Tests and Diagnosis
If Dr. Gholami suspects you have a kidney stone, he generally recommends an imaging test to help him with diagnosis.
- Imaging tests. Imaging tests may show kidney stones in your urinary tract. Dr. Gholami usually first recommends a computerized tomography (CT) scan, as it provides him with the most information and may reveal even tiny stones. In some cases, he may recommend an ultrasound of the kidneys (renal ultrasound) instead. This is a noninvasive test, but it does not provide Dr. Gholami with as much information as a CT scan, so he generally does not recommend it first.
After Dr. Gholami diagnoses you with a kidney stone, his next step is to recommend a treatment for you. Treatment for kidney stones varies, depending on the size and location of the stone.
Small stones with minimal symptoms
Some kidney stones won’t require invasive treatment. You may be able to pass a small stone by:
- Drinking water. Drinking as much as 2 to 3 quarts (1.9 to 2.8 liters) a day may help flush out your urinary system. Unless Dr. Gholami tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
- Pain relievers. Passing a small stone can cause some discomfort. To relieve mild pain, Dr. Gholami may recommend pain relievers such as ibuprofen (Advil, Motrin, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve).
- Medical therapy. Dr. Gholami may give you a medication to help pass your kidney stone. This type of medication, known as an alpha blocker, relaxes the muscles in your ureter, helping you pass the kidney stone more quickly and with less pain. The most common alpha blocker medication that Dr. Gholami recommends is called Rapaflo.
Large stones and those that cause symptoms
Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more invasive treatment.
The most common type of procedure that Dr. Gholami performs for kidney stones is extracorporeal shock wave lithotripsy (ESWL).
- Extracorporeal shock wave lithotripsy (ESWL)In this 1-hour outpatient procedure, Dr. Gholami uses sound waves to break your kidney stone(s) into small pieces that can more easily travel through your urinary tract and pass from the body. The stone pieces will usually pass in your urine within a few days. You may be given a strainer to collect them. You may also need a stent, which is a small, short tube of flexible plastic mesh that holds your ureter open to help the stone pieces pass without blocking your ureter.
In some cases, Dr. Gholami may recommend one of the following procedures to you:
- Surgery to remove very large stones in the kidney. A procedure called percutaneous nephrolithotomy (nef-row-lih-THOT-uh-me) involves surgically removing a kidney stone using small telescopes and instruments inserted through a small incision in your back. You’ll receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Dr. Gholami may recommend this surgery if ESWL was unsuccessful or if your stone is very large.
- Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, Dr. Gholami may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Dr. Gholami may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.
After you pass your kidney stone or have a procedure to remove it, Dr. Gholami will recommend various tests to figure out what is causing you to get kidney stones and help prevent you from getting them in the future.
- Analysis of passed stones. Lab analysis will reveal the makeup of your kidney stones. Dr. Gholami uses this information to determine what’s causing your kidney stones and to form a plan to prevent more kidney stones.
- Urine tests. Tests of your urine, such as the 24-hour urine collection, may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances. Based on these results, Dr. Gholami can recommend dietary changes for you.
- Blood tests. Blood tests may reveal too much calcium or uric acid in your blood. Dr. Gholami can prescribe medications to help reduce these levels, if that is the case for you. Blood test results help monitor the health of your kidneys and may lead Dr. Gholami to check for other medical conditions.
- Parathyroid hormone (PTH) level. Dr. Gholami also checks the level of parathyroid hormone (PTH) in your blood. PTH is released by your parathyroid glands, which are located on the four corners of your thyroid gland, just below your Adam’s apple. Some calcium stones are caused by overactive parathyroid glands. When these glands produce too much PTH (hyperparathyroidism), your calcium levels can become too high and kidney stones may form as a result. Hyperparathyroidism sometimes occurs when a small, benign tumor forms in one of your parathyroid glands or you develop another condition that leads these glands to produce more parathyroid hormone. Removing the growth from the gland stops the formation of kidney stones. Or Dr. Gholami may recommend treatment of the condition that’s causing your parathyroid gland to overproduce the hormone.