Lakewood Ranch, FL
A male asked:
Diagnosis, treatment, and diet for people with kidney stones
3 doctor answers • 13 doctors weighed in
Nephrology and Dialysis 14 years experience
Diagnosis, treatment, and diet for people with kidney stones: Since we have been discussing kidney stones over the last few weeks, i wanted to highlight a few points about the diagnosis and treatment of kidney stones, <i>as it pertains to patients</i>. I am not going to get in to the technical details of what a nephrologist or a urologist would do. My idea is to emphasize what you can do to complement your physician's treatment plan. <br> one of the perks of practicing nephrology in bradenton, florida, is that you get a pretty good experience seeing patients with kidney stones. <a href="http://www.Kidneydoctorbradenton.Org/2013/04/what-are-kidney-stones-what-are_30.Html" rel="nofollow">maybe it is the weather!</a> most patients that i see have already received a diagnosis of kidney stones (nephrolithiasis or urolithiasis) via imaging studies by the time i see them in my clinic. Imaging studies used to diagnose kidney stones include ct scans, x-rays, or ultrasounds. The latter two modalities can often miss certain types of stones (like uric acid), which is why ct scans are considered the "gold standard". <br> the usual narrative from the patient runs something like..."doc, i had excruciating flank (or groin) pain. I went to the er, and had a ct scan which showed a stone. The stone passed/was removed. I got my pain meds and returned home". The end. Certain things rile me about this all-too-familiar story. What we usually end up treating are the disease symptoms, and not the disease itself. In fact, i tend to look at kidney stones as an a downstream <i><b>effect</b></i> of an abnormal metabolic state (which happens to be the real<b><i> disease</i></b>; for instance, hyperoxaluria, where you pee out too much oxalate in the urine). Now, it wouldn't make much sense if you don't treat the hyperoxaluria after you get the stone out, would it?! unfortunately, that is what usually happens. Patients are seldom set up to have a <b>complete metabolic evaluation</b> to determine the risk factors for them forming stones in the first place. Most of the times, our ers do not do a good job of sending the <b>stone for chemical analysis</b>. This is inexcusable in my opinion. <u>these two tests provide invaluable information that would determine treatment course. </u>this is one of those few medical entities where "how" you diagnose a disease is as important as "what" you diagnose. <br> so what is this metabolic evaluation? This test often involves a few blood tests (for instance, checking your calcium, uric acid, PTH levels, etc), and perhaps more importantly, a 24-hour collection of your urine to see if you peeing out too much calcium, oxalate, phosphate, etc. (<a href="http://www.Kidneydoctorbradenton.Org/2013/05/why-do-people-develop-kidney-stones.Html" rel="nofollow">factors that increase risk of stone formation</a>). Conversely, you could be peeing out too little citrate, or your urine could be to be too acidic or alkaline, or you could have a very concentrated urine; all of which would also increase your stone risk. In my practice, i prefer doing at least <b>two</b> of these collections initially. Similarly, using the stone as a resource of knowledge, rather than just a novelty to be kept on your shelf will go a long way as well. Do not throw the stone away! have a physician send it for analysis. knowing the specific risk factors will help your physician prescribe treatments like the amount of water intake, or medications like chlorthalidone, hctz, (hydrochlorothiazide) potassium citrate, etc. These will greatly reduce the risk of your forming another stone. As you can see, in this case, prevention goes hand in hand with cure. <br> <br><a href="http://2.Bp.Blogspot.Com/-y3dqqahbu3q/uzu845x0sji/aaaaaaaaam8/fhegazhehpy/s1600/id-100129639.Jpg" rel="nofollow"></a>spinach is high in oxalate and should be avoided if you have high urine oxalate<br>(image courtesy of smarnad/ freedigitalphotos.Net) <br> <br> what is <i>your</i> role in all of this? As far as diagnosis goes, insist on having the stone sent in for analysis. If you are not sure, or if you pass the stone at home, hold on to it and bring it to your favorite nephrologist or urologist. <u>once the physician prescribes the appropriate treatment, ask for a diet plan.