Ashlee Williams, MD: One moment you might feel perfectly fine. Then suddenly you experience some of the most intense pain imaginable. That's exactly what kidney stones can do. These small hard deposits develop quietly over time and can often take weeks to pass naturally.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams, and today I'm talking with Dr. Nwamaka Fadahunsi, a Board Certified Urologist at Kaiser Permanente about what to know when it comes to kidney stones, from symptoms and treatments to tips on prevention. Dr. Fadahunsi, thank you so much for joining us today.

Nwamaka Fadahunsi, MD: Thank you for having me.

Host: Okay. Let's just start with the basics. What exactly are kidney stones and how do they form?

Nwamaka Fadahunsi, MD: Well, kidney stones are hard clumps of minerals and salts that form inside the kidneys. The most common cause of kidney stones is simply dehydration, not drinking enough. This can cause minerals to build up in the kidneys and crystallize in the urine. Stones typically take a long time to form.

Even though we see a lot of patients presenting to the ER in the summer and early fall, these stones typically have been developing for months or years prior to when they actually cause symptoms. There are certain medications such as those used for seizures or HIV medications that can contribute to stone formation.

Also, certain underlying health conditions such as diabetes or obesity or even weight loss surgery and even some genetic factors can contribute to stone formation.

Host: Can you talk a little bit about the main symptoms of kidney stones? I can't tell you how many times I have patients come in, they say my back is hurting. Is it a kidney stone?

Nwamaka Fadahunsi, MD: Yes. One of the very telling signs of kidney stones is a sharp, intense pain. And some people describe it as worse than childbirth. I mean, it is that bad. The pain can reside in your back or what we call flank, which is where the kidneys usually reside. The pain can also travel down the lower abdomen, as the stone travels from the kidney to the bladder.

You can also notice blood in your urine. Your urine can look pink, could look red, or it could even look brown. Other symptoms include nausea, vomiting, inability to keep fluids or food down, and you could have frequent urination, especially if the stone is close to the bladder. If you notice these symptoms, you shouldn't hesitate to come to the ER or seek medical attention.

Ashlee Williams, MD: What about misconceptions? Can you talk about some misconceptions with kidney stones?

Nwamaka Fadahunsi, MD: One of the common things that we hear people say or think is that kidney stones happen to just older men, but actually anyone can form a kidney stone. We have women, we have children, teenagers, they can all form kidney stones just as easily as older men. And in fact, the occurrence of kidney stones happen just as frequently in women as in men.

Another thing that people think is that once you pass the kidney stone, you're all clear, but actually, the risk of you having more kidney stones, increases if you get a kidney stone to begin with. And the reason is because the factors that cause you to have or form a kidney stone, is still there once you get your first kidney stone.

Another misconception that people have is that if you cut out calcium completely from your diet, that this can prevent you from forming more stones in the future. And we typically don't recommend that. Everyone needs a certain amount of calcium in their diet to be healthy, and so we don't recommend cutting out calcium completely from your diet.

Other popular home remedies that people find online for kidney stones is that they can drink a large amount of water at once. They can drink lemon juice or apple cider vinegar. And all of these stuff can dissolve kidney stones. While some of these things can actually help your kidney health

overall, they are not really substitutes for evidence-based medical treatment. So we definitely recommend that one should seek care as soon as they think they have a kidney stone.

Host: Let's talk about hydration. Hydration is important in general, especially during the summer months when it's easier to get dehydrated. How does hydration play a role with kidney stones?

Nwamaka Fadahunsi, MD: It is very, very important. It's really the most single, most important thing that you can do to prevent kidney stones from forming. We don't typically recommend a specific amount of water or fluid intake because everyone's needs are different based on their particular health circumstances, based on their exercise tolerance.

But what we do want you to do is pay attention to your thirst mechanism. Your body will tell you when you need to drink. And we also want you to pay attention to the color of your urine. We'd like for your urine to be light colored and not very dark, and that's usually a good sign that you are hydrated or you are well hydrated.

Host: So you talked a little bit about calcium consumption as a misconception about kidney stones. What role does diet play in the formation of kidney stones?

Nwamaka Fadahunsi, MD: Diet is a really big factor in kidney stone formation. We found that there's a lot of data that suggests that drinking lots of soda, sweetened iced tea, sports drinks and energy drinks contribute to stone formation. We usually recommend that people replace sugary drinks with water, sparkling water and adding a splash of lemon or lime is for flavor, is actually really good practice to help prevent you from forming kidney stones and from recurrent kidney stones.

 There are certain kinds of stones that can form from a high protein diet because this can raise the level of uric acid in your urine, and this can contribute to the formation of uric acid stones. So we recommend having a balanced protein diet. We don't want you to eliminate it completely from your diet, but to have a balanced, limited amount of protein intake and consider using other plant-based proteins like lentils, beans, tofu, or quinoa in your meals. Other foods that are high in oxalate such as spinach and nuts can contribute to certain kinds of stones. And then we also suggest limiting certain foods that are high in oxalate. Like I said earlier, getting enough dietary calcium is actually protective. We don't want you cutting out calcium completely out of your diet. We want you having some calcium, because that's just good for you in general.

Host: Who would you say is most at risk for developing kidney stones?

Nwamaka Fadahunsi, MD: That is a great question. So the most common reason for people to form kidney stones is if you're not staying hydrated enough. So if you have professions that keep you outside, especially in the summer months, that is a risk factor for developing kidney stones. People who have had stones before are at risk of forming stones in the future.

People who have a family history of kidney stones are also at risk of forming stones. We mentioned certain medications, medications for HIV, anti-seizure medications, certain, antibiotics can actually cause stone formation, and there are certain conditions like obesity and diabetes that also can cause stone formation as well.

Host: So if there are people who are at increased risk because they've had stones before, or they're on medications that increase the risk, how does one lower their risk of getting kidney stones?

Nwamaka Fadahunsi, MD: Again, the best way to lower your risk is hydration. That's what I tell patients, number one, number two, number three, hydration. Because as long as the minerals in the urine stay dissolved in the urine, they will not crystallize, the minerals will not come together to form stones. The ticket is to keep your urine as dilute as possible to keep the minerals from crystallizing.

Host: What treatment options exist other than surgery for kidney stones?

Nwamaka Fadahunsi, MD: Another very, very good question. So a lot of small stones will pass on their own. Proper hydration and pain medications such as nonsteroidal, anti-inflammatory medications like ibuprofen, Advil. For larger stones, we do have non-invasive treatment options like extracorporeal shockwave lithotripsy that can be used to break the stones apart and then you can pass the stones on your own.

And in certain situations when patients are in significant pain or their kidneys are blocked, we will recommend surgery. But these are minimally invasive surgeries. They are same day surgeries and typically patients go home the same day after their stones have been removed.

Host: Thank you so much Dr. Fadahunsi for helping us understand kidney stones and how to deal with them. Here are a few of the top takeaways. One, stay hydrated. Light colored urine is a good indicator that you're drinking enough water. Two, watch out for symptoms such as side pain or blood in the urine and seek medical help early.

Three, be mindful of your diet. Avoid high oxalate foods and cut back on salty and processed items. Four, most stones can be treated without surgery and prevention is key to avoiding future issues. And five, everyone can be at risk. But small lifestyle changes can go a long way in staying free of kidney stones.

For more information from our experts, visit kp.org/doctor and check out more episodes of Healthier You wherever you get your podcast. If you found this episode helpful, be sure to share it with others. Thank you, and from all of us at Kaiser Permanente, be well.