Diagnosis

Diagnostic steps for kidney stones include:

• Physical exam and imaging test to establish the presence or absence of kidney stones as soon as possible so that pain management can begin if necessary.
• If a kidney stone is present, use imaging techniques to determine whether the stone is obstructing the urinary tract.
• Blood and urine tests to determine the substance forming the crystal so that appropriate treatment and preventive measures can be taken. There is some question about the value of identifying the stone properties in people who have had only one attack. Some experts argue, however, that because of the high risk for recurrence, analyzing the stone from even a single attack may help prevent subsequent ones. Most doctors, though, delay detailed diagnostic evaluations until a stone recurs or grows in size.
• Blood and urine chemistry tests to determine any metabolic abnormalities in people with recurrent stones. According to a 2000 study, only 35% of patients with recurrent stones are given such tests. About half of children with stones have an identifiable metabolic disorder, which increases their risk of stone recurrence five-fold.

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Experts argue over whether tests for metabolic abnormalities are routinely needed once the stone composition has been determined. Studies suggest the following:

• People with recurrent calcium stones have a wide range of abnormal blood or urine chemistries indicating a variety of metabolic disorders. (For example, calcium stones in women may be due to parathyroid abnormalities.)
• Calcium phosphate stones raise the likelihood of renal tubular acidosis.
• People with non-calcium stones generally have identifiable metabolic disorders.