Physicians can only do so much with stone prevention because a large part of the work can only be done by patients themselves. The Five Steps to Stone Prevention, the two articles on how to read your 24 hour laboratory reports for calcium and uric acid stones, and the article on how to be a successful kidney stone patient are the reference materials you need to accomplish your part of your personal stone prevention program. It is now time to pull these four articles together into an organized approach that any patient can follow. USE YOUR PHYSICIAN INTELLIGENTLY Before your visit to decide on prevention Read the article on how to be a successful kidney stone patient, where  you will find lists of materials to … Continued


The pretty picture shows uric acid crystals in urine magnified 400x under polarized light to bring out their shapes with special clarity. Here is what to look for and what to do if your stones have uric acid in them or are entirely uric acid. A caution: Occasional stones are not uric acid but a salt of uric acid: Sodium hydrogen urate or ammonium hydrogen urate. This article is not for them, They occur in unusual situations, not as yet covered here or anywhere else on this site. Urine pH Uric acid is a large carbon based molecule. Water ‘dissolves’ molecules because of charge attraction. But there is not a lot of charge on this kind of molecule. In fact there … Continued


Jeff, a reader of this site, suggested this topic and I realized it was one that I should have written long ago. You can make sense of all those numbers in the 24 hour kidney stone reports. You can use those numbers to understand how things stand with you. Reading the numbers can help you achieve your best possible chance at stone prevention – which is the only reason all those lab tests were done in the first place. This article deals with calcium stones. A second one will cover uric acid stones. Be Sure You Have Been Screened For Systemic Diseases Your physician does this part. But even for systemic diseases stone risk is gauged in the urine so you can read along … Continued


Thiazide Type Diuretics Reduce Stone Formation The common thiazide type drugs in use today are hydrochlorothiazide, chlorthalidone, and indapamide. All three have been used in stone prevention trials and shown to have beneficial effects. A nice recent review is also the source for the drug structures pictured above. I have obtained and studied nine trials. In all nine trials, there was a comparison – untreated – group. This spreadsheet contains links to the trial documents, but you will find it not easy to obtain the original publications unless you have access to a university library system. For this reason I have copied out the key data. Briefly, there were 330 controls, of which 149 relapsed (45%), and 314 treated subjects of whom 72 relapsed (23%), … Continued


At the end of it all, the science, the medical visits, the surgeries, what we really want is to prevent new stones. That is the main goal. Modern surgery is a blessing for those with stones. But no surgery is far better than even the most skilled and effective surgery. Prevention of stones is orderly and occurs only over time. Here is how to do it. This article is designed to go with my other one which tells how to organize your medical visits so as to achieve these steps.  What is the Science of the Five Steps? Stones are made of crystals. Supersaturation drives crystal formation and growth – this is a physical law that must always apply. Supersaturation … Continued

Control Your Salt for Fewer Stones and Stronger Bones

Here is my ‘bottom line’ on salt: The more you eat, the higher will be your urine calcium and – from what trial data I can find – the higher your risk of forming stones and losing bone mineral. The big articles, on salt and on idiopathic hypercalciuria have put into place the structure I need to make this simple generalization acceptable. That is part of the reason I wrote them – to be a structure I can rely on and work off of. The large image is from a recent publication about the bone disease of idiopathic hypercalciuria. The full report is available and I recommend it.  So here is a new kind of article, from me to you, … Continued


Being chronic in many cases, stones need to be prevented not just removed. That accomplishment, prevention, needs the skills, efforts, and cooperation of two people. I am writing this for the one who makes the stones, and my purpose is to promote success: No more stones. I have never known physicians who do not want successful treatment for their patients. It is the ultimate satisfaction. But they are time pressured, as are we all in this hectic world, and you can help by doing before and after a visit all that you can do to make the visit time count – to waste as little as possible, and put to use as much as you can get by way of treatment. I … Continued


Perhaps the most common abnormality among calcium stone formers, idiopathic hypercalciuria (IH) causes calcium kidney stones and can lead to bone mineral loss and fracturing bone disease. Proper treatment requires a high calcium intake, a low sodium intake, moderation of very high protein intakes, and – not rarely – use of diuretic drugs which can lower urine calcium losses, prevent stones, and protect bones. All this requires effort and belief. I have found that patients will change their diets and take medications only if they fully understand why such measures are likely to benefit them. That is why I have written this article. Unlike Supersaturation, what stones are, citrate, IH is not a topic amenable to piecewise narration. It is one single complex departure from normal, and needs one single … Continued


I do not know if Edvard Munch (1863 – 1944) had Lot’s wife in mind, but I do and thought this an apt image. She crystallized, perhaps into calcium carbonate, hence my putting her here at the beginning of our sojourn into the vast territories of calcium metabolism and the hypercalciuric states. If I were to single out one condition that dominates stone disease prevention because of sheer commonness and reliable means of treatment it would be this one. I have put off the crucial topic of hypercalciuria for the first year of this site because I wanted to build a proper foundation. We now have good materials about stones and stone crystals, supersaturation, and certain critical treatments such as potassium citrate and … Continued


So much has been said about supersaturation it is time I organize things for everyone who visits. For this I like the walking tour motif, being a lifetime walker. Not all of my colleagues worldwide will agree with me about the primacy of supersaturation in causing stones, but almost all will agree it is very important. Morning Tour Something You Can Do at Home The simple childrens’ experiment of dissolving sugar in warm water and letting it cool is supersaturation at work. When you spoon sugar into water until no more will dissolve and some grains lie at the bottom of the glass, you have made a saturated solution. You cannot supersaturate it by spooning in more sugar – that is the … Continued