Lucas Cranach the Elder (1475 – 1553) painted the Judgement of Paris between 1512 and 1514. The painting hangs in the Metropolitan Museum of Art. 


Testing, Evaluation, and Diagnosis

Fluids, Diet, and Meds for Common Stones

Stones from Systemic Diseases

Pain and Injury from Stones

Stone Surgery

How Stones Form

Science and Kidney Stone Disease

Don’t See It? Ask Here

Other Sources We Recommend


This Book is in Preparation

The term ‘infection stones’ means stones caused by the action of bacteria. At the present time only struvite stones belong in this category. Struvite is a composite of magnesium, ammonium ion, and phosphate ion. Certain bacteria can decompose urea in urine to ammonia creating conditions that promote crystallization of ammonium ion with the phosphate and magnesium normally present in urine. That is the big picture. I mean to put in the details. I have already placed struvite stones within the pantheon of stone disease.  The beautiful photograph of a struvite stone is by Susumu Nishinage (from the remarkable photographic collection ‘Science Photo Library Art’, part of finartamerica. The Broad Picture of Struvite Stones This straightforward and useful clinical review tells us … Continued

It is not enough to tell people they need to change this or that in their diets for stone prevention. We did that already, here, in a lot of articles. What people need is a meal plan that has in it all the things for stone prevention and tastes good, is easy enough to make for busy people, and not too expensive. The enticing salad is kidney stone safe, and from the Jill Harris kidney stone diet Meal Plan collection.  What Problem Are We Trying to Solve? For years Jill and I have heard patients complain that they do not know how to eat or what to eat. All the lists, especially the oxalate lists confuse them, and they wonder … Continued

A Good Place to Start VIDEO 1: RISK FACTORS (17 min). VIDEO 2: EVALUATION (13 min) AND TREATMENT (13 min). The videos review the chapter and emphasize the main points. I would start with them. Salt Ponds The featured image shows salt harvesting from evaporation ponds. The sea is salty and like our blood holds its salts in solution. But if you channel the sea into ponds, and balance things so the sun evaporates water faster than new water can enter, the remaining water overloads with sodium chloride. It crystallizes out of solution as sea salt. Workers collect it for us to season our food with. Is it not an apt picture? Our Blood is the Sea, our Kidneys Make the … Continued

Watch the Video The video is a big enhancement of this article, I recommend it. The Structure of Kidneys Stones form inside the kidneys and the urine collecting system. How they form matters to patients because surgeons can see formation sites during stone removal by ureteroscopy or percutaneous nephrolithotomy. The amount of such sites gives a clue as to future stone risk and also to possible damage done from crystal deposits in kidney tissue. We cannot discuss where stones form unless you know how kidneys are constructed. If you already know this, move on. But if you do not let’s stop here and review how kidneys are put together.  The linked article is long, so focus only on the cutaway … Continued

Among the thousands of comments on this site, this one theme rings out. Patients Are Confused Many patients just have no idea about what to do. They suffer from confusion. They have stones, one or many. Surgeries occur, or not. CT scans show this number of stones, or that number. Physicians may say contradictory things, or things that seem contradictory. And all the while new stones may form, more pain attacks may come, and lay to waste life otherwise spent in pursuit of work and family happiness. As a way out, people seek remedies, on the web, from friends, from physicians, of course, and often they do not work. Or, they do work but seem not to. The painting, Taking the Census, by Francis William … Continued

Phenotype is a medical term physicians use to identify groups of patients who share diagnoses and treatments in common. Although every kidney stone former has unique traits that need attention, they can be grouped into phenotypes for which certain general treatment approaches have been tried and found valuable. Within those general approaches refined treatment answers to those unique details particular to a given patient. Your Name When successful, the process of this chapter grants you a name. That name sums up where you fit in as a type of patient. Because patients within a given type have in common causes of stones, treatments and trials, and long term outlooks – so called prognoses you want to know where you fit in. That name is the name … Continued

You have idiopathic calcium stones. That means much of this site applies to you and your disorder. But the many articles read without a guide or sequence can confuse. You would be best off reading here, and following links as they come up. Of course you are free to browse as you like, but if you want a guide, I am here. Pieter Brueghel II (The Younger) A Village Fair (Village festival in Honour of Saint Hubert and Saint Anthony) 1564/1638 (Mackelvie Trust Collection, Auckland Art Gallery Toi o Tāmaki, purchased 1961) shows a crowd, which is appropriate for this most common kind of stone former.  Begin Here You should not use this chapter unless you have come to it by the right … Continued

