Do you also develop uric acid stones in your kidneys? Let's be aware of this!

Do you also feel pain and discomfort when you urinate? You may have noticed a little blood in your urine. It is actually normal to feel a little scared when something like this happens. But there is no need to be ashamed of this or keep it to yourself. Because these can be symptoms of a condition called “uric acid stones” that form in the kidneys. So today, let’s talk in detail and very simply about what these uric acid stones are, how they form, what are the symptoms, how to treat them, and how to prevent them.

What are uric acid stones?

Simply put, uric acid stones are one of the four types of kidney stones. A kidney stone is a solidified mass of minerals and salts in our body that forms in the urine. It looks like a small pebble. They can form in your kidneys or anywhere in your urinary system – the part of your body where urine passes out of your body. Uric acid stones can cause pain when you urinate and blood in your urine (hematuria). Don't panic if you have these symptoms. But it's important to see a doctor as soon as possible to find out exactly what it is and to make sure there are no other complications.

What is uric acid?

Uric acid is a waste product in our blood. It is formed when our body breaks down substances called ``Purines``. These purines are commonly found in meat, especially red meats like beef and pork, and in some alcoholic beverages like beer and liquor. Normally, most of this uric acid dissolves in the blood, passes through the kidneys, and is excreted from the body in the urine. However, uric acid stones begin to form when:

• If the uric acid level in your urine is very high .
• If your urine is always too acidic .

Both of these reasons can be influential.

How common are uric acid stones?

Researchers say that in countries like the United States, approximately one in ten people will develop a kidney stone in their lifetime. Of these, 8% to 10% are uric acid stones. This condition is now common in Sri Lanka as well.

What are the symptoms of uric acid stones?

The symptoms of uric acid stones are similar to those of other types of kidney stones. The main symptom is pain . This pain is caused by pressure from the stones, either inside the kidney or in the urinary tract, causing them to become lodged or injured. You may feel pain:

• In the lower abdomen.
• Flanks.
• In the stomach.
• In the area between the thighs (`Groin`).

Other symptoms that may be seen include:

• Blood in the urine.
• Nausea or vomiting .
• Fever.
• Feeling cold (`Chills`).
• Having a bad odor in the urine.
• Dark-colored urine.

How do these uric acid stones form?

If your uric acid levels are high (medically called hyperuricemia), uric acid crystals begin to form. These uric acid crystals combine with other substances in the body to form a solid stone. Then the stone gets bigger and bigger. It can either be in the kidney itself, or it can travel down the urinary tract and get stuck in the ureter. We call it a ureteral stone. If these stones are very small, they can pass out of the body with urine, sometimes without any pain or with a little pain. But if they don't, they can get stuck in the kidneys, ureters, bladder, or urethra, blocking the flow of urine. That's when the pain and other symptoms start to appear, because these stones damage the walls of the blocked tubes.

What are the main causes of uric acid stones?

The main reasons why your urine becomes more acidic are:

The body's inability to properly regulate uric acid or protein in food

When our body cannot properly control uric acid or protein, the urine becomes acidic. This condition is usually something you inherit from your parents. Another condition related to this is ``Gout``. Gout causes high levels of uric acid in the blood and painful crystals to form in the joints.

Eating foods high in purines

Animal protein, such as beef, chicken, pork, eggs, and fish, is high in purines. These are especially abundant in animal organs like liver and kidneys (calves, kidneys). If you eat a lot of this type of animal protein, uric acid can build up in your urine. This can build up and form stones, either alone or in combination with calcium. However, diet alone is not usually the cause of uric acid stones. They are most often formed in people who eat foods high in purines and who are genetically predisposed to stone formation.

Other causes of high uric acid levels

There are several other reasons why uric acid levels may increase:

• Body mass index (BMI) greater than 25 (which means overweight or obesity ).
• Some medications and supplements, for example, diuretics and immunosuppressants .
• Chemotherapy treatment for cancer.
• Type 2 diabetes .
• Adding too much salt and sugar to food.
• Having a family history of kidney stones.
• Not getting enough physical activity.
• Having undergone weight loss surgery (`Bariatric surgery`).

In addition to all this, if you don't drink enough water , you are at a much higher risk of developing not only uric acid stones, but also other types of kidney stones.

Who is most likely to develop uric acid stones?

Men are more likely to develop any type of kidney stone. Their lifetime risk of developing a stone is about 19%. For women, the risk is about 9%. Most people don't develop kidney stones before the age of 30. But they can develop them earlier, and sometimes even in young children.

What are the possible complications of uric acid stones?

Any type of kidney stone increases your risk of developing chronic kidney disease (CKD). If you have one stone, you are at higher risk of developing another within the next five to seven years. So it is important to be aware of this.

How to identify uric acid stones?

When you go to see a doctor, he or she will ask about your medical history, ask about your symptoms, and perform a physical exam. If he or she suspects you have a uric acid stone, he or she will order several tests to confirm.

What are these tests?

The doctor may order tests like these:

• Blood tests: These tests can detect high levels of uric acid or calcium in the blood, and can also help determine if there are other conditions that could be causing your symptoms.
• Urinalysis: You may be asked to collect a 24-hour urine sample to check the amount of uric acid and calcium in your urine.
• Imaging tests: A CT scan or ultrasound scan can help pinpoint the exact location of stones in the urinary tract. These scans can find even very small stones. Abdominal X-rays are not usually used for this purpose, as they can miss small stones.
• Stone analysis: You may be given a special strainer and asked to urinate through it. This is done to catch any stones that pass out with your urine. The stones are then sent to a lab for analysis to determine what type of stone they are. By analyzing the stone in this way, your doctor can determine what caused the stone to form and what you can do to prevent it from forming again.

