How to rid kidney stones?

How to Get Rid of a Kidney Stone: Letting Them Pass and Other Treatment Options

For this procedure, a doctor uses a machine that generates a targeted high-energy shock wave to the kidney stone under imaging guidance. No incisions are required. “We aim to hit the stone several times,” says Michael W. Sourial, MD, endourology and minimally invasive surgery fellow at The Ohio State University Wexner Medical Center in Columbus. Patients are given general anesthesia, and the procedure takes about two hours. Urologists target the stone so that it breaks into smaller pieces that patients can then pass on their own — “hopefully without too much discomfort,” adds Dr. Sourial.

Shock wave lithotripsy is often used for smaller stones that are sitting up high in the kidney, so that once they’re fragmented, they are likely to pass. Doctors may recommend this procedure when the stone size is less than 2 centimeters (cm) in diameter. (8)

Patients may have some blood in their urine for a few days after the procedure, but usually can return to work or their usual routine the following day, notes Sourial.

While shockwave lithotripsy is the least invasive of the procedures available for breaking up kidney stones, it’s not always effective. “Sometimes these fragments either just stay in the kidney or are too large to pass through the ureter and out of the body,” says Dr. Ramin.

Ureteroscopy

Another minimally invasive outpatient procedure is ureteroscopy, in which urologists place a small, lighted tube — called a ureteroscope — with a camera at its tip into the urethra, the passageway that carries urine from the bladder to the outside of the body. They then pass the scope into the bladder, then further up into the ureter, says Ramin. Next, they pass a small laser device through the scope to break down the stone. This laser can pulverize stones of 1 to 1.5 cm into sand-like particles, he says. No incisions are required, and patients receive general anesthesia.

Sometimes, doctors use a basket passed through the scope to remove fragments, says Sourial. The may also place a stent, or a rubber tube, in the ureter that allows particles to pass through the urinary system and out of the body, he says.

Patients who undergo ureteroscopy recover quickly. “They’re usually able to get back to work the next day,” says Sourial.But they may have some blood in the urine for a few days after the procedure, he adds.

Those who have a stent visit their doctor about a week after the procedure to have it removed, says Sourial. Doctors use a ureteroscope to do this in the office while the patient is awake. A topical numbing jelly relieves discomfort and the removal takes just a few seconds, Sourial says.

Percutaneous Nephrolithotomy and Nephrolithotripsy

For stones larger than 2 cm, doctors may recommend percutaneous nephrolithotomy or nephrolithotripsy (PCNL). Both of these procedures require urologists to make a small incision in the back to create a pathway to the kidney, through which they insert a nephroscope, a tube with a camera on the tip, and surgical tools. (9)

If doctors use these tools to remove the kidney stone, the procedure is called a nephrostolithotomy. If they use these tools to break up the stone first, the procedure is called a nephrolithotripsy.

Urologists may use a laser or an ultrasonic device that vibrates at a high frequency to fragment stones, says Sourial. Suction on these devices allows doctors to remove pieces of stone. Doctors may also insert a stent in the ureter to help with swelling and so that patients can urinate.

For nephrostolithotomy or nephrolithotripsy patients stay in the hospital overnight.
“Typically, we’ll recommend people avoid physical exertion for about 10 days to two weeks, so the urinary tract heals,” Sourial says. People can return to work, but may want to perform lighter tasks. A trip to the doctor’s office is required to remove the stent, which is done using a ureteroscope while the patient is awake, Sourial says.

Robotic Assisted Laparoscopic Nephrolithotomy

A robotic assisted laparoscopic nephrolithotomy can be another option for patients with a large stone, says Ramin. For this procedure, surgeons make small incisions in the abdomen through which they insert a laparoscope, a lighted tube with a camera at its tip, and tiny surgical tools to access and open up the kidneys to retrieve the stone. These surgical tools are controlled by the surgeon using a computer console in the operating room.

Ramin recommends robotic laparoscopic nephrolithotomy over open nephrolithotomy, an operation that requires a larger incision in the side of the body. The tiny incisions used with robotic surgery help patients heal quicker and experience less bleeding than with an open procedure, he explains. In addition, with robotic surgery, patients can generally can go home after one or two days in the hospital and go back to work within a week.

