Kidney stone prevalence, since my initial 2018 article, has exponentially increased following the COVID-19 pandemic. This is mostly linked to weight gain, slow metabolism and dietary changes, which are associated with stone development.

Moreover, use of certain supplements in excessive amounts, including Vitamin D and Vitamin C, are noted to exacerbate the risk in patients who already have a predisposition for stone formation.

Types of Kidney Stones

Calcium oxalate stones remain the most prevalent stones in the population, yet with recent increases in obesity and metabolic syndromes, uric acid stone incidents are rising in the population. These stones are often associated with diagnosis of pre-diabetes and pre-hypertension, which are manifestations of metabolic syndrome.

Risk Factors for Kidney Stones

• History of prior kidney stones
• Positive family history of kidney stones
• Bariatric procedures, GI malabsorption syndromes
• Dietary factors: low water intake, high salt intake, high animal protein diet, certain beverages, etc.
• Obesity/metabolic syndrome
• Other less common risk factors

Workup for Kidney Stones

• Basic metabolic panel — This panel evaluates kidney functions, potassium, magnesium and calcium levels.
• Parathyroid hormone levels — Parathyroid hormone, also known as PTH, can be elevated and form certain types of calcium stones. This needs further evaluation by an endocrinologist or an ear, nose and throat (ENT) specialist.
• Vitamin D levels — A history of kidney stones can predispose an individual to heightened risk of osteoporosis and fractures. Low vitamin D levels need to be corrected with careful monitoring of labs in stone patients. On the other hand, too high of Vitamin D levels can cause increased risk of calcium-based stones.
• 24-hour urine evaluation — This is a key component of the kidney stone workup, which helps in identifying the risk of future stones and adding preventive therapy tailored to patient’s other medical needs.

Treatment of Kidney Stones

• Medical Prevention: Certain medications have been deemed safe and effective for stone prevention. Some patients start medications after they try dietary modifications. Others need medical prevention/treatment right after their first stone episode, specially if they are diagnosed with stones in both kidneys, stones in a single kidney or have chronic kidney disease, bariatric surgery, etc.
• Dietary Prevention: Most patients need assistance from a dietitian to plan their meals and eat healthy along with instructions to avoid certain foods given history of stones. Extreme diets, such as high protein diets, have been noticeably linked to higher risk of stones in patients with a predisposition for stone formation. Receiving appropriate instructions from a dietitian for weight control and following a balanced meal plan are key elements for stone prevention.

We Can Help!

Identifying risk factors for future stones and starting preventive diet or medications early can prevent future stones, hospital visits, emergent surgeries and risk for kidney failure. Getting basic blood work, urine studies and risk factor evaluation can be performed by your PCP. Further evaluation and treatment can be performed by specialized stone centers with multidisciplinary teams, including urologists, nephrologists, dietitians and other stone specialists.

WakeMed remains the only health care system in the Triangle to have a specialized Kidney Stone Center. Our skilled team, supported by provider and dietitian Parul Kharod, RD, LDN, offer specialized medical and surgical help for patients with kidney stones. If you wish to explore this option, contact the Kidney Stone Center at 919-350-ROCK.

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About Shams Zia, MD

Dr. Zia earned her undergraduate degree from St. Joseph’s Government College in Karachi, Pakistan.

She attended medical school at Dow Medical College in Karachi, Pakistan. Her internship was completed at the Aga Khan University Hospital. She went on to complete a three-year residency at SUNY Upstate Medical University in Syracuse, NY, where she also served as Chief Resident. She completed a fellowship in the Department of Nephrology at Duke University Medical Center as well as serving as a clinical research fellow in Nephrology and Transplant with the Duke Clinical Research Institute.

In addition to serving as a nephrology consultant for the Kidney Stone Center, Dr. Zia also serves as an adult hospitalist on the WakeMed Raleigh Campus.

Appointments with Dr. Zia are made by referral through WakeMed Physician Practices — Urology.

She sees patients at all five WakeMed Urology locations.

About WakeMed Kidney Stone Center

At the Kidney Stone Center, we strive to offer the next available appointments for diagnosis and treatment. Depending on your history of kidney stones and symptoms, this means being able to call in prescriptions right away, bypassing the emergency room and directly admitting you to the hospital for treatment, and/or arranging same-day appointments with one of our board-certified urologists.

Disclaimer: The advice of individual medical providers serves as guidance from the specific provider and is not intended to establish standards of clinical practice or rules of law for WakeMed Health and Hospitals.