Kidney stone types
Crystals make stones and their names signify the kidney stone types. Here are the names of the crystals that make the stones: CAOX, Calcium Oxalate; CAP, Calcium phosphate; UA, Uric Acid; Cystine; Struvite.
The wedges on my pie chart show the relative abundances of stone types in our large population of stone forming patients. Calcium oxalate stones predominate by a wide margin in our clinic and in all others I know of.
The names, matter because the whole science of stone prevention focuses upon stone crystals. Each kidney stone crystal creates its own unique illness and requires specific treatment. That is why we name stones by the names of their crystals and why when stones are analysed the results are reported by these very same names.
Being a bold and rather large graphic, the featured picture does what I intended, brings the main facts into view as, at a circus, the great animals and the small animals circle the ring by way of an introduction. Come. I will show you all the common stones, like at a fashion show, or a circus parade. You can watch as they go by and remind yourself, or wonder, which ones might have been yours.
Here they are.
Which type do you have?
You might think your doctors know what stones you have formed, but don’t rely on it. People move, doctors move, health records are far from ‘all electronic’. That stone report from 4 years ago could lie in a dusty filing cabinet, your new doctors unaware it exists. Worse, it could hide in a dresser drawer and you forgot it you put it there. Perhaps even more worse, the stones might stay in that drawer, never analysed at all. Find the stones, find missing reports, urge analysis by your physicians. They can help you most if they know your stone analysis.
When they do not know, physicians can still mount prevention efforts but with less focus and probably less effect than when guided by a knowledge of the crystals. So always seek treatment. If a stone comes along the way, make every effort to get it analysed.
Why should you care to know all this?
Because you will conduct much of your own treatment, and over many years.
Since stones tend to recur, prevention requires treatment over long periods. These treatments work by altering urine chemistry in a direction that minimizes the risk of forming crystals. Such altering of urine chemistry requires control of fluid intake, lifestyle, and diet, and sometimes additional use of medications.
Just as the sailor who aims along a chosen track against the random, misdirecting, confusing sea and air maintains a constant way in proportion to that skill which comes from knowing the way of the boat, patients who aim to keep a certain kind of condition in their urine despite the demands and temptations of the world do so, I believe, in proportion to skills that come from knowing how their work and lives and foods affect their bodies, and how those crystals form which they so much desire to prevent.
Put another way, knowledge is power.
Why is this article so long?
I wanted to put all five main types of kidney stones. That makes a long story. But probably you will care to read about only your own type.
I should mention here, to save a lot of confusion, that stones often contain mixtures of crystals.
The pie chart refers to the most common crystals in a stone, for which the stone is usually named. Much of the time, minor crystal components are not crucial, but sometimes – to jump forward a bit – they are. Even a trace of struvite or cystine, for example, can have great diagnostic importance.
Calcium stones
Calcium Oxalate Crystals
In the great circle atop this page article, the calcium oxalate stone, being most common, occupies a lion’s share of the space.
The calcium oxalate crystal forms when calcium combines with oxalic acid. Oxalic acid (at left), a dead end waste product that the kidneys remove, contains two carbon atoms (the large black spheres), four oxygen atoms, and two hydrogen atoms (silver).
At the acidity of urine, the positively charged hydrogens leave their negatively charged oxygens. As a result the oxalate molecule carries two negative charges. In the figure at right one negatively charged oxygen attracts the hydrogen of a nearby water molecule (H – O -H) while another attracts a positively charged calcium atom.
You can imagine how another oxalate ion (the name for a charged molecule in water) could attract the same calcium, or another calcium atom attract the bottom oxygen on the oxalate molecule so the chain extends and makes a crystal. You can see more about this in a video I made. Broadly speaking – though my more expert colleagues may bridle at such a simplification – the calcium atoms and oxalate molecules combine by the attraction of their opposite charges.
The calcium oxalate kidney stone comes in two varieties, calcium oxalate monohydrate and calcium oxalate dihydrate. The former are harder and therefore more resistant to fragmentation by lithotripsy. Likewise, the former appear more often when elevated levels of urine oxalate are present.
Calcium oxalate stone formers
From Systemic Diseases
Sometimes this kidney stone arises from a systemic cause, like bowel disease, primary hyperparathyroidism, or primary hyperoxaluria. Only physicians can establish that a known disease – like bowel disease – is the cause of stones. Only physicians can discover underlying primary hyperparathyroidism as a cause of stones. Patients cannot do much for themselves except provide as complete a medical record as possible.
Idiopathic
Most of the time this kidney stone arises simply from the interplay between inheritance, diet, and aspects of daily living. We call such patients idiopathic calcium oxalate stone formers, from Greek ἴδιος idios “one’s own” and πάθος pathos “suffering”.
Even though physicians discover the links between daily living and stone production, and select those changes that can prevent new stones, patients themselves must create and maintain those changes. I believe patients can so this in proportion to how well they understand what is needed, and why. When changes in daily life are not enough, physicians add medications, so even then patients remain active therapists for their own disease.
Stones usually form on kidney surfaces
About one million nephron units make up a normal adult kidney. The calcium oxalate kidney stone type does not grow in the tubules of the nephrons but ‘outside’ them, on the surfaces of the renal pelvis where final urine collects and drains through the ureter to the bladder. Here is a video that shows how they can form.
Calcium phosphate crystals
Phosphate ion and urine pH
Calcium phosphate stone crystals form when calcium atoms combine with phosphoric instead of oxalic acid and produce the calcium phosphate kidney stone.
Phosphoric acid is simply a phosphorus atom (shown as the ‘P’ in the line drawing to the left) with 4 oxygen atoms bonded to it. One oxygen atom has two lines for its bond to phosphorus; this oxygen cannot provide any charge with which to bond calcium atoms to make a crystal. The other three have ordinary bonds that are shown by a line, and a dashed and solid arrow. These two arrows mean simply that the oxygens lie above and below the plane of the paper – so if you built the molecule with sticks and balls it would have a three dimensional shape.
One of the three negatively charged oxygens never has a hydrogen on it in urine but only in exceedingly acidic solutions. A second charged oxygen is always occupied by a hydrogen atom in urine.
This makes the third oxygen, variably occupied by a hydrogen in urine, a tie breaker.
In a urine of average normal acidity (pH around 6), most of the tie breaker oxygens have their hydrogen leaving the phosphate ion only one negative charge. Not enough to make a crystal.
When the urine is abnormally alkaline (pH above 6.3 or 6.5), the variable oxygen becomes charged so the ion has two negative charges that can combine with calcium to make crystals. For this reason the calcium phosphate kidney stone tends to occur in people who produce a more alkaline urine than those who produce calcium oxalate kidney stones.
Brushite vs. hydroxyapatite
Much like calcium oxalate, calcium phosphate crystals begin simply as one to one pairings of doubly negative phosphate ions with doubly positive calcium atoms. This initial crystal is named brushite. Brushite, which is an equal mixture of calcium and phosphate ions, can convert to hydroxyapatite (HA), which has a more unbalanced proportion of calcium to phosphate. Hydroxyapatite crystals make bones hard.
Because less soluble than brushite, hydroxyapatite cannibalizes brushite. The organic molecules in urine modify this process.
Calcium Phosphate stone formers
From Systemic diseases
Primary hyperparathyroidism and renal tubular acidosis raise average urine alkalinity (higher urine pH) and foster calcium phosphate kidney stones. Many uncommon genetic diseases do the same.
