In my 25 years of working with stone formers, as a nurse in residence at Litholink Corporation and in my own practice, the number one question has always been: ‘How much water do I really need to drink?’ Maybe as important is: ‘How Do I Do It?’
Tread Slowly
Many patients leave their doctor’s office with the vague instruction to increase their water input. How much are you supposed to drink to reduce your stone risk?
Even more, patients are told to go home and start drinking a gallon of water a day. If you don’t drink more than a couple of glasses per day now, how are you supposed to drink a gallon tomorrow?
Drinking more water is a simple way to reduce your stone risk, but simple does not mean easy. Most of you find this task extremely hard. I tell everyone to start out slowly. If you drink one glass per day now, then drink two tomorrow. Set new goals to increase your water consumption each week. I have seen people go from 1 glass per day to 10 glasses per day within a month.
Spend Time to Avoid Pain
I can hear you saying now; “I don’t have enough time in the day to spend it in the washroom”.
This is a legitimate response and one I have heard many times throughout my career. I will not lie. You will spend more time in the bathroom, but you will get accustomed to your more frequent bathroom visits. The bigger picture is the one to focus on. Better hydration means you will be less likely to form more stones; this means that water can reduce ER and doctor visits, and lost time away from work. What is going to the bathroom a few more times a day compared to all of the pain, suffering, and expense you will endure if you don’t drink more water?
Be Willful
I have seen my share of pilots, teachers, surgeons, nurses, and traveling salesman all increase water intake despite the time constraints of their occupations. The one thing they all do is make the time.
I have worked with surgeons and surgical nurses before and it is true that they cannot leave the OR to use the bathroom during an 8 hour open heart surgery. Intermittent dehydration can be a real problem in this case. My clients who work in the OR do their best to drink for the rest of the day to try and make up for the loss. Sometimes there is really no choice. Thankfully this is the exception, not the rule.
Once you make up your mind that you do not want to suffer with the severe consequences that kidney stones bring to your life, you will find a way to incorporate more water into your daily routine. It is your choice, your commitment to your health that creates a one day at a time habit of drinking more water.
How Much?
Under the usual conditions of life, 3 – 4 liters of fluids a day will provide 2.5 to 3 liters of urine volume, and this is enough. The average healthy adult bladder holds about 1/2 liter, so this means 7 – 9 bathroom trips in 24 hours.
Input Doesn’t Always Equal Output
Four factors make the answer harder to come by: sodium intake, geographical location, occupation, and exercise.
Sodium intake
High sodium intake can confuse people. It is does not by itself change how much you need to drink, but salt intake can shift the timing of water loss so you think you are not increasing your urine volume even though you are drinking. It does something more. It increases urine calcium losses, a matter we will come back to at a later time.
When you eat a meal that is high in salt, you can count on it decreasing your urine output. I have clients tell me that they drink “a ton” of water but they never have to use the bathroom. The reason is that water is retained with the excess sodium. High sodium meals will decrease urine output that day and even that night, thus causing bloating, worsened hypertension, and higher risk for stones because of higher urine calcium.
But a steady high sodium intake, not just the effects of one meal, will cause a steady water retention and stable weight gain so after a while the extra water you drink will appear in the urine. In fact, when people lower their salt intake they become less thirsty so they have to focus more on drinking or they will ‘forget’.
Even so, keeping your water intake high and lowering your sodium consumption is best. Stone formers who have no medical contraindications to lower salt diets should be aiming for about 1500 mg of sodium per day. People become accustomed to high water intake and low sodium intake, and can benefit not only from the stone prevention but often from a lower blood pressure. How you lower your sodium intake to this number will be discussed in a future post.
Geographical location
There are actually places on the map that we who deal with kidney stones call the “stone belt”. Basically these are the states that are consistently hot and humid or hot and dry. Why is where you live a problem? Simply put, you sweat more. If you sweat more, you run the risk of becoming dehydrated, and being dehydrated reduces your urine volume and makes you more prone to form a stone. If you live in a hot, humid or dry state, you need to drink more to compensate.
Occupation
Are you working construction in the summer in Texas? Are you a camp counselor in Arizona? Do you wash windows for a living in Florida? Your occupation can be the increased risk factor for your stone disease. The reason is the same as above. You are sweating more and need to drink more than the office worker seated in the air conditioned office whose windows you are washing.
Exercise
I am very proud of you that you are doing your daily exercise. We all know how important that is to maintain good health. Exercise plays an important part in stone prevention so make sure you do it. Just remember to hydrate before, during, and after to balance the water lost from sweating!
Tricks
Here are few ways to make water drinking more enjoyable.
Stylish water bottle
Find a water bottle http://www.zazzle.com/fun+water+bottles that you really like carrying around. Seems like such a silly thing, but it really does help. I like big ones so I don’t have to keep getting up to fill it and it makes me very proud to see it empty. You may find smaller ones keep you inspired and you can easily go refill it as you make your bathroom pit stop. Here is an awesome water bottle I have found to help http://www.amazon.com/Basily-Infuser-Bottle-Around-Hydrated/dp/B00M1UOF3K/ref=dp_ob_title_sports
Make Tasty
Add fruit to your water. Adding lemons to your water has the added benefit of increasing your citrate level which is a natural inhibitor of stones, but use fruit that makes you smile most.
Using the product Mio http://www.makeitmio.com/ has helped many patients who constantly tell me that water is BORING. My reply is always, “better boring water than excruciating stones”. It is at that point that they take another sip.
Water is the most benign way to increase fluid intake, but don’t forget to include other beverages in your daily intake: Green tea, lemonade (no sugar), flavored waters, even fruit like watermelon, grapes, etc. will be helpful.
Be Techy
If you’re a phone app geek like me, download this app and track your progress https://itunes.apple.com/us/app/waterlogged-drink-more-water/id352199775?mt=8
Treats
Eat Your Water
Here is a list of foods that are made up of at least 90% water. Be careful. Some of them are high in oxalate and for those of you who need to limit your oxalate intake I have asterisked them: cucumbers, radishes, iceberg lettuce celery*, tomato*, green peppers, cauliflower, spinach*, starfruit, strawberries, broccoli, grapefruit, baby carrots*, and watermelon.
Channel Your Inner Child
I have straws on my counter top in a cute container. They add color, fun, and make drinking water a much more whimsical experience. They also makes the water go down a bit faster. I find myself downing a glass with ease when I have a straw. My son likes it too. No matter what your age or disposition, straws add fun to an otherwise boring activity.
If you are enjoying some grape or apple juice, dilute it with half water. You will cut down on your sugar and increase your water intake. This is a win-win.
A neat way to add color and zest to your water without added calories or artificial flavors: Freeze grapes, or lemon, lime, or orange peels, and add to your water instead of boring ‘ole ice cubes.
Make new habits
Every time you reach for a diet soda, replace it with water. Soon you will just reach for water and your old diet soda will be a long forgotten bad habit.
Upon waking, drink a glass or two of water with lemon. This helps keep your urine alkaline and gets you feeling ready for the day.
In winter, get some hot water, lemon and honey. It will warm you up on a cold day.
Green tea (yes, low in oxalate).
Le Croix. For those of you who are addicted to bubbles. Try this no calorie, carbonated water. It comes in many flavors and has been a staple in my house for the past year. There are generic versions of it for budget conscience stone formers.
Drink a glass of water before and after a meal. Drink water. Eat less. Yet another win, win. Who knew it would be this fun?
Be Patient and Persist
I want you to know that incorporating large amounts of water into your life takes a bit of time. New habits are built with commitment, patience, and an understanding that you are not perfect. You will have days that you cannot get in the amount of water that you would like to. It is ok. Your goal is to do your best on more days than not. And when you don’t, you can get back on track the next day.
