Hydration, hydration, hydration — remember when people simply just said, “drink plenty of water?”
Whatever name you give to it, there is good reason for the advice, especially when it comes to kidney stones and the Southwest. If you draw a line along the Southern states, this area is often referred to in the medical profession as the “Stone Belt” because of the hot climates where dehydration is common. A study several years ago in the Proceedings of the National Academy of Sciences suggested that as global warming causes temperatures to rise, Americans living in certain areas of the country may suffer from as many as 30 percent more kidney stones by the year 2050.
Fluid loss through excess sweating explains the link between hot climate and kidney stones. More water loss through perspiration means more concentrated urine — and more concentrated urine means a higher risk of kidney stones.
Of course, there are many reasons for kidney stones beyond dehydration. If you’ve had kidney stones, you know what they are and how they feel. If you haven’t been diagnosed before, there are signs to watch out for.
What are kidney stones (besides painful)?
Kidney stones are small, hard deposits that form inside your kidneys. The stones are made of mineral and acid salts. They can have many causes and can affect any part of your urinary tract from your kidneys to your bladder.
Passing stones can be very painful, but usually causes no permanent damage. In some instances, however, stones can become lodged in the urinary tract or cause other complications and require surgery.
Signs of a problem
You may not experience any symptoms until a stone moves around within your kidney or passes into your ureter (the tube connecting the kidney and bladder). If that happens, you may experience one or more of the following:
• A persistent need to urinate
• Cloudy or foul-smelling urine
• Fever and chills (if an infection is present)
• Nausea and vomiting
• Pain when urinating
• Severe pain in your sides and back, below the ribs
• Pain that spreads to your lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Pink, red or brown urine
• Urinating more often than usual
• Urinating small amounts of urine
You should seek immediate medical attention if you experience:
• Blood in your urine
• Difficulty passing urine
• Pain so severe that you can’t find a comfortable position
• Pain accompanied by nausea and vomiting
• Pain accompanied by fever and chills
But why?
Kidney stones often have no definite, single cause, although there are several factors that can increase your risk.
Dehydration. Not drinking enough water can increase your risk of kidney stones and people who live in warm climates (like here in Southern Nevada) and those who sweat a lot (e.g., those who perform manual labor, especially outdoors) may be at higher risk than others.
Diet. A diet high in protein, sodium and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium increases the amount of calcium your kidneys must filter and increases your risk of developing kidney stones.
Digestive diseases and surgery. Chronic diarrhea, inflammatory bowel disease or gastric bypass surgery can cause changes in digestion that increase the levels of stone-forming substances in your urine.
Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones. And if you’ve already had one or more kidney stones, you’re at increased risk of developing them again.
Obesity. A high body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.
Things you can do
Prevention may include a combination of lifestyle changes and medications.
We need to drink a lot of water to stay healthy and function well in an environment where summer daytime temperatures commonly hover above 100 degrees and relative humidity is often below 20 percent. Drinking an average of eight glasses of water a day (about 1 liter) will curb dehydration. This equates to drinking one 16-ounce bottles of water with each of three meals a day and one or two bottles of water in between meals. If you exercise frequently you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water.
But water is obviously just part of your diet. Choosing a diet low in salt and animal protein can help reduce your risk. You can continue eating calcium-rich foods, but you should be cautious with calcium supplements. Calcium in food doesn’t have an effect on your risk of kidney stones. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people. Your doctor can refer you to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.
What your doctor can do
If your doctor suspects you have a kidney stone, there are different diagnostic tests and procedures that may be used, such as:
Analysis. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the composition of your kidney stones and provides your doctor with the information needed to determine what’s causing your kidney stones.
Blood tests. These tests can reveal the level of calcium or uric acid in your blood. It can also help your doctor monitor your kidney health.
Imaging. Imaging tests may show kidney stones in your urinary tract. Imaging options range from non-invasive tests like simple X-rays to computerized tomography (CT) scans and ultrasounds. Other imaging tests include intravenous urography, which involves injecting dye into an arm vein and taking X-rays or obtaining CT images as the dye travels through your kidneys and bladder.
Urine tests. A 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances.
Getting rid of those stones
Treatment of kidney stones can vary, depending on the type and cause of the stone. If the kidney stones are small, and symptoms are minimal, they typically won’t require invasive treatment.
Drinking as much as 2 to 3 quarts a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine.
Passing even a small stone can cause discomfort. To alleviate mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve). Your doctor may give you a prescription medication known as an alpha-blocker to help pass your kidney stone. This type of medication relaxes the muscles in your ureter and helps you pass the stone more quickly and with less discomfort.
Large kidney stones that can’t be treated with these milder measures may require surgical intervention. Using sound waves to break up stones is one solution. Depending on the size and location of the kidney stone, your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to create strong vibrations that break the stones into tiny pieces that can be passed in your urine.
To remove a small stone in your ureter or kidney, your doctor may pass a thin, lighted tube equipped with a camera (called a ureteroscope) through your urethra and bladder to your ureter. Once your doctor locates the stone, special tools can grab the stone or break it into tiny pieces that will pass in your urine.
If the stone is larger and located in the kidney, a procedure called “percutaneous nephrolithotomy” may be recommended. This procedure involves removing a kidney stone using small scopes and instruments that are inserted through a small incision in your back. You would typically receive general anesthesia during the surgery and be in the hospital for one to two days while you recover.
Your family doctor can usually treat small kidney stones that don’t block your kidney or cause other problems. But if you have a large kidney stone and experience severe pain or kidney problems, your doctor may refer you to a urologist — a doctor who treats problems in the urinary tract.