Opinions Of Urologists In General
Though the physiologic basis of pain in the setting of obstruction is clear, it does not provide an explanation for one of the most commonly encountered conundrums in stone disease the symptomatic non-obstructing stone. These can be actual free stones that have not passed, stones attached to plaque, or actual plugs in the kidney tubules that are massed together enough to show up on a CT scan as stones though actually tissue calcifications.
There is perhaps as much variation in clinical opinion in such instances as any other clinical scenario in the field.
If one were to ask a group of urologists whether they believed that small nonobstructing stones could cause renal colic, opinions would range from absolute certainty to complete dismissal of the concept altogether.
Where Is Kidney Stone Pain Located
The sharp pain associated with a kidney stone moves as the stone progresses through your urinary tract. The most common places to feel pain are in your:
- Lower abdomen or groin
- Along one side of your body, below your ribs
- Lower back
However, while pain is certainly the most noticeable symptoms of kidney stones, its not always the earliest sign or even the most telling sign, for that matter.
The pain associated with a kidney stone typically isnt felt until after its already formed and is passing through your urinary tract, explains Dr. Kannady. In addition, due to differences in anatomy, men and women describe kidney stone pain slightly differently. Not to mention that pain itself is relative and everyone has a different threshold for it.
Plus, the intensity of the pain isnt necessarily a measure of how problematic the kidney stone might be or become. Smaller stones that are likely to pass on their own can still be very painful. And not every kidney stone that requires medical intervention comes with gut-wrenching pain.
Any time youre experiencing pain, its important to see your doctor. But if youre experiencing pain, even if its only mind, in combination with the kidney stone symptoms above and, in particular, if you have a fever or severe trouble urinating its definitely important to see your doctor, warns Dr. Kannady.
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Hydroxyapatite Grows Over Exposed Tissue Plaque
This dramatic human example of a stone growing on plaque was found years ago, and is probably the best one available.
The stone grew on a stalk that is the calcium phosphate overgrowth on plaque. This is just like the stone with plaque on its underside and its matching plaque I showed in the surgical video image.
This sample has the advantage of showing the plaque in the kidney tissue. It is the black material calcium phosphate is stained here to bring it out.
The tissue below it is renal papilla. You can see a few end on tubules looking like round tubes.
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Who Gets Kidney Stones What Are The Risk Factors
Kidney stones are common. According to the most recent data from the National Institute of Diabetes and Digestive and Kidney Diseases, about 11 percent of men and 6 percent of women in the United States have kidney stones at least once during their lifetime. Men are affected more often than women, and overweight and obese people are more likely to get a kidney stone than people of normal weight.
Risk factors include:
- Gender men are more likely than women to develop a kidney stone
- Age older people are more affected
- Race Caucasians are at higher risk
- Family History
- Certain medications including, indinavir , acyclovir , diuretics , sulfadiazine
- Associated conditions including, obesity, inflammatory bowel disease, gout, hyperparathyroidism
- Anatomic conditions urinary obstruction, UPJ obstruction, urinary stasis
Once you have a kidney stone, you are also more likely to develop a future kidney stones.
The UCLA study Prevalence of kidney stones in the United States published in European Urology reported on the risk factors that make a person especially likely to develop a kidney stone.
What Is The Treatment For Cystinuria
Treatment starts with doing things to keep stones from forming. For adults and children, this means drinking more water, reducing salt, and eating less meat. If these steps are not enough, you may also need to take special medicine to help keep stones from forming.
- Drinking more water. Drinking lots of water will lower the ability for the cystine to form stones in the urine. Ask your healthcare provider how much water you should drink each day to help keep stones from forming.
- Changing your diet. Cystine stones are less able to form in urine that is less acidic. Eating more fruits and vegetables can make the urine less acidic. Eating meat produces urine that has more acid, which can increase your risk for cystine stones.
- Reducing salt. Eating less salt can help keep cystine stones from forming. Try not to eat salty foods, including potato chips, French fries, sandwich meats, canned soups, and packaged meals.
- Medicine. Some people may also need to take prescription medicine to help keep stones from forming. Different medicines work in different ways. Some types help to keep your urine less acidic. Other types help keep cystine stones from forming by not allowing crystals to come together. Your healthcare provider can explain these different options and help you find the right medicine for you.
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Can Children Get Kidney Stones
Kidney stones are found in children as young as 5 years. In fact, this problem is so common in children that some hospitals conduct ‘stone’ clinics for pediatric patients. The increase in the United States has been attributed to several factors, mostly related to food choices. The two most important reasons are not drinking enough fluids and eating foods that are high in salt. Kids should eat less salty potato chips and French fries. There are other salty foods: sandwich meats, canned soups, packaged meals, and even some sports drinks. Sodas and other sweetened beverages can also increase the risk of stones if they contain high fructose corn syrup.
