Treating Kidney Stones Often Has Complications

People who have suffered kidney stones say there’s nothing more painful. But according to new research, for a disturbing number of patients, treating them can cause complications requiring emergency follow-up. All the more reason to heed some good advice about how to prevent them in the first place.

Kidney stones are small, hard pebbles formed in the kidneys from minerals and acid salts. They pass through the urinary tract, from the kidneys to the bladder. Before passing them painfully during urination, victims often suffer from extreme pain in the back, side, abdomen and/or groin. Sometimes there’s nausea and vomiting. As horrible as it to have kidney stones, generally they cause no permanent damage.

As reported in the journal Surgery, researchers from Duke Medicine have determined that as many as 1 in 7 patients receiving treatment for kidney stones experience complications requiring emergency care.

The study analyzed the outcomes of more than 93,000 privately insured patients who had undergone treatment for kidney stones. Their initial procedures, which cost an estimated $10 billion per year, included:

  • shock wave lithotripsy – the most common U.S. treatment that uses shock waves targeted externally at a kidney stone to break it into tiny bits;
  • ureteroscopy – an endoscope passed through the urethra, bladder and into the upper urinary tract that enables removal of the stone;
  • percutaneous nephrolithotomy – a small incision in the back that enables the use of a miniature fiberoptic camera and other small instruments to remove the stone.

The researchers tallied emergency department visits or hospital admissions among this population within 30 days of their original procedure. As would be expected, patients who had had their initial treatments at hospitals that did high volumes of the procedure were much less likely to have complications.

The least common complications occurred following shock wave lithotripsy, affecting 12 in 100 patients. People treated with ureteroscopy, had about 15 in 100 unplanned visits. (But emergency visits associated with shock wave lithotripsy had higher costs associated with the emergency visits, at more than $32,000.) Costs for emergency complications of nephrolithotomy were the highest – more than $47,000, on average.

Researchers said that patients, especially those who had received the minimally invasive treatment, might not be prepared for complications. “From the patient perspective, an unplanned emergency department visit or hospital admission after a low-risk ambulatory procedure is a significant event,” said the lead researcher, Dr. Charles D. Scales, in a Duke Medicine statement. “Kidney stones are excruciatingly painful and primarily affect people who are of working age. These patients face not only the cost of treatment, but also the financial difficulties from time off work due to pain and treatment.”

That seems a rather obvious observation, but Scales’ point is the need to identify the causes of the complications, and figure out how to avoid them. His concern primarily is financial, and of course costs should concern everyone. But if you’re the one whose kidney stone adventure never seems to end, the most important message here is how to avoid them in the first place.

The National Kidney Foundation (NKF) is an excellent resource for understanding the causes and treatments of kidney stones. About 1 in 10 people, it estimates, will experience a kidney stone at some point, and their incidence appears to be rising.

Here are six ways the NKF says you can ward off this painful experience:

1. Monitor your sweat. Saunas, heavy exercise and hot weather can promote the formation of kidney stones from lack of water and, therefore, less urine production. The more you sweat, the less you urinate, which encourages stone-causing minerals to settle and bond in the kidneys and urinary tract.

So if you sweat, drink a lot of water.

2. Monitor your consumption of oxalate. Many foods contain this organic acid, including fruits and vegetables, nuts and seeds, legumes, grains, chocolate and tea. Foods especially high in oxalate are peanuts, rhubarb, spinach, beets, chocolate and sweet potatoes.

Unless you’re prone to forming kidney stones, you needn’t cut out these foods, just eat them in moderation, and when you eat them, also eat foods rich in calcium. That helps oxalate and calcium bind to one another in the stomach and intestines before the kidneys begin processing, making it less likely that kidney stones will form.

3. Monitor your consumption of purines. Not all stones are the same. Besides oxalate, uric acid can encourage the formation of kidney stones. Meat and most high-protein foods have high concentrations of a natural chemical compound called purines, which produce uric acid. It boosts the overall acid load the kidneys must excrete, and makes urine more acidic. That invites uric acid stones to form.

So cut down on high-purine foods, including organ meats (liver, tongue, sweetbreads), ham, veal, venison, bacon, beef, anchovies, sardines, lobster, shrimp and codfish. Cauliflower as well, is high in purine.

4. Don’t be afraid of calcium. Many people attribute kidney stones to consuming too much calcium, but a diet low in this mineral actually increases your risk of developing stones. Instead of cutting back on calcium, reduce the amount of sodium in your diet.

5. Citrus is your friend. Drink lemonade or limeade. Chronic kidney stones often are treated with potassium citrate, but studies have shown that fruits and juices high in natural citrate offer the same stone-preventing benefits. Watch the sugar content, though, because it can increase kidney stone risk. Try sugar-free lemonade, or make your own by mixing lime or lemon juice with water and using a tiny amount of sugar or a substitute.

6. Continue your care. Having a kidney stone one time greatly increases your chances of having another. Studies have shown, however, that about 15 in 100 kidney stone patients didn’t take prescribed medications, and more than 4 in 10 did not follow the nutritional advice that might keep stones from recurring. So … comply with post-treatment advice to minimize the changes for recurrence.

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