KIDNEY STONE THREAD

CLASS,

WHAT LIFESTYLE CHANGES ARE RECOMMENDED AFTER KIDNEY STONE REMOVAL?

PROF. BONDAD

Diet & Kidney Stone prevention ¨C Low Oxalate diet
Your kidneys are two bean-shaped organs, each about the size of your fist. They're located in back of your abdomen on each side of your spine, and their main function is to remove excess fluid, unneeded electrolytes and waste from your blood in the form of urine. The ureters carry
urine from your kidneys to your bladder, where it's stored until you eliminate it from your body.
The crystals that lead to kidney stones are likely to form when your urine contains a high concentration of certain substances !a especially calcium, oxalate, uric acid and rarely, cystine a or low levels of substances that help pevent crystal formation, such as citrate and magnesium. Crystals also may form if your urine becomes too concentrated or is too acidic or
too alkaline.
A number of factors can cause changes in your urine, including the effects of heredity, diet,
drugs, climate, lifestyle factors and certain medical conditions. Each of the four main types of
kidney stones has a different cause: Calcium stones. Roughly four out of five kidney stones are calcium stones. These
stones are usually a combination of calcium and oxalate. Oxalate is a compound that
occurs naturally in some fruits and vegetables. A number of factors can cause high
concentrations of these substances in urine. Excess calcium, for instance, may result
from ingesting large amounts of vitamin D, from treatment with thyroid hormones or
certain diuretics, and from some cancers and kidney conditions. You may also have
high levels of calcium if your parathyroid glands, which regulate calcium metabolism,
are overactive (hyperparathyroidism). On the other hand, certain genetic factors,
intestinal bypass surgery and a diet high in oxalic acid may cause excess amounts of
oxalate in your body.
Prevention
In many cases, you can prevent kidney stones by making a few lifestyle changes. If these
measures aren't effective and blood and urine tests reveal a correctable chemical imbalance or
that the stones you have are getting bigger, your doctor may prescribe certain medications.
Lifestyle changes
For people with a history of kidney stones, doctors usually recommend passing at least 2.5
quarts of urine a day. To do this, you'll need to drink about 3.5 quarts (14 cups) of fluids every
day !a and even more if you live in a hot, dry limate. Although most liquids count, water is
best.
In addition, if you tend to form calcium stones !a a combinationof calcium and oxalate !a your
doctor may recommend restricting foods rich in oxalates. These include:
draft beer, chocolate beverage mixes, cocoa, instant tea and coffee
Beverages:

Breads & Cereals: Grits(white corn) wheat bran/germ and whole-wheat flour
Desserts: Fruitcake, deserts containing fruits listed below
nuts, Nut butters (including Peanut butter)
Fats:
Fruits:
berries, Concord grapes, red currants, damson plums, rhubarb, lemon, lime and
orange peels, tangerines, star fruit.
Baked beans with tomato sauce, tofu
Meats & meat subs:
Beans (wax or legume) beets, beets & beet greens, collards, okra, refried beans,
Vegetables:
greens (spinach, endive, escarole, parsley, swiss chard), eggplant, summer squash, sweet
potatoes, sesame seeds, almonds and soy products.
Misc: Chocolate, cocoa, carob powder, Vitamin c intake in excess of RDA
What's more, studies show that an overall diet low in salt and very low in animal protein can
greatly reduce your chance of developing kidney stones.
As a general rule, restricting your intake of calcium doesn't seem to lower your risk. In fact,
researchers have found that women with the highest calcium intake are less likely to develop
kidney stones than are women who consume less calcium. Why? Dietary calcium binds with
oxalates in the gastrointestinal tract so that oxalates can't be absorbed from the intestine and
excreted by the kidney to form stones.
An exception to this rule occurs when an individual absorbs too much dietary calcium from the
intestine. In such a circumstance, restricting calcium intake is useful.
Calcium supplements seem to have the same protective effect as dietary calcium, but only if
they're taken with meals. When taken on an empty stomach, the calcium can't bind with the
oxalates in food.
Medications
Medications can control the level of acidity or alkalinity in your urine and may be helpful in
people who form certain kinds of stones. The type of medication your doctor prescribes will
depend on the kind of kidney stones you have: Calcium stones. To help prevent calcium stones from forming, your doctor may
prescribe a thiazide diuretic or a phosphate-containing preparation. If you have calcium
stones because of a condition known as renal tubular acidosis, your doctor may suggest
taking sodium bicarbonate or potassium bicarbonate.

