Nephrolithiasis affects about 10% of people living in developed countries and its
incidence has increased along with other issues related to diet changes in the
population such as obesity, hypertension and diabetes mellitus.11 Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M, et
al. Epidemiology and risk factors in urolithiasis. Urol Int 2007;79:3-7. PMID:
17726345 DOI: http://dx.doi.org/10.1159/000104434
http://dx.doi.org/10.1159/000104434...
Despite being influenced by other factors, urine composition is largely determined by
the individual's diet makeup.22 Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease.
Adv Chronic Kidney Dis 2013;20:165-74. DOI:
http://dx.doi.org/10.1053/j.ackd.2012.12.001
http://dx.doi.org/10.1053/j.ackd.2012.12...
Several studies
showed that the typical diet of industrialized countries - rich in sodium, animal
protein and sugar and fructose sweetened beverages, causes a high excretion of calcium,
uric acid, oxalate and phosphorus; and a decrease in citrate and urinary pH, thus
favoring the formation of stones.33 Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of
incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc
Nephrol 2004;15:3225-32. DOI:
http://dx.doi.org/10.1097/01.ASN.0000146012.44570.20
http://dx.doi.org/10.1097/01.ASN.0000146...
4 Taylor EN, Curhan GC. Fructose consumption and the risk of kidney
stones. Kidney Int 2008;73:207-12. DOI:
http://dx.doi.org/10.1038/sj.ki.5002588
http://dx.doi.org/10.1038/sj.ki.5002588...
-55 Massey LK, Whiting SJ. Dietary salt, urinary calcium, and kidney stone
risk. Nutr Rev 1995;53:131-9. PMID: 7666985 On the other hand, an
adequate intake of fruits and vegetables appears to be a protective factor against stone
formation, because it is directly related to the ingestion of antilithogenic factors
such as potassium, magnesium, citrate and phytate.33 Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of
incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc
Nephrol 2004;15:3225-32. DOI:
http://dx.doi.org/10.1097/01.ASN.0000146012.44570.20
http://dx.doi.org/10.1097/01.ASN.0000146...
,66 Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et
al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int
2004;66:2402-10. PMID: 15569332 DOI:
http://dx.doi.org/10.1111/j.1523-1755.2004.66029.x
http://dx.doi.org/10.1111/j.1523-1755.20...
Thus, nutritional counseling is an affordable and safe strategy to help prevent the
occurrence and recurrence of kidney stones for both healthcare professionals and
patients. It is important to note that to obtain better results, dietary recommendations
should be established according to the type of stone and characteristics of 24h urine
analysis.22 Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease.
Adv Chronic Kidney Dis 2013;20:165-74. DOI:
http://dx.doi.org/10.1053/j.ackd.2012.12.001
http://dx.doi.org/10.1053/j.ackd.2012.12...
For instance, dietary tips for
those who make calcium oxalate stones are not exactly the same used for people who make
uric acid stones. And for those whose stones are of infectious origin (struvite), there
was no influence of diet composition.22 Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease.
Adv Chronic Kidney Dis 2013;20:165-74. DOI:
http://dx.doi.org/10.1053/j.ackd.2012.12.001
http://dx.doi.org/10.1053/j.ackd.2012.12...
Therefore,
a habit that should be advised to all individuals with nephrolithiasis is increased
fluid intake to decrease the urinary concentration of stone formation components.
Although the exact amount has not yet been established, these patients should be
encouraged to drink a minimum of 30 ml/kg of body weight of fluid per day.22 Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease.
Adv Chronic Kidney Dis 2013;20:165-74. DOI:
http://dx.doi.org/10.1053/j.ackd.2012.12.001
http://dx.doi.org/10.1053/j.ackd.2012.12...
