HOW TO DRINK ENOUGH WATER

Jill jpegIn my 13 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.

Understanding how much water to drink and all of the details behind it can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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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

Jill Harris on Variety of Beverages

Our Page Dedicated to Patients

Tips On How To Get The Most From Your Physician

Supersaturation: The Key To Stone Disease

Understanding how much water to drink and all of the details behind it can be exhausting. I just released a course called The Kidney Stone Prevention Course to help you understand how to implement your physician’s prescribed treatment plans.

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220 Responses to “HOW TO DRINK ENOUGH WATER”

  1. Awais

    thanks for article …
    I just want to know that is there any connection between kidney & testicles ..
    bcoz I’m having pain in my kidney ,, which is now almost cured after taking many water ,,, but I also have a slight pain in my one testicle

    Reply
    • Fredric Coe, MD

      Hi Awais, Pain from the kidney can radiate into the testicle on that side – shared nerves. So be wary the pain is not from a stone blocking the kidney on that side. Regards, Fred Coe

      Reply
  2. Alfred Reed

    Americans who are honest about this will admit to confusion by the jumble of terminology: liters, gallons, ounces, and glasses. A writer, as well as a doctor, should be specific and consistent. My recommendation: First of all PLEASE, PLEASE use American vocabulary of gallons and ounces consistently. Second, do not use the term “glasses,” because household water glasses easily range from 8 ounces to 16 ounces. I suggest that writers and physicians simply tell us HOW MANY OUNCES per day. Readers and patients are very capable of using an American measuring cup from the kitchen, and then choosing appropriate glasses or other vessels to use for drinking!

    Reply
    • Fredric Coe, MD

      Hi Alfred, thanks for the serious and important comment. You are right about glasses and also about the problem of US vis. much of the world in terms of units. I am asking Jill to read this, too, and perhaps we can go back into the key articles and be sure US units are available throughout. Regards, Fred Coe

      Reply
    • jill Harris

      Dear Dr. Reed,

      I not only appreciate your feedback, but know you are absolutely right. We will go back and edit our articles.

      Many thanks-

      Jill

      Reply
  3. Robert McClure

    Hi, can water flavoring packets cause stones ? is there an ingrediant that i should look out for in the packets ?

    thank you !

    Reply
  4. homa

    Thanks for the great Idea and that’s useful for kidney stone, nowadays I feel good the whole day after I drink more than 3 litres a day compared to those days I used to drink only one glass per day.

    Thanks a lot.

    Reply
  5. Susan

    Hello,
    I have just had my first experience with kidney stones, calcium oxalate, and had a laser lithotripsy procedure which went very well. My stones were attributed to a vegetarian diet extremely high in oxalate. all these foods were in my diet on a daily basis – spinach (at least 2 servings per day), almonds, cashews, peanut butter, carrots, tomatoes, black tea, etc. I also didn’t consume much calcium, or water, and I am now seeing a nutritionist and she has created a plan to balance my diet. My problem continues to be water consumption. I am committed to doing all I can to prevent future stones, but I am not sure how much to drink. My nutritionist established a range for me, and also advised that I be guided by the color of my urine as a gauge of whether I’m staying well hydrated. I have been consuming between 50 and 70 oz. per day, and keeping track of it on an app, but I really don’t feel well over the course of the day when I drink this much. My urine is usually very light to almost clear by early to mid afternoon, and sometimes I feel dizzy when I reach this point. Does this mean I’m consuming too much water? I spread it out over the course of the day, learning my lesson after feeling awful after consuming 88 oz. by noon several days after my procedure. I only weigh 97 lbs. and I’ve read that a person should consume ounces about half of their body weight. I don’t know how much I should be drinking, so that it’s enough to help prevent stones but not too much to create other problems. Also, how would I accurately measure output? Thanks for your help, I really need some guidance!

    Reply
    • Fredric Coe, MD

      Hi Susan, You are encountering the problems with a single modality treatment – just fluids have proven inadequate and cumbersome. Take a look at what it did indeed do and fail to do. You presume your diet caused the stones and maybe it did, but be sure you really know what is the cause. Here is a plan. Assuming you are a common CaOx stone former, here are the treatment data and how that kind of person can treat stones without drowning. Good Luck, Fred Coe

      Reply
    • Fredric Coe, MD

      Hi Susan, You are encountering the problems with a single modality treatment – just fluids have proven inadequate and cumbersome. Take a look at what it did indeed do and fail to do. You presume your diet caused the stones and maybe it did, but be sure you really know what is the cause. Here is a plan. Assuming you are a common CaOx stone former, here are the treatment data and how that kind of person can treat stones without drowning. Good Luck, Fred Coe

      Reply
      • Susan

        Thank you, Dr. Coe,
        This is fantastic information I will be reading several times, as there is so much to learn and balance. I will definitely be implementing more changes in what I need to do in my quest for no more stones. Again, thank you!
        Susan

        Reply
    • jill Harris

      Hi Susan,

      I am happy to hear that your procedure went well. Have you done a 24 hour urine collection to see precisely why you made kidney stones?

