What are Kidney Stones?
Kidney stones can be composed of different substances, but the most common ones (80% of stones) consist of calcium salts, mostly in the form of calcium oxalate and calcium phosphate.[1] Less common kidney stones may form from other substances such as medications, struvite, uric acid, or cystine.[2] Kidney stones tend to occur more frequently in men, with an incidence of 10% compared to 5% in women.[3][4]
When a stone is dislodged from the kidney and enters the ureter (the tube that connects the kidney to the bladder), it often causes significant pain by irritating the urether, and sometimes by blocking the normal flow of urine. While most stones pass on their own, they may also block the urinary tract, requiring treatment or surgery for removal. (Most stones are small, <6mm, and pass on their own; larger stones tend to require procedures for removal.)
What are the main signs and symptoms of Kidney Stones?
One of the main symptoms of kidney stones is reno-ureteral colic, or “renal colic”, a sudden pain somewhere in the area along the route of the ureter (from the flank/mid-back to the lower abdomen) that is usually caused by the irritation of the ureter (causing spasm) and/or obstruction blocking the flow of urine from the kidney to the bladder.[5]
Additional symptoms that people with kidney stones may experience include the following:[6]
- Burning sensation during urination
- Nausea and/or vomiting
- Changes in urine (presence of blood, cloudy, or foul-smelling)
Some people with kidney stones may have no symptoms at all.
How are Kidney Stones diagnosed?
Although acute pain in the kidney area is a common symptom, diagnosis of kidney stones can only be confirmed from the observation of an actual stone, which may be detected after passing through the urinary tract, with imaging tests, or during surgery. When kidney stones are suspected, a physician will first obtain a detailed medical history and perform a physical exam. Imaging tests such as ultrasound or computerized tomography (CT) may be used to examine the urinary tract for the presence of stones.[7][8] X-ray imaging may also be used, but is more often used in follow-up care,[9] due to its more limited ability to detect smaller stones.[10]
What are some of the main medical treatments for Kidney Stones?
To treat pain associated with kidney stones, non-steroidal anti-inflammatory drugs (NSAIDs) are the main treatment, but opioids may be used if NSAIDs aren’t effective for relieving pain.[11]
Treatment of the stones themselves has evolved over the past 30 years, from removal by open surgery to treatment with less invasive methods.
These are the three main treatments for kidney stones in current use:[5]
Extracorporeal shock wave lithotripsy (SWL): SWL, or “lithotripsy,” is a non-invasive treatment that targets stones with powerful ultrasound waves, causing them to break into small enough fragments to pass through the urinary tract along with the urine.[12]
Uteroscopic procedures: A urologist will insert a small scope into the urinary tract to locate the stone, and remove via a small wire basket that latches onto and grabs the stone. If the stone is too large for removal or can’t be dislodged from its location, a stent may be placed in the ureter to encourage the stone to pass, or it may instead be broken into tiny pieces with a laser, sound waves, or electrical energy.[13]
Percutaneous nephrolithotomy (PCNL): PCNL is a surgical procedure that involves the insertion of an endoscope through a small incision in the skin into the kidney. The procedure is performed under general anesthesia and is generally used in cases when stones are large(> 2 cm) in size.[14]
Have any supplements been studied for Kidney Stones?
Many of the studies on the effects of supplements on kidney stones have focused on the impact of supplementation on the risk of developing stones. Vitamin C has been studied frequently, since it’s converted to oxalate after ingestion and excreted via the urine, which could potentially promote stone formation by increasing oxalate levels in the urine. A couple of studies found a high vitamin C intake was associated with an increased risk of kidney stone risk in men.[15][16] An additional study found evidence that a high intake of vitamin C from supplements was likely responsible for the increased kidney stone risk in men.[17] Other notable supplements that have been studied for their effect on kidney stones include caffeine,[18] calcium, and vitamin D.[19]
How could diet affect Kidney Stones?
