Funcional Foods For The

Treatment Of Kidney
Stones
Presented by Faiza Ikram
Summitted To: Dr. Anwaar Ahmad
Kidney stones (offen
called nephrolithiasis). In
Kidney there are hard,
crystalline mineral
concretions.
Types of kidney stones
There are 4 main types of kidney stones:
• There are 4 main types of kidney stones
• Calcium stones
• It occur in 2 forms
• Calcium oxalate (the most common kidney stone)
• Calcium phosphate.
• Uric Acid Stones
• when the urine is acidic. A diet rich in purines increases uric acid
in urine.
• Struvite Stones form in infected bladders or kidneys;
• Cystine stones are rare and hereditary.
Prevalance

Renal stone disease has been bothering humans for millions of

years. The prevalence of urinary tract stone disease is increasing.
• According to the U.S. National Health and Nutrition Examination
Survey (NHANES), as of 2012, 10.6% of men and 7.1% of women in
the United States are affected were effected. Furthermore, the 5-
year recurrence rates of stone disease are as high as 30% to 50% .
• Amongst other countries, it is most prevalent
in Pakistan2,3 wherestone patients represent the bulk of all
urological patients. In our clinic, more than 50% of all urological
patients are stone cases. (Scales CD, 2012).
• Following the dietary guidelines below may help to reduce the risk
of kidney stone format.
Risk Factor For Calcium Stone

(Vadim and David, 2016).

Risk Factors
Non Dietary Factors
• Family History (The risk of becoming a stone former is more than 2.5
times greater in individuals with a family history of stone disease.
• combination of genetic predisposition
• similar environmental exposures (e.g. diet).
• Increasing body size ( Weight gain also increases the risk of stone
formation. A 35 pound weight gain since early adulthood increased risk
of stone formation by 40% in men and 80% in women)
• History of gout (a history of gout was associated with a doubling of the
risk of forming a stone, independent of diet, weight and medications)
• Diabetes mellitus (a history of type II DM increased the risk of stone
formation by 30–50% in women but not in men).
• Environmental factors ( working in a hot environment appear, lower
fluid intake (Goldfarb†, 2006 ).
Nutrition assessment
• The dietitian's role in nephrolithiasis care is very important. Dietary assessment is very
important both in treating and preventing stone formation.
• The dietitian should evaluate dietary intakes of calcium, oxalates, sodium, protein
(both animal and plant), dietary supplements and fluid intake since these can either
promote or inhibit stone formation, and plan the therapeutic diet based on those
information (Haewook et al. , 2015).
DIETARY MANAGEMENT OF CALCIUM OXALATE STONES

• Hydration

For the eradication the risk of kidney stone one should increase the fluide intake to
reduce kidney stone risk. Low fluid in our body, urine output is decreased and urine flow
is slower, both of which are the sign for the risk of stone formation. We recommend 2.5
to 3L of fluide intake for drinking. Almost all beverages, including coffee, tea, wine, beer,
and fruit juices, are acceptable (Pearle MS, 2014).

• Fluids to avoid:
Tomato, Grapefruit, Cranberry juice,
• Tomato juice is high in sodium whereas grapefruit and cranberry juices are rich in
oxalate.
• Soda consumption may play a role in stone formation. One study found that patients
who quit soda drank at least 160 mL/d of soft drinks. they will be free from 3 years of
reocurrence than those who didn’t quit soda.However, this only for patients who drank
phosphoric acid-containing sodas, which consist primary of the colas, and not in
patients who drank citric acid-containing sodas, which include most clear soft drinks.
(Shuster J1 J. A., 1992).
3. Calcium
There is a misconception if we decrease calcium intake we will decreases the risk
of calcium stone formation. In fact, studies have shown that low dietary calcium actually
increases the risk of symptomatic kidney stones.
• With low calcium intake, there is not enough calcium in the digestive tract to bind with
oxalate, leading to increased oxalate absorption and oxalate excretion.
• Dietary sources of calcium include dairy products; calcium-fortified foods such as
orange juice, soy milk, tofu, and selected cereals; sardines with bones; and almonds.
• Target calcium intake is 1,200 mg, which is the equal of four 8-oz glasses of milk.
• Dietary calcium is more recommended than the calcium supplementation because
supplements may be a cause of stone formation.The reason has not been fully
elucidated but is thought to be secondary to timing of supplement intake or excessive
total calcium.
• If patients require calcium supplements, calcium citrate should be utilized instead of
calcium carbonate.
• Patients should take low-salt diet because NaCl leads to urinary calcium excretion
(Nouvenne A, 2010).
• 2,300 mg, or 1 teaspoon, of salt intake there is a 23-mg increase in urinary calcium A
good rule of thumb is the "5" rule, which dictates that if the word salt or sodium is
listed in the first five ingredients of a food label, that food should be avoided. Other
salt-rich foods that should be avoided include pizza and canned soups. (Curhan GC, 1997).
Dietary Calcium's effect on stone
recurrence
. There is a inverse relation between dietary calcium intake and recurrence rates in
epidemiologic evidance.
. A randomized controlled trial (RCT) assigned men with hypercalciuria to follow
either a diet low in calcium (400 mg) and oxalate or a diet higher in calcium (1200
mg) with restricted intake of oxalate, protein and salt.
At 5 years, the latter group had a 51% lower rate of stone recurrence than those
following a low-calcium diet. Low-calcium diets are not recommended and can
exacerbate the well-documented association of hypercalciuria with low bone
mineral density and increased fracture rates.
• But calcium supplements could in lowering stone recurrence rates has not been
tested. Taking calcium carbonate supplements with meals reduces oxaluria,
whereas taking them at bedtime increases calciuria and has no effect on oxaluria.
• The calcium supplement which is recommended only for kidney stone patient is
‘’calcium citrate’’ because it helps to increase urinary citrate excretion.
Recommended dose is 200–400 mg if dietary calcium cannot be increased. (Vadim
and David,2016 )
Supplementation Effect
• The impact of supplemental calcium appears to be different
from dietary calcium. In older women, calcium supplement users
were 20% more likely to form a stone than women who did not
take supplements, after adjusting for dietary factors.
• In younger women and men, the link between calcium
supplement use and risk of stone formation was not found.
• The discrepancy between the risks from dietary calcium and
calcium supplements may be due to the timing of calcium intake.
In these studies, calcium supplements were often taken in
between meals, which would diminish binding of dietary oxalate.
• The Women’s Health Initiative randomized trial also says that
there is 17% increased risk of stones with calcium
supplementation. (Gary,2009 ).
Oxalate

