Kidney Stones in Adults (cont.)
Preventing Kidney Stones
A person who has had more than one kidney stone may be likely to form
another; so, if possible, prevention is important. To help determine their
cause, the doctor will order laboratory tests, including urine and blood tests.
The doctor will also ask about the patient's medical history, occupation, and
eating habits. If a stone has been removed, or if the patient has passed a stone
and saved it, a stone analysis by the laboratory may help the doctor in planning
treatment.
The doctor may ask the patient to collect urine for 24 hours after a stone
has passed or been removed. For a 24-hour urine collection, the patient is given
a large container, which is to be refrigerated between trips to the bathroom.
The collection is used to measure urine volume and levels of acidity, calcium,
sodium, uric acid, oxalate, citrate, and creatinine -- a product of muscle
metabolism. The doctor will use this information to determine the cause of the
stone. A second 24-hour urine collection may be needed to determine whether the
prescribed treatment is working.
How are kidney stones treated?
Fortunately, surgery is not usually necessary. Most kidney stones can pass through the urinary system with plenty of water -- 2 to 3 quarts a day -- to help move the stone along. Often, the patient can stay home during this process, drinking fluids and taking pain medication as needed. The doctor usually asks the patient to save the passed stone(s) for testing. It can be caught in a cup or tea strainer used only for this purpose.
Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink
more liquids -- water is best. Someone who tends to form stones should try to drink
enough liquids throughout the day to produce at least 2 quarts of urine in every
24-hour period.
In the past, people who form calcium stones were told to avoid dairy products
and other foods with high calcium content. Recent studies have shown that foods
high in calcium, including dairy products, may help prevent calcium stones.
Taking calcium in pill form, however, may increase the risk of developing
stones.
Patients may be told to avoid food with added vitamin D and certain types of
antacids that have a calcium base. Someone who has highly acidic urine may need
to eat less meat, fish, and poultry. These foods increase the amount of acid in
the urine.
To prevent cystine stones, a person should drink enough water each day to
dilute the concentration of cystine that escapes into the urine, which may be
difficult. More than a gallon of water may be needed every 24 hours, and a third
of that must be drunk during the night.
Medical Therapy
A doctor may prescribe certain medications to help prevent calcium and uric
acid stones. These medicines control the amount of acid or alkali in the urine,
key factors in crystal formation. The medicine allopurinol may also be useful in
some cases of hyperuricosuria.
Doctors usually try to control hypercalciuria, and thus prevent calcium
stones, by prescribing certain diuretics, such as hydrochlorothiazide. These
medicines decrease the amount of calcium released by the kidneys into the urine
by favoring calcium retention in bone. They work best when sodium intake is low.
Rarely, patients with hypercalciuria are given the medicine sodium cellulose
phosphate, which binds calcium in the intestines and prevents it from leaking
into the urine.
If cystine stones cannot be controlled by drinking more fluids, a doctor may
prescribe medicines such as Thiola and Cuprimine, which help reduce the amount
of cystine in the urine.
For struvite stones that have been totally removed, the first line of
prevention is to keep the urine free of bacteria that can cause infection. A
patient's urine will be tested regularly to ensure no bacteria are present.
If struvite stones cannot be removed, a doctor may prescribe a medicine
called acetohydroxamic acid (AHA). AHA is used with long-term antibiotic
medicines to prevent the infection that leads to stone growth.
People with hyperparathyroidism sometimes develop calcium stones. Treatment
in these cases is usually surgery to remove the parathyroid glands, which are
located in the neck. In most cases, only one of the glands is enlarged. Removing
the glands cures the patient's problem with hyperparathyroidism and kidney
stones.
Next: Surgical treatment of kidney stones »
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