Idiopathic
Idiopathic calcium phosphate stone formers share a common set of traits. Perhaps because urine contains far more phosphate than oxalate, they form more frequent and larger stones than idiopathic calcium oxalate stone formers. Often the stones originate as crystal plugs at the terminal ends of the kidney tubules. More crystals deposit over the end of the plug open to the urine, to make the final stone. Crystal plugs damage the cells that line the tubules and cause local scarring.
Uric acid stones
Uric acid crystals
Structure and charged sites
A breakdown product of DNA and RNA, uric acid forms crystals in abnormally acidic (low pH) urine. Obese and diabetic people, those with gout or kidney disease typically produce abnormally acid urine. I know how the urine becomes acid, but leave it for elsewhere on the site.
Uric acid, the molecule we are interested in here (shown to the far right), has two linked rings made of carbon atoms (they are at the angles where lines join), with interposed nitrogen (N), oxygen (O), and hydrogen (H) atoms.
This molecule has only two charged sites, the nitrogen atoms at the bottoms of the rings. In urine of pH 6 or so, one nitrogen lacks its hydrogen and therefore carries a single negative charge. In more alkaline solutions both nitrogens lack hydrogens, but urine does not normally achieve such alkalinity (pH>8).
When urine pH is low (<5.5) and both nitrogens have their hydrogens, the molecule lacks any charged site, so water can no longer find a hold on the molecule. It crystallizes. It simply leaves the water as water droplets themselves form from the high and vaporous late afternoon clouds and fall from the air as the warm rains of springtime.
Relation to water
Water molecules are each a single oxygen atom (large ball) bonded with two hydrogen atoms (small balls) as in this picture from Wikipedia. The hydrogen side has a positive, the bare side of the oxygen a negative charge. So water molecules link to each other, positives to negative surfaces, to make up the clear and seemingly continuous fluid we drink, swim in, and hold up umbrellas to keep off of us when it rains. They link by charge at angles, shown by the number ‘1’ so as to make up a three dimensional macrame.
To be ‘in solution’ means to have some charge to which water molecules can link up with by attraction. Calcium atoms are positive and become surrounded by a shell of water molecules facing it with their bare negative surfaces. Oxalic and phosphoric acids have negative charges and are surrounded by water molecules pointing their positive or hydrogen sides to them.
Uric acid at neutral pH has its one negatively charged nitrogen water can grasp. But when pH falls, and neither nitrogen has any extra charge for water to bind with, how can the molecule remain among the water molecules? It cannot. The molecules stack into solid crystals and fall from solution.
Uric acid stone formers
The stones can be orange – red, large, and numerous
The stones can be red or orange because uric acid crystals absorb hemoglobin breakdown products that are red – orange pigments in urine. Sometimes uric acid crystals pass in urine as a red orange gravel.
Uric acid does not have to connect itself to some other atom or molecule to make a crystal, in the way that calcium must bond with oxalate or phosphate ions to make calcium oxalate or calcium phosphate crystals. When pH is low enough to extinguish its charge, uric acid can crystallize very fast, in seconds, and pass as an orange gravel in the urine. If retained, such crystals can grow rapidly into large stones. Because there is much more uric acid in urine than there is oxalic acid, uric acid stones can grow very large and rapidly. Some fill up the entire collecting system of the kidney.
Urine pH controls stone formation
But because the whole process depends almost completely on the acidity of the urine, uric acid stones are very easy to treat. Just a modest amount of supplemental alkali will make the urine of almost any patient alkaline enough that the hydrogen atoms are removed from the one crucial charged nitrogen. Water can bond there so uric acid remains in solution. Because so simple, treatment prevents stones with certainty. Relapse need never occur.
Mixed stones require special care
Unfortunately, however, stones commonly contain uric acid mixed with calcium oxalate. In this case, one needs to track down the cause of the calcium oxalate stones as well as make the urine alkaline enough to stop uric acid stones from forming. Calcium phosphate crystals mix with uric acid only rarely, because it takes a rather alkaline urine to remove the hydrogen atoms from phosphate so it has two negative charges and can bind efficiently with calcium atoms. At that higher pH, uric acid will have its charge site and remain in solution.
Struvite stones
Urea and the planet
Kidneys cannot make struvite. Bacteria make it. Not all bacteria, either. It takes bacteria that normally thrive in the soil, and they do it for ancient and compelling reasons. These bacteria produce the kidney stone named Struvite after Heinrich Christian Gottfried von Struve (1772–1851).
Animals deposit urea (at left) all over the planet when they urinate. Plants cannot use it.
Like oxygen, nitrogen is an essential for life yet dangerous. It is integral to proteins, DNA and RNA. As these molecules are broken down and remade, some of their nitrogen slips by and can form poisonous compounds unless caught up in safe waste products. Of these, the main one, urea, contains 2 nitrogen atoms bound to a single carbon atom (‘C’ in the picture to your left).
Uric acid contains 4 nitrogen atoms (look back at the picture of it). Birds and reptiles excrete most of their nitrogen as uric acid; mammals like us excrete nitrogen mainly as urea.
As the animals of the world urinate on the soil, their urea brings nitrogen to plant roots, but the plants cannot use it. They cannot release the nitrogens from the carbon atom that holds them. Those soil bacteria that make struvite crystals have an enzyme, called urease, that can release the nitrogen for plants to use as their nitrogen supply.
So, soil bacteria with urease maintain the nitrogen cycle of the earth.
Struvite crystals
As they release nitrogen from its carbon in urea, the nitrogen takes up a proton making ammonia (NH3). Ammonia is a powerful alkali and takes up another proton.
As it does so, the working bacteria surround themselves with spheres of very alkaline fluid enriched with ammonium ion (NH4) that carries one positive charge. Soil magnesium ( an atom with two positive charges) and phosphate sans all of its protons (an ion with three negative charges) spontaneously form their triple salt: three negative phosphate charges, two positive from magnesium, one positive from NH4).
The crystals anchor the bacteria and help create a porous nitrogen rich soul good for plants to grow in
The struvite kidney stone
Why they start
Because urine is filled with urea, soil bacteria that get into the urinary tract can break it down to ammonia and create struvite from the magnesium and phosphate urine always contains.
You might wonder how soil bacteria get into the urinary system.
Because we eat them, with foods that are not cooked, and they become part of the intestinal bacterial population from an early age. In us and around us, they find a way into the urinary system, especially in women whose shorter urethra makes entry easier. No matter how skillfully used, any instrument put into the bladder can carry our personal soil bacteria with it.
What they do
Because they live among molds and fungi, soil bacteria easily mount resistances to antibiotics, so antibiotics given for a urinary tract infection will tend to kill sensitive bacteria and select out those that can resist them.
Soil bacteria can produce struvite stones de novo, or infect calcium stones to produce a mixed stone. Either way, struvite stones are infected by their very nature. They can become huge. Their bacteria can injure the kidneys, even enter the bloodstream and cause sepsis.
Treatment is a mix of thoughtful surgery and selection of antibiotics after such surgery to kill bacteria that remain. If the stones are a mixture of struvite and calcium crystals, new calcium stones need to be prevented.
Cystine stones
Inherited kidney abnormality
Lemon yellow with a sugary coating these form only in people who have an inherited kidney disorder called cystinuria.
Although the kidneys function well, they permit abnormal amounts of four amino acids to enter the urine. Three do not matter that we know of. The fourth makes crystals and the cystine kidney stone type.
Cystine
Cystine (left) forms through the coupling of two identical amino acids – called cysteine – through their sulfur atoms (‘S’ in the line drawing).
Each cysteine contains two carbon atoms – not shown except as corners – bonded together (shown by the single long line that connects the two corners) as in oxalic acid.
