A common health myth has been busted by a leading kidney specialist. The widespread belief that kidney stones are primarily caused by not drinking enough water is an incomplete picture, according to recent medical insights. Nephrologist Dr Arjun Sabharwal, MBBS, has clarified through a detailed social media post that while dehydration is a risk factor, recurrent stone formation is usually driven by a complex interplay of other, often overlooked, reasons.
Metabolic and Dietary Culprits Behind Stone Formation
Dr Sabharwal, referencing major studies published in journals like The New England Journal of Medicine and Nature Reviews Nephrology, outlined a comprehensive list of root causes. He emphasised that simply increasing water intake is insufficient for patients who experience stones repeatedly. A proper medical evaluation is crucial.
High urine calcium, or hypercalciuria, is a leading factor, present in 30-60% of stone patients. This condition occurs when the kidneys excrete too much calcium or the body absorbs an excessive amount from food, leading to crystal formation. Another major contributor is oxalate overload, which can come from consuming foods like spinach, nuts, and chocolate, or from high-dose vitamin C supplements. This oxalate binds with calcium to form the most common type of stone.
Interestingly, low dietary calcium can also increase risk, as it fails to bind oxalate in the gut, allowing more to be absorbed into the body. High salt and animal protein intake, along with low levels of a natural stone inhibitor called citrate in urine, further tip the balance towards stone formation. Conditions like obesity, diabetes, and gout significantly elevate the odds, as do recurrent urinary tract infections.
The Critical Role of Genetics and Medications
The predisposition to kidney stones isn't solely about lifestyle choices. Family history and genetics play a substantial role, increasing an individual's risk by about 2.5 times. Specific genetic conditions, such as those causing primary hyperoxaluria, though rare, can lead to severe stone disease.
Furthermore, Dr Sabharwal pointed out that certain long-term medications are unsuspecting contributors. Drugs including diuretics (water pills), some migraine medications, and even calcium-based antacids can promote an environment conducive to kidney stones. This highlights why a thorough medical history is a vital part of the diagnostic process.
Diagnosis and Moving Beyond the "Water Cure"
The sharp pain, blood in urine, and nausea caused by kidney stones are well-known. While low water intake concentrates urine and raises the risk, Dr Sabharwal stresses that recurrent stones "always need full metabolic evaluation." The cornerstone of this investigation is a 24-hour urine test, which analyses the urine's chemical composition to pinpoint the exact imbalances causing stone formation.
Once the specific cause is identified—be it high uric acid, low citrate, or a genetic leak of calcium—targeted treatment can begin. This may involve dietary modifications, specific medications like thiazides to reduce calcium leakage, or strategies to alter urine pH. Treating these root causes is proven to be far more effective in preventing future episodes than relying on increased hydration alone.
The key takeaway from the expert is clear: if kidney stones keep coming back, do not just drink more water. Consult a nephrologist, undergo a complete metabolic workup, and discover your unique stone type to treat the problem at its source.
