Kidney stone primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]

Overview

Effective measures for the primary prevention of nephrolithiais include diet control and high fluid intake.

Primary Prevention

• Effective measures for the primary prevention of nephrolithiais include:

Diet

•  A balanced diet is important along with its management for the risk groups.
  • It comprises fruits, vegetables, and fibers due to beneficial effects of fiber. The vegetarian diet provides alkaline content that help rise to a desirable increase in urinary pH.
  • An excessive intake of oxalate-rich products should be limited or avoided to prevent an oxalate load. This includes fruit and vegetables rich in oxalate such as wheat bran. This is particularly important in patients in whom a high oxalate excretion has been demonstrated. The following products have a high content of oxalate:
    • Rhubarb, 530 mg oxalate/100 g
    • Spinach, 570 mg oxalate/100 g
    • Cocoa, 625 mg oxalate/100 g
    • Tea leaves, 375 to 1450 mg oxalate/100 g
    • Nuts, 200 to 600 mg oxalate/100 g
    • Vitamin C is a precursor of oxalate, taking more than 500 to 1000 mg/day is not recommended.
  • Protein intake should be carefully monitored as it may cause hypercalciuria, hypocitraturia, low pH, hyperoxaluria, and hyperuricosuria. Animal protein should be limited to 0.8 to 1 g/kg body weight.
  • There is an inverse relationship between dietary calcium and calcium stone formation. The minimum daily requirement for calcium is 800 mg and the general recommendation is 1000 mg/day (refers to elemental calcium). Calcium supplements are not recommended except in cases of enteric hyperoxaluria.
  • A high consumption of sodium causes hypercalciuria by reduced proximal tubular reabsorption of calcium. Urinary citrate is reduced. The risk of forming sodium urate crystals is increased and the effect of thiazide in reducing urinary calcium is counteracted by a high sodium intake. The daily sodium intake should not exceed 3 g.
  • The intake of food particularly rich in urate should be restricted in patients with hyperuricosuric calcium oxalate stone disease, as well as in patients with uric acid stone disease. The intake of urate should not exceed 500 mg/day. Examples of food rich in urate include:
    • Calf thymus, 900 mg urate/100 g
    • Liver, 260 to 360 mg urate/100 g
    • Kidneys, 210 to 255 mg urate/100 g
    • Poultry skin, 300 mg urate/100 g
    • Herring with skin, sardines, anchovies, sprats, 260 to 500 mg urate/100 g

Other measures

• High fluid intake
  • Increased fluid intake of 2-3 L per day is protective against stone disease.