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Symptoms, Treatment and Prevention of Kidney Stones

Online Health Chat with ­Manoj Monga, MD and Juan C. Calle, MD

October 18, 2013

Description

Kidney stones cause debilitating pain in both men and women. Each year in the United States, kidney stones result in over one million visits to health care providers and more than 300,000 visits to hospital emergency rooms. Recurrent or complex kidney stones are particularly painful, and require special treatment. The majority of these kidney stones, depending on their size and location, can be removed with minimally invasive techniques such as shock wave lithotripsy (SWL), ureteroscopy or percutaneous surgery. SWL is a relatively non-invasive procedure that uses targeted shock waves to break stones into tiny pieces that are passed naturally in the urine.

It is important to not only understand the symptoms and treatment options for kidney stones, but also the best ways to prevent them from recurring.

About the Speaker

­Manoj Monga, MD is the director of Cleveland Clinic’s Stevan B. Streem Center for Endourology and Stone Disease in Glickman Urological & Kidney Institute. He is board certified in urology. His specialty interests are kidney stones, ureteral strictures, ureteropelvic junction (UPJ) obstruction, retroperitoneal fibrosis and kidney (renal) stone disease.

Dr. Monga completed his research fellowship, residency in urology and general surgery residency at Tulane University Hospital & Clinics, in New Orleans. He graduated from medical school from Chicago Medical School, in Chicago.

Dr. Manoj Monga sees patients at Cleveland Clinic’s Center for Endourology and Stone Disease in Glickman Urological & Kidney Institute at main campus.

Juan C. Calle, MD is an associate staff physician in the Department of Nephrology and Hypertension in Glickman Urological & Kidney Institute. Dr. Calle is board certified in internal medicine–nephrology and his specialty interests include kidney stones and oxalate controlled-diet (stone prevention), hypertension and nephrology. Dr. Calle completed his fellowship in nephrology and hypertension at Mayo Clinic, in Rochester, MN after completing his residency in internal medicine at Mount Sinai Medical Center, in Miami Beach, Fl. He graduated from medical school at Instituto de Ciencias de la Salud CES, in Medellin/Antioquia, Columbia.

Dr. Juan Calle currently sees patients at Cleveland Clinic main campus.


Let’s Chat About Symptoms, Treatment and Prevention of Kidney Stones


Kidney Stone Diagnosis: Causes, Signs and Symptoms

priyankap:

  1. Do kidney stones developed in the kidney? Or is it possible that it may get developed outside the kidney, like the ureter?
  2. What kind of stones can cause infections?
  3. If one ureter has the stone of size 11 X 9 mm, is that tract still passing urine or not? Is there pressure on the kidney in this case?
  4. What is the possibility of passing the stone that is 1 cm3 in size without surgical intervention?

Manoj_Monga,_MD:

  1. Kidney stones develop in the kidney. One can also develop in the bladder if the bladder doesn't empty fully. They do not form in the ureter.
  2. Struvite is the most common type of stone associated with infection. The usual bacteria involved are klebsiella, pseudomonas, staphylococcus and proteus.
  3. If you have a 11 mm stone in the ureter, you are at high risk to lose the kidney if you don't get it treated. The pressure can lead to renal failure.
  4. There is less than 10 percent chance of passing a 1 cm stone.

Xomue: How long does it take a kidney stone to form—days, months or years?

Juan_C._Calle,_MD: It usually takes years to form. However, depending on the cause, there may be some subjects prone to form and growth stones in months.

priyankap: I believe it is only when the stone is removed, it is tested to see its composition? Is it possible that a person may get stones with different compositions?

Juan_C._Calle,_MD: Yes, it is possible that people may form different types of stones throughout life. This may change also depending on treatment given and/or other medical conditions associated.

VirginiaAnn: I have had recent serum calcium results of 10.4 and 10.9 (with normal parathyroid hormone [PTH] and normal ionized calcium) and 24-hour urine test results of 300 and 400. I am at a high risk for kidney stones. My doctor has eliminated hyperparathyroidism as the cause due to the normal laboratory results and thinks I may have a idiopathic hypocalciuric hypercalcemia. How can I determine if that is indeed the cause of the high calcium results? I have severe osteoporosis likely as a result of the high serum and urine calcium results. Vitamin C is one of many supplements recommended to help build bone. Does vitamin C convert to an oxalate?

