As many people will tell you, kidney stones can be quite painful. Some stones will pass spontaneously with minimal treatment, however, for some that do not pass on their own, there are treatments available.
Dr. Leslie Spry discusses kidney stones and treatment options available if you discover you have formed kidney stones.
Selected Podcast
Kidney Stones: Prevention, Symptoms & Treatment
Featured Speaker:
Leslie Spry, MD, Lincoln Nephrology & Hypertension
Dr. Leslie Spry is a nephrologist with Nephrology & Hypertension. Transcription:
Kidney Stones: Prevention, Symptoms & Treatment
Melanie Cole (Host): According to the National Kidney Foundation more than half a million people visit emergency rooms each year for kidney stones. My guest today is Dr. Leslie Spry. He’s a nephrologist with Lincoln Nephrology and Hypertension. Dr. Spry, explain for the listeners a little bit about what kidney stones are and are there certain times of year when they’re more common?
Dr. Leslie Spry (Guest): Yes, well it turns out that kidney stones are extremely common, especially in the more warm or arid parts of the year, especially during the summertime, and especially in very hot, humid kinds of weather where people are prone to sweating and dehydration. Men have more stones than women and it turns out than about one in seven men in their lifetime will have a stone event and about half of that rate occurs in females. Although it’s interesting to note that in the last 10 to 20 years or so, incidents of kidney disease in females has actually be increasing. Males has been increasing as well but not as fast as females.
Melanie: Wow, so how do they form?
Dr. Spry: Well kidney stones are formed as a result of too much stuff, chemicals and things like that that build up in the urine. The most common reason is that calcium gets into the urine in higher concentrations than it should and that calcium forms stones and it either can form stones called calcium oxalate stones or calcium phosphate stones and that’s the most common. About eight out of ten stones that are formed are calcium stones, and a smaller percentage are what we call uric acid or gout stones. We see a few that are infection stones where people have chronic infections, and those infection stones are much less common, but I said the most common stone that people experience is a calcium stone and they’re formed by having too much calcium and other things in the urine. It turns out the most common cause of stone disease is a high salt diet.
Melanie: Well I was going to ask you how your diet affects the formation of kidney stones. So a high salt diet and what else? Are there other things that can contribute?
Dr. Spry: Certainly, the risk factors for kidney stones are increasing age. As we all get older, we’re more prone to get kidney stones. I mentioned the fact that men have stones more than women. It turns out if you’re part of the white population, you have the highest incidence of kidney stone disease and higher than any of the other ethnic minorities. If you have a family history of kidney disease or family history of stones, you’re more likely to develop stones, and probably the main reason we’re seeing more stones in the United States today is the epidemic of obesity. People who are obese and people who lose weight actually as a result of things like bariatric surgery or weight reduction surgery, those two populations probably have the highest incidence of kidney stone disease.
Melanie: So what are the symptoms, Dr. Spry? What would somebody notice before it becomes something that they rush off to the doctor? Are there some early symptoms and what are the red flags?
Dr. Spry: Yes, the most common symptom obviously of kidney stones is pain. That pain usually is rather abrupt in onset. That pain usually is in your back, or what we call the flanks, although the pain can be any of a number of different areas, starting from your back, rotating around to the side, going into your groin, and in some cases it actually goes into your genital area such that men will have pain into the testicle and women will have pain into the labia and that will be the pain that is again abrupt in onset, quite severe, and usually associated with at least some blood in the urine. Sometimes you see blood, sometimes you don’t. But again, abrupt onset of pain, especially in the flank, would be the most common symptom associated with a kidney stone.
Melanie: Is this an emergent condition? So do you go to the emergency room or do you go see a nephrologist? And what treatment options are available?
Dr. Spry: Well if you’re having an acute pain, obviously the most common thing you’re going to do is go to either an urgent care or an emergent care setting. In most cases in order to diagnose stone disease, you’re going to need to have the availability of at least some type of x-ray procedure or ultrasound and you’re also going to need to have the availability of a way to examine the urine because the two most prominent findings of stone disease would be blood in the urine, either in microscopic amounts that you have to test for, or in visible amounts where you might actually see some red blood in the urine. The other thing that needs to happen is we’ll need to take some x-rays. The best x-ray is called a helical CT scan, or a thin sliced CT scan, it’s sometimes called a low dose CT scan. Those kinds of scans usually have to be done in the emergency rooms and are the best way to screen for stone disease. Other tests can be done that includes just a flat abdominal film of the abdomen or an ultrasound, but those are usually less sensitive in picking up stones, and again the urinalysis is also extremely important. A good history and physical examination is also important as well because the major differentials for stone disease include things like pelvic infection, bladder infections, you could even have appendicitis or even gallbladder attacks that can mimic kidney stones.
