Kidney Stones (Nephrolithiasis)

Kidney stones are hard and irregular in shape, and looks like actual stones. They may be comprised of calcium and oxalate, and more often uric acid that form in the kidneys. The stones may form in different areas of the kidneys. Namely, the renal pevlis, ureters or bladder. Depending on the area of stone formation, patients may complain of mild to severe pain. The presentation of any patients to the ER with suspected kidney stones is classic. They are usually in severe pain, wailing and unable to lie still. Nausea and vomiting usually accompanies the pain. Pain is usually felt in the lower back (flank) right or left. There may be visible hematuria (blood in the urine). Or seen on urinalysis. When the stone travels towards the bladder VIA the ureters, they may get stuck in the ureters. This condition is called obstructive urolithiasis. When this happens, urine backs up into the kidneys resulting in hydronephrosis, and swelling of the kidneys. There is a high risk of infection without antibiotics. There will aslo be damage to the kidney itself. When there is an obstructive stone, antibiotics should be promptly administered to prevent infection. A urologist will also need to relieve the obstruction to prevent long term kidney damage. This is usually done either by Lithotripsy (ultrasound waves are used to break up the stone), Ureteroscopy- this procedure involves a special device that is pushed through the urethra and bladder, and into the ureter to pull out the stone. Surgery may be needed as a last resort to remove the stone

<script async src="https://pagead2.googlesyndication.com/pagead/js/adsbygoogle.js?client=ca-pub-3762875292967767"

crossorigin="anonymous"></script>

Treatment Of Kidney Stones

Treatment for kidney stones is based on the location, size and whether or not it is obstructing. In severe cases, over night hospital stay with urology consult is recommended. In the Emergency Room (ER), a non steroidal anti inflammatory (NSAID) such as toradol may be given intravenously (IV) with zofran for nausea. Sometimes a narcotic mediation such as morphine may be added if the pain is not resolved with NSAID alone. Also flomax 0.4 mg PO is given to aid the passage of the stone. Sodium chloride solution is also given to maintain hydration. If the stone is non obstructing, and small enough to pass on its own. The patient may be discharged from the ER to pass it at home. It is advised to strain each stream of urine, using a simple strainer to detect when it has passed. If the stones are too large, then a procedure called lithotripsy is done by an urologist.

Making The Diagnosis

Obtaining a history of the onset and nature of the pain is the first step. Pain is usually described as sudden, sharp, and severe, with tenderness in the flank area, that worsens with palpation. Microscopic urinalysis that reveals blood, and a plain (non-contrast) CT scan of the abdomen and pelvis. CT scans usually reveals location and size of the kidney stones.

Discharge Instructions

If you were seen in an ER, it is recommended to adhere to the discharge instructions, and follow up with an urologist for continued management. It is always advised to seek medical attention and return to the ER if symptoms worsens. In the meantime, drink plenty of fluids, This means at least 12, 8 ounce glasses of fluid- mostly water each day. Reduce salt intake. Each time you pass urinr, do it in a jar. Pour the urine from the jar through the strainer and into the toilet. Continue doing this until 24 hrs after your pain stops. By then, if there was a kidney stone, it should pass from your bladder. Some stones dissolve into sand-like particles and pass right through the strainer. In that case, you will not ever see a physical stone.

Save any stone that you find in the strainer and bring it to your healthcare provider to look at. It may be possible to stop certain types of stones from forming. For this reason, it is important to know what kind of stone you have.

Try to stay as active as possible. This will help the stone pass. Do not stay in bed unless your pain keeps you from getting around. You may notice a red, pink, or brown color to your urine. This is normal while passing a kidney stone.

Remember, always follow the advice of your medical provider.