One carbon atom has 2 oxygens bonded to it; the other has one nitrogen (which makes it an amino – nitrogen containing – acid), a hydrogen atom, and a sulfur atom. As for phosphate, the dashed and solid arrows simply mean the hydrogens and sulfurs lie above and below the plane of the page and a stick model would have a three dimensional shape.
Cystine Crystals
Cysteine itself is very soluble because the sulfur atom has an appreciable negative charge.
But the big, long cystine molecule has very little charge because the sulfurs bind to each other. So, like uric acid, cystine loses intimacy with water molecules and simply leaves the solution as crystals. Also like uric acid, the process is fast.
Cystine stones
Because people with cystinuria lose large amounts of cystine in their urine stones readily grow large, and fast.
Stones probably form in the urine itself. But cystine crystals can plug the ends of kidney tubules, as calcium phosphate crystals do, causing cell damage.
Since cystinuria is an inherited disease, stones may begin in childhood.
Effective treatment always requires very large amounts of fluids to dilute the urine. The few effective drugs resemble cysteine. Their sulfur groups bond with cysteine to form a ‘mixed disulfide’ more soluble than cystine. But their side effects can limit use.
Rare stones
Here and there we find patients who make uncommon crystals and require very special care.
Uric acid, as an example, can form odd crystals such sodium or ammonium acid urate, especially in people with bowel disease and chronic diarrhea.
Anti-viral drugs can crystallize in urine and form stones only recognized for what they are through stone analysis.
Very rare disorders of metabolism can produce molecules which crystallize in the urine, for example 2-8 dihydroxyadenine.
Although it can take a while before the right answer emerges, stone analyses will put physicians on the right track for these special cases.
The end of a very long post
That’s my parade.
The common animals and the rarer animals have gone by, and you have glimpsed the main ones, big and small.
The one point is what it was at the beginning. Each kind of kidney stone has its own ways, and treatment requires we know which one you have.
Likewise, for whatever that one may be, it is good to know as much about it as you can know. For long term prevention of stones is hard to come by and ultimately what the patience and and consistency of patients themselves matters most.
If you don’t know which stones you have made, find out.
Track down old reports and pull them together.
Keep copies and send everything to the doctors who care for you.
Fred Coe MD
Hello, Dr. Coe.
I have had kidney stones since I was in my mid thirties. I have recently been diagnosed with medullary sponge kidney, although notes mention the possibility back on 2009.
Until recently my stones seem to have been Utica Acid and could only be seen on u/s or CT’s. I’ve had numerous procedures to clean out stones. The last two procedures were 4 mo this apart with removal of over 120 stones (60 from the left and 40 from the right) in the first procedure. The second procedure yielded over 40 – the the doc stopped counting.
Now I am having stones begin to show up on X-ray as well.
I have never passed a stone. Mine are adhered to the micro ducts.
I suffer extraordinary pain on a daily basis… average daily pain runs at a 6-7, and spikes at 9-10 two to three times a month for several days at a time.
ER releases me with a sneer at “punctuate stones – too numerous to count” with no relief for the pain.
My last urine collection was a month ago. The first was completed on a Sunday, the second on a Monday. The results were all within normal range with the exception of mildly low citrate on the Sunday collection. On the past my 24 hour collections have also been in the normal range.
I saw Dr Moe at SW University of Texas in 2013. He agreed my urine collection at that time was perfectly normal and I did. Not look like a stone former from that standpoint. He had no explanation other than some people just have pain with stones in their kidneys. Plan to deal with it.
I now have two Urologists, one locally and one in Little Rock, AR at UAMS and a local Nephrologist. My Nephrologist is seeking an MSK specialist recognizing his own knowledge is too limited to help.
I cannot get a pain management clinic to assist with pain management due to the restrictions put on doctors with the new laws.
My biggest concern is pain management as I don’t pass stones but the constant pain is excruciating. The holmium laser procedures are being limited due to the increased risk of scarring from frequent procedures.
I am having increasing amounts of UTIs despite a daily low dose antibiotic to try to help prevent them. I just clear one up and another strikes. The pain with these infections is very intense.
My quality of life is deteriorating. I am trying to remain a productive citizen and mom to two kids, but the pain is ruling my life and limiting my ability to provide for my family. I do not want to be a victim.
I’m interested in how a normal weekend and weekday 24 hour urine collection play into all of this and what you recommend for pain management?
Warm regards and thank you for your consideration.
Hi Tammy, I doubt the many stones are uric acid,, and suspect they are calcium phosphate – perhaps brushite. Although numerous, my experience is that this kind of accelerated stone disease is rather easy to treat and often associated with normal 24 hour urine collection data. The amount of pain is unusual but may be in part for continued crystal formation. Dr Moe is an outstanding expert, by the way, so your problem must be unusually difficult to resolve. I doubt you have MSK; the physicians who did your ureteroscopy saw your renal papilla and should be able to say yes or no; I suspect it is not MSK but a more common form of tubule plugging. That is what they meant by adherent to micro tubules. I am willing to see you as a patient at U Chicago if your physicians believe I can be of some help. Regards, Fred Coe
Dear Dr. Coe,
I stumbled across your website tonight as I searched for “magnesium ammonium phosphate” in the google search feature. I received my lab results back from a stone I passed last week and it was made up of “20% Calcium Oxalate, 20% Magnesium Ammonium Phosphate and 60% Calcium Phosphate. This composition is unusual as compared to my previous stones and the Dr. is recommending getting a metabolic workup to see why I’m making these types of stones. This is the first stone that I actually passed as the prior instances included uretescopic, shockwave and lithotripsy. In the middle of 2017 I have had a urinary track infection and upon further testing and analysis stones were discovered and lithotripsy was performed in Dec of 2017. I continued to have other issues and as a lifestyle enhancement I was prescribed flomax whic has helped tremendously. Then last week suddenly I passed a stone but I did not experience the severed back pain that accompanied my other stones. I don’t have the actual size but it was bigger than a raisin and spherical in shape. Anyway they also want to do a CT scan abdomen/pelvis to understand if there may be other issues. Thanks for your information on stones just wondering why I have had so many problems with my kidneys over the last year. Thanks, Bob
Hi Bob, magnesium ammonium phosphate – struvite – comes from infection and from faulty stone lab analyses – I would have more stones analysed and have your urine cultured for urea splitting organisms – your physician will understand to do that. 24 hour testing often reveals very high urine ammonia and pH values as signs of such infections. The CT is a good idea as well to see what is there. Glad you found the site. Regards, Fred Coe
Dear Dr. Coe,
I stumbled across your website tonight as I searched for “magnesium ammonium phosphate” in the google search feature. I received my lab results back from a stone I passed last week and it was made up of “20% Calcium Oxalate, 20% Magnesium Ammonium Phosphate and 60% Calcium Phosphate. This composition is unusual as compared to my previous stones and the Dr. is recommending getting a metabolic workup to see why I’m making these types of stones. This is the first stone that I actually passed as the prior instances included uretescopic, shockwave and lithotripsy. In the middle of 2017 I have had a urinary track infection and upon further testing and analysis stones were discovered and lithotripsy was performed in Dec of 2017. I continued to have other issues and as a lifestyle enhancement I was prescribed flomax whic has helped tremendously. Then last week suddenly I passed a stone but I did not experience the severed back pain that accompanied my other stones. I don’t have the actual size but it was bigger than a raisin and spherical in shape. Anyway they also want to do a CT scan abdomen/pelvis to understand if there may be other issues. Thanks for your information on stones just wondering why I have had so many problems with my kidneys over the last year. Thanks, Bob
Hi Bob, magnesium ammonium phosphate – struvite – comes from infection and from faulty stone lab analyses – I would have more stones analysed and have your urine cultured for urea splitting organisms – your physician will understand to do that. 24 hour testing often reveals very high urine ammonia and pH values as signs of such infections. The CT is a good idea as well to see what is there. Glad you found the site. Regards, Fred Coe
Hi, Dr.