Drinking more water is the number one thing you can do to help prevent further stone formation. It also has no bad side effects. So what do you say? Let’s raise a glass, a refreshing, ice cold glass of water. It might just save you from your next ER visit.
A Reservation
Water is always the first line of treatment for stones.The most important thing to do about supersaturation is lower it, and water will do just that. In relation to kidney stone prevention, more is better. In a perfectly healthy younger (below age 50) person taking no medications, up to 5 or even 6 liters a day is safe provided it is consumed over the whole day and never all at once. But if you have heart disease, kidney disease, or liver disease, or are elderly, great caution is important and the amount of water needs to be determined individually for you. When diuretic drugs are being used, to lower urine calcium excretion for stone prevention or for blood pressure control, water intake needs to be no more than 3-4 liters a day and testing is necessary at intervals to be sure blood sodium levels have not fallen. Many other medications interfere with water excretion; psychoactive drugs can do this, for example. All drugs in use must be reviewed with your physician before drinking large volumes of water, above 2.5 liters daily. It is true that most people can easily and safely drink the extra water needed for stone prevention, but the reservations are important, always.
I have recently put together a private FB page called THE Kidney Stone Diet. It is a group that helps educate you on your physician prescribed treatment plans. I moderate it to keep it clinically sound. Come on over and join the discussion!
More You Might Like
Amazing tips tricks and thoughts – personally I love la croix – peach pear is a favorite. I hate water and could never drink it, but la croix has made me a water fan. I can almost say I love it. When I don’t drink water, I now feel the nasty effects: dry mouth, fatigue and salt retention… I don’t want to think about the effects I cannot see.
Thanks for the great ideas!
Hi Laura,
Thanks for writing. Whatever it takes, just do it! Glad you found a way to get your water intake higher. Le Croix is a fun and safe way to increase your water. They make many flavors and it is also a good replacement for soda and/or alcohol.
Thank you for taking the time out of your day to reply.
Very Best,
Jill
For people who spend time sitting in office, going to bath room gives a chance to get out of the chair and do some excercise. Prolonged sitting is not good. Water is also good for complexion, I am told. I like the way you explained the link between salt consumption and water retention.
Dear Barry,
Glad to hear that you have found ways to get your water in. I, too, enjoy room temp water as I find I can drink more that way too!
Love that you found “tricks” that work for you and TV is a great way to get your water in. Better to sip mindlessly, then to eat mindlessly. Good for you!
Very Best,
Jill
P.S. Go GATORS!
Dear Saeed,
Thank you for your comments. You made an excellent point. Getting up to fill your water cup is an easy way to stay hydrated and MOVE! Just another fact I love about water.
Glad you enjoyed the post.
Be Well,
Jill
Dear Dr. Eisner,
I think you are an extremely thoughtful and considerate clinician. Your suggestions are nothing short of brilliant.
Yes, I agree with you. Most patients do not understand how much their urine output is and they do NOT understand how much a liter is- much less two or three. I think your suggestion of getting a bottle that is marked is excellent.
I also agree with your suggestions of tea and coffee and any other drink that adds to daily output. I tell patients to count all fluids as long as they limit sugar, caffeine, and alcohol. It makes the task of drinking more fluids less boring, more doable, and less overwhelming- which naturally adds to better patient compliance. Without compliance we are all wasting are breath, so it is important to make these changes as easy as we can for our patients.
I am so pleased for your suggestions and thank you for taking the time to share them.
Warmly,
Jill
I’ve heard that food colouring could be a cause of kidney stones. Is that information substantiated? If yes, I guess water flavour enhancers should not be used too much.
I know of no evidence that food coloring agents promote kidney stones. So far as I know water flavor enhancers are not a problem in that regard unless they contain a high sugar content.
I having an attack right now and everything I drink including water comes
Right back up.
When stones pass, nausea is all too common, and whatever we write about high fluids becomes for the moment immaterial. The attack needs its own care. It is all the rest of the time that high fluids offer their protection, so that new stones do not form, and new attacks cause all their miserable symptoms and positive risks of harm. Right now, your stone attack needs proper care. Later on, when you feel well, do read the article again and try to follow what Jill Harris said. High fluids are utterly safe and powerfully protective.
I’ve had calcium oxalate kidney stones twice in the last 3 years. I try to drink a lot of water. Crystal Light lemonade flavor has potassium citrate, sodium citrate, and citric acid as some of its ingredients. Are there any bad effects from drinking it instead of (or in addition to) water? How much would one need to drink of it to get enough citrate?
Hi Richard,
Thank you for asking this question. Drinking Crystal Light will indeed help increase urine citrate levels. Doctors will ask you to drink it when your citrate levels are just below what they like to see on your urine chemistries. For great citrate discrepancies they will typically prescribe potassium citrate pills. Has your citrate been tested and found to be low? Or are you just drinking it as a precaution? Dr. Coe has a great post (http://kidneystones.uchicago.edu/price-of-potassium-citrate/) that talks about how much citrate is needed to equal potassium citrate pills.
There is no harm in adding it to your fluid menu. Water can become boring for some and variety is needed.
Keep us posted on how you are doing. And sorry for the late response, I have had my own medical issues recently which makes me even more compassionate in helping you.
Very best,
Jill
Thanks for the great Idea, nowadays I feel good the whole day after I drink 3-4litres a day compared to those days I used to drink only one glass per day.
Dear Z.M,
Good for you. Thanks for taking the time to share your success with fellow stone formers. You are instrumental in motivating others.
Warmly,
Jill
i recently experienced my first kidney stone last week. Prior to this i was drinking around 2-4 glasses of water a day and usually with a lemon or lime added to the water. I am now trying and purposefully trying to drink more water. i have six siblings and 3 of them have also experienced kidney stones. Could this be a genetic trait? i am watching my sodium intake and drinking more water.
My dear Teresa,
You will have to forgive me. I see that I have been negligent in responding to your question. No excuse, but I was in the hospital during the time in February and missed seeing it.
To answer your question, yes- there is definitely a genetic component to forming kidney stones. I am happy that you are paying attention to drinking more water and limiting salt. As you may know, it is important to increase your water intake to 2.5 to 3 liters per day. This is a lot I know, but better this than a trip to the emergency room.
Make sure to get a 24 hour urine collection ordered by your doctor so that you can see exactly why you are forming the stones. There may be other issues besides hydration and genetics that can lessen your risk of forming new ones. Please be diligent on keeping your fluid intake up. It is your BEST defense.
Best of health,
Jill
Dear Jill,
I just had my second calcium oxalate kidney stone in 2 years.
I have lactose intolerance and what the urologist suggested about taking high amounts of dairy products is out of the question.
There are so much healthy green vegetables, fruits, berries, nuts and beans are also high in oxalate which I have to eliminate.
I am now taking 1000mg calcium supplement prescribed by my GP which gives me constipation.
I drink over 2 liters of liquid per day but I hardly pee during the day, frequent urinate starts in late afternoon/evening and I get up 3 times at night during sleep…
I am stress because I still have not found a balance diet to prevent kidney stone.
Please advice and thank you very much in advance.
Sincerely yours
Heidi
Heidi,
I am sad to hear that you are having a hard go of it! You have many different issues here and I will do my best to address each one.
It can be challenging to get enough calcium into your diet, but not impossible. We adults need between 1,000-1,200 mg/day of calcium. Getting it through food is always the best. I would love to see just how high your oxalate content really is before you cut out all healthy, green, veggies. There are actually a lot of things you can still eat in your diet, it is just keeping it all balanced. One of the biggest misconceptions about oxalate is that you can never have fruits or a vegetables again. That is not true and someone who is well versed in a low oxalate diet should be called. I have worked with many people who are diabetics and/or have heart conditions, and I can tell you that after they have a kidney stone and the urologist tells them to stay away from fruits and veggies and nuts these patients are at a loss as to what to do. They have one doc telling them one diet and others telling them the exact opposite. It is very frustrating.