In people who are prone to getting kidney stones, dietary factors can play a role in the risk of developing stones.[21]
Specific types of diets have also been studied for their potential effect on kidney stone risk. Low-carbohydrate, high-protein diets such as the Atkins diet may have a detrimental effect on urine composition (e.g., higher urinary calcium and uric acid, lower urinary citrate levels), potentially increasing the risk of forming kidney stones.[22][23]
In contrast, the DASH diet[24] and Mediterranean-style diets[25] have been associated with reduced risk of developing kidney stones.
Note that many of the observational studies on diet and kidney stones examine the association between diets and any type of kidney stone. There are also specific dietary recommendations for preventing kidney stones depending on the type.
Are there any other treatments for Kidney Stones?
Medication may be prescribed by a physician to help kidney stones pass. Alpha-adrenergic receptor blockers, such as tamsulosin,[36][37] and calcium channel blockers[36] cause dilation of the urethra, which increases the chance of stones passing on their own.
If kidney stones continue to be a recurring problem for people following all of the recommended dietary guidelines, then pharmaceutical treatments may also be an option for prevention.[5] Thiazide diuretics have shown some efficacy in preventing calcium kidney stones in people with normal urine calcium levels.[38] Drugs such as allopurinol or febuxostat, which reduce uric acid levels, may be helpful for preventing uric acid kidney stones in people with high levels of uric acid in their urine. [29] Treatment with citrate (from potassium citrate), which inhibits the formation of calcium crystals,[39] has also shown some efficacy for preventing stones in randomized controlled trials.[40][41]
What causes Kidney Stones?
All compounds dissolved in aqueous solution have a threshold concentration at which they are no longer soluble. When this concentration is exceeded, the molecules become supersaturated, at which point they begin to form insoluble crystals. Calcium oxalate, a soluble salt forming the most common type of kidney stones, becomes supersaturated at higher concentrations, forming stones that accumulate in the kidneys or urinary tract.[42]
Examine Database: Kidney Stones
Research FeedRead all studies
Frequently asked questions
Kidney stones can be composed of different substances, but the most common ones (80% of stones) consist of calcium salts, mostly in the form of calcium oxalate and calcium phosphate.[1] Less common kidney stones may form from other substances such as medications, struvite, uric acid, or cystine.[2] Kidney stones tend to occur more frequently in men, with an incidence of 10% compared to 5% in women.[3][4]
When a stone is dislodged from the kidney and enters the ureter (the tube that connects the kidney to the bladder), it often causes significant pain by irritating the urether, and sometimes by blocking the normal flow of urine. While most stones pass on their own, they may also block the urinary tract, requiring treatment or surgery for removal. (Most stones are small, <6mm, and pass on their own; larger stones tend to require procedures for removal.)
One of the main symptoms of kidney stones is reno-ureteral colic, or “renal colic”, a sudden pain somewhere in the area along the route of the ureter (from the flank/mid-back to the lower abdomen) that is usually caused by the irritation of the ureter (causing spasm) and/or obstruction blocking the flow of urine from the kidney to the bladder.[5]
Additional symptoms that people with kidney stones may experience include the following:[6]
- Burning sensation during urination
- Nausea and/or vomiting
- Changes in urine (presence of blood, cloudy, or foul-smelling)
Some people with kidney stones may have no symptoms at all.
Although acute pain in the kidney area is a common symptom, diagnosis of kidney stones can only be confirmed from the observation of an actual stone, which may be detected after passing through the urinary tract, with imaging tests, or during surgery. When kidney stones are suspected, a physician will first obtain a detailed medical history and perform a physical exam. Imaging tests such as ultrasound or computerized tomography (CT) may be used to examine the urinary tract for the presence of stones.[7][8] X-ray imaging may also be used, but is more often used in follow-up care,[9] due to its more limited ability to detect smaller stones.[10]
To treat pain associated with kidney stones, non-steroidal anti-inflammatory drugs (NSAIDs) are the main treatment, but opioids may be used if NSAIDs aren’t effective for relieving pain.[11]
Treatment of the stones themselves has evolved over the past 30 years, from removal by open surgery to treatment with less invasive methods.
