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Kidney stones

Kidneystonesoccurwhensaltsintheurineformasolidcrystal.Thesestonescanblocktheflowof
urineandcauseinfection,kidneydamageorevenkidneyfailure.Betweenfourandeightpercent
oftheAustralianpopulationsufferfromkidneystonesatanytime.Theycanvaryinsizeand
location.Kidneystonesaresometimescalledrenalcalculi.
Mostkidneystonescanbetreatedwithoutsurgery.However,paincanbesoseverethathospital
admissionandverystrongpainkillersmaybeneeded.Alwaysseekimmediatemedicalattentionif
youaresufferingstrongpain.
Theriskofkidneystonesisaboutonein10formenandonein35forwomen.Afterhavingone
kidneystone,thechanceofgettingasecondstoneisbetweenfiveand10percenteachyear.Up
tohalfthepeoplewithafirstkidneystonewillgetasecondstonewithinfiveyears.Afterfive
years,theriskdeclines.However,somepeoplekeepgettingstonestheirwholelives.
Types of kidney stones
Therearefourmajortypesofkidneystones,including:
stonesformedfromcalciumnotusedbythebonesandmuscles,combinedwithoxalateor
phosphatethesearethemostcommonkidneystones
stonescontainingmagnesiumandthewasteproductammoniathesearecalledstruvite
stonesandformafterurineinfections
uricacidstonestheseareformedwhenthereistoomuchacidintheurine
cystinestonesthesearerareandhereditary.
Causes of kidney stones
Akidneystonecanformwhensubstancessuchascalcium,oxalate,cystineoruricacidareathigh
levelsintheurine,althoughstonescanformevenifthesechemicalsareatnormallevels.
Medicationsusedfortreatingsomemedicalconditionssuchaskidneydisease,cancerorHIVcan
alsoincreaseyourriskofdevelopingkidneystones.
Asmallnumberofpeoplegetkidneystonesbecauseofsomemedicalconditions,whichcanleadto
highlevelsofcalcium,oxalate,cystineoruricacidinthebody.
Symptoms of kidney stones
Manypeoplewithkidneystoneshavenosymptoms.However,somepeopledogetsymptoms,
whichmayinclude:
agrippingpainintheback(alsoknownasrenalcolic)usuallyjustbelowtheribsonone
side,radiatingaroundtothefrontandsometimestowardsthegroin.Thepainmaybe
severeenoughtocausenauseaandvomiting
bloodintheurine
shivers,sweatingandfeveriftheurinebecomesinfected
smallstonespassingoutintheurinelikegravel,oftencausedbyuricacidstones
anurgentfeelingofneedingtourinate,duetoastoneatthebladderoutlet.
Diagnosis of kidney stones
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Manystonesarediscoveredbychanceduringexaminationsforotherconditions.Urineandblood
testscanhelpwithfindingoutthecauseofthestone.Furthertestsmayinclude:
ultrasound
CTscans
x-rays,includinganintravenouspyelogram(IVP),wheredyeisinjectedintothe
bloodstreambeforethex-raysaretaken.
Ifyoupassastone,collectitandtakeittoyourdoctorforanalysis.Analysisofastoneisvery
useful.
Complications of kidney stones
Kidneystonescanrangeinsizefromagrainofsandtothatofapearlorevenlarger.Theycanbe
smoothorjagged,andareusuallyyelloworbrown.Alargestonemaygetstuckintheurinary
system.Thiscanblocktheflowofurineandmaycausestrongpain.
Kidneystonescancausepermanentkidneydamage.Stonesalsoincreasetheriskofurinaryand
kidneyinfection,whichcanresultingermsspreadingintothebloodstream.
Treatment for kidney stones
Mostkidneystonescanbetreatedwithoutsurgery.Ninetypercentofstonespassbythemselves
withinthreetosixweeks.Inthissituation,theonlytreatmentrequiredispainrelief.However,pain
canbesoseverethathospitaladmissionandverystrongpainkillersmaybeneeded.Alwaysseek
immediatemedicalattentionifyouaresufferingstrongpain.
Smallstonesinthekidneydonotusuallycauseproblems,sothereisoftennoneedtoremove
them.Adoctorspecialisinginthetreatmentofkidneystonesisthebestpersontoadviseyouon
treatment.
Surgery for kidney stone removal
Ifastonedoesntpassandblocksurinefloworcausesbleedingoraninfectionthenitmayneedto
beremoved.Newsurgicaltechniqueshavereducedhospitalstaytimetoasshortas48hours.
Othertreatmentsinclude:
Extracorporealshock-wavelithotripsy(ESWL)ultrasoundwavesareusedtobreakthe
kidneystoneintosmallerpieces,whichcanpassoutwiththeurine.Itisusedforstones
lessthantwocminsize.
Percutaneousnephrolithotomyasmallcutismadeinyourback,thenaspecial
instrumentisusedtoremovethekidneystone.
Endoscoperemovalaninstrumentisinsertedintotheurethra,passedintothebladder
andthentowherethestoneislocated.Itallowsthedoctortoremovethestoneorbreakit
upsoitcanpassmoreeasily.
Surgeryifnoneofthesemethodsaresuitable,thestonemayneedtoberemovedusing
traditionalsurgery.Thiswillrequireacutinyourbacktoaccessyourkidneyandureterto
removethestone.
Medication for kidney stones
Formostpeoplewithrecurrentcalciumstones,acombinationofdrinkingenoughfluids,avoiding
urinaryinfectionsandspecifictreatmentwithmedicationswillsignificantlyreduceorstopnew
stoneformation.
Certaindrugssuchasthiazidediureticsorindapamidereducecalciumexcretionanddecreasethe
chanceofanothercalciumstone.Potassiumcitrate(Hydralyte,Pedialyte,Urocit-K),orcitricjuices
areusedtosupplementthiazidetreatmentandareusedbythemselvesforsomeconditionswhere
thereisaproblemacidifyingtheurine.
Forpeoplewhohaveahighlevelofuricacidintheirurine,orwhomakeuricacidstones,thedrug
allopurinolwillusuallystoptheformationofnewstones.

