Care for Kidney Stones
Today, physicians have expanded tools and know-how for helping patients to avoid kidney stones, for detecting these stones (also called renal calculi) when they occur, and for treating them. This includes treatments that are less invasive and have fewer side effects than in the past.
Middle-aged men are the broad group most likely to experience kidney stones, though they can occur for almost anyone. And patients who have already had a kidney stone or who have a family history of kidney stones are especially likely to get them. Patients with decreased kidney function causing blood acidosis are also at increased risk.
Experienced services at Lourdes for care of kidney stone focus on these three areas:
Prevention
Preventing kidney stones has to do mostly with dietary adjustments, steps that are particularly important for anyone at higher risk for the condition. These changes generally include drinking more fluid (and avoiding dehydration), moderating intake of calcium (if the patient forms calcium stones and has high calcium), reducing salt consumption and eating lower amounts of protein. Patients who have experienced certain types of stones may receive an additional list of dietary adjustments specific for their needs.
Certain medications can also help to prevent new kidney stones from forming. Doctors will prescribe these medications according to the composition of the kidney stones a patient has experienced. Lourdes skilled kidney specialists and primary-care physicians can counsel on these steps for preventing kidney stones.
Diagnosis
Kidney stones often remain in place for a long time or for good without causing symptoms. Even a dislodged stone moving through the urinary tract, may pass unnoticed on urination, especially if it is small. Larger or irregular stones, though, typically cause sudden and acute pain and cramping in the back and side around the kidney when they are passing or stopped somewhere in the urinary tract. Fever may indicate a resulting urinary tract infection as well. Kidney stones may also cause bleeding that puts blood in the urine.
A variety of other conditions, ranging from gallstones to diveriticulitis to hiatal hernias can cause pain similar to that of a kidney stone, so the medical team needs to make a careful diagnosis. An x-ray, ultrasound or other radiologic image will often reveal a kidney stone – including silent ones found only incidentally. Knowing the size and location of the stone helps the medical team if and how to intervene, as may blood and urine tests.
A CT scan (sometimes with contrast dye) can add to the diagnosis, revealing tiny stones not evident on the x-ray. Or the doctor may decide to perform an intravenous pyelogram, which involves injecting dye into the blood to obtain a better x-ray image as the contrast agent passes through the urinary tract.
Doctors will also want to evaluate the stone itself, whether saved by the patient or retrieved medically. Additionally, lab evaluation of a 24-hour urine collection can help the doctor determine the cause of the stone, by giving a more complete reading on the levels of acidity, calcium, sodium, uric acid, oxalate, citrate and creatinine that the patient is excreting.
Treatment
Usually kidney stones pass on their own. Typically, this takes a few hours, days or weeks. To help the stone pass, patients usually drink extra fluids, and to tolerate the discomfort they may need to take pain medication. Other medications that may be useful at this time are antibiotics to fight infection, an antispasmodic to relax the ureter muscles or diuretics to prevent urine from staying in the kidney.
Intervention to remove the stone is only necessary if the stone does not pass because it is too large or in a difficult location, or if it is blocking the flow of urine or causing bleeding or infection. Specialists can use a number of methods to remove kidney stones:
- lithotripsy. Hospitals very commonly use extracorporeal shockwave lithotripsy to breakdown stubborn stones so that they pass easily. Lithotripsy involves anesthetizing the area, placing the patient in a bath or against a water cushion and creating shockwaves that pass through the body until they reach and disrupt the stones, turning them into finer pieces. Usually, the procedure is performed on an outpatient basis and patients recover in just a few days.
- endoscopy. If the stone is particularly large or in a location where lithoptripsy is not appropriate, the interventional team can also access the stone visually with tiny scopes and use instruments to disrupt or remove it. The surgical specialist may use a small incision in the back to gain access with a nephroscope, or use the even finer ureteroscope introduced up through the urethra, into the bladder and into the ureter.
- surgery. Common decades ago for this condition, surgery can usually be avoided today with the outpatient procedures described above. When stones are very difficult to remove otherwise, open surgery remains a dependable option. It involves a larger incision in the side and in the kidney, to allow the general surgeon to remove the stone with forceps. It also requires an inpatient stay, and a longer period of recovery.
Overactive parathyroid glands are also a cause of high levels of calcium that can lead to calcium stones. Surgery to remove the abnormal parathyroid gland usually resolves the condition. Lourdes experts in endocrinology can help to evaluate this condition.
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