Melanie: And then what? What are the treatment options? Is this something that is medication intervention? Is it hydration? Does it usually require some sort of procedure? Tell us about treatments.
Dr. Spry: Yeah well the treatment is, it depends on the size of the stone. If it turns out this stone is quite large on the examination, then that’s going to require some kind of surgical intervention and that’s where my colleagues who are urologists are involved. If the stone is generally greater than about 10 mm, it’s not going to pass on its own and its going to require surgical intervention. If the stone is less than about 5 mm, which is quite small, then that stone most likely will pass just with medical management. Medical management usually involves use of pain medications to treat the stone pain and also use of hydration. If the patient is nauseated or vomiting as a result of extreme pain, then you’re going to need to administer that fluid and hydration by vein; otherwise if you can orally hydrate, that’s the best thing you can do and try to force that stone out. The other treatments that are often given, there are certain medications called alpha blockers that are often used to help facilitate stone passage and other medications are out there, but the two predominant medical treatments are hydration and pain control. Beyond that, we try to do things that prevent future stones, and so for the acute treatment of the stone, we’re trying to get that stone to pass and try to make sure that all the stones have been removed from the urinary tract and from that then we go on to try to prevent future stones.
Melanie: Does the person have to be hospitalized while they’re working on hydration or whatever procedure you decide to do, do they have to be hospitalized or is this something that they just sort of wait out at home?
Dr. Spry: Well again it depends on the degree of pain. Most of the time it depends on whether or not they can orally hydrate. If you have somebody who is having such severe pain that they’re vomiting or having severe nausea, which can be very common with stone disease, then those folks are going to have to be hospitalized because the only way to hydrate them is with intravenous fluid. If they can take oral pain medicines and if they can orally hydrate, we would prefer to send them home. So that’s usually the main differentiating feature is can the patient orally hydrate and can they take oral pain meds. If they can’t take by oral, then they’re going to have to be hospitalized.
Melanie: Then give us your best advice about prevention, as you’ve mentioned a couple of times prevention in the first place and prevention of future stones if you’ve already had one, what do you tell people every day that they really need to do to try and keep this from happening?
Dr. Spry: So the main treatment of kidney stone disease is hydration. I tell my patients that they think about this like you would putting sugar in iced tea. If you put too much sugar in iced tea it all falls to the bottom and the only way you can get it back in solution is to put in more tea. Well that’s the same thing that happens in the urine is you get too much stuff in the urine and it all falls out and forms crystals and stones and so the main thing to do is to try to hydrate and we usually recommended that they hydrate so that they’re urine is rather light yellow in color. Some people what to know exactly how much water to drink and I’m afraid I don’t know that. I usually tell them to keep hydrating until their urine is light yellow, and in some cases if some people have lots of kidney stones, they may actually have to get up in the middle of the night to drink water because during the night is the longest time you go without liquid and that’s when you’re urine is going to get most concentrated and potentially form a kidney stone. The other thing that we do for prevention is to have somebody on a low salt diet. As I mentioned earlier, salt intake is the most common reason why people have stones. The more salt you take in means the less of other things that you can put in your urine, the less of things like calcium and gout, things like uric acid. Those things are in the urine in a certain concentration, and then if you put salt in there, that salt will actually act to what we call salt out stones, in other words the salt acts as a chemical constituent in the urine that actually forces the other chemicals like minerals to come out in the form of crystals and stones, and so I’m a very strong proponent of something called a DASH, D-A-S-H diet, that’s been a diet that’s been shown to decrease the incidence of stone diseases and also lower blood pressure. That stands for Dietary Approaches to Stop Hypertension. You can look up the DASH diet by Googling DASH and NIH, which is the National Institutes of Health. The National Institutes of Health did studies on the DASH diet dating back into the 90s and have shown it to be a very good diet for lowering blood pressure as well as preventing kidney stones.
