Breaking Your Stones

Kidney stones are aren’t exactly small rocks, but despite the coarse comparison to a certain part of a male’s anatomy, they’re no laughing matter: If you have or have had kidney stones, you already know it can range from bearable discomfort to intense pain.

Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They form when your urine contains more crystal-forming substances—such as calcium, oxalate and uric acid—than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

Kidney stones have many causes and can affect any part of your urinary tract—from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together. While painful, passing kidney stones usually cause no permanent damage as long as they are dealt with appropriately. You may need to only take pain medication and drink lots of water to pass a kidney stone. In other instances—for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications—surgery may be needed.

What Causes Kidney Stones?

Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a naturally occurring substance found in food and is also made daily by our liver. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate content. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine.

Calcium stones may also occur in the form of calcium phosphate. This type of stone may also be associated with certain migraine headaches or with taking certain seizure medications, such as topiramate (Topamax).

Struvite stones form in response to an infection, such as a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning. Uric acid stones can form in people who don’t drink enough fluids or who lose too much fluid, those who eat a high-protein diet, and those who have gout. Certain genetic factors also may increase your risk of uric acid stones. And cystine stones form in people with a hereditary disorder that causes the kidneys to excrete too much of certain amino acids (cystinuria).

People prone to kidney stones should make some changes to their diet to help prevent recurrences. This may include drinking more water, reducing salt intake and eating less meat. There are certain foods you can have, and other foods you should avoid, to reduce the chance that kidney stones will return. If you had kidney stones before, you are more likely to get them again. But by following the eating plan your doctor or dietitian suggests, you may prevent new kidney stones.

How to Prevent Kidney Stones

Here are some tips to help lower your chance of getting kidney stones:

• Drink more fluids, especially water. Try to drink eight to 10 glasses of water a day. If you don’t already drink that much, slowly increase how much you drink over a week or two. This slow increase will give your body time to adjust to the extra fluids. You are drinking enough water when your urine is clear or light yellow. If it is dark yellow, you are not drinking enough fluids.
• Eat less salt and salty foods. One way to do this is to avoid processed foods and limit how often you eat at restaurants, as well as to avoid adding salt to your meals and when you cook.
• Talk to your doctor or dietitian about how much calcium you need every day. Try to get your calcium from food, rather than from supplements. Milk, cheese, and yogurt are all good sources of calcium.
• If you had an oxalate kidney stone, your doctor may ask you to limit certain foods that have a lot of oxalate, such as dark green vegetables, nuts, and chocolate. You don’t have to give up these foods, just eat or drink less of them.
• Eat a balanced diet that is not too high in animal protein. This includes beef, chicken, pork, fish, and eggs. These foods contain a lot of protein, and too much protein may lead to kidney stones. You don’t have to give up these foods. Talk to your doctor or dietitian about how much protein you need and the best way to get it.
• Increase how much fiber you eat. Fiber includes oat bran, beans, whole wheat breads, wheat cereals, cabbage, and carrots.
• Avoid grapefruit juice.
• Drink lemonade made from real lemons (not lemon flavoring). It is high in citrate, which may help prevent kidney stones.

Talk to your doctor if you take vitamins or supplements. He or she may want you to limit how much fish liver oil or calcium supplements you take. Also, do not take more than the recommended daily dose of vitamins C and D.

Treating Kidney Stones

Kidney stones that can’t be treated with conservative measures — either because they’re too large to pass on their own or because they cause bleeding, kidney damage or ongoing urinary tract infections — may require more-extensive treatment. Procedures may include:

Using sound waves to break up stones. For certain kidney stones — depending on size and location — your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL).

ESWL uses sound waves to create strong vibrations (shock waves) that break the stones into tiny pieces that can be passed in your urine. The procedure lasts about 45 to 60 minutes and can cause moderate pain, so you may be under sedation or light anesthesia to make you comfortable.

Surgery to remove very large stones in the kidney. A traditional procedure involves surgically removing a kidney stone using small scopes and instruments inserted through a small incision in your back. You will receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your doctor may recommend this surgery if ESWL was unsuccessful.

Using a scope to remove stones. To remove a smaller stone in your ureter or kidney, your doctor may pass a thin lighted tube (ureteroscope) equipped with a camera through your urethra and bladder to your ureter. Once the stone is located, special tools can snare the stone or break it into pieces that will pass in your urine. Your doctor may then place a small tube (stent) in the ureter to relieve swelling and promote healing. You may need general or local anesthesia during this procedure.

Remember, the best way to reduce your risk of kidney stones is to drink a lot of water. It’s also a good idea to ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!