What is a Kidney Stone?
A kidney stone is a rock. When one is passing, it will feel like a boulder. The stone comes from the kidney Calcium crystalizes. It is then unleashed down into the kidney tubes.
Kidney stone pain is horrendous.
Imagine a rock pushing through a sensitive tubule; Each movement scraping the sides. That is the kidney stone through the ureter.
Quickcare or ER?
I have some some patients with kidney stones come to the clinic. However, Kidney stones should be seen in the ER if there is:
- Severe pain
What will your doctor ask?
Your doctor will want to know your symptoms. Remember, a symptom is your description of your condition. It is your story
Your doctor will want to know:
Where is the pain?
Is the pain in one spot or does it radiate to other parts of your body?
What is you pain like? (sharp/dull, local,severe)
What makes the pain better?
What makes the pain worse?
Do you have fever with the pain?
Do you have vomiting with the pain?
Typical kidney stone symptoms are a sudden onset of sever flank pain. The pain is colicky (comes and goes). In men, the pain may travel to the testicles.
What will your doctor look for?
Your doctor will look for signs. Remember a sign is an objective finding that a doctor discovers upon examination.
The most obvious sign is the writhing of pain associated with a kidney stone.
Your doctor will want to do a urinalysis. Typically, the urine result is bloody. That makes sense since the stones is scraping the tubes as it is passing to the bladder.
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms.
This list is called a differential diagnosis.
What causes kidney stones is a crystallization of minerals. Most of the time, calcium is the mineral that crystalizes.
Other causes include intestinal diseases called Chron’s or Ulcerative Colitis. Hyperparathyroidism may also lead to calcium oxalate stones.
Gout may produce uric acid stones.
Rarely are there inborn errors of metabolism that lead to cysteine stones.
Trust me. Your doctor will want to make the diagnosis.
CT had been the imaging study of choice. However, a recent article demonstrates ultrasound’s validity in diagnosing kidney stones. Both do not clarify the kidney function; Only the presence or absence of the stone.
Kidney stones in women presents unique challenges. If my patient is pregnant, then I will do an ultrasound so that radiation will not harm the baby. Also, the blood in the urine may be due to menses and not a stone.
One other key point for your doctor to consider: If you are age 60 or older, then typical kidney stone pains such as severe flank pain, blood in the urine may be due to an Abdominal Aortic Anuerysm (AAA). This is serious. A CT scan or ultrasound is needed to rule out this potentially life threatening condition.
What is the treatment of Kidney Stones?
Most of my patients ask, “Why me? What did I do to cause this stone.?”
This leads to a more important question: “How to prevent kidney stones? ” I tell my patients to drink lots of fluids during the hot summer months. For the more unique causes such as Chron’s, then treating the underlying disease the best strategy.
Stones present in many sizes. Key question. Which will pass and which ones need to be surgically removed?
Here is a guide:
If the stone is less than 5 mm…….50% will pass. I prescribe pain medications such as Norco and Naproxen. Flomax also helps.
If the stone is greater that 6 mm…..only 10% will pass. I will prescribe pain medications such as Norco and Naproxen.
If the stone is at 10 mm (one centimeter)…..It will not pass and thus needs a surgical removal. I call a Urologist at this point.
In addition to pain control, I add on a medication called Flomax (Tamsulosin). This medication relaxes the muscles around the bladder and urethra allowing for better passage of the stone.
How long will you have the Kidney Stones?
Some patients unfortunately have chronic kidney stones. They constantly come to the ER seeking pain medications. Metal tubes may be placed in the ureters to assist in passing the stones.
Most others with stones less than 6 mm pass their stones after a few days. Patients tell me that they urinate out either a pebble or sand.
Let me tell you a Story……….
I see a lot of Mexicano workers at the clinics. There are many persons named Jose, Jesus, Maria. Names from the entire Holy Family are very well represented.
When I see a patient named Francisco, then I usually will ask which nickname they use. Just like the name “Elizabeth” may translate to “Beth, ” “Liz,” “Lizzy,” so too with Francisco. It may be “Pancho,” “Panchito”, “Kiko,” “Paco”, “Pacito.”
This Francisco was totally Americanized. He only wanted to be called “Franky.” Ok. Sounds more Italiano. But, hey, this is California; The ultimate melting pot. ”Franky” it is.
Franky worked as a forklift driver. The persistent bumping up and down while drive would cause anyone to have an occasional back spasm. Add to that was the repetitive getting off and on from the vehicle.
When Franky complained of pain in his lower back, I thought that this was going to be easy. With his occupation, anyone would jump to a diagnosis of lumbar strain. Like anyone, doctors fall into routines. It would be easy to assume that his lower back pain was due to muscle strain. A simple diagnosis. A treatment that everyone knows- Motrin and Rest.
But, this pain was different. My ears perked up when he said his pain caused nauseousness. Hmmmm. No injury. No fall. Sudden onset. He later said,” Yeah. I started sweating when the pain hit me ….and doc, it felt like my balls were in a vice.” This is radiation of pain. Ouch. I answered with a straight face, ” Have you ever had your testicles in a vice?” Franky laughed and shook his head side-to-side.
Sure enough, his urine had loads of blood with just a hint of an infection.Since he had no fever, vomiting or severe pain, I gave a prescription of Norco and Naproxen. An outpatient appointment was made for him with a urologist.
I hope this helps.