Kidney Stone Prevention: 5 Tips for Long-Term Health

Kidney stones are solid masses made of crystals that originate in the kidneys but can travel down the urinary tract. They cause excruciating pain and are a common reason for emergency room visits. This article aims to provide a comprehensive guide on how to pass a kidney stone and offer preventive tips to avoid future occurrences. As healthcare professionals, understanding the mechanisms, symptoms, treatments, and preventive measures of kidney stones can help us better advise our patients.

What Are Kidney Stones?

Kidney stones (renal calculi) are hard deposits made of minerals and salts that form inside the kidneys. They can develop due to various reasons, including dehydration, dietary factors, obesity, certain medical conditions, and even some supplements and medications. There are different types of kidney stones, including:

1. Calcium Stones: The most common type, often composed of calcium oxalate. They can also form from calcium phosphate.
2. Uric Acid Stones: More common in men than women, they can form in people who do not drink enough fluids, lose too much fluid, eat a high-protein diet, or have gout.
3. Struvite Stones: These can form in response to an infection, such as a urinary tract infection. They can grow quickly and become quite large.
4. Cystine Stones: These are rare and occur in people with a genetic disorder called cystinuria, which causes the kidneys to excrete excessive amounts of certain amino acids.

Symptoms of Kidney Stones

Kidney stones may go unnoticed until they move within the kidney or pass into the ureter, the tube connecting the kidney to the bladder. At this point, the following symptoms may be experienced:

• Severe pain in the side and back, below the ribs
• Pain that radiates to the lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Pain during urination
• Pink, red, or brown urine
• Cloudy or foul-smelling urine
• Nausea and vomiting
• Persistent urge to urinate
• Urinating more often than usual
• Fever and chills if an infection is present

How to Pass a Kidney Stone

The passage of kidney stones can be a painful and challenging process. The time required to pass a kidney stone varies depending on its size and location. However, the following strategies can aid in passing a stone more quickly and with less discomfort:

1. Hydration: The Key to Flushing Out Stones

Drinking plenty of water is essential for passing a kidney stone. Staying well-hydrated helps dilute the substances in urine that lead to stone formation. The goal is to produce clear or nearly clear urine. Healthcare professionals recommend at least 2 to 3 liters of water per day. In some cases, a physician may suggest intravenous fluids if a patient is unable to maintain adequate hydration due to nausea or vomiting.

1. Pain Management: Over-the-Counter and Prescription Medications

Pain caused by kidney stones can be severe. Over-the-counter pain relievers such as ibuprofen (Advil), acetaminophen (Tylenol), or naproxen (Aleve) can help alleviate discomfort. For more intense pain, prescription medications such as alpha-blockers (tamsulosin or alfuzosin) can relax the muscles in the ureter, aiding in the stone's passage. Narcotic analgesics may be prescribed in cases of extreme pain.

1. Medical Expulsive Therapy (MET)

Medical expulsive therapy involves the use of medications that promote the spontaneous passage of kidney stones. Alpha-blockers such as tamsulosin and calcium channel blockers like nifedipine are commonly used to relax the muscles in the ureter, making it easier for the stone to pass. This approach is generally effective for stones smaller than 10mm and can reduce the need for surgical intervention.

1. Extracorporeal Shock Wave Lithotripsy (ESWL)

For stones that are too large to pass naturally or do not respond to medication, extracorporeal shock wave lithotripsy (ESWL) is a non-invasive treatment option. ESWL uses shock waves to break the stones into smaller fragments that can be passed more easily in urine. This procedure is usually performed under sedation or anesthesia and may cause some discomfort, bruising, or blood in the urine post-procedure.

1. Ureteroscopy and Laser Lithotripsy

Ureteroscopy is a procedure in which a small scope is inserted through the urethra and bladder to locate the stone. A laser fiber is then used to break the stone into smaller pieces, which can be removed or allowed to pass naturally. This minimally invasive procedure is particularly useful for stones located in the lower ureter and is generally performed under general anesthesia.

1. Percutaneous Nephrolithotomy (PCNL)

For large stones or those that cannot be treated with other methods, percutaneous nephrolithotomy (PCNL) may be necessary. PCNL involves making a small incision in the back to access the kidney and remove the stone using specialized instruments. This procedure is more invasive and requires a hospital stay, but it is highly effective for large or complex stones.

1. Hydration and Dietary Adjustments Post-Stone Passage

After passing a kidney stone, it is crucial to prevent future stone formation. Hydration remains key, with recommendations for a daily intake of fluids that keep urine output at around 2.5 liters. A healthcare professional may also recommend dietary adjustments to reduce oxalate intake (found in spinach, nuts, and tea), reduce sodium intake, or limit animal proteins.

5 Tips to Prevent Kidney Stones

Prevention is always better than cure, and this holds true for kidney stones as well. Here are five effective tips for preventing kidney stones:

1. Stay Hydrated

The most crucial step in preventing kidney stones is staying hydrated. Drinking enough water helps dilute the substances in urine that lead to stones. Aim for at least 2 to 3 liters of water daily. Encourage patients to drink a glass of water with each meal and snack and to choose water as their primary beverage. In hotter climates or for patients who exercise regularly, even more water may be necessary.

1. Adopt a Kidney-Friendly Diet

A balanced diet low in oxalates and sodium can help prevent the formation of kidney stones. Encourage patients to eat plenty of fruits and vegetables, which help produce less concentrated urine. Reducing oxalate-rich foods such as nuts, chocolate, beets, and spinach may be recommended for those prone to oxalate stones. Additionally, a diet low in salt can help reduce calcium levels in the urine, thereby decreasing the risk of stones.

1. Increase Citrate Intake

Citrate, found in citrus fruits like lemons and oranges, can prevent stone formation by binding to calcium in the urine, preventing crystal formation. Suggest patients add lemon juice to their water or consume citrus fruits regularly. Some patients may also benefit from potassium citrate supplements; however, this should be determined by a healthcare provider.

1. Limit Animal Protein Intake

Animal protein sources such as red meat, poultry, eggs, and seafood increase uric acid levels and can lead to uric acid stones. A diet high in animal protein can also reduce citrate levels, a chemical that helps prevent stones. Encourage patients to consume plant-based proteins like beans, lentils, and tofu as an alternative.

1. Monitor Calcium Intake

Contrary to popular belief, adequate calcium intake is crucial in preventing stones. A diet low in calcium can lead to oxalate levels rising and potentially forming stones. Encourage patients to consume calcium-rich foods like milk, yogurt, and cheese with meals to reduce the risk of stones. However, calcium supplements should be taken with caution and under a doctor's supervision.

Conclusion

Kidney stones are a common, painful urological condition that can severely impact a patient's quality of life. Understanding how to pass a kidney stone effectively and how to implement preventive measures can help healthcare professionals better manage and advise their patients. Combining hydration, dietary changes, and appropriate medical therapies can significantly reduce the risk of kidney stones and improve patient outcomes.