Please go to the Harvard list of oxalate content and you will see that there are still plenty of items you can eat. Also, eating calcium with oxalate foods will help absorb the extra oxalate. For example, have almond milk yoghurt with berries. Salmon, orange juice fortified with calcium and vitamin d, oatmeal and cereals fortified with calcium, sardines, etc.
I am interested in why you are not peeing the water you are drinking out during the day? Do you start drinking later in the day?
If you have time you should email me at jharris1019@gmail.com and perhaps we can set up a time to talk so that I can provide you a bit of help in sorting this all out. It would be a pleasure to help and of course I will do it free of charge.
Hope this helps you feel less frustrated-
Jill
Dear Jill,
I forgot to write in my last email that I also have a soft water system in the house which uses salt. I am very careful and use very little salt in cooking, but I drank over 1 liter of green tea per day make from this “salted” water. Has this water any impacted on my sodium intake?
Sincerely
Heidi
Hi Heidi,
It may, depending on how much sodium you are actually ingesting. You would need to test it to make sure it is not the hidden culprit in your diet!
Very Best,
Jill
Dear Jill,
Thank you for your support and kidness.
I will contact the company which installed the soft water system, and check about the degree of saltines in the water.
I have gone through many websites for days, and made a long list of all the low/medium/high oxalate food. Yes, there are still a lot I can take but it is a bit confusing as the same vegetable/fruit is low/medium on one website but high in another one.
Most website said no nuts at all, therefore cannot take almond milk as you suggested.
I am now buying all the lactose free dairly product, copied many calcium-oxalate balanced recipes, hope I can get enough natural calcium instead of the supplement.
Will write to you about my fluid consumption.
Thanks again for your support.
Best regards
Heidi
I will contact you via email about my
Dear jill now my father’s have some kidney problem.my father’s kidney has 20% damage so plz give me some tips for drinking water everyday.
Jill passed this along to me. High fluid intake is a very good component of treatment for kidney stones, but has little proven worth for kidney diseases otherwise. If your father has had kidney damage because of stones, and you also have stones, this particular post is an excellent guide. Likewise her other one which goes over many kinds of beverages. If indeed you have stones, you also should be evaluated by your physician concerning why you form them, so other treatments you might benefit from can be offered to you.
my dad has renal stones doctor has advised to drink lots of water and he preferred to drink boiled water is there any problem
Boiling is not a problem nor a virtue.
My dad has been at the hospital since 6:15am (March 30) expected to have surgery to remove his kidney stones. They could not get a hold of a doctor so he will be having his surgery tomorrow. I’m at the hospital with him now 11:17pm (March 30) and they haven’t fed him nor have they gave him anything to drink! Is he allowed to drink water? What’s going on?!
I am sorry your dad is ill. I am away in another country or I would have tried to answer sooner. It is common, safe, and usual to give IV fluids and avoid oral fluids or food pending surgery. This is for safety. He should not eat or drink if told not to, as this might prevent safe surgery. The IV fluids will usually be all he needs. Stone surgery is a very well developed area of medicine and I would have good reasons to expect an excellent outcome.
Hi,
On 3/19/15 I had ureteroscopy w/laser to break up a 5mm stone. I found out today via phone call from the nurse that it was a cysteine stone. Does that mean I have cystinuria? I am very upset about this. I do have an appt with the dr. I was told to continue drinking lots of liquids.
Dear Cathy, if indeed the stone was made of cystine, then you have cystinuria. Your physician will know how to treat you so as to prevent recurrences. We have a recent article on this site for patients; here is the link. Lots of fluids are ideal, and there are other treatment options as well, so you do not need to be so upset. Regards, Fred Coe
sir,i have right kidney stone of 7.8mm. So,plz tell me how much water is sufficent to remove this stone??…n how much time it will take to remove stone.??
I am afraid that no amount of water will dissolve a calcium stone, and it is likely that your stone is indeed made of calcium. Uric acid and cystine stones can be made to dissolve with water, however, so the composition of your stones is very important. The water you drink can be crucial in preventing more stones from forming. Water is very valuable for prevention, but often more is required. Fred Coe
Dear Puneet,
It is important to drink as much water as you can to help aid in the removal of the stone. There is no set amount to ensure the natural removal, but suffice to say drink as much as you can tolerate.
It is equally hard to define the exact time it will take for the stone to leave your body. Perhaps it doesn’t and it is keeping you from doing daily activities. If this is the case, you should talk to your doctor and keep him/her advised to your progress.
Keep us posted on how you are doing.
Jill
i have been detected with a 4.4 mm stone in the right kidney in the mid calyx. what can be done to remove it? i need to get rid of it in 1-2 weeks time.
Hi Adolf. This is not a simple question. Often a small stone in a calyx does not need to be removed at all. Exceptions are people for whom a stone presents some special hazard – pilots for example. Removing the stone is a surgical procedure even if shock wave lithotripsy is employed. You will need to consult your urologist about this matter, as the decision for removal, and especially the proposed time table seem challenging. Fred Coe
but can it go through urine…. by drinking water? is cocunut water effective on it?
The stone could pass, like all stones can. Usually this is painful. Drinking water is not known to alter the chances of stone passage. Coconut water has no role I know of.
Hello,
I will be having stone removal surgery on Thursday because the Shockwave procedure did not work. I am not a huge water drink, but I upped my water intake per my urologist request due to the fact that I have the bladder stent in which was placed before the Shockwave was done.
If any of you end up with a bladder stent prior to a procedure, please do what the doctor says and drink the water!! This article lays it out for you. The bladder stent can be irritating but if you drink the water it helps the stent keep from irritating your bladder. I always know when I have not had enough water because it irritates me.
I am nervous about my procedure on Thursday, but also anxious to get it over with and done. Hopefully they will test the stone so I know what is causing them to form.
Caryn
Hi Caryn,
I am sorry to hear that you are having all this trouble. Kidney stones are horrible and everything that goes along with them! Good comments to post for everyone to see. I understand that you are anxious, but getting the stone and having it analyzed will help your doctor accurately prescribe a prevention plan for you.
Hope the procedure went well. Please keep us informed.
Very Best,
Jill
Hello ,
My Whole Abdominal Ultrasound report says :
Right kidney shows dilated pelvicalyceal system with maximum calyceal separation of 7mmat upper pole.Parenchymal thicknessis normal. Acalculus of 4.2mm is seen in its middle calyx.
Rt. ureter is dilated in its upper part (6mm) Lower part is not dilated.
Lt.kidney is normal.
RT. Imp: Hydro-Uretero-nephrosis ( GR-1)
? URTERIC Calculus
Small Rt. RENAL calculus
I was suffering from jaundice in nov and dec.
Please let me know the treatment for this.
Thanks
Akki
right now i had recovered from jaundice , from jan.
Now , i am feeling nausea , fatigue and most of the times , it feels like i will vomit.
Please let me know what should be the right treatment …
Your report and symptoms – they are in your second comment I have not answered separately – suggest you are passing or have passed a right kidney stone – dilated right ureter. The jaundice from last fall was not caused by kidney stones, but perhaps during that illness you were dehydrated and this promoted stones. Your physician has obtained an ultrasound and will no doubt manage your stones properly. You should mention the prior jaundice to any of your physicians who do not already know about the event. I am quite sure the physicians who took care of you while you were jaundiced know what caused the jaundice and have already provided for your care.