Melanie: Thank you so much Dr. Spry for being with us today and explaining it so very well about kidney stones, and more importantly, the prevention of them in the first place. Thank you so much again and a special thank you to our podcast partner, Davis Design. If you’d like to learn more about healthy living, please visit bryanhealth.org, that’s bryanhealth.org. This is Bryan Health Podcast. I’m Melanie Cole, thanks for tuning in.
Kidney Stones: Prevention, Symptoms & Treatment
Melanie Cole (Host): According to the National Kidney Foundation more than half a million people visit emergency rooms each year for kidney stones. My guest today is Dr. Leslie Spry. He’s a nephrologist with Lincoln Nephrology and Hypertension. Dr. Spry, explain for the listeners a little bit about what kidney stones are and are there certain times of year when they’re more common?
Dr. Leslie Spry (Guest): Yes, well it turns out that kidney stones are extremely common, especially in the more warm or arid parts of the year, especially during the summertime, and especially in very hot, humid kinds of weather where people are prone to sweating and dehydration. Men have more stones than women and it turns out than about one in seven men in their lifetime will have a stone event and about half of that rate occurs in females. Although it’s interesting to note that in the last 10 to 20 years or so, incidents of kidney disease in females has actually be increasing. Males has been increasing as well but not as fast as females.
Melanie: Wow, so how do they form?
Dr. Spry: Well kidney stones are formed as a result of too much stuff, chemicals and things like that that build up in the urine. The most common reason is that calcium gets into the urine in higher concentrations than it should and that calcium forms stones and it either can form stones called calcium oxalate stones or calcium phosphate stones and that’s the most common. About eight out of ten stones that are formed are calcium stones, and a smaller percentage are what we call uric acid or gout stones. We see a few that are infection stones where people have chronic infections, and those infection stones are much less common, but I said the most common stone that people experience is a calcium stone and they’re formed by having too much calcium and other things in the urine. It turns out the most common cause of stone disease is a high salt diet.
Melanie: Well I was going to ask you how your diet affects the formation of kidney stones. So a high salt diet and what else? Are there other things that can contribute?
Dr. Spry: Certainly, the risk factors for kidney stones are increasing age. As we all get older, we’re more prone to get kidney stones. I mentioned the fact that men have stones more than women. It turns out if you’re part of the white population, you have the highest incidence of kidney stone disease and higher than any of the other ethnic minorities. If you have a family history of kidney disease or family history of stones, you’re more likely to develop stones, and probably the main reason we’re seeing more stones in the United States today is the epidemic of obesity. People who are obese and people who lose weight actually as a result of things like bariatric surgery or weight reduction surgery, those two populations probably have the highest incidence of kidney stone disease.
Melanie: So what are the symptoms, Dr. Spry? What would somebody notice before it becomes something that they rush off to the doctor? Are there some early symptoms and what are the red flags?
Dr. Spry: Yes, the most common symptom obviously of kidney stones is pain. That pain usually is rather abrupt in onset. That pain usually is in your back, or what we call the flanks, although the pain can be any of a number of different areas, starting from your back, rotating around to the side, going into your groin, and in some cases it actually goes into your genital area such that men will have pain into the testicle and women will have pain into the labia and that will be the pain that is again abrupt in onset, quite severe, and usually associated with at least some blood in the urine. Sometimes you see blood, sometimes you don’t. But again, abrupt onset of pain, especially in the flank, would be the most common symptom associated with a kidney stone.
Melanie: Is this an emergent condition? So do you go to the emergency room or do you go see a nephrologist? And what treatment options are available?
Dr. Spry: Well if you’re having an acute pain, obviously the most common thing you’re going to do is go to either an urgent care or an emergent care setting. In most cases in order to diagnose stone disease, you’re going to need to have the availability of at least some type of x-ray procedure or ultrasound and you’re also going to need to have the availability of a way to examine the urine because the two most prominent findings of stone disease would be blood in the urine, either in microscopic amounts that you have to test for, or in visible amounts where you might actually see some red blood in the urine. The other thing that needs to happen is we’ll need to take some x-rays. The best x-ray is called a helical CT scan, or a thin sliced CT scan, it’s sometimes called a low dose CT scan. Those kinds of scans usually have to be done in the emergency rooms and are the best way to screen for stone disease. Other tests can be done that includes just a flat abdominal film of the abdomen or an ultrasound, but those are usually less sensitive in picking up stones, and again the urinalysis is also extremely important. A good history and physical examination is also important as well because the major differentials for stone disease include things like pelvic infection, bladder infections, you could even have appendicitis or even gallbladder attacks that can mimic kidney stones.