      Typically you want to be having 2.5 liters of output to decrease your risk of new stones. As funny as it may seem you can track how much you are peeing by using a “hat” underneath your toilet seat like they use in hospitals and measure how much urine you are producing every day. Look on Amazon or your nearest medical pharmacy. Use this link for Amazon: https://www.amazon.com/s/ref=nb_sb_noss_1?url=search-alias%3Daps&field-keywords=urine+hat

      As far as you feeling dizzy, you should report this to your doc.

      Best,
      Jill

      Reply
      • Susan

        Hi Jill,
        Thanks so much for your reply. I have had a 24 hour urine with a urologist I wasn’t particularly happy with, and at that time, I had another appointment scheduled with a different urologist who would be doing my procedure, so I didn’t ask any questions beyond what the first doc told me about my test. Frankly, I didn’t know what to ask and he didn’t go over each value with me. The urologist who did my procedure didn’t give me feedback on the 24 hour urine ordered by the other doctor, and I will contact him to explain these values to me because your question about the 24 hour collection prompted me to look at the results and there are are three that appear to be out of range. What is Dietary P24, PCR, and CA24/CR24? My risk factor profile looks okay, the only value being toward the right as a higher risk value was Ph. I fault myself for not pursuing more details about my test results, I am usually one who wants all the information, but I didn’t pursue further answers in this situation. I will definitely do that now. Thanks again for your reply, and link to the hat. I’ll get one and see how I’m doing!

        Susan

        Reply
    • jill Harris

      Susan,

      Good to hear. Think about taking The Kidney Stone Prevention Course that Dr. Coe and I put on. Go to my website to check it out- jillharriscoaching.com/course. New course is starting next week. You will find it very helpful!

      Jill

      Reply
  6. Mark

    hey im drinking a lot of water but its really hard to pee and when i drink so much water it causes me to vomit. The doctor said he’s seeing small crystals on my kidney when i went to have an ultrasound. I’m still trying to drink as much water as I can to somewhat remove the thing that blocks when im trying to urinate. If there’s any advice you can give to me that will be helpful.

    Reply
  7. Saket K

    I was diagnosed with a 3.4 mm stone in ultrasound which was sitting in calyx , right kidney. Few days later I had severe pains running thru kidney, stomach and the abdomen. I got my CT scan done on that day and was told that the stone is somewhere in the bladder junction. The pains were miserable and stopped by end of the day. I guess I passed the stone as I could notice some particles.

    A week later after I had my ultrasound done, a stone sized 3.6 mm was found sitting in calyx of right kidney. I am bit confused as to whether this is a new stone formed or the same one with increased size. Additionally, the stone was found in bladder thru CT scan. Is it possible that a stone may not be detected in either of the tests even if it existed?

    What home remedies would you advice for less painful passing the stone? And of course I have been drinking a lot of water.

    Reply
    • Fredric Coe, MD

      Hi, Saket, No home remedies in this kind of complicated situation. You may have two stones, one in the kidney and one near the bladder. Only your physicians – who can see your scan images – can tell, and you need to be sure from them. The kidney stone would not form in a few days, and CT scans far surpass ultrasound in stone detection, so the story does not seem quite right as it stands. As for prevention, here is a good plan. Nothing but fluids and, where needed, medications matter for passing stones. The key is prevention of more. Regards, Fred Coe

      Reply
  8. Tina

    Hello, I have been a stone former for 33 years now and have have had upwards of 38 ESWL and my nephrologist says absolutely no more of them. I am sitting here today with not only stones but MSK and PCK which upon reading of the CT with and without contrast the techs stopped counting at 12 obviously huge cysts (over 12 cm each) The stones I have now are all sitting in the lower pole and unable to pass. The hydronephrosis has dissipated this week but is likely to return at any time. I have high BUN and Creatinine and my eGFR is down in the upper 40’s most times. I follow protocol and was taken off hydrochlorothiazide and put on chlorthalidone as I was told this was better for stone formers, and had been stone free for 3 years. My new primary care took me off the chlorthalidone in January and within 3 months I was back forming the stones. The only change was the removal of the diuretic so I can only assume that is the problem. I am also now a full member of the osteoporosis club and osteoarthritis clan. She wanted me to take calcium but my nephrologist was adamant about not taking calcium at all. I am confused on this aspect having read so many responses where you say taking calcium is better to bind the oxalates for removal. What are the next steps for someone who can no longer have the ESWL with all the side issues I have. Oh and I am going to say I only drink water (infused with fruit or lemons) and nothing else. But I do drink 5/30oz cups a day or more depending on my thirst level.