Juan_C._Calle,_MD: Usually these levels of calcium in the urine are not seen in patients with idiopathic (mainly called familial) hypocalciuric hypercalcemia. Up to ten percent of patients with primary hyperparathyroidism and hypercalcemia may have ‘normal’ levels of PTH, so I am not completely sure we can say with 100 percent certainty that you don't have hyperparathyroidism. Vitamin D levels may also affect these results. I would also need to know of other medications that can affect these levels.

The diagnosis may be done with measurement of calcium and creatinine in the 24-hour urine collection and finally by genetic testing, but that is further down the road.

slah: Is there any connection between kidney stones and diabetic medications, such as metformin, glipizide, Januvia® (sitagliptin) and pioglitazone? Can any or a combination of these cause extremely rapid kidney stone formation?

Juan_C._Calle,_MD: Although there has not been a clear association of these medications with kidney stone formation, diabetes does increase the risk of stones. Some of the medications for the treatment of diabetes may actually decrease the rate or speed of recurrence or formation of stones.


Kidney Stones and Pregnancy

priyankap: I am not even 30 years old yet and I have 11 x 9 mm kidney stone in my right ureter. Can I plan to be a mother while I am taking treatment?

Manoj_Monga,_MD: Have you had the stone removed? You can absolutely plan to be a mother. What treatment are you taking? During pregnancy the calcium in the urine increases, but other inhibitors of stones increase also. The main thing is to drink plenty of fluids.


Water Intake and Bladder Issues

Indigo: How can I increase my water intake if my bladder only holds 150 ml? I know this from the four 24-hour urine tests I've done. I don't know how to drink the amount of water I'm supposed to after having had a kidney stone without just going ahead and living in the bathroom. This has been a real source of distress because if I drink enough that my output is two liters, then I am in misery and my bladder actually gets irritated from all the activity. Is this something I would adjust to over time? How can I do something as simple as take a walk in the park if my bladder is always full?

Manoj_Monga,_MD: It may be helpful to talk with your urologist about your bladder issues. There may be medications to ‘relax’ your bladder so that you will be able to hold more and be more comfortable.


Diagnostic Imaging

mmabsb: I had a 5 mm kidney stone on the right side discovered by CT scan. Another CT scan showed a 5 mm stone on the left side. My doctor wanted an x-ray. The x-ray did not show any kidney stones. A procedure was scheduled to blast them. Prior to procedure, my doctor ordered me to go to the surgical center and they used the machine that blasts them to see if they could find the stones. They did not find stones and the procedure was cancelled. Where did they go? I did not pass them, because I know I would have felt them. These are the third and fourth stones I have had. What means of prevention can be done? I am going out of state for the winter and do not have a regular doctor there.

Manoj_Monga,_MD: A CT will show all stones while a kidney, ureter and bladder (KUB) plain x-ray will show 70 to 80 percent of stones. It may be that your stone is not dense enough on a plain x-ray to see. Believe the CT scan. You could still have shockwave using contrast to help identify the right spot to treat. Or you could try ureteroscopy to remove the stones. If they are not bothering you, observation is another option. A 24-hour urine test will help direct how to prevent stones. You should definitely do this as you are at a high risk for recurrent stones.

Xomue: I had a CT scan recently of my abdomen to look for causes of gastrointestinal problems. If there was no mention in the written report of finding a kidney stone (it did mention seeing a small cyst in my kidney), would that mean that no stone was seen on the scan?

Manoj_Monga,_MD: If the CT scan was done without contrast, a stone would have been seen. If the CT was done with contrast, then a small stone could have been missed. It is always good to have your doctor look at the CT scan to confirm that there are no stones.


Testing with 24-Hour Urine Collection

denise70: How do I go about finding out my urine oxalate levels, etc? I don't recall my urologist ever offering any information on this. Is there formal testing, or is it a simple urine specimen?

Juan_C._Calle,_MD: Those levels are obtained from a 24-hour urine collection.

rwb: How do I go about having a 24-hour urine analysis?

