When Surgery Is Necessary
If you think you might have a kidney stone, you should see your doctor as soon as possible. If youre found to have one, your doctor can help you determine whether to try to pass the stone naturally, take medication, or get the stone surgically removed.
In some circumstances, your doctor might recommend immediate surgical removal without a waiting period. This will usually be because the stone is too big to pass naturally or is blocking urine flow. If the stone is blocking the flow of urine, it can lead to an infection or renal damage.
In other circumstances, your doctor might recommend waiting to see if you can pass the stone on your own. You should check in with your doctor often during this time to see if anything is changing, especially if you have new symptoms.
During the waiting period, your doctor might recommend surgery if the stone continues to grow, youre having unmanageable pain, or you develop signs of infection, such as a fever. Infection, fever, kidney damage, intractable pain, or intractable vomiting are all indications for immediate surgery.
Certain Foods Can Cause Stones But Not Calcium
Ironically, although kidney stones are often made up of calcium, they are not caused by calcium intake itself. Calcium does not usually affect stone formation, unless you are eating much, much more than the recommended daily amount, Nabhani explains. We recommend most patients with kidney stones eat the daily recommended amount of calcium.
So what foods do lead to kidney stones?
High salt and nondairy animal protein all types of meat, beef, chicken, fish and pork are associated with increased stone formation, Nabhani says.
Salt keeps calcium from being absorbed by the body.
In addition, foods rich in oxalate, such as nuts, chocolate, spinach and tea, may cause increased stone formation, he adds.
Diagnosis: Too Much Calcium In The Urine
Possible treatments:
Thiazide diuretics
These drugs help to decrease urine calcium excretion. They also help to keep calcium in the bones, reducing the risk for osteoporosis. The most common side effect of thiazide diuretics is potassium loss, so in many cases your doctor will prescribe a potassium supplement to go along with the thiazide diuretic.
Lower sodium intake
The human body carefully regulates its sodium levels. When excess sodium is excreted in the urine, calcium is also excreted proportionally. In other words, the more sodium you consume, the more calcium that will be in your urine. Your goal should be to reduce your sodium intake so that you consume less than 2 grams of sodium per day. Watch out for silent sources of salt, such as fast foods, packaged or canned foods, softened water and sports drinks.
Normal calcium diet
People who form stones sometimes think that because there is too much calcium in their urine, they should restrict their calcium intake. There is no research that supports this practice. Your body needs dietary calcium to support the skeleton. You should be encouraged to consume two servings of dairy or other calcium-rich foods to maintain bone stores of calcium.
Increase fluid intake
No matter what your diagnosis, you should drink enough water to produce at least 2 liters of urine per day.
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What Size Of Kidney Stones Require Surgery
The hard deposits of minerals such as calcium or uric acid that form in the kidneys are called kidney stones. It is one of the most common health conditions that trouble both genders.
Some kidney stones that are quite small in size, tend to pass on their own through urine. That is why drinking enough water and healthy fluids helps a lot in dealing with kidney stones.
Whether a stone can pass naturally through the urine or needs medical intervention for removal depends upon the size, type, and location of the stone. In most cases, stones that have a high probability of getting stuck anywhere in the urinary tract require surgical treatment for removal.
According to doctors, the kidney stones that are larger than 6mm in size can obstruct the ureter or bladder. This causes intense pain and complications. These stones have less than a 20 percent chance of passing naturally and even if they do, it may take up to a year for this to happen. Thus, doctors are of the opinion that the kidney stones of 6mm or more require surgery.
A quick fact: Stones of size 4mm or less have an 80 percent chance of passing on their own. The probability of a stone passing through urine decreases with the increase in the size of the stone.
Other reasons for carrying out surgery for kidney stones may include intense and unbearable pain, an infection in the kidney stone, or the obstruction of urine flow by the kidney stone.
Locating The Kidney Stone
Having a kidney stone pass easily also involves where the location of the mineral buildup is within the renal system. While formation takes place inside the kidneys, the hardened stones can also be found in the ureters the thin tubes that allow urine to pass from the kidneys into the bladder. After moving through the kidneys and ureters, kidney stones can be located inside the bladder, waiting to exit the body.
Research has shown that kidney stones inside the ureter, which are closer to the bladder, have a 79 percent chance of passing on their own. Kidney stones higher up in the ureter only have shown a 48 percent chance of passing without medical treatment.
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How Are Kidney Stones Diagnosed
Your healthcare provider will discuss your medical history and possibly order some tests. These tests include:
- Imaging tests: An X-ray, CT scan and ultrasound will help your healthcare provider see the size, shape, location and number of your kidney stones. These tests help your provider decide what treatment you need.
