Kidney Stones (Renal Lithiasis): Causes, Symptoms, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Kidney stones form in the urinary tract and can cause intense pain. Types of stones, causes, treatment, and prevention of recurrence in Quebec.\">\n<meta name=\"keywords\" content=\"calculs r\u00e9naux, lithiase r\u00e9nale, pierre aux reins, calcul r\u00e9nal sympt\u00f4mes, calcul r\u00e9nal traitement, calcul oxalate calcium, calcul acide urique, lithiase urinaire, r\u00e9cidive calcul r\u00e9nal, calculs r\u00e9naux Qu\u00e9bec\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap');\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; margin-top: 10px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; 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Urinary lithiasis is a very common pathology: it affects around 10 to 15 % of the Canadian population over the course of a lifetime, with prevalence rising steadily since the 1970s, in connection with the Western diet (hypercaloric, rich in animal proteins and salt), sedentary lifestyle, obesity and climate change (dehydration linked to rising temperatures). The recurrence rate is high - 50 % at 5 years and 75 % at 20 years without prevention - making urinary lithiasis a chronic disease requiring long-term metabolic and preventive management after a first episode. Urinary calculi differ from gallstones (vesicular lithiasis) in their location, composition and management - although the two conditions are often confused in common parlance. The majority of kidney stones remain silent as long as they remain in the renal cavities - they only become symptomatic when they migrate into the ureter and cause obstruction, manifesting as renal colic. Management is based on three complementary principles: treatment of the acute phase (analgesia, encouraging spontaneous expulsion), urological management of stones requiring intervention, and prevention of recurrence through targeted nutritional and medicinal measures depending on the composition of the stone.\n <\/div>\n\n <h2>Types of calculations and composition<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:200px;\">\n <col style=\"width:90px;\">\n <col style=\"width:100px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Type of calculation<\/th>\n <th style=\"text-align:center;\">Frequency<\/th>\n <th style=\"text-align:center;\">Radiopacity<\/th>\n <th>Risk factors and context<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Calcium oxalate monohydrate (whewellite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">35\u201340 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Idiopathic hypercalciuria, hyperoxaluria (dietary or primary), hypocitraturia, chronic dehydration; very hard stones\u2014resistant to extracorporeal shockwave lithotripsy (ESWL).<\/td>\n <\/tr>\n <tr>\n <td>Calcium oxalate dihydrate (weddellite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">35\u201345 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Hypercalciuria; more friable than whewellite \u2014 better response to ECR; often associated with a diet rich in oxalates (spinach, rhubarb, nuts, chocolate)<\/td>\n <\/tr>\n <tr>\n <td>Uric acid<\/td>\n <td style=\"text-align:center; font-weight:600;\">5-10 %<\/td>\n <td style=\"text-align:center;\">Radiotransparent<\/td>\n <td>Chronic acidic urine (pH < 5.5), hyperuricemia (gout, metabolic syndrome, type 2 diabetes), chemotherapy (lysis syndrome), diet rich in purines; the only type of stone that can be dissolved by urine alkalization (medical treatment)<\/td>\n <\/tr>\n <tr>\n <td>Calcium phosphate (apatite, brushite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">5-8 %<\/td>\n <td style=\"text-align:center;\">Very radiopaque<\/td>\n <td>Distal renal tubular acidosis (urinary pH constantly > 6.0), primary hyperparathyroidism, hypercalciuria with alkaline urine; brushite - very hard, resistant to ESWL<\/td>\n <\/tr>\n <tr>\n <td>Struvite (magnesium ammonium phosphate)<\/td>\n <td style=\"text-align:center; font-weight:600;\">2\u20135 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Recurrent urinary tract infections with urease-positive bacteria<em>Proteus mirabilis<\/em>, <em>Klebsiella<\/em>, <em>Pseudomonas<\/em>; coraliform calculations mold renal cavities; almost exclusively in women; risk of renal destruction if untreated<\/td>\n <\/tr>\n <tr>\n <td>Cystine<\/td>\n <td style=\"text-align:center; font-weight:600;\">1\u20132 %<\/td>\n <td style=\"text-align:center;\">Slightly radiopaque<\/td>\n <td>Hereditary cystinuria (autosomal recessive) - defect in tubular reabsorption of cystine, ornithine, lysine, arginine (COLA); first stone often before 20 years of age; multiple recurrences throughout life; yellowish stones with \u00abfrosted glass\u00bb appearance on CT scan<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>General risk factors<\/h2>\n <ul class=\"co-list\">\n <li>Chronic dehydration: a universal risk factor \u2014 insufficient diuresis (<1.5 L\/day) concentrates all lithogenic solutes; exposed occupations (hot environment workers, firefighters, cooks), residence in hot regions, intensive sports practice without sufficient hydration compensation; urine should be clear to pale yellow \u2014 dark urine indicates insufficient hydration<\/li>\n <li>High intake of animal proteins: red meat, charcuterie, seafood \u2014 increases the urinary acid load (lower pH \u2192 uric acid precipitation), urinary calcium and oxalate excretion, and reduces calciuria (natural inhibitor of crystallization); hypercaloric Western diet \u2014 major explanatory factor for the increasing prevalence.