Original Article:http://www.mayoclinic.com/health/kidney-stones/DS00282

th
Edition
Additional resource: American Dietetic Association Manual of Clinical Dietetics 6

ANSWER: According to this research recurrent kidney stone will be prevented by a low salt and low protein diet. A low calcium diet is not beneficial to prevent kidney stone formation and it can cause decalcification of bones thus kidney stone formation will occur. This type of lifestyle is recommended to patients undergone a kidney stone removal to prevent the burden from pain and expenses from surgery and having the disease.

TITLE: What is the best diet to prevent recurrent calcium oxalate stones in patients with idiopathic hypercalciuria?
BY: Andrew R. Lockman

This is a study by Andrew R Lockman to compare the traditional low calcium diet with a diet that is low in animal protein and salt if which is best to prevent the recurrence of kidney stone formation. Many physicians recommend a low-calcium diet in patients with calcium oxalate stones to prevent recurrence but recent studies suggest that a low-calcium diet may not be effective and that intake of animal protein and salt may influence renal calcium excretion. This study enrolled 120 men with idiopathic hypercalciuria with urinary calcium excretion of more than 300 mg per day on an unrestricted diet who had been referred to a nephrology clinic in Parma, Italy, and who had had at least 2 episodes of symptomatic renal stones. The basis for exclusion included previous visits to any “stone disease center” and conditions associated with calcium stones, such as hyperparathyroidism or inflammatory bowel disease. The researchers randomly assigned subjects, using concealed allocation, to 1 of 2 diets in this randomized controlled study. The low-calcium diet with a 400 milligrams per day. The other diet, which included about 1200 mg per day of calcium, limited sodium chloride to about 3000 mg and animal protein to 93 g or 15 percent of total calories. The primary measure of outcome of this study was the time to development of the first recurrence of a renal stone, whether or not it was clinically evident and the other measure of outcomes included changes in calcium and oxalate excretion and calcium oxalate saturation in the urine.

The result of this study after 5 years shows that a low-protein, low-sodium diet led to fewer recurrences with a 20 percent compared with 38 percent in the low-calcium group. The risk of recurrence in the low-calcium group was similar to the 35 percent to 40 percent expected in the absence of any intervention. The changes of this type of disease in urine characteristics were predictable such as urinary calcium decreased in both groups, but oxalate secretion increased in the low-calcium group, causing greater calcium oxalate saturation.

A low calcium diet is not recommended to patients with previous kidney stones, a low calcium diet may lead to bone decalcification and cause calcium oxalate formation in the urine. Some research says that you should maintain the recommended calcium level but minimize the intake of food reach in protein and salt to prevent the attraction of calcium to stay in urine.


Reference:
Lockman A.R. (2002). What is the best diet to prevent recurrent calcium oxalate stones in patients with idiopathic hypercalciuria? The Journal of Family Practice. Vol. 51, No. 4 pages 77-84.
http://www.jfponline.com/Pages.asp?AID=1174

ANSWER: Changes in the diet or food lifestyle is imperative after kidney stone removal. Diet modifications will depend on the type of stone removed to prevent recurrence of that kind of stone. the study below attest to my statements:

Kidney stone disease

About 5% of American women and 12% of men will develop a kidney stone at some time in their life, and prevalence has been rising in both sexes. Approximately 80% of stones are composed of calcium oxalate (CaOx) and calcium phosphate (CaP); 10% of struvite (magnesium ammonium phosphate produced during infection with bacteria that possess the enzyme urease), 9% of uric acid (UA); and the remaining 1% are composed of cystine or ammonium acid urate or are diagnosed as drug-related stones. Stones ultimately arise because of an unwanted phase change of these substances from liquid to solid state. Here we focus on the mechanisms of pathogenesis involved in CaOx, CaP, UA, and cystine stone formation, including recent developments in our understanding of related changes in human kidney tissue and of underlying genetic causes, in addition to current therapeutics.

