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Review

Dietary and medical management of recurrent nephrolithiasis

Silvi Shah, MD and Juan Camilo Calle, MD
Cleveland Clinic Journal of Medicine June 2016, 83 (6) 463-471; DOI: https://doi.org/10.3949/ccjm.83a.15089
Silvi Shah
Department of Nephrology, University of Alabama at Birmingham
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Juan Camilo Calle
Department of Nephrology and Hypertension, Glickman Urological & Kidney Institute, Cleveland Clinic
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  • For correspondence: callej@ccf.org
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    TABLE 1

    The prevalence of kidney stones is increasing

    NHANES study periodMenWomen
    1976–19802  4.9 ± 0.42a2.8 ± 0.17a
    1988–19942  6.3 ± 0.56a4.1 ± 0.27a
    2007–2010110.6 (9.4–11.9)b7.1 (6.4–7.8)b
    • ↵a Percent prevalence ± standard error of the mean

    • ↵b Percent prevalence and 95% confidence interval

    • NHANES = National Health and Nutrition Examination Survey

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    TABLE 2

    Systemic conditions associated with nephrolithiasis

    Coronary artery disease
    Chronic kidney disease and end-stage kidney disease
    Bone disorders and fractures
    Aortic calcification
    Hypertension
    Type 2 diabetes mellitus
    Gout
    Metabolic syndrome
    Sarcoidosis
    Renal tubular acidosis
    Bowel disease and intestinal surgery
    Renal and bladder anatomic anomalies
    Medications
    Genetic abnormalities
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    TABLE 3

    Interventions to prevent recurrent kidney stones

    DIETARY INTERVENTIONS
    All—Increase fluid intake to produce a urine volume of at least 2.5 L/day
    Calcium stones and hypercalciuria—Limit sodium intake to 2,300 mg/day; consume at least 1,000 or 1,200 mg/day of dietary calcium; restrict nondairy animal protein to 0.8 to 1 g/kg/day; increase intake of fresh fruits and vegetables
    Calcium oxalate stones and relatively high urinary oxalate intake—Limit intake of oxalate-rich foods and maintain normal calcium intake
    Calcium oxalate stones and hypocitraturia—Increase intake of fruits and vegetables and limit nondairy animal protein
    Uric acid stones or calcium stones with hyperuricosuria—Limit intake of nondairy animal protein to 0.8 to 1 g/kg/day
    Cystine stones—Limit sodium intake to 2,300 mg/day and protein intake to 0.8–1g/kg/day
    PHARMACOLOGIC INTERVENTIONS
    Hypercalciuria and recurrent calcium stones—Thiazide diuretics
    Recurrent calcium stones and hypocitraturia—Potassium citrate
    Uric acid and cystine stones—Potassium citrate to alkalize urine to optimal level
    Recurrent calcium oxalate stones and hyperuricosuria— Allopurinol
    Uric acid stones—Do not use allopurinol as first-line therapy, but consider it in refractory cases
    Type 1 hyperoxaluria—Pyridoxine
    Cystine stones unresponsive to conservative measures— Offer a cystine-binding thiol drug, eg, D-penicillamine or tiopronin. Pharmacotherapy should always be used in conjunction with conservative measures of dietary modification and urinary alkalization
    Residual or recurrent struvite stones, and surgical interventions are contraindicated or refused—Consider urease inhibitors, acetohydroxamic acid
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Cleveland Clinic Journal of Medicine: 83 (6)
Cleveland Clinic Journal of Medicine
Vol. 83, Issue 6
1 Jun 2016
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Dietary and medical management of recurrent nephrolithiasis
Silvi Shah, Juan Camilo Calle
Cleveland Clinic Journal of Medicine Jun 2016, 83 (6) 463-471; DOI: 10.3949/ccjm.83a.15089

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Dietary and medical management of recurrent nephrolithiasis
Silvi Shah, Juan Camilo Calle
Cleveland Clinic Journal of Medicine Jun 2016, 83 (6) 463-471; DOI: 10.3949/ccjm.83a.15089
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  • Article
    • ABSTRACT
    • COMMON AND INCREASING
    • MOST STONES CONTAIN CALCIUM
    • INCREASED FLUID INTAKE FOR ALL
    • PREVENTING CALCIUM OXALATE STONES
    • PREVENTING CALCIUM PHOSPHATE STONES
    • PREVENTING URIC ACID STONES
    • PREVENTING STRUVITE STONES
    • CYSTINE STONES
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