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DownloadYou will be referred to the virtual stone clinic via an online referral. This will be reviewed the following Thursday after your admission to A&E.
You will be contacted via a letter with your plan of care from the Urology Team shortly after this review has taken place.
Ideally A&E will have discharged you home with pain relief such as paracetamol, ibuprofen and or if suitable Diclofenic Suppositories.
Drinking enough fluid is the most important way of preventing stone formation and reduces your risk of stone formation by almost one third (30-40%). Not drinking enough fluid causes your urine to become concentrated and makes stones more likely to form.
Try to drink two to three litres (four to six pints) of fluid each day (water, squash, or fizzy drinks). You should aim to keep your urine colourless throughout the day. This equates to a urine output of at least two litres (four pints) per day. In patients with cystine stones, however, an output of 3.5 litres per day is required.
Tea, coffee & alcohol can be consumed in moderation but the majority of your fluid intake should be as above. In addition, it is helpful to try and drink one or two glasses of water before going to bed and on rising in the morning.
Tips to help you increase your fluid intake.
and
We may sometimes ask you to test the acidity of your urine at particular times of day and we also measure it in your 24 hour urine collection specimens. The acidity of urine normally varies throughout the day, depending on your diet. Acidity and alkalinity is expressed as pH (pH 7 or less is acidic, pH greater than 7 is alkaline).
The acid educing effect of water with a high bicarbonate content is useful for patients who form uric acid stones. Mineral water with a high bicarbonate content (example Vichy, Badoit, Vittel, Buxton) also increases citrate levels in the urine, citrate is a known inhibitor of stone formation.
If you have pure calcium phosphate stones, you should avoid alkalinising urine and should drink tap water rather than mineral water. You should also avoid mineral waters with a high sodium content (e.g. Vichy, Vichy Catalan).
Fizzy drinks such as Diet Coke, Coke Zero & Diet Pepsi are relatively poor at alkalinising your urine. There is some evidence that Diet 7Up, Diet Sunkist and Diet Sprite may be better, and is worth considering if you have uric acid stones or calcium oxalate stones
Yes. A high intake of animal protein appears to increase the risk of stone formation. Avoid large portions of meat, fish, eggs, cheese and milk. Aim for four of the following exchanges each day:
Two of the four exchanges should be milk, cheese or yogurt to ensure an adequate intake of calcium. You can replace protein with starchy foods (bread, potatoes, pasta, fruit and vegetables) to fill you up. Reducing your protein intake also increases the amount of citrate you excrete in your urine; citrate is a known inhibitor of stone formation. You should not consume protein build-up drinks.
An example for a daily meal plan would be:
Breakfast.
Lunch.
Dinner.
It is something to consider, and it will benefit you in other ways (by reducing your risk of Type 2 diabetes, high blood pressure and raised cholesterol). Being overweight has been linked to high uric acid levels and overweight people tend to have acidic urine; acidic urine can increase the risk of most types of stone.
Yes. A high salt intake can contribute to calcium stone formation as well as reducing urine citrate levels. Do not add salt to your food at the table. Use pepper, herbs, spices or vinegar as alternative flavourings. You can, however, add a small amount of salt during cooking.
Foods that contain less than 0.4g (40mg) of sodium per serving are low-salt choices and you should aim to keep your salt intake down to these levels. Avoid tinned, packet and processed foods (soups, salted crisps, nuts, tinned meats, meat paste, smoked fish and fish paste).
No. Severe calcium restriction can actually increase the risk of stone formation because it will result in high levels of oxalate in your urine. If you follow the recommendations above for milk, cheese and eggs, no further action is needed.
You should not take calcium supplements or ‘over the counter’ medicines for indigestion (which may contain a lot of calcium). If your GP has said that you must take calcium supplements, take them with food to reduce the risk of stone formation. Products containing calcium citrate are better at increasing citrate levels in your urine than those with calcium carbonate.
The calcium you drink in tap water cannot cause kidneys stones and there is no need to restrict your intake of tap water and no point in purchasing a water softener (which is not connected to your drinking water). Some people prefer the taste and smell of filtered water but there is no evidence that it reduces the risk of stone formation.
Fruit and vegetables have many beneficial effects and they also have an alkalinising effect on your urine. They contain a lot of fluid which helps with your daily fluid intake. Oxalate stone formers should, however, take care to avoid any oxalate rich fruit and vegetables from the list above.
