Prevention is better than cure
The easiest and most important thing you can do is to stay hydrated. Drink plenty of fluids all year round. You should consume a minimum of 2 litres of liquid a day, but if you are predisposed to kidney stones, increase this to at least 2 1/2 litres.
About 80 percent of kidney stones are partially or entirely of the calcium oxalate type. They form when urine is persistently saturated with calcium and oxalate. Although some of the oxalate in urine is produced by the body, some foods are also a contributing factor and should be consumed in low quantities. Foods high in oxalate are beans, beetroot, beer, chocolate, coffee, black tea, fizzy drinks, sweet potato, chestnuts, orange, dark green leaves (e.g. spinach) and soya-based products (e.g. soya milk and tofu).
If you are partial to oxalate-rich foods, some can be cooked in boiling water which can reduce the amount of oxalate in their composition by up to 90 percent. Alternatively, you can increase your calcium intake as oxalates steal the calcium you eat. In general, you should try to consume at least 1 gram of calcium daily. Good sources are cheese, yogurt and broccoli - among others.
If you want to approach the dietary preventative method from a different angle, you can adopt a diet that is low in oxalate with foods such as apple, avocado, melon, plum, cucumber, broccoli, asparagus, coconut, dairy, fish, eggs and meat.
For those with a history of kidney stones, it is important to pay attention to the amount of oxalate consumed per day, as this may contribute towards stone formation. Experts recommend that oxalate consumption for these people should not exceed the ideal amount of 50 milligrams of per day.
What are the symptoms?
Renal colic is the pain caused by the presence of kidney stones. In the lead up to this, you may experience a burning sensation when you urinate and a reduction in urine flow. As these symptoms are very similar to those of a urinary tract infection (UTI), misdiagnosis is common. In these cases, antibiotics are prescribed as a form of treatment and the cause is not highlighted until a later date. When the kidney is in distress, you will experience a sharp stabbing pain in the lower back (flank), left or right side between the ribs and hips, which is occasionally accompanied by pain in your abdomen. If you experience this type of pain, you should go to your nearest hospital where you can be treated. The most common form of diagnosis is for blood and urine samples to be tested but these are not always the most effective methods. If there is no blood in the urine, you may be told you have an infection though, if you suspect this is not the case, insist on a scan as this will eliminate any doubt. Blood is not always present in the urine when you have kidney stones – despite this being the baseline used by the SNS - Serviço Nacional de Saúde (the Portuguese National Health Service).
What is the treatment?
Treatment really depends on the size of the stone and its composition. If a stone is 6mm or less in size, you may be given pain killers and be told to let nature take its course. A stone of this size can be passed and the pain can be managed.
If you have a stone of between 6mm and 2cm, dependent on its composition, it may be broken down using Shock Wave Lithotripsy (SWL) where the stones are targeted from outside the body and broken down into tiny pieces that can be passed. The size and shape of stone, where it is lodged in your urinary tract, your health, and your kidneys' health are all deciding factors as to whether this is the best form of treatment for you. Because x-rays and shock waves are needed in SWL, pregnant women with stones are not treated this way. People with bleeding disorders, infections, severe skeletal abnormalities, or who are morbidly obese are also not good candidates for this procedure.
A more common procedure in Portugal is a Ureteroscopy. This involves the passage of a small telescope, called a ureteroscope, through the urethra and bladder and up the ureter to the point where the stone is located. If the stone is small enough, it may be snared with a basket device and removed whole. If the stone is large, or if the diameter of the ureter is narrow, the stone will need to be broken down with a laser. As this procedure will most likely result in swelling of the ureter, a small tube, called a ureteral stent, is often temporarily placed inside the ureter to ensure that the kidney drains urine well. This will later be removed as an outpatient procedure once your ureter has had an opportunity to recover.
Unfortunately, due to a lack of funds and resources, diagnosis on the SNS is not always straightforward and treatment waiting lists (for non-emergency cases) are extensive. The cost of a Ureteroscopy in the private sector is just under 5000€ and therefore, having a good health insurance plan is always advisable as this will open up this treatment option - avoiding a lengthy wait for a resolution.