- Blood test: A blood test will reveal how well your kidneys are functioning, check for infection and look for biochemical problems that may lead to kidney stones.
- Urine test: This test also looks for signs of infection and examines the levels of the substances that form kidney stones.
What Are The First Signs Of Kidney Stones
Identifying the early signs of kidney stones is very important. It may be easier to pass the stone, and also in order to prevent complications such as kidney or urinary tract infections and the forming of larger kidney stones that may be harder to pass.
Common kidney stone early symptoms may include:
- Painful urination, often with burning.
- Frequent urination, urgent need to go.
- Sudden, severe waves of pain in the back, lower back, belly, sides, front, lower abdomen pain or general abdominal pain.
- Blood in the urine .
- Fever and chills are usually a sign of a urinary tract infection or kidney infection.
References
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What Are The Types Of Kidney Stones
The four types of kidney stones are:
Calcium
Calcium oxalate stones are the most common type of kidney stone. They represent almost 70-80% of all stones. They are caused by a build-up of calcium and oxalate or phosphate. While there are many reasons for why calcium stones form, calcium intake, too little fluid intake, or even too much Vitamin C consumption are some of the more well recognized causes.
Uric Acid
This type of kidney stone can be caused by urine that is too acidic or in individuals with gout. It results from the buildup of uric acid.
Struvite
Struvite kidney stones are uncommon . They are typically caused by certain bacteria that may infect the kidney. Stones are comprised of magnesium, phosphate and ammonium.
Cystine
Cystine stones are quite rare and usually only found in people with genetic condition called cystinuria. This condition makes them unable to reabsorb a normal body chemical, called cystine. As a result, they excrete an abnormal amount of cystine which can crystallize, forming stones.
Acid Reflux Medicines May Cause Kidney Damage
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Long-term use of certain medications commonly used to treat heartburn, acid reflux, and ulcers can have damaging effects on the kidneys. The findings come from a study appearing in an upcoming issue of the Journal of the American Society of Nephrology . In 2013, an estimated 15 million Americans were prescribed proton pump , which reduce gastric acid production. This number is likely an underestimate because the medications are also available over-the-counter and can be purchased without prescription.
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Risk Factors You Can’t Control
White men have a greater risk for kidney stones than other groups, starting in the 40s. Women see their risk rise in the 50s. And your odds also go up if you have a family history of kidney stones. Certain medical conditions can boost the risk — high blood pressure, gout, urinary tract infections, certain kidney conditions such as polycystic kidney disease — but treating or controlling these conditions generally helps prevent stone formation.
Interventions For Preventing Kidney Stone Recurrence
Dietary interventions help prevent stone recurrence by altering concentrations of crystal-forming or crystal-inhibiting substances in urine. Certain dietary recommendation are:
- Increasing water intake
- Reducing dietary animal protein and other purines
- Maintaining normal dietary calcium
Pharmacological interventions may also be suggested to prevent stone recurrence in high risk patients, such as use of:
- Thiazide diuretics
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Extracorporeal Shock Wave Lithotripsy
All shock wave lithotripsy machines deliver shock waves through the skin to the stone in the kidney. Most but not all of the energy from the shock wave is delivered to the stone.
Stone size is the greatest predictor of ESWL success. Generally:
- stones less than 10 mm in size can be successfully treated
- for stones 10 to 20 mm in size, additional factors such as stone composition and stone location should be considered
- stones larger than 20 mm are usually not successfully treated with ESWL.
Stones in the lower third of the kidney can also be problematic because, after fragmentation, the stone fragments may not be cleared from the kidney. Due to gravity, these fragments dont pass out of the kidney as easily as fragments from the middle and upper thirds of the kidney.
Obesity also influences whether ESWL treatment will be successful. The urologist will calculate the skin-to-stone distance to help determine whether this treatment is likely to be effective.
The possible complications of ESWL include:
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Whats The Urinary Tract How Does It Work
Your urinary tract is vital to your body because it gets rid of waste and extra fluid. Its made up of both your kidneys, two ureters, your bladder and your urethra. Each organ has an important job :
- Kidneys: Your fist-sized, bean-shaped kidneys are located on either side of your spine, below your rib cage. Each day they filter 120 to 150 quarts of your blood to remove waste and balance fluids. Your kidneys make one to two quarts of urine every day.
- Ureters: After your kidney creates urine, the liquid travels through the tube-shaped ureter to the bladder. There is one ureter per kidney. Kidney stones can pass through the ureters or, if theyre too big, get stuck in them. You may require surgery if the stone is too large.
