Tuesday, July 7, 2009



The first case experience was in 1968 , while the writer was a physician in the Hospital and Municipality Health Service Officer in Sibolga City, Tapanuli North Sumatra Indonesia. The patient family name was Taylor, male , age is about 25 years; job was truck conductor [the truck driver assistant] , with symptoms of hematuria [blood in the urine], pain in the lumbar side and lower abdomen. The x-ray examination showed the few stones in the kidney and bladder, the diameter between 0.8 to 1.2 cm and urine examination under microscope, there were the crystals in the urine sediments.
How to help or to treat the patient?

The treatment consists of:
General measures
Specific treatment to dissolve the kidney stones
Base or acid forming food diet treatment to support the specific treatment
Emergency measures in case of colic pain attack and prevention.

General measures:
If the patient does not develop anuria [cessation of kidney function and urine volume] or oliguria [less urine volume], general measures consist of forcing fluids with water intake should be increased about 3 quarts per day in order to maintain a high urine flow, and to dilute the urine and to dissolve the substances in the urine. Calcium oxalate and uric acid intake should be limited or minimized.
Many primary kidney stones consist largely of calcium oxalate. When ingested oxalic acid is eliminated, at least in part, unchanged. Since many common articles of diet, for examples, rhubarb, spinach, tomatoes, asparagus, apples, cabbage, grapes, lettuce etc., contain relatively high oxalates [or precursor] it seems probable that they are responsible for most of the calcium oxalate crystals or stones in the kidney, they should be limited intake. The rhubarb leaves contain 1.2 % of oxalic acid; spinach contains 0.8 to 0.9 % , they should be avoided intake with kidney stones.
It is of interest that oxalic acid is one of the end products of in vitro oxidation of ascorbic acid [vitamin C], so that the drug contain high dose of vitamin C 1000 mg effervescent with 1000 mg calcium carbonate should be avoided, vitamin C less than 100 mg is permitted. Other drugs which contain calcium is avoided.
Other green vegetables such as lettuce, celery, endive, broccoli, Brussels sprouts contain very small amounts of oxalic acid, generally less than 0.1 per cent, they are saved for intake.

Specific treatment to dissolve the kidney stones
What is the keyword substance for treatment of kidney stones?
The basic keyword substance is sodium bicarbonate tablet, as drug this was based on the source: Henry Brainerd, M.D. et al. Current DIAGNOSIS AND TREATMENT, Lange Medical Publications, California, USA, 1962, p 662.
It can be substituted with baking soda or baking powder. The second keyword is base-forming and acid-forming foods , which the main sources from daily foods intake.
How can the sodium bicarbonate and base-acid forming foods dissolve the kidney stone?
The sodium bicarbonate or NaHCO3 ingestion, a part of bicarbonate is changed to water and carbon-dioxide by hydrochloride acid secretion in stomach, the other parts and sodium will be absorbed to blood vessels in intestine. The bicarbonate HCO3 negative ion is changed to water and carbon-dioxide or CO2 in the lung, and the CO2 is discharge in to the alveoli. The sodium or Na positive ions secreted in the urine act as solvents can replace the calcium, magnesium or ammonium from the stone in dilute urine of the kidney, or dissolve the stone, eventually decreased the size of the stone and dissolve the crystals, sand and gravel.

The treatment with sodium bicarbonate tablet/500 mg thrice 4-5 grams daily 2 hours after meals [ the sodium bicarbonate has effect also as antacid for gastric ulcer] can alkalinizing the urine. The sodium bicarbonate is non-prescription drug or OTC. The treatment of kidney stones size less than 15 mm is about one month, it needs 450 gram for one month with cost is about $ 40.Treatment of kidney stones size 15-25 mm [1 inch] is about 1-3 months with the cost about $ 40.00 to $ 120.00.
Treatment with baking soda , add one teaspoon baking soda [ 4800 mg sodium bicarbonate] to one glass [225 ml] of water 2 hours after meals 2 to 3 times daily. The patient need 10-15 g /day or about one lb/month [the price is about $ 20.00/lb per month] for treatment of kidney stones size less than 15 mm.

