As part of the "stone belt" — an area comprised of several Southern states — Kentucky has among the highest rates of kidney stones in the nation. Many factors play a role in this finding, including lifestyle, diet, obesity and a warmer climate.
Numerous minerals and molecules are excreted as waste products from the body, via urine, to maintain balanced levels within our bodies.
In normal conditions, these minerals pass harmlessly out of the body. However, in many people, these minerals reach a concentration that allows them to crystalize, forming what we commonly refer to as a kidney stone.
The size of a kidney stone and its location within the renal system — which connects your kidney ureters, bladder and urethra — determines whether or not the stone causes pain or discomfort. Many kidney stones go unnoticed by patients simply because they're small enough to flow through the urinary tract without causing any blockage of urine. Those we associate with pain are large enough and in a location so that they obstruct urine flow.
Most people describe this pain as acute or sudden, severe pain that is typically isolated to the flank area. In many cases, the pain is severe enough to cause associated symptoms of nausea and vomiting. The pain may come and go in waves, a phenomenon referred to as renal colic. Most stones occur in the absence of urinary tract infection. However, if a patient experiences fever in addition to the kidney stone, emergency medical treatment is needed. In these cases, the patient may become septic, which can be life-threatening if not immediately treated.
If your doctor suspects a kidney stone, treatment will depend on the size and location of the stone, and the patient's level of discomfort. If the pain can be controlled on an outpatient basis, a patient may elect a trial of passage, which can be aided by pain medications, as well as medications to help dilate the ureter, to aid in the stone flowing through.
For larger stones, there are several options available for treatment. In the short term, a ureteral stent may be placed alongside the stone to provide a channel for urine to flow from the kidney to the bladder. This is a temporizing measure that often relieves pain, but further intervention is required to remove the stone.
In stones smaller than two centimeters, one option for definitive management is the use of extracorporeal shockwave lithotripsy). This is an outpatient procedure done under general anesthesia in which a "lithotripter" is placed against the patient flank. A high-energy shockwave is targeted at the stone with the intention to break it into smaller pieces that can flow out of the body without causing obstruction. This therapy is typically contraindicated in patients who take long-term blood thinners.
An alternative treatment is known as ureteroscopy. Though also done in an outpatient setting, this procedure is more invasive that ESWL. Under anesthesia, a small scope is inserted through the urethra, bladder and into the ureter and/or kidney. No incisions are made. The scope is advanced until the stone is visualized, at which point, a laser is used break the stone into smaller pieces that can be removed using a small wire basket.
Kidney stones can form for a variety of reasons, but in nearly 95 percent of cases, their formation can be traced to a metabolic abnormality within the body that makes their formation more likely. While nearly 80 to 85 percent of all stones are calcium based, they can form due to a wide range of abnormalities. A 24-hour urine study, performed at home, can help your doctor identify which processes are occurring and make give clues as to specific dietary and medication changes that can greatly reduce the chance of forming future stones.
Your doctor may recommend a "stone diet" to help prevent future stones from forming. Though each person is different, this diet typically includes consuming less than 2,300 mg of sodium per day; a diet that is low in oxalates (often found in spinach, chocolate, tea and beets); calcium intake in moderation (between 1,000 and 1,200 mg per day); avoiding high doses of vitamin C; and limiting intake of animal protein.
Above all else, the most important thing you can to limit your chance of forming kidney stones is to stay hydrated. Be sure to drink enough liquid so that your body produces 2.5 liters of urine per day. This is especially important in the summer months when we tend to be more dehydrated. This dehydrated state causes the body to conserve water by making urine more concentrated. Staying adequately hydrated will make it more difficult for these minerals to crystalize, preventing the pain and related health concerns caused by kidney stones.