By far the most important lifestyle change to prevent stones is to drink more fluids….water is best. If you tend to form stones, you should try to drink enough liquids throughout the day to produce at least two litres of urine every 24 hour period. As stones form only when the urine is concentrated, it is possible to know when you are at high risk – look at your urine – if it is dark then you should be drinking more. Aim for pale clear urine.
People who form calcium stones used to be told to avoid dairy products and other foods with high calcium content. But recent studies have shown that foods high in calcium don’t increase the risk of developing stones.
As well as lifestyle changes mentioned above, drugs such as hydrochlorothiazide are also occasionally used to help prevent calcium stones. These drugs decrease the amount of calcium released by the kidneys into the urine. Uric acid stones are the only stones that can be dissolved. This is difficult but is possible by taking medicine to make the urine less acidic (the pH must be over 6.5) and taking a large amount of fluids. Once they are dissolved, fluids alone can prevent more stones.
To prevent cystine stones, it is necessary to drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than four litres of water may be needed every 24 hours, and a third of that must be drunk during the night. Various medicines are used at times also.
For struvite stone(s) that have been totally removed, the first line of prevention is to keep the urine free of the bacteria that can caused infection. Your urine will be tested regularly to be sure that no bacteria are present. People with hyperparathyroidism sometimes develop calcium stones. Treatment in these cases is usually surgery to remove the parathyroid glands (located in the neck). In most cases, only one of the glands is enlarged. Removing the glands cures the patient’s problem with hyperparathyroidism and with kidney stones as well.
Surgery is reserved as an option for cases where other approaches have failed or shouldn’t be tried. Surgery may be needed to remove a stone if:
- Does not pass after a reasonable period of time and causes constant pain.
- Is too large to pass on its own, or is caught in a difficult place.
- Blocks the flow of urine.
- Causes ongoing urinary tract infection.
- Damages kidney tissue or causes constant bleeding
- Has grown larger (as seen on follow-up x-ray studies).
Until the last few decades, surgery to remove stones meant an open operation. It involved cutting the skin and was very painful. It also required a lengthy recovery time (4-6 weeks). Today, surgical treatment for stones is greatly improved and open surgery is very rarely required. Most treatment options are much easier for the patient and do not require major surgery.
Your surgeon will discuss with you which option is best for you.
- If you have a family history of stones or have had more than one stone, you are likely to develop more stones. Drink plenty of fluids – water is best.
- If you are at risk for developing stones, ask your doctor to perform certain blood and urine tests to determine which factors can best be altered to reduce that risk. You may need medicines to prevent stones from forming.
- If you have chronic urinary tract infections and stones you will often need the stone removed if you doctor determines that the infection results from the stone’s presence.
- Ensure you receive careful follow up to be sure that the infection has cleared.
Food choices for people with kidney stones
- Reduce salty foods in your diet including salted chips/nuts, stock cubes, commercial sauces and spreads and take away foods. Avoid adding salt at the table or in cooking.
- Not all salt comes in a shaker – diagram
- Drink at least three litres of water each day. Try carrying a bottle of water with you or drink one glass of water each hour.
- Have no more than 600mls of milk (milk substitutes) each day.
- Reduce meat/fish serves to 150 gms each day.
- Avoid foods high in oxalates: dark green vegetables, rhubarb, beetroot, cocoa, chocolate, milo, ovaltine, strong black tea, berry fruits and nuts.
- Avoid vitamin c supplements.
- Weight loss – aim for a body mass index between 20-25 as obesity leads to more acidity in the urine which may precipitate stones.