Dr. Truesdale discusses the risk factors of kidney stones and how to prevent them.
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Kidney Stones: Risk Factors and Prevention
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Dr. Truesdale completed his medical degree at Columbia University College of Physicians and Surgeons in New York City. During medical school, he completed the prestigious Doris Duke Clinical Research Fellowship in Urologic Oncology where he studied under his mentors in the Department of Urology at Columbia University completing research on robotic surgery for prostate and kidney cancer.
Dr. Truesdale then completed his 6-year urology residency training at The University of California in San Francisco, in the Department of Urology, which is consistently ranked in the top 5 Urology Departments in the United States by the US News and World Reports. During his residency training, he completed a 1-year surgical education research project and educational curriculum through the Department of Medical Education at The University of California in San Francisco.
Learn more about Matthew Truesdale, MD
Matthew Truesdale, MD
Dr. Matthew Truesdale is a board certified urologist with special interest in robotic surgery, urologic oncology and urinary stone disease. Dr. Truesdale is originally from Ocala, FL. He then attended Dartmouth College where he earned his B.A. in Psychology with a concentration in Social Behavior and studied Spanish literature and art at the Universidad de Barcelona in Barcelona, Spain.Dr. Truesdale completed his medical degree at Columbia University College of Physicians and Surgeons in New York City. During medical school, he completed the prestigious Doris Duke Clinical Research Fellowship in Urologic Oncology where he studied under his mentors in the Department of Urology at Columbia University completing research on robotic surgery for prostate and kidney cancer.
Dr. Truesdale then completed his 6-year urology residency training at The University of California in San Francisco, in the Department of Urology, which is consistently ranked in the top 5 Urology Departments in the United States by the US News and World Reports. During his residency training, he completed a 1-year surgical education research project and educational curriculum through the Department of Medical Education at The University of California in San Francisco.
Learn more about Matthew Truesdale, MD
Transcription:
Kidney Stones: Risk Factors and Prevention
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Over the past several decades, the prevalence of kidney stones has increased significantly. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing kidney stones. Joining me is Dr. Matthew Truesdale. He's a Urologist with BayCare. Dr. Truesdale, I'm so glad to have you with us. Thank you for being with us today. Tell us what kidney stones are and are there certain times of the year when they're more common?
Dr. Truesdale: So kidney stones are basically calcifications that form in the urinary part of the kidney. Unfortunately these calcifications can get stuck on their way out of the urinary system and can cause pain. One of the biggest causes of kidney stone formation is actually dehydration. So times of the year where it's hotter and warmer, like the summer and fall months, actually put people at greater risk for forming stones. So we see more in the summer months.
Host: Then tell us a little bit about geographic location. Is that something that has anything to do with the formation of stones?
Dr. Truesdale: Absolutely. That's a great question. So kind of going along the lines of hotter times, putting people at greater risk. Areas of our country that are warmer climates like the South and the Southeast actually are shown to have the highest rates of stone formation. So patients and people who live in the Southeastern United States actually are at the highest risk for stones. And we see the most of those in our hospitals, unfortunately.
Host: So as we're talking about how they actually form what they actually are, does your diet make a difference? Tell us a little bit about how you even get one.
Dr. Truesdale: You know, unfortunately the, probably the greatest risk is genetics. So family members who have had stones or people who have family members that have had stones, they're probably at increased risk. But what we eat and what we drink can have a huge contribution to stone formation. So the greatest risk factor actually for forming stones is actually being dehydrated. So not drinking enough fluid and we recommend people to try to drink enough fluids so that they're making over two liters of urine a day, which is actually quite a lot when people actually try to think about it. So the rule of thumb that I always use for patients is that you look at your urine. If your urine is really dark, really yellow, you're not drinking enough. So you want to try to keep your urine looking as clear as possible. On the flip side of hydration, things that kind of relatively dehydrate, you can also be increased risk factors for stone formation. And that includes things like salt and sodium. So adding salt to your food or eating processed foods or fast foods that are high in sodium concentrations actually will relatively dehydrate you. So it'll kind of waste all that extra fluid that you took in, because you're going to lose it from all the extra sodium. So decreasing the sodium in your diet can also decrease your risk of stone formation too.
