Kaitlyn Tull

Foundations of Nutrition
6 November 2016
Identifying Kidney Stones and How to Prevent Them
Introduction
For this paper, I will be discussing how kidney stones form and the most common ones that
occur, the symptoms associated with all kidney stones, plus specific symptoms for different types
of stones, and finally how to prevent them, and if needed, the available treatments. As someone
who has personally dealt with kidney stones, I thought this would be an interesting topic to write
about. From doing the research, I have learned much more about kidney stones than I ever
thought I would. Researching has helped me to try and identify the type of stones I personally
have dealt with; although I am not trying to medically diagnosis myself, as I am not a medical
professional. I believe I may have Calcium stones, although I am not entirely sure. I have been
on Potassium Citrate pills for quite a while now, and I will be discussing what these particular
supplements do, as well as others that are used to treat other kinds of stones.
Identifying Kidney Stones
The diagnoses for nephrolithiasis (Frassetto and Kohlstadt), more commonly known as
kidney stones, has been slowly increasing. Once thought to be more prevalent in men, studies
have shown that kidney stones are appearing more frequently in women and with increasing
age (Frassetto and Kohlstadt 1234). According to the Institute for Quality and Efficiency in
Health Care, kidney stones are usually made out of miniscule mineral caches (1) and more often
than not form in a lower part of the kidney called the renal pelvis (Institute for the Quality
and Efficiency in Health Care). Kidney stones are typically formed by mineral deposits

collecting in the renal pelvis, and slowly accumulate more mass over a period of time (Frassetto
and Kohlstadt 1234). Stones that enter the ureters are more commonly referred to as ureteral
stones (Institute for Quality and Efficiency in Health Care). The ureters are small tubes that
transport urine from both kidneys to the bladder (Institute for Quality and Efficiency in Health
Care).
Most kidney stones are smaller in size, ranging from 3-5 cm (Institute for Quality and
Efficiency in Health Care), and therefore are generally easier to pass, in this case, the
recommended course of action would be drink plenty of fluids and just wait to pass the stone
through the urine (Institute for Quality and Efficiency in Health Care). However, if the kidney
stone is larger than 7 cm. and ranging close to either 10 or 12 cm, then it would be wise to seek
medical intervention (Frassetto and Kohlstadt 1234). Larger stones are more likely to get stuck
in the ureter and cause large amounts of pain, which according to the Institute for Quality and
Efficiency in Health Care, is called renal colic. This happens when the pain from the kidney
stone occurs in the lower abdomen or the flank (1). Physical and bodily symptoms of this
include but are not limited to blood in the urine, painful urination, and a stronger or more
frequent urge to urinate; the pain can also spread to the genitals as well (Institute for Quality
and Efficiency in Health Care).
As mentioned before, kidney stones form when, according to Frassetto and Kohlstadt,
minerals accumulate in the kidney and over time produce crystals that eventually turn into stones
(1234). According to the Institute for Quality and Efficiency in Health Care, there are three main
types of kidney stones (2). The most common stones, approximately 80%, are made up of
calcium (Institute for Quality and Efficiency in Health Care); and this makes sense, as most
people eat a diet high in calcium. There are two distinct types of calcium stones, calcium

oxalate and calcium phosphate (Institute for Quality and Efficiency in Health Care). Uric acid
stones, which contribute to about 5-10% of affliction (Institute for Quality and Efficiency in
Health Care), are derived from uric acid, which occurs when the pH of the urine is too low
(Institute for Quality and Efficiency in Health Care). Finally, Struvite stones, which account for
10% or less of diagnoses (Institute for Quality and Efficiency in Health Care), consist of
mostly magnesium and phosphate (Institute for Quality and Efficiency in Health Care). Since
Calcium stones are the most prevalent, many people are at risk for developing them. They
develop rather quickly (about 3-4 months) and usually result from high levels of calcium in the
urine (Institute for Quality and Efficiency in Health Care). This happens quite frequently in
people who have a high intake of calcium in their diet. This, in turn, can increase the percentage
of calcium found in blood, which is eventually released through the kidneys and into the urine
(Institute for Quality and Efficiency in Health Care). According to Frassetto and Kohlstadt, the
high levels of calcium found in the blood could be a precursor for over-active parathyroid glands
(1237). Calcium stones may also form due to high concentrations of oxalic acid in the urine
(Institute for Quality and Efficiency in Health Care). Found usually in plant-based foods, oxalic
acid or hyperoxaluria may be caused by certain medical conditions or be related to the diet, and
often it is not possible to find an exact source (Institute for Quality and Efficiency in Health
Care).
The second most common kidney stones to occur are uric acid stones. These form when
the levels of uric acid in the blood increase, which in turn lowers the pH of the urine to unsafe
levels (Institute for Quality and Efficiency in Health Care). According to the Institute for
Quality and Efficiency in Health Care, other medical ailments attributed with uric acid stones are
gout: which is a metabolic disorder in which the level of uric acid in the blood is too high and

ultimately leads to uric acid being released into the urine, diabetes: however the actual cause is
unknown and people with diabetes possibly have more acidic urine, and finally chronic diarrhea:
where dehydration caused by diarrhea makes the urine more acidic (2).
Struvite stones, the third most prevalent stones, only form when the pH of the urine is
too high (Institute for Quality and Efficiency in Health Care). In general, pH is used to assess
how acidic something is. The lower the pH, the more acidic something is.

Common symptoms of kidney stones

Sad to say, most kidney stones are not diagnosed right away and are really only found by
chance. An individual may feel pain in the lower back area near the kidneys and may not
attribute it to kidney stones. They are really only noticed when they block the renal pelvis or
travel through the ureter (The Institute for Quality and Efficiency in Health Care). There are
specific symptoms with different kinds of kidney stones, however, there are also universal
symptoms that occur with all types. It is extremely common to experience stomach or flank
pain along with cramping in the lower back or renal pelvis, this occurs as kidney stones travel
within the urinary tract (Frassetto and Kohlstadt). This is generally accompanied by hematuria,
or the presence of blood in the urine, nausea or vomiting, and malaise; fever and chills may also
be present (Frassetto and Kohlstadt). The different diagnoses for the different type of stones
range anywhere from moderate to severe. For example, the symptom of a uric acid stone would
most likely be a urinary tract infection, due to the low pH of the urine (Frassetto and
Kohlstadt). Calcium and struvite stones are more prone to abdomen malignancies, and
musculoskeletal inflammation or spasm (Frassetto and Kohlstadt).

According to the Institute for Quality and Efficiency in Health Care, kidney stones, if left
untreated, have a possibility of blocking the ureters (3). This increases the risk of infection,
primarily Urinary Tract Infections, and adds temporary strain on the kidneys (Institute for
Quality and Efficiency in Health Care).However, these problems are exceedingly rare; as most
kidney stones are treated before they can cause complications (Institute for Quality and
Efficiency in Health Care). If left unattended for a long period of time, however, an infection of
the upper urinary tract can occur (Frassetto and Kohlstadt). Symptoms to be aware of include
fever, chills, side and low back pain, and nausea or vomiting (Institute for Quality and
Efficiency in Health Care).
Treatment and Prevention
According to the Institute for Quality and Efficiency In Health Care, without doing
anything about the underlying cause for kidney stones, they will almost always come back (3).
Depending on the kind of stone, the treatments can differ. One way to determine what kind you
have is use a filter or sieve to collect fragments when you urinate (Institute for Quality and
Efficiency in Health Care). By doing this, it helps keep track of the stones that are passed, and if
enough of a stone is present, it may be able to be analyzed in a laboratory.
According to the Institute for Quality and Efficiency in Health Care, experts generally
recommend drinking enough fluid to produce two liters (about 8.5 cups) of urine per day. Also,
depending on the cause of the kidney stones, dieticians may advise lowering the level of
oxalates, salt, meat or protein (Institute for Quality and Efficiency in Health Care). Certain
medications can also help to diminish the risk of getting kidney stones, as well as preventing
them as a whole. These medications include Potassium Citrate, Thiazide Diuretics, Allopurinol,
and other types of medications (Institute for Quality and Efficiency in Health Care).

Potassium Citrate lowers the acidity of the urine, improving its ability to dissolve salts
(Institute for Quality and Efficiency in Health Care). Typically, Potassium Citrate is
commercially available in dissolvable tablet, capsule, and powder form; and used to prevent
calcium, uric acid, and cysteine stones from forming (Institute for Quality in Health Care).
Thiazide Diuretics reduce the amount of calcium entering the blood stream, and they promote
the production of urine, preventing calcium stones from forming (Institute for Quality and
Efficiency in Health Care). Allopurinol inhibits the breakdown of purines which is a colorless
crystalline compound with basic properties, forming uric acid on oxidation to uric acid, which
lowers the uric acid levels in the urine (Institute for Quality and Efficiency in Health Care).
Effectiveness of the Medications
According to the Institute for Quality and Efficiency in Health Care, Allopurinol is
primarily utilized to stop the formation of uric acid stones (3), or stop the growing process
(Institute for Quality and Efficiency in Health Care). According to the Institute for Quality and
Efficiency in Health Care, other medications are available to help either stop kidney stones from
forming, or halt the growing process (2). L-methionine increases the acidity of the urine, and
can prevent kidney stones caused by urinary tract infections (Institute for Quality and Efficiency
in Health Care). Along with L-methionine, dietary supplements with magnesium increase the
levels of magnesium in the urine (Institute for Quality and Efficiency in Health Care). This
ultimately binds with oxalate and is believed to prevent the formation of calcium oxalate
stones (Institute for Quality and Efficiency in Health Care). According to the Institute for
Quality and Efficiency in Health Care, studies have shown that Potassium Citrate, without a
doubt, is an effective supplement/medication that stops stones from forming and or growing
larger (3). Results from a study, conducted by the Institute for Quality and Efficiency in Health

Care, showed that with Potassium Citrate, only 13 out of 100 people had another kidney stone
within the next three years (Institute for Quality and Efficiency in Health Care). Meanwhile,
without Potassium Citrate, 53 out of 100 people had another kidney stone within the next three
years (Institute for Quality and Efficiency in Health Care). However, possible side effects of
this medication include gastrointestinal problems and diarrhea (Institute for Quality and
Efficiency in Health Care). According to the Institute for Quality and Efficiency in Health Care,
roughly 13 people out of 100 may have stopped treatment due to the side effects that accompany
this medication (3).
Without Thiazide diuretics 47 out of 100 people had another kidney stone within three years,
while only 24 out of 100 people had a kidney stone while using this medication within three
years (Institute for Quality and Efficiency in Health Care). However, approximately 8 out of
100 people dropped out of the study due to the side effects of the drug, including low blood
pressure accompanied by dizziness and drowsiness, a dry mouth and erectile dysfunction
(Institute for Quality and Efficiency in Health Care).
With Allopurinol, studies were only conducted on people who were experiencing calcium
stones, so those studies just showed that Allopurinol was effective in treating calcium stones; but
according to the Institute for Quality and Efficiency in Health Care, without allopurinol, 55 out
of 100 people had another kidney stone within three and a half years, meanwhile only 33 out of
100 people who were taking allopurinol experienced another kidney stone within three and a half
years (3). Finally, other medications, such as the ones mentioned before (L methionine and
magnesium), have not yet been tested in professional studies, and so the effects of actually
preventing kidney stones are still unclear. According to Frassetto and Kohlstadt, when choosing a

medication to help with stones, it is generally recommended that a medical professional be

present when making a decision (1242).
Conclusion
To review the information, kidney stones form primarily by mineral deposits collecting in
the renal pelvis and eventually forming crystals that become stones (Frassetto and Kohlstadt).
Diagnoses are made usually by chance, and by then the stones have already formed. Common
symptoms associated with all types of kidney stones include nausea and abdominal or flank
pain. Treatment can include anything from drinking more water than usual to taking certain
medications. The medications include Potassium Citrate, Thiazide diuretics, Allopurinol
(Institute for Quality and Efficiency in Health Care), and other medications such as L
methionine and magnesium may reduce the chance of kidney stones forming from urinary tract
infections (Institute for Quality and Efficiency in Health Care). However, there have not been
any professional studies conducted. Having a doctor or medical professional present when
deciding a medication is recommended, as they can help pick what one would work best for the
type of stones (Frassetto and Kohlstadt).

Work Cited

Frassetto, Lynda, MD, and Ingrid Kohlstadt, MD. Treatment and Prevention of Kidney Stones.
American Family Physician. 84.11 (2011): 1234-1242. U.S. National Library of
Medicine, 1 Dec. 2011. Web. 3 Nov. 2016.

Institute for Quality and Efficiency in Health Care. Kidney Stones: Overview. National Center
For Biotechnology Information. National Library of Medicine, 25 Feb. 2016. Web. 11.
Nov. 2016
<www.ncbi.nlm.nih.gov/pubmedhealth/PMH0085155>
Institute for Quality and Efficiency in Health Care. Preventing Kidney Stones. National
Center
For Biotechnology Information. National Library of Medicine, 25 Feb. 2016. Web. 11.
Nov. 2016.
<www.ncbi.nlm.nih.gov/pubmedhealth/PMH0085159>