Kidney stones are concretions made from urinary minerals that are usually dissolved in the urine. If they grow to more than 2-3 millimeters they can cause obstruction of flow of urine. This leads to pain in the flank, lower abdomen and groin, sometimes associated with nausea and vomiting. If left untreated they can lead to kidney blockage and renal failure.

Kidney stones are extremely common. More than 1 out of every ten people will develop kidney stones over the course of their lifetime. More than 50% of people that have formed one stone will form a second and third. It is commonly said that the pain of a kidney stone attack is often worse than the pain of childbirth! Yet, most people don’t realize how many tools we have in our arsenal to prevent those horrible attacks. The majority of the time all that’s needed are some straightforward dietary changes. Sometimes we supplement with specific minerals and electrolytes that prevent stone formation. And if those don’t work, we move to pharmaceutical intervention.

Do you suffer from kidney stones? Come see us for a consultation. It’s time to prevent the next one!

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Chronic kidney disease is a progressive loss of kidney function. It can occur over a period of months to years. Most patients have no symptoms and when symptoms do arise they are nonspecific, such as malaise and a decreased appetite. It is most often diagnosed by abnormal blood tests for Creatinine and Blood Urea Nitrogen. When these are elevated they are due to decreased filtration capacity by the kidneys.

In early stages there may be normal filtration but evidence of abnormal loss of protein or cells into the urine. Early treatment at this stages can prevent progression.

According to the National Kidney Foundations Kidney Disease Outcomes Quality Initiatives (NKF KDOQI), there are five stages of CKD or chronic kidney disease. Stage 1 is the mildest form, with the least loss of kidney function. Stage 5 is at or near kidney failure. When kidneys fail the term end stage renal disease, or ESRD, is used. Those reaching this stage need dialysis or a kidney transplant.

About 13% of US adults have Chronic Kidney disease, which is around 26 million people. There are now 430,000 Americans with kidney failure who rely on dialysis, 90,000 of these are waiting for a kidney transplant. Diabetes and high blood pressure account for two thirds of all new cases.


Risk factors for Chronic Kidney Disease include:

  • Family history of kidney disease
  • Older age, risks increases significantly over age 60
  • Elevated weight
  • Ethnic group (there is a higher rate of kidney disease amongst African Americans, Hispanics, and Native Americans)
  • Overuse of certain medications for pain such as ibuprofen or naproxen
  • Use of street drugs
  • Certain health conditions such as: DIABETES, HIGH BLOOD PRESSURE, HEART DISEASE, OBESITY, LUPUS and many others may contribute to your risk.

If you have any of the above risk factors, be sure to speak to your doctor or come in to see us for a thorough evaluation.

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According to the National Kidney Foundations Kidney Disease Outcomes Quality Initiatives (NKF KDOQI), there are five stages of CKD or chronic kidney disease. Stage 1 is the mildest form, with the least loss of kidney function. Stage 5 is at or near kidney failure.



  • See your nephrologist on a regular basis
  • Get regular blood work to follow your kidney function
  • Take your medications regularly as prescribed
  • Be careful to avoid any substances that may be toxic to your kidneys
  • Stop smoking
  • Maintain optimal body weight
  • Control your blood pressure and blood glucose


If you are diagnosed with kidney disease in the early stages there are steps we can take to delay the progression of kidney disease and significantly improve your quality of life. Control of blood sugar is critical. Blood pressure should be kept below 130/80 to prevent progression of kidney disease.

Careful avoidance of any medications or products toxic to the kidney, such as prescription and non-prescription pain killers, some antibiotics, and contrast dye used in medical tests is essential. Avoidance of smoking, losing excess weight, and proper nutrition are also important. Research continues as to other foods and drugs in delaying progression of kidney disease, including fish oil, antioxidants and anti-inflammatory vitamins and foods, and new drugs to treat kidney disease.


If kidneys fail there a number of different treatment options that can be used to remove extra fluid and waste from the body. These include hemodialysis, home hemodialysis, overnight in center hemodialysis, and peritoneal dialysis. Once this stage is reached we will discuss all these options with you and help you pick the one that best suits your lifestyle and health. We will encourage you to attend a Davita Kidney Smart class that will also help you clarify these choices.

In center dialysis is most often done in a dialysis center by a staff of nurses or trained technicians. It can be done in two ways, during the day three times a week for 3-4 hours, or at night for 6-8 hours while you sleep. With overnight dialysis you get about twice as much treatment as with regular hemodialysis and your treatment does not take time out of your day.

Peritoneal dialysis is another form of dialysis that also removes extra fluid and waste from your body. However, instead of using a dialysis machine it uses your own body. A catheter needs to be placed into your abdominal cavity, or peritoneum. The peritoneum is then filled with a special solution that allows transfer of fluid and waste through the peritoneal membrane, into the solution which is then drained out of your belly. This can be done manually on average 4-5 times per day or overnight with a machine called a cycler which does the exchanges at while you sleep.

A kidney transplant is thought of as the gold standard because it is the treatment that comes closest to normal kidney function. A kidney transplant, however, is not for everybody and requires a lifelong commitment to a medication regimen and careful follow up with a doctor specializing in kidney transplantation. Several factors will help determine whether a transplant is an option, including general health, emotional health, and insurance coverage. Early referral to a transplant center is crucial to minimizing the time to a kidney transplant.

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High Blood Pressure

High blood pressure, or hypertension, is defined as a blood pressure of over 140/90 for a sustained period of time. In the U.S. approximately one in 3 adults has hypertension. It is one of the leading causes of kidney disease. It is also a leading cause of stroke, heart attacks, vision and memory loss. Symptoms can include headache, nausea, dizziness, blurred vision, shortness of breath and palpitations, but often patients have no symptoms at all. Factors that affect a person’s blood pressure include genetics, age, stress, smoking, dietary salt, alcohol abuse, and being sedentary. A consultation for hypertension will include a history and physical exam and a workup to diagnose the cause of hypertension if appropriate. Treatment includes lifestyle changes including diet, exercise and stress reduction, as well as medications. Dr Joseph is board certified as a Specialist in Hypertension by the American Society of Hypertension.

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We also specialize in Internal Medicine which is general medical care for adults. Our focus is on health promotion and prevention of aging and disease. We offer a wide variety of options, skills, and testing to encourage behavior that leads to the prevention of disease processes and encourages healthy living, with special attention to staying active and independent.