Finding a Kidney-Stone Prevention Team

Kidney stones can be a significant health concern, causing both physical discomfort and emotional distress. Beyond the immediate pain, they can disrupt daily life, impacting work, finances, and overall well-being. Furthermore, recurring kidney stones can lead to lasting damage to the kidneys.

It is estimated that approximately half of those who experience a kidney stone will have another one within 10 years. ¹ Therefore, identifying the underlying cause of an individual's stone formation is crucial for effective prevention. While analyzing the composition of a passed kidney stone can be informative, advanced diagnostic methods, such as metabolic testing, offer deeper insights.

Metabolic Testing: A Key to Prevention

The American Urological Association (AUA) recommends metabolic testing for individuals at high risk of stone formation and for those who have experienced one or more stones.² A cornerstone of this evaluation is the 24-hour urine collection.

This convenient at-home test, ordered by a physician, involves collecting urine in a provided container over a full 24-hour period. The sample is then submitted to a laboratory for comprehensive analysis. Upon receipt of the results, the ordering physician interprets the findings, which can be extensive.

The analysis measures various components within the urine, including total volume, sodium, potassium, phosphorus, magnesium, calcium, ammonium, chloride, sulfate, urea nitrogen, uric acid, and cystine. Critically, it also assesses supersaturations, which can indicate an elevated risk for specific stone types, such as calcium phosphate, calcium oxalate, or uric acid stones.

Due to the complexity of the data generated by metabolic testing, it is essential to consult with a physician experienced in kidney stone prevention for accurate interpretation and personalized guidance. These specialists may include urologists, nephrologists, and primary care physicians with expertise in this area.

The Role of the Kidney Stone Prevention Specialist

These physicians possess unique expertise in evaluating the underlying causes of kidney stones and developing tailored medical interventions. Patients can expect the following from these specialists: ³

1.     Comprehensive Assessment of Personal Stone History: This includes documenting the number of stones passed, frequency of episodes, and age of onset.

2.     Evaluation of Co-existing Medical Conditions and Relevant Family History: Identifying contributing factors is crucial for effective prevention.

3.     Thorough Review of Current Medications: This review identifies medications that may contribute to stone formation.

4.     Ordering of Diagnostic Tests:  These tests could include blood work, urine testing, 24 hr urine collection and, when indicated, genetic testing.

5.     Prescription of Medications for Stone Prevention: These medications may include thiazide diuretics, Xanthine Oxidase Inhibitors, Potassium Citrate Supplements, Bile Acid Sequestrants, Bisphosphonates, and others.

6.     Dietary Guidance:  most physicians will provide basic dietary advice for kidney stone treatment; however, they will often refer patients to see a skilled dietitian.

Personalized Nutrition Therapy for Kidney Stone Prevention

While general dietary advice can be helpful, personalized medical nutrition therapy (MNT) based on metabolic testing is more effective in reducing kidney stone recurrence. ⁴

Even patients whose stone formation is primarily related to medication use or underlying medical conditions, rather than dietary habits, can benefit significantly from individualized counseling.

A registered dietitian specializing in kidney stone management is the ideal professional to develop a comprehensive strategy for long-term success. Dietary modifications alone often lead to significant improvements in metabolic testing results, potentially reducing or eliminating the need for prescription medications and extensive physician monitoring.

Here is what you can expect from a registered dietitian specializing in kidney stones:

1. Comprehensive Evaluation of Medical History and Nutritional Needs: The dietitian will thoroughly review your past medical history to understand how it may influence your dietary requirements.

   
   

2. Personalized Dietary Assessment: This includes a detailed review of your dieting history, allergies, intolerances, cultural and spiritual beliefs, and any challenges you experience with food intake.

   
   

3. Medication and Supplement Review: The dietitian will examine all nutrition and diet-related medications, vitamins, minerals, herbal supplements, and commercial food/beverage supplements you are currently using.

   
   

4. Development of a Tailored Dietary Plan: Based on the assessment, the dietitian will create a personalized dietary prescription, including specific nutrient recommendations, such as protein intake and appropriate supplement use.

   
   

5. Nutritional Education and Practical Strategies: You will receive education on the relationship between nutrition and your metabolic testing results, along with practical guidance on meal planning, food label reading, and managing specific dietary situations.

   
   

6. Goal Setting and Behavior Change Support: The dietitian will assist you in establishing realistic dietary goals and developing effective behavior change strategies to ensure long-term adherence and success.

   
   

Conclusion:  For the best kidney stone prevention results, choose a collaborative physician-dietitian team!

Florida Residents:

Looking for personalized kidney stone prevention? The Kidney Stone Prevention Clinic of Florida provides virtual consultations with nephrologist Dr. Paul Dreyer and dietitian Kidney Kat. We'll work with you, wherever you are in Florida. Follow the link to schedule your free 15-minute discovery call with the Kidney Stone Prevention Clinic of Florida today!

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References

1) Scales CD Jr, Smth AC, Hanley JM, Saigal CS, Urologic Diseases in America Project. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160-165.

2) Pearle MS, Goldfarb DS. Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316-324.

3) Shastri S, Patel J, Kamalanthan K. et al. Kidney stone pathophysiology, evaluation and management: core curriculum 2023. AJKD 82(5):617-634

4) Kocvara R, Plasqura P, Petrik A, et al. A prospective study of nonmedical prophylaxis after a first kidney stone. BJU Int 1999(84):393.