These are the three main treatments for kidney stones in current use:[5]
Extracorporeal shock wave lithotripsy (SWL): SWL, or “lithotripsy,” is a non-invasive treatment that targets stones with powerful ultrasound waves, causing them to break into small enough fragments to pass through the urinary tract along with the urine.[12]
Uteroscopic procedures: A urologist will insert a small scope into the urinary tract to locate the stone, and remove via a small wire basket that latches onto and grabs the stone. If the stone is too large for removal or can’t be dislodged from its location, a stent may be placed in the ureter to encourage the stone to pass, or it may instead be broken into tiny pieces with a laser, sound waves, or electrical energy.[13]
Percutaneous nephrolithotomy (PCNL): PCNL is a surgical procedure that involves the insertion of an endoscope through a small incision in the skin into the kidney. The procedure is performed under general anesthesia and is generally used in cases when stones are large(> 2 cm) in size.[14]
Many of the studies on the effects of supplements on kidney stones have focused on the impact of supplementation on the risk of developing stones. Vitamin C has been studied frequently, since it’s converted to oxalate after ingestion and excreted via the urine, which could potentially promote stone formation by increasing oxalate levels in the urine. A couple of studies found a high vitamin C intake was associated with an increased risk of kidney stone risk in men.[15][16] An additional study found evidence that a high intake of vitamin C from supplements was likely responsible for the increased kidney stone risk in men.[17] Other notable supplements that have been studied for their effect on kidney stones include caffeine,[18] calcium, and vitamin D.[19]
Although dietary factors are important for people who are prone to kidney stones, evidence that supplements may be able to treat or prevent stones is lacking.
The high prevalence of kidney stones in the general population has created a strong demand for supplements with potential for prevention or treatment. Unfortunately, some supplement companies have marked products for this purpose with little to no evidence of efficacy on kidney stones.
One paper published in 2020 surveyed the available supplements on two popular online supplement sellers, analyzing 27 products that contained 56 different ingredients. The product claims included dissolving kidney stones, preventing stone formation, and relieving symptoms of kidney stones. The authors noted that of the 56 ingredients assessed, only 9 had been studied in the context of kidney stones, and only 5 had any published evidence in support of their use. Additionally, two-thirds of the supplement products assessed either contained ingredients with conflicting evidence for their efficacy, or no evidence at all.[20]
In people who are prone to getting kidney stones, dietary factors can play a role in the risk of developing stones.[21]
Specific types of diets have also been studied for their potential effect on kidney stone risk. Low-carbohydrate, high-protein diets such as the Atkins diet may have a detrimental effect on urine composition (e.g., higher urinary calcium and uric acid, lower urinary citrate levels), potentially increasing the risk of forming kidney stones.[22][23]
In contrast, the DASH diet[24] and Mediterranean-style diets[25] have been associated with reduced risk of developing kidney stones.
Note that many of the observational studies on diet and kidney stones examine the association between diets and any type of kidney stone. There are also specific dietary recommendations for preventing kidney stones depending on the type.
The following dietary guidelines may help to prevent stone formation in people who are susceptible:[5]
Drink lots of water, frequently: According to the National Kidney Foundation, one of the best strategies to avoid kidney stones is to drink lots of water on a daily basis.[26] The formation of kidney stones is partially a function of the concentration of stone-forming substances in the urine. Frequent water intake will make the urine more diluted, preventing the buildup of stone-forming substances.[27] People who are prone to getting kidney stones should aim to drink more than 2 liters of water per day (more during the summer, to account for increased water loss through sweating).[27][5]
Note, however, that aggressive hydration, or drinking large volumes of water to “make a kidney stone pass faster,” is not supported by the evidence and will only make more urine, which will in turn cause more pain as the urine attempts to pass the kidney stone. Hydration is important in the prevention of kidney stones, but once someone has renal colic, overhydration does not help.[28]
