Your friend's effeft. Kidney disease, Anti-aging pills diarrhea, other GI conditions such Replenish eco-conscious choices stonez disease or surgery in the intestines, certain cancers such as leukemia and lymphomaand sarcoidosis a type of systemic disorder that causes inflammation and release of parathyroid hormone-like protein put people at higher risk for stones. Living Well.

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Diuretics - Mechanism of Action of Different Classes of Diuretics, Animation

Diuretic effect on kidney stones -

The VUMC study, published Nov. Thiazide diuretics are recommended by international guidelines for the prevention of calcium kidney stones with long-term safety data.

The all-VUMC team of researchers plans to investigate the underlying mechanisms by which thiazide diuretics lower the risk of kidney stones next. Other Vanderbilt collaborators who participated in the study include Ryan Hsi, MD, Guanchao Wang, Elvis Akwo, MD, MS, Lee Wheless, MD, PhD, Hua-Chang Chen, PhD, Ran Tao, PhD, T.

Alp Ikizler, MD, and Cassianne Robinson-Cohen, PhD. Toggle navigation. New study uses genetic data to support use of thiazide diuretics for kidney stone prevention Dec. Thiazide rather benefits bone and is a proven benefit for stone reduction.

Best, Fred Coe. Thank you very much, Dr. To clarify, are you implying that blood chloride levels somewhat below the normal range e. Kind regards, Al. I am a 39 yo male who produced CaOx stones. I believe my stones are under control no new stones for at least a couple years.

I have been on a thiazide for about 4 years. I have only learned how to follow a proper diet over the last 2 years, following your site and Jill Harris. I would like to potentially get off of my thiazide and just stick to my new diet, if I can do so safely.

So, I was hoping to taper off the thiazide and see how much my SS CaOx increases. Even on lower dose thiazide, low sodium, and low sugar diet my Ca 24 is in the range, but SS CaOx is below 4. How do I know I have enough margin of safety to safely come off the thiazide?

Is there a magic SS CaOx number to stay below, or is it just much more complicated? My hypothesis is that my thiazide is not really helping my SS CaOx levels as much, now that I have cleaned up the rest of my dietary habits.

All of the stone vs. risk data are using multivariable analysis to isolate individual effects, so strictly speaking urine calcium, oxalate, citrate, and volume and SS can be considered independent. But in terms of crystallization SS is the one single measure of free energy available for solid phase transformation and I favor it.

Apart from one trial by Borghi we have no diet trials sans thiazide, although that one was positive. So I have to say stopping the drug is neither unreasonable nor fully supported by trial data — it is a matter of weighing one thing against another and you are judge and jury.

If you asked me technically I would have to say success is better left alone, but that is mere chatter from the sidelines.

Your physicians have a stake in the game, and I would be sure to seek their opinions. Dr Coe, 1 In this article it states Thiazides lower urine PH. You say a rise in urine PH?? If a person keeps their diet sodium between with no problem doing so is that an issue if they are ever put on Thiazide?

Hi Lisa, Potassium depletion from thiazide can raise urine pH, but the drug absent potassium depletion lowers urine pH. So when we want to lower urine pH thiazide is a reasonable possibility and KCl the potassium replacement of choice, not potassium citrate.

Thiazide will lower body sodium stores unless diet sodium rises — any age. Blood calcium can rise from thiazide, not clinically important so far as I know.

Thiazide is reasonable for CaP stones, especially with low diet sodium, and potassium chloride, not citrate, as replacement. Hi there, Just started following your articles and am finally feeling like I have some solid information. Recently saw an endocrinologist for the first time as I have been diagnosed with fairly severe osteoporosis.

All of my blood work and 24 hour urine were normal except the calcium in my urine at My vitamin D was slightly low at I also have several kidney stones in my left kidney.

My question is: would it be safe and effective to take actonel along with the Thiazide and potassium citrate? Thank you! Hi Marjorie, Genetic hypercalciuria causes stones and can cause loss of bone mineral, too.

Actonel, a bisphonate goes well with a low sodium high calcium diet, which is good for bones. Thiazide, if diet is not adequate, helps preserve bone mineral. Potassium citrate, if otherwise desirable, is an alkali load and those help bone mineral maintainance.

So, to your question: Yes. I have learned the most about my idiopathic hypercalciuria by browsing this website. It has been a great resource! Thank you to you and your colleagues for putting it together.

