Thursday, November 29, 2018

Dietary Risk Factors For Calcium Stones

1) Fluids:
A lower fluid intake will lead to lower urine output, thereby promoting stone formation by increasing the concentration of calcium and oxalate.

Type Of Fluid :
1) Coffee and tea have, in the past, been considered to have a high oxalate content but recent studies show they have negligible impact.

2) Alcoholic beverages had been purported to increase the risk of stones. However, prospective studies found that beer and wine were associated with a lower risk of stone formation

3) Orange juice(which contains both potassium and citrate) was associated with a lower calculated risk of crystal formation (possibly due in part to increased urinary citrate excretion)

2) Low Dietary Calcium:
This was a surprise to me because I always thought High Calcium in the diet leads to the formation of stones. Now to explain this- Normally dietary Calcium binds to dietary Oxalate in the gut to form a non-dissociable complex that can't be absorbed into the blood. If Calcium in the diet is less, Oxalate will be in free form which is then absorbed into the blood and excreted into urine and thus increases the risk of stone formation.

3) High Dietary Oxalate:
High Oxalate is normally found in chocolate, nuts, spinach. If dietary oxalate is higher than Calcium, all the free oxalate is then absorbed into the blood and thus increasing the risk of stone formation.

NOTE: In Crohn's disease where there is fat malabsorption, Calcium in the gut binds to this fat and forms a complex thus decreasing the Calcium available for oxalate. So all the free oxalate is absorbed and the risk of development of Oxalate stones is increased.

4) High Dietary Sodium:
If dietary sodium is high, we absorb less sodium from PCT and thus decreasing Calcium absorption. So there is increased calcium excretion which increases the incidence of stone formation.

5) High Animal Protein:
Long term, a high-protein diet may lead to higher urine calcium excretion by increasing renal calcitriol production that may be mediated by an increase in renal mass.

SOURCE: UpToDate, UWorld.

-Srikar Sama

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