Kidney stones are the formation of small, hardened pebbles in the kidney, which can affect any part of the urinary tract. The physicians at Saint John’s Health Center can successfully treat kidney stones and other urologic conditions.
About the Kidneys and Kidney Stones
Our kidneys are the filters for our blood. They not only remove waste but regulate our electrolytes. When kidney stones occur, chemicals and minerals that are concentrated within urine crystallizes, forming a small stone. Though they start small, stones can grow over time to an inch in diameter or larger. Though kidney stones can successfully be treated successfully, they can recur in the future.
Depending on where the stone resides in the urinary tract, it will indicate the type of diagnosis. Urolithiasis, for example, means stones appear in the urinary tract (ureter), while nephrolithiasis (nephro = kidney) refers to stones in the kidney. The size of the stone and where it is located, and whether it obstructs the passing of urine, is most important. A blockage of urine can cause an infection and kidney damage, creating potentially life-threatening complications. A stone in the kidney will not typically cause pain unless it is blocking the ureter, which causes pressure to back up into the kidney. This can cause swelling of the kidney, resulting in pain and nausea.
Your doctor can determine the composition of the stone with a blood test, which may indicate the need for other treatments or medical intervention. For example, a calcium stone (high calcium in the blood) may be the result of another underlying condition, such as with hyperparathyroidism. A cysteine stone would indicate a buildup of an amino acid in the urine called cystine (aminoaciduria). Other types of stones include oxalate, urate, xanthine, and phosphate.
What are the Signs and Symptoms of Kidney Stones?
- Pain in the lower back or flank of body
- Nausea and/or vomiting
- Blood in the urine
- Pain when urinating
- Unable to urinate
- Feeling the need to urinate more often
Kidney Stones Risk Factors
There are several risks for developing kidney stones include. Those most at risk may present with more than one risk factor.
- Dehydration
- Recurrent urinary tract infections
- Blockage of urine in the urinary tract
- Family history of kidney stones
There are a variety of common health conditions that can increase risk because of how each can affect urine chemical composition, which causes stones to form.
These include:
- Hypercalciuria, which is high calcium levels in the urine
- High blood pressure
- Diabetes
- Obesity
- Osteoporosis
- Gout
- Kidney cysts
- Cystic fibrosis
- Parathyroid disease
- Inflammatory bowel disease
- Chronic diarrhea
- Some surgical procedures, including weight loss surgery or other stomach/intestine surgeries can present some risk
Medications that can cause kidney stones
Certain medications including protease inhibitors, antibiotics, and diuretics, can increase the risk for kidney stones. Supplements can also present risk for kidney stones, such as taking calcium supplements beyond recommended levels. Other medications such as indinavir sulfates (Crixivan®), which is used to treat HIV infections, and Topiramate (Topamax®), used to treat seizures, are known to cause kidney stones/kidney damage in their reported use.
Passing a Kidney Stone
Passing kidney stones can be quite painful. Kidney stones that are 4 mm and smaller (about the size of a popcorn kernel) can be expelled naturally from the body in about 90 percent of cases. Those that are 5 to 7 mm (larger than a pencil erasure but smaller than a green pea) can be passed in 50 percent of cases. Stones that are larger than 7 mm rarely pass without a surgical procedure. There is usually no permanent damage if kidney stones are recognized and treated in a timely fashion.
How do you Diagnose Kidney Stones?
Diagnosis starts with a physical exam and review of your medical history. One or more tests may be performed to determine the extent and location of the stone(s).
Common kidney stone tests include:
- Blood test
- Urine test
- Imaging tests: kidney ultrasound, X-rays, and CT scan
How are Kidney Stones Treated?
Kidney stone treatment depends on the size and type of stone as well as whether infection is present. Kidney stones can be treated several ways including shockwave lithotripsy, ureteroscopic lithotripsy, Percutaneous Nephrolithonomy (PCNL), medication, and occasionally, open or laparoscopic surgery. A basic metabolic evaluation is needed which consists of a urinalysis and assessment of electrolyte levels, checking for hypercalcemia (high calcium in the blood).
Medication
Medications called alpha-blockers have been shown to increase the spontaneous passage of kidney stones, especially smaller stones that are in the lower ureter near the bladder. These medications can relax the ureter which has been shone to improve stone passage by about 30 percent. Alpha-blocker medications include tamsulosin (Flomax®), alfuzosin (Uroxatral®), terazosin (Hytrin®), and doxazosin (Cardura®).
Extracorpeal Shockwave Lithotripsy (ESWL)
ESWL is used to treat stones in the kidney. An X-ray or ultrasound will be is used to locate the stone while focused shock waves break it down. The smaller pieces of the stones then pass out in the urine over the course of a few weeks. Patients can go home the same day and resume normal activities in two to three days after treatment. ESWL does not work well on hard stones made of cystine, calcium oxalate, and calcium phosphate, or when stones are large. The risks and side effects of ESWL treatment are blood in the urine, infection or abscess, or hematoma around the kidney.
Ureteroscopy (URS)
Ureteroscopy (URS) is an outpatient procedure most commonly performed to treat stones in the ureters (narrow tubes that connect the kidneys to the bladder). URS can also be used to treat stones in the kidney. The device consists of a thin, fiber optic camera which helps the urologist guide the flexible instrument, traversing into the bladder, up the ureter, and into the kidney. The URS device also has a built-in laser, which is used to bombard the stone into smaller pieces. The smaller pieces of the stone can then be collected and removed by the urologist. The procedure is typically performed with the patient under general anesthesia (asleep).
Once the stone has been removed, a ureteral stent is placed into the tract. A stent is a tiny, rigid plastic tube that helps hold the ureter open so that urine can easily drain from the kidney into the bladder. Typically, the stent is removed within 1 week to 10 days after treatment but can be advised for longer periods of time. This can cause some urgency and frequency of urination and may cause some bladder discomfort. Just like shockwave treatment, patients can go home the same day as their URS treatment and begin normal activities in two or three days.
Having an instrument inserted into the urinary tract may produce some urinary symptoms, which will fade in the coming days. These include a mild burning sensation when urinating, a need to urinate more frequently, discomfort in the bladder or kidney when urinating, and finding small amounts are blood in the urine. Patients are asked to drink more often but in smaller amounts after their treatment, which helps the healing process.
If you have questions regarding kidney stone treatment, please call today. Click here to request an appointment.
