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
Answered by
kb
, an ibibo Citizen,
at
2:54 AM on February 05, 2008