Health Advice

Kidney Stone Disease (Nephrolithiasis)

What is a Kidney Stone ?

Kidney stone is a hard deposits that form in the kidney when high level certain minerals are bound together which causes crystal formation in your urine. [1,2]

Type of Kidney Stone and Its Prevalence

Kidney stone can be classified into 4 types; calcium oxalate or phosphate, uric acid, struvite and cystine. [1] The most common kidney stone is calcium oxalate and calcium phosphate (70-80%), followed by uric acid stone and struvite stone (10%), cystine stone (<1%). Previously, kidney stones disease was predominant in males, however, the gender gap was closing and females became more likely to develop kidney stone disease. [3] Lastly, the prevalence of kidney stones is 10-20% in Asia whereas 15-18% in Western countries. [4]

Sign and Symptoms of Kidney Stone Disease

Sign and Symptoms include: [4]

  • Severe pain in side, back, lower abdomen, groin
  • Burning and painful sensation while urinating
  • Frequent urination due to only can urinate in small amount
  • Bad smell, cloudy, pink, red, brown color urine
  • May experience nausea and vomiting or fever and chills, if worsens

Some kidney stones may be as small as a grain of sand which passes through the urinary tract, causing little or no pain. [2] However, larger kidney stones may get stuck in the urinary tract and block the flow of urine, causing severe pain. [2] Pain relievers may be needed to ease painful sensation caused by small stones whereas surgery may be needed in severe cases. [2]

Dietary Management of Kidney Stone Disease

NutrientGeneral Recommendation [1]
Sodium<2300 mg/day
Calcium800 – 1200 mg/day
Oxalate40 – 50 mg/day
Protein0.8 – 1.4 g/day
Fluid>2.5 L/day
Vitamin CBased on Dietary Reference Intake, <1000 mg/day

Tips To Reduce Sodium Intake [2,5]

We are advised to avoid high sodium intake by limiting salt intake (not more than 1 teaspoon of salt per day). Salt can be replaced by herbs and spices such as garlic, ginger, cumin and turmeric powder. Besides, remember to limit sauces such as ketchup and salad dressing that are high in sodium. Other examples of high sodium foods are canned food, highly processed food such as sausage and luncheon meat or fast food.

Tips to Reduce Oxalate Intake [2,5,6,7]

Oxalate is naturally found in many foods, so we should:

  • Limit spinach, beet, rhubarb, chard, root vegetable such as sweet potatoes and potatoes <100g (without skin has lower oxalate content)
  • Limit fruit such as start fruit, berries, dried figs
  • Limit nuts like peanuts, almond, cashew, walnuts and pecans,
  • Limit chocolate, soy, wheat bran
  • Consume calcium-containing food (around 300-400 mg calcium per serve) when having oxalate-containing food. For example:

→Chocolate (oxalate-rich food) + Milk (calcium-rich food)

→Almond/Peanut (oxalate-rich food) + Yoghurt (calcium-rich food)

Tips To Get Adequate Calcium Intake [2,5]

There is often a misconception that reducing calcium intake will reduce risk of calcium stone. Conversely, adequate calcium intake will help reduce the formation of calcium stone. This may be due to, calcium will bind oxalate in the stomach or intestine, thus reducing oxalate absorption into the body and the risk of calcium oxalate in the kidney. Hence, it is advised to pair calcium- and oxalate-containing food sources while eating. Dietary sources of calcium can be classified into 2 categories: dairy (milk, cheese, yoghurt) and non-dairy (chia seed, broccoli, chickpeas and kale). However, it’s better to select calcium-containing food that has less salt or added sugar.

Tips To Have A Moderate Amount of Protein Intake [2]

Limiting animal protein may reduce the risk of kidney stones. Examples of animal-based proteins include chicken, pork, beef, especially organ meat, egg, fish (anchovies, sardines, mackerel, herring) and shellfish (scallops, shrimps and mussels). Besides, animal proteins that are rich in purine content such as anchovies, sardines, mackerel, herring, and internal organs may increase uric acid production which can make urine become acidic. Thus, it would be better to consider replacing animal protein with plant-based protein (such as dried peas, beans and lentils) which is less likely to form acidic urine. A good method to practice is to increase consumption of plant-based protein but a small amount of animal protein diet.

