Symptoms/complaints

Kidney stones are mainly found in the calyx system, where the kidney stones often do not cause any symptoms (so-called “silent” kidney stone). However, the kidney stone can also cause colic (wavelike, cramp-like pain with a pain-free interval) if it moves from the renal pelvis further into the ureter and passes through several narrow points. Depending on where the kidney stone is located, the pain radiates in a typical way.

With kidney stones, it is mainly the lumbar region that is affected (“low back pain“). Kidney stones that have already reached the bladder lead to a painful and frequent urge to urinate, whereby the pain radiates into the penis and testicles or clitoris and labia. The colic is often accompanied by nausea and vomiting.

The abdomen is distended. Reflexes may accompany the colic and lead to paralysis of the bowel (ileus), the heart beats more slowly (bradycardia). Fever is only found when there is a simultaneous urinary tract infection (cystitis, inflammation of the renal pelvis).

Those affected are restless and writhe in pain, which is repeatedly interrupted by painless periods. Bladder stones are usually caused by a disorder of the urine flow, e.g. enlarged prostate (prostate hyperplasia). In rare cases they can grow up to the size of a chicken egg. Since they usually do not obstruct the bladder outlet, they cause few complaints: more frequent urination (pollakiuria) and occasionally blood in the urine (hematuria). Furthermore, lower abdominal pain, interrupted urination and an unsuppressible urge to urinate may occur.

Diagnosis

Patients at high risk are those with: Urine is tested for red blood cells and bacteria when kidney stones are diagnosed using test strips and sediment analysis (one looks at the solid components).In this way, a blood discharge via the urine and a urinary tract infection are examined. The pH value should also be checked several times, because deviations in the corresponding symptoms can indicate kidney stones/urinary stones. In the blood (laboratory) calcium, phosphate, chloride, creatinine and uric acid (indication of urinary calculus forming substances) are checked.

If there is a suspicion of a kidney stone disease, this must be confirmed by an ultrasound and X-ray examination. If the kidney stone is not visible on the X-ray, it must be remembered that not all stones cast a shadow visible on the X-ray or that other causes may be behind a disturbance in the flow of urine (see above). In rare cases, vascular occlusion can also cause colicky pain.

Family members already affected
Inflammatory bowel diseases (e.g. Crohn’s disease, ulcerative colitis)
Osteoporosis
Small bowel surgery
Kidney stones in the prehistory

A urogram may only be performed in colic-free intervals, otherwise there is a risk of ureteral tearing. In the diagnosis of kidney stones, a contrast medium containing iodine is introduced into the vein and then excreted by the kidneys. After 7 and 15 minutes, X-rays are taken, on which the kidneys, renal pelvis, ureter and bladder become visible and may unmask non-radiopaque stones by the contrast medium washing around them.

It should also be clarified whether the cause for the formation of the stone is to be found in the patient’s metabolism (enzyme defects or similar). For this purpose, eating habits, drinking habits and medications taken are queried. For children and patients with recurring urinary stones, the diagnosis is extended.

Urine is collected twice 24 hours and examined for calcium, magnesium, pH value, uric acid, creatinine, cystine, oxalate, citrate and phosphate. Deviating values indicate the metabolic disorders already described above. The choice of therapy for kidney stones depends on the location of the stone in the urinary tract, its size and renal function.

Gallstones: They can cause biliary colics, whose pain extends into the shoulder and middle abdomen.
Appendicitis (inflammation of the appendix): There is no typical colic, but rather permanent pain with pressure sensitivity at certain points.
In women, it is also possible to think of pinched off ovarian cysts or an ectopic pregnancy.