Kidney stones

Treatment depends on the type of stone and the severity of your symptoms.

Kidney stones that are small most often pass through your system on their own.

  • Your urine should be strained so the stone can be saved and tested.
  • Drink at least 6 to 8 glasses of water per day to produce a large amount of urine. This will help the stone pass.
  • Pain can be very bad. Over-the-counter pain medicines (for example, ibuprofen and naproxen), either alone or along with narcotics, can be very effective.

Some people with severe pain from kidney stones need to stay in the hospital. You may need to get fluids through an IV into your vein.

For some types of stones, your provider may prescribe medicine to prevent stones from forming or help break down and remove the material that is causing the stone. These medicines can include:

  • Allopurinol (for uric acid stones)
  • Antibiotics (for struvite stones)
  • Diuretics (water pills)
  • Phosphate solutions
  • Sodium bicarbonate or sodium citrate
  • Water pills (thiazide diuretics)
  • Tamsulosin to relax the ureter and help the stone pass

Surgery is often 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
  • The pain cannot be controlled

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

  • Lithotripsy is used to remove stones slightly smaller than a half an inch (1.25 centimeters) that are located in the kidney or ureter. It uses sound or shock waves to break up stones into tiny fragments. Then, the stone fragments leave the body in the urine. It is also called extracorporeal shock-wave lithotripsy or ESWL.
  • Procedures performed by passing a special instrument through a small surgical cut in your skin on your back and into your kidney or ureters are used for large stones, or when the kidneys or surrounding areas are incorrectly formed. The stone is removed with a tube (endoscope).
  • Ureteroscopy may be used for stones in the lower urinary tract.
  • Rarely, open surgery (nephrolithotomy) may be needed if other methods do not work or are not possible.

Talk to your provider about what treatment options may work for you.

You will need to take self-care steps. Which steps you take depend on the type of stone you have, but they may include:

  • Drinking extra water and other liquids
  • Eating more of some foods and cutting back on other foods
  • Taking medicines to help prevent stones
  • Taking medicines to help you pass a stone (anti-inflammatory drugs, alpha-blockers)

6 natural home remedies for kidney stones

Share on PinterestA person with kidney stones should drink plenty of water.

Before trying any home remedies for kidney stones, it is important to seek consultation with a doctor, especially when a person has an underlying medical condition or takes medications regularly.

Also, although many of these remedies may help relieve the symptoms or reduce the risk of future recurrences, kidney stones can cause intense pain. Home remedies may be best alongside more traditional treatments.

Some people may even need surgery to extract or break up the stones, as well as intravenous pain medication.

The sections below discuss some home remedies for easing the symptoms of kidney stones.

1. Drink water

Drinking water is one of the easiest ways to treat and prevent kidney stones, as dehydration is one of the main causes.

Most health authorities recommend drinking six to eight glasses of water per day to prevent dehydration.

2. Drink lemon juice

Lemons contain citrate, a compound that helps break down calcium deposits and slow their growth.

A 2019 cross-sectional study found that sugar-free lemon juice was an effective remedy for kidney stones.

In fact, consuming only 4 ounces of lemon juice can increase citrate levels effectively.

It is important to examine labels carefully when purchasing juice products. Many lemon juice products contain small amounts of pure lemon extract and high amounts of sweeteners, which can actually increase the risk of kidney stones.

Buying pure extract or purchasing fresh lemons and squeezing them at home are the easiest ways to get undiluted lemon juice. Good alternatives include melon and orange juice, which both contain high levels of citric acid.

A range of lemon juice products are available for purchase online.

3. Consume apple cider vinegar

Apple cider vinegar also has citric acid content that may help dissolve calcium deposits.

A 2019 study of over 9,000 people found that those who consumed vinegar had a significantly lower risk of kidney stones.

However, more research will be necessary to confirm the benefits of apple cider vinegar, specifically, as a standalone natural remedy for kidney stones.

Apple cider vinegar and its supplements are available to purchase online.

