There is no doubt about what I say to patients: ” Analyse every kidney stone. Bring in any stones you have tucked in a dresser drawer and get them analysed. Bring me all the analyses that have been performed on your kidney stones.”
But what do I say to me, and what do I do as time goes on and more stones form or are passed? Do I analyse every kidney stone?
Do you?
The problem of keeping track
Whenever I get a new patient, the stone analyses are at the top of my mind. How can I do anything rational about prevention if I don’t know what the stone crystals are? If there are no analyses at the first visit, like you I do everything I can to track them down; and, I usually succeed. But as time goes on with a patient, and more stones come along – many of them old ones, I hope – there is a tendency to let them go. After all, there were two calcium oxalate stones documented 2 years ago, I say to myself; do I really need to send more of them off in order to prove the obvious, or to meet some standard of perfection?
The problem is, at least in the patients I have studied, things change, and not always for the better.
Evidence for stone conversion
You probably already know that calcium phosphate stones, brushite especially, are much more trouble than routine calcium oxalate stones. What I suspected, and have had an occasion to document Nephrology Dialysis Transplantation Volume 24, Issue 1Pp. 130-136. is that conversion from calcium oxalate to calcium phosphate stone formation is not so rare among our patients with sequential stone analyses during treatment. Out of 4767 patients, we found 445 who had two or more stone analyses, lacked any systemic disease as a cause of stones, had well preserved kidney function, and formed calcium stones without any admixed uric acid, struvite, or cystine: were, in short, idiopathic calcium stone formers with at least two stone analyses.
I would have thought, incidentally, this being a stone research center, we would have had many more stone analyses for this most common kind of patient, but we did not. If it were not for our research, and if we were not maintaining such complete research records as we do, I would never have known we did not have more.
The details of what we found
Of the 445, 62 had a first stone >50% calcium oxalate by analysis and a last stone at least 20% higher in calcium phosphate content. These were the patients who converted from calcium oxalate to calcium phosphate stone formers. As controls we selected from the 445 181 patients who met rather stringent criteria: First stone >90% calcium oxalate and increase of stone calcium phosphate was <20%. In actual fact, the median stone calcium phosphate percentage of those who converted were 12% at the start and 75% at the end, whereas those who did not convert began with a median calcium phosphate percentage of 2% and ended up at about the same. Given only the most rigorously selected patients, 62/(62+181) or 25.5% converted.
In an altogether unrelated study of VA hospital stone analyses, Mandel et al found that successive recurrences of stone had increasing calcium phosphate percentages. They specifically echo our idea, actually antedate our presentation of that idea in print, that stone analyses should be continuous because conversion is not at all uncommon.
Why is increase of stone calcium phosphate important?
I have already pointed out that calcium phosphate stones are more serious a problem than calcium oxalate stones: they are larger on average, often more numerous, and involve the kidney epithelial cells. Brushite stones are very hard and do not fragment well with shock wave therapy. So conversion is not a good clinical outcome.
An altogether different problem is that treatment may not be the same for idiopathic calcium phosphate and calcium oxalate patients. We treat idiopathic calcium stone formers like you do: fluids, reduced diet oxalate, reduced diet sodium, thiazide diuretic agents to lower urine calcium when it is high, and potassium citrate, and use these modalities in various combinations depending on the situation. All of these treatments are reasonable, and the two drugs each have some RCT support.
But potassium citrate has never been tried in calcium phosphate stone formers per se. Some calcium phosphate stone formers no doubt have been in the three RCT for potassium citrate, but we do not know which ones they were, and whether perhaps they did poorly with the drug – had more stones, or perhaps stone growth.
There are reasons to believe calcium stone formation might increase or decrease. Potassium citrate can raise urine citrate and thereby reduce calcium phosphate formation. This is true because citrate binds calcium in a soluble complex leaving less to combine with phosphate, and also because citrate can inhibit the formation and growth of calcium phosphate crystals. But citrate is an alkali and can raise urine pH, and therefore raise urine calcium phosphate supersaturation. So we do not know if it is a good or bad treatment for patients producing calcium phosphate stones. Lacking a trial the matter is moot and wisdom dictates caution.
