BOOK DOWNLOAD: Physiology of Kidney Stone Formation

A Free New Book About Kidney Stones

Here is a download link for the book

Here is a brief video that walks you through the book

Why Another Book?

It has long been my impression that discussion of kidney stone formation arises less out of the rich detail of kidney function than out of specialized accounts of urine chemistry. This site and the mass of reviews and textbooks seem to share this weakness, that I believe limits understanding and patient care.

Stones form in urine, certainly, but kidneys produce urine in order to regulate blood levels of stone forming materials, and balance their excretions (and that of water) against intakes. So far as I can tell, kidneys must produce urine that satisfies these two life sustaining biological requirements irregardless of whether or not a particular combination of water and mineral losses raises kidney stone risk. So our behavior drives stones, and it is how kidneys regulate blood levels and balance excretions against intakes that translates our behavior into stone formation. I wrote this new book in an attempt to make this translation better understood, in the interest of improved stone prevention.

What is This New Book?

I describe how kidneys fashion urine to match maintain steady and correct blood volume and levels of sodium, calcium, phosphate and acidity, despite what we eat and drink. Looked at from that point of view, urine saturation becomes – as a biological necessity – seemingly incidental, and kidneys indifferent as to whether or not stones will form. On the other hand, over evolutionary time stones must have been a great hazard, pointing to a need for better study aimed at possible safeguards not immediately apparent – at least to me. All of our treatments act on the renal systems that control concentrations and balance, and that has implications for physicians and patients.

The Site Already Has a Book

Its central pylon is a page called ‘Kidney Stone Book‘. It holds a collection of articles written in the form of book chapters each focused on a particular topic. Together they make up what I have chosen as a worthwhile online book for a wide audience. In form it resembles many of the textbooks I have written or edited on the subject. Like them, it fails to show how stones arise as an byproduct of normal renal regulation of stone forming materials. But it does work well as a convenient online source for the kind of information all of us use.

Something in Return

The site and the book have no cost as I believe it a proper thing to make knowledge available everywhere. But in return I would appreciate your knowledge, a kind of trade. The book is version 1. If you find infelicities or downright errors, or a better way to put things, please let me know. A site comment is best as it creates a permanent record on the site so I can be sure and make good use of your contribution. An email is alright, too, but more apt to loss.

22 Responses to “BOOK DOWNLOAD: Physiology of Kidney Stone Formation”

  1. Al

    Dear Dr. Coe,
    Digging into page 61, could you possibly explain whether you think it may be plausible that someone drinking, say 3.5 liters of water per day might see a noticeable daily cycle with “washout of renal medullary urea so that osmotic concentrating power is reduced” by evening-leading to some dehydration during the night, with restoration of more normal concentrating power sometime in the morning each day? Or would such a cycle of any noticeable magnitude be expected to take much longer than a day?
    Thank you, Al

    • Fredric Coe, MD

      Hi Al, It would take a scientific study to test this idea. I think regeneration of medullary solute can occur overnight and washout proceed during the day but whether that would translate into actual overnight water loss excess is very hard to tell. Even if it did, maxumum urine concentration would be less than normal and stone risk as well. Best, Fred

  2. Al

    Hi Dr. Coe,
    I’m learning so much from your book. Thank you! The sections around “Water Balance” and “Adaption to High Water Intake” got me wondering what factors might potentially be contributing to this scenario:
    A kidney stone patient in the care of a nephrologist on a moderate salt & protein diet and drinking 3.5-4 liters of water per day (mostly during waking hours).
    What seems odd is the passing a whopping 50% of daily urine output during the 8 hours of sleep – and requiring drinking of at least 2 liters of water in the first part of the morning to recover from dehydration and get urine flow going normally again.
    Grateful for any insights you might share. – Al

  3. Wendy

    My urologist did not follow through with any suggestions or treatment plan. Would you give me guidance on appropriate treatment you would advise? My 24 hour urinalysis showed normal results except calcium 24 he urine is 480 whereas less than 250 is normal and my brushfire is 2.75 whereas less than 2 is normal. Suspected problem listed on report states hypercalciuric nephrolithiasis.
    Thank you

    • Fredric Coe, MD

      Hi Wendy, Your urine calcium is very high! I suspect your urine pH is also a bit high and wonder if your stones contain considerable calcium phosphate. But all that is mere chatter as I do not really know your medical situation. If your physicians deign to treat, perhaps they might like to suggest a convenient stone center where your rather obvious ‘hypercalciuria’ can be treated along with whatever else may be wrong. I would certainly ask them. Regards, Fred Coe

  4. Eli Coffman

    Thank you, Dr. Coe, for taking the time to write this for all of us to read and learn. Surely appreciated by us all.
    I am going to print this book but (sorry to be picky) I was wondering if there is a way to print with a white background and black printing. The black ground uses a lot of black ink that a white background would not. I can’t figure out if there’s a way to do that. Thank you. Eli Coffman

    • Fredric L Coe, MD

      Hi Eli, White was not good for the many figures. Unfortunately if I make the background white I cannot get the footnote color to become black – I can order the main text to do it. The footnotes are crucial. Some printers have features to print the black as a lighter gray, and some can reverse the printing altogether. I had to make choices! If there is a demand for a book format it will be in white background, and figures will work well for other reasons, but there is no telling it that will prove economically feasible. Best, Fred

      • Al R.

