroidism, excess calcium or oxalate, or low levels of magnesium or citrate in the urine

• Uric acid stones: usually related to more acidic urine, a high intake of purine-rich foods, gout, or cancer

• Struvite stones: made up of calcium phosphate, magnesium, and ammonium, and may be caused by urinary tract infections (UTIs) due to microorganisms

• Cystine stones: rare and related to a kidney defect that affects the reabsorption of cystine, lysine, ornithine, and arginine

Identifying the type of nephrolithiasis may be recommended to determine the stone’s composition and guide appropriate treatment, as well as help prevent future stones.

Possible causes

Possible causes of nephrolithiasis include:

• Anatomical changes that cause urine retention

• Low water intake

• Urinary tract infections

• High intake of salt, animal protein, sugar, and high-oxalate foods

• Low calcium intake in the diet

• Use of medications such as atazanavir, guaifenesin, indinavir, and sulfonamides

• Inherited genetic factors, such as cystinuria

Some factors that may increase the risk of nephrolithiasis include a personal or family history of kidney stones, diabetes, high blood pressure, gout, metabolic syndrome, obesity, chronic diarrhea, and gastric bypass surgery, for example.

Treatment options

Treatment for nephrolithiasis should be done as recommended by a healthcare provider and may include:

1. Medications

Medications such as diclofenac, ibuprofen, acetaminophen, tramadol, or methscopolamine may be recommended by a healthcare provider to relieve renal colic.

Allopurinol is the main medication that may be prescribed to dissolve kidney stones made of uric acid, helping with their elimination and preventing new uric acid kidney stones from forming.

 2. Surgery

Surgery for nephrolithiasis is recommended for large stones or stones that are blocking urine flow.

This surgery can be performed using different techniques depending on the stone’s location, such as extracorporeal shock wave lithotripsy, percutaneous nephrolithotomy, or ureteroscopy.

3. Diet

A kidney stone diet, ideally guided by a registered dietitian, typically includes drinking at least 2 liters of water per day, limiting salt intake, and consuming moderate amounts of oxalate-rich foods and animal protein.

It also emphasizes choosing fresh, minimally processed foods such as fruits, vegetables, and whole grains, as recommended by the CDC for overall health and chronic disease prevention.

4. Home remedies

Some home remedies for kidney stones, such as chanca piedra tea, hibiscus tea, or black mulberry tea, may be used to complement medical treatment for nephrolithiasis.

These home remedies may have diuretic and anti-inflammatory effects, which can help fight inflammation caused by stones passing through the urinary tract.