4. Manage weight

According to a 2019 study of 146 people with recurring kidney stones, 43.8% had obesity or overweight.

Although this does not suggest causality, there may be a link between weight and kidney stones. The study authors believe that metabolic conditions such as high cholesterol and high blood pressure may contribute to kidney stone formation.

Managing body weight and adopting a nutritious, balanced diet are important steps for the prevention and treatment of kidney stones.

5. Avoid sugary or caffeinated drinks

Carbonated, caffeinated, and alcoholic drinks can all increase a person’s risk of developing kidney stones.

Research suggests that drinking caffeine can increase the risk of stones. Drinks and sodas that contain real or artificial sugars can also lead to kidney stones.

Also, foods high in sugar, salt, and fat are known to increase the risk of kidney deposits and intensify the symptoms.

6. Meet the daily calcium requirements

For people with calcium oxalate stones, which are the most common kind, finding sources of calcium can help them meet their daily calcium requirement and manage their risk of kidney stones.

It is important to note that taking calcium supplements can increase the risk of kidney stones, as they may provide more than the recommended daily intake. Obtaining calcium from food sources, however, can help reduce the risk.

People can get calcium from:

  • dairy products
  • kale
  • broccoli
  • grains
  • Chinese cabbage
  • fish with soft, edible bones
  • calcium-enriched cereals and juices

© Getty Getty Passing a kidney stone is one of the most painful things you can do – apart from childbirth.

Now a new study published this week in Mayo Clinic Proceedings suggests that they’re becoming more common.

Part of the increase is down to the way doctors monitor stones – they used a CT scan rarely before, but the rise in the technology meant they found the stones easier.

It’s not all down to the tests though.

Kidney stones can develop in anyone – and in one or both kidneys, but what actually causes them?

They’re quite common, with about three in 20 men and up to two in 20 women developing them at some point.

Most often people aged 30 to 60 are affected by them.

© Provided by Trinity Mirror Shared Services Limited Credits: Getty

Symptoms

Kidney stones, medically known as nephrolithiasis, cause severe pain, also known as renal colic.

Small stones can go undetected – but they can be passed out when you wee, according to the NHS. It’s fairly common for a stone to block part of the urinary system.

If you’re suffering from a blockage you’ll have severe pain in the abdomen or groin – it can also sometimes cause a urinary tract infection (UTI).

Half the people who have had kidney stones will experience them again within five years of having them.

Look out for:

  • Ache in your lower back, sometimes in the groin – men can have a pain in their testicles and scrotum
  • Periods of intense pain in the back or side of your abdomen
  • Feeling restless and unable to lie still
  • Nausea
  • Needing to urinate more
  • Pain when you urinate
  • Blood in your urine

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What causes kidney stones?

Waste products in the blood can occasionally form crystals that collect inside the kidney.

Over time they build up and form hard stone-like lumps.

If you don’t drink enough fluids it’s more likely to happen. If you’re taking some types of medication or if you have a condition that raises levels of certain substances in your urine it can also raise the risk.

The rise in kidney stones – mostly calcium stones – is also down to a change in diet. Stones are helped along by diets high in fat, sugar and salt.

Race also played a factor in the findings. Nearly 90 per cent of kidney stones happen in white people.

© Provided by Trinity Mirror Plc File photo (Image: Getty) What causes kidney stones:

  • calcium
  • ammonia
  • uric acid – a waste product produced when the body breaks down food to use as energy
  • cysteine – an amino acid that helps to build protein

People who have the following are likely to get recurring kidney stones:

  • eat a high-protein, low-fibre diet
  • are inactive or bed-bound
  • have a family history of kidney stones
  • have had several kidney or urinary infections
  • have had a kidney stone before, particularly if it was before you were 25
  • have only one fully working kidney
  • have had an intestinal bypass

Medication that makes it more likely

  • aspirin

  • antacids

  • diuretics (used to reduce fluid build-up)

  • certain antibiotics

  • certain antiretroviral medication (used to treat HIV)

  • certain anti-epileptic medication

How to get rid of them

Smaller stones will pass when you go to the toilet in your urine.