I often hear physicians say, ‘Of course, a lot of my patients had only one stone, so I just tell them to drink a lot of water.’ I don’t criticise them for saying it or doing it. They follow standard practice. The defects lie in those of us who study the data and fail to make ourselves useful by making ourselves clear. Let me be clear, then. Ideally, prevention should start before the first stone. The Image, Jan Steen, Couple in a Bedroom, 1665-1675 seems to convey the idea of ‘Why Wait’. Water is Great Water as a treatment is spectacular. It undoes the very process of renal water conservation that creates supersaturation. And let’s be clear. Supersaturation is the beginning … Continued

Watch the Video In my very long and complicated article I detailed primary hyperparathyroidism (PHPT) like a good scientist should. With all my heart I tried to make it plain enough for people in general to get a sense of how things work, but looking back on it, I doubt many will. Anyway, this book structure makes a place for summary and synthesis. Is this PHPT lite? Not really. It is PHPT practical, devoid of all but assets material to evaluation and treatment. Even so, in those areas I go into perhaps greater depth than in the parent article. The two articles complement each other as best I can arrange. Alabama Grist Mill Dam by Beverly Hammond catches the sense of how … Continued

Uric acid stones, to me, means not just pure uric acid stones but any uric acid in stones. If this seems fey, let me explain. Uric acid is a peculiar kind of crystal. Low urine pH causes them and treatment that raise urine pH prevent them altogether. Whether they form combined with calcium stones or pure, treatment is the same. Why then scruple over percentages? If I find uric acid in any stone, I look at urine pH with a yellow eye. Should it be low I treat it surely and on the moment so at least that crystal be banished forever. The Profligate Punished by Neglect, Edward Penny 1774 catches the common motif of diet excess, obesity, diabetes, and … Continued

The old fashioned intravenous pyelogram pictured in the header of this article depicts the normal left kidney of an 18 year old woman, and her severely obstructed right kidney – from a stone. That kidney has lost some of its tissue. In his review of stone pain, Mike Borofsky showed that obstructing the kidney of an animal reduces its function and provokes inflammation. Obstructing stones affect human kidneys similarly, and can damage them, but we know fewer details. Fortunately, kidneys seem resilient enough that most stone formers maintain reasonable kidney function. But stone formation not rarely leads to kidney disease. Though often mild, in some cases losses can be severe, even to kidney failure. What do we know about the … Continued

A very useful introduction by Dr Anna Zisman. In general the articles on this site are a bit more detailed and referenced than this one, but the disease is very complex and we thought a fairly simple and brief introduction would be ideal for patients and their families.

Pieter Brueghel the Elder [Public domain], via Wikimedia Commons

Obesity Is Epidemic World Wide Anyone can find ample evidence of US obesity. Here is a recent CDC map. In response, ‘bariatric’ surgeries designed to reduce body fat stores by limiting and re-routing nutrient absorption have risen to very high levels. The American Society for Metabolic and Bariatric Surgery estimates rates at 158,000 procedures in 2011 and 216,000 in 2016. Europe, and the rest of the world share the obesity problem. This is one of an almost endless number of graphs and maps I can put forward to document what is in fact a remarkable event in human history. Naturally, bariatric surgery rates have risen world wide, as they have in the US. The magnificent Tower of Babel Pieter Brueghel the Elder  (1526/1530–1569) hangs in the Kunsthistorisches Museum, … Continued

The large picture shows a papillum of a patient with ileostomy as seen at surgery for stone removal. The large white patch between the arrows is plaque, the stuff calcium oxalate stones can anchor to and grow on. The yellow material between arrowheads is terminal ducts of Bellini (BD) plugged with crystals. Both are abundant in patients with ileostomy and part of how they form stones. This article relies on only three research publications, and in all modesty I must admit they arose from our research group. But in defense, one is remarkably comprehensive and one the only one with detailed study of kidney tissue obtained during stone surgery. Also in defense, their reference lists are good enough to give … Continued

I do not know why anyone would diagnose distal RTA (dRTA) very often. As I will show you it has colorful and unusual characteristics as unmistakable as rare, so diagnosis is not difficult. But many more people think they have than have it. In my 50 years of kidney stone prevention I have perhaps a few dozen examples or so, out of many thousands of stone formers. This is another of those long, elaborate articles only the most devoted read. Even so, elaborate as it is, this article tells only part of the story. It simplifies or simply ignores the mechanism for low potassium in dRTA, and left for another time its genetic causes, and also the bone and mineral … Continued