<\/li>\n <li>High salt (sodium) diet: Idiopathic hypercalciuria is largely sodium-dependent \u2014 renal sodium excretion is accompanied by a parallel urinary calcium leak; 2 g\/day sodium reduction \u2192 50 to 100 mg\/day calciuria reduction<\/li>\n <li>Oxalate-rich diet: spinach, rhubarb, beet, walnuts, almonds, dark chocolate, black tea, wheat bran - foods with very high oxalate content; limit but do not eliminate (dietary calcium taken at the same time as the meal chelates oxalate in the intestine, reducing its absorption).<\/li>\n <li>Low calcium intake (paradox): Contrary to intuition, a diet low in calcium increases the risk of calcium oxalate stones \u2014 in the absence of dietary calcium in the intestine, oxalate is absorbed in greater quantities by the intestinal lining \u2192 hyperoxaluria \u2192 precipitation in the urine; recommendation: normal dietary calcium (1,000\u20131,200 mg\/day); calcium supplements taken between meals increase the risk (no intestinal chelation).<\/li>\n <li>Obesity and metabolic syndrome: hyperinsulinism \u2192 urine acidification (pH < 5.5) \u2192 risk of uric acid stones; hypercalciuria associated with obesity; insulin resistance \u2192 reduced calciuria; management of metabolic syndrome directly reduces stone risk<\/li>\n <li>Predisposing pathologies: primary hyperparathyroidism (hypercalcemia \u2192 hypercalciuria); gout (hyperuricemia \u2192 uric acid stones); Crohn's disease and ileal resections (intestinal hyperabsorption of oxalate - enterogenic oxaluria); bariatric surgery (gastric bypass - post-bypass hyperoxaluria due to fat malabsorption); horseshoe kidney (anatomical anomaly \u2192 urinary stasis); medullary sponge kidney (ectatic collecting tubules); type 1 renal tubular acidosis<\/li>\n <li>Genetic factors: first-degree family history \u2192 risk multiplied by 2 to 3; hereditary cystinuria; primary hyperoxaluria type 1 (hepatic alanine-glyoxylate aminotransferase - AGXT - deficiency); xanthinuria<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Kidney stones are distinct from gallstones (gallbladder or bile duct stones): they form in different organs, have different compositions, and are treated differently. A kidney stone typically causes flank pain that radiates to the groin (renal colic) accompanied by hematuria, whereas a gallstone causes pain in the right hypochondrium (right side under the ribs) that radiates to the right shoulder after a fatty meal, without hematuria.<\/span>\n <\/div>\n\n <h2>Symptoms<\/h2>\n <ul class=\"co-list\">\n <li>Silent intrarenal stones: The vast majority of stones in the renal cavities (calyces or renal pelvis) remain asymptomatic for months to years and are discovered incidentally during an abdominal ultrasound or CT scan performed for another indication; their size can gradually increase without symptoms until they migrate into the ureter.<\/li>\n <li>Renal colic (ureteral stone): acute unilateral lumbar pain of maximal intensity radiating along the ureteral path towards the iliac fossa, groin, and external genitalia; paroxysmal, with no relieving posture (the patient is agitated, writhing in pain\u2014unlike peritoneal pain where the patient is immobile); nausea and reflex vomiting in 50\u201360 % of cases; microscopic or macroscopic hematuria in 85 % of cases<\/li>\n <li>Isolated hematuria: incidental finding of microscopic hematuria (on dipstick or urinalysis) without associated symptoms \u2014 may reveal a silent intrarenal stone or a small, minimally obstructive ureteral stone; always investigate hematuria, even isolated, to rule out a urological tumor<\/li>\n <li>Recurrent urinary tract infection on struvite stone: recurring urinary tract infections <em>Proteus mirabilis<\/em> or other urease-positive germs, sometimes with recurrent pyelonephritis; struvite stones serve as a bacterial reservoir\u2014the infection promotes stone growth, and the stone promotes infection<\/li>\n <li>Silent chronic kidney disease: recurrent bilateral stones (cystinuria, primary hyperoxaluria), staghorn calculi progressively obstructing the renal cavities, or unrecognized chronic hydronephrosis can lead to insidious CKD discovered late.