Kidney Stones: Why Low Water Alone Isn’t the Only Cause — Hidden Triggers to Know

 

Kidney stones — more than just dehydration

Most people believe that not drinking enough water is the major reason for kidney stones. And indeed, low fluid intake can concentrate urine, increasing risk. 

But according to Arjun Sabharwal — a nephrologist — that’s only part of the story. Recent insights show that many other metabolic, dietary, genetic and medical factors often play a bigger role in stone formation. 

Hidden causes of kidney stones

Dr. Sabharwal highlights several lesser-known triggers which may explain why some people get stones even when they drink enough water: 

Excess calcium in urine (hypercalciuria): When kidneys leak too much calcium or the body absorbs too much from food, calcium can combine with other elements to form stones. 

High oxalate levels: Foods rich in oxalate (like spinach, nuts, chocolate) or certain gut disorders can lead to higher oxalate absorption — which then binds with calcium to form calcium-oxalate stones. 

Low urinary citrate: Citrate naturally helps prevent crystals. Low citrate (due to high animal-protein diets, metabolic issues or gut problems) removes this protective factor. 

High uric acid / Purine-rich diet: Diets heavy in red meat or seafood raise uric acid — which can lead to uric-acid stones or promote calcium stone formation by affecting urine chemistry. 

High salt or excessive animal protein consumption: These dietary patterns raise calcium and other mineral concentrations in urine, increasing crystallization risk. 

Underlying health or genetic conditions: Obesity, diabetes, gut disorders, urinary tract infections, and family history are also known risk factors — meaning stones can form independent of hydration level. 

What this means — don’t just rely on “drink more water”

Drinking enough water still matters — it dilutes urine and reduces stone risk. But water alone isn’t enough if other risk factors remain unaddressed.

If you’ve had recurrent kidney stones, the best strategy is a full metabolic evaluation (including 24-hour urine tests) to determine what kind of stone you are prone to — calcium, oxalate, uric acid, etc. 

Adjusting diet (cutting down salt, reducing excessive animal protein or oxalate-rich foods), managing metabolic conditions (e.g. diabetes, obesity), and keeping up with medical check-ups are crucial to prevent recurrence.

Tips to Lower Kidney-Stone Risk

Do This	Avoid / Limit This
Drink water regularly to keep urine diluted	Very high salt intake
Eat a balanced diet—moderate calcium and more plant-based foods	Overconsumption of red meat or high-purine foods
Include fruits and vegetables instead of salty or processed foods	Relying only on drinking water without addressing diet
Manage obesity, diabetes, gout, and recurring UTIs with medical guidance	Excessive calcium supplements or unnecessary medications
Get a metabolic evaluation if kidney stones keep returning	Assuming hydration alone prevents all stones

The bottom line

Yes — not drinking enough water can contribute to kidney stones. But as nephrologists now warn: most stones arise from a complex mix of dietary habits, metabolism, health conditions, and even genetics. 

If you’ve experienced stones more than once, consider a deeper assessment beyond hydration — and adopt a holistic, balanced diet and lifestyle.