There are other kinds of stone conversion
It is not just increasing stone phosphate content that has taken me by surprise. Although I have not written a paper about them, I have patients who started as idiopathic calcium oxalate stone formers and began making mixed calcium oxalate – uric acid stones over time. They needed treatment to raise their urine pH. Some had become diabetic; some became obese; some just got old and lost some kidney function. But how many patients have done this I do not know. Occasionally struvite begins forming in calcium stone formers. Eventually the infection becomes obvious: stones become large and gnarled; the urine is obviously infected. But perhaps a more timely analysis would have hastened diagnosis.
What I have begun to do
My message to myself, which I am sharing with you, is that stone analyses are really important over time, and being not too expensive (I have no financial relationships with this vendor, it just so happened to offer me a convenient web site for a reference) is probably worthwhile for most stones that are removed from patients or passed.
I am changing my ways. I send every stone for analysis. I suppose some money will be wasted, but maybe in the long run a lot more will be saved. Even a single extra stone attack can be very expensive.
Should we do research about this topic?
At first thought research would seem practical, and likely to help me decide if my new way is right – or wrong. But the matter is both mundane and not so easily transformed into an experiment. To do what Mandel did, analyse successive stones and determine phosphate content is to do what has already been done. What we did has also been done except for the specific search for new uric acid or struvite appearing over time.
This leads me, at least, to say no. We have a decent clue as to what happens to patients, and the belaboring of the matter may not be worthwhile. Others may say I am wrong in this, and even wrong to do too many stone analyses.
Fred Coe MD
I need a suggestion for my disease from you how I get that from you. Shall I send my report
I have written to you directly. Regards, Fred Coe
Hi…I have had kisney stones ans my analysis report back to me. My brushite number is 9.04 and I have other areas that are concerning also. If I send you my report and can you please help me to prevent as much as I can…I am pregnant ans not wanting to ezperoence these again let alone while Im pregnant.
Hi April, I guess you mean the percent brushite in your stone is 9% but I cannot be sure. If you wish, I can surely help you interpret your reports. Please call my secretary at 773 702 1475 to arrange sending. Fred Coe
Sir,Thank for sharing valuable research work.
I had stones since 2002 now I am 34.Never they hurt me too much even though come out through urine.I had picked up the stones for analysis,but no doctor interested in.recently a stone size 10x6mm blocked in my upper part of the ureter below 6 cm to the pelve…and had successfully come out with out much pain.Sir,I humbly request you to kindly analysis the reason for continuos formation of stones and suggest changes in my life style. Give me the address where shall I send the reports and stones
Thanking
RAKESH YELLAMELLI INDIA
Hi Rakesh, Right now I am unable to provide personal health care for patients who do not come to the university of chicago – my employer. We are trying to begin telemedicine which would enable such but for the moment it is not available. All I can offer is the kind of general advice that is already on the site. It is very important to analyse these stones, and I am sure a laboratory is available to do this – it is the first step to prevention. Regards, Fred Coe
Dr. Coe, I would greatly appreciate it if you could contact me. I could really use some help. Thank you
Respectfully,
Chad R
Hi CHad, The easiest way is if you email me; coe@uchicago.edu. Regards, Fred Coe
A million thanks to you for sharing this information. For two years I told my primary that I thought something was wrong with my kidneys and I thought perhaps kidney stones might be contributing. No advice was given in any way so I assumed there was no harm. Now I realize that all this time I was passing multiple kidney stones. It is extremely difficult to find competent medical people. A urologist instructed me to go to a vegan diet which I did and several weeks later I called to find out lab resuts and I was told the stones had been “calcium”. No elaboration on what type of calcium stone and clearly the vegan diet had greatly increased any urine oxalate levels. I now pass many stones a day. I look forward to finally meeting with a nephrologist in a couple more weeks. Thanks to your articles I will be informed and understand what is being said.
I can not thank you enough for posting these extremely informative essays. You are helping countless people and I know you will never receive adequate thanks.
