Kidney stones are a common occurrence in the USA; statistics
indicate that 1 in 9 adults will have a kidney stone in their life time. The
tiny stones may pass unnoticed but a larger stone can induce excruciating pain
– possibly the worst pain a person can experience. And once someone has had a
kidney stone, there is a 50% chance of a reoccurrence. Men have more kidney
stones than women and Caucasians are more prone than African Americans.
It’s interesting to note that North Carolina has the highest
incidence of kidney stones in the nation! White collar workers have the highest
incidence among North Carolinians. It has been speculated that high consumption
of ice tea and tea's calcium oxalate levels is the cause. Another theory is the
high mineral content in well water throughout the state.
What Are Kidney Stones?
Kidney stones (renal
calculi) are solid, rock like material formed from mineral salts that crystallize
anywhere in the kidney and may break loose and lodge anywhere along the urinary
tract. A kidney stone with a diameter less than 5 mm (about 3/16 of an inch) will
usually pass without the need for surgery. Even so, these stones can be painful.
The larger stones may lodge in the ureter, bladder, or urethra. Lodged stones
block urine flow completely and may cause extreme pain. In addition to the
pain, long-term blockage of urinary structures can cause hydronephrosis, a condition that occurs when a kidney becomes
swollen due to the failure of normal drainage of urine from the bladder. Lab
values may reflect decreased kidney function via an increase in creatinine
levels.
Signs and Symptoms
Symptoms include sudden
extreme cramping pain that comes in waves in the lower back and the side. The
pain can move down into the abdomen and into the groin area. Nausea and
vomiting may also come in waves. Blood in the urine may turn it pink, red or
brown. Because the stones block or decrease urine flow, urinary tract
infections (aka UTIs) are common. Symptoms of a UTI include urine that becomes
cloudy in appearance and has a bad odor. Burning and a frequent “need to go”
sensation are common, and fever and chills also commonly present. Any of these
symptoms require evaluation by a physician.
Types of
Calcium Oxalate
Calcium oxalate is the most
common type of stone; 60% to 65% of kidney stones are comprised of calcium and
oxalic acid, which form calcium oxalate crystals inside the kidneys. Some
people are genetically predisposed to excreting high levels of oxalate in the
urine (thus increasing the incidence of kidney stones), but this is not
commonly the case. Instead, the lack of a beneficial bacteria found in the
colon, called Oxalobacter formigenes,
and/or uncombined intestinal oxalic
acid are the culprits for calcium oxalate kidney stones. During normal
digestion, calcium crystaizes with oxalate, never gets absorbed, and is
eliminated in the stool. Oxalobacter formigenes uses oxalate as a source of
energy, reducing the amount of oxalate in urine. A loss of Oxalobacter
formigenes may result in elevated concentrations of urinary oxalate, increasing
the risk of forming a calcium oxalate kidney stone.
Taking antibiotics is one contributor to the loss of Oxalobacter
formigenes from the colon's natural bacterial flora; however, studies show that
when Formigenes is taken as a probiotic, it can re-establish itself in the gut
and reduce the urinary oxalate concentration, thereby possibly reducing the
incidence of calcium oxalate kidney stone formation.
Oxalic acid passes through
the intestinal wall, into the blood and enters the kidneys where it combines
with calcium to make a calcium oxalate crystal. Therefore, if it is combined
with dietary or supplemental calcium (i.e. calcium citrate) inside the intestinal tract, oxalic acid
will never reach the kidneys (and calcium oxalate kidney stones cannot be
formed). Oxalate is mostly found in fruits and vegetables. Vegetables high in
oxalate include spinach, greens (including beet greens), beet roots, okra, leeks,
parsley, cocoa, nuts, green and black tea, wheat bran and soybeans. Fruits with
high oxalate include berries, plums, currants, kiwifruit, concord grapes, figs,
and tangerines.
Calcium phosphate stones
are not as common as calcium oxalate stones. It is more common to find combinations
of calcium oxalate and calcium phosphate crystals together. Usually more than
50% of the stone is calcium
oxalate.
If a stone has a large
content of calcium phosphate, then medical causes should be investigated. These
include hyperparathyroidism and renal tubular acidosis (RTA). Patients
with calcium phosphate stones are treated with citrate and they tend to have
multiple recurrent stones and loss of bone density.
Struvite Stones
Struvite stones are the
least common type of kidney stones. Struvite stones can be one of the most
troublesome. These are fast-growing stones that grow and fill up the cavities
in the kidney and take on a "stag horn" appearance. Struvite stone
formation occurs only when ammonia production is increased and the urine pH is elevated
(becomes alkalinized), decreasing the solubility of phosphate. Staghorns most
commonly occur with urinary tract infections which lead to the precipitate of
magnesium ammonium phosphate crystals. These stones can cause significant
damage to the involved kidney.
Cystine stones
Cystine stones are from a
genetic disorder that causes cystine to leak through the kidneys and into the
urine. When this happens, crystals form into stones. These stones are also very
rare.
Uric acid stones
Uric acid stones are made from purines, which break down into uric
acid. When the uric acid becomes concentrated in the urine, it can form a uric
acid stone by itself or combined with calcium. When uric acid forms a crystal
with calcium, the stone will have uric acid in the middle and calcium oxalate
on the outside. The stones will be brown and not white like other types of
kidney stones. Foods high in purines include organ meats, meats, shellfish,
sardines, herring, anchovies, yeast, and other animal proteins. Other foods
include dried legumes, spinach and mushrooms. People who form uric acid stones
should limit their meat consumption to no more than 6 ounces each day.
