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Kidney Stones & Kidney Disease: who to see and what helps

Kidney Stones & Kidney Disease · Kitchener, Waterloo & Cambridge

Kidney stones are hard crystals that form in the urine; chronic kidney disease is a lasting loss of kidney function. They are different problems with one thing in common: what you eat and drink matters. For stones, the firmest advice is to drink enough to pass 2.5 litres of urine a day and to keep eating calcium. Chronic kidney disease is a serious diagnosis managed by your physician or kidney team, who also set the diet; CARESPACE supports that care and does not replace it. The first visit at CARESPACE is with a Registered Dietitian.

What kidney stones and chronic kidney disease are

A stone starts when chemicals in the urine form a tiny crystal. Most stones, 70 to 80%, are calcium oxalate. The Kidney Foundation of Canada estimates that about 12% of men and 6% of women will have one in their lifetime. Stones are usually painless in the kidney and hurt when they move toward the bladder.

Chronic kidney disease means the kidneys’ structure or function has been abnormal for at least three months. Long-standing high blood pressure and diabetes are the most common causes. It is found by blood and urine tests, usually long before it is felt. Blockages from recurrent stones are among its causes.

Symptoms

  • Kidney stones: sudden, severe pain that starts in the side and worsens in waves, spreading to the lower belly, groin or genitals; blood in the urine; painful or frequent urination; nausea and vomiting
  • Chronic kidney disease, early: usually none
  • Chronic kidney disease, later: tiredness, swollen ankles, feet or hands, shortness of breath, nausea, passing less urine, trouble sleeping

Causes and risk factors

  • Stones: not drinking enough water is the most common cause. Others are a family history, gout, inflammatory bowel disease, metabolic syndrome, some medicines, and a diet high in salt or animal protein.
  • Chronic kidney disease: high blood pressure and diabetes above all; also kidney inflammation, inherited polycystic kidney disease, repeated kidney infections, blockages, and long-term regular use of lithium or anti-inflammatory painkillers.

Long shifts on a plant or warehouse floor, where water breaks are easy to skip, are a common way to end up short on fluid.

How they are diagnosed

Stones are confirmed by a physician’s examination, often with a CT scan or ultrasound. If you pass a stone, save it and ask whether it should be analyzed, because the type changes the advice. People at risk of more stones may be asked for 24-hour urine collections. Chronic kidney disease is found with a blood test (creatinine, reported as eGFR) and a urine test for protein (ACR), repeated to confirm the result has lasted three months. Ontario’s primary care kidney toolkit, KidneyWise, advises testing people with high blood pressure, diabetes or cardiovascular disease, First Nations, Inuit and Métis adults, and close relatives of people with kidney disease.

When to get urgent help

Call 911 if someone with kidney disease has chest pain, severe shortness of breath, severe muscle weakness, or a heart rate that is very slow (under 50 beats a minute) or very fast (over 120).

Go to an emergency department now if you have stone pain together with a fever, chills or shivering. A stone that blocks a kidney while there is an infection needs urgent drainage. Go as well if you vomit blood or see blood in your stools.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Go to an urgent care clinic or an emergency department the same day for severe pain in your side, belly, groin or genitals, which may come in waves, or for nausea and vomiting so severe that you cannot keep fluids or pain medicine down.

See a physician or nurse practitioner the same day, or go to an urgent care clinic, if you have blood in your urine or pain or burning when you urinate. If you have kidney disease, call your physician or kidney team the same day about increasing fatigue, nausea and vomiting, loss of appetite or being unable to sleep, which together are called uremic syndrome. Call your physician or nurse practitioner if you are more tired or weak than usual, your feet or arms are swelling, or you bruise easily or have unusual bleeding such as nosebleeds. If you are on dialysis, call about belly pain during peritoneal dialysis, signs of infection at your catheter or access site, such as pus draining from the area, or anything else your dialysis nurse or manual tells you to report.

What the evidence says

  • Where these points come from. For stones, the Canadian Urological Association’s 2022 guideline, which grades its advice from A (strongest) to D. For chronic kidney disease, the international KDIGO 2024 guideline, in which “recommend” is firmer than “suggest” and other advice is labelled a practice point.
  • Stones: fluid. Everyone who forms stones should aim for a urine output of 2.5 litres a day, with water as the first choice (Grade B). Sugar-sweetened pop may raise the risk.
  • Stones: keep the calcium. Aim for 1,000 to 1,200 mg of calcium a day from food (Grade B). Cutting calcium is described as a public misconception; if a supplement is needed it goes with meals.
  • Stones: sodium and protein. With recurrent calcium stones, limit sodium to 1,500 mg a day and do not exceed 2,300 mg (Grade B). With recurrent calcium or uric acid stones, moderate animal protein (Grade C).
  • Stones: oxalate and vitamin C. Minimizing high-oxalate foods is advice for people whose urine oxalate is high (Grade C), not for everyone. Vitamin C supplements above 1,000 mg a day are not recommended (Grade C).
  • Kidney disease: protein. KDIGO suggests a protein intake of 0.8 g per kilogram of body weight a day in adults whose disease is at stage G3 to G5, and advises against high intakes, above 1.3 g per kilogram, when the disease is at risk of progressing.
  • Kidney disease: sodium and the overall pattern. It suggests less than 2 g of sodium a day, and advises a varied diet with more plant-based than animal-based foods and fewer ultra-processed ones.
  • Kidney disease: who teaches the diet. The practice point is to use renal dietitians or accredited nutrition providers to teach changes to sodium, phosphorus, potassium and protein, fitted to the person and the stage of disease.
  • Kidney disease: activity. KDIGO recommends moderate-intensity activity adding up to at least 150 minutes a week, or to a level that your heart and your physical tolerance allow.

