What Are Kidney Stones?
- Category: Urology
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Dr. Nathan Grunewald: Kidney stones is really a generic term that we often use with patients. What we really mean when we say a kidney stone, you could have a stone in your kidney, in the tube that drains your kidney down to your bladder, or you could even have a stone in your bladder.
80% of kidney stones are calcium as their main base, and there's a few others like uric acid stones and cystine stones, but really the majority of them are calcium.
And when a stone that starts up in the kidney, and that's where most stones form, if that falls into that little tube and your body starts to try and push that stone out, it blocks the flow of urine down that tube. And that's what hurts. This is 10 out of 10 pain. This pain to some people is worse than childbirth.
The most common symptoms people have when they have a kidney stone: pain on their side, nausea, could have vomiting, and they may notice some urinary symptoms – frequency, having to go to the bathroom more often than usual. Most people cannot tolerate that at home and it often results in a trip to the emergency department.
In some cases, the pain isn't maybe the worst you've ever had, but maybe it's just dull and achy and keeps coming and going and not going away, and you may end up in your primary care's office to discuss those symptoms. But that whole constellation of symptoms: the flank pain, the nausea that goes along with it., you may have some lab values that are out of range. Those really tip an individual off to suspect a kidney stone. And the most common way that it then is diagnosed is actually with a CAT scan, actually scanning the abdomen and looking. In most cases, they're sometimes looking for both kidney stones or other problems, appendicitis or gallstones.
Really, the most common cause of kidney stones is dehydration, just simply not having enough fluid in your system and not making enough urine. By becoming dehydrated, you've effectively decreased the amount of urine you're going to make, you've concentrated your urine, those crystals then can come out and start forming. And all they need is just a little head start and once a crystal forms, if you continue to stay dehydrated, that stone may continue to crystallize and get more and more – and more larger.
Treatment of kidney stones can vary. The three mainstays are just observation, where maybe a patient has a small stone and it's not causing them a ton of symptoms, but we know it's there and it's not so bad.
Something called medical expulsive therapy, which is really about providing medications, usually some sort of pain reliever and something to relax that actual urine tube that we can give you to help you pass a stone on your own. And really that's dependent on the stone size and what your symptoms are. If you're in excruciating pain and we can't get it any better, you're probably not a candidate for that.
And then the most definitive treatment is somehow removing the stone. Nowadays, we can do a much of this with miniaturized telescopes and laser therapy.