Kidney Stones

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). Kidney stones can obstruct your urinary system, and cause pain and/or  infection.

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)

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

• High levels of calcium or oxalate in the urine
• Recurrent urinary tract infections
• High levels of uric acid in the urine (often related to a high protein intake)
• Family history of kidney stones
• Dehydration and certain dietary choices may also play a role
• Certain 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.

During your visit with Spokane Urology, 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: A 24-hour urine test in which you save your urine for 24 hours. This volume of urine allows us 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).

Non-surgical treatments:

• Passing the stone on your own: Spontaneous passage of stones is possible for patients with 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.
• Tamsulosin (Flomax) may be used to help a stone pass.
• Ibuprofen or naproxen 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 continued pain.
• Causes recurrent urinary tract infections. Sometimes bacteria can become embedded in a stone and be difficult to clear completely unless the stone is removed.
• Damages kidney tissue or causes bleeding.
• Is too large to pass on its own or is caught in a difficult place.
• Blocks the flow of urine.
• Has grown larger over time, as seen on follow-up x-ray or ultrasound.

Surgical options:

• ESWL (Shockwave Lithotripsy): Breaks up stones using focused sound waves transmitted from outside of the skin.
• Ureteroscopy: A scope is inserted into the bladder and ureter and the stone is lasered (typically) and the fragments are removed.
• PCNL (Percutaneous Nephrolithotomy): For very large stones, a scope is inserted directly into the kidney through a tiny incision in your back, and the stone is broken up and removed.

Prevention:

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

• Drink plenty of water especially when doing activities that cause a lot of sweating.
• Avoid dark soft drinks like colas and root beer.
• Reduce sodium: High-sodium 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, be sure to take in an amount of calcium appropriate for your age and get it through foods or supplements at mealtimes.
• Avoid certain foods: Chocolate, beets, spinach, rhubarb, black 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 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 oxalate or 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 2300mg/day) and low in animal protein (less than 1g of protein per Kg of body weight per day).