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PATIENT STORY

A 55-year-old woman presents with severe pain in the right flank. The pain began suddenly after supper and increased dramatically over the next hour. Urinalysis shows blood but no signs of infection. Abdominal X-ray reveals bilateral renal stones (Figure 70-1). A noncontrast CT scan confirms multiple bilateral renal stones, with an obstructing right distal ureteral stone and enlargement of the right kidney (Figure 70-2). She is subsequently found to have hyperparathyroidism, which is the cause of her multiple stones.

FIGURE 70-1

Plain X-ray of the abdomen in a 55-year-old woman showing several stones in the right kidney (red arrow) and a large left ureteral stone (white arrow) adjacent to the L2-L3 disc space.

FIGURE 70-2

Noncontrast CT of the abdomen and pelvis of the same woman showing several of the stones seen in Figure 70-1, including a nonobstructing stone in the interpolar region of the right kidney. Because the right ureter is obstructed by a distal stone (not visible on this image), the right kidney is enlarged, with collecting system dilation and perinephric stranding. The large left proximal ureteral stone seen in this image is only partially obstructing, causing mild dilation in the left kidney collecting system. Several small stones are visible in the left kidney, and the left kidney is somewhat atrophied from chronic obstruction.

INTRODUCTION

A kidney stone is a solid mass that forms when minerals crystallize and collect in the urinary tract. Kidney stones can cause pain and hematuria and may lead to complications, such as urinary tract obstruction and infection.

SYNONYMS

Kidney stone, nephrolithiasis, renal calculus, renal stone, urinary tract stone, ureterolithiasis, urolithiasis.

EPIDEMIOLOGY

  • The prevalence of kidney stones is increasing worldwide across all age, gender, and racial/ethnic groups. This is due to multiple causes, but is clearly associated with increasing rates of obesity and diabetes.1,2

  • Data from 2007–2010 show that 8.8% of adults in the United States reported having kidney stone disease, including 10.6% of men and 7.1% of women.2

  • Men between the ages of 40 and 60 years have the highest risk of stones; for women, the risk peaks in their 50s.3

  • Black (non-Hispanic) and Hispanic Americans have lower rates of kidney stones than white Americans.2,4

  • Calcium oxalate and calcium phosphate stones are the most common, occurring in 75% to 85% of patients. Struvite (magnesium ammonium phosphate) stones occur in 5% of cases. Uric acid stones occur in 5% to 10% of patients, and cystine stones occur in 1% of cases. Other types of stones are less common.5

  • Calcium stones are more ...

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