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Kidney stones

Also listed as: Urolithiasis

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Kidney stones are a painful disorder of the urinary tract. These stones happen four times more often in men than in women, with 240,000 - 720,000 Americans affected yearly. The pain of having a stone has been compared to that of childbirth. The stones can be made of various minerals, including calcium, uric acid, and oxalate.

Signs and Symptoms

You may have no symptoms if the stone is found by an x-ray for an unrelated condition, or you may have some or all of the following symptoms:

• Sudden onset of excruciating pain in the buttocks area
• Abdominal pain
• Nausea and vomiting
• Constant movement to relieve the pain
• Pain in the genital area as the stone moves
• Fever and chills

What Causes It?

People develop kidney stones because the small bowel absorbs too much calcium, their diet is too high in calcium or another mineral, or there are intestinal problems, a urinary tract infection, or an inherited disorder. You may not be drinking enough fluids (especially in the summer) or exercising enough.

What to Expect at Your Provider's Office

If you are in extreme pain, your health care provider may give you a strong pain reliever. Your health care provider will need a urine sample to check for infection and to see if your urine is acidic or alkaline, which indicates the type of stone. You may need to collect your urine for 24 hours if this is not your first stone. Your health care provider will also take a blood sample.

With time, the stone generally passes out of the body by itself. If not, or if you have severe pain, bleeding, fever, nausea, or can't urinate, your health care provider can shatter the stone with shock waves (an outpatient procedure), and the smaller pieces can pass with much less pain. Rarely is surgery needed.

Treatment Options

Usually taking pain relievers and drinking at least six to eight glasses of water a day, plus one at bedtime and another during the night, enables the stone to pass more easily. You may need to urinate through a strainer to collect the stone and give it to your health care provider for analysis.

Drug Therapies

You may need pain medication while the stone is moving through your system. After it passes, you may need other drugs so that you don't form stones again. Drugs may include:

• Narcotics to control severe pain
• Allopurinol, 100 - 300 mg daily, to control hyperuricemia
• Potassium citrate, 100 mEq tablets twice daily, to raise urinary pH
• Hydrochlorothiazide, 25 - 50 mg daily, for calcium type I stones
• Cellulose sodium phosphate 10 g daily, for calcium type I stones and to decrease bowel absorption
• Orthophosphates, for calcium type III stones

Surgical and Other Procedures

Surgery is recommended for patients with severe pain that does not respond to medications, for those with serious bleeding, and persistent fever, nausea, or significant urinary obstruction. If no medical treatment is provided after surgery, stones recur in 50% of patients within 5 years.

• Urethroscopy -- a diagnostic procedure for identifying stones in the lower third of the ureter
• Extracorporeal shock wave lithotripsy (ESWI) -- an outpatient procedure in which shock waves are used to shatter stones under 2 cm
• Percutaneous nephrolithotripsy -- a surgical procedure for removing large or dense kidney stones. Instruments are inserted into the kidney to break up stones

Complementary and Alternative Therapies

Kidney stones require medical attention. Alternative therapies aid in reducing the risk of recurrent episodes and increasing the overall vitality of the urogenital system. Start with nutritional guidelines for prevention of recurrence. Herbs and homeopathic remedies can be used for acute pain relief and long-term toning of the urinary tract. Always tell your health care provider about the herbs and supplements you are taking.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
• Cut down on oxalate-containing foods, such as spinach, rhubarb, beets, nuts, chocolate, black tea, wheat bran, strawberries, and beans.
• Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, zinc and selenium.
• Magnesium citrate, 200 - 400 mg daily, for symptoms of kidney stones.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbs of oil one to two times daily, to help decrease inflammation and help in general health. Cold-water fish, such as salmon or halibut, are good sources.
• IP-6 (Inositol hexophosphonate), 1 - 8 grams daily on an empty stomach, for kidney health. Check with your health care provider for proper dosing.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Grapefruit seed extract ( Citrus paradisi ), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial, antifungal, and antiviral activity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Cranberry ( Vaccinium macrocarpon ) standardized extract, 300 - 400 mg daily, for kidney health. You may also drink 8 - 16 ounces of unsweetened cranberry juice daily.
• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Relora, 250 mg 1 - 3 times a day, for stress.

Homeopathy

Some of the most common remedies used for kidney stones are listed below. Usually, the dose is three to five pellets of a 12X to 30C remedy every 1 - 4 our hours until your symptoms get better.

• Berberis for sharp sticking pains that radiate to your groin
• Colocynthis for restlessness and pain that feels better when you bend forward
• Ocimum for nausea and vomiting from the pain

Physical Medicine

Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to skin, cover with a clean soft cloth (for example, flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 - 60 minutes. For best results, use for three consecutive days.

Following Up

Fifty percent of patients pass the stone in 48 hours. If there are complications, your health care provider may refer you to a urologist or admit you to the hospital. After you pass the stone, keep drinking fluids, and change your diet to reduce the chance of forming more stones in the future.

Special Considerations

Shock-wave therapy is not appropriate for women of childbearing age. If you think you might be pregnant, tell your health care provider. Your health care provider will also want to rule out ectopic pregnancy or a ruptured ovarian cyst.

Supporting Research

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr . 2006;25(2):79-99.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 268.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm . 2004;54(3):243-50.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res . 2002;16 Suppl 1:S40-4.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther . 2006;4(2):261-75.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep . 2005;7(4):308-16.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St Louis, Mo: Mosby-Year Book; 1999.

Grases F, Costa-Bauza A. Phytate (IP6) is a powerful agent for preventing calcifications in biological fluids: usefulness in renal lithiasis treatment. Anticancer Res . 1999;19(5A):3717-22.

Grases F, et al. Urolithiasis and phytotherapy. Int Urol Nephrol. 1994;26:507-511.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med . 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Krieg C. Role of diet in the prevention of common kidney stones. Urol Nurs . 2005;25(6):451-7.

Larson DE, ed. Mayo Clinic Family Health Book. 2nd ed. New York, NY: William Morrow and Company; 1996.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 452-454.

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Lieske JC, Goldfarb DS, De Simone C, Regnier C. Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int . 2005;68(3):1244-9.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA . 2005;294(3):351-8.

Massey L. Magnesium therapy for nephrolithiasis. Magnes Res . 2005;18(2):123-6.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-24.

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• Review Date: 8/11/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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