Friday, July 24, 2009



Advice: Drinking higher water more than normal about 10-12 cup of water [2.5-3 liter] every day.
The diet with limited or restriction of high calcium oxalate content foods such as rhubarb, spinach, tomatoes, asparagus, apples, cabbage, grapes and lettuce etc.
Limiting the foods that contain potentially harmful compounds such as calcium, oxalate and phosphate of foods such as: Broccoli, collards, carrot, parsley, romaine, sweet potato turnip green and watercress.
The quantitative data of plant content of oxalate, calcium, phosphorus and protein in the following table, where the 3 highest content of oxalate are parsley, spinach and broccoli; the three highest content of calcium are collards, parsley and turnip green; the three highest content of phosphorus are squash winter, parsnip and broccoli.

Table: Calcium oxalate in mg content of
100 g selected food plants
Name………….... Ox... Ca.. P..Pr
Broccoli………... 610....42.. 58.. 3
Collards……… ...450..218.. 29.. 3
Carrot…………... 500... 30..48.. 1
Kale…………........ 20... 90.. 38.. 2
Parsnip……….. ....40... 70.. 96.. 2
Parsley………....1700..122.. 38.. 2
Romaine………...330... 20.. 26.. 1
Spinach……….....970... 51.. 28.. 2
Squash, summer. 20.. 36.. 38.. 1
Squash, winter.... 20.. 57.. 98.. 4
Sweet potato…...240.. 29.. 37.. 2
Turnip………...... 210... 5... 39.. 1
Turnip green…....50..105.. 23.. 1
Watercress…….. 310.. 53.. 19... 1

Note: Ox=Oxalate, Ca=Calcium, P=Phosphorus, Pr=Protein
Source: Melissa Kaplan 2007, http//

Reducing the foods from plant high source of calcium such as: soybeans green, tofu, soymilk, fortified soymilk, soy yogurt, sesame seeds, dried figs, calcium-fortified orange juice and fortified cereal [ready to eat].

Avoid high vitamin C and calcium drugs content such as calcium lactate, combined vitamin C 1000 mg and calcium carbonate effervescent, and other drugs with high calcium content
The formation of kidney stones are about 80 % in acid urine, so that they need
Base-Forming Foods for prevention such as beans, beet greens, chard leaves, taro figs , raisins, coffee, molasses, potato chips, brown sugar, tea, yeast, dried skim milk.The 0ption of foods intake are about 2 types of foods 3 portions every day and tea or coffee one cup thrice daily.

Medicine to prevent calcium stones:
Sodium bicarbonate [or baking soda] 2 g per oral every day and potassium citrate 50 % solution one tablespoon twice daily can prevent the urine from becoming too acidic, which can prevent and treat the uric acid, oxalate and cystine kidney stones.
Thiazides such as hydrochlorothiazide 25 mg/tablet once daily and potassium citrate are commonly used to prevent calcium stones.
Allopurinol 100 mg/tablet daily can treat the gout patient and prevent uric acid stones.
Vitamin B6 100 mg/tablet once daily can reduce the production of oxalate in the liver



If anyone patient with kidney stones applies the method of SIMPLE AND LOW COST TREATMENT OF KIDNEY STONES ; PREVENTION OF KIDNEY STONES, please feedback success story to:


Friday, July 17, 2009



Open surgery through the abdominal wall was necessary to remove the stone from the kidney until 20 years ago.

Today, treatment for these stones is improved, and many options do not require major open surgery and can be performed in outpatient setting.

Open surgery was necessary to remove the kidney stones until 20 years ago. This surgery required a recovery time of 4 to 6 weeks. Today, treatment for these stones is greatly improved and a few options without open surgery

Extracorporeal Shock Wave Lithotripsy [ESWL]

Picture: ESWL

This method is the most commonly used procedure for the treatment of kidney stone. In ESWL, shock travel through the skin and body tissues and then hit the stones; the stones breakdown into small particles and are easily passed the urinary tract in the urine.

Complications of ESWL may occur such as hematuria or blood in the urine for a few days after treatment; bruising and minor discomfort in the back or abdomen from the shock wave.

Percutaneous Nephrolithotomy or Nephrolithotripsy [PCNL]



This treatment is often used if ESWL does not work or if the stone is very large. In this procedure , the surgeon makes a tiny incision in the back and creates a tunnel directly to the kidney. Using an instrument called a nephroscope, the surgeon locates and removes the stone. For large stones, some type of energy probe such as ultrasonic may be needed to break the stone into small pieces. The patients stay in the hospital for several days and may have a small tube called a nephrostomy tube left in the kidney during the healing process.
The risks associated with PCNL:
• Bleeding may result from injury to blood vessels within the kidney or in the area of incision
• Formation of an arterio-venous fistula
• Injury to the surrounding organs, in rare cases to spleen, liver, pancreas.
• Fluid accumulation in the area around the incision.
Retreatment is occasionally necessary in case of large stone.

Ureteroscopic Stone Removal

Ureteroscopy may be needed for mid-ureter and lower-ureter stones. No incision is made this procedure. The surgeon passes a very thin telescopic tube a small fiber-optic instrument called ureteroscope through urethra and bladder into the ureter. The surgeon locates the stone and either removes it with a cage-like device or shatters it with a special instrument that produces a form of shock wave. A small tube or stent may be left in the ureter for a few days to help urine flow.



Friday, July 10, 2009



The renal colic pain attack is a rare event.
But if a patient get a colic pain attack, administer antispasmodic drug such as atropine 0.5 mg/ml SC injection or Scopolamine one mg /ml SC injection, combine with Diazepam 5 mg IM injection. If the pain had been relieved, administer Diazepam 2 mg/tablet per oral twice daily, combine with Buscopan 10 mg/tablet per oral twice daily.
For preventive of colic pain attack, Diazepam 2 mg/tablet once daily at bed time or phenobarbital 30 mg per oral daily.
If there is infections , administer Impresial [pipemidate acid] 400 mg/capsule per oral twice daily for 7 days, or ofloxacin 200 mg/capsule twice daily per oral for 7-10 days.
This treatment should be done or conducted by physician.


