Letter to editor concerning kidney stones
Dear Mr Taylor, July 23, 2010
Regarding today’s story by Martin Mittelstaedt titled “Scientists taking vitamin D in droves” there is one error that is misdirecting.
The sentence in question is “Too much vitamin D, which is determined through a serum test, leads to kidney stones and excessive calcium in the blood.”.
I have information from Dr. Robert Heaney mentioned in the article and he states;
•	Kidney stones are of many types and have many causes. 
•	The most common types in the US are calcium oxalate stones. (80%) 
•	The stone should be analyzed so as to determine the approach to treatment. 
•	Whatever the stone type, stone formers have a defect in kidney production of a solution stabilizer, normally secreted into the urine.  This keeps the commonly supersaturated urine from forming precipitates (which then aggregate into stones). 
•	There are two basic approaches indicated in most cases.  
o	One is to drink large amounts of water each day to keep the urine dilute 
o	The second is to reduce the urine content of components that form precipitates.  For example, if the stone is a urate stone, medicines will be prescribed that reduce the body's production of uric acid.  Or if the stone is calcium oxalate, large quantities of calcium should be ingested to block absorption of oxalic acid from the intestinal contents, thereby reducing the amount of oxalate that will have to be excreted through the kidneys.  While high calcium intake sounds counter-intuitive, there is a solid scientific base for the recommendation, and persuasive clinical trial data showing that it works.  Placing patients on low calcium diets will actually double the risk of having a second stone. 
•	There are several other approaches that might be taken, but the foregoing hit the main points.  It's important to remember that the basic defect (absence of a solution stabilizer) persists, so whatever strategy works will have to become permanent. 
•	Vitamin D, in doses producing desirable serum levels of 25(OH)D, do not adversely affect any of the components of this system 
Calcium is a component of the stone itself, but issues in the kidney unrelated to calcium form them.
There is even research that calcium supplementation prevents kidney stones.
Why oral calcium supplements may reduce renal stone disease ...
by C Williams - 2001 - Cited by 17 - Related articles
Seasonal variations in the composition of urine in relation to calcium stone-formation. ... A common molecular basis for three inherited kidney stone diseases. .... ReviewEffectiveness and safety of vitamin D in relation to bone health. ...
www.ncbi.nlm.nih.gov › ... › J Clin Pathol › v.54(1); Jan 2001 - Similar
As you may know summer is considered kidney stone season.  However, research shows that increased macrophage migration (getting deeper into tissue) is the reason for this.  Macrophages are part of the immune system.  Vitamin D enhances macrophages considerably and the macrophages eliminate the foreign body of a kidney stone.
… of Genes Related to Kidney Stone Formation and Elimination in the Calcium Oxalate Nephrolithiasis Model Mouse: Detection of Stone-Preventive Factors and …
A Okada, T Yasui, S Hamamoto, M … - Journal of Bone …, 2009 - interscience.wiley.com
... Fgg) tissue sclerosis-related genes, procollagen type III, a 1 (Col3a1), procollagen type I, a 2
(Col1a2), cadherin 11 (Cad11 ... Among genes previously reported as being involved in urolithiasis,
kidney stones, hyperoxaluria, or hypercalciu- ria, the expressions of 49 genes could ... 
Cited by 3 - Related articles - All 7 versions
In conclusion, inflammation and immune reactivity through macrophage migration are involved in stone formation and elimination in mouse kidneys.
Again vitamin D improves the migration and and potential of macrophages;
Summary  Vitamin D3 deficient (D−) mice show a depressed inflammatory response and both inflammatory peritoneal macrophages and bone marrow polymorphonuclear leukocytes of D− (deficient) mice exhibit a decreased spontaneous migration under agarose. The impaired phagocytic response of peritoneal macrophages from D− mice can be corrected by incubation with 1,25-dihydroxyvitamin D3 and is not affected by interaction with other vitamin D3 metabolites. Transfer of mice from the D− to the D+ state results in correction of both the inflammatory and the phagocytic response. Intactness of phagocyte function is thus directly dependent on vitamin D3 metabolism.