    Reply
    • Fredric Coe, MD

      Hi Tina, If you have PCK – polycystic kidney disease this site may not serve your needs well. That disease causes stones but is quite specialized. I am not sure about why your drugs are changed but perhaps your nephrologist can help. In terms of using supplements, have you been evaluated to determine your urine oxalate – is it high? Do you need something to lower it. Given kidney disease, bone disease becomes complex in its causes. My suggestion is to discuss with your nephrologist what it is you really have; if it is PCKD with significant kidney insufficiency your treatment must focus there – on those diseases. If any confusions exist, perhaps you might seek consultation at a university center that specializes in PCKD management. Given 38 SWL treatments, however, I wonder if your kidney disease may not reflect effects of so much shock wave exposure. Regards, Fred Coe

      Reply
  9. Sherry

    I am a kidney stone patient (had 2 stones, 1 is now gone after shockwave treatment; other one is not causing problems now). I am trying to work up to drinking at least 2.5 liters of water a day. So far I have only gotten up to about 60 ounces, and that is hard enough. My problem is that I get an uncomfortable abdominal bloated feeling by the end of the day from so much water. Is there anything i can do to prevent this or remedy it? Thanks very much.

    Reply
    • Fredric Coe, MD

      Hi Sherry, You need an organized prevention program. Here is a good plan. If you can try to follow it and find out what is best for you to prevent more stones. Water alone is cumbersome because if it is your only protection you need so much. It is better to look at all the stone factors and improve each one a little bit to achieve protection. Regards, Fred Coe

      Reply
    • jharris

      Hi Sherry,

      Many times drinking water and being bloated is bc you are eating too much salt. Lessen your salt to 1,500 mg/day and you will definitely feel less bloated.

      Jill

      Reply
  10. A

    How to drink enough: chug 16.9 ounce bottles of water 4-8 times a day. Four 16.9 ounce bottles of water is exactly 2 liters and is roughly the minimum amount of water people should drink daily. It’s really that simple. There are no tricks needed. Fear of pain should be enough motivation. 😂

    Reply
  11. Rich

    Hi Fred. Am slightly confused as to why they didn’t test for oxalate, given my stones are calcium oxalate. I have asked. Anyway, thanks for your comments, good to know it looks normal.

    Reply
    • Fredric Coe, MD

      Hi Rich, I cannot find the thread for this. Most 24 hour urine packages include urine oxalate. I must have seen results and commented but cannot find where I wrote it on the post noted above. Regards, Fred

      Reply
  12. Aleksandar

    Hello and thank you for this article. At the age of 18 I have just been diagnosed with one kidney stone (0.5 x 0.5 cm) but other than that I’m “clean”. I have never drunken al lot of water or fluids ever. In fact I only drink water and sometimes juices (never sodas). But still I have always seemed to dehydrate myself up to the point where I had headaches and needed to vomit (with the age of four I started to hesitate to drink enough fluids). I will be trying to drink more (using the tips listed above) but I still feel like it is more to it. Why would I never drink enough? My doctor told me that it is rare to have kidney stones at my age. So there has to be a reason for my “not drinking”. They have not removed the stone yet (and once they remove it they will analyse where it came from) so do you think it could be something special other than a calcium stone? Thank you for you time and help here.
    Best wishes
    Aleksandar

    Reply
    • Fredric Coe, MD

      Hi Aleksandar, There probably is more to it. People who make stones usually harbor more causes than just low fluid intake. Low intake is habitual and you can change that habit but only over a long time and slowly. Make slight increases and hope for perhaps an extra liter of intake over a year. Whatever else caused your stone proper testing can disclose – here is a good plan of action. One removes stones for a reason – pain, bleeding, obstruction, infection, so there is no need to do so if it is not disturbing you or your kidney. Finding the cause is important and so is a gradual increase of fluids. Regards, Fred Coe

      Reply
  13. Jeff

    Hello,
    I endured my first stone 5 months ago. I didn’t know what was going on and went to the E.R. I’ve had spiral fractures, diverticulitis, ruptured discs, and nothing compared to this. The CT scan showed a 4.5MM stone , which I passed about 14 hrs later in the hospital, and several stones in both kidneys. I have passed 6 more stones since then, at home, at an average of one per month. Most took about 4-8 hrs of agony to pass, with the help of drinking a glass of water every 30 mins. My question is how can I find out how many are left my kidneys??? I understand just because they are there doesn’t mean I will ever pass them, but I would like to know what to expect because having this happen every month is giving me severe anxiety. I asked my doctor and all he would tell me is the report said there were several in both kidneys. I know CT scans are expensive, but is there any way to convince them to give me another one and maybe count the stones that are left just for peace-of-mind? I’d like to get them all out and have a clean slate to work with.
    Thank You,
    Jeff

    Reply
    • Fredric Coe, MD

      Hi Jeff, You are passing many stones and need to know why. Here is a good plan. Be sure and analyse the stones – all of them – to know what you are trying to prevent. As for the CT, of course you need it. How else to know what is in the kidneys as a baseline for prevention. As for removing them, No; until you know what is causing the stones, removal is foolish; they will come back. Regards, Fred Coe

      Reply
  14. SG

    I’m a type 2 diabetic. I drink a lot of water which causes me to urinate alot. Recently I started having a lot of urination even though I’m drinking a large amount of water. What could be the cause of this?

