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Nephrolithiasis

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Nutrition in Kidney Disease

Part of the book series: Nutrition and Health ((NH))

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Abstract

Nephrolithiasis (kidney stones, urolithiasis) is the formation of stone-like concretions in the urinary system caused by the precipitation of calcium, phosphate, urate, and other molecules. The incidence and prevalence of nephrolithiasis among adults in the USA have been increasing for 30 years. According to the National Health and Nutrition Examination Survey (NHANES 2007–2010), current prevalence is estimated at 8.8% among adults as compared to a prevalence of 5.2% in 1994. More than $5.3billion is spent directly and indirectly on treatment for nephrolithiasis annually in the USA. Kidney stones are more prevalent in men than women with a lifetime risk of 12% in men and 6% in women. As many as 20% of patients present with renal colic and require urological intervention.

The editors acknowledge Julian L. Seifter’s contribution to this chapter in Nutrition in Kidney Disease, Second Edition, Nutrition and Health, DOI: https://doi.org/10.1007/978-1-62703-685-6_1, © Springer Science+Business Media, New York, 2014.

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Author information

Authors and Affiliations

  1. Atrius Health, Department of Nephrology, Boston, MA, USA

    Haewook Han

  2. MS/DI Program Director, Tufts University Friedman School, Boston, MA, USA

    Haewook Han

  3. Tufts Medical Center, Division of Nephrology, Boston, MA, USA

    Haewook Han

Authors
  1. Haewook Han
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Corresponding author

Correspondence to Haewook Han .

Editor information

Editors and Affiliations

  1. School of Health Professions and Nursing, Long Island University, Greenvale, NY, USA

    Jerrilynn D. Burrowes

  2. Division of Nephrology, University of Tennessee Health Science, Memphis, TN, USA

    Csaba P. Kovesdy

  3. School of Health Professions, Rutgers University–Newark, Newark, NJ, USA

    Laura D. Byham-Gray

Appendices

Acknowledgement

Dr. Han is grateful for the contributions and support of Drs. Mutter and Nasser to this chapter.

Case Studies

Case 1

The following 24-h urine values were observed in a 45-year-old man.

 

Volume

Ca

Oxalate

Citrate

Uric acid

pH

Creatinine

Na

Phos

NH4

Results

2.506

364 mg

77 mg

1278 mg

1.806 g

5.1

3040 mg

426 mEq

1.5 g

108 mM

Ref value

>2.5 L

<250

<40

200–1000

<0.8

5.8–6.2

 

<150

<1.2

<60

Case Questions and Answers

  1. 1.

    What type of stone risk does this patient have?

    1. (a)

      Calcium oxalate

    2. (b)

      Uric acid

    3. (c)

      Struvite

    4. (d)

      Cysteine

Answer: The answer is A and B – CaOx and uric acid stone. Calcium and oxalate levels are high. Also, uric acid level is very high with low pH.

  1. 2.

    What would be the preferred treatment strategy for the patient in case 1?

    1. (a)

      Allopurinol

    2. (b)

      Na citrate

    3. (c)

      K citrate and increase urine volume to 3 L

    4. (d)

      Na and protein-restricted and low oxalate diet

    5. (e)

      Thiazide diuretics

Answer: The answer is D – sodium and protein-restricted and low oxalate diet.

  • The patient has a large excretion rate of sodium, which will increase urinary calcium excretion.

  • He also has high urinary oxalate, which increases CaOx stone risk with low urine pH.

  • High protein intake is suggested by the elevated ammonium, uric acid, and phosphate in the urine, as well as by the high creatinine excretion.

  • One would need to confirm that this is not an over-collection.

Case 2

A 45-year-old woman is referred for recurrent oxalate stone formation. The following is her 24-h urine result.

 

Vol

SSCaOx

Ca

Ox

Cit

SSCa

UpH

SSUA

UA

Results

1.52

10.04

40

143

23

0.09

5.5

0.53

0.202

Ref value

>2.5

6–10

<200

20–40

>550

0.5–2

5.8–6.2

0–1

<0.75

Case Questions and Answers

  1. 1.

    What is the likely cause of her disorder?

    1. (a)

      Renal tubular acidosis resulting in hypocitraturia

    2. (b)

      Dietary excess of nuts, chocolate, and berries

    3. (c)

      Hyperparathyroidism

    4. (d)

      Crohn’s disease

    5. (e)

      Oxalosis

Answer: The answer is D – Crohn’s disease causing low urinary calcium excretion.

  • There is low citrate, high oxalate, and low volume in this intestinal malabsorptive condition.

  • RTA does not explain increased urine oxalate.

  • Nuts, etc., do not explain the degree of hyperoxaluria.

  • Oxalosis does not explain low urine citrate and low urine calcium.

  1. 2.

    The preferred treatment for the patient in case 2 would include all except the following:

    1. (a)

      Na citrate

    2. (b)

      Ca supplementation with meals

    3. (c)

      Cholestyramine

    4. (d)

      K citrate

    5. (e)

      Dietary oxalate restriction

Answer: The answer is D. K citrate is not ideal.

  • In this case of volume depletion associated with intestinal disorders, alkali therapy with sodium salts is preferable as it may increase the extracellular volume and urine output.

  • Restrict dietary oxalate.

  • Use cholestyramine to bind intestinal oxalate.

  • Calcium with meals binds intestinal oxalate.

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Han, H. (2020). Nephrolithiasis. In: Burrowes, J., Kovesdy, C., Byham-Gray, L. (eds) Nutrition in Kidney Disease. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-44858-5_25

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