Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list

Hess, Bernhard; Michel, Robert G.; Takkinen, Ritva; Ackermann, Daniel; Jaeger, P

doi:10.1093/ndt/9.6.642

Cited by 50 publications

(36 citation statements)

References 22 publications

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“…Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and consequently decreases urinary saturation for calcium oxalate and calcium phosphate. In fact hypocitraturic subjects have a lower fruit intake (Domrongkitchaiporn et al 2006, observational study L) (5) and an high consumption of vegetables involves a significant protection against the risk of stone formation (Hess et al 1994, observational study L, Siener et al 2005, observational non controlled study L, Trinchieri A et al 2006 and, observational studies L, Meschi et al 2004, interventional study M) (6)(7)(8)(9)(10).…”

Section: Vegetablesmentioning

confidence: 99%

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Prezioso

Strazzullo

Lotti

et al. 2015

Arch Ital Urol Androl

158

103

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Objective: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. Materials and Methods: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. Results: Evidence from the selected studies were used to form evidencebased guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. Conclusions: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. Hypercalciuria: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. Hyperoxaluria: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. Hyperuricosuria: In patients with renal calcium stones SummaryNo conflict of interest declared. DOI: 10.4081/aiua.2015.2.105the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not cle...

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Section: Vegetablesmentioning

confidence: 99%

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Prezioso

Strazzullo

Lotti

et al. 2015

Arch Ital Urol Androl

158

103

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“…In general, lithiasic subjects who have no renal tubular acidosis frequently exhibit hypocitraturia, which is chiefly of digestive origin and probably consecutive to an insufficient intake of alkalinising agents (fruits and vegetables). In this view, Hess et al (1994) proposed that 'low vegetable-fibre intake and low urine volume' could be added to the list of risk factors for low urine citrate.…”

Section: Anti-acidosis Mechanisms Operating In Kidneysmentioning

confidence: 99%

Organic anions and potassium salts in nutrition and metabolism

et al. 2004

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The present review examines the importance of dietary organic anions in preventive nutrition. Organic anions are chiefly supplied by plant foods, as partially neutralised K salts such as potassium citrate, potassium malate and, to a lesser extent, oxalate or tartrate salts. Animal products may also supply K anions, essentially as phosphate, but also as lactate as a result of fermentative or maturation processes, but these K salts have little alkalinising significance. Citrate and malate anions are absorbed in the upper digestive tract, while a substantial proportion is probably metabolised in the splanchnic area. Whatever their site of metabolism, these anions finally yield KHCO 3 which is used by the kidneys to neutralise fixed acidity. This acidity essentially reflects the oxidation of excess S amino acids to sulfate ions, which is mainly related to the dietary protein level. Failure to neutralise acidity leads to low-grade metabolic acidosis, with possible long-term deleterious effects on bone Ca status and on protein status. Furthermore, low-grade acidosis is liable to affect other metabolic processes, such as peroxidation of biological structures. These metabolic disturbances could be connected with the relatively high incidence of osteoporosis and muscle-protein wasting problems observed in ageing individuals in Europe and Northern America. Providing a sufficient supply of K organic anions through fruit and vegetable intake should be recommended, fostering the actual motivational campaigns ('five (or ten) per d') already launched to promote the intake of plant foods rich in complex carbohydrates and various micronutrients.

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“…More citrate is excreted during metabolic alkalosis as a result of lower tubular reabsorption of filtered citrate (normal plasma concentration 0.1 mmol/1) [3,9]. Sodium chloride loading depresses urinary citrate excretion [10], whereas a large vegetable fibre intake and high urine volume have the opposite effect in adult calcium stone formers with hypocitraturia [11]. Potential disadvantages of prescribing sodium citrate are the added osmotic load and, possibly, an increased intestinal absorption of oxalate, since sodium oxalate is more soluble than calcium oxalate.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of oral citrate administration in primary hyperoxaluria

Leumann

Höppe

Neuhaus

et al. 1995

Nephrology Dialysis Transplantation

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Abstract. Urinary citrate is a potent inhibitor of calcium oxalate (CaOx) crystallization, but oral citrate has rarely been used in patients with primary hyperoxaluria (PH). We studied the effect of sodium citrate administration (0.1-0.15 g/kg/day) on urinary citrate excretion and CaOx saturation in seven paediatric patients and the clinical response to long-term treatment (average 4 years) in five patients. Urinary citrate increased from 0.73 to 2.54 mmol/24h/l .73 m 2 and urinary saturation for CaOx (calculated by equil 2) decreased from 11.41 to 6.79 (for both, p<0.02). Long-term administration of alkali citrate [0.15 g (0.5mmol)/kg/day] resulted in stable or improved renal function in three and slow deterioration in two partially non-compliant patients. Alkali citrate is effective in patients with PH.

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Risk factors for low urinary citrate in calcium nephrolithiasis: low vegetable fibre intake and low urine volume to be added to the list

Cited by 50 publications

References 22 publications

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Organic anions and potassium salts in nutrition and metabolism

Efficacy of oral citrate administration in primary hyperoxaluria

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