Which Diet for Calcium Stone Patients: A Real-World Approach to Preventive Care

Abstract

Kidney stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. Dietary and lifestyle changes represent an important strategy for the prevention of kidney stone recurrences and cardiovascular damage. A full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of calcium kidney stone disease, yet it is rarely performed outside of stone specialist clinics. Many patients have a history of kidney stone disease while lacking a satisfactory metabolic profile. Nonetheless, in a real-world clinical practice a rational management of kidney stone patients is still possible. Different scenarios, with different types of dietary approaches based on diagnosis accuracy level can be envisaged. The aim of this review is to give patient-tailored dietary suggestions whatever the level of clinical and biochemistry evaluation. This can help to deliver a useful recommendation, while avoiding excessive dietary restrictions especially when they are not based on a specific diagnosis, and therefore potentially useless or even harmful. We focused our attention on calcium stones and the different scenarios we may find in the daily clinical practice, including the case of patients who reported renal colic episodes and/or passed stones with no information on stone composition, urinary risk factors or metabolic cardiovascular risk factors; or the case of patients with partial and incomplete information; or the case of patients with full information on stone composition, urinary risk factors and metabolic cardiovascular profile.

Risk of Kidney Stones: Influence of Dietary Factors, Dietary Patterns, and Vegetarian–Vegan Diets

“…Diet is considered a fundamental tool for the management of kidney stone recurrence [102]. Above all dietary indications and the possibility to give patient-tailored dietary suggestions [108], maintaining an elevated fluid intake [25] is the most important element for kidney stone prevention.…”

Dietary Oxalate Intake and Kidney Outcomes

“…Dietary modification is an effective first-line strategy in kidney stone prevention [88,89]. The effect of dietary oxalate intake on oxalate stone risk was investigated in a study conducted on three prospective, long-term cohorts of 45,985 men, 101,824 younger women, and 92,872 older women (Health Professionals Follow-up, Nurses' Health Study I and II).…”

A Specific Urinary Amino Acid Profile Characterizes People with Kidney Stones

“…Stone formers are more likely to have more significant urinary and metabolic abnormalities compared with nonstone formers [32]. At the moment, there are no reliable biomarkers to predict risk of recurrent stones.…”