    Reply
    • Fredric Coe, MD

      Hi SG, If you drink a lot of water you will excrete it, so urine volume will rise. Your question says you are having a lot of urination even though you are drinking a lot of water; I presume you mean even though you are not drinking a lot of water. If that is what you mean, and you are a diabetic, the usual cause is that your blood glucose is high and you are losing excess glucose in your urine. Glucose is a diuretic. You need to let your physician know right away and without fail so things can be checked and if abnormal treated before something unfortunate occurs. Regards, Fred Coe

      Reply
  15. Stephen

    Hi, I just have a question! My grandpa has had a kidney stone, only one. He was a big fan of nuts, and I heard nuts can cause stones. My dad formed two stones b/c he constantly had a half gallon of Wawa iced tea everyday. I’m 18, and a male, I was hoping that drinking enough water a day and watching sodium and oxalate input will lower my chances of kidney stones. There is no past of family health problems with stones. And I wanna know if drinking enough water will severely lower my chances of a kidney stone. I really don’t want one. Please help!

    Reply
  16. Erin Coyle

    Hi I am a procedural nurse, and have had two very large stones, in 2002, passed one and had lithotripsy for the other large one. The small stones in my left kidney didn’t respond to lithotripsy- With working in the OR I am often frustrated that there is no time in between cases to void. I do drink an average of about 3.5 liters of water daily. At my annual check up, in September the UA was positive for blood, rechecked a week later and was also positive. CT showed tiny stones in the left kidney, I think they are the same ones that did not respond to lithotripsy. 24 hour urine was output of about 2500 cc- elevated calcium at 318 , low phos 0.5 and low protein 26. I am unconvinced that these are new stones. I have had two UA negative for blood. I am pretty disciplined about keeping my fluids to between 3000-4000 cc /day. I eat very few carbohydrates, limit salt, and am wondering if I should be on hydrochlorthyazide? My urologist is keen to do a cystoscopy, I am normal weight, take wellbutrin, no other meds, and am experiencing NO symptoms. NL BP, no diabetes… not really wanting a cystoscopy …. since my UA’s have shown no blood ? What are your thoughts?

    Reply
    • Fredric Coe, MD

      Hi Erin, You have hypercalciuria presumably idiopathic, and a job that may lead to periodic and repeated low urine volumes within a day that is overall marked by high urine flow. Those dips in flow in the OR – if any – are an opportunity for increased supersaturation and crystal formation. You did not mention your urine sodium; given the urine calcium is quite high I wonder if the sodium is really as low as you might like it. The stones may well be calcium oxalate being small, and one wonders if the oxalate is higher than is ideal, and likewise about citrate. Here is an article you might find useful. Here is another. As for small stones in kidneys sans symptoms, I know of no evidence supporting removal just because they are there. Regards, Fred Coe

      Reply
  17. google

    Your style is really unique in comparison to other
    people I have read stuff from. Thank you for posting when you’ve got the
    opportunity, Guess I will just bookmark this
    page.

    Reply
    • jharris

      Hi Nolan,

      Thanks for taking the time to write. Glad you are finding the articles useful. Let us know if you need anything-

      Jill

      Reply
  18. ashok

    I have kidney stone of 6mm and 6.9uric acid blood but very good in 24hr urine collection but my protein level in24hr urine collection is 156 .is it the singn kidney failure

    Reply
    • Fredric Coe, MD

      Hi Ashok, Protein in the urine can be from blood. Stones cause blood in the urine. As a first step check the report and see if the protein was measured in a urine sample that tested positive for blood. Repeat the measurement using a sample that tests negative for blood. Regards, Fred Coe

      Reply
  19. Linda J

    I’ve suffered from kidney stones. Since my last attack, I drink at least 84 oz of water a day. I started drinking decaf green tea but was told not to by my doctor because it could cause stones. Is this true? I enjoyed the tea but don’t want to go thru that pain again. I would appreciate your input

    Reply
  20. Sailon

    Every morning I drink 2 liters of water at the same time. is there any other side effect for kidney?

    Reply
    • jharris

      Hi Sailon,

      I think it is great you are drinking so much in the morning, but does this mean you don’t drink anything else for the day? I always say that each of you needs to find out what works for you best, that is the only way you stay on your treatment plans. But I think that although you are doing an excellent job in the am, you might want to think about incorporating more fluid throughout the day.

