CASE 2: A Calcium Oxalate Stone Former

CLINICAL FINDINGS A man in his fifties formed his first stone in the early 2000’s and his last 6 months ago. There was a single passage event a year or two after the first stone at which time he was given hydrochlorothiazide 25 mg daily. A right SWL procedure was performed 1.5 years ago because of a stone attack, and  potassium citrate 10 mEq twice daily was added in treatment. A right sided URS procedure was performed 8 months later but was not completed because of bleeding. A right URS 6 months ago is said to have left his right kidney stone free, but some stones were seen on the left. I did not have images to review when I saw him. He believes that all of … Continued

CASE 1: A stone Former

CLINICAL FINDINGS A large but fit man in his fifties has had kidney stones, for the first time 7 – 8 years ago and the last time 4 months ago. In between he had 6 SWL and one URS procedure as well as perhaps over a hundred stone passage events. Looking back, he may have had a first attack as long as 12 year ago, but that is uncertain. At the onset 7 -8 years ago he was told his CT showed ‘staghorn’ stones bilaterally. Four of his 6 SWL procedures were for these staghorn stones. His stones were said to contain a mixture of uric acid and calcium but I had no analysis reports. He was given potassium citrate … Continued


You might say this article culminates the two years this site has been on the web. It is about treatment of the most common stone patients, treatment to prevent more stones, and therefore the topmost important matter for patients and their physicians. The topic is so important I plan three versions. This one is primary, and has not only references but linked documents so original materials are available to everyone. The next will be a video that offers the material in a more fluent if less documented format. Finally Jill Harris has promised to coauthor with me a version in her lovely and popular style. I present all of the treatment trials in the context of the supersaturation hypothesis for stone formation … Continued

Video article: Supersaturation – The calcium crystals

This is a three part video about supersaturation, the most unique and critical measurement for evaluation and prevention of kidney stones. Specifically it is about the calcium crystal supersaturations, calcium oxalate and calcium phosphates. The main theme is how supersaturation can be produced and maintained. Urine volume, excretion rates of calcium, oxalate, citrate, uric acid, and urine pH all affect supersaturation and are measured in routine 24 hour urine test panels. We try to prevent stones by altering these excretion rates. But crystals cannot ‘know’ anything about excretion rates, nor about a single concentration, like urine calcium or oxalate. Crystals know only the supersaturation, which reflects the products of calcium and oxalate or calcium and phosphate concentrations. Although we treat excretion rates we really treat supersaturation. … Continued

Video Article: How Stones Form

This is the first of what may become a series of articles done as videos. The site is now a reasonably complete knowledge base but many of the ideas are hard to get and there is a lack of overview materials that are integrative. That is what I plan for these video articles to do. This first one tells about how crystals form and how they form specifically in kidneys to create stones and nephrocalcinosis. It draws upon many of the articles as a base and pulls them together into one narrative. It also adds materials not found anywhere else on the site because best presented in a video format. Please let me know what you think. Regards, Fred Coe … Continued


Unlike Zeus, or Athene, Janus did not come down to the Romans from the Greeks. Instead Janus appears to have originated in myths concerning what may have been an actual person present very early in Roman history and later deified. Janus presided over beginnings and endings, over gateways and doors, and was invariably dual in nature. Like the idiopathic calcium oxalate stone formers, these are people whose stones are composed of calcium crystals and who have no systemic disease as a cause of their stones – therefore ‘idiopathic’ stone formers. But unlike the calcium oxalate stone formers, their stones contain predominantly calcium phosphate crystals. And unlike their more unitary counterpart, calcium phosphate stones can be one of two different kinds – brushhite … Continued


A RELIABLE AND PATIENT FOCUSED SITE Dr Mike Nguyen,  Associate Professor of Clinical Urology at the Keck School of Medicine of USC in Los Angeles, CA, founded this site years ago and it has grown into a wonderful resource for patients. He is a superb stone surgeon and offers patients opportunities to ask questions and also write posts about their own personal experiences. I am impressed with the level of patient involvement, and the strong orientation to the details of their clinical care. From a scientific standpoint I think Dr Nguyen’s site is completely reliable, which is critical for patients and family members who want to be sure what they are reading is as true as science can make it. … Continued


This is the first of a series of articles concerning the stone former phenotypes. ‘Phenotypes’ means literally the types of appearances of stone formers as observed medically, by which is meant observed using the common tests and measurements of medicine. These ‘types’ have value as they constellate abnormalities that might be individually confusing into patterns that can be recognized and that have implications for treatment and prognosis. More precisely, medicine works entirely from abnormalities, meaning departures from what I might call the normative trajectory, the sum of all measurements and characteristics one expects among healthy people as they move through life. The abnormalities of medicine are all departures that produce a state of unwellness, or illness as is more accurately said. … Continued

A Success Story

When my husband, Pat, had his first kidney stone, his doctor advised him to “take the salt shaker off of the table.”  He thought that would be easy.  He didn’t consider that every-day foods are packed with sodium. Sticking to a low-sodium diet isn’t easy.  It takes planning. With so many convenience foods available, I feel like a pioneer woman making chicken stock from bones and canning tomatoes to avoid high sodium canned versions. It’s worth it, though. Pat has now attained sodium consumption below the typical non-stone forming American. We’re all hoping this helps him avoid future issues. “Convenience food” has to be homemade when you are on a low sodium diet. This eliminates frozen meals, canned soup, Velveeta,  frozen … Continued

The Idea of Partnership in Treatment and Prevention of Kidney Stones

Partner: ‘a person who takes part in an undertaking with another…‘. Part: ‘a piece or segment of something … which combined with other pieces makes up the whole‘. I am not about trivium in posing this fairly obvious idea. It is not to repeat the obvious. What I am after is clarity about a fact of all medical care – that patients have their part in the matter and that part is at once essential and perhaps not always defined the in best way. The Girl Before a Mirror was painted by Picasso in 1932. I have slightly misaligned it so as to emphasize the faces – her and her images. THE NATURAL DELIMITERS Treatment and Prevention Concern the Body of the … Continued