I am curious what treatment, if any, is advisable for someone who has both idiopathic hypercalciuria and low blood pressure? My parents also have low blood pressure. It has never posed a challenge until now.

I have been unable to take either chlorthalidone or hydrochlorothiazide because of its impact on my blood pressure. I even tried 6. I consumed 1, mg of diet calcium and limited my diet sodium to 1, mg. I did this for a couple weeks. But I experienced the same symptoms of when I was on the low dose chlorthalidone or hydrochlorothiazide.

So I ended up increasing my diet sodium to 2, mg and diet calcium to 1, mg. I was just retested last week. The low s seems to be my baseline. Until today, I did not know Indapamide was an option so I may try that but I am not confident I will be able to tolerate it.

The only other treatment I can think of is keeping my diet calcium at 1, mg — 1, mg, limiting my diet sodium to 1, — 1, mg, and taking a medication to raise my blood pressure. The stakes are quite high because even though I am only in my 30s, my bone loss is severe.

Depending on the area scanned by the DEXA, my z-scores from last summer were from Hi Matt, Is your serum PTH, by chance, below normal? Is your serum calcium borderline high? Is your serum 1,25D high?

Obviously you have a genetic variant of IH, with early bone disease, and perhaps bone directed medication — even a simple bisphosphonate — might lower urine calcium remarkably and possibly stabilize your bones.

I think you warrant deeper study than is usual, and perhaps more unusual treatment. Thanks for the reply. I went back through my medical records from May This is when I was diagnosed with IH before beginning any treatment.

Below are the results. Aside from the vitamin D, everything else was within normal. I have had normal but borderline high calcium serum results a couple of times, but its been years. I have also had these tests repeated at least once a year and everything has come back normal I started taking vitamin D3.

The only reason I was diagnosed with IH is because while at the podiatrist, I had x-rays on my feet. He came back and told me the bones were extremely thin and that I should have a DEXA right away.

I also found the results from my first 24 calcium urine: At the time, I suspect I was consuming no more than mg of calcium per day either through diet or supplements. Thanks to following the principals laid out on this website, I am now consuming 1, mg calcium per day and yet my urine calcium is usually mg lower.

I of course do not have to tell you, but I think its all because I am very careful with my sodium consumption. As mentioned in my original post, my most recent 24 urine calcium was What I did not mention is my 24 hour sodium was But I think my situation is unusual.

I am also going to be seeing nephrologist at Indiana University Health for input soon. Hopefully, I will be able to develop an effective treatment plan. Thanks for the suggestion of the bisphosphonate.

I will pass that along to the endocrinologist who is currently treating me. Hi Matt, At IUPUI Dr James Lingeman is a famous stone surgeon — but you do not speak of stones.

As for virtual appointment, I do them and the number will get you to my secretary. Dear Dr. Coe My son has osteoporosis due to Idiopathic Hypercalciuria. He is taking mg calcium per day, HCTZ 25 mg, Vitamin D and no bisphosphonate.

Bones have been improved a little within last 15 months but still his 24 hours calcium is high mg. Shall he change HCTZ to Chlorthalidone? Thanks in advance. Hi Dr Sharifi, His urine calcium is indeed high — is his urine sodium perhaps very high?

How old is he? If very young I would be concerned about a genetic cause. Regards, Fred. I have tried different thiazides and indapamide seems to lower my calcium the best per urine testing.

However, lately I have been having some side effects of muscle spasms, weakness, and numbness tingling — mostly in my hands but other places as well. My metabolic panel came back with all normal results, though.

So, I was hoping you could clarify if the side effects can still happen with normal blood work? I will most likely go off the thiazide temporarily, or try going back on HCTZ. Thanks for all you do! Hi Tad, This drug is not known to cause neurological disease but can cause spasms and numbness as you describe at higher doses.

The lowest dose below 2 mg is not known to cause these and perhaps will be enough. Thank you Dr. Would these symptoms still potentially exist with a normal blood workup, though? Or would they only exist if my electrolyte balance was off?

Hi Tad, Indapamide is said to cause some of these symptoms and there is no mention of a linkage to blood chemistry measurements. I presume you might want to use the drug at the lowest dosage. Hi there, My son has Dent disease and is currently being treated with ramipril 2.

His last three ultrasounds May, June and August this year all detected renal calculi but it is unknown whether they are calcium oxalate or calcium phosphate stones. The largest ones measure approximately 0. I was hoping you could weigh in on his treatment plan. Any thoughts would be appreciated! Hi Drina, Dent disease is really complex, so I presume his treatment is at a major academic center.