Treatment trials: stone recurrence outcomes

To date, 7 of 8 prospective trials, each lasting at least 3 years, have shown that selective treatments have a distinct benefit for idiopathic CaOx SFs (Table (Table5).5). Table Table55makes clear that dropout rates were high, and we are not aware that any of the investigators followed up with those individuals that did not complete the trial in order to ascertain their stone status. Therefore, additional trials may not be altogether without merit. Even so, and despite these imperfections, it is difficult to conclude that treatments are without important benefits.

Thiazide and citrate: recurrent calcium SFs.
Three prospective trials of potassium citrate salts have been performed to date, and 2 (115, 116) indicate therapeutic benefit (Table (Table5).5). The third (117) lacks a double-blind design, and its control subjects formed fewer stones than those in the other studies. All subjects were CaOx SFs with hypocitraturia. Thiazide diuretic agents have been studied in 3 randomized, controlled, double-blind trials. Chlorthalidone (118) at doses of 25 mg/d or 50 mg/d gave equivalent results that are pooled (Table (Table5).5). Hydrochlorothiazide gave therapeutic effects equivalent to chlorthalidone (119), as did indapamide (120).
Dietary changes for recurrent calcium SFs.
Borghi et al. (32) compared a low-calcium diet to a normal calcium diet reduced in protein and sodium in a 5-year randomized trial (Table (Table5).5). The 2 diets gave comparable results during the first 3 years, but by 5 years, the normal calcium, reduced sodium, and protein diet proved superior in that only 23% of patients had formed a new stone.
Allopurinol: recurrent calcium SFs.
Allopurinol (121) has been shown to reduce new CaOx stone formation in patients with hyperuricosuria (Table (Table55).
Patients who have formed only 1 calcium stone.
Over a 5-year period, 20% of patients who maintained a urine volume above 2.5 l/d had stone recurrence (122) compared with approximately 50% of patients who were counseled to avoid dehydration and to observe moderate salt and protein intakes. Counseled controls did not actually increase urine volume. We do not combine this trial with the others, as it concerns only SFs with a single stone.

It is difficult to accept recurrent stone formation as incidental in any patient and allow it to continue without efforts to understand its causes and offer such treatments as seem appropriate. Available trials offer physicians excellent treatment strategies for prevention of calcium stones, and since UA stones are a consequence of low urine pH, physicians can treat them confidently despite the lack of prospective trials for additional therapeutics. Even cystine stones can be prevented, albeit with imperfect remedies. But treatments may pose their own problems. Although potassium citrate salts are effective, they, along with ESWL, may promote the formation of CaP stones, the prevalence of which continues to rise with time. Possibly this means that the use of citrates requires special attention to avoid increasing CaP SS excessively via high urine pH. Although we treat urine SS, the tissue processes of stone formation are complex, not as yet obviously related to solution chemistry within specific nephron segments, and not well understood. This is a significant area of interest that requires new research. Abnormal urine pH and calcium excretion rate are predominant findings in SFs that play a major role in the pathogenesis of stone formation. Their biologies are therefore also of particular research importance. Perhaps most important in the long run will be uncovering the links between genetic variability and urine calcium excretion and pH, for these seem at the very center of the problem of kidney stone disease.

Reference: Coe, F. et. al. Kidney stone disease. The Journal of Clinical Investigation. 2005 October 1

WHAT LIFESTYLE CHANGES ARE RECOMMENDED AFTER KIDNEY STONE REMOVAL?

-Drink plenty of fluids (water,orange juice), have regular exercise to maintain ideal weight because obesity and weight gain increase the risk of kidney stone formation(Taylor, Stampfer and Curhan, 2005) and modify the Diet(depends on the type of stone that was previously developed). Below is the study made by Clarita Odvina about the role of orange juice in reducing the risk for recurrent kidney stone.