Tips To Get Adequate Fluid Intake [7,8,9]

Drinking plenty of water may also help in preventing kidney stone formation too! It is because inadequate fluid results in the production of concentrated urine (dark yellow colour) that may allow  minerals to crystallise and stick together. It’s recommended to have at least 2.5L of water every day, and plain water is preferred in an effort to reduce risk of kidney stones. You may add lemon juice to plain water to enhance the taste. Lastly, you should avoid sugar-sweetened beverages, except 100% pure fruit juice.

Tips To Prevent Excessive Vitamin C Intake

High doses of Vitamin C consumption will increase the risk of oxalate production. So, it is best to get your daily dose of vitamin C from fruits and vegetables instead of high dose supplements.

Changes in Eating, Diet and Nutrition Are Required According to Types of Kidney Stones [1,7,10]

Calcium Stone→Reduce sodium intake
→Reduce oxalate intake
→Adequate calcium intake
→Moderate amount of protein intake
→Adequate fluid intake
→Avoid high dose of vitamin C supplement
Uric Acid Stone→Limit intake of food sources that contain high purine, such as animal protein (red meat, organ meat, meat extract, anchovies, shellfish), sugar-sweetened food and beverages, as well as alcohol intake.
→Adequate fluid intake
Struvite Stone→Caused by urinary tract infection, mainly treated by surgery.
Cystine StoneCaused by genetic defects, mainly treated by surgery.

Take Home Message

In short, some changes in your diet may help to prevent kidney stones such as calcium and uric acid stone, but there are some other types of kidney stones such as struvite and cystine stone that may need to get medical treatment immediately. Besides, we should always take care of our kidneys as it is an important organ to filter blood and remove extra waste such as urine.


Reference List

  1. Han, H., Segal, A. M., Seifter, J. L., & Dwyer, J. T. (2015, July). Nutritional management of kidney stones (nephrolithiasis). Clinical nutrition research. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525130/
  1. S. Department of Health and Human Services. (n.d.). Definition & Facts for Kidney Stones. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved February 8, 2023, from https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/definition-facts
  1. Gillams, K., Juliebø-Jones, P., Juliebø, S. Ø., & Somani, B. K. (2021, October 8). Gender differences in kidney stone disease (KSD): Findings from a systematic review. Current urology reports. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497339/
  1. (2016, April 7). Urinary stones. PORTAL MyHEALTH. Retrieved February 8, 2023, from http://www.myhealth.gov.my/en/urinary-stones/
  1. Kidney stones: Diet plan and prevention. National Kidney Foundation. (2022, November 4). Retrieved February 8, 2023, from https://www.kidney.org/atoz/content/diet#:~:text=To%20prevent%20uric%20acid%20stones,and%20low%2Dfat%20dairy%20products
  1. Mitchell, T., Kumar, P., Reddy, T., Wood, K. D., Knight, J., Assimos, D. G., & Holmes, R. P. (2019, March 1). Dietary oxalate and Kidney Stone Formation. American journal of physiology. Renal physiology. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459305/
  1. Diet and Kidney Stones – Queensland Health. (n.d.). Retrieved February 24, 2023, from https://www.health.qld.gov.au/__data/assets/pdf_file/0024/151863/renal_kdnystones.pdf
  1. (n.d.). Prevention of Kidney Stones. NHS choices. Retrieved February 8, 2023, from https://www.nhs.uk/conditions/kidney-stones/prevention/#:~:text=The%20best%20way%20to%20prevent,throughout%20the%20day%2C%20every%20day.
  1. Pearle MS;Goldfarb DS;Assimos DG;Curhan G;Denu-Ciocca CJ;Matlaga BR;Monga M;Penniston KL;Preminger GM;Turk TM;White JR; ; (n.d.). Medical Management of Kidney Stones: AUA guideline. The Journal of urology. Retrieved February 8, 2023, from https://pubmed.ncbi.nlm.nih.gov/24857648/
  1. Gul, Z., & Monga, M. (2014, November 28). Medical and dietary therapy for Kidney Stone Prevention. Korean Journal of Urology. Retrieved February 8, 2023, from https://synapse.koreamed.org/articles/1006212
Hi, I’m Gregory Low

Leave a Reply

Your email address will not be published. Required fields are marked *