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Some patients who have had kidney or ureteral stones may form more stones in the future. After your stone passes or is removed, your doctor will determine if you are at high risk of recurrence. To do so, he or she will need to analyse the stone. In addition, the doctor will consult the results of your blood and urine tests which were done before treatment.

If your risk of recurrence is low, general lifestyle changes will be enough to cut the risk of forming another stone.

If you have a high risk of recurrence, the doctor will run a series of specific blood and urine tests called metabolic evaluation. Depending on the test results, the doctor will recommend preventive measures or further tests.

General lifestyle advice to prevent stones

Even if you have a low risk of forming another stone, your doctor and nurse will advise you to make some lifestyle changes. These measures reduce the risk of you getting another stone and improve your health in general. The following advice is for adults.

  • Drink more
  • Make sure you drink 2.5 to 3 litres every day
  • Drink evenly throughout the day
  • Choose pH-neutral drinks such as water or milk
  • Monitor how much you urinate. It should be 2 to 2.5 litres every day
  • Monitor the colour of your urine: it should be light
  • Drink even more if you live in a hot climate or do a lot of physical exercises. This will help you to balance your fluid loss

Adapt your diet

Depending on your individual situation, your doctor may recommend that you adapt your diet. It is important to discuss this with the doctor first.

  • Have a balanced and varied diet
  • Avoid excessive consumption of vitamin supplements
  • Eat lots of vegetables, fibres, and fruits (especially citrus fruits)
  • Try to eat more low-oxalate foods like eggs, lentils, white rice, peeled apples, grapes, cauliflower, squash, etc
  • Make sure your diet contains a sufficient amount of calcium (about 1,000 milligrams a day). However be careful with calcium supplements and always ask your doctor or nurse for advice
  • Reduce the amount of salt in your diet (no more than 3 to 5 grams a day)
  • Do not eat too much animal protein, especially meat from young animals. Instead, eat more vegetable protein, found for example in avocado, cauliflower, or peas
  • Maintain a healthy weight (your Body Mass Index should be between 18-25 kg/m2)

Healthy habits

  • Adopting a healthy lifestyle is always a good idea.
  • Try to exercise 2 or 3 times a week
  • Avoid stress

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Metabolic evaluation

If you have a high risk of forming more stones, your doctor will do a metabolic evaluation. This is a series of blood and urine tests to determine which additional treatment you may need.

As part of the metabolic evaluation your doctor will ask you to collect your urine in 2 separate periods of 24 hours. For the initial metabolic evaluation, you should keep to a self-determined diet. The evaluation is done some 3 weeks after your stone has passed or has been removed. The amount of urine is measured and so are the levels of different substances in the urine.

Depending on the test results, you may get medication. Generally, the medication will cause little or no side effects. In addition, it may be helpful to consider lifestyle changes (See Prevention of Stone Recurrence).

Two to three months after you start medication, the doctor will take another urine sample to check if the dosage should be adjusted. For a large part, treatment depends on the kind of stone you had.

Interesting Fact

Urine substances of the methabolic work up includes creatinine, calcium, oxalateuric acid, citrate, magnesium, inorganic phosphate, ammonium, and cystine.

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