Kidney Stone in the Elderly: Symptoms, Treatment & Prevention Strategies

Understanding Kidney Stones

Before delving into the specifics of kidney stone symptoms in the elderly, it is important to understand what kidney stones are and what causes them.

What are Kidney Stones?

Kidney stones are hard, crystal-like deposits that form in the kidneys. These stones are typically composed of calcium, uric acid, or other substances, and can vary in size. While small stones may not cause noticeable symptoms, larger stones can be quite painful and lead to serious complications, including urinary tract infections and kidney damage.

Causes and Risk Factors

Kidney stones can develop at any age, but the risk increases as people age. The average age for the onset of new kidney stones is 35, with a spread of about 12 years, meaning that by age 45, one might expect the odds to be in their favor. However, kidney stones can still develop later in life, even in one's fifties or sixties.

Certain conditions can increase the risk of developing kidney stones in the older population. For instance, Primary Hyperparathyroidism (PHPT) is not rare as a cause of kidney stones, with an average age of diagnosis in a recent VA hospital record review being 67-68. A large Canadian survey suggests that diagnosis is typically after 50 years old, and women are more frequently affected than men.

Moreover, the type of kidney stones can change with age. Uric acid stones, for instance, become more common with age, affecting both sexes after age 40 in men and age 50 in women. By the time individuals are in their sixties, uric acid stones are more common than calcium phosphate stones in both sexes.

Changes in the body’s ability to absorb alkali can also play a role. Although the absorption of alkali rises with age, urine pH can actually fall. Women have a greater ability to absorb alkali from their diet, which makes their urine more alkaline. However, with age, the ability to absorb alkali rises in both men and women, yet urine pH falls.

Additionally, certain health issues can increase the risk of developing kidney stones. Diabetes and insulin resistance, for instance, can lower urine pH significantly, causing uric acid stones. Individuals with serious obesity or those over age 50 are more likely to develop diabetes or insulin resistance, leading to a decrease in urine pH and an increased risk of uric acid stones.

By understanding the causes and risk factors of kidney stones, individuals can take appropriate steps to prevent their formation and manage existing stones effectively. In the following sections, we will discuss the specific symptoms of kidney stones in the elderly population, as well as diagnosis and treatment options.

Kidney Stones in Elderly: A Closer Look

Navigating the maze of kidney stone symptoms in the elderly can be challenging. In this section, we'll delve deeper into the prevalence of kidney stones among the elderly, the role age plays, and what symptoms to look out for.

Prevalence and Age Factor

Kidney stones are a common health concern in the United States, with an approximate prevalence of 11% in men and 9% in women. Notably, the risk of developing kidney stones tends to increase with age, peaking between the ages of 40 to 60 [2].

Further reinforcing this point, a study of 1390 elderly people found that 14.53% of the cases had kidney stones. Factors such as being under age 75, being male, and having a BMI of 30 kg/m2 or higher were significantly associated with stone formation. Interestingly, the prevalence of diabetes, metabolic syndrome (MetS), and smoking was lower in patients with nephrolithiasis compared to those without it.

Symptoms in the Elderly

Identifying kidney stone symptoms in elderly individuals can be challenging due to the presentation of atypical or no pain, fever, diarrhea, pyuria, urinary tract infections, and bacteremia. Additionally, older individuals were less likely to pass the stone spontaneously and more likely to require surgical intervention [4].

Typical symptoms of kidney stones include severe pain in the side and back, pain that radiates to the lower abdomen and groin, pain that comes in waves and fluctuates in intensity, pink, red or brown urine, cloudy or foul-smelling urine, nausea and vomiting, persistent need to urinate, urinating more often than usual, and fever and chills if an infection is present [2].

However, in the elderly, symptoms can be less specific, leading to delayed diagnosis and treatment. Common symptoms in the elderly can include confusion, delirium, hallucinations, and non-specific abdominal pain.

Given the less typical presentation of kidney stone symptoms in the elderly, it becomes even more crucial for caregivers and healthcare providers to be vigilant. Timely diagnosis and appropriate treatment can make a significant difference in managing kidney stones in this population.

Diagnosis of Kidney Stones

Once kidney stone symptoms in elderly individuals have been identified, healthcare professionals move on to the next step of the process that involves confirming the diagnosis. This is typically done using a combination of imaging tests and lab tests.

Imaging Tests

Imaging tests such as abdominal x-rays and computed tomography (CT) scans are often used by healthcare professionals to diagnose kidney stones in elderly individuals. These tests can help identify kidney stones in the urinary tract, determine the size and location of the stone, identify any blockages in the urinary tract, and reveal any underlying conditions that may have led to the formation of the kidney stone.

