Kidney Stones and Diabetes

“People with diabetes are 60% more likely to produce kidney stones compared to the general population.” The reason for this is that because of an increase in obesity rates, diabetes rates, eating a high salt/sugar diet, plus a better awareness and detection of kidney stones.

The medical name for kidney stone formation is nephrolithiasis. In the past it was considered a “episodic illness, a one and done problem. Now it is thought of as a chronic medical condition.” The relapse rate of forming additional kidney stones is extremely high.

Why do people with diabetes have a higher risk of developing kidney stones?

The main reasons for the stone formation with diabetes is because people with diabetes have a “lower urine PH or more acidic urine.” With diabetes, you generally have insulin resistance, meaning your insulin does not perform properly. Insulin resistance causes your urine to become more acidic.

People with diabetes have more calcium in their urine, creating a higher production of calcium-based kidney stones. High blood sugars cause you to quickly become dehydrated and make your urine more acidic, which raises kidney stone risk.

Chronic high blood sugars also damage delicate blood vessels creating an inflammatory state, with more defects in kidney function and a higher risk of kidney stone formation.

Can forming kidney stones have an impact on your diabetes control?

The answer is yes. Kidney stones can lead to more dehydration and raise blood sugar, causing your diabetes to be out of control. Urinary tract infections (UTIs) develop more frequently with kidney stones, and the UTI can also raise blood sugar.

Acute kidney stones can cause pain and prevent you from exercising or walking, also raising your blood sugars. Pain may be associated with grabbing easy quick processed foods raising your blood sugars.

What is urine PH?

Urine PH measures the level of acid in your urine. Certain kidney stones form in acidic conditions and others form in alkaline conditions. Uric acid stones form in acidic urine and calcium phosphate/oxalate stones form in alkaline urine.

People with diabetes form both stone types. Calcium stones are most common at 80%. Your blood PH is very different and generally maintains balance.

Explain the different levels?

Normal urine PH levels fluctuate between 4.6-8.0 with neutral being 7.0. The PH of plain water is 7.0. Average urine PH levels are about 6.0. Acidic urine is “5.0 or below.” Alkaline urine is a level of “8.0 or above.”

How is urine PH tested?

After providing a urine sample, a health care provider uses a dipstick with a special color-sensitive pad. Depending on the color the pad turns, the result tells the health care provider if your urine is neutral, acidic or alkaline. Your physician may tell you to stop certain medications prior to performing this test which may give you a false reading.

What may influence the results of the PH urine test?

Hydration levels. Dehydration or not drinking enough fluids can make your urine more concentrated and acidic with a lower PH.
Medications. Certain medications and medical conditions may influence your urine PH.
Diet. Eating lots of protein like fish, poultry, meat, organ meats, cheese, sugary foods and wheat products can lower the PH, making it more acidic.
Eating many fresh fruits such as vegetables, nuts, seeds and drink herbal teas to increase the PH making it more alkaline.
Milk, dairy products and fats are considered “neutral” for urine PH, but those eating an alkaline diet also “avoid dairy products.”

What exactly are kidney stones?

Kidney stones are also called “renal calculi or nephrolithiasis.” Kidney stones can form from months to years. Kidney stones are made from deposits such as minerals, acids and salts, that form in the kidney and can cause extreme pain when they block the flow of urine from the kidneys to the ureter.

They are made from “excessive calcium oxalate, struvite, brushite, uric acid or cysteine.” The most common ones are calcium stones followed by uric acid stones. Sometimes they are just crystals and can easily pass in the urine but many times they are hard stone-like formations, that are too large to pass.

They can be as “small as a grain of sand up to the size of a golf ball.” Kidney stones may be asymptomatic or cause severe pain. About 80% of kidney stones pass on their own. Once it reaches the bladder, it usually passes in a few days. “It may take up to three weeks to pass a stone on your own.” Most people create natural chemicals in the urine that keep stones from forming.

How common are kidney stones?

One in ten people will develop a kidney stone during their lifetime.

Besides diabetes, what also raises the risk of developing kidney stones?

