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


One Paper We Never Wrote There was and is a list of papers we never wrote. At the top of that guilt making list is the paper on “Low Flows”. You, who are being encouraged, nagged, exhorted to drink more water will be familiar with the reasoning – dilute the stone forming salts. Why, you think, do I form stones and those of my friends and neighbors who drink no more than I do, do not. The answer, in short – is that you cannot get away with it. Whether you have elevated urine calcium or for some other reason, you cannot get away with it and must drink more. What is a “Low Flow”? It Is Not Evident at the … Continued


This word is commonly used to describe stone disease. It can sound worrisome for patients. Physicians tend to think about uncommon diseases which cause stones. Scientists think about crystals in kidneys of humans and animals, and theorize about their causes. But the term has become vague and blurred, we believe, and in need of sharpening. That is why we wrote this article. Because the material is complex, we have added summaries in bold italic at the top of sections that might pose problems for the non technical reader. Lacking such a summary, read on confidently. WHAT DOES ‘NEPHROCALCINOSIS’ MEAN? The boyish face is Fuller Albright, perhaps the greatest 20th century scientist concerned with kidney stones. The lovely biography Alexander Leaf wrote in his … Continued


This site is now one year old, and big enough to lose yourself in. I decided to try something new. How about walking tours? This is just that. I have organized a nice stroll through the site for just one topic: Kidney stones themselves. Not how to form them, or remove them, or prevent them, but just about them – their natures, their names, how they are put together, how we know what they are. You can start with me and sightsee, stop for a while, come back, abandon the tour as uninteresting. I mean it as a way of seeing a topic with a guide who knows something about the big rambling posts you find on this site, and … Continued


Doctor David Goldfarb is a recognized authority on medical prevention of kidney stones, and has played a very important international role as an expert and brilliantly informed advocate for high quality care of the millions of patients with this disease. The American College of Medicine, through its organ – The Annals of Internal Medicine – is known for publishing excellent guidelines that primary care physicians can use in their practices to achieve a reliable quality of outcomes. Here we have come upon a true conflict between experts like Dr. Goldfarb and the College of Medicine. He was chosen, by right of his expertise, as a peer reviewer of the defective guidelines the College promulgated last fall, improper and misleading guidelines for … Continued


Our Tasty Villain Salt, sodium chloride, part of our commons, our everyday, and central altogether in prevention of kidney stones. My recent article on the use of 24 hour urine collections was about stone risk: Supersaturation, and the key 24 hour urine components that affect supersaturation – volume, calcium, oxalate, citrate, and pH. Of these five components we think first about water when we treat patients to lower supersaturation: Fluid Prescription; Thirst for Variety; How to Drink Enough Water. But, if we are wise, we should think next about salt, and how to lower it, because in so many people it is a key to treatment success. It is key because sodium chloride strongly controls urine calcium and therefore the risk of kidney stones. Likewise, it is key … Continued

Why 24 Hour Urine: Supersaturation

My friends in the humanities are more popular than I am. At parties they can talk about poems, plays, novels, the modern and the ancient all with authority and considerable charm. Of course every doctor gets a share of medical questions. But when that brief flurry ends, and people ask what I do, a kind of pall falls over the table, or the little group at a cocktail party. What can I say besides that I prevent kidney stones? After a few curious people ask about how I do this, and others mention advice everyone seems to have heard somewhere, my moment passes. Even worse, if pushed for details, I am up against the unmentionable business of sampling body fluids. Which … Continued


A FIRST EXAMPLE OF WHAT I AM AFTER On the main page of Site Logic, I outlined my purposes. Science informs medicine, medicine uses science to alleviate illness. Among other matters I am in search of the paths between them. Said more exactly, I am after the mechanisms through which science arises from medicine and how the results of science inform practice. This one disease will suffice, I think, but only if we are willing to study individual examples from it. That is my purpose here. The picture gives away my general idea. The path is not a labyrinth but a maze. You walk the former pleasurably, there being one path to its center and another back without confusions. You walk the other for it’s wit … Continued