Morning, Fredric Coe,
No no , the stone has not passed away. its still in my kidney. I don’t feel much pain for that but when i sit i feel like there is some thing which is stuck at bottom right side ..
Right now i am taking homeopathic medicines for kidney removal.
please let me know the precautions i need to take for this ..
Is there any specific food i need to avoid?
Is there any specific exercise or yoga , by which i can get rid of this stone?
Do i jog/run . i mean is jogging good or bad in stone problem?
Thanks in advance,
Akki
I think it is most important for you to have your physician provide care for you. I know of no exercises, nor food which will alter the course of an actual stone obstructing a ureter or kidney. It is unclear to me what is wrong. Your physicians need to determine this as an obstructing stone can cause kidney damage. Please consult a trained urologist immediately. Fred Coe MD
Thanks 🙂
I just wanted to comment on your thorough and helpful information contained in the “how much water to drink” — thank you very much it was incredibly well written and helpful. Thank you!
Diane-
It is an honor and a privilege to provide help to you.
Warmly,
Jill
Hi, I also want to thank you for your article. I drink a lot of water, my urologist made it clear 7 yrs ago when kidneys were bleeding and so badly I saw more blood than urine. Ct scan showed, according to my Dr too many stones to count and surgery would damage my kidneys more. I do drink as much water as you said. I watch sodium intake, ect. I passed most without a lot of pain. Just recently, had the worst kidney stone pain I’ve ever experienced. Couldn’t urinate for many many hrs. Drank more and more water and cranberry juice. Had a painful urge to urinate really so painful. When I finally did urinate, was very little but looked all blood. The next time I could urinate was much more and still mostly blood. On my 8th day and still urinating blood and water intake is a lot. Saw e.r Dr and she done a culture to see if antibiotics would kill infection and blood test also. No scan and I even asked for one. Still have kidney pain and do not know for sure if it is or was a kidney stone w/ no ct scan done. I don’t feel well,but my concern Is my si sister I lost to bladder csncer, my brother had one kidney removed covered in cancer but his other one was good and is doing well after 10 yrs. Are my chances of cancer great due to siblings having cancer ? I’m sorry but I’m aggitated no ct scan was done and the Drs know of cancer in my family. It has been a long time since I had a ct scan because I was passing stones but now I’m really worried. I’m only allowed which urologist my reg Dr will send me too because I have medicaid. All this blood for yrs worries me. Thank you and sorry for long post. Need advice!
Hi Joanie, Given the amount of recent bleeding and that the blood is so visible, and your family history of bladder cancer I think cystoscopy is a very good idea. In all likelihood the bleeding is indeed from stones but even so stone formers can get other diseases. The pain sounds severe, and that makes me think more of a stone than bladder cancer, so you should have ultrasound or a CT to find out where the stones are, if there is obstruction or not, and if you need a procedure. Regards, Fred Coe
Hi. I have “bleeding kidneys” one urologist said 7 yrs ago. Saw a diff urolgist that said kidneys don’t bleed for no reason. Ct scan showed more stones than dr said could be counted. Advice-surgery would damage kidneys more. I see my reg dr mostly because I have medicaid. Yes the blood in urine is seen by the eye. I just recently endured I believe is a stone. That has had me in extreme pain with a constant painful need to urinate. No urine flow entire night. I do faithfully drink water as you said and watch sodium intake. Dr did no ct scan but checked urine and culture. Finally urinating but it’s mostly blood, kidneys still hurt and done with antibiotics prescribed. My concern is I lost my sister to bladder cancer, my brother had one kidney removed that was cancer but he’s doing fine after 10 yrs. I’m I high risk like I think due to my siblings? I feel I need more testing but Dr is not doing any. Plz advise me of what actions to take. I’m sick more than well and very depressed I can’t live a normal life. Thank you and sorry post was so long.
Hello again, Joanie, I believe I already answered these questions, but if not please let me know. Best, Fred Coe
Hello Dr. Coe: Thank you so much for making this great article available to us “stone throwers.” I am a 14 year kidney stone patient. I have had about 20 =/- lithotrypsies. I pass stones regularly, about one to twice per month without major pain (thank the Lord), and have quite a collection in my kidneys. Last week I experienced my first all out assault of kidney stone symptoms which had me out of work and screaming for 3.5 days. Ugh! I don’t want a repeat incident. My urologist have recommended surgery to have the stones surgically removed which requires 4-6 or 8 weeks of recovery. Can you share any thoughts for me on that via email. Again, thanks and blessings. Bob Cruz
Bob, I just had a laser lithotripsy performed last night to remove a 5 mm stone that was stuck in the ureter just before its entry to the bladder. Debilitating pain started 17 days ago. The next morning, after that first symptom night (2.5 weeks ago), the pain was minor. We gave it 2 weeks to pass with no luck. Over the course of those 2 weeks I had three nights of being up to 4 am…which is what ultimately drove me to go for the lithotripsy…plus I have a 7 day, 4 city trip that involves a lot of air travel. I am now 18 hours post surgery. Didn’t really sleep well last night. Took a Dilaudid about 3 am and finally got to sleep around 4:30 am. No NSAIDs today or Dilaudid and I have minor discomfort for most of the day….however, urinating is fairly uncomfortable. A stent was placed in my ureter…which is likely the cause of the discomfort..but again, mostly only when I urinate. I’ve been performing light yard work, lifting items weighing 25 lbs, and spent 30 minutes on the elliptical. The stent comes out on Wednesday. So I am not sure where the 4-6 week recovery time comes from….but it doesn’t look like that is what I am likely to experience. But this was my first stone and he only lasered one of them. He poked around in the kidney for a minute to see if there was something worth blasting up there, but found only moderate traces of Randall’s plaque, so no additional work was done in that area. Your procedure may be more extensive given your history. My procedure lasted 1 hour. I am 51 years old. My family has a history of kidney stones.
John, Thank you for sharing your experiences. We appreciate your doing it. Regards, Fred Coe
Have had several lithos. Drink lots of water. Most of my lithos are July or December. In December i run around Christmas shopping and don’t drink enough water; July i forgot to adjust for hot weather and drnk more. Have stones right now, on antibiotic for infection. See doc again next week, just had a CT Scan. Question is, i have calcium oxalate stones, also have osteoporosis. Hw do i take calcium for that and not form more stones.
H Judy, Your Question is very important. People with calcium stones and osteoporosis often have high urine calcium excretion – so called idiopathic hypercalciuria. Also, they often form calcium oxalate stones with a higher than average content of phosphate admixture. The treatment of hypercalciuria to prevent stones and protect stones requires that first the 24 hour urine calcium be known and shown to be high. If it is, treatment begins with reduction of sodium intake. Our site is in progress, as is evident, and has not as yet got itself around to the massive calcium story. It will. In the meantime start with knowing your urine calcium level. Low calcium diet is never a treatment for calcium stones when bones are already abnormal – in fact once sodium intake has been lowered properly diet calcium needs to be rather high. But supplements are tricky and high calcium low sodium foods not that common. Once your urine tests are complete and you know your urine calcium and sodium your physician can surely help you find the best way to reduce stone risk. Fred Coe
I just had my 7th lithrotrypsy in 7 years. I have been dealing with calcium oxalate stones for 20 years, but it was last 7 years I consistently increased water intake. I only drink water, not liking milk, coffee, tea or pop I drink minimum of 80 oz a day, trying to get closer to 100 oz. I gave up eating chocolate. I was eating nuts for protein the found out they are bad, so gave up those too. I have approx 20 small stones in each kidney, at one time having 40 in each. (Prior to changing diet drinking more water). So despite my increase in intake over the course of a year, one or more stones grow larger and get stuck blocking my urine. 24 urine levels are normal. Salt intake is not high. BUT I am a sugar addict and trying to control that. Is that causing my stones to get bigger and more to form? I have low vitamin D but urologist said no calcium or vitamin D supplements. I did for a time drink green smoothies (couple of months) and felt fantastic, but quit because of the oxalate. I have idipathic peripheral neuropathy, rare eye disease and overwhelming fatigue. (Not diabetic). I am frustrated. Tired of being “sick” and in pain. I feel like if I eat healthy diet for kidneys, then my other issues bother me. I dont know where to turn. My naturopath is trying to help me navigate this too. Would magnesium supplements help? Am I supposed to or not supposed to take calcium supplements. Any input would be appreciated.