Manoj_Monga,_MD: There are some commercial services which do a detailed stone risk profile (Quest Diagnostics®, Litholink®, etc.). Your doctor orders it by filling out a form. Alternatively, some hospitals do the test ‘in-house’. Most important components of a 24-hour urine test are sodium, calcium, citrate, oxalate, pH, volume and uric acid. Usually a urologist or a nephrologist will be the one to order the test.

denise70: Would there be any particular reason why I have never had a 24-hour urine collection before? I have had three lithotripsies on just one large stone. I do not have a lengthy history of stones in comparison to the other patients I'm reading about here.

Manoj_Monga,_MD: A 24-hour urine test is strongly recommended for patients with recurrent stones, multiple stones, a family history of stones or certain other risk factors. Anyone can have one though. Since you have had three procedures for your stones, and sound motivated to work on prevention, I think it would be a good idea to get this done.

Indigo: Can a 24-hour urine oxalate of 101 damage the kidneys?

Juan_C._Calle,_MD: Those levels may increase the risk of formation of kidney stones. Most likely reasons are because of gastrointestinal issues associated with malabsorption. Investigations should also be done to rule other genetic conditions that may be associated to high levels of oxalate in the urine if the clinical history, symptoms and presentation warrant further investigation.

Xomue: My parathyroid hormone (intact) was 73. My blood calcium was 9.1. My 24-hour urine calcium was 351. My 24-hour urine creatinine was one. These were my readings in May. A month later a retest of 24-hour urine calcium was 630. My doctor said I was at extreme risk of a kidney stone. I have severe osteoporosis and hypothyroidism. I am 73 years old and have never had a kidney stone. When this lab work was done in May and June, I was sick with a very high level of inflammation in my body (18 CRP). I am well now with a normal/low level CRP. Could the inflammation I was experiencing then account for the extremely high 24-hour urine calcium test?

Juan_C._Calle,_MD: I would recommend you to repeat the 24-hour urine collection now that you are sound and well since many hormonal changes may affect such collections. Nonetheless, I would also pay attention to the consumption of sodium as this greatly affects the excretion (release) of calcium.


Kidney Stones and Nutrition: Diet and Supplements

runforlife: Which high-oxalate foods do you recommend to avoid in someone with calcium-oxalate stones?

Juan_C._Calle,_MD: Usually the main culprit with high oxalate levels are spinach, nuts (especially almonds), chocolate, some berries, All-bran® cereal, rhubarb, beets and star fruit. I would recommend you to go online (our website has some information on it) and search for oxalate food content and there are various lists that pinpoint other foods with a high oxalate content.

Xomue: I have been warned that I am at high risk of a kidney stone because of a high level of calcium in my urine. Do you have any dietary recommendations to decrease the chance? I have severe osteoporosis and need to take calcium. I have no history of stones--I am an elderly woman in my 70s. Without a history of stones to determine its composition, how can it be determined what foods one should avoid?

Juan_C._Calle,_MD: Hypercalciuria (high levels of calcium in the urine) is definitively the most common risk factor for kidney stones. I would advise to try to have good fluid intake for a goal of at least 2 liters of urine per day. Decrease the amount of salt (sodium) in your diet, add non-dairy protein and eat a low oxalate diet. I would also strongly advise you to have normal consumption of calcium and not to limit this in your diet. A low oxalate diet is can be achieved by limiting the consumption of spinach, rhubarb, All-bran® cereal, berries, chocolate and nuts.

Xomue: To clarify, you said to decrease the risk of kidney stones I should decrease the intake of salt, non-dairy protein, etc. Did you mean that I should decrease the intake of non-dairy protein or to increase the intake of non-dairy protein (i.e., stay away from non-dairy protein)?

Juan_C._Calle,_MD: It seems that non-dairy protein e.g. mainly animal protein has an increased risk of promoting formation of kidney stones. In other words, decrease the consumption of meats.

robtoby: Thanks for the link to the food oxalate lists. However, those lists are over six years old. Is there any chance that they can be updated?

Manoj_Monga,_MD: The two best sources for information on oxalates are that list from Harvard and this one from www.wakehealth.edu.

sw4health: I eat a mostly plant-based diet for heart health, but need to keep my oxalate intake low due to calcium oxalate stones. Since oxalate is in plants, how do you achieve both targets?

