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

2. 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?

3. 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

4. Making a stone is a chemical reaction in your kidney
Normal urine pH is
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

6. 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

7. 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

8. 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

9. 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

10. What if it doesn’t pass????

11. 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”

13. URETEOSCOPY, LASER LITHOTRIPSY

14. PERCUTANEOUS NEPHROLITHOTOMY

15. 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

16. What do they look like?

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