Spring Cleaning

Some of my most important articles have aged poorly. They seemed musty and faded to me. So I cleaned and polished them to a new luster and that chore has taken up all my work on this site since the middle of February. Some have new names better suited to what they actually say. All read better, more clearly. I am happy with them. If you have a taste for it, take a look. Because they say it better they say more than they did.







Low Oxalate Diet?

Who needs to lower diet oxalate? Certainly not all stone formers. Not even all calcium oxalate stone formers. This articles singles out those for whom this diet is important. For the rest, it seeks to free people from restrictions they need not tolerate. Rather than begin with an oxalate list, the article suggests to reserve that list as a final resort. I could summarize what the article says but the article already summarizes several longer articles and is itself brief. So brief and so sharply written I hesitate to paraphrase it here. Read it; you may be happy you did.

Kidney Stone Prevention Course

I never intended this web book to just be here. I always thought of it as a means for taking action, action directed to prevention of kidney stones. Now, we have the first actual action, in this course. Jill Harris, who wrote some of the most popular articles on the site, has opened her course for kidney stone patients. Presently she is opening her seventh class. As you might expect she teaches patients how to do what their physicians hope they will do about fluids and diet. Being modern she relies on social media and web technology. She opened a Facebook page for interested patients that grew rapidly and from it interested patients have visited her 6 hour long course presentations. We – she and I – are very happy to see so many people really learning how to do what they need to do so I wrote this article telling about it. To us it is the first – and perhaps the most important – activity this site has engendered. There will be more but that is later on. The five steps have been on the site for a while but hearing her tell about them is a far better – and more entertaining – way to learn than just reading in a corner. Read the article about her course – the one the header links to – because it tells about our immediate and long term thinking about how to foster stone prevention and what this site and her course are really all about. We believe that at least in this part of medicine we need a new look and a new way. Fancy people refer to new paradigms, Jill says a call to action.


Use The Table of Contents to find articles within the framework of stone disease entire.

If you are already familiar with stone disease use Quick links, below, to browse by interest category.


The entire TOC is available on the left side of all the articles. Click on the category of interest and it will unfold and show you the related articles as quick links. Any page a link takes you to will have the TOC open to where you last looked.



Kidney Stones

What is In It?

What stones are Structure of stones
Matrix of Stones The organic part of stones
Types of stones A primer showing stone types
Stone analyses How it is done; how often is it needed
Quality of stone analysis Flaws in commercial labs
Nephrocalcinosis A radiological term easily misunderstood
Stones Themselves  A review of several articles on stones
Pain from Stones  How stones cause pain
Theory of Stone disease A sketch of the whole field



What is In It?

The Science of the Kidney Stone Diet Evidence for the kidney stone diet
The Kidney Stone Diet Best diet for stone prevention
The Science and Politics of the US Diet Guidelines From 1977 to 2020 – scandal, politics, how to eat
How to Eat the Kidney Stone Diet Special aspects of the kidney stone diet
How to Eat a Low Salt Diet How to shop and select for low sodium diet
The Low Oxalate Diet Our best oxalate lists and how to use them
High Calcium Low Sodium Diet Our best list of the best bargains
How Much Protein Should you Eat Does protein cause stones or bone disease?
How Much Fluid is Enough How supersaturation varies with urine flow
Variety of Fluids Fluid options and how to plan a day
How to Drink enough Tips on ways to make high fluids a pleasure
The Low Flows What makes some people avoid fluids
ACP Fluid Guidelines  Faulty but useful
Does Water Prevent Stones – What’s your Bet? Review of water trial data



What is In It?

Cost of potassium citrate How to lower the cost of alkali treatment
Stone prevention by citrate How citrate prevents stones
Thiazide to Prevent Stones  The drugs and how they work
Ureteroscopy New techniques vs. old ones
Prevention of Calcium stones The treatment trials and what they say
ACP  Med Guidelines Faulty but useful
Rebuke of ACP Guidelines Critique by an expert
Coke Treatment Probably nonsense but popular on the web



What is In It?

Putting it all together The whole process of prevention
5 Steps to Stone Prevention Details of the stages in evaluation and treatment
How to Be a Successful Patient Organize properly for medical visits
Take Charge of Stone Prevention A summary with emphasis on diet management
How To Do 24 Hr Urines The central test: Common mistakes you can avoid
Web apps & smart bottles Are fancy new devices worthwhile?
24 hr urines – Ca Stones How to read your own tests
24 hr urines – UA Stones How to read your own tests
My Lab Report: 5 Questions How treatment follows test results
Style of Practice My personal clinical approach to stone prevention
Assessment of Plaque CT estimate of kidney calcium deposits


How Stones Form

What is In It?

Video: How Stones Form Crystal formation in kidneys
Growth on Plaque Tissue calcium deposits anchor growing stones
Tubule Plugging Crystals plug nephrons; stones overgrow
Medullary Sponge Kidney A disease with tiny crystals in cysts
Role of Immunity Innate immune system and plaque



What is In It?

An Introduction A simple explanation and home experiment
Video: Supersaturation Serious but narration makes things easier
Use of Supersaturation Role in clinical practice
Why Use 24 Hour Urines?  Benefit of 24 hour urine averages
Science of Supersaturation Review of selected scientific papers
Supersaturation  A review of multiple articles


Urine Risk Factors

What is In It?

Oxalate Physiology  Control of Urine Oxalate
Hypercalciuria in General Idiopathic and from systemic diseases
Idiopathic Hypercalciuria Pathophysiology of IH
How Salt Works Sodium physiology BP and IH
Salt Stones and Bones  Bone disease in IH and role of sodium
How Citrate Works Physiology of urine citrate regulation
Calcium binding Importance of citrate calcium binding
Crystal Inhibition Citrate effects on stone crystals
Citrate and Metastable limits  Citrate inhibition of crystal formation
Dr. Charles Pak An homage to a founder of citrate usage



What is In It?

CaOx Stone Formers General appearance – plaque emphasized
Phosphate Stone Formers Plugging, young women predominate
Medullary Sponge Kidney Case 4: A patient with MSK, shows OR and tissues



How Stones Form

What is In It?

Cystinuria A general overview



Science and medicine

What is In It?

Three Medical Sciences  Discovery, trials, and diagnosis
Science in medicine Basic science in clinical practice
Applied Medical Science  The scientific basis of trials
 Science Marries Medicine Stone disease as an instance