Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And we have a panel for you today to learn about the prevention and treatment of kidney stones. Joining me in this panel is Dr. Michael Amirian, he's an assistant attending urologist at New York-Presbyterian Hospital/Queens, and an Assistant Professor of Clinical Urology at Weill Cornell Medical College Cornell University; and Dr. Kavita Gupta, she's an assistant attending urologist at New York-Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Urology at Weill Cornell Medical College Cornell University.

Doctors, thank you so much for joining us today. This is a great topic. People don't understand kidney stones. They don't really know what they are. They just hear about pain, they hear about waiting it out. So, we're going to learn a lot about them today. And Dr. Amirian, I'd like to start with you. Will you tell us what they are? What are kidney stones, and how do they form?

Michael Amirian, MD: Absolutely. So, kidney stones are crystals that form in the urine that end up sticking together and forming like a rock-like structure. These stones develop along the urinary tract and at times can become quite bothersome where they end up blocking the kidney and causing significant pain.

Melanie Cole, MS: Thank you for explaining really what they are. Now, Dr. Gupta, are certain people more at risk for getting these, male versus female, people that live in certain parts of the country? Tell us a little bit about risk factors and what the greatest risk is for stone formation.

Kavita Gupta, MD: Yeah. So, men are more likely than women to get kidney stones; however, there has been a change in the last several years to make it a little bit more equal amongst demographics. Also, if you have family history of kidney stones in your family, you're more likely to get them. And if you have had a kidney stone episode, you're more likely than someone in the regular population to have another kidney stone, which is why prevention is so important. So if you've passed the kidney stones, you should seek a urologist, because they can give you some tips on how to prevent having those stone episodes in the future.

Melanie Cole, MS: Wow. So, having one puts you at a greater risk for having another one. When we think about prevention, Dr. Amirian, can diet make a difference in the formation of stones? For instance, higher sodium intake, can that increase stone formation? And conversely, are there things that we can include in our diet that can help prevent stones from forming?

Michael Amirian, MD: Good news is, is absolutely. So, diet is a huge part of kidney stone prevention and management. And that's what we do as urologists, is to counsel patients. And also, sometimes bring in a nutritionist if needed. But, absolutely, hydration, fluid intake is the number one aspect for kidney stone prevention. That's what I tell all my patients is hydrate, hydrate, hydrate. The more diluted the urine is, the less likely the crystals are to stick together and form a stone.

And absolutely, diet in terms of high sodium intake, which sodium is found hidden in so many different things in our diet-- takeout food, fast food, canned foods. Even a lot of salad dressings are very high in sodium. And that sodium can drive calcium into the urine, which will form stones. So, definitely limiting our sodium intake. And not just table salt, really just watching labels, looking at the sodium contents of all the foods that we're eating, processed foods especially are very high in sodium. So snacks, chips, cold cuts, frozen foods, packaged foods. So, we really have to pay very close attention to our sodium intake.

And then, there are things that we can take in our diet for prevention purposes. And usually, those are foods containing citrates, so citric acid-containing foods. So, things such as lemons, grapefruits, these have citrate in them, which can actually be something to prevent stones for us.

Kavita Gupta, MD: one thing I would like to add, and there's like a belt near the equator of very high temperatures, in very hot climates. The tendency or people in those climates are not hydrating enough, so they're more likely to develop kidney stones. So, that's one of the things that's very important.

And one of the things that Mike was, you know, addressing is a lot of times when we eat out, we can't really look at the ingredients and people add salt to make it taste better. So, one of the things that we're doing at Weill Cornell is we're looking at those type of things to try to help our patients and prevent them from making kidney stones.

Melanie Cole, MS: That's interesting that you mentioned the geographical location. I've heard about that, but I don't think I've really understood until you said that, that the people in those areas maybe tend not to hydrate as much because they're in the hotter climates. So, that kind of makes more sense now.

And Dr. Gupta, sticking with you, symptoms. I mean, we get pains, oh, everybody always goes right to appendicitis. Where would we feel the pain of a kidney stone? How would we know what side? Give us a little geographical location on our body to tell us where this pain would be felt. What does it feel like?

