Abstract
We thank Dr Patel for his comments on our article and agree with the primary prevention strategies supporting our article. 1,2 Given the pathophysiologic mechanisms involved in kidney stone disease (KSD), it is clear that “stone” is more a “symptom” of underlying metabolic abnormality in the long-term development of metabolic syndrome (MetS) in these patients. 3 In a long-term follow-up of 19 years, stone formers were twice as likely to develop MetS compared with matched controls, especially for uric acid stones. 3 Perhaps assessment for MetS should be standard in patients with KSD, given the individual and health policy implications of the cardiovascular outcomes.
Lifestyle factors should also target other associated factors such as tea, coffee, fluid intake, and modern dietary fads. 4,5 Contrary to the popular belief, recent systematic review by Barghouthy et al. shows that provided the overall fluid intake is maintained, moderate coffee does not increase the risk of KSD, and green tea might even be protective. 4 Similarly, high intake of fluid low in calcium, grapefruit, and orange juice might reduce the risk of stone disease. 5
Social media (SoMe) and internet search engines have shown to provide help to patients with KSD. 6 However, in their article, the authors concluded that although this information was good for dietary and fluid management, it was not comprehensive and did not include advice on other aspects of KSD prevention. MetS comprises obesity, hypertension, diabetes mellitus, and dyslipidemia, 7 and KSD might be an “early warning” in these patients, they should be monitored and counseled for lifestyle changes that can alter their risk, thereby decreasing their risk of both KSD and cardiovascular events.
Given the cost associated with KSD, it is perhaps in the interest of health care systems and insurance companies to invest in programs and preventative measures to raise awareness toward the benefits of moderate exercise, lower calorie intake, and stop smoking. 8 Similarly, SoMe can be utilized in patient education, and to enhance motivation and adherence to primary prevention. Besides lowering the risk of KSD, these would have an improvement in global health of our patients.