      Let me know what you do for fluids after the morning.

      Best,

      Jill

      Reply
  21. Bella Roberts

    Hello! I am a 13 year old girl and this advice will be helping me! I first learned about My kidneys being in danger when I was at my doctor. Now I am drinking fluently of water. But my problem until now was: It was not helping much! It will be a pain to eat vegetables, but I will live through it. I already spin in a circle for 40 or 30 minutes, but I will pick it up. And I am now saying it: NO MORE SODAS!

    Reply
    • Fredric Coe, MD

      Hi Bella, It is unusual for stones to damage kidneys so I wonder what it is your physicians have found that puts them in danger. The only thing I know about like that is very high urine oxalate. Is that what you have??
      Regards, Fred Coe

      Reply
  22. imran

    Hello Dear jharris,

    Hope you are doing well. I am 38 year old male, On 25/5/2016 i got sudden pain in right kidney when i did the ultra sound i found 2mm stone there. i was very worried but the doctor told me no medication at this point just take more and more water daily. So from 1/6/2016 to 31/8/2016 in my daily diet i include almost 5-6 litter bottle water . The water which is available in our market mostly bottle and almost every brand have such composition like Bicorbanates. 26, Sulphates,26,Cholorides,19.Calcium,11,Magensium,3.4, sodium,17. During 1/6/2016-31/8/2016 my salt intake was normal . on 1/9/2016 i did my ultra sound again and was surprise bcz stone size was now 3.7mm in right kidney i am very worried now bcz i was thinking since i m drinking water daily so might be stone will be gone but its actually increase.

    In short now my dr told me that i should not eat salt at all.
    My question is:
    should i stop eating salt at all?
    can i continue to drink bottle water with above mentioned composition? is it safe ?

    In vegitable and in fruits which exact things i should NOT EAT AT ALL?

    Just for your kind ref i am taking mutton only once in a month and chicken once in a week

    Your advise will be so appreciate.

    Reg

    Reply
    • Jill

      Hi!

      First off- you know I am going to ask this question- have you done a 24 hour irine collection to see if you need diet alterations? You need to if you haven’t.

      I cannot recommend any diets to you until we know that vital information!

      Whether you make stones or not, limiting sodium to 1,500 mg/day is best for stone prevention and general good health.

      As far as fruits and veggies you need to do a collection to see if these healthy foods need to be limited. Come back and let us know that answer to that.

      Thanks for writing!

      Jill

      Reply
  23. Reka

    Hi I have a question too. I recently started having high bp 160-130/110-90 for the last month. It keeps varying. Few months ago my bp spiked when I had fever. It came normal later on. I had done tests, ecg and echo to check my heart function, which seems to be fine. My cholesterol is also ok. Doc says I don’t have ashma. Sometimes I keep getting breathless. How woken up at night a few times due to it. I took a urine test and scan which showed 2-3 kidney stones biggest of which was 3mm.

    My questions are: does high bp cause breathlessness? Does high bp cause stones or is it beacouse of high bp that i got stones?

    Also, recently I have been under stress. Had a loss in the family. My dad had cardiovascular problems. His bp was normal though. My cousins from mother s side have kidney stones previously.

    Please reply.

    Thanks in advance,
    Reka

    Reply
    • Fredric Coe, MD

      Hi Reka, The stones should not be causing high blood pressure nor will high blood pressure cause stones; I assume your kidneys function normally as your physicians have been careful about your care. The intermittent breathlessness with high pressure, also intermittent, coupled with stress in the family could be panic attacks – they mimic heart disease. Your doctors would have thought of pheochromocytoma, a rare benign endocrine tumor that raises blood pressure. I think panic attacks are worth thinking about with your physicians although at this distance I am just guessing. Be sure and seek prevention against more stones. Regards, Fred Coe

      Reply
  24. Austin

    Hi there!

    I have a question about family history and the possibility of stones. I’m 30 and have never had a stone but I know that my grandfather on my mother’s side suffered with them. My mom also had one a few years ago, though the doctor believed it was due to taking huge amount of calcium supplements and that they had built up over time. Once she cut back on those she’s thankfully had no issues. My father and sister have never had one either, yet I’ve been doing some research and found that family history can play a big role in how susceptible you are to stones. Once I learned this I panicked and have been doing everything I can do watch what I eat, from cutting back on meat and sodium to drinking 3-5 liters of water a day.

    I’m not a health nut but I do try to take care of myself but I’m worried that all of this may be for nothing if it’s something that’s inherited. I’ve been losing sleep and stressing out over the thought of being unable to do anything about. Is there anything else I can do? Thanks!

    Reply
    • jharris

      Hi back Austin-

      I understand your stress regarding family history and stones. The best advice I can give is to you is to keep on doing what you are doing for drinking. Sodium consumption should be limited to 1,500 mg/day. You can also ask your doc to order a 24 hour urine collection to see what your values look like just to keep on top of it. I would not do anything else with your diet until you know for sure. The less meat is always a good thing as we tend to overeat it. Anything other than that could be in vain and I don’t want you to avoid healthy foods when you don’t know if you need to.

      Hope this makes sense. If not, I’m here.

      Jill

      Reply
      • Austin

        Thanks Jill. I try to keep an eye on the nutrition contents on what I eat and to make sure everything is balanced. I feel like I’m going crazy but I believe the horror stories and want to do whatever it takes to prevent it.

        Reply
        • jharris

          Water is your very best bet, and the least invasive. Keep it up. The salt is imperative too. Do these two things for now and you will be doing everything you possibly can.

          Good luck-

          Jill

          Reply
  25. Atif

    I have stones in both kidneys but the pain is bearable how many liters of water intake and what medicine and tips please

    Reply
  26. sandip pandey

    does the consumption of beer helps in removing the stone from kidney?do beer have any sideeffects if consumed by kidney stone patient?faithfully

    Reply
    • Fredric Coe, MD

      Hi Sandip, Beer use is associated with less stones on average, so it is fine. Nothing I know of beside surgery will remove stones. Regards, Fred Coe

      Reply
  27. Ray

    I recently had a second kidney stone… So with the advice of the doctor I have increase my water intake. Over about the past 3 months of doing this i have added about 8 pounds of weight…. Water Retention? How do i deal with that? if i keep adding 2 to 3 pounds a month i will be ginormous in a short while.
    thanks,

    ray

    Reply
    • jharris

      Hi Ray,

      Love your frankness…. the world needs more of that. So, about your weight gain (which is also a problem for kidney stone formers)- You are adding weight because you are eating too much salt. Water likes to follow salt. Too much salt, too much bloating, too much weight, too much Ray. Many women know this, drink more water, lessen salt, and you will lose weight. That 8 pounds will be lost as fast as you gained it, actually it will come off much faster.

      Lessen your sodium intake to 1500 mg/day and you will be peeing like a champ! No point in drinking more water if you are not going to pee it out. So do that. Watch your sodium intake and when I say that I mean start looking at all the labels. If you are eating out a lot, then you are eating tons of sodium. It is in everything from cereal to mustard to just about everything you put in your mouth.

      Do this and I promise you you will feel lighter in a couple of days. Keep drinking, lessen salt, you will be less ginormous quickly.

      Best,

      Jill

      Reply
      • jharris

        P.S.

        Let us know your outcome. I would like you to be our latest role model!

        Reply
  28. Alex

    Hello Jill,

    If an egg white is 88-90 water, would you include consuming egg whites as an effective way to eat your water?

    Alex

    Reply
    • Fredric Coe, MD

      Hi Alex, We need liters of water, and if you use egg white you get massive amounts of protein. In a liter of water – 1000 mg of water – there will be 10% protein or 100 gm. That is more than one would eat of protein in a whole day! So, no. Regards, Fred Coe

      Reply
      • Alex

        Thank you, Frederic. I understand what you’re saying but my question wasn’t clear enough. If a kidney stone former was eating a much smaller number of egg whites and getting most of their water by drinking straight water, would you count the water content of the egg whites as part of the daily amount needed to protect the kidneys?

        Alex

        Reply
        • Fredric Coe, MD

          Hi Alex, you could but it would be too small to matter. An egg has perhaps 10 ml of white, giving 8 ml of water which is 1.5 teaspoons. If you fry the egg the water is gone, so it would have to be boiled or raw. Regards, Fred

          Reply
  29. Majid Hussain

    Hi dear Jeff.
    I’m suffering from kidney stone tell me the quantity of water and other fruites to avoid kidney stone and to rectify this problem , I’m feeling so pained !!!!

    Reply
  30. SRoy

    For a middle-aged person staying in India, doing moderate daily exercises (equivalent to 20-30 mins brisk walking), and used to having 3 to 3.5 litres of water every day: is it okay to drink 3-4 glasses of water (nearly one litre) at a time? thanks in advance.

    Reply
    • jharris

      Hi-

      If it is not causing you ill effects to drink that much at one time, I don’t see the harm in it. Don’t drink it terribly fast is the only thing I would advise.

      Thanks for writing-

      Jill

      Reply
  31. Tali

    I noticed that you list spinach and strawberries in the section “Eat Your Water”. Just FYI, these are both foods that can cause calcium stones! I used to make strawberry and spinach salads to take with me to work almost every weekday during the summer months until I ended up with kidney stones and had to take several weeks off work to recover after lithotripsy 🙁

    Reply
    • jharris

      Hi Tali,

      Yes, we are very aware that those foods are high in oxalate, as we noted in the article. People who don’t have oxalate issues but need to find more inventive ways to get more water will benefit. Those that have high oxalate levels will not!