</u> this has a huge influence of future stone risk, and you are really in the driver's seat as far as this aspect of treatment goes. ask for a referral to a dietitian who specializes in kidney stone prevention. Here are a few other pointers that you should remember: <br> 1) think water, water, and water. Assuming you do not have any major contraindications to increased water intake (like congestive heart failure, cirrhosis, low sodium in your blood, etc), the traditional recommendation is to drink at least 64 ozs or about 2 liters of water daily. However, we all know that even with this intake, the amount of urine you make will also depend on external factors like the weather, or whether you spent the day playing tennis! hence, a better recommendation is to aim to drink enough water so as to produce 64 ozs or about 2 liters of (ideally, clear) urine daily. In other words, if it is hot out and you see that your urine looks dark amber/concentrated, drink more. Some specific kinds of kidney stones would require the intake of even higher amounts (up to 4 liters) of water daily. <br> 2) when i say water, i mean water. I do not mean colas, gatorade, fruit punch, etc. A lot of these drinks would have sugar or sodium or phosphoric acid in them, all of which would increase your stone risk. Therefore, and to spare my patients any confusion with fluid intake, i ask them to stick to good old h2o. <br> 3) stick to a <a href="http://www.Kidneydoctorbradenton.Org/2013/04/diet-for-patients-with-kidney-disease.Html" rel="nofollow">low sodium diet</a>; since sodium will increase the amount of calcium you pee out. Cut out the sugar (sucrose, fructose) as well. <br> 4) a diet high in <i>dietary</i> calcium is advised (so milk is good, but no calcium <i>supplements</i>). I have discussed this conundrum in <a href="http://www.Kidneydoctorbradenton.Org/2013/05/why-do-people-develop-kidney-stones.Html" rel="nofollow">my previous post.</a> <br> 5) there is conflicting evidence on whether tea increases your risk. Most tea varieties are high in oxalate, a major risk for stone formation, but to what extent is this oxalate actually absorbed and excreted in to the urine is still controversial. Green tea is purportedly better than black tea on account of its lower oxalate content. Other foods that you need to watch for oxalate include spinach, cereal, potatoes, bread, rhubarb, chocolate, nuts, and beets. A more comprehensive list is available <a href="https://regepi.Bwh.Harvard.Edu/health/oxalate/files" rel="nofollow">here</a>. <br> 6) supplemental vitamin c is an oxalate precursor and is not recommended. <br> 7) increase your potassium and phytate (grains, legumes) intake. <br> 8) going vegetarian might help. Studies have shown that animal protein intake is associated with a higher stone risk. <br><div class="attribution">also posted <a href="http://www.Kidneydoctorbradenton.Org/" target="_blank" rel="nofollow">on this blog</a></div>.
5.1k viewsReviewed >2 years ago
Infectious Disease 56 years experience
Depends: On the cause of the kidney stones. These have to be analyzed for content and then the source of the problem identified. As an example, do you have excess parathyroid hormone causing calcium salt stones? Are these due to gout? See a doctor and get this worked out in detail.
5.1k viewsReviewed >2 years ago
Nephrology and Dialysis 28 years experience
Combo: For most patients, reduction in sodium intake, and increasing water to 2L per day is usual except for those with uric acid. Most calcium containing stones will benefit to these. The rest will depend on the type to stone if known and the metabolic workup, uric acid etc.
2.7k viewsReviewed >2 years ago
A 31-year-old member asked:
Is the mediterranean diet healthy for people who are prone to kidney stones?
1 doctor answer • 1 doctor weighed in
Specializes in Pediatric Urology
Yes, provided:: Subject keeps salt itake low ; water intake high, same as for anyone who is prone to kidney stones. Basically, olive oil, used in mediterranian cooking, is healthier than animal fat anyway.
4.8k viewsAnswered >2 years ago
Carmel By the Sea, CA
A 58-year-old male asked:
Why do some people develop kidney stones and some more than once?
1 doctor answer • 1 doctor weighed in
Urology 38 years experience
Genes/diet/lifestyle: A genetic predisposition, dietary factors and lifestyle excesses all contribute to stone formation. Since you can't do anything about your genes, you should focus on diet and lifestyle changes that you can control. Your md will need to know the composition of your stones, as well as the results of a PTH assessment and urorisk evaluation. Adequate hydration for a uop > 2l/24hours is paramount.
4.2k viewsAnswered >2 years ago
Last updated Nov 27, 2017
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