Alternativesto kidney stone surgery

Many people live with kidney stones and manage them without the need for surgery.

As long as they aren’t too painful, and aren’t causing complications, you can live with kidney stones. There are ways to help prevent them from growing and causing problems. Small kidney stones (less than 4 mm diameter) can often be passed in your urine.

If you’ve already had a painful kidney stone, there’s at least a 50-50 chance you’ll have another one. You’ll be pretty keen to stop it from happening again and you can reduce the risk of growing kidney stones primarily by increasing your fluid intake and by reducing your salt intake.

Modifying your diet may help but before doing this, talk to your doctor or dietitian and be sure to follow their advice.

Medications can also help prevent certain types of stones.

If you’ve had a kidney stone, it helps to know what type of stone it was so your prevention and treatment can be more targeted.

What type of kidney stones do I have?

Kidney stones can be made from calcium, uric acid, struvite or, occasionally, cystine. Sometimes it’s a mixture of minerals. You may be able to collect some stones or gravel by straining your urine through a fine sieve or gauze. Do this first thing in the morning for the best chance of collecting stones. They may be as tiny as grains of sand. Put them in a bag or jar and take them to your doctor to have them analysed.

Your urologist may ask you to collect all your urine for 24 hours to analyse it for the concentrations of different stone-causing minerals and salts. This may help your doctor to diagnose the cause and give you specific advice for prevention.

Prevention

For all types of kidney stones

• Drink plenty of water unless your doctor advises otherwise. Water dilutes the minerals and salts in your urine that form kidney stones. Try and drink enough fluid so that you can produce at least 2.5 litres of urine a day. That means drinking at least 2.5 litres of fluid, or 10 cups.
  
  This amount of fluid should ensure your urine stays diluted. Diluted urine is a light straw colour. If it’s dark, it could be too concentrated. Try and include some citrus-based drinks like orange, lemon or grapefruit juice. They contain citric acid, which can help to stop kidney stones from forming.
• Hydrate before sweaty workouts. Sweating can lead to dehydration and more concentrated urine, so drink extra fluid before, during and after your workout.
• Aim for your ideal weight. People who are overweight or obese are more likely to have kidney stones. Weight loss is a mainstay of therapy for kidney stone disease, although having weight loss surgery can often increase your risk of kidney stones. It’s designed to reduce high blood pressure but is also good for kidney stone prevention. It’s rich in fruits, vegetables, low-fat dairy and whole grains and low in salt and added sugars. A dietitian can help you plan your weight loss diet and support your efforts.

For calcium stones

• Reduce sodium intake. A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. A low salt diet is recommended for the stone prone. Current guidelines suggest limiting total daily sodium intake to 2,300 mg (about a teaspoonful). If sodium has contributed to your kidney stones before, try and reduce your intake to 1,500 mg a day.
• Eat foods that contain calcium. Although calcium oxalate kidney stones contain calcium, if you lack calcium, the level of oxalate in your blood can rise and cause kidney stones. It’s best to get calcium from your diet rather than supplements, because the supplements can encourage stone formation. Good sources of calcium include milk, yoghurt, cheese and certain vegetables.
• Avoid oxalate-rich foods: Beetroot, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate. If you suffer from stones, your doctor may advise you to avoid these foods or consume them in smaller amounts. If you’re eating an oxalate-rich food, team it with a calcium-rich food. For example, dairy foods like ice-cream, yoghurt or cheese can be paired with rhubarb, spinach or beetroot. The calcium binds with the oxalate and you’ll excrete both in your faeces.
• Limit meat, eggs and seafood. Eating too much animal protein, such as red meat, poultry, eggs, and seafood increases your level of uric acid. This encourages kidney stones to form and grow. A high-protein diet also reduces levels of citrate, the chemical in your urine that helps to prevent stones from forming. Limit your daily meat intake to a piece about the size of a pack of playing cards.
• Increase your fibre intake. Choose wholemeal and wholegrain breads, flour, cereals, pasta, biscuits and crackers. Avoid processed foods.
• Avoid vitamin C supplements, vitamin D supplements and cod liver oil.

For uric acid stones

• Avoid foods high in purines. This includes red meat, organ meats, gravies, meat extracts and shellfish as well as oily fish such as sardines, mackerel and anchovies.
• Reduce sugar. Refined sugar found in soft drinks, lollies, cakes and many processed foods reduces urine output which can encourage stone formation.
• Eat more fruit and vegetables. Eating less animal-based protein and eating more fruits and vegetables will help decrease the acidity of your urine. This reduces your risk of stones.

Medications

Some medications can increase your risk of kidney stones. Ask your doctor to review the medications you’re taking. Other medications can help to prevent certain types of kidney stones:

Urinary alkalinisers

Making your urine less acidic can help prevent kidney stones from forming and may even dissolve them. Ural®, Citralite® and Citravescent® are urinary alkalinisers used for this purpose. They’re available over-the-counter from pharmacies and some supermarkets. Some people find that urinary alkalinisers have a slight laxative effect. Urinary alkalinisation isn’t recommended for struvite-containing kidney stones.

Thiazide diuretics

These are prescription drugs more often used for reducing high blood pressure and include hydrochlorothiazide, chlorthalidone, amiloride and indapamide. 

A thiazide diuretic may prevent the formation of calcium oxalate-containing kidney stones, especially if changing your diet and drinking more fluids haven’t helped. Taking a thiazide can more than halve your risk of getting another calcium-oxalate kidney stone.

Possible side effects of thiazides include increased blood glucose levels, loss of appetite, itching, nausea, stomachache, erection problems, headache and weakness. They can also make your skin more sensitive to the sun.

Allopurinol

If you have uric acid-containing kidney stones, lowering the amount of uric acid in your body can help prevent them. Allopurinol lowers uric acid levels, and can even help to dissolve uric acid kidney stones if taken with a urinary alkaliniser. It is a prescription drug.

Adverse effects include a skin rash, which is more likely if you have renal impairment or if you’re also taking a thiazide diuretic. Drowsiness, dizziness, headaches, nausea and taste disturbances can also occur.

Penicillamine

This prescription medication is used to prevent cystine-containing kidney stones. Common side effects include stomach pain, nausea and vomiting, loss of appetite, diarrhoea and decreased sense of taste.

Tamsulosin (Flomaxtra®)

This is one of a group of prescription drugs that can relax the muscles of your urinary tract to help you pass a kidney stone without surgery. Common side effects include cough, hoarseness, fever, low back pain and difficulty urinating.

Antibiotic

If you have struvite-containing kidney stones, your doctor may prescribe an antibiotic to reduce the infection often associated with this type of stone. An antibiotic may also help to partially dissolve these stones.