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RENAL LITHIASIS ANDNUTRITION
Nutrition Related Disease
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Regulation of Calcium
Metabolism Minerals; serum concentration Calcium (Ca2+); 2.2-2.6 mM (total) Phosphate (HPO4
2-); 0.7-1.4 mM Magnesium (Mg2+); 0.8-1.2 mM
Organ systems that play an import role in Ca2+metabolism Skeleton GI tract Kidney
Calcitropic Hormones Parathyroid hormone (PTH) Calcitonin (CT) Vitamin D (1,25 dihydroxycholecalciferol) Parathyroid hormone related protein (PTHrP)
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Three Forms of Circulating
Ca2+
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Calcium Balance Intake = output Negative calcium
balance: Output > intake Neg Ca2+ balance leads to
osteoporosis
Positive calcium balance:Intake > output Occurs during growth Most people are
asymptomatic Classically affects skeleton,
kidneys, and GI tract
Triad of complaints: bones,stones, and abdominalgroans
Renal stones are most
common single presentingcomplaint
Usually due to an adenoma(tumor)
Calcium is essential, wecant synthesize it
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Major Mediators of Calcium and
Phosphate Balance
Parathyroid hormone (PTH)
Calcitriol (active form of vitamin D3)
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Protective and Problems
Foods High-Potassium Foods. A study of 46,000 men conducted by Harvard
University researchers found that a high
potassium intake can cut the risk of kidneystones in half. Potassium helps the kidneys retain calcium,
rather than sending it out into the urine.
Potassium supplements are not generallynecessary. Rather, a diet including regularservings of fruits, vegetables, and beanssupplies plenty of potassium.
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Main Purine Rich Animal
Foods
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Renal Calculi
Author: Sandy Craig, MD, Adjunct Associate Professor, Department of Emergency
Medicine, University of North Carolina at Chapel Hill, Carolinas Medical
Center Contributor Information and Disclosures, Updated: Oct 29, 2009
Calcium stones (75%): Recent data suggest that a low-protein, low-salt diet may bepreferable to a low-calcium diet in hypercalciuric stone formers for preventing stonerecurrences.3 Epidemiological studies have shown that the incidence of stone disease isinversely related to the magnitude of dietary calcium intake in first-time stone formers.There is a trend in the urology community not to restrict dietary intake of calcium inrecurrent stone formers. This is especially important for postmenopausal women in whom
there is an increased concern for the development of osteoporosis. Calcium oxalate,calcium phosphate, and calcium urate are associated with the following disorders:
Hyperparathyroidism - Treated surgically or with orthophosphates if the patient is not asurgical candidate
Increased gut absorption of calcium - The most common identifiable cause ofhypercalciuria, treated with calcium binders or thiazides plus potassium citrate
Renal calcium leak - Treated with thiazide diuretics Renal phosphate leak - Treated with oral phosphate supplements
Hyperuricosuria - Treated with allopurinol, low purine diet, or alkalinizing agents suchas potassium citrate
Hyperoxaluria - Treated with dietary oxalate restriction, oxalate binders, vitamin B-6, ororthophosphates
Hypocitraturia - Treated with potassium citrate Hypomagnesuria - Treated with magnesium supplements
http://emedicine.medscape.com/article/766906-overviewhttp://emedicine.medscape.com/article/444866-overviewhttp://emedicine.medscape.com/article/444683-overviewhttp://emedicine.medscape.com/article/444968-overviewhttp://emedicine.medscape.com/article/444968-overviewhttp://emedicine.medscape.com/article/444683-overviewhttp://emedicine.medscape.com/article/444866-overviewhttp://emedicine.medscape.com/article/766906-overview7/28/2019 Renal Lithiasis and Nutrition 2003
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Oxalate Intake and the Risk for
Nephrolithiasis
(J Am Soc Nephrol 18: 21982204, 2007)
CONCLUSION
Our data do not support the contention that
dietary oxalate is a major risk factor for incidentkidney stones. The risk that was associated withoxalate intake was modest even in individualswho consumed diets that were relatively low incalcium. We hope that our study encouragesadditional research into the relations betweendietary oxalate, other dietary factors,endogenous oxalate production, urinary oxalate,and kidney stone formation.
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Mechanism of Urinary Calcium Regulation by Urinary
Magnesium and pH (J Am Soc Nephrol 19: 15301537,
2008)
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DASH-Style Diet Associates with Reduced Risk
for Kidney Stones (J Am Soc Nephrol 20: 2253
2259, 2009)
In conclusion, consumption of a DASH-stylediet is associated with a marked decrease inkidney stone risk
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Here are simple steps to help your
patients avoid kidney stones.
Encourage patients to drink plenty of water orother fluids, staying ahead of their thirst.
Diets including generous amounts of vegetables,fruits, and beans are rich in potassium and verylow in sodium.
If you prescribe calcium supplements, encouragepatients to take them with meals, rather thanbetween meals.
Encourage patients to avoid animal products(