Dear Laurie, I am sorry to hear that your stone problem has proven so intractable. I suspect that although your 24 hour urine studies are apparently normal there is something about the results which could be used as a basis for treatment. For example, if you are making new stones the supersaturations are too high. Sugar will raise urine calcium briefly and lower urine volume at the same time, so perhaps that is contributing, but I doubt that stone numbers such as you describe are arising only from that. You mention the stones are calcium oxalate – is that in fact the case? Often stones are not calcium oxalate but contain considerable phosphate, and require different treatment.
I hope these comments help. Regards, Fred Coe
This is truly one of the best, very detailed tips/advice I’ve read about how to drink enough water. I have friends and family who will surely find this helpful so I’m forwarding this page to them. Glad to have found your site. Appreciate the share and looking forward to read more.
Hip Pain Langhorne PA
Hi. I so appreciate you taking the time to send a reply. It is a distinct honor and pleasure to provide as much info as we can and be helpful.
Enjoy the rest of summer-
Jill
My dad just informed me he has to drink lots of water and take it easy. He is not a happy man just waiting on this stone or stones to come out. I want to help so bad and he is 76 and does not do well sitting at home, I want to help with what will help him pee more and maybe what foods could help? Also he has cholesterol high, border diabetic, and he is not a water drinker. Business man down and out and not even nice to be around. HELP please! Daughter wants to help
Hi Susan, Jill Harris has several articles on this site about how to drink water and other beverages, and which are safe for stone formers. The kind of stones he forms is essential; check out the article and find out what they are. Sometimes men like him form uric acid stones – these are really easy to prevent. I am sure his doctors are doing all they can to prevent more stones, and I am also sure that you are helping a lot by just being there with him and trying to do all you can. Regards, Fred Coe
I’ve been drinking 3-4 litres of water a day for kidney issues. I totally agree that getting a water bottle you like is a big hlep. I tried a few, then found the S’well bottle. Super nice, easy to hold, many design options and it’s double-walled so keeps cold water cold for 24 hours (and hot water hot for 12). Here’s a link to the website http://www.swellbottle.com/
Hi Janice, thanks for the advice on the water bottle. Do you think that very high water intake has reduced your production of stones? Have others in your web support group said this as well? I think it is very important for people to know what seems to be working. Regards, Fred Coe
What an informative and interesting article. Thank you very much for this information. I really do not like the taste of plain water, it makes me nauseous. It was mandatory in basic training, but I still got very nauseous from drinking it. Is it safe to use the Kool-Aid water flavor enhancers? I really love this particular enhancer and just wondered if using it in my water is still a better health option than drinking sweet tea, juice, and soda? Thank you very much.
Hi Yolanda, The mate to this article lists quite a few beverage alternatives and I would advise you pick from them. Likewise you might enjoy the recent article on the water problem – a kind of personal view by my long time research partner. Whatever you do choose, choose a lot of it so urine volumes are high steadily throughout the day and – if you can stand it – night, too. This recent ‘walking tour’ covers the whole matter of fluids and their benefits. Best, Fred Coe
Thank you very much for the response and information. I will definitely check out the links.
very helpful thank you .. I just want you to see my schedule of drinking water a day and tell me if I’m doing anything wrong! .. I drink one liters of water within one hour before breakfast and then I wait for 15 mins in order to have enough time to be absorbed and then I eat my breakfast .. I do the same before lunch and dinner .. and the total is 3 liters .. one thing is that my urine is diluted and I immediately go to the bathroom after I drink the liter ( I urinate 2-3 times after every liter I drink) .. is that normal and healthy or I’m just wasting my time by drinking this amount in short time and then losing it to urine immediately? .. Thank you xxxx
Hi Julie, Yes, you may be doing not quite the best for yourself, and you seemed to say so. If you are about stone prevention you are about crystal prevention, and certainly diluting the urine is a wonderful way to achieve this goal. But if you drink so much in so short a time, the effect may wear off – you will get rid of all the water in a short time – and the urine can become concentrated until the next liter. Crystals never sleep and never make a mistake. So any periods with low flow give them a chance to form and grow. They will try to use that chance. A better approach is to spread the water out evenly throughout the day and evening and, if you can stand it, getting up once at night. Thanks for the wonderful question. Fred Coe
Thank you so much for the reply ! .. I’ll try to change the schedule :* <3
Having been a stone former for over 24 years, two operations and several sessions of lithotripsy, I class myself as lucky. Our ancestors have died from infections and blockages in the urine system and were not as fortunate as us. Yes the pain is excruciating but, at least it comes to a stop with the help of medical professionals. So I would like to thank all those who have set up websites like this one where we realize we are not alone and where we can educate ourselves.
Hi Tony, I am happy for your excellent outcome – no more stones. Likewise, I am happy that the site is useful for you. Regards, Fred Coe
Today, I found I have kidney stone using CT. I am so sad that I cannot breastfeeding in next 24 hours. My son only one month old . Any article or recommendation about how to prevent or help new mom with kidney stone. Do I need more water ? I am so sorry if I cannot brestfeed my son.
Hi, I cannot fathom why you cannot breast feed. Simply maintain a very high – 3 liters or more of fluids a day – fluid intake and go ahead. The amount of fluids you need is easy to judge: If the urine looks concentrated – dark – drink more. When you are done breast feeding, have your physician do the proper testing to find out why you have stones. All the best, Fred Coe
i would like to know however my hubby has kidney stones….he seems drink two glasses of water a day which I think is not enough to flush out the stones also is it normal for a man of 70 to sleep almost all day….he can’t eat even small meals cos he feel sick…let me know any of you experienced those
Hi Sandra, I gather your husband has kidney stones, does not drink much, and does not eat well. What matters here is what kind of stones he forms – usually they are analyzed. As for fluids, if he is making stones, here is a good guide to how much. That he sleeps all day, cannot eat well, and feels sick, for these things he needs to be evaluated by his physician, as kidney stones themselves would only do that during an acute passage episode or because of infection. Have his physician take a look here, and figure out the problem. Best, Fred Coe
Hello, I hate water and could never drink it, but la croix has made me a water fan, thanks.
Hi Alex, I like it, too. Any fluid of this type is fine. Regards, Fred Coe
This is a very good article Fredric which I have just shared in our group. I have a feeling many of our members underestimate the importance of drinking water although they have all been prescribed high fluid intake for stone and MSK prevention. Time flies for all of us, it flies just as fast for stone formers and MSK patients, before they know it hours have gone by in their busy lives without drinking water. If they only knew just how important it is, hopefully they’ll make a bigger effort. I think this article will explain a lot besides giving them helpful tips on how!
Thank you, Celia, It is really critical for patients to keep up a very large fluid intake. Warm Regards, Fred
Hi Fredric,
Great read and very inspiring. I recently had a physical and while drawing blood the nurse mentioned my blood was very dark. She asked me “do I ever drink water” and I replied “sometimes “. Two days later I get my results back and my doctor mentioned something being a little off with my kidneys and everything else checking out fine. We talked and I explained I work outdoors (moving people in Texas at age 42) and sweat alot but would never really drink water. My doctor believes hopefully I’m just dehydrated and to do a follow up in 30 days. I was asked to drink 5 to 10 glasses of water throughout the day before my followup. Well I started drinking a few days back and was curious if it matters what type of water you drink? You see I’ve read that magnesium (found in Evian and Fiji)is very important and regular bottled water really has no health benefit. Yes my question is a little off but wouldn’t it be more beneficial to drink spring mineral water versus typical bottled water?
