Kidney Research Since 1999

Andrew Colucci, MD
Andrew Colucci, MD

2012 Doctor of Medicine (M.D. cum laude) procured at Boston University School of Medicine - Currently a radiologist in Massachusetts

Jan 23, 2019 5 min read

Kidney Stone Diagnosis Exams and Identification Tests

kidney stones

When the pain of a kidney stone strikes, there are two things you want: immediate relief and a quick diagnosis. Due to the severity of the pain that is often associated with kidney stones, many people head to the emergency room or urgent care clinics to find out what is wrong.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), kidney stones are most likely to affect individuals between ages 20-4o and occur more frequently among Caucasians and men. A family history of kidney stones, or previous occurrence of kidney stones, can increase your risk of having them, in addition to the following risk factors:

  • Obesity
  • Dehydration
  • Diets high in protein, salt, and glucose
  • Inflammatory bowel disease
  • Gastric bypass surgery
  • Hyperparathyroid condition
  • Diuretics, seizure medication, and certain antacids

What are the First Signs of a Kidney Stone?

Intense pain in your abdomen, side, lower back, and groin area is one of the first tell-tale signs that you are suffering from a kidney stone. Other signs and symptoms that might make you head to the doctor include:

  • Frequent need to urinate
  • Only urinating small amounts
  • Blood in the urine
  • Nausea and vomiting
  • Fever and chills
  • Discolored or foul-smelling urine

Though kidney stones are often associated with pain, there are some kidney stones that pass that you might not even know about. This is because they are small and easily pass through your urinary tract. The bigger stones are usually the troublemakers that send you to the doctor for relief.

Kidney Stone Diagnosis

There are a number of tests and examinations your doctor may perform when you are complaining of kidney stone symptoms. Your doctor will want to ask you a number of questions and perform physical exams not only to diagnose the kidney stones, but to also rule out any underlying medical condition that might be contributing to them and/or the cause of your symptoms.

Lifestyle Questions: How active are you? Do you stay hydrated? Can you describe your diet for me? These are all likely questions your doctor will ask you when you are suffering from a kidney stone. Not staying properly hydrated throughout the day is one of the most common causes of kidney stones. Though, certain fluids might make you at greater risk for developing a kidney stone – like grapefruit juice. Sticking to water is always a safe bet. A sedentary lifestyle is also a contributing factor to kidney stone development, though, if you do work out a lot, it’s important to stay properly hydrated. Foods that are high in oxalates (dark leafy greens, chocolate, and beans) can increase your chances of developing kidney stones, as can diets high in sodium, protein, low in calcium, and eating a lot of foods that are high in Vitamin C and Vitamin D.

Medical Questions: Do you take any medications? Are you suffering from any type of medical condition? Let your doctor know the medications you are taking, because some of them might be causing or contributing to your kidney stones. In addition certain medical conditions have been found to increase your chances of developing kidney stones, including gout, inflammatory bowel disease, sarcoidosis, parathyroid disease, frequent UTIs, abdominal surgery – such as gastric bypass, and being on bed rest.

Physical Exam: During your physical exam, your doctor will check all of your vitals, take your temperature and weight, and examine your abdomen and groin area for enlarged lymph nodes, pain, and fluid buildup.

Laboratory Tests: In addition to the asking a number of questions about your lifestyle, diet, family history, and medical history, your doctor might perform a number of laboratory tests for kidney stone diagnosis. These might include:

  • Performing blood tests to check for levels of calcium, uric acid, phosphorous, and other electrolytes – buildup of these in the kidneys are all contributing factors to kidney stones. Blood tests can also alert your doctor to other  medical problems.
  • Assessing kidney function by testing for blood urea nitrogen (BUN) and creatinine.
  • Conducting a urinalysis to look for crystals, blood, bacteria, and white blood cells. A urinalysis can alert doctors to the excretion of too many kidney-stone forming minerals, or two few stone-preventing substances.
  • Examining stones that you have passed to determine type of stone your body is producing. This gives your doctor more information on how to proceed for treatment.

Obstruction Tests: These tests can rule out obstruction and more fully diagnose the presence of kidney stones

  • Abdominal X-rays to provide pictures of the abdomen, kidneys, bladder, and the ureters
  • Non-contrast spiral CT scan – one of the most common tests for kidney stone diagnosis
  • Intravenous pyelogram (IVP) – X-rays of the urinary tract
  • Retrograde pyelogram
  • Ultrasound – this examination is the most preferred test for pregnant women who are suffering from kidney stones

Identification Tests and Treatment

Not all kidney stones are alike. Some are painful, some are not. Some are small, some are large. And one stone may have a different makeup over the other. To assess the type of kidney stone you have, your doctor may ask you to collect your stones as they pass to determine the type. This can be done through straining your urine. Collection of urine over a number of days can also aid your doctor in determining the characteristics of your urine to determine an overabundance or lack of certain minerals.

Once your doctor identifies the type of kidney stone you are suffering from, its size, and other characteristics, a more solid treatment plan can be delivered. Some stones pass on their own and you might be sent home with some pain medication and instructions to increase your fluid intake while the stone passes.

Medications: If you are suffering from kidney stones, your doctor may prescribe you a narcotic for pain and treatment for infection. Some commonly prescribed medications include diuretics, phosphorus solutions, sodium bicarbonate, sodium citrate, allopurinol.

Lithotripsy: This treatment method using sound waves to break up large stones. Once the large stones are broken up, the smaller parts can more easily pass through the urinary tract. Lithotripsy treatment often requires low doses of anesthesia because it can be rather painful and cause bruising on surrounding organs.

Tunnel Surgery: Your doctor will make a small incision in your back and remove the stone when the stone is too large to pass, causes intense pain with no relief, and the stone has led to complications.

Ureteroscopy: In this procedure, your doctor will use a small instrument, known as a ureteroscope to go in and manually remove a stone that has gotten stuck in the ureter. The ureteroscope is attached with a camera so your doctor can visually find the stone and capture it with a small cage to capture it off and send it to the lab for testing.

Prevention

Kidney stone pain is something you never want to experience. And, if you have already experienced it, it’s something you never want to experience again. You can’t prevent your family history, but you can take some measures to decrease your risk of developing kidney stones in the future. These include staying properly hydrated, eating a well-balanced diet, and staying active. All tips to living a healthy lifestyle in general. Eating a moderated diet of foods high in oxalates, reducing your salt intake, and the amount of protein-rich foods you eat all contribute to a lifestyle void of kidney stones.