kidney Stones (calcium oxalate)

by CDC recommendation

at the first the normal urine output range for 24 hour urine volume is 0.5 - 1.5 CC/kg / hr

all stones formers pt may benefit from increased fluid intake to produce at least 2 liters of urine per day

most common diseases need the nutrition education and intervention

it's very known medical history may suggest that lifestyle that may contribute to the stones formation, including:

1- dietary habits (high animal protein,high vitamin C and vitamin D supplements,etc..)

2- low fluid consumption

3-excessive intake of stones trigger foods (high oxalate foods choices, etc....)

for diagnosis of kidney stones by lab investigations (urinalysis, blood test, and radiography )

urinalysis should include:

1-acidity, A pH that is above the normal range may mean you are at the risk for a kidney stone, a PH greater than 7.5 raises the possibility of the formation of a stones

2- protein, But it should only be in your blood, not in your urine, When your kidneys are injured, protein leaks into your urine

3-Glucose (sugar) is usually a sign of diabetes

4-White blood cells (pus cells) are signs of infection, like UTI

5-Bilirubin is a waste product from the breakdown of old red blood cells, Its presence in the urine may be a sign of liver disease

6-Blood can be a sign of an infection, a kidney problem

1-calcium oxalate kidney stone is the most common

Calcium stones are the most common. They’re often made of calcium oxalate (though they can consist of calcium phosphate or maleate). Eating fewer oxalate-rich foods can reduce your risk of developing this type of stone

2- Uric acid stones Uric acid stones form when your urine is often too acidic. Uric acid can form stones by itself or with calcium

3- Struvite stones can happen when you have certain types of urinary tract infections in which bacteria make ammonia that builds up in your urine

4-Cystine stones are made of a chemical that your body makes naturally, called cystine. Cystine stones are very rare, and happen in people who have a genetic disorder that causes cystine to leak from the kidneys into the urine

pt at risk to develop calcium oxalate kidney stones:

a diet too high in (protein, oxalate, sodium, suger)

obesity

medical condition

digestive disease or surgery(gastric bypass, Crohn's disease, IBD

Dehydration from not drinking enough fluid

MEDICAL NUTRITION THERAPY DIFFERNET ACCORDING TO THE TYPE OF STOENES

• CALCIUM OXALATE

1- increase fluid intake

This will dilute urine and reduce the concentration of harmful substances that may cause kidney stones to form, At least half of the liquid drink each day should be water

although it is not essential that the pt wake up several times per night to urinate

the risk for stones formation might be affected by the type of beverage consumed

Sugar sweetened colas and non-cola drinks were associated with the development of kidney stones. Punch was also associated with more stones. But drinks with sugar in them were not all bad. Apple juice, grapefruit juice, cranberry juice and tomato juice did not raise or lower risk of stones.

Coffee, decaffeinated coffee, tea, red wine, white wine, orange juice, and beer were the winners. People who used more had a lower risk of new stones

2-reduce intake of non-diary animal protein (eat in moderation)

a high protein diet since the metabolism of sulfur containing amino acids increase the daily acid load by generating sulfuric acid

it has a higher sulfur content and therefore generates more acid

lowering animal protein intake will produce favorable changes in the urine, however, it has not been proven that this will reduce the incidence of stone formation.

3-limit dietary oxalate intake

the most high oxalate foods are ( spinach,potatoes), in addition, some nuts and legumes

however, there is low evidence that low oxalate diets reduce the risk of stone formation, so high oxalate foods not causing kidney stones

but should be avoided when for treatment of calcium oxalate stone

and not support to strict oxalate restriction

how many gm of oxalate in foods to be high source ?

if the oxalate content reach 10 mg or more per serving

by Harvard school of public health (nutrition department's), which is a great reference for high oxalate foods, and alternative, low oxalate diet example by so simple table on excel

to continue reading at Harvard website click here

also to national kidney foundation, A better plan? Eat and drink calcium and oxalate-rich foods together during a meal. Doing this helps oxalate and calcium “bind” to one another in the stomach and intestines before reaching the kidneys, making it less likely for kidney stones to form in the urine

and following the plate for calcium oxalate stone:

1- 2 fruits serving

1 cup cooked or 2 cups raw

2- 3 oz = 60 - 90 gm lean protein serving

1-2 grain serving

3 liter of fluid daily

3 serving of dairy products with each meal

there is a plate for the vegan also

4- limit sodium intake

Limit table salt to no more than ¼ teaspoon a day

Omit salt in cooking; add ¼ teaspoon to fresh or prepared food to maximize flavor.

higher sodium intake may be associated with higher urine volume

5-calcium intake

restricting dietary calcium intake is not generally recommended

recommend advising patient patient for 1200 mg/day not exceed 1500 mg/day

It should be noted that calcium supplements do not appear to be effective in preventing recurrent stones and may even slightly increase risk

In patients with a history of stones who require calcium supplements (eg, for the treatment of osteoporosis), a suggested approach is to measure urinary calcium excretion before and approximately one month after starting the calcium supplement.

so not to supplement patient with calcium if not consume 1200 mg/day only natural sources

6- vitamin c supplement

Vitamin C may also be a problem because it can be converted to oxalate

Do not consume more than 500 mg of vitamin C each day. This includes vitamin C from the foods you eat and from any oral supplement you may take.

7-weight control

may help prevent stones recurrence

for my next topic, I will explain MNT for other stones (URIC ACID, etc...)

References

https://www.kidney.org/atoz/atozTopic_KidneyStones

https://www.kidney.org/sites/default/files/11-10-1815_HBE_PatBro_Urinalysis_v6.pdf

https://www.nhs.uk/conditions/kidney-stones/prevention/

https://www.jrnjournal.org/

https://www.jrnjournal.org/action/showPdf?pii=S1051-2276%2811%2900136-1

https://www.sciencedirect.com/science/article/pii/S0085253815469157

https://www.kidney.org/atoz/content/calcium-oxalate-stone

#stones #kidney #MNT #DIET #CALCIUMOXALATE #VITAMINC