By Alan Glatz, CNP
An estimated 13 million people in the United States have kidney stones, and many are unaware. Once a person passes a kidney stone, there is a 50-90 percent chance within five to ten years that they will experience another episode. There are multiple factors that put an individual at risk for forming kidney stones: family history, occupation, climate, and certain medications can all contribute to the formation of stones.
The exact cause of kidney stones remains somewhat speculative. We know stone disease happens when the concentration of crystals in the urinary tract is increased. Along with these crystals, there is often a matrix component to stones, which is predominantly protein. Different ions in the urine also play roles in formation; these include: calcium, sodium, oxalate, phosphate, and uric acid. Additionally, multiple dietary deficiencies can contribute to stone formation. There are many different types of kidney stones. Unfortunately, preventing stones isn’t as simple as limiting the dietary intake of the composition of a stone.
Kidney stones are insidious, often forming unbeknownst to an individual, waiting to cause problems later. They typically take years to form and don’t begin to cause trouble until moving from the kidney into the ureter, the tube connecting a kidney to the bladder. Stone passage is often not subtle, and the pain is described as severe.
Pain from passing a stone usually has a fairly sudden onset and is on one side of the flank (back) or abdomen. The pain may radiate into the pelvis and even down to the testicles in a male. Nausea, vomiting, blood in the urine, chills, or urinary symptoms may also be present. There are several other conditions that can mimic stone passage, and it is important to seek medical attention if these symptoms present themselves.
Along with a history and examination, a urinalysis can aid in the decision to proceed to a CT scan. Other diagnostic tests include a KUB (X-ray) and a renal ultrasound; however, these are of limited utility.
Obstructing stones that have dislodged from the kidney and moved into the ureter require medical attention, even if the decision to conservatively manage the situation is made. Stones that do not pass from the ureter into the bladder can cause permanent kidney damage in the matter of only a few weeks and should be monitored. A patient passing a stone requires a medical professional to check for the presence of other signs or symptoms which can point to further potential complications.
Kidney stones come in all shapes, colors, and sizes. Once a stone reaches four to five millimeters (about the size of a BB), its odds of passing spontaneously within an acceptable period are only 40-50 percent. Once a stone reaches six millimeters, the odds of passage decrease significantly. It is important to note that the size of a stone does not necessarily indicate how eventful passage will be for the patient.
If a patient’s pain or nausea is not controlled with medications, it’s often time to intervene. Other concerning symptoms, such as the presence of an infection, can affect the decision to expedite treatment as well. There are multiple interventions for stones, and there are several factors which affect a surgeon’s choice in a particular patient. Lithotripsy utilizes an energy source to send shock waves at a stone to cause dispersal. While this treatment is less invasive than other treatments, it can be less effective. If a stone is lower in the ureter, a ureteroscopy and stone extraction is often the treatment of choice. This is highly effective as the stone is directly visualized by the surgeon.
Prevention of stones is a great treatment option once problematic stones have been addressed. Modifications such as increasing fluid intake, dietary changes, and even taking certain medications are strategies that can be employed to limit future stone formation. Often, a metabolic work-up can be used to identify specific areas to correct which can slow or stop the formation of future stones.
For more information about kidney stones or other urologic conditions, please contact OSF Medical Group – College Avenue Urology at 309-664-3000 or visit www.osfmedicalgroup.org.