This Emergency Room Kidney Stone

Suggestion #1--maybe read the last post first (National Archives and Gallery of Art)
Suggestion #2--if you don't want to be bored, skip down to the personal part
Suggestion #3--if you don't think you want to really know, read the next blog (Allison's Birthday)

Stones in a Kidney and how they come out:

Everything you ever wanted to know about Kidney Stones:

Kidney stones


Renal calculi; Nephrolithiasis; Stones - kidney

Last reviewed: January 14, 2009.

U.S. National Library of Medicine
National Institutes of Health
National Center for Biotechnology Information
U.S. National Library of Medicine

National Institutes of HealthA kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
See also: Cystinuria

Causes, incidence, and risk factors

Kidney stones can form when urine contains too much of certain substances. These substances can create small crystals that become stones.

The biggest risk factor for kidney stones is dehydration.

Kidney stones may not produce symptoms until they begin to move down the tubes (ureters) through which urine empties into the bladder. When this happens, the stones can block the flow of urine out of the kidneys. This causes swelling of the kidney or kidneys, causing pain. The pain is usually severe.

Kidney stones are common. A person who has had kidney stones often gets them again in the future. Kidney stones often occur in premature infants.

Some types of stones tend to run in families. Certain kinds of stones can occur with bowel disease, ileal bypass for obesity, or renal tubule defects.

There are different types of kidney stones. The exact cause depends on the type of stone.

• Calcium stones are most common. They occur more often in men than in women, and usually appear between ages 20 - 30. They are likely to come back. Calcium can combine with other substances, such as oxalate (the most common substance), phosphate, or carbonate to form the stone. Oxalate is present in certain foods. Diseases of the small intestine increase the risk of forming calcium oxalate stones.
• Cystine stones can form in people who have cystinuria. This disorder runs in families and affects both men and women.
• Struvite stones are mostly found in women who have a urinary tract infection. These stones can grow very large and can block the kidney, ureter, or bladder.
• Uric acid stones are more common in men than in women. They can occur with gout or chemotherapy.
• Other substances also can form stones.

Symptoms

The main symptom is severe pain that starts suddenly and may go away suddenly:
Pain may be felt in the belly area or side of the back
Pain may move to groin area (groin pain) or testicles (testicle pain)

Other symptoms can include:

Abnormal urine color
Blood in the urine
Chills
Fever
Nausea
Vomiting

Signs and tests

Pain can be severe enough to need narcotic pain relievers. The belly area (abdomen) or back might feel tender to the touch.

Tests for kidney stones include:

Analysis of the stone to show what type of stone it is
Uric acid level
Urinalysis to see crystals and red blood cells in urine

Stones or a blockage of the ureter can be seen on:

Abdominal CT scan
Abdominal/kidney MRI
Abdominal x-rays
Intravenous pyelogram (IVP)
Kidney ultrasound
Retrograde pyelogram

Tests may show high levels of calcium, oxylate, or uric acid in the urine or blood.

Treatment

The goal of treatment is to relieve symptoms and prevent further symptoms. (Kidney stones that are small enough usually pass on their own.) Treatment varies depending on the type of stone and how severe the symptoms are. People with severe symptoms might need to be hospitalized.


When the stone passes, the urine should be strained and the stone saved and tested to determine the type.

Drink at least 6 - 8 glasses of water per day to produce a large amount of urine. Some people might need to get fluids through a vein (intravenous).
Pain relievers can help control the pain of passing the stones (renal colic). For severe pain, you may need to take narcotic pain killers or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen.
Depending on the type of stone, your doctor may prescribe medicine to decrease stone formation or help break down and remove the material that is causing the stone. Medications can include:

Allopurinol (for uric acid stones)
Antibiotics (for struvite stones)
Diuretics
Phosphate solutions
Sodium bicarbonate or sodium citrate (which make the urine more alkaline)

Surgery is usually needed if:

The stone is too large to pass on its own
The stone is growing
The stone is blocking urine flow and causing an infection or kidney damage


Today, most treatments are much less invasive than in the past.

Extracorporeal shock-wave lithotripsy is used to remove stones slightly smaller than a half an inch that are located near the kidney. This method uses ultrasonic waves or shock waves to break up stones. Then, the stones leave the body in the urine.

Percutaneous nephrolithotomy is used for large stones in or near the kidney, or when the kidneys or surrounding areas are incorrectly formed. The stone is removed with an endoscope that is inserted into the kidney through a small opening.

Ureteroscopy may be used for stones in the lower urinary tract.

Standard open surgery (nephrolithotomy) may be needed if other methods do not work or are not possible.

Expectations (prognosis)

Kidney stones are painful but usually can be removed from the body without causing permanent damage. They tend to return, especially if the cause is not found and treated.

Complications

Decrease or loss of function in the affected kidney
Kidney damage, scarring
Obstruction of the ureter (acute unilateral obstructive uropathy)
Recurrence of stones
Urinary tract infection

Calling your health care provider

Call your health care provider if you have symptoms of a kidney stone.

Also call if symptoms return, urination becomes painful, urine output decreases, or other new symptoms develop.

Prevention

If you have a history of stones, drink plenty of fluids (6 - 8 glasses of water per day) to produce enough urine. Depending on the type of stone, you might need to take medications or other measures to prevent the stones from returning.

You may need to change your diet to prevent some types of stones from coming back.


So, we came home from our little day out in D.C., gave kids baths, and put kids to bed.  I was trying to finish up some things I needed done for church the next day.  One side of my back started to hurt.  After about an hour, not only was it not going away, it was starting to get worse.  I've had blocked kidney stones before and was sure that this was it now.  One indicator is that the pain actually moves to the side.  I have an aunt in the area and we called her to come over and potentially spend the night.  I knew the pain was going to get bad fast, and fortunately the Emergency Room recognizes and sympathizes with this.

All in all, I had 8 mg of morphine and 1 mg of delotted plus a drug to decrease the nauseousness.  The CT scan only showed inflammation and the doctor decided that I'd passed the stone and the pain was a "residual" effect (meaning afterwards) and can be common.

The good news is that I don't have to do anything else (like take pain meds and wait around OR have any procedures done to have any removed).  The other good news is that the CT scan did not show anymore.

The bad news is that I've officially been "labeled" as "chronic" and now need to visit a urologist on a more regular/structured basis...

Answers to questions I've been asked in the past couple days:  No known family history of them, no morphine did not do the full trick, yes I had side-effects to the delotted drug (vomitted for 12 hours) but yes it did take the whole pain away, don't have a plan yet other than meeting with a new urologist here in this area, yes the pain is worse than childbirth, no you just about can't walk when the pain is in full-effect, no it actually didn't hurt to pass this stone, yes I'm still sore from all the trauma to that area of the body, yes I've had most of the procedures done for the past stones (all except the surgery where they actually open you up), yes the ER was nice, yes they guessed correctly on what it was, no I was only there for 4 hours, no Jeremy did not get up and take all the kids to church a few hours later (everyone lounged on the couch with the t.v. and DVDs).