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Kidney stones

Also listed as: Urolithiasis

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
 
Following Up
Special Considerations
Supporting Research

Kidney stones are a painful disorder of the urinary tract, affecting about 10% of Americans. Stones occur 2 times more often in men than in women. The pain of having a stone has been compared to that of childbirth. The stones grow slowly over several months or years and are made of hard deposits of various minerals, including calcium, uric acid, and oxalate.

Signs and Symptoms

Asymptomatic stones may be found by an x-ray for an unrelated condition, or you may have some or all of the following symptoms:

  • Sudden onset of excruciating pain in the buttocks area
  • Abdominal pain
  • Nausea and vomiting
  • Constant movement to relieve the pain
  • Pain in the genital area as the stone moves
  • Fever and chills
  • Increased age
  • Obesity

What Causes It?

People develop kidney stones because the small bowel absorbs too much calcium, their diet is too high in calcium or another mineral, or there are intestinal problems, a urinary tract infection, or an inherited disorder. You may not be drinking enough fluids (especially in the summer) or exercising enough. People who have hypertension are up to 3 times more likely to develop kidney stones. Additional factors include a sedentary lifestyle, poor dietary habits, metabolic syndrome and a family history of stone disease. Other medical conditions, such as gout, chronic diarrhea, certain cancers, and inflammatory bowel disease, may also be associated with stone formation.

What to Expect at Your Provider's Office

If you are in extreme pain, your health care provider may give you a strong pain reliever. Your health care provider will need a urine sample to check for infection and to see if your urine is acidic or alkaline, which indicates the type of stone you have. You may need to collect your urine for 24 hours if this is not your first stone. Your health care provider will also take a blood sample and may request additional tests to confirm the diagnosis, such as a computed tomography scan (CT), ultrasound, or x-rays.

With time, the stone generally passes out of the body by itself. If it doesn't pass, or if you have severe pain, bleeding, fever, nausea, or can't urinate, your health care provider can shatter the stone with shock waves (an outpatient procedure), and the smaller pieces can pass with much less pain. In rare cases, surgery may be required.

Treatment Options

In about 85% of cases, kidney stones are small enough to pass during urination. Passing usually occurs within 72 hours of the first symptoms. Taking pain relievers and drinking at least 6 - 8 glasses of water a day, plus one at bedtime and another during the night, usually enables the stone to pass more easily. You may need to urinate through a strainer to collect the stone and give it to your health care provider for analysis. Surgery may be required for stones that are too large to pass on their own, or that may cause bleeding or tissue damage.

Drug Therapies

You may need pain medication while the stone is moving through your system. After it passes, you may medication to prevent stones from forming again. Drugs may include:

  • Narcotics to control severe pain
  • Allopurinol, 100 - 300 mg daily, to control hyperuricemia
  • Potassium citrate, 100 mEq tablets twice daily, to raise urinary pH
  • Hydrochlorothiazide, 25 - 50 mg daily, for calcium type I stones
  • Cellulose sodium phosphate 10 g daily, for calcium type I stones and to decrease bowel absorption
  • Orthophosphates, for calcium type III stones

Surgical and Other Procedures

Surgery is recommended for patients with severe pain that does not respond to medications, for those with serious bleeding, and persistent fever, nausea, or significant urinary obstruction. If no medical treatment is provided after surgery, stones recur in 50% of patients within 5 years.

  • Urethroscopy -- a diagnostic procedure for identifying stones in the lower third of the ureter
  • Extracorporeal shock wave lithotripsy (ESWL) -- an outpatient procedure in which shock waves are used to shatter stones under 1 cm so they can pass more easily
  • Percutaneous nephrolithotripsy -- a surgical procedure for removing large or dense kidney stones during which the doctor inserts instruments into the kidney to break up stones

Complementary and Alternative Therapies

Kidney stones require conventional medical attention. Do not treat kidney stones with alternative therapies. Alternative therapies may help aid in reducing the risk of recurrent episodes and increasing the overall vitality of the urogenital system. Start with nutritional guidelines for prevention of recurrence. Herbs and homeopathic remedies can be used for acute pain relief and long term toning of the urinary tract if used under the guidance of a knowledgeable health care provider. Always tell your health care provider about the herbs and supplements you are taking.