      Thanks for writing!

      Jill

      Reply
  32. marie

    Do you think it could be cancer

    Reply
    • Fredric Coe, MD

      Hi Marie, It can always be a tumor as I noted below. Usually not, but have your physician make sure. I deleted the duplicate of this question for you. Regards, Fred Coe

      Reply
  33. marie

    I have a stone in my left kidiney about 10 years l have pain inmy
    Kidney and if i sit on the toilet and move to the left or lie down i have pain most of the time i have microscope blood in my urine.

    Reply
    • Fredric Coe, MD

      Hi Marie, Perhaps the stone is indeed causing pain – it certainly could cause bleeding. If the pain is very bothersome, it consider having it removed. The fact that the pain is related to movement makes me wonder if it is really from the kidney or from the back muscles. Kidney pain is not usually affected by movement or posture. As for the blood, you should have a urologist be sure it is indeed from the stone; I would much advise you do that. Almost all the time it is, but as you point out above sometimes a very early cancer can be present – even the beginnings of a cancer. These are easily cured at the beginning. Regards, Fred Coe

      Reply
  34. Pam

    Four years ago I had lithotripsy to break up stones two large to pass. On my follow up appt I still had a smaller stone in the upper right pole. Two years ago I was experiencing pain again and the CT scan showed the exact same stone was now 5mm in size. I was told at that time it could not be causing pain. I have just dealt with the on again off again pain. I was diagnosed in January for a UTI and then again in April. I was experiencing severe right groin pain and right back flank pain recently which landed me in the hospital. They did an ultra sound and pap smear but said they could not find anything except the urine culture came back and they put me on Cipro for an infection. Went to Urologist and had another CT scan and I have a 10mm stone lodged in my upper right pole of kidney, same exact spot where the 5mm stone was. The urologist again is stating that this can not be causing the pain. I drink 64 -94 oz of water a day and keep forming calcium stones. What would you recommend my coarse of action would be at this time? Why would they not do lithotripsy again?

    Reply
    • Fredric Coe, MD

      Hi Pam, It is very hard for me to tell if the enlarging stone is the cause of your pain, but it certainly could be doing so. The episode of flank and groin pain sounds like stone passage, perhaps a small fragment. Lithotripsy would no longer be the single choice for your stone, if any procedure were indicated; flexible digital ureteroscopy might be preferable, depending on the details of location and anatomy. If you have a lot of pain, and your personal physicians are not sure about the best course, I would think they might want to help you seek a second opinion about treatment options. You have growth of a stone, but you speak of forming calcium stones – are you indeed making new ones. If so, you need prevention measures to stop that process. Regards, Fred Coe

      Reply
    • Jeff

      Try Chanca Piedra “stone Breaker” herbal supplement (pure stuff without a whole lot of additives!). I took 2 500mg pills every 6-8 hours for a week along with 2 tablespoons of Braggs Apple cider vinegar 2-3 times daily and passed a 7mm CALCIUM stone … the stone actually came out 7X3X2 mm and was very brittle and porous and seemed to be kind of slimy when I passed it. Also my pain level went from a 9 to a max of 4-6 and usually just annoying while on this protocol. I drank a lot of water and stopped adding salt to food. So do some research …. also you may want to start off with a lower dosage of the Chanca Piedra but still take the Braggs vinegar. I still take 1 Chanca Piedra daily at night on an empty stomach. You may want to try this for awhile and then go get another CT scan to see if it helped … Also this worked for a Calcium stone … if you have a different type then I don’t know if it will work …. Best of luck

      Reply
      • Fredric Coe, MD

        Hi Jeff, I am happy to post this, but I have to make clear as a professor and physician that I do not know anything about it and can neither endorse it or raise objections to it as a treatment. If we find a number of people using it, I will try to get some research on it and post an opinion. Best, Fred Coe

        Reply
  35. Cherie Wiggins

    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

    Reply
    • Fredric Coe, MD

      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

      Reply
  36. Akash Malviya

    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..

    Reply
    • Fredric Coe, MD

      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

      Reply
  37. Mark

    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)?

    Reply
    • jharris

      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

      Reply
  38. Lisa Gregory

    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?

    Reply
  39. Ashley

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  40. Tonya

    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.

    Reply
    • Jill

      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

      Reply
  41. Meagan

    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?

    Reply
    • Fredric Coe, MD

      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

      Reply
  42. Judy Campbell

    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

    Reply
    • Fredric Coe, MD

      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

      Reply
      • Judy Campbell

        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

        Reply
        • Fredric Coe, MD

          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

          Reply
          • Judy

            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

            Reply
            • Fredric Coe, MD

              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

              Reply
              • Judy

                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

              • Fredric Coe, MD

                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

  43. Rich

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
      • Rich

        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!

