Kidney Stones

Ochsner is home to the region’s first multi-disciplinary kidney team which includes experts in urology, nephrology, nutrition and radiology.

Together, they will decide the best way to treat your stone, taking your health, the size and location of your stone, and other circumstances into consideration.

Our team works together to alleviate your pain and get you back to the activities you love quickly. What’s more, we strive to prevent recurring stones and more trips to the emergency room by identifying the cause of your stones and educating you on necessary dietary changes and medications moving forward.

To schedule an appointment with our team, please give us a call.

• Ochsner Medical Center - Jefferson Hwy.: 504-842-4083
  
• Baptist: 504-894-2887
• Kenner & River Parish: 504-464-8588
• Northshore: Slidell, St. Tammany & Covington: 985-639-3789, ext: 52761
• West Bank: 504-842-8780
• Baton Rouge: 225-761-5200

Each year, more than half a million people go to emergency rooms for kidney stones. Approximately one in 10 people will have a kidney stone at some time in their lives. The number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4% of the population had experienced kidney stones; by the early 1990s, more than 5%. The rates continue to increase.

The peak age for stones is between 20 years and 50 years. Caucasian Americans are more prone to develop kidney stones than African Americans and men are much more likely to develop stones than women. Other diseases like gout, hyperparathyroidism, high blood pressure, diabetes, obesity, osteoporosis, and chronic diarrhea/dehydration might increase the risk of stones. Diabetes increases the risk of developing kidney stones, especially in younger women. Only about 25% of kidney stones occur in people with a family history of stones. Doctors say they're seeing increasing numbers of children with kidney stones. After bariatric (weight loss) surgery, in which the digestive tract is altered, kidney stones are more common. Levels of urinary oxalate are much higher after this surgery.

A kidney stone is a hard object that is made from chemicals in the urine. Urine has various wastes dissolved in it. When there is too much waste in too little liquid, crystals begin to form. The crystals attract other elements and join together to form a solid that will get larger unless it is passed out of the body with the urine. Usually, these chemicals are eliminated in the urine by the body's master chemist: the kidney. In most people, having enough liquid dilutes other chemicals in the urine to prevent a stone from forming. The stone-forming chemicals are calcium, oxalate, urate, cystine, xanthine and phosphate.

After it is formed, the stone may stay in the kidney or travel down the urinary tract into the ureter. Sometimes, tiny stones may move out of the body in the urine without causing too much pain, but stones that don't pass spontaneously may cause a back-up of urine in the kidney (called hydronephrosis). Hydronehprosis is what we believe causes the pain from kidney stones.

Possible causes of kidney stones include drinking too little water, exercise (too much or too little), obesity, weight loss surgery or eating food with too much salt or sugar. Infections and family history might be important in some people. Eating too much animal protein (fish/seafood, poultry, pork, beef) can also increase your chance of forming kidney stones. Eating too much fructose correlates with increasing risk of developing a kidney stone. Fructose can be found in table sugar and high fructose corn syrup. In some individuals, fructose can be metabolized into oxalate.

Some kidney stones are as small as a grain of sand. Others are as large as a pebble. A few are as large as a golf ball! As a general rule, the larger the stone, the more noticeable are the symptoms and the less likely you are to pass it spontaneously.

The symptoms could be one or more of the following:

• Severe pain on either side of your lower back
• More vague pain or stomach ache that doesn't go away
• Blood in the urine
• Nausea or vomiting
• Fever and chills
• Urine that smells bad or looks cloudy

The kidney stone starts to hurt when it causes irritation or blockage. This can progress rapidly to extreme pain. In most cases, kidney stones pass without causing damage - but often not without causing a lot of pain. Pain relievers may be the only treatment needed for small stones. Additional treatment may be needed, especially for those stones that cause lasting symptoms or other complications. In severe cases, however, surgery may be required.

What should you do if you have these symptoms and think you have a stone? See a doctor as soon as possible. You may be asked to drink extra fluid in an attempt to flush out the stone out in the urine. If you strain your urine and can save a piece of the stone that has passed, bring it to your doctor. In some cases, the stone may need to be removed with the help of an outpatient surgical treatment. Usually, you don't have to be hospitalized.

Three Simple Tests to Check for Kidney Disease

More than 26 million Americans-one in nine adults-have kidney disease. Millions more are at increased risk for getting it, and most don't know it. Kidney disease can be found and treated early to prevent more serious kidney disease and other complications.

