HJAR Nov/Dec 2021

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2021 49 Kevin Claybrook, MD Arkansas Urology There are several different types of kid- ney stones, and each type contains various combinations of chemicals. The most com- mon type of kidney stone contains calcium combined with either oxalate or phosphate. Another type of stone, called a struvite, is caused by infection in the urinary tract. Uric acid stones and cystine stones are the least common types. Kidney stones are most commonly caused by not drinking enough water. They can also be caused by various diseases and disorders and are more likely to develop in people with a family history of kidney stones. Other risk factors include: • Obesity. • Urinary tract infections. • Kidney and metabolic disorders. • Diets rich in calcium and oxalates (found in nuts, chocolate, pickles and high fructose corn syrup). • Sedentary lifestyle. • Inflammatory Bowel Disease or Crohn’s Disease. Treatment Treatment depends on the type of stone, how large it is and the length of time the pa- tient has had symptoms. Most small kidney stones will pass through the urinary tract with plenty of water to help move them along. In fact, about 80% of stones pass within two days. However, in some cases, medication or other treatment may be nec- essary to treat kidney stones and prevent development of future stones. Other treatments to break up stones may be necessary if a stone causes the complete block of urine flow or extreme pain that is not controllable withmedication or if a stone is clearly too large to pass. These treatment options include: • Extracorporeal shockwave lithotripsy (ESWL), which uses sound waves that travel through the skin and body tis- sues until they hit the stones and break themdown into particles that can easily pass through the urinary tract. • Percutaneous nephrolithotomy, which may be used if a stone is very large or in a location that is not conducive to us- ing ESWL. In this procedure, a needle is passed through the skin into the kidney to break up or remove the kidney stone. • Ureteroscopy, which uses a tube called a ureteroscope that is passed through the urethra and bladder into the ureter, where the stone is then broken up and removed. Surgery is an option for removing kid- ney stones and is generally used when stones are symptomatic and too big to pass spontaneously. Prevention About half of all people who develop kidney stones will have more stones in the future, so prevention is critical. A urologist will discuss prevention options after the chemical makeup of the stone is determined. Prevention may include dietary changes, such as drinking more water and reducing the intake of protein and sodium. n Kevin Claybrook, MD, earned amedical degree from the Indiana University School of Medicine after receiv- ing a bachelor’s degree in biochemistry from Indiana University. He joinedArkansas Urology in 2005 after completing a residency at the University of Missouri at Columbia’s Division of Urology. Claybrook is certi- fied by theAmerican Board of Urology and is certified for robotic laparoscopic surgery. He is a member of the American Urological Association, the American Association of Clinical Urologists, Arkansas Medical Society and Pulaski County Medical Society. amounts of red blood cells that can’t be seen with the naked eye. • Nausea and vomiting. • Fever, profuse sweating. • Diarrhea or constipation (rare). • Loss of appetite. In addition to causing severe pain, a lodged stone can block the flow of urine, causing wastes to back up into the kidneys. If immediate action is not taken, serious kid- ney damage and related medical problems can result. Diagnosing Kidney Stones Kidney stones are diagnosed through a simple medical evaluation. Ahealth history and physical exam may reveal signs of a stone. Then, diagnostic tests will confirm the presence of a stone and help locate it in the body. Detailed metabolic tests of your blood, urine and the stone may also be performed to determine the best course of treatment. Diagnostic tests detect infection or reveal the image of the stone. These tests include: • Urinalysis, or urine test. • Urine culture. • Blood test. • Kidney, ureter and bladder X-ray. • Ultrasound. • CT scan. Metabolic tests will help the doctor de- termine why the stone developed and what kind of stone may form in the future. These tests include: • Blood screen to test for minerals and body chemistry. • 24-hour urine sample. • Stone analysis. • Provocative tests to see how your kid- neys handle metabolic minerals and proteins, such as calcium.