- Bladder: Between your hip bones is your bladder, an organ that stores urine. It stretches to hold about one and a half to two cups.
- Urethra: Like a ureter, your urethra is a tube through which urine passes. Its the final stop of the urinary tract where your urine leaves your body. This is called urination.
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Early Signs Of Passing Kidney Stones
Kidney stones often cause extreme pain while they pass via urine however, all kidney stones are not painful. Some kidney stones present noticeable symptoms while they are passed and therefore give a clear indication that you need to visit a doctor. Some of the early signs of passing kidney stones are mentioned below:
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How Small Is Small Enough
The smaller the kidney stone, the more likely it will pass on its own. If it is smaller than 5 mm , there is a 90% chance it will pass without further intervention. If the stone is between 5 mm and 10 mm, the odds are 50%. If a stone is too large to pass on its own, several treatment options are available.
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Types Of Kidney Stones
There are four main types of stones:
How Can Ureteral Stones Be Prevented
You will not have ureteral stones if you do not have kidney stones. If you have had a kidney stone, your doctor can help you learn how it was formed and what you can do to prevent others from forming. Your doctor may treat the stone BEFORE it moves into the ureter and causes pain.
You may be asked to change your diet in the following ways:
- Drink more fluids.
You may also be prescribed medications to help prevent the formation of kidney/ureteral stones.
Last reviewed by a Cleveland Clinic medical professional on 09/18/2017.
References
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How To Help Preventing Kidney Stones
There are many things that you can help your child do to reduce the chances of developing more kidney stones. Children with kidney stones should:
- Drink a lot of fluid throughout the day . Ask your healthcare team for an amount that’s right for your child. If your child has kidney disease and needs to limit fluid, please discuss this with the team.
- Limit salt in the diet.
- Eat more fruits and vegetables, especially citrus fruits.
- Eat fewer meats, processed foods, fast food, and sodas.
- Avoid food and drinks with high fructose corn syrup.
- Keep a healthy weight.
- Eat the recommended amount of calcium-rich foods and drinks. Cutting back calcium in the diet is not recommended and can sometimes actually increase stone risk. On the other hand, don’t take a calcium supplement unless your doctor says your child needs one.
Your doctor may also recommend that your child see a pediatric nephrologist, a kidney specialist who treats children with kidney stones. Blood tests and a 24-hour urine collection test may determine why your child formed a kidney stone. With this information, a registered dietitian nutritionist can make specific dietary recommendations and your doctor and health care team can prescribe medicines to reduce your child’s risk for making future kidney stones.
Removing Stones Through An Endoscopic Procedure
There are two common methods for removing stones through a surgical procedure: ureterorenoscopy and percutaneous nephrolithotripsy .
- Ureterorenoscopy : In this method, tiny instruments are moved through the urethra and bladder with the help of an , and pushed up into the ureter where the stone is. There the stone is either broken up mechanically or using a laser so that the pieces can be flushed out in the urine or removed using the endoscope. URS is used for stones that are bigger than 10 millimeters in diameter and are in the middle or lower third of the ureter. Kidney stones up to 20 millimeters in diameter are often removed using URS.
- Percutaneous nephrolithotripsy : In this method, an is moved into the renal pelvis or the kidney through a small cut made on your back. There the stones can also be either broken up mechanically or with a laser. Tiny forceps are used to remove the pieces of the kidney stones. This method is mainly used to treat kidney stones greater than 10 millimeters in diameter.
General anesthesia and a short hospital stay are necessary for both of these approaches.
Nowadays, more major surgery is only very rarely needed to remove kidney stones.
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How Should My Kidney Stone Be Treated
Historically, the treatment of kidney stones required major surgery and was associated with long hospitalization and recovery periods. However, in recent years an improved understanding of kidney stone disease, along with advances in surgical technology, has led to the development of minimally invasive and even noninvasive treatments for people with kidney stones.
At Johns Hopkins, we believe that the treatment of a patients stones requires an approach that is unique to that individual. We offer a complete range of state-of-the-art treatment options, including ESWL , ureteroscopy and PERC, and we will discuss with you the advantages and disadvantages of each therapy as they apply to your situation. Our goal is to provide each patient with a clear understanding of the nature of their stone burden as well as the most appropriate course of treatment.
What Are The Most Common Types Of Kidney Stones
The most common type of kidney stone is a calcium oxalate stone. This type happens when calcium and oxalate combine in your urine. It can happen when you have high quantities of oxalate, low amounts of calcium and arent drinking enough fluids.
Stones caused by uric acid are also fairly common. These come from a natural substance called purine, which is a byproduct of animal proteins .
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