Kidney Stones

Hydration MOST IMPORTANT: 2.5-3 liters fluid/day (goal: urine output >2L/day, pale yellow urine), drink water throughout day, increase fluids in hot weather or with exercise, lemon water (citrate prevents stones), For calcium oxalate stones (80% of stones): adequate dietary calcium 1000-1200mg/day from food (binds oxalate in gut, prevents absorption—paradoxically protective, low calcium diet increases stone risk), avoid calcium supplements unless with meals, reduce high-oxalate foods (spinach, rhubarb, beets, swiss chard, almonds, cashews, chocolate, tea—if hyperoxaluria on 24-hour urine), increase citrate (lemon juice, orange juice, citrus fruits—alkalinizes urine, prevents crystallization), moderate animal protein (limit to 6-8 oz/day—high protein increases calcium and uric acid excretion), reduce sodium <2300mg/day (high sodium increases calcium excretion), adequate magnesium (nuts, seeds, whole grains, leafy greens—binds oxalate), For uric acid stones: low-purine diet (limit red meat, organ meats, shellfish, beer), alkalinize urine (eat more fruits and vegetables, potassium citrate), limit animal protein, For struvite stones (infection stones): treat underlying UTI, For cystine stones (rare genetic): high fluid intake 4L+/day, alkalinize urine, limit animal protein, General: adequate calcium from food, increase fruits and vegetables (alkalinize urine, provide citrate), limit salt, moderate protein, adequate hydration, avoid excessive vitamin C supplements, avoid excessive fructose (increases uric acid), limit sugar-sweetened beverages (increase stone risk), Coffee and tea paradoxically protective (despite oxalate in tea—fluid intake likely protective), Beer and wine in moderation may reduce risk (diuretic effect), grapefruit juice increases risk (avoid).

Hydration critical: drink 2.5-3L fluid/day (10-12 cups), spread throughout day, drink extra in hot weather or with exercise, urine should be pale yellow (dark yellow or amber means inadequate hydration), set reminders to drink water, carry water bottle, Prevent stone passage complications: if stone <5mm likely passes spontaneously (90% pass within 4 weeks), stay active (movement helps stone pass), strain urine (catch stone for analysis), medications for medical expulsion therapy (tamsulosin—Flomax, alpha-blocker relaxes ureter, increases passage rate 65-90% for stones 5-10mm, NSAIDs for pain), adequate pain control (passing stones extremely painful—don't suffer, use pain medications), hydration (paradoxically helps stone pass), For stones >10mm or failing to pass: lithotripsy (shockwave therapy—breaks stone into smaller pieces, 70-90% success, outpatient procedure, some discomfort), ureteroscopy (scope through urethra to bladder to ureter, retrieve or break stone, 90-95% success, outpatient), percutaneous nephrolithotomy (surgical removal through small back incision—for large stones >2cm, more invasive), Prevention after first stone CRITICAL (50% recur within 5 years without intervention): 24-hour urine collection (identifies specific metabolic abnormalities—guides targeted treatment), adequate hydration (most important), dietary modifications based on stone type, potassium citrate supplementation (proven to reduce recurrence 50-80%), magnesium supplementation, treat underlying conditions (gout, hyperparathyroidism, metabolic syndrome, recurrent UTIs), Weight loss if overweight (obesity increases stone risk), avoid rapid weight loss (increases uric acid), Treat underlying conditions: hyperparathyroidism (surgery if indicated), gout (lower uric acid), recurrent UTIs (increase stone risk—prophylactic antibiotics if needed), metabolic syndrome (weight loss, diet, exercise), Monitor: repeat imaging (ultrasound or CT) as indicated, repeat 24-hour urine after treatment changes (assess effectiveness).