[Guest]

Thank opportunity to ask a question from an expert. I had a kidney stone broken up by ESWL 3 years ago. follow-up KUB showed it gone -- a very good news! After noticing blood in my urine a month ago, IVP done two stones, one large one small were found in upper a of same kidney (left). My last stone calcium oxalate, I guess se of same type (am I right?). My doctor said he would do anor ESWL to get rid of se. Should I discuss option of PNL procedure as opposed to ESWL? Does he know 's best? pros & cons? Also, I've been doing a lot of research on stone prevention I'm getting conflicting advice. I can underst, example dairy prodcucts (calcium rich) used to be thought as being bad, since y bond oxalate, y considered to be good according to new researches. about parsley? WebMD.com says cut back on it, many or sces say eat more of it. Parsley is one of my favorite vegetables I really need to know about . Thank very kindly.

[Guest]

Whether you had an ESWL three years ago or not is irrelevant to what is the best way to treat stones now. Unless the stones are unusually large or in a pocket of the kidney, ESWL is the preferred method for removal.

Why would you want a more invasive, painful procedure that makes a good sized hole in the kidney when you can have a nice, non-invasive ESWL? There are a few cases where percutaneous procedures are preferred, but the overwhelming majority use ESWL.

Just knowing what the stone material is (calcium oxalate) is insufficient. It's important, but it's just not enough information. Did the stone form because of too much calcium or too much oxalate? Was there too much sodium or uric acid? Was there insufficient citrate or volume? Until these questions are answered, I'm just guessing about what's going on. You need a 24 hour urine test collection analysis to give use these chemical details of your metabolism.

Without knowing the details, my usual advice is dietary moderation with not too much of anything with the exception of water.

Parsley is high in oxalate, but most people eat very little of it so it's not a problem. Even if you eat tons of it, if your bottom line urine excretion of oxalate is normal then you don't really need much of a reduction.

Let me make this perfectly clear. Current research clearly indicates that people on too low a dietary calcium have MORE stones than people on a reasonably high calcium diet. The reason is oxalate binding in the intestinal tract. The more calcium and oxalate bind together in the GI tract, the less of either is available for absorption and eventual excretion in the urine. It turns out that oxalate is about 15 times a stronger promotor of stone production than an equivalent amount of calcium.

For more information on kidney stone prevention, please get hold of a copy of my book, "The Kidney Stones Handbook".

Stephen W. Leslie, MD FACS

Assistant Clinical Professor
Dept. of Urology
Medical College of Ohio

Founder and Medical Director
Lorain Kidney Stone Research Center
Lorain, Ohio

[Guest]

It's amazing how quickly I received a response. Thank you very much. The test results from three years ago showed I had high level of oxalate (I don't remember the others). I was eating a lot of nuts back then, but I've cut back considerably. The new test (from last month) showed all levels were normal, including oxalate. But, I don't know why these new stones have formed. I will find out if the new stones are in a kidney pocket and how hard it will be to get at them with ESWL. I will definitely get your book, doctor. Thank you very much for your advice; it's priceless!

[Guest]

You're welcome. By the way, I don't accept "normal" as an adequate response. I would like to know the actual numbers. The normal ranges were originally obtained from large numbers of "normal" people, not stone formers and arguably there may be different levels of certain chemicals to try to obtain in a stone former than in others. So if possible, please provide the actual 24 hour mg urine totals for at least the big 5: volume, oxalate, citrate, calcium and uric acid. Good luck.

By the way, you were just lucky that I happened to be on the Internet at just the time your message arrived. Please don't count on an response within just a few minutes as a routine.

Stephen W. Leslie, MD

[Guest]

Could you please elaborate on how tests are conducted. When a patient finds out, for example, he has a kidney stone, he gets concerned and starts drinking a lot more liquid than he normally does. He might do some research, and therefore cuts back on salt, sugar, nuts, chocolate, soda, tea, and everything that is bad for him. A few days later he does a 24-hour test. Wouldn't the test results be reflective of his, let's say, 7-10 days past habit? This was my case. Thank you for your input. (I'll get those numbers for you.)

[Guest]

Absolutely right. That's why we usually wait a few weeks or a month so that the patient is back on their regular routine. I tell patients who are interested in doing the 24 hour test to do and eat exactly what they would normally, with the possible exception of drinking more water. If they are doing something that puts them at risk, I want to find out what it is. Otherwise, people will be on "good behavior" and the critical item will be missed.

Stephen W. Leslie, MD