If you’ve ever had a kidney stone, you surely remember it. The pain can be unbearable, coming in waves until the tiny stone passes through your urinary plumbing and out of the body. For many, kidney stones aren’t a one-time thing: in about half of people who have had one, another appears within seven years without preventive measures.
Preventing kidney stones isn’t complicated, but it does take some determination.
Kidney stones form when certain chemicals become concentrated enough in the urine to form crystals. The crystals grow into larger masses (stones), which can make their way through the urinary tract. If the stone gets stuck somewhere and blocks the flow of urine, it causes pain.
Most stones occur when calcium combines with one of two substances: oxalate or phosphorous. Stones can also form from uric acid, which forms as the body metabolizes protein.
Preventing kidney stones means preventing the conditions that support their formation. I asked Dr. Melanie Hoenig, an assistant professor of medicine at Harvard-affiliated Beth Israel Deaconess Medical Center, for the top ways to prevent kidney stones. Here are her recommendations:
Drink plenty of water: Drinking extra water dilutes the substances in urine that lead to stones. Strive to drink enough fluids to pass 2 liters of urine a day, which is roughly eight standard 8-ounce cups. It may help to include some citrus beverages, like lemonade and orange juice. The citrate in these beverages helps block stone formation.
Get the calcium you need: Getting too little calcium in your diet can cause oxalate levels to rise and cause kidney stones. To prevent this, make sure to take in an amount of calcium appropriate to your age. Ideally, obtain calcium from foods, since some studies have linked taking calcium supplements to kidney stones. Men 50 and older should get 1,000 milligrams (mg) of calcium per day, along with 800 to 1,000 international units (IU) of vitamin D to help the body absorb the calcium.
Reduce sodium: A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. So a low-sodium diet is recommended for the stone prone. Current guidelines suggest limiting total daily sodium intake to 2,300 mg. If sodium has contributed to kidney stones in the past, try to reduce your daily intake to 1,500 mg. This will also be good for your blood pressure and heart.
Limit animal protein: Eating too much animal protein, such as red meat, poultry, eggs, and seafood, boosts the level of uric acid and could lead to kidney stones. A high-protein diet also reduces levels of citrate, the chemical in urine that helps prevent stones from forming. If you’re prone to stones, limit your daily meat intake to a quantity that is no bigger than a pack of playing cards. This is also a heart-healthy portion.
Avoid stone-forming foods: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, and colas are rich in phosphate, both of which can contribute to kidney stones. If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.
For everyone else, particular foods and drinks are unlikely to trigger kidney stones unless consumed in extremely high amounts. Some studies have shown that men who take high doses of vitamin C in the form of supplements are at slightly higher risk of kidney stones. That may be because the body converts vitamin C into oxalate.
Prevention of kidney stones may include a combination of lifestyle changes and medications.
Lifestyle Changes Kidney Stones
You may reduce your risk of kidney stones if you:
Drink water throughout the day. For people with a history of kidney stones, doctors usually recommend passing about 2.6 quarts (2.5 liters) of urine a day. Your doctor may ask that you measure your urine output to make sure that you're drinking enough water.
If you live in a hot, dry climate or you exercise frequently, you may need to drink even more water to produce enough urine. If your urine is light and clear, you're likely drinking enough water.
- Eat fewer oxalate-rich foods. If you tend to form calcium oxalate stones, your doctor may recommend restricting foods rich in oxalates. These include rhubarb, beets, okra, spinach, Swiss chard, sweet potatoes, nuts, tea, chocolate and soy products.
- Choose a diet low in salt and animal protein. Reduce the amount of salt you eat and choose nonanimal protein sources, such as legumes. Consider using a salt substitute.
- Continue eating calcium-rich foods, but use caution with calcium supplements. Calcium in food doesn't have an effect on your risk of kidney stones. Continue eating calcium-rich foods unless your doctor advises otherwise. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people.
Ask your doctor for a referral to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.
Medications can control the amount of minerals and acid in your urine and may be helpful in people who form certain kinds of stones. The type of medication your doctor prescribes will depend on the kind of kidney stones you have. Here are some examples:
- Calcium stones. To help prevent calcium stones from forming, your doctor may prescribe a thiazide diuretic or a phosphate-containing preparation.
- Uric acid stones. Your doctor may prescribe allopurinol (Zyloprim, Aloprim) to reduce uric acid levels in your blood and urine and a medicine to keep your urine alkaline. In some cases, allopurinol and an alkalizing agent may dissolve the uric acid stones.
- Struvite stones. To prevent struvite stones, your doctor may recommend strategies to keep your urine free of bacteria that cause infection. Long-term use of antibiotics in small doses may help achieve this goal. For instance, your doctor may recommend an antibiotic before and for a while after surgery to treat your kidney stones.
- Cystine stones. Cystine stones can be difficult to treat. Your doctor may recommend that you drink more fluids so that you produce a lot more urine. If that alone doesn't help, your doctor may also prescribe a medication that decreases the amount of cystine in your urine.
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