When Carolyne worked in the Urology Department of her local hospital, she noticed each year during the summer holidaymaker season (“grockle” season as it’s known in her area) the rate of emergency admissions with renal colic would rise considerably.
So, as we are now in “grockle” season we thought a brief piece about this subject might help to reduce the incidence of sufferers. Firstly, let’s talk about the kidneys. They are fist sized organs situated either side of your spine under your lower ribcage.
Their job is to control the bodies fluid and chemical levels. They remove fluid and waste products from the bloodstream to produce urine which travels down the ureters into the bladder. This is then excreted via the urethra. The kidneys control the levels of sodium, calcium and potassium in the blood. Urine contains dissolved minerals and salts. Elevated levels of these can form stones.
What are kidney stones made of?
• Calcium stones are most common (80%).
Too much calcium in the urine will produce kidney stones.
• Uric Stones (5-10%). Uric acid is a waste product from chemical changes in the body. Uric Acid crystals don’t dissolve in acidic urine and
will form stones.
Causes: Being overweight, Chronic diarrhoea, Type 2 Diabetes, Gout, Diet high in animal protein and low in fruit and veg.
• Struvite/Infection Stones (10%) Related to chronic urinary tract infections. Common in people with indwelling catheters.
Bacteria makes urine less acidic and more alkalinic. Struvite (magnesium ammonium phosphate) stones form in alkaline urine. These stones tend to grow fast.
Causes of Kidney stones/renal colic
Dehydration. If a person doesn’t drink enough there is less fluid to keep salts dissolved. This is why holiday makers are more prone to it during the warm
• Studies show restricting dietary calcium can be bad for both bone health and increase the risk of stone formation. Instead of lowering calcium intake the salt intake should be reduced. Salt in the urine prevents calcium from being re-adsorbed from the urine to the blood.
• Low salt = low Calcium in the urine.
• A diet high in animal proteins can increase acid levels. High acid levels = calcium oxalate and ureteric stones.
• Conditions that cause diarrhoea such as Crohn’s Disease or Ulcerative Colitis, also gastric bypass surgery increase the risk of forming calcium oxalate
• Diarrhoea = loss of large volume of fluid = low urine volume = less fluid to keep salts dissolved
• Obesity changes acid levels in the urine = stones form.
• Parathyroid glands control calcium metabolism.
• Increased calcium levels in the blood and urine = stone formation.
• Calcium and Vitamin C supplements can cause stones.
• There appears to be a family connection if a parent or siblings suffer.
Often seen on an X-ray, CT scan or IVP (x-ray with dye) during investigations into blood in the urine or renal colic pain
• Sharp, cramping intermittent pains in the back, sides and abdomen/ groin. Caused by the stone moving down the urinary tract
• Intense need to urinate
• Blood in the urine
• Nausea & vomiting
• Pain in the tip of the penis
Treatment depends on the size, type and position of the stone. Consideration is also made about the symptoms and length of time of the symptoms.
• Watch and wait. Small stones are more likely to pass without intervention. If the symptoms are bearable, the kidneys are not blocked and there is no infection a wait of approximately 6 weeks can be advised.
• Medication. A medication called Tamsulosin is often prescribed along with analgesics (pain killers) to help with the passing of the stone naturally.
• Surgery. If the kidney is blocked a stent may be inserted to help the kidney drain and dilate the collapsed ureter beneath the stone.
There are three different types:
1. Ureteroscopy and stone extraction – a procedure to look up the ureter and remove the stone using a scope.
2. Lithotripsy (ESWL) – Shock wave treatment. Non-invasive
treatment where shock waves break the stone into passable stone
3. Percutaneous Nephrolithotomy (PCNL).
The stone is removed under ultrasound guidance through an opening in the skin. Please note that with the surgical option, there is a 50% risk of forming another kidney stone within 5-7 yrs.
Ways to reduce your risk of kidney stones
• Drink enough to make your urine a pale straw colour.
• Increase the amount of fruit and veg in your diet as this makes urine less acidic.
• Reduce the amount of salt in your diet.
• Try to keep to a “normal” weight but avoid using high protein or crash diets.
• There is insufficient published evidence to support the use of herbal substances.