FAQ

Questions from fellow kidney stone formers.

Here you will find the answers to the most common questions I receive from kidney stone formers.

Which tests should I ask my doctor to order?

Your doctor should order both a 24 hour urine collection and also a fasting blood draw to rule out any systemic diseases that may be causing your kidney stones.

Why do I need a 24 hour urine collection?

There are many reasons why you could be making stones. After you have your FIRST stone, your doctor needs to look at your urine test results in order to customize a treatment plan for you. A doctor would not start you on blood pressure medication before taking your blood pressure. How can a doctor prescribe a preventative stone treatment plan if he doesn’t know what is causing your stones?

Please always ask for a copy of your results (this goes for all of your medical testing) so you have them for your records.

Should I alter my diet before doing my urine collection?

No. Eat and drink as you were when you were making kidney stones. It is important that you do not make changes before the urine collection.

Why do I need a fasting blood test?

Many doctors do not order a fasting blood test, but it is important, so your doctor can rule out medical issues that could also be a factor in your stone disease.

I finally changed to a “healthier” diet but now I have a stone.

Portion size is key, even with a healthy diet. Many, many, patients have to come to me feeling angry and anxious that their newly implemented healthy diet caused their kidney stones.

How do I juggle all my different dietary sensitivities and restrictions?

It can be very difficult when you are faced with conflicting dietary orders. Did your diabetes doctor tell you to incorporate more plants foods into your diet and your kidney stone doctor tell you to stay away from green, leafy, vegetables? It is difficult to know what to do in this scenario. If you sign up for The Kidney Stone Prevention Course, you will learn how to make the changes necessary to keep all your doctors happy and you healthy.

My doctor told me to stop eating dairy.

This will not only increase your risk of kidney stones, but will also increase your risk of bone loss. It is very important that you get enough calcium every day.

My urine test says that I have too much calcium in my urine. Why should I eat foods high in calcium if my urine calcium is already high?

The calcium that is coming out in your urine could be from your bones. If you don’t eat enough food that contains calcium, you might be increasing your risk for stone and bone disease. You also need calcium to rid your body of the extra oxalate you consume.

What causes excess calcium in urine if I am not eating any calcium?

Eating too much sugar, salt, and protein can increase the amount of calcium in your urine and create bone loss as well. Other causes of high urine calcium could be medical conditions that could be ruled out by doing the fasting blood test.

What if I cannot tolerate dairy products?

Did you just come from Dr. Coe’s website and read where we tell you to add dairy into your diet for your much needed calcium intake but you are lactose intolerant? Thankfully, there are many non-dairy alternatives today.

Look for lactose free milk (I love Fairlife). If you are sensitive to casein (a protein found in milk), then you can use unsweetened flax milk or fortified coconut or rice milk.

Can I continue to be a vegan and prevent stones?

Yes, is the short answer. You can remain a vegan and still lower your kidney stone risk.

Click here to read about a private client who had dangerously high levels of urinary oxalate.

After working with me, she was able to get her oxalate levels down from over 100 mg/day to 29 mg/day. She happily continues her vegan lifestyle and keeps her oxalate levels within normal range.

How much fluid should I drink?

It is recommended that you drink enough fluid to produce at least 2.5 liters of urine per day.

How do I get my kidney stone analyzed?

If you pass a stone at home, save it and take it to your doctor’s office so that it can be analyzed. If you have surgery to remove the stone(s), please ask your doctor to send them out for analysis. Just because you made one type of stone doesn’t mean you will always make that type. Get all stones analyzed.

Why do I need to do a follow up urine collection?

Once you get on a treatment plan, you want to make sure it is having the desired effect, and by that, I mean lessening your kidney stone risk. You will only know the answer if you do a follow-up urine collection.

Many doctors do NOT order the follow-up tests, and I have many patients who say, “I did the first urine collection and changed my diet, but was not told to do the follow-up collection”. Why did they come to me? Because they made another stone. They thought they had changed their diet sufficiently but in reality had not. The follow-up test would have indicated that more dietary changes were needed.

Why do I need to do an annual urine collection?

As we age, our urine chemistries may change. Your urologist or nephrologist should do yearly urine and blood work-ups to make sure you managing the recommended dietary changes correctly and that they continue to be effective. The annual urine collection is a good way to stay on top of things. Another great way to stay compliant is to join the Kidney Stone Accountability Group.

Why is lowering my sugar intake important in stone disease?

Eating too much added sugar will cause calcium to be leached from your bone and into your urine. It will also lead to decreased urine output and increase your risk of obesity and diabetes.

What oxalate list should I trust?

Dr. Coe and I recommend the oxalate list put out by Harvard which you can find here. We have used it for many years and our patients do lower their urinary oxalate when they follow it and our other advice.

Why do oxalate levels vary from list to list?

Oxalate content is dependent on the soil and growing conditions of the plant. The Kidney Stone Prevention Course will teach you how to understand and use the list.

How much protein can I have per day?

Somewhere within this range.

0.8 gm/kg/d – 1 gm/kg/d

Example: I weigh 125 pounds. Divide 125 by 2.2 to get to kg. The kg would be 56.8. If I use the equation above and plug in my numbers it would look like this: 0.8 x 56.8 = 45.4 and 1.0 x 56.8 = 56.8.

I can eat between 45.4 gm/day – 56.8 gm/day in animal protein. After converting the grams to ounces it equals 1.6 – 2.0 oz/day. Not very much is needed as you can see.

My doctor wants to put me on medications to help prevent my kidney stones.

Sometimes you have to start medications to lessen your stone risk due to genetic issues that cannot be resolved by diet alone. Most of the time implementing the dietary changes will at least lower the dose you were originally asked to go on.

