People between 20 and 50 years of age most often suffer from kidney stones. It affects men more often and people who have a genetic predisposition to its occurrence.
Its occurrence may also be affected by a high-protein diet, drinking highly mineralized water, consuming too little water and a warm climate. The most common symptom
is renal colic. Stones often do not cause any symptoms and are detected during routine examinations. Sometimes patients experience periodic recurring pain in the
lumbar region or in the abdomen. Typical symptoms of renal colic are: very intense pain in the lumbar region, radiating to the iliac fossa and lower abdomen, pain and
burning when urinating, pollakiuria, nausea, vomiting, flatulence, reluctance to eat and drink liquid.
Calcium oxalate stones - the most popular stone formation, associated with excessive deposition of minerals in the kidneys - oxalates and calcium, with a limited supply
of citric acid. The testimony of deposits may be caused by genetic conditions, diet, the patient's health condition, or frequent urinary tract infections.
Urate stones – may occur in various parts of the kidney (urethra, renal calyx, bladder, ureters). Pain occurs when urate deposits accumulate in the urinary system. The
reasons for this may be limited water consumption (generally fluids), magnesium deficiency, and even frequent digestive system infections.
Phosphate stones – this is one of the rarest stones. It is associated with urinary tract infections, and the urine reaction changes from slightly acidic to alkaline. A change
in pH contributes to the deposition of phosphate deposits.
Struvite urolithiasis – is a type of phosphate urolithiasis. Bacteria responsible for the alkalinization of urine cause the residual sediment to consist of phosphorus-
magnesium-ammonium.
Phosphate-calcium stones.
Cystine stone disease - is associated with impaired reabsorption of cystine in the tubules (naturally, it should be reabsorbed). The cause may be genetic conditions. The
deposits are shiny, yellow in colour, waxy and have a soft consistency.
Dietary management is an essential element in both the prevention and treatment of kidney stones. The doctor determines the kidney stones' cause, type, and dietary
management.
The diet for kidney stones depends on the type of stones that build up in the kidneys. We distinguish: Calcium oxalate urolithiasis - deposits contain calcium salts,
mainly oxalates (occurs in 80% of patients);Struvite urolithiasis - the deposit-forming component is struvite, i.e. ammonium-magnesium phosphate (occurs in about 10%
of patients);Urate urolithiasis - stones are made of uric acid; Cystine urolithiasis - deposits consist of cystine (occurs in about 1-2% of cases).
Adjusting the diet to the type of kidney stones and specific metabolic disorders,
Fluids - patients with kidney stones should drink large amounts of fluids, which reduces the concentration of urine components and prevents their precipitation in the
form of crystals. Drinking enough fluids significantly reduces the risk of developing or recurring kidney stones. Recommended fluids are table water, mineral water, boiled
water, birch infusion, and weak tea. Fluids given before bed are essential as they dilute the urine at night.
Limiting the consumption of table salt - sodium is a promoter of calcium oxalate urolithiasis, increasing the excretion of calcium and sodium urate. Therefore, restricting
table salt, products with added salt and monosodium glutamate, and products rich in oxalic acid are essential.
In some cases, attention should be paid to the supply of calcium, phosphorus, magnesium and proteins. A diet rich in animal protein may also contribute to urolithiasis
formation.
Increasing potassium intake - too little potassium in the diet increases urinary calcium excretion and probably reduces the amount of citrate excretion,
adjusting the amount of animal protein consumed to the body's needs - high protein consumption leads to urine acidification. It promotes increased uric acid, oxalic acid
and calcium excretion and decreased citrate excretion. Protein supply in the diet should be 0.8-1.0 g per kg of body weight,with no drastic restrictions on calcium supply
- a significant reduction in calcium intake may lead to secondary excessive excretion of oxalic acid in urine and loss of bone mass from which calcium will be taken to
compensate for the deficiencies.
