Overview

The kidneys filter waste products from the blood and add them to the urine that the kidneys produce. When waste materials in the urine do not dissolve completely, crystals and kidney stones are likely to form.

Small stones can cause some discomfort as they pass out of the body. Regardless of size, stones may pass out of the kidney, become lodged in the tube that carries urine from the kidney to the bladder (ureter), and cause severe pain that begins in the lower back and radiates to the side or groin. A lodged stone can block the flow of urine, causing pressure to build in the affected ureter and kidney. Increased pressure results in stretching and spasm, which cause severe pain.

Stone Formation
Kidney stones form when there is a high level of calcium (hypercalciuria), oxalate (hyperoxaluria), or uric acid (hyperuricosuria) in the urine; a lack of citrate in the urine; or insufficient water in the kidneys to dissolve waste products. The kidneys must maintain an adequate amount of water in the body to remove waste products. If dehydration occurs, high levels of substances that do not dissolve completely (e.g., calcium, oxalate, uric acid) may form crystals that slowly build up into kidney stones.

Urine normally contains chemicals— citrate, magnesium, pyrophosphate— that prevent the formation of crystals. Low levels of these inhibitors can contribute to the formation of kidney stones. Of these, citrate is thought to be the most important.

Types
The chemical composition of stones depends on the chemical imbalance in the urine. The four most common types of stones are comprised of calcium, uric acid, struvite, and cystine.

Calcium Stones Approximately 85% of stones are composed predominantly of calcium compounds. The most common cause of calcium stone production is excess calcium in the urine (hypercalciuria). Excess calcium is normally removed from the blood by the kidneys and excreted in the urine. In hypercalciuria, excess calcium builds up in the kidneys and urine, where it combines with other waste products to form stones. Low levels of citrate, high levels of oxalate and uric acid, and inadequate urinary volume may also cause calcium stone formation.

Calcium stones are composed of calcium that is chemically bound to oxalate (calcium oxalate) or phosphate (calcium phosphate). Of these, calcium oxalate is more common. Calcium phosphate stones typically occur in patients with metabolic or hormonal disorders such as hyperparathyroidism and renal tubular acidosis.

Uric Acid StonesDigestion produces uric acid. If the acid level in the urine is high or too much acid is excreted, the uric acid may not dissolve and uric acid stones may form. Genetics may play a role in the development of uric acid stones, which are more common in men. Approximately 10% of patients with kidney stone disease develop this type of stone.

Struvite StonesThis type of stone, also called an infection stone, develops when a urinary tract infection (e.g., cystitis) affects the chemical balance of the urine. Bacteria in the urinary tract release chemicals that neutralize acid in the urine, which enables bacteria to grow more quickly and promotes struvite stone development.  Struvite stones are more common in women because they have urinary tract infections more often. The stones usually develop as jagged structures called "staghorns" and can grow to be quite large.

Cystine StonesCystine is an amino acid in protein that does not dissolve well. Some people inherit a rare, congenital (i.e., present at birth) condition that results in large amounts of cystine in the urine. This condition (called cystinuria) causes cystine stones that are difficult to treat and requires life-long therapy.