My son 8 years, recently urine microscopy reveals plenty oxalate crystals,epith cells, pus cells no growth of organisms, ALL child.
What could be responsible?
Thanks
Pam DC
Hi Pam, Your son may have idiopathic hypercalciuria a common genetic cause of kidney stones, and crystals and bleeding in childhood. His physician can order a 24 hour urine to check, and treatment with diet is very helpful: reduced sodium and ample calcium. Regards, Fred Coe
Hi, Dr.
My son 8 years, recently urine microscopy reveals plenty oxalate crystals,epith cells, pus cells no growth of organisms, ALL child.
What could be responsible?
Thanks
Pam DC
Hi Pam, Your son may have idiopathic hypercalciuria a common genetic cause of kidney stones, and crystals and bleeding in childhood. His physician can order a 24 hour urine to check, and treatment with diet is very helpful: reduced sodium and ample calcium. Regards, Fred Coe
What are you thoughts about Lithostat? I am retired NP, responsible for my brother who has recently had his 4th PCNL in a period of about 3 yrs-he had a large staghorn stone about a year ago and then another smaller stone removed Jan this year and again Aug 31 followed by about 3wks of Irtapenem
Had Postop CT that showed no stones but started having catheter plugging again last week and when catheter pulled, passed a lentil sized stone
He is SCI, post CVA ,age 76, indwelling cath now for about 2yrs ( previously had condom cath before but started retaining) Cultures have grown ESBL, Proteus, Pseudomonas, and gets very septic with recurrent infections
Had Infectious Disease consult after last stone removal in Aug-discussed longer term antibiotic use and possibility of trying Lithostat- he didn’t think Lithostat would be of use since his recent cultures had not grown out Proteus and just advised the longer course of Irtapenem. His urologist had thought the Lithostat would be worth a try ( since his septic episodes are so severe it would be worth the risk-also he is on Eliquis which should decrease risk of PE) but this urologist had suddenly dropped his practice in this area -have a appt with new one in a few weeks
I only have a couple of stone reports
this one from the PCNL this August
Calculi composed primarily of
calcium phosphate (hydroxy- and carbonate- apatite)
and this from a yr ago
40% magnesium ammonium phosphate (struvite),
50% calcium phosphate (hydroxy- and carbonate- apatite), and
10% ammonium acid urate.
I would appreciate any thoughts you might have on this
Hi Carole, The lithostat inhibits urease and would block production of struvite from hydrolysis of urea to ammonia. It will not affect the calcium phosphate or ammonium acid urate. But, if he has struvite stones in his kidneys they will be infected whatever the cultures show, and the lithostat will render the bacteria unable to form more struvite. So, yes, I would give it a try. Very complex problem, and I am very far away, so my opinion is pretty general at best. Regards, Fred Coe
Thanks for your previous reply
my brother recently passed a small stone during an episode of catheter plugging and the analysis again showed up calcium phosphate /apatite so his urologist did not think we should try the Lithostat
I don’t think I mentioned before that he consistently runs an alkaline urine-around 7.5 and I have read about L-methionine and wondered if you had any experience with this ? It would seem that if his urine could be acidified that would help (he has been using cranberry tablets and vitamin C tablets) but he every UA shows alkaline urine
Thanks
Hi Carole, One cannot acidify urine with acid loads for very long for fear of bone problems and also loss of appetite. I would be sure and do 24 hour urine testing to be sure the urine ammonia is not high – urea hydrolysing bacteria. If his kidneys are producing alkaline urine and calcium phosphate stones, this is usually due to a few conditions and treated reasonably. Infection remains high on my list, so when he has a proper workup with 24 hour urines keep an eye out for high urine ammonia. Regards, Fred Coe
What are you thoughts about Lithostat? I am retired NP, responsible for my brother who has recently had his 4th PCNL in a period of about 3 yrs-he had a large staghorn stone about a year ago and then another smaller stone removed Jan this year and again Aug 31 followed by about 3wks of Irtapenem
Had Postop CT that showed no stones but started having catheter plugging again last week and when catheter pulled, passed a lentil sized stone
He is SCI, post CVA ,age 76, indwelling cath now for about 2yrs ( previously had condom cath before but started retaining) Cultures have grown ESBL, Proteus, Pseudomonas, and gets very septic with recurrent infections
Had Infectious Disease consult after last stone removal in Aug-discussed longer term antibiotic use and possibility of trying Lithostat- he didn’t think Lithostat would be of use since his recent cultures had not grown out Proteus and just advised the longer course of Irtapenem. His urologist had thought the Lithostat would be worth a try ( since his septic episodes are so severe it would be worth the risk-also he is on Eliquis which should decrease risk of PE) but this urologist had suddenly dropped his practice in this area -have a appt with new one in a few weeks
I only have a couple of stone reports
this one from the PCNL this August
Calculi composed primarily of
calcium phosphate (hydroxy- and carbonate- apatite)
and this from a yr ago
40% magnesium ammonium phosphate (struvite),
50% calcium phosphate (hydroxy- and carbonate- apatite), and
10% ammonium acid urate.
I would appreciate any thoughts you might have on this
Hi Carole, The lithostat inhibits urease and would block production of struvite from hydrolysis of urea to ammonia. It will not affect the calcium phosphate or ammonium acid urate. But, if he has struvite stones in his kidneys they will be infected whatever the cultures show, and the lithostat will render the bacteria unable to form more struvite. So, yes, I would give it a try. Very complex problem, and I am very far away, so my opinion is pretty general at best. Regards, Fred Coe
Thanks for your previous reply
my brother recently passed a small stone during an episode of catheter plugging and the analysis again showed up calcium phosphate /apatite so his urologist did not think we should try the Lithostat
I don’t think I mentioned before that he consistently runs an alkaline urine-around 7.5 and I have read about L-methionine and wondered if you had any experience with this ? It would seem that if his urine could be acidified that would help (he has been using cranberry tablets and vitamin C tablets) but he every UA shows alkaline urine
Thanks
Hi Carole, One cannot acidify urine with acid loads for very long for fear of bone problems and also loss of appetite. I would be sure and do 24 hour urine testing to be sure the urine ammonia is not high – urea hydrolysing bacteria. If his kidneys are producing alkaline urine and calcium phosphate stones, this is usually due to a few conditions and treated reasonably. Infection remains high on my list, so when he has a proper workup with 24 hour urines keep an eye out for high urine ammonia. Regards, Fred Coe
Thank you for your clear, concise and user friendly articles. I’m not in the medical field, but wanted more detailed answers to my questions. Your articles were exactly what I was looking for.