Hi Michelle, You need to know the type of stone – the real name, and work from there. Take a look at a strategy. It is all about lowering supersaturation for the crystals in your stones, and that means you have to know what they are. These three short videos tell all about the matter, and the ending of the last of the three really is central. Warm regards, Fred Coe
Dear sir,
it was in the year 1996 when i felt severe pain in the flank area; i visited a surgeon and he advised me using antibiotics. since that time, i have been the victim of stones once in two-year time. Now the doctors say, collect the stones and get them analysed; but the problem is the stones are too minute and i am not able to collect that. some of my tests are as follows; (a) uric acid 5.7 (b) PTH 35 (c) calcium 10.00 (d) calcium and (e) the urine tests often show as normal. the ultrasound results says, concretions. Sir, what would you suggest in order to avoid this havoc.
Hi Muhammad, Even if minute the crystals can be caught and analysed. If you urinate through a coffee filter paper in a plastic cone the particles may be caught. No matter how small an analysis can be made. The blood values are normal. Until you know what the crystals are it is hard to use the urine values because the supersaturation of your urine with respect to those crystals you form is too high but right now you do not know the crystals. If you assume they are calcium based crystals try to lower the calcium oxalate and calcium phosphate supersaturations to one half of their present values. Ways to do that are in these articles on calcium and oxalate. Regards, Fred Coe
I’m almost 21, and I have been plagued by brushite stones since I was in elementary school. I’ve had 4 surgeries to remove large stones. The past few days I have passed two small stones, which I believe are pieces of a larger stone. Doctors don’t seem to want to help me, I’ve been dealing with this for so long. I’ve tried every diet tip don’t eat this eat this try not eating this, etc. Nothing works, any advice?
Hi Megan, Your perceptions about brushite stones are accurate. This is a nasty kind of stone disease and physicians do not generally see enough cases to be expert about the problem as they are about the more common apatite stones or calcium oxalate stones. Brushite stones are very difficult to fracture with shock waves so most urologists avoid that modality – I gather yours did which is good. The stones can be large and grow rapidly. Plugging of renal ducts is common and the plugs can be large. Prevention is no different from that for other calcium stones – lowering supersaturation, but more urgent as the stones are a menace in your case. Follow the approach so supersaturation is lowered a lot day after day and during the course of every day and new stones will be reduced. The problem is that prior stones may seem like new ones if there is a lot of crystal in the kidneys. This is a matter for your urologist to reckon with, and I am sure he/she will already be aware of the problem. Regards, Fred Coe
Thank you so much for sharing this information. I just collected a stone last month. My doctor said it’s consistent with calcium oxalate. I had 24hrs urine collection test after that. The report showed two of all are out of standard range:
Oxalate Rate is 46mg/day (just higher than 45mg/day);
BRUSHITE RELATIVE SUPERSATURATION is 2.96 (way higher than 2.00).
Do you think I’m at high risk of calcium phosphate? What’s your advice on diet to prevent from forming calcium phosphate stone?
Many thanks!
Hi Jim, I guess the first big question is just what that stone was indeed made of. The analysis would have been of the crystals, usually by infrared spectroscopy and your physician will know what they are. If they are calcium oxalate the high CaP SS is a problem because the initial nidus for formation is on calcium phosphate. Of course, if the stone has a lot of phosphate crystals, that SS is too high. So it needs to be lower. Such a SS is from low volume, high pH, high urine calcium, or some mixture – so take a longer look at the numbers. Treatment is usually a mixture – fluids, low sodium if calcium is high (over 200 is high), high diet calcium is oxalate is high, and possibly meds like potassium citrate or thiazide. Here is a pretty good outline of how things can be made to work for you. I think I am answering your question: The right answer is pretty specific to your results. Regards, Fred Coe
Dr. Coe: Thank you so much for the quick response. I’m taking potassium citrate now, which brings up a higher PH I think. Here’s my recently 24hrs urine test result:
Calcium rate, 24 hr urine: 212 mg/day
Oxalate rate, 24 hr urine: 46 mg/day
Uric acid rate, 24 hr urine: 647 mg/day
Citrate, 24 hr urine : 443 mg/day
PH, urine: 7.2
Specimen volume, urine: 2.46 L/day
Sodium, 24 hr urine: 151 mEq/day
Phosphate, 24h ur,qn: 792 mg/day
MAGNESIUM, 24 HR URINE: 90 mg/day
POTASSIUM, 24 HR URINE: 66 mEq/day
Creatinine, 24 hr urine: 1617 mg/day
SULFATE, 24HR URINE: 16 mmol/day
SODIUM URATE RELATIVE SUPERSATURATION: 1.47
CALCIUM OXALATE RELATIVE SUPERSATURATION: 1.80
BRUSHITE RELATIVE SUPERSATURATION: 2.96
URIC ACID RELATIVE SUPERSATURATION: 0.09
SUPERSATURATION INDEX WITH RESPECT TO: Brushite (Ca phosphate)
SUSPECTED PROBLEM IS: Hyperoxaluric Nephrolithiasis
Any advice will be greatly appreciated.