Limit high-oxalate foods: Since so many foods contain oxalate, a ‘low-oxalate diet’ may be difficult to achieve. Instead, foods that are high in oxalate should be limited. Some examples of foods with high oxalate content include spinach, beets, peanuts, chocolate, sweet potatoes, and wheat bran. In situations where high- oxalate foods can’t be avoided, there may be a benefit to consuming food high in calcium at the same time, which could limit oxalate absorption.[29]
Consume calcium-rich foods: This one is counterintuitive—since most kidney stones consist of calcium oxalate, it would seem that limiting calcium intake would be beneficial. However, calcium has the opposite effect. The binding of calcium ions to oxalate in the stomach and intestines rather than the kidneys makes it less likely for stones to form. When calcium binds to oxalate in the gastrointestinal tract, the low-solubility calcium oxalate salt is mostly excreted in the stool. In contrast, low-calcium intake increases the absorption of oxalate molecules through the intestines and excretion via the urine. When oxalate levels increase in the urine, it is available to interact with calcium ions, where it forms calcium-oxalate kidney stones in the urinary tract.[30]
Reduce sodium intake: Consuming extra sodium increases calcium leakage into the urine, promoting conditions for stone formation.[31] It’s unclear exactly what sodium intake is ideal, but reducing sodium intake reduces urinary calcium levels, in turn reducing kidney stone risk.[32]. A common recommendation is to aim for less than 2 g of sodium per day, which is equivalent to 5 g of table salt.[5]
Avoid soda and other sugar-sweetened beverages: Consuming one or more sugar-sweetened sodas per day was associated with a 23-33% increase in risk of kidney stone formation compared to less than one serving per week.[33] The connection between soda intake and kidney stones has been confirmed in a randomized controlled trial, which found that habitual soda-drinkers had reduced risk of recurring kidney stones after eliminating their intake of all soft drinks.[34]
Limit animal protein consumption: Consumption of animal proteins can increase the amount of stone-forming substances such as calcium and uric acid in the urine, which could promote stone formation in people who are prone to getting kidney stones.[35] Current guidelines from the American Urological Association recommend that people who are prone to getting kidney stones should limit their intake of animal proteins.[29]
Medication may be prescribed by a physician to help kidney stones pass. Alpha-adrenergic receptor blockers, such as tamsulosin,[36][37] and calcium channel blockers[36] cause dilation of the urethra, which increases the chance of stones passing on their own.
If kidney stones continue to be a recurring problem for people following all of the recommended dietary guidelines, then pharmaceutical treatments may also be an option for prevention.[5] Thiazide diuretics have shown some efficacy in preventing calcium kidney stones in people with normal urine calcium levels.[38] Drugs such as allopurinol or febuxostat, which reduce uric acid levels, may be helpful for preventing uric acid kidney stones in people with high levels of uric acid in their urine. [29] Treatment with citrate (from potassium citrate), which inhibits the formation of calcium crystals,[39] has also shown some efficacy for preventing stones in randomized controlled trials.[40][41]
All compounds dissolved in aqueous solution have a threshold concentration at which they are no longer soluble. When this concentration is exceeded, the molecules become supersaturated, at which point they begin to form insoluble crystals. Calcium oxalate, a soluble salt forming the most common type of kidney stones, becomes supersaturated at higher concentrations, forming stones that accumulate in the kidneys or urinary tract.[42]
Although insolubility/supersaturation is the root cause of all kidney stones, the specific cause depends on the composition of the stones.
Calcium stones, which are the most common, form when calcium combines with oxalate or phosphate to form stones. The tendency for this to occur depends on factors that affect the composition and concentration of these substances in the urine.
Cystine kidney stones can occur in people who have cystinuria, a genetic condition that increases the amount of the amino acid cysteine in the urine.[5]
Uric acid kidney stones usually occur under conditions that affect uric acid levels in the urine, such as hyperuricemia (high uric acid levels in the blood) or chemotherapy.[43][44] Uric acid stones may also form if the urine becomes highly acidic, with a common cause being chronic diarrhea.
