I had my first kidney stone+kidney colic: What now?
on 12/12/11 4:19 am, edited 12/18/11 6:42 am
You'll need to have your stones analyzed to see what they are made of, since different stones have different causes, but the most common, and likely what you have are calcium/oxalate. I'll share some of my info, which I'll say right now if for calcium/oxalate stones, so if your are different, much of this won't apply. Your doc will also need to do a 24 hour urine collection to help see why you made a stone, and to help prevent you from making more. The probably already told you, but the fact that you already had one, makes it MUCH more likely you will have subsequent stones. You don't want your pcp doing this, you need something like a urologist or nephrologist that specializes in renal stones.
I'm going to copy paste some kidney stone stuff from my profile page here, and it's looong. I'll friend you so you can look at the rest of it if you want, but it goes into the treatments and stuff. My 24 hour tests consistently show high oxalates, and low citrate, so I've left some info specific to that, as it's common to stone formers.
I also take Urocit-K, which is a type of potassium to help with the low citrate. If you find ANY type of pain med helps when you go to ER for a stone, write it down. Most pain meds will feel like you've taken a placebo, and if they get something that helps, even if it's making you unconscious so you can ride it out, get the name, and then make sure you have some on hand for the next time. No one likes to writhe in pain for hours in the ER waiting their turn.
Kidney stones
This is info about preventing them that I have collected from my urologist, nephrologist, and the most recent studies. There are some studies on a probiotic called Oxalobacter formigenes that I don't have info on here, but it looks promising, so I'm linking to Wiki for that here. There are some studies underway, but I don't have links to anything here.
My family has at least four generations that have been kidney stone formers, and have had at least one related death, and one sister has a medullary sponge kidney, which basically means she makes LOTS of stones, at all times. We currently have11 stone forming family members trying these things, and while that is certainly not enough for a decent study, we have had much better results than we have had from prescriptions. There are several family members who have passed stones about twice per year, every year since 18 years of age, and are now over 80 (AAAARRRGH), and are FINALLY going years at a time without stones, so I'm sticking with these supplements until something better comes along.
My stones are calcium oxalate, which is the most common type. In order to slow the calcium being purged into the kidneys, and to help it bind to the oxalate to move it out via the intestines, I take some calcium carbonate or citrate (yes, carbonate is OK for this purpose, since it's just meant to bind that oxalate and get pooped out) to bind it with every meal, and lots of calcium citrate, as well as vitamin b6, magnesium citrate and potassium citrate. I make sure I drink at least64 oz of water a day (which you should be if you've had WLS anyway), and if I can get more citrate in any form, such as making lemonade with real lemon juice and splenda, that's even better. Citrate helps prevent stones by keeping things dissolved and in solution.
A few more things about drinks:
While I add some lemon juice (about 1/2 cup per 64 oz) to water through the day, I avoid other juices because some (like orange, cranberry and apple) raise oxalates. Grapefruit juice has been linked to stone formation as well, but I'm not sure why.
Drinks with phosphoric acid should be avoided (like colas) because it reduces citrate in the urine, but drinks containing citrate seem to be OK. If you drink soda, at least drink "light" soda, or citrus flavored, as they are highest in citrates. Wine may also help prevent stones, but not beer or other alcoholic drinks with purines, as those can cause some other types of kidney stones.
Some research has reported a lower risk for stones in people who drink tea and both regular and decaffeinated coffee, but my urologist told me "no tea" to avoid oxalates, so I'm a bit confused about that. Tea does have oxalates, so I avoid foods that are high in them.
Since I've had the DS, I have some malabsorption that others don't, so I can take much higher doses of many supplements that would be too much for "normal people". I wouldn't add anything more than the typical amounts you can buy at any vitamin store without the OK of your urologist, since some of them such as b6 in too high doses (500 - 2,000 mg daily over long periods) can cause serious stuff like nerve damage. I do take a b6 supplement, but also try to get extra b6 with meats, oily fish, poultry, whole grains, soybeans, avocados, baked potatoes with skins, watermelon, plantains, bananas, peanuts, and brewer's yeast.
I have noticed that in the medical studies, most supplements, especially calcium, are best at preventing stones if you get them naturally in the diet. Sadly, I can only eat so much cheese, peanuts, fish, etc.
Many of these things are the exact opposite of what my doctors were telling me to do only a few years ago, so they are finding out new info regarding kidney stones every day. Maybe by next year they will say that chocolate donuts are the perfect food to cure kidney stones, but until then I can dream.
Preventative Testing
The only way to definitively identify the underlying causes for kidney stones is to perform a 24-hour urine collection analysis. This test ideally should be done after the painful kidney stone attack is over and the patient has resumed his or her usual diet and routine activities.