Melanie: And then what? What are the treatment options? Is this something that is medication intervention? Is it hydration? Does it usually require some sort of procedure? Tell us about treatments.
Dr. Spry: Yeah well the treatment is, it depends on the size of the stone. If it turns out this stone is quite large on the examination, then that’s going to require some kind of surgical intervention and that’s where my colleagues who are urologists are involved. If the stone is generally greater than about 10 mm, it’s not going to pass on its own and its going to require surgical intervention. If the stone is less than about 5 mm, which is quite small, then that stone most likely will pass just with medical management. Medical management usually involves use of pain medications to treat the stone pain and also use of hydration. If the patient is nauseated or vomiting as a result of extreme pain, then you’re going to need to administer that fluid and hydration by vein; otherwise if you can orally hydrate, that’s the best thing you can do and try to force that stone out. The other treatments that are often given, there are certain medications called alpha blockers that are often used to help facilitate stone passage and other medications are out there, but the two predominant medical treatments are hydration and pain control. Beyond that, we try to do things that prevent future stones, and so for the acute treatment of the stone, we’re trying to get that stone to pass and try to make sure that all the stones have been removed from the urinary tract and from that then we go on to try to prevent future stones.
Melanie: Does the person have to be hospitalized while they’re working on hydration or whatever procedure you decide to do, do they have to be hospitalized or is this something that they just sort of wait out at home?
Dr. Spry: Well again it depends on the degree of pain. Most of the time it depends on whether or not they can orally hydrate. If you have somebody who is having such severe pain that they’re vomiting or having severe nausea, which can be very common with stone disease, then those folks are going to have to be hospitalized because the only way to hydrate them is with intravenous fluid. If they can take oral pain medicines and if they can orally hydrate, we would prefer to send them home. So that’s usually the main differentiating feature is can the patient orally hydrate and can they take oral pain meds. If they can’t take by oral, then they’re going to have to be hospitalized.
Melanie: Then give us your best advice about prevention, as you’ve mentioned a couple of times prevention in the first place and prevention of future stones if you’ve already had one, what do you tell people every day that they really need to do to try and keep this from happening?
Dr. Spry: So the main treatment of kidney stone disease is hydration. I tell my patients that they think about this like you would putting sugar in iced tea. If you put too much sugar in iced tea it all falls to the bottom and the only way you can get it back in solution is to put in more tea. Well that’s the same thing that happens in the urine is you get too much stuff in the urine and it all falls out and forms crystals and stones and so the main thing to do is to try to hydrate and we usually recommended that they hydrate so that they’re urine is rather light yellow in color. Some people what to know exactly how much water to drink and I’m afraid I don’t know that. I usually tell them to keep hydrating until their urine is light yellow, and in some cases if some people have lots of kidney stones, they may actually have to get up in the middle of the night to drink water because during the night is the longest time you go without liquid and that’s when you’re urine is going to get most concentrated and potentially form a kidney stone. The other thing that we do for prevention is to have somebody on a low salt diet. As I mentioned earlier, salt intake is the most common reason why people have stones. The more salt you take in means the less of other things that you can put in your urine, the less of things like calcium and gout, things like uric acid. Those things are in the urine in a certain concentration, and then if you put salt in there, that salt will actually act to what we call salt out stones, in other words the salt acts as a chemical constituent in the urine that actually forces the other chemicals like minerals to come out in the form of crystals and stones, and so I’m a very strong proponent of something called a DASH, D-A-S-H diet, that’s been a diet that’s been shown to decrease the incidence of stone diseases and also lower blood pressure. That stands for Dietary Approaches to Stop Hypertension. You can look up the DASH diet by Googling DASH and NIH, which is the National Institutes of Health. The National Institutes of Health did studies on the DASH diet dating back into the 90s and have shown it to be a very good diet for lowering blood pressure as well as preventing kidney stones.
Melanie: Thank you so much Dr. Spry for being with us today and explaining it so very well about kidney stones, and more importantly, the prevention of them in the first place. Thank you so much again and a special thank you to our podcast partner, Davis Design. If you’d like to learn more about healthy living, please visit bryanhealth.org, that’s bryanhealth.org. This is Bryan Health Podcast. I’m Melanie Cole, thanks for tuning in.