How much the cost treatment of kidney stone?
The treatment of kidney stones size less than 15 mm for one month with baking soda is about $ 20.00, and for stone size 15-25 mm for 3 months is $ 60.00.
The treatment of stones with sodium bicarbonate tablet, stone size less than 15 mm for one month is about twice or thrice of baking soda or about $ 40.00 to $ 60.00; and for stones size 15-25 mm for 3 month is about $120.00 to $ 180.00 .
The average direct medical costs of Extracorporeal Shock Wave Lithotripsy [ESWL] is about $ 4 300.00 according to NLM Gateway.
The costs of surgical treatment with Percutaneous Nephrolithotomy or Nephrolithotripsy [PCNL] may be double of ESWL, because the PNCL procedure is more sophisticated than ESWL. The ESWL and PNCL surgical treatments are expensive for the middle and low income groups.

So, taking various perspective in calculating costs may change the decision about which treatment is to be preferred. From the point of view of optimal treatment and the capability to pay the real costs would be helpful for the decision of the patients

Please give comment and feedback success story to email:

The combination of general measures with forcing fluids or water intake and alkalinizing urines with sodium bicarbonate as well as potassium of base-forming foods can dissolve the stone in dilute urine,which caused by higher intake of water. The more rapid dissolved are particularly the stones which are formed in the acid and neutral urines such as uric acid, calcium oxalate, and calcium phosphate; the processes are reversing the formation of kidney stone in supersaturated and acid urine condition.

Base-forming and acid forming foods. Certain foods, such as vegetables and fruits, on burning outside or inside the body leave an ash or residue in which the basic elements [sodium, potassium, calcium and magnesium] predominate; whereas cereals, meat and fish foods leave an ash in which the acid forming elements [chlorine, phosphorus, and sulfur] predominate. Such foods are spoken of as base forming and acid-forming foods , respectively, and will influence the acid base balance of the body and the acidity of the urine.
The properties of sodium and potassium are strong alkali metal , strong base solution in water; the strong bases act as solvents can replace weak base alkali such as calcium, magnesium and ammonium from the salt stone in the urine, and thus dissolved the stones So that sediment crystals, sand and gravel and small stone can dissolve or soluble in the urine; the larger stone decreased in size and smoothing the stone surface . The chlorine and sulfate acid are strong acid can act as solvents to weak acid such as the salt of carbonic acids and phosphate acids in the dilute urine.

Quantitative data of base-forming foods, Calories, and weight of average portions.
The alkaline effect is given in terms ml of N alkali [+] corresponding to 100 grams or 100 ml of food. The measure of “average portion” as given is based upon the edible portion only and upon articles of average size. The food is calculated as in the raw state. In these tables, T=tablespoon, t=teaspoon, c=cup.
The 20 name of foods were selected from the alkaline [+] values range [+1] to [+63].

Table: Base-forming foods, Alkaline [+] and portion [Total calories, measure, weight]
Name.................A[+] T.C. M W [g]


Avocados………......+11..259..½ pear 100
Beans, dried lima.+42....91..1/8 c. 28
Beans,green lima.+28..125...2/3 c. 100
Beans, soy………...+17...158.. 2/3 c. 100
Beet greens……....+27...28........1 c. 100
Chard, leaves…….+16...22.... 1 ½ c. 100
Carrots………….....+11.. 40....1 large.100
Chives………….......+13..52..2 bunch.100
Dates, dried……...+11...92...4 stones. 30
Dandelion greens.+18..45....1 c....... 100
Taro……………......+18..93....1 corm.100
Figs, dried…….....+33..83....1 1/2.... 30
Raisins…………....+34..131....1/3 c....45
Milk, dried skim..+18..80....2 T.......16
Coffee…………......+63 .. ........1 c... .180
Molasses……….... +60..40......2 t.... .14
Potato chips……..+21...97..10 pieces 17
Sugar, brown……+60...19.......2 t..... .5
Tea………………....+47 .............1 c...180
Yeast, dried……...+17...35....1 T.. ....10