Regardless of the type of kidney stones, each patient should:
Drink at least 2-2.5 liters of water (low mineralized, low sodium);Limit the consumption of salt and salt-rich products (e.g. fast food, broth cubes, vegeta spices,
powdered soups and sauces, salty snacks, cold cuts, sausages, frankfurters, cheeses, blue cheeses, processed cheeses, pickles);Eliminate or greatly reduce alcohol
consumption; Limit drinking strong coffee and tea; Limit the use of hot spices; Increase physical activity.
Calcium oxalate urolithiasis occurs with excessive amounts of oxalic acid or oxalates in the urine, in inflammatory bowel diseases and after intestinal resection, with a
very high supply of vitamin C, vitamin B6 deficiency and impaired excretion of hydrogen ions by the kidneys.
Diet for calcium oxalate urolithiasis
With increased intestinal absorption of calcium and oxalates, products that are a source of these ingredients are limited; this urolithiasis is promoted by excess sodium in
the diet, which increases the excretion of sodium urate and calcium. Therefore, the consumption of table salt should be limited if urolithiasis is caused by excessive
excretion of calcium by the kidneys, e.g. in hyperthyroidism or osteoporosis, the calcium supply is not limited. A decrease in calcium in the diet increases the absorption
of oxalates from the gastrointestinal tract, so the balance between calcium and oxalic acid in the meal is essential. It is advisable to increase the supply of substances
that prevent the formation of deposits - magnesium, citrates, phosphates and fluids in an amount of at least 2 litres a day; the consumption of animal protein should also
be limited.
Products recommended for calcium oxalate urolithiasis
A large amount of fluids, fruit juices, citrus fruits, whole grain cereal products, cucumbers, onions, corn, butter.
Products recommended in limited quantities
Milk and milk products, potatoes, carrots, beets, peas, tomatoes, legumes, green leafy vegetables, brassicas, lettuce, plums, gooseberries, nuts, meat and meat
products, fish, and eggs.
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What is urate urolithiasis?
In this type of urolithiasis, uric acid deposits form, which is the final product of metabolism. Under normal conditions, uric acid in dissolved form is excreted by the
kidneys. Still, when the urine pH is less than 5.3, it crystallizes, forming urate stones.
It is more common in men and is caused by a high-purine diet associated with excessive consumption of protein, and alcohol, intense physical exercise, rapid weight
loss, body wasting, gout, cancer, infectious diseases, and liver cirrhosis.
Dietary management in urate urolithiasis
Limiting the compounds in the diet that are a source of purines, which are metabolized in the body to uric acid, is necessary to reduce the risk of developing urate
stones. And therefore contribute to increasing its concentration in blood and urine. The source of these compounds is primarily meat products - offal, meat stocks and
sauces, meat jellies, sardines and herring. Plant products rich in purines include mainly legumes and mushrooms.
You should avoid fried, baked and stewed foods. Steaming is the best method of preparing food. Meat should be cooked in large amounts of water, and the resulting
broths should not be used to prepare soups and sauces. The most recommended meats are lean: chicken, turkey, and veal, and their amount in the daily food ration
should be at most 100-150 g.
Consuming approximately 40-50 g of protein and 2000-2200 kcal per day is recommended.
You should increase the amount of fluids you drink to over 2 litres daily.
The diet should alkalize urine because uric acid dissolves in an alkaline environment. A dairy-vegetarian diet is recommended because milk, vegetables and fruits have
alkalizing properties. The concentration of hydrogen ions should not fall below 6.5-7.0, because calcium phosphate crystals may precipitate at a lower pH.
Products recommended for urate urolithiasis
A large amount of fluids mineral waters, vegetables and fruits – lemons have a beneficial effect as they increase the metabolism of purines, potatoes, milk, low-fat
cottage cheese, honey, sugar.
Products recommended in limited quantities
Other types of meat – only cooked (100-150 g/day) because purines pass into the broth, fish, grain products.