Comparative Value of Orange Juice versus Lemonade in
Reducing Stone-Forming Risk
Clarita V. Odvina

Odvina, C. made a randomized, crossover study to analyze and compare the effects of orange juice and lemonade on acid-base profile and urinary stone risk factors while on constant metabolic diet. A total of 14 participants involved in the study .10 healthy volunteers and 4 stone formers with age ranging from 20 to 65 years were included. Exclusion criteria: recurrent or active urinary tractinfection; with renal tubular acidosis; primary hyperparathyroidism; hyperkalemia;those who have diseases or medications that potentially could affect acidbase Status; gouty diathesis; gastrointestinal disease; renal insufficiency;chronic diarrhea; pregnant women; women who were nursing; patients with hypercalcemia; with calcium phosphate stones with secondary etiology; struvite; and uric acid stones. All of the participants underwent three phases of the study, each lasting 1 week. During the orange juice phase, participants were asked to consume 400ml of orange juice three times a day with meals. In the lemonade phase, participants drank 400 ml of lemonade three times a day with meals. In the control phase, participants drank 400 ml of distilled water using the same dosing interval. Participants were maintained on a constant low-calcium, low-oxalate, metabolic diet throughout the 3 phases.


There is a significantly higher urinary citrate excretion of orange juice consumption while lemonade had no significant effect on urinary citrate. Urinary oxalate was significantly higher with the orange juice compared with control (distilled water), this was not seen with lemonade consumption. Urinary pH was higher in the orange juice phase by 0.6 unit compared with the lemonade and control phases. Orange juice phase (RSR0.82) have higher Relative saturation ratios of brushite compared with lemonade (RSR0.32 )and control phases (RSR 0.42 ).


The randomized, crossover study by Odvina, C. provided an evidence that orange juice provides an alkali load based on the rise in NGIA, urinary pH, and citrate, and reduction in urinary ammonium, titratable acidity, and net acid excretion. Orange juice also reduces the propensity for crystallization of calcium oxalate and uric acid and promotes hypercitraturia.Since an increase in urinary citrate and pH could provide protection against calcium and uric acid stone formation, orange juice but not lemonade potentially could play an important role in the management of recurrent nephrolithiasis. Orange Juice may be considered an option in patients who are intolerant of potassium citrate.

Odvina, Clarita. (2006). Comparative Value of Orange Juice versus Lemonade in Reducing Stone-Forming Risk. Clin J Am Soc Nephrol 1: 1269–1274. Retrieved August 13, 2009 from http://cjasn.asnjournals.org/cgi/reprint/1/6/1269.pdf

Taylor, E, Stampfer,M., Curhan, G. (2005). Obesity, Weight Gain, and the Risk of Kidney Stones. JAMA.293(4):455-462. Retrieved August 15, 2009 from http://jama.ama-assn.org/cgi/reprint/293/4/455.pdf

Concentrated urine enhances the formation of crystals so sufficient fluid should be consumed to produce 2000 mL of urine per day. About 300 mL or 13 cups of water per day are necessary to produce this amount or urine.
Approximately 80% of kidney stones are composed of calcium oxalate, which led to early prescriptions for low-calcium diets, but it was later found that a high-calcium intake binds dietary oxalate in the gastrointestinal tract and prevents its absorption, thereby reducing urinary oxalate formation. If a low-oxalate diet is prescribed, foods such as beets, rhubarb, spinach, cocoa, and instant coffee may be restricted.
Uric acid kidney stones can be a complication of gout, which is a disorder of purine metabolism. Purines are end products of digestion of certain proteins and are present in some medications. High-purine foods include fruits, milk, cheese, refined grains, sugars, coffee, tea, carbonated beverages, tapioca, yeast, and vegetables (except asparagus, beans, cauliflower, mushrooms, peas and spinach).


Reference:
Williams, L. S. & Hopper, P.D. (2007). Understanding Medical-Surgical Nursing, 3rd edition. Philadelphia, PA: F.A. Davis Company. 37: 785.

