Kidney stones affect one person in ten in a lifetime. They are most common in caucasian men between the ages of 30 and 50, and once you have had one, the incidence of recurrence is high. While there is evidence that kidney stones have been around for as long as humans have, the incidence has increased. And as with most other
health problems in humans in the past 30 years, this is most likely due to poor
diet and laziness.
Kidneys are located in the middle of the back under the rib cage. Composed of nearly 40 miles of tubes, they process approximately 100 gallons of blood per day, removing extra water and waste to convert it into urine. They also balance salts and other substances in the blood stream, produce hormones for bone fortification and help to form red blood cells. Kidney stones develop right in the kidney when waste materials do not dissolve completely, and build up along the lining.
It is possible to pass many tiny, undetected stones through your urinary tract (composed of the ureter, a tube that leads from the kidney to the bladder; the bladder, where urine is stored; and the urethra, which leads urine from the bladder out of the body). It is when the stone spends a longer time in the kidneys, allowing it to build up, that the process becomes extremely painful.
Causes and Composition
In the most general sense, kidney stones usually form when there is a breakdown in the balance of liquids and solids in your urine. Hydration is one of the most important elements of healthy kidney function. You need enough water in your urine in order to dissolve solids and carry them painlessly through the urinary tract.
There are four common types of stones, which all develop due to different conditions in the body. The most common type of stone is composed of calcium (either bound to oxalate or phosphate in the system). Approximately 85% of kidney stones are composed of calcium and produced due to excess calcium in the urine. Excess amounts of calcium can be present for several reasons, including hormonal disorders like hyperparathyroidism, excessive amounts of calcium being absorbed by the intestines, or a kidney condition called renal calcium leak. Other causes of high calcium levels in the kidneys can include use of steroids, calcium-based antacids or diuretics like furosemide. Nutritional causes include diets that are high in red meat and poultry, or vitamins A and D.
Uric acid stones are more common in men than in women and account for about 10% of renal stone disease. Uric acid is produced in digestion, and an abundance may lead to an inability to break down the acid, causing stones to form. Also possible are struvite stones, which are caused by bacterial infection in the urinary tract, an affliction more common in women, and cystine stones, composed of the amino acid, cystine, which does not dissolve well.
Symptoms
If you are producing kidney stones that are very small, chances are that they will pass unnoticed. As they accumulate mass, however, they are understandably more painful to eliminate. In fact, women who have had kidney stones and bore children have attested to the fact that they would choose childbirth over the pain of passing a kidney stone.
Kidney stones generally do not get painful until they leave the kidneys and attempt to make their way down the ureter. Initial symptoms include sharp pain shooting through the back and flank (side of your body). As the tiny ureter contracts to push the stone through, the flow of urine can get blocked. Pain can shoot around into the abdomen and groin, causing nausea and sometimes vomiting. You may feel the urge to pee frequently, which might burn coming out, and you may notice that your urine has become discoloured, cloudy or pinkish (indicating blood in the urine). If you experience fever or chills, there is most likely infection present, so if the excruciating pain hasn’t inspired you to contact your doctor yet, do so.
When you go to the doctor or emergency room, the doctor will order a CT (computed tomography) scan or an IVP (intravenous pyelogram) to diagnose the stones. This will enable them to detect the stone’s size and location in your urinary tract. If you need to just forge ahead and pass the stone, the best way to do so is to drink as much water as you can stand (2-3 quarts a day) and stay active. The stone is much more likely to move if you are moving around.
Treatment and prevention
Most physicians prefer to allow kidney stones to pass through the urinary tract on their own rather than intervene surgically. If a kidney stone is under ¼ inch in diameter, you will most likely be encouraged to drink lots of water and pass the stone naturally. If they are larger than a ¼ inch, there are several ways in which a doctor can ease the process of passing the kidney. Major surgery used to be the most common treatment for the removal of kidney stones, but doctors have sought to develop new, less intrusive ways that do not require the 4-6 weeks of recovery time.
Extracorporeal Shockwave Lithotripsy (ESWL) is one of the more common procedures. The kidney stones are located using an x-ray and shock waves are directed at the kidney stones in order to break them up into manageable pieces that can then pass through your system. While anesthetic is used in this therapy, it is usually performed on an outpatient basis. The pieces of stones may still take up to three months to work themselves out of your system, however.
Two methods of extraction that do not require passing the stone naturally include the Percutaneous Nephrolithotomy (PNL) and Ureteroscopic stone removal (URS). In PNL, the surgeon inserts an instrument into your kidney through a tiny incision in your back and removes the stones. This may require a few days’ stay in the hospital. The URS procedure can be used when the stones are lodged in the mid- to lower-ureter. A fiberoptic scope is inserted into the urethra, through the bladder and into the ureter where it wither grabs the stone or, if it is too big, shatters it with a shock wave. Some doctors may perform the same procedure using lasers to vaporize the stone.
All in all, it’s hard to get through the kidney stone experience without some succinct pain and incredibly uncomfortable sounding procedures involving things going in those places where you are only used to things coming out. If you have family members who have had kidney stones, there is a higher risk that you too will get them, so your best chance at evading these procedures is prevention.
Some prevention tips:
- If you have had a stone, have your doctor analyze it so you know what it is formed of and can make a prevention plan based on that.
- To avoid the most common types of stones, calcium-based stones, a diet that is high in naturally occurring calcium is good, but stay away from artificial sources (antacids, supplements).
- Sodium causes calcium levels in blood to rise, so lessen your salt intake.
- Cut back on foods with high oxalate levels (as that is what calcium often binds to), including beets, chocolate, caffeinated beverages (coffee, tea, colas), rhubarb, spinach, strawberries.
- Eat lots of foods high in potassium and magnesium, as these help to dissolve solids in the kidneys
- Be active. Inactivity leads to a higher incidence of kidney stones.
- Most importantly, drink plenty of fluids, every day.
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