Questions for the Nurse Practitioner:

"What are kidney stones and how many types are there?"
There are four major types of kidney stones: calcium, struvite, uric acid and cystine.
Calcium kidney stones are the most common. About 80% to 90% of kidney stones are mainly calcium mixed with other minerals (typically oxalate or phosphate). Excess calcium is eliminated through the kidneys. This excess is usually flushed out in the urine. If the calcium is not flushed out, or if there is simply too much to dissolve, it can turn into crystals and join with other minerals to form a stone. Calcium stones often occur in people with high levels of vitamin D or overactive parathyroid glands. People with chronic kidney disease are more likely to get calcium kidney stones.
Struvite kidney stones typically form after a urinary tract infection. They are more common in women, who tend to have chronic urinary infections more often than men. Chronic urinary tract infections create enzymes that increase the amount of ammonia in the urine. This excess ammonia allows bacteria to grow more quickly helping to create the struvite stone. Struvite stones tend to be jagged or stag-horn shaped stones and can become rather large, which can cause damage to the kidneys.
Uric acid kidney stones are formed due to too much uric acid in the urine. When the acid level is high, crystals form and combine calcium and oxalate to make a kidney stone. This type of renal stone is more common in men. A diet high in animal protein can contribute to the amount of uric acid in the body. People with gout are at risk for uric acid stones.
Cystine kidney stones are rare compared to the other types of kidney stones because they are caused by an inherited disease. Cystine is an amino acid (building block of protein). Some people have a genetic condition called cystinuria that doesn’t let the kidneys reabsorb cystine into the blood. Cystine does not dissolve well in urine, so when left there it forms crystals that can grow into cystine stones. Most people with this condition are diagnosed at a young age and will be treated for this throughout their lifetime.

"Ouch! I think it's moving! What happens if it gets stuck?"
Most of the time, you should be able to pass the stone without intervention. If you are one of the unlucky ones, that can't pass it on their own:
Surgery may be needed to remove a kidney stone if it does not pass after a reasonable period of time and causes constant pain, is too large to pass on its own or is caught in a difficult place, blocks the flow of urine, causes an ongoing urinary tract infection, damages kidney tissue or causes constant bleeding, has grown larger, as seen on follow-up x rays.
Until 20 years ago, open surgery was necessary to remove a stone. The surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved, and many options do not require major open surgery and can be performed in an outpatient setting.
One such treatment may take a procedure such as Extracorporeal shock wave lithotripsy (ESWL). It is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Sometimes a procedure called percutaneous nephrolithotomy is recommended to remove a stone. This treatment is often used when the stone is quite large or in a location that does not allow effective use of ESWL. In this procedure, the surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe may be needed to break the stone into small pieces. Often, patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.

"I already had a stone and it was horrible! How can I prevent them from coming back?

Drinking about 2 to 3 quarts of water a day is usually recommended for someone with a history of kidney stones (unless on a fluid-restricted diet). Also, if you form calcium stones, your health care provider may recommend reducing your intake of oxalate-rich foods such as nuts and nut butters, rhubarb, beets and beet greens, spinach, tea, chocolate, strawberries and black raspberries. Diets lower in protein may help to reduce the chances of developing some types of kidney stones.

Your health care provider may prescribe medicines that help control the amounts of certain kidney stone-causing minerals from developing in the urine.