The Painful Journey of Kidney Stones
Kidneys are bean-shaped organs seated just below the ribcage. Their main job is to filter toxins and waste from urine. When urine levels of calcium, oxalate, cystine or phosphorus are too high, kidney stones can form. The stones can be as small as grains of sand and may not cause any problems. But larger kidney stones and those that get trapped can be quite problematic.
“Kidney stones can get stuck in the ureter, which is the tube that connects the kidney to the bladder,” says urologist Kymora Scotland, MD, PhD, UCLA Department of Urology. “In some cases, this can be associated with infection, and this can be particularly serious for older adults. Any signs of infection in someone who has active kidney stones should be discussed with your physician.”
A recent study in the Journal of Nephropathology reports that while there is an increase in kidney stones across all age groups, the most prevalent rise is among people ages 60 to 74. The risk for women also increases with age. It is believed that estrogen may protect women from forming stones, but that protection diminishes after menopause.
Pain and Symptoms
The most common symptom is back pain. In Dr. Scotland’s excellent UCLA Health video (https://tinyurl.com/UCLAKidneyStones) she points out that the back pain from kidney stones can be quite severe. Patients report that they just can’t sit still. So-called “flank pain” is a distinguishing factor. Flank pain moves from the back and radiates around to the front of the body.
“As the stone moves down the ureter, you can have different symptoms,” explains Dr. Scotland. “As it moves toward the bladder the pain can extend into the groin or genitals.” Some people report pressure in the bladder, a constant need to pee, and a burning sensation. Because the stone can disrupt urine flow, the stream can be slow or interrupted. If the stone moves back and forth, the pain can come and go.
Other symptoms include fever, chills, vomiting, dizziness, and blood in the urine. Severe nausea and vomiting, and/or fever and chills, particularly if you have a urinary tract infect, warrant a visit to the emergency department.
“Sometimes kidney stone pain goes away even when the stone is still stuck in the ureter; however, kidney stones can cause kidney injury even if they are no longer causing pain,” says Dr. Scotland. “So, it is important to get routine imaging to confirm that a stone has passed, especially if you did not actually see or capture the stone.”
A physician can provide you with details on how to capture kidney stones at home. Analyzing the stone’s composition informs both treatment and prevention.
Prevention and Treatment
Physicians diagnose kidney stones by taking a medical history (there is a genetic predisposition to them), a physical exam, labs, and imaging. There are several types of stones, but the majority are composed of calcium and oxalate.
Back pain is a common symptom, but not the only one caused by kidney stones.
To treat and prevent any kidney stones, the recommendation is to drink lots of water. Water keeps urine diluted and helps flush out the minerals before they can clump together and form stones. As a treatment to help pass stones, Dr. Scotland recommends drinking at least 3 liters of water a day to increase urine production, which can help move the stone through the ureter. For pain, nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) are recommended. For nausea, there are medications available over the counter or by prescription. Some people may receive a medication that relaxes the ureter so that the stone is able to pass into the bladder. Larger stones may need to be removed by a urologist through a procedure that breaks it into small pieces.
Treatment for common calcium oxalate stones includes limiting sodium, animal proteins, and avoiding certain other foods, such as nuts and nut products, rhubarb, spinach, and wheat bran.
Medications that increase risk of kidney stones include topiramate (Topamax), which is a seizure medication, indinavir (Crixivan), an HIV medication, and some antibiotics, such as ciprofloxacin (Cipro XR). “It is also important to check the ingredients in any supplements that you are taking,” advises Dr. Scotland. “Some commonly used supplements, such as turmeric and vitamin C, have high levels of oxalate, which can lead to stones. If you form kidney stones, please make sure that your supplements are not contributing to your stones.
“Prevention is key to managing kidney stones,” says Dr. Scotland. Fifty percent of people who have had a kidney stone will have another one within five years if they do nothing to prevent formation.
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