Treatment And Medication Options For Kidney Stones
You may not always need treatment for a kidney stone. A small stone can pass through the urinary tract without intervention. But larger stones can block the ureter and cause pain and other symptoms.
Kidney stone pain can be severe at first and may require carefully administered narcotics for relief, says Ralph V. Clayman, MD, a professor in the department of urology at the University of California in Irvine. Subsequent pain can often be managed using nonsteroidal anti-inflammatory medication, he says.
Drinking a lot of water can help to pass the stone. In addition, doctors may prescribe tamsulosin, which is a medication that relaxes the muscles of the ureter, helping the stone pass, says Dr. Lesser.
If a stone is too big to pass or a patient has an intolerable amount of pain, doctors may intervene with procedures that either break up or remove the stones, says Lesser.
These procedures include:
Kidney stones call for conventional medical care, so dont try to treat kidney stones with alternative therapies.
Antibiotics continue to be the number one go-to treatment for urinary tract infections.
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.
Who Is More Likely To Develop Kidney Stones
Men are more likely to develop kidney stones than women. If you have a family history of kidney stones, you are more likely to develop them. You are also more likely to develop kidney stones again if youve had them once.
You may also be more likely to develop a kidney stone if you dont drink enough liquids.
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Causes Of Kidney Stones
Kidney stones happen when your pee has a high concentration of minerals and other substances — like calcium, oxalate, and uric acid — that come together to make crystals. Crystals stick together to make one or more stones. Stones happen when your urine doesnât have enough fluid and other substances to keep them from happening.
A kidney stone can be as tiny as a grain of sand, and you can pass it without ever knowing. But a bigger one can block your urine flow and hurt a lot. Some people say the pain can be worse than childbirth.
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.
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Kidney Stones And Pain
Kidney stone pain can be excruciating. Individuals who have never had a stone may be suffering from a great deal of discomfort without knowing why. In reality, kidney stones are generally silent until they begin to pass. A stone that grows to 3 millimeters or larger can block the ureter as it moves from the kidney to the bladder. This movement can cause unbearable pain, usually in the lower back, right / left flank, or groin. Kidney stone pain can be intermittent or ongoing.
Diagnosis: Too Much Calcium In The Urine
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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Who Is At Risk For Kidney Stones
Anyone may develop a kidney stone, but people with certain diseases and conditions or those who are taking certain medications are more susceptible to their development. Urinary tract stones are more common in men than in women. Most urinary stones develop in people 20 to 49 years of age, and those who are prone to multiple attacks of kidney stones usually develop their first stones during the second or third decade of life. People who have already had more than one kidney stone are prone to developing further stones.
In residents of industrialized countries, kidney stones are more common than stones in the bladder. The opposite is true for residents of developing areas of the world, where bladder stones are the most common. This difference is believed to be related to dietary factors. People who live in the southern or southwestern regions of the U.S. have a higher rate of kidney stone formation, possibly due to inadequate water intake leading to dehydration than those living in other areas. Over the last few decades, the percentage of people with kidney stones in the U.S. has been increasing, most likely related to the obesity epidemic.
A family history of kidney stones is also a risk factor for developing kidney stones. Kidney stones are more common in Asians and Caucasians than in Native Americans, Africans, or African Americans.
Uric acid kidney stones are more common in people with chronically elevated uric acid levels in their blood .
What Is Shock Wave Lithotripsy
Shock Wave Lithotripsy is the most common treatment for kidney stones in the U.S. Shock waves from outside the body are targeted at a kidney stone causing the stone to fragment. The stones are broken into tiny pieces. lt is sometimes called ESWL: Extracorporeal Shock Wave Lithotripsy®.
These are what the words mean:
- extracorporeal: from outside the body
- shock waves: pressure waves
So, SWL describes a nonsurgical technique for treating stones in the kidney or ureter using high-energy shock waves. Stones are broken into “stone dust” or fragments that are small enough to pass in urine. lf large pieces remain, another treatment can be performed
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What Causes Kidney Stones
- By Kevin R. Loughlin, MD, MBA, Contributor
Stone disease has plagued humanity since ancient times. Kidney stones have been identified in Egyptian mummies. The Hippocratic oath describes their treatment: I will not use the knife, not even verily, on sufferers from stone, but I will give place to such as are craftsmen therein.
What Are The Types Of Kidney Stones
There are four types of kidney stones:
Calcium stones are the most common type of kidney stones. They form when calcium mixes with oxalate in your urine. These form when you are not getting enough fluids or calcium.
Uric stones are also a common type of kidney stone. High levels of a natural chemical called purine in your body can cause a high level of a chemical called urate that can create these kidney stones. This type of kidney stone tends to run in families.
Struvite stones are less common than calcium and uric stones. Struvite stones can happen when bacteria from upper urinary tract infections get into your urinary tract.
Cystine stones are caused by a rare condition called cystinuria that is passed down in families. Cystinuria causes a natural chemical called cystine to leak into your urine. When there is too much cystine in your urine, kidney stones can form. These stones can get stuck in your kidneys, bladder or anywhere in your urinary tract. Most people with cystinuria will get many stones in their life. It is a lifelong condition that can be treated but not cured.
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Symptoms Of Kidney Stones
Small kidney stones may go undetected and be passed out painlessly in the urine. But it’s fairly common for a stone to block part of the urinary system, such as the:
- ureter the tube connecting the kidney to the bladder
- urethra the tube urine passes through on its way out of the body
A blockage can cause severe pain in the abdomen or groin and sometimes causes a urinary tract infection .
