Dietary pattern analysis among stone formers: resemblance to a DASH-style diet

Abstract Recent epidemiological studies have shown that dietary patterns may have a more persistent impact on the risk of stone formation than single nutrients of the diet. Dietary Approaches to Stop Hypertension (DASH), a low-sodium and fruits/vegetables-rich diet, has been associated with a lower risk of nephrolithiasis, due to altered urinary biochemistry. This observational study aimed to investigate whether the dietary pattern of stone formers (SF) resembled a DASH-diet and its influence on urinary lithogenic parameters. Anthropometric data, fasting serum sample, 24-h urine samples, and a 3-day food intake record under an unrestricted diet were obtained from 222 SF and compared with 136 non-SF subjects (controls). The DASH-diet food portions were determined from the food records whereas intakes of sodium chloride (NaCl) and protein (protein equivalent of nitrogen appearance, PNA) were estimated from 24-hr urinary sodium and urea. A dietary profile close to a DASH-diet was not observed in any of the groups. NaCl intake and PNA were significantly higher in SF versus non-SF (12.0 ± 5.2 v.s. 10.1 ± 3.4 g/day, p = 0.01 and 1.8 ± 0.1 v.s. 1.4 ± 0.1 g/kg/day, p = 0.03). SF exhibited a positive correlation of NaCl intake and PNA with urinary calcium, oxalate and uric acid, and of PNA with urinary sodium. SF consumed more vegetables and legumes, but less fruits and low-fat dairy items than non-SF. The present series presented a dietary profile characterized by low calcium and high salt and protein contents, not reflecting an ideal DASH-style diet pattern.

Download Full-text

Urinary calcium oxalate crystal growth inhibitors.

Journal of the American Society of Nephrology ◽

10.1681/asn.v55s46 ◽

1994 ◽

Vol 5 (5) ◽

pp. S46

Author(s):

E M Worcester

Keyword(s):

Crystal Growth ◽

Calcium Oxalate ◽

Stone Formation ◽

Bone Matrix ◽

Urinary Calcium ◽

Crystal Nucleation ◽

Calcium Oxalate Crystal ◽

Stone Formers ◽

High Concentrations ◽

Renal Tubular

Calcium stones occur because renal tubular fluid and urine are supersaturated with respect to calcium oxalate and phosphate. The process of stone formation includes crystal nucleation, growth, aggregation, and attachment to renal epithelia. Urine contains macromolecules that modify these processes and may protect against stone formation. Attention has focused especially on inhibitors of crystal growth, and several have been isolated from urine, including nephrocalcin, an acidic phosphorylated glycoprotein that contains several residues of gamma-carboxyglutamic acid per molecule; osteopontin (uropontin), a phosphorylated glycoprotein also found in bone matrix; uronic acid-rich protein, which contains a covalently bound glycosaminoglycan residue; and several others. Abnormalities in structure and/or function have been detected in some of these proteins in stone formers' urine. However, the overall ability of urinary macromolecules to inhibit calcium oxalate crystal growth is often normal in stone formers. Recently, attention has been focused on the ability of these molecules to inhibit other stages in stone formation. Nephrocalcin can inhibit crystal nucleation, for example, and both nephrocalcin and Tamm-Horsfall protein inhibit crystal aggregation. Nephrocalcin and Tamm-Horsfall protein from stone formers are less active in preventing aggregation, and under some conditions, Tamm-Horsfall protein may promote the formation of crystal aggregates, especially in the presence of high concentrations of calcium. The structural abnormalities responsible for impaired inhibitory activity are not completely understood.