A simple and most important lifestyle change to prevent stones is to drink more liquids—water is best. In general, someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.

In the past, people who formed calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that a reasonable intake of foods high in calcium, including dairy products, may actually help prevent calcium stones . Taking calcium in excess, however, may increase the risk of developing stones.

Someone who has highly acidic urine or with high urinary uric acid levels may need to eat less meat, fish, and poultry. These foods increase the amount of acid and uric acid in the urine.

To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night. The goal with cystine stones is to drink sufficient water to make at least 3 liters of urine a day or more.

People prone to forming calcium oxalate stones may be asked to limit or avoid certain foods if their urine contains an excess of oxalate. These high-oxalate foods include:

* Rhubarb
* Spinach
* Beets
* Swiss chard
* Wheat germ
* Soybean crackers
* Peanuts
* Okra
* Chocolate
* Black Indian tea
* Sweet potatoes

Foods that have medium amounts of oxalate may be eaten in limited amounts. These foods include:

* Grits
* Grapes
* Celery
* Green pepper
* Red raspberries
* Fruit cake
* Strawberries
* Marmalade
* Liver

Dietary and Holistic Treatment of Recurrent Calcium Oxalate Kidney Stones
Laura R. Flagg, MSN, RN, CNP

Having kidney stones can cause morbidity among clients who are vulnerable to this kind of condition. Certain dietary measures were traditionally tested and advised to these clients to prevent recurrence or to decrease risks of developing the condition. These include increase fluid, oxalate, protein, citrate, calcium, and sodium changes in the diet. However, evidence-based practice recommends that only a little evidence confidentiality supports diet modification and fluid intake to affect formation of stones or reduce risks of recurrence of stone formation. The study conducted by Flagg (2007) regarding the dietary and holistic treatment of recurrent calcium oxalate kidney stones provided literature which may be used for evidence-based practice to prevent stone reformation.

A literature review did provide good evidences that having an increased in fluid intake may reduce the rate of stone formation. It is suggests that the urine should me maintained to appear very light yellow in color to clear at all times. With this, the measurement of the water requirement can be easily estimated. This technique can be recommended safe for clients without kidney or heart failure.

Supporting evidences about the regulation of calcium intake to prevent stone formation was also reviewed. Based on previous researches, dietary calcium is safer than intake of supplemental calcium. If the patient is having calcium supplements, it should be considered to take it with meals only.

An increase in meat consumption can also increase the risk of developing kidney stones. Patients should reconsider a choice to have a low-carbohydrate, high-protein diet as a weight loss diet program while taking in consideration the risk of stone formation.

The information on vitamin C intake is contradictory. Supplemental vitamin C use should be undertaken cautiously among stone formers. Lemonade may be a good fluid choice among patients known to have low levels of urinary citrate, rather than grapefruit juice. Future studies should attempt to evaluate the breakdown of ascorbate to oxalate vs. citrate, as the association each has to stone formation is significant.

Patients may find the use of herbal therapies appealing, particularly when traditional Western treatment fails. Clinicians need to inquire about herbal treatments used by patients in their assessments, especially when their stones recur. It is important for the clinician to communicate, through nonjudgmental language, that there is insufficient evidence to support the use of phytotherapeutic agents for kidney stones at this time as the field remains untested.

References:
Laura R. Flagg, MSN, RN, CNP, is a Clinical Nurse at The University Hospital, and a Graduate Student at the University of Cincinnati, Cincinnati, OH.

Natural Net. (n.d.). Dandelion Taraxacum officinale. Encyclopedia of herbs. Retrieved December 4, 2006, from http://www.allnatural.net/herbpages/dandelion.shtml

Borghi, L., Meschi, T., Amato, F., Briganti, A., Novarini, A., & Giannini, A. (1996). Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: A 5-year randomized prospective study. Journal of Urology, 155, 839-843.

Chai, W., Liebman, M., Kynast-Gales, S., & Massey, L. (2004). Oxalate absorption and endogenous oxalate synthesis from ascorbate in calcium oxalate stone formers and non-stone formers (abstract). American Journal of Kidney Diseases: The official journal of the National Kidney Foundation, 44, 1060-1069.