        Hi Dr. Coe, all,
        I found reading white text on black uncomfortable but found a simple workaround that I’d like to share in case it might help others: This assumes that you are viewing the book in a web browser. Search the web for “invert web pages”. That will lead you to a variety of free extensions for many popular web browsers that can add a button to the toolbar that instantly toggles between white-on-black and black-on-white by inverting the colors (remember photographic negatives?) This works perfectly for text-only pages, but you may not want to invert pages containing photographs.

        I can’t thank you enough for the amazing resources you have published on the web and the care you show in personally answering people’s questions. I have something more than normal IH and you have really made a difference in my health and life!

        • Fredric L Coe, MD

          Thank you, Al. The figures do not show up well on white so I had to make a choice. The book is in PDF because I mean to evolve it, and a printed version is confining. Fred

  5. Clarence (C. J. ) Wheeler, MD

    Dr. Coe, you are one of the most amazing people I have ever met! You can’t retire anytime soon. You’re not replaceable! Thanks for continuing to generously share your expertise from which we have all learned much. I hope you’ll be at the ASN this year so that I can hear another one of your beautiful presentations.
    Take care and God bless,
    C. J.
    PS – I have forwarded your email to Dr. Paul D. Miller and Dr. E. Michael Lewiecki. Paul wrote that he was excited about being able to download the book.

    • Fredric L Coe, MD

      Hi Dr WHeeler, Much thanks for the commendation. I will not be at ASN but several of my proteges will be presenting and they are outstanding. The book is important to me as a way of integrating stone disease into the greater complexities of renal fluid and electrolyte physiology. It is a first attempt as I have never tried to do this before. My thanks for letting Drs Miller and Lewiecki know. zMy best to both, and to you as well, Fred

    • Laura bousada

      I agree Dr. Fred Coe us one of a kind and the most generous doctor I’ve ever come across. Generous with his incredible mind and information. Thank you forcall of your article, your website, your accessibility. Thank for all your write and your book. I still cannot see where to change my old email in order to prescribe i guess I’ll keep looking

  6. Neil Mandel

    I am really looking forward to reading your new treaties on our favorite scientific and clinical subject.

    • Fredric L Coe, MD

      Hi Neal, I hope all is well with you and your family. The book aims at integration of stone (and bone) disease into the broad reach of renal physiology, which latter includes the regulators as well. It is a first version, and I did it that way because this integration has not been refined in this way before. No doubt experts like you will find suggestions – very welcome. I plan to update the writing. The simple PDF format makes that practical as opposed to a finished book. Warmest regards, Fred

  7. Maria Franco

    I’ve had stones 7 times and still get them

  8. Jamie

    Amazing! Looking forward to reading it. You are truly a gem. Thank you!

  9. Liz

    Greetings from Australia. I look forward to reading the book and thanks very much for writing and sharing it. I hope it will give me clues as to why my 24hr urine tests are completely normal but my kidney sprouted a stone so painful the ED had me on fentanyl. I suspect I need to understand the interaction with diabetes.
    I tried looking at the video link just now and sorry to say it’s still coming up as “Video unavailable
    This video has been removed by the uploader” on the provided link . However as I’m subscribed to your YouTube page I was able to find a link that works (as have 80 others) and it’s .
    No such problem with the book link.
    I would like to be able to follow you on Twitter and Facebook if you use them, but those links at the bottom of your recent email only take me to the home page and when I search for your name to follow, but it doesn’t appear.
    Thanks again and good luck with sorting the teething problems.
    I don’t like social media generally. Only people such as yourself, who produce excellent information, lure me into that murky world. Thanks again .. Liz

    • Fredric L Coe, MD

      Hi Liz, I tried answering you directly but the email did not go through. It was a momentary error that I made and things work well now. I was on Twitter and Facebook but stopped as it took considerable effort. My partner Jill Harris does social media and sees to it we are visible. If you sign up for my emails you will know anytime I put something new up. As you have guessed I am a professor, and very professor – like, which has its good points. Warm regards, Fred

  10. Rebeccah

    YouTube says the video has been removed by the uploader.

    • Fredric L Coe, MD

      Hi Rebeccah, It was during a transition I made, and now over. Everything is where it is supposed to be. Sorry for the problem. Fred


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