In order to prevent this problem in the population, the most appropriate strategy is to
encourage a balanced diet. A recent publication that examined the association between
dietary habits and the risk of nephrolithiasis in more than 50,000 people concluded that
the main protective factors were the high magnesium intake from fresh fruits and fiber
from whole grains. Furthermore, when compared to participants who had a high intake of
meat (> 100 g/ day), those who had a moderate (50-99 g/day) or low (< 50 g/day)
intake had 20% and 48% less chance of developing stones, respectively.77 Turney BW, Appleby PN, Reynard JM, Noble JG, Key TJ, Allen NE. Diet and
risk of kidney stones in the Oxford cohort of the European Prospective Investigation
into Cancer and Nutrition (EPIC). Eur J Epidemiol 2014;29:363-9. DOI:
http://dx.doi.org/10.1007/s10654-014-9904-5
http://dx.doi.org/10.1007/s10654-014-990...
This issue of the BJN includes the paper in which Gordiano et al. analyzed the main dietary and metabolic characteristics of 31 patients with nephrolithiasis treated at a Nephrology clinic and compared the results with those obtained from a control group.88 Giordiano EA, Tondin LM, Miranda RC, Baptista DR. Avaliação da ingestão alimentar e excreção de metabólitos na nefrolitíase. J Bras Nefrol 2014;36:437-45. Although only a small number of patients were included, the nutritional profile found (88% were diagnosed with overweight or obese according to BMI) and the high prevalence of hypertensive individuals (64%) showed the close relationship between these metabolic disorders and nephrolithiasis.
With respect to the investigation of diet despite the limitations inherent to the methodologies used to assess dietary intake, the authors observed a high consumption of protein and sodium, with calcium, potassium and fluid intake below recommended levels in both groups; and as the authors aptly pointed out, these are dietary behaviors which favor the recurrence of nephrolithiasis. These findings stress the importance of nutrition counseling and monitoring of individuals affected by this problem, which besides affecting quality of life, may consequently lead to irreversible loss of kidney function.
Referências
-
1Bartoletti R, Cai T, Mondaini N, Melone F, Travaglini F, Carini M, et al. Epidemiology and risk factors in urolithiasis. Urol Int 2007;79:3-7. PMID: 17726345 DOI: http://dx.doi.org/10.1159/000104434
» http://dx.doi.org/10.1159/000104434 -
2Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Adv Chronic Kidney Dis 2013;20:165-74. DOI: http://dx.doi.org/10.1053/j.ackd.2012.12.001
» http://dx.doi.org/10.1053/j.ackd.2012.12.001 -
3Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol 2004;15:3225-32. DOI: http://dx.doi.org/10.1097/01.ASN.0000146012.44570.20
» http://dx.doi.org/10.1097/01.ASN.0000146012.44570.20 -
4Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int 2008;73:207-12. DOI: http://dx.doi.org/10.1038/sj.ki.5002588
» http://dx.doi.org/10.1038/sj.ki.5002588 -
5Massey LK, Whiting SJ. Dietary salt, urinary calcium, and kidney stone risk. Nutr Rev 1995;53:131-9. PMID: 7666985
-
6Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G, et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int 2004;66:2402-10. PMID: 15569332 DOI: http://dx.doi.org/10.1111/j.1523-1755.2004.66029.x
» http://dx.doi.org/10.1111/j.1523-1755.2004.66029.x -
7Turney BW, Appleby PN, Reynard JM, Noble JG, Key TJ, Allen NE. Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Epidemiol 2014;29:363-9. DOI: http://dx.doi.org/10.1007/s10654-014-9904-5
» http://dx.doi.org/10.1007/s10654-014-9904-5 -
8Giordiano EA, Tondin LM, Miranda RC, Baptista DR. Avaliação da ingestão alimentar e excreção de metabólitos na nefrolitíase. J Bras Nefrol 2014;36:437-45.
Publication Dates
-
Publication in this collection
Oct-Dec 2014
History
-
Received
10 Oct 2014 -
Accepted
15 Oct 2014