Purpose Of Proposed Comparative Effectiveness Review
There is significant variation in current medical practice regarding management to prevent recurrent nephrolithiasis. Clinical uncertainty exists regarding the effectiveness, comparative effectiveness, and adverse effects of different dietary and pharmacological preventive treatments the value of urine and blood biochemical measures for initiating and/or modifying treatment and the potential impact of patient and stone characteristics on important treatment outcomes. Where data allow, the proposed systematic review and meta-analysis will comprehensively address all these questions. Our findings should inform providers and patients making treatment decisions, organizations developing clinical guidelines, and policymakers making coverage decisions. Results also should effectively define the limitations of existing evidence and the parameters of any future RCTs or other research studies needed to address remaining evidence gaps.
Calcium Is Not The Enemy
But it tends to get a bad rap! Most likely due to its name and composition, many are under the impression that calcium is the main culprit in calcium-oxalate stones. “I still see patients who wonder why they are getting recurring stones despite cutting down on their calcium intake,” said Dr. Jhagroo. “I’ve even had patients say that their doctors told them to reduce their calcium intake.” A diet low in calcium actually increases one’s risk of developing kidney stones.
Don’t reduce the calcium. Work to cut back on the sodium in your diet and to pair calcium-rich foods with oxalate-rich foods.
How Long Does It Take A Kidney Stone To Form
You can have kidney stones for years without knowing theyre there. As long as these stones stay in place within your kidney, you wont feel anything. Pain from a kidney stone typically starts when it moves out of your kidney. Sometimes, a stone can form more quickly within a few months.
Talk with your healthcare provider about your risk factors. They might do a 24-hour urine test to check how quickly you develop stones.
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How Can I Tell If I Have A Kidney Stone
Routine screening for kidney stones common but not recommended for all people.
Kidney stones can be detected using imaging such as X-rays, ultrasound, CT scan, or MRI. The best imaging currently available for kidney stone detection is a CT scan.
If you have crystals in your urine, that does not mean that you have a kidney stone. Crystals in the urine are common. If you have crystals in your urine along with other symptoms of kidney stones, you should see a doctor for an exam and imaging.
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What Questions Should I Ask My Healthcare Provider
- Do I have a kidney stone or is there another reason for my symptoms?
- What type of kidney stone do I have?
- What size is my kidney stone?
- Where is my kidney stone located?
- How many kidney stones do I have?
- Do I need treatment or will I be able to pass the kidney stone?
- Should I be tested for kidney disease?
- What changes should I make to my diet?
- What type of procedure should I have to get rid of the stones?
A note from Cleveland Clinic
Kidney stones can be frustrating at best and agonizingly painful at the worst. To stop your situation from getting worse, you should be evaluated by a healthcare provider as soon as possible. The pain can get severe, and surgery might be necessary. Remember: dont skip your prescriptions, drink lots of water and follow any dietary guidelines. Also, remember that kidney stones are a temporary condition. They wont bother you forever.
Last reviewed by a Cleveland Clinic medical professional on 05/03/2021.
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The Good News Is That Tonsil Stones Are Usually Not Harmful
While tonsil stones may be troublesome, they are generally not harmful. And they are not a sign of cancer or another illness. Some people may become concerned when they see these deposits on their tonsils and may think they have a tumor or another illness, says Thatcher. But the fact is that tonsils stones are not something to worry about. Its not life-threatening and its not linked to severe disease, says Thatcher.
In some cases, tonsil stones may increase your risk of tonsillitis . And in rare cases, if the growths are very large, they may cause breathing or swallowing problems, according to a paper published in April 2018 in the Saudi Medical Journal.
If you suspect that you may have tonsil stones, its important to see an otolaryngologist to get the right diagnosis and rule out other serious medical problems that may be causing some of your symptoms, such as strep throat, tonsillitis, or cancer. And be sure to see your doctor if you spot any of the following symptoms, which can be a sign of infection or more serious medical problem:
- A chronic sore throat that lasts more than a month
- Breathing problems
- Trouble swallowing
- Severe pain, especially on one side
- One tonsil is larger than the other
Treatment For Your First Stone
If your doctor thinks the stone can pass on its own, and if you feel you can deal with the pain, he or she may suggest home treatment, including:
- Using pain medicine. Non-prescription medicine, such as non-steroidal anti-inflammatory drugs , may relieve your pain. Be safe with medicines. Read and follow all instructions on the label. Your doctor can prescribe stronger pain medicine if needed.
- Drinking enough fluids. You’ll need to keep drinking water and other fluids when you are passing a kidney stone.
Your doctor may prescribe medicine to help your body pass the stone. To learn more, see Medications.
If your pain is too severe, if the stones are blocking the urinary tract, or if you also have an infection, your doctor will probably suggest a medical procedure, such as lithotripsy, or surgery to deal with the stone. For more information, see Other Treatment and Surgery.