Nutrition and Supplements

These nutritional tips may help promote overall health and prevent recurrence of kidney stones:

  • Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
  • Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Low antioxidant intake is associated with stone formation.
  • Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy is present) or beans for protein. High animal protein intake may cause you to excrete more calcium and uric acid, increasing the risk of stone formation.
  • Cut down on oxalate containing foods, such as spinach, rhubarb, beets, nuts, chocolate, coffee, black tea, wheat bran, strawberries, and beans.
  • Include foods rich in magnesium and low in calcium, such as barley, bran, corn, rye, oats, soy, brown rice, avocado, banana, and potato.
  • Use healthy cooking oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily. Some experts recommend doubling previous fluid intake after a stone diagnosis.
  • Exercise at least 30 minutes daily, 5 days a week.
  • Reduce sodium and sugar intake, both of which are linked to increased risk of stone formation.

You may address nutritional deficiencies with the following supplements:

  • A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, zinc, and selenium.
  • Magnesium citrate, 200 - 400 mg daily, for symptoms of kidney stones. In sensitive people, magnesium can cause loose stools or a drop in blood pressure.
  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoon of oil 1 - 2 times daily, to help decrease inflammation and promote general health. Cold water fish, such as salmon or halibut, are good sources. Fish oil supplements can increase the effects of certain blood thinning medications.
  • IP-6 (Inositol hexophosphonate) on an empty stomach, for kidney health. Check with your health care provider for proper dosing. IP-6 can interfere with the absorption of iron and it may interact with blood thinning medications, such as coumadin (Warfarin) and others.
  • N-acetyl cysteine, 200 mg daily, for antioxidant effects.
  • Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Refrigerate probiotic supplements for best results.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. Always tell your health care provider about any herbal therapies you may be using, as certain herbs can interfere with conventional medications.

  • Cranberry (Vaccinium macrocarpon) standardized extract, 300 - 400 mg daily, for kidney health. You may also drink 8 - 16 ounces of unsweetened cranberry juice daily.
  • Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
  • Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg 2 - 3 times daily, for detoxification support. There is some concern about people with sensitivity to ragweed or a history of hormone related cancers taking milk thistle. Since milk thistle works on the liver, it can potentially interact with a variety of medications. Speak with your physician.
  • Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops in your favorite beverage 3 times daily for antibacterial, antifungal, and antiviral activity. Grapefruit products can potentially interact with a variety of medications. Speak with your physician. 

Homeopathy

Some of the most common remedies used for kidney stones are listed below. Usually, the dose is 3 - 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

  • Berberis for sharp sticking pains that radiate to your groin
  • Colocynthis for restlessness and pain that feels better when you bend forward
  • Ocimum for nausea and vomiting from the pain

Following Up

About 50% of patients pass the stone in 48 hours. If there are complications, your health care provider may refer you to a urologist or admit you to the hospital. After you pass the stone, keep drinking fluids, and change your diet to reduce the chance of forming stones in the future. Up to 50% of people who form stones will have a recurrence during their lifetime. They can dramatically reduce their risk of developing future stones by following general lifestyle recommendations (as indicated above).

Special Considerations

Shock wave therapy is not appropriate for women of childbearing age. If you think you might be pregnant, tell your health care provider. Your health care provider will also want to rule out ectopic pregnancy or a ruptured ovarian cyst. Some studies also suggest that shock wave treatment may cause kidney damage, thereby increasing the risk of recurrent stone formation. In children who are on a ketagenic diet for intractable epilepsy, oral potassium citrate may be an effective preventive supplement against kidney stones (because it makes the urine more alkaline).

Supporting Research

Al-Tawheed AR; Al-Awadi KA; Kehinde EO; Abdul-Halim H; Hanafi AM; Ali Y. Treatment of calculi in kidneys with congenital anomalies: an assessment of the efficacy of lithotripsy. Urol Res. 2006;34(5):291-8.

Ando R, Suzuki S, Nagaya T, Yamada T, Okada A, Yasui T, et al. Impact of insulin resistance, insulin and adiponectin on kidney stones in the Japanese population. Int J Urol. 2011; 18(2):131-8.

Asplin JR. Evaluation of the kidney stone patient. Semin Nephrol. 2008;28(2):99-110.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Das M, Sur P, Gomes A, Vedasiromoni JR, Ganguly DK. Inhibition of tumor growth and inflammation by consumption of tea. Phytother Res. 2002;16 Suppl 1:S40-4.

