Daily News: Disease

Kidney punch

Pueblo Chieftain (CO)

06-10-14

June 10--When it comes to kidney stones, size matters. Often, these crystals aren't even noticeable. They're tiny and make their way through the body without any indication of their presence.

It's the other times -- the times when they're larger or cause an obstruction -- that we usually hear about. Those who've had such an experience will describe a pain unlike any other.

"Pain depends on the size of the stones and a patient's tolerance level," said Dr. Tony Feliz, a Pueblo urologist. "It's usually when you get an obstruction that you get the symptoms."

Kidney stones form when urine becomes concentrated and crystallizes. The most common type of stone is calcium oxalate, but high uric acid levels -- which also cause gout -- can be a source, too. About 1 in 10 people experience kidney stones, Feliz said.

Discomfort comes when the stones travel from the kidney down the ureter, which connects to the bladder. Pain may be felt down the side of the back and in the lower abdomen. It can be mild or debilitating.

One of the major causes of kidney stones is dehydration so people living in hot, arid climates like ours need to make sure to stay hydrated. Feliz recommends drinking 3 liters of liquid (preferably water) every day to keep urine diluted and the kidneys flushed. Caffeine and alcohol will have a dehydrating effect.

Other risk factors are genetics, obesity, excessive protein or sodium consumption and occasionally digestive problems.

"People who've had gastrointestinal surgeries and diversions of their digestive tract can be more susceptible," said Feliz.

Treatment can be as simple as drinking more water and taking over-the-counter pain medication, but sometimes more is needed.

"If there's an infection or obstruction, our primary goal is to get the kidney functioning again," said Feliz. "We may place a stent in the urinary tract to bypass the stone. At that point we don't really try to dissolve the stone, just treat the infection."

If the stones are a recurring issue or there's a family history of them, a urinalysis and blood work will give a doctor more information with which to treat the problem.

Stones can be broken up through a procedure called lithotripsy, in which shock waves are used. For more acute cases, an incision is made in the back and a scope is run directly into the kidney, where stones are dissolved and vacuumed out. Feliz said it's uncommon to do a more invasive "open surgery" in which the kidney itself is opened up to reach the stones.

The number of kidney stone cases is almost even between men and women, said Feliz, and there's a more troubling trend.

"We're seeing more and more children and teenagers with kidney stones," he said. Often those cases are hereditary, but a diet with more junk food and sodium can contribute, too.

In addition to drinking more, it's possible to reduce the odds of getting kidney stones by restricting sodium and foods high in oxalate (see sidebar). However, one thing that doesn't need to be avoided is calcium.

"There's a common misconception that people with kidney stones need to avoid dairy products and calcium. That's false," Feliz said. "You need to keep up a pretty standard intake (and don't) overdo it to either extreme."

amym@chieftain.com

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