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Things That Can Help You Take A Pass On Kidney Stones
- By Matthew Solan, Executive Editor, Harvard Men’s Health Watch
If youve ever passed a kidney stone, you probably would not wish it on your worst enemy, and youll do anything to avoid it again. “Kidney stones are more common in men than in women, and in about half of people who have had one, kidney stones strike again within 10 to 15 years without preventive measures,” says Dr. Brian Eisner, co-director of the Kidney Stone Program at Harvard-affiliated Massachusetts General Hospital.
It’s Not One And Done
Passing a kidney stone is often described as one of the most painful experiences a person can have, but unfortunately, it’s not always a one-time event. Studies have shown that having even one stone greatly increases your chances of having another. “Most people will want to do anything they can to ensure it doesn’t happen again,” said Dr. Jhagroo. “Unfortunately, it doesn’t seem to be the case that people make the changes they need to after their first stone event.”
Research conducted by Dr. Jhagroo shows that those with kidney stones do not always heed the advice of their nephrologists and urinary specialists. About 15% of kidney stone patients didn’t take prescribed medications and 41% did not follow the nutritional advice that would keep stones from recurring. Without the right medications and diet adjustments, stones can come back, and recurring kidney stones also could be an indicator of other problems, including kidney disease.
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Excessive Protein On Keto Diets
Although a true keto diet isnt high in protein, diet culture keto tends to be incredibly high in protein. There isnt a formal definition for diet culture keto, but I would guess many people are easily eating 4x their protein needs.
All this extra protein causes a dramatic drop in urine pH. During metabolism, dietary protein produces acid. Assuming someone has normal kidney function, the body gets rid of extra acid via the urine. High urine acid levels make both uric acid and calcium oxalate kidney stones more likely.
Excess protein can also increase urine calcium, which is another risk factor for kidney stones.
How Long Does It Take To Pass A Kidney Stone
The amount of time it can take for you to pass a kidney stone is different from anothers. A stone thats smaller than 4 mm may pass within one to two weeks. A stone thats larger than 4 mm could take about two to three weeks to completely pass.
Once the stone reaches the bladder, it typically passes within a few days, but may take longer, especially in an older man with a large prostate. However, pain may subside even if the stone is still in the ureter, so its important to follow up with your healthcare provider if you dont pass the stone within four to six weeks.
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Duration Of Kidney Stones
A kidney stone often goes unnoticed until it starts to pass into your ureters. Once this happens, symptoms typically appear without warning. Youll likely feel sharp, stabbing pain at the bottom of your ribcage, though the pain can shift into the genital area as well.
The pain from kidney stones often comes in waves, and you may feel better for a few hours before the pain comes back.
Depending on the size of the stone, it can take up to six weeks to pass . Small stones may take only a few days to a week to pass. Your doctor will likely prescribe medications to help you manage the pain during this time.
Avoiding Recurrence Of Kidney Stones
If you have had one kidney stone, some tips that may help to prevent a second stone forming include:
- Talk to your doctor about the cause of the previous stone.
- Ask your doctor to check whether the medications you are on could be causing your stones. Do not stop your medications without talking to your doctor.
- Get quick and proper treatment of urinary infections.
- Avoid dehydration. Drink enough fluids to keep your urine volume at or above two litres a day. This can halve your risk of getting a second stone by lowering the concentration of stone-forming chemicals in your urine.
- Avoid drinking too much tea or coffee. Juices may reduce the risk of some stones, particularly orange, grapefruit and cranberry. Ask your doctor for advice.
- Reduce your salt intake to lower the risk of calcium-containing stones. Dont add salt while cooking and leave the saltshaker off the table. Choose low- or no-salt processed foods.
- Avoid drinking more than one litre per week of drinks that contain phosphoric acid, which is used to flavour carbonated drinks such as cola and beer.
- Always talk to your doctor before making changes to your diet.
Drinking mineral water is fine it cannot cause kidney stones because it contains only trace elements of minerals.
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Calcium Supplements And Kidney Stones
The connection between calcium supplements and kidney stones is somewhat controversial. There were some concerns that calcium supplements can cause kidney stones, although most of the studies show no increase in stone risk with high calcium intake. In fact, some evidence suggests the opposite, where calcium intake is shown to lower the risk of developing kidney stones.. Furthermore, according to the medical literature, a diet too low in calcium can actually increase the risk of getting calcium stones .
The general recommendation is to maintain moderate dietary calcium intake, and when needed take calcium supplements with a meal. If you are at risk of developing kidney stones, you should consult your doctor in order to monitor the calcium levels and the related kidney stones parameters .