My 12 years old boy had a surgery done last August supposedly for 3 stones one of them 8cm and the other 6cm and a smaller one , the dr says she was only able to take out only 1 the smallest one because she says the other 2 are inside the kidney calcified and she has no access to enter the kidney, my question is what can be done? These stones are growing ….. can something be done? Please I need some answers I’m very worried about my son kidney issues
Thank you
Hi Taimy, I gather your urologist removed one stone from the kidney and found 2 calcified areas inside the kidney that looked like stones by CT but were not movable. These would be plugs, I suspect, and she could tell if she was doing ureteroscopy. Your child needs serum and 24 hour urine testing to determine the cause of stones, and of course analysis of the removed stone. If the stones are calcium, the most likely cause is high urine calcium that can be managed medically. But testing is necessary. Also, plugging is uncommon in children so his physicians have to consider more complex diseases, including those inherited. Regards, Fred Coe
My 12 years old boy had a surgery done last August supposedly for 3 stones one of them 8cm and the other 6cm and a smaller one , the dr says she was only able to take out only 1 the smallest one because she says the other 2 are inside the kidney calcified and she has no access to enter the kidney, my question is what can be done? These stones are growing ….. can something be done? Please I need some answers I’m very worried about my son kidney issues
Thank you
Hi Taimy, I gather your urologist removed one stone from the kidney and found 2 calcified areas inside the kidney that looked like stones by CT but were not movable. These would be plugs, I suspect, and she could tell if she was doing ureteroscopy. Your child needs serum and 24 hour urine testing to determine the cause of stones, and of course analysis of the removed stone. If the stones are calcium, the most likely cause is high urine calcium that can be managed medically. But testing is necessary. Also, plugging is uncommon in children so his physicians have to consider more complex diseases, including those inherited. Regards, Fred Coe
I’m 33, I had a total gastrectomy in 2016 due to CDH1. Four months later I got my first kidney stone, and several after. A lot has changed in the past couple of years, weight loss, food and water intake. I drink less water now because without a stomach I must try and balance between liquid or calories, though I was never a big water drinker to begin with. My metabolism is now night and day, I can lose pounds in a day, meds kick in quickly but don’t last very long. The stones I had tested where classified as calcium. Every now and then I will get pain for a few days that feels like a stone is working its way out, but I will not always have blood or feel the stone leave. I just had an ultrasound come back clear while having kidney stone symptoms. I read your article about crystals and thought maybe that would be a good place to start with my physician. What are your thoughts? I know I am a complicated case…
Hi Robby, A complex problem. You would benefit from 24 hour urine studies for stone risk factors, as the total gastrectomy may have produced more than a few that need correcting. Symptoms sans visible stones on US could be crystals, that can hurt and cause bleeding. Begin with proper stone risk 24 hour urines and work from there. Regards, Fred Coe
I’m 33, I had a total gastrectomy in 2016 due to CDH1. Four months later I got my first kidney stone, and several after. A lot has changed in the past couple of years, weight loss, food and water intake. I drink less water now because without a stomach I must try and balance between liquid or calories, though I was never a big water drinker to begin with. My metabolism is now night and day, I can lose pounds in a day, meds kick in quickly but don’t last very long. The stones I had tested where classified as calcium. Every now and then I will get pain for a few days that feels like a stone is working its way out, but I will not always have blood or feel the stone leave. I just had an ultrasound come back clear while having kidney stone symptoms. I read your article about crystals and thought maybe that would be a good place to start with my physician. What are your thoughts? I know I am a complicated case…
Hi Robby, A complex problem. You would benefit from 24 hour urine studies for stone risk factors, as the total gastrectomy may have produced more than a few that need correcting. Symptoms sans visible stones on US could be crystals, that can hurt and cause bleeding. Begin with proper stone risk 24 hour urines and work from there. Regards, Fred Coe
What is I’m told I have both calcium phosphate AND calcium oxalite stones?
What is I’m told I have both calcium phosphate AND calcium oxalite stones?
Could you please give some advice for me on what to do? I’ve been told by a kidney doctor that I have both calcium phosphate and calcium oxalite stones. He wants to use a scope and suck them out. I might agree to do this, but I would like to try diet and medication first.
Hi Jana, You need a proper evaluation and then treatment of what is found as the cause of your stones. If stones need removing – pain, bleeding, obstruction, infection, perhaps very large size – go ahead; testing must wait at least 6 weeks for recovery. Or, do it before, and then get on treatment afterwards. If the stones do not need removing, leave them alone. Regards, Fred Coe
Could you please give some advice for me on what to do? I’ve been told by a kidney doctor that I have both calcium phosphate and calcium oxalite stones. He wants to use a scope and suck them out. I might agree to do this, but I would like to try diet and medication first.
Hi Jana, You need a proper evaluation and then treatment of what is found as the cause of your stones. If stones need removing – pain, bleeding, obstruction, infection, perhaps very large size – go ahead; testing must wait at least 6 weeks for recovery. Or, do it before, and then get on treatment afterwards. If the stones do not need removing, leave them alone. Regards, Fred Coe
Dear Dr. Coe, I am a 28 year old male. I just passed a 4 mm stone made of 95% calcium oxalate dihydrate and 5% calcium oxalate monohydrate. My urologist won’t be able to meet with me for months but I want to be proactive with prevention. I have found a lot of contradicting information online regarding oxalate contents of various foods. Do you know of a user friendly list out there that I can use to begin diet planning? Do you have any other recommendations for me till my urologist can get back to me?
Hi John, although oxalate is in your stone, prevention usually does not center around diet oxalate. While waiting for your urologist, here is a good place to start reading about stone prevention. Do not just do an oxalate diet – likely a waste of time sans testing. Even if your urologist has no time right now S/He can order your 24 hour urine and serum testing, and perhaps you could use a nephrologist as a supplement. Regards, Fred Coe
I appreciate you getting back to me so fast. Thank you for the advice.
Dear Dr. Coe, I am a 28 year old male. I just passed a 4 mm stone made of 95% calcium oxalate dihydrate and 5% calcium oxalate monohydrate. My urologist won’t be able to meet with me for months but I want to be proactive with prevention. I have found a lot of contradicting information online regarding oxalate contents of various foods. Do you know of a user friendly list out there that I can use to begin diet planning? Do you have any other recommendations for me till my urologist can get back to me?
Hi John, although oxalate is in your stone, prevention usually does not center around diet oxalate. While waiting for your urologist, here is a good place to start reading about stone prevention. Do not just do an oxalate diet – likely a waste of time sans testing. Even if your urologist has no time right now S/He can order your 24 hour urine and serum testing, and perhaps you could use a nephrologist as a supplement. Regards, Fred Coe
I appreciate you getting back to me so fast. Thank you for the advice.
What category do carbonate apatite stones fall into?
Hi Amanda, These are calcium phosphate stones, and call for careful evaluation and a high prevention effort. Here is profile of such patients. Do not delay overly and be sure treatment is based on what is wrong and causing the stones. Regards, Fred Coe
What category do carbonate apatite stones fall into?
Hi Amanda, These are calcium phosphate stones, and call for careful evaluation and a high prevention effort. Here is profile of such patients. Do not delay overly and be sure treatment is based on what is wrong and causing the stones. Regards, Fred Coe
Dear Dr. Coe,
I have a question about calcium oxalate crystals that I can’t find the answer for online, and I got conflicting info about from a doctor. Are calcium oxalate crystals the same as calcium oxalate stones? The reason I ask is because my toddler had a very severe episode of pain on the right side and fell to the floor screaming on and off holding his side. (The day before he asked me if he had a knife or slivers in his peepee or back, but other than that he was okay.)
I took him to the ER when he fell to the floor, but his pain had subsided when we got there. Hhis urine sample showed high level of RBC and blood and calcium oxalate crystals were present. U/S showed no evidence of urine backup in the kidneys, but he had a very inflamed bladder. Was told by the Dr. it was highly unlikely he had kidney stones and that the crystals are not necessarily stones.
I am just curious if calcium oxalate crystals are the same as stones, and if not would there presence in a urine sample indicate a potential stone issue? We are looking for a specialist for further diagnostic testing but until then I am curious about stones vs. crystals. Thanks!
