Urology Center Of Idaho

Urology Center of Idaho
208.233.3355
500 S 11th Ave # 301

Pocatello, ID 83201

         
 

Kidney stones are likely the most disturbing thing that can happen to anyone. Women who had children have told me that they would take childbirth over having a stone any day of the week.

If you present to the emergency room the doctor may suspect a stone as the cause for your acute pain. A special X-ray called CT may be done. This is the best study to discover a stone. Once discovered, its size will determine if it is possible to pass it. If it is a stone less than 4 mm, there Is a good chance it can. In this case, you will benefit from five measures:

  1. Hydration: The more fluid you take in, the more will the stone push out.
  2. Alpha blockers: This class of medication will relax the muscular tube (called the ureter) which connects the kidney to the bladder which is where the stone is stuck. Relaxing this muscular tube increases the chance of the stone to pass.
  3. Pain medication: This will be necessary when stone pain hits.
  4. Nausea medication: When a stone causes massive pain, frequently the bowel quits, too. Managing nausea and vomiting is therefore paramount in managing stone problems.
  5. Strainer: Once the stone made it to the bladder, it is comparatively easy to be passed with the urine. You might not even notice this, since the bladder outflow tube (called the urethra) is much wider than the ones connecting the kidneys to the bladders (the ureters). This is why a sieve is given to you: Urinate through it, and you can capture the stone for analysis so its composition can be determined.

Once kidney stones start to form, they usually increase in size. As long as they are small, they may pass with the urine without being noticed. If they do not pass, however, they may stay in the kidney and grow. As long as they stay in the kidney, they cause no problems, but once they move into the narrow tube connecting the kidney to the bladder, called the ureter, they become a problem. They do this by obstructing the urine flow. The pressure builds up. This pressure is what causes the intense pain associated with what we call ‘renal colic’.

This is usually when I see a patient: Intense pain in the flank, possibly bloody urine, and a history of presenting to an emergency room for help.

The options involved to address this condition are usually related to where the stone is located:

  1. If the stone located near the kidney, extracorporeal lithotripsy is the best choice. This is a method of stone breakage which relies on the fact that kidney stone is brittle. A sonic bang is created outside of the patient’s body which is then focused into the patient’s kidney stone.
  2. Distal stone: This is addressed with a direct approach to the stone. This is called ureteroscopy which means looking into the ureter. General anesthesia is applied. No cuts are made. A small camera is introduced into the urinary canal. When the stone is found, a tiny fiberglass fiber is then used to break up the stone. Larger fragments are then recovered and saved for analysis, so the chemical composition of the stones can be found.

Why Do Stones Form?

The most commonly found stone in humans is a Calcium Oxalate stone. Normally, urine contains a multitude of compounds which were excreted by the kidneys. These compounds are in solution, just like common salt is dissolved in water. Stones form when the concentration of these compounds is too high; there just is not enough water to keep things dissolved. 

I’ll explain: The kidneys’ job is to filter the blood. This is why of all the blood the heart is pumping, a full ¼ goes through the kidneys. Doing this, they produce about 180 liters (about 50 gallons) of urine every single day! Obviously, life would be unsustainable at this urine output. The kidney then concentrates the urine down by recovering water back into the bloodstream. It does this more or less, depending on how much fluid we drink. When it is done, and we did not drink enough fluids, the resulting solution is laden with compounds which ordinarily could not dissolve in the volume of water provided. This is called a supersaturated solution.

Stones form when in this situation when an irregularity causes a site of crystallization. It may be triggered by a small crystal of uric acid, a suture left after an operative procedure, or anatomic variation of the kidney’s inner structure. In any case, small imperfections will produce the seed for kidney stones. It is like something is instructing the dissolved compounds to come together and form a solid.  

How can stones be prevented?

Stones are very common. If any stone or fragment is recovered, it is usually sent for analysis. If anyone has more than one stone, it is time to investigate what may have caused it. We will do a simple set of tests to find out what may have caused the stone to form. Once this is known, more specific ways to prevent further stones to form can be concluded.