Juan_C._Calle,_MD: In fact, that is one of the major issues I run into when giving advice to my patients. To that end, I always say and recommend trying to have a balance and be moderate—especially in certain foods that have increased oxalate content. I would recommend for you to go online and search for ‘oxalate food content.’ Once you review the lists (there are various lists including our own), you’ll see that there are some foods that have much higher content—and perhaps should be avoided or at least dramatically decreased in your diet.

robtoby: I have had calcium oxalate stones in the past, and I'm happy to say I'm currently 'stone free'. I am curious about your advice on oxalates as they relate to calcium oxalate stones. There are so many lists out there regarding oxalate content of foods that it makes my head spin. Should I just eat anything I want 'in moderation' or are there any 'oxalate-rich' foods I should really stay away from?

Juan_C._Calle,_MD: I understand the confusion with so many lists out there and I do think low oxalate diet is key for prevention of stones. Although there are some conflicting results on the content of oxalate on some foods, I would advise you to avoid as much as possible the ones we do know have high oxalate and are consistent in pretty much all lists; e.g. spinach, All-bran® cereal, all types of nuts, chocolate and the majority of berries. Nonetheless, as you said and that pretty much works for everything else in life, ‘everything in moderation.’

Indigo: I successfully decreased my 24-hour urine oxalate level from 101 mg to 40 mg via diet changes and calcium supplements. I had been a vegetarian who ate low calcium and a high oxalate diet, and I got a seven mm stone. Can magnesium citrate bind to oxalates like calcium does? Are there any other supplements that can help?

Juan_C._Calle,_MD: While most of the evidence we have comes from calcium binding the oxalate in the gastrointestinal tract, there have been some reports suggesting that magnesium may also have this effect. The main issue is that either of them should be used with meals so the binding process takes place in the gut and prevents the absorption of oxalate. The problem with magnesium is that it may cause gastrointestinal side effects such as loose or frequent stools. As far as other supplements, vitamin B6 or pyridoxine may also be helpful for prevention of such stones.

fern:

  1. Which is more important to prevent the recurrence of a calcium oxalate stone—eating low oxalate foods or eating alkaline foods?
  2. How important is pH in the prevention of stones?
  3. Do you recommend drinking alkaline water?
  4. How important is HCL in the prevention of stones?
  5. Will a 24-hour urine test predict future stone formation?
  6. In a urinalysis, is 15 high for oxalates? What number is ‘normal?’
  7. What is the normal range for calcium in a blood test? When is a tumor on the parathyroid indicated?
  8. What kind of calcium and magnesium is best to take? What should be the ratio of magnesium to calcium? Does magnesium bind to oxalate?
  9. Do you recommend transdermal magnesium?
  10. Do you recommend trace minerals?

Juan_C._Calle,_MD:

  1. I would consider low oxalate foods more important than alkaline foods.
  2. The pH plays a role in the formation of stones mainly based on the type of kidney stone we are dealing with.
  3. There has not been conclusive studies showing alkaline water to be superior to regular water, although there is at least one study I'm aware of that supports this. If you have access to it and enjoy it, the I would not discourage you from drinking alkaline water then.
  4. I believe the 24-hour urine test to be a good indication for recurrence of stones, and follow it regularly in my practice.
  5. Oxalate should be measured only in 24-hour urine collections. A normal level is considered to be below 40 mg/day.
  6. Our laboratory considers normal calcium to be 8.5 to 10.5 mg/dL but it varies amongst different laboratories.
  7. Parathyroid hormone, calcium and phosphorus levels should be checked for consideration of a parathyroid adenoma or ‘tumor’.
  8. Depending on results of metabolic analysis, most likely calcium and magnesium citrate would be preferred.
  9. Magnesium does seem to bind oxalate, but there is more known about calcium.
  10. I do not recommend transdermal magnesium nor trace minerals.

Painfull: I have had 35 kidney stone operations over the past 24 years! Is there any solution to completely prevent them, other than death? I weigh 195 lbs and I am five foot 11 inches tall. I am now 61 years old. If it is dietary, please let me know what I should not eat or drink! I really hope that your solution is proven and works!