Hi Tim, Blood looks dark, and I suspect your blood just looked that way. Drinking water will not usually alter the color of blood being drawn. I suspect that you do get dehydrated working outside in the Texas heat and that your doctor found an increased BUN depicting dehydration. Water is a great idea, and whatever kind is provided by your municipality will be fine. Bottled water offers no advantages except you can keep the bottle and fill it from the sink as a convenient way to carry water around. I gather you are not a stone former; if so, you would need a lot more water than otherwise/ I lived in Texas long ago and remember the summers!! Regards, Fred Coe
Does bottle lemon juice kill the kidney stones like regular lemons do?
Hi Susan, Lemon juice from bottles is likely to be like that from lemons. We have an article about how much citrate you can get from lemons and some commercial lemon products. Check it out and compare to medical citrate. The whole idea about lemons is that they have citrate and are cheaper and more appealing than potassium citrate tablets. In general it takes 3 tablets a day to get an effect that is likely to prevent stones. To the extent the product has been tested you can tell if the amount in the beverage will be enough to matter. Regards, Fred Coe
Hi, I absolutely HATE water, I’ve tried putting things in it and it doesn’t help. I am a chronic kidney stone maker, over 14 surgeries in two years and just had another one last Friday. I want to like it but I’m just having a very hard time. The other thing, I don’t get thirsty…ever! I don’t drink soda’s other than sprite and I don’t drink any types of caffeine. My Doctor said I should drink a gallon of water a day….that’s a lot of water. I like iced tea but he said to lay off the tea, I’m not sure he was aware that I only drink decaf iced tea, is this still bad? Please help, I’m at the point of desperation, as I was informed that my right kidney is now so stretched out that if I get another stone in the right kidney I won’t feel it, he said my kidney is starting to fail. I’m just beside myself at this point.
Hi Jennifer, Your problem is not rare. Low flows who hate water find ways. Yea is alright, plain water is never enough. Take a look at what Jill Harris offers for variety. I am sure you have had 24 hour urine testing, and perhaps there are other problems like increased urine calcium, low urine citrate, or other issues that are contributing to stones and can be managed with medications. It is rare that stones cannot be stopped, and I am sure your physicians can offer not only high fluids but additional improvements in urine chemistry. Do not give up on prevention, it is almost always possible. Regards, Fred Coe
I am having stone in both the kidney be oz off calcium oxalates and I also having fatty liver 1st stage.My doctor give me Blong tablet for calcium oxalates. Which I am taking twice a day. I also takes near about 4 to 5 litres of mineral water.what u advice me to do to get free from kidney stone.my another question is I should take tape water or mineral water and how many litres my age is 32.and I am living right now in Oman.
Hi Toufiq, Four to five liters of water is a lot but do you produce at least 3 -4 liters of urine? If your climate is warm, you may need even ore water to achieve those urine volumes. Did your 24 hour urine test show high oxalate, calcium, low citrate? Treatment is aimed at what is abnormal, and water alone may not be enough. Get tested, and be sure your treatments correct abnormal urine chemistries. Regards, Fred Coe
I see that you have Green Tea listed as an acceptable substitute/addition to plain water. Since I have been dealing with calcium oxalate stones for years something besides just plain water would be welcome. Does it matter if it is decaf or regular Green Tea?
Hi Sherry, No; it is not a stone risk beverage and you can use it freely. Regards, Fred Coe
Besides green tea, are there other teas that are low in oxalate that you can recommend?
Hi Sherry, when we made the list we foraged over how things are and came up with only the green stuff. Black teas can have oxalate, and vary a lot, too. One tip: Milk in the tea will inhibit oxalate absorption because of its calcium which binds the oxalate. A proper article on oxalate is long overdue. It is just that this site has a blueprint, a design, and oxalate has not come up yet. Regards, Fred Coe
Hi,
I want to you ask that does working out daily for 40 minutes reduce the risk of kidney stones?
Hi Janki, No it does not, but if you remain well hydrated it also does not pose a risk for more stones, either. Regards, Fred Coe
Nice article. I am a heavy Mio drinker – but my first liter of water every day is usually flavored with the caffinated mio. Does this make a difference? I also have the “fun” perk of horseshoe /conjoined kidneys. My one brush with kidney stones had me in the er on Christmas morning with 15 stones, a kidney infection and sepsis so I’m trying to avoid a repeat.
Hi Aimee, the flavoring and caffeinated addition are not a problem. Regards, Fred Coe
I heard from someone who also has kidney stones that they drink organic lemonade to prevent forming kidney stones.
Is there any truth that drinking organic lemonade will help prevent kidney stones?
Hi David, No there is not a shred of evidence about lemonade. Potassium citrate pills have been effective in preventing calcium stones, and will prevent uric acid stones, and citrus fruits contain citrates, but whether a particular fruit or product contains enough citrate to be useful requires one analyse it. Crystal Light lemonade beverage does contain 20 mEq of potassium citrate equivalent in a liter, so that lemonade product should do what potassium citrate itself does. The idea about lemonade per se was promulgated with no evidence, and is just an idea without support. Fred Coe
Yesterday I had a non contrast CT which showed a 2mm stone in distal ureter, doc. said he thinks it will pas last night or today but nothing yet …have pushed water like crazy… 14 ounces every hour or more. Want to go back to work but trips to wash room every 15 minutes doesn’t work and the strainer is cumbersome. How important is it to analyze the first stone I ever had? Age 62. no pain now after initial bouts before CT.
Hi Shirley, Given the small size it is likely to pass. The frequent urination suggests it is at the junction of the ureter and bladder so it should soon be gone. It is VERY important to analyse the stone, because without knowledge of its crystals you have a much poorer chance at effective prevention. Stones may have started a bit late in life but even so they can become troublesome and prevent is very important. Regards, Fred Coe
Hi Fredric,
10 years ago I had an episode of renal colic (left hand side). I was in a fairly remote area and was dealt with at a very small hospital on a Sunday morning (radiology closed) so that by the time they did a scan I’d already passed the stone (which was lost). 10 years later (and 10 days ago) I had two nights of renal colic (right hand side this time) and was admitted to my local ER. CT scan showed a 5mm stone lodged at UVJ so under GA it was removed (a DJ stent left in place and that was removed yesterday – very painful). I am awaiting results from the stone analysis. However, the scan also showed that I have 3 more stones remaining in the right renal pelvis (largest 5mm). Is there any way of knowing when these will emerge? Is there any way of making them smaller (without medical intervention)? Great, interesting and helpful website! Thanks! Rich.
Hi Rich, Sorry you have accumulated some stones. It would appear you are forming stones, too, because you do not mention the right pelvis stones from 10 years ago. There is no way to predict when or if these three will pass. In fact the statistics of stone passage strictly follow the Poisson function – the one that describes radioactive decay and gambling outcomes – pure stochastics. Unless the stones are uric acid or cystine – the latter is very unlikely – they will not shrink even with medical intervention. What is available is shock wave lithotripsy and digital flexible ureteroscopy with laser disruption. I favor the latter should you opt for prophylactic intervention. Unless you travel to remote places or have a job that stones would affect – airline pilots are a prime example – the best approach is to leave them be but take steps to reduce future growth and new stone formation. This latter requires you know the crystals in the stones and that you take steps to lower urine supersaturation with respect to those crystals. This is the message of this site. I would ask my physicians to help me do this, without hesitation, and now. Regards, Fred Coe
Thanks Fredric for your response which is very very helpful. Yes, as you say, the scan 10 years ago revealed nothing in my right kidney so these stones have formed since then. I do sometimes travel to somewhat remote places so I will ask my physician about the available interventions. I note your comment and your preference for laser disruption, but may I ask why you prefer laser to SWL? Is it simply more successful? I’m still awaiting the analysis of the stone (and am looking forward to more focussed reading on this site once I have it!) In the meantime, I have increased urine flow to over 2L/day and working on increasing further still, although this is a challenge!
