December 15, 2022
Dr. Jerry Williams of Urgent Care 24/7 discusses kidney stones.
If you've ever had one, you'll never forget it. Kidney stone pain is quite exquisite.
In fact, Jeff Foxworthy does a stand up routine on kidney stones that is absolutely priceless. Now, if you're suffering from kidney stone pain, there's nothing funny about it in the moment, and Dr. Williams suggests you not watch that right now. Kidney stones can be a very serious medical problem and patients who are prone to create kidney stones typically have these problems on-going where they have recurrences of kidney stones. It can really be debilitating, can affect the overall health of your kidney and can be life threatening.
We see a lot of patients with kidney stones nationally at Urgent Care 247 and the primary presenting complaint is very severe pain in the abdomen, the side or in the back, or we call the flank. That's called CVA tenderness. In the back here costovertebral, which means rib, vertebral, your spinal column vertebra, the costovertebral angle, where the ribs and the spine come together, the kidney sits retroperitoneal in the back there, and the patients will experience severe, low and mid back pain. The kidney stone patient is different than a patient with an acute abdomen like appendicitis or something like that. The kidney stone patient, whereas the acute abdomen appendicitis patient will live very still. That's what makes them feel more comfortable.
The kidney stone patient cannot get comfortable. They're constantly pacing and changing positions and moving and they just can't get comfortable. So that's, that's one way to make the diagnosis is based on that behavior. The other symptom that's very common is nausea and vomiting. And the pain is so severe, the patients will frequently have a very difficult time keeping anything down by mouth. And so there's a risk for dehydration. It also poses a problem, the nausea and vomiting in trying to give pain medications by mouth because they can't keep it down.
So frequently, we'll give patients pain medications and at the same time, give them anti medications or anti nausea and anti vomiting medications to help them keep the pain medication down. Also, in that scenario, you can imagine that these patients can get dehydrated. If you think about it with the kidney, saying we want to have lots of urine flow to help flush that kidney stone out of the kidney out of the ureter and into the bladder and then through the urethra and out.
So it's not good that these patients can get dehydrated. So it's very important that they push fluids and that they can keep the fluids down if they can't. They frequently require IV fluids to keep their hydration status or intravascular volume up, so they're constantly creating urine. Typically there are two types of kidney stones. There's uric acid, kidney stones, and there's calcium oxalate crystals, that can cause kidney stones. When a patient has their first kidney stone, we encourage them to actually give them a filter to urinate through so that they can capture the kidney stone when they ultimately pass it and it can be sent to the laboratory for analysis to find out if it's a calcium based or a uric acid based stone, because the treatment and the recommendations for those two different types of kidney stones are very different.
Patients who have a higher uric acid level in their blood are more prone to creating uric acid kidney stones, whereas patients who have a higher calcium level are more likely to have calcium based kidney stones. So, if you have a kidney stone, if you think you have won out, you encourage you to push lots of fluid. If you are having difficulty keeping fluids down or the pain persists or is worsening, seek medical attention immediately, so they can assess your hydration status, give you effective pain management, anti nausea and vomiting medications, and also imaging to determine the size of the kidney stone. If it's sustained, you can actually pass without requiring lithotripsy or any more invasive intervention, such as surgery, or cystoscopy, where they will actually put a scope up into through the through the urethra into the bladder and up into the ureter, to use a basket to capture the stain and to pull it out.
If you got a kidney stone, there's some pretty distinct features that will point to that diagnosis, the most common symptoms being pain and nausea, and getting medical attention to determine the type of stain that you have treating the symptoms effectively and determining size of the stain to determine an ongoing treatment plan for conservative measures to allow the stand to pass on its own or, if more invasive requirements such as lithotripsy or surgical or cystoscopy are required.
Dr. Williams hopes you found this information useful, and he hopes you don't have a kidney stone. But if you are a loved one, do now, you'll know how best to handle it.
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