You think you know kidney stones: relatively innocuous until they try to make their way through the tubes that connect the kidneys and bladder. At this point acute, stabbing pain to the back, and sides radiating into the groin and legs may be met with nausea, vomiting, pain while urinating and more. Nephrolithiasis is the medical term for this condition, where hard crystalline minerals are formed in the kidneys. They’re no fun once they start to move.
But usually, you’d expect someone having problems with kidney stones to present to urgent care instead. So, what do chiropractors need to know about it?
The first interesting piece of information is that there is an upwards trend in the prevalence of kidney stone disease (according to the national health and nutrition examination survey). [1] The highest prevalence is thought to be in males aged 49-59 [2] We know that kidney stones can get lodged in renal calyces or renal pelvis (nephrolithiasis) and that low back pain (LBP) and sacroiliac joint pain (SJP) are common symptoms that drive patients to present for chiropractic care.
The following case report discusses the diagnosis of atypical nephrolithiasis. [3]
A 63-year-old female patient presented at the chiropractic practice for low back pain and SJP and thoracic posterior rib pain. Previously, she had received chiropractic care and mechanical massage, with success. She had also had a kidney stone five years earlier. At the time, she had experienced the typical symptoms associated with developing a kidney stone. This included pain radiating into her posterior flank, pelvis, and groin. She had visited the emergency department and received medication for pain relief, after which she was released from the hospital to wait for the stone to pass.
This time, the patient presented for chiropractic care, seeking help with her current pain, only noting an increase in her physical activity level and no injury or trauma. The chiropractic exam revealed a decreased active motion in the left lumbar and sacroiliac regions with pain in the end range of extension, decreased extension and right rotation of the lumbar spine on a sitting Kemps test. She had hypertonicity (increased muscle tension) in the left quadratus lumborum muscle (the back and side of the abdominal wall) with decreased range of motion on extension.
The chiropractor found left thoracic regions (T6, 10, and 12) and associated ribs elicited pain to the touch. After the initial examination, she was sent for x-rays and a radiograph of her kidney, ureter, and bladder (KUB). The imaging revealed calcification within the left renal calculus. The patient was then referred to a urologist for a CT scan, which revealed a 2.6cm stone in her left renal calyces. A urinalysis confirmed blood in the urine with high specific gravity, and she was then scheduled for surgery. Following the surgery, the patient reported no LBP, SKP, or mid-thoracic pain.
The author notes that this case is unique in that the patient exhibited a clinical presentation of mechanical joint pain and the short-term resolution of the pain through chiropractic manipulation.
Without a thorough examination, and the chiropractor following up on something that didn’t feel right by ordering imaging, something requiring a surgical intervention may have been missed. While this study details an individual case, and thus cannot be generalised to the wider population, it is interesting to note the different ways in which this case presented. Thus, it shows how vigilant we must be, and that it pays to be aware of the changes and variations in things we might ordinarily take for granted.
References:
- Chen Z, Prosperi M, Bird VY. Prevalence of kidney stones in the USA: the national health and nutrition evaluation survey. J Clin Urology. 2019;12(4):296-302. doi:10.1177/2051415818813820
- Chen HW, Chen YC, Yang FM et al. Mediators of the effects of gender on uric acid nephrolithiasis: a novel application of structural equation modeling. Sci Rep 2018;8(1):6077. doi:10.1038/s41598-018- 24485-x
- Krayenhagen, K., Bhatti, J., & Twist, E. (2023). ATYPICAL PRESENTATION OF NEPHROLITHIASIS GIVING PERCEPTION OF MECHANICAL BACK PAIN: A CASE REPORT. Journal of Contemporary Chiropractic, 6(1), 8–12. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/253