Because uric acid also requires acidic urine to crystallize,
eating healthy foods such as organic fruits and vegetables will metabolically
alkalinize the body, including the urine.
Treatments
Identifying the type of
kidney stone, size of kidney stone and signs and symptoms will determine the
appropriate treatment. This can be accomplished by straining urine at home with
a fine colander. Retrieve the stone for the doctor.
The most important thing to
do to prevent kidney stones is to stay well hydrated, which keeps the urine
from becoming concentrated. Also urinate when needed; this prevents the
accumulation of stone-forming components in the kidneys. An inability to keep
fluids down warrants a hospital visit.
For proper hydration, using
the following formula: body weight in lbs/2 = number of fluid ounces of water
that should be consumed per day. For example, an individual who weighs 120 lbs
should consume 60 oz of water per day (120/2 = 60). Add a fresh-squeezed lemon to
increase the citric acid levels and stop crystal formation. Drinking even more
is recommended for patients with kidney stones, provided they are able to keep
the fluid down. Consuming up to 2-3 quarts of water a day is needed to flush a kidney
stone out.
Taking an over-the-counter
pain medication or herbal remedy for pain is also advised. Aleve for pain may
be used: a first dose of 440 mg, then 220 mg orally 2 or 3 x day (up to a maximum
of 660 mg/day). Another choice could be Advil: 300 mg - 800mg orally 3 or 4 x
day with a max of 3200 mg/day. These over-the-counter pain medications should
be taken with food and avoided with stomach ulcers and bleeding problems.
A safer, natural pain
reliever is curcumin: up to 3000 mg/day. Decreasing the pain will also help
relax the ureter, allowing the stone to pass more easily.
Herbs can also be used for
the successful treatment of kidney stones. Bergenia Liqulata can prevent and
even dissolve kidney stones. Varuna reduces the body’s production of oxalate
and has been used for more than 3000 years in Ayurvedic medicine. Chanca Piedra
keeps calcium crystals, especially calcium oxalate, from entering the kidneys.
Birch leaf stimulates urination while preventing inflammation and spasms, while
Khella also prevents inflammation and spasms, it also helps heal trauma to the
tissues caused by a stone passing. Marshmallow also has properties that sooth
inflamed and irritated tissue and is mostly known for this effect on the
bladder and kidney.
When consuming foods
containing oxalate, take calcium citrate (150 mg to 300 mg); the calcium
citrate will combine with the oxalate and be eliminated in your stool. Magnesium
citrate can be taken as a preventive measure and it can actually melt calcium oxylate
kidney stones. The process of melting the stones with magnesium citrate can
take a few months. This process includes taking as much magnesium citrate as
needed to induce diarrhea, then reducing from that dosage just enough to not
cause diarrhea.
Individuals with Struvite
stones can be treated with acetohydroxamic acid, while those with uric acid
stone can be treated with allopurinol to decrease uric acid levels. Those with cystine
stones can take tiopronin or penicillamine and increase their B12, B6, and
folic acid levels. By increasing these levels, homocysteine levels decrease which
in turn decrease cystines. Adequate vitamin K2 inhibits formation of calcium kidney
stones.
The American Classic Diet,
which includes processed foods, contributes to increased occurrence of kidney
stones. People who are overweight, pre Diabetics and Type Two Diabetics excrete
an increased amount of urinary calcium, which increases stone formation. Eating
a meal high in simple sugars also increases urinary calcium oxalate especially
in those who have had recurrent stones. Avoid soft drinks with phosphoric acid
because they reduce citrate levels in the urine. This includes many dark sodas.
If conservative measures do
not work then invasive procedures are indicated. There are two procedures by
which kidney stones can be removed. For larger stones Percutaneous
Nephrolithotomy ( PCNL) is used and for smaller stones Extracorporeal Shock
Wave Lithotripsy (ESWL) is used. A combination may be used for some large Struvite
stones.
Shock Wave Lithotripsy
ESWL (extracorporeal shock
wave lithotripsy) is a procedure that uses sound waves. The sound waves pass
through the person’s body to break the kidney stone into smaller pieces so they
can pass more readily through the urinary tract. A long stent is placed using a
cystoscope, by going through the urethra (the final tube where urine exits),
the bladder, the ureter and up into the kidney. Using ultrasonography or
fluoroscopy to visualize, a shock wave is then transmitted through a water
cushion or tube resulting in breaking up the stone or stones in fragments. This
is done on an outpatient basis and anesthesia is used.
Percutaneous Nephrolithotomy
In this procedure, an instrument called a nephroscope is used
to locate and remove the stone through a nephrostomy tube. The nephrostomy tube
is inserted directly into the affected kidney/kidneys through a small incision
in the person’s back. For large stones, an ultrasonic probe that acts as a
lithotripter may be needed to deliver shock waves that break the stone into
small pieces to be removed. The nephrostomy tube drains urine and any residual
stone fragments from the kidney into a urine collection bag. The tube/tubes are
usually left in the kidney for 2 or 3 days while the person remains in the
hospital.
Tina Arey, BSN, RN, is Board Certified as a
Holistic Nurse by the American Holistic Nursing Association. She is a Certified
Reflexologist and a Healing Touch Level 3 Student. As a team member at Vaughan
Integrative Medicine, she works directly with Elizabeth Vaughan, M.D. providing
patient education and coaching individuals who are willing to make substantive
lifestyle changes.
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