Kidney Stone Care and Understanding

Kidney stones are hard deposits that form inside your kidney from minerals and salts contained in urine. Stones differ in size mostly based on when they started forming and how long it takes until they are discovered. If a stone is left undiscovered for a long time, it has more time to grow.

In most cases, stones are entirely asymptomatic, meaning they don’t cause any signs or symptoms at all. Stones do not cause pain. Pain associated with stones happens only when they move into a position where they block the flow of urine out of the kidney, known as obstruction. Obstructing stones can cause pain that starts in the side of the abdomen and can travel into the groin. Other symptoms often include nausea and vomiting. Stones are usually discovered either when they move and become obstructing or when they are incidentally found on imaging performed for other reasons.  

Stone types and treatment

There are several different types of kidney stones. The most common type are calcium stones that form when calcium binds other substances in the urine that crystalize to create stones. Uric acid stones are less common and are caused by too much uric acid in the urine. This is one of the few stone types that can be dissolved by medication.

Infection stones like those made of magnesium ammonium phosphate can form when a person has recurrent kidney infections. The infections change the chemistry of the urine to make a more favorable environment for stones to grow. Less common stones include cysteine, tyrosine, and leucine stones, among others. These often form because of some metabolic abnormality.

Treatment options for kidney stones largely depends on three factors –the size of the stone, its location, and whether it’s obstructing or non-obstructing. In some cases, if stones are small and non-obstructing, a good option is just to watch them and take measures to keep them from getting bigger or from making more stones. Trial of passage is a treatment option used for stones that have moved from the kidney into the ureter (the tube that drains urine from the kidney to the bladder). In this case, medicines are prescribed to help control pain and nausea while the patient tries to pass the stone.

Shockwave lithotripsy is a well-tolerated and non-invasive procedure performed in the operating room, in which sound waves are used to fragment stones into sand which passes easily and painlessly down the ureter.

Another procedure called a ureteroscopy uses a fine camera that’s passed into the urinary tract to treat stones.A laser fiber or other instruments are used to break up and remove stones. It is effective for treating multiple stones throughout the urinary tract. Percutaneous nephrolithotomy is used to treatment very large or complex kidney stones. It’s generally reserved for cases where there are a significant number of stones or large stones that require treatment, or the other procedures aren’t possible or successful.

Risk factors and prevention

The main risk factor for kidney stones is dehydration, which is common in the southeast. Guidelines suggest that people who have a long history of making stones should be drinking at least 2.5 liters of fluid daily. Other factors that increase the risk of making stones are not enough citrate in the diet, eating too much sodium, and eating too much animal protein. Anyone can reduce their risk of developing kidney stones by increasing fluid intake, eating more citrus fruits, limiting dietary sodium and eating less meat.

When to see a doctor

If you have a history of stones, it’s important to schedule an appointment to see a urologist who has experience not only in treating stones but also in helping patients to prevent them from forming. Once kidney stones have been treated, some people may benefit from a metabolic workup to further assess why they are so prone to make stones. With this information, recommended dietary changes or medicines can significantly reduce a patient’s risk of making more stones.

When to go to the emergency department

Kidney stones may cause sudden, severe pain in the abdomen, side, groin or genitals.They may come with fever, chills, nausea or vomiting. You should visit the emergency room immediately if you have sudden onset of pain in the side with associated, progressive nausea or vomiting, or high fevers with shaking chills.

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