Answer:
Diet modification such us increased fluid intake, avoid oxalate rich foods, low protein, and low salt diet.

Diet to Reduce Mild Hyperoxaluria in Patients with Idiopathic Calcium Oxalate Stone Formation: A Pilot Study
Nouvenne A., et. al.

Approximately 10% Americans suffered from kidney stones which is a very common and painful; urological disorder. While most stones pass spontaneously, obstructions result in renal colic, often requiring aggressive management of pain. If obstructions persist, extracorporeal shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy may be required for a stone's removal. According to American Society of Consultant Pharmacists, Incorporated (2009), the recurrence rates are high and prevention includes increased fluid intake, dietary restrictions, and the use of pharmacotherapy. Stone recurrence increases with age, underscoring the importance of prevention for those 60 years of age and older.
The article treated 56 patients with idiopathic calcium oxalate stone formation who presented with mild hyperoxaluria (40 mg/d), while consuming a free diet with a normal-calcium, low-animal protein, and low-salt diet for a 3-month period. Diet modification is prescribed to client with high risk urine lithogenic profile or those clients that is high risk for stone formation with mild hyperoxaluria. The results suggest that the diet prescription is beneficial effects during the high risk stone forming patient. Daily nutrient composition for a post renal client is the prescribed normal-calcium, low-animal protein, and low-salt diet. The patients were also instructed to avoid oxalate-rich foods such as spinach, rhubarb, beets, chocolate, cereals, nuts, tea, wheat bran, and strawberries and to drink water in amounts of roughly 2 L during cold weather and 3 L during warm/hot weather.

Reference:
Nouvenne A., et. al. (2008), Diet to Reduce Mild Hyperoxaluria in Patients with Idiopathic Calcium Oxalate Stone Formation: A Pilot Study, Retrieved on August 17, 2009 from, http://www.mdconsult.com/das/article/body/146357743-3/jorg=journal&source=MI&sp=21986404&sid=856919973/N/692863/s0090429508018359.pdf?SEQNO=5&issn=0090-4295

Dietary modification is recommended after kidney stone removal to prevent formation of kidney stone. Intake of 2.5–3 L of fluids per day is prescribed. For unclear reason, drinking grapefruit juice consistently increases stone risk, while lemon juice with higher citrate content might have helpful effects on urinary chemistry but intake of it has not been revealed to prevent stones.

Calcium citrate is the preferred calcium supplement for people at risk of stone formation as it helps to increase urinary citrate excretion. Recommend dose is 200–400 mg/day if dietary calcium cannot be enhanced. High oxalate food should be limited. Since vitamin C can be converted to oxalate, vitamin C supplements may increase oxaluria and be associated with an increased risk of stone formation; therefore, the dose should be limited to less than 1000 mg/d.

Animal protein ingestion has adverse affects on urine chemistries as it decreases citrate excretion and increases calcium and uric acid excretion. Epidemiologic data reveal that it correlates well with the prevalence of stone formation. Popularity of diet that is low in carbohydrates and high in animal protein has refocused attention on protein intake as a risk factor for stones. Patients with recurrent stones should limit protein intake to less than 80 g/d.

Reference:
Finkielstein, V., & Goldfarb, D. Strategies for preventing calcium oxalate stones. Canadian Medical Association Journal (2006). 174 (10). Retrieved August 18, 2009, from http://www.cmaj.ca/cgi/content/full/174/10/1407

WHAT LIFESTYLE CHANGES ARE RECOMMENDED AFTER KIDNEY STONE REMOVAL?