Jim
Hi Jim, with your present volume and supersaturation values, the high pH is not in your favor – but I still do not know the real stone analysis. Was it calcium oxalate? If so was there admixed calcium phosphate? How much? One cannot really say what is important in these data unless we know what crystals we want to stop. The high pH is from the potassium citrate, and perhaps your physician might want to balance the value of the increased urine citrate against the higher urine pH in the light of the stone crystals. Frankly, I am suspicious that you formed stones under conditions that differed from those of the present collection. Perhaps volume was lower? Regards, Fred Coe
I am taking Norvasc and Flomax for suspected kidney stone. Today I noticed two round discs in my urine. They were very small and looked like white egg shell. I notice white is not listed as a kidney stone color. Could I be expelling something else beside particles of kidney stone? Thank you for your reply.
Hi Yolanda, whatever it is, turn it in for stone analysis. If it has any crystals in it they are a clue. Color is not a sure enough clue. Regards, Fred Coe
Hi
Just come across your website whilst trying to look for new information or actually anything that will help me. I am 38 years old. For the past 3 years i have been producing Brushite stone at a rapid rate. In all i have 10 / 12 surgical operations to remove stones 2 of which were emergency. I am looking for anything or any advice to try and slow this process down. I have been diagnosed with Renal Tubular Acidosis which affects the kidney stone producing. I have been given Sodium Citrate to drink daily, tried cutting things out of diet, drink plenty but no one seems to know what to do with my case. I am from the Wales in the UK. Any advice or information will be given will be greatly appreciated. ANY!!
Hi Emma, Brushite stones are nasty and a special breed. Usually there is idiopathic hypercalciuria with increased urine pH and normal blood. Treatment is as for all calcium stone formers and we just put up our opus magnum. A good step program will help. Sodium citrate is not ideal because of the sodium; potassium citrate is better. Because they are nasty I would advise you follow the five steps with your physicians; Wales is said to be a lovely place and I am sure the physicians are wonderful. Regards, Fred Coe
Thank you so much for your quick reply, this is the most information i have been given in 3 years so really appreciate it. I will definitely bring the information to my next appointment, whenever that will be. Unfortunately, at the moment i am only seeing a consultant who like is said is a surgeon, great for the removal of stones but so great for slowing the process down. Thank you again Fred, and if anyone over that side of the water wants a complex case to study (that’s what they said here, probably not that complex to you) they are more than welcome to have mine. P.S. Wales is a beautiful place you should come and see for yourself sometime. Many Thanks. Emma.
Hello. I’m 42yrs old (female) and passed a kidney stone for the first time 8 months ago. I passed another stone two weeks later, and then another 3 months later. A few weeks after the third one I had a bad reaction to valtrex (prescribed for cold sore) and it caused impaired kidney function for a few days. Imaging done at that time showed many small stones in both kidneys. I’m pretty sure I either passed another stone last night or its on its way. The only stone I was able to catch was that first one but no one wanted it. My primary care dr said to give it to the kidney specialist but I lost my medical insurance and wasn’t able to keep that appt. The stone has since been lost.
I’m curious what may have changed to cause me to suddenly have kidney stones. Is this typical as we age?
Thanks in advance.
Hi Robin, SO much can change to cause stones – diet, fluids, lifestyle, and in your case there are many stones. That one stone was invaluable and that it was lost a sad outcome. Do not let anyone do that again – they must be analysed. Here is a way to get evaluated properly. regards, Fred Coe
Hi, would you be interested if I sold you my kidney stone for research?