What your physician, urologist or kidney team provides

CARESPACE does not provide these, but it helps to know where they fit.

  • For a stone: pain relief, medicine to help it pass, and for larger or blocking stones, shock-wave treatment or removal through a scope.
  • To prevent more stones: for some people, a thiazide diuretic, an alkali citrate or allopurinol, chosen from urine and blood results.
  • For chronic kidney disease: blood pressure treatment, kidney-protecting medicines, regular blood and urine tests, and referral to a kidney specialist when results cross set thresholds. Dialysis or a transplant is for kidney failure.

How each CARESPACE service helps

Nutrition

For stones, a Registered Dietitian can go through your day and find where fluid, salt, calcium and animal protein sit against the targets above, by stone type where it is known. Chronic kidney disease is different. Limits on protein, potassium, phosphorus and fluid depend on your stage and your blood results, so the diet is set with your physician or kidney program, whose dietitian leads it if you have one. Bring your latest results and whatever you have been told, and a CARESPACE dietitian can help you turn it into meals. Ask when you book for a dietitian with experience in kidney disease.

See our dietitian team →

Nurse Practitioner

The tests that find and track kidney disease, eGFR and urine ACR, and the blood pressure and diabetes treatment that protect the kidneys, are work a Nurse Practitioner is authorized to do in Ontario: ordering and interpreting tests, diagnosing and prescribing.

See our nurse practitioner team →

Other services people ask about

Naturopathic Medicine: for kidney disease, the KDIGO guideline advises reviewing and limiting over-the-counter medicines and dietary or herbal remedies. For stone formers, high-dose vitamin C is the supplement advised against. Talk to your pharmacist, physician or nurse practitioner before starting any supplement or herbal product.

Where most people start

Stone pain goes to a physician first, by the routes in the urgent section above. Once the stone has passed or been treated, book a Registered Dietitian at CARESPACE to work on preventing the next one. With chronic kidney disease, start with your physician or kidney team, and add a dietitian with their targets in hand. You leave the first visit with a plan.

How your team works together

At CARESPACE this is mostly one service, the dietitian. Your physician, urologist or kidney team orders the tests and prescribes, and for kidney disease sets the limits the eating plan has to respect.

Browse by service: registered dietitians and nurse practitioners.

What to expect at your first visit

  1. What you know so far. Stone type if it was analyzed and how many stones; or your latest eGFR and urine results and any limits you have been given.
  2. Your medicines and supplements, including vitamin C, vitamin D, calcium and protein powders.
  3. A usual day of eating and drinking, with how much fluid and when.
  4. A plan to leave with.

What you can do at home

  • After a stone: drink 2.5 to 3 litres of fluid through the day, mostly water. Dark urine is a sign you are behind.
  • Keep calcium-rich foods in your meals, and if you had calcium oxalate stones, eat them alongside high-oxalate foods such as spinach, rhubarb, beets, nuts, dark chocolate and black tea.
  • Keep sodium under 2,300 mg a day.
  • With kidney disease: avoid anti-inflammatory painkillers such as ibuprofen unless your physician has said otherwise, and tell your physician or pharmacist about every over-the-counter and natural health product you take.
  • Do not start a restricted kidney diet from a list online; the limits differ from person to person.

Outlook

Most small stones pass by themselves: 90% of those under 5 mm do, within hours or days by the Kidney Foundation’s account, though the NHS in the United Kingdom allows up to a few weeks. Stones often return, in 30 to 50% of people within 10 years of a first one. Chronic kidney disease has no cure, but treatment can stop it getting worse; the NHS reports that it progresses to kidney failure in about 2 in 100 people who have it. It also raises the risk of heart attack and stroke.

Kidney stone and kidney disease support in Kitchener, Waterloo and Cambridge

Kitchener. Nutrition in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nutrition in Waterloo and Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Nutrition in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

How much water should I drink to prevent kidney stones?

The Canadian guideline’s target is a urine output of 2.5 litres a day. HealthLink BC’s dietitians advise at least 2.5 to 3 litres of fluid a day, 10 to 12 cups, which they say should produce about 2 to 2.5 litres of urine. Water comes first.

Should I cut out calcium if I have had a calcium stone?

No. The Canadian guideline calls that a misconception and sets a goal of 1,000 to 1,200 mg a day from food.

Are coffee, tea and alcohol a problem for stones?

Sugar-sweetened pop is the drink linked to more stones. On the rest the sources differ. The Canadian guideline says coffee, other caffeinated drinks, wine and beer may have a protective effect, which must be weighed against their other effects on health. The NHS in the United Kingdom, in its advice on preventing stones, says to avoid drinking lots of fizzy, caffeinated or alcoholic drinks. Neither is a reason to drink more of them; water is the first choice. Black tea is high in oxalate.

What foods should I avoid with chronic kidney disease?

There is no single list. The general advice is less salt, fewer ultra-processed foods, more plant-based foods and no high-protein diet. Limits on potassium, phosphorus and fluid apply to some people and not others.

Is there a dietitian for kidney stones in Kitchener, Waterloo or Cambridge?

Yes. CARESPACE has Registered Dietitians in all three cities. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

High Blood Pressure
Diabetes
Gout
Heart Disease & Heart-Healthy Exercise

The CARESPACE Central Reception Team

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Book online with a Registered Dietitian, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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