How to cure uric acid stones?

If the stone is less than 7 millimeters, which means it is very small, it may pass on its own. This can take about three weeks. However, even if such a stone passes on its own, it is very important to talk to a doctor to find out what you can do to prevent uric acid stones from forming again. Here are some things that happen when you drink plenty of water:

• The concentration of minerals in your urine decreases. The fluid dissolves the minerals and makes them easier to pass out with your urine.
• It encourages frequent urination, which flushes out chemicals that can cause stones.

Doctors recommend drinking enough fluids to produce about 2.5 liters of urine per day. To produce that much urine, you need to drink about 3 liters of fluid per day. This is because our bodies lose fluids through sweating and exercise. While it's important to drink any type of fluid, drinking water is best .

Are there any medications that can dissolve uric acid stones?

Of all the types of kidney stones, uric acid stones are the only type that can be dissolved with medication . There are several types of medications used for this:

• Potassium citrate tablets (e.g. Urocit-K®).
• Calcium carbonate tablets (e.g. Tums®).
• `Allopurinol` (`Allopurinol`).

Potassium citrate or calcium carbonate tablets work by making your urine more alkaline. Allopurinol lowers your uric acid levels. If your doctor prescribes these medications, it's important to drink plenty of water along with them. Drinking plenty of water helps dissolve uric acid. Your doctor may also prescribe medications called alpha-blockers, which can help your kidneys pass stones more quickly.

Will I need surgery?

You may need surgery if your uric acid stone is in one of these conditions:

• If the stone is very big .
• If it obstructs the flow of urine.
• If it causes an infection .
• If you don't go out after four or six weeks.

Surgical alternatives include minimally invasive or noninvasive procedures. Some examples include:

• Extracorporeal shock wave lithotripsy (ESWL): This involves using high-energy sound waves to break up stones. There are no incisions or anything put inside the body.
• ``Ureteroscopy``: In this procedure, the doctor inserts a long, thin instrument (an ``endoscope``) through your urethra into the affected ureter. The surgeon then uses a small ``basket`` to remove the stone. Sometimes a ``laser`` may be used to break up the stone and remove the pieces.
• Percutaneous nephrolithotomy (PCNL): This procedure is used for larger stones. The surgeon makes a small incision in your back and enters the kidney. The stone is then removed, or the stone is broken up first and then removed.

After surgery, the doctor sends the stone or fragments of the stone to a lab for analysis.

How can drinking water help reduce the risk of uric acid stones?

Drinking the recommended amount of water daily is one of the best things you can do to reduce your risk of developing uric acid stones and other kidney stones. Fluids dilute the waste products in your urine and flush out chemicals, preventing stones from forming.

How else can I prevent uric acid stones?

Here are some other steps you can take to prevent the formation of uric acid stones:

• Drink at least 91 ounces (2.7 liters) to 125 ounces (3.7 liters) of fluids daily. Water is best .
• Maintain a healthy weight that suits you.
• Follow the `DASH` (Dietary Approaches to Stop Hypertension) eating plan. This can reduce both high blood pressure (hypertension) and the risk of kidney stones. (This involves eating less salt and more vegetables, fruits, and whole grains).
• Use the medications prescribed by your doctor to prevent the formation of uric acid stones properly.

What can I expect if I have uric acid stones?

The prognosis for uric acid stones and other kidney stones is generally good. Most of the time, the stones pass on their own. You may not need treatment. Even if treatment is needed, the available treatments are effective. You can make a full recovery. However, there is a risk that uric acid stones will come back. So talk to your doctor about making changes to what you eat and drink and other steps you can take to prevent stones from forming again.

How do I take care of myself?

If you have previously had uric acid stones, or are at high risk of developing kidney stones (of any type), following these steps can help you stay healthy:

• Drink plenty of water.
• Follow a healthy diet.
• Use medications or supplements exactly as prescribed by your doctor.
• If you experience severe pain or other worrisome symptoms, see a doctor immediately.

What foods should you not eat if you have uric acid stones?

Avoid or limit foods high in purines. When you eat too many purines, your body produces more uric acid. When uric acid levels are high, your urine becomes more acidic, which can lead to the formation of uric acid stones. Examples of foods high in purines include:

• Red meat (beef, goat meat, pork).
• Animal internal organs (bowel, spleen, brain, kidneys).
• Beer and other alcoholic beverages.
• Sauces made from meat (`Gravies`).
• Small fish like sardines, sprats, and halibut, and seafood like oysters, shrimp, and crab.

It's also a good idea to limit foods and drinks high in sugar, especially those containing ``High-fructose corn syrup.'' It's a good idea to eat more of these things:

• Fruits and vegetables.
• Whole grains.
• Low-fat dairy products.

When should I see a doctor?

If you think you have a uric acid stone and have these symptoms, see a doctor immediately or go to an emergency room:

• A fever of more than 38.6 degrees Celsius (101.5 Fahrenheit).
• Burning or severe pain when urinating.
• Unbearable pain.
• Blood in the urine.
• Persistent nausea and vomiting.
• If you have a condition that puts you at higher risk of complications from kidney stones, such as diabetes, having only one kidney, or other kidney problems.

What questions should I ask the doctor?

• What treatment method is best for me?
• Will I need surgery?
• What should I do to prevent uric acid stones from forming again?
• Do I need to make any changes to what I eat and drink?
• Do I need to take any supplements or medications?