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Straight, No Chaser: Kidney Stones (Nephrolithiasis)

By Jeffrey Sterling, MD August 11, 2020

In the emergency room setting, women are vicious when it comes to how men handle pain. It’s really humorous to see the female nurses’ attitudes change when a large or otherwise studly man crumbles at the notion of receiving an injection or having an IV line started. I’m pretty comfortable saying without fear of being biased that women in general hold the upper hand on men in the pain game. As only a few thousand of them have told me over the years, “Until men start having babies, you’ll never experience what we go through and can tolerate.”
Actually, that’s not true, or at least the women who populate the emergency rooms I’ve frequented have started changing their stories. It appears that the pain of a kidney stone is on par with or greater than the pain of childbirth, according to a large majority of the female patients with whom I’ve discussed this.
Kidney stones are among a few diagnoses that an emergency physician can just walk into a room and diagnosis to a high degree of medical certainty within seconds. (Don’t try this at home, because it’s about more than just the pain.) Once you’ve had one, you’ll go out of your way to avoid another one, which is another way of saying you should avoid them in the first place. Here are some questions and answers about kidney stones to steer you away from getting them and toward treatment if you do.


What are they and how do I get them?
Kidney stones are hard, solid particles that congregate in the kidney and proceed down the urinary system with the intention of being eliminated through your urine. Too often (meaning even once) they become lodged somewhere along the way. It’s amazing how much trouble they cause, given their size. The overwhelming majority of them are smaller than the blacks in the center of your eyes (your pupils).
There is a pretty impressive variety of ways that someone can get stones, but here are some simple considerations that increase the probability of getting a kidney stone.

  • You have a family history of kidney stones.
  • You have frequent and recurrent urinary tract (“bladder”) infections.
  • You have an existing blockage of your urinary tract.
  • You have various medical conditions that alter substances in your urine. (Stones are most often causes by excessively high levels of calcium, oxalate and phosphorous in your urine. These substances aren’t likely to cause problems at regular levels. Conditions that increase these levels increase the risk of stones.)
  • You eat certain foods that are high in sodium or animal protein.
  • You are obese or are gaining weight.
  • You don’t drink enough fluid.
  • You take certain medication (those that increase those substances mentioned earlier).


What are the symptoms?
Symptoms may not be present, depending on the size of the stone. However, when symptoms are present, they’re typically severe.

  • You may have a sharp pain in (most typically) one side of your back or abdomen, between the level of your chest and hips.
  • You may have blood in your urine.
  • You may have pain while urinating.
  • You may nausea and vomiting associated with these pains.


How are they treated?
There’s no uniform treatment for kidney stones. In the short-term (i.e., a presentation to your doctor’s office or an emergency room), your pain and vomiting will be addressed. Dependent on the size and composition of your stones, or based on the effects the stones are having on your body, the stones may be broken up or removed by a specialist.
How are they prevented?
Knowing your risks and making adjustments in your diet are important steps to preventing and avoiding kidney stones. Staying hydrated is perhaps the one step you can take most easily to get the biggest yield.
What else do you want us to know?
If you have a history of kidney stones or certain other conditions (e.g., migraines and certain types of abdominal pain), you run the risk of becoming comfortable (figuratively speaking) with your symptoms. What I mean by this is sometimes the diagnosis of kidney stones is incorrect, even if you have a history of kidney stones. Unfortunately, in this example, the consequences can be deadly. More to follow…
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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