The doctor will ask you questions regarding the timing, nature, progression, and any changes in the pains that you have felt. It is also very important to know all the other symptoms that you have experienced, including any fever and burning with urination.
In addition to checking for any history of kidney stones (yours or your family members’), the doctor will need to be updated on all of your medical problems and the names of the medications you are currently taking.
The doctor will do a physical examination that will include a thorough evaluation with a specific focus on your abdomen and back, with a testicular exam in males.
The doctor will order the laboratory to do a dipstick and microscopic analysis of a urine sample. This is one of the most important tests in the beginning and may be one of the hardest because you often will have a hard time giving a urine sample. The doctor may also have your blood tested to look for signs of infection and to check on kidney functioning.
The emergency department may use an ultrasound machine and a plain abdominal x-ray called a KUB (for kidneys, ureters, and bladder) as a quick screening to look for blockage. If you already know that you have a stone, these techniques may be used to help find the position of a migrating stone.
X-rays and ultrasound examinations may also be performed by technicians and read by a radiologist outside of the emergency department. Ultrasound is very important if you are pregnant and cannot be exposed to x-rays.
Intravenous pyelography (IVP) is a dye study that may also be performed to look at your kidney function and to check for a kidney stone. Dye is injected through an IV catheter, and many x-rays are taken over a period of time. A special non-ionic dye should be used if you have asthma, multiple allergies, severe cardiac disease, or have had a previous reaction to the less expensive ionic contrast agents. The IVP study shows how well your kidneys are functioning and may also be done later by a urologist if it wasn’t used for diagnosis.
A CT scan of your abdomen (which can be done with or without IV contrast dye) is being used more frequently as a test to check for kidney stones. This very rapid and sensitive test also reveals other diseases that might mimic a kidney stone, such as abdominal aortic aneurysms, diverticular disease of the bowel, pancreatitis, appendicitis, or disorders of the gallbladder.
A study was conduced at Channing Laboratory, Department of Medicine, Brigham in collaboration with Women’s’ Hospital, Harvard Medical School, Boston, Massachusetts, USA, to assess the relationship between risk of stone formation and the levels of urinary factors. This study proves without doubt that results of a 24-hour urine collection are integral to the selection of the most appropriate intervention to prevent kidney stone recurrence.
Currently, the accepted definitions of normal urine values are not firmly supported by the literature. In addition, there is very little information about the relationship between risk of stone formation and the levels of urinary factors. Unfortunately, the majority of previous studies of 24-hour urine chemistries were limited by the inclusion of recurrent stone formers and inadequately defined controls.
The study was conducted on 807 men and women with a history of kidney stone disease and 239 without a history who were participants in three large ongoing cohort studies. Their 24 hour urine samples were collected and obtained. The participants were from the Nurses’ Health Study I (NHS I; mean age of 61 years), the Nurses’ Health Study II (NHS II; mean age of 42 years), and the Health Professionals Follow-up Study (HPFS; mean age of 59 years).
24-hour urine analysis showed higher calcium excretion and lower urine volume in most cases, but urine oxalate and citrate did not differ. Among women, urine uric acid was similar in cases and controls but was lower in cases in men. The frequency of hypercalciuria was higher among the cases in Nurses’ Health Study I, NHS II, and HPFS.
The frequency of hyperoxaluria did not differ between cases and controls, but was three times more common among men compared with women. After adjusting for the other urinary factors, the relative risk of stone formation increased with increasing urine calcium levels and concentration in all three cohorts but not in a linear fashion. There was substantial variation in the relative risks for stone formation for the concentration of other urine factors within the different cohorts.
The traditional definitions of normal 24-hour urine values need to be reassessed, as a substantial proportion of controls would be defined as abnormal, and the association with risk of stone formation may be continuous rather than dichotomous. The 24-hour urine chemistries are important for predicting risk of stone formation, but the significance and the magnitudes of the associations appear to differ by age and gender.
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