My Question

Tell me what you want next on this site; that is my question.

I have been writing this site – with the able help of my co-authors – since July 2014, and have reached what I might call a kind of plateau. Much of what I came to say about the most common kinds of kidney stone patients is said. Because the main work is done for the moment I have come with my question to you.

The readership of the site has grown from 50 people in the first month to a present running average of 55,000 – 65,000 people monthly, depending on the season, and many of the visitors read quite a bit each. People find the site valuable, and I am happy for that.

But, what next? I can guess, I can plan, and I can write.

I can also ask.

You might question why I chose Wedding Dance Outdoors by Pieter Bruegel the Elder. The picture is wonderful, so my reasons may not matter all that much.

Up Till 2017

Because I set out to create a definitive site, not a mere collection of opinions, I built a three layer cake.

Primary articles rest on peer reviewed literature and have links in them – some say too many, some say not enough – to scientific papers on PubMed. Secondary articles elaborate on and explain the primary ones in less technical detail. They link back to the primary articles rather than to PubMed. Public articles are for patients and their families. They show how science gives us useful ways to prevent stones. They have fewer links, and those are mainly to secondary articles.

Since 2017 to now – July 2018

Since I first wrote this article I created the Kidney Stone guide Book, and new topic listings for the whole site. Some of what people asked for I have done. Here is the table of all of it. Done means just that. Part means I know I need some components. Some means I have examples and can add more.

Going Forward

As I did in 2016, I am asking again for your suggestions. Please leave them as comments. Since I have added a lot this past year, perhaps your topic is already here. If so it will be a link or at least an entry in the table.

140 Responses to “A QUESTION TO MY READERS”

  1. Dan S.

    When I started to eat a very healthy, vegetarian diet, my kidney function started to slowly decline over the course of 2 years Creatinine level crept up to 2.0. My nephrology was puzzled as I am a healthy 66 years old bike rider. Suddenly, in Nov. 2019, my creatinine spiked to 5.0 and I was in hospital for 3 days. Kidney biopsy shows a lot of oxalate in kidneys, driven by lots of spinach and nuts and oxalate in my supposedly “healthy diet”. Drinking 2.5 liters of water and severely restricting oxatle in foods has brought creatinine back down to 2.1 over 2 months. Any suggestions or comments? I have never had a stone. But did have very high antibiotic use for Lyme 3 years ago. I use the oxalate chart on this site for my diet. Thanks!!!

    • Fredric L Coe

      Hi Dan S, This is a very serious matter. I do not believe a diet of spinach etc can cause oxalate nephropathy without some other cause(s) also in play. Common ones include prior GI weight loss surgery, some form of GI malabsorption, concomitant use of diuretics, laxatives, or high dose NSAIDS, or underlying primary hyperoxaluria of mild degree. I presume your urine oxalate has been measured, but you do not mention the level. If you and your physicians wish I would be pleased to look in more detail, because if mere diet caused a creatinine of 5 and your kidney has oxalate crystals in the tissues one needs to know why so another episode does not occur. I am not at all convinced that mere diet will be enough. Regards, Fred Coe

  2. kristin

    My family is not predisposed to kidney stone but they are predisposed to osteoporosis. Is calcium citrate the best form of calcium to take as a supplement – in terms of reducing risk of kidney stones? Thank you.

  3. Kimberly

    Hello Dr. Coe,
    I have Medullary Sponge Kidneys and have kidney stones. The stones come and go and vary in size. I now have bad hypertension which they are possibly contributing to the fact that it was found that I have renal artery stenosis. I also have high PTH but normal calcium & have previously had low phosphorus. My question is, do you know if the renal artery stenosis is related to the Medullary Sponge Kidneys? I cannot find any correlation & am concerned as to why I developed renal artery stenosis. Also wondering why I am suddenly having possible parathyroid issues. I do know that parathyroid issues tend to go along with kidney disease but it is odd to me that it all went crazy at once. Any input greatly appreciated. Thanks so much.

  4. Jamie

    I have a long history of kidney stones. My most recent stone was analyzed at 10% calcium oxalate/ 80% calcium monohydrogen phosphate dihydrate (brushite), and 10% calcium phosphate. I have had this same composition for the previous stone I passed as well. I have yet to be able to prevent stone formation. With this stone makeup, what are your thoughts on why I’m getting them and how to avoid getting them? Thanks

  5. Edward Trolley

    Dr COE, I am sitting in a Lithtripsy center where my wife is having her 22nd lithotripsy. She had gone 5 years since last one but we ended up in emergency room last weekend and scan detected a 4 mm and 8 mm stones. I assume 22 of these things is not normal. Do you have any suggestions on what she should do?