Dogan HS; Tekgul S. Management of pediatric stone disease. Curr Urol Rep. 2007;8(2):163-73.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Dryden GW Jr, Deaciuc I, Arteel G, McClain CJ. Clinical implications of oxidative stress and antioxidant therapy. Curr Gastroenterol Rep. 2005;7(4):308-16.

Ferri: Ferri's Clinical Advisor 2012, 1st ed. Philadelphia, PA: Mosby; 2011.

Goldman. Goldman's Cecil Medicine, 24th ed. Philadelphia, PA: Saunders; 2011.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

Hoesl CE; Altwein JE. The probiotic approach: an alternative treatment option in urology. Eur Urol. 2005;47(3):288-96.

Holoch PA, Tracy CR. Antioxidants and self-reported history of kidney stones: the National Health and Nutrition Examination Survey. J Endourol. 2011: 25(12):1903-8.

Hoppe H; Studer R; Kessler TM; Vock P; Studer UE; Thoeny HC. Alternate or additional findings to stone disease on unenhanced computerized tomography for acute flank pain can impact management. J Urol. 2006;175(5):1725-30.

Jeong IG, Kang T, Bang JK, Park J, Kim W, Hwang SS, et al. Association between metabolic syndrome and the presence of kidney stones in a screened population. Am J Kidney Dis. 2011; 58(3):383-8.

Krieg C. Role of diet in the prevention of common kidney stones. Urol Nurs. 2005;25(6):451-7.

Lieske JC, Goldfarb DS, De Simone C, Regnier C. Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int. 2005;68(3):1244-9.

Lichtenstein AH, Russell RM. Essential nutrients: food or supplements? Where should the emphasis be? JAMA. 2005;294(3):351-8.

Losito A, Nunzi EG, Covarelli C, Nunzi E, Ferrara G. Increased acid excretion in kidney stone formers with essential hypertension. Nephrol dial Transplant. 2009;24(1):137-41.

Massey L. Magnesium therapy for nephrolithiasis. Magnes Res. 2005;18(2):123-6.

McNally MA, Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH. Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics. 2009;124(2):300-4.

Meschi T, Nouvenne A, Borghi L. Lifestyle recommendations to reduce the risk of kidney stones. Urol Clin North Am. 2011; 38(3):313-20.

Miano R; Germani S; Vespasiani G. Stones and urinary tract infections. Urol Int. 2007;79Suppl1:32-6.

Pasch A. Urine analyses for workup of kidney stone disease -- interpretation and therapeutic consequences. Ther Umsch. 2006;63(9):569-74.

Perez-Castro E. Birth and development of uterorenoscopy. Arch Esp Urol. 2007;60(8):985-8.

Primak AN; Fletcher JG; Vrtiska TJ; Dzyubak OP; Lieske JC; Jackson ME; Williams JC; McCollough CH. Noninvasive differentiation of uric acid versus non-uric acid kidney stones using dual-energy CT. Acad Radiol. 2007;14(12):1441-7.

Robinson MR, Leitao VA, Haleblian GE, et al. Impact of long-term potassium citrate therapy on urinary profiles and recurrent stone formation. J Urol. 2009;181(3):1145-50.

Schade G, Faerber G. Urinary Tract Stones. Primary Care: Clinics in Office Practice. St. Louis, MO: WB Saunders; 2010: 37(3).

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-24.

Taylor EN; Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int. 2008;73(2):207-12.

Vujovic A; Keoghane S. Management of renal stone disease in obese patients. Nat Clin Pract Urol. 2007;4(12):671-6.

Wendt-Nordahl G; Trojan L; Alken P; Michel MS; Knoll T. Ureteroscopy for stone treatment using new 270 degrees semiflexible endoscope: in vitro, ex vivo, and clinical application. J Endourol. 2007;21(12):1439-44.

Xue YQ, He DL, Chen XF, Li X, Zeng J, Wang XY. Shock wave induced kidney injury promotes calcium oxalate deposition. J Urol. 2009;182(2):762-5.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Zanni GR. Kidney stones: painful and common--but preventable. Consult Pharm. 2009;24(5):338-50.


Review Date: 6/9/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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