Note:A[+]=Alkaline [+]. TC=Total Calories

M=Measure, W[g]=Weight [grams]

Source: Philip B. Hawk et al Practical Physiological Chemistry. New York, 1954,
p 1358-64 Note: These Base-forming foods are selected from Alkaline [+] range value [+1] to [+63]

Treatment combination of sodium bicarbonate, forcing or high intake of water and acid-forming foods, can dissolve the stones which are formed in alkaline urine such as magnesium ammonium phosphate calcium carbonate and ammonium urate stones. Where the sodium and potassium can replace the calcium, magnesium or ammonium from the stones; the chlorine and sulfate acid from the acid-forming foods are strong acid solution can replace the weak acid such as phosphate, carbonate and urate of the stones, so those of stones can be dissolved, eventually decreased the size of the large stone. The sediment crystals, sand and gravel stones can dissolve or soluble in the dilute urine.

Table: Acid Forming Foods, Acids [-] and Portion

Name......... A[-] T.C. M. W[g]

Macaroni…...-14..101..¼ c. 28
Oatmeal……..-12...98..¼ c. 25
Wheat bran…-25...87..1 c...28
Wheat germ..-20..76..2 T...20
Wheat,whole -12...72..2 T.. 20
Beef brains…-21..144..¼ lb. 113
Beef, chuck ..-11..303..¼ lb 113
Beef steak….-11...263..¼ lb 113
Chicken……..-14..141..¼ lb 113
Crabs………..-40...92..2/3 c.113
Duck………...-24.180..¼ lb 113
Egg yolk……-27...60..1 yolk 17
Haddock…..-12...81..¼ lb fl 113
Lobster…….-38..95..2/3 c. 113
Scallops……-36..84..2/3 c. 113
Turkey……..-11..176..¼ lb 113
Veal chops -14..236..2 ch 113

Source: Ibid
Note: The 18 name of foods were selected from the acids [-] range values [-1] to [- 40];A[-]= Acid [-],T.C.=Total Calories,M=Measure, W[g]=Weight[g], fl=filet ,ch=chops

During treatment of large kidney stones need another medication [prescription drugs] to relax the smooth muscle of ureter and urethra, such as Buscopan [hyoscine-N-buthil bromide] 10 mg/tablet per oral once daily or Scopolamine 0.25 mg per oral once daily, or Hyoscyamine 0.15 mg/tablet per oral once daily, so that higher output of urine with relax ureter and urethra can pass the stone with diameter less than 10 mm. The urine should be put or caught in the pot or urinal to proof of passed stone and for examination.
Uric acid kidney stones with gout patient, additional treatment allopurinol 100 mg/tablet/ day. If the patient with edema, administer Hydrochlorothiazide [HCT]25 mg/tablet once to twice daily.
The writer experience’s treatment of kidney stone, if diameter, width or length more than 10 mm to 15 mm, the stone can pass between one week to one month. If the diameter more than 15 mm to 25 mm, the stone can pass between one month to 3 months. No case of the stone more than 25 mm, but if there is stone more than 25 mm, it may be needed treatment for 3 to 6 months.
After treatment of stone should be checked again with x-ray or ultra sound graph. [USG], and urine sediment.
There is no complication treatment of kidney stone with sodium bicarbonate or baking soda until today, there is a mild feeling distention of stomach due to the gas CO2 [carbon dioxide] formation as the result reaction of sodium bicarbonate with the acid of gastric secretion.

These experiences need a further extend clinical trial in the hospital, health center or research center. The results might be the input for treatment and prevention of kidney stones.

The writer's friend physicians and health office services,the readers, families and friends,please try to apply:


Good luck !

Hope and believe the patients relieve.

No comments:

Post a Comment