Since women and men differ in so many ways, why not expect differences in how and why they form kidney stones? They do differ, and in ways that can matter as we try to prevent new stones and think about what is most likely to work best for each. The haunting and beautiful “Isaac and Rebecca”, Known as ‘The Jewish Bride’, Rembrandt van Rijn, c. 1665 – c. 1669, oil on canvas, hangs in the Rijksmuseum, Amsterdam. Despite many speculations as to the subjects, including the biblical one at the museum site, experts have failed to reach a consensus. Old News We have known a few differences for a while now, so before I tell you what is new let’s … Continued

Moonstone, KSPtabs, Litholyte, Kidney COP – K Citrate Alternatives

AWAITING COMPOSITION INFORMATION FROM SELLERS Considerable scientific research supports the idea that urine citrate reduces crystallization of calcium kidney stone salts. The research includes two prospective double blind controlled kidney stone prevention trials. Citrate binds calcium, reducing the fraction free to bind with oxalate or phosphate. Citrate inhibits formation and growth of calcium stone forming crystals. Almost certainly, brushite or octocalcium phosphate crystals help initiate calcium oxalate crystallization in urine, and citrate strongly inhibits that process.  Kidney cells control how much citrate is in the urine. Blood concentration is high enough that large amounts of citrate are filtered, but much of the filtered citrate is reabsorbed back into kidney proximal tubule cells that metabolize it for energy. The reabsorption of filtered … Continued


Let me put the main points first, so you know what you are going to read about. Kidney stone formers have increased pregnancy risks for prematurity, need for C-section, low birth weight newborns, gestational diabetes, and preeclampsia. To write about all this I did a PubMed search: “Pregnancy AND kidney stones” which yielded 357 papers published between 1962 and 2021 – a surprisingly small collection. Many are reviews, guideline statements, or specialized  beyond the uses of this article. From the lot, I selected 25 with original data, of which I use those few that concern risks to mothers and their fetuses. I use additional references about preeclampsia risks unrelated to kidney stones. The detail from the gorgeous Arnolfini Portrait, Jan Van … Continued


VIDEO ARTICLE: Watch it or read it.  The title is my story’s conclusion. We know that calcium phosphate crystals in plaque, plugs, and the vast majority of stones are hydroxyapatite, yet when we measure supersaturation with respect to calcium phosphate we measure that for brushite, the pretty crystal in the big image that begins this work. We do it because brushite crystals may initiate calcium oxalate stone disease, so it is wise to prevent their forming. The beautiful image is a hand colored electron micrograph of brushite crystals by Kseniya Shuturminska. I have written about brushite on this site before, but this crystal is so important yet buried in that eerie world where atoms and molecules combine, it seemed to … Continued


Empirical science is ancient beyond imagining, for it is nothing more than the modern version of exploring to find out what is there. Don’t you do it after checking in to the hotel in a city new to you? Go out on the streets and see what is going on, where things are? How people dress, what there is to do? This video, the second in the series, tells about this most reliable and fundamental branch of research science.  The first video in this series, the one that preceded this one, tells about all three branches of science, and is useful here as background.  The featured image that depicts the death of Captain James Cook, painted by Johan Joseph Zoffany … Continued


This entire site concerns the science from which we have derived what we offer to patients for prevention of kidney stones. Every article rests on a base of established and peer reviewed science. This video tells about how science works. We Have Always Had a Science Page For years I have posted articles about science, for those interested. But they have been a mixture of things that interested me from time to time, not an organized primer one could learn about science from. I have made such a primer and plan to present here, on this site. Partly I needed to capture the ideas of science in a physical form to teach it with. Partly I needed to capture ideas … Continued


While half of the world was at Woodstock, I was planning a program for which I had no real model. So I made it up as best I could The press photo shows a Chicago policeman donating blood for his partner who was injured in the line of duty – Michael Reese Hospital 1969.  The Clinical Pathway Sequence I could see no benefit to the conventional clinical visit, laboratory testing, second visit and treatment. Instead the laboratory testing would come first. That way one saves a visit and be more substantive when taking the clinical history. Even then, kidney stones seemed to arise from a delimited set of serum and urine abnormalities we could look for in everyone who formed … Continued


In 1968, I was near the end of my training in renal medicine, at University of Texas SW Medical school,Dallas, and it was time to plan my next few years. I had a job, back at the school I graduated from – University of Chicago – stationed at Michael Reese Hospital. I had some money to build a program and no idea of what to do. The picture is from 1968 and shows the Chair of Medicine meeting with house staff. I was not in this picture. William Yeats and Unity of Being My last teacher, Donald Seldin, Chair of Medicine at UT SW got me reading Yeats. Among his ideas this one seems somehow very important to me. Life has … Continued


As much as diet causes kidney stones, diet change prevents them. Not diet in general, of course, too vague to matter. Thus far decent science identifies only seven components of diet as affecting stone formation: calcium, sodium, refined sugars, potassium, protein, oxalate and high fluids of the proper kinds. A diet correct for the first five components corresponds with present day healthy diet recommendations for all people in the US. Everyone should eat it. Oxalate control and high fluids are specific to stones, however, so all seven components combined is properly named the “kidney stone diet”.  The featured picture shows a new collection of recipes by Melanie Betz that address, excluding fluids, all components of the kidney stone diet. It … Continued


These videos seems very popular and so I have collected all of them in one place so people can find them easily. Some are part of written articles, and essentially walk through the articles and explain what is said. Others are free standing and more elaborate. I confess that video making is a bit new to me, so these are not perfect. But I have lectured for decades and have a reasonable grasp of how to communicate, so if the technique could be better the narrative seems to me pretty good most of the time. This is the growth area of the site, so it will enlarge rapidly. The wonderful picture is by Laurentius de Voltolina (Florence, 1300’s). It hangs … Continued


Pieter Bruegel the Elder (1530-1569) painted ‘Children’s Games’ in 1560. It resides in the Kunsthistorisches Museum, Vienna. Video: Stones in Children On the Rise If you read the many reviews that abound (Pediatr Ann. 2017;46(6):e242-e244; Bowen D K Urol Clin N Am 45 (2018) 539–550; Evaluation and Medical Management of Kidney Stones in Children 2014) they mostly all say the same things. Stones are becoming more frequent among children and adolescents. Generally children form calcium stones, as do adults. They benefit from the same surgical procedures as adults but their smaller size demands specialized skills. Genetic causes of stones tend to manifest earlier in life and are therefore enriched among children. What seems unique to children is their stone risk … Continued


Of all the knowledge on this site, a tiny nugget of three well established facts has explosive power for patients and physicians. Put to actual use they let you prevent idiopathic calcium stones and preserve bone mineral. If you do not want to read the article, I have made a VIDEO to tell you the story in about 13 minutes. On my iphone the video opens well and looks better horizontal. Please let me know if it does not work well for you.  I have not been shy nor secretive. Article after article speak about the three, but always in context so other facts can distract one, as can superb but unmagical paintings from a few masterpieces hung on the … Continued


We have known for a long time that phosphate stone formers are mainly women. We also have long known that phosphate stones form when urine is more alkaline, and that women produce a more alkaline urine than men. So the fact of phosphate stones being more in women seemed a consequence of their physiology. But why? Why do women have this physiology, this alkaline urine? Have it so consistently they form calcium phosphate stones as geological relics? If asked, most would say women do this because of how they eat. Compared to men women eat more veggies, a source of alkali, and less meats – a source of acid. More alkali in their diets, a more alkaline urine, phosphate stones, … Continued