The kidney stone guidebook now has links to everything on the site. When you open it from here or from its big tab on the home page, you will find ‘ARTICLES BY TOPIC’. The site is so big, you need a topic guide; here it is.
We know forming stones indicates above average risk for high blood pressure, and for kidney, cardiovascular, and bone disease. We also know that our modern diet promotes all of these diseases. Finally we know that not everyone responds to the diet by becoming ill – many seem relatively unaffected. This leads me to propose the idea of linked diet disease susceptibilities: stone formers are susceptible not only to stones but to an entire manifold of cardiovascular, renal, and bone diseases promoted by our present unhealthy diet. If true this speculative idea means that failure of stone formers to improve diet may be more harmful than in the average person, not just because of stones but because of the entire manifold of diseases, many far worse than stones. Scientists need to test the idea, but that will take time. As we wait on science’s progress, we need to highlight that dietary stone prevention is always important. Medications and fluids, valuable as they are, need to be in addition to, never in place of a correct diet.
Counting new stones right is absolutely necessary. You can’t sail a ship, or fly an airplane, or drive to the shopping mall without keeping track of where you are, and the same for stone prevention. New stone counts tell us if a patient is an active stone former or not, and if our treatment is a success or a failure. New stones are those passed or removed, or seen on an image, and not present on a prior image – radiographic or ultrasound. To know new from old requires, therefore, we read our images correctly and correlate stone numbers in time with stone events. Physicians have ultimate responsibility for counting right, but patients can help immeasurably by keeping track. This is how I count new stones, and I believe it is a correct way.
Recent epidemiology has linked forming stones to these dire conditions. Increase in risk is not large, but seems undeniable. The increase is most evident among younger women perhaps because their baseline risk of vascular disease is lower than that of men, but it can be seen in both sexes. These new facts add weight to the need for comprehensive care of all stone formers. As a group they have increased risks for bone disease with fracture, hypertension, kidney disease, and now we know for stroke and heart attack. We have no information about whether prevention of stones helps reduce these risks, but certainly it can do no harm.
Lower is better – that is the main burden of the new US hypertension guidelines. This applies to all of us. But kidney stone formers have a special place because their diet and treatment needs for stones closely overlay with those for blood pressure. The good part is synergy: If careful, treatment for the one will do for the other. The alternative is a piling up of treatments that eventually tire patients and lead to dropout. In this article I detail how to do the better way. The article is long because it includes home blood pressure techniques, and the evidence for lower treatment goals. But it is worth the read. Lower blood pressure saves lives, prevents strokes. It is so important. Give it your time.
We cannot ignore the excellent body of work that has disclosed undeniable associations between stone forming and significant bone, hypertensive, and kidney disease. Multiple investigators have found that having stones predicts higher risks we need to mitigate through treatment that can both reduce stone forming and protect against fractures, high blood pressure, and kidney disease. The main stay of such treatment is the kidney stone diet. It so much resembles the diet recommended for all Americans I cannot but say every stone formers should adopt it. While incomplete treatments like very high fluid intake, or perhaps rigorous low oxalate diet may stave off stones, they fail to address the range of diseases to which stone formers are more prone than otherwise normal people. There is no sense to such incomplete measures when proper diet can do so much more.