Kidney stones may present in various ways. Most often, they present with intermittent radiating pain on one side and can be accompanied by waves of nausea and/or vomiting. Other, may lead to significant changes in voiding patterns, such as increased urgency and frequency of urination, intermittent flow, burning and/or blood in the urine. Sometimes kidney stones are completely asymptomatic and may be picked up as an incidental finding when patients undergo imaging for other reasons. Patients may have a “positive urine analysis” and be found to have microscopic blood or inflammatory markers in the urine. Kidney stones may be diagnosed with medical imaging such as ultrasound, xray and/or CT scan of the Abdomen and Pelvis. Once diagnosed, if a patient is asymptomatic, it is important to follow them to confirm passage of the stone, either with spontaneous passage or with some type of intervention.
Most often, stones that are found within the ureter (the tube that drains the kidney and connects to the bladder) or those that are obstructing the kidney (which means they are causing backup of urine, thereby putting pressure on the kidney) require treatment. An “obstructing stone” prevents drainage of urine from the kidney and can lead to infection, sepsis and over an extended period of time, loss of renal function. These could also lead to formation of ureteral strictures. Kidney stones don’t always require immediate intervention. They may not need any treatment, other than making dietary and or medication changes to avoid an increase in stone size and number.
Management of stones depends on the location, size and number of stones. It must be individualized to each patient and depends often depends on one’s overall medical health. For evaluation, a full dietary intake with a complete medical history and physical is required. Though most stones are composed of calcium oxalate, the reason one forms stones will vary from patient to patient. Issues may include poor hydration status, acidic urine, high salt intake, large meal sizes, too much animal protein (which is found in beef, chicken and fish). Excessive intake of vitamins C, D, high dietary salt intake or calcium supplements can also contribute. You should not make dietary or medication changes until a full evaluation has been completed. For example if you have been diagnosed with osteopenia or osteoporosis (i.e. bone loss), and have kidney stones, do not change your bone health medications without the proper medical advice. Patients with gout or high blood levels of uric acid have a higher risk of forming stones. Interventions shown to decrease stone recurrence rates include drinking at least 2.5 liters of water per day, maintaining a normal calcium diet and adhering to a low salt diet. Appropriate modifications can be made once a 24 hour urine collection is performed.
If you feel you may have a kidney stone, please call our office (212-570-6800) for an appointment. We can offer same day evaluation and treatment as indicated.More