Primary Hyperparathyroidism (PHPT)

This curable systemic disease lurks as a not uncommon cause of calcium stones. When physicians look carefully they will find and usually cure it. Every kidney stone patient should know about PHPT and be sure of its exclusion.  Abnormally high serum calcium is the very make and mark of PHPT, so every calcium stone former deserves careful fasting blood measurements before treatment begins. It may appear as the years pass, so one look is not enough. Yearly or so, more fasting serum calcium values are worthwhile. Some debate whether symptomless PHPT need curative surgery. Often it does no apparent harm. But in a stone former no one demurs: Unless impossible, cure it by surgery. Medicine has only a few curable diseases. This is one of them.

The Kidney Stone Book

Some time ago I mentioned that this site is like a book in that the separate articles have begun to cover the field of kidney stone disease the ways books do. But it is not really a book because the articles, being separate, lack narrative coherence and make no place for scientific insights that span over many articles at once. This link is to a new page that contains the book. The introduction together with my older articles on science introduce proper scientific ideas and illustrate them with specific examples drawn from contemporary kidney stone research issues. At the end of the introduction are Chapters one and two, about what stones are and how stones form. Anyone who mainly wants information will probably use the left margin TOC and read the articles of interest. But those who want a broader look at the disease and especially the science that underlies what the articles say will ultimately browse a bit in the book chapters. Right now I have only two, although the introduction is itself very substantial. More will come.


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



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 Kidney 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
Kidney Stone prevention by citrate How citrate prevents stones
Thiazide to Prevent Kidney Stones  The drugs and how they work
Ureteroscopy New techniques vs. old ones
Prevention of Calcium kidney 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 Kidney Stone Prevention Details of the stages in evaluation and treatment
How to Be a Successful Patient Organize properly for medical visits
Take Charge of kidney 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 Kidney Stones Form

What is In It?

Video: How Kidney 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