HOW CAN KIDNEY STONES BE PREVENTED?

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HOW CAN KIDNEY STONES BE PREVENTED?

 

http://urology.jhu.edu/kidney/STONESprevention.php

 

If you have had one kidney stone, you are likely to form another. To

reduce your chances of forming another stone, the first step is to

determine why your original stone formed in the first place. At the

Brady Urological Institute at Johns Hopkins, we believe in the

adage,

"An ounce of prevention is worth a pound of cure," so we place great

emphasis on a thorough metabolic evaluation, so that therapies can

be appropriately directed towards reducing the risk of recurrent stone

disease.

 

If you passed your stone on your own, and still have it, your doctor

will send it to a laboratory to be analyzed to see what it is made of.

 

Usually, if your stone is removed by ureteroscopy or PERC, your

doctor will send a piece of the stone for analysis, too. The composition of

a stone is an important piece of information to know, as treatment is

specific to the type of stone.

 

Because we know that kidney stones form when the urine has too high

a concentration of crystals and/or not enough substances that protect

against the crystals, a detailed analysis of the metabolism of a

stone former is important. Typically, the metabolic evaluation of a stone

former consists of a simple blood test and two 24 hour urine

collections.

 

The results of these metabolic studies will provide an assessment of

the risk of future stone formation. One or more of the following

diagnoses and treatments may be made based on these metabolic data.

 

Diagnosis: Low urine volume.

Treatment: Increase fluid intake

The most basic thing you can do to prevent stone formation is to

drink more fluids, thereby diluting your urine. Your goal should be to

urinate more than two liters per day. All fluids count towards this goal,

but water is, of course, the best.

 

Diagnosis: Too much calcium in the urine (hypercalciuria)

Possible Treatments:

 

Low sodium intake

The human body carefully regulates its sodium levels. When excess

sodium is excreted in the urine, calcium is also excreted proportionally.

In other words, the more sodium you consume, the more calcium that will

be in your urine. Your goal should be to reduce your sodium intake so

that you consume less than 2 grams of sodium per day. Watch out

for "silent

sources" of salt, such as fast foods, packaged or canned foods,

softened water, and sports drinks.

 

Normal calcium diet

Stone formers sometimes think that because there is too much calcium

in their urine, they should restrict their calcium intake. There is no

research that supports this practice.

Your body needs dietary calcium to support the skeleton. For

patients who form calcium oxalate stones, it is doubly important to consume

adequate dietary calcium, because under normal circumstances calcium

and oxalate bind together in the intestine and are eliminated from the

body.

If there is no calcium to join with oxalate, the oxalate will be

reabsorbed by your body and passed into the urine where it may

increase the risk of calcium oxalate stones.

 

Increase fluid intake

No matter what your diagnosis, you should drink enough water to

produce at least 2 liters of urine per day.

 

Diagnosis: Hypocitraturia (too little citrate in the urine)

Possible Treatments: Citrate supplementation

Citrate is a molecule that binds to calcium in the urine, preventing

calcium from binding to oxalate or phosphate and forming a stone. If

your potassium level is low or normal, your doctor may prescribe

potassium citrate supplement. If you have high blood potassium

levels, your doctor may prescribe a sodium citrate supplement, such as

Bicitra or sodium bicarbonate.

There is some evidence that citrus juices, such as orange juice or

lemonade may increase urinary citrate levels, so these fluids would

be particularly good for patients with hypocitraturia.

 

Diagnosis: Hyperoxaluria (too much oxalate in the urine)

Possible Treatments:

Low Oxalate Diet If you form calcium oxalate stones, it is important that you limit

your intake of dietary oxalates. Many healthy foods contain oxalate, so

rather than exclude these foods entirely, we just ask that you limit

those foods that are particularly high in oxalate. If you do consume

foods high in oxalate, be sure to flush out the extra load of

oxalate with an added glass or two of water.

 

Normal Calcium Diet

Oxalate and calcium bind together in the intestine and leave the

body together in the stool. If there is not enough calcium, then the

extra oxalate will have nothing in the intestine to bind to, so it will be

absorbed into the bloodstream and end up in the urine, where it will

form a calcium oxalate stone.

 

Increase Fluid Intake

No matter what your diagnosis, you should drink enough water to

produce at least 2 liters of urine per day.

 

Hyperuricosuria (too much uric acid in the urine)

Possible Treatments Low protein diet

Most Americans far exceed the necessary protein intake, which can

lead to too much uric acid in the urine. As a general recommendation,

limit your daily protein intake to 12 ounces per day of beef, poultry,

fish, and pork. Twelve ounces is equivalent in size to about three decks

of cards. This will be plenty of protein to meet your body's needs.

 

Increase Fluid Intake

No matter what your diagnosis, you should drink enough water to

produce at least 2 liters of urine per day.

 

Diagnosis: Low Urine pH (too much acid in the urine)

Possible Treatments:

Citrate Supplementation

Citrate supplements, such as potassium citrate, will raise the pH of

your urine, making stones, such as those composed of uric acid, less

likely to form. If your blood potassium level is high, your doctor

may prescribe sodium bicarbonate or Bicitra.

 

Lower Protein Intake

A diet high in protein will reduce urinary pH. As a general

recommendation, limit your daily protein intake to 12 ounces per day

of beef, poultry, fish, and pork. Twelve ounces is equivalent in size

to about three decks of cars. This will be plenty of protein to meet

your body's needs.

 

Increase Fluid Intake

No matter what your diagnosis, you should drink enough water to

produce at least 2 liters of urine per day.