I’ve had quite a few female patients who’ve told me that the pain of having a kidney stone is similar to the intensity of pain during childbirth. A patient came in the other night with intense abdominal/side pain associated with nausea and vomiting. At first I thought he might have had appendicitis but after we were able to give him enough fluid by IV to rehydrate him and get a urine sample I saw he had blood in his urine and the CT scan showed a 3mm stone in his kidney.
Kidney stones (also called nephrolithiasis or urolithiasis) are small solid fragments or crystals with sharp barbs on them that form within the urinary tract. They can be made up of calcium, oxalate, cysteine, uric acid or a combination of these and other substances. When these crystals form within the kidney or urinary tract they can become anchored or stuck and get larger. Sometimes additional kidney stones are also formed while one is already lodged within the kidney or ureter. The ureter is a small tube that drains the urine from the kidney down to the bladder. When a kidney stone travels down the ureter it can cause pain that radiates from the kidney all the way down the side and abdomen to the urinary bladder.
Risks for Developing Kidney Stones: Certain factors can increase your chances of developing a kidney stone including:
2) Diet with high level of sugars
3) High sodium diet
4) Low calcium in your diet
5) Diet with lots of animal protein
6) Diet with low levels of phytate (phosphorus that we get mostly from plants)
7) Patients with gout
9) Crohn’s disease
10) History of bariatric surgery such as gastric or intestinal bypass surgery
1) Pain – most patients complain of pain either in the back, flank or abdomen. The pain seems to come on in waves (called renal colic) and sometimes it may be barely noticeable and then become so intense that it requires treatment in the hospital.
2) Bloody urine
3) Pass small stones in the urine
6) Pain with urination
Diagnosis: Sometimes the patient’s symptoms and history can be very suggestive of kidney stones and making the diagnosis is easy. Other times it can be more challenging to diagnose kidney stones and imaging studies such as a CT scan or ultrasound. Plain x-rays can also sometimes show kidney stones.
Treatment: For patients who come to the medical clinic we try to ensure that they are well hydrated to prevent the formation of more stones and help the current stones to pass. Some patients need IV fluids to help with the hydration process, especially if they have been vomiting and aren’t keeping fluids down. Depending on the size of the stone and location, the patient may be able to treat their symptoms at home with over the counter pain medications such as Advil or Aleve. In addition, we may prescribe medications that help the stone to pass more easily. If the pain becomes severe, the patient may need to be treated with stronger pain medications and sometimes hospitalization is necessary. If the stones are larger than 5mm, they don’t pass on their own very easily and generally require a procedure to break them up or remove them. Some treatments to remove the stones may include:
1) Shock wave lithotripsy (SWL): Ultrasonic energy is used to break up the larger stone so that it can be passed more easily
2) Percutaneous nephrolithotomy (PNL): A surgical procedure that is minimally invasive may be required to remove a stone that is extremely large or complex, especially if SWL is not effective. Small instruments are inserted through the skin in the operating room to remove the stone.
3) Ureteroscopy: A small scope is passed through the urethra up into the bladder and then up into the ureter. This scope has a small camera and instruments that are used to remove the stone or break it up into small pieces. This procedure is used more often if a stone is blocking the ureter and causing swelling of the kidney.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO