Consider thiazide for hypercalciuria (avoid loop diuretics)
High Protein diet is associated with stones - reduce
Recurrent stone formation is common, but people who have frequent early recurrences should be screened for risk factors. Check:
| Blood | Renal
function Ca and PO4 Uric acid HCO3 |
| Urine |
Infection Request 24h urine for 'stone screen' (Edinburgh labs), (plain bottle), to check volume, calcium, oxalate, Na, urate, cystine. Note that creatinine and protein need to be requested separately. |
| Stone | don't forget to analyze the stone itself |
| Family history | hypercalciuria, medullary sponge kidney, distal RTA, Dent's disease |
| Drug history | occasionally stones formed from drugs (including ephedrine) |
| Dietary assessment | important. See Diet. |
As for protein, urinary calcium can be measured as a ratio with creatinine, instead of a 24h clearance:
|
Ca/Creat ratio
|
Comment
|
|
< 0.6
|
Normal |
|
0.6 - 0.8
|
Equivocal
|
|
> 0.8
|
High
|
Important principles are common to most stones:
|
Maintain high urine volume, especially at night |
|
Restrict dietary sodium |
|
Maintain good dietary calcium intake |
|
Consider thiazide for hypercalciuria (avoid loop diuretics) |
|
High Protein diet is associated with stones - reduce |
For management of individual metabolic abnormalities, seek specific information.
Patient information on renal stones from EdRenINFO
Neil Turner was the main author for this page. It was last updated
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.