Southern Illinois Urology

Dr. Hatchett’s Kidney Stone Prevention Tips

The most common kidney stones are calcium oxalate. The calcium can be increased in the urine from the amount of calcium in our water but also certain people are what we call renal leakers and just excrete more calcium. One thing that causes an increase of calcium excretion is sodium intake. If you eat a lot of salt the kidney will pump out calcium in the urine for every sodium it intakes. There are certain preventative measures that I recommend. First of all is citrate. Citrate is what we call a stone inhibitor because I want citrate to bind to the calcium instead of the calcium binding to oxalate. This is what we call competitive inhibition.

  1. Increase your citrate to help prevent calcium oxalate stones. You can find citrate in your diet therefore I recommend:
    • Lemonade, which has high citrate content. My recommendation is ½ of lemon in the morning and ½ lemon in the afternoon in the form of lemonade, four glasses per day.
    • Country Time Lemonade or Crystal Light has less sugar. I would recommend four glasses per day.
    • Oranges or orange juice has citrate but not as much as lemons.
    • Limes are also helpful but have less citrate than lemons or oranges.
  2. Avoid high oxalate intake:
    • Black tea has the highest oxalate content. The weaker the tea the less oxalate.
    • Green tea is okay and does not affect the oxalate levels.
    • Avoid dark or colored sodas because they have phosphoric acid, which makes your urine too acidic and also causes dehydration.
    • Drink clear sodas versus dark sodas because clear sodas have citric acid instead of phosphoric acid. Therefore you are receiving the citrate benefits, which is still a stone inhibitor even though sodas may be causing some diuretic effect and dehydration.
  3. Avoid high sodium intake:
    • The daily amount of sodium intake per day for a stone former should be only 2300 mg. This is the equivalent of one can of soup.
    • As I stated above the kidney will excrete more calcium in the urine for every sodium that it intakes therefore high salt diets lead to more calcium in the urine.
    • Avoid dark or colored sodas because they have phosphoric acid, which makes your urine too acidic and also causes dehydration.
  4. For uric acid stone formers your recommendations will be different:
    • Uric acid formers are what we call a metabolic stone former. This means your body is either producing too much uric acid or it is also because your kidneys keep your urine too acidic.
    • It is important that the ph of your urine stay above 6.0 and there are a few ways of achieving a higher urine ph which are:
      • Drinking large amounts of citrate, or
      • You can buy sodium bicarbonate tablets over the counter without a prescription and I would recommend one to two tablets three times a day, or
      • Baking soda one to two teaspoons three times a day.
    • You can purchase urine ph strips either at the pharmacy over the counter or at a pet store. Yes, you can get these at a pet store because many people check the ph of their fish tanks with the same type of ph strips. As long as your ph is above 6.0 then your stone can dissolve. Uric acid is one of the only stones that can be dissolved before preventing the stone from forming and also possibly preventing surgery.
    • Allopurinol is a medication that many stone formers need to take if their serum uric acid is high.
  5. Recommendations for women taking calcium replacements:
    • We recommend that you do not stop your calcium because if you are low in calcium your body will pull the calcium out of your bones and increase your risk of osteoporosis.
    • We recommend taking Citracal and not Oscal. Once again you are getting the beneficial effects of the citrate in the Citracal.

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