This is the first of what may become a series of articles done as videos.
The site is now a reasonably complete knowledge base but many of the ideas are hard to get and there is a lack of overview materials that are integrative.
That is what I plan for these video articles to do.
This first one tells about how crystals form and how they form specifically in kidneys to create stones and nephrocalcinosis.
It draws upon many of the articles as a base and pulls them together into one narrative.
It also adds materials not found anywhere else on the site because best presented in a video format.
Please let me know what you think.
Regards, Fred Coe
Further Reading:
Organic Materials that Coat Crystals
Idiopathic Hypercalciuria – Another review of the nephron
Control of Urine Oxalate – Yet another view of the nephron
Tremendous, Fred!! You have painted a vivid picture of the stone formation process that is a work of art. I really admire the way you have been able to bring together basic scientists, kidney specialists and surgeons to make this in depth understanding possible.
Hi Ross, Coming from a scientist of your stature, this is a high complement and I treasure it. Warmest regards, Fred
I was very interested in your video. The section on Cystine stone formation was very informative since that is the type of stone former that I am. I am looking forward to your video concentrating on this.
I am glad it was useful for you. I will be doing that video, but not right away. Regards, Fred Coe
Well done, Dr. Coe! My advice is rather than present one long video, you may want to break these types of programs into numerous smaller segments so it’ll be easier for your viewers to watch over time.
By the way, now that you’ve become a big-shot producer, I hope this doesn’t mean you won’t have any time to do research.
Thanks, Dave; Given the advice is from a real producer I had better think carefully about it. Fred
Fascinating Fredric! I’m hoping our MSK members will all be watching this video, so informative seeing as most do make stones, nephrocalcinosis and most likely have duct pluggings although not specifically diagnosed, in fact very few have heard of them.
I’m hoping a future video will show how MSK tubule stones are formed!
Thank you so much for your helpful work!
Thank you, Celia. Warm regards, Fred
Hi Dr. Coe,
Well done! This topic is particularly well suited for video. It really helped me to visualize crystallization, kidney anatomy, plaques, plugs and more. The “further reading” section is a good idea too.
This video is also a nice complement to your helpful piece on Citrate and the Ostwald Limit. Your IH article with the wonderful bathtub analogy (one of my all-time favorite articles) could possibly be a good candidate for a future video.
As for style, thankfully you’ve kept it interesting and avoided the all too common model of “talking PowerPoints” in which a subject matter expert off screen simply reads dry, bulleted slides to you for hours.
A table of contents with times could be a helpful addition.
This web site offers an incredible wealth of profoundly useful and helpful information. I send all my friends with stone/bone issues. Thank you again for all you do.
Best regards, Al
Thanks, Al, In fact I am doing another and your suggestions are excellent. Warm Regards, Fred
Dear Dr Coe, thank you for this informative and somewhat entertaing video. I love that you did this. It is so telling and well done. I for one, hope you definitely continue to make these videos. When you have a disease like msk it effects your cognitive abilities also and a comprehensive video like this is so much easier to follow, then papers and articles. This could be a redundant question I’m not sure but do we know exactly why some of us make oxalate stones, and others make CaP brushite and hydroxyapatite stones.?
Thank you again doctor for this video and all of your articles we are so lucky to have crossed paths. Best regards Laurie
Thank you, Laura; I am doing more. As for the phosphate and brushite stones, the main factor is urine pH – higher with phosphate stones; why a higher pH? That is our current research. There is no way to lower it. Warm Regards, Fred
Thank you dear doctor!
Dear Fred:
Thank you Fred for this enlightening Video. Elegant and cristal clear a constant in your presentations.
Remember your first time you came to Acapulco invited by Jaime Herrera an myself. That was quite a happening. You have travel a long and brilliant journey since that time. Warmest regards
Jose Carlos
Dear Jose Carlos, Thank you for watching, and for remembering. I do so miss Jaime Herrera Acosta, and I shall never forget my all too brief time sharing your graceful moonlit Acapulco life, where all the women are beautiful and no one goes out for the evening until midnight or comes home until dawn. Withall, the science was terrific, and the people, too. Warmest personal regards, Fred
DEAR DR COE
EXCELLENT VIDEO. YOUR CONTRIBUTION WITH THE MEDICINE IN SPECIAL WITH THE NEPHROLOGY IS SO VALUABLE AND MAGNIFICENT.
YOUR WORK BELONGS TO THE WORLD MEDICINE. YOU ARE A LIVING LEGEND.
THANK A LOT
Thank you, kindly. Fred
Good day Dr Coe. Very informative video. Im 36 and have had 3 x calcium oxalate stones in the past 9 years. I studied Biochestry so im interested in the biology in ocurrence and preventing these nasty buggers.
My last small (2mm) stone was treated with ESWL which got me thinking. For a mineral stone to form the different molecules have to bind to each other. The bigger the surface area the easier/faster they will bind. With ESWL they break a stone up in millions of small sandlike particles. According to my logic if some of this “sand” remains in kidney it would speed up formation of new stones? Does the kidney excrete all this broken pieces or could some remain in the kidney?
