Hello
I recently took 24 hour urine test with Quest and calcium levels were 334 the first time then 300 the second in April and May of this year. I had Jill analyze my results and I had also informed her that I was taking over the counter potassium citrate, she advised me that taking this unnecessarily could cause calcium phosphate stones, so I immediately went off of it since I did not need it. From March to November I formed yet another stone. I recently just completed a third test with Litholink Labcorp and shockingly my urine calcium was 444. I am dumbfounded as I have done ALL the right things to get my numbers better including all the recommendations as it pertains to sugar, salt, calcium thru diet,, water and low oxalates eating more fruits and veggies. Recently I implored my doctor to get me on Thiazides but now I have concerns that it may solve one issue but then cause problems in another area such as hypercalcemia as I have provided in the article website above. Aside from some kidney stones I am a very healthy 55 year old woman and am becoming increasingly concerned that taking medication is going to create additional problems down the line. Can you please advise?
Hi Patricia, Possibly the higher urine calcium with the switch between vendors reflects their different approach to sample collection, but clearly you have very high urine calcium levels. I presume your urine sodium is indeed well controlled – 100 or less mEq/day. In general stubborn high urine calcium has a reasonable liklihood of arising from specific causes, such as primary hyperparathyroidism and, with recent advances in technology, specific gene variations. I would advise your physicians consider such possibilities. Reards, Fred Coe
Dr. Coe,
Do you have an opinion on the highly advertised Kidney C.O.P. supplement which touts some 99+% reduction in calcium oxalate stone formation? The primary ingredient is citric acid but it also contains inositol hexakisphosphate to inhibit calcium absorption in the intestines.
Working in the drinking water industry, I am familiar with the chemical process of sequestering certain minerals in the distribution system to prevent binding ( using sodium hexametaphosphate), so a similar concept with those substances that cause kidney stones seems to makes sense. Any thoughts? Thank you.
Hi Ron, I started an article on this and its associates but never went on to finish it. Much hype and in my opinion misleading advertising to the public. The material can – they say – alter growth of crystals in vitro by 99%; this has no clear relationship to a change in human kidney stone production. At most the products – this one included – provide alkali, and therefore act like potassium citrate. Reduction of calcium absorption, if it in fact happens, would threaten bone and act like low calcium diet, a much undesired outcome. Here is a good review of current products by the Dallas group more or less showing how much alkali they provide, and pricing – more or less all there is to say about them. Regards, Fred Coe
Dear Dr Coe,
The studies showing a change from high CT papillary density to nearly normal after a year of increased fluid intake is remarkable. Since the plaque is unlikely to change (ever), have you (or anyone) documented just how fast the change in papillary density happens? You suggested it might be a matter of weeks. This would be high motivation for us stone-formers.
Also, has anyone documented less or smaller stone formation in patients who showed the decrease in papillary density? References appreciated.
Hi Dr Kolba, Thanks for being interested in this matter. I am but no one else I know! I have no data beside what is in the article. Frankly I think the high density is from high papillary calcium concentrations – not crystals – but how to prove that?? Plaque certainly will not change in a year with fluids- our repeat URS cases show it is very stable over even a decade. No one has done a shorter interval hydration study like the one in the article. Warm regards, Fred
I have a recurrent problem with bladder stones related to chronic foley catheter usage. Are kidney stones and bladder stones two different conditions, or can your Kidney stone information and recommendations be used to treat bladder stones also? Thank you!
Hi Richard, They are different. But often abnormal urine chemistries play a role in bladder stones. Your physician will want to analyze the stones and see if there are any prevention options. Likewise she/he will want 24 hour stone urine chemistries for the same reason. Crystals are the same whereever they are and follow well known physical laws. Regards, Fred Coe
Had a stone recently, 5th I think in the last 30 years. Second one I had to have surgically removed. All have been Calcium Oxalate Stones. This is the first time thought it sent me to the ER, so this is the first time I have taken it far more seriously. After a fee 24 hour urine test I can say there are some issues
Urine Calcium: 400-510
Calcium/Creatinine: 300+
Urine PH: High 6.5-6.8
Other good factors
Citrate 700-800, Oxalate 20-25, Urine Volume 3-3.25ml. Urine Sodium around 150.
My doc has me going low sodium (staying under 2000mg/day), and made changes to my diet. I am a 1g or protein per pound of body weight guy as I am a weight lifter. So i have dropped my protein down to 120-150 instead of 200+ grams per day. I normally eat a low fat, low processed food diet. I drink 170-200 ounces of water per day. I get 1000-1500mg of calcium from my food.
Your website has been so incredibly helpful. Full of such detailed information. Is there anything else I can be doing to decrease my risk of forming another stone? Of getting my urine calcium down under the 250 level?
