Kidney stones

Signs and Symptoms

Asymptomatic stones may be found by an x-ray for an unrelated condition. Or you may have symptoms such as:

• Sudden onset of excruciating pain in the buttocks area
• Abdominal pain
• Nausea and vomiting
• Constant movement to relieve the pain
• Pain in the genital area as the stone moves
• Fever and chills
• Increased age
• Obesity

What Causes It?

People develop kidney stones because:

• Their small bowel absorbs too much calcium
• Their diets are too high in calcium or another mineral
• They have intestinal problems
• Urinary tract infections
• They may have inherited a certain disorder that makes their bodies more likely to form kidney stones

Other factors that increase the risk of kidney stones include:

• Not drinking enough fluids (especially in the summer)
• Not exercising enough, or a sedentary lifestyle
• Hypertension, which makes people nearly 3 times more likely to develop kidney stones
• Stress
• Poor dietary habits
• Metabolic syndrome
• Obesity
• Family history of kidney stones
• Continual exposure to high temperatures, which makes people nearly 8 times more likely to form kidney stones
• Other medical conditions, such as gout, chronic diarrhea, certain cancers, and inflammatory bowel disease (IBD)

What to Expect at Your Doctor's Office

If you are in extreme pain, your health care provider may give you a strong pain reliever. Your provider will need a urine sample to check for infection and to see if your urine is acidic or alkaline, which indicates the type of stone you have. You may need to collect your urine for 24 hours if this is not your first stone. Your provider will also take a blood sample and may request additional tests to confirm the diagnosis, such as a computed tomography scan (CT), ultrasound, or x-rays.

With time, the stone generally passes out of the body by itself. If it doesn't pass, or if you have severe pain, bleeding, fever, nausea, or can't urinate, your provider can shatter the stone with shock waves (an outpatient procedure), and the smaller pieces can pass with much less pain. In rare cases, surgery may be required.

Treatment Options

In about 85% of cases, kidney stones are small enough to pass during urination. Passing usually occurs within 72 hours of the first symptoms. Taking pain relievers and drinking at least 6 to 8 glasses of water a day, plus one at bedtime and another during the night, usually enables the stone to pass more easily. You may need to urinate through a strainer to collect the stone and give it to your doctor for analysis. Surgery may be required for stones that are too large to pass on their own, or that may cause bleeding or tissue damage.

Drug Therapies

You may need pain medication while the stone is moving through your system. After it passes, you may need medication to prevent stones from forming again. Drugs may include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Narcotics to control severe pain
• Allopurinol, to control hyperuricemia
• Potassium citrate, to raise urinary pH
• Hydrochlorothiazide, for calcium type I stones
• Cellulose sodium phosphate, for calcium type I stones and to decrease bowel absorption
• Orthophosphates, for calcium type III stones

Surgical and Other Procedures

Surgery is recommended for patients with severe pain that does not respond to medications, for those with serious bleeding, and persistent fever, nausea, or significant urinary obstruction. If no medical treatment is provided after surgery, stones recur in 50% of patients within 5 years.

• Urethroscopy. A diagnostic procedure for identifying stones in the lower third of the ureter.
• Extracorporeal shock wave lithotripsy (ESWL). An outpatient procedure in which shock waves are used to shatter stones under 1 cm so they can pass more easily.
• Percutaneous nephrolithotripsy. A surgical procedure for removing large or dense kidney stones during which the doctor inserts instruments into the kidney to break up stones.

Complementary and Alternative Therapies

Kidney stones require conventional medical attention. DO NOT treat kidney stones with alternative therapies. Alternative therapies may help aid in reducing the risk of recurrent episodes and increasing the overall vitality of the urogenital system. Start with nutritional guidelines for prevention of recurrence. Herbs and homeopathic remedies can be used for acute pain relief and long-term toning of the urinary tract if used under the guidance of a knowledgeable health care provider. Always tell your doctor about the herbs and supplements you are taking.

Nutrition and Supplements

These nutritional tips may help promote overall health and prevent recurrence of kidney stones:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your doctor may want to test for food sensitivities.
• Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Low antioxidant intake is associated with stone formation.
• Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed. Preliminary studies suggest a diet high in fiber, including fruits and vegetables, is associated with a lower risk of developing kidney stones.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy is present) or beans for protein. High animal protein intake may cause you to excrete more calcium and uric acid, increasing the risk of stone formation.
• Cut down on oxalate-containing foods, such as spinach, rhubarb, beets, nuts, chocolate, coffee, black tea, wheat bran, strawberries, and beans.
• Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans fatty acids, found in such commercially-baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily. Some experts recommend doubling previous fluid intake after a stone diagnosis.
• Exercise at least 30 minutes daily, 5 days a week.
• Reduce sodium and sugar intake, both of which are linked to increased risk of stone formation.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, zinc, and selenium. Keep in mind that total and supplemental vitamin C intake has been associated with a higher risk of developing kidney stones among men, but not among women.
• Magnesium citrate. For symptoms of kidney stones. In sensitive people, magnesium can cause loose stools or a drop in blood pressure.
• Omega-3 fatty acids, such as fish oil. To help reduce inflammation and promote general health. Cold-water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood-thinning medications.
• IP-6 (Inositol hexophosphonate). On an empty stomach, for kidney health. Check with your provider for proper dosing. IP-6 can interfere with the absorption of iron, and it may interact with blood-thinning medications, such as coumadin (Warfarin) and others.
• N-acetyl cysteine. For antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus). For maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results. Probiotic supplements may not be appropriate for people who are severely immunocompromised, or on immunosuppressive drugs. Speak with your physician.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 grams) herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. You may use tinctures alone or in combination as noted. Always tell your provider about any herbal therapies you may be using, as certain herbs can interfere with conventional medications.

• Green tea (Camellia sinensis). For antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Milk thistle (Silybum marianum). For detoxification support. There is some concern about people with sensitivity to ragweed or a history of hormone-related cancers taking milk thistle. Since milk thistle works on the liver, it can potentially interact with a variety of medications. Speak with your physician.
• Grapefruit seed extract (Citrus paradisi). For antioxidant, antifungal, and antiviral activity. Grapefruit products can potentially interact with a variety of medications. Speak with your physician.

Homeopathy

Some of the most common remedies used for kidney stones are listed below. Usually, the dose is 3 to 5 pellets of a 12X - 30C remedy every 1 to 4 hours until your symptoms get better.

• Berberis. For sharp sticking pains that radiate to your groin.
• Colocynthis. For restlessness and pain that feels better when you bend forward.
• Ocimum. For nausea and vomiting from the pain.

Following Up

About 50% of patients pass the stone in 48 hours. If there are complications, your health care provider may refer you to a urologist or admit you to the hospital. After you pass the stone, keep drinking fluids, and change your diet to reduce the chance of forming stones in the future. Up to 50% of people who form stones will have a recurrence within 5 years of their original episode. They can dramatically reduce their risk of developing future stones by following general lifestyle recommendations (as indicated above).

Special Considerations

Shock wave therapy is not appropriate for women of childbearing age. If you think you might be pregnant, tell your health care provider. Your provider will also want to rule out ectopic pregnancy or a ruptured ovarian cyst. Some studies also suggest that shock wave treatment may cause kidney damage, thereby increasing the risk of recurrent stone formation. In children who are on a ketagenic diet for intractable epilepsy, oral potassium citrate may be an effective preventive supplement against kidney stones (because it makes the urine more alkaline). Kidney stone formers have a slightly higher risk of developing heart disease and kidney cancer.

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