Being overweight or obese.
Having polycystic kidney disease.
Having isolated kidney cysts.
Having a family history of kidney stones. There are genetic tendencies within families who develop kidney stones. There is a genetic kidney stone panel which assesses “72 genes associated with inherited conditions that lead to stone formation.” Using the panel can lead to more effective ways to diagnose and personalize prevention.
Taking vitamin C supplements.
Western lifestyle and diet.
Living in warm climates.
Being a male.
Being in your 30s-40s.
Having osteoporosis.
Having previous stomach surgery, especially gastric bypass surgery.
A history of smoking cigarettes.
Having metabolic syndrome.
Having hypertension.
Eating a diet high in sodium.
Eating a diet high in animal protein.
Eating a diet high in sugar.
Certain medications including diuretics to treat high blood pressure and metformin to treat diabetes.
Having gout.
Excessive perspiration. Examples would be hot saunas, hot yoga classes and heavy sweating due to exercise.
Having severe diarrhea or vomiting.
Having recurrent urinary tract infections.
Being Caucasian.
Having a certain gut microbiome.
Having Crohn’s disease or Irritable Bowel Syndrome.

Which medication may raise the risk of developing kidney stones?

Anticonvulsants for migraines or seizures.
Certain antibiotics.
HIV/AIDS medications.
PPIs – Proton pump inhibitors for gastric reflux.
Laxatives for constipation.
Certain chemotherapy drugs.

What other medical conditions can kidney stones cause?

Urinary tract infections. Chances of a UTI increase. A kidney stone blocks urine flow trapping bacteria. The bacteria may create a UTI, often raising blood sugars.
Osteoporosis or osteopenia. Calcium imbalances may strip bones and create thinning of the bones as well as lead to fractures.
Cardiovascular disease. Since having kidney stones shares many risk factors with cardiac disease such as hypertension, high cholesterol, CKD (chronic kidney disease), and metabolic syndrome, these conditions may be inter-related.

What are the usual symptoms of kidney stones?

Kidney stones may display no symptoms at all and are sometimes only located during a radiological test. This is called “an incidental finding.” Other times, you may experience severe side or flank pain accompanied by blood in your urine.

You may also have a burning sensation when you try to urinate, have a fever, have chills, be nauseated, have severe back pain, lower abdominal pain or groin pain. You may suffer from profuse vomiting. Your urine may have a foul odor, bloody tinge or appear cloudy instead of clear.

What type of physician should you consult when you have kidney stones?

A urologist specializes in the function of the urinary tract, including kidney stones. There is a recent trend that having a “medical team including a nephrologist who specializes in kidney disease, your PCP /internist, a dietitian, an endocrinologist who specializes in hormones and diabetes and an interventional radiologist be included in the care.”

What other tests are usually done to screen for kidney stones?

A physical examination and verbal history.
A complete metabolic profile (CMP) This requires specific bloodwork giving you a snapshot of your “chemical balance and metabolism.” Included are liver and kidney function, blood glucose level, electrolyte levels, sodium, potassium, chloride, bicarb and calcium level.
Serum uric acid level.
Urinalysis with microscopy. Urine culture.
24-hour urine collection.
X-rays.
CT scan without contrast.
Possible ultrasound.

What are the most common treatments for kidney stones?

It depends on the size of the stone, the minerals, acids and salts in the stone and whether you can pass it on your own.

Usually, small stones that are not causing pain are treated by:

Drinking 2-3 quarts of water a day will help it pass more quickly through the bladder. Being fully hydrated is the most important factor.
Flomax. Flomax is an alpha blocker medication (in pill form) which relaxes the ureter sphincter and allows a small kidney stone to pass into the urine.
Pain relief. For those who have moderate pain but still a small kidney stone to pass (6mm or less), taking ibuprofen Advil, Motrin, or Aleve can be helpful. Check with your health care provider to see which OTC pain reliever will work for you. Ibuprofen is filtered through your kidneys and should not be taken during an acute kidney stone episode.
Larger stones. Extracorporeal Shock Wave Lithotripsy (ESWL). This uses sound waves to create strong vibrations. Shock waves break up stones into tiny pieces. It usually takes 45-60 minutes to perform, may cause moderate pain and blood in your urine. After the procedure, the broken-up stone generally passes.
Ureteroscopy. A thin laser scope with a camera is placed into the urethra and is used to find the stone, snare it, and break it into smaller pieces, before removing the kidney stone.
Percutaneous nephrolithotomy. A small tube is inserted directly into your kidney in your back by an incision. An ultrasound probe is used to break up the kidney stone and then it is removed.