Hi Kenneth, It is interesting to me the stones are calcium oxalate given the urine calcium is very high and the oxalate remarkably low. The pH is very high as well – so I would have expected calcium phosphate stones. Please be sure if that is not the case. Check the actual stone report yourself. I like the high calcium and reduced sodium, and that no one has suggested potassium citrate (urine citrate is high and so is the pH). You do not mention stones in your kidneys, so be sure and get a CT scan (no contrast, modern machines are very low radiation) to ascertain any risk from stones already present. Regards, Fred Coe
Reading through your site there is no mention of medications adding to the formation of kidney stones. I’m 70 yrs old and since being diagnosed with RA 10 yrs ago have been taking Enbrel, Methotrexate, Celebrex, occasional steroid shots and now Lisinopril as HCT lead to raised uric acid levels and “Gouty Arthritis”. I have developed continuous kidney stones – had lithotripsy, ureteroscopy and 3 trips to the ER. Potassium Citrate was prescribed by a Nephrologist but caused extreme, unbearable body & leg cramps within a week of starting the script. Been a life long Water drinker – have an occasional tea and that’s it. Have stopped RA meds a couple of times and stone formation has slowed. I agree diet and water consumption is important – but it is hard to believe that medications can’t also be part of mix.
Hi Sally, You do not say what the stones are made of. The HCT will raise serum uric acid and can cause gout. Given continuous stones, their crystal composition is crucial and likewise for sleuthing which drugs might matter. Regards, Fred Coe
I have a friend who has (1) stone in left kidney in the crick and (1) stone in the right kidney in the crick. They have talked to a dietitian but their Dr will not give them any meds or prevention help. Says eat calcium foods, follow a low oxalate diet, push fluids. The stones are 8 mm and 9mm and may need to be surgically removed. They have been dealing with stones since 2014. Then in 2019 they ended up in the hospital for 4 days from sepsis from a infected kidney stone & UTI. They almost died. I have said to them that they need a new Dr. They also have a cyst on their left kidney besides. Nothing seems to help my friend get rid of the one’s they have or prevent more.
Hi DeeDee, stone prevention is a process. Here is my best by way of an introduction. See if she/he finds it useful. I do not know what the crick of a kidney is, but if the stones are not obstructing, or causing pain, bleeding or infection removal is elective. Regards, Fred Coe
86 Responses to “FLUIDS”
Patricia V
Hello
I recently took 24 hour urine test with Quest and calcium levels were 334 the first time then 300 the second in April and May of this year. I had Jill analyze my results and I had also informed her that I was taking over the counter potassium citrate, she advised me that taking this unnecessarily could cause calcium phosphate stones, so I immediately went off of it since I did not need it. From March to November I formed yet another stone. I recently just completed a third test with Litholink Labcorp and shockingly my urine calcium was 444. I am dumbfounded as I have done ALL the right things to get my numbers better including all the recommendations as it pertains to sugar, salt, calcium thru diet,, water and low oxalates eating more fruits and veggies. Recently I implored my doctor to get me on Thiazides but now I have concerns that it may solve one issue but then cause problems in another area such as hypercalcemia as I have provided in the article website above. Aside from some kidney stones I am a very healthy 55 year old woman and am becoming increasingly concerned that taking medication is going to create additional problems down the line. Can you please advise?
Fredric Coe, MD
Hi Patricia, Possibly the higher urine calcium with the switch between vendors reflects their different approach to sample collection, but clearly you have very high urine calcium levels. I presume your urine sodium is indeed well controlled – 100 or less mEq/day. In general stubborn high urine calcium has a reasonable liklihood of arising from specific causes, such as primary hyperparathyroidism and, with recent advances in technology, specific gene variations. I would advise your physicians consider such possibilities. Reards, Fred Coe
Ron Z
Dr. Coe,
Do you have an opinion on the highly advertised Kidney C.O.P. supplement which touts some 99+% reduction in calcium oxalate stone formation? The primary ingredient is citric acid but it also contains inositol hexakisphosphate to inhibit calcium absorption in the intestines.
Working in the drinking water industry, I am familiar with the chemical process of sequestering certain minerals in the distribution system to prevent binding ( using sodium hexametaphosphate), so a similar concept with those substances that cause kidney stones seems to makes sense. Any thoughts? Thank you.
Fredric L Coe, MD
Hi Ron, I started an article on this and its associates but never went on to finish it. Much hype and in my opinion misleading advertising to the public. The material can – they say – alter growth of crystals in vitro by 99%; this has no clear relationship to a change in human kidney stone production. At most the products – this one included – provide alkali, and therefore act like potassium citrate. Reduction of calcium absorption, if it in fact happens, would threaten bone and act like low calcium diet, a much undesired outcome. Here is a good review of current products by the Dallas group more or less showing how much alkali they provide, and pricing – more or less all there is to say about them. Regards, Fred Coe
Karen Kolba,MD
Dear Dr Coe,
The studies showing a change from high CT papillary density to nearly normal after a year of increased fluid intake is remarkable. Since the plaque is unlikely to change (ever), have you (or anyone) documented just how fast the change in papillary density happens? You suggested it might be a matter of weeks. This would be high motivation for us stone-formers.
