By Dr Prajwal Ravinder

Mangaluru, Mar 11: Two questions commonly encountered from stone patients are “Doctor how do these stone form? Once I have passed the stone or if removed can this problem recur?”

The answer to the first can be found in our very own home laboratory – the kitchen. When any solute gets concentrated it begins to crystallise as seen in sugar syrup or what happens in the salt pans where water evaporates leaving behind salt crystals. As for the second Q: a fact any stone former should keep in mind - they are at a lifetime risk of reforming stones.

Summer is the time to be cautious especially in areas which experience high temperatures. Dehydration is the obvious reason for stone formation and the remedy seems straightforward – hydration!

Fluid and dietary advise forms the backbone of stone prevention strategies. Let us settle some common queries.

Amount of fluid: Target a minimum of 2.5–3 l of liquid daily to prevent urine from getting concentrated. This amount may be variable depending upon the weather, your immediate working environment and physical activity when you may have to increase your fluid intake accordingly. One rule of thumb is to target a urine output of 2 litres per day and ensure that the urine colour is clear or pale straw coloured. High coloured urine could be a sign of dehydration.

Choice of fluid: Water is of course the best fluid to keep yourself hydrated. Coconut water, buttermilk, and lemon water are excellent choices. Carbonated soft drinks are extremely unhealthy should be avoided by all, irrespective of age or state of health. Alcoholic beverages have multiple adverse health effects and must be avoided; people love to grab a beer quoting their doctors advise to stay hydrated. Most of the so called ‘health drinks’ are often high in added sugars and are best left on the supermarket shelf.

Dietary advise: Patients love an elaborate diet plan, but the best advise I can offer is a rather boring one – a balanced diet. Most diet recommendations centre around demonising common food components like tomatoes, milk and vegetables. The real criminals hiding in plain sight are actually high salt containing snacks, processed foods and carbonated drinks. Limiting animal protein especially red meat, avoiding excess salt (snacks) and eating a high fibre balanced diet including protein is essential. It is important to have appropriate levels of dietary calcium which helps to bind with oxalate in the gut and reduce stone risk. Calcium is a vital component in our essential systems and dietary deficiency will be made up by resorption from the bony skeleton.

Regular, moderate exercise appropriate for your age and health status helps maintain overall kidney and cardiac function.

It is important to remember that these recommendations are for healthy individuals, those with renal or cardiac illness will need fluid and dietary advise tailored to their specific circumstances. Excess fluid in such patients can result in fluid overload.

If you do suffer from kidney stones it is imperative that you consult a urologist for expert advise. All patients would like to avoid surgical intervention but prolonged delay in intervention, inappropriate use of ‘flush therapy’ and unsupervised painkiller use can prove very harmful to your kidneys.

Stay hydrated, stay stone free.

Dr Prajwal Ravinder, consultant Urology, KMC Hospital Mangaluru.