Objective Evidence for the Beneficial Effect of a High Fluid Intake in the Management of Nephrolithiasis

Sakhaee, K.; Zerwekh, Joseph E.; Pak, Charles Y.C.

doi:10.1007/978-1-4684-8977-4_37

Cited by 5 publications

(2 citation statements)

References 17 publications

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“…Increasing water intake has been identified as an important strategy in the management of patients with urolithiasis, primarily because of its role in increasing urine volume. The effect of this is a decrease in saturation through dilution of calculogenic material (7) , and an increase in the minimum supersaturation required to elicit initiation of crystallisation (8,9) , and these benefits outweigh the potential negative effects of dilution of inhibitors of crystallisation or growth (10) . In the present study, each dietary moisture level would have offered the same calculogenic load, because the cats were offered the same amount of food differing only in the levels of water added.…”

Section: Discussionmentioning

confidence: 99%

Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat

Buckley¹,

Hawthorne²,

Colyer³

et al. 2011

Br J Nutr

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It has been reported that daily fluid intake influences urinary dilution, and consequently the risk of urolithiasis in human subjects and dogs. The aim of the present study was to investigate the role of dietary moisture on urinary parameters in healthy adult cats by comparing nutritionally standardised diets, varying only in moisture content. A total of six cats were fed a complete dry food (6·3 % moisture) hydrated to 25·4, 53·2 and 73·3 % moisture for 3 weeks in a randomised block cross-over design. Urinary specific gravity (SG), urine volume, water drunk and total fluid intake were measured daily; relative supersaturation (RSS) for calcium oxalate (CaOx) and struvite was calculated using the SUPERSAT computer program. Cats fed the 73·3 % moisture diet produced urine with a significantly lower SG (P,0·001) compared with diets containing 53·2 % moisture or lower. Mean RSS for CaOx was approaching the undersaturated zone (1·14 (SEM 0·21); P ¼ 0·001) for cats fed the diet with 73·3 % moisture and significantly lower than the 6·3 % moisture diet (CaOx RSS 2·29 (SEM 0·21)). The effect of diet on struvite RSS was less clear, with no significant difference between treatment groups. Total fluid intake was significantly increased (P , 0·001) in the 73·3 % moisture diet (144·7 (SEM 5·2) ml, or 30 ml/kg body weight per d) compared with the 6·3 % (103·4 (SEM 5·3) ml), 25·4 % (98·6 (SEM 5·3) ml) and 53·3 % (104·7 (SEM 5·3) ml) moisture diets, despite voluntary water intake decreasing as dietary moisture intake increased. Cats fed the 73·3 % moisture diet had a higher total daily fluid intake resulting in a more dilute urine with a lower risk of CaOx when compared with the lower-moisture diets.The extent to which cats are able to adjust the amount of water they drink in relation to the moisture content of their diet has been a source of investigation over the last 30 years. Cats fed an all meat or wet diet, which typically contains in excess of 75 % moisture, will voluntarily drink only small quantities of water (1,2) . Although cats drink more water when offered dry diets, they do not drink amounts that would be expected to compensate for the significant reduction in moisture content of these diets (2) .It is believed that cats adjust their water intake such that they effectively excrete their renal solute load. Since cats fed dry food have a lower total water intake than when fed wet food, it would suggest that the absolute water requirement to dilute the renal solute load is lower than that resulting from a wet-food diet. This means that cats fed wet or natural diets may consume water in excess of any physiological requirement.Dry cat foods have been implicated as a risk factor for cats susceptible to feline lower urinary tract disease (3) , while feeding wet diets has been shown to reduce the recurrence of calculi and signs of idiopathic cystitis compared with dry food (4) .While the benefits of wet food are thought to be attributed to the increased water intake and related increase in urine volume, additional ...

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Section: Discussionmentioning

confidence: 99%

Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat

Buckley¹,

Hawthorne²,

Colyer³

et al. 2011

Br J Nutr

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“…Although the resulting dilution effect involves both promoting and inhibiting substances, the overall risk of forming stones decreases through both a decrease in the urine state of saturation with calcium oxalate and calcium phosphate and an increase in the minimum supersaturation required to elicit initiation of crystallization [2]. The Tamm-Horsfall glycoprotein, the most abundant protein in human urine, changes its physicochemical properties from promoting to inhibiting by lowering ionic strength [3], as in the case of urine dilution.…”

Section: Introductionmentioning

confidence: 99%

Effects of Mineral Composition of Drinking Water on Risk for Stone Formation and Bone Metabolism in Idiopathic Calcium Nephrolithiasis

Marangella¹,

Vitale²,

Petrarulo³

et al. 1996

Clinical Science

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1. To assess whether the mineral content of drinking water influences both risk of stone formation and bone metabolism in idiopathic calcium nephrolithiasis, 21 patients were switched from their usual home diets to a 10 mmol calcium, low-oxalate, protein-controlled diet, supplemented with 21 of three different types of mineral water. Drinking water added 1, 6 and 20 mmol of calcium and 0.5, 10 and 50 mmol of bicarbonate respectively to the controlled diet. 2. The three controlled study periods lasted 1 month each and were separated by a 20 day washout interval. Blood and urine chemistries, including intact parathyroid hormone, calcitriol and two markers of bone resorption, were performed at the end of each study period. The stone-forming risk was assessed by calculating urine saturation with calcium oxalate (beta CaOx), calcium phosphate (beta bsh) and uric acid (beta UA). 3. The addition of any mineral water produced the expected increase in urine output and was associated with similar decreases in beta CaOx and beta UA, whereas beta bsh varied marginally. These equal decreases in beta CaOx, however, resulted from peculiar changes in calcium, oxalate and citrate excretion during each study period. The increase in overall calcium intake due to different drinking water induced modest increases in calcium excretion, whereas oxalate excretion tended to decrease. The changes in oxalate excretion during any one study period compared with another were significantly related to those in calcium intake. Citrate excretion was significantly higher with the high-calcium, alkaline water. 4. Parathyroid hormone, calcitriol and markers of bone resorption increased when patients were changed from the high-calcium, alkaline to the low-calcium drinking water. 5. We suggest that overall calcium intake may be tailored by supplying calcium in drinking water. Adverse effects on bone turnover with low-calcium diets can be prevented by giving high-calcium, alkaline drinking water, and the stone-forming risk can be decreased as effectively as with low-calcium drinking water.

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Therapeutic Modalities for the Prevention of Nephrolithiasis

Tschöpe

Horsch

Ritz

1986

Phosphate and Mineral Homeostasis

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Objective Evidence for the Beneficial Effect of a High Fluid Intake in the Management of Nephrolithiasis

Cited by 5 publications

References 17 publications

Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat

Effect of dietary water intake on urinary output, specific gravity and relative supersaturation for calcium oxalate and struvite in the cat

Effects of Mineral Composition of Drinking Water on Risk for Stone Formation and Bone Metabolism in Idiopathic Calcium Nephrolithiasis

Therapeutic Modalities for the Prevention of Nephrolithiasis

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