Update in Diagnosis and Management
On this slide are listed the general dietary guidelines that are applicable for patients with idiopathic calcium oxalate stones. Those with an asterisk have clinical trails to support their use, at least to some degree. Urinary volume is an important determinant of the concentration of urinary lithogenic substances such as calcium, and is largely determined by how much fluid one drinks. Therefore, all stone patients are encouraged to drink enough to have a urine volume of at least 2 liters. This requires 64-96 ounces per day. About half should be water. Low dietary calcium has been associated with increased stone risk, while the use of calcium pills may slightly increase kidney stone incidence. Therefore, patients are encouraged to get their recommended daily allowance of calcium, but from food and dairy sources and not pills.
High protein diets do many things that might increase kidney stone risk, such as increase urinary uric acid and reduce urinary citrate. Therefore a modest intake of 8 ounces or less of protein is advised. Lower sodium excretion will reduce urinary calcium levels, and also make thiazides more effective for reducing urinary calcium excretion. Finally, a lower oxalate intake will reduce the need for urinary elimination of oxalate. Dietary oxalate restriction is particularly important for patients with fat malabsorption and enteric hyperoxaluria, who absorb a higher percentage of oxalate from foods.
Jump to section:
- Kidney Stones
- Why do Kidney Stones Form?
- Genetics and Environment
- Not All Stones are Created Equal: Stone Analysis is Very Helpful
- Laboratory Evaluation
- Supersaturation Index
- Components of the Urinary Supersaturation Profile
- Uses of Urinary Supersaturation
- Common Features Increase Urinary Supersaturation in Patients with Idiopathic Calcium Oxalate Nephrolithiasis
- "Conservative" Dietary Recommendations for Calcium Oxalate Stone Formers
- Causes of Hypercalciuria
- Genetic Hypercalciuria
- Genetic Hypercalciuria: Treatment
- What is Oxalate?
- Hyperoxaluria: What is the Relevant Concentration?
- Oxalate Balance on a Typical Western Diet
- Enteric Hyperoxaluria is Caused by Fat Malabsorption
- Control of Urinary Citrate: Largely Due to Systemic Acid Base Balance
- Treatments for Enteric Hyperoxaluria
- Low Urinary Citrate
- Hyperuricosuria is a Risk Factor for Calcium Oxalate Stones
- Uric Acid is Very Insoluble at Low pH
- Calcium Phosphate is Very Insoluble at High pH!
- Cystine Stones
- Struvite stones