August 06, 2018
Q. Kidney stones can sometimes require a visit to the ER for pain control. What pain medications are available, so I don’t have to make a costly visit to the ER?
A. There are several medications that can be helpful to relieve pain while passing a kidney stone.
- Flomax (Tamsulosin) will help the ureter to relax and stones to pass.
- Ibuprofen/Aleve can be a very helpful for kidney stone pain.
- Toradol, a non-narcotic, which can be used for 5 days at a time to help with pain.
Q. What should I do if I have a kidney stone attack?
A. Patients should call their doctor or go to the hospital emergency room if they experience severe or persistent bleeding, if the pain continues to be severe, unrelenting and persistent, if fever and chills or nausea and vomiting develop, or if urine smells especially bad or looks cloudy. If your nausea and vomiting do not stop, you need to call a physician or go to the ER for treatment.
Q. How long does it typically take to pass a kidney stone?
A. Size and location are the two factors that determine how long it will take to pass a stone.
- Small-The size of the stone is a major factor in whether it can pass naturally. Stones smaller than 4 millimeters typically pass on their own. You can expect smaller stones to take an average of 31 days to pass.
- Medium-Stones that are 4–6 mm are more likely to require some sort of treatment, but can also pass naturally. You can expect medium size stones to pass an average of 45 days.
- Larger-Stones larger than 6 mm usually need medical treatment to be removed. You can expect larger size stones to take up to a year to pass if left untreated.
Size and location are important factor in whether stones will pass on their own.
- Ureter– Stones that are in the end of the ureter closer to where it attaches to the bladder — rather than the end that attaches to the kidney — are more likely to pass on their own.
- Bladder-The closer the stones are to the bladder, the more likely they will pass on their own.
Q. What are the indications for surgery to remove kidney stones?
A. We typically recommend removal for any obstructing kidney stone, regardless of size. If it has not passed within 4-8 weeks to prevent kidney damage. We devise treatment plans based on individuals needs and should be discussed with a urologist. If a kidney stone is small enough, it can move or “pass” through your urinary tract and out of the body on its own. Larger stones can get stuck in either a kidney or ureter. Treatment options for breaking up larger stones include:
- Extracorporeal Shock Wave Lithotripsy
- Ureteroscopy with Laser Lithotripsy
- Ureteral Stent Placement
- Percutaneous Nephrolithotomy (PCNL)
Q. What causes kidney stones?
A. Kidney stones form when a change occurs in the normal balance of water, salts, minerals, and other things found in urine. The most common cause of kidney stones is not drinking enough water. It is recommended to drink 8 to 10 glasses of water per day. Other factors can be genetic or due to a medical condition.
Q. What are the signs and symptoms of kidney stones?
A. Some kidney stones do not cause symptoms at all, especially if they are very small and pass on their own. Sometimes, the clusters can clump together and form bigger clusters, which may eventually become large enough to block the ureter or lodge in the bladder, causing severe pain.
Symptoms may include:
- Pain in lower back
- Blood in the urine
- Nausea and vomiting
- Sweating, fever and shivers
You should visit the doctor immediately if there are any of the symptoms above. After taking the pain medication make an immediate appointment so an urologist can diagnose, and determine if treatment is necessary. If the size of the stone is lesser than 5mm it can be treated with medication but if it’s larger than 5mm, there are different surgical and non-surgical treatment available.
Q. How are kidney stones diagnosed?
A. Various imaging scans and tests may be needed to confirm the diagnosis, see where the kidney stones are located and their size.
- CT Scan -used to see whether there is a stone and check the state of the urinary tract.
- Ultrasound– uses sound waves to create a picture of kidney and bladder
- Urine Test– used to show whether there is an infection and to measure the chemicals that cause stones.
- Blood test -used to show how well the kidneys are working
Q. Can you avoid getting kidney stones?
A. Even though kidney stones can be common and recur once you’ve had them, there are simple ways to help prevent them. Here are some strategies that can help:
- Drink enough water. A 2015 meta-analysis from the National Kidney Foundation found that people who produced 2 to 2.5 liters of urine daily were 50% less likely to develop kidney stones than those who produced less. It takes about 8 to 10 8-ounce glasses (about 2 liters total) of water daily to produce that amount.
- Skip high-oxalate foods. Such foods, which include spinach, beets, and almonds, raise oxalate levels in the body. However, moderate amounts of low-oxalate foods, such as chocolate and berries, are okay.
- Enjoy some lemons. Citrate, a salt in citric acid, binds to calcium and helps block stone formation. “Studies have shown that drinking ½ cup of lemon juice concentrate diluted in water each day, or the juice of two lemons, can increase urine citrate and likely reduce kidney stone risk,” says Dr. Eisner.
- Watch the sodium. A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. Federal guidelines suggest limiting total daily sodium intake to 2,300 milligrams (mg). If sodium has contributed to kidney stones in the past, try to reduce your daily sodium to 1,500 mg.
- Cut back on animal protein. Eating too much animal protein, such as meat, eggs, and seafood, boosts the level of uric acid. If you’re prone to stones, limit your daily meat intake to a quantity that is no bigger than a pack of playing cards.