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      Role of Nutrition in the Formation of Calcium-Containing Kidney Stones


      Nephron Physiology

      S. Karger AG

      Kidney stones, Nephrolithiasis, Stone-formers, Dietary risk factors

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          Diet plays an important role in the pathogenesis of calcium-containing kidney stones. Although much work has demonstrated that specific dietary components alter urinary composition and supersaturation, relatively few studies link the ingestion of these components with actual nephrolithiasis. This article reviews the dietary factors thought to promote or inhibit the formation of calcium stones and discusses the current controversies in the field of nutrition and nephrolithiasis. Special attention is paid to the roles of dietary calcium, supplemental calcium, oxalate, phytate, and n–3 fatty acids. We offer dietary recommendations to individuals who have suffered from a calcium-containing kidney stone, and emphasize that a patient’s 24-hour urine chemistries should be used to help guide dietary intervention.

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          Most cited references 66

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          Kidney stones.

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            Relationship of animal protein-rich diet to kidney stone formation and calcium metabolism.

            We wished to determine whether different types of dietary protein might have different effects on calcium metabolism and on the propensity for renal stone formation. Fifteen young normal subjects were studied during three 12-day dietary periods during which their diet contained vegetable protein, vegetable and egg protein, or animal protein. While these three diets were constant with respect to Na, K, Ca, P, Mg, and quantity of protein, they had progressively higher sulfur contents. As the fixed acid content of the diets increased, urinary calcium excretion increased from 103 +/- 15 ( +/- SEM) mg/day (2.6 +/- 0.4 mmol/day) on the vegetarian diet to 150 +/- 13 mg/day (3.7 +/- 0.3 mmol/day) on the animal protein diet (P less than 0.02). Despite the increased urinary calcium excretion, there was a modest reduction of urinary cAMP excretion and serum PTH and 1,25-dihydroxyvitamin D levels consistent with acid-induced bone dissolution. There was no change in fractional intestinal 47Ca absorption. The inability to compensate for the animal protein-induced calciuric response may be a risk factor for the development of osteoporosis. The animal protein-rich diet was associated with the highest excretion of undissociated uric acid due to the reduction in urinary pH. Moreover, citrate excretion was reduced because of the acid load. However, oxalate excretion was lower than during the vegetarian diet [26 +/- 1 mg/day (290 +/- 10 mumol/day) vs. 39 +/- 2 mg/day (430 +/- 20 mumol/day); P less than 0.02]. Urinary crystallization studies revealed that the animal protein diet, when its electrolyte composition and quantity of protein were kept the same as for the vegetarian diet, conferred an increased risk for uric acid stones, but, because of opposing factors, not for calcium oxalate or calcium phosphate stones.
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              Beverage use and risk for kidney stones in women.

               Gary Curhan (1998)
              An increase in fluid intake is routinely recommended for patients who have had kidney stones to decrease the likelihood of recurrence. However, data on the effect of particular beverages on stone formation in women are limited. To examine the association between the intake of 17 beverages and risk for kidney stones in women. Prospective cohort study with 8 years of follow-up. United States. 81093 women in the Nurses' Health Study who were 40 to 65 years of age in 1986 and had no history of kidney stones. Beverage use and diet were assessed in 1986 and 1990 with a validated, self-administered food-frequency questionnaire. The main outcome measure was incident symptomatic kidney stones. During 553 081 person-years of follow-up over an 8-year period, 719 cases of kidney stones were documented. After risk factors other than fluid intake were controlled for, the relative risk for stone formation for women in the highest quintile of total fluid intake compared with women in the lowest quintile was 0.62 (95% CI, 0.48 to 0.80). Inclusion of consumption of specific beverages in the multivariate model significantly added to prediction of risk for kidney stones (P < 0.001). In a multivariate model that adjusted simultaneously for the 17 beverages and other possible risk factors, risk for stone formation decreased by the following amount for each 240-mL (8-oz) serving consumed daily: 10% (CI, 5% to 15%) for caffeinated coffee, 9% (CI, 2% to 15%) for decaffeinated coffee, 8% (CI, 1% to 15%) for tea, and 59% (CI, 32% to 75%) for wine. In contrast, a 44% (CI, 9% to 92%) increase in risk was seen for each 240-mL serving of grapefruit juice consumed daily. An increase in total fluid intake can reduce risk for kidney stones, and the choice of beverage may be meaningful.

                Author and article information

                Nephron Physiol
                Nephron Physiology
                S. Karger AG
                October 2004
                19 October 2004
                : 98
                : 2
                : p55-p63
                Renal Division, Brigham and Women’s Hospital, Boston, Mass., USA
                80265 Nephron Physiol 2004;98:p55–p63
                © 2004 S. Karger AG, Basel

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                Page count
                Tables: 3, References: 90, Pages: 1
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