When Kidney Stones Become a Problem

When Kidney Stones Become a Problem

If you've ever had a kidney stone, you know how painful ii: can be.

But your doctor can help you get rid of your stone safely and quickly.

Treatment can be tailored for the location and type of stone. And you

can also take steps to reduce your risk of future stones.

 

 

The Pain You'll Never Forget

Most stones cause pain so severe that it's unforgettable. It may come in waves that begin in your lower back. Then the pain may move to your side or groin. You may also have other symptoms of scones. These include bloody urine, burning on urination, fever, or nausea. In some cases, "silent" kidney stones produce few to no symptoms.

Treating Your Stones

                                                                                     You and your doctor will work together  to form a treatment plan.

    Your doctor may suggest that you lee your stone pass

    naturally. Or you may manage it with medications. Special treatment (ESWL)

    or surgery may also help. And you will be told how you can help prevent kidney

    stones in the future.

Assess your risk by answering the following questions:

 

Do you Drink fewer then eight glasses of water a day?

 

Do you live in the "southeast" or hot climate?

 

Ever had a kidney stone before?

 

Has anyone in your family ever had a kidney stone?

 

Are you a male between the ages of 30 and 50?

 

Have you had a kidney infection in the last few months?

 

Do you take large does of calcium or vitamin C supplements?

 

Do you often eat or drink dairy products (high calcium food) ?

 

Do you often drink cola and tea, chocolates, spinach, or eat peanuts (high oxalate foods) ?

How Great Is Your Risk?

 

The more times you answered "yes" the greater your risk of forming kidney stones.

BUT, you can help reduce your risk.

Learn more about kidney stones and how they form.

 

Are you at Risk For A Kidney Stone?

 

}

People who form stones often share certain risk factors. Middle-aged men, for instance, are more likely to form stones than other people. A family history of stones also increases your risk.

Understanding Kidney Stones

Your kidneys are the chemical filters for your body. These bean-shaped

organs constantly screen your blood, removing wastes and excess fluids.

Healthy kidneys maintain the chemical balance your body needs. But sometimes certain chemicals build up within a kidney.

They can then  form a stone. There are several types of stones. Some stay in the kidney. Others may move into the urinary tract.

Healthy Kidneys

Within the kidney, tiny filters remove waste substances from your blood.

You excrete these in urine. After the “cleanup" job your kidneys perform, your blood returns to circulate

through your body.

 

 

 

 

 

Your kidneys filter your blood and release chemicals into the urine.

Why Kidney Stones Form Kidneys form stones for many reasons. If you don’t drink enough water, for instance, you wont have enough urine to dilute chemicals. Then the chemicals may form crystals, which can develop into stones.

Fluid Loss (Dehydration)

can concentrate urine, causing

stones to form.

 

Certain foods contain large

amounts of the chemicals

that somtimes crystallize

into stones.

 

Kidney infections foster

stones by slowing urine

flow or changing the acid

balance of your urine.

 

Where Stones Form and Lodge

Stones begin in the cup-shaped part of the kidney (calix). Some stay and grow, like the staghorn. Others move within the kidney or into the ureter. There they can lodge, block the flow of urine, and cause pain.

Identifying Kidney Stones

Your kidney stones size and shape determine whether it is likely to pass by itself. knowing a stone's composition helps your doctor find its cause. Then he or she can suggest the best treatment.

 

Size

A stone may be as small as a grain of sand.

Or it may be as huge as a golf ball. Small

stones may pass out of the body when you urinate.

 

 

 

 

 

Shape

Small smooth, round stones may pass easily.

Jagged-edged stones often lodge

inside the kidney or ureter. Staghorn

stones can fill the entire kidney.

 

 

Composition

Most stones are calcium oxalate, a hard compound.

Stones made of cystine or uric acid, or caused

by infection, are less dense.

Stones often contain more than one chemical.

Symptoms

Many stones cause sudden and severe pain, bloody urine, or fever. Others cause nausea to frequent, burning urination. Symptoms and treatment plans vary. They depend on your stone’s size and  location.

 

Medical Evaluation A medical evaluation helps your doctor find out what's causing your symptoms. A health history and physical exam may reveal signs of a stone. Diagnostic studies can confirm the presence of a stone and locate it. Detailed metabolic tests of your blood, urine, and the stone may also be done. These test results help your doctor recommend treatment.

Health History

In some cases, your symptoms, risk factors, and past health problems may point to kidney stones. Your doctor can then make a diagnosis right away.

 

 

Physical Exam

During your exam, you will be checked for fever and a tender flank (side pain). These may be signs of a. stone-related kidney infection or blockage.

Side Pain is common symptom of kidney stone pain A Fever can also be symptom of kidney stone

Diagnostic Tests

These tests confirm your doctor's diagnosis. They can detect infection or reveal the image of a stone. You may not need all of these tests:

 

  • Urinalysis looks for blood in the urine (hematuria), one sign of a stone. Pus (pyuria) suggests a stone or infection.

 

  • A urine culture can reveal a urinary Tract infection. Test results appear 24-48 hours after the urine sample is collected.