Struvite, which is a salt composed of magnesium ammonium phosphate, can also form kidney stones, which are frequently associated with urinary tract infections.[45]
Certain medications with poor solubility or medications that are metabolized into low-solubility metabolites may also form supersaturated solutions in the urine, leading to stone formation. An example of medications linked to kidney stones is the protease inhibitors indinavir and atazanavir, which are prone to crystallization and stone formation.[46][47]
Kidney stones can also be caused by foods or supplements with low-solubility contaminants, such as melamine. Melamine may be present in nutritional supplements in particular, where it has been used as an additive to fraudulently increase the measured protein content.[48][49] In China, melamine present in infant formula caused a crisis in 2008, resulting in the development of kidney stones in a few hundred thousand infants, many of whom required hospitalization, resulting in 6 fatalities.[50]
Previous history of kidney stones: Although many people with kidney stones develop a stone as an isolated occurrence,[51] the chance of getting more stones tends to increase with each successive occurrence. One study tracking stone recurrence in people with kidney stones found that the first, second, third, and fourth or higher cases of kidney stones had a 5-year recurrence rate of 17%, 32%, 47%, and 60%, respectively.[52][53]
Additional risk factors for kidney stones include:
References
- ^Coe FL, Parks JH, Asplin JRThe pathogenesis and treatment of kidney stones.N Engl J Med.(1992-Oct-15)
- ^Evan APPhysiopathology and etiology of stone formation in the kidney and the urinary tract.Pediatr Nephrol.(2010-May)
- ^Johnson CM, Wilson DM, O'Fallon WM, Malek RS, Kurland LTRenal stone epidemiology: a 25-year study in Rochester, Minnesota.Kidney Int.(1979-Nov)
- ^Hiatt RA, Dales LG, Friedman GD, Hunkeler EMFrequency of urolithiasis in a prepaid medical care program.Am J Epidemiol.(1982-Feb)
- ^Saeed R Khan, Margaret S Pearle, William G Robertson, Giovanni Gambaro, Benjamin K Canales, Steeve Doizi, Olivier Traxer, Hans-Göran TiseliusKidney stonesNat Rev Dis Primers.(2016 Feb 25)
- ^Kidney stone symptoms. MedlinePlus. Bethesda (MD): National Library of Medicine (US); updated 2016 Dec 8; cited 2023 Jan. 31
- ^Kanno T, Kubota M, Sakamoto H, Nishiyama R, Okada T, Higashi Y, Yamada HThe efficacy of ultrasonography for the detection of renal stone.Urology.(2014-Aug)
- ^Kanno T, Kubota M, Sakamoto H, Nishiyama R, Okada T, Higashi Y, Yamada HDetermining the efficacy of ultrasonography for the detection of ureteral stone.Urology.(2014-Sep)
- ^Johnston R, Lin A, Du J, Mark SComparison of kidney-ureter-bladder abdominal radiography and computed tomography scout films for identifying renal calculi.BJU Int.(2009-Sep)
- ^Heidenreich A, Desgrandschamps F, Terrier FModern approach of diagnosis and management of acute flank pain: review of all imaging modalities.Eur Urol.(2002-Apr)
- ^Serinken M, Eken C, Turkcuer I, Elicabuk H, Uyanik E, Schultz CHIntravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial.Emerg Med J.(2012-Nov)
- ^Manzoor H, Saikali SWRenal Extracorporeal LithotripsyStatPearls.(2022-07)
- ^Wason SE, Monfared S, Ionson A, Klett DE, Leslie SWUreteroscopyStatPearls.(2022-11)
- ^Thomas Knoll, Francisco Daels, Janak Desai, Andras Hoznek, Bodo Knudsen, Emanuele Montanari, Cesare Scoffone, Andreas Skolarikos, Keiichi TozawaPercutaneous nephrolithotomy: techniqueWorld J Urol.(2017 Sep)
- ^Taylor EN, Stampfer MJ, Curhan GCDietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up.J Am Soc Nephrol.(2004-Dec)
