The rising incidence of kidney stones – now affecting roughly one in ten Americans – isn’t just a matter of discomfort; it’s a growing public health concern linked to increasing rates of obesity, diabetes, and dietary shifts towards higher protein and sodium intake. A recent review published in Annals of Internal Medicine offers a crucial, evidence-based roadmap for prevention, moving beyond anecdotal advice to concrete strategies backed by rigorous study. This isn’t simply about managing pain when a stone strikes; it’s about proactively mitigating a risk factor for long-term kidney disease and potentially life-threatening complications like sepsis.
Meet the experts: Daniel Marchalik, M.D., F.A.C.S., a urologist at MedStar Health; and Jason Fung, M.D., a nephrologist and disease prevention specialist.
The most common types of kidney stones – calcium phosphate and calcium oxalate – form when urine becomes overly concentrated with minerals. But understanding the *why* behind this concentration is key. It’s not just about calcium intake, but the interplay of hydration, diet, and underlying metabolic factors.
“Kidney stones affect roughly one in 10 Americans, and incidence has been rising for decades,” says Daniel Marchalik, M.D., F.A.C.S., a urologist at MedStar Health. “They are significantly more common in patients with a personal or family history of stones. Stones may cause extreme pain, but more importantly, they may lead to urinary obstruction, which may cause lasting or even permanent damage to the kidney and increase the risk of sepsis if not treated promptly.” Recurrence of kidney stones is common, Dr. Marchalik says, which is why it’s important for those prone to stay vigilant about prevention.
- Hydration is paramount: Aim for 2.5 liters (85 ounces) of urine output daily, requiring approximately 100 fluid ounces (12-13 cups) of fluid intake.
- Dietary balance matters: Prioritize a low-sodium, low-animal-protein, and average-to-high calcium diet.
- Medical interventions can help: Alkali therapy (potassium citrate) and diuretics (thiazide) have demonstrated significant recurrence reduction in clinical trials.
Below are the strategies that were proven to work, per the recent review published in Annals of Internal Medicine. Before trying anything yourself, be sure to consult your physician.
How to prevent kidney stones, according to the latest research
“Each intervention targets a different part of the stone-forming process,” says Dr. Marchalik.
Hydration
Stones form when minerals in urine become concentrated enough to crystallize, explains Dr. Marchalik. More water keeps that concentration below the threshold needed to form stones. The Kidney Foundation recommends drinking enough so you pee about 2½ liters (or about 85 ounces) each day. That means aiming to drink about 100 fluid ounces (or 12 to 13 cups) of fluid daily.
A low-sodium, low-animal-protein, high-calcium diet
Higher protein diets may increase the acidity of urine and make people more prone to stones, explains Jason Fung, M.D., a nephrologist and disease prevention specialist. However, the findings hone in on prioritizing animal protein because it “raises uric acid and suppresses citrate in the urine, which naturally inhibits stone formation,” says Dr. Marchalik.
On the topic of sodium, too much of it causes the kidneys to excrete more calcium, which is the primary raw material for stones, adds Dr. Marchalik. That’s not to say patients should skip dietary calcium altogether, though. In fact, average to high calcium intake is recommended for kidney stone prevention, which can be a bit confusing. “Counterintuitively, restricting dietary calcium makes things worse, because when there isn’t enough calcium in the gut to bind oxalate, oxalate ends up in the kidney and leads to more stone formation,” Dr. Marchalik explains.
Put differently, according to the Kidney Foundation, dietary calcium helps lower how much oxalate gets absorbed from the healthy foods you eat. The foundation recommends getting 1,000 to 1,200 milligrams of calcium per day, which may look like two to three servings of dairy daily with meals.
Alkali therapy
Oral alkali therapy, most commonly in the form of potassium citrate tablets, says Dr. Marchalik, helps to raise urinary pH levels and increase citrate directly, restoring acidic balance to the body. This treatment showed 333 fewer recurrences per 1,000 patients across four trials reviewed by scientists. Treatment with lemon juice had a more modest effect and also showed a small increase in adverse events.
Diuretics
Thiazide diuretics—a medication that makes you pee—can reduce how much calcium the kidneys excrete into urine by having the kidney reabsorb it instead, explains Dr. Marchalik. In the review, this therapy showed roughly 217 fewer stone recurrences per 1,000 patients across three trials.
Allopurinol
This prescription medication lowers uric acid production. Per the review, there were 265 fewer recurrences per 1,000 patients in two trials, with no meaningful increase in adverse events.
The bottom line
The information provided by this review “reinforces current management of stones but highlights things you can do to prevent them,” says Dr. Fung. It’s also worth noting that the clearest effective prevention tactics were those that don’t require a prescription—drinking more water and reducing sodium and animal protein, Dr. Marchalik notes. “That matters for who can actually act on this information,” he concludes. Of course, consult your physician before making any changes to your routine.
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