Nutrition and Kidney Stones, Part II

Nutrition and Kidney Stones, Part II

G. Douglas Andersen, DC, DACBSP, CCN

Volume 22, number 25, 11/30/04, page 14
Hyperoxaluria, Hyperuricosuria, Hypocitraturia, Hypomagnesuria, Renal Tubular Acidosis

This month we conclude our two-part series on nutrition and kidney stones based on the fine article by Bhandari and Menon.¹

Hyperoxaluria
Malabsorption in the small intestine reduces calcium levels in the intestinal lumen to a level where it is insufficient to bind with oxalate; thus, oxalate levels rise and, in the kidney, will bind with calcium and cause stone formation. Nutritional support includes increased fluid consumption (to a level where at least 64 ounces of urine are produced per day), increased calcium carbonate (500mg TID - 1500mg total), increased vitamin B6 (100-150mg/day), increased tyrosine, decreased dietary oxalate, and decreased dietary fat. If calcium carbonate is consumed with each meal it will bind with oxalates, thus reducing urinary levels. Vitamin B6 may reduce oxalate levels in the urine by reducing endogenous synthesis. Tyrosine can also reduce oxalate synthesis by blocking the conversion of hydroxyproline to oxalate. If dietary calcium is low or restricted, the body will tend to eliminate oxalates via the urine, which is problematic in oxalate stone formers.

Hyperuricosuria
Uric acid can promote calcium oxalate kidney stone formation in some people. Those who are susceptible to hyperuricosuria almost always consume a high purine diet. Nutritional support includes reducing dietary beef, pork, poultry, and fish. Bhandari and Menon state that in these types of cases getting a meat eater to become almost vegetarian can be very difficult. Often these people will prefer to eat their meat and take medicine to decrease uric acid synthesis.

Hypocitraturia
Hypocitraturia is most often associated with patients who suffer from urinary tract infections or are acidotic. Kidney resorption of citrate is elevated. Nutritional therapy includes more alkaline foods (most fruits and veggies) and less acid foods (Beef, beans, beer, coffee, cocoa, vinegar and grains). Sodium bicarbonate (300mg/kg/bw or 135 mg/lb/bw) may also be used to promote an alkaline environment. 64 oz of fresh lemonade daily can be substituted for the bicarbonate and used with it in tough cases.

Hypomagnesuria
Hypomagnesuria is most commonly seen with patients who suffer from inflammatory conditions of the gastrointestinal tract. Inflammation reduces the absorption of magnesium. When magnesium levels are deficient, there is no antagonist to prevent calcium and oxalate to crystalize. Nutritional therapy is magnesium, 200mg twice daily. Citrate is the preferred form, but not the only form that will work.

Renal Tubular Acidosis
This syndrome is the result of a kidney disorder due to hydrogen ion secretion causing urinary acidification. The stones that are formed in this condition are composed of calcium phosphate. There are subclassifications of renal tubular acidosis that are beyond the scope of this article. Treatment is aimed at alkalization, most commonly potassium (either bicarbonate or citrate). Dietary support is - you guessed it, alkaline foods high in potassium (fruits and veggies) and limited amounts of acid foods.

References

Bhandari, A., Menon, M. Reducing the Risk of Kidney Stone Recurrence. Patient Care. www.patientcareonline.com. April 2004. 26-32.

916 E. Imperial Hwy.
Brea, CA. 92821

(714) 990-0824
Fax: (714) 990-1917

gdandersen@earthlink.net
www.andersenchiro.com