May 28, 2021

Ouch! Is it a kidney stone?

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How to know if that pain in your side is the result of an acute kidney stone episode.

Most people don’t think of a kidney stone episode until they’re experiencing the extreme pain stones can cause. However, kidney stones are not exactly out of the ordinary.

“Kidney stones are very common and their prevalence in the U.S. has continued to rise over the last few decades,” said Ryan Hsi, M.D., assistant professor of urology at Vanderbilt University Medical Center and a physician at the Vanderbilt Stone Center. “There are many people with stones in the kidney who probably don’t know about them — many stones will never cause a problem. But when a stone starts moving and passing down the ureter, causing the blockage of urine — that’s when severe pain occurs.”

This sudden onset of severe pain is what’s known as an acute kidney stone episode, and it lands a lot of people in the emergency room the first time it happens. But how do you know it’s an acute stone episode? And what should you do during one? We questioned Hsi to get his expert perspective.

What are kidney stones, and what causes them to form?

Hsi: Urine contains many minerals and salts, of which their concentration depends on fluid intake. Kidney stones form when these substances join together to form crystals. The most common are calcium-based stones, and the second most common are uric acid-type stones. The main causes of kidney stones are related to lifestyle factors — for example, hydration, diet — and genetics.

Are there any certain risk factors that would predispose someone to kidney stones?

Hsi: Kidney stones often run in families, so if you have a first-degree relative who has had a kidney stone, that is a strong risk factor. If you have any gut malabsorption syndromes such as inflammatory bowel disease, cystic fibrosis or prior stomach or bowel surgery, those also put you at a higher risk. Recurrent urinary tract infections can be a risk factor, as can both diabetes and obesity.

What symptoms might someone experience during an acute stone episode?

Hsi: The telltale symptom is going to be a pain in the right or left flank that can radiate around the front side towards the groin. The pain is not going to feel like a muscle pain or a back spasm where you can sit down or lie down and feel better or worse — it’s not going to be related to position. And the pain is not going to go down to the leg, across the back or up to the shoulder. You might also feel bladder pressure or see blood in your urine, and oftentimes the symptoms will be accompanied by nausea and vomiting.

Are there any symptoms that indicate an emergency situation?

Hsi: Some may see very slight elevation in temperature, since your body’s in a stress response. But if you have a temperature over 101.5 with the severe flank pain, you need to go to the emergency room because that might mean you not only have the stone, but also an infection. Also, if you can’t keep down any fluids, or if your pain is out of control to where you just cannot get relief, you should head to the ER.

Are there other options besides the ER for an acute episode?

“The general rule of thumb is to make a self-assessment: Do you need a doctor immediately such as in an ER setting, or is it a situation where we need to facilitate a clinic visit for you to come in and get imaging or lab work to confirm the stone?”

Hsi: If it is your first kidney stone episode, you could start with a call to your primary care physician if you do not have any of the symptoms above. But you may need to go to the emergency room to allow doctors to cast a broad diagnostic net — they’ll be able to rule out any other diagnoses.

A stone clinic like the one at Vanderbilt, however, may a good option if you’re certain the pain you’re experiencing is a stone — that is to say, if you’ve had one before — or if you already have imaging that shows the stone. You’ll be able to receive a stone-specific treatment and prevention plan in an outpatient setting that’s really easy to access.

The general rule of thumb is to make a self-assessment: Do you need a doctor immediately such as in an ER setting, or is it a situation where we need to facilitate a clinic visit for you to come in and get imaging or lab work to confirm the stone? That’s what can be confusing during an acute episode — navigating where to go, understanding how urgent things are, etc. That’s why at the Vanderbilt Stone Center we’ve worked to improve the second scenario so that there is easier clinic access and an improved ability to take care of stones with a personalized treatment plan.

A man paddles a canoe on a river.

The Vanderbilt Stone Center is located at Vanderbilt Health Belle Meade, a new multi-specialty facility designed to provide an array of services across several medical specialties. Vanderbilt Health Belle Meade provides convenient, state-of-the-art care closer to where patients live and work. The 50,000 square foot building has 7 operating rooms, clinic exam rooms, infusion stations and imaging capabilities.

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