Overview

LOOK IN THE BOOK

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.

NEWEST ARTICLES

MIDDLE AGE AND KIDNEY STONES? WHY NOW?

Most diseases have a common age at onset and stones the same – about 30 or so. Like most diseases, this one has its range, young and old. Here is about the latter, people whose stones begin on the last side. Why care? Partly people are curious. But as we looked into the matter there are special meanings to a late start. Some diseases are more prevalent. There are a few precautions. All in all it is good to keep this matter in mind. If you are one of the late ones, take a look.

Something Special Women Do

When women and men eat the very same food, the women absorb from the food more alkali. As a result, for any amount of acid load our Western diet imposes they do better. Their selective absorption of alkali helps offset the diet acids. Acid loads are not a good thing. Experts in many fields link acid load to worsening glucose tolerance, bone mineral loss, kidney disease, hypertension, and even reduced longevity. By raising urine calcium, diet acid load certainly can raise risk of kidney stones. On top of that, women tend to eat foods with more alkali, like fruits and veggies. The dark side – there is always one, it would seem – is that when they do form stones women are more prone than men to form calcium phosphate stones. Phosphate stones are more likely to get larger, and numerous. So women have special powers and also special risks. Physicians need to know that, and so do they.

Canary in the Mine Shaft

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.

How to Count Kidney Stones

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.

Kidney Stones, Stroke, and Myocardial Infarction

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.

Treating Hypertension in Kidney Stone Patients

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.

Treat the Patient Not Just the Stones

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.