Larger stones may need breaking up. Doctors use an ultrasound or laser energy to do this, but sometimes keyhole surgery is needed to remove the very large stones.

What to eat?

If your stone is caused by too much calcium you need to reduce the amount of oxalates in your diet.

They prevent calcium being absorbed into your body.

© Provided by Trinity Mirror Shared Services Limited Credits: Getty Foods that contain oxalates are:

  • Beetroot
  • Asparagus
  • Rhubarb
  • Leeks
  • Chocolate

© Provided by Trinity Mirror Shared Services Limited Credits: Cultura Exclusive

  • Berries
  • Parsley
  • Celery
  • Almonds, peanuts and cashew nuts
  • Soy products
  • Grains, such as oatmeal, wheat germ and wholewheat

Always check with your doctor before you change your diet.

How to avoid them

© Provided by Trinity Mirror Shared Services Limited Credits: Photolibrary RM Drink plenty of water everyday. A good test is to check if your urine is diluted (clear) to prevent waste products forming into kidney stones.

Types of Stones

Calcium Stones

They if there’s too much calcium in the urine. They’re usually either large and smooth or spiky and rough.

Struvite Stones

Often caused by infections and most commonly occur after a urinary tract infection.

More common in women than men.

Uric acid stones

They can form if there’s a large amount of acid in your urine. If you have a high-protein diet or a condition like gout.

Cystine stones

Rarest type of kidney stone. It’s caused by an inherited condition called cystinuria.

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Disclaimer: Views expressed in this article are the author’s own and MSN does not endorse them in any way. Neither can MSN independently verify any claims made in the article. You should consult your physician before starting any weight loss or health management programme to determine if it is right for your needs.

Who Is More Likely to Get Them?

“Kidney stones” is a term that covers different types of small, solid crystals. They can have different causes and different food culprits. Some are related to kidney infections. Others form because you have too much of certain minerals in your system.

Genes can play a role, too. Forty percent of the people who get kidney stones have relatives who have them, too. Their bodies may get rid of too much calcium or too little citrate (a chemical found in citrus fruits) in their pee, for instance.

Other conditions that make kidney stones more likely include:

Obesity . When you’re overweight, you tend to get them more often. The same is true if you havediabetes.

Gout. This painful condition happens when uric acid builds up in your blood. That makes crystals form in the joints or kidneys.

Intestinal surgery. If you’ve had certain types of gastric bypass surgery or other intestinal surgery, your risk may go up.

Hyperthyroidism. It can aises calcium levels in your blood and trigger kidney stones.

Certain kidney diseases. One example is polycystic kidney disease, in which clusters of cysts grow in your kidneys. Another is medullary sponge kidney, a birth defect that causes cysts to form in the organ’s tubes.

Middle-aged men are most likely to get kidney stones, though it can happen to people of any age or gender.

Treatment


Kidney stones

Treating large kidney stones

If your kidney stones are too big to be passed naturally, they’re usually removed by surgery.

The main types of surgery for removing kidney stones are:

  • shockwave lithotripsy (SWL)
  • ureteroscopy
  • percutaneous nephrolithotomy (PCNL)

Your type of surgery will depend on the size and location of your stones.

Shock wave lithotripsy (SWL)

SWL involves using ultrasound (high-frequency sound waves) to pinpoint where a kidney stone is.

Ultrasound shock waves are then sent to the stone from a machine to break it into smaller pieces so it can be passed in your urine.

SWL can be an uncomfortable form of treatment, so it’s usually carried out after giving painkilling medication.

You may need more than 1 session of SWL to successfully treat your kidney stones.

Ureteroscopy involves passing a long, thin telescope called a ureteroscope through the tube urine passes through on its way out of the body (the urethra) and into your bladder.

It’s then passed up into your ureter, which connects your bladder to your kidney.

The surgeon may either try to gently remove the stone using another instrument, or they may use laser energy to break it up into small pieces so it can be passed naturally in your urine.

Ureteroscopy is carried out under general anaesthetic, where you’re asleep.

Percutaneous nephrolithotomy (PCNL)

PCNL involves using a thin telescopic instrument called a nephroscope.

