Diet and Stone Disease in 2022

Abstract

Diet plays a central role in the development and prevention of nephrolithiasis. Although pharmacologic treatment may be required for some patients who are resistant to dietary measures alone, dietary modification may be sufficient to modulate stone risk for many patients. While there is no single specialized diet for stone prevention, several dietary principles and recommendations for stone prevention are supported by practice guidelines, including adequate fluid intake, modest calcium intake, low dietary sodium, and limited animal protein. In this review, we summarized the evidence supporting these dietary recommendations and reviewed the current literature regarding specific dietary components and comprehensive diets for stone prevention.

Calcium salt crystalluria in a captive chimpanzee (Pan troglodytes) population

“…Calcium oxalate is the primary component of the majority of nephroliths in humans 16,20,21 . Calcium oxalate crystalluria is associated with the ingestion of plants that are high in oxalate, including spinach, rhubarb, beets, and various types of nuts, 5,6,22–24 all of which were offered to the chimpanzees as part of their diet throughout the study period. Calcium oxalate crystalluria can also be associated with ethylene glycol toxicity 5,11 ; however, none of the chimpanzees had access to antifreeze, nor did any chimpanzees exhibit any other symptoms of this toxicity at any time.…”

“…Leendertz et al reported that lower urinary specific gravity correlated with the rainy season, when access to water was more reliable 1 ; Krief et al also stated that urine concentration was influenced by fluid consumption 30 . High fluid consumption in humans is also strongly correlated with a reduced risk of nephrolith and urolith formation 22 . However, it should be noted that Eder reported a higher mean specific gravity of 1.013 in his study on captive chimpanzee renal function despite continuous availability of water and juices 37 …”

Shockwaves and the Rolling Stones: An Overview of Pediatric Stone Disease

“…106,107 A reason for this may be the low pH of lemon juice, so that citrate exists primarily in the form of citric acid and thus provides little, if any alkali load. 104 A list of medications commonly used in the treatment of urinary stone disease, including citrate, is provided in Table 3. The dose should be distributed throughout the day, as much as possible, unless delayed-release formulations are used.…”

“…Urine alkalinization can be achieved in different ways, including dietary modification (reducing animal protein intake) and alkali supplementation. 104 Though the type of alkali should make no difference with regards to raising urine pH, there is a theoretical concern that sodium-containing alkali salts could lead to an increase in urine calcium excretion and most clinicians therefore use potassium-alkali salts, typically potassium citrate. 105 Acceptance of this treatment in children may be improved if lemonade is used for citrate provision, but the results of clinical trial have been varied.…”

“… 106 , 107 A reason for this may be the low pH of lemon juice, so that citrate exists primarily in the form of citric acid and thus provides little, if any alkali load. 104 …”