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Three Phases Of Pain In More Detail
The Physiology
No discussion regarding ureteral obstruction would be complete without the work of E. Darracott Vaughan, who characterized the physiology of urinary obstruction in the 1970s.
Assuming two functional kidneys, the physiologic effects of acute unilateral ureteral obstruction can be marked by three distinct phases.
In phase one, the effects of the inflammatory cascade described above cause a progressive rise in renal blood flow and renal pelvis and ureteral pressure. This phase lasts for approximately one to one and a half hours. This is the portion where the afferent arteriole the faucet is maximally opened.
Phase two is marked by efferent arteriolar vasoconstriction which causes a decrease in overall renal blood flow but an increase in ureteral pressure for up to five hours. The faucet is opened and the end clamp is tightened.
Phase three is marked by a further decrease in renal blood flow to the affected kidney and ultimately decreased ureteral pressure. The end clamp is progressively tightened so blood flow to the kidney is reduced enough that filtration and urine production begin to fall, and pressure with it.
Measurements of ureteral pressure and renal blood flow after onset of acute unilateral ureteral obstruction.
The Symptoms
It is easy to conjecture how these three distinct phases correlate clinically to the symptoms experienced during an acute episode of colic.
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Passing A Kidney Stone
Small kidney stones may pass on their own without treatment. A doctor may recommend drinking more fluids to help flush the stone out of the system.
In some cases, the doctor may prescribe the medication Tamsulosin. This drug relaxes the ureter, making it easier for stones to pass. Some people may also require over-the-counter or prescription pain relief medication.
According to the AUA, a person should wait no longer than 6 weeks to pass a small kidney stone. They should seek medical attention sooner if they experience worsening pain or an infection.
In some cases, a doctor may recommend surgery to place a ureteral stent to allow urine to bypass the stone, with or without removing the stone at the same time. According to the Urology Care Foundation, doctors usually reserve surgery for stones that may have caused or lead to infection or stones that do not pass and block urine flow from the kidney.
When To See A Doctor
In many cases, small kidney stones can pass on their own and dont require any treatment.
If youre able to manage your pain with over-the-counter medications and dont have any signs of infection or severe symptoms like nausea or vomiting, you may not need treatment.
However, if you experience any of the following symptoms, you should seek immediate medical attention:
- blood in the urine
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Diagnosis: Low Urine Ph
Possible treatments:
Citrate supplementation
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.
What Are Kidney Stones
Usually, your kidneys remove waste from your blood to make urine . When there is too much waste in your blood and your body is not producing enough urine, crystals begin to form in your kidneys. These crystals attract other wastes and chemicals to form a solid object that will get larger unless it is passed out of your body in your urine.
Kidney stones can be as small as a grain of sand or as large as a golf ball.
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Kidney Stone Undescended No Symptoms
A kidney stone starts as tiny crystals that form inside the kidney where urine is made. Most kidney stones enlarge to about 1/8 to 1/4 inch in size before leaving the kidney and moving toward the bladder. There are 4 types of kidney stones. Eighty percent are calcium stonesmostly calcium oxalate but also some with calcium phosphate. The other 3 types include uric acid stones, struvite stones , and rarely, cystine stones.
When the stone breaks free and starts to move down the ureter it often causes sharp, severe back and side pain, often with nausea and vomiting. When the stone reaches the bladder, the pain stops. Once in your bladder, the kidney stone may pass through the urethra while you are urinating . Or, it may break into such small fragments that you dont notice it passing.
Your kidney stone is still inside the kidney. There is no way to predict how long it will be before it breaks free and causes any symptoms. Most stones will pass on their own within a few hours to a few days . You may notice a red, pink, or brown color to your urine. This is normal while passing a kidney stone. A large stone may not pass on its own and may require special procedures to remove it. These procedures include:
-
Lithotripsy. This uses ultrasound waves to break up the stone.
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Ureteroscopy. A thin, basket-like instrument is pushed through the urethra and bladder to pull out the stone.
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Direct surgery through the skin
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Dietary Calcium And Kidney Stones
Only lower your calcium intake below that of a normal diet if instructed by your doctor. Decreased calcium intake is only necessary in some cases where absorption of calcium from the bowel is high.
A low-calcium diet has not been shown to be useful in preventing the recurrence of kidney stones and may worsen the problem of weak bones. People with calcium-containing stones may be at greater risk of developing weak bones and osteoporosis. Discuss this risk with your doctor.