A small cut (incision) is made in your back and the nephroscope is passed through it and into your kidney.

The stone is either pulled out or broken into smaller pieces using a laser or pneumatic energy.

PCNL is always carried out under general anaesthetic.

10 ways to prevent kidney stones

Share on PinterestStaying hydrated may help prevent kidney stones.

Researchers are still not exactly sure how or why kidney stones develop.

Dehydration is the primary risk factor for kidney stones. However, certain foods and various lifestyle habits can also increase the risk of developing them.

People who suspect that they have kidney stones or are at high risk of developing them should consult a doctor to find out what type of kidney stone they have and determine which specific foods or activities to avoid.

There are many steps a person can take to reduce the risk of kidney stones, including:

1. Staying hydrated

When urine contains more fluid, it is less likely that minerals and salts will cluster together and form stones. Darker urine is a sign of dehydration. Ideally, urine should appear pale yellow.

Doctors tend to recommend that a person drinks between six and eight 8 ounce (oz) glasses of water per day.

Learn about the different colors of urine and what they mean here.

2. Reducing salt intake

Sodium, or salt, can cause water retention and lead to dehydration. The Food and Drug Administration (FDA) suggest that adults aim to keep their salt intake below 2,300 milligrams (mg) daily. This is equivalent to around one teaspoon of table salt.

Some examples of high salt foods include:

  • deli or smoked meats
  • most packaged or prepared meals
  • potato chips
  • most canned soups
  • most ready-to-make noodle or side dishes
  • foods that contain other types of sodium, including sodium bicarbonate, disodium phosphate, monosodium glutamate, baking powder, nitrites, and sodium nitrate

Learn more about dietary steps to prevent kidney stones here.

3. Maintaining a healthy body weight

Having overweight or obesity can put stress on the kidneys. However, it is always important to lose weight gradually and safely.

Crash dieting and following a diet high in animal protein can both increase the risk of kidney stones.

4. Limiting foods with calcium oxalate

Kidney stones can consist of many different compounds, including uric acid, struvite, and cysteine. The most common type of kidney stone involves calcium oxalate.

One 2014 study examined nearly 44,000 kidney stones and found that 67% were composed predominately of calcium oxalate.

Doctors usually only recommend restricting oxalate intake to those at a high risk of kidney stones or those with high oxalate levels.

Consuming calcium alongside oxalate-rich foods may reduce the risk of kidney stones by binding the chemicals together before they reach the kidneys.

Foods that contain high levels of oxalate include:

  • grapefruit and cranberry juice
  • potatoes
  • soybeans
  • spinach
  • some nuts, including cashews and peanuts
  • chocolate
  • rhubarb
  • beets
  • asparagus
  • most berries
  • celery and parsley
  • whole grains
  • tea

5. Avoiding excessive caffeine consumption

Caffeine speeds up metabolism and can cause dehydration. The recommended upper limit for adults is 400 mg of caffeine daily, which is equivalent to about four cups of coffee.

It is important to remember that certain sodas, chocolate, teas, and energy drinks can also contain caffeine.

6. Avoiding sugary drinks

Some studies have linked sweetened drinks, especially those containing high-fructose corn syrup, to the development of kidney stones.

At least half of a person’s fluid intake should be pure water. Some research suggests that caffeinated drinks can increase the risk of stones, as can sweetened drinks and sodas.

7. Getting enough dietary calcium

Although calcium oxalate is the most common compound in kidney stones, consuming some dietary calcium helps reduce the risk of stones.

Most dairy products are a good source of calcium. Manufacturers fortify many other foods with calcium, including:

  • orange juice
  • canned fish with bones, such as sardines
  • tofu
  • some cereals

8. Increasing citric acidic intake

About 60% of people with kidney stones also have low citric acid levels.

Some good sources of citric acid include:

  • one 4 oz glass of undiluted, unsweetened lemon or lime juice
  • one 8 oz glass of orange juice
  • one 8 oz glass of melon or mango juice

9. Monitoring the intake of high acid foods

Highly acidic urine can increase the risk of uric acid kidney stones and make passing them more painful.