Hydration

The most important thing you can do to prevent stones is to increase fluid intake: This will make the stone forming compounds less concentrated in the urine preventing crystallization. This recipe to prevent stones works for any of the stones, and should be the first measure taken against stones. 

Calcium Oxalate Stones 

This is the most common kidney stone. They happen when Calcium and Oxalate are too concentrated. These two “like and find each other and form a solid we call a stone". So if we don’t want to make stones, we better keep Calcium and Oxalate concentration in the urine as low as possible.

Calcium

Calcium is a very important ion for the human body. Besides being important to bone formation, it actually is a neurotransmitter. If it not present in the body at an exact concentration, none of our nervous system would work. If it gets out of balance, our muscles start to cramp, and we actually go crazy. That is why the body has a very close watch on how much Calcium is taken up by the gut – no matter how much Calcium we eat, the body decides how much ends up in the bloodstream, and subsequently how much is put in the urine by the kidneys.  

A hormone called “parathyroid hormone” responds to variations in calcium level. It regulates how much calcium is taken up from the bowels. This means that no matter how much calcium we take up by mouth, only a fraction is taken up into the bloodstream. So reducing the intake of calcium will not reduce your risk of calcium stone formation, and more calcium will not pose a higher risk for stones.

Oxalate

Oxalate is a compound present in lots of foods. And, unlike calcium, its uptake from the gut is not regulated: The more we take in by mouth, the more is going to be taken up in the blood stream. Once it is there, the kidneys have to deal with it: They excrete it into the urine. So in the case of oxalate, reducing its intake will actually reduce the risks of kidney stones. Some suggestions how to do this are found in the #Oxalate diet suggestions. 

Since the uptake of Oxalate is not controlled by the body (unlike the case with Calcium), and since only free Oxalate is taken up by the gut, anything we can do to ‘bind’ it while it is passing through our system will reduce its uptake. Now, we know that it LOVES Calcium (after all, that is how it forms stones when it finds it in the urine). So, if there is Calcium in our diet, Oxalate will bind to it and will not be taken up into the bloodstream. We will get rid of it with a bowel movement, and it is not available to make stones. So this very surprising fact becomes clear: By taking extra calcium by mouth, you can actually prevent calcium stones by adding calcium to your diet! 

Salt and Sugar 

The kidneys have to deal with a multitude of substances. This process goes along with an increased excretion of Calcium, as is the case with Sodium (in table salt) or Fructose (in sugar). That is why excessive intake of these increase the risk of stones.

Stone Preventing Foods 

There are substances which have a preventative effect on stone formation. Citrate is the most important. When it shows up in the urine, it binds and therefore hides calcium but without forming a solid, keeping it from making stones. Citrate naturally occurs in oranges and lemons.

Drinks which in a recent study have shown to prevent stones include orange juice (12%), caffeinated coffee (16%), tea (11%), wine (31-33%), and beer (41%).

Uric Acid Stones 

This is the second most cause for renal stones. These are especially devious since they are frequently not seen on plain Xrays. CTs can detect them, though.

Uric acid forms when genetic material (DNA) is broken down by the gut. The DNA is located in the nucleus of any cell. In most plants, the cell is very large in comparison to the nucleus. In meat, it makes up much more of the total. This means that when we eat meat versus vegetables, much more nuclear material is taken up producing more uric acid. So when we try to prevent uric acid stones, what sounds like ‘listening to you mom’ becomes important: More vegetables, less meat!

For most first-time stone formers this may be enough. But when uric acid stone recur, it is time to think about preventing them with medication which is able to stop uric acid to be produced in the first place.

Your Office Visit  

As a Urologist, I believe I am foremost a teacher, not a doctor or a surgeon. If my patients know what is going on they, not me, will be the most important actor in keeping disease at bay.

Still, the above does not replace an actual consulting visit with a Urologist or Nephrologist. Everyone is different, and individual advice is the best thing to prevent problems.  

 

 
 

Urology Center of Idaho
500 S 11th Ave # 301
Pocatello, ID 83201
208.233.3355

 
 
         

Urology Center of Idaho
500 S 11th Ave Ste. 301,
Pocatello, ID 83201
208.233.3355

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98 Poplar St.
Blackfoot, ID 838221
208.785-3800

 

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