- ^Thomas LD, Elinder CG, Tiselius HG, Wolk A, Akesson AAscorbic acid supplements and kidney stone incidence among men: a prospective study.JAMA Intern Med.(2013-Mar-11)
- ^Pietro Manuel Ferraro, Gary C Curhan, Giovanni Gambaro, Eric N TaylorTotal, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney StonesAm J Kidney Dis.(2016 Mar)
- ^Jiwen Geng, Yuxuan Qiu, Zhefeng Kang, Yupei Li, Jiameng Li, Ruoxi Liao, Zheng Qin, Qinbo Yang, Baihai SuThe association between caffeine intake and risk of kidney stones: A population-based studyFront Nutr.(2022 Oct 10)
- ^Bargagli M, Ferraro PM, Vittori M, Lombardi G, Gambaro G, Somani BCalcium and Vitamin D Supplementation and Their Association with Kidney Stone Disease: A Narrative Review.Nutrients.(2021-Dec-04)
- ^Koo K, Aro T, Matlaga BRBuyer Beware: Evidence-Based Evaluation of Dietary Supplements for Nephrolithiasis.J Endourol.(2020-Jun)
- ^D H Hosking, S B Erickson, C J Van den Berg, D M Wilson, L H SmithThe stone clinic effect in patients with idiopathic calcium urolithiasisJ Urol.(1983 Dec)
- ^Shalini T Reddy, Chia-Ying Wang, Khashayar Sakhaee, Linda Brinkley, Charles Y C PakEffect of low-carbohydrate high-protein diets on acid-base balance, stone-forming propensity, and calcium metabolismAm J Kidney Dis.(2002 Aug)
- ^Friedman AN, Ogden LG, Foster GD, Klein S, Stein R, Miller B, Hill JO, Brill C, Bailer B, Rosenbaum DR, Wyatt HRComparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney.Clin J Am Soc Nephrol.(2012-Jul)
- ^Taylor EN, Fung TT, Curhan GCDASH-style diet associates with reduced risk for kidney stones.J Am Soc Nephrol.(2009-Oct)
- ^Leone A, Fernández-Montero A, de la Fuente-Arrillaga C, Martínez-González MÁ, Bertoli S, Battezzati A, Bes-Rastrollo MAdherence to the Mediterranean Dietary Pattern and Incidence of Nephrolithiasis in the Seguimiento Universidad de Navarra Follow-up (SUN) Cohort.Am J Kidney Dis.(2017-Dec)
- ^Kidney Stone Diet Plan and Prevention
- ^Borghi L, Meschi T, Amato F, Briganti A, Novarini A, Giannini AUrinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study.J Urol.(1996-Mar)
- ^Springhart WP, Marguet CG, Sur RL, Norris RD, Delvecchio FC, Young MD, Sprague P, Gerardo CA, Albala DM, Preminger GMForced versus minimal intravenous hydration in the management of acute renal colic: a randomized trial.J Endourol.(2006-Oct)
- ^Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, Monga M, Penniston KL, Preminger GM, Turk TM, White JR,Medical management of kidney stones: AUA guideline.J Urol.(2014-Aug)
- ^Bushinsky DA, Bashir MA, Riordon DR, Nakagawa Y, Coe FL, Grynpas MDIncreased dietary oxalate does not increase urinary calcium oxalate saturation in hypercalciuric rats.Kidney Int.(1999-Feb)
- ^K Sakhaee, J A Harvey, P K Padalino, P Whitson, C Y PakThe potential role of salt abuse on the risk for kidney stone formationJ Urol.(1993 Aug)
- ^Ticinesi A, Nouvenne A, Maalouf NM, Borghi L, Meschi TSalt and nephrolithiasis.Nephrol Dial Transplant.(2016-Jan)
- ^Ferraro PM, Taylor EN, Gambaro G, Curhan GCSoda and other beverages and the risk of kidney stones.Clin J Am Soc Nephrol.(2013-Aug)
- ^Shuster J, Jenkins A, Logan C, Barnett T, Riehle R, Zackson D, Wolfe H, Dale R, Daley M, Malik ISoft drink consumption and urinary stone recurrence: a randomized prevention trial.J Clin Epidemiol.(1992-Aug)
- ^Tracy CR, Best S, Bagrodia A, Poindexter JR, Adams-Huet B, Sakhaee K, Maalouf N, Pak CY, Pearle MSAnimal protein and the risk of kidney stones: a comparative metabolic study of animal protein sources.J Urol.(2014-Jul)