<\/li>\n <\/ul>\n\n <h2>Diagnostic and metabolic assessment<\/h2>\n <ul class=\"co-list\">\n <li>Abdomino-pelvic scanner without injection (uro-CT): reference examination for diagnosis\u2014sensitivity 96\u201399 %, specificity 95\u201399 %; localizes the stone, measures its size (mm), assesses its density in Hounsfield units (HU\u2014predictive of composition and friability), and quantifies the degree of obstruction (hydronephrosis, ureteronephrosis); uric acid stones are radiolucent on KUB but visible on CT (density 200\u2013500 HU); cystine stones have intermediate density (400\u2013600 HU)<\/li>\n <li>Urinary tract ultrasound: first-line in pregnant women (avoiding radiation) and children; lower sensitivity than CT for small ureteral stones (45\u201370 %) but excellent for detecting hydronephrosis; useful for monitoring known kidney stones without acute colic<\/li>\n <li>Analysis of expelled or extracted stones (IRTF): essential for guiding relapse prevention \u2014 asking the patient to filter their urine (coffee filter, gauze) to retrieve the stone; Fourier Transform Infrared Spectrometry (FTIR) \u2014 reference method; X-ray crystallography<\/li>\n <li>Urinary and blood metabolic panel (after first episode or early recurrence): 24-hour urine - calciuria (normal < 6.25 mmol\/day H, < 5 mmol\/day F), oxaluria (normal 1.7 mmol\/day - crystallization inhibitor), uricuria, phosphaturia, creatininuria, urinary sodium, urinary volume (target > 2 L\/day); urinary pH on 3 morning fasting samples (pH 6.5 \u2192 struvite or ATR type 1); blood: creatinine and GFR, calcemia, phosphatemia, uricemia, intact parathyroid hormone (PTH) (hyperparathyroidism), 25-OH vitamin D, bicarbonates; urinary amino acid electrophoresis if cystinuria suspected (sodium nitroprusside test - positive if cystinuria)<\/li>\n <\/ul>\n\n <h2>Treatment and prevention of recurrence by stone type<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:170px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Type of calculation<\/th>\n <th>Preventive measures and specific treatments<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Calcium oxalate (any type)<\/td>\n <td>Hydration: diuresis > 2.0\u20132.5 L\/day (universal goal \u2014 most effective measure for all stones combined); normal dietary calcium 1,000\u20131,200 mg\/day with meals (chelates intestinal oxalate); reduce extreme dietary oxalates; reduce animal protein (< 1 g\/kg\/day); reduce salt (< 5 g NaCl\/day); if persistent hypercalciuria despite measures: hydrochlorothiazide 25 mg\/day or chlorthalidone 25 mg\/day (reduce calciuria by 40\u201350 %); if hypocitraturia: potassium citrate 20\u201340 mEq\/day (alkalinizes urine, inhibits calcium crystallization)<\/td>\n <\/tr>\n <tr>\n <td>Uric acid<\/td>\n <td>Urine alkalization \u2014 target urinary pH 6.0\u20136.5: potassium citrate 20\u201360 mEq\/day in 3 doses or sodium bicarbonate 3\u20136 g\/day; uric acid stones can dissolve completely with medical alkalization (chemolysis \u2014 the only type of medically dissolvable stone); reduction of dietary purines (red meat, offal, beer); allopurinol 300 mg\/day if persistent hyperuricemia (> 480 \u00b5mol\/L); treatment of metabolic syndrome<\/td>\n <\/tr>\n <tr>\n <td>Calcium phosphate (apatite)<\/td>\n <td>Abundant hydration; treatment of renal tubular acidosis type 1 (potassium citrate \u2014 alkalizes urine and provides citrate); surgery if primary hyperparathyroidism (parathyroidectomy \u2014 lithiasis cured in 90 % of cases); reduce salt and animal protein<\/td>\n <\/tr>\n <tr>\n <td>Struvite<\/td>\n <td>Prolonged antibiotic treatment targeting urease-positive bacteria (guided urine culture); complete surgical removal of all fragments (PNL + ureteroscopy) \u2014 essential as residual fragments are a permanent infectious focus maintaining stone growth; acetohydroxamic acid (inhibitor of bacterial urease) \u2014 effective but poorly tolerated (nausea, headaches, thrombosis); urine acidification (ascorbic acid) \u2014 poorly effective and not recommended for routine use<\/td>\n <\/tr>\n <tr>\n <td>Cystine<\/td>\n <td>Very intensive hydration: diuresis of > 3 L\/day mandatory (to dilute cystine below its solubility); intense urinary alkalinization: potassium citrate for a target pH > 7.5 (cystine solubility increases exponentially at pH > 7.0); D-penicillamine (cystine chelator \u2014 very effective but significant toxicity: nephrotoxicity, thrombocytopenia, induced lupus); tiopronin (Thiola \u2014 \u03b1-MPG) \u2014 less toxic than D-penicillamine, preferred as a first-line chelator; captopril (ACE inhibitor \u2014 forms soluble cystine-captopril complexes) \u2014 limited data<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Urologic interventions<\/h2>\n <ul class=\"co-list\">\n <li>Expulsion spontan\u00e9e et traitement m\u00e9dical expulsif : calculs \u2264 5 mm \u2014 taux d'expulsion spontan\u00e9e 60\u201380 % en 4 semaines ; calculs 5\u201310 mm \u2014 40\u201360 % avec traitement m\u00e9dical expulsif ; tamsulosine (Flomax) 0,4 mg\/jour \u2014 alpha-1 bloquant relaxant la musculature lisse ur\u00e9t\u00e9rale distale ; calculs > 10 mm \u2014 expulsion spontan\u00e9e < 10 % \u2014 intervention urologique quasi syst\u00e9matique<\/li>\n <li>Extracorporeal shock wave lithotripsy (ESWL): kidney or proximal ureteral stones \u2264 20 mm; CT density < 900 HU (very dense stones\u2014whewellite, brushite, cystine\u2014are resistant); no complete obstruction; contraindications: pregnancy, bleeding disorders, pacemaker, aortic aneurysm, stone on a single kidney without an available urologist<\/li>\n <li>Flexible ureteroscopy (FURS) with holmium laser: ureteral stones of any size; renal stones \u2264 15\u201320 mm; treatment of choice for radiolucent uric acid stones (well fragmented by laser); treatment of choice if ESWL is contraindicated<\/li>\n <li>Percutaneous Nephrolithotomy (PCNL): kidney stones > 20 mm; staghorn (struvite) stones; failure of ESWL or URS; lower pole stones > 15 mm difficult to drain by PCNL; mini-PCNL (Mini-PCNL) technique reducing bleeding<\/li>\n <li>Double-J stent (ureteral stent): Emergency internal drainage for febrile nephritic colic (infected obstruction - pyonephrosis) or obstruction of a single kidney; can be left in place for 4 to 6 weeks during planned lithotripsy<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Feverish calculation - absolute emergency: dial 911<\/div>\n <p>Dial <strong>911<\/strong> Go immediately to the emergency room if severe lower back pain is accompanied by fever (> 38.5\u00b0C) and chills\u2014this indicates an infected urinary obstruction (pyonephrosis) requiring urgent urinary drainage (Double-J stent or percutaneous nephrostomy) and IV antibiotics. Without rapid drainage, the risk of septic shock and irreversible kidney destruction is significant. Also, go to the emergency room if the pain is refractory to usual painkillers, or if you have a single kidney, a kidney transplant, or are currently pregnant.<\/p>\n <p>For metabolic assessment, relapse prevention, and interpretation of imaging or stone analysis results, Clinique Omicron physicians will guide you and coordinate your urological care. Consultations are available at our service points in Quebec as well as through telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron manages uncomplicated urinary stones, prescribes urinary CT scans and complete metabolic stone workups (24-hour urine collection, hormonal profile, stone analysis), initiates expulsion treatment and recurrence prevention measures tailored to the stone type, and refers to partner urologists for stones requiring intervention. Consultations are available at our service points in Quebec as well as through telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not substitute for the advice of a qualified healthcare professional. Any febrile kidney stone is a urological emergency requiring immediate hospitalization.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Calculs r\u00e9naux (lithiase r\u00e9nale) : causes, sympt\u00f4mes et traitement | Clinique Omicron Urologie & N\u00e9phrologie Calculs r\u00e9naux \u2014 Lithiase r\u00e9nale Les calculs r\u00e9naux \u2014 aussi appel\u00e9s lithiases urinaires ou \u00ab pierres aux reins \u00bb dans le langage courant \u2014 sont des concr\u00e9tions solides qui se forment dans les voies urinaires hautes (calices, bassinet r\u00e9nal) par… <a href=\"https:\/\/cliniqueomicron.ca\/en\/calculs-renaux\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Kidney Stones (Renal Lithiasis): Causes, Symptoms, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Calculs r\u00e9naux (lithiase r\u00e9nale) | Omicron","_metasync_otto_description":"Les calculs r\u00e9naux (pierres aux reins) se forment dans les voies urinaires et peuvent causer une douleur intense. 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margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Urology & Nephrology<\/span>\n <h1>Kidney stones - Renal lithiasis<\/h1>\n<style>.oc-fiche-cta{margin:8px 0 34px;padding:22px 24px;border:1.5px solid rgba(50,60,82,.15);border-left:4px solid #FF611C;border-radius:12px;background:#F4F6F8;font-family:Poppins,sans-serif}.oc-fiche-cta-t{font-size:18px;font-weight:600;color:#323C52;margin:0 0 4px;line-height:1.35}.oc-fiche-cta-x{font-size:15px;color:#4D6577;margin:0 0 14px;line-height:1.55}.oc-fiche-cta-b{display:flex;flex-wrap:wrap;gap:10px}.oc-fiche-cta-b a{display:inline-flex;align-items:center;justify-content:center;min-height:44px;padding:10px 18px;border-radius:8px;font-size:14px;font-weight:600;text-decoration:none;box-sizing:border-box}.oc-fiche-cta-b .oc-p{background:#FF611C;color:#fff}.oc-fiche-cta-b .oc-p:hover{background:#E04E0C}.oc-fiche-cta-b .oc-s{background:#fff;color:#323C52;border:1.5px solid rgba(50,60,82,.25)}@media (max-width:600px){.co-wrap h1{font-size:24px;line-height:1.25;text-transform:none}.oc-fiche-cta{padding:18px 16px}.oc-fiche-cta-b a{flex:1 1 100%}body .co-wrap > .co-table,body .co-wrap > .co-table tbody,body .co-wrap > .co-table tr,body .co-wrap > .co-table td{display:block;width:100%;box-sizing:border-box}body .co-wrap > .co-table{min-width:0;table-layout:auto}body .co-wrap > .co-table thead{display:none}body .co-wrap > .co-table tr{margin:0 0 10px;border:1px solid rgba(77,101,119,.18);border-radius:8px;overflow:hidden}body .co-wrap > .co-table td{padding:9px 12px;border:0}body .co-wrap > .co-table td:first-child{font-weight:600;color:#323C52;background:rgba(77,101,119,.07)}#ocw{transform:scale(.8);transform-origin:bottom right}}<\/style><div class=\"oc-fiche-cta\" data-oc-cta=\"fiche-haut-consult\"><p class=\"oc-fiche-cta-t\">Obtenir un avis adapt\u00e9 \u00e0 votre situation<\/p><p class=\"oc-fiche-cta-x\">Consultation en clinique ou en t\u00e9l\u00e9consultation, partout au Qu\u00e9bec.<\/p><div class=\"oc-fiche-cta-b\"><a class=\"oc-p\" href=\"https:\/\/cliniqueomicron.ca\/rendez-vous\/\">Make an appointment<\/a><a class=\"oc-s\" href=\"https:\/\/cliniqueomicron.ca\/consultation-en-ligne\/\">Consult online<\/a><a class=\"oc-s\" href=\"tel:+15146063350\">514 606-3350<\/a><\/div><\/div>\n\n\n <div class=\"co-intro\">\n Kidney stones - also known as urinary lithiasis or \u00abkidney stones\u00bb in everyday language - are solid concretions formed in the upper urinary tract (calyces, renal pelvis) by the precipitation and crystallization of mineral or organic substances normally dissolved in urine. Urinary lithiasis is a very common pathology: it affects around 10 to 15 % of the Canadian population over the course of a lifetime, with prevalence rising steadily since the 1970s, in connection with the Western diet (hypercaloric, rich in animal proteins and salt), sedentary lifestyle, obesity and climate change (dehydration linked to rising temperatures). The recurrence rate is high - 50 % at 5 years and 75 % at 20 years without prevention - making urinary lithiasis a chronic disease requiring long-term metabolic and preventive management after a first episode. Urinary calculi differ from gallstones (vesicular lithiasis) in their location, composition and management - although the two conditions are often confused in common parlance. The majority of kidney stones remain silent as long as they remain in the renal cavities - they only become symptomatic when they migrate into the ureter and cause obstruction, manifesting as renal colic. Management is based on three complementary principles: treatment of the acute phase (analgesia, encouraging spontaneous expulsion), urological management of stones requiring intervention, and prevention of recurrence through targeted nutritional and medicinal measures depending on the composition of the stone.\n <\/div>\n\n <h2>Types of calculations and composition<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:200px;\">\n <col style=\"width:90px;\">\n <col style=\"width:100px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Type of calculation<\/th>\n <th style=\"text-align:center;\">Frequency<\/th>\n <th style=\"text-align:center;\">Radiopacity<\/th>\n <th>Risk factors and context<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Calcium oxalate monohydrate (whewellite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">35\u201340 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Idiopathic hypercalciuria, hyperoxaluria (dietary or primary), hypocitraturia, chronic dehydration; very hard stones\u2014resistant to extracorporeal shockwave lithotripsy (ESWL).<\/td>\n <\/tr>\n <tr>\n <td>Calcium oxalate dihydrate (weddellite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">35\u201345 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Hypercalciuria; more friable than whewellite \u2014 better response to ECR; often associated with a diet rich in oxalates (spinach, rhubarb, nuts, chocolate)<\/td>\n <\/tr>\n <tr>\n <td>Uric acid<\/td>\n <td style=\"text-align:center; font-weight:600;\">5-10 %<\/td>\n <td style=\"text-align:center;\">Radiotransparent<\/td>\n <td>Chronic acidic urine (pH < 5.5), hyperuricemia (gout, metabolic syndrome, type 2 diabetes), chemotherapy (lysis syndrome), diet rich in purines; the only type of stone that can be dissolved by urine alkalization (medical treatment)<\/td>\n <\/tr>\n <tr>\n <td>Calcium phosphate (apatite, brushite)<\/td>\n <td style=\"text-align:center; font-weight:600;\">5-8 %<\/td>\n <td style=\"text-align:center;\">Very radiopaque<\/td>\n <td>Distal renal tubular acidosis (urinary pH constantly > 6.0), primary hyperparathyroidism, hypercalciuria with alkaline urine; brushite - very hard, resistant to ESWL<\/td>\n <\/tr>\n <tr>\n <td>Struvite (magnesium ammonium phosphate)<\/td>\n <td style=\"text-align:center; font-weight:600;\">2\u20135 %<\/td>\n <td