First off, kidney stones are common.

They are literally a ‘rock’ that is in the urinary tract.  The medical term for a stone is nephrolithiasis.  If a kidney stone is passing that means that it is working its way down from the kidney to the bladder.  During this route, it can sometimes get stuck.  This will block the flow of urine and cause pressure and swelling on the urinary tract and that STINKS.  This stretching is the source of pain and what prompts you to do the ED or the doctor’s office.

There are many layers to kidney stones and this is a starting point to have this conversation.

Medical terms you may hear during your appointment

• Kidney stone:
  • We use the word kidney stone but in reality it could be in the kidney or the ureter depending on its location\
• Obstruction
  • The urologist will use this term to say that the urinary tract is blocked. Imaging (ultrasound and/or CT) will show that the kidney is stretched or dilated indicating that the kidney is not draining well and is blocked.
• Hydronephrosis
  • This is the term we use to say that the kidney is swollen or dilated.  Usually this is a sign that the kidney is not draining well
• Ureter
  • The name of the tube that carries urine down from the kidney to the bladder

For the rest of this post, I am going to review some important questions to ask and review during your appointment

Is my kidney obstructed?

This is the key question. It will answer the question you have if there is any urgency regarding treatment.  Oftentimes patients will have a kidney stone but it is “non-obstructive”.  If a stone is not obstructing the kidney, it is likely not causing pain and the decision to treat becomes more elective. It is also important to know where the stone is located. So let’s do a brief anatomy lesson. There is the kidney parenchyma which is the meat of the kidney and helps to serve many functions, which especially includes filtering the blood. From this parenchyma, urine will be made and is collected in the aptly named collecting system. This is where kidney stones hang out. This collecting system combines into what is called the renal pelvis and then there is a tube called the ureter which carries the urine from the kidney to the bladder. So when we say you are “passing” a stone, we are talking about a kidney stone that has moved from the kidney towards the bladder and is stuck in the ureter tube. When this happens, the kidney becomes blocked or obstructed.

What size is my stone(s)?

This is one of, if not, the main factor in how a urologist decides when to treat surgically. If a stone is “passing” down the ureter, the size is a major factor in evaluating if surgery is needed or not. If a stone is less than 5-mm in size, there is a 90% chance or more that you can eventually pee it out without needing surgery. So when I am reviewing the images, I will look at the size of the stone(s) and use this as an important consideration as to if and when we should operate.

Do I have other stones?

Oftentimes, the radiologist or the urologist will only focus on the stone which is causing a problem and fail to mention if other stones are present. This is important to know so you can follow later on if you have another stone attack.  It also may prompt follow up imaging to monitor any stones that you have. Lastly, if you have more stones it is all the more important to think about how you can change your diet to help prevent the stone from getting bigger or from forming new stones.

What kind of stone do I have?

If you pass the stone or if it is removed during surgery, we can analyze the stone and figure out what it is made of. The most common type of stone is a calcium based stone. This usually has nothing to do with how much calcium you eat.  Additionally, lowering your calcium intake may actually be worse for you so ask your doc.  Usually the best treatment for this is to hydrate better and try and increase citrate in your diet–orange juice, lemon juice, etc.

The other most common stone is a uric acid stone. This stone is unique for several reasons.  Firstly, this stone is not well seen on a regular x-ray so that’s important.  The evaluate for this stone you will need an ultrasound or more likely a CT scan. Also, this stone can sometimes be dissolved if you are able to make the urine less acidic.  There are medications that can be prescribed to help with that which will change what is called the pH in the urine to make is less acidic. By doing so, it can dissolve uric acid stones and also prevent more stones from coming back.

What can I do to prevent stones?

In real estate, they talk about location, location, location. For stones we talk about hydration, hydration, hydration.  I have found that hydrating is the simplest, yet oftentimes hardest, behavior to change.

For stone-formers we want them to pee out about 2-2.5 liters a day.  THAT IS A LOT OF PEE.  I will frequently have patients perform a “24 hour urine collection” to assess this as it is hard to tell how much we urinate in a typical day. My best recommendation is to invest in a water bottle. If you see the bottle nearby, you are more likely to drink fluids and hydrate. If you do nothing else, just increasing your fluid intake can make a big big difference.

For some kidney stones, there are medications that can be given to help reduce the chance of kidney stones coming back.  This will be a judgement call for you to decide if taking a medication to prevent the possibility of more stones coming in the future.

Wait, these can come back?

Sadly…yes.  If I take all my patient’s, on average one out of every two patients (50%) will have another stone episode within 10 years time.  That is a high number. This is why I spend so much time encouraging my patients to hydrate.

So how can stones be treated?

This is a longer discussion, so head over to my post about this topic reviewing the different surgeries for kidney stone management.