The National Kidney Foundation (NKF) recommends three simple tests to check for kidney disease:

• Blood pressure: High blood pressure is the second most common cause of kidney disease. High blood pressure may also happen as a result of kidney disease. A blood pressure of 140/90 or higher is called high blood pressure. If you have diabetes or kidney disease a target less than 130/80 is recommended. Keeping blood pressure under control is important to lower risk of kidney disease, heart and blood vessel disease and stroke.
  
• Urinalysis: A urinalysis is a test that checks a sample of your urine for the amount of protein, blood (red blood cells and white blood cells) and other things. Protein and red and white blood cells are not normally found in the urine, so having too much of any of these may mean kidney disease. Having protein in the urine is one of the earliest signs of kidney disease especially in people with diabetes. Several other tests can be done to check for protein in urine. One of the tests is called the protein to creatinine ratio. It is the most accurate way to measure protein in the urine. A value of 200 mg/gm or less per day is normal. A value higher than 200 mg/gm is too high. Another test, called the albumin to creatinine ratio, is good for people at increased risk for kidney disease — people with diabetes, high blood pressure or family history of diabetes, high blood pressure or kidney disease. A value of less than 30 mg/gm per day is normal for the albumin to creatinine ratio; a value of 30 mg/gm per day or higher is high and may be a sign of early kidney disease. With either of these tests, you don't need to collect a 24-hour urine sample, which may be hard to collect.
  
• Glomerular filtration rate (GFR): GFR is estimated from results of a serum (or blood) creatinine test. The GFR tells how well your kidneys are working to remove wastes from your blood. It is the best way to check kidney function. A serum (or blood) creatinine test alone should not be used to check kidney function. GFR is calculated using the serum creatinine and other factors such as age and gender. In the early stages of kidney disease GFR may be normal. A value of 60 or higher is normal (GFR decreases with age). A GFR number of less than 60 is low and may mean that you have kidney disease. Check with your doctor about having the GFR test. If you are at increased risk for kidney disease (have diabetes, high blood pressure or family history of diabetes, high blood pressure or kidney disease), you should find out if you have kidney disease. Ask your doctor about these three simple tests. They should be done at least once a year so that if you have early kidney disease, it can be treated right away. Early kidney disease can and should be treated to keep it from getting worse!

Diagnosis of a kidney stone starts with a medical history, physical examination and imaging tests. Your doctors will want to know the exact size and shape of the kidney stones. This can be done with a high-resolution CT scan from the kidneys down to the bladder, an ultrasound of the kidneys, or an x-ray called a "KUB'' (kidney-ureter-bladder x-ray) which can show the size of the stone and its position. The KUB x-ray is often obtained by the surgeons to determine if the stone is suitable for shock wave treatment. The KUB and kidney ultrasound tests may be used to monitor your stone before and after treatment, but the CT scan is usually preferred study for initial diagnosis.

Knowing the cause of your stone will help prevent a recurrence. After removal, your stone will be analyzed. Your doctor may test your blood for calcium and/or uric acid.

There are four types of stones. The most common type of stone contains calcium, a normal part of a healthy diet. The kidney usually removes extra calcium that the body doesn't need. Often people with stones keep too much calcium. This calcium combines with waste products like oxalate to form a stone. The most common combination is called calcium oxalate followed by calcium phosphate.

Less common types of stones are: Infection-related stones, containing magnesium and ammonia called struvite stones and acid-related stones, called uric acid stones, which might be related to eating too much protein or pre-existing gout. The rarest type of stone is a cystine stone that tends to run in families.

Kidney stones increase the risk of developing chronic kidney disease. Plus, if you have had one stone, you are at increased risk of having another. Those who have developed one stone are at approximately 50% risk for developing another within five years.

You can reduce your risks by

• Drinking more fluids
• Reducing your salt intake
• Getting to normal weight
• Avoiding high-protein weight loss diets
• Adding citrate to your diet (add lemons/lemon juice to water, lemonade, Crystal Light, orange juice — all are good sources of citrate)

Some herbal substances are promoted as helping prevent stones. You should know that there is insufficient published medical evidence to support the use of any herb or supplement in preventing stones.

Ochsner urologists perform kidney stone surgery at the following locations:

Ochsner Medical Center ­– New Orleans

Ochsner Medical Center ­– Baton Rouge

Ochsner Baptist – A Campus of Ochsner Medical Center

Slidell Memorial Hospital East

Ochsner Medical Center ­– Kenner