Has there been any research done on an increase of recurrence after ESWL?
Hi Albert, You are an astute thinker – yes, work has been done. SWL has virtues and some drawbacks. For prevention we need an organized approach. Here is one. For calcium oxalate stones not due to systemic disease – probably what you have – this is a very good summary of treatment. Be sure to read both articles. Regards, Fred Coe
Thank you for the reply and informative articles. Your work gives so many of us a good understanding and idea on how to better deal with our unfortunate situation. I will be doing my best to prevent future occurrence.
What does Potasium do to prevent stones?
Hi Belle, potassium does not prevent stones, potassium citrate can – it is the citrate. Here is the article about how it works to prevent stones. Here is another showing the trials and how it fits into a complete treatment plan. Regards, Fred Coe
Hi Dr. Coe,
Thank you for taking your time and help us understand the formation of the stones. I have passed four smaller, 3-4mm stones between 1998 and 2016, every 4 years. I pass the stones within 3 days of the attack. However i just had another 6mm stone within 1year and i had to go through painful surgery,(The stone result came back as came back Calcium Oxalate Dihydrate (Weddellite) 65% Carbonate Apatite (Dahllite) 35%) the only life style change i can remember in the last two years are high consumption of mixed nuts and from 5 glass of alcohol per week to no Alcohol at all. All tests came back normal except border line Uric Acid 7.2mg.
I can not thank you enough for all your assistance
Solomon
Hi Solomon, I doubt the tests are normal, simply the normal ranges are too wide or possibly you have changed things yet again. Read your report yourself for starts. Your kind of stones go with relatively high urine calcium and pH. Regards, Fred Coe
Hello Dr. Coe.
I just wanted to thank you for the interesting and informative video and your review of kidney stone formation and treatment. You have certainly expanded my lay understanding of kidney stones and all they entail. I have Crohn’s disease, diagnosed about 32 years ago, and I only recently became aware that Crohn’s patients are prolific stone producers. This came to my attention after some personal research following the passing of seven stones last year over a period of about four months. I managed to catch the seven I know of using a disposable filter cone. No surprise to you, I’m sure, they were found to be oxalate stones. Under the care of an endocrinologist starting last year, we are addressing this “stone problem” with daily doses of oral potassium chloride along with other lab values that ebb and flow with Crohn’s symptoms. Since I live in Canada, regular visits to the specialist and frequent monitoring of lab results for hematology and general chemistry, make managing all this easier. My Crohn’s and Type II diabetes, combined with various treatment therapies for them, sometimes makes it a challenge to address many serum and chemistry levels outside the norm, but it always helps me to know exactly what is going on and you’ve certainly helped me there.
Again, thank you.
Stephen
Hi Stephen, IN Crohn’s’ disease, urine oxalate is often high and can be lowered with high calcium timed to go with meals. I have not as yet written the article on the disease. But the calcium effect on oxalate is here. I do not have comparable data for bowel disease, but I have lots of experience. It works. Regards, Fred Coe
really liked your presentation but found the back ground music very annoying
Hi Joy, Thanks for the constructive criticism. I worry about it, too, and need to edit it out. It was my first venture into the medium. Regards, Fred
Hi Dr. Coe,
Thanks for the video. I was expecting information about prevention/ unpacking. Do we need to take more water? Dietry changes?
Thanks
Jude
Hi Jude, Here is a good plan for stone prevention. The video was meant as an informational. Regards, Fred Coe
Dear Sir,
My wife had gone to gynecologist for the check and as per the report , TSH was 2.86 uIU/ml (Range : 0.2-4.2). The doctor prescribed her Tab Loette, Tab Melmet SR 500, Myocyst Sachet, Tab Esmocim 40 mg and Syp Lucid 2 TSF. After 1 year when she again check the TSH it was 5.750 uIU/ml (0.465-4.68), FT3 was 4.09 pg/ml (Range: 2.7-5.2) and FT4 was 1.29 ng/dL (Range: 0.78-2.19). The test for latter was done through ECLIA method. I am very tensed with the latter report. How can the TSH increase just in the span of 1 year.
Could you please tell me if the TSH could be reduced or bring it in normal range naturally .
Regards
Nimesh
Hi Nimesh, I am afraid my site does not concern thyroid disease. I am not a thyroid expert and cannot comment on these data. Regards, Fred Coe
I just recently had a uric acid and uric acid dehyhdrate stone . I have also had calcium oxolate and calcium phosphate. Is this normal to have three types ?
I also have a citrate deficiency.
Hi Ben, That is a common example of a stone forming trait. The same alkali that will prevent uric acid stones usually will raise the urine citrate. Regards, Fred Coe
Hi Ben, Uric acid stones arise from an overly acidic urine pH and are corrected by raising that pH with alkali. Here is the article you want. The other stones have other causes, and the way to find them is via 24 hour urine testing. I would pursue this. Yes, all three crystal types can be formed by one person. Regards, Fred Coe
It appears to be the video link is broken.
