Kidney Stone Disease (Nephrolithiasis)

Health Advice

Article by: Consultant Dietitian from Beacon Premier Wellness


What is a Kidney Stone ?

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

Types of Kidney Stone and Its Prevalence

They 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, yet they can pass through the urinary tract, causing little or no pain. [2] However, larger kidney stones may get stuck in the urinary tract, thereby blocking the flow of urine and causing severe pain.[2] Additionally, pain relievers may be needed to ease the painful sensation caused by small stones, while surgery may be necessary 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

Suggestions To Reduce Sodium Intake [2,5]

Moreover, 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. Additionally, remember to limit sauces such as ketchup and salad dressing that are high in sodium.

Other examples of high sodium foods include canned food, highly processed food such as sausage and luncheon meat, or fast food.

Best practices to Reduce Oxalate Intake [2,5,6,7]

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

  • Furthermore, limit spinach, beet, rhubarb, chard, and root vegetables such as sweet potatoes and potatoes (without skin has lower oxalate content) to less than 100g.
  • Limit fruit such as start fruit, berries, dried figs.
  • Moreover, reduce nuts such as peanuts, almonds, cashews, walnuts, and pecans.
  • Additionally, reduce consumption of chocolate, soy, and 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) + Yogurt (calcium-rich food)

Recommendations To Get Adequate Calcium Intake [2,5]

Moreover, there is often a misconception that reducing calcium intake will reduce the risk of calcium stone formation. Conversely, adequate calcium intake can help reduce the formation of calcium stones. This is because calcium binds to oxalate in the stomach or intestine, thereby reducing oxalate absorption into the body and the risk of calcium oxalate stone formation in the kidneys.

As a result, it is advised to pair calcium- and oxalate-containing foods while eating. Dietary sources of calcium fall into two categories: dairy (such as milk, cheese, and yogurt) and non-dairy (including chia seeds, broccoli, chickpeas, and kale). However, it is preferable to select calcium-containing foods that have less salt or added sugar.

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

Limiting animal protein intake may reduce the risk of kidney stones. Examples of animal-based proteins include chicken, pork, beef, especially organ meat, eggs, fish (such as anchovies, sardines, mackerel, and herring), and shellfish (including scallops, shrimp, and mussels). Additionally, animal proteins rich in purine content, such as anchovies, sardines, mackerel, herring, and internal organs, may increase uric acid production, leading to acidic urine.

Ergo, it would be advisable to consider replacing animal protein with plant-based protein sources (such as dried peas, beans, and lentils), which are less likely to contribute to acidic urine formation. A beneficial approach is to increase the consumption of plant-based protein while reducing the intake of animal protein in the diet.

Methods 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 color) that may allow  minerals to crystallize 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.

Approaches 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

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