style=\"text-align:center;\">Radiopaque<\/td>\n <td>Recurrent urinary tract infections with urease-positive bacteria<em>Proteus mirabilis<\/em>, <em>Klebsiella<\/em>, <em>Pseudomonas<\/em>; coraliform calculations mold renal cavities; almost exclusively in women; risk of renal destruction if untreated<\/td>\n <\/tr>\n <tr>\n <td>Cystine<\/td>\n <td style=\"text-align:center; font-weight:600;\">1\u20132 %<\/td>\n <td style=\"text-align:center;\">Slightly radiopaque<\/td>\n <td>Hereditary cystinuria (autosomal recessive) - defect in tubular reabsorption of cystine, ornithine, lysine, arginine (COLA); first stone often before 20 years of age; multiple recurrences throughout life; yellowish stones with \u00abfrosted glass\u00bb appearance on CT scan<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>General risk factors<\/h2>\n <ul class=\"co-list\">\n <li>Chronic dehydration: a universal risk factor \u2014 insufficient diuresis (<1.5 L\/day) concentrates all lithogenic solutes; exposed occupations (hot environment workers, firefighters, cooks), residence in hot regions, intensive sports practice without sufficient hydration compensation; urine should be clear to pale yellow \u2014 dark urine indicates insufficient hydration<\/li>\n <li>High intake of animal proteins: red meat, charcuterie, seafood \u2014 increases the urinary acid load (lower pH \u2192 uric acid precipitation), urinary calcium and oxalate excretion, and reduces calciuria (natural inhibitor of crystallization); hypercaloric Western diet \u2014 major explanatory factor for the increasing prevalence.<\/li>\n <li>High salt (sodium) diet: Idiopathic hypercalciuria is largely sodium-dependent \u2014 renal sodium excretion is accompanied by a parallel urinary calcium leak; 2 g\/day sodium reduction \u2192 50 to 100 mg\/day calciuria reduction<\/li>\n <li>Oxalate-rich diet: spinach, rhubarb, beet, walnuts, almonds, dark chocolate, black tea, wheat bran - foods with very high oxalate content; limit but do not eliminate (dietary calcium taken at the same time as the meal chelates oxalate in the intestine, reducing its absorption).<\/li>\n <li>Low calcium intake (paradox): Contrary to intuition, a diet low in calcium increases the risk of calcium oxalate stones \u2014 in the absence of dietary calcium in the intestine, oxalate is absorbed in greater quantities by the intestinal lining \u2192 hyperoxaluria \u2192 precipitation in the urine; recommendation: normal dietary calcium (1,000\u20131,200 mg\/day); calcium supplements taken between meals increase the risk (no intestinal chelation).<\/li>\n <li>Obesity and metabolic syndrome: hyperinsulinism \u2192 urine acidification (pH < 5.5) \u2192 risk of uric acid stones; hypercalciuria associated with obesity; insulin resistance \u2192 reduced calciuria; management of metabolic syndrome directly reduces stone risk<\/li>\n <li>Predisposing pathologies: primary hyperparathyroidism (hypercalcemia \u2192 hypercalciuria); gout (hyperuricemia \u2192 uric acid stones); Crohn's disease and ileal resections (intestinal hyperabsorption of oxalate - enterogenic oxaluria); bariatric surgery (gastric bypass - post-bypass hyperoxaluria due to fat malabsorption); horseshoe kidney (anatomical anomaly \u2192 urinary stasis); medullary sponge kidney (ectatic collecting tubules); type 1 renal tubular acidosis<\/li>\n <li>Genetic factors: first-degree family history \u2192 risk multiplied by 2 to 3; hereditary cystinuria; primary hyperoxaluria type 1 (hepatic alanine-glyoxylate aminotransferase - AGXT - deficiency); xanthinuria<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Kidney stones are distinct from gallstones (gallbladder or bile duct stones): they form in different organs, have different compositions, and are treated differently. A kidney stone typically causes flank pain that radiates to the groin (renal colic) accompanied by hematuria, whereas a gallstone causes pain in the right hypochondrium (right side under the ribs) that radiates to the right shoulder after a fatty meal, without hematuria.<\/span>\n <\/div>\n\n <h2>Symptoms<\/h2>\n <ul class=\"co-list\">\n <li>Silent intrarenal stones: The vast majority of stones in the renal cavities (calyces or renal pelvis) remain asymptomatic for months to years and are discovered incidentally during an abdominal ultrasound or CT scan performed for another indication; their size can gradually increase without symptoms until they migrate into the ureter.