Ashish R. Parekh, MD Urologic Surgery Kaiser Permanente, WLA KIDNEY STONES; WHY ME?!! Ashish R. Parekh, MD Urologic Surgery Kaiser Permanente, WLA

Who gets them? Men>Women (4:1 ratio) Age 20-50 Prior stone former 10x more likely to get another stone in his lifetime Hereditary Medullary sponge kidney, hyperoxaluria, cystinuria, renal tubular acidosis (RTA) Who gets them?

Contributing Factors Dehydration Excessive salt Excessive oxalates Medications Indinavir, Guifenesin, topirimate, diuretics Medical problems Hyperparathyroidism, gout, intestinal malabsorption, laxative abuse, obesity, diabetes, recurrent urinary tract infections Fad diets Contributing Factors

Making a stone is a chemical reaction in your kidney Normal urine pH is 5.5-6.5 The kidneys filter EXCESS minerals (potassium, calcium, phosphorus, etc) and metabolites (oxalates, uric acid) from the blood When the pH is TOO HIGH (alkaline) or TOO LOW (acidic) AND there is TOO MUCH mineral/metabolite, STONES FORM IN THE KIDNEY, just like in a test tube in chemistry class; it’s a concentration/crystallization problem! Making a stone is a chemical reaction in your kidney

Stone History Earliest stone: Egyptian mummy, 4500-5000 BC Earliest stone surgery (literary documentation): Sushruta performed a perineal lithotomy, India, ~6th century BC Documented in Sushruta Samhita Modern day surgery: 1800s: perineal lithotomy (bladder stone removal) 1900s: percutaneous stone removal, ESWL, ureteroscopy Stone History

Pain in the upper back (SEVERE), either the LEFT or RIGHT side Blood in urine Fevers, nausea, vomiting DO NOT IGNORE THESE SYMPTOMS!! Typical presentation

Typical Medical Evaluation Proper history FROM THE PATIENT Hydration, control of pain, nausea, vomiting Urine and blood tests Imaging test (plain Xray, CT scan or ultrasound) Antibiotics are OPTIONAL, but life-saving if there is sign of infection Urology referral Typical Medical Evaluation

Typical Medical Treatment Pain medication NSAIDs are best Narcotics in case of severe pain Medication to help pass the stone Tamsulosin FOLLOWUP IMAGING TO PROVE STONE HAS PASSED! Instructions on how to PREVENT future stones Hydration, less salt, less animal protein, add lemon juice to your water Typical Medical Treatment

What if it doesn’t pass????

LITHOTRIPSY: “RUBBING (BREAKING) THE STONE” EXTRACORPOREAL SHOCKWAVE LITHOTRIPSY Least invasive German-engineering at its finest! URETEROSCOPY WITH LASER LITHOTRIPSY Endoscopic (no “cutting”) PERCUTANEOUS NEPHROLITHOTOMY Small hole in your back LITHOTRIPSY: “RUBBING (BREAKING) THE STONE”

URETEOSCOPY, LASER LITHOTRIPSY

PERCUTANEOUS NEPHROLITHOTOMY

MOST stones pass (especially if <7mm) without surgery ONLY uric acid stones can be dissolved Stones can cause kidney failure, if causing a blockage Stones are possible even if you have NO PAIN Kidney stones are COMPLETELY different than gallstones Catch your stone, so we can analyze and give recommendations TRUTHS ABOUT STONES

What do they look like?

Stone types (60-70%) Calcium Oxalate Calcium Phosphate Uric Acid (10-15%) Struvite (10-15%)