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Dear Dr. Roach: I just found out that I have a kidney stone. I'm 77 years old, and I don't want to deal with it. I've heard of potassium citrate and pulverizing it with sound waves. Are these options? -- J.M.
Answer: When a person gets a kidney stone, the goals are to manage any symptoms, determine if a person's health is at risk (especially from infection or kidney damage), and decide which treatment might be necessary to prevent any new stones.
Extracorporeal sound wave lithotripsy is one way of removing symptomatic stones, as is ureteroscopy with laser lithotripsy. The decision of whether intervention needs to be done is made by a urologist with expertise in stone management, and treatment depends on the size, type and location of your stone(s).
Prevention of a recurrent stone depends on the specific stone type and any metabolic issue the person has. Nearly everyone with stones is recommended to increase their water intake (adequate enough to make at least 2 liters of urine a day -- and yes, we measure it) and decrease their salt intake (less than 2,300 mg of sodium a day). My former professor at the University of Chicago, Dr. Fred Coe, told me that he has seen people with sodium levels in their urine exceeding 25,000 mg a day. A high sodium level strongly favors stone formation.
Potassium citrate is a good choice for people who have calcium oxalate stones (60% to 80% of stones) and low measured citrate in their 24-hour urine tests. A low-oxalate diet may also be appropriate, but you can't make an informed decision without knowing which kind of stone you have and what your metabolism is like.
If you do pass a stone, save it; it will be useful for your doctor. There are several different types of less-common stones, and management can't be tailored for you without this information.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.