The following information is designed to inform our patients about the complex and delicate management of kidney stone disease and to aid our patients and should not be substituted for the advice of a physician or a urologist. Anyone who has had a kidney stone at one point would agree that kidney stones especially when they’re passing are not fun! In fact it is during their passage that kidney stones are often very painful, and patients would often do anything to avoid having to experience that pain again.
Dr. Ebrahimi who is a fellowship trained endourologist, believes that the treatment of kidney stones has two phases: treating the current stones and preventing the future ones. Briefly stated treatment of kidney stones can be divided into observation versus surgical treatment. Observation is generally elected for stones that would otherwise pass on their own (i.e. generally less than 5 mm), or are in an area of the kidney which is not amenable to surgical treatment (i.e. the kidney stone is in the parenchyma of the kidney – the meat of the kidney). Furthermore, some patients who are considered high risk for surgery may elect to have observation.
The surgical treatment of kidney stones generally falls under a three major types of surgery which include ureteroscopic laser lithotripsy, extracorporeal shock wave lithotripsy, or percutaneous nephrostolithotomy. These procedures are further defined on our website, and please click on those links to read further about them.
The prevention of future kidney stones is where medical management of kidney stone disease helps patients from future episodes. The risk factors for kidney stone formation are dehydration, diets which is high in animal sources of protein in fat, certain medications such as excessive amounts of vitamin C, family history of kidney stones especially in those with cystine stones, or patients with chronic urinary tract infections.
During evaluation one may consider a complete history including the patient’s diet, in the history of urinary track infections, any stone provoking behavior such as excessive intake of iced tea or caffeine which may lead to dehydration, or any activity which would cause excessive fluid loss and potentially cause a kidney stone. Some of the laboratory tests to be considered are a urinalysis and culture. Some of the blood test consider our serum calcium phosphate potassium bicarbonate magnesium uric acid and PTH level. If a stone specimen is available, stone analysis may be considered.
The gold standard of kidney stone diagnosis is a non-contrast CT scan. However most stones excluding uric acid some due to infections are generally visible with a plain KUB x-ray. Real ultrasound may also be considered, and in the right hand it can yield a great deal of information. The shortcoming of these tests are that a CT scan has a great deal of radiation associated with it. A KUB has far less radiation, but may miss a small stone, or if the stone is not visible on a KUB such as a uric acid stone or a struvite stone. Lastly ultrasound may be somewhat difficult to replicate reliably.
Advice for patients with kidney stones:
according to Dr. Ebrahimi, it is imported to take a detailed history from the patient and advise them on how to modify their lifestyle to prevent future stones. Consideration should be given to assessing a kidney stone patient’s level of animal protein diet, the amount of salt intake, fluid intake, calcium intake, oxalate intake, and level of citrus intake. Specifically patients should drink at least 3 Liters of fluid daily to assure in your output of approximately 2 L per day. Dr. Ebrahimi who works in Glendale, California and is considered to have warm weather most of the year, advises his kidney stone patients to drink at least 4 L of water which is equivalent to 1 gallon daily. This is to compensate for the amount of fluid that is lost due to evaporation and respiration during a hot day. Of course Dr. Ebrahimi also advises his patients who work outside during the day such as those who are gardeners or in construction, to supplement their food intake accordingly.
In patients sodium intake as a great impact on their calcium metabolism and generally avoidance of sodium is recommended. The upper limit of sodium intake should be 2 grams but if someone has hypertension and should be far less than that. Dr. Ebrahimi also advises his patients to avoid high oxalate containing foods such as spinach chocolates tea potatoes vitamin C supplements. Lastly there have been several studies that show increase intake of citrus to be protective against kidney stone formation. Thus Dr. Ebrahimi advises his patients to increase their citrus intake.
If further evaluation for kidney stones is deemed necessary, a 24 hour urine collection may be considered. Efforts should be made to diagnose underlying disease process if possible in order to prevent future kidney stones.