Kidney Stones in India: Why They're So Common and What May Help Prevent Them

Ask around in any Indian office and you'll find someone who has passed a kidney stone, or has a family member who has. People who've had one usually describe it as the worst pain of their life: a sudden, cramping ache in the side or lower back that moves towards the groin and won't settle no matter how you sit or lie.

Stones are common here for fairly ordinary reasons. Long hot summers, long commutes without a water bottle, salty snacks and a habit of holding off on drinking water so you don't need a washroom at work all add up. Parts of north and west India are sometimes called a "stone belt" because doctors there see so many cases.

The useful news is that a lot of stones are preventable, and the steps are mostly simple.

What a kidney stone actually is

Urine carries dissolved minerals and salts. When there isn't enough water to keep them dissolved, they can form crystals that slowly stick together into a stone. Small ones may pass on their own without much trouble. Larger ones can get stuck in the tube from the kidney to the bladder, and that's when the pain starts.

Most stones in India are calcium oxalate stones. Others include uric acid stones, which are more common in people with high uric acid or gout, and a few less common types linked to infections or inherited conditions. The type matters, because prevention advice is not the same for every stone.

Signs you shouldn't ignore

• Sharp pain in the side or back, often coming in waves, sometimes spreading to the lower belly or groin

• Pink, red or brown urine

• Burning while passing urine, or needing to go very often

• Nausea or vomiting with the pain

• Fever or chills along with pain, which can mean an infection and needs urgent care

If you have fever with stone pain, can't pass urine, or the pain is too much to manage, go to a hospital the same day. A blocked, infected kidney is an emergency.

Who is more likely to get them

Anyone can get a stone, but the risk tends to be higher if you:

• Drink little water, or sweat a lot through outdoor work, travel or exercise

• Eat a lot of salt, pickles, papad, namkeen and packaged food

• Have had a stone before, since many people get another one within a few years

• Have a family history of stones

• Live with obesity, diabetes, high blood pressure or high uric acid

• Have certain gut conditions or have had weight-loss surgery

Tests that help

An ultrasound is usually the first scan, and a CT scan may be used to see small stones more clearly. If you've had a stone before, it's worth asking your doctor about a few more things: getting the stone analysed if you passed it, a blood test for calcium, uric acid and kidney function, and sometimes a 24-hour urine test that shows what's in your urine through a full day. That last one sounds like a hassle, but it's often what tells your doctor exactly what to change.

Water comes first

The single habit with the strongest backing is drinking enough fluid to pass plenty of urine. Many doctors suggest aiming for about 2.5 litres of urine a day for people who've had stones, which usually means drinking more than that, and more again in summer or on days you sweat. A practical check is the colour: pale yellow is the goal, dark yellow means you need more.

Spread it through the day rather than drinking a lot at once. Keep a bottle at your desk and in the car. Nimbu pani without much sugar, plain water and coconut water can all count. Cutting back on sugary cold drinks is a good idea, since sweetened drinks have been linked with a higher stone risk in some studies.

If you have heart or kidney failure, or a doctor has told you to limit fluids, follow their advice instead.

Food habits that may help

Watch the salt. Extra sodium pulls more calcium into the urine. Cutting down on pickles, papad, chips, instant noodles and restaurant food often makes a bigger difference than people expect.

Don't cut out calcium. This surprises many people. Getting enough calcium from food like curd, milk and paneer may actually lower the risk of calcium oxalate stones, because calcium binds oxalate in the gut before it reaches the kidneys. Very low calcium diets can backfire. Calcium supplements are a different matter, so check with your doctor before taking them if you've had stones.

Be sensible with high-oxalate foods. Spinach, beetroot, nuts, chocolate and strong tea are higher in oxalate. You don't usually need to ban them, but eating huge amounts every day, like a big palak smoothie habit, isn't wise if you form oxalate stones. Eating them with a calcium-rich food may help.

Go easy on animal protein. Large amounts of meat, chicken and fish can raise uric acid and calcium in the urine. Normal portions are fine for most people.

Citrus may help. Lemon and other citrus fruits contain citrate, which can make it harder for stones to form. The evidence for lemon water on its own is mixed, but it's a pleasant way to drink more fluid anyway.

About supplements and home remedies

You'll find plenty of advice online about barley water, horse gram, Ayurvedic syrups and "stone-dissolving" mixes. Some of these may help simply because they make you drink more. Very few have good clinical trials behind them, and none should replace a proper check-up if you have pain or blood in your urine.

Be careful with high-dose vitamin C supplements. In some people, large doses may raise oxalate levels. If you've had stones, talk to your doctor before starting any new supplement, including vitamin D and calcium. Vitamin D is often low in Indians and is important, but the dose should suit your blood levels and your stone history.

For people who keep getting stones, doctors may prescribe medicines such as potassium citrate or others based on the stone type and urine results. These work best when matched to your test results, which is why the tests above are worth doing.

A simple way to think about it

If you've had one stone, treat it as a warning, not just a bad week. Drink more through the day, cut back on salt, keep normal calcium from food, and ask your doctor whether your stone type and urine should be tested. Those few steps may save you a second trip to the emergency room.

This article is for general information only and isn't medical advice. Please talk to your doctor before changing your diet, starting a supplement, or if you have a medical condition or take regular medicines.