When you have kidney pain that radiates in your back and your side and feels like someone is stabbing you with a knife or sword and moving it back and forth, people an Emergency Room visit is usually soon to follow. When you arrive and have blood in your urine, it is usually a good sign that it might be a stone. But this will be determined by doing an initial evaluation and running some follow up tests to figure out what really is going on.
An initial evaluation should involve a past history of symptoms including hematuria, previous kidney stones, urinary tract infections, family history, and a dietary history. Blood and urine analysis can determine the presence of an infection and the stone’s chemical composition and aid in determining the best treatment or if surgery is likely to produce the best results. Blood tests should include serum electrolytes, creatinine, calcium, phosphorus, and uric acid. Urinalysis should also include crystallographic studies.
Physicians typically use x-ray to confirm that a stone is causing symptoms. X-rays and ultrasound can be used to determine the size, shape, number, and location of kidney stones and the management of the stones.
Radiopaque stones such as cystine stones, absorb more x-rays than the surrounding tissue and appear white on x-ray. Radiolucent stones (these include uric acid stones) are easily identified. A stone containing both radiopaque and radiolucent elements will appear to be mottled on the x-ray.
Those that are very small or obscured by bone or bowel gas also do not show up on x-ray. Intravenous pyelogram (IVP), which involves the injection of a dye, can aid in the determination of stone types. The dye collects in the urinary system and improves the contrast of x-rays. There is a possible cross-reaction to (IVP) if you are allergic to shellfish, as the test uses iodine. You must tell them if you have allergies and ask for the non-iodine dye that is available for us. CT scans are useful for obscured or small stones. Ultrasound, though very useful, produces generally poor results for the obese general and fails to detect very small stones (< 3mm).
If stone is less than 4 mm and symptoms not severe, then observation or expectant treatment is most likely to be recommended. Drink plenty of water to flush out stone and to prevent reoccurrence. Another round of x-rays in a few weeks to make sure that the stones have passed. If not progressing, your physician should reevaluate the treatment plan. Avoid becoming sedentary, but you may need to change or stop work if a sudden attack of pain could cause injury. Stain urine to catch small stones for analysis.
A patient with kidney stones will say the most important treatment is pain management, which may require narcotic medications to provide adequate coverage. Generally, pain management starts with acetaminophen for mild pain, motrin or advil for stronger pain, acetaminophen with codeine for even stronger pain, and a narcotic like percocet for severe pain.
For those with determined to have a low risk of reoccurrence due to their history, it is recommended to continue the dietary and fluids management to prevent future stones. For those determined from their history to have a high reoccurrence risk, a follow-up after 6 to 8 weeks of the first episode should be conducted. This follow-up should include 24-hour urine collection for volume, calcium, phosphorus, uric acid, citrate, oxalate, creatinine, magnesium, and cystine. From this urinalysis, it can be determined if any underlying diseases are playing a part in stone formation and then medical intervention can be prescribed to correct the underlying disease.
Chemolysis is the use of chemicals to dissolve certain types of stones. Uric stones can be dissolved by sodium bicarbonate in saline. Cystine stones can be treated by combination of acetylcystine and sodium bicarbonate in saline. Struvite and carbon apatite stones can be treated with an acidic solution of hemiacidrin. Chemolysis does not work well with calcium stones.
Surgery may be indicated for various reasons. Kidney stones that do not pass after a reasonable period of time with constant pain. A stone too large to pass on its own or caught in a difficult spot to treat otherwise. Stones that prevent urine flow, causes UTI, damages the kidney tissue, cause contact bleeding, or ones that continue to grow in size may also need surgery.
It is always better to learn how to eat the foods that you need to eat to help prevent or avoid kidney stones. Natural home remedies or cures always are a better choice when possible to avoid having stones. But some stones do require surgery or other treatment methods. Find a urologist that will sit with you and talk with you about your specific needs. Knowing the right questions to ask before ever seeing a doctor will better prepare you for the best outcome!