Higher oxalate intake has been shown to increase kidney

oxalate levels. The higher urinary oxalate levels increase the risk
of nephrolithiasis.
• However, we recommend limiting dietary oxalate only if the
patient has hyperoxaluria, because many of the oxalate-rich
foods are considered "heart-healthy." Together, spinach,
potatoes, and nuts account for 44% of oxalate intake for the
average. The simplest way to minimize oxalate intake is to
monitor consumption of these foods. In younger women,
chocolate is a significant source of dietary oxalate intake and
should be consumed sparingly (Taylor EN, 2007).
Vitamin C
• Higher vitamin C intake could increase the risk of calcium oxalate
stone formation.
• A metabolic trial demonstrated that the consumption of 1000 mg of
supplemental vitamin C twice daily increased urinary oxalate
excretion by 22%.
• An observational study in men found that those who consumed 1000
mg or more per day of vitamin C had a 40% higher risk of stone
formation compared to men who consumed less than 90 mg/day (the
recommended dietary allowance). This relation was observed only
after accounting for dietary potassium intake. Although
restricting dietary vitamin C does not seem appropriate (as foods high
in vitamin C are also high in inhibitory factors such as potassium), a
calcium oxalate stone former should be encouraged to avoid vitamin
C supplements (Gary C., 2009).
Protein

• The ingestion of animal protein has adverse affects on urine

chemistries:
• It lowers citrate excretion and increases calcium and uric acid
excretion.
• The recent popularity of diets low in carbohydrates and high in
animal protein have refocused attention on protein intake as a
risk factor for stones.
• Patients with recurrent stones should minimize their protein
intake to less than 80 g/d (Goldfarb†, 2006).
MANAGEMENT OF URIC ACID
STONES
• Uric acid stones account for 15% of all kidney stones. Animal protein
increases urinary calcium and uric acid, decreases urinary citrate and pH,
and increases bone resorption.
• Fish are particularly high in purines, secondary to their high protein levels,
and should be avoided in patients with uric acid stones .
• Other high-purine foods include organ meats, glandular tissue, gravies, and
meat extracts. Because uric acid stones form in acidic environments,
patients should increase their alkaline load by increasing their intake of
fruits and vegetables.
• Plant proteins do not seem to acidify the urine as much as animal proteins
and are therefore preferable. However, mushrooms, asparagus, green peas,
and spinach should be avoided.
• Patients with uric acid stones should also avoid high-fructose corn syrup,
which has been associated with hyperuricemia and hyperuricosuria [34].
• At a urinary pH of less than 5.5, uric acid is poorly soluble, but solubility
increases at a pH greater than 6.5 (Haewook. 2014).
MANAGEMENT OF STRUVITE
STONES
• Struvite stones are caused by an infection of the urinary tract
with urease-producing organisms, such
as Pseudomonas, Klebsiella, Proteus, Staphylococcus,
and Escherichia coli species. There is no role for dietary
therapy in the management of struvite stones. Treatment is
primarily surgical. If surgical options have been exhausted,
patients can be medically managed with acetohydroxamic acid
(AHA), 250 mg three times a day (Williams JJ, 1984.In
randomized controlled trials, AHA inhibited the growth of
struvite stones. However, patients undergoing AHA therapy
have to be monitored carefully for the serious side effects of
treatment, including phlebitis and hypercoagulable
phenomena (Rodman JS, 1987).
MANAGEMENT OF Cystine stones
• Hydration, dietary modification and urinary alkalinisation
• The main aim of treatment is the prevention of new stones and the dissolution
of existing ones. Hydration is the mainstay of the treatment. Patients are
advised to wake up at night to drink water in addition to their daytime intake.
Therefore, maintaining the urine output to keep up with cystine excretion
helps the prevention of stone formation. To prevent nocturnal aggregation of
crystals, 500 ml of water intake at bed time and another 300 ml overnight is
advocated.
• Methionine, a component of high-protein foods, is a metabolic precursor of
cystine; therefore, its restriction is advocated. Some have stressed the
decreased intake of sodium, as it has been shown to be effective in reducing
urinary cystine excretion.
• Urinary pH has a key role in the prevention of stone formation (Norman R W,
1990).Therefore, cystine stone formation can be reduced by increasing the pH
level. Oral alkalinisation treatment is a safe and effective way of keeping the
urine pH between 7.5 and 8.0. Potassium bicarbonate is safer than the sodium
compound (starting at 60–80 mEq/day) (Christopher S, 2001).
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