Products contraindicated in urate urolithiasis
Offal (liver, kidneys, brain, hearts),mutton, pork, herrings, sardines, sprats, caviar, meat and fish stocks, legumes, mushrooms, milk and dark chocolate, cocoa powder,
nuts, strong tea, natural coffee.
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What are calcium phosphate stones?
The main component of deposits in this type of stone is calcium phosphate. It is produced in alkaline urine, which results from infection with certain bacteria that break
down urea into ammonia and carbon dioxide. An increase in ammonia concentration leads to the alkalinization of urine.
Diet for calcium phosphate urolithiasis
Your diet should limit salt and products rich in phosphates, calcium and oxalates, such as milk and dairy products, eggs, legumes, canned fish,
the supply of magnesium, citrates and fluids should be increased,
It is advisable to administer acidifying products in large quantities, including meat, cold cuts, fish, and cereal.
Products recommended for calcium phosphate urolithiasis:
A large amount of fluids , meat (especially poultry), fish, bread, coarse grain groats, pasta, plums, blueberries, cranberries, raisins (due to the content of benzoic acid),
juices and citrus fruits, honey, butter.
Products recommended in limited quantities:
Potatoes, celery, cauliflower, radishes, carrots, other fruits, nuts, milk, eggs.
Products contraindicated in calcium phosphate urolithiasis:
Alkaline mineral waters, legume seeds, spinach, sorrel, rhubarb, milk and dark chocolate, cocoa powder, strong tea, natural coffee, salted preserves, spicy spices and
monosodium glutamate.
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What are struvite stones?
Stones precipitate in alkaline urine during urinary tract infection with urease-producing bacteria. This type of urolithiasis occurs more often in women who often suffer
from infectious urinary tract diseases. In such a situation, urine becomes alkalinized (pH>8), and the ammonia from urea created by bacteria promotes the formation of
stones composed of magnesium-ammonium phosphate (struvite) and carbonate apatite`s.
Struvite (magnesium ammonium phosphate) stones are often referred to as "infection stones" since they are strongly associated with urinary tract infections (UTIs)
with urea-splitting organisms. They may grow rapidly over a period of weeks to months and, if not adequately treated, can develop into a staghorn or branched calculus
that fills the entire kidney collecting system. If left untreated, this can lead to deterioration of kidney function and end-stage kidney disease. In addition, since the stones
often remain infected, there is a risk of developing sepsis. Thus, most patients require definitive surgical treatment.
Struvite stones occur more often in women who often suffer from infectious diseases of the urinary tract. The ammonia from urea created by bacteria promotes the
formation of stones composed of magnesium ammonium phosphate. The formation of cystine stones is a consequence of a disease called cystinuria, which involves
impaired reabsorption of cystine in the kidneys.
Dietary management in struvite urolithiasis
The diet used to treat this type of urolithiasis should limit phosphates, the source of which are:
Ripening cheeses, processed cheeses, milk, egg yolks, meat and meat products, offal, fish, canned goods, coarse grain products, dry legumes, cocoa, chocolate, and
nuts.
You should increase the amount of fluids you drink to over 2 litres daily. Suppose there are low concentrations of citrate and magnesium in the urine. In that case, the
amount of juices drunk and the consumption of citrus fruits and vegetables rich in magnesium, especially corn, increases in the diet.
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The formation of cystine stones is a consequence of a congenital disease called cystinuria, which involves impaired reabsorption of one of the amino acids in the kidneys
- cystine, which is excreted in large amounts in the urine.
Dietary management in cystine urolithiasis
The most crucial nutritional recommendation is to limit the supply of amino acids in the diet, such as cystine and methionine, a significant amount of which is metabolized
to cystine. Products low in these amino acids include milk and dairy products and products of plant origin.
You should limit the consumption of meat and meat products. Protein intake should be limited to 0.8 g per kg of body weight - this facilitates the alkalinization of urine
and reduces the supply of methionine.
You should increase the amount of fluids you drink to twice your average requirement - up to 6 litres a day (according to the patient's tolerance), drunk in equal portions,
also at night.
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