THIAZIDE DIURETICS FOR STONE PREVENTION

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

THE FIVE STEPS TO STONE PREVENTION

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

How To Eat A Low Oxalate Diet

LISTS – AND LISTS I know you are all looking for THE list. Here is one from a reliable source. We have downloaded one version on their site to a separate document so it opens with one click a useful table of oxalate foods. Get yourself acquainted with it. It will tell you much of what you need to know. A lot of it will even surprise you. You are not as restricted as you think you are or as you have been told. A more dramatic list is the 180 high oxalate foods distilled out of the big list. Here are culprits! Not on this list? Probably not very high in oxalate so far as we know – with perhaps a few exceptions. Note that … Continued

How To Eat a Low Sodium Diet

One of the most common things I hear throughout the day when I talk about eating a low sodium diet is ‘I don’t use the salt shaker.’ Using salt shakers is the least of our problems. The message is: Salt is in everything we eat, from cereal to soda. Salt is sodium chloride. When we talk about salt intake we will be talking about sodium because that is what is on all the labels. But the word ‘salt’ is what most of us say, so I use both sodium and salt. Why Should You Care How Much Sodium You Eat? First, the more salt you eat the higher the level of calcium you will find in your urine. When you have more calcium … 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

HOW TO BE A SUCCESSFUL KIDNEY STONE PATIENT

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

IDIOPATHIC HYPERCALCIURIA (IH)

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

HYPERCALCIURIA

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

WALKING TOUR: SUPERSATURATION

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

THE LOW FLOWS

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