Combating kidney stones
through prevention, treatment

She awoke at 3 o’clock in the morning with a pain in her lower abdomen that rivaled childbirth. She felt an urgent need to urinate, but nothing would come; and bearing down was intolerable. Soon, she headed to the Emergency department at Community Hospital, while her husband stayed home with their sleeping children.

She’d never had a kidney stone before but had heard they were horrible, so she assumed this was her first. A doctor confirmed her self-diagnosis and introduced her to another first: treatment to break up the stone so it could pass more easily.

Fortunately, not every kidney stone rises to the level of an emergency, and there are ways to reduce the risks of having them, says Dr. Michael Jacobson, a urologist with Montage Medical Group.

Kidney stones occur in the urinary tract when urine contains more crystal-forming substances —calcium, oxalate, or uric acid — than the urine can dilute. Though stones can form anywhere in the urinary tract, they form most often in the kidneys.

There are a variety of causes for kidney stones, but the most common are poor diet and dehydration.

“Kidney stones form most commonly in people who don’t drink enough fluid, particularly during exercise or hot weather,” Jacobson says. “People, particularly those who have a history of forming stones, need to consume at least 2.5 liters of fluid a day to produce at least 2.5 liters of urine per day, which is a lot.”

In general, people need to maintain enough hydration so their urine is light yellow or clear.

“For the most part, it doesn’t matter what fluids are consumed; water, coffee, tea, even beer, lemonade, or clear sodas don’t cause stones,” Jacobson says.

“Something about dark sodas, however — Pepsi®, Coke®, Dr. Pepper® — perhaps the caramel coloring, makes people secrete a lot more calcium, which can cause stones.”

Another cause is over-consumption of salt. Jacobson and his fellow Montage Medical Group urologists, Dr. Andrea Chan, Dr. Harsha Mittakanti, and Dr. Craig Stauffer, advise a low-sodium diet, generally 3 grams or less per day. They recommend reading food labels, and if an item contains more than 30 percent of the recommended daily allowance of sodium per serving, make another choice.

“People say they don’t eat much salt but often have no idea how much sodium they consume,” Jacobson says. “Salt is insidious, particularly in pre-packaged, pre-prepared, canned, and frozen foods, which often contain large amounts of salt to make them more palatable.”

Over-indulging in animal protein is another contributor.

“I say anything that ever swam or walked or had a face — poultry, fish, or muscle meat — should be consumed sparingly,” Jacobson says. “We don’t necessarily recommend becoming a vegetarian, but we do suggest to anyone who’s had a problem with stones that they limit the consumption of purines, a chemical compound found in high concentrations in meat and meat products. Purines, which break down into uric acid, can cause kidney stones.”

People concerned about kidney stones often turn to the internet. The first thing to come up, says Jacobson, is avoiding oxalate. Ironically, it is found in typically healthy foods such as greens, nuts, and berries.

“Healthy people are not going to have a problem with these foods,” he says, “with the exception of spinach. It contains a gigantic amount of oxalate. A spinach shake with almond milk is like an oxalate bomb.” So, with all due respect to Popeye, someone who has a history of kidney stones may want to reduce or eliminate spinach consumption.

Common kidney stone symptoms include:

• Severe, sharp pain in the side and back, below the ribs
• Radiating pain in the lower abdomen and groin
• Pain that fluctuates in severity
• Pain or burning while urinating

You should seek immediate medical attention if you have:

• Pain so severe you can’t get comfortable
• Pain with nausea
• Pain with fever and chills
• Blood in urine
• Difficulty urinating

If a stone is diagnosed and the doctor feels it will pass without infection, the best course may be no intervention. Otherwise, Jacobson says, shockwave treatments have been the standard since the 1970s to break up the stone so it can pass. If the stone is particularly large, laser treatments can be used to pulverize it.

“An emergency situation is when a stone is trying to pass from the kidney into the ureter, the tube that connects the kidney to the bladder, blocking the flow of urine and causing an infection,” Jacobson says. “The blocked urine can go backward and enter the blood stream, causing sepsis. When people are septic from a kidney stone, this is a potentially deadly problem requiring surgery.”

“Kidney stones are so common, and we’ve been really fortunate to have the support of Community Hospital to acquire the most advanced equipment possible to resolve them,” Jacobson says. “But most important to understand is that most stones are preventable, if we know how.”

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