If your doctor wants to start you on medications, ask if you can first make an effort to change your diet to see before you start medication. If you do need medications, even after incorporating dietary changes, perhaps you will require a lower dose of the meds being prescribed. Check your progress by doing a follow up 24-hour urine collection to see if the dietary changes had a positive effect on your urine results.

Should I use lemons in my water to prevent stones?

If you have low citrate levels in your urine (determined by a 24 hour urine collection), it has been shown that you can add lemons to your water to help increase your citrate levels.

What about all the remedies I read about on the internet like Chanca Piedra and Apple Cider Vinegar?

There is no science to back up these claims.

Will I form another kidney stone?

Unfortunately, statistics show 50 percent of you will form another kidney stone within the next 5 years.

Another way to say it is 1 in 2 will form another stone in 5 years. Those are NOT good odds! Prevention is key and education is power. Take the Kidney Stone Prevention Course so you can learn how to lessen the chance of it ever happening again!

Which fluids are best?

I get asked this a lot. All fluids count, but water is best, not to mention, healthiest for you.

Why is lowering my sodium intake important in stone disease?

Eating foods high in sodium can cause calcium to be leached from your bones and put you at risk of forming stones. It will also lead to decreased urine output.

Lowering your sodium is also very important in managing blood pressure, the risk of stroke and other cardiovascular conditions.

What are the first signs of a kidney stone?

Blood in the urine, dull back pain, intense abdominal pain, side pain, cloudy or foul smelling urine, urgency to urinate, pain during urination, nausea, vomiting, diarrhea, fever, chills, and going a little bit at a time.

What is best to drink if you have kidney stones?

Water is always best for stone formers and in fact for anyone who is trying to increase fluid volume.

What does a urologist do for a kidney stone?

A urologist is a surgeon who evaluates your condition and determines whether or not you need to have your kidney stone removed, and then if need be, removes the stone. As part of your evaluation, urologists will order tests that may include analysis of blood and urine samples to help determine why you are forming stones.

How do you check to see if you have a kidney stone?

You should speak to your doctor about your symptoms. Based upon your symptoms, the doctor will determine whether or not some type of imaging should be ordered to see if there is a kidney stone present.

Can you tell if you have kidney stones by doing a urine test?

You cannot definitively tell if you have a current stone from doing a urine test. The urine test will help explain why you made a stone and the changes you will need to make in order to lessen the chance of forming another one. Only by using imaging techniques, an ultrasound, KUB or CT scan, will you know if you currently have stones.

Can you die from having a kidney stone?

Risk of death is very low (see here),but it can happen.

What are the worst foods for kidney stones?

A diet that is high in sugar and salt, and low in calcium will increase your risk of forming more stones.

Why do some people get kidney stones?

There are many variables that contribute to stone formation. Genetics, lifestyle and other diseases are all factors that increase stone risk.

What should my first steps be once I discover that I have a kidney stone?

Getting a referral to a urologist is the first course of action. Most urologists routinely order blood and urine tests to determine the best preventative treatment for you. If not, ask your doctor to order a 24-hour urine collection to help understand why you are forming stones and to pinpoint the specific foods you need to eliminate or modify. These tests might also uncover an underlying medical condition that is causing your stones. Here is an article that you should find helpful.

Can you get a kidney stone from stress?

You will not get a kidney stone specifically from stress itself. But you can increase your stone risk if the stress you are experiencing is causing you to eat poorly, or not drink enough fluids.

How long does it take for a kidney stone to pass?

It varies, but if your stone is small (less than 4 mm) about 1 to 2 weeks. If the stone is greater than 4mm, it can take 2-3 weeks. If you drink lots of water, that may help speed up the process. Also, if you feel up to it, walking or moving, in general, may help you pass the stone.

Is drinking cranberry juice good for stones?

There is no proof that cranberry juices aids in stone prevention.

Is lemon juice good for stone prevention?

Only if your citrate level just needs a bit of help in getting to normal values. Best to get your citrate up by eating your 3-4 servings of fruits and veggies a day.

Do kidney stones run in families?

Yes, frequently there is a genetic component.

Can kidney stone pain come on suddenly?

Yes.

Can the pain from a stone come and go?

Yes. It can be intermittent pain or pain that is intense and won’t subside. The latter may warrant a trip to the emergency room.

Is peanut butter bad for kidney stones?

Peanut butter is high in oxalate. Overeating foods high in oxalate can increase your risk of forming kidney stones.

What helps kidney stones?

Treatments that may lower your risk of forming new stones or keeps the ones you may have from growing include increasing fluids, dietary changes, and sometimes prescribed medications.

What can you drink to dissolve kidney stones?

There are no drinks that have been proven to dissolve kidney stones.

Is coffee good for kidney stones?

Drinking coffee in normal amounts will actually lower your risk of new kidney stones. (see here).

Is green tea good for kidney stones?

Here is a study showing the oxalate levels in a variety of teas. Green tea was found to be lower in oxalate than black tea.

Are kidneys stones as painful as childbirth?

Kidney stone pain has been described by women as being as painful as childbirth, some say even more painful.

How do you verify you have a kidney stone?

You will need to do some type of imaging to get a definitive diagnosis. Your doctor might order an ultrasound, a KUB, or a CT.

Do you have to “pee” out a kidney stone?

You will either pass the stone in your urine or have it removed by a urologist if it is too large to pass. Some people have smaller stones and they opt to have periodic imaging to monitor if the stone grows or moves.

Can the pain from a stone come and go?

Yes.

What can you do to relieve kidney stone pain?

Sit in a warm bath. Use a heating pad to relieve soreness around your back or abdomen. If the pain gets too intense or you have a fever, go to your local ER.

What are the five types of kidney stones?
  • Calcium Oxalate
  • Calcium Phosphate
  • Struvite
  • Cystine
  • Uric Acid