Stones without blood in the urine

[Tery__0]

Posted by Terry on July 27, 1999 at 12:01:58
I have suffered with Kidney Stones for the last 20 years.  Most have been composed of calcium.  The problem I run into is some do not show on X-rays and with the past three stones I have had there has been no blood found in my urine.  I insisted once that my Dr. Perform a cystoscope and he found a stone the size of a nickel about an inch from my bladder that did not show on x-rays
on another occasion one had to be removed from my prostate.
Since that time I have had three or four episodes of what feels like stone pain.  I will go to the Dr. and if there is no blood in the urine he will tell me the chances are I do not have a stone and try to treat it with muscle relaxers.  On at least one of those occasions I have passed a small stone the size of a popcorn kernel
My question is it possible to have no blood in my urine and have stones?  Why do these stones not show up on x-rays?............      

Posted by HFHS M.D.-JS on August 05, 1999 at 10:30:33

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Thank you for your inquiry.The signs and symptoms of kidney are varied according to the type of stone, the size of the stone and the location of the stone.  The most common presentation for kidney stones is acute onset intermittent flank pain where the patient cannot find a comfortable position.  If a urinalysis is performed it often reveals microscopic hematuria, occasionally white blood cells and bacteria.  There may also be crystals in the urine and /or casts.  The different types of renal calculi present with different features on a urinalysis or  X ray.  For example calcium kidney stones often produce microscopic hematuria, if a urinary tract infection is present there may be increased number of WBC’s or bacteria.  That doesn’t mean that all stones produce microscopic hematuria.  The stone when it passes down the ureter causes trauma to the mucosal lining of the ureter and RBC’s show up in the urine.  Kidney stones resting up in the kidney often do not produce trauma to the GU tract and thus the urinalysis may be negative.  The majority of kidney stones are made up of calcium which can be seen on a plain x ray.  Uric acid stones are on the other end of the spectrum and are radiolucent often are not easily seen on a plain X-ray.  A CT scan without contrast is a new imaging modality which better visualizes all types of stones.  IVP(Intravenous pyelogram is also helpful to locate stones especially those passing down the ureter causing obstruction.
To help make a diagnosis of calculus in the urinary tract it is best to approach the problem thoroughly, with a history and physical exam if this indicates there may be a stone i.e. acute onset flank pain in a person with a history of renal calculi then it is very suspicious for a recurrent problem.  Performing a urinalysis is often helpful to identify hematuria if present as well as infection.  If the urinalysis is negative but the history is still suspicious an X-ray starting with a plain KUB can help identify a calcification.  The CT or IVP are also helpful to locate stones and rule out obstruction.  If all these tests are negative then one may have passed the stone and not realized it, of course the pain should then improve.  Small stones can sometimes missed on X ray depending on the quality of the film.  The technician can vary the degree of penetrance of the x-ray particles and in an obese person the particles it can be difficult to distinguish small calcifications.
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Sincerely,
HFHS M.D.-JS
*Keyword: Hematuria