Ralph A. Highshaw, M.D.

Kidney stones or nephrolithiasis can be a cause of severe pain. Typical symptoms include back pain on the side of the stone that may be associated with nausea, vomitting, fever, and chills. Stones that are found in the ureter, the tube connecting the kidney to the bladder (which drains the kidney), often get stuck and obstruct the flow of urine. This leads to severe back pain known as flank pain or renal colic. It can lead to an infection of the kidney as well known as pyeloneprhitis.

Depending on the severity of your symptoms, you should immediately see a urologist or go directly to the emergency room for relief. A CT scan of the abdomen and pelvis without contrast is usually ordered. This test gives the highest chance of finding a stone and the location of the stone. Other laboratory findings aid in the diagnosis such as elecrolyte studies and urine analysis.

There are many types of stones. The most common stone is a calcium oxalate stone. These result from not drinking enough water (dehydration), drinking tea, dark sodas(cola), excessive amounts of nuts or a diet prominent in green leafy vegetables. A diet high in sodium or salt also is a cause for Calcium-based stones. In addition family history plays a large role. For instance, if your mother or father has a history of kidney or ureteral stones, then you have a higher likelihood of having stone disease as well.

There are other types of kidney or ureteral stones which occur less frequently. These include calcium phospate stones, uric acid stones ( which can occur in a person with gout, heavy beef eaters), cystine stones, struvite stones (caused by urinary tract infections/bacteria), sodium urate stones, and drug-induced stones ( such as indinavir or triamterene).

Treatments are as follows: Shock wave lithotripsy if the stone is less than 2cm and in the renal pelvis. Some stones in the upper portion of the ureter called the UPJ can be treated with shock wave lithotripsy. Laserlitotripsy is used to break-up and remove stones within the ureter or kidney. Both shock wave lithotripsy and laserlithotripsy are non-invasive or minimally invasive methods of treatment of stone disease. Percutaneous nephrolithotomy is an invasive method for removing large renal stones.

Stones that are 4mm or less are likely to pass 80% of the time. However, passing stones is usually very painful. It has been described by many of my female patients as more painful than natural child birth without the reward of a child. Tamsulosin is a drug used in the treatment of BPH (enlarged prostate) in men. It has been found to increase passage of small stones through the ureter.

There are some myths about stone treatment and management. One common myth is that cranberry juice will help pass or prevent kidney stones. This is not true. There are other concoctions which patients have brought to me, such as a mixture of soda (cola) and lime juice. I have not had any patients who have benefited from this mixture. I have had one patient who passed a small ureteral stone with the aid of a brazilian tea. However, the stone passage was painful.

The best prevention is to drink plenty of water ( 64 ounces/ day or about 2 liters/ day), cut out dark sodas or teas (if prone to stones), and commit to a low sodium diet.

For more information on management and treatment of kidney or ureteral stones, contact Dr. Highshaw at    (714)751-0100 or (951)509-9000.

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