High amounts of acid in the urine also encourage the kidneys to reabsorb citrate rather than excrete it. Citrate is a compound that can help flush out calcium-based stones, as well as impair their growth.

Highly acidic foods include:

  • red meat and pork
  • poultry
  • most types of fish
  • most cheeses
  • eggs

People do not need to avoid high acid foods entirely, as they can be a good source of protein. However, a person should monitor and limit their intake of these foods if they experience frequent kidney stones.

10. Taking supplements and vitamins

A wide range of natural supplements and vitamins are available that may help reduce the risk of kidney stones in some people, including:

  • potassium citrate
  • vitamin B-6, which occurs in foods such as bananas, mangos, soybeans, avocados, and halibut
  • other B vitamins, including riboflavin, thiamin, and B-12, none of which are harmful to people with kidney stones
  • vitamin D
  • calcium
  • fish oils

However, for many of these, it is best to check with a doctor or dietitian before use. Some supplements can increase the risk for some individuals.

Treatment for Kidney Stones

How do health care professionals treat kidney stones?

Health care professionals usually treat kidney stones based on their size, location, and what type they are.

Small kidney stones may pass through your urinary tract without treatment. If you’re able to pass a kidney stone, a health care professional may ask you to catch the kidney stone in a special container. A health care professional will send the kidney stone to a lab to find out what type it is. A health care professional may advise you to drink plenty of liquids if you are able to help move a kidney stone along. The health care professional also may prescribe pain medicine.

Larger kidney stones or kidney stones that block your urinary tract or cause great pain may need urgent treatment. If you are vomiting and dehydrated, you may need to go to the hospital and get fluids through an IV.

Kidney stone removal

A urologist can remove the kidney stone or break it into small pieces with the following treatments:

Shock wave lithotripsy. The doctor can use shock wave lithotripsy to blast the kidney stone into small pieces. The smaller pieces of the kidney stone then pass through your urinary tract. A doctor can give you anesthesia during this outpatient procedure.

Cystoscopy and ureteroscopy. During cystoscopy, the doctor uses a cystoscope to look inside the urethra and bladder to find a stone in your urethra or bladder. During ureteroscopy, the doctor uses a ureteroscope, which is longer and thinner than a cystoscope, to see detailed images of the lining of the ureters and kidneys. The doctor inserts the cystoscope or ureteroscope through the urethra to see the rest of the urinary tract. Once the stone is found, the doctor can remove it or break it into smaller pieces. The doctor performs these procedures in the hospital with anesthesia. You can typically go home the same day.

Percutaneous nephrolithotomy. The doctor uses a thin viewing tool, called a nephroscope, to locate and remove the kidney stone. The doctor inserts the tool directly into your kidney through a small cut made in your back. For larger kidney stones, the doctor also may use a laser to break the kidney stones into smaller pieces. The doctor performs percutaneous nephrolithotomy in a hospital with anesthesia. You may have to stay in the hospital for several days after the procedure.

After these procedures, sometimes the urologist may leave a thin flexible tube, called a ureteral stent, in your urinary tract to help urine flow or a stone to pass. Once the kidney stone is removed, your doctor sends the kidney stone or its pieces to a lab to find out what type it is.

The health care professional also may ask you to collect your urine for 24 hours after the kidney stone has passed or been removed. The health care professional can then measure how much urine you produce in a day, along with mineral levels in your urine. You are more likely to form stones if you don’t make enough urine each day or have a problem with high mineral levels.

Health care professionals usually treat kidney stones based on their size and what they are made of.

How can I prevent kidney stones?

To help prevent future kidney stones, you also need to know what caused your previous kidney stones. Once you know what type of kidney stone you had, a health care professional can help you make changes to your eating, diet, and nutrition to prevent future kidney stones.

Drinking liquids

In most cases, drinking enough liquids each day is the best way to help prevent most types of kidney stones. Drinking enough liquids keeps your urine diluted and helps flush away minerals that might form stones.

Though water is best, other liquids such as citrus drinks may also help prevent kidney stones. Some studies show that citrus drinks, such as lemonade and orange juice, protect against kidney stones because they contain citrate, which stops crystals from turning into stones.

