Kidney Stone Prevention: Is There a Role for Complementary and Alternative Medicine?

Abstract

Complementary and alternative medicine (CAM) is often implemented in kidney stone patients. It consists of preparations including different ingredients, such as herbs, probiotics, and vitamins, often together with alkali, that are classified within the dietary supplementation category. The majority of dietary supplements claiming to treat or prevent kidney stones contain ingredients with conflicting or no scientific evidence to support their claims. Clinicians should advise stone formers that the effects of most supplements are unknown or unstudied in humans and that the absence of evidence does not imply absence of potential harm. Unfortunately, the CAM preparation consists of a mix of different molecules, often including alkali, with different potential mechanisms of action and, even when favorable results are reported, the role of the single molecules cannot be assessed. Despite all these concerns, CAM products remain quite popular among kidney stone patients. The scarce knowledge in this field prevents one from recommending CAM products in daily clinical practice; only a weak suggestion for their use in kidney stone patients may be reasonable.

Pathophysiology and Main Molecular Mechanisms of Urinary Stone Formation and Recurrence

“…Current guidelines recommend maintaining a urine output >2.0–2.5 L/day and a fluid intake of 2.5–3.0 L/day [ 56 ]. Some beverages consumed every day, such as coffee and tea, can also exert a diuretic effect.…”

“…In addition, weight loss in those with obesity or who are overweight is also recommended in order to maintain a normal body mass index (BMI) to reduce the risk of kidney stone formation [ 56 ]. An in vivo study also showed that weight loss through dietary restriction and exercise increases urinary citrate excretion and reduces the risk of kidney stone disease [ 56 ]. In both sexes, physical activity was inversely associated with nephrolithiasis prevalence.…”

“…In addition, athletes have some protective factors, such as high levels of magnesium in the urine. Fluid balance during and after strenuous physical activity and exercise also needs to be considered, which can lead to profuse sweating and dehydration [ 56 ].…”

“…In people with arterial hypertension, it is strongly recommended to reduce salt intake to no more than 5 g of table salt [ 56 ]. Restricting sodium intake, combined with higher intakes of potassium, magnesium, and citrate, not only reduces the risk factors for urinary stone formation, but also prevents bone loss and hypertension, despite blood flow, kinetic sensitivity to sodium increases intake and reduces urolithiasis.…”

“…Restricting sodium intake, combined with higher intakes of potassium, magnesium, and citrate, not only reduces the risk factors for urinary stone formation, but also prevents bone loss and hypertension, despite blood flow, kinetic sensitivity to sodium increases intake and reduces urolithiasis. Renal function in older adults must also be considered [ 7 , 56 ].…”