Kidney Stones

 What are kidney stones?

A kidney stone is a hard object that is made from chemicals in the urine. Data shows the incidence of kidney stones in the United States has increased over the years and they can be treated a variety of different ways. It is important to understand every kidney stone is different in the way they form which can affect the way they are treated.

Here are the four major types of kidney stones;

Calcium stones – The most common type of kidney stone forms in two primary ways: calcium combining with oxalate in your urine (calcium oxalate) or a high amount of calcium plus increased pH levels in your urine (calcium phosphate).

Uric acid stones – If you eat a high-protein diet, are obese, or suffer from gout, you may have an increased level of uric acid in your urine. If uric acid becomes too concentrated, which may occur when the urine pH becomes abnormally low, or if uric acid combines with calcium, it can form a stone.

Struvite stones – If your kidney or urinary tract becomes infected, you may develop struvite stones, which can grow rapidly and become very large in size. Left untreated, they can cause chronic infection and seriously damage your kidney.

Cystine stones – These rarer stones are due to a genetic disorder that causes the amino acid cystine to leak into urine from your kidneys, forming crystals that may accumulate into stones.

 Causes

A kidney stone forms when substances in your urine become highly concentrated – which makes fluid intake one of the biggest contributing factors. If you do not drink enough water, you may put yourself at a higher risk for developing a stone.

Other possible causes include:

• Exercise (too much or too little)

• Family or personal history of kidney stones

• Food with too much salt or sugar

• Infections

• Medications

• Obesity

• Weight-loss surgery

Symptoms

If you have a kidney stone, you may experience:

• Sharp pain in your back or lower abdomen

• Vague discomfort or dull pain, like a stomachache that doesn’t go away

• Pain while urinating or blood in your urine

• Pain in your groin or thigh (if you have a ureteral stone)

• Pain in your testicles

• Nausea and occasional vomiting

• Fever and chills

• Cloudy or foul-smelling urine

If your stone creates an irritation or blockage, your pain may ramp up quickly. Most stones pass without causing damage – but usually not without causing pain. While pain relievers may be the only treatment needed for small stones, your doctor may recommend other treatment options if you are in danger of further complications.

Treatment Options

Treatment Options

There are several different categories of treatment:

• Passing the stone naturally

• Medically Expulsive Therapy (MET)

• Shock Wave Lithostripsy (SWL)

• Ureteroscopy (URS)

• Percutaneous Nephrolithotomy (PCNL)

In-Depth Discussion

Passing the stone naturally

Many kidney stones pass through the urinary system naturally, while others respond well to medical therapy. Yet some stones require a surgical procedure to break up and remove them. Treatment depends on the type and size of your stone, its location in your body, and how your symptoms have progressed over time. Talk to your doctor to determine the best plan for you.

Waiting for your kidney stone to pass on its own is generally considered to be safe as long as your pain is bearable, you do not show signs of infection and the stone is reasonably small enough to pass spontaneously.

Passing a small stone can cause variable pain (can range from mild to severe) and discomfort, so your doctor may recommend pain relievers such as ibuprofen, acetaminophen, naproxen sodium or narcotic analgesics. You may also need anti-nausea medicine.

Medically Expulsive Therapy (MET)

If you have a small stone in your ureter, medically expulsive therapy may be right for you. The medication may help you pass the stone spontaneously – without the need for surgery.

If you are a suitable candidate for MET, you can be prescribed an alpha blocker medication to be taken for up to 4 to 6 weeks.  An alpha blocker relaxes the muscles in your ureter to make it easier for the stone to pass. Drinking plenty of fluids (six to eight glasses of water every day) will help flush your urinary system.

Even passing a small stone can cause severe pain and discomfort, so it may be recommended pain relievers such as ibuprofen, acetaminophen, naproxen sodium or narcotic analgesics. You may also need anti-nausea medicine as you wait for the stone to pass.

Shock Wave Lithotripsy (SWL)

Your doctor may recommend SWL if you have a medium-sized stone in your kidney or ureter. SWL typically takes one hour and can be done as an outpatient procedure. You should be able to resume normal activities in two to three days.

After you are under anesthesia, your doctor uses x-rays or ultrasound to locate the stone, then targets the stone with high-energy shock waves from outside the body. The goal of the procedure is to break the stone into small fragments that can pass in the urine over the next few weeks; however, passage of the stone fragments can create pain requiring analgesics. lf large pieces remain, another treatment can be performed or the recommendation may be to proceed with an alternative treatment, such as ureteroscopy or percutaneous nephrolithotomy. SWL does not work well on hard or large stones.