Favorite Kidney Stone Blogs
CareBlog is the blog of the Urology Care Foundation, an organization dedicated to supporting urologic research and providing urologic health information to the public. The blog features information on kidney stones, as well as information on general urologic health .
Want to hear about kidney stones from people whove gone through the experience? Let this website, which was founded by Mike M. Nguyen, MD, MPH, an associate professor of urology at the Keck School of Medicine at the University of Southern California in Los Angeles, be your guide. You can read through essential information from experts, as well as patient accounts and contributor articles that answer questions you may be wondering about, such as: Do vegetarians get kidney stones? and Does drinking a lot of water help a stone pass faster?
With additional reporting by Lauren Bedosky.
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When To See A Urologist
Kidney stones that do not receive the proper medical treatment can ultimately cause bleeding, urinary tract infections, and organ damage/failure. If you suspect you might have a kidney stone or are having complications with your renal system seeing a urologist is strongly recommended.
Contact our office to be seen by a specialist to provide personalized care and treatment for all your urology needs.
Vitamin D And Kidney Stones
The connection between vitamin d and kidney stones has been evaluated in many published studies. According to research, vitamin D levels were significantly higher in kidney stone patients compared to healthy adults . On the other hand, vitamin D intake in typical amounts was not statistically associated with risk of kidney stone formation .
The bottom line: vitamin D is an important vitamin that plays a key role in many body functions. Research data suggests that 50% of Americans have vitamin D deficiency . For this reason, it is very important to make sure you are not deficient in vitamin D. If you are at a risk of developing kidney stones, you may want to consult your doctor in order to determine the exact amount of vitamin D you need.
To learn more about the importance of vitamin D to a healthy immune system, risks of vitamin D deficiency and the best ways to get vitamin D, see: Vitamin D and your immune system.
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B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions
We will identify evidence for this review by searching relevant bibliographic databases, as well as several sources commonly used to identify grey literature. Bibliographic database searching will utilize MEDLINE and the Cochrane Central Register of Controlled Trials to identify RCTs published in 1948 to the present . Initially, the search strategy will identify studies indexed with the MeSH term urolithiasis and related keywords. Results from this initial search will be limited to relevant publication types or keywords to identify controlled trials, RCTs, systematic reviews, and meta-analyses. Bibliographic database searches will be supplemented with hand searching of the reference lists of included studies, previous systematic reviews, and relevant clinical guidelines. Additional search strategies may include forward citation searching of included RCTs and systematic reviews by using the Web of Science and Google Scholar. The literature search will be updated while the draft report is under public and peer review.
The search strategies we will use are outlined below:
- Ovid MEDLINE Search Strategy
- 1 urolith*.mp. or exp Urolithiasis/
- 2 .mp.
- 3 renal colic.mp. or exp Renal Colic/
- 4 hypercalciuria.mp. or exp Hypercalciuria/
- 5 exp Hyperoxaluria, Primary/ or exp Hyperoxaluria/ or hyperoxaluria.mp.
- 6 hyperuricemia.mp. or exp Hyperuricemia/
- 7 cystinuria.mp. or exp Cystinuria/
- 8 .mp.
- 20 limit 19 to English language
Diagnosis Of Kidney Stones
Many kidney stones are discovered by chance during examinations for other conditions. Urine and blood tests can help with finding out the cause of the stone. Further tests may include:
- CT scans
- x-rays, including an intravenous pyelogram , where dye is injected into the bloodstream before the x-rays are taken.
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Let Kidney Stones Pass
Stones typically take several weeks to a few months to pass, depending on the number of stones and their size. Over-the-counter pain medications, like ibuprofen , acetaminophen , or naproxen , can help you endure the discomfort until the stones pass. Your doctor also may prescribe an alpha blocker, which relaxes the muscles in your ureter and helps pass stones quicker and with less pain.
If the pain becomes too severe, or if they are too large to pass, they can be surgically removed with a procedure called a ureteroscopy. Here, a small endoscope is passed into the bladder and up the ureter while you are under general anesthesia. A laser breaks up the stones, and then the fragments are removed.
Diagnosis: Low Urine Ph
Citrate supplements, such as potassium citrate, will raise the pH of your urine, making stones, such as those composed of uric acid, less likely to form. If your blood potassium level is high, your doctor may prescribe sodium bicarbonate or Bicitra.
Lower protein intake
A diet high in protein will reduce urinary pH. As a general recommendation, limit your daily protein intake to 12 ounces per day of beef, poultry, fish and pork. Twelve ounces is equivalent in size to about three decks of cards. This will be plenty of protein to meet your bodys needs.
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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How Are Children Treated For Kidney Stones
Most childrens kidney stones can be treated with the shock wave lithotripsy , a completely non-invasive procedure. Your child is placed under anesthesia and sound waves of specific frequencies are focused on the stones to shatter them into fragments small enough to be easily passed during urination.
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