Hi M.H., Indeed pain, bleed, and crystals all go together as a not uncommon problem in children. It usually arises from genetic hypercalciuria and can be treated with either low sodium diet or low dose thiazide. The crystals cause extreme bladder irritation, and can be a prodrome of stones. He needs 24 hour urine testing – serum as well to be sure about causes -. Hematuria /crystalluria is so common as to have become a routine pediatric diagnosis. Regards, Fred Coe
Dear Dr. Coe,
Thank you for sharing this information. So far no one has brought up crystalluria, but we haven’t seen a nephrologist yet.
Is it possible for calcium oxalate crystals to be transient in nature? He has had several urinalysis in the past for suspected UTIs, but never had crystals. He has had one known UTI, a kidney infection last year (in the same kidney that caused the acute pain episode 2 weeks ago) so I am nervous there is a connection, but he had no crystals when he had the infection,.
Thank you for your wonderful blog and sharing information!
Hi M.H. Crystals are transient. They can produce stone pain with bleeding, and vanish. Regards, Fred Coe
Dear Dr. Coe,
I have a question about calcium oxalate crystals that I can’t find the answer for online, and I got conflicting info about from a doctor. Are calcium oxalate crystals the same as calcium oxalate stones? The reason I ask is because my toddler had a very severe episode of pain on the right side and fell to the floor screaming on and off holding his side. (The day before he asked me if he had a knife or slivers in his peepee or back, but other than that he was okay.)
I took him to the ER when he fell to the floor, but his pain had subsided when we got there. Hhis urine sample showed high level of RBC and blood and calcium oxalate crystals were present. U/S showed no evidence of urine backup in the kidneys, but he had a very inflamed bladder. Was told by the Dr. it was highly unlikely he had kidney stones and that the crystals are not necessarily stones.
I am just curious if calcium oxalate crystals are the same as stones, and if not would there presence in a urine sample indicate a potential stone issue? We are looking for a specialist for further diagnostic testing but until then I am curious about stones vs. crystals. Thanks!
Hi M.H., Indeed pain, bleed, and crystals all go together as a not uncommon problem in children. It usually arises from genetic hypercalciuria and can be treated with either low sodium diet or low dose thiazide. The crystals cause extreme bladder irritation, and can be a prodrome of stones. He needs 24 hour urine testing – serum as well to be sure about causes -. Hematuria /crystalluria is so common as to have become a routine pediatric diagnosis. Regards, Fred Coe
Dear Dr. Coe,
Thank you for sharing this information. So far no one has brought up crystalluria, but we haven’t seen a nephrologist yet.
Is it possible for calcium oxalate crystals to be transient in nature? He has had several urinalysis in the past for suspected UTIs, but never had crystals. He has had one known UTI, a kidney infection last year (in the same kidney that caused the acute pain episode 2 weeks ago) so I am nervous there is a connection, but he had no crystals when he had the infection,.
Thank you for your wonderful blog and sharing information!
Hi M.H. Crystals are transient. They can produce stone pain with bleeding, and vanish. Regards, Fred Coe
Just received lab analysis of my stone. Calcium carbonate (calcite) and calcium oxalate dihydrate. Doctor gave me tips for reducing oxalates. What about carbonate? Could this be from using antacids like Tums? I take about 2 every day. I don’t find anything in my searches about carbonate.
Hi Sandra, Tums can cause calcium stones because of their high calcium content. I would stop them and then get fully evaluated for the other possible causes of stones. Here is a good plan for you. Do not do your testing while taking the Tums. Regards, Fred Coe
Just received lab analysis of my stone. Calcium carbonate (calcite) and calcium oxalate dihydrate. Doctor gave me tips for reducing oxalates. What about carbonate? Could this be from using antacids like Tums? I take about 2 every day. I don’t find anything in my searches about carbonate.
Hi Sandra, Tums can cause calcium stones because of their high calcium content. I would stop them and then get fully evaluated for the other possible causes of stones. Here is a good plan for you. Do not do your testing while taking the Tums. Regards, Fred Coe
Hello Dr. Coe. I have a question, I recently found out that I have a Kidney stones (just less than 1 cm) I was told that it is positioned in the middle of the kidney in a resting area.s I have seen 3 specialists in Urology 2 recommended ESWL and 1 mentioned extracting the stone. My question is because of where my stone is located will it still be possible to extract or break up the stone easily and if so what type of operation/ treatment would be best. The other question I have is how do you find out the compesition of kidney stones. I fear that my kidney stone is in the worse possible place. Any help/ advice would be greatly appreciated.
Hi Michael, With one reasonably large stone, I would hope for ureteroscopy, ideally with a ureteral sheath so ‘dusting’ is not needed, if that is reasonable to your surgeon. The stone material is analysed at a commercial vendor; they all use the same FTIR technique these days. Given the stone be sure to pursue prevention. Here is a good place to start. Regards, Fred Coe
Hello Dr. Coe. I have a question, I recently found out that I have a Kidney stones (just less than 1 cm) I was told that it is positioned in the middle of the kidney in a resting area.s I have seen 3 specialists in Urology 2 recommended ESWL and 1 mentioned extracting the stone. My question is because of where my stone is located will it still be possible to extract or break up the stone easily and if so what type of operation/ treatment would be best. The other question I have is how do you find out the compesition of kidney stones. I fear that my kidney stone is in the worse possible place. Any help/ advice would be greatly appreciated.
Hi Dr. Coe. 1 yr ago I had 5 stones removed from my lt kidney. The stone culture was 40% calcium oxalate monohydrate, 20% calcium oxalate dehydrate & 40% calcium phosphate. At that time, my 24hr urine (Litholink) showed: Citrate 409, pH 6.532, all others values were within the normal reference range. I was directed to add lemon to my water.
Now, a yr later, my ct scan shows 2 stones in that same lt kidney along with two Bosniak 2 renal cysts.
I don’t eat cheese and for the past 7 years drank very little milk. The only dairy in my diet was yogurt, so surely not getting enough calcium. Should I be raising my diet calcium and lowering sodium to balance the oxalate to prevent stone formation or observe a low oxalate diet? Other than autoimmune hypothyroidism, I’m a healthy 60 yr old female, not overweight. Thanks for sharing your knowledge and information here. I find the website fascinating and love the artwork!
Hi Suzanne, So you are forming new stones, or perhaps the two were present after your surgery. Was there a CT after surgery or just a flat plate?? The normal reference ranges are legal fictions, not medically sound. Take a look here, where I give the actual risk vs. measurement values and outline a prevention plan. That your stone was 40% phosphate reflects the high pH and lemons etc have no place. I am glad you like the art – so do I! Regards, Fred Coe
Hi Dr. Coe. 1 yr ago I had 5 stones removed from my lt kidney. The stone culture was 40% calcium oxalate monohydrate, 20% calcium oxalate dehydrate & 40% calcium phosphate. At that time, my 24hr urine (Litholink) showed: Citrate 409, pH 6.532, all others values were within the normal reference range. I was directed to add lemon to my water.
Now, a yr later, my ct scan shows 2 stones in that same lt kidney along with two Bosniak 2 renal cysts.
I don’t eat cheese and for the past 7 years drank very little milk. The only dairy in my diet was yogurt, so surely not getting enough calcium. Should I be raising my diet calcium and lowering sodium to balance the oxalate to prevent stone formation or observe a low oxalate diet? Other than autoimmune hypothyroidism, I’m a healthy 60 yr old female, not overweight. Thanks for sharing your knowledge and information here. I find the website fascinating and love the artwork!