Hi Claire, I am afraid we do not need more stones! Also we would never purchase specific items for research. We do reimburse all research subjects in our NIH funded studies and offer a modest honorarium for their time and trouble, but moneys must never be enticement for scientific work. Thank you, anyway; Regards, Fred Coe
I just wanted to say I used to have a stone about every two years and after I went on bp meds with a diuretic my stones went away. And came back when I lost weight and cut back on the bp meds. I don’t drink much of anything . Just a little water. Just never thirsty. Only with food. I’m going to try the diet and drink more water. MAYBE I should go back on the bp meds.
Hi Jeffrey, I hazard my guess that you have idiopathic hypercalciuria, the thiazide for blood pressure lowered your urine calcium and prevented stones. If you want prevention without the drug you will need a lot of fluids. Regards, Fred Coe
Hi, I just passed my first kidney stone and have an appointment with a urologist in Scottsdale, AZ to analyze it. I have been told I have another one that is larger waiting to drop. I am a 56 year old woman and a raw foodist. I live on green juices, green smoothies and salads to control my RA. I eat bananas, strawberries, blueberries, spinach, walnuts, almonds, seeds and coconut water every single day. I eat other fruits and veggies but these are my main go to foods throughout the day. Green juice of celery, cucumber, spinach, kale, chard no fruit. Could this diet be the culprit to my kidney stones? Most of my foods are high oxalates and that concerns me until I get my stone analyzed. Thank you!
Hi Keckert, Indeed your diet sounds like an oxalate feast, especially if diet calcium is not high. Here is a good approach for your evaluation. Regards, Fred Coe
I’m amazed and impressed by the amount of information here and your willingness to advise people. It’s wonderful to know that there are healers out there (not just physicians). Thank you, both for the info in these pages and for your dedication to helping people!
What does a “large & gnarled” kidney stone looks like?
Hi Sheila, I guess if I am to be graphic I had better be able to say it in words. This visual applies mostly to struvite stones and form in layers. I think of rugged, twisted; large means they fill up a large fraction of the renal pelvis even into the calyces to make a staghorn pattern. But gnarled is not just twisted it is like ginger. Does that help?? Regards, Fred
Dear Sheila, I think my original answer to your question was lost. It looks like ginger root. Large means it fills up much of the renal pelvis and even extends into the calyces to produce a staghorn appearance. Regards, Fred
I am 22 years old and currently 17 weeks pregnant. I just had my first stone removed via lithro. it was 9mm. The results of the send out were:
1st Constituent 50% Calcium phosphate (brushite)
2nd Constituent 40% Calcium oxalate dihydrate
3rd Constituent 10% Calcium phosphate (apatite)
I havent been able to really find any answers on prevention of future stones like these. Is there medications that can be prescribed to help prevent future stones like this?
Hi Mandy, You do indeed have a major issue. You form calcium phosphate stones and the more serious of them – brushite. Brushite stones are hard to fracture, and hard to prevent. Here is how to go about evaluation. Please do not skip steps. Here is a good treatment article once you know that you are without systemic disease and also what is wrong. But, while pregnant testing is futile so wait until it is over and – should you choose breastfeeding – that, too, is over. Regards, Fred Coe
I have a stone – 5 mm and several smaller ones in my left kidney, and several small ones in my right kidney. What will they look like – what shall I look for as I strain my urine to catch when they pass? I have something that looks like fine salt – can feel them between my fingers.
Hi Natalie, the fine sand is probably calcium phosphate if white, uric acid if orange. Get it analysed even if it seems like silt. The stones will look like – well, stones. Get any you pass analysed. For prevention, take a look here. REgards, Fred Coe
I have been reading all this material, and am wondering what “lifestyle” actually means. I have been under extreme stress recently, and am wondering if this could have caused my stones. The last time I had a stone was 10 years ago, and I was taking care of my husband during his declining health, and going thru a very stressful time.
Hi Natalie,
I am sorry to hear about your stress levels and your husband’s health. Lifestyle does include eating well, exercise and how you manage your stress because we all have it. Many manage it by making unhealthy eating choices, not drinking, drinking too much alcohol, etc. So is your lifestyle a healthy one? In what ways do you cope with stress? Perhaps you were not taking care of yourself bc you were so busy taking care of him. You must take care of you so that these horrible stones don’t come back. Need me, write jillharriscoaching.com/contact
Warmly,
Jill
Hi,
My son is 0 years old and last week his urine was cloudy dark. The urine test showed a lot of blood without any infection and ultrasound showed a kidney stone (4mm x 0-4 mm).