Drinking fruit juice does appear to reduce urine oxalate and increase citrate levels. Fruit juice should be consumed with caution because some contain a lot of sugar. The evidence for taking cranberry or grapefruit juice is uncertain and, as a general rule, increasing your intake of fruit juice is probably not beneficial. A single glass with your breakfast is, however, recommended but, if you have oxalate stones, fruit juices are probably best avoided.
High fibre, plant based foods contain a compound called phytate and studies have shiown that a low intake of phytates increases your risk of calcium-based stones; Increasing your intake, therefore, will probably be beneficial.
The normal recommended intake of fibre for adults is 12 to 24g per day. See the below table for the fibre content of some common foods
| Food per portion |
Average portion | Fibre | |
| Wholemeal bread | 72g (2 slices) | 3.6g | |
| Porridge | 160g | 1.4g | |
| Baked beans | 135g | 5g | |
| Fibre cereal | 45g | 3.8g | |
| Dried apricots | 32g | 2g | |
| Spinach | 90g | 1.9g | |
|
Jacket potato Brown rice |
180g 180g |
4.9g 1.4g |
Most vitamins are harmless but you should not take Vitamin D preparations (including fish oils and multivitamin preparations) because they increase calcium absorption. You should avoid taking Vitamin C supplements because they can increase the excretion of oxalate in your urine.
Calcium oxalate stones
Only 10 to 15 percent of urinary oxalate comes from your dietary intake. It is not, therefore, necessary to eliminate oxalate containing foods completely from your diet.
You should, however, aim for a moderate (and sensible) intake of oxalates.
Foods which are expecially high in oxalates (example All Bran, almonds, beet, rhubarb and spinach) should be consumed sparingly. The following foods are known to be high in oxalate
Uric acid stones
If you form uric acid stones, you should try to limit the amount of purines in your diet. These are natural substances found in most foods, and are broken down by the body into uric acid. The main dietary sources of purines are
Uric acid formation is also higher in overweight individuals, so losing weight may be beneficial. Taking the drug allopurinol, which lowers uric acid levels in the blood, has not been shown to help in reducing the risk of uric acid stones.
Calcium phosphate stones
Specific dietary measures have little effect on the formation of calcium phosphate stones. All the general advice above is valid although it is probably not helpful to alkalinise your urine.
Cranberry juice, however, can be beneficial because it lowers urine oxalate levels slightly and acidifies the urine.
Struvite (‘triple phosphate’) stones
These are mostly seen in women after the menopause, and are almost invariably due to urine infection. The bacteria involved (usually Proteus species) produce an enzyme (called urease) which splits the urea in urine to form ammonia. This renders the urine highly alkaline and encourages the rapid formation of stones made from calcium, magnesium, ammonium phosphate (‘triple phosphate’).
A high fluid intake, low-dose antibiotics (as necessary) and acidification of the urine are all effective but the main aim is to remove all stones surgically, thereby eliminating the potential for recurrent urinary infections.
Drugs specifically designed to destroy the enzyme produced by the infecting bacteria have been developed, but are not normally used because of the high-risk of major side effects.
Cystine stones (cystinuria)
Simple, basic measures remain the most important methods of preventing cystine stone formation:
There are drugs are available to treat cystine stones, but they are only required in a minority of patients. The main reasons for using them are very rapid stone formation, a frequent need for surgery and poor compliance with, or response to, the measures described above.
Treatment must be very closely monitored and the drugs used include:
A normal calcium, low salt, low protein diet can reduce your risk of stone formation by a half. Keeping your urine colourless by increasing your fluid intake may reduce the risk by a further one third.
For some types of stone, additional specific measures can help minimise further stone formation.
This information includes advice from specialists, the British Association of Urological Surgeons, the Department of Health and other sources. You should read this information with any advice your GP or other healthcare professional may already have given you. Alternative treatments can be discussed in more detail with your urologist or specialist nurse.
While we have made every effort to be sure the information here is accurate, we cannot guarantee there are no errors or omissions. We cannot accept responsibility for any loss resulting from something that anyone has, or has not, done as a result of this information.
This article is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information in this article is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.
Publication Date: May 2018
Review Date: October 2022