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Avoiding recurrence of kidney stones
Ifyouhavehadonestone,sometipsthatmayhelptopreventasecondstoneforminginclude:
Talktoyourdoctoraboutthecauseofpreviousstones.
Askyourdoctortocheckwhatmedicationsyouareontoseeiftheymightbecausingyour
stones.Donotstopyourmedicationswithouttalkingtoyourdoctor.
Getquickandpropertreatmentofurinaryinfections.
Avoiddehydration.Drinkenoughfluidstokeepyoururinevolumeatorabovetwolitresa
day.Thiscanhalveyourriskofgettingasecondstonebyloweringstone-forming
chemicals.
Avoidtoomuchteaorcoffee.Citrusjuicesmayreducetheriskofsomestones,particularly
orange,grapefruitandcranberry.
Mineralwatercannotcausekidneystonesbecauseitcontainsonlytraceelementsof
minerals.
Reducingsaltoftenlowerstheriskofcalciumcontainingstones.Dontaddsaltwhile
cookingandleavethesaltshakeroffthetable.Chooseloworno-saltprocessedfoods.
Loweringcalciumbelowthatofanormaldietisonlynecessaryinsomecaseswhere
absorptionofcalciumfromthebowelishigh.Alow-calciumdiethasnotbeenshowntobe
usefulinpreventingtherecurrenceofkidneystonesandmayworsentheproblemofweak
bones.Peoplewithcalcium-containingstonesmaybeatgreaterriskofdevelopingweak
bonesandosteoporosis.Discussthisriskwithyourdoctor.
Dontdrinkmorethanonelitreperweekofdrinkswithphosphoricacid,whichisusedto
flavourcarbonateddrinkssuchascolaandbeer.
Alwaystalktoyourdoctorbeforemakingchangestoyourdiet.
Where to get help
Inanemergency,alwayscalltriplezero(000)
Yourdoctor
Yourlocalcommunityhealthcentre
KidneyHealthAustraliaInformationLineTel.1800454363,TTYusersphone1800555
677thenaskfor1800454363
Things to remember
Thelifetimeriskofdevelopingkidneystonesisonein10formenandonein35forwomen.
Newtechniquescanremovekidneystoneswithouttheneedforanoperation.
Acombinationofdrinkingenoughfluids,avoidingurinaryinfectionsandspecifictreatment
withmedicationswillsignificantlyreduceorstopnewstoneformation.

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KidneyHealthAustralia
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