Medications
If you have a kidney stone, your doctor will prescribe a painkiller, such as Panadeine Forte or the narcotic pethidine. You may also be given an antispasmodic drug to make it easier to pass the stone. If your urine chronically contain high levels of calcium, oxalate or uric acid, your doctor might prescribe drugs to help prevent development of kidney stones. The decision will be based on the chemical make-up of your stone and whether your lab tests and blood work indicate you are at high risk for recurrence.
What makes a person susceptible to kidney stones is not always clear, although a family history of this disorder makes you more prone to forming stones. In most cases, despite all sorts of diagnostic testing, doctors never find out why the stone appeared. What is known, however, is that if you pass one stone, you're more likely to have another. That statistic makes it important for you to have blood and urine tests and, if possible, have the stone itself analysed. This will arm you with what you need to know to help prevent a recurrence.
>Should I avoid foods high in oxalates?
That depends on what type of kindneystores you have. If your urine chronically contains high levels of oxalate, you may well benefit from a change in your diet. But if your stone was not composed of calcium and oxalate combined, reducing oxalate consumption won't take much difference. However, unlike cutting back on calcium (needed for healthy ones), ingesting less oxalate include spinach, strawberries, nuts, rhubarb, beets, soy products, tea, cola drinks, apple juice and cranberry juice.
Procedures
Not long ago, the only option for removing a larger kidney stone was major surgery, lengthy recovery and a big scar to show for your troubles. Today, doctors can choose from several far gentler alternatives.
Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used technique to break up stones in the kidney or upper ureter (see illustration). In some cases, your doctor may place a small tube, called a stent, within the ureter to widen it and allow the stones to move more easily. Often, you'll go home just a few hours after an
During this procedure, water-filled cushions are positioned on either side of the sedated patient. The lithotriptor machine (above) then fires high-frequency shock waves (1000 to 2000 over 45 minutes or so) at the stone, literally shattering it into sandlike granules without harming the surrounding organs. The granules are then painlessly excreted in the urine.
THE CALCIUM QUESTION
Logic might dictate that if excess calcium in the urine is a prime cause of kidney stones, then decreasing your calcium intake should reduce your risk of developing a stone. And indeed, many urologists instruct their patients to cut down on dairy products and other high-calcium foods.
But it turns out that this may not be good advice. In a clinical trial in Italy, 120 men with a histroy of calcium oxalate kidney stones (the most common type) were divided into two groups: one ate a low-calcium diet wit average amounts of animal protein and sodium while the other ate a nromal-calcium diet with reduced meat and sodium.
After five years, nearly twice as many men on the low-calcium diet had formed new stones compared with those on the normal-calcium diet. There appeared to be two reasons for this: the low-calcium group had higher levels of urinary oxalates (and thus stones) because they didn't have enough calcium in their systems to bind (and thus render harmless) the oxalates. Those in this group also didn't cut down on meat and sodium, which promote stone formation.
ESWL, although a day or two of hospitalisation may be necessary as a precuation. Success rates range from 50 to 90 percent, depending on the stone's location and chemical composition. Sometimes multiple treatments are needed. ESWL does not work for cysteine stones, or usually for largest stones (more than about 2 cm). After ESWL, expect to see blood in your urine and feel soreness in your side or abdoment for a few days. Complications are rare.
Stones caught in the middle or lower part of the ureter aren't good candidates for ESWL. Instead, your doctor may attempt a minimally invasive technique called ureteroscopy, in which a small fibre-optic scope is threaded into the urethera and through the bladder. Smaller stones are plucked out manually with small baskets or graspers. Larger ones may first be shattered with lasers, ultrasonic shock waves or electric shocks delivered through the scope. The procedure is successful 90 percent of the time. Sometimes, ESWL precedes ureterscopy to break up stones, making them easier to remove.
Larger stones wedged in the kidney or upper ureter, and those that simply prove too stubborn for ESWL or ureteroscopy, are candidates for percutaneous surgery, the preferred therapy for cysteine stones. For this surgery, the urologist cuts a tiny incision in your back, creates a tunnel into the kidney and, through an instrument called a nephroscope, locates and removes the stone. Ultrasound or a laser may be needed to break up very large stones. The success rate is a whopping 98 percent for stones in the kidney, 88 percent for those in the ureter. Serious complications are very rare.
The rarer types of kidney stones--uric acid, struvite and cysteine stones--may be chemically are delivered through a catheter inserted through the urethra in a series of treatments. Chemolysis may be used as a primary treatment or in combination with others, but it doesn't work for calcium stones. Fewer than 2 percent of people will require standard open surgery (nephrolithotomy). It's done only when all other attempts to blast or remove the stone have failed, or if there are special circumstances, such as obesity or an abnormal kidney structure.
If you have a kidney stone, your doctor will prescribe a painkiller, such as Panadeine Forte or the narcotic pethidine. You may also be given an antispasmodic drug to make it easier to pass the stone. If your urine chronically contain high levels of calcium, oxalate or uric acid, your doctor might prescribe drugs to help prevent development of kidney stones. The decision will be based on the chemical make-up of your stone and whether your lab tests and blood work indicate you are at high risk for recurrence.
- For calcium-based stones: preventive medication include thiazide diuretics, commonly used to treat high blood pressure and eliminate fluid and sodium from the body. You will probably be given hydrochlorothiazide (Moduretic, Dithiazide), chlorthalidone (Hygroton) or bendrofluazide (Aprinox).
- For uric acid stones: commonly prescribed drugs include allopurinol (Zyloprim).
- For struvite stones: medications such as aceto-hydroxamic acid or hydroxyurea (Hydrea) and long-term antibiotics may help.
- For cysteine stones: doctors will typically prescribe penicillamine (D-penamine) or alpha-mercaptopropionyl glycine.
What makes a person susceptible to kidney stones is not always clear, although a family history of this disorder makes you more prone to forming stones. In most cases, despite all sorts of diagnostic testing, doctors never find out why the stone appeared. What is known, however, is that if you pass one stone, you're more likely to have another. That statistic makes it important for you to have blood and urine tests and, if possible, have the stone itself analysed. This will arm you with what you need to know to help prevent a recurrence.
>Should I avoid foods high in oxalates?
That depends on what type of kindneystores you have. If your urine chronically contains high levels of oxalate, you may well benefit from a change in your diet. But if your stone was not composed of calcium and oxalate combined, reducing oxalate consumption won't take much difference. However, unlike cutting back on calcium (needed for healthy ones), ingesting less oxalate include spinach, strawberries, nuts, rhubarb, beets, soy products, tea, cola drinks, apple juice and cranberry juice.
Procedures
Not long ago, the only option for removing a larger kidney stone was major surgery, lengthy recovery and a big scar to show for your troubles. Today, doctors can choose from several far gentler alternatives.
Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used technique to break up stones in the kidney or upper ureter (see illustration). In some cases, your doctor may place a small tube, called a stent, within the ureter to widen it and allow the stones to move more easily. Often, you'll go home just a few hours after an
During this procedure, water-filled cushions are positioned on either side of the sedated patient. The lithotriptor machine (above) then fires high-frequency shock waves (1000 to 2000 over 45 minutes or so) at the stone, literally shattering it into sandlike granules without harming the surrounding organs. The granules are then painlessly excreted in the urine.
THE CALCIUM QUESTION
Logic might dictate that if excess calcium in the urine is a prime cause of kidney stones, then decreasing your calcium intake should reduce your risk of developing a stone. And indeed, many urologists instruct their patients to cut down on dairy products and other high-calcium foods.
But it turns out that this may not be good advice. In a clinical trial in Italy, 120 men with a histroy of calcium oxalate kidney stones (the most common type) were divided into two groups: one ate a low-calcium diet wit average amounts of animal protein and sodium while the other ate a nromal-calcium diet with reduced meat and sodium.
After five years, nearly twice as many men on the low-calcium diet had formed new stones compared with those on the normal-calcium diet. There appeared to be two reasons for this: the low-calcium group had higher levels of urinary oxalates (and thus stones) because they didn't have enough calcium in their systems to bind (and thus render harmless) the oxalates. Those in this group also didn't cut down on meat and sodium, which promote stone formation.
ESWL, although a day or two of hospitalisation may be necessary as a precuation. Success rates range from 50 to 90 percent, depending on the stone's location and chemical composition. Sometimes multiple treatments are needed. ESWL does not work for cysteine stones, or usually for largest stones (more than about 2 cm). After ESWL, expect to see blood in your urine and feel soreness in your side or abdoment for a few days. Complications are rare.
Stones caught in the middle or lower part of the ureter aren't good candidates for ESWL. Instead, your doctor may attempt a minimally invasive technique called ureteroscopy, in which a small fibre-optic scope is threaded into the urethera and through the bladder. Smaller stones are plucked out manually with small baskets or graspers. Larger ones may first be shattered with lasers, ultrasonic shock waves or electric shocks delivered through the scope. The procedure is successful 90 percent of the time. Sometimes, ESWL precedes ureterscopy to break up stones, making them easier to remove.
Larger stones wedged in the kidney or upper ureter, and those that simply prove too stubborn for ESWL or ureteroscopy, are candidates for percutaneous surgery, the preferred therapy for cysteine stones. For this surgery, the urologist cuts a tiny incision in your back, creates a tunnel into the kidney and, through an instrument called a nephroscope, locates and removes the stone. Ultrasound or a laser may be needed to break up very large stones. The success rate is a whopping 98 percent for stones in the kidney, 88 percent for those in the ureter. Serious complications are very rare.
The rarer types of kidney stones--uric acid, struvite and cysteine stones--may be chemically are delivered through a catheter inserted through the urethra in a series of treatments. Chemolysis may be used as a primary treatment or in combination with others, but it doesn't work for calcium stones. Fewer than 2 percent of people will require standard open surgery (nephrolithotomy). It's done only when all other attempts to blast or remove the stone have failed, or if there are special circumstances, such as obesity or an abnormal kidney structure.
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