        Reply
        • Fredric Coe, MD

          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

          Reply
          • Rich

            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

            Reply
            • Rich

              …since posting the above I found https://kidneystones.uchicago.edu/how-to-eat-a-low-oxalate-diet/ … a must read!

              Reply
            • Fredric Coe, MD

              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

              Reply
              • Rich

                Thanks Fred, much appreciated. Rich.

              • 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

              • Fredric Coe, MD

                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

  44. Shirley

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  45. David Moeller

    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?

    Reply
    • Fredric Coe, MD

      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

      Reply
  46. Aimee

    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.

    Reply
  47. Janki shah

    Hi,
    I want to you ask that does working out daily for 40 minutes reduce the risk of kidney stones?

    Reply
  48. Sherry G.

    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?

    Reply
    • Fredric Coe, MD

      Hi Sherry, No; it is not a stone risk beverage and you can use it freely. Regards, Fred Coe

      Reply
      • Sherry G.

        Besides green tea, are there other teas that are low in oxalate that you can recommend?

        Reply
        • Fredric Coe, MD

          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

          Reply
  49. Toufiq

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  50. Jennifer

    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.

    Reply
  51. Celia Mac Donald

    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!

    Reply
    • Fredric Coe, MD

      Thank you, Celia, It is really critical for patients to keep up a very large fluid intake. Warm Regards, Fred

      Reply
      • Tim Hunter

        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?

        Reply
        • Fredric Coe, MD

          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

          Reply
        • Susan

          Does bottle lemon juice kill the kidney stones like regular lemons do?

          Reply
          • Fredric Coe, MD

            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

            Reply
  52. Alex marco s

    Hello, I hate water and could never drink it, but la croix has made me a water fan, thanks.

    Reply
  53. Sandra

    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

    Reply
  54. Sadness mom with stone

    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.

    Reply
  55. toni

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  56. Julie

    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

    Reply
    • Fredric Coe, MD

      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

      Reply
      • Julie

        Thank you so much for the reply ! .. I’ll try to change the schedule :* <3

        Reply
  57. Yolanda Powell

    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.

    Reply
  58. Janice

    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/

    Reply
    • Fredric Coe, MD

      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

      Reply
  59. susan

    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

    Reply
    • Fredric Coe, MD

      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

      Reply
  60. Hip Pain Langhorne PA

    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

    Reply
    • Jill

      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

      Reply
  61. Laurie

    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.

    Reply
  62. Judy

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  63. Bob Cruz

    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

    Reply
    • John

      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.

      Reply
  64. Diane Iles

    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!

    Reply
    • Jill

      Diane-

      It is an honor and a privilege to provide help to you.

      Warmly,
      Jill

      Reply
      • Joanie

        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!

        Reply
        • Fredric Coe, MD

          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

          Reply
      • Joanie

        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.

        Reply
  65. Akki

    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

    Reply
    • 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 …

      Reply
    • Fredric Coe, MD

      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.

      Reply
      • Akki

        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

        Reply
        • Fredric Coe, MD

          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

          Reply
  66. Caryn D.

    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

    Reply
    • jharris

      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

      Reply
  67. Adolf furtado

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
      • Adolf furtado

        but can it go through urine…. by drinking water? is cocunut water effective on it?

        Reply
        • Fredric Coe, MD

          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.

          Reply
  68. Puneet

    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.??

    Reply
    • Fredric Coe, MD

      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

      Reply
    • jharris

      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

      Reply
  69. Cathy Siegel

    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.

    Reply
    • Fredric Coe, MD

      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

      Reply
  70. NH

    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?!

    Reply
    • Fredric Coe, MD

      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.

      Reply
  71. sangeetha

    my dad has renal stones doctor has advised to drink lots of water and he preferred to drink boiled water is there any problem

    Reply
  72. jeetendra prasad rath

    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.

    Reply
    • Fredric Coe, MD

      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.

      Reply
  73. Heidi

    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

    Reply
  74. Heidi

    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

    Reply
    • jharris

      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

      Reply
  75. Heidi

    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

    Reply
    • jharris

      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

      Reply
  76. Teresa Moore

    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.

    Reply
    • Jill

      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

      Reply
  77. Mkali, Z.M

    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.

    Reply
    • Jill

      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

      Reply
  78. Richard Fox

    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?

    Reply
    • Jill

      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 (https://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

      Reply
  79. George Koperna

    I having an attack right now and everything I drink including water comes
    Right back up.

    Reply
    • Fredric Coe, MD

      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.

      Reply
  80. Vincent

    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.

    Reply
    • Fredric Coe, MD

      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.

      Reply
  81. 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

    Reply
  82. Jill

    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

    Reply
  83. Saeed R. Khan

    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.

    Reply
    • Jill

      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!

      Reply
  84. Laura

    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!

    Reply
    • Jill

      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

      Reply

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