Here is a link to a government site. It was updates in I should not comment on treatment complexities in this kind of complex condition but do note that thiazide can lower urine pH If desired I could try to help via telehealth Banita Williams, but Mayo Clinic has a rare disease program and should be an ideal source.

Dr Coe, I am 72 and have a long history of Calcium Ox stones. Ureteroscopy in and In I was informed that ultrasound was incorrect and instead of multiple stones that randalls placque was present and fewer stones were found. Based on your website I got my first thyroid test in and it resulted in parathyroid surgery.

I hoped this would finally stop stone growth as my calcium levels improved from Last October they showed 7 and 5mm. My only diet change was psylium wafers-2 daily and 12 oz of oat milk.

Also, I use polyglycol powder several times thruout the month-GI issues I follow a low sodium and oxalate diet and have for some years now with discipline.

My family Doc says psyllium and glycol piowder is equivalent to eating spinach and likely responsible for this doubling stone growth. I am unable to find any data to substantiate this and am a bit incredulous. I would like to be a patient and have your input on what may be happening.

My GI history and Fathers medical past may be helpful. How do I proceed. I live in Pa and hope that you see patients virtually ongoing. Also, very willing to meet initially if required.

Thanks, John. Hi John, You have indeed a complex history. I do telehealth — Sect. Banita Williams ; bwilliams15 bsd. She can arrange a visit. Please bring together all of your prior documents, including stone analyses, 24 hour urine testing and the operative report for your parathyroid surgery.

I am on cholorthaidone 25mg, IU Vitamin D daily and 3 KCL tabs per day. Is it worth trying Indapaminde? My PTH is normal, Vitamin D level is all other indices are good on my litholink testing.

why is my urine calcium so stubborn? o and have been having calcium stone problems for the last 2 years. The first culprit was my vitamin D was deficient, which had my PHT and my blood calcium off.

I went to an endocrinologist and was given a vitamin prescription for a while and have been taking 4, IU per day since. No stones for about 15 months. Then I started getting stones.

I did a Litholink, PTH, blood calcium and vitamin D test. All tests other than the Litholink tests were normal. The Litholink test showed my calcium was …yes My citrate was , oxalates I had been taking Potassium Citrate twice a day. My new urologist I moved prescribed 25mg of Chlorthalidone and quit the potassium citrate.

He says this will fix my issue. Is there something else I should be doing? Thank You! Hi Joe, I presume your blood calcium was normal — below 10 — on multiple occasions. Likewise that your serum PTH is not pathologically low — below 15 or so.

You are right, that urine calcium is very high. Are you very large, perhaps. Are you an early diabetic? Is your serum vitamin D level above 50? Your urine citrate is very high, which gives one ideas that more is wrong than the calcium.

Repeat the test to be sure it is not misleading. Dr Coe, In your response here to Joe you asked if his serum vitamin D level was about 50, does that cause high urine calcium if vitamin D is above a certain level in the blood? Hi GF, Actually no, unless the levels are clearly above normal to s significant extent.

Thank You Dr Coe! My blood calcium level was 9. The PHT was 57 in November. My vitamin D was 75 in October and I continue to take vitamin D every day.

My blood sugar is usually at the top of normal or a little high. There is a history of obesity and diabetes in my family so I try to keep my weight in check. I exercise vigorously about 3. Happy Holidays!

My sodium intake is around mg daily. I drink approximately 4 liters of water daily and get mg of calcium. I was put on Chlorthalidone 25mg and KCL 40meq daily about 2 years ago.

Ever since then, my urine calcium has continued to increase from to current level of My PTH is normal. I have not made any new stones, but my bone disease continues to get worse. Why would the Chlorthalidone increase my urine calcium instead of decreasing it?

Thanks, JoAnn. Hi JoAnn, Thiazide does not increase urine calcium, so there must be more to the story. Possibly your bone disease has been accelerating and causes the high urine calcium, and if so that is a separate problem.

If it is the cause you would want to be taking a bone directed drug — bisphosphonate is a common choice. WIthout more detail I am afraid I cannot add much more. Hi Dr Coe, Could you guve me your thoughts on taking Hydroxy Citrate for calcium oxalate stones.

