Every stone former needs fasting serum and 24 hour urine testing. Likewise important, kidney stone analysis and review of images – CT scans especially.
Medical evaluation is what physicians do. They integrate the testing with the history of stones and everything that can promote stones in any one patient.
Diagnosis is also what physicians do. It is the final synthesis and directs treatment.
The lovely painting by Jan Steen (1625-1679) hangs in Apsley House, London.
I have used it also for the page on systemic causes of stones because I like it a lot.
24-Hour Urine Collections: Why and how – The basis for prevention, never omit them
How to Use Urine Supersaturations – What a given value means in terms of kidney stone risk
How to read your kidney stone lab report 1; Calcium stones
How to read your kidney stone lab report 1; Uric acid stones
My Lab Report – A nifty self help guide
Kidney stone types – Full review of stone compositions and their meaning
Kidney stone analysis: How Bad is It?
Analyse every kidney stone – Evidence that stone type can change so treatment needs to change
Stones in Children – A primer of special needs for children
Middle Age and Kidney Stones? Why Now? – A primer of special needs for these late comers
How to Count Kidney Stones – Prevention means fewer new stones; how do we know if we can’t count right?
Chapter 3: Coping with confusion – What to do when everything seems just confusing
How to be a successful kidney stone patient – Lists and hints to get the most out of your physician visits
Putting it all together – Full guide from first stone through follow up of your prevention
The five steps to kidney stone prevention – Step by step instructions on how to get evaluated
Treat the patient not just the stones – Stone formers are a risk for bone and kidney disease, and hypertension
Art of stone prevention – My personal style of stone prevention practice
Chapter 1: Personalized kidney stone prevention – Truly each patient is unique
Case 1: A stone former – How you integrate clinical history and labs to determine treatment
Case 2: A calcium oxalate stone former – A surprise lurked in this otherwise ‘easy’ case
CT papillary density may predict new stones – Any physician can make this measurement
Chapter 4: Who are you? – What are the main diagnosed causes of stones?
Idiopathic calcium oxalate stone formers – Calcium oxalate stones, systemic diseases have been excluded
Idiopathic calcium phosphate stone formers –Calcium phosphate stones, systemic diseases have been excluded
Chapter 8: Uric Acid Stones – Any uric acid in stones means this applies to you
Chapter 9: CYSTINURIA: An Introduction for Patients – Special treatment, inherited renal transport disorder
Chapter 7: Primary hyperparathyroidism – Not rare, diagnosed from blood and urine tests, curable
Distal Renal Tubular Acidosis – Rare disease, diagnosed from blood and urine tests
Chapter 10: Bariatric surgery and kidney stones – Obesity surgeries cause stones; special treatment needed
Medullary sponge kidney – Uncommon, over diagnosed, special treatment problems
Case 4: Medullary sponge kidney – For 24 years I missed the diagnosis
Case 5: Severe dietary hyperoxaluria – Massive hyperoxaluria reverted to normal with simple diet change
Chapter 11: Ileostomy and Kidney Stones – How ileostomy causes stones and how to prevent them
10 Responses to “Testing, Evaluation, and Diagnosis”
Thank you for your incredibly helpful articles. I have vastly improved my diet because of them.
QUEASTION: I have been using potassium chloride salt to boost my potassium intake while keeping sodium intake low. Does potassium chloride help fight kidney stones the way potassium citrate does?
Fredric L Coe, MD
Hi Joe, I believe you are saying that you use potassium chloride in place of sodium chloride so as to lower diet sodium and therefore lower urine calcium. If so, the potassium chloride is just a way of tolerating less diet sodium and the real benefit will be the lower urine calcium. So no, the potassium chloride helps to lower diet sodium and urine calcium, potassium citrate – miserable taste! – would be if your urine citrate or pH were too low. Regards, Fred Coe
Hi Dr. Coe,
I’m wondering whether lack of sleep (say, only getting 4-5 hours) could affect risk factors like urinary oxalate, CaOx Supersaturation and Urine Volume. I’ve been having some insomnia recently but I am also about to take another 24-hour urine test – wondering whether sleep deprivation could skew the results, or else whether kidney function is mostly independent from sleep. Should I wait to do the test until I resolve my insomnia?
Fredric L Coe, MD
Hi Bobby, disordered sleep is a major health issue. I have no studies to link it or not to stones, but surely agree on the importance of remedy for it. The 24 hour urines are interpretable in relation to stone risk, but the effects of sleep on those risks cannot be known from the test itself. Regards, Fred Coe
Dear Dr. Coe
My 24 hour analysis indicated: 3200 urine ml, oxalates 31 mg/24 h; citrate 886 mg/24 h; uric acid 595 mg/24 h; calcium 109 mg/24 h; phosphorus 1.00 and pH 5.00. I drink about 2 liters of water a day, with about half a lemon juice. Dont take medication, just prozac. Am careful with sugar and salt and also avoid high oxalate foods. Have never been able to catch a stone for analysis. It hurts a lot, although mine are small (around 3.2 mm). I have one in my right kidney of this size and it came out. At least it reached the bladder. Is anything I need to do, extra? Thanks a lot. Kind regards Maria
Fredric L Coe
Hi Maria, the very low isolated urine pH of 5 makes me think your stones are uric acid, and that treatment to raise the pH will be important. Get the stone analysed – most important thing to do! Lemon juice may not raise urine pH, and if the stone is uric acid you will need more treatment. If you do not catch the stone, color helps; uric acid stones are red. Likewise your urologist can measure the density of the stone on CT – uric acid has a low density. Regards, Fred Coe
Thank you for the wonderful article and information. Through my regular GP visit after multiple abnormal urinalysis an ultrasound and CT were ordered which showed 3 stones. 18mm, 11mm and 3 mm. I was referred to two urologists one recommendation was PCNL the other ureteroscopy x3. I scheduled the latter to take place over three consecutive weeks. I have no symptoms from the stones and the pain of either procedure and potential down time is concerning. Do you have a recommendation for which direction to go? Thank you, Lisa
Fredric L Coe
Dear Lisa, The stones are not likely to pass, but indications for stone removal are pain, obstruction, bleeding or infection. Otherwise you can wait and pursue prevention against more stones. The stones may in the future cause problems, of course. Between PCNL and URS I always favor the latter is it is deemed feasible by the surgeon. Proper evaluation as to cause is imperative so you will not have more of the stones. Regards, Fred Coe
Thank you for all of your published articles. They have been very helpful. I am a 45 yr old woman with an unremarkable health history and my first diagnosis of kidney stones. 2 detected on CT. Largest is 5mm. Neither has begun to pass but I’m experiencing mild back pain unrelated to musculoskeletal issues. I was prescribed Flomax but am nervous to take it. I would like to move the stones and pass them, but am uncertain the best immediate course. Can you point me towards the best article for advice?
Fredric L Coe
Hi Christina, Possibly the stones, though not passing through the ureter, are obstructing within the kidney. If you have pain otherwise unexplained, your physician might want to remove these stones. Flomax is a common medication that is usually quite safe. I have not written any specific article on this topic, but this one on ureteroscopy – the preferred modality for removing multiple stones – might be of value. Regards, Fred Coe