Host: So then how would you know, what are the symptoms? Is it always incredibly painful? And is it emergent, Dr. Truesdale tell us a little bit about what we would feel and when you feel it's important that somebody go to their primary care provider or a urologist or the ER?
Dr. Truesdale: The way that stones cause pain is that as they get stuck in the urinary system, they actually cause an obstruction or a blockage and that blockage leads to stretch on the kidney because the kidney is going to continue to make urine, but when the urine can't get out, it just starts to build up and it's that stretch that causes severe pain. And patients who have had stones and delivered children actually report that the stones are more painful than actually giving birth. So the symptoms that people generally have are pretty severe onset pain that comes in the back, pain that does not get better with change in position. And this can also be associated with nausea, feeling really nauseous and even vomiting. Something that would make you have to go to the emergency room emergently would be those types of symptoms and anything with a fever greater than a 100.3 degrees. If someone has those types of symptoms and a fever that can be a urological emergency because when there's a blockage and there's infection, antibiotics can't get to that urine and patients can get very sick, very quickly. In addition, if someone's having that pain and they try to take a Tylenol or an Advil and it's not working, that's another reason to go and seek care so that you can get stronger types of pain medications. And finally, if you're having that nausea and that vomiting to a point where you're not able to drink fluid and keep yourself hydrated, that's another reason to seek medical care in a hospital, to get IV fluids while you're getting treated for this problem.
Host: So what does the treatment involve?
Dr. Truesdale: So the treatment for kidney stones really depends on one, the size of the stone. Two, the location of the stone. And then three, sort of the clinical stability of the patient. So the most conservative treatment for kidney stones is something called medical expulsion therapy, which means that in a patient who is healthy, doesn't have any signs of infection or fever and the stone that's of an appropriate size that could potentially be passed on its own. We encourage hydration. Sometimes we'll give medications to help pass the stone. We give the patient a trial to pass the stone on their own. Now in order to qualify for that, a person needs to be stable. They can't have a fever and their pain has to be well controlled with medications. For stones that are about five millimeters or about half of your thumbnail or smaller, you have about a 50% chance of being able to pass that stone on your own, and avoid a surgery. If at any point during that time they develop any of those severe symptoms of the pain and inability to drink fluids or fevers or chills, then they no longer qualify for medical expulsion therapy and then they'll need an intervention.
The most common types of treatments that we do for kidney stones are surgical. Now the two types of surgeries that we do, number one, a procedure called a ureteroscopy and laser lithotripsy, which is a fancy way of saying that the patient goes to sleep. We put a camera up the urethra and then up to the stone and using a laser, we will break up the stone into small fragments and pull out the pieces. Another option is something called extracorporeal shockwave lithotripsy, which is a fancy way of saying that a patient goes to sleep and we use sound waves through the skin, and fracture the stone into small pieces and then the patient passes those pieces on their own. The benefit of the shocking is that there's nothing that goes into the patient, so it's less invasive. The downside of that though is that they have to still pass those fragments on their own, which can be uncomfortable and painful.
Host: Well, that was an excellent explanation, Dr. Truesdale. Thank you so much for that. Before we wrap up, can they be prevented? You talked about the importance of hydration, but in looking at our diet, whether it's foods high in oxalate or calcium, dairy, whatever it is, give us your best advice about kidney stones and if they can be prevented and what you want us to know when it's important to really call your doctor.
Dr. Truesdale: Absolutely. So the most common type of kidney stone that people get are stones that are made of something called calcium and oxalate, which is the formation of two components in the urine. Now a common misconception is that increasing your calcium in your diet will increase your risk of stones. And we've actually learned over time that this is not true, so people should continue to eat the normal amounts of calcium in their diets and not decrease that. Now the greatest risk of stone formation, as we talked about earlier, is dehydration. So staying hydrated is the number one thing that patients can do to decrease their risk of stone formation. And then as we discussed, decreasing sodium also can decrease that risk as well. Now, there are certain types of foods that are high in oxalate, which is the other component of the most common type of kidney stones. Those types of foods include green leafy vegetables like spinach or kale, nuts, chocolate, coffee, and beer. Unfortunately, those are also all really good things that people like to eat.