Read more about the symptoms of kidney stones.
Calcium Oxalate And Calcium Phosphate Stones
Calcium stones are the most common type of kidney stones, and can be either calcium oxalate or calcium phosphate. As mentioned, good hydration is important to prevent calcium stones. It may be surprising, but results of a randomized clinical trial show that people with calcium kidney stones should not cut back on dietary calcium. In fact, they should consume the recommended daily allowance of calcium . Why? Calcium binds to oxalate in the intestine and prevents its absorption through the gut, so there is less in the urine to form stones. Ideally, calcium should come from food. Talk with your doctor before taking calcium supplements, and increasing fluid intake might be beneficial depending on how much calcium you take.
Foods high in oxalates can increase the amount of oxalate in the urine. Consume these in moderation.
Calcium phosphate stones are less common than calcium oxalate stones. Causes include hyperparathyroidism , renal tubular acidosis , and urinary tract infections. It is important to understand if one of these conditions is behind the formation of calcium phosphate stones.
Good hydration can help prevent recurrence of calcium stones. In addition, thiazide diuretics such as hydrochlorothiazide can help the kidney absorb more calcium, leaving less of it in the urine where it can form stones. Potassium citrate is another medication that can bind to calcium and help keep calcium oxalate and calcium phosphate in the urine from forming into stones.
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Signs And Symptoms Of Kidney Stones
Pain is a classic symptom of kidney stones, says Prakash N. Maniam, MD, a urologist at Oviedo Medical Center in Oviedo, Florida. The pain is usually sharp and felt along the sides of the torso. It may radiate around to the abdomen and into the groin area as the stone moves through the urinary tract system, he says.
As the stone moves along the tract, it can block the natural flow of urine, which causes the kidney to swell, Dr. Maniam explains. The swelling activates nerves, which sends signals that are interpreted by the brain as an intense visceral pain, he says.
More than half a million people go to the emergency room because of kidney stones every year.
In addition to pain, blood in the urine and a burning sensation during urination are other common symptoms of kidney stones, says Maalouf. Sometimes with severe pain, patients develop nausea and vomiting, he adds.
If stone pain and fever develop, go directly to the ER, advises Timothy F. Lesser, MD, a urologist at Torrance Memorial Medical Center in Torrance, California. Fever is a sign of infection. Notably, a kidney stone with a urinary tract infection may cause and must be treated immediately.
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.
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Why You Get Stones
Part of preventing stones is finding out why you get them. Your health care provider will perform tests to find out what is causing this. After finding out why you get stones, your health care provider will give you tips to help stop them from coming back.
Some of the tests he or she may do are listed below.
Medical and Dietary History
Your health care provider will ask questions about your personal and family medical history. He or she may ask if:
- Have you had more than one stone before?
- Has anyone in your family had stones?
- Do you have a medical condition that may increase your chance of having stones, like frequent diarrhea, gout or diabetes?
Knowing your eating habits is also helpful. You may be eating foods that are known to raise the risk of stones. You may also be eating too few foods that protect against stones or not drinking enough fluids.
Understanding your medical, family and dietary history helps your health care provider find out how likely you are to form more stones.
Blood and Urine Tests
When a health care provider sees you for the first time and you have had stones before, he or she may want to see recent X-rays or order a new X-ray. They will do this to see if there are any stones in your urinary tract. Imaging tests may be repeated over time to check for stone growth. You may also need this test if you are having pain, hematuria or recurrent infections.
Urge To Urinate Or Frequent Urination
Sometimes people with kidney stones feel like they need to peea lot. This symptom depends on where the stone is located. Stones that are close to the bladder will have a lot of bladder symptoms: frequency, urgency, needing to get to the bathroom quickly, and going small amounts, Dr. Pearle notes.
The reason? Stones irritate the walls of the bladder and that manifests as the bladder contracting, she says, which makes you feel like youve gotta go.
If not a lot of pee comes out, you might think youre having trouble passing urine. But those bladder contractions can occur even if your bladder is empty, Dr. Peale explains. Unless the stone is actually in the urethra, there shouldnt really be trouble urinating, she says. You should always be making urine.
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What Are The Symptoms Of Kidney Stones
If you have a small kidney stone, it may travel out of your body through your urine . You may not have any symptoms and may never know that you had a kidney stone.
If you have a larger kidney stone, it may get stuck in your urinary tract and block urine from getting through. You may notice symptoms, including:
- Pain while urinating
- Sharp pain in your back or lower belly area
- Stomachache that does not go away
- Feeling sick to your stomach or throwing up
- A fever and chills
- Urine that smells bad or looks cloudy
You may feel a lot of pain when you pass a kidney stone or if a large kidney stone blocks the flow of your urine.
If you are having any of these symptoms, contact your doctor.
Where Kidney Stones Grow
With that in mind, and to begin with, what exactly do we know?
One thing we know for certain: clinically significant calcium oxalate kidney stones grow in human kidneys attached to plaque deposits of calcium phosphate embedded within kidney tissue.
Another: Calcium phosphate deposits plug the terminal ends of kidney tubules. On the open ends of such plugs ends that face onto the urine small rounded overgrowths form. They contain mixtures of calcium oxalate and calcium phosphate. We believe they detach and grow into significant stones stones big enough to cause pain, obstruction, need for surgery. But we do not know for sure because we see and harvest overgrowths only a few millimeters around too small to do much to patients.
Often we find stones attached to nothing. They bear on their surfaces no traces of a prior attachment site. We believe such stone stones form in urine not necessarily attached to anything.
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