What can you do for possible prevention of future kidney stones?

Drink lots of water. Stay hydrated with sugar-free liquids.
Talk to your health care provider about a “personalized program” just for you, since not all people produce the same kind of kidney stones and the reasons they form may be different.
Limit organ meats and shellfish which increases your uric acid levels. This is related to gout. Many stones can form from high uric acid.
Limit added sugar. You should be doing this from a diabetes standpoint, but also to reduce kidney stones. Eating added sugar is associated with more calcium kidney stones.
Limit animal protein. Try not to eat excess beef, pork, lamb, chicken or fish. “Animal protein can increase urine calcium and oxalate. It also can lower urine PH and raise acidity creating more uric acid stones.” Eat beans, lentils, seeds and nuts, and plant proteins when possible.
Add dairy sources of protein. Examples would be low-fat milk, Kefir, yogurt and cheese. Eating at least 1200mg of calcium a day is important. By eating enough calcium, you “can inhibit oxalate absorbed from food.” By eating too little calcium, you may increase the chance of kidney stones.
Do not overeat foods high in oxalates. This does not mean you need to eliminate them. Originally it was recommended that “oxalate containing foods be removed from your diet” but this is no longer a current recommendation. These foods tend to be healthy and are especially important to consume when you have diabetes. High oxalate foods include spinach, rhubarb, soymilk, cornmeal, grits, buckwheat, dried figs, prunes, kiwi, dates, beet greens, Swiss chard, mustard greens, Tahini, sesame seeds, almonds, cocoa, sweet potatoes, wheat germ, peanut butter and other nut butters. When eating high oxalate vegetables, first boil them in water prior to eating as this will drain off some of the oxalate.
Avoid cola drinks even if they are sugar-free. They are high in phosphates which can increase the risk of kidney stones.
Make sure to pair calcium foods with oxalate foods which will bind together, help oxalate from reaching the kidneys and prevent forming kidney stones.
Limit sodium intake. High sodium in your diet causes more calcium to excrete through your kidneys.
The Mediterranean diet and the DASH diet. Just as there is “no one specific diabetes diet” there is not one specific kidney stone diet to prevent stone formation. The Mediterranean diet and the DASH diet, as often recommended with diabetes, are often recommended to lower your risk of creating kidney stones.
Always check with your physician prior to taking any added vitamins, especially vitamin D and vitamin C.
Calcium supplements. Dietary calcium from foods is protective, but calcium supplements may heighten your risk of making kidney stones. Always talk to your health care provider before taking any calcium supplements. If you do decide to take them, consider taking calcium citrate over calcium carbonate.
Exercise. Exercise with weights and doing aerobics help to maintain your ideal weight and blood sugars.
Electrolyte drinks. Watch out for electrolyte drinks which “promise to hydrate you” but may contain too much sodium or sugar.
Collagen supplements. Many people now take collagen supplements to benefit their bones, joints and skin. Check with your physician since the “body may process the amino acids in collagen and create kidney stones.”

Kidney stones are common but even more so when you already have diabetes. Be aware of the symptoms, risks and treatments to help you stay healthy and kidney stone free!

References-

https://www.webmd.com/diet/alkaline-diets
https://pmc.ncbi.nlm.nih.gov/articles/PMC9573143/
https://www.kidney.org/kidney-topics/kidney-stone-diet-plan-and-prevention
https://medlineplus.gov/lab-tests/comprehensive-metabolic-panel-cmp/
https://news.mayocliniclabs.com/renal/urinary-stone-services/hereditary-causes-of-kidney-stones/
https://www.mayoclinic.org/diseases-conditions/kidney-stones/diagnosis-treatment/drc-20355759
https://www.urologynashville.com/blog/exploring-the-link-between-diabetes-and-kidney-stones/
https://www.healio.com/news/endocrinology/20240619/qa-what-people-with-diabetes-should-know-about-preventing-kidney-stones
https://my.clevlandclinic.org/health/diseases/15604-kidney-stones
https://physiciansallianceofconnecticut.com/blog/foods-to-avoid-with-kidney-disease-and-diabetes/