TO HELL & BACK WITH KIDNEY STONES

With painful kidney stones on the rise – and affecting younger people – it’s important to know their causes, preventions and treatments

BY MID-2013, Joanne Bull had been on a diet and eating healthily for six months. The non-drinking, non-smoking 43-year-old mother of two from Belrose in Sydney’s north was feeling fabulous, knowing she would be going out that night with her husband for their wedding anniversary before celebrating their son’s birthday the next day.

Then, just as Joanne was driving through the morning peak-hour traffic towards her office, she felt a sharp pain on the left side of her back that then seared towards the front. “It was like someone was putting a knife into me and just turning it,” she says. “Other than childbirth, I have never felt pain like it. And it was constant, it was never-ending.”

Terrified, Joanne turned around and made it back home, where she collapsed as her mother called an ambulance. A few hours later, after an ultrasound and several doses of pain medication, a doctor told her she had five kidney stones.

Kidney stones are probably the most painful condition known. Considering their tiny size – typically just a couple of millimetres although some may be smaller or grow larger – it’s surprising that they can cause such debilitating symptoms. And for so many of us.

About one in ten Australian men and one in 35 women will develop kidney stones at some time in their lives – and if you’ve had one, you may be unlucky enough to be one of the 30 to 50 per cent of people who will get a second one within five years.

“More than 40,000 people in Australia go to hospital with a kidney stone every year,” says urologist Dr Peter Heathcote, the president of the Urological Society of Australia and New Zealand. Of those, up to half will be back with another stone within five years.

And the incidence worldwide has been rapidly increasing. Considering their prevalence, it’s important to be informed.

How the Stones Form

Various substances circulate through your body all the time; any excess is sent to the kidneys for disposal. The more urine you produce, the more likely your body is to flush away this excess. But when minerals and other substances clump together before they can be expelled, kidney stones can form.

The typical kidney stone is a combination of calcium and oxalate or phosphate. Sometimes stones develop from uric acid, the culprit in gout – not surprisingly, gout predisposes people to produce kidney stones. Less common are stones caused by an infection in the urinary tract, due to inherited abnormalities, or stones that are due to other medical conditions, such as high blood pressure, diabetes and obesity.

To confirm that pain is due to a kidney stone, doctors perform CT scans ( helpful for detecting tiny stones) as well as X-rays and ultrasound. Blood and urine analysis can show whether greater-than-normal levels of stone-forming substances are circulating through your system.

Most kidney stones don’t cause any symptoms at all. If a stone gets stuck in the ureter (through which urine moves from the kidney to the bladder)

and blocks the flow of urine, the pain can be extreme – usually in the back or the side, but sometimes in the abdomen. It’s the body’s unsuccessful attempts to push through the blockage that’s causing the pain. Other symptoms include blood in the urine or an urge to urinate more often.

That’s why Joanne Bull’s pain was so extreme. One of her kidney stones, measuring 6mm, was too big to pass from her kidney to her bladder through her ureter – it was stuck, and causing her agony.

She was discharged from hospital but rushed back there at 3am when she had a second attack. All day she received strong pain relief until she was finally taken for surgery at 8pm to insert a stent into her ureter. Ten days later, still in severe pain, she was back in hospital to have the stones removed by laser surgery and then start a slow recovery. During her ordeal, Joanne lost 8kg.

What Causes Them?

People who develop kidney stones are usually genetically predisposed to them – they don’t have any underlying disease, it’s just bad luck. Dehydration is a major risk factor. “They’re very common in the summer months in Australia and that’s associated with dehydration,” says Sydney urologist Dr Michael Wines.

But with more and more people developing stones, it can’t be all chalked up to low fluid intake. Instead, blame it on the good life. As we grow in bulk, becoming a more overweight population, we also grow more prone to kidney stones. And it’s not just how much we eat, but what we eat.

“A high-protein diet is associated with kidney stones as protein makes urine more acidic,” says Heathcote.

A diet heavily reliant on processed food, such as canned, frozen and other packaged fare, can also increase the risk of stone problems, according to the US’s National Intitute of Diabetes and Digestive and Kidney Diseases. Processed foods tend to be high in sodium and increased salt increases the amount of calcuim you excrete in your urine.

In Australia, you’re also more likely to develop kidney stones if you live in a regional area or if you are Aboriginal. But during heatwaves when we don’t drink enough, everyone is at risk. >>

A HIGH-PROTEIN DIET IS ASSOCIATED WITH KIDNEY STONES AS PROTEIN MAKES URINE MORE ACIDIC

>> And, while kidney stones are most often a problem for the middleaged and older, according to a 2016 US study, children, too, especially adolescents, are susceptible. In the US, the risk of kidney stones in adolescents doubled between 1997 and 2012 – a worrying trend because having the condition young can increase your risk of developing kidney, heart and bone diseases.

How to Prevent a Second Bout

If you’ve suffered one bout of kidney stones, you have as high as a 50 per cent chance of having another. “Some people just leak too much calcium into their urine and it combines with other elements to cause crystals, which become bigger and bigger and cause a stone. High levels of uric acid are also more likely to cause crystals to form,” says Professor Carol Pollock, a director of Kidney Health Australia. “Anyone with a kidney stone needs to have blood tests to see whether there is any abnormality in the bloodstream to predispose them to forming another.”

Everyone who has suffered a kidney stone needs to keep adequately hydrated. “The most important thing is fluid intake and output – make sure your urine is the colour of gin rather than whiskey,” says Wines.

You should also eat a balanced diet, with plenty of calcium – which actually means you’re less likely to develop calcium stones – plenty of fibre, low salt and low protein. If you tend to form calcium oxalate stones, you may need to eat fewer foods containing oxalates, such as rhubarb, beetroot, spinach, sweet potato, nuts, tea, chocolate and soy-based foods.

For some people, kidney stones are a problem that just keeps recurring. If this happens, your doctor will likely run some tests to see if you have an underlying problem with your metabolism.

In the months after her ordeal, Joanne Bull carefully followed a low-sodium diet and drank two litres of water daily – making it more interesting with a squeeze of citrus. But after two years the pain returned and she was told she had formed three more stones.

Now Joanne is waiting for them to pass. As anyone who’s been through kidney stone hell will tell you, it’s worth almost anything to prevent another bout.

IF YOU’VE SUFFERED ONE BOUT OF KIDNEY STONES, YOU HAVE AS HIGH AS A 50 PER CENT CHANCE OF HAVING ANOTHER