- ^Picozzi SC, Marenghi C, Casellato S, Ricci C, Gaeta M, Carmignani LManagement of ureteral calculi and medical expulsive therapy in emergency departments.J Emerg Trauma Shock.(2011-Jan)
- ^Campschroer T, Zhu X, Vernooij RW, Lock MTAlpha-blockers as medical expulsive therapy for ureteral stones.Cochrane Database Syst Rev.(2018-Apr-05)
- ^Yendt ER, Cohanim MPrevention of calcium stones with thiazides.Kidney Int.(1978-May)
- ^Pak CY, Sakhaee K, Fuller CJPhysiological and physiochemical correction and prevention of calcium stone formation by potassium citrate therapy.Trans Assoc Am Physicians.(1983)
- ^Barcelo P, Wuhl O, Servitge E, Rousaud A, Pak CYRandomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis.J Urol.(1993-Dec)
- ^B Ettinger, C Y Pak, J T Citron, C Thomas, B Adams-Huet, A VangesselPotassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasisJ Urol.(1997 Dec)
- ^Prochaska M, Taylor E, Ferraro PM, Curhan GRelative Supersaturation of 24-Hour Urine and Likelihood of Kidney Stones.J Urol.(2018-May)
- ^Grases F, Villacampa AI, Costa-Bauzá A, Söhnel OUric acid calculi: types, etiology and mechanisms of formation.Clin Chim Acta.(2000-Dec)
- ^Wiederkehr MR, Moe OWUric Acid Nephrolithiasis: A Systemic Metabolic Disorder.Clin Rev Bone Miner Metab.(2011-Dec)
- ^C Kristensen, J H Parks, M Lindheimer, F L CoeReduced glomerular filtration rate and hypercalciuria in primary struvite nephrolithiasisKidney Int.(1987 Nov)
- ^Izzedine H, Lescure FX, Bonnet FHIV medication-based urolithiasis.Clin Kidney J.(2014-Apr)
- ^Omer A Raheem, Hossein S Mirheydar, Kerrin Palazzi, Marianne Chenoweth, Charles Lakin, Roger L SurPrevalence of nephrolithiasis in human immunodeficiency virus infected patients on the highly active antiretroviral therapyJ Endourol.(2012 Aug)
- ^Gabriels G, Lambert M, Smith P, Wiesner L, Hiss DMelamine contamination in nutritional supplements--Is it an alarm bell for the general consumer, athletes, and 'Weekend Warriors'?Nutr J.(2015-Jul-17)
- ^Rai N, Banerjee D, Bhattacharyya RUrinary melamine: proposed parameter of melamine adulteration of food.Nutrition.(2014-Apr)
- ^Ding JChildhood urinary stones induced by melamine-tainted formula: how much we know, how much we don't know.Kidney Int.(2009-Apr)
- ^Gambaro G, Reis-Santos JM, Rao NNephrolithiasis: why doesn't our "learning" progress?Eur Urol.(2004-May)
- ^Vaughan LE, Enders FT, Lieske JC, Pais VM, Rivera ME, Mehta RA, Vrtiska TJ, Rule ADPredictors of Symptomatic Kidney Stone Recurrence After the First and Subsequent Episodes.Mayo Clin Proc.(2019-Feb)
- ^In Gab Jeong, Taejin Kang, Jeong Kyoon Bang, Junsoo Park, Wansuk Kim, Seung Sik Hwang, Hong Kyu Kim, Hyung Keun ParkAssociation between metabolic syndrome and the presence of kidney stones in a screened populationAm J Kidney Dis.(2011 Sep)
- ^Scales CD, Smith AC, Hanley JM, Saigal CS,Prevalence of kidney stones in the United States.Eur Urol.(2012-Jul)
- ^Obligado SH, Goldfarb DSThe association of nephrolithiasis with hypertension and obesity: a review.Am J Hypertens.(2008-Mar)
- ^Taylor EN, Stampfer MJ, Curhan GCDiabetes mellitus and the risk of nephrolithiasis.Kidney Int.(2005-Sep)
- ^West B, Luke A, Durazo-Arvizu RA, Cao G, Shoham D, Kramer HMetabolic syndrome and self-reported history of kidney stones: the National Health and Nutrition Examination Survey (NHANES III) 1988-1994.Am J Kidney Dis.(2008-May)
Examine Database References
- Kidney Stone Symptoms - Mohammad R Naghii, Behzad Einollahi, Zohreh RostamiPreliminary evidence hints at a protective role for boron in urolithiasisJ Altern Complement Med.(2012 Mar)