Imaging Test	Function
Abdominal X-ray	Uses low levels of radiation to visualize kidney stones in the urinary tract
CT Scan	Uses a combination of x-rays and computer technology to create detailed images of the urinary tract

Further, health history, family history of kidney stones, dietary habits, and presenting symptoms are significant factors that healthcare professionals consider when diagnosing kidney stones in elderly individuals, emphasizing a comprehensive approach to the diagnostic process [5].

Lab Tests

Lab tests like urinalysis and blood tests are also employed to diagnose kidney stones in elderly patients. These tests can help determine if the urine contains high levels of minerals that form kidney stones and identify specific mineral levels in the blood that can lead to kidney stones [5].

Urinalysis, a common lab test, can detect blood in urine and minerals that form kidney stones, providing valuable insights into the presence of kidney stones in elderly patients. Additionally, the presence of white blood cells and bacteria may indicate a urinary tract infection.

A combination of these imaging and lab tests helps in accurately diagnosing kidney stones in the elderly. Once a definitive diagnosis is made, healthcare professionals can move forward with the appropriate treatment plan.

Treatment Options for Elderly

When it comes to addressing kidney stone symptoms in the elderly, treatment options can be broadly classified into non-invasive and invasive treatments. The choice of treatment depends on several factors, including the size, location, and composition of the stones, as well as the individual's overall health.

Non-invasive Treatments

Non-invasive treatments primarily involve medications and lifestyle modifications. Pain management is a key aspect of non-invasive treatment, often involving over-the-counter or prescription pain medications to alleviate discomfort associated with kidney stones.

In addition to pain management, preventive measures are crucial in reducing the risk of future kidney stones. These measures include staying hydrated, controlling weight through a balanced diet and regular exercise, limiting sodium and animal protein consumption, and avoiding foods and activities that may lead to stone formation.

Invasive Treatments

Invasive treatments for kidney stones in the elderly become necessary when the stones are too large to pass naturally, cause severe pain, or lead to complications such as urinary tract infections. According to a study published by NCBI, older individuals with kidney stones are more likely to require surgical intervention compared to younger individuals.

The three main types of invasive treatments are:

Shock Wave Lithotripsy (SWL): This is the most common treatment for kidney stones. High-energy sound waves are used to break the stones into tiny pieces that can then be passed in the urine.
Ureteroscopy: In this procedure, a thin tube is passed through the urinary tract to locate the stone. A small basket or laser is then used to remove or break up the stone.
Percutaneous Nephrolithotomy (PNL): This is used for larger or more complicated stones. A small incision is made in the back, and instruments are inserted to remove the stone.

The choice between these invasive treatments depends on the individual's overall health and the characteristics of the kidney stone. A urological consultation at presentation is more common in older individuals, and diagnostic CT imaging is often used to guide the choice of treatment.

Remember, each individual's condition is unique, and treatment options should be discussed thoroughly with a healthcare provider to ensure the best possible outcome.

Prevention and Management

After understanding kidney stone symptoms in elderly individuals and exploring the diagnosis and treatment options, it becomes crucial to delve into prevention and management strategies. These measures can go a long way in reducing the risk of kidney stone formation and ensuring the overall health and well-being of the elderly.

Lifestyle Modifications

Lifestyle modifications play a significant role in preventing the occurrence of kidney stones. One of the primary preventive measures includes staying adequately hydrated. Not drinking enough water can increase the risk of kidney stones due to urine becoming too concentrated, leading to the crystallization of waste products in the body [7].

Controlling weight through a balanced diet and regular exercise is another important factor in kidney stone prevention [6]. Obesity can lead to an increased risk of stone formation.

Moreover, certain activities that may lead to stone formation should be avoided. These include excessive consumption of sodium and animal protein. Both factors can contribute to the formation of kidney stones and should be regulated.

Dietary Changes

In addition to lifestyle modifications, making specific dietary changes can further reduce the risk of kidney stone formation. Consuming red meat, poultry, eggs, dairy, and seafood can raise uric acid levels, potentially leading to kidney stone formation due to the intake of animal proteins [7].

On the other hand, an excessive intake of oxalate-rich foods, such as many fruits, vegetables, and nuts, can cause crystals to form and contribute to kidney stone development. Therefore, it's important to know which foods are low in oxalate and regulate their consumption accordingly.

Implementing these preventive measures and making necessary lifestyle and dietary changes can significantly reduce the risk of kidney stones in the elderly. However, it's essential for individuals to consult a healthcare provider before making any significant changes to their diet or lifestyle. A healthcare professional can provide personalized advice based on an individual's health history and specific needs.