Kidney Stones: Treatment Overview

Reviewed by the Office of Clinical Evaluation and Policy (OCEP), Evernorth

Kidney stones are a common occurrence in the United States, with 1 in 10 Americans reported to experience a kidney stone at least once in their lifetime. However, some people may be at a higher risk than others. The prevalence of kidney stones is higher in men than in women.

Having kidney stones, also known as nephrolithiasis and renal calculi, can be painful for many people. For others, kidney stones may cause mild discomfort or no symptoms, especially if the stones are small enough to pass through the urine. A healthcare provider may recommend different treatment options, depending on the size and type of kidney stone. These treatment options may include dietary changes, medication and, in severe cases, surgery or other procedures.

Continue reading to learn more about treatment options for kidney stones.

What Are Kidney Stones?

To understand the treatment options for kidney stones, it’s important to understand what kidney stones are and the different types of kidney stones.

Kidney stones can form from various waste products and chemicals found in the urine. Not enough liquid in the urine can lead to crystals forming, which can lead to a solid or stone-like structure. Kidney stones are typically made up of one of four main substances: calcium oxalate, uric acid, struvite or cystine.

Kidney stones usually range in size from a grain of sand to a chickpea. Sometimes, kidney stones are small enough to pass through the urine with no treatment needed. Other times, kidney stones can become lodged in the kidneys or ureter (tube that carries urine from kidney to bladder), causing pain and discomfort. Symptoms of kidney stones may include nausea, vomiting, fever, pain in the lower back and blood in the urine.

Kidney Stones Treatments

A healthcare provider will diagnose kidney stones through imaging studies, bloodwork, urinalysis, a physical exam and a thorough medical history. After confirming a diagnosis, a healthcare provider will determine the most appropriate treatment based on the size and makeup of the stone. In some cases, a combination of treatments may be recommended. Follow-up exams and preventative treatments may also be needed to ensure the kidney stone is gone and decrease the chance of kidney stones returning.

Lifestyle Modifications

In many cases, medications and procedures are unnecessary for small stones. Instead, dietary therapies may be recommended. For example, drinking plenty of fluids can help pass a stone. A healthcare provider will provide recommendations on the exact amount of fluids to drink per day, as it can vary by person.

Based on the type of kidney stone you had, you may be able to prevent kidney stones by making changes in your diet, such as reducing your sodium intake. Restricting calcium intake in the diet is unnecessary, but people who take calcium supplements may need to use caution and monitor for calcium kidney stones. Eating fewer foods with oxalates, such as nuts, spinach, soy, beets and okra, may help reduce the risk of calcium oxalate stones. In addition, food with animal protein, such as beef, chicken, dairy products and fish, may contain high levels of uric acid that may affect the development of uric acid and calcium stones. Your healthcare professional will be able to advise on dietary recommendations.

Medications

There are several medications available to treat kidney stones. For small kidney stones, an over-the-counter pain reliever like acetaminophen or ibuprofen can help with minor pain or discomfort. Tamsulosin is a prescription alpha-blocker that can help relax the muscles of the ureter to make it easier to get rid of the kidney stone through the urine. A thiazide diuretic such as hydrochlorothiazide or chlorthalidone can help treat and prevent calcium stones.

For uric acid stones, allopurinol may be prescribed due to its ability to reduce uric acid in the urine. As struvite kidney stones are typically formed from a UTI, a healthcare provider may recommend antibiotics. In addition, potassium citrate may be used to treat and prevent kidney stones.

Surgery or Procedures

For more severe kidney stones that are large or cause symptoms, different procedures may be performed. Extracorporeal shock wave lithotripsy (ESWL) uses focused shock waves or vibrations to break up a kidney stone into smaller pieces that can be passed through the urine. The procedure typically lasts an hour and can cause discomfort that usually requires general anesthesia. Percutaneous nephrolithotomy is a more invasive procedure that involves surgically extracting the kidney stone with a scope and other tools. For this procedure, general anesthesia is required, and the kidney stone is removed through an incision in the lower back.

Bottom Line

Kidney stones are common. They are treatable through various options, depending on the type of kidney stone. If you or a loved one experiences a kidney stone, a healthcare provider can prescribe medication, recommend lifestyle changes or do a procedure to help remove the stone.

Sources:

• https://www.auanet.org/guidelines-and-quality/guidelines/kidney-stones-medical-mangement-guideline
• https://www.mayoclinic.org/diseases-conditions/kidney-stones/diagnosis-treatment/drc-20355759
• https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/treatment