And some of those things are incredibly healthy too. So decreasing oxalate is not always an easy thing to do, but a trick is to make sure that when you're eating foods, like I mentioned, that are high in oxalates, making sure that there's some dietary calcium, meaning some milk or cheese or something with calcium in it, will actually allow that oxalate that you ate to stay bound in your intestines. And when oxalate and calcium are bound, they actually can't be absorbed into the bloodstream. So what ends up happening is you eliminate them in your stool so you don't have the oxalates being seen by the calcium in the urine and it doesn't form the stones there. So, if you're not one who likes to eat calcium then taking a Tums, just a regular, Tum's over the counter can also help to form that formation. But I wouldn't recommend that for all people. That would be for people that are higher risk for stones, either who have had a stone or had a first degree relative with stones. Those people are at the highest risk and they should probably speak to their doctor about things that they can do to decrease their risk further.
Host: Great information, really usable advice. Dr. Truesdale, thank you so much for joining us today and sharing your incredible expertise. That concludes this episode of BayCare HealthChat. Please visit our website at baycare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips, just like these and updates, please follow us on your social channels. I'm Melanie Cole.
Kidney Stones: Risk Factors and Prevention
Introduction: This is BayCare HealthChat, another podcast from BayCare Health System. Here's Melanie Cole.
Melanie Cole: Over the past several decades, the prevalence of kidney stones has increased significantly. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing kidney stones. Joining me is Dr. Matthew Truesdale. He's a Urologist with BayCare. Dr. Truesdale, I'm so glad to have you with us. Thank you for being with us today. Tell us what kidney stones are and are there certain times of the year when they're more common?
Dr. Truesdale: So kidney stones are basically calcifications that form in the urinary part of the kidney. Unfortunately these calcifications can get stuck on their way out of the urinary system and can cause pain. One of the biggest causes of kidney stone formation is actually dehydration. So times of the year where it's hotter and warmer, like the summer and fall months, actually put people at greater risk for forming stones. So we see more in the summer months.
Host: Then tell us a little bit about geographic location. Is that something that has anything to do with the formation of stones?
Dr. Truesdale: Absolutely. That's a great question. So kind of going along the lines of hotter times, putting people at greater risk. Areas of our country that are warmer climates like the South and the Southeast actually are shown to have the highest rates of stone formation. So patients and people who live in the Southeastern United States actually are at the highest risk for stones. And we see the most of those in our hospitals, unfortunately.
Host: So as we're talking about how they actually form what they actually are, does your diet make a difference? Tell us a little bit about how you even get one.
Dr. Truesdale: You know, unfortunately the, probably the greatest risk is genetics. So family members who have had stones or people who have family members that have had stones, they're probably at increased risk. But what we eat and what we drink can have a huge contribution to stone formation. So the greatest risk factor actually for forming stones is actually being dehydrated. So not drinking enough fluid and we recommend people to try to drink enough fluids so that they're making over two liters of urine a day, which is actually quite a lot when people actually try to think about it. So the rule of thumb that I always use for patients is that you look at your urine. If your urine is really dark, really yellow, you're not drinking enough. So you want to try to keep your urine looking as clear as possible. On the flip side of hydration, things that kind of relatively dehydrate, you can also be increased risk factors for stone formation. And that includes things like salt and sodium. So adding salt to your food or eating processed foods or fast foods that are high in sodium concentrations actually will relatively dehydrate you. So it'll kind of waste all that extra fluid that you took in, because you're going to lose it from all the extra sodium. So decreasing the sodium in your diet can also decrease your risk of stone formation too.
Host: So then how would you know, what are the symptoms? Is it always incredibly painful? And is it emergent, Dr. Truesdale tell us a little bit about what we would feel and when you feel it's important that somebody go to their primary care provider or a urologist or the ER?
Dr. Truesdale: The way that stones cause pain is that as they get stuck in the urinary system, they actually cause an obstruction or a blockage and that blockage leads to stretch on the kidney because the kidney is going to continue to make urine, but when the urine can't get out, it just starts to build up and it's that stretch that causes severe pain. And patients who have had stones and delivered children actually report that the stones are more painful than actually giving birth. So the symptoms that people generally have are pretty severe onset pain that comes in the back, pain that does not get better with change in position. And this can also be associated with nausea, feeling really nauseous and even vomiting. Something that would make you have to go to the emergency room emergently would be those types of symptoms and anything with a fever greater than a 100.3 degrees. If someone has those types of symptoms and a fever that can be a urological emergency because when there's a blockage and there's infection, antibiotics can't get to that urine and patients can get very sick, very quickly. In addition, if someone's having that pain and they try to take a Tylenol or an Advil and it's not working, that's another reason to go and seek care so that you can get stronger types of pain medications. And finally, if you're having that nausea and that vomiting to a point where you're not able to drink fluid and keep yourself hydrated, that's another reason to seek medical care in a hospital, to get IV fluids while you're getting treated for this problem.
