Kidney Stones – What Are They?
Conveniently located to serve Houston and Clear Lake, TX
What Is It?
Kidney stones are hard deposits that are made from minerals and salts that form in the urine. They are also known as renal calculi, ureteral calculi, nephrolithiasis, or urolithiasis. Kidney stones can affect any portion of the urinary tract, from your kidneys down to the bladder.
Typically, stones form when urine turns concentrated, permitting minerals to crystallize and stick to one another. 50% of patients who form a stone will have additional stones in the future. Recently, younger adults and even children are now suffering from nephrolithiasis due to changes in lifestyle and diet.
For this reason, it is important to schedule a consultation with Dr. Dhir when initially diagnosed with stone disease.
What are the Symptoms?
- Pain that occurs in waves and varies in intensity
- Flank pain radiating to the lower abdomen or groin
- Burning with urination or urgency to urinate
- Bloody, tea-colored, or cloudy urin
- Fever, chills, nausea, and/or vomiting
Stones form in the kidney and increase in size over time. Stones in the kidney do not typically cause any symptoms or pain. Unfortunately, these stones eventually dislodge and pass down the ureter – the drainage tubes connecting the kidneys to the bladder. The ureters are quite narrow, therefore most stones over 5mm in size will get stuck.
When these larger stones get stuck and block the ureter, urine backs up in the kidneys in a condition called hydronephrosis. Hydronephrosis, with its accompanying ureteral spasms, is a very painful experience. Most women will compare it to the pain of childbirth!
What are the Causes?
There are many factors that can increase your risk for kidney stones. Genetics, diet, obesity, medical conditions such as diabetes, history of gastric bypass, as well as certain medications and vitamins are all contributory factors.
When the urine contains more substances that are crystal-forming – like oxalate, calcium and uric acid – the urinary environment is at risk for stone formation. Low urinary citrate, a urinary metabolite that protects from stone formation, can also be a deficiency leading to recurrent stones.
What are the Treatment Options?
- Metabolic Expulsion Therapy (MET) – Smaller stones, usually <5mm, are treated conservatively with pain medication, drinking large amounts of fluid to pass the stone, and using an a-blocker medication (like Flomax) to aid in passing the stone into the bladder.
- Surgical Management:Large stones in the kidney are usually treated with surgery before they lodge themselves in the ureters and cause a painful ER visit. Additionally, stones larger than 5mm stuck in the ureters will also cause pain and necessitate surgery.
Surgical options for kidney stones include:
- Extracorporeal Shockwave Lithotripsy (ESWL): ESWL uses minimally-invasive acoustic sound waves to break up stones that form in the kidney or ureter, enabling easy passage of the resulting “stone dust” through the urine. ESWL is a one-hour procedure and patients go home the same day. Most patients can resume activities or work after 24 hours.
- Ureteroscopy with Laser Lithotripsy (URS): URS with laser lithotripsy involves a thin, long flexible telescope called a ureteroscope, to internally examine the ureter and kidney for stones. Stones identified are then pulverized using a laser filament with fragments sometimes removed using a small “stone basket”. This procedure usually takes under an hour, involves no cuts or incisions, and also allows patients to go home the same day.
How do I Prevent Stones?
After a stone is passed, it is important to undergo a metabolic stone evaluation. Analysis of the stone usually identifies stones composed of calcium oxalate. Other common types identified include struvite stones and uric acid stones.
Struvite stones are associated with recurring urinary infections; uric acid stones are commonly associated in patients with gout, chronic diarrhea, or diets high in animal protein.
Dr. Dhir will also order a 24-hour urine test to identify any other mineral imbalances in the urine that could lead to future stone formation. Labs – including parathyroid hormone, uric acid, and calcium – are important to identify risk factors in the blood.
Based on the results of testing, removing calcium and vitamin C supplements, increasing fluids, reducing oxalate-rich foods, or decreasing animal protein in the diet may be recommended. Oxalate rich foods include tea, tree nuts, beets, dark leafy greens (spinach and kale), and chocolate. In certain instances, medications may be prescribed to reduce calcium levels in the urine or increase citrate in the urine to disrupt stone formation.
Contact Our Office
In cases of painful stones or recurrent urinary stones, HTX Urology is here to help! Dr. R. Robert Dhir is a highly skilled and board-certified Urological surgeon who proudly serves patients in the greater Clear Lake area of Houston, TX. His clinical focus includes leading-edge, minimally-invasive treatments of stone disease with an emphasis on prevention.
If you are interested in learning more about kidney stones and what you can do to manage this recurrent condition, please contact our office at 281-946-6462 or schedule online for your consultation today.