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Thread: Kidney Stones

  1. #1
    Senior Member feisty's Avatar
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    Jun 2005
    Midtown, Sacramento, CA

    Kidney Stones

    what are they?
    why do they hurt so bad?
    what did I do to deserve them? (lol)
    how long till they're gone?

    Last edited by SCI-Nurse; 09-01-2005 at 03:43 PM.
    An administrator made me remove my signature.

  2. #2

    Kidney stones are among the most common afflictions of humankind. The National Kidney and Urologic Diseases Information Clearinghouse web site points out that doctors saw over 2.7 million patients with kidney stones and 600,000 went to emergency rooms because of kidney stones in 2000. There are many Internet web sites that provide information about kidney stones, how they are formed, and what to do about them. Unfortunately, some of information on prevention and treatment of kidney stones and also what many doctors were taught in medical school are folklore and not well-supported by evidence. I will try to correct some of these misapprehensions below.

    Imaging Stones. Kidney stones usually contain calcium oxalate, uric acid, magnesium and ammonium (struvite), or combinations of these. Over 90% of kidney stones are predominantly calcium oxalate. Since calcium absorbs x-rays, calcium oxalate stones are readily observable on plain x-ray or CT-scan (which uses x-rays). Struvite stones usually do show on CT. MRI scans are generally insensitive to kidney stones and often may miss them. Neither x-rays nor MRI show uric acid stones. To see uric acid stones and to determine whether the stones are blocking urine flow, clinicians sometimes order an intravenous pyelogram (IVP), which injects an x-ray opaque dye into the blood. The dye goes into the urine and therefore can be followed with sequential x-rays. Stones show up as areas in the kidney, ureter, or bladder that do not have dye. The first test for stones is a CT-scan followed by an IVP. Ultrasound can also be used to detect kidney stones if they are big.

    Preventing Stones. The most effective way to prevent kidney stones is to drink lots of fluid. The more fluid that one drinks, the more dilute the urine will be. Higher urine flow tends to dissolve and wash out small stones. Contrary to what some web sites say, coffee causes more urine formation and several studies have shown that coffee reduces stone formation, as long as one is drinking plenty of other fluids of course. For many years, doctors thought that dietary calcium contributes to stone formation and therefore restricted dietary calcium. However, many recent studies suggest that dietary calcium and even calcium supplements do not increase and may even reduce the risk of kidney stone formation. It seems that reduced oxalate levels accompany higher calcium concentrations in the urine. Uric acid stones have also been attributed to diet. Since uric acid is a byproduct of purine metabolism and is the same agent that causes gout, some doctors tell people to avoid red meat, seafood, and vegetables that contain high concentrations of purines. However, many studies suggest that foods with high concentrations of purines or proteins do not increase urinary uric acid. However, diets containing fat does increase urinary uric acid and obesity predisposes to gout. So, particularly in overweight people, a low-fat high-protein diet is advisable. In some people, a hormonal condition called hyperparathyroidism may cause stones and should be corrected.

    Stones and Infections. Kidney stones sometimes result from urinary tract infections. Certain bacteria (Klebsiella, Serratia, Proteus, Providencia species) make urease, an enzyme that breaks down urea (a urinary waste product) into ammonia, which binds magnesium to form "struvite" stones. People with spinal cord injury have a high incidence of urinary tract infections and as many as half of the stones seen in people with spinal cord injury are struvite stones resulting from urinary tract infections. One should of course avoid urinary tract infections for many other reasons but it becomes even more important when one has a history of kidney stones because bacteria can hide inside the stones from antibiotics. The presence of stones may predispose to recurrent infections. When one has stones, urinary tract infections should be treated aggressively and for longer periods with antibiotics to ensure that the stones have been sterilized. In short, kidney and bladder stones not only result from urinary tract infections but they can predispose to them, forming a vicious circle. There is a drug called acetohydroxamic acid (AHA) that can be given alongside antibiotics to prevent infection-induced stones.

    Pain from stones. Many people describe kidney stones as the most painful experience in their lives, comparable or worse than childbirth. In general, small kidney stones themselves do not cause much pain. It is usually when the stones dislodge and are stuck in the ureters, the tubes connecting the kidneys to the bladder. Because people with spinal cord injury often do not have sensation below their injury site, the “pain” frequently manifest as severe autonomic dysreflexia with very high blood pressures, spasticity, sweating, and other autonomic symptoms. The symptoms can be constant or intermittent, often occurring in progressively worsening waves. When a person with spinal cord injury suddenly develops severe autonomic dysreflexia that does not go away, it is important to get a CT-scan to rule out stones in the kidneys, ureters, and bladder. Sometimes, the pain abates when the stone passes out. Strong narcotic pain medications may be necessary and should be given to relieve the pain and the autonomic dysreflexia. The doctor will generally tell you to drink plenty of fluids (2-3 quarts per day), prescribe pain medications, and ask you to try to collect the stones if they pass after a few days.

