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    Kidney Stones, Part 1

    Deaconess Clinic Urology​ 04/10/2014

    If you’ve ever had a kidney stone, you know how extraordinary the pain can be. I’ve had female patients who have given birth tell me that having and passing a kidney stone is worse than childbirth—without the reward at the end!

    Let’s start by talking about what kidney stones are. Your kidneys filter blood, and in doing so, they remove waste and excess water and minerals. These materials are carried out of the body as urine. If an imbalance of minerals in the urine occurs, kidney stones can result.
    Risk Factors
    Risk factors are things that make you more likely to develop kidney stones. For instance, people who don’t drink enough water are at higher risk of getting kidney stones. Assess your own risk factors by answering “yes” or “no” to the questions below. The more times you answer “yes,” the higher your chances of forming kidney stones.

    • Do you drink fewer than eight glasses of water a day?
    • Have you had a kidney stone before?
    • Has anyone in your family had kidney stones?
    • Are you between the ages of 30 and 50?
    • Do you live in a hot climate?
    • Do you have frequent urinary tract infections?
    • Do you have a history of gout or bowel disease?
    • Is your diet high in sodium (salt) or animal protein?
    • Do you often have cola, black tea, chocolate, spinach, or nuts?
    • Are you overweight?

    Symptoms of Kidney Stones
    Some classic symptoms for kidney stones include:

    • Mild to severe pain, which typically starts in the mid-back or side (flank) but can move to the front and down to the groin.
    • Nausea and vomiting
    • More frequent urination
    • Burning with urination
    • Blood in the urine

    Patients often come to the emergency room in tremendous pain, and are examined for the cause. If a kidney stone is suspected, there are a few diagnostic tests that are used to determine that a kidney stone is the cause, and also the type, size and location of the kidney stone.
    I have a kidney stone…now what?
    For people with first-time kidney stones, we can help reduce their risk for future stones by at least 50% if they follow a few simple instructions.

    • Increasing fluids so that daily urinary output is about two quarts. This is for all seasons. The purpose is to flush out the body.
    • Drink lemonade. Citrus fruits have citric acid, which is a stone-formation inhibitor. The easiest source for citric acid is lemonade, and the best source is homemade lemonade, made with real lemon juice.  Substitutes can help, but may not be as effective.
    • Reduce salt. Salt is your enemy if you’re prone to kidney stones. This includes salt in already-prepared foods, not just the kind in your salt shaker on the table.
    • Magnesium supplement. This can be picked up at any health food store or drug store. Magnesium and calcium look alike to your kidneys, and can trick your kidneys into excreting magnesium instead of calcium. (About 90% of kidney stones are mostly made up of calcium.)

    It should be noted that if you have ever had a kidney stone, the chances are high that you will develop another stone.

    Diagnosis, Treatment and Relief!
    A kidney stone is diagnosed through a CT scan or an abdominal x-ray. This helps us also determine the size, shape and location of the stone. The passage of a stone depends on location (upper, middle or lower ureter, which is the tube that goes between the kidneys and the bladder), stone size, and any previous stone passage history.

    Location - The higher the stone when it gets “stuck,” the lower the chance of passing it. This is often when we see people showing up in the emergency department in terrible pain.

    Size - Kidney stones can be various sizes. Those that are 3mm and smaller have about an 85% of passing on their own. Stones 4mm have about a 50% chance, and stones 5mm and above have about a 30-40% chance of a person passing it successfully.

    Previous history - Those who may have passed stones in the past are usually able to pass larger stones in the future.
    Passing a kidney stone
    There are ways we can assist in the passing of a stone. Managing stone passage means:

    • Controlling the pain and nausea with pain medication and anti-vomiting medication.
    • Medications to help the ureter relax so that the stone can pass through more easily. Currently, we use a drug called Flomax.
    • Stones made of uric acid (which occurs in about 10% of stones); we can help dissolve those with medication to make the urine less acidic.
    • Regular follow-up with abdominal x-ray to determine if the stone is moving down.

    If you are in the process of passing a kidney stone, contact your doctor if you have the following symptoms:

    • Severe pain or nausea and vomiting that doesn’t respond to the oral medications.
    • Development of fever above 101 degrees, and chills.
    • Inability to urinate, more in men than women.

    In part 2 of this article, we'll discuss the treatment methods for kidney stones.

    Krames patient education material content also contributed to this article.


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