Host: So what does the treatment involve?
Dr. Truesdale: So the treatment for kidney stones really depends on one, the size of the stone. Two, the location of the stone. And then three, sort of the clinical stability of the patient. So the most conservative treatment for kidney stones is something called medical expulsion therapy, which means that in a patient who is healthy, doesn't have any signs of infection or fever and the stone that's of an appropriate size that could potentially be passed on its own. We encourage hydration. Sometimes we'll give medications to help pass the stone. We give the patient a trial to pass the stone on their own. Now in order to qualify for that, a person needs to be stable. They can't have a fever and their pain has to be well controlled with medications. For stones that are about five millimeters or about half of your thumbnail or smaller, you have about a 50% chance of being able to pass that stone on your own, and avoid a surgery. If at any point during that time they develop any of those severe symptoms of the pain and inability to drink fluids or fevers or chills, then they no longer qualify for medical expulsion therapy and then they'll need an intervention.
The most common types of treatments that we do for kidney stones are surgical. Now the two types of surgeries that we do, number one, a procedure called a ureteroscopy and laser lithotripsy, which is a fancy way of saying that the patient goes to sleep. We put a camera up the urethra and then up to the stone and using a laser, we will break up the stone into small fragments and pull out the pieces. Another option is something called extracorporeal shockwave lithotripsy, which is a fancy way of saying that a patient goes to sleep and we use sound waves through the skin, and fracture the stone into small pieces and then the patient passes those pieces on their own. The benefit of the shocking is that there's nothing that goes into the patient, so it's less invasive. The downside of that though is that they have to still pass those fragments on their own, which can be uncomfortable and painful.
Host: Well, that was an excellent explanation, Dr. Truesdale. Thank you so much for that. Before we wrap up, can they be prevented? You talked about the importance of hydration, but in looking at our diet, whether it's foods high in oxalate or calcium, dairy, whatever it is, give us your best advice about kidney stones and if they can be prevented and what you want us to know when it's important to really call your doctor.
Dr. Truesdale: Absolutely. So the most common type of kidney stone that people get are stones that are made of something called calcium and oxalate, which is the formation of two components in the urine. Now a common misconception is that increasing your calcium in your diet will increase your risk of stones. And we've actually learned over time that this is not true, so people should continue to eat the normal amounts of calcium in their diets and not decrease that. Now the greatest risk of stone formation, as we talked about earlier, is dehydration. So staying hydrated is the number one thing that patients can do to decrease their risk of stone formation. And then as we discussed, decreasing sodium also can decrease that risk as well. Now, there are certain types of foods that are high in oxalate, which is the other component of the most common type of kidney stones. Those types of foods include green leafy vegetables like spinach or kale, nuts, chocolate, coffee, and beer. Unfortunately, those are also all really good things that people like to eat.
And some of those things are incredibly healthy too. So decreasing oxalate is not always an easy thing to do, but a trick is to make sure that when you're eating foods, like I mentioned, that are high in oxalates, making sure that there's some dietary calcium, meaning some milk or cheese or something with calcium in it, will actually allow that oxalate that you ate to stay bound in your intestines. And when oxalate and calcium are bound, they actually can't be absorbed into the bloodstream. So what ends up happening is you eliminate them in your stool so you don't have the oxalates being seen by the calcium in the urine and it doesn't form the stones there. So, if you're not one who likes to eat calcium then taking a Tums, just a regular, Tum's over the counter can also help to form that formation. But I wouldn't recommend that for all people. That would be for people that are higher risk for stones, either who have had a stone or had a first degree relative with stones. Those people are at the highest risk and they should probably speak to their doctor about things that they can do to decrease their risk further.
Host: Great information, really usable advice. Dr. Truesdale, thank you so much for joining us today and sharing your incredible expertise. That concludes this episode of BayCare HealthChat. Please visit our website at baycare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips, just like these and updates, please follow us on your social channels. I'm Melanie Cole.