Kavita Gupta, MD: People, you know, sometimes will just point to the lower back. But often, the flank or where the kidneys are is actually a little bit closer in the posterior rib area. If you have lower back pain, that's more in the middle of the back, so sometimes it's a little bit hard to distinguish between the two. But I would say the more on the side back is where your kidneys are located. So, you can have pain there. You can also have pain in the lower stomach area as well. But often, you'll have pain, but you'll have other symptoms as well, like nausea or vomiting or blood in the urine or some patients will have symptoms of like a urine infection. They'll have fever, chills, or they feel like they need to pee more often.

And what I would say is if you're having any of those symptoms, you definitely need to see a urologist. However, if you're having fever, chills, and you cannot drink anything, take anything down, you definitely need to see someone emergently and go to the emergency room because those will require an immediate treatment.

Melanie Cole, MS: How's it diagnosed, Dr. Gupta? If somebody does go to the emergency room, how do they know that this is what it is?

Kavita Gupta, MD: So in the emergency room, they'll do a CAT scan, which is a scan that looks at all the abdominal organs. And actually, kidney stones are pretty easy to diagnose because they're like a rock structure. They look white on CAT scan. So, you'll be able to easily diagnose it because you can see the kidney in detail. You can see the ureter, which is the tube that connects the kidney to the bladder. And you can see the ureter, you see if the stone is in the ureter or the bladder, where that's where we urinate from. So, you can identify it pretty easily with a CAT scan.

Melanie Cole, MS: That's so interesting. Now, Dr. Amirian, once it's been diagnosed, what then? What happens next? Tell us about some of the treatment options that are available, whether they're pharmacologic in nature or interventional? And how do you help the patient with the pain of this particular situation?

Michael Amirian, MD: Absolutely. I mean, our first goal as doctors, obviously, is to get patients comfortable, get their pain controlled. And we do that. We have various ways in the emergency room or in our office to give certain medications to help alleviate the pain. Once we get the pain under control, the good news is that most stones are able to pass on their own. And we're able to facilitate that with certain medications. A specific medication we prescribe is something called tamsulosin. The brand name is Flomax. That helps relax the ureter so that smaller stones can pass on their own.

The key also is hydration. You know, it comes back to hydration. Really, fluid intake to try to flush the stone out. Unfortunately, there are certain stones that are larger or just stuck that will not pass. In those situations, sometimes a procedure is necessary to remove the stone.

Melanie Cole, MS: Dr. Amirian, when we think of these treatments, you said many times it passes on its own. What's that like? Is that a hospital situation? Does the person go home and wait for this thing? I mean, how do they know? Tell us about what happens in that case.

Michael Amirian, MD: Great question. If the patient's at the hospital, and we able to get their pain controlled, there's no signs of infection, this is all checked in the emergency room, and the stone is of a size that we think can pass on its own, we're able to safely discharge patients to home. And we wait it out, give them a strainer so they can strain the urine and see if a stone, passes and capture it. Because that's very important data for us, is to analyze that stone, see what it's made of and what we can do for prevention in the future. But yeah, most of the time, patients are able to be sent home and pass the stones on their own.

Melanie Cole, MS: So, you want them to capture it and put it in a little bottle or something and bring it to you.

Michael Amirian, MD: Bring it to us. Absolutely. Yeah.

Melanie Cole, MS: And does that tell you what type of formation it is and help you to decide maybe their risk of future stones?

Michael Amirian, MD: Exactly. Yeah. So, the stone analysis is important for us. There's different stone types. Just to name a few, calcium oxalate is one, uric acid is another, calcium phosphate. So, all of these stones, there's different causes for them or different reasons that they may form. And having that analysis in conjunction with other tests that we do helps us decide on prevention for future stones.

Melanie Cole, MS: Dr. Gupta, are there any non-pharmacologic interventional treatments that can maybe help to speed the process along if the person does have to stay in the hospital? Tell us about some interventional treatments that you might try or modalities that can help get that thing out of there.

