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Kidney Stones: Causes, Treatment and Prevention

Dr. Amanda Macejko August 20, 2013 9:00 AM This chat has ended. Thank you for participating.
Brenna (Moderator) - 8:38 AM:
Our chat with Amanda Macejko, MD, Urologist at NorthShore, will begin in approximately 30 minutes. Please submit your questions now or at any point during the chat. Until the chat begins, please feel free to check out NorthShore's John and Carol Walter Center for Urological Health.

Andrea (Chicago, IL) - 8:59 AM:
My mom had several kidney stones when she was around my age. Does that mean I will be prone to them too?

Dr. Amanda Macejko (NorthShore):
Stones can certainly have a hereditary component so yes, you may be prone to developing stones. One of the best things you can do to decrease your risk is to make sure you drink plenty of water.

John (Chicago) - 9:02 AM:
My wife was diagnosed with "infectious stones". How can she prevent or minimize these stones from recurring? Thankyou.

Dr. Amanda Macejko (NorthShore):
Bacteria live inside of infection stones which are not penetrated by antibiotics. Therefore, soon after completing antibiotics the infection will recur. The infection causes the urine pH to increase which is the environment in which these stones form. It really becomes a vicious cycle. The goal in treating infection stones is to remove all of the stone within the kidney. After the stones are treated it is important to make sure that infections are treated promptly and that she is drinking plenty of water.

Cathy Ronzanui (Highland Park, IL) - 9:08 AM:
I have bilateral nonobstructing kidney stones. Largest is 4mm in the lower pole of moderately atrophic appearing right kidney. I've had stones most of my adult life and had stents put in and lithotripsy done years ago. If I don't do anything about them will there be worse problems as I get older? Does having kidney stones mean that I might one day be on dialysis?

Dr. Amanda Macejko (NorthShore):
Nonobstructing stones (as yours are) in general should not cause renal failure. However, untreated obstructing stones may eventually cause renal impairment. Stone prevention in your case is important as it sounds like you only have one functioning kidney. If you were to have stone symptoms in your functioning kidney I would seek urgent meddical treatment. In general 4 mm stones have a high likelihood of spontaneous passage and so treatment is not usually recommended. Furthermore, noninvasive treatment of lower pole stones tends to be somewhat disappointing.

Brian (Arlington Heights) - 9:16 AM:
I'm 42 and have had 7-8 stones in the last half of my life; one lithotripsy with stent placement. Aside from drinking a lot of water, what other preventative measures can be taken to avoid recurrance. I understand they are Calcuim Alginate when the two that I've caught have been tested.

Dr. Amanda Macejko (NorthShore):
Great question. In general the stone prevention diet includes drinking 2.5-3 liters of water daily, limiting salt intake, avoiding foods high in oxalates, and limiting consumption of animal protein. It is important to note that calcium restriction is not recommended. For someone with multiple stones I highly recommend a metabolic work up. This involves bloodwork and a 24 hour urine collection (48 hours the first time). This allows us to figure out what your specific risk factors are for stone formation as well as look for possible underlying medical conditions. We peform this service in the Stone Clinic which is staffed by myself, Dr. Park (urology) and Dr. Sprague (nephrology).

mary milano (evanston il) - 9:23 AM:
are there any specific foods that should be avoided once you are a kidney stone patient??

Dr. Amanda Macejko (NorthShore):
Salt intake increases calcium in the urine so we recommend avoiding canned, processed and fast foods which contain a lot of sodium. For people with calcium oxalate stones foods high in oxalate should be avoided. Some of the main high oxalate foods include tea, spinach, nuts and chocolate (sorry!). Animal protein (including red meat, chicken, fish) should also be limited.

Nicole Vander Vliet (Orland Park, IL) - 9:29 AM:
I suffered horrible kidney stones while I was pregnant, symptoms of them started around 20 weeks of pregnancy. Doctors claimed I may have had them prior to being pregnant. My question is will I be prone to having kidney stones every time I get pregnant, and what are steps I need to take before planning on getting pregnant again. I have had no signs and all negative test of kidney stones since I had my son 2 1/2 years ago. Any help with this issue will help

Dr. Amanda Macejko (NorthShore):
I'm sorry that you went through that! Some of the changes that occur during pregnancy increase your risk for stones while other changes decrease your risk. All in all, we do not believe that pregnant women are at higher risk for stones. If you are clear of stones currently, I would recommend that you follow the stone prevention diet before and during pregnancy with an emphasis on drinking lots of water (recurrent theme of this chat).

Don (Wilmette) - 9:39 AM:
Should you always go to the hospital for kidney stones? If not, how do you know when you should go and when you shouldn’t?

Dr. Amanda Macejko (NorthShore):
This is really important. If your pain is tolerable with pain medication (whether over the counter or prescription) then you can probably follow up with your primary care doctor or urologist to work out a plan. However, if your pain is not well-controlled or you have significant nausea/vomiting, you will need to go to the emergency room. Oftentimes, they can control your pain and/or nausea and you can return home. Most importantly, if you have fever (>100.5) or shaking chills you need to go to the emergency room immediately. An obstructing stone associated with an infection is very serious and can be life threatening.

Brenna (Moderator) - 9:44 AM:
There are 15 minutes left in this chat. This has been a very popular topic. We will try to get through as many questions as possible and apologize if we are unable to get to yours.

Mirek (chicago IL) - 9:45 AM:
What is the best method of getting rid of 14 mm kidney stone and what are the dietary changes to make after it is removed?

Dr. Amanda Macejko (NorthShore):
If the stone can be seen on a plain x-ray, a stone of this size and location would typically be treated with shock wave lithotripsy. This is an outpatient procedure performed under anesthesia in which we break the stone using sound waves. After the procedure you then pass the fragments. The stone fragments can then be collected and sent for analysis to determine the type of stone. If this is your first stone, a stone prevention diet including increased fluid intake, low salt, low oxalate and decreased animal protein is typically recommended.

Abby (Chicago, IL) - 9:52 AM:
Is there a particular group of people who are at higher risk of developing kidney stones?

Dr. Amanda Macejko (NorthShore):
Peak incidence of stones occur in people between the ages of 30-60. Caucasians and people who live in warm, dry climates are at higher risk of developing stones. Additionally, people with higher body mass index are also at increased risk.

Sue S. (Orland Park, IL) - 9:55 AM:
Is there any truth to the 'Appalachian Cure' for kidney stones still in the kidney? A combination of Coke, and fresh or canned asparagus in a short period of time is supposed to dissolve stones (supposedly evidenced by a sludgey/gritty urine). I know, odds are it's an old wives tale- but I have to ask.

Dr. Amanda Macejko (NorthShore):
I've not heard that one before! Calcium-based stones (which are the most common type) cannot be dissolved. They either need to pass or be removed surgically. We can sometimes dissolve uric acid stones with medication called potassium citrate.

Starla (Indiana) - 9:58 AM:
If I have a kidney stone and I’d rather pass it at home, what can I do to ease the pain from home?

Dr. Amanda Macejko (NorthShore):
Most patients take some form of pain medication whether it be over the counter or a prescribed narcotic while they are passing a stone. Additionally, we often prescribe an alpha-blocker. (These are the same medications used to increase the flow of urine through enlarged prostates.) These medications have been shown to help relax the ureters and increase the rate of stone passage.

Brenna (Moderator) - 10:01 AM:
Thank you everyone for your participation. We apologize if we were unable to get to your question. Go to the John and Carol Water Center for Urological Health webpage for more information on kidney stones.
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