Answer

Recurrence of Kidney stones formation after its removal had been markedly known in the field of research and medicine. The focus of my answer to the thread question is on the factors specifically the diet that has been proven to have an effect on recurrence of kidney stone. The research entitled:” Dietary Factors and the Risk of Incident Kidney Stones in Men: New Insights after 14 Years of Follow-up” confirms the importance of individual dietary factors in the development of symptomatic kidney stones. The researchers show the importance of evaluating the intake of foods that are high in calcium, potassium, and magnesium that increases the risk of kidney stones recurrence. . Although vitamin C intake is associated with an increased risk of stones, the high amount of potassium in vitamin C-rich foods suggests that limiting the intake of dietary vitamin C in men with calcium oxalate nephrolithiasis is unwarranted. However, they recommend that calcium oxalate stone formers abstain from cosuming supplemental vitamin C. The finding also show that the association between dietary factors and kidney stone formation varies with age and BMI.

Referrence:

Eric N. Taylor , Meir J. Stampfer, and Gary C. Curhan ; Dietary Factors and the Risk of Incident Kidney Stones in Men: New Insights after 14 Years of Follow-up. J Am Soc Nephrol 15: 3225-3232, 2004.

Increase your liquid intake - Dehydration is a major risk factor for kidney stones. Drinking lot of water and natural juice allows your body to diluting elements present in the urine. you should drink at least 8 glasses of water per day for less active people, and at least 10 glasses for athletes。 Although it can be annoying, it is also important to drink a glass of water during the night. During hot season, you should drink even more.
Eat more fruits and vegetables - curative effects of eating fruits is enormous. A diet rich in fruits participates in many vital body functions, including increasing citrate, a major inhibitor of crystallization of salts in your urine. However, consumption of certain fruits and vegetables must be limited.
Lemonades and grapefruit juice significantly increase urinary excretion of citrate, calcium and magnesium. Citrus fruit juices could represent a natural alternative to potassium
Orange juice is also recommended; it increases citrate in the urine while reducing the crystallization of uric acid and calcium oxalate.
Limit your protein intake – high protein intake tends to cause crystallization of salts in the urine, by increasing the level of calcium, oxalate and uric acid, and lowering the level of citrate (a key substance in the prevention of formation of kidney stones). Animal proteins (meat, fish, poultry, game, etc.) are most often involved in this disorder.
It is important that you reduce consumption of foods high in oxalate: chocolate, peanuts, hazelnuts, asparagus, beets, spinach, rhubarb, etc.
Reduction of salt in your diet is also essential. Salt and salted products promote formation of calcium in the urine, which leads to kidney stones. In addition, avoid beer and soft drinks. These drinks are too acidic for your urine; they can lead to formation of stones. Certain supplements such as vitamin C must be taken in small quantities.
reference:http://www.articlesbase.com/diseases-and-conditions-articles/4-methods-for-kidney-stone-removal-644071.html

answer:

Lifestyle Changes
A simple and most important lifestyle change to prevent stones is to drink more liquids—water is best. In general, someone who tends to form stones should try to drink enough liquids throughout the day to produce at least 2 quarts of urine in every 24-hour period.

In the past, people who formed calcium stones were told to avoid dairy products and other foods with high calcium content. Recent studies have shown that a reasonable intake of foods high in calcium, including dairy products, may actually help prevent calcium stones . Taking calcium in excess, however, may increase the risk of developing stones.

Someone who has highly acidic urine or with high urinary uric acid levels may need to eat less meat, fish, and poultry. These foods increase the amount of acid and uric acid in the urine.

To prevent cystine stones, a person should drink enough water each day to dilute the concentration of cystine that escapes into the urine, which may be difficult. More than a gallon of water may be needed every 24 hours, and a third of that must be drunk during the night. The goal with cystine stones is to drink sufficient water to make at least 3 liters of urine a day or more.

People prone to forming calcium oxalate stones may be asked to limit or avoid certain foods if their urine contains an excess of oxalate. These high-oxalate foods include:

Rhubarb
Spinach
Beets
Swiss chard
Wheat germ
Soybean crackers
Peanuts
Okra
Chocolate
Black Indian tea
Sweet potatoes
Foods that have medium amounts of oxalate may be eaten in limited amounts. These foods include:

Grits
Grapes
Celery
Green pepper
Red raspberries
Fruit cake
Strawberries
Marmalade
Liver

Nancelle Grace G. Dumlao

KIDNEY STONE THREAD

WHAT LIFESTYLE CHANGES ARE RECOMMENDED AFTER KIDNEY STONE REMOVAL?
ANSWER :

People with a history of kidney stone must double their efforts in changing their lifestyles. They must be more mindful of what they eat because they appear to be more sensitive to certain foods than those who have not had kidney stones. These vulnerable patients must coordinate closely with their doctors to come up with a diet tailored for their own individual needs.

