Personalized kidney stone prevention perfectly exemplifies the goals and aspirations of this modern age of precision medicine. Nowhere more than here is treatment specific to a given patient. Computer – like and driven by exacting physical laws, stone crystals respond to forces we can quantify in homely but surprisingly informative 24 hour urine collections. Crystal specific, patient specific treatments not only reduce stone formation. I have observed that patients easily distinguish this treatment from vague nostrums or imagined remedies thrown out to them by friends or busy and distracted practitioners. I believe such understanding promotes long term use, although I have no trial to prove it. The featured image shows salt harvesting from evaporation ponds. Saltwater evaporates in sunlight, overloads with sodium chloride … Continued
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Lucas Cranach the Elder (1475 – 1553) painted the Judgement of Paris between 1512 and 1514. The painting hangs in the Metropolitan Museum of Art.
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How kidney stones form surely offers clues to how to prevent them. But they hide those clues very well. We cannot watch them form, as in a movie. It would take too long and we have no cameras inside kidneys. Stones form hidden from sight and all we have is the final results. So, we need hypotheses about how they form. Where Kidney Stones Grow With that in mind, and to begin with, what exactly do we know? One thing we know for certain: clinically significant calcium oxalate kidney stones grow in human kidneys attached to ‘plaque’ – deposits of calcium phosphate embedded within kidney tissue. Another: Calcium phosphate deposits plug the terminal ends of kidney tubules. On the open ends … 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
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 PTH works on … 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
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.
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