    Removing stones. Some stones are too big to pass out by themselves, may be obstructing urinary flow, or is causing recurrent urinary tract infections. In such cases, the doctor may choose to intervene with the following approaches, in order of desirability:
    • Extracorporeal Shockwave Lithotripsy. A machine is used to send sound waves through the body. The patient is anesthetized and placed in a tub of water containing the shockwave generator. This is usually done on an outpatient basis. The shockwaves should break up the stone and the fragments then pass out. It is only effective for small to medium sized stones.
    • Percutaneous Nephrolithotomy. A tube is inserted into the kidney, under ultrasonic guidance, and the stone is removed.
    • Ureteroscopic Removal. If the stone is in the ureter or bladder, it is possible to use a ureteroscope to capture or crush the stone in the bladder or ureter.
    • Open Surgery. This is seldom necessary except when significant kidney, ureteral, or bladder damage is apparent and surgery is necessary to repair the tissues.

    In summary, drink lots of fluids. Treat urinary tract infections aggressively with antibiotics if there are stones. Take pain medications if you have severe pain or autonomic dysreflexia. Hope that the stones pass out by themselves. If they do not pass over several days (or even several weeks, depending on your symptoms and patience), you may need shockwave (lithotripsy) therapy to break up the stones or surgical removal of the stones.

    Last edited by Wise Young; 08-31-2005 at 10:48 AM.

  3. #3
    Senior Member feisty's Avatar
    Join Date
    Jun 2005
    Midtown, Sacramento, CA
    Hey thanks...

    I know google provides tons of information on any given topic, but the signifigance or rellevance to SCI is hard to pinpoint.

    During my online search I found lots of info about them, but not many examples of young(er)-I'm 27- people or those with SCI getting them.

    Thanks again for all the information you provide us with!
    An administrator made me remove my signature.

  4. #4
    You're welcome. Kidney stones is not an old person's disease. Many young people get stones. Also, there is a genetic component. One twin study showed that if one member of an identical twin has stones, the other member has a 57% chance of having a stone also, even if they have different dietary and other habits. Do you have any family members who have had stones? Did the stone pass? Wise.

  5. #5

    25 year old T12 complete here ... so don't feel like you're the only young person with stones. I've recently had Extracorporeal Shockwave Lithotripsy and have been passing stones for a couple of weeks. LOTS of back pain. Unlike many SCI folks on here, I don't generally have any pain, so this has really knocked me out. But I've also had other unusual problems lately: several migranes, periods of vomiting, hot flashes, extreme fatigue. I can't say I've ever had AD before (or at least never known that's what it was) but after reading Dr. Wise's post, I wonder if maybe I'm passing stones and getting mild AD, which is causing some of the symptoms above. On the other hand, I've also had 2 nasty UTIs in the last month which could be making me feel bad.

    Survey says .... ?

  6. #6

    i'm a c5 complete and i've been having trouble with my catheter getting blocked up and urine coming out around the catheter. i had it changed last night. there was a lot of sediment on the end. if i might have a kidney stone or bladder stone, would that produce a lot of sediment and restrict the flow? when the new catheter was put in a lot of sediment came out. also the weird thing is it seems to flow better when i'm lying down in bed. this would be the first problem with my bladder because that i saw in reading your post that you should drink a lot which i do. i have a water bottle on my chair which is refilled a few times a day. i also have an appointment with a urologist next week to see what he says.


  7. #7
    Senior Member feisty's Avatar
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    Jun 2005
    Midtown, Sacramento, CA
    I had a routine appointment with my urologist last Monday, and when I complained of abdominal pain in between my right hip and my belly button, she dismissed me and said it was my ovary.

    On Friday I spent 15 hours in the emergency room, apparently I had exactly what Dr. Young said... a kidney stone stuck in the tube that runs between my kidney and bladder, as was diagnosed by a CT scan.

    I was told that the UTI I had was directly related to my stone, and my symptoms are almost EXACTLY what you posted. Fever, massive migranes, sweating, aches and pains (worse at night), appearance of blood and sediment in my urine, etc...

    I think it passed because In the past 2 or 3 days I've had more cathing volumes than what my intake is/was, all my sediment is gone, and the pain is subsiding.

    Sneaky stones!
    at least it wasn't my ovary after all.
    An administrator made me remove my signature.

  8. #8
    well i'm going to print out what dr. young posted and take it to my appointment!!

    by the way feisty how exactly did you get rid of it? did the hospital get rid of it? what did they give or do to get it to pass? i'm going to a concert on saturday the 10th and i don't wanna be spending it in the hospital after waiting a couple of mouths for the show to come to town.

  9. #9
    Quote Originally Posted by feisty
    I think it passed because In the past 2 or 3 days I've had more cathing volumes than what my intake is/was, all my sediment is gone, and the pain is subsiding.

    Sneaky stones!
    at least it wasn't my ovary after all.
    Glad you're feeling better Feisty! Sneaky? You can say THAT again!

  10. #10
    Senior Member Aly's Avatar
    Join Date
    Feb 2005
    Radford, Va
    Feisty, tha sounds rough. Stones are something I have worried about. I have a few friends (not sci) that have delt with it. My uro has an ultrasound done on me once a year. Used to do the IVP but the dye makes my sick and I have passed out after its over everytime I had one so he quit having me do them.
    The trick is in what one emphasizes. We either make ourselves miserable or we make ourselves strong. The amount of work is the same. ~ Don Juan Matus
    We are Virginia Tech… We must laugh again… No one deserves a tragedy… We are strong, and brave, and innocent, and unafraid…We are better than we think and not quit what we want to be…We are the Hokies…We will prevail, we will prevail, we will prevail. We ARE Virginia Tech! ~ Nikki Giovanni

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