 

  • Blood tests can confirm a kidney infection. They show any abnormalities in the white cell count of your blood.

 

  • A KUB (Kidney, Ureter, Bladder) x-ray provides a view of the entire abdomen. An IVP (intavenous pyelogram} x-ray uses dye to locate your stone.

 

  • Ultrasound uses sound waves co create a picture of the kidney. This helps show stones and reveal blockages in the urinary tract.

 

  • A CT (computed tomography) scan takes multiple x-rays of the urinary tract. This helps locate and identify a stone. A CT scan can be done without dye. This makes it safe for patients who have dye allergies or kidney disease.

Metabolic Tests

If you have a stone, your doctor may order one or more. metabolic tests. These rests may show why you formed a stone. And they show what kind of stone you may form in the future.  This helps your doctor plan your treatment and prevention program.

 

 

  • A blood screen may show the kind of stone you have. The screen measures

 

  • A 24-hour urine sample shows the level of stone-related chemicals in your urine.

 

  • Blood tests can confirm a kidney infection. They show any abnormalities in the white cell count of your blood.

 

  • Stone analysis shows your stone's chemical makeup, if the stone is retrieved.

 

  • Provocative tests show how your kidneys handle chemicals, such as calcium.

 

 

Managing Kidney Stone Most kidney stones are about the size of a grape seed. Stones of this size are small enough to pass naturally. Once it is passed a stone can be analyzed. This “wait and see” approach is called “Expectant Therapy”. In some cases, your doctor may prescribe medications to dissolve or prevent stones. Or medications may be prescribed to stop an infection. Once the infection is controlled, your stones can be removed.

Expectant Therapy

small stones can often be If passed with expectant therapy. If pain is a problem, ask your doctor about pain medications. Then follow his or her directions on how much water to drink. Drinking more water creates more urine to “flush out” your stone.  Also be sure to strain your urine. Take any stones you pass to your doctor for analysis.

Drinking lots of water

helps your stone pass. Water also dilutes the chemicals in your urine. This reduces your risk of forming new stones. You maybe told to drink 12 (8) ounces glasses of water a day. Avoid liquids that dehydrate you, such as those containing caffeine or alcohol.

Straining your urine

lets you collect your stone for analysis. Use the strain each time you urinate. Strain your urine for as long as your doctor suggests. Watch for brown, tan, gold, or black specks or tiny pebbles. Those may be kidney stones.

If you pass your stone, then take it to your doctor.

Follow up

by taking any stones you find to your doctor for analysis. The type of stone you have determines your diet and prevention program. You may need more tests in the future. These tests will ensure that new stones are not forming.

Medications For uric acid or cystine stones, your doctor may prescribe medications. You'll take these for your lifetime. Medications can't dissolve calcium oxalate stones, but often help prevent them. If you have an infection stone, your doctor may prescribe antibiotics. You may take these before and after your stone is removed.

Uric acid stones are caused

by too much uric acid in your urine. This can be worsened

by a high-meat diet. Allopurinol reduces uric acid.

The stone can be dissolved with bicarbonate, potassium

citrate, or a similar drug.

 

Cystine stones are caused by too much cystine (an amino acid)

in your urine. This condition is uncommon and inherited.

Penicillamine or tiopronin reduces cystine. Bicarbonate, porassium

citrate, or a similar drug dissolves cystine stones.

 

Infection stones are caused by kidney or bladder

infections that change the chemical balance of your urine.

Antibiotics control the infection and may slow the stone's growth.

Then your stone is removed.

Medications For uric acid or cystine stones, your doctor may prescribe medications. You'll take these for your lifetime. Medications can't dissolve calcium oxalate stones, but often help prevent them. If you have an infection stone, your doctor may prescribe antibiotics. You may take these before and after your stone is removed.

Extracorporeal Shock Wave Lithotripsy - ESWL

ESWL is sometimes called shock wave lithotripsy. There are several types of  ESWL, but the principles are the same for all. You lie down on a water cushion. Or you sit in water medium. Then a rapid series of high-energy shock waves comes from beneath you. They pass through the water and your body to the stone. The goal is to shatter the stone into very fine sand. In most cases there is no injury and only a small amount of bruising.

Your Treatment Experience

ESWL takes place at a hospital, lithotripsy center, or specially equipped mobile unit. ESWL is an outpatient procedure. You may need another procedure before ESWL is done. For instance, a ureteral stent may be inserted in the ureter. This is a. soft plastic tube that helps urine drain past the stone. ESWL itself takes about an hour. Most pro­cedures do not require anesthesia. But you may be sedated to help you relax.

Your Recovery

Nurses will monitor you during a brief stay in the recovery room. You'll receive pain medication, if needed. Most patients can go home in a few hours. You may have blood in your urine for a few days.

The Follow Up

You  may be asked to strain your urine for several days or weeks after ESWL. Many patients are free stones in these months. Some need further ESWL treatments or an invasive procedure to get rid of remaining fragments. Follow up tests such as KUB or ultrasound will likely be done.