…activated vitamin D, 1,25(OH)2D, a steroid hormone, has profound effects on human immunity. 1,25(OH)2D acts as an immune system modulator, preventing excessive expression of inflammatory cytokines and increasing the 'oxidative burst' potential of macrophages.”…
So with the current vitamin D insufficiency and deficiency epidemic you would expect more kidney stones;
Rise in Kidney Stones Is Seen in U.S. Children 
To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6. While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.
Are kidney stones asymptomatic until serum vitamin D levels enhance macrophages and eliminate them, healing the problem?
Asymptomatic kidney stones — Many people with kidney stones have no symptoms (asymptomatic means without symptoms). These kidney stones are usually found when an imaging study (such as an ultrasound, x-ray or CT scan) is performed is done for other purposes. Stones can remain in the kidneys for many years without ever causing symptoms. (See "The first kidney stone and asymptomatic nephrolithiasis in adults".)
Asymptomatic Nephrolithiasis Detected by Ultrasound
Amar D. Bansal,* Jennifer Hui,* and David S. Goldfarb*†
*Department of Medicine, New York University School of Medicine, New York, New York; and †Nephrology Section, New York Harbor Veterans’ Affairs Medical Center and Department of Urology, St. Vincent's Hospital, New York, New York
Correspondence: Dr. David S. Goldfarb, Nephrology Section/111G, New York Department of Veterans’ Affairs Medical Center, 423 E. 23rd Street, New York, NY 10010. Phone: 212-686-7500 ext. 3877; Fax: 212-951-6842; E-mail: David.Goldfarb@va.gov 
Received October 6, 2008; Accepted January 2, 2009.
Abstract
Background and objectives: Data from several countries suggest a recent world-wide increase in the prevalence of stone disease. However, these studies have not analyzed the effect that increases in utilization of imaging modalities have had on detection of asymptomatic stones.
Design, setting, participants, & measurements: A retrospective chart review of all patients who had an abdominal or retroperitoneal ultrasound in 2005 at a Department of Veterans’ Affairs Medical Center was conducted. The charts of patients who had ultrasounds demonstrating kidney stones were further reviewed. Patients were classified into symptomatic and asymptomatic groups on the basis of their clinical history. Age and sex for all patients were recorded. For those patients with stones, additional data were recorded. Of all patients in the study, the percentage of those with asymptomatic stones was calculated. Taking into account uncertainty about symptomaticity in some patients, a sensitivity analysis for the presence or absence of gross and microhematuria was performed to determine a range for the percent of asymptomatic stones. Appropriate statistical tests were used to determine significance.
Results: The prevalence of all kidney stones in the study group was 8.6 %. Using the sensitivity analysis, 29.8 to 45.7% of all stones were asymptomatic. Of stones found on abdominal ultrasounds, 71.4% were asymptomatic, whereas 36.8% of stones found on retroperitoneal ultrasound were asymptomatic.
Conclusions: Asymptomatic stones have a relatively high prevalence on ultrasound. Epidemiologic estimates of prevalence of nephrolithiasis need to account for increases in utilization of imaging modalities and the resulting detection bias.
People are never aware they have a kidney stone for it never passes due to a continued vitamin D deficiency in the population.
From the correlations I have indicated above proper serum vitamin D HEALS kidney stones by eliminating them with proper functioning macrophages.
Those same properly functioning macrophages reduced incidence of H1N1 influenza as well by 58%;
http://www.reuters.com/article/idUSTRE62I3MK20100319 
During the study, conducted between December 2008 and March 2009, 31 of 167 children taking placebo caught influenza A, the most common form of the virus, compared with only 18 of 167 taking vitamin D.
The vitamin D group was 58 percent less likely to catch influenza A, the researchers report in the American Journal of Clinical Nutrition.
So you can see the statement made about calcium causing kidney stones is inherently wrong, and there are many indicators that elevated summer serum vitamin D heal kidney stones.  Passing a kidney stone is a healing event, not a disease event.
This is all due to a properly functioning immune system that eliminates foreign bodies, and proper serum vitamin D appears to be the answer.
Could you please pass this data along to Martin Mittelstaedt.
Also Dr. Robert Heaney reccomends 75iuD3/kg/d for winter supplementation.