Hi Rich, I prefer ureteroscopy with laser stone disruption because your urologist can see all the stones in the kidney, even small ones, and also take a look at the kidney itself looking for plaque and plugging. SWL causes a lot of kidney trauma, bleeding, and tearing, which certainly was preferable to older treatments, but modern scopes have made SWL rather a secondary approach except if you had one isolated stone in the renal pelvis and wanted it out. Fluids are great but so are 24 hour urines to look for causes of stones, and likewise a routine blood to be sure about other diseases. Regards, Fred
Hi Fred, I have the stone analysis; it’s a whewellite type 1a, composition >95% calcium oxalate monohydrate, dark brown, regular, concentric. Analysis also says this suggests intermittent hyperoxaluria. Ok. I don’t have 24hr urine or blood tests at this stage. Apart from keeping up the fluids, I guess this means I should limit dietary oxalate? But is it true that dietary oxalate is OK if eaten with high calcium foods (idea here being, I suppose, to form calcium oxalate in the gut rather than in urine)? Anything else I can do? By the way, from a dietary perspective I am vegetarian and have been for most of my life. Appreciate your comments, thanks, Rich
…since posting the above I found http://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/ … a must read!
Rich, It is a great article, but get tested, too! Fred
Hi Rich, The stone is the most common one and does not ‘suggest’ intermittent hyperoxaluria’ as the hyperoxaluria might be constant or not at all, and the problem lie elsewhere. Yes, you do need 24 hour urine studies because without them you and your physician are flying in the fog with no instruments turned on. For the time, I would drink enough water to get three liters of urine while waiting for the test results. There is no reason to bother yourself with diets until you know they are necessary. I must say that vegetarian does sound oxalate like, but why guess? Regards, Fred
Thanks Fred, much appreciated. Rich.
Hello Fred, it’s been a little while but I had a 24 hour urine test. I wonder if you have any comments on the following data.
Urine Calcium (random) 1.82 mmol/L
24hr urine volume (acid) 3000 mls
Calcium (urine 24 hours) 5.46 mmol/24
Phosphate (inorganic urine) 13.4 mmol/L
Urine Phosphate (24hrs) 40.2 mmol/24h
Rich
Hi Rich, The volume is great. Urine calcium is fine, the calcium concentration in the 24 hour urine is low – 1.82, the phosphate is not useful by itself, and there are no supersaturations. But from what I see things seem pretty good. Regards, Fred
Hi again,
I forgot to update…I underwent right flexible ureterorenoscopy, stone extraction and retrograde ureteropyelogram. 3 stones were removed. All calcium oxalate as previously. Also from the surgeon in follow up letter…”There were other areas in his kidney with calcifications within the renal papillae, a condition called Randall’s plaques, which are associated with an increased risk of further stone formation.”
Hi Rich, Plaque is an anchored crystal deposit on which calcium oxalate stones form. The linked article links to the other articles on it in the site. Plaque does indeed mean that recurrence is perhaps more likely, and that prevention proportionately more important. Here is my favorite article on the subject. Regards, Fred Coe
Hi Dr. Coe,
I came across your website today and find it quite informative. Thank you for posting it. I am a stone former for approximately 31 years (right after my first child) and have had approximately 20 stones. Over the years I have followed my MDs tx plan at one time low calcium, (that changed), then low oxalate consumption (that changed somewhat) and have been told to increase my water consumption which I have. Most stones I passed, but only the last 2 years have I had to have procedures of x3 SWL and 1 PCNL. I have several questions. Do you need to drink that much water (2000-2500 cc) if you are not active? I use a wheelchair now (last 5 years) and weight 135 pounds and spend a lot of time in front of my laptop. In the past I have had several 24 hour urine tests with volumes ranging from 1150 to 1250 cc but did only had stones occasionally. I have now increased that to 1800 cc. I was told in the past that I have calcium oxalate stones but my recent 24 urine saturation test showed calcium oxalate crystals to be 1.10 while my hydroxypatite crystal level was 3.96. My pH was 6.2. As I just received the results today from the hospital’s portal, I have not heard from my MD. Can you switch from ca oxalate stones to ca phosphate stones? Thank you. Judy
Hi Judy, I like the high volumes, and you should keep them up. Yes you need the high urine volumes whatever you do. The urine volumes you describe are too low, the 1800 is just adequate. Indeed you can switch from calcium oxalate to calcium phosphate stones. I am going to guess that your urine calcium is high, which – with the modestly high pH – will foster calcium phosphate stones. If it is high low sodium diet and perhaps thiazide diuretics will prevent more stones. Regards, Fred Coe
Thank you for your response. My urine Ca was 194 and P at 774. All other tested minerals were also wnl. My nephrologist called me back and we discussed the test results. His opinion is that taking K Citrate (10 meq) along with HCTZ (12.5 mg) to prevent additional calcium oxalate stones elevated the hydroxpatite crystal level. He wishes to continue with the treatment plan and have me retested in 6 months. I will continue on a low sodium diet but plan to increase my oxalate consumption in vegetables as I would like to drop 10 pounds as my BP, ironically, has become elevated (164/74). Life is all about balance! Thank you. Judy
Hi Judy, your urine calcium under treatment is just under the beginning of stone risk (200 mg/day) so low sodium diet and the drug are a good idea. There are many vegetables with little oxalate, so it is not necessary to add much oxalate in order to eat that class of foods. Harvard has the best list. I am sorry I have not as yet been able to get an article on food oxalate up on this site, but will. With high fluids and the rest of your treatments, your urine calcium phosphate supersaturation can certainly be lowered. All the best, Fred Coe
Thank you again. I find it difficult to drink as much fluids as is required. For most of my life I was known as a “camel” but have tried to change my life patterns. I had to push fluids to reach 1800 cc as my output. It is now challenging to transfer with a wheelchair. I will check Harvard’s website for their list on oxalate levels in vegetables. I found that my Vit D3 levels significantly increased due to even a low level of HCTZ (from 74 to 132) without sun exposure and immediately quit taking my Vit D3 supplements for osteoporosis. After 3 months of no Vit D3 supplements, my level decreased to 56. I have decided to re-start taking 2000 units x3 a week (MWF) for its cardiovascular and dental health benefit. I wish to increase my level to 70-80 range. I will try to maintain my fluid intake. Best regards, Judy
Good Luck, Judy, in keeping up high fluids. I was not aware that thiazide diuretics raise 25D levels in people taking supplements. Regards, Fred Coe
I had two pharmacists check for drug interactions under the Facts and Comparisons website. As I have my Vit D25 level checked usually twice a year, I assumed it was from one of the meds prescribed by my nephrologist as no other variables had changed since the last test. Both pharmacists found the reaction from adding the HCTZ. Thank you for recommending Harvard U for a complete list of foods that contain oxalate. It was a surprise to see such a large amount of foods on it that contained high levels of oxalate. In all the years that I have had kidney stones, both MDs and RDs gave me a short list of foods to avoid. This was a shock. I have not been been able to determine what is the normal daily recommendations of oxalate and what level is recommended for those of us who form calcium oxalate stones. Thank you again. Judy
Hi Judy, we are preparing a new article on oxalate. I think 50 – 100 mg of oxalate is about the right range for a stone former. The article seeks to make a reasonable diet plan, but will be not be done for a week or so. In the meantime the list is ideal and try to fashion a plan from it. Note how many foods are completely fine! I take it your stones are indeed calcium oxalate. Some people form calcium phosphate stones so oxalate intake is less important. Regards, Fred Coe
Hi Fredric, I am 24 years old and have had kidney stones for the past 4 years now. It started out where I had one every so often and then gradually progressed to every few months, then every month, every week, and now I pass a few on a weekly basis. I am fortunate that I have not had to have surgery and that they pass with less intense pain on most. It still hurts and stops me from time to time, but being in constant pain I have learned to somewhat get used to it. I drink at least 64 oz daily and have stopped drinking my beloved sweet tea. I have went to the doctor many times, but they are not concerned and say that it will not cause permanent damage. My husband and I are trying to get pregnant, but I do not want it to become worsened due to the pregnancy. Do you know anything about this or how I can stop or slow them?