Hello Dr. Coe, What are your thoughts on using a thiazide diuretic in pts with unknown stone type who refuse 24 hour urine collections. Coe: I would like your opinion on the recent clinical trial published March 2nd in the new England Journal of Medicine that reported no benefit on kidney stone prevention from HCTZ in doses ranging from How do you explain these results that contradict previous studies?

Hi Dr Feldman, Of no significance. There is already too much thiazide trial data for this one to change practice. This one used a short acting drug none of us in the business rely on, and I suspect it was their main problem.

As well stone counting was complex. I plan a serious review of the trial perhaps as my next article. So take this as my best right now. Coe, Do you have any thoughts on vitamin k2 for its reputed effects on bone health and its possible relevance to the calcium metabolism of stone formers?

Thank you so much. As rule the paradigm was that vitamin K dependent proteins containing gamma carboxy glutamic acid GLA inhibit crystallization so low vitamin K increases and high vitamin K decreases stones.

The best clinical test of this idea was essentially negative but now enough to falsify the entire idea. No data support supplemental vitamin K as a prevention a trial, for example.

Good question, good idea, unproved. For someone that has low to normal blood pressure but needs to lower calcium in urine, like myself, would hydrochlorothiazide be a better choice.

It may be enough. As for the short acting OHCTZ it is not my favorite choice. One can use very low doses of chlorthalidone — for example I offer my experience as merely one case history regarding the use of HCTZ to stem kidney stones.

Thirty yrs ago, followiung my third painful bout with stones, my PCP suggested there had been studies showing HCTZ at Hi Joel, it is not that OHCTZ does not help prevent stones, it is that is is relatively weak in that regard as noted in the trial.

I am happy for your excellent outcome. Best, Fred. Coe, Are you familiar with K-Phos a. potassium acid phosphate as a way to lower urine PH? Would K-Phos offer any advantages or disadvantages compared to potassium chloride? Hi Dick, Very complex issue.

KCl is used when potassium depletion has led to increased urine ammonia excretion and increased urine pH. It is the specific treatment and KPHOS would be wrong.

Now in some patients urine pH is higher than one would like for reasons not at present known. The value of KPHOS is not known. On the one hand urine pH might fall due to the acid load, But urine calcium might rise for the same reason. So no one knows if it is a good idea.

Have been following your research for 5 yrs! Thank you for all you do. PTH, serum calcium normal. Last year, doctor prescribed 1. However, without potassium citrate supplement, serum K fell too low at 2. However, 9 months into it, I started producing calcium phosphate stones passed and the doctor decided to stop thiazide and potassium citrate due to high urine PH 8 and he does not know what the next option is.

Would you be able to give us some clues on what to try? Would a Bisphosphonate be a good option for idiopathic hypercalciuria? Looking forward to your thoughts! Hi Connie, Indeed your urine calcium seemed to fall nicely with indapamide and only the potassium is holding things back.

Possibly the high alkali load and high pH led to phosphate in your recent stones. I would replete potassium using potassium chloride, not citrate, and adding back the indapamide with KCl. The lower you keep your diet sodium, the lower the dose of indapamide needed and the less potassium loss.

A sodium of is not low, it is just a bit above the US upper limit of recommended Of course I am writing to your physicians who may choose to ignore me as being utterly uninformed about your overall health issues and therefore at best a chatbox, at worst a trouble maker.

Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. The University of Chicago. Thiazide Type Diuretics Reduce Stone Formation The common thiazide type drugs in use today are hydrochlorothiazide, chlorthalidone, and indapamide.

Thiazide is Not Used Alone Because they can reduce formation of new calcium stones, thiazide type diuretics are co-equal with potassium citrate as a medication physicians can use for stone prevention.

Why Use Diuretics? It is Not to Raise Urine Volume Because of the name one might think the drugs work by increasing urine volume, and therefore prevent stones the way water or other fluids might. They Lower Urine Calcium and Urine pH How they do this is a matter for some detailed commentary, but let us begin by saying they do indeed.

They Must Lower Calcium Salt Supersaturations on Average This is an old theme on the site. How do Thiazides Affect the Kidneys? Calcium and Sodium With a brief blush and downward gaze, I choose our own publication as perhaps not unreasonable as a source. Acidity of the Urine Chlorthalidone, and presumably other thiazide type drugs make urine more acidic.

Urine Oxalate In our paper reviewed above we found no changes in urine oxalate with chlorthalidone, and did not therefore include oxalate data in the tables. How Do Thiazides Lower Urine Calcium? But almost is not quite unchanged. If I were young I would test this idea in humans.

