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


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

Web Apps and Smart Bottles

This is an article for all of you to write. The web is awash in apps for tracking fluid intake, and kidney stone prevention is all about fluids. Some ‘smart bottles‘ have arrived on the market. They track what you drink and keep the results on your smartphone. Since some of these are kickstarter efforts there is even an article on Slate about them. Some appear to be finished and rather sleek products. We know nothing about them. There are apps for sodium intake, calcium intake – We think. The field looks thin for calcium apps. Low sodium and high calcium diets are important in stone prevention. We even found one app for preventing kidney stones – see if you can find it. … Continued

Control of Urine Oxalate Excretion

Although seemingly devoid of biological importance in humans, oxalate traces a curiously elaborated path in and out of the body. Incidentally, and from time to time, it contributes to calcium oxalate stones, and in extreme instances, to kidney damage and even kidney failure. You have two choices. You can read the article OR you can watch this brief movie which says what is in the article by way of an introduction. The Main Factors The large drawing that heads this article summarizes oxalate movements through the body. What enters the blood is the sum of oxalate produced by the liver plus the amount absorbed from foods, minus the amount transported out of blood back into the gut lumen. What enters the urine is the sum of … Continued

My Lab Report

To me at least, the lovely Blue Door watercolor by Andrew Wyeth is simplicity created by studied art. Take a look at your lab report(s) and answer these questions. If you have two 24 hour urine collections this time answer from the more abnormal in every case. Here is help for reading these if you are confused. Here is more help. But keep this in mind. I assume here you have personal physicians; that you have been screened properly to rule our systemic diseases as a cause of your stones; and that your other health issues are being looked after by your physicians. This kind of simplified approach is nice for otherwise healthy idiopathic calcium or uric acid stone formers. Others may … Continued


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