CALL A DOCTOR IF:

  • You have a fever over 100 degrees farienheit
  • You have svere flank pain unreleved by
  • pain medication.
  • You have trouble urinating.
  • You bleed heavily in your urine after ESWL.
  • You have nausea that doesnt go away.
Procedures and Surgery In some cases, a procedure or surgery (invasive treatment) is needed. This may be done before, after, or instead of other treatments. If you need an invasive procedure, your doctor will discuss its risks and any complications. You will be told how to prepare and you will be told about anesthesia that will keep you pain-free during treatment. Your follow-up will include a program to reduce the risk of future stones. Be sure to visit your doctor as directed.

Removal Through Ureter

Ureteroscopic stone removal extracts a small stone in your ureter without an incision. Your doctor places a viewing tube (ureteroscope) in your ureter. A wire basket inserted through the tube removed the stone. Sometimes, a laser or a mechanical device is used to break up the stone. A soft tube may

be left in your uteter briefly to drain urine.

Lithotripsy with Incision

Percutaneous lithotripsy  removes larger stones through a small incision. Your doctor places a viewing robe through your incision. The stone is sighted, shattered with a special device if needed., and removed. Afterward, you'll briefly have a small rube in your incision. This tube carries urine away from your kidney.

Open surgery

 removes very large or oddly located stones. For this surgery, your doctor makes an incision in your side. Your kidney or ureter is opened, and the stone is removed. Then your kidney is sutured closed. A drain is left near the incision to carry urine away from the wound. The drain is later removed.

 

Removal Through Ureter

Lithotripsy with Incision

Open Surgery

CALL A DOCTOR IF:

  • You have a fever over 100 degrees fahrenheit
  • You have severe sudden or flank pain
  • You have nausea that lasts for days
  • You bleed heavily in your urine
  • You bleed heavy bleeding through your drainage tube
  • You have swelling or redness around your incision

Recovery for the Procedures

 

Ureteroscopic Procedure: This is an outpatient or overnight procedure. For a few days after your surgery, you may feel some pain when you urinate. Or you may need to urinate more often, or have bloody urine. you may have a ureteral stent. this is a soft tube that prevents bloackage from swelling after the procedure. The stent is removed when the swelling goes down, often within days. Follow up as instructed to check for any new stones.

 

Lithotripsy with Incision: You may spend 1 to 3 days in the hospital. The tube in your side will be removed during or shortly after your hospital stay. A follow-up visit in three months will ensure that your stone is gone. Later visits will help your doctor spot new stones if any form.

 

Open surgery: You may spend up to 7 days in the hospital. The drain in your incision will be removed before you leave. You’ll need about six weeks of rest at home to recover fully. Follow-up visits will help your doctor spot any new stones early. This may help you avoid future surgeries.

Prevention for a Lifetime

If you’ve had a kidney stone, you may worry that you'll have another. Removing or passing your stone doesn't prevent future stones. With your doctor's help, though, you can reduce your risk of forming new stones. Ask your doctor how much water to drink each day. You may also need to make simple diet changes or take medications. And schedule follow-up visits to help your doctor detect any new stones.

Drink Lots of Water

Staying well-hydrated is the best way to reduce your risk of future stones. Depending on your health, you may be asked to drink 12 eight-ounce glasses of water daily. Have two with each meal and two between meals. Try keeping a pitcher of water nearby during the day and at night.

Follow Your Prescribed Diet

Your doctor will tell you which foods contain the chemicals you should avoid. Your doctor may also suggest talking to a dietitian.

He or she can help you plan meals you'll enjoy. These meals wont put you at risk for future stones.

Limit Certain Foods Diet changes depend on the type of stone you've had. Your doctor will tell you which foods to limit.

For calcium oxalate stones: Limit high calcium foods (dairy products), and calcium or vitamin C supplements. Limit high-oxalate foods (such as cola, tea, chocolate, and peanuts).

 

For uric acid stones: limit high-purine foods, such as anchovies, poultry, and organ meats. These foods increase uric acid production.

 

For cystine stones: high-methionine foods (fish is the most common). These foods increase your production of cystrine.

Take Medications If Needed

 

Medications, including vitamins and minerals, may be prescribed for certain types of stones. You may want to write your doses and medication times on a calendar. Some medications decrease stone-forming chemicals in your blood. Other help prevent those chemicals in your blood. Others help prevent those chemicals from crystallizing in urine. Still others help keep a normal acid balance in your urine.

 

 

 

 

 

 

 

See Your Doctor Regularly

                                                                                                                                                            Regular visits to your doctor will help him or her detect new stones early. Visits will also help ensure that old stones are gone. Follow-up tests may include urinalysis, blood tests, and imaging studies. You may follow up every three months to once a year for a lifetime.

 

 

 

 

 

 

 

 

Moving On You can make the pain of kidney stones a thing of the past. As a team, you and your doctor will choose the best treatment for you. ﷯You can also reduce your risk of forming new stones. Then you can get back to enjoying your life.

 

Associates in Urology of Central Florida

a division of Orlando Physician Specialists, LLC