Dual-Specialty Approach at UF Health Reduces Risk of Kidney Stone Recurrence
About one in 10 people get a kidney stone in their lifetime, and unless aggressive preventive measures are sought, it’s likely that more than half will have a recurrence within five years. The UF Health Urology kidney stone clinic draws on the expertise of urologists and nephrologists to help patients reduce their risk of recurrent kidney stones.
Vincent G. Bird, M.D., the David A. Cofrin Endowed Professor of Endourology and chief of the division of minimally invasive surgery in the department of urology, says assessment often includes imaging in the form of X-rays, ultrasound or CT scans. The clinic also conducts blood testing and both spot urine testing and 24-hour urine collection. “We look for any recurrent stone disease, we assess the growth of any known stones, we check the patient’s symptoms and assess if they need further treatment based on what we find with the imaging,” Bird explains. “Then we adjust their fluid, diet, medication and supplement regimen.”
People who have recently undergone bariatric surgery are a good example of those who are likely to benefit from the comprehensive care at the clinic. People who have had gastric bypass often develop new-onset kidney stones, because the bowel’s absorption state changes substantially.
Bird explains that these patients are predisposed to excess absorption of oxalate, which goes to the kidney, where it can increase the risk of stones. They also experience substantial water loss through the bowel and can become dehydrated, which decreases urinary citrate, a substance that helps prevent stone growth. In addition, they frequently have substantial calcium loss. Usually these patients can be helped by calcium citrate and potassium citrate supplementation.
“In conjunction with the nephrology department, we extensively review patients’ diet and nutritional status, and we make recommendations about how to identify food items that may place them at higher or lower risk for kidney stones,” Bird explains. “It is through the combined approach of fluids, diet modification, supplements and sometimes medications that we come up with a total prevention plan, devised by the urology team and the nephrology team together.”
Bird says patients appreciate the one-stop care. “They avoid getting conflicting information from different specialists at different times and locations. I think they appreciate receiving one unified plan from the entire team. Also, they know they can readily contact us should there be any changes in their health or other needs related to their kidney stone disease.”
Bird thinks multidisciplinary care of specific diseases is the way medicine needs to go. “I am very proud of our department. We have leaders in various areas of urologic disease. A key reason is that the University of Florida fosters the coming together of multiple areas of expertise to grow a new and better care model for patients.”