Kidney Stones

When a kidney stone blocks the urinary tract, it can be extremely painful. The good news, though, is that most of these stones can be treated

Kidney stones are minerals excreted from the kidney that crystallize and bind together. They can either deposit and stay in the kidney or pass into the ureter (the tube connecting the kidney to the bladder). The most frequent type of stones are calcium oxalate. Kidney stones can result in urinary obstruction, pain, infection, or all three. One in 10 people will develop kidney stones at some point in their life.

If you have a kidney stone, you may experience:

• Blood in your urine
• Fever
• Nausea/vomiting
• Pain (typically in your side, back, or stomach)
• Change in urination (more often with urgency or frequency but sometimes burning as you urinate)

The movement of kidney stones through the urinary tract also may cause extreme pain that does not go away, painful urination, blood in urine, chills, fever, nausea and vomiting. When experiencing such symptoms, it is important to see a doctor as soon as possible for prompt medical attention.

Your risk of developing kidney stones is higher if you have one or more of the following:

• Recurrent urinary tract infections
• Uric acid in the urine (often related to a high protein intake)
• Live in a hot climate and tend to lose a lot of water in sweat
• Have high levels of calcium or oxalate in your urine
• Family history of kidney stones

Dehydration and certain dietary choices may also play a role. Kidney stones are twice as common in the southeastern United States, as the warmer climate likely leads to increased sweating, insensible fluid loss, and lowered urine output.

Urinary tract infections, kidney disorders, and some metabolic disorders like hyperparathyroidism are also linked to kidney stones. More than 70 percent of people with renal tubular acidosis develop kidney stones.

What to know before your visit to the Advanced Urology Institute of Florida:

• During your visit, your doctor will ask you questions regarding your medical history, surgical history, and dietary patterns.

Tests that may be performed during or after your visit:

• Urinalysis: This looks for blood or infection in the urine.
• Blood tests: This helps identify possible metabolic abnormalities that contribute to stone formation.
• Urine studies: You may be asked to collect your urine for 24 hours and submit to the lab in order to analyze it for minerals and electrolytes that may increase your risk of future stones or identify a potential metabolic reason for stone formation.
• Imaging: An ultrasound of the kidneys, x-ray of the kidneys, or low-dose CT scan (without contrast).
• An intravenous pyelogram (IVP): A series of x-rays using a contrast dye to highlight abnormalities (this test is less commonly used).

NON-SURGICAL TREATMENTS

It is possible to pass the stone on your own if you have sufficient pain tolerance, adequate kidney function, no fevers/chills, and with stones less than 1 cm in size. The size and location of the stone significantly impacts the success rates of passage (please review with your provider). Note: it may take up to 4-6 weeks for a stone to pass.

• • Drinking water: your physician may prescribe drinking plenty of water – at least three quarts a day
  • Tamsulosin (Flomax): a medication that may be used to help a stone pass.
  • Ibuprofen: may be used to control pain and help a stone pass.

SURGICAL TREATMENTS

Surgery may be needed to remove a kidney stone if:

• It doesn’t pass after a reasonable period of time and causes pain.
• Causes an ongoing urinary tract infection.
• Damages kidney tissue or causes bleeding.
• It’s too large to pass on its own or is caught in a difficult place.
• It blocks the flow of urine.
• Has grown larger, as seen on follow-up x-ray or ultrasound.

Surgical options:

• Ureteroscopy: a scope is inserted into the bladder and ureter and the stone is lasered (typically) and the fragments are removed without incisions.
• ESWL (Shockwave Lithotripsy): ideal for larger stones or stones in the kidney or upper ureter. This treatment breaks up stones by transmitting sound waves through the skin and kidney to the stone, allowing the smaller pieces to be passed.
• PCNL (Percutaneous Nephrolithotomy): a scope is inserted directly into the kidney through a tiny incision in your back, the stone is fragmented and the pieces removed through the scope.

While some people are more susceptible to kidney stones, there are things you can do to decrease your risk of stone formation:

• Drink plenty of water: especially when doing activities that cause a lot of sweating.
• Avoid dark soft drinks like cola and root beer.
• Reduce sodium: High-salt diets can trigger kidney stones because it increases the amount of calcium in your urine.
• Get the calcium you need: Getting too little calcium in your diet can cause oxalate levels to rise and cause kidney stones. To prevent this, make sure to take in an amount of calcium appropriate to your age.
• Avoid certain foods: Chocolate, beets, spinach, rhubarb, tea, and many nuts are rich in oxalate, and soda is rich in phosphate, which can contribute to kidney stones. Don’t avoid healthy foods like spinach and beets, but just balance your diet with other foods and drink plenty of water.
• Limit animal protein: Eating too much red meat, poultry, eggs, and seafood can boost the level of uric acid and could lead to kidney stones.
• Consider the DASH diet: Dietary Approaches to Stop Hypertension, which is thought to be the best diet for people who frequently form stones – high in fruits/vegetables, low in sodium (less than 2300 mg/day) and low in animal protein (less than 1g of protein per Kg of body weight per day).