Hi KJ, Thanks. I will go in and figure out what went wrong. Fred
Yes, I would like to see the video too. Thanks!
Hi G Mead, I fixed the link and the video runs fine. I hope you like it. Fred
Thank you! This video was exactly what I was looking for! I loved it and how you explained everything. I passed my 3rd crystal today and need to learn about prevention. How much is about diet snd how much about other factors?
I really like your style doc!
Marv
Hi Marv, I am glad it worked for you. Best, Fred
Very interesting! I suffered with over 50 kidney stones. I had to get rushed to a different state to get them pulled out one by one. After they were done they put a stent in each kidney. Just recently I recovered from sepsis and two months before that I had sepsis shock. After I recovered then they had to remove five more kidney stones. The kidney stone had ripped me internally and caused a blood infection which gave me sepsis. I just don’t understand how they don’t have medicine or some thing for this. My diet is fine except for my calcium and potassium is low. I am understanding how the process works but there has to be something that can be done. Very painful!!!! With having sepsis and a kidney stone I don’t even remember being in the ICU. Doctors aren’t telling me much But at least they are removing them
Dear Laura, you need to prevent more stones, and here is my best on that. The recurrent sepsis is very worrying, and suggests that your surgery must be unusually complicated. Regards, Fred Coe
Ugh . Just had another kidney stone had to got to the emergency room last Saturday into Sunday . The pain was so bad . Lucky the the iv with fluids and pain meds helped . By Tuesday my stone finally passed .
My stone was Calcium Oxalate Dihydrate (Weddellite) 20%
Calcium Oxalate Monohydrate (Whewellite) 80% . It’s weight was 0.050 and about 6 mm. I hate these things . What do you think about chanca piedra to help stones ?
Hi Ben, There is a lot to do for prevention. Here is my best on the topic by way of an introduction. See if it works for you. Regards, Fred Coe
Hello , I just had another kidney Stone attack recently and had to go to emergency room. I hate kidney stones . It was a Oxloate stone . Have you heard anything about Chanca Piedra Tea ? It’s advertised as a stone breaking tea . Any thoughts?
Hi Ben, Chanca.. is most likely useless for stone prevention. I began some scholarship about it years ago and frankly dropped it for boredom. I should go back and write it up. If you have so many stones, a proper evaluation is SO important and treatment aimed at cause. I see you have 6 other comments on this site (the software does not let me review them – a big defect). If you have not considered this chapter, please consider it as a way forward. I am sad that someone who has been here is not more free of stones, and would like to do better. Best, Fred
Hello , thank you for your positive and information. Im just seeing this now . For some reason. My nephrologist had me do double 24 hour urine test . Wants me to lower my salt . Also non stop drinking water with crystal light . Also him and my endocrinologist put me on a medication jardians which will help me pee more often . He said Chanca there’s not enough of evidence . But he said I can try in small doses .
Hi Ben, I presume your urine calcium is high and sodium, as well. Jardiance (empagliflozin) is an inhibitor of kidney cell glucose reabsorption and used for heart failure, diabetes, and kidney disease. I do not know of a role in kidney stone prevention. I assume you have some one of these other reasons for using it. As for Chanca, there is no evidence for effectiveness. Regards, Fred Coe
Hello , I have lower level order line diabetic that is well managed along with other stuff like Hashimotos and primary ciliary dyskinesia. Never a dull moment . They said that for sugar purposes I don’t really need Jardiance. But they felt that it would cause me pee more also check out this article :
https://www.diabetesselfmanagement.com/news-research/2022/06/27/jardiance-linked-to-lower-kidney-stone-risk-in-type-2/
Hi Ben, The drug is an inhibitor of the glucose transporters in the proximal tubule of the kidney and can lower blood glucose, help manage hypertension and perhaps protect against kidney disease progression. The article you quote is a fragment and too small for use. Quite possibly the drug may help with stones, but I cannot recommend it presently. Regards, Fred Coe
Hi, I’ve had four episodes of kidney stones and their removal, all of which took place in the hospital over a span of fifty years. The first was removed, the second and third by use of a stent, finally the last episode which was last week and the stone was removed.
All of the these stones were Calcium Oxalate.
The last stone was composed of 80% calcium monohydrate, 10% calcium oxalate dihydrate and 10% calcium phosphate (hydeoxy- and carbonate- apatite).
Will eating more calcium rich dairy products be of value to me? Are there any drugs that would be of beneficial use to me?
Thank you,
Al
Hi Albert, fortunately your stones have been spaced out but I would find the cause via a complete evaluation. There is almost certainly something causing them and most of the time causes can be corrected to prevent more stones. Diet and drugs are available but best used with knowledge of cause. Regards, Fred Coe