Melanie Cole (Host): As many as one in eleven people will experience a kidney stone at some point in their lives, but preventing stones is far more effective, less painful, and less expensive. At Maine, we’re committed to helping you do so. My guest today is Dr. Eric Taylor. He’s a nationally recognized authority on kidney stones at Maine Medical Center. Welcome to the show, Dr. Taylor. Tell us first, what are kidney stones?
Dr. Eric Taylor (Guest): Thank you, Melanie. Kidney stones are an abnormal collection of minerals that form in the kidney and they can cause problems when they pass from the kidney into the ureter and block the normal flow of urine.
Melanie: Do people that develop kidney stones, do they have to develop kidney stones? How do they develop them?
Dr. Taylor: Yes. There are lots of different kinds of kidney stones and there are lots of different ways of preventing them. One of the major things that I like to communicate to my patients, and also to anyone who suffers from kidney stone disease, is that if you do have a problem with stones, you don't have to continue having that problem. With the right evaluation and the right treatment strategy, kidney stone recurrence is completely preventable.
Melanie: Can you prevent it before you even have your first kidney stone?
Dr. Taylor: You can. I generally don't recommend the primary prevention of kidney stones. In other words, if you’ve never had a kidney stone before, I don't think it makes sense to take special measures to prevent the development of the first one. The risk of recurrence in someone who’s already had a stone is quite high. It can be up to around 40% at five years, so if someone has had a kidney stone, even one, I generally offer them a metabolic workup so we can formulate a plan for prevention.
Melanie: Tell us how this kidney stone prevention program works.
Dr. Taylor: Well, the first thing that we do is we get a referral, which is often but not always, from the patient’s urologist. Urologists are surgeons that often specialize in removing kidney stones. The way we start is we see if there’s a kidney stone available for us to analyze. Sometimes, we have that; sometimes, we don't. But the cornerstone of our metabolic analysis is a 24-hour urine collection. After we have a 24-hour urine collection, then I have my first meeting with the kidney stone patient. I get to know about them, about their medical history, about their prior attempts at kidney stone prevention and then we decide if we need to do more diagnostic evaluation. We review the urine collection and then we prescribe a specific set of either dietary interventions and sometimes we even prescribe medications as well.
Melanie: What then would send somebody to see you? They’ve had recurring kidney stones, they start this program with you; what does the outcome look like?
Dr. Taylor: Well, for patients who are motivated to change dietary or lifestyle behaviors, the outcomes can be very, very good. There are a variety of randomized control trials that have shown that the risk of recurrence can be reduced dramatically with appropriate therapies, between 50 and 80% reduction in risk of recurrence. We generally don't offer kidney stone prevention strategies to patients who aren’t really interested in making any changes because that wouldn’t be productive.
Melanie: Tell us about dietary changes and what goes on with somebody that is really dedicated to the program.
Dr. Taylor: Almost all of my patients end up making dietary changes. The exact dietary recommendation, however, can depend on the type of kidney stone they’ve had and also depends on the composition of the 24-hour urine. With the exception of increased fluid intake, we don't make specific recommendations about diet until we’re able to look at the 24-hour urine.
Melanie: What would some of those diet recommendations be, for the listeners?
Dr. Taylor: Some common dietary prescriptions include reductions in salt intake. We occasionally make modification of the amount of animal protein intake. We also quite frequently will discontinue or adjust current medications that patients are on. We make recommendations about certain dietary supplements, and there’s many more.
Melanie: What about ongoing monitoring? If somebody is following the program, then how are you monitoring their treatment?
Dr. Taylor: The long-term goal of working with a kidney stone patient is to actually not have them need a urologist, not to have them need a kidney stone surgeon anymore. After we’ve recommended our prevention regimen, we’ll often repeat the 24-hour urine collection. If the patient has been stone-free for a number of years and if the 24-hour urine collection looks good over a number of years, we can often discharge the patient from the program. But a number of my patients, I will see annually, and what we’ll do is we’ll monitor both their clinical kidney stone disease as well as the urine composition.
Melanie: Dr. Taylor, is there anything in the general public that we should know? Does drinking water help prevent kidney stones, or eating calcium-rich foods but not using so much calcium supplements? Are any of these types of things good ideas?
Dr. Taylor: Yes. Again, if the patient or an individual has never had a problem with kidney stones, I don't think it makes sense to worry about it. For individuals who have suffered from kidney stones, however, and generally absolutely right, increasing fluid intake will help. We no longer recommend dietary calcium restriction for prevention of calcium-containing kidney stones. But, again, the important take-home message is that specific dietary recommendations really need to be tailored to the individual patient and that does involve a metabolic evaluation.
Melanie: Dr. Taylor, tell patients why they should choose the Maine Medical Partners Kidney Stone Prevention Program?
Dr. Taylor: Yeah. Well, we are a unique program. We’re the first and currently only comprehensive kidney stone prevention program in New England and we have a collaborative focus. We work very closely with our colleagues in urology as well as our colleagues in endocrinology and pediatric nephrology. We also have the resources of a dedicated dietitian as well, so I think we’re a very special program.
Melanie: It sounds like it. Now give your best advice for the listeners that have had recurring kidney stones, things that you really want them to know.
Dr. Taylor: I think that the single most important message I’d like to convey is that recurrent kidney stones are preventable. I see a very large number of patients in my practice who have had a numerous debilitating events of symptomatic kidney stones, as well as many patients who’ve had many surgeries for kidney stone removal. The most important thing is that people know that something can be done about that. This is a preventable disease.
Melanie: Well, that is great information. Thank you so much, Dr. Eric Taylor. You’re listening to MMC Radio, and for more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening.