Stones from Systemic Diseases

Here, stones are due to some serious systemic disease. We need to prevent them, but that invariably requires we cope with the disease that causes them.

One could rightly say that uric acid stones fall in this category in that the low urine pH that drives them arises usually from obesity, diabetes, gout, or at least metabolic syndrome. But in all cases treatment devolves into simple increase of urine pH, and one does not cope with the underlying disease.

Likewise for cystinuria. It arises from inherited transport abnormalities in the kidney proximal tubule. Once again, we cannot treat those abnormalities but only the final urine cystine concentration and therefore supersaturation. Even so, renal function tends to fall more in cystinuria than most other forms of stone disease, so I list it here.

Medullary sponge kidney is also hard to be sure about. A developmental renal malformation, it nevertheless has been described in association with other diseases and so is included here, as well.

The lovely painting by Jan Steen (1625-1679) hangs in Apsley House, London. 

Systemic Stone Disease

Chapter 12: Distal renal tubular acidosis – Detailed, but also clinically useful

Chapter 7: Primary Hyperparathyroidism – Covers diagnosis and treatment

Primary HyperparathyroidismA detailed review including familial disease

Chapter 10: Bariatric surgery and kidney stones – Mechanisms and treatment

Case 6: Bariatric surgery and kidney injury – How to protect against oxalate kidney injury

The diagnostic dilemma of medullary sponge kidney – Stones occur because of abnormal kidney structure

Chapter 9: Cystinuria: An Introduction for Patients

Chapter 11: Ileostomy Kidney Stones – Mechanisms of stones and treatment

13 Responses to “Stones from Systemic Diseases”

  1. Sylvia Melton

    A year and five months ago I had surgery to remove a nearly one inch kidney stone. My stone compensation is 80% Uric Acid and 20% Calcium Oxalate. I have constant diarrhea and supposedly have Ulcerative Colitis but no medication has worked for me. Plus I have no gallbladder now and I do not follow the normal Colitis symptoms. After the surgery in May 1, 2019, I passed a stone in February 2020 and a CTScan showers two more small stones in the bottom of my kidney. I drink lots of water and try to follow diet recommendations but still are forming these stones. I did better it seemed before I tried the low purine diet. I really need help and my intestinal problem plus the Covid exposure keeps me from seeing a doctor tho I have an appointment this week. I’m getting afraid of the numerous CTScans for fear of cancer. What should I do? Would a registered diatician help? Thanks, I’m really up the creek without a paddle. I also have about five ulcers in my stomach and Cipro given seems to have caused an occasional acid reflux.

    • Fredric L Coe, MD

      Hi Sylvia, You are forming Uric acid stones because of GI alkali losses which lower urine pH. POtassium, or even sodium alkali will prevent uric acid stones, and your physicians can easily provide it. You need 24 hour urine testing to determine you4 24 hour average pH and with treatment to be sure it has risen about 6. Once again, your physicians can easily do this. Water alone will not work and low purine diet is useless as the problem is from too acid a urine, Regards Fred Coe

  2. Bob Bogardus

    Dr. Coe,
    I’m following your recommendations through Jill Harris’s web site and coaching and have made great strides in reducing my CaOx stone risk.

    Every few weeks I treat myself to higher oxalate food. How many days should I wait after an uncharacteristic meal before I do a Litholink collection?

    I have a slow bowel, where sometimes I go 3 days between BMs. Does that impact my CaOx risk or affect my Litholink testing?

    Thanks for your work!
    Bob Bogardus
    Carmel, CA
    (Resubmitted as I had typed Jill’s last name wrong… Sorry!)

    • Fredric L Coe

      Hi Bob, I would guess about 4 days will be enough that the one meal will be without effect. But, remember, the Litholink will look a lot better than during your treat! Bowel transit has no known relationship to stone disease. Regards, Fred Coe

  3. Ruth

    Would the plant-based digestive enzymes (VeggieGest made from asperguillis niger) that I take for my exocrine pancreatic insufficiency contribute to calcium/oxalate stone formation? I spoke with a company rep that said the enzymes are grown on aspergillus niger, but then purified and made into plant enzymes.

    • jharris

      Hi Ruth,
      Not sure about this. After the purification process, it might lessen any oxalate that was originally contained. What plant enzymes are being used?

  4. Jennifer Johnson

    I ran across a correlation between tuberculosis and kidney problems, but can’t find much about it at all. I had tuberculosis as an infant and kidney stones pretty consistently as an adult. Would that disease or the medications fighting the disease have started something way back then that would translate into making kidney stones now? Mine are calcium oxalate.

  5. Ruth

    Can exocrine pancreatic insufficiency and/or low stomach acid contribute to calcium oxalate stone formation and if so, how? Can taking plant-based (aspergillus) digestive enzymes

    • Fredric L Coe

      Hi Ruth, indeed pancreatic insufficiency can lead to high urine oxalate and stones. If you have that you need 24 hour urine studies to measure oxalate excretion, as it can be rather high and pose risks of stones and kidney damage. Regards, Fred Coe

      • Ruth Stuckey

        Thank you. I have an appointment with a nephrologist on Thursday.

      • Dan

        How does the low bicarbonate output from the pancreas, that is common with severe EPI, relate to urine pH and stone formation?

        • Fredric L Coe

          Hi Dan, Exocrine pancreatic insufficiency – I am sure this is what you meant by the abbreviation – can cause stones a lot of ways and it also depends on the cause. Malabsorption is not rare, and leads to high urine oxalate excretion and calcium oxalate stones. Cystic fibrosis causes EPI and also renal tubular acidosis and calcium phosphate stones. The reduced bicarbonate secretion would reduce bicarbonate losses from the blood, but I do not think this would alter acid excretion or urine pH enough to cause stones – not a lot of data on this! I guess stone analysis and urine studies are essential in this condition, and I presume you have had them. If not, I strongly urge you do. Regards, Fred Coe


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