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Urology/24 hour urine & kidney stones


QUESTION: My husband has had several kidney stones through the years, he has been drinking 5 liters of water a day due to a nephrologist recommendation because his creatinine reached 2.1 in November 2013.  Now his creatinine is 1.4 thankfully.

He did a 24 hour urine and we would like to know what kind of diet he should be following...  because before the test they suggested low oxalate, low sodium, low purine diet.

His results for stone risk factors are:  Urine Oxalate 23, Urine Citrate <83, Dietary factors NA24 234.

ANSWER: Sandy:

The 24 hour urine results are incomplete with just citrate, oxalate and sodium.  What is needed are the 24 hour totals in mg for the following:

-Total Volume in mL.




-Uric Acid



With this information we can make some kind of analysis.  However, from the limited numbers provided, it looks like his citrate is low and his sodium is high.  Please send the rest of the data so we can give you some additional advice.  What did his physicians recommend based on this data?

---------- FOLLOW-UP ----------

QUESTION: Stone Risk Factors/Cysteine Screening  Negative 6/19/14
Urine Volume     5.54
SS CaOx          0.55
Urine Calcium    80
Urine Oxalate    23
Urine Citrate    <83
SS CaP          0.11
24 Hour Urine pH 6.143
SS Uric Acid     0.08
Urine Uric Acid  0.261

Dietary Factors:
Na 24   234
K 24    42
Mg 24   73
P 24    1.166
Nh4 24  40
CI 24   219
Sul 24  43
UUN 24  11.52
PCR     0.8

Normalized Values:
Cr 24        2139
Ca 24/kg     19.2
Ca 24/kg     0.7
Ca 24/Cr 24  38

The urologist is going to review, nurse did say may treat with potassium citrate. We would like to know what to watch on his diet, we are already on low sodium diet now.  Also on low oxalate but we are wondering if that is necessary?  

Any advice is welcome, thank you!


Urine volume is very high.  That's good for stones, not so good for running to the bathroom every hour.  We tend to shoot for about 2500 mL and the patient is up to 5540.

Citrate is very, very low.  He will need some potassium citrate supplements.

Oxalate is fine.  He may not need to restrict his oxalate quite so much.  His calcium is also low, so I often will recommend taking a calcium citrate tablet with dinner (which is when we typically have the highest oxalate meal).  The calcium binds the oxalate to prevent absorption.  The calcium citrate should be without vitamin D.

His sodium is also a little high so cutting back slightly on salt is recommended.   But the main problem is the citrate.


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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