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Kidney stones are one of the most common urological disorders and by far the most painful. In fact, some women who have experienced a kidney stone say the pain is so excruciating, it’s worse than childbirth. The majority of people who have kidney stones, however, are men, accounting for four out of five patients.

Steve Karian, M.D., urologist at Mount Auburn Hospital, a teaching hospital of Harvard Medical School says a person can pass a kidney stone and not even know it. “Stones don’t cause any symptoms unless they are obstructing or causing a blockage.”

Kidney stones are believed to be caused by a couple of factors: a chemical in-balance in the urine or an inadequate amount of water in the kidneys. Urine contains several chemicals; high levels of three in particular, calcium, oxalate, and uric acid, experts say lead to the formation of crystals. These crystals stick together creating a hard mass or stone. The stone can grow in size ranging from a grain of sand to the size of a golf ball. Urine containing low amounts of other chemicals, including citrate, magnesium and pyrophosphate, can lead to the formation of stones as well because these chemicals work to prevent crystals from forming.

Water helps to dilute the levels of calcium, oxalate and uric acid in the urine, so if the kidneys are dehydrated, those chemicals have a good chance of forming crystals, which over time, may grow into stones.

Dr. Karian says approximately 85 percent of kidney stones contain a chemical combination of calcium and oxalate. A large part of a person’s diet contains these chemicals and in appropriate amounts, they’re very important to our bodies. They help to make muscles and bone strong. Dr. Karian says, “It’s normal to excrete calcium, but what you want to do is decrease the amount of calcium excretion.” He suggests decreasing foods that are high in the chemical oxalate. Foods containing high levels of oxalate include:

· Beets

· Chocolate

· Nuts

· Rhubarb

· Spinach

· Strawberries

· Wheat bran

Some drinks also contain high levels of oxalate: cola, coffee and tea. Dr. Karian says in many cases, patients may still consume these foods and drinks, just in a more sparing amount. He also says increasing fluids is a good idea as well as monitoring sodium intake to help prevent calcium oxalate stones.

Dr. Karian says a small percent of people (seven to eight percent) experience a uric acid stone. “A uric acid stone is much easier to manage because uric acid stones are formed due to high levels of uric acid in the blood or urine. A person with a uric acid kidney stone may also have gout.” Gout is a build up of uric acid in the body’s joints causing pain, swelling or inflammation. A major sign of gout is a swollen, stiff and inflamed big toe. Medications are prescribed to decrease the risk of recurring uric acid stones.

Symptoms associated with kidney stones include: a severe stabbing or sharp pain, beginning in the kidneys and radiating to the abdomen and pelvis; and in some cases flu-like symptoms, nausea, vomiting, fever and chills. Kidney stones don’t cause pain until they start to travel down and block the urinary tract.

“Treating a kidney stone has really come a long way. Advancements in procedures have drastically reduced the need for surgery,” says Dr. Karian.

Dr. Karian says most stones that are three to four millimeters wide should pass on their own with a lot water and pain medication. If the stone is larger or can’t pass on its own, the most common treatment option is called extracorporeal shockwave lithotripsy (ESWL). It uses a shockwave to break up the stone into smaller fragments. The smaller fragments are then passed on their own. “ESWL is best for stones in the renal pelvis, which located in the kidney just before the ureter, because stones break better when they’re surrounded by water,” says Dr. Karian.

Another technique used to remove kidney stones is called a ureteroscopy. Dr. Karian says this procedure is used for stones in the mid to lower portion of the ureter. A surgeon will take a ureteroscope through the urethra and bladder into the ureter and either remove the stone or break it up much like the ESWL procedure. In some cases, a laser is used to break up a kidney stone. Uretal stents are then implanted to keep the ureter open so the fragments can pass.

Dr. Karian suggests practicing prevention. “Drink plenty of fluids, specifically water, to decrease the chance of having kidney stones. Be aware of the foods you’re eating and your sodium intake.” If there is a history of kidney stones in your family or if your medical history lends itself to the formation of stones, your doctor may provide you with medications.

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