Preventing kidney stones
People who have had a kidney stone are quite likely to get another one. To prevent that from happening, it's usually enough to drink plenty of water and change your diet. If kidney stones still keep on forming, medication can be used as prevention.
About 30 to 50 out of 100 people who have had a kidney stone can expect to have another within five years. About 10 out of 100 will develop kidney stones more regularly. Many people who are affected want to know what they can do to prevent new kidney stones from forming.
Because kidney stones can have so many different possible causes, it’s important to find out what the stones are made of. The levels of some substances in your blood and urine may also help to determine the cause. About 80% of all kidney stones are calcium stones. Uric acid stones make up about 5 to 10% of all kidney stones. The rest are made of struvite, cystine or other less common substances.
Drinking enough fluids and, if necessary, changing your diet is usually all you need to do to lower your risk of kidney stones. People who have a higher risk of kidney stones can also consider taking medication to prevent them.
Does drinking a lot of water help?
Kidney stones develop if the calcium or uric acid salts in the urine can no longer dissolve. That may happen if the concentration of these substances is too high. The salts then form crystals, which develop into stones. This risk is lower if the urine is diluted as much as possible.
One study suggests that the risk of developing a second kidney stone can be reduced by drinking more water than usual. Participants drank enough to produce about 2.5 liters of urine per day. After a period of five years, the study showed the following:
- 27 out of 100 people who drank the same amount as they did before developed another kidney stone.
- 12 out of 100 people who drank more than they did before developed another kidney stone.
So drinking more helped prevent another kidney stone from forming in 15 out of 100 people. The study participants found it easy to drink more fluids.
Try to avoid soft drinks
Many soft drinks like cola contain phosphoric acid (food additive E338), which may possibly increase the likelihood of kidney stones forming. There has only been one high-quality study on the question of whether not drinking soft drinks also lowers the risk of developing more kidney stones. In the study, 500 men were advised to drink fewer soft drinks. On average, they lowered their consumption to under 100 milliliters per day – that's less than half a glass. Their risk of kidney stones dropped in comparison to the group of men who didn't change their drinking habits. The study showed the following after three years:
- 41 out of 100 men who drank as many soft drinks as before developed another kidney stone.
- 34 out of 100 men who drank fewer soft drinks developed another kidney stone.
In other words, drinking fewer soft drinks prevented the development of further kidney stones in 7 out of 100 men. Some men dropped out of the study early – possibly because they found it difficult to change their drinking habits.
Is changing your diet a good idea?
Low-calcium diets are more likely to be harmful
Calcium stones are often made up of calcium and oxalate (calcium oxalate). Both of these substances are found in many different foods. Not eating foods that contain oxalate – such as rhubarb, parsley, walnuts, spinach and chocolate – is considered to be helpful. But it’s not a good idea to avoid foods that are rich in calcium, like milk, cheese or yogurt. Research shows that a low-calcium diet tends to increase the risk of kidney stones: If you get too little calcium in your diet, more oxalate can enter your urine.
Major change in diet could help
- Drink plenty of fluids
- Don't eat food that are rich in oxalate, like walnuts, spinach and chocolate
- Eat less animal protein, such as meat and eggs
- Stick to a low-salt diet
- Get enough – but not too much – calcium, for example in the form of milk, cheese or yogurt (about 1,000 to 1,200 milligrams per day).
The men in the comparison group were only instructed to drink more fluids and to reduce the oxalate and calcium in their diet.
The results show that a major change in diet can lower your risk of kidney stones:
- 38 out of 100 men who didn't make major changes to their diet, and in
- 20 out of 100 men who did make major changes to their diet.
So the dietary changes prevented further kidney stones in 18 out of 100 men.
Sometimes a fiber-rich diet is also recommended, but there is no scientific proof that it will prevent kidney stones.
The impact of a low-purine diet is not clear
People who develop uric acid stones often have gout or diabetes. Uric acid is a waste product generated by substances called purines. Purines are mainly produced by the body itself, but are also found in some foods. This is the reasoning behind recommending a low-purine diet with less fish, meat and seafood to prevent uric acid stones from forming.
There has not yet been any scientific research to test whether a low-purine diet can lower the risk of developing uric acid stones.
When are medications used to prevent kidney stones?
Preventive medication is an option for people who are at a greater risk of developing further kidney stones. Any of the following things may be a sign that you have a higher risk:
- if you develop kidney stones in childhood or as a teenager
- if other people in your family have kidney stones
- if you have a medical condition affecting the kidneys, urinary tract or gastrointestinal tract
- if you have an overactive parathyroid gland
- if you have had kidney stones that were caused by a urinary tract infection
- if you have uric acid stones
- if you have cystine stones (caused by a rare inherited metabolic disorder)
The type of medication that is used will depend on the type of stone:
- Citrate salts: They bind to the calcium dissolved in urine to prevent calcium crystals from developing. Citrate salts are commercially available in the form of soluble tablets, capsules, and powder. It is used to prevent calcium stones, uric acid stones and cystine stones.
- Thiazide diuretics: These medications reduce the amount of calcium entering the urine from the bloodstream. They promote the production of urine, preventing calcium stones.
- Allopurinol: This drug inhibits the breakdown of purines to uric acid, lowering the uric acid levels in the urine. Allopurinol is mostly used to prevent uric acid stones.
- Other medications: If someone has kidney stones caused by urinary tract infections, they can try to prevent them using medication containing L-methionine, which increases the acidity of the urine.
- Dietary supplements with magnesium increase the levels of magnesium in urine. The magnesium attaches to oxalate in the urine and is believed to prevent the formation of calcium oxalate stones in this way.
Doctors can use blood tests and urine tests, as well as an analysis of the kidney stones, to decide which of the medications are most suitable.
Medications to prevent kidney stones are taken once a day for life. They're usually only considered if someone has already had kidney stones at least twice.
How effective are the medications used for prevention?
Research shows that medicines that are commonly used to prevent kidney stones can be effective. Calcium stones are the most common type of kidney stone, and most of the studies in this area have involved people with calcium stones.
Several studies have shown that potassium citrate salts can prevent kidney stones:
- Without citrate salts, 44 out of 100 people had another kidney stone within two years.
- With citrate salts, 11 out of 100 people had another kidney stone within two years.
In other words, this medication prevented the development of another kidney stone in 33 out of 100 people.
The possible side effects of citrate salts are stomach and bowel (gastrointestinal) problems and diarrhea. About 12 out of 100 people in the studies stopped their treatment early due to the side effects.
Research has also shown that thiazide diuretics lower the risk of kidney stones:
- Without thiazide diuretics, 47 out of 100 people had another kidney stone within three years.
- With thiazide diuretics, 24 out of 100 people had another kidney stone within three years.
So taking thiazide diuretics prevented the development of further kidney stones in 23 out of 100 people.
Thiazide diuretics can have various side effects, including low blood pressure accompanied by dizziness and drowsiness, a dry mouth and erection problems. 8 out of 100 people in the studies stopped their treatment early due to side effects.
- Without allopurinol, 55 out of 100 people had another kidney stone within three and a half years.
- With allopurinol, 33 out of 100 people had another kidney stone within three and a half years.
So the medication prevented the development of a further kidney stone in 22 out of 100 people.
Allopurinol may cause rashes and sometimes trigger gout attacks. But the number of people in the studies who dropped out due to side effects was no greater in the group that had the allopurinol treatment than in the group that did not.
Other types of medications used for the prevention of specific types of kidney stones, such as magnesium or L-methionine, have not yet been tested in good-quality studies, so it's not clear whether they can prevent kidney stones.
Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R et al. Medical management to prevent recurrent nephrolithiasis in adults: a systematic review for an American College of Physicians Clinical Guideline. Ann Intern Med 2013; 158(7): 535-543.
Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR et al. Recurrent nephrolithiasis in adults: Comparative effectiveness of preventive medical strategies. (AHRQ Comparative Effectiveness Reviews; Volume 61).
Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database Syst Rev 2015; (10): CD010057.
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