Performing the test is not difficult, but interpretation of the results can be complicated and many physicians have little or no experience in this type of complex laboratory analysis. If possible, try to find a specialist in kidney stone prevention analysis to help or ask your physician about his or her experience in this particular area. If your urologist is not comfortable analyzing this type of test data, ask for a referral to an expert.
Another problem with 24-hour urine testing is the need for long-term compliance by the patient. Most patients start with the best of intentions, but after 6 months or so many patients have given up on their preventive treatments and go back to their old ways.
In order to prevent as many stones as possible, patients must do the 24-hour urine test so the underlying causes can be identified. Then, they must find a physician skilled in this area and follow his or her advice on a long-term basis, even if they don't think it’s helping. Patients with stones are kidney stone formers for life and if preventive treatment is not continued, more stones will begin to form.
Also, even the very best preventive treatment plan may eventually fail. This is not due to bad science, but is due to the fact that preventing kidney stones is fighting against nature. Successful treatment often means not giving up even if an occasional stone develops.
The five most common findings on 24-hour urine tests are hypercalciuria (high urinary calcium), hyperuricosuria (high urinary uric acid), hyperoxaluria (high urinary oxalate), hypocitraturia (low urinary citrate) and low urinary volume.
Hypercalciuria
Thiazides, water pills (diuretics), are sometimes prescribed to reduce high levels of urinary calcium (hypercalciuria) and to increase urinary volume. Salt (sodium) intake needs to be reduced for thiazides to be effective. Patients with hypercalciuria who do not respond to thiazide therapy may be prescribed orthophosphates to reduce calcium absorption and may be given moderate dietary calcium restrictions.
Patients should not reduce their calcium intake unless their physicians advise them to do so. Overly aggressive oral calcium restrictions have been shown to actually increase calcium stone disease. The reason for this is that calcium binds other minerals and chemicals like oxalate in the digestive tract. If the oral calcium intake is too low, then there is no intestinal oxalate binding and the oxalate absorption and urinary excretion increases dramatically. This results in a net increase in kidney stone production.
Hyperoxaluria
Hyperoxaluria (high levels of urinary oxalate) may be mild, enteric, or primary. Mild hyperoxaluria is usually caused by an excess of dietary oxalate (found in tea, chocolate, cola, nuts, and green leafy vegetables). Prevention consists of daily doses of pyridoxine (vitamin B-6), which reduces oxalate excretion, increased fluids, phosphate therapy, and sometimes calcium citrate supplementation.
A low-oxalate, low-fat diet, increased fluid intake, and calcium supplementation is prescribed for enteric hyperoxaluria. This rare condition is often severe and is usually caused by an intestinal disorder (e.g., Crohn's disease, colitis). Calcium citrate,magnesium, iron, and cholestyramine may be given to reduce oxalate levels.
Primary hyperoxaluria is rare, severe, and caused by an inherited liver disorder. Primary hyperoxaluria requires aggressive treatment to prevent severe renal stone disease and kidney failure. High doses of vitamin B-6, orthophosphates, magnesiumsupplements, and increased fluid intake (to produce 2 liters of urine/day) are prescribed. Rarely, kidney and liver transplants are necessary.
Hypocitraturia
Hypocitraturia (low levels of urinary citrate) usually requires a prescribed supplement, such as potassium citrate. The dosage depends on the level of urinary citrate, which is determined initially by the 24-hour urine test but can also be monitored by measuring the urinary antacid level (ph) with special dipsticks. Patients with renal tubular acidosis usually respond particularly well to treatment with prescription potassium citrate supplements. Citrus fruits and lemon juice can also be used as additional sources of natural potassium citrate.
Low Urine Volume
Low urinary volume is both the easiest and the hardest problem to solve. It can be very difficult for many stone patients to significantly increase their fluid level on a daily basis for long periods of time. Increasing fluid intake is the only known remedy that helps all types of stones, regardless of the chemical makeup of the stones.
While increasing fluid intake often is difficult at first, there are some helpful techniques to make the transition easier. First, try drinking a small glass of water, roughly 4 ounces, with each meal. Then, slowly increase the frequency of that extra small glass from mealtimes to in-between and other convenient times.
Follow the 24-hour urine volume—if the volume is close to 2000 cc (roughly ½ gallon), then you are probably doing fine. Once the urinary volume up to where it should be, your system will adjust and you will become used to this increased fluid. At that point, you will become thirsty if you skip some your usual water intake.
Measuring 24-hour urine volume is a far better way to manage fluid intake than an arbitrary number of glasses of water to drink. If you just can't stand any more water, try lemonade made with real lemon juice to break up the monotony. Real lemon juice also is rich in natural citrates.