Juan_C._Calle,_MD: I am sorry that you have dealt with this for a long time. Having such severe disease will merit for you to have a complete metabolic work up and there may be some therapies that will help to prevent or decrease the rate of formation of stones. In general, high fluid intake to produce as much as two to three liters of urine per day (70 to 100 oz) should be your goal. Decrease your salt intake for a goal of two to three grams of sodium per day. You should also have low non-dairy protein intake and more vegetables and fruits. Again, there are medications that should probably be tried, but we would need to see first what type of abnormality we find.

rwb: I am a 53-year-old male in good health leading an active life. My diet excludes red meat and I enjoy a glass of red wine every day. I have recurring kidney stones on my right and left sides. I take potassium citrate daily at breakfast and dinner. My urologist says the stones offer no information to help isolate a specific cause. I follow recommendations to stay hydrated with water and avoid the common foods associated with kidney stones as best I can. On the last three occurrences shock wave lithotripsy (SWL) was successful. The most recent occurrence was in August with three small stones between my right and left sides. A recurrence of seven years has been identified. I have a follow up x-ray planned in five years, in the hope that we identify a stone early so that the SWL rather than ureteroscopy can be performed. Should I be concerned about a continued regimen of x-rays, CT scans and SWL for the rest of my life? Should I consider other preventative measures such as lifestyle changes?

Manoj_Monga,_MD: It sounds like you are doing all the right things. The 24-hour urine usually guides what diet and medications to follow. Some studies have said that using a thiazide diuretic helps and should be considered in all patients with recurrent calcium stones and not just those with high calcium in the urine. You might like to discuss this with your radiologist. Cumulative radiation is a concern. It is best to use a plain x-ray and ultrasound to follow stones if you are not having pain. You should reserve CT scan for those times when you are having pain or considering surgery.

vasillia: I follow the strictest anti-calcium oxalate diet to stop kidney stone recurrence to no-avail. Am I doing anything wrong? Will anything work for me? What is the verdict on orange juice—can I have a little or not at all?

Juan_C._Calle,_MD: I believe diet is key in the prevention of kidney stones, so I would continue to recommend a low-oxalate, low-sodium and low-protein diet. Your calcium intake should be normal. You don't need to restrict your calcium intake, and fluid is very important too. Regarding orange juice, it may have both beneficial and deleterious effects. My main concern would be increased calorie intake if you only drink milk, which would increase your risk of gaining weight. Also, it may increase the levels of oxalate. However, the content of citrate may be helpful. I would recommend you not to have this as the only fluid intake.

robtoby: You mentioned that Cleveland Clinic has an oxalate list for foods? Can you provide the link for that list?

Manoj_Monga,_MD: The best source is: https://regepi.bwh.harvard.edu/health/Oxalate/files.

Indigo: I would like to know more about what type of calcium is best for binding to oxalates. Also, how much is needed, since there's some research about taking a lot of supplemental calcium long term may not be healthy?

Juan_C._Calle,_MD: The type of calcium may not be the main factor for binding of oxalate. The main difference is mainly on the other component associated to the calcium. However, I would recommend that you to try to get as much as possible the calcium intake from normal dietary intake and not supplements. If supplements are used, I would use them with meals and not to have excessive supplementation. Your recommended daily intake of calcium (diet and supplements) should be between 1000 to 1200 mg of calcium per day for an adult.

Indigo: You said lemon juice is good for us to drink. Why does it help?

Manoj_Monga,_MD: Lemons, limes, oranges and melons are rich in citrate which is an important inhibitor of stone formation.

Xomue: How much water per day should a person drink to lessen the chance of getting a kidney stone? I have read that drinking water with lemon juice helps to prevent kidney stones. Is that true?

Juan_C._Calle,_MD: The goal should be to have at least 10 to 12 glasses of fluid per day. Lemon does help to prevent formation of kidney stones and I would add that fluids with sugar or corn fructose syrup should be avoided.

kurocks19: Does drinking soda pop have any effect on getting kidney stones?

Juan_C._Calle,_MD: Yes, it does. Many studies have shown that people who consume larger quantities of soda—especially sweetened and dark colas—have an increased risk of forming kidney stones.

mmabsb: What effect does coffee have on the formation of kidney stones?

Manoj_Monga,_MD: Epidemiological studies suggest that drinking coffee has a protective effect on stone formation (meaning coffee drinkers appear to have fewer stones).


Medications for Kidney Stones

vassilia: I am a 60-year-old white male with recurrent calcium hydroxide kidney stones that I have had since I was 22 years old. Most stones are small and pass on their own, but more recently two large stones were removed. One 6 mm stone got stuck at the entrance of the bladder and had to be removed through laser lithotripsy; the second stone measured 8 mm as it was trying to leave kidney. It was smashed through shock wave lithotripsy. Imagery shows two smaller stones on the other kidney.