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What Does A Kidney Stone Feel Like
Most people dont notice they have a kidney stone until it moves from the kidney into the ureter the tube that carries urine from the kidney to the bladder and causes pain. There are a few symptoms to watch for, including:
-
Severe, sharp pain in lower abdomen or back, typically on one side
-
Burning sensation when urinating
-
Eating foods high in sugar or salt
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Genetic predisposition
Kidney stones are most common in men between the ages of 20 and 49. The primary reasons men are more likely to develop kidney stones include:
-
Diet. A high protein, high salt diet makes kidney stones more likely. Men tend to have a greater intake of both.
-
Dehydration. Men tend to drink less water than the recommended daily intake about 64 ounces a day.
Urine Contacts The Tissue Plaque
Most of the plaque you see in the picture is inside the shiny membrane that covers the papillary surface. So long as the membrane covers it stones cannot form. But where the stone grew that membrane gave way. Urine bathed the exposed plaque and minerals from that urine formed the initial hydroxyapatite binding site that shows up at the bottom of the stone in the right hand panel of the picture.
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What Will Happen After I Leave The Hospital
After treatment, you will have blood in your urine and possibly abdominal pain or aching for several days. Other people experience a severe cramping pain as shattered stone fragments make their way out of the body. Oral pain medication and drinking lots of water will help relieve symptoms.
Sometimes, the stone is not completely broken up, or big pieces remain and additional treatments may be needed.
Rarely, more serious problems occur, such as bleeding near the kidney that might require a blood transfusion, damage to the area around the stone, or pieces of the stone blocking the flow of urine.
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:
- ultrasound
- 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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Clinical Presentation Of Nephrolithiasis
Nephrolithiasis often is incidentally identified in asymptomatic patients who undergo plain radiographs or computed tomographic imaging for another indication.15 Small stones generally pass through the urinary tract without symptoms. While larger stones may cause symptoms, more than 90 percent of stones 5 mm in diameter still pass through the urinary tract without intervention, as compared to spontaneous passage of approximately 50 percent of stones 5 to 10 mm in diameter.16 Potential symptoms of nephrolithiasis include: urinary symptoms such as dysuria, hematuria, and urgency renal colic with severe abdominal and flank pain nausea and vomiting urinary tract obstruction infection and acute, though generally transient, impairment in renal function. Large struvite stones remain in the renal pelvis and may not cause pain. Some studies have suggested that nephrolithiasis also may increase the risk of chronic kidney disease.17,18 Nephrolithiasis also may lead to hospitalizations and procedure-related morbidity. Direct medical expenditures for nephrolithiasis in the United States have been estimated at $2.1 billion annually.1
Youve Probably Heard That Passing A Kidney Stone Can Be Very Painful But You Might Not Know Exactly What They Are Or How To Avoid One In The First Place
Kidney stones and passing a kidney stone, in particular are notorious for being painful. Theyre also surprisingly common. In fact, 11% of men and 6% of women in the United States will have a kidney stone at least once in their lifetime.
While kidney stone pain is unmistakable, its also possible to have a kidney stone and not even know it. If the stone is small enough to pass through your urinary tract, it may cause little to no pain at all but if its large and gets stuck, you may have severe pain and bleeding.
Kidney stones that cause symptoms or cannot pass on their own need to be treated by a medical professional.
What are kidney stones?
The kidneys two bean-shaped organs located just below the rib cage on each side of the spine filter waste and extra water from the bloodstream to create urine. From the kidneys, urine then moves through two thin tubes, called ureters, into the bladder.
In addition to filtering waste, the kidneys also regulate water, salt and mineral levels in your blood. Renal calculi, the medical term for kidney stones, form when there is a high level of these minerals in the urine.
Are there different types of kidney stones?
Kidney stones can range in size and shape, with some as small as a grain of sand, others the size of a pebble and less commonly, some growing as large as a golf ball. Kidney stones can also be made of different substances, and they are divided into four common types.
The types of kidney stones are:
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What Are Percutaneous Nephrolithotomy And Percutaneous Nephrolithotripsy
These procedures are treatments for kidney stones that are used in patients with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by SWL or those who are not candidates for another common stone treatment, ureteroscopy. Stones that are bigger than 2 cm require this procedure.
Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and “vacuum” up the dust using a suction machine.
This is what the words mean:
- Percutaneous means through the skin
- Nephrolithotomy is a combination of the word roots nephro- , litho-, and -tomy
- Nephrolithotripsy is a combination of the word roots nephro- , litho , and -tripsy