Download Full-text

Utility of urinary calcium/creatinine ratio in evaluation of urinary stone formers: a Sudanese case control study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20164538 ◽

2016 ◽

Vol 5 (1) ◽

pp. 146

Author(s):

Awad Elkarim Hassan Abdallah ◽

Abuobieda Bala Abusharib ◽

Abdulhadi Mohamed Elbashir ◽

Ihab Hamed Nourien

Keyword(s):

Case Control Study ◽

Stone Formation ◽

Urinary Stone ◽

Case Control ◽

Urinary Calcium ◽

Creatinine Ratio ◽

Evaluation Tool ◽

Mean Values ◽

Stone Formers ◽

Control Study

Background: Hypercalciuria is a common cause of urinary stone formation in both children and adults; one of the components of the comprehensive evaluation of stone formers is to measure 24 hours urinary calcium, which is a complicated method especially in children, therefore some physicians depend on calcium creatinine ratio instead of it. The objective of this study was to assess the utility of calcium/creatinine ratio as an evaluation tool for hypercalciuria in urinary stone formers.Methods: This was a case control study in which forty patients of urinary stone formers along with fifteen healthy controls group were enrolled; after fulfilling specific inclusion and exclusion criteria a questionnaire was filled, then an early morning urinary samples were collected for calcium and creatinine measurement to calculate the calcium creatinine ratio.Results: The results showed significantly higher mean value of calcium/creatinine ratio in the stone formers group compared with controls one. Also there were statistically insignificant differences in the urinary calcium between the two groups. Moreover this study showed higher mean values of both calcium and calcium/creatinine ratio in recurrent stone formers when compared with first time stone former.Conclusions: This study concluded that calcium/creatinine ratio is a useful and easier method for the initial evaluation of stone formers.

Download Full-text

The use of indexes evaluating the adherence to the Mediterranean diet in epidemiological studies: a review

Public Health Nutrition ◽

10.1079/phn2005936 ◽

2006 ◽

Vol 9 (1a) ◽

pp. 132-146 ◽

Cited By ~ 221

Author(s):

Anna Bach ◽

Lluís Serra-Majem ◽

Josep L Carrasco ◽

Blanca Roman ◽

Joy Ngo ◽

...

Keyword(s):

Mediterranean Diet ◽

Dietary Pattern ◽

A Priori ◽

Epidemiological Studies ◽

Global Evaluation ◽

Food Groups ◽

Reference Pattern ◽

Diet Pattern ◽

The Mediterranean ◽

Quantitative Definition

AbstractThe purpose of this paper is to review some of the methods that several epidemiological studies use to evaluate the adherence of a population to the Mediterranean diet pattern. Among these methods, diet indexes attempt to make a global evaluation of the quality of the diet based on a traditional Mediterranean reference pattern, described as a priori, general and qualitative. The Mediterranean diet indexes, hence, summarise the diet by means of a single score that results from a function of different components, such as food, food groups or a combination of foods and nutrients. The reviewed evaluation methods can be classified into three categories depending on the way they are calculated: (1) those based on a positive or negative scoring of the components, (2) those that add or substract standardised components, and (3) those that are based on a ratio between components.Dietary scores have been used to explore the multiple associations between the Mediterranean diet, as an integral entity, and health parameters such as life expectancy or the incidence of obesity, cardiovascular diseases and some types of cancers. Moreover, these indexes are also useful tools to measure food consumption trends and to identify the involved factors, as well as to develop comprehensive public health nutrition recommendations.A more precise and quantitative definition of the Mediterranean diet is required if the adherence to such a dietary pattern is intended to be more accurately measured. Other aspects of the Mediterranean diet indexes should also be taken into account, like the inclusion of typical Mediterranean foods such as nuts and fish and the validation of the dietary pattern approach by using biomarkers.

