Have you ever heard that passing a kidney stone is more painful than giving birth or having a heart attack? That’s what Veronica told her family doctor after being asked about her medical history. She has given birth to birth to three children, suffered a heart attack and was treated for kidney stones.
She said, “Doctor, kidney pain is the worst pain. Seven months ago, around one o’clock in the morning, I got this agonizing pain below my ribs on my right side that went towards my back. I jumped out of bed and was hopping around as if I was walking on hot charcoal. I couldn’t get comfortable. I felt queasy and vomited. The pain was horrendous.
My husband drove me to the hospital and the emergency room doctor asked me questions. I told him about the pain and me vomiting. He suspected I had kidney stones (K. S.) and gave me pain medicines that really didn’t work that well.
They put a needle in my vein, took some blood, a urine sample and wheeled me to the X-ray department. The radiologist told me I had a kidney stone in the ureter and it’s causing the pain. He talked briefly about the ureter and kidneys but it went over my head. I just wanted the pain to go away. Since then, I’ve learned a lot about kidney stones.”
Kidney Stones (K. S.) are pebble-like pieces of material made of minerals and acid salts that form inside your kidney. Most kidney stones are as small as a grain of sand and pass out of the body in the urine without the need of a doctor. However, they can be as large as a jagged pearl or bigger. They can remain in the kidney or travel into the ureter, a tube that connects the kidney and the bladder. The ureter is particularly sensitive to being stretched, which triggered Veronica’s pain.
Urinary system
- Kidneys: The kidneys are two bean-shaped organs that have many functions. For example, they filter waste from the blood and produce urine.
- Ureters: They are two thin, pain sensitive tubes that move urine from the kidney to the bladder
- Bladder: a sac that holds urine until you need to go to the bathroom
- Urethra: the tube that passes urine from the bladder out of the body when you urinate
Symptoms
Kidney stones cause intense, excruciating pain on your side or in the back that may be associated with nausea and vomiting. People are up and down finding it difficult to get into a comfortable position.
As the stone moves down the ureter, people can experience pain that moves from the back and side to over the abdomen, thigh or in the groin. As the stone gets ready to pass into the bladder, people may also complain of urinary frequency. Once the stone enters the bladder, the pain subsides and, eventually, the stone passes through the urethra and out of the body in the urine.
Other findings include fever and chills, blood in the urine and cloudy urine that burns when you urinate.
Diagnostic Workup
A good history and examination most of the time leads to the correct diagnosis of K. S. In addition, obtaining a urinalysis, urine culture, and imaging studies add vital information. Urinalysis can identify microscopic blood in the urine as well as detecting stoneforming minerals. Urine cultures are useful to rule out infection.
Imaging studies include a CT that can identify the presence and location of renal stones. Ultrasound is the preferred test to be used in pregnant women with stones. Another test involves injecting a dye into the vein in your arm and taking X-rays.
‘Types’ of Kidney Stones
There are four types of kidney stones:
Calcium stones
Calcium stones accounts for approximately 80% of kidney stones. Calcium oxalate is the most common type of calcium stone (more than calcium phosphate). Extra calcium that isn’t used by your bones or muscles goes to the kidney. If it’s not eliminated with the urine, it can combine with other minerals to form calcium stones.
Uric Acid Stones
A diet rich in red meat, fish and seafood may lead to uric acid stones
Struvite Stones
Such stones may form after you have had urinary tract infections.
Cystine Stones
These stones result from a hereditary disorder, one that is passed down through families. The amino acid cystine travels through the kidneys into the urine (cystinuria). In such families, there’s a two times increased risk in getting stones.
Treatment
Treatment depends on identifying the type of kidney stone and obtaining image studies that pinpoint the stone’s size and its location. Lifestyle and dietary adjustments are useful in minimizing future bouts of kidney stones. If you have uric acid stones, for instance, minimize or eliminate foods such as red mead, anchovies and seafood from your diet.
Medications have been used successfully to dilate the ureter and aid in the passing of kidney stones. Medications dissolve uric acid kidney stones. There is no need for surgery in these cases. Other patients with different stones have required surgery to remove large kidney stones.
In Veronica’s case, she was diagnosed as having calcium oxalate stones and underwent a lithotripsy. This is a procedure done under general anesthesia wherein ultrasound shock waves pulverize a kidney stone into small particles, so that they can be passed out through the urine. Lasers are also used to crumble kidney stones.
After Veronica returned home, she spent less time sitting at the computer, enrolled in an exercise program and avoided becoming dehydrated. She was informed to reduce her salt intake, since excess salt in the diet increases the risk of kidney stones.
Kidney stones are a common disorder about equally prevalent in men and women. Being well hydrated is an essential first step to minimize future episodes of K. S. It follows that the more diluted the mineral crystals are in the kidney, the more difficult it is to form kidney stones The take home message from a few urologists who suffer from kidney stones is to, “Drink lots of water!”
References
- Tilahun Alelign and Beyene Petros; Kidney Stone Disease: An Update on Current Concepts Adv Urol, 2018
- Wayne Brisbane, et al; An overview of kidney stone imaging techniques; Nat Rev Urol. 2016 Nov; 13
- L. F. Fontenlleand; T. D. Sarti; Kidney Stones: Treatment and Prevention; Kidney Stones:
- Treatment and Prevention; Am Fam Physician, April, 2019
- American Urologic Association; Medical Student Curriculum: Kidney Stones; 2019
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.