First, I want to make sure you know the difference between a urologist and a nephrologist because both specialties help patients with kidney stones. Urology is the branch of medicine that deals with the diagnosis and treatment of diseases of the urinary tract and urogenital system. Nephrology is the science that deals with the kidneys, especially their functions or diseases. Urologists perform surgery to remove stones. Nephrologists do not perform surgery. Instead, kidney doctors focus on why the patient is prone to get stones. This evaluation is called a "metabolic work up." Frequently the nephrologist and urologist work together to provide a patient with total kidney stone care.

The only universal recommendation I make to my kidney stone patients is that they need to drink enough water so that they produce more than two liters of urine per day. The water ingestion should be throughout the day. The urine concentration needs to be dilute so that the risk of kidney stone formation is decreased. Here's why: let's say a person is prone to make calcium oxalate stones — a frequent type of kidney stone. In order for the calcium to attach to the oxalate, the two molecules have to get "near enough" to each other.

| calcium --> <-- oxalate |
A concentrated urine. Easier for calcium and oxalate to find each other.

| calcium -->                              <--oxalate|
A dilute urine. Harder for calcium and oxalate to find each other. Decreases the likelihood of stone formation.

Unfortunately, kidney stone evaluation is not that simple. You have to take into account the "saturation risk" of the two molecules joining. Simply stated, there is other "stuff" in the urine which may increase the likelihood of the calcium binding with the oxalate. A super-saturation profile gives us this necessary information:

| calcium --> <-- oxalate |
This urine has 1 time the risk of forming a kidney stone.

| calcium --> <-- oxalate |
This urine has 3 times the risk of forming a kidney stone — even though the amount of urine is the same as the sample above!

Therefore, I recommend you come to me for a kidney stone evaluation prior to altering your approach to reducing your kidney stones. You want to make sure you are doing the right thing prior to making a lifestyle intervention. I've seen people inadvertently INCREASE their risk, and I don't want that to happen to you.

Now we can answer the questions:

Can vitamin C lead to kidney stones?
Yes it can, but in high doses. High amounts of vitamin C increase the oxalate production in the body. Therefore, more oxalate is excreted in the urine, and in some cases the risk for kidney stones (nephrolithiasis) increases!

What about calcium supplements?
NO! Turns out that calcium when eaten with meals binds the oxalate you eat IN THE GUT, so the oxalate is less absorbed and you decrease your risk for kidney stone formation! What you have heard all these years turns out to be a myth!

Therefore, go to your primary provider and get your blood checked. Keep your weight, blood pressure, and blood sugar controlled. And if appropriate, see a kidney doctor/nephrologist sooner rather than later. I can do more for you to decrease the risk of progression of kidney failure when your kidney function is 60% as opposed to when it is 15%.

Here's a question I frequently get from my patients:

"I have cramps in my legs. Is it due to low potassium or other electrolyte problem?"

The answer is that hypokalemia (low potassium) frequently results in leg cramps. Heart doctors see many patients with high blood pressure and heart failure. And in this setting, it is common to see these patients taking water pills to remove the excess fluid in their bodies. One of the effects of water pills (diuretics) is to decrease total body potassium. So in that setting, when patients present with leg cramps, a common cause is low potassium. And this is one of the reasons why frequent blood tests are required for patients who are prescribed diuretics—to make sure that their potassium level doesn't get too low.

Unfortunately, there is more to this story. Excessive use of diuretics leads to volume depletion, and volume depletion alone can cause leg cramps. In fact, one of the tricks kidney doctors use to determine if we have removed enough fluid during a dialysis treatment is to remove fluid until the patient starts complaining of leg cramps. Also, there are other metabolic causes of leg cramps which include diabetes, alcoholism, and hypothyroidism.

So the moral to the story is that if you are a heart patient and are on diuretics and start having muscle cramps, talk to your doctor. Regional experts in heart failure like Dr. Van De Graaff have much experience in determining the cause of the problem and providing a solution. Although low potassium is a frequent cause of leg cramps, there are many other possibilities as well. People run into problems when they try to self diagnose, change their water pill dose on their own, increase their potassium intake drastically without supervision, etc.

By the way, if you have a kidney, blood pressure, stone question, etc. that you would like answered. Please feel free to ask!

Sidebar: There was a recent study that came out which suggested that women need to exercise approximately 1 hour daily just to maintain their current weight. Therefore, in order to lose weight, you need to alter your caloric intake.

Diet soda frequently has caffeine. Caffeine is a natural diuretic, so you may urinate more, but that shouldn't adversely affect the kidneys. What most people don't appreciate, is that diet soda has a lot of sodium. Some have argued, that this makes you more thirsty. High levels of sodium in the diet lead to hypertension. As we just talked about, high blood pressure can lead to kidney failure and the need for kidney dialysis. So plain old water is the best option to quench the thirst.