Unless you have kidney failure, you should drink six to eight, 8-ounce glasses a day. If you previously had cystine stones, you may need to drink even more. Talk with a health care professional if you can’t drink the recommended amount due to other health problems, such as urinary incontinence, urinary frequency, or kidney failure.

The amount of liquid you need to drink depends on the weather and your activity level. If you live, work, or exercise in hot weather, you may need more liquid to replace the fluid you lose through sweat. A health care professional may ask you to collect your urine for 24 hours to determine the amount of urine you produce a day. If the amount of urine is too low, the health care professional may advise you to increase your liquid intake.

Medicines

If you have had a kidney stone, a health care professional also may prescribe medicines to prevent future kidney stones. Depending on the type of kidney stone you had and what type of medicine the health care professional prescribes, you may have to take the medicine for a few weeks, several months, or longer.

For example, if you had struvite stones, you may have to take an oral antibiotic for 1 to 6 weeks, or possibly longer.

If you had another type of stone, you may have to take a potassium citrate tablet 1 to 3 times daily. You may have to take potassium citrate for months or even longer until a health care professional says you are no longer at risk for kidney stones.

Type of kidney stone Possible medicines prescribed by your doctor
Calcium Stones
  • potassium citrate, which is used to raise the citrate and pH levels in urine
  • diuretics, often called water pills, help rid your body of water
Uric Acid Stones
  • allopurinol, which is used to treat high levels of uric acid in the body
  • potassium citrate
Struvite Stones
  • antibiotics, which are bacteria-fighting medications
  • acetohydroxamic acid, a strong antibiotic, used with another long-term antibiotic medication to prevent infection
Cystine Stones
  • mercaptopropionyl glycine, an antioxidant used for heart problems
  • potassium citrate

Talk with a health care professional about your health history prior to taking kidney stone medicines. Some kidney stone medicines have minor to serious side effects. Side effects are more likely to occur the longer you take the medicine and the higher the dose. Tell the health care professional about any side effects that occur when you take kidney stone medicine.

Hyperparathyroidism surgery

People with hyperparathyroidism, a condition that results in too much calcium in the blood, sometimes develop calcium stones. Treatment for hyperparathyroidism may include surgery to remove the abnormal parathyroid gland. Removing the parathyroid gland cures hyperparathyroidism and can prevent kidney stones. Surgery sometimes causes complications, including infection.

MIT engineers used human ureteral smooth muscle cells grown in a lab dish to identify drugs that would help to relax the muscle cells. Credit: Christopher Lee and Michael Cima

Muscle relaxants delivered to the ureter can reduce contractions that cause pain when passing a stone.

Every year, more than half a million Americans visit the emergency room for kidney stone problems. In most cases, the stones eventually pass out of the body on their own, but the process can be excruciatingly painful.

Researchers at MIT and Massachusetts General Hospital have now devised a potential treatment that could make passing kidney stones faster and less painful. They have identified a combination of two drugs that relax the walls of the ureter — the tube that connects the kidneys to the bladder — and can be delivered directly to the ureter with a catheter-like instrument.

Relaxing the ureter could help stones move through the tube more easily, the researchers say.

“We think this could significantly impact kidney stone disease, which affects millions of people,” says Michael Cima, the David H. Koch Professor of Engineering in MIT’s Department of Materials Science and Engineering, a member of MIT’s Koch Institute for Integrative Cancer Research, and the senior author of the study.

This kind of treatment could also make it easier and less painful to insert stents into the ureter, which is sometimes done after a kidney stone is passed, to prevent the tube from becoming blocked or collapsing.

Christopher Lee, a recent Ph.D. recipient in the Harvard-MIT Division of Health Sciences and Technology, is the lead author of the study, which appears today (December 2, 2019) in Nature Biomedical Engineering.

Local drug delivery

Kidney stones are made from hard crystals that accumulate in the kidneys when there is too much solid waste in the urine and not enough liquid to wash it out. It is estimated that about one in 10 people will have a kidney stone at some point in their lives.

