If you’ve had kidney stones once, does that mean you’ll get them again?
Anyone who has ever dealt with kidney stones knows how awful of an experience they can be. Once the kidney stone has passed or been removed, that’s the end of things, right? Well, not exactly. Family nurse practitioner Leslie McDill, FNP, spoke with us about how likely kidney stones are to happen again and how to prevent them.
What are kidney stones?
“Kidney stones, also called renal stones or urinary stones, are small, hard deposits that form in one or both kidneys,” said McDill. “They’re made up of minerals and other compounds found in urine, such as calcium, oxalate, uric acid or other substances. These stones vary in size, shape and color. Some are as small as a grain of sand, while others can grow to several centimeters.”
Kidney stones form when there’s more of these materials in your urine than can be dissolved. There’s a couple of reasons this might happen, whether there’s too much stone-forming material, not enough liquid to dilute it or a combination of the two.
About 75% of all kidney stones are composed primarily of calcium.
How likely are kidney stones to recur?
“Unfortunately, if you’ve had one kidney stone, you’re at significant risk of developing another,” said McDill. “Research shows that 35–50% of people who have one kidney stone will develop additional stones, often within 5–10 years of the first stone.”
Several factors could make you more likely to deal with recurring kidney stones, including:
- Younger age when you first have a kidney stone
- Being male
- Family history of kidney stones
- Obesity
- Diabetes
- Certain stone types, such as brushite, struvite or uric acid stones
What can you do to prevent kidney stones?
“The good news is that lifestyle and dietary changes can significantly reduce your risk of developing another stone,” said McDill. “Maintain a healthy body weight, stayi physically active, avoid smoking cigarettes or quit if you currently smoke and make sure to drink extra fluids if you work or live in a high-temperature environment to help you make up for that fluid lost from sweat.”
Changes to your diet that help prevent kidney stones include:
- Increased fluid intake, primarily water, to dilute the minerals in urine.
- Stick to 1,000–1,200 mg of calcium per day from food sources. A low-calcium diet can actually increase your risk!
- Reduce your sodium to 2–3 grams of sodium per day, or about 3–5 grams of table salt. High sodium increases the calcium in your urine.
- Limit animal protein. Excessive protein, especially from animal sources, increases your risk of kidney stones.
- Those who have had calcium oxalate stones should limit oxalate-rich foods like spinach, rhubarb, nuts and chocolate.
- Drink less soda, especially those acidified with phosphoric acid.
- Eat more citrus fruits! Citrus helps to prevent stone formation. Try adding lemon juice to your water throughout the day.
Are there medications that help prevent kidney stones?
“For those who have had recurring calcium stones, there are some medications that can help,” said McDill. “Thiazide diuretics reduce calcium in urine, citrate supplements increase your citrate levels and allopurinol helps those with high uric acid levels.”
When should you see your doctor about kidney stones?
Seek immediate emergency medical attention if you experience:
- Severe pain that you cannot control with over-the-counter medications
- Pain accompanied by fever, chills, weakness or other signs of infection
- Inability to urinate or significantly decreased urine output
- Nausea and vomiting that prevents you from keeping down fluids or medications
- Blood in your urine along with severe pain
Speak with your regular doctor if you have symptoms of a kidney stone, especially if you have one functioning kidney, persistent pain lasting more than a few hours, recurring episodes of pain or if you know you have a kidney stone but are experiencing new symptoms.
Even if your kidney stone passes on its own, you should still see your doctor to figure out what type of kidney stone it was, talk about strategies to help prevent it from happening again and potentially metabolic testing to see if you have a high chance of recurrence.
How do you treat kidney stones that won’t pass on their own?
Most small stones, which are less than 5 mm, will pass on their own with pain control and good hydration,” said McDill. “Stones between 5–10 mm have variable outcomes, while stones larger than 10 mm rarely pass without intervention.”
For stones that are obstructing the flow of urine, causing infection and persistent pain despite medication, stones that don’t pass after 4–6 weeks of home management or if you have kidney damage or renal failure, your doctor may recommend surgery to fully remove the stone.
Surgical treatment options are available in some cases:
- Shock wave lithotripsy (SWL): Uses sound waves to break stones into smaller pieces that can pass more easily. This is often used for smaller kidney stones (5 mm to 2 cm) and some ureteral stones.
- Ureteroscopy: A thin scope is passed through the urethra and bladder into the ureter or kidney. The stone can be removed with a basket or broken up using a laser. This procedure has higher stone-free rates than SWL but slightly higher complication rates.
- Percutaneous nephrolithotomy (PCNL): For large stones (over 2 cm) or complex stone burdens, a small incision is made in the back, and instruments are passed directly into the kidney to remove the stone. This requires general anesthesia and hospitalization but can achieve a stone-free kidney in one procedure.
- Open or laparoscopic surgery: Rarely needed today but may be used in challenging cases when other methods have failed.
“What treatment works best for you really depends on the size of the kidney stone, its location, its composition, your overall health and your own preferences,” said McDill. “Your urologist will speak with you about the best option for your specific situation.”
Should you head to the ER, or go to urgent care?
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