Imagine lying in bed enjoying a night’s rest and suddenly being woken by a terrific pain on one side of the back that radiates to the abdomen and groin. There is a stone that formed in the kidney and it has shifted and started a journey down the small tube from the kidney to the bladder. The pain is coming in waves and makes you sick to your stomach to the point of vomiting. No matter what position you are in or even if you lay perfectly still the pain won’t stop. You feel like you have to urinate often and the urine is tinged with blood. Your urinary tract is trying to force this hunk of minerals that feels like a ball of barbed wire down to the bladder. If you are lucky the stone completes its journey to the bladder and there is relief. You may see the stone after it passes and will marvel at how something the size of a rice kernel can cause so much pain. If you are not so lucky you may end up at the emergency room for help.
In 2009 there were about 1.3 million (3,600 per day) emergency room visits for kidney stones in the US. About 1 in 11 people will experience a kidney stone sometime in their life. Stones tend to be more common in men, Caucasians, and obese people but can occur in anyone. Kidney stone pain tends to be acute and severe so the emergency room is commonly where kidney stone patients are seen.
The kidney’s main job is to filter the blood and remove waste products from the blood stream. There are minerals that are expelled in the urine. These minerals have the potential to become concentrated and precipitate to form crystals. When the crystals come together to form a stone as big as about 3 millimeters, the stone can get caught and cause trouble. The ureter is the tube that leads from the kidney to the bladder and it is the narrowest part of the urinary tract. If a stone can make it to the bladder it generally will pass.
Generally the symptoms and detection of blood in the urine is enough to diagnose the problem. Now that CT scanners are readily available, a kidney stone can be diagnosed, measured, and the location can be determined. Most stones will pass if given time. The location and the size can help predict if it will pass. Generally treatment is aimed at relieving symptoms and providing adequate hydration.
Stones that do not pass spontaneously can be treated with shock waves to break them up (known as lithotripsy) or a small tube can be placed through a surgical procedure into the ureter to allow the urine to pass around the stone to facilitate passage. Sometimes medications can be taken to try to improve the chances of passing the stone.
Once someone has had a kidney stone their chances of having another one is fairly high. About 50% of people will have another stone within 5 yrs. The best way to prevent a stone is to keep the urine dilute by drinking plenty of water. It is recommended that patients who have had stones drink enough to put out about 2 liters of urine daily. There can be different types of stones though calcium oxalate is far and away the most common type. If the stone can be collected and analyzed, treatment measures can be directed toward the specific type of stone that that is causing the problem. Some people seem to be genetically predisposed to forming stones.
What did the mama kidney stone say to the baby kidney stones? “I’m sorry to have to tell you this, but your father passed last night.”
Hopefully you won’t have a kidney stone. Maintaining adequate hydration is the best way to try to avoid one. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