Download Full-text

Urinary phosphorus rather than urinary calcium possibly increases renal stone formation in a sample of Asian Indian, male stone-formers

British Journal Of Nutrition ◽

10.1017/s0007114507778686 ◽

2007 ◽

Vol 98 (6) ◽

pp. 1224-1228 ◽

Cited By ~ 1

Author(s):

Shoma Berkemeyer ◽

Anupam Bhargava ◽

Usha Bhargava

Keyword(s):

Renal Stone ◽

Stone Formation ◽

Renal Stones ◽

Urinary Calcium ◽

Healthy Controls ◽

Dietary Intakes ◽

Stone Formers ◽

Dietary Record ◽

Biochemical Analyses ◽

Serum And Urine

The contribution of dietary Ca and P in renal stone formation is debated. Thus, the main objective was to investigate if there were any differences in the dietary, serum and urine values of Ca and P in stone formers (SF) compared with healthy controls (HC). The secondary aim was to analyse if dietary, serum and urine Ca and P correlated. The study enrolled ten patients with renal stones admitted for stone removal and ten healthy controls. Their dietary macronutrients, Ca and P intakes were calculated from 2-d dietary records. On the second day of dietary record 24-h urine was collected and on the third day morning a 5 ml blood sample was collected. Biochemical analyses were conducted for serum and urine Ca, P and uric acid with qualitative renal stone analysis. All the dietary intakes and urine P were significantly higher (P < 0·05) in SF than in HC. Correlation results showed that in SF dietary Ca correlated to serum and urine Ca. No such correlations were seen for P. Additionally, in SF urine Ca correlated to dietary proteins and fats but not to carbohydrates. None of the biochemical values lay outside the normal range of values. The study suggests urine P rather than urine Ca to be probably at work in the formation of renal stones. Limitation of protein intake with normal Ca intakes could provide a suitable measure to avoid renal stone formation.

Download Full-text

The Role of Inhibitors and other Factors in the Pathogenesis of Recurrent Calcium-Containing Renal Stones

Clinical Science ◽

10.1042/cs0530141 ◽

1977 ◽

Vol 53 (2) ◽

pp. 141-148 ◽

Cited By ~ 8

Author(s):

J. M. Baumann ◽

S. Bisaz ◽

R. Felix ◽

H. Fleisch ◽

U. Ganz ◽

...

Keyword(s):

Inhibitory Activity ◽

Stone Formation ◽

Renal Stones ◽

Urinary Calcium ◽

Stone Disease ◽

Calcium Excretion ◽

Crystal Formation ◽

Inorganic Pyrophosphate ◽

Control Subjects ◽

Stone Formers

1. In order to assess the relative importance of possible pathogenetic factors in the formation of calcium-containing renal stones, a group of 18 patients (12 men, six women) with active, recurrent stone disease were compared with 16 age-matched control subjects (10 men, six women) given an identical diet. 2. Fifteen (83%) of the patients showed at least one, eight (44%) showed two, and one (6%) patient showed three abnormalities that might predispose to stone formation. 3. Increased urinary calcium excretion was the most common abnormality (11 patients, 61%), particularly in the women (83%). 4. A diminished excretion of inhibitors of crystal formation of calcium phosphate was the next most common abnormality, which occurred in eight patients (44%), all of whom were men. It was largely attributable to a diminished excretion of inorganic pyrophosphate (PPi). The PPi/orthophosphate ratios were also lower in the stone-formers. Significant differences in residual inhibitory activity after enzymatic removal of PPi between control subjects and stone-formers could not be found in 24 h urine samples but were present during certain times of the day. Pyrophosphate showed a higher inhibitory activity in urine than in control solutions, this enhancement being absent in stone-formers. 5. Nine (50%) of the patients, but only one of the control subjects, produced crystal aggregates greater than 50 μm in diameter after an oral load of oxalate.

Download Full-text

Does the Urinary Calcium/Citrate Ratio Add to the Diagnostic Workup of Children at Risk of Kidney Stones? A Cross-Sectional Study

Journal of Child Science ◽

10.1055/s-0039-1677818 ◽

2019 ◽

Vol 09 (01) ◽

pp. e1-e6

Author(s):

Misan Lee ◽

Carmen Rodriguez Cuellar ◽

Ravneet Nagra ◽

Zhan Tao Wang ◽

Vipin Bhayana ◽

...

