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Optimum Nutrition for Kidney Stone Disease

  • Ita P. Heilberg
    Affiliations
    Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil; and Nephrology Division, New York University Langone Medical Center, New York, NY, and Nephrology Section, New York Harbor VA Health Care System, New York, NY
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  • David S. Goldfarb
    Correspondence
    Address correspondence to David S. Goldfarb, Department of Nephrology, New York VA Medical Center, 423 E 23rd St./111G, New York, NY 10010.
    Affiliations
    Nephrology Division, Universidade Federal de São Paulo, São Paulo, Brazil; and Nephrology Division, New York University Langone Medical Center, New York, NY, and Nephrology Section, New York Harbor VA Health Care System, New York, NY
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      We summarize the data regarding the associations of individual dietary components with kidney stones and the effects on 24-hour urinary profiles. The therapeutic recommendations for stone prevention that result from these studies are applied where possible to stones of specific composition. Idiopathic calcium oxalate stone-formers are advised to reduce ingestion of animal protein, oxalate, and sodium while maintaining intake of 800 to 1200 mg of calcium and increasing consumption of citrate and potassium. There are few data regarding dietary therapy of calcium phosphate stones. Whether the inhibitory effect of citrate sufficiently counteracts increasing urine pH to justify more intake of potassium and citrate is not clear. Reduction of sodium intake to decrease urinary calcium excretion would also be expected to decrease calcium phosphate stone recurrence. Conversely, the most important urine variable in the causation of uric acid stones is low urine pH, linked to insulin resistance as a component of obesity and the metabolic syndrome. The mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion. For cystine stones, restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine. Reduction of urine sodium results in less urine cystine. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones because the amino acid cystine is soluble in more alkaline urine. Because of their infectious origin, diet has no definitive role for struvite stones except for avoiding urinary alkalinization, which may worsen their development.

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