Also, has anyone documented less or smaller stone formation in patients who showed the decrease in papillary density? References appreciated.
Fredric L Coe, MD
Hi Dr Kolba, Thanks for being interested in this matter. I am but no one else I know! I have no data beside what is in the article. Frankly I think the high density is from high papillary calcium concentrations – not crystals – but how to prove that?? Plaque certainly will not change in a year with fluids- our repeat URS cases show it is very stable over even a decade. No one has done a shorter interval hydration study like the one in the article. Warm regards, Fred
Richard T.
I have a recurrent problem with bladder stones related to chronic foley catheter usage. Are kidney stones and bladder stones two different conditions, or can your Kidney stone information and recommendations be used to treat bladder stones also? Thank you!
Fredric L Coe, MD
Hi Richard, They are different. But often abnormal urine chemistries play a role in bladder stones. Your physician will want to analyze the stones and see if there are any prevention options. Likewise she/he will want 24 hour stone urine chemistries for the same reason. Crystals are the same whereever they are and follow well known physical laws. Regards, Fred Coe
Kenneth Mantei
Had a stone recently, 5th I think in the last 30 years. Second one I had to have surgically removed. All have been Calcium Oxalate Stones. This is the first time thought it sent me to the ER, so this is the first time I have taken it far more seriously. After a fee 24 hour urine test I can say there are some issues
Urine Calcium: 400-510
Calcium/Creatinine: 300+
Urine PH: High 6.5-6.8
Other good factors
Citrate 700-800, Oxalate 20-25, Urine Volume 3-3.25ml. Urine Sodium around 150.
My doc has me going low sodium (staying under 2000mg/day), and made changes to my diet. I am a 1g or protein per pound of body weight guy as I am a weight lifter. So i have dropped my protein down to 120-150 instead of 200+ grams per day. I normally eat a low fat, low processed food diet. I drink 170-200 ounces of water per day. I get 1000-1500mg of calcium from my food.
Your website has been so incredibly helpful. Full of such detailed information. Is there anything else I can be doing to decrease my risk of forming another stone? Of getting my urine calcium down under the 250 level?
Fredric L Coe, MD
Hi Kenneth, It is interesting to me the stones are calcium oxalate given the urine calcium is very high and the oxalate remarkably low. The pH is very high as well – so I would have expected calcium phosphate stones. Please be sure if that is not the case. Check the actual stone report yourself. I like the high calcium and reduced sodium, and that no one has suggested potassium citrate (urine citrate is high and so is the pH). You do not mention stones in your kidneys, so be sure and get a CT scan (no contrast, modern machines are very low radiation) to ascertain any risk from stones already present. Regards, Fred Coe
Sally Rishel
Reading through your site there is no mention of medications adding to the formation of kidney stones. I’m 70 yrs old and since being diagnosed with RA 10 yrs ago have been taking Enbrel, Methotrexate, Celebrex, occasional steroid shots and now Lisinopril as HCT lead to raised uric acid levels and “Gouty Arthritis”. I have developed continuous kidney stones – had lithotripsy, ureteroscopy and 3 trips to the ER. Potassium Citrate was prescribed by a Nephrologist but caused extreme, unbearable body & leg cramps within a week of starting the script. Been a life long Water drinker – have an occasional tea and that’s it. Have stopped RA meds a couple of times and stone formation has slowed. I agree diet and water consumption is important – but it is hard to believe that medications can’t also be part of mix.
Fredric L Coe, MD
Hi Sally, You do not say what the stones are made of. The HCT will raise serum uric acid and can cause gout. Given continuous stones, their crystal composition is crucial and likewise for sleuthing which drugs might matter. Regards, Fred Coe
DeeDee B
I have a friend who has (1) stone in left kidney in the crick and (1) stone in the right kidney in the crick. They have talked to a dietitian but their Dr will not give them any meds or prevention help. Says eat calcium foods, follow a low oxalate diet, push fluids. The stones are 8 mm and 9mm and may need to be surgically removed. They have been dealing with stones since 2014. Then in 2019 they ended up in the hospital for 4 days from sepsis from a infected kidney stone & UTI. They almost died. I have said to them that they need a new Dr. They also have a cyst on their left kidney besides. Nothing seems to help my friend get rid of the one’s they have or prevent more.
Fredric L Coe, MD
Hi DeeDee, stone prevention is a process. Here is my best by way of an introduction. See if she/he finds it useful. I do not know what the crick of a kidney is, but if the stones are not obstructing, or causing pain, bleeding or infection removal is elective. Regards, Fred Coe