According to current estimates, kidney stones will develop in one in 10 people during their lifetime. This translates into nearly 30 million people in the United States.

The prevalence is highest among those aged 30-45 years. High urinary calcium can be the cause of kidney stones in upwards of 80% of cases. The most prevalent stone composition is calcium oxalate. Once kidney stones develop, patients have a 50%-75% likelihood of developing another stone.

The yearly cost of kidney stones in the United States was $2 billion (treatments, hospitalizations, lost work, etc.) in 1994 and is now estimated at $5 billion.1

Clearly, prevention is paramount when dealing with kidney stones. General guidelines for prevention include moderate protein intake, minimal salt ingestion, and drinking enough clear liquids to generate two liters of urine per day. A low oxalate diet has proved beneficial for preventing calcium oxalate stones.

Reducing elevated urinary calcium levels helps to improve urinary saturation kinetics. Uric acid stones require dietary manipulation, adequate fluid intake to optimize volumes, and manipulation of urinary pH. Cystine stones, while relatively rare, require their own preventive measures.

Which fluid to drink is controversial. While water is the mainstay, a number of articles tout the benefit of different juices. For example, lemon juice increases urinary citrate and may prevent calcium stones. Whether one uses the recommended half cup of lemon juice per day straight up or diluted, is a personal choice. Lemonade is another frequently recommended choice.

There are various opinions when it comes to the benefits of orange juice. It, too, increases urinary citrate levels, but there is concern that it could raise oxalate levels. Apple and cranberry juice contain oxalates and have been associated with a higher risk of calcium oxalate stones.

So what would be a straight forward routine recommendation to prevent kidney stones for the majority of patients?  It would be to limit salt, drink adequate and appropriate fluids, moderate animal protein intake, minimize sugar intake of all forms, ingest adequate amounts of calcium, and strongly consider intake of high fiber plant foods containing phytate.

It would also be beneficial to consider taking magnesium oxide, pyridoxine, citrate, and IP-6. Some supplements are available that combine these substances. These include Renalstat (Rematech Nutrahealth),  Kidney Support Formula (VRP), and Kidney Stone Formula (Bio Essence). All of this together should help to minimize your patient’s risk of recurrent kidney stones.

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