The high cost of kidney stones

I wish I could share the photo of my 4mm boomerang shaped kidney stone.  I labored for 2 months, back in early 2009 to pass it, the second stone in 5 years.

During my ordeal with these stones, I had the following health care encounters, tests, medicines, lab and imaging tests.

  1. at least 5 sets of blood work, with CBC and chemical profiles, parathyroid studies
  2. several urine tests, including urinalysis and urine culture, and 2 24 hour urine tests (a third 24 hour urine test was recommended but I declined)
  3. 2 CT scans
  4. 1 MRI
  5. 4 specialist visits, 2 primary care visits, 2 ER visits (involving IVs, pain meds, lab studies)
  6. prescriptions for antibiotic (no infection) and Flomax
  7. lab analysis of my kidney stone

The actual costs generated because of these things evades me, because until recently, I have been a passive insured health care consumer.  Now that I work on health care issues as a patient safety advocate, I am more aware of overuse and the costs associated with it.  More care does not mean better care and it is depleting our health care resources.   My estimate for all of the items listed is around $15,000, and probably more.  My out of pocket costs were insignificant because my copays have always been very small.

The point of my story is that the outcome, my tiny kidney stone, would have been the same if I had paid $0, instead of generating all of these costs.  At the time I thought I was doing the right thing, but by the time I visited an endocrinologist, and he ordered the exact same tests that my urologist had done within a few months before that visit, I knew it was time to say “whoa.”

As anyone who has had a kidney stone can attest, the pain is excruciating.  I have a new determination that if I ever have another stone, I will find a way to get pain control through my primary care doctor and avoid an ER visit.  An ER visit pretty much guarantees you a CT scan, IV, lab tests, prescriptions and so much more.  I don’t need to know anything more about my kidney stones.    Pushing fluids, taking pain medication, stopping my calcium supplements and watching certain foods in my diet are all that are necessary. Passing a stone will be the final outcome of any future kidney stone encounters, with or without all the tests and other expensive tests, medicines and doctor visits.  My slightly elevated blood calcium level will be followed by my primary doctor at annual visits.

I am a consumer member of a Choosing Wisely leadership team in Maine.  I become more aware and educated all the time about medical overuse.  Confidence comes with experience.  During my last ER visit because of kidney stone I questioned the need for a CT scan, since my stone had moved and I didn’t even need pain medication.  I could have easily left the ER at that time, and been no worse off.   The doctor insisted and I got the scan.   That will not happen again.  When I sense that something is not necessary, I will discuss then reject overuse of tests and other medical recommendations, unless there is a strong argument for it.

Kathy Day is a patient safety advocate.

The high cost of kidney stones

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

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  • buzzkillerjsmith

    You had a weird situation. 4 mm stones usually pass. And waiting 2 months is not something that would be done in these parts. One CT usually suffices and MRIs are a bit odd in stones. A 24 hour urine collection and some blood tests are not unreasonable, but I often wait until the second stone. CBC, basic chemistries, and UA and urine culture should be done. PTH has been low-yield, at least in my experience. The urologists around here are OK with all this.

    An antibiotic is not indicated unless you have an infection.

    I assume the stone was at the ureterovesicular junction. Our local urologists would have gone after it much sooner, even in this little cow town.

    • ninguem

      I had cramping left flank pain last week. Woke up with it. Wondered if I had strained my back somehow. Then I realized it was colicky and I threw up. Took some high-dose NSAID’s and went to work. Solo practice.

      My nurse wondered who the patient was, when she saw me at the microscope. No patient in the office yet.

      “It’s my urine”

      Blood and calcium oxalate crystals.

      I think I took too much antacid the day before. Lesson learned.

      Hour later or so, felt symptoms resolved with clearing of the urine.

      Minor case I think.

      The doctor has a fool for a patient.

      But I’m like Kramer.

      http://www.youtube.com/watch?v=wXeV5cqb_3Y

      • buzzkillerjsmith

        I admire your grit but agree with your last sentence.

  • buzzkillerjsmith

    A CT-KUB ought to pick up a stone and often hydronephrosis as well. Not pefect of course.

    I agree that radiculopathy can sometimes mimic a stone as can many other conditions, urological and non-urological, as you well know. I have seen cholecystitis and appendicitis mimic ureterolithiasis many times. I’m sure you have too. Never seen an MI and an aortic catastrophe mimic it, but it can happen.

    I agree with your other comments, especially A and H.

  • abcornwell

    My husband suffers from frequent bouts with kidney stones. They usually hit him in the middle of the night, over a holiday. The pain is so terrible he wants to die. We go to the ER, and I’m glad we do, because when happened in 2012 it turned out the stone was “stuck” (I know I’m not using the right word) in the area between his kidney and ureter. His kidney had already become swollen, he couldn’t urinate, and he ended up having emergency surgery to remove some very large stones and ureteral stents were placed. I must admit that since that event I would be hesitant to not go to the ER. We do not have insurance, so I do know what it costs to deal with kidney stones!