Kidney health alert: Low water intake is not the only reason behind kidney stones, warns nephrologist, reveals hidden causes – The Times of India

When it comes to kidney stones, the most common perception is that they are caused by insufficient water consumption, however, that is not always the case. Dr Arjun Sabharwal, MBBS and nephrologist, recently posted an IG video in which he highlighted that kidney stones are not just caused by low water intake, but a host of other reasons. He said,“Kidney stones are not caused by low water intake alone. They form due to a combination of metabolic, dietary, genetic, and medical factors-this has been clearly shown in multiple large studies published in The New England Journal of Medicine (NEJM), American Journal of Kidney Diseases (AJKD), and Nature Reviews Nephrology.

The most common causes include:• High urine calcium (hypercalciuria)• High oxalate (from diet or gut absorption)• Low urine citrate (a natural stone protector)• High uric acid (often linked to red meat & gout)• High salt and animal protein intake• Low dietary calcium• Oxalate-rich foods (spinach, nuts, chocolate)• Excess vitamin C supplements• Obesity, diabetes, gout, thyroid and bowel disorders• Recurrent urine infections• Family history & genetic risk• And even some long-term medicines (diuretics, migraine drugs, calcium antacids)Low water intake does increase stone risk by concentrating urine-but studies clearly confirm that recurrent stones always need full metabolic evaluation, including a 24-hour urine test to identify the true cause.If stones keep coming back, don’t just increase water-find your stone type and treat the root cause.”Let us now examine that in detail…Problems that arise because of kidney stonesKidney stones cause sharp pain in the back or side, blood in urine, and nausea when they block urine flow. Many people blame low water intake, but stones form from a mix of metabolic, dietary, genetic, and medical factors. Low water does concentrate urine and raise risk, but recurrent stones need a full check with 24-hour urine tests to find the real causes. Treating the root fixes the problem better than water alone. Let’s examine reasons highlighted by Dr Sabharwal...

High urine calciumHigh urine calcium, or hypercalciuria, affects 30-60% of stone formers. It happens when kidneys leak calcium, or the body absorbs too much from food. This leads to calcium oxalate or phosphate crystals, that grow into stones. Studies show these imbalances cause supersaturation in urine, even with good hydration. A 24-hour urine test spots it, and drugs like thiazides lower calcium output.Oxalate overload from diet and gutHigh oxalate in urine comes from foods like spinach, nuts, chocolate, or excess vitamin C supplements. It binds calcium to form sharp oxalate stones, the most common type. Gut issues like low Oxalobacter formigenes bacteria, and boost absorption by 10-50%. Even though primary hyperoxaluria is genetic and rare, but severe. Even normal eaters get hit if urine volume drops, or calcium is low. To tackle this, limit high-oxalate foods, and pair with calcium-rich meals to bind it in the gut.

Low citrate lets stones form easilyCitrate acts as a natural blocker, by binding calcium and raising urine pH to dissolve crystals. Low urine citrate, or hypocitraturia, hits 20-60% of patients. Causes include chronic diarrhea, high animal protein, potassium lack, or infections. Without it, calcium stones grow fast. Acidic urine from exercise or drugs worsens this. Large studies link low citrate to recurrence even in hydrated people.Uric acid and excess proteinHigh uric acid forms acidic stones in 5-10% of cases, often from red meat, seafood, or gout. It lowers urine pH and seeds calcium oxalate stones too. Metabolic syndrome boosts this, via insulin resistance. High animal protein adds acid load, dropping citrate. Obesity and diabetes double odds. NEJM reviews show purine-rich diets raise risk 2-3 times. To counter this, reduce meat consumption, and add veggies for balance.Salt, low calcium, and hidden diet trapsHigh salt intake pulls calcium into urine; over 6g daily doubles stone risk. Low dietary calcium fails to bind oxalate in the gut, raising absorption. To prevent this, get 1,000-1,200mg from dairy or greens, and not supplements, since excess vitamin C turns to oxalate. Studies confirm these dietary shifts cause stones beyond dehydration. Track sodium under 2,300mg, and eat calcium with meals.Medical conditions and genetics play big rolesObesity, diabetes, gout, thyroid issues, IBD, and UTIs change urine chemistry, while family history raises odds 2.5 times, via genes like those for hypercalciuria. Drugs like diuretics, topiramate, or calcium antacids too, can lead to kidney stones. Disclaimer: This article is informational only and not a substitute for medical advice