While the end of summer may be filled with enjoying friends and family, barbecues, and getting some last-minute hot weather, it also represents the time we are most at risk for kidney stones. And if you live in or around Atlanta, you have the dubious distinction of being part of the Stone Belt – an area encompassing the Southeast United States where patients are particularly prone to develop kidney stones. Why is that? The combination of outdoor activity, hot weather, and many of us being chronically dehydrated can increase stone development during these hot months.
What are Kidney Stones?
Kidney stones are the buildup of material within the kidney that eventually solidifies and hardens to form a rock-like structure. Most kidney stones are made primarily from calcium and will appear on an X-ray, making them more easily diagnosable and treatable. There are several other forms of kidney stones, some of which cannot be seen with standard imaging.
When Do Kidney Stones Become Problematic?
Kidney stones can grow unnoticed for quite some time within the kidney before they become symptomatic. Typically, the symptoms hit when the stones dislodge and move into the ureter – the tube that drains urine from the kidney into the bladder. If the ureter is sufficiently blocked, urine pushes back into the kidney, causing enlargement and inflammation that can be extremely painful. Male patients say the pain is the worst they’ve ever experienced, while female patients often compare it to childbirth. It’s not something you can ignore.
Kidney stones can also become symptomatic if they stay within the kidney but become extremely large. This can block critical parts of the kidney and start to reduce kidney function. This pain should not be ignored because it can eventually lead to kidney failure. A patient experiencing kidney stones should speak to their urologist as soon as possible to understand if treatment is necessary or if it is simply back pain.
Treatment Options for Kidney Stones
For many patients with smaller kidney stones, increasing hydration to help pass the stone is painful, but ultimately, the safest way to get rid of a smaller stone – as big as 4 mm. Passing a stone can take anywhere from hours to days. In conjunction with your urologist, you can decide if further intervention is necessary. Larger stones, those over 5 mm, typically cannot be passed through the ureters and will be watched or addressed with a procedural intervention like the ones detailed below.
Eswl or Extra Corporal Shockwave Lithotripsy
Because they are so common, several possible, safe, and effective kidney stone treatments exist. Many patients undergo ESWL or extra corporal shockwave lithotripsy, which fires concentrated shock waves at the stone to break it up and allow it to be passed more easily. ESWL is performed from outside the body, making it completely non-invasive. It still requires anesthesia and a hospital visit. On the one hand, ESWL can be an excellent option for softer calcium-based stones, most often found within the kidney. However, because we don’t directly visualize the stone, remnant stone material is usually left behind, which can lead to future stone formation.
Ureteroscopy With Laser Lithotripsy
For more stubborn stones and those not calcium-based, ureteroscopy with laser lithotripsy is often an option. Albeit somewhat more invasive than ESWL, ureteroscopy involves inserting a rigid or flexible tube up the urethra, through the bladder, and into the ureter; at this point, the stone is visualized and pulverized using laser energy. Because we can visualize the stone, this is usually ideal for those within the ureter rather than those in the kidney. Because we can visualize the stone, there is a good chance of getting the patient entirely stone-free. Ureteroscopy does not have many significant side effects, especially in the hands of a highly experienced urologist. However, a stent must be placed for a few days to ensure no stenosis or narrowing of the ureter. Most patients usually tolerate this stent well, but if they have a significant adverse reaction, it is possible to remove it sooner.
PCNL or Percutaneous Nephrolithotomy
Lastly, PCNL or percutaneous nephrolithotomy is an option for large and stubborn kidney stones. This procedure is the most invasive of the three, requiring a radiologist to insert an access (tube through the skin) a day or two before the procedure. This access gives us a direct view of the stone within the kidney by placing a tube through the skin directly into the kidney. At this point, mechanical or laser technology allows us to break up the stone effectively and either physically remove it or allow it to be passed over time. The PCNL is invasive, so we reserve it for more complex kidney cases.
Prevention of Kidney Stones
Before we get into effective prevention techniques, it’s essential to understand what does not work. First is cranberry juice – no data shows that cranberry juice mitigates kidney stone formation. In fact, some studies show that it might promote the formation of the stones. That said, the concept that UTIs (urinary tract infections) may be mitigated by cranberry juice does have legs. Also, a common misconception regarding kidney stones is that if the pain goes away, you must’ve passed the kidney stone. Unless you see the kidney stone pass in your urine, it’s best to assume that it could still be there and that your urologist should monitor you throughout the process.
Some patients also mistakenly believe they should reduce their calcium intake because most kidney stones are made of calcium. This is not the case. Normal calcium levels in the blood have been shown to reduce the risk of developing kidney stones. Interestingly, consuming too much or too little calcium is a factor in developing calcium-based kidney stones.
You may also have heard that dark leafy greens, especially spinach, contain a compound known as oxalate, which may promote some kidney stones. While reducing spinach and other dark green intakes may be tempting, this is not advisable because it eliminates some phenomenally nutritious foods.
The best way to reduce the risk of kidney stones is by staying hydrated and drinking 64 ounces or more of water each day. Your body may need significantly more, especially if you’re outside in the heat and/or exercise regularly. Some experts even recommend dividing your weight in pounds by two and drinking that many ounces of water daily. It might seem like a lot, but once you start drinking throughout the day, you’ll start feeling better and do your urinary tract a big favor.
Next Steps
If you develop a kidney stone and are feeling excruciating pain associated with a symptomatic stone, or if you’ve been diagnosed with kidney stones, it’s essential to see your urologist to learn more about your treatment options and whether the stone can be treated, passed, or watched. Schedule a consultation with Dr. Kapadia.