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Kidney stones are an extremely common medical condition occurring in approximately 2% of the population. The likelihood that you’ll suffer from a kidney stone is influenced by many different factors. Although kidney stones can occur at any age, they are much more common in adults between the age of 20-50. Men are affected roughly twice as often as women. People in southern, dryer climates are also more prone to stone formation than those people living in cooler northern climates — perhaps because they may become dehydrated more often.
The kidneys are paired organs that filter our blood to remove metabolic waste and produce urine. Kidney stones develop when minerals and salts — which exist normally in our urine — get out of balance, crystallize and then join together to form stones. Small stones are often harmless and can be passed in the urine without you even noticing. But larger stones will block the ureter, the tube that leads from your kidneys to your bladder. When this blockage occurs, the kidney continues to produce urine, yet the urine has nowhere to go. In this situation everything upstream from the blockage swells and stretches the collecting system causing the severe pain. This is similar to a jam in a river causing the stream to overflow its banks creating havoc.
There are many different types of kidney stones, and they develop for various reasons. In general, most stones form due to relative dehydration, which allows minerals in the urine to become supersaturated and no longer stay dissolved in solution. The most common are calcium oxalate and calcium phosphate stones. They account for approximately 70% of all kidney stones. They develop as a result of excessive oxalate levels in the body or metabolic disorders of the intestines.
The next most common type of stone is struvite. They develop in chronically infected kidneys, and can often be very large. Uric acid stones develop as a result of excess uric acid in the blood. This is the same condition that causes gout. Uric acid stones account for 5-10% of all kidney stone disease. Cystine stones are calcifications occurring as a result of a rare hereditary disorder in the metabolism of the compound cystine. Cystine stones account for less than 5% of all kidney stones. There are a number of other extremely rare types of stones which occur due to congenital metabolic problems, or medications taken to treat other medical illnesses.
How do you know if you have a kidney stone? The most common symptom is pain in the upper back, which often radiates to the front of the abdomen and down to the lower abdomen or groin region. This pain is often accompanied by nausea and vomiting. Some people also experience pain or difficulty with urination. In some situations, the stone can be painless and the initial symptom is blood in the urine. Patients commonly describe the pain of a kidney stone as being the most horrific pain they have ever experienced. It often strikes suddenly and with amazing severity. If you are experiencing these symptoms and suspect you may have a kidney stone, you should call your doctor immediately.
Treatment of kidney stones depends on many factors including stone size, stone location, and the severity of symptoms. If stones are small and symptoms minimal, the management usually consists of hydration and pain medication. If the stone is large and the symptoms severe, intervention is usually required.
Some of the more common treatment options are extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, or percutaneous nephrolithotomy. ESWL is a non-invasive procedure in which shock waves are sent through the body to fragment stones into thousands of tiny particles. This option is considered if the stone is still in the kidney or the first portion of the ureter. Ureteroscopy is the placement of a thin, narrow telescope into the ureter and removing the stone, or fragmenting it using a laser. This is preferred for stones that are further down the ureter. In certain situations where the stone is large, a procedure known as a percutaneous nephrolithotomy is recommended. This involves placing a tube through the skin in the back, which enters the kidney, and removing the stone with instruments. Often a small tube known as a ureteral stent is placed to eliminate the stone blockage and relieve the pain when treating a kidney stone.
As with all diseases, prevention is superior to cure. Once you have had a stone, your chances of developing another are much greater than the average person. In situations where you are developing numerous recurrent stones, it is important to evaluate the composition of the stone as well as indentify metabolic factors that are making you prone to stone formation. In all cases, drinking more fluid (2-3 liters/day) is essential to preventing more kidney stones in your future.
Dr. Sean Manion is a board certified urologist at Longmont Clinic. He can be reached at 720-494-3137.
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