The Medical Minute: Kidney stone prevention is worth the time

Anyone who has developed a kidney stone will tell you that the pain of passing one is worth an ounce of prevention.

About 10 percent of the population will form a stone-like calcium deposit in the urinary tract at some point in their lives, and contrary to popular belief, these stones are not caused by an excess of calcium in the diet but by other dietary factors such as dehydration and excess sodium.

Although there is a genetic component, kidney stones are more likely to occur in people who have health problems such as obesity, diabetes and high blood pressure.

“The more stuff there is in the urine, the more stuff there is to make a stone,” said Dr. John Knoedler, a urologist at Penn State Health Milton S. Hershey Medical Center. “People are chronically dehydrated and almost every diet in America contains too much sodium, among other dietary factors.”

Historically, men have been producing kidney stones more often than women, but research shows that the gap is closing. Additionally, increasing health problems with age increase the risk of stones, while younger patients are more likely to have recurrent issues due to inborn issues associated with genetics and family history.

“The younger you are when you first get one, the more likely you are to get them again,” Knoedler said.

People who work in professions with little access to regular hydration or restroom breaks, such as surgeons, operating room personnel, truck drivers and teachers are more likely to develop kidney stones.

Kidney stones are not routinely screened for, though they can show up on X-rays done for other purposes. In most cases, people don't even know they have one until they begin to pass it, developing acute pain in their back or side that drives them to a local clinic or emergency department.

“You can go from no discomfort to pretty significant discomfort very quickly,” Knoedler said. “It can wake you from your sleep.”

Treatment for kidney stones often includes medication to help pass the stone, but in some cases, surgery is required to remove it.

Knoedler said chronic or large kidney stones—or ones left untreated—can cause long-term kidney damage. The biggest problem, though, is the pain.

Once the acute event has passed, Knoedler recommends that patients get a metabolic evaluation to provide information about what is causing their body to make the stones. That evaluation includes a detailed health history, bloodwork and a 24-hour urine collection.

“The evaluation is an important second step that isn't always done,” Knoedler said. “You want to be proactive with preventative management.”

In some cases, doctors recommend medication to change the makeup of the urine or the way that the kidney processes calcium.

Knoedler says eating a balanced, healthy diet and managing other health conditions are the best ways to prevent kidney stones.

“Those things will make a big difference.”

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The Medical Minute is a weekly health news feature produced by Penn State Health Milton S. Hershey Medical Center. Articles feature the expertise of faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

August 1, 2018 Penn State Health News

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