Kidney Stones and the Ketogenic Diet: Risk Factors and Prevention

Abstract

A cohort study was performed of children started on the ketogenic diet for intractable epilepsy from 2000 to 2005 (n = 195). Children who developed kidney stones were compared with those without in terms of demographics, urine laboratory markers, and intervention with urine alkalinization (potassium citrate). Thirteen children (6.7%) developed kidney stones. The use of oral potassium citrate significantly decreased the prevalence of stones (3.2% vs 10.0%, P = .049) and increased the mean time on the ketogenic diet before a stone was first noted (260 vs 149 patient-months, P = .29). The prevalence of kidney stones did not correlate with younger age or use of carbonic anhydrate inhibitors (eg, topiramate or zonisamide) but trended toward higher correlation with the presence of hypercalciuria (92% vs 71%, P = .08). No child stopped the diet due to stones; in fact, the total diet duration was longer (median 26 vs 12 months, P < .001). Kidney stones continue to occur in approximately 1 in 20 children on the ketogenic diet, and no statistically significant risk factors were identified in this cohort. As oral potassium citrate was preventative, prospective studies using this medication empirically are warranted.

Risk Factors for Urolithiasis in Gastrostomy Tube Fed Children: A Case-Control Study

“…Additionally, one could also consider administering potassium citrate prophylaxis in patients who must stay on topiramate; this strategy has shown to be effective in patients on the ketogenic diet for seizure control. 14,15 We also observed a strong association between a documented UTI and the presence of stones in our population. Despite this, only 2/8 (25%) of patients with a stone analysis had struvite as a stone component, and a higher proportion of controls (60%) versus cases (30%) had evidence of infection with a urea splitting organism.…”

Urolithiasis in Childhood: Review

“…63,69 Ketojenik diyet ürolitiyaz riskini artırmaktadır. 70 Erişkinlerde yapılan çalışmalarda yağdan zengin yiyeceklerin ve obezitenin kalsiyum bazlı taş oluşumuna neden olan faktörlerin üriner atılımını artırdığı gösterilmiş iken, çocuklarda böyle bir ilişki gösterilememiştir. 71 Çin'de 2008 yı-lında süt tozlarına melamin katılmasıyla çocuklarda taş olgularında büyük bir artış rapor edilmiştir.…”

Pediatric Nephrolithiasis: Trend, Evaluation and Management: A Systematic Review

“…Struvite stones also in the setting of spinal cord injuries or neurogenic bladders might be considered. In patients with seizures, ketogenic diet and anti-seizer medications result in acidosis, hypercalciuria that need more attention (27)(28)(29).…”