Kidney Stones

One of my patients once said, “I have delivered three children and this is the worst pain I’ve ever experienced.” She was not alone in reporting that having kidney stones can be one of the most intensely painful experiences imaginable. Patients have described the pain as ranging from a dull ache to a red-hot poker burning in their back.

Kidney stone disease is relatively common – all humans form them but they are usually small enough to pass without notice. In the last decade, however, the incidence of painful kidney stones has risen, especially in western society.  We usually see patients with kidney stones in the emergency department or doctor’s office. They are acutely ill, in severe pain, nauseated and vomiting. These patients require quick diagnosis, treatment and eventual management. Fortunately, this can be done rapidly.

Is it something I ate?

Kidney stone formation is very complex and not well understood, but most of the stones in humans are calcium-based. There are other minerals which account for approximately 15 percent of the disease, but they are mostly calcium. Main risk factors include family history, chronic dehydration, bowel disease, some medications, and kidney abnormalities. Patients with risk factors are apt to form stones more quickly which can grow rapidly enough to cause symptoms.

Most people who have passed a kidney stone never want to experience it again. When we look at prevention, a patient’s risk factors are more important than trying to understand why they formed a stone in the first place. The good news is that patients can significantly halt kidney stone disease and reduce its reoccurrence by adjusting their diet and making lifestyle changes. This is important because patients who form calcium-based stones are at significant risk to get more.

Note: there is no need to avoid coffee and soda – they have not been proven to contribute to stone disease; and calcium restriction is usually not recommended unless the patients are on supplementation.

Most kidney stones do not cause pain after they have formed and are in the kidneys.  It is only when they move into the urinary tract when they begin to cause severe symptoms.  Fortunately, most stones are very small and can pass easily. It should be noted that stones generally do not cause pain when they are being passed through the urethra.  It is only when the stones are stuck in the ureter (the upper urinary tract) that they will cause symptoms.  Ironically, the smaller stones cause more pain as they migrate through the ureter. Fortunately there are medications now available to help patient’s pass stones more quickly.

Although treatment can be provided by noninvasive methods, prevention remains the goal to avoid acute and painful illness.