  6. Yuri

    Hi Dr. Coe,
    I am a 53 year old Make that has been having kidney stones since I was 33 yrs old. Had 4 cases where medical intervention was needed. The most recent was 8/2018 on the right side what was 6.5mm and I need Laser Lithotrypsy when it was stuck.
    in 2010 I had a 5.7 on the left side that was stuck, developed hydronphrosis on top of it all.
    The stones are a mix, mostly on the Uric acid side.
    Last 24 hr collection test showed:
    SSCaOx – 10.37
    Urin Calsioum -191
    Urin Oxalate – 54
    PH – 6.118
    Uric Acid – 0.875
    Was hoping you can suggest something.

    Thank you.

    • Fredric L Coe

      Hi Yuri, Your labs show a urine pH too high for uric acid stones, but a SS for CaOx perfectly compatible with calcium oxalate stones. Are you sure you know what the stones are? Your oxalate is very high, calcium borderline, and perhaps this reflects a low calcium cite. Surely urine volume is too low given the high SS CaOx, as calcium is not high enough for that. My suggestions are in this article, and this one, too. I think that a methodical evaluation and treatment follow through should be enough. Regards, Fred Coe

      • Yuri

        Thank you Dr. Coe for your fast reply.
        the last 24hr test was done 3 months after the last 4x3x5 stone was broken down in 2018 in the right proximal ureter. I was given potassium cytrate, and I started drinking water with high PH. Increased the intake after this test, but still not at 3 liters given the lifestyle.

        After the last procedure to remove the stone, I asked if the sample was collected and I was told no.

        I am hoping you might be able to recommend someone in the NY area to be able to help if needed. I am trying not to lead to surgery every time I have a stone. The stones in every case were detected over a week prior to getting blockage. The process of lets wait and see if it will pass is not working.
        Id there a way to break down the stone before it gets stock.

        Thank you again,

        • Fredric L Coe

          Hi Yuri, Dr David Goldfarb at NYU would be my choice – he is very skilled in stone prevention. Please feel free to use my name by way of introduction. Regards, Fred Coe

  7. JC

    Hi Dr. Coe, after having abdominal pain since August 4th, I went in for a CT scan on August 8, which showed a 5-6mm stone in my right proximal ureter. X-ray on August 14th showed stone still in proximal ureter, but while I experienced frequent pain from August 4th – August 13th, no pain since August 13th. My urologist wants to schedule ureteroscopy, but I was wondering if it would be imprudent to wait 2-4 more weeks to see if the stone passes naturally. Thank you and my best regards.

    • Fredric L Coe

      Hi JC, I presume your urologist has decided that your proximal ureteral stone is not destined to pass – it is at the critical size – and poses a risk for obstruction. Lack of pain means nothing, as obstruction can painlessly destroy a kidney. So, I sense your urologist is right to want to remove the thing. Of course I am far away and without any details here so this is mere commentary. Regards, Fred Coe

  8. Victor Stankevich

    Hello Dr. Coe. I’ve searched your site but could find no information regarding Chanca Piedra (Phyllanthus niruri). Anecdotal information seems to be encouraging. Is there any research on this? Thank you.

    • Fredric L Coe

      Hi Victor, I have promised myself to write on this and cannot quite get up the energy. It is probably nonsense so far as I can tell, but one really good scientist did some nice work in it. As for dissolving stones, no possibility. For prevention, unlikely, but I need to read the few publications worth reading. Sorry for the delay, Fred Coe

    • Arlene Kuchar

      Dr Coe. I have had large uric acid stones. Lithotripsy, laser surgery and surgery thru my back to crush and vacum the stones..
      However, once I started Potassium citrate acid crystals powder 2x a day in liquids…I’ve been stone free for almost 2 years…MY DILEMMA…BOTH PHARMACEUTICAL COMPANIES HAVE DISCONTINUED PRODUCING THIS PRODUCT…I TOOK CYTRA-K CRYSTALS 3300/1002 mg.

      What can I take as a replacement..I am also hoing to have Bariatric sleeve surgery in a few months…
      Thank you in advance for your response and guidance..

  9. Ed Haidenthaller

    I have been told i have silica based stones. I get one about every 10 years and they normally are 9 MM or larger and require lithotrypsie to breakup before they can be passed. How can i prevent them?

  10. alex

    Dr Coe,want to get an opinion on a patients panel, how can I contact you


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