Abstract
Nephrolithiasis is a common medical condition influenced by multiple environmental factors, including diet. Since nutritional habits play a relevant role in the genesis and recurrence of kidney stones disease, dietary manipulation has become a fundamental tool for the medical management of nephrolithiasis. Dietary advice aims to reduce the majority of lithogenic risk factors, reducing the supersaturation of urine, mainly for calcium oxalate, calcium phosphate, and uric acid. For this purpose, current guidelines recommend increasing fluid intake, maintaining a balanced calcium intake, reducing dietary intake of sodium and animal proteins, and increasing intake of fruits and fibers. In this review, we analyzed the effects of each dietary factor on nephrolithiasis incidence and recurrence rate. Available scientific evidence agrees on the harmful effects of high meat/animal protein intake and low calcium diets, whereas high content of fruits and vegetables associated with a balanced intake of low-fat dairy products carries the lowest risk for incident kidney stones. Furthermore, a balanced vegetarian diet with dairy products seems to be the most protective diet for kidney stone patients. Since no study prospectively examined the effects of vegan diets on nephrolithiasis risk factors, more scientific work should be made to define the best diet for different kidney stone phenotypes.
Highlights
Nephrolithiasis is known to be a medical condition characterized by high prevalence all over the world [1,2,3]
Of all dietary interventions aimed to reduce the risk of kidney stones, fluid intake is one of the most important factors, being directly associated with the incidence of nephrolithiasis: for each 200 mL of fluids consumed per day, a 13% reduction in the risk of stone formation was found [31]
We showed that only increased dietary animal protein to potassium ratio was associated with a greater risk of incident nephrolithiasis, whereas vegetable proteins have no significant association to stone risk [79]
Summary
Nephrolithiasis is known to be a medical condition characterized by high prevalence all over the world [1,2,3]. In combination with oxalate or, less frequently, phosphate is by far the most common form, representing. The prevalence of uric acid nephrolithiasis does not exceed 10% [6]. The pathogenic pathway of calcium oxalate stone formation includes several processes (Figure 1), starting from nucleation, crystal growth, and crystal aggregation. Many factors influence urine supersaturation for calcium oxalate, being classified as promotors or inhibitors. High urinary excretion of calcium, oxalate, and urate are considered as promotors. Citrate, magnesium and potassium and other organic substances (nephrocalcin, urinary prothrombin fragment-1, osteopontin) are known to inhibit stone formation [7]
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