Facts about kidney stones from an expert
By Keith Desonier, PA-C
Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They can be caused by or have an affect on any part of your Urinary Tract- from your kidneys and ureters to your bladder and urethra. Most commonly stones form when the urine becomes too concentrated, allowing these mineral to crystallize and stick together to form a stone. There’s no way to predict how quickly stones will form in any given individual.
Overall, kidney stones affect about 1 in 11 people in the USA- 19% of men and 9% of women by age 70. There has been an increase in the number of women being diagnosed, also at younger ages, without a clear cause. The SouthEast region, including Texas and Oklahoma, is known at the “kidney stone belt”, inferring higher rates of stone formation compared to other parts of the USA. Many patients can have stones that do not block the flow of urine out of the kidney and can remain there or grow in size and never cause any symptoms. However, when a stone is passing down the ureter (the tube that drains the kidney) and becomes lodged, people will become highly symptomatic and should seek medical care as this could be an emergency.
The most common signs of kidney stones are severe pain that will come and go- typically one side of the back or lower abdomen or the other, usually never centralized back pains. Additionally, fever or chills, nausea/vomiting, an increase in urgency or frequency of urination are often experienced. Many, but not all, patients can pass blood in their urine or urine becomes darker. If any of these arise, that person should seek medical attention.
Short of passing a stone and bringing it into the office, the diagnosis of kidney stones will come essentially from a radiologic exam. Common studies used are CT scans (which are the most accurate in showing size, number, and location of the stone(s)), a KUB (an Xray that focuses on the Kidney, Ureters, and Bladder), a Renal or Abdominal Ultrasound, or an IVP (an Xray exam that uses IV contrast/dye to better locate an obstruction).
Treatment options will depend on the size and location of the stone as well as if there are signs of kidney damage or a systemic infection. Smaller stones can be treated with pain control, adding meds to allow easier passage of the stones, increasing fluids, and straining urine to ensure passage. For larger stones, some form of surgery is typically required and fortunately rare cases a scalpel is needed. This can be done with an external soundwave treatment or an internal treatment with special “telescopes” and lasers and you’ll go home the same day. Many times with either of those, we’ll utilize a stent (long plastic temporary tube) to protect the kidney or alleviate an infection before and/or after treatment. For “Texas sized” stones, more aggressive type surgeries are used in order remove the stone, fortunately this is less commonly needed.
Having one stone increases the chance of having a second stone by 50% within the next 10yrs, thus prevention is necessary to reduce chances of stone formation. Current recommendations are to drink 3 quarts (or 90oz) of water daily and possibly more during the warmer months. To reduce sodium intake to less than 2500mg daily- which we remind everyone anything in a box, bag, bottle, frozen, or fried often has sodium added in. To keep dietary intake of calcium to no more than 1200mg daily; Calcium supplements have higher rates of causing stones. Many times we’ll check a 24hr urine collection analysis which will identify any other specific risks an individual might have and can help guide other preventative recommendations. Additionally, we will address certain medications and/or health conditions that will increase risks of future stone formation.
References: Mayoclinic.org – Kidney stones, UrologyHealth.org- The Urology Care Foundation, AUAnet.org