<\/li>\n <li>Renal colic (ureteral stone): acute unilateral lumbar pain of maximal intensity radiating along the ureteral path towards the iliac fossa, groin, and external genitalia; paroxysmal, with no relieving posture (the patient is agitated, writhing in pain\u2014unlike peritoneal pain where the patient is immobile); nausea and reflex vomiting in 50\u201360 % of cases; microscopic or macroscopic hematuria in 85 % of cases<\/li>\n <li>Isolated hematuria: incidental finding of microscopic hematuria (on dipstick or urinalysis) without associated symptoms \u2014 may reveal a silent intrarenal stone or a small, minimally obstructive ureteral stone; always investigate hematuria, even isolated, to rule out a urological tumor<\/li>\n <li>Recurrent urinary tract infection on struvite stone: recurring urinary tract infections <em>Proteus mirabilis<\/em> or other urease-positive germs, sometimes with recurrent pyelonephritis; struvite stones serve as a bacterial reservoir\u2014the infection promotes stone growth, and the stone promotes infection<\/li>\n <li>Silent chronic kidney disease: recurrent bilateral stones (cystinuria, primary hyperoxaluria), staghorn calculi progressively obstructing the renal cavities, or unrecognized chronic hydronephrosis can lead to insidious CKD discovered late.<\/li>\n <\/ul>\n\n <h2>Diagnostic and metabolic assessment<\/h2>\n <ul class=\"co-list\">\n <li>Abdomino-pelvic scanner without injection (uro-CT): reference examination for diagnosis\u2014sensitivity 96\u201399 %, specificity 95\u201399 %; localizes the stone, measures its size (mm), assesses its density in Hounsfield units (HU\u2014predictive of composition and friability), and quantifies the degree of obstruction (hydronephrosis, ureteronephrosis); uric acid stones are radiolucent on KUB but visible on CT (density 200\u2013500 HU); cystine stones have intermediate density (400\u2013600 HU)<\/li>\n <li>Urinary tract ultrasound: first-line in pregnant women (avoiding radiation) and children; lower sensitivity than CT for small ureteral stones (45\u201370 %) but excellent for detecting hydronephrosis; useful for monitoring known kidney stones without acute colic<\/li>\n <li>Analysis of expelled or extracted stones (IRTF): essential for guiding relapse prevention \u2014 asking the patient to filter their urine (coffee filter, gauze) to retrieve the stone; Fourier Transform Infrared Spectrometry (FTIR) \u2014 reference method; X-ray crystallography<\/li>\n <li>Urinary and blood metabolic panel (after first episode or early recurrence): 24-hour urine - calciuria (normal < 6.25 mmol\/day H, < 5 mmol\/day F), oxaluria (normal 1.7 mmol\/day - crystallization inhibitor), uricuria, phosphaturia, creatininuria, urinary sodium, urinary volume (target > 2 L\/day); urinary pH on 3 morning fasting samples (pH 6.5 \u2192 struvite or ATR type 1); blood: creatinine and GFR, calcemia, phosphatemia, uricemia, intact parathyroid hormone (PTH) (hyperparathyroidism), 25-OH vitamin D, bicarbonates; urinary amino acid electrophoresis if cystinuria suspected (sodium nitroprusside test - positive if cystinuria)<\/li>\n <\/ul>\n\n <h2>Treatment and prevention of recurrence by stone type<\/h2>\n <table class=\"co-table\">\n <colgroup>\n <col style=\"width:170px;\">\n <col>\n <\/colgroup>\n <thead>\n <tr>\n <th>Type of calculation<\/th>\n <th>Preventive measures and specific treatments<\/th>\n <\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Calcium oxalate (any type)<\/td>\n <td>Hydration: diuresis > 2.0\u20132.5 L\/day (universal goal \u2014 most effective measure for all stones combined); normal dietary calcium 1,000\u20131,200 mg\/day with meals (chelates intestinal oxalate); reduce extreme dietary oxalates; reduce animal protein (< 1 g\/kg\/day); reduce salt (< 5 g NaCl\/day); if persistent hypercalciuria despite measures: hydrochlorothiazide 25 mg\/day or chlorthalidone 25 mg\/day (reduce calciuria by 40\u201350 %); if hypocitraturia: potassium citrate 20\u201340 mEq\/day (alkalinizes urine, inhibits calcium crystallization)<\/td>\n <\/tr>\n <tr>\n <td>Uric acid<\/td>\n <td>Urine alkalization \u2014 target urinary pH 6.0\u20136.5: potassium citrate 20\u201360 mEq\/day in 3 doses or sodium bicarbonate 3\u20136 g\/day; uric acid stones can dissolve completely with medical alkalization (chemolysis \u2014 the only type of medically dissolvable stone); reduction of dietary purines (red meat, offal, beer); allopurinol 300 mg\/day if persistent hyperuricemia (> 480 \u00b5mol\/L); treatment of metabolic syndrome<\/td>\n <\/tr>\n <tr>\n <td>Calcium phosphate (apatite)<\/td>\n <td>Abundant hydration; treatment of renal tubular acidosis type 1 (potassium citrate \u2014 alkalizes urine and provides citrate); surgery if primary hyperparathyroidism (parathyroidectomy \u2014 lithiasis cured in 90 % of cases); reduce salt and animal protein<\/td>\n <\/tr>\n <tr>\n <td>Struvite<\/td>\n <td>Prolonged antibiotic treatment targeting urease-positive bacteria (guided urine culture); complete surgical removal of all fragments (PNL + ureteroscopy) \u2014 essential as residual fragments are a permanent infectious focus maintaining stone growth; acetohydroxamic acid (inhibitor of bacterial urease) \u2014 effective but poorly tolerated (nausea, headaches, thrombosis); urine acidification (ascorbic acid) \u2014 poorly effective and not recommended