Effect of Thiazide on Bone Mineral Balance All this raises an obvious question: Do thiazides improve bone health, reduce fractures, increase bone mineral content? The overall impression is that one would not win by betting against thiazide as helpful to bone. How About Salt? Is One Drug Better Than Another?

Dosage I like to start with lower doses than used in the trials. What Have We Learned? Traci on April 17, at pm. Traci Reply. Fredric L Coe on April 18, at am.

Regards, Fred Coe Reply. Traci on April 24, at pm. Fredric L Coe, MD on April 26, at pm. Traci on April 25, at pm.

Traci on April 28, at pm. Fredric L Coe, MD on May 3, at am. Alissa on May 7, at pm. Fredric L Coe, MD on May 14, at pm. Hi Alissa, Yes it is. Fred Reply. Mohamed Roshdy on May 19, at am. I am a fresh gradate medical student from Egypt , your articles are really helpful ,every patient i meet i search for opinion and your studies about am just want to inform you that million around the world get better rbeacause of you ore great prof Reply.

Fredric L Coe, MD on May 25, at am. Dear Dr Roshdy, You are very kind to say this. Warm regards, Fred Reply. Kevin T Besaw on June 21, at am. thank you……….. Please I am sick of these things, any help would be appriciated Reply.

Fredric L Coe, MD on June 30, at pm. Fred Coe Reply. Traci on July 4, at pm. Traci2 on July 4, at pm. Fredric L Coe, MD on July 6, at pm. Nick on July 15, at pm. Fredric L Coe, MD on July 23, at am. Nick on July 27, at pm. Nick on September 1, at pm. Fredric L Coe, MD on September 4, at pm.

Reply Fredric L Coe, MD July 23, Edit Hi Nick, I am afraid your nephrologist might have missed the emphasis from the stone analysis. Nick on October 13, at pm. Any chance you can comment or confirm if what this specialist is saying is true?

Fredric L Coe, MD on October 19, at pm. Nick on November 17, at pm. Fredric L Coe, MD on November 23, at pm. Julia Lockwood on August 22, at am. Thanks for any advise Regards Julia Reply. Fredric L Coe, MD on August 30, at pm. Darice on September 11, at am.

Fredric L Coe, MD on September 18, at am. Al on September 13, at pm. Many thanks, Al Reply. Fredric L Coe, MD on September 18, at pm. Best, Fred Coe Reply.

Al on September 21, at am. Kind regards, Al Reply. Fredric L Coe, MD on September 21, at pm. Yes, Fred Reply. Tad Sligar on November 3, at pm. Coe, I am a 39 yo male who produced CaOx stones. Fredric L Coe, MD on November 14, at pm. lisa on December 6, at am. Fredric L Coe, MD on December 6, at pm.

marjorie s bose on February 28, at pm. Fredric L Coe, MD on March 1, at pm. Matt on June 2, at pm. Coe, I have learned the most about my idiopathic hypercalciuria by browsing this website.

Best, Matt Reply. Fredric L Coe, MD on June 4, at pm. Matt on June 6, at pm. Coe, Thanks for the reply. vit D Fredric L Coe, MD on June 20, at pm.

Alireza Sharifi on August 1, at am. Thanks in advance Reply. Fredric L Coe, MD on August 9, at pm. Regards, Fred Reply. Tad on August 26, at am. Fredric L Coe, MD on August 26, at am.

Tad on August 28, at am. Fredric L Coe, MD on September 11, at pm. Drina on September 19, at pm. Fredric L Coe, MD on October 3, at am. john carlucci on September 23, at am.

Thanks, John Reply. Barb on November 30, at am. Fredric L Coe, MD on December 4, at pm. Hi Barb, I believe I answered this on your first comment.

Joe on December 15, at pm.

My urologist effecy me on a efgect, HCTZ, Duretic flushed Breakfast skipping and hormonal balance kidneys. Since I started taking it, I have not had a single kidney stone. A: Replenish eco-conscious choices you for sharing your experience. Urologist Hot flashes relief Coe agrees that thiazide diuretics such as hydrochlorothiazide HCTZchlorthalidone or indapamide can reduce the chance of kidney stones. Researchers have found that low-dose thiazides work as well as high doses to prevent development of kidney stones Canadian Journal of Health and Disease, July 15, Coe recommends some diet and lifestyle changes as well. Drinking plenty of fluids and avoiding foods rich in oxalate can help.