Keyword(s):

At Risk ◽

Kidney Stones ◽

Clinical Laboratory ◽

Urinary Calcium ◽

Urinary Sodium ◽

Calcium Citrate ◽

Sodium Potassium ◽

Positive Correlation ◽

Stone Formers ◽

Urinary Citrate

The purpose of the study was to evaluate urinary citrate/creatinine (UCi/UCr) and urinary calcium/citrate (UCa/UCi) ratios for distinguishing stone formers (SF) from non-stone formers (NSF) in an at-risk population. This was a retrospective study that included all pediatric patients who underwent urinary citrate testing from April 2017 to March 2018. The urinary levels of citrate, calcium, sodium, potassium, creatinine, oxalate, urate, pH, and specific gravity (SG) were measured in our clinical laboratory. Diagnosis of kidney stones was obtained through chart review.A total of 97 patients were included (46 NSF and 51 SF). The UCi/UCr ratio was not significantly different between NSF and SF. Median UCa/UCr ratio was higher in SF (0.67) compared with NSF (0.21, p < 0.0001). The median ratio of UCa/UCi was also higher in SF (1.30) than in NSF (0.65, p = 0.001). Oxalate, urate, pH, SG, and urinary sodium/potassium ratio did not differentiate between the SF and NSF. Positive correlation was seen between UCa/UCr and urinary sodium/creatinine UNa/UCr (p < 0.0001), as well as between UCa/UCr and UCi/UCr (p < 0.0001).The study has demonstrated significantly higher UCa/UCi and UCa/UCr in SF compared with NSF, while the use of urinary oxalate, urate, pH, and SG did not differentiate between SF from NSF. We also confirmed a positive correlation between UNa/UCr and UCa/UCr. While the utility of UCa/UCr is well established, our data suggest that UCa/UCi rather than UCi/UCr may be more predictive in the clinical setting when evaluating for nephrolithiasis.

Download Full-text

Recurrent urolithiasis following parathyroidectomy for primary hyperparathyroidism

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13629960048712 ◽

2013 ◽

Vol 95 (7) ◽

pp. 523-528 ◽

Cited By ~ 15

Author(s):

C Rowlands ◽

A Zyada ◽

S Zouwail ◽

H Joshi ◽

MJ Stechman ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Recurrence Rate ◽

Stone Formation ◽

Urinary Calcium ◽

Calcium Excretion ◽

Stone Formers ◽

Group 3 ◽

Group 2 ◽

Group 1

Introduction The effect of parathyroidectomy on the incidence of recurrent stone formation is uncertain. We aimed to compare the biochemistry and recurrence rate of urolithiasis in patients with primary hyperparathyroidism (pHPT) and stone formation (SF) and non-stone formation (NSF) with idiopathic stone formers (ISF). Methods Patients with pHPT and SF (Group 1) were identified from a prospective database. pHPT patients and NSF (Group 2) and ISFs (Group 3) were randomly selected from respective databases to form three equal groups. Preoperative and postoperative biochemical data were analysed and recurrent urolithiasis diagnosed if present on follow-up radiology. Out-of-area patients were asked about recurrence via telephone. Results From July 2002 to October 2011, 640 patients had parathyroidectomy for pHPT. Of these, 66 (10.3%) had a history of renal colic; one was lost to follow-up. Patient demographics were similar across all three groups. Three months post-parathyroidectomy, Groups 1 and 2 had significantly reduced serum calcium concentrations (p<0.01). Group 1 had lower urinary calcium excretion after parathyroidectomy (p<0.01), but estimated glomerular filtration rate did not change following surgery. During median follow-up of 4.33 years (0.25–9 years) in Groups 1 and 2 and 5.08 years (0.810–8 years) in Group 3, one patient (1.5%) in Group 1 and 16 patients (25%) in Group 3 had recurrent urolithiasis (p<0.01). No Group 2 patients developed stones. Conclusion Curative parathyroidectomy confers a low recurrence rate for urolithiasis, but does not prevent recurrence in all patients. Further research should aim to identify the risk factors for continued SF in these patients.

Download Full-text