Hi Suzanne, So you are forming new stones, or perhaps the two were present after your surgery. Was there a CT after surgery or just a flat plate?? The normal reference ranges are legal fictions, not medically sound. Take a look here, where I give the actual risk vs. measurement values and outline a prevention plan. That your stone was 40% phosphate reflects the high pH and lemons etc have no place. I am glad you like the art – so do I! Regards, Fred Coe
Hello,
I recently had a kidney stone lithroscopy and a stone analysis is done. I do not understand my results. Do you have any insight?
Calculi composed primarily of:
10% calcium oxalate monohydrate,
20% calcium oxalate dihydrate, and
70% calcium phosphate (hydroxy- and carbonate- apatite).
INTERPRETIVE INFORMATION: Calculi (Stone) analysis
Calculi are the products of physiological processes that yield
crystalline compounds in a matrix of biological compounds and
blood. Matrix components are not reported. The clinically
significant crystalline components identified in calculi specimens
are reported. Gross description may not be consistent with
composition determined by FTIR analysis.
Hi Krista, I do. Your stone is mainly calcium phosphate, and diagnosis of cause and prevention are very important. Here is an article about your type. Here is one about treatment. Regards, Fred Coe
Hello,
I recently had a kidney stone lithroscopy and a stone analysis is done. I do not understand my results. Do you have any insight?
Calculi composed primarily of:
10% calcium oxalate monohydrate,
20% calcium oxalate dihydrate, and
70% calcium phosphate (hydroxy- and carbonate- apatite).
INTERPRETIVE INFORMATION: Calculi (Stone) analysis
Calculi are the products of physiological processes that yield
crystalline compounds in a matrix of biological compounds and
blood. Matrix components are not reported. The clinically
significant crystalline components identified in calculi specimens
are reported. Gross description may not be consistent with
composition determined by FTIR analysis.
Hi Krista, I do. Your stone is mainly calcium phosphate, and diagnosis of cause and prevention are very important. Here is an article about your type. Here is one about treatment. Regards, Fred Coe
Hi Dr Coe, In the past I have had kidney stones, sometimes I pass them, and a few times I have required surgery to remove them and have been told they are Calcium Oxalate type. The colour of them is almost black or very dark. Just over 6 months ago I had a number of them removed by Laser lithotripsy. After treatment I was passing small bits that were almost black in colour as per usual. In the past month or so, I have passed some more, the largest being about 2 or 3 millimetres, but the ones I have passed since the surgery are completely ivory in colour, (no other colour).
For the past 25 years all kidney stones removed or passed have been dark in colour, and even after previous surgery I may pass small fragments for two or three weeks only.
This seems unusual considering my history with kidney stones that I am still passing some and are of a different colour.
My question is: Why would I still be passing stones and why would they now be of a different colour ?
Hi Daryl, I would suggest your physician have these new stones analysed. They sound like calcium phosphate stones, and that can strongly affect your treatment approach for prevention. I might mention that after 25 years of stones, prevention efforts may be less than ideal. Take a look here at an approach your physician may want to consider. Regards, Fred Coe
Dr Coe, thank you for the reply.
Two days ago I visited my Dr and left samples to be analysed.
During the consultation I happened to mentioned to my Dr that my specialist had put me on Vitamin D3 1000IU tablets, and to take 3 tablets per day for 3 weeks and then 1 per day.
I began taking them approx. 8 weeks ago.
My Dr has told me to stop taking the Vitamin D until they have been analysed.
He was surprised by the amount I left as samples. I would pass anywhere from 4 to 16 each day and most very small, about half the size of a sand grain.
Hi Daryl, I presume the samples are stones you have passed. You are wise to have them analysed. You should also want serum and 24 hour urine testing to find out their cause – I cannot find your prior post, so perhaps I have already said this. Such large amounts of stone are not really rare, and often patients who do this exhibit rather modest 24 hour urine abnormalities, but treatment to lower supersaturation usually stops the stones. Regards, Fred Coe
Hi Dr Coe, In the past I have had kidney stones, sometimes I pass them, and a few times I have required surgery to remove them and have been told they are Calcium Oxalate type. The colour of them is almost black or very dark. Just over 6 months ago I had a number of them removed by Laser lithotripsy. After treatment I was passing small bits that were almost black in colour as per usual. In the past month or so, I have passed some more, the largest being about 2 or 3 millimetres, but the ones I have passed since the surgery are completely ivory in colour, (no other colour).
For the past 25 years all kidney stones removed or passed have been dark in colour, and even after previous surgery I may pass small fragments for two or three weeks only.
This seems unusual considering my history with kidney stones that I am still passing some and are of a different colour.
My question is: Why would I still be passing stones and why would they now be of a different colour ?
Hi Daryl, I would suggest your physician have these new stones analysed. They sound like calcium phosphate stones, and that can strongly affect your treatment approach for prevention. I might mention that after 25 years of stones, prevention efforts may be less than ideal. Take a look here at an approach your physician may want to consider. Regards, Fred Coe
Dr Coe, thank you for the reply.
Two days ago I visited my Dr and left samples to be analysed.
During the consultation I happened to mentioned to my Dr that my specialist had put me on Vitamin D3 1000IU tablets, and to take 3 tablets per day for 3 weeks and then 1 per day.
I began taking them approx. 8 weeks ago.
My Dr has told me to stop taking the Vitamin D until they have been analysed.
He was surprised by the amount I left as samples. I would pass anywhere from 4 to 16 each day and most very small, about half the size of a sand grain.
Hi Daryl, I presume the samples are stones you have passed. You are wise to have them analysed. You should also want serum and 24 hour urine testing to find out their cause – I cannot find your prior post, so perhaps I have already said this. Such large amounts of stone are not really rare, and often patients who do this exhibit rather modest 24 hour urine abnormalities, but treatment to lower supersaturation usually stops the stones. Regards, Fred Coe
Hi Dr. Coe. I received my stone analysis yesterday and it is as follows: CA OXALATE DIHYDRATE 55%, CA OXYLATE MONOHYDRATE 30%, and CALCIUM PHOSPHATE 15%. I would like to know why it’s composition is in 3 different types please. I cannot find any information on kidney stones that are composed of differing types. Also, I would particularly like to have any preventative measures, especially diet, that I can utilize to decrease the formation of future stones. Thank you
Hi Vickie, The article you have posted on tells about the two types of calcium oxalate. The dihydrate occurs more when urine calcium exceeds oxalate – in molar terms. But more or less you are a calcium oxalate stone former, and your evaluation and treatment are pretty well covered in this article. Regards, Fred Coe
Hi Dr. Coe. I received my stone analysis yesterday and it is as follows: CA OXALATE DIHYDRATE 55%, CA OXYLATE MONOHYDRATE 30%, and CALCIUM PHOSPHATE 15%. I would like to know why it’s composition is in 3 different types please. I cannot find any information on kidney stones that are composed of differing types. Also, I would particularly like to have any preventative measures, especially diet, that I can utilize to decrease the formation of future stones. Thank you
Hi Vickie, The article you have posted on tells about the two types of calcium oxalate. The dihydrate occurs more when urine calcium exceeds oxalate – in molar terms. But more or less you are a calcium oxalate stone former, and your evaluation and treatment are pretty well covered in this article. Regards, Fred Coe
Hello, I have had kidney stones since age 15 I am 31 now, I pass upwards off 100+ stones per year some with really large crystals, some almost black, some a lighter brown, some very light colored, some a light orange, the stones I pass are different sizes and shapes. I had 1 get stuck and almost kill me. I had a temp of 104.1, was transferred to another hospital and in surgery within 30 mins of arriving. I pass very large stones sometimes. I have save them. I guess my question would be, would a serious medical condition cause that many stones. I don’t even go to hospital anymore, I just wait the agony out at home. I get stones in both kidneys. I’ve passed over 10 a day onetime. I started put at 15 getting 1 every other year, after i had a baby and had gall stones and gall bladder removed I then was getting them every other month, which increased to monthly and over the last 8 years I’m passing upwards of 100+ stones yearly.
