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Expert Pearls

Nephrolithiasis - Calcium

Calcium restriction is not beneficial in calcium oxalate stones. Restriction may increase stone risk by 1) increasing oxalate excretion and 2) causing bone resorption. [Clinical Science, 1997;93:257-263. 28618 (1998)] Summary Interview

Nephrolithiasis - Diet

Diet - increase water intake; normalize protein and caloric intake. [Clinical Science, 1997;93:257-263. 28618 (1998)] Summary Interview

Nephrolithiasis - Diet - 2

Diet with normal calcium intake (1000 mg/d) and reduced animal protein and sodium cut risk of recurrent stones in half compared to low calcium (400 mg/d) and normal animal protein and sodium intake. [N Engl J Med, January 20, 2002;346(2):77-84. 38750 (2002)] Summary Interview

Nephrolithiasis - Diet - 3

Dietary approach for calcium oxalate stones: reduce animal fat (correlates with oxalate excretion), sodium (calcium excretion), coffee and tea (rich in oxalate); reduce weight (increased calcium excretion) by reducing protein and carbohydrate intake; increase calcium from calcium-rich mineral water 100-200 ml per hour, low fat milk (calcium), low fat cheeses (calcium) and seaweed (rich in calcium and magnesium) which binds oxalate intestine. [Eur Urol, 2000;37:140-144. 34864 (2000)] Summary Interview

Nephrolithiasis - Diet - 4

Dietary factors that may be of benefit: vegetable protein instead of animal protein (reduced acid load); calcium citrate (does not enhance crystallization of calcium salts), calcium carbonate blocks oxalate absorption; vitamin B6 and magnesium citrate may prevent calcium oxalate stone formation by lowering the metabolic production of oxalic acid and inhibiting its crystallization respectively; sugars restriction can decrease endogenous oxalic acid production and urinary calcium excretion; soft drink reduction may reduce the acid environment and reduce calcium excretion. [N Engl J Med, January 20, 2002;346(2):77-84. 38750 (2002)] Summary Interview

Nephrolithiasis - Diet - 5

Dietary factors are to reduced fat which binds to calcium forming soaps and leaves less calcium to bind with oxalate; normal, not low, calcium diets should be recommended to bind oxalate in the intestine. [Urol Int, 1998;61:192-195. 32611 (1999)] Summary Interview

Nephrolithiasis - Eicosapentaenoic acid

Eicosapentaenoic acid (EPA) 1800 mg/d reduced urinary calcium excretion in stone formers. [Eur Urol, 2001;39:580-585. 38323 (2001)] Summary Interview

Nephrolithiasis - Magnesium, citrate, vitamin B6

Supplements of magnesium, citrate and vitamin B6 may be inhibitory while vitamin D and PTH may increase risk. [Clinical Science, 1997;93:257-263. 28618 (1998)] Summary Interview

Nephrolithiasis - Phytate

Phytate 120 - 300 mg/dy or diet high in legumes, nuts and cereal grains. [Eur Urol, 2001;39:580-585. 38323 (2001)] Summary Interview
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