He did not have any pain, He is healthy and active boy with a 3-year- medical treatment for several complicated surgeries on his intestine when he was under age 4 years old.
we are waiting for hie doctor appointment for any necessary treatment. I gave him a lot of water and try to give him some herbal medicine and force him to do some jumping rope. I wish the stone can be broken and pass without any severe pain.
Hi KP, I presume his age is 10. Intestinal surgeries can lead to stones – super complex issue in children. He needs complex evaluation and thoughtful treatment. He is best off having at least some evaluation in a university based pediatric department with special skills in the GI and urological matters you have mentioned. Perhaps his personal physicians are themselves so specialized that they can do it all. That would be ideal. But to me evaluation and treatment would be very challenging. Urine oxalate may be high, urine pH too low, urine calcium too high – etc. And depending on the surgery there may be more to consider. Be sure the stone is analysed and keep copies of the report. I have not as yeet written about the bowel disease stone problem, so I cannot point to an article for you. Regards, Fred Coe
I have had recurring stones for some years now. As long as I can remember they have always been in the left kidney.
Would this steer your advice for prevention in a different direction than what you’d advise for patients who get them in both sides?
Is that normal? Or do they normally occur in either and/or both sides for reoccurring patients?
Thank you for your time,
Brian
Hi Brian, Years ago I actually looked into this question. I decided it was just chance plus how crystals work. If you start forming them, they template each other so the chance of more rises with more crystals. But the other kidney remains at risk, so prevention is for both. Regards, Fred Coe
Many thanks for your many years of work In this area. Also thanks for your down to earth approach to some of these highly scientific issues. I believe you would be making a significant contribution at all different levels. I have been suffering with Uric acid stones for five years now ( I am 68 years old) and they are always occurring in my left kidney. I live in Western Australia and my doctors and specialist are pushing me to use allopurinol for the rest of my life. This seems to be a standard medical protocol over here. I have checked the side affects of this drug and feel somewhat uncomfortable about using it. I am not and have never been on any medication over a long term and have avoided painkillers and whatever drugs over my whole life. From my limited research pH levels seem to be the critical component and I like the idea of potassium citrate 40 mEq and potassium bicarbonate 20 mEq per day, in two doses as you proposed in your earlier article. I did discuss this with my doctor and he admitted he had no idea. Do you think I have anything to lose by trying this and getting a blood test before and then maybe after a month to see the affect on the Uric acid levels? Kind regards Tony.
Hi Tony, You are right. Here is a good review of the treatment. It is all urine pH, raise it and stones stop and some dissolve. Regards, Fred Coe
In have about 6 kidney stones (largest ~5mm) in my right kidney, one in my left they are believed to be calcium oxalate based on analysis of previous stones . I have not passed a stone in about 8 -9 years since last laser litho, yet most of these have all formed since. One stone remained in my kidney after surgery. I have had two laser litho’s and one ECSWL since about 1991. I have changed urologists because my previous urologist , while bent on doing further surgery had done nothing to advise on prevention or get to the root cause. My previous urologist mentioned Randalls Plaques but promptly forgot he said that 6 months later, thus triggering my change of providers. My new urologist had me on a 24 HR urinalysis and right away found I had low urine volume at 1.7 liter and also found that I am supersaturated with Brushite.
My questions:
1) Am I likely to be forming calcium phosphate stones given this new discovery?
2) The stones apparently are ‘fixed” and not moving. Should I take a wait and see approach given the risks of surgery (I am 65 and have complicated medical conditions, Hemochromatosis, Mitral valve calcification)
3) Would robotic per-cutaneous surgery be a less risky option? Go in and get them all?
4) Are there any nerves inside the kidney itself? I have intermittent RLQ pain and yet no stones are moving.
5) I have a small stone in my prostate is that a problem?
6) While I am working to improve my water consumption, I understand that nothing will dissolve the stones. Is this correct?