Hi Amber, You need to know what these stones are made of, and also what is abnormal in your serum and 24 hour studies that causes such stones. With so many stones, and what sounds like at least one episode of sepsis a proper evaluation is crucial, and followed by specific prevention. I am surprised this has not been done already as it is so important for you. Regards, Fred Coe
Hello, I have had kidney stones since age 15 I am 31 now, I pass upwards off 100+ stones per year some with really large crystals, some almost black, some a lighter brown, some very light colored, some a light orange, the stones I pass are different sizes and shapes. I had 1 get stuck and almost kill me. I had a temp of 104.1, was transferred to another hospital and in surgery within 30 mins of arriving. I pass very large stones sometimes. I have save them. I guess my question would be, would a serious medical condition cause that many stones. I don’t even go to hospital anymore, I just wait the agony out at home. I get stones in both kidneys. I’ve passed over 10 a day onetime. I started put at 15 getting 1 every other year, after i had a baby and had gall stones and gall bladder removed I then was getting them every other month, which increased to monthly and over the last 8 years I’m passing upwards of 100+ stones yearly.
Hi Amber, You need to know what these stones are made of, and also what is abnormal in your serum and 24 hour studies that causes such stones. With so many stones, and what sounds like at least one episode of sepsis a proper evaluation is crucial, and followed by specific prevention. I am surprised this has not been done already as it is so important for you. Regards, Fred Coe
I thought i passed some kidney stones as i had the painfull symptoms. After seeing stuff in toilet, i collected a sample. My kidney docs ordered analysis. It said 100 percent mucin. I do have stage 4 kidney disease, and ipon ct scan my kidneys full of small stones. I also have primary hyperparathyroidism.
Hi Deloris, You have matrix stones that are not rare in kidney disease. You also seem to have a disease that can cause kidney disease, meaning primary hyperparathyroidism. Primary means your serum calcium is itself high, not just that your serum PTH is high. I am sure your physicians will not want you to have uncured PHPT, so perhaps it is just high PTH from your kidney disease, and your serum calcium is normal. I have no real knowledge of your condition so these remarks are just that, and your physicians are entirely responsible for your care. Even so, be sure about this distinction. Regards, Fred Coe
I thought i passed some kidney stones as i had the painfull symptoms. After seeing stuff in toilet, i collected a sample. My kidney docs ordered analysis. It said 100 percent mucin. I do have stage 4 kidney disease, and ipon ct scan my kidneys full of small stones. I also have primary hyperparathyroidism.
Hi Deloris, You have matrix stones that are not rare in kidney disease. You also seem to have a disease that can cause kidney disease, meaning primary hyperparathyroidism. Primary means your serum calcium is itself high, not just that your serum PTH is high. I am sure your physicians will not want you to have uncured PHPT, so perhaps it is just high PTH from your kidney disease, and your serum calcium is normal. I have no real knowledge of your condition so these remarks are just that, and your physicians are entirely responsible for your care. Even so, be sure about this distinction. Regards, Fred Coe
Can kidney stones be a nidus of infection for UTIs in men
Hi Mary, Yes, they can, in a man or a woman. Regards, Fred Coe
Can kidney stones be a nidus of infection for UTIs in men
Hi Mary, Yes, they can, in a man or a woman. Regards, Fred Coe
My dr said I have calcium oxalate mono hydrate kidney stones, I don’t see that one?, is that the same as calcium oxalate kidney stones?
My dr said I have calcium oxalate mono hydrate kidney stones, I don’t see that one?, is that the same as calcium oxalate kidney stones?
Hi Susan, Calcium oxalate monohydrate is indeed a form of calcium oxalate in stones. Regards, Fred
Sorry should of added, my left kidney is blocked, per the IVP exam I had dr said hasn’t been working for a while, but going to leave it at this time, recently had a 4mm Stone zapped out, want to eat the right diet to keep from getting more stones. Thank you
Hi Susan, This sounds like a serious loss of kidney tissue. If there is any residual kidney left the obstruction should be fixed. If there is no longer any functioning kidney then I suppose there is nothing more to do. Be sure to discuss this with your physician. Regards, Fred Coe
Sorry should of added, my left kidney is blocked, per the IVP exam I had dr said hasn’t been working for a while, but going to leave it at this time, recently had a 4mm Stone zapped out, want to eat the right diet to keep from getting more stones. Thank you
Hi Susan, This sounds like a serious loss of kidney tissue. If there is any residual kidney left the obstruction should be fixed. If there is no longer any functioning kidney then I suppose there is nothing more to do. Be sure to discuss this with your physician. Regards, Fred Coe
I received message from urologist that recent kidney stone analysis showed it was 40% calcium sulfate and was complex. Is that possible? Should the nurse have said phosphate instead of sulfate?
Hi Cathy, I am rather certain she should have said phosphate, so call back and check. Perhaps, get a copy of the report. Regards, Fred Coe
I received message from urologist that recent kidney stone analysis showed it was 40% calcium sulfate and was complex. Is that possible? Should the nurse have said phosphate instead of sulfate?
Hi Cathy, I am rather certain she should have said phosphate, so call back and check. Perhaps, get a copy of the report. Regards, Fred Coe
My most recent stone analysis was 5% ca, oxalate monohydr 65% ca phosphate and 30% hydrogen phos, what kind of stone former am I consider.
I started getting stones at 15 but only in my left kidney I have had 13 surgerys and over a hundred I have suffered through passing at home.
Hi Tina, this covers both of your comments. You are a calcium oxalate stone former who also forms calcium hydrogen phosphate – brushite – stones, and almost certainly have genetic hypercalciuria that needs treatment. The brushite stone crystals are worrisome as such stones are quite hard and can grow rapidly and also plug kidney tubules. So a complete evaluation is imperative, and treatment, too. Regards, Fred Coe
My most recent stone analysis was 5% ca, oxalate monohydr 65% ca phosphate and 30% hydrogen phos, what kind of stone former am I consider.
I started getting stones at 15 but only in my left kidney I have had 13 surgerys and over a hundred I have suffered through passing at home.
Hi Tina, this covers both of your comments. You are a calcium oxalate stone former who also forms calcium hydrogen phosphate – brushite – stones, and almost certainly have genetic hypercalciuria that needs treatment. The brushite stone crystals are worrisome as such stones are quite hard and can grow rapidly and also plug kidney tubules. So a complete evaluation is imperative, and treatment, too. Regards, Fred Coe
Are you available for consult via Skype or phone for interpretation of pediatric litholink urinalysis results as well as other quest urinalysis results? Ordering physician unsure of significance of various values and unable to provide guidance going forward re abnormal results.
Hi Dina, Telemedicine is not as yet approved for University of Chicago medical faculty. There are legal issues, insurance issues. Because I do not actually see you in person, there are questions about whether we have a medical relationship, questions that predate modern technologies and the laws have not as yet caught up with reality. If you want to post data on line I can comment about numbers, I do that all the time, and that is not considered medical care because separate from direct medical advice. Sorry for the long and complicated answer. Regards, Fred
my MRI Report says its 1.5mm Cystine-Struvite stone.
Any explanation?
Hi Meski, Cystine is a very special kind of stone, so is struvite. I did not think MRI could do this kind of stone type estimates, and suspect you mean CT scan. A 1.5 mm stone is very small, and I frankly doubt the validity of the report. You should ask your personal physician if he/she is any more convinced than I am. Regards, Fred Coe