Kavita Gupta, MD: So, I mean, as Dr. Amirian was saying, a lot of times, if the stone is a certain size, we give that medication for the ureter to relax. But again, like I would have to push the hydration. If there have been episodes where if a patient is unable to drink enough water, if they're hospitalized, you'll give them IV fluids, because that gives them enough hydration to try to push the stones out.

However, if the stone is large or if the patient has a ureter that is very tight, and the patient can't pass the stone, then we have to do some surgical options. And one of the most common surgical options we do is called a uteroscopy, where we place a very, very tiny, tiny scope, which is like a little spaghetti noodle scope. And we put it into the ureter, we break up the stone, and we have to remove the pieces. And then, there's other options, you know, depending on the location of where the stone is. There's one where you can use some sound waves to break up the stone, and the patient will pass it by themselves.

And then, for very, very, very large stones that are located in the kidney, there's a more invasive approach where we put a little straw on the kidney and a camera. And we break up the stone and we remove the stone. So, those are the options for when our patients are unable to pass the stone or the stone is too large for them to pass it as well.

Melanie Cole, MS: Really interesting ways for this to happen. And I think this is something that's really been around a very long time. So, I mean, it's so interesting how we've come up with different ways to treat it, but some are just kind of you got to just pass it on your own. So, Dr. Gupta, I'd like to give you each a chance for a final thought.

Dr. Gupta, we mentioned nutrition. We've mentioned hydration quite a few times. Tell us a little bit about this multidisciplinary approach, the need for sometimes other specialists to come in and help the patient, especially if it's family history or they've had one before, to help them so that maybe they don't have it happen again.

Kavita Gupta, MD: Yeah. So, we believe in like a personalized approach, because everyone is different. Everyone's environment is different. Everyone's diet and nutritional status is different. Everyone's family history is different. And even their stone types are different. So, we use all of that data to give us information on how they can prevent them from making stones.

Also, patients can go into different risk categories. So if you made a stone once every 20 years, you're a lower risk patient. So, your nutritional plan may not be the same as someone who make stones like every three months, they have to be a little bit more strict. And if you're a medium risk patient, like you make a stone once every two years, your plan is going to be different. So, we use all of this data together to help us make a plan for each patient.

One of the other things is when we do our nutritional counseling, some of our patients will have kidney disease at baseline. So, sometimes we need to bring a nephrologist to help with that as well. So, we use our nutritional data. We have our own urologic data with the kidney stone, and sometimes we have to recruit a nephrologist to help with that information. But the urologist is kind of responsible for bringing all that information together, so then the patient has something palatable and easy to follow in terms of their stone prevention.

Melanie Cole, MS: And Dr. Amirian, last word to you. I'd like you to summarize. And when people hear the word kidney stones, they think of pain. And you mentioned pain control before. And once this stone has passed, is the pain then gone? I'd like you to speak about after the fact. We've spoken about hydration and you can reiterate it because it certainly is one of the more important aspects we've discussed here today. But I'd like you to summarize for us and speak about what happens after the stone has passed and preventing recurrence.

Michael Amirian, MD: Absolutely. I mean, my goal-- and I'm sure Dr. Gupta and everyone at Weill Cornell Urology-- is we want prevention of kidney stones. We do not want patients to suffer or have to go through these kidney stone episodes. So, we really have a dedicated team working with patients to figure out exactly what was your risk factor, what was the underlying cause of the stone? And we work together for prevention purposes. And part of that is certain tests or exams we may conduct, like something called the 24-hour urine collection. That gives us a lot of data. The stone, if we're able to analyze it, that gives us data. And sometimes it requires, just as we talked about, something as simple as increase your hydration. But other times, it may necessitate certain medications that need to be started for prevention purposes and we're able to kind of guide the patient, guide the plan based on the history and based on the data that we have. like I said, again, our goal is prevention and that's what we really strive for for our patients.

Melanie Cole, MS: Thank you both so much for joining us today and sharing your incredible expertise. People have so many questions and you've both been so generous with your information today. Thank you so much again for joining us.

And Weill Cornell Medicine continues to see our patients in-person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcast, Spotify, iHeart, and Pandora. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. We have so many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

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