Hi Joe, stones that do not obstruct or cause pain or bleeding, or become infected can be left alone or removed as an elective choice. I cannot predict your stone type based on the 24 hour urine SS, but if brushite SS is high and CaOx is not, it is quite possible. PERC is a big procedure, and ureteroscopic removal greatly preferable if your surgeon considers it viable for your specific case. Prostate stones are trivial. More water is always a good idea but prevention always requires more. Here is a good starting place to read in. Regards, Fred Coe
I passed a small fragment of a stone. The analysis said they were unable to identify the stones constituents.
Is this common? What does this indicate?
Hi Diane, It says that perhaps the fragment contained no crystals, or that the lab was not able to get a spectrum off of the sample. It is not common and not ideal as you do not know what you are trying to prevent. It indicates your approach to prevention is a little more open minded than would be ideal. Here is a good prevention article, see if it helps you. Regards, Fred Coe
I recently passed a kidney stone. Where can I get it tested to determine what kind of stone it is? Thank you, David
Hi David, Your physician can send it out to a lab she/he uses. Given a stone, one is best off with a full evaluation for cause – 24 hour urine testing – because waiting for a second stone is not a fine strategy. Regards, Fred Coe
Dear Dr. Coe, I found your piece very interesting. Over my lifetime I have passed kidney stones and have lithotripsy on one of the original dorenier lithtrypsy machines in CA. Since my episode over 30 years ago I have had one serious Gall stones episode which passed naturally while in an emergency bed with morphine for pain. I am still wondering if there is a similar chemistry in the formation of both in the body. But recently even as of today I passed small mostly soft particles in my urine I can’t really call them stones as they are not hard. I typically retrieve them from my urinal and I have analyzed them earlier on when they were harder and they were lab tested as calcium oxalate stones. However on a regular basis when my diet is more in grain and nuts and often proteins high rich I seem to produce them more often. When I place them between my thumb and fore finger and rub the material fragments and sometimes seems sandy in part. I definitely feel them passing through my penis but it is not painful just noted. Probably 2- 5mm at most. Because they are mostly soft lately I wondered if you might suspect they form lower in my bladder. I would be pleased to hear your thoughts on this. I am on synthroid for my thyroid and atorvastatin and also thought could play some part. I also take Ibuprophen for my back pain for moderate scoliosis and question how these drugs may contribute. I try to consume citrus regularly in oranges mainly and some lemons to try to keep my acidity level higher having read that alkalinity is likely culprit. This is a wonderful world we live in where we can share so much information over the Internet with people like you and hopefully learn from both sides. Sincerely, Jeff Z.
I passed 1 large stone and 3 smaller stones. The large stone seems to be one or more smaller black stones encased in an outer shell that is smooth and brownish yellow in color. The smaller stones are smooth and the brownish in color. I do not have insurance or a doctor, is there anyplace I can get these stones analyzed??? Thanks in advance.
Hi Robert, You do need a physician, and the stones analyzed. First, save the stones for when you get some insurance – just put them in a clean envelope in a drawer. Most medical schools do some free or reduced cost care and I would much advise you look around. Too many stones to let them just form. Fred
Dr Coe, first off thank you for this incredible source of information, of which I will be diving deep into over the next few weeks.
Quick question if I may.
I was just in ER for a kidney stone, and have passed and collected the stone at home. I do not have insurance, but would like to get the stone analyzed. From your article I am correct in understanding this http://www.herringlab.com/ is the lab I can send the stone to be analyzed?
Frustratingly I’ve searched for hours on Google trying to figure out how I can send the stone somewhere to analyzed, and I have had ZERO luck figuring that out. The closest I’ve come is on Amazon…..not sure if that’s legit or not.
Are there specific tests or procedures I need to recommend to the linked lab above to ensure I get the most accurate composition as I want to do EVERYTHING in my power to prevent further stones and understand accurate composition will assist in that.
Thank you so much for putting all this information together, truly grateful to have found this resource.
Hi Luke, The large companies like LabCorp do stone analyses, and are probably most reliable. No one is free, though, and being a stone former you need health insurance. Even a most minor stone attack could cost thousands of dollars. The lab you mention is venerable and fine, also not free. As for the stones, they have causes, and you need medical evaluation including 24 hour urine studies. Here is my best overview of that. With Obamacare, one can usually get coverage, an urgent matter for you. Regards, Fred