Video Article: How Stones Form

MeThis 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

Plaque in Kidneys


What Stones Are


Idiopathic Hypercalciuria – Another review of the nephron

Control of Urine Oxalate – Yet another view of the nephron


26 Responses to “Video Article: How Stones Form”

  1. Stephen O'Mara

    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.

    • Fredric Coe, MD

      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

  2. Solomon Lemma

    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

  3. Belle

    What does Potasium do to prevent stones?

  4. Albert

    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?

    • Fredric Coe, MD

      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

      • Albert

        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.






  6. Jose Carlos Peña MD

    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

    • Fredric Coe, MD

      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

  7. Laura bousada

    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

    • Fredric Coe, MD

      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

  8. Al R.

    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

  9. Celia MacDonald

    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!

  10. Dave Monk

    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.

  11. Marcia PETCHENIK

    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.

  12. Ross Holmes

    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.


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