There are different kidney stones and each has a special diet regimen, but for all types, the number one rule is to drink plenty of fluids to prevent recurrence of any stones. Doctors recommend drinking 3 to 3.5 liters of fluids and passing at least 2.3 liters of urine per day and more if the climate is hot and dry. Water is the best option, but drinkng a glass of lemonade is recommended (avoid powdered lemonade mixes) because it allows more citrate to be excreted in the urine and thus preventing stone formation. Orange juice is not recommended even if it also increases citrate levels in the urine because it does not lower calcium and in fact it raises oxalate levels.

Another diet change should be restricting oxalate-rich foods if the patient tend to form calcium oxalate stones. Some foods rich in oxalates are beets, okra, spinach, sweet potatoes, sesame seeds, almonds and soy products. Moreover, there are studies which support that low-salt and very low animal protein diet can reduce recurrence of stones.

On the other hand, studies show that restricting calcium intake does not really reduce the risk of forming stones. In fact, calcium in the diet helps calcium to bind with oxalates in the gastrointestinal tract so that oxalates will not be absorbed from the intestines and excreted by the kidney to form stones.

This is supported by the study below which was conducted by von Unruh and colleagues in 2004 on the dependence of oxalate absorption on the daily calcium intake.

Dependence of Oxalate Absorption on the Daily Calcium Intake.
By: von Unruh, G.E., Voss, S., Sauerbruch, T., Hesse, A (2004)

This study was conducted to validate the claim that increasing daily calcium in the diet will help reduce oxalate absorption since oxalate binds with calcium and thereby reducing the presence of oxalates in the urine which may lead to formation of calcium oxalate stones.

The participants in the study involved 8 healthy volunteers, 3 women and 5 men, with age ranging from 20 and 59, weight range from 49 to 92 kg, BMI of 17 to 26 kg/m2. The volunteers had normal urinalyses using dipsticks before each test and had no history of GIT or kidney illness. To assess the amount of oxalate excreted in the urine, the standardized [13C2]oxalate absorption test was developed by using the original [14C]oxalate absorption test as a model.

The volunteers were given identical diet for 2 consecutive days. The standard diet contained 2500 kcal, 83 g protein, 350 g carbohydrates, 96 g fat, 800 mg (20 mmol) Ca, 750 mg (31 mmol) Mg (data calculated), and 63 mg (0.7 mmol) oxalic acid per day (measured by an HPLC enzyme reactor method). Absorbed oxalate levels were measured from urine collected at certain time intervals. All reported values refer to urine collected in 24 hours after intake of a labeled sodium oxalate capsule soluble in gastric juice. With a daily intake of about 800mg of calcium, about 2 to 20% of ingested oxalate is absorbed in the GIT of healthy persons. The study investigated the oxalate absorption in the volunteers with calcium intake ranging from 200 to 1800 mg per day.

Results show that GIT oxalate absorption depends linearly and strongly on 200mg to 1200 mg of calcium intake per day. Additional calcium of more than 1200 mg/day ( to about 1800mg) reduced oxalate absorption but only minimally. Thus, the study proved that calcium in the diet of 1200 to 400 mg increases the absorption of dietary oxalate by fivefold resulting to reduced incidence of calcium oxalate stone formation. Hence, these findings could be used to explain why doctors should advice their patients that a low- calcium diet could increase the risk of developing calcium oxalate stones.


Reference:
von Unruh, G.E., Voss, S., Sauerbruch, T., Hesse, A. Dependence of Oxalate Absorption on the Daily Calcium Intake. Journal of American Society of Nephrology. 2004, 15:1567-1573.