Should I leave them alone? Should I do another lithotripsy before start moving? Being a frequent flyer averaging ten hour flights, I dread the moment that a big attack will occur while on a plane. When I was younger, doctors had prescribed shots that could carry with me. What is the strongest pain killer I can carry with me on the plane? Will it save me? How do I get it? Could someone eventually die from unbearable pain? Will the pain eventually stop if you stay still and do nothing about it? Does heat work? Will lemon juice work if you are having an attack?

Manoj_Monga,_MD: If the stone measures less than 4 mm, it is best to leave it alone. Keep a prescription of Flomax® (tamsulosin) in your flight bag. It decreases pain and the time for stone passage. Consider treating larger stones larger than 4 mm before they move and cause pain. Heating pads are used in ambulances in Europe since paramedics there do not use narcotics. Toradol® (ketorolac tromethamine) is a good medication to keep on hand if you pass stones recurrently and your kidney function is ok. Toradol® cannot be taken for more than five days at a time.

Xomue: What is the best pain killer that an emergency room can offer for the extreme pain of kidney stones?

Manoj_Monga,_MD: Toradol® (ketorolac tromethamine)—if your renal function is ok and the narcotic morphine.

vassilia: What happens eventually if you do not have access to strong pain medication to treat the pain from a kidney stone attack? Does the pain go away after a certain amount of time of suffering? Could people die from this kind of pain?

Manoj_Monga,_MD: Pain from the kidney stone passage is related to the pressure that builds up behind the stone. Usually the pressure will dissipate as more urine production is shifted to the ‘unblocked’ kidney and as the urine finds a way to get by the stone.

Moderator: For more information about kidney stones please access our Cleveland Clinic guide.

Eddiebear: I have chronic kidney stones. Are there any new medications to dissolve them?

Juan_C._Calle,_MD: Unfortunately, there are no new medications approved for this purpose only. However, you may benefit from other medications to try to prevent the formation and growth of stones.


Lithotripsy

priyankap: I have heard about removing a kidney stone with a laser. Is it same as lithotripsy?

Manoj_Monga,_MD: Lithotripsy means to ‘break up stone.’ That can be done with a laser (from the inside) using a ureteroscope or it can be done from the outside (extracorporeal) lying on a table.

jerry56: I have a 6 mm kidney stone at the ureteropelvic junction. The stone has been growing by 1 mm per year recently, and my urologist has started to discuss having shockwave lithotripsy sometime in the future. In a previous Cleveland Clinic chat, you recommended shockwave lithotripsy when the stone measures between 5 and 15 mm. In this size range, what do you think is the optimal size for me to have shockwave lithotripsy if the stone remains in the ureteropelvic junction and does not cause pain? I am a 45-year-old male in good health.

Manoj_Monga,_MD: If it were me, I would do shockwave lithotripsy for a 6 mm kidney stone. It is the least risky and least invasive procedure. The stone has now reached the point where if it were to start to move, your chance of passing it would be less than 50 percent.

priyankap: Are there any side effects of shock wave lithotripsy (SWL)?

Manoj_Monga,_MD: The immediate risk is bleeding, which has a 0.3 percent risk of a serious bleed with SWL. The long-term risk may be a slightly higher risk of developing high blood pressure (hypertension). About half of the published medical studies say yes, this occurs; and the other half of the studies say no.

vassilia: Is it possible to produce nerve damage during shock wave lithotripsy (SWL) on a stone at the lower end of the kidney?

Manoj_Monga,_MD: I am not aware of nerve damage occurring during SWL. Chronic pain can develop in the kidneys with no surgery at all or with any type of surgery. Unfortunately, the reason for why people get chronic kidney pain is not well understood.


Ureteroscopy

denise70: I have had lithotripsy on a 16 mm stone three times. The first two therapies didn't accomplish anything, but the third reduced it to 8 mm. My urologist initially indicated that it was imperative for me to go through these procedures because if I didn't, the stone could eventually kill off or significantly damage my kidney. Now he says we are just going to watch the stone to see if it moves, grows, etc. All of this started in January 2012. My question is, should I seek a second opinion and start from scratch on this, or simply follow my doctor’s recommendation and leave it alone? Is it safe to leave things alone, or should I seek further treatment?