for routine use<\/td>\n <\/tr>\n <tr>\n <td>Cystine<\/td>\n <td>Very intensive hydration: diuresis of > 3 L\/day mandatory (to dilute cystine below its solubility); intense urinary alkalinization: potassium citrate for a target pH > 7.5 (cystine solubility increases exponentially at pH > 7.0); D-penicillamine (cystine chelator \u2014 very effective but significant toxicity: nephrotoxicity, thrombocytopenia, induced lupus); tiopronin (Thiola \u2014 \u03b1-MPG) \u2014 less toxic than D-penicillamine, preferred as a first-line chelator; captopril (ACE inhibitor \u2014 forms soluble cystine-captopril complexes) \u2014 limited data<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Urologic interventions<\/h2>\n <ul class=\"co-list\">\n <li>Expulsion spontan\u00e9e et traitement m\u00e9dical expulsif : calculs \u2264 5 mm \u2014 taux d'expulsion spontan\u00e9e 60\u201380 % en 4 semaines ; calculs 5\u201310 mm \u2014 40\u201360 % avec traitement m\u00e9dical expulsif ; tamsulosine (Flomax) 0,4 mg\/jour \u2014 alpha-1 bloquant relaxant la musculature lisse ur\u00e9t\u00e9rale distale ; calculs > 10 mm \u2014 expulsion spontan\u00e9e < 10 % \u2014 intervention urologique quasi syst\u00e9matique<\/li>\n <li>Extracorporeal shock wave lithotripsy (ESWL): kidney or proximal ureteral stones \u2264 20 mm; CT density < 900 HU (very dense stones\u2014whewellite, brushite, cystine\u2014are resistant); no complete obstruction; contraindications: pregnancy, bleeding disorders, pacemaker, aortic aneurysm, stone on a single kidney without an available urologist<\/li>\n <li>Flexible ureteroscopy (FURS) with holmium laser: ureteral stones of any size; renal stones \u2264 15\u201320 mm; treatment of choice for radiolucent uric acid stones (well fragmented by laser); treatment of choice if ESWL is contraindicated<\/li>\n <li>Percutaneous Nephrolithotomy (PCNL): kidney stones > 20 mm; staghorn (struvite) stones; failure of ESWL or URS; lower pole stones > 15 mm difficult to drain by PCNL; mini-PCNL (Mini-PCNL) technique reducing bleeding<\/li>\n <li>Double-J stent (ureteral stent): Emergency internal drainage for febrile nephritic colic (infected obstruction - pyonephrosis) or obstruction of a single kidney; can be left in place for 4 to 6 weeks during planned lithotripsy<\/li>\n <\/ul>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Feverish calculation - absolute emergency: dial 911<\/div>\n <p>Dial <strong>911<\/strong> Go immediately to the emergency room if severe lower back pain is accompanied by fever (> 38.5\u00b0C) and chills\u2014this indicates an infected urinary obstruction (pyonephrosis) requiring urgent urinary drainage (Double-J stent or percutaneous nephrostomy) and IV antibiotics. Without rapid drainage, the risk of septic shock and irreversible kidney destruction is significant. Also, go to the emergency room if the pain is refractory to usual painkillers, or if you have a single kidney, a kidney transplant, or are currently pregnant.<\/p>\n <p>For metabolic assessment, relapse prevention, and interpretation of imaging or stone analysis results, Clinique Omicron physicians will guide you and coordinate your urological care. Consultations are available at our service points in Quebec as well as through telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron manages uncomplicated urinary stones, prescribes urinary CT scans and complete metabolic stone workups (24-hour urine collection, hormonal profile, stone analysis), initiates expulsion treatment and recurrence prevention measures tailored to the stone type, and refers to partner urologists for stones requiring intervention. Consultations are available at our service points in Quebec as well as through telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is for informational purposes only and does not substitute for the advice of a qualified healthcare professional. Any febrile kidney stone is a urological emergency requiring immediate hospitalization.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Calculs r\u00e9naux (lithiase r\u00e9nale) : causes, sympt\u00f4mes et traitement | Clinique Omicron Urologie & N\u00e9phrologie Calculs r\u00e9naux \u2014 Lithiase r\u00e9nale Les calculs r\u00e9naux \u2014 aussi appel\u00e9s lithiases urinaires ou \u00ab pierres aux reins \u00bb dans le langage courant \u2014 sont des concr\u00e9tions solides qui se forment dans les voies urinaires hautes (calices, bassinet r\u00e9nal) par… <a href=\"https:\/\/cliniqueomicron.ca\/en\/calculs-renaux\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Kidney Stones (Renal Lithiasis): Causes, Symptoms, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Calculs r\u00e9naux (lithiase r\u00e9nale) | Omicron","_metasync_otto_description":"Les calculs r\u00e9naux (pierres aux reins) se forment dans les voies urinaires et peuvent causer une douleur intense. 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