Hi Meagan, At 24 years old and passing a few stones every week I would say your physicians might want to be concerned a lot. There is a reason for all those stones, and virtually all stones can be prevented. You need proper evaluation and preventive care. Please bring the need for prevention to your physicians. If they cannot provide 24 hour urine and blood testing, and use it for prevention, ask if they can make a referral to a convenient physician who can. If not, let me know and I will try to identify someone near where you live who can help you. Fred Coe
Hello. I am a 36 year old single mother of 3. I have had several kidney stones in the past and last Monday was diagnosed with 2 more, both which are 7mm in size. After the ones I had a few years ago I started drinking more water and less caffeine and I had been doing well until recently. My issue is that I have a hard time getting my day started if I don’t have caffeine, I’m always tired or just have no energy. I usually drink a large coffee every morning and then a 12oz can of soda in the afternoon. I know I need to drink more water but I’m very picky about what I drink. I don’t like carbonated water or water with fruit taste and I can’t stand tea. Is the Mio bad for the body like caffeine? Do I need to cut out my caffeine all together? I’ve been pushing myself to drink more water but it’s hard when I’m never thirsty. How can I change that or make myself WANT to drink more? Thank you.
Hi Tonya-
I don’t have a problem with you having the coffee. That is ok. You do however need to drink water as well, even though you don’t have thirst. I rarely am thirsty, but will drink anyway.
You can add Mio to your water. Not a problem. Drinking more water will help keep your energy up as well- believe it or not. You just need to make the commitment to drinking more water. You do it because you have three kids, are way too busy, and don’t have time to deal with getting more stones.
Perhaps thinking hard about the consequence of NOT drinking more water will increase your motivation to do so.
Other beverages count toward your total daily fluid too. If you have time-read the post on this site discussing “variety”.
Hope that helps-
Jill
Hi– I had a kidney stone when I was pregnant with my son two years ago and am now pregnant with my second child. I am 18 weeks and have had a couple of ‘pain episodes’ already that I believe are kidney stone pains. The only recommendation my doctor says is to drink lots of water. I drink 32 ounces of water at work plus usually another 2-3 glasses of water, green tea, soda, or milk a day. Any recommendations on preventing another kidney stone? And, why does pregnancy cause me to have them? My mother, father, brother, and sister have all had kidney stones, but I have only gotten one while pregnant.
Thanks.
Hi Ashley, I imagine your family harbors idiopathic hypercalciuria, and you have it too. During pregnancy urine calcium rises in everyone, but perhaps more in your situation. In our one study of the matter, pregnancy itself did not seem to promote more stones. The problem is that not a lot can be done during pregnancy because of risk. Also, because it changes the contours of the urinary tract pregnancy may foster passage of old stones so it is never clear if attacks are from new stones. I would try to keep my urine volume above 3 liters daily as much as is possible to reduce the chance of crystallization- that is 3 quarts, and when you have had your baby get tested for the cause of stones and also get proper prevention. If you nurse, do not do testing because nursing will distort the pattern of mineral metabolism and be misleading. Fred Coe
I have had numerous episodes of kidney stones being passed over the lat few years. How do you know if its related to kidney disease or real function issues?
Hi Lisa, Usually kidney stones do not cause kidney disease of major significance. It is important that your physician screen for systemic diseases that can affect the kidneys. Assuming none are present you can pursue prevention of stones so they will not keep forming. Regards, Fred Coe
Thank you.. my concern is I am 46 and having alot of stone episodes.. none have had to be removed.. thank goodness.. but does entering the “pre-menopause” stages of life. Can that cause more stones to develop?
Hi Lisa, Urine calcium may increase with menopause and possible foment stones. Whatever the cause, stone episodes can be reduced. Give it a try. Regards, Fred Coe
So is that a thumbs up or a thumbs down on adding Mio? As someone who runs too, nearly daily for 30-60 minutes, and sweats moderately (more in the summer), I probably need to consume an additional liter to liter and a half, give or take. I’ve also read that gender and weight are a factor (male, 215 lbs and losing, for the record)… FYI, if I run 60 minutes or more, I usually do a sports drink post-run, but any less, and it’s plain water. So guess my 2 questions are, 1) does 160 US fl oz (4.7 L) sound like it’s in the ballpark for me personally, as a starting goal? And 2) does the slight sodium content in the Mio have an adverse effect on my system in terms of kidney stone (uric acid) prevention, but beneficial to my exercise (electrolyte replenishment/avoiding hyponatremia)?
Hi Mark,
I have no problem at all with adding Mio. The sodium is very low and I understand the need for the electrolytes with you being a runner. Go for it. As far as the amount of water you are consuming, you keep that up and you are off to a great running start – sorry couldn’t help myself.
Keep up the good work!
Jill
Hello sir ! I’m Akash ! I’m 19 year old, I had two kidney stones 2 years ago..first was at the age of 15 and another was at age of 17.. Boath stones size was 1 centimetres squire.. The stones were made of calcium oxhilate.. Since I increased the volume of urine.. I drink 3-4 litre of water.. And I maintain my Diet.. I reduce the calcium and sodium as well oxhilate in my food.. Even though I got again pain while urine.. And in ultrasound stones have not seen yet.. Last time when stones came out in 5 ultrasounds stones were not seen.. Please suggest something to reduce my tension.. Thanks..
Hi Akash, Calcium oxalate stones are the common type but they are not so common in people as young as you and your brother. I think it is very important to have proper 24 hour urine testing to find out the cause, and fix whatever is causing them. In particular urine oxalate is a possible problem. You need to have your physician do this for you. Regards, Fred Coe
I am a 52 year old woman. I have had 3 parathyroids removed. I have since then found out I have a 3 mm non obstructive kidney stone. I have a lot of flant pain related with this stone. My doctors say there is no pain related to the stone. There going to check me every year to monitor the stone. And will not treat the pain. I was wondering if I could get some idea’s on how to get this stone to pass so I don’t have to deal with it anymore? I have pain each and everyday. It is becoming very depressing. Any advice I can get would be greatly appreciated. My doctors have not been very informative. Thank you
Dear CHerie, I gather you have had surgical treatment for primary hyperparathyroidism and I presume you are not cured. Likewise I gather the stone has been discovered since that cure, although it may have formed when the disease was active. A stone should be removed if it causes significant pain, obstruction, bleeding or infection. If you have so much pain as to warrant surgery then you should discuss that with your physicians who would want to help rid you of that pain. By the way, many patients remain hypercalciuric after curative parathyroid surgery so be sure to get followup 24 hour urine testing to be sure there is no more stone risk.Regards, Fred Coe