Several years ago, Cima and Brian Eisner, who co-directs the Kidney Stone Program at MGH and is also an author of the paper, began thinking about ways to improve the treatment of kidney stones. While some larger stones require surgery, the usual treatment plan is simply to wait for the stones to pass, which takes an average of 10 days. Patients are given painkillers as well as an oral medication that is meant to help relax the ureter, but studies have offered conflicting evidence on whether this drug actually helps. (There are no FDA-approved oral therapies for kidney stones and ureteral dilation.)

Cima and Eisner thought that delivering a muscle relaxant directly to the ureter might offer a better alternative. Most of the pain from passing a kidney stone arises from cramps and inflammation in the ureter as the stones pass through the narrow tube, so relaxing the muscles surrounding the tube could help ease this passage.

Around this time, Lee, then a new student in MIT’s Health Sciences and Technology program, met with Cima to discuss possible thesis projects and became interested in pursuing a kidney stone treatment.

“If you look at how kidney stones are treated today, it hasn’t really changed since about 1980, and there’s a pretty substantial amount of evidence that the drugs given don’t work very well,” Lee says. “The volume of how many people this could potentially help is really exciting.”

The researchers first set out to identify drugs that might work well when delivered directly to the ureter. They selected 18 drugs used to treat conditions such as high blood pressure or glaucoma and exposed them to human ureteral cells grown in a lab dish, where they could measure how much the drugs relaxed the smooth muscle cells. They hypothesized that if they delivered such drugs directly to the ureter, they could get a much bigger relaxation effect than by delivering such drugs orally, while minimizing possible harm to the rest of the body.

“We found several drugs that had the effect that we expected, and in every case we found that the concentrations required to be effective were more than would be safe if given systemically,” Cima says.

Next, the researchers used intensive computational processing to individually analyze the relaxation responses of nearly 1 billion cells after drug exposure. They identified two drugs that worked especially well, and found that they worked even better when given together. One of these is nifedipine, a calcium channel blocker used to treat high blood pressure, and the other is a type of drug known as a ROCK (rho kinase) inhibitor, which is used to treat glaucoma.

The researchers tested various doses of this combination of drugs in ureters removed from pigs, and showed that they could dramatically reduce the frequency and length of contractions of the ureter. Tests in live pigs also showed that the treatment nearly eliminated ureteral contractions.

For these experiments, the researchers delivered the drugs using a cystoscope, which is very similar to a catheter but has a small fiber optic channel that can connect to a camera or lens. They found that with this type of delivery, the drugs were not detectable in the animals’ bloodstream, suggesting that the drugs remained in the lining of the ureter and did not go elsewhere in the body, which would lessen the risk of potential side effects.

Ureteral relaxation

More studies are needed to determine how long the muscle relaxing effect lasts and how much relaxation would be needed to expedite stone passage, the researchers say. They are now launching a startup company, Fluidity Medicine, to continue developing the technology for possible testing in human patients.

In addition to treating kidney stones, this approach could also be useful for relaxing the ureter to help doctors insert a ureteral stent. It could also help when placing any other kind of instrument, such as an endoscope, in the ureter.

“The platform pairs drug delivery to the ureter. We are eager to first target muscle relaxation, and as offshoots of that, we have kidney stones, ureteral stents, and endoscopic surgery,” Lee says. “We have a bunch of other urological indications that would go through different developmental pathways but can all be hit and all have meaningful patient populations.”

Reference: “Identification and local delivery of vasodilators for the reduction of ureteral contractions” by Christopher X. Lee, Jaime H. Cheah, Christian K. Soule, Huiming Ding, Charles A. Whittaker, Kyle Karhohs, Aurora A. Burds, Kriti S. Subramanyam, Anne E. Carpenter, Brian H. Eisner and Michael J. Cima, 2 December 2019, Nature Biomedical Engineering.
DOI: 10.1038/s41551-019-0482-4

The research was funded by the MIT Institute of Medical Engineering and Science Broshy Fellowship, the MIT Deshpande Center for Technological Innovation, the Koch Institute Support (core) Grant from the National Cancer Institute, and the National Institutes of Health.

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