Why recurring kidney stones?

[pace]

my poor brother, business traveling for past three wks, is stuck in Brussels hospital suffering again from kidney stones! He seems to have these recurring attacks every year for past 12, so what can possibly be going on? Is this indicative of down-the-road kidney failure?

[Burrido]

My brother has the same problem. They recently sent some of his stones in to test to see why he keeps getting them. Part of the problem is heredity. My mother and sister had kidney stones as well. I dodged the bullet so far it seems. Diet could be another part. Diets high in fat/salt/dairy as well as low water intake. The doctors need to see what kind of stones they are as well. There’s a couple varieties.

[Qadgop_the_Mercotan]

Here’s a good general link about kidney stones: http://kidney.niddk.nih.gov/kudisea...s/stonesadults/

Here’s a quote from an old thread about kidney stones:

@QtM

a competent doc should be able to test your stone to determine its type, test your urine for critical high and/or low levels of key metabolites, and suggest a dietary change/medication addition which could prevent future stone formation, and which could dissolve stones which are still sitting in the kidney and not yet causing problems.

Uric acid stones can often be avoided by maintaining urine pH in the 6.5 to 7 range. Sodium or potassium citrate is often used to do this. If the stones are forming because of excess excretion of urate, restriction of dietary proteins may help. If not, then allopurinol might prevent future stone formation too.

Pure calcium phosphate stones are uncommon and need further medical evaluation to determine why one is forming them.

Mixed calcium phosphate & oxalate stones have a number of possible causes. All with different treatments.

If they form because of concentrated urine, drink more fluid. If they form because there is excess calcium in the urine, then calcium levels in the blood should be checked. If blood calcium levels are normal, you actually probably need more dietary calcium, but in a form that’s retained in your body better, and not as calcium supplement tabs. If that fails, your doctor might recommend urine acidification or other drug therapy, like hydrochlorothiazide.

But: If your mixed calcium phosphate and oxalate stones form because you are putting too much oxalate in your urine, then treatment will depend on just how much excess oxalate is in your urine. If only mildly elevated, you just might need to lower the oxalate in your diet and make sure you’re getting less than 2 grams of vitamin C a day. If medium, you might need an agent to bind the oxalate in your gut, and not let your body absorb so much. Cholestyramine works for this purpose. If real high, you may need high dose vitamin B 6 (pyridoxine) to to control it, and your liver should probably be evaluated to see why you put out so much oxalate.

However: If your mixed calcium phosphate and oxalate stones are a result of low levels of citrate in the urine, then merely adding potassium citrate to your diet should suffice.

Oddly enough: Sometimes, the first-mentioned excess urate in the urine causes not uric acid stones, but mixed calcium phosphate and oxalate stones! (is it not to laugh?) If that is what is occurring, then go ahead and treat with the measures recommended for treating uric acid stones.

Now: There are a myriad of cases which are not so clear-cut as the above, so I won’t get into them here.

In the meantime: Drink lots of water!!!

BTW, here’s a rather technical link which helps one figure out what to do based on what type of stone, with a bit of background epidemiology.

http://fpnotebook.com/URO107.htm

from this thread: http://boards.straightdope.com/sdmb/showthread.php?t=246401

Here’s another old thread on the topic: http://boards.straightdope.com/sdmb/showthread.php?t=309861

In short, some people are prone to forming certain types of stones, for a variety of reasons. Most commonly, as long as the stones are treated properly, it doesn’t cause kidney failure.

[vivalostwages]

My dad is prone to forming the calcium/oxalate ones, though he hasn’t been plagued with any for quite a while now. In his “heydey” he must have had at least 8 or 9 lithotripsies to break up those little bastids. Some people just produce them more than others.

[lee]

My husband had recurring stones until he started taking allopurinol for his gout and followed a gout diet. Since then the only time he has had stones is when an incompetant doctor inadvertanly cut his dosage drastically. We found out it was indavertant when he was being treated for the stones he was passing. After his dosage was returned to normal, no more stones have shown up. The nice thing aside from no more stones, is that allopurinol is inexpensive and so far studies only turn up good things about it.

[fortytwo]

@lee

My husband had recurring stones until he started taking allopurinol for his gout and followed a gout diet. Since then the only time he has had stones is when an incompetant doctor inadvertanly cut his dosage drastically. We found out it was indavertant when he was being treated for the stones he was passing. After his dosage was returned to normal, no more stones have shown up. The nice thing aside from no more stones, is that allopurinol is inexpensive and so far studies only turn up good things about it.

That’s interesting, I’ve had kidney stones in the past and more recently been prescribed Allopurinol for gout. Hopefully I will gain the same benefit.

[Qadgop_the_Mercotan]

@Vetch

That’s interesting, I’ve had kidney stones in the past and more recently been prescribed Allopurinol for gout. Hopefully I will gain the same benefit.

It’ll be mainly of benefit only if you had a uric acid stone, or a mixed calcium phosphate and oxalate stone which precipitated due to excess urate in the urine.

See my post above for further elaboration.