The presence of calculi in the kidney.

Most kidney stones occur from unknown causes. However, 80% are said to be formed of calcium (Ca), 5% uric acid, and 2% cystine. In addition, 5% of patients with Ca stones have primary hyperparathyroidism. There have been additional causes identified, but they are considered rare.

Although calculi can occur without symptoms, they may cause pain, bleeding, obstruction, and resultant infection. Symptoms related to the kidney and gastrointestinal tract are as follows:

• Kidney symptoms: Back pain or renal colic may occur depending on what structures are affected. Renal colic is characterized by excruciating and intermittent pain. It begins in the flank of the back or kidney area and moves across the abdomen along the course of the ureter. The pain frequently extends into the genital region and inner thigh. If calculi are located in the bladder, they may cause suprapubic pain.

• Gastrointestinal symptoms: Manifestations that may occur include nausea, vomiting, and abdominal distention that may confuse the origin of the disorder. Chills, fever, hematuria, and frequent urination occur especially when a calculus passes through the ureter.

A dietary history is helpful in the diagnosis. Looking for reversible influences, e.g., a high-protein diet and the use of vitamin C or D supplements. The occurrence of the aforementioned symptoms with no obvious localized kidney lesions suggests renal colic from calculi. Urinalysis may be normal even in the presence of calculi. Most urinary calculi can be seen on x-ray. Renal ultrasound may be helpful. Urography may show the calculi and the extent and degree of obstruction. Noncontrast spiral computed tomography (CT) scan may be utilized in the emergency room to evaluate acute flank or abdominal pain, detect a calculus, determine the extent of possible obstruction, or differentiate the condition from other causes of the pain.

Small, single calculi that are not complicated by infection or obstruction may have no indications for treatment. Treating underlying causes may prevent the need for surgery. If infection is not eradicated, then continual therapy to suppress infection may be necessary. Narcotics may relieve pain resulting from colic.

The use of shock waves to crush renal calculi (shock wave lithotripsy) can replace traditional surgery for calculi in the renal pelvis or the ureter. Incision of the kidney to remove calculi (nephrolithotomy) may be done. In addition, a scope to visualize the ureters (ureteroscopy) may be used to remove larger calculi or ureteral calculi.
 

The affected kidney may stop functioning intermittently during acute renal colic due to the ureteral stone, even after it has passed.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See 38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• Rate as hydronephrosis, except for recurrent stone formation requiring invasive or non-invasive procedures more than two times/year.

• This disease shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied [ 38 CFR 3.309 .  [Disease subject to presumptive service connection], 38 CFR 3.309(a) [chronic disease].

• When evaluating any claim involving loss or loss of use of one or more creative organs, refer to 38 CFR 3.350 of this chapter to determine whether the Veteran may be entitled to special monthly compensation. Footnotes in the schedule indicate conditions which potentially establish entitlement to special monthly compensation; however, there are other conditions in this section which under certain circumstances also establish entitlement to special monthly compensation.