Manoj_Monga,_MD: It is uncommon for stones to cause kidney failure, although it can happen if the stone causes prolonged blockage. This is more common if the stone is in the ureter or renal pelvis. It looks like shockwave eventually did do some good, if it decreased the stone by 50 percent. So you could try another shockwave or you could move on to the ureteroscopy. Observation is also an option with ultrasound and kidney, ureter and bladder x-ray every six months to confirm that your kidney is in good shape.


Repeat Procedures for Kidney Stones

finnishgirl: I have had stones for over 35 years. After many lithotripsies, a couple surgeries and wire basket removal—I have given up. By taking 50 mg hydrochlorothiazide and potassium, I seem to be able to get rid of them eventually by myself although some are large. Presently I have six stones on one side and three on the other. I believe there is nothing more I can do but accept this. A person can only have so many procedures in a lifetime. Do you have any recommendations?

Manoj_Monga,_MD: If you are able to pass most of them by yourself, then it is always better to do that than run the risks of surgery. If you were to need a surgery, or were concerned about a larger stone, then you should consider doing the procedure. As far as we know repeat procedures do not harm the kidney.


Alternative Therapies

denise70: Are alternative therapies, such as hydrangea root, a viable option, or not recommended? I've heard of some folks actually dissolving their stones by using alternatives.

Manoj_Monga,_MD: A variety of alternative approaches have been used. The ones that have been best studied include fish oil (if your urinary calcium is high or urinary citrate is low) and vitamin B6 (if your urinary oxalate is high).

zoelayne: Have you ever heard of Renavive®? It is supposedly a natural kidney cleanse that will dissolve calcium stones. Could this product work?

Juan_C._Calle,_MD: I have not heard of this product before. I usually take a very conservative approach to supplements in which we don't have much formal research. These products are not even regulated by any agencies that can reproduce results.


Research and New Therapy

Indigo: Has there been any headway in terms of testing for or supplementing oxalobacter formigenes in people with stones due to hyperoxaluria?

Juan_C._Calle,_MD: Although more studies continue to show the association of low oxalobacter formigenes with increased risk of stones and recurrence of this stones, there has not been major advancement to suggest this as therapy for hyperoxaluria. However, it is a hot topic in research of kidney stones, and surely we will have further answers on the subject.


Closing

Moderator: I am sorry to say that we are at the end of our chat. Thank you, Dr. Monga and Dr. Calle, for sharing your expertise and answering questions today about kidney stone symptoms, treatment options and prevention. We hope to do another kidney chat in the spring. We offer several different health chats during the week. Check out chat.clevelandclinic.org for updates.

Juan_C._Calle,_MD: It was a pleasure to be with you today. I hope this was informative and helpful.

Manoj_Monga,_MD: Thank you very much for joining us today. The best of luck to all of you with preventing stones!


For Appointments

If you would like to make an appointment with Dr. Monga, Dr. Calle or any of our other urologists in the Glickman Urological & Kidney Institute, please call 800.223.2273 or request an appointment online by visiting www.clevelandclinic.org/appointments.


For More Information

On Cleveland Clinic

Cleveland Clinic’s Stevan B. Streem Center for Endourology and Stone Disease is located within the Glickman Urological & Kidney Institute. Through a multidisciplinary approach, urologists and nephrologists explore all medical and surgical treatment options to ensure the most successful possible outcome for each patient.

Experienced urologists and nephrologists investigate the causes of kidney stone formation through 24-hour urine analyses and blood tests. They then develop prevention strategies tailored to individual patients, such as tailored dietary recommendations based upon the 24-hour urine evaluation. Our patients receive a better understanding of why their kidney stones develop and what lifestyle changes they can make to prevent them.

At Cleveland Clinic, our urologists are trained in performing shockwave lithotripsy under conscious sedation. Cleveland Clinic urologists were among the first in Ohio to use shockwave lithotripsy. Percutaneous nephrolithotomy is used for larger stones, and is a procedure our urologists perform regularly. Cleveland Clinic urologists also employ a ‘tubeless’ approach in select patients.

On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org.

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.


Contact Information

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Reviewed: 11/13

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.

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