General measures: Small stones may be passed. They do no harm if infection is not present. Fluids, if patient does not develop anuria [stop urine flow]or oliguria [less urine volume], fluids or water is best should be forced intake 2,5-3 liter per day in order to maintain a high urine flow and dilute the urine and the substances potentially form the stones. Calcium intake should be limited. Check carefully for passage of stone. If does not occur, examine by x-ray for position of stones. Attempt to recover stone by having patient void through a funnel layered with several thickness of gauze, and analyze chemically to determine type of stone.
Special measures: Treatment of calcium oxalate with potassium citrate or sodium citrate with moderate oxalate, fat and protein intake. Certain diuretics such as hydrochlorothiazide can treat the calcium phosphate stone, the effect decrease the amount of calcium released by the kidneys into the urine by favoring calcium retention in bone. The medicine allopurinol [drug for gout] may also be useful in some case of increases uric acid secretion. Struvite stone treatment with mandelamine and vitamin C. Sodium cellulose phosphate can administer to hypercalciuria [increased calcium in the urine] , which binds calcium in the intestines and prevents it from leaking in to the urine. Cystine stone treatment with alkali therapy penicillamine. Coexisting infection should be treated with suitable antibacterial drugs.
Treat predisposing disease such as surgical removal of parathyroid tumor or hyperplastic glands.
Additional vitamin A 20 000 IU/tablet PO once daily for prevention of vitamin A deficiency and regenerate the epithelia of the tubular of kidney for urine filtration.
Neurobion consists of vitamin B1 100 mg, B6 [pyridoxine] 100 mg] and vitamin B12 200 micro-grams /tablet once PO daily. Vitamin B1 for prevent of edema; vitamin B6 for decreasing production of oxalic acids in the liver and vitamin B12 for treatment or prevention of anemia due to hematuria [ red blood cells and white blood cells in urine]


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.

Friday, July 3, 2009



These vary with the size, shape and position of the stone. Minute, smooth stones or gravel diameter less than 5 mm may be passed without symptoms. A smooth stone fixed in one of the calices of kidney, and without infection, may remain for years without symptoms and signs.
The most common symptom of a larger stone is intermittent dull pain in the flank or back, intensified by motion or a sudden jolt, sometimes dysuria [painful urination]. Abnormalities in the urine occur one time or another in 80 % of cases; albuminuria [protein in urine], which may be minimal, while hematuria [red blood cells and white blood cells in the urine] and pyuria [pus in the urine] each occurs in about half of cases.
A rare happened is the classic attack of renal colic caused by the passage of the kidney stone into and down the ureter, the stone large enough to obstruct it in the ureteral-bladder junction. There is a sudden onset of severe pain on the affected side; abdomen, radiating to the groin, bladder, testes, inner thigh or other adjacent areas. The pain is frequently sufficient severe to induce nausea, vomiting, profuse sweating, faintness and shock .If there is infection, there will be fever and leukocytosis [increase white blood cells in the blood] in addition. The attack may last only a few minutes, but usually persists for several hours. A patient may have but one attack of colic and pass the stone without further difficulty, or with multiple stones there may be repeated attack over a period of years.

In patients suffering from typical attacks of renal colic, the diagnosis can be made with comparative case from the clinical history and is supported by laboratory examination.
Laboratory examinations of urine with the presence of blood [red blood cells and white blood cells] and numerous crystals in a freshly voided urine. A catheter specimen should be obtained in women.
Under microscope the calcium oxalate is found in the acid urine sediment at two distinct types of crystals: the dumbbell and “octahedral” types. Calcium
Phosphate [Stellar Phosphate] may occur in the neutral urine in 3 forms: amorphous, granular or crystals; the crystals as individual or group together in the formed rosettes. Uric acid sediment of urine which is acid in reaction; it occurs in varieties of crystals being rhombic prism, prismatic rosettes or hexagonal plates. Cystine crystallizes in the form of thin, colorless, hexagonal plates.
Nevertheless, the diagnosis can be established only by x-ray, ultrasound or pyelogram study.
At times the shape and type of the shadows seen on x-ray plate are characteristic: Calcium oxalate stones may have a snowflake form with spicule [a slender pointed body] radiating from a central hard focus. Lamellar stones are usually phosphate in composition. Large stag-horn stones are calcium phosphate, calcium carbonate or cystine. Uric acid, urate and cystine stones often fail to give a visible shadow. Intravenous pyelogram [contrast medium graph of kidney] may outline the stone. The doctor may decide to scan the urinary system using a computerized tomography [CT] scan. The result of this test help determine the proper treatment.

PROGNOSIS [ A forecast of the course of kidney stone]

The prognosis in patients with kidney stone is extremely variable, depending upon the size, shape and position of the stone, and the presence of obstruction and of infection. Small stones retained may do no harm, the stones less than one cm diameter, width or length are likely to pass spontaneously, while stones more than one cm diameter, width or length are unlikely to pass spontaneously. Irregularly shaped stones are unlikely to pass spontaneously. All stones tend to grow if no treatment of the kidney stones.
Kidney stone without treatment is one of the most common causes of infection and hydronephrosis [obstruction of urine in the kidney], which may give rise to renal insufficiency, uremia and generalized sepsis.

What are the treatment options of kidney stones?


Simple and low cost treatment of kidney stones, the writer experiences.
Conservative forms of medical treatment
Surgical treatment

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