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Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women
Abstract
Calcium intake is believed to play an important role in the formation of kidney stones, but data on the risk factors for stone formation in women are limited.
To examine the association between intake of dietary and supplemental calcium and the risk for kidney stones in women.
Prospective cohort study with 12-year follow-up.
Several U.S. states.
91,731 women participating in the Nurses' Health Study I who were 34 to 59 years of age in 1980 and had no history of kidney stones.
Self-administered food-frequency questionnaires were used to assess diet in 1980, 1984, 1986, and 1990. The main outcome measure was incident symptomatic kidney stones.
During 903,849 person-years of follow-up, 864 cases of kidney stones were documented. After adjustment for potential risk factors, intake of dietary calcium was inversely associated with risk for kidney stones and intake of supplemental calcium was positively associated with risk. The relative risk for stone formation in women in the highest quintile of dietary calcium intake compared with women in the lowest quintile was 0.65 (95% CI, 0.50 to 0.83). The relative risk in women who took supplemental calcium compared with women who did not was 1.20 (CI, 1.02 to 1.41). In 67% of women who took supplemental calcium, the calcium either was not consumed with a meal or was consumed with meals whose oxalate content was probably low. Other dietary factors showed the following relative risks among women in the highest quintile of intake compared with those in the lowest quintile: sucrose, 1.52 (CI, 1.18 to 1.96); sodium, 1.30 (CI, 1.05 to 1.62); fluid, 0.61 (CI, 0.48 to 0.78); and potassium, 0.65 (CI, 0.51 to 0.84).
High intake of dietary calcium appears to decrease risk for symptomatic kidney stones, whereas intake of supplemental calcium may increase risk. Because dietary calcium reduces the absorption of oxalate, the apparently different effects caused by the type of calcium may be associated with the timing of calcium ingestion relative to the amount of oxalate consumed. However, other factors present in dairy products (the major source of dietary calcium) could be responsible for the decreased risk seen with dietary calcium.
... In those with hyperoxaluria, it is also beneficial to use calcium supplements with meals to bind oxalate in the gut and prevent absorption [51,55,56]. Dietary calcium of 800-1200 mg daily is suggested [51][52][53][54][55][56][57][58]. Use of pyridoxine (vitamin B6) may also be associated with lower urine levels of oxalate and decreased risk of stone formation [56,59]. ...
... It is appropriate to assess bone mineral density. While treatment with calcium supplements can potentially aggravate the stone risk in some cases [58], due to increased risk of GI absorption, increase in dietary calcium is appropriate to 800 to 1200 mg daily [55][56][57][58]. In fact, diets low in calcium can actually increase stone risk by increasing risk of excess urine oxalate, as intestinal calcium helps to bind oxalate in the intestine and prevent excess oxalate absorption [14][15][16][17]58]. ...
... It is appropriate to assess bone mineral density. While treatment with calcium supplements can potentially aggravate the stone risk in some cases [58], due to increased risk of GI absorption, increase in dietary calcium is appropriate to 800 to 1200 mg daily [55][56][57][58]. In fact, diets low in calcium can actually increase stone risk by increasing risk of excess urine oxalate, as intestinal calcium helps to bind oxalate in the intestine and prevent excess oxalate absorption [14][15][16][17]58]. ...
Background
Nephrolithiasis as a feature of rheumatologic diseases is under recognized. Understanding presenting features, diagnostic testing is crucial to proper management.
Case presentation
A 32 year old woman with a history of recurrent complicated nephrolithiasis presented to a rheumatologist for a several month history of fatigue, dry eyes, dry mouth, arthralgias. She had a positive double-stranded DNA, positive SSA and SSB antibodies. She was diagnosed with Systemic Lupus erythematosus (SLE) and Sjogren's syndrome and was started on mycophenalate mofetil. Of relevance was a visit to her local emergency room 4 years earlier with profound weakness with unexplained marked hypokalemia and a non-anion gap metabolic acidosis. Approximately one year after that episode she developed flank pain and nephrocalcinosis. She had multiple issues over the ensuing years with stones and infections on both sides. Interventions included extracorporeal shockwave lithotripsy as well as open lithotomy and eventual auto-transplantation of left kidney for recurrent ureteric stenosis. 24 h stone profile revealed marked hypocitraturia, normal urine calcium, normal urine oxalate and uric acid. She was treated with potassium citrate. Mycophenolate was eventually stopped due to recurrent urinary tract infections and she was started on Belimumab. Because of recurrent SLE flares, treatment was changed to Rituximab (every 6 months) with clinical and serologic improvement. Her kidney stone frequency gradually improved and no further interventions needed although she continued to require citrate repletion for hypocitraturia.
Conclusions
Nephrolithiasis can be a prominent and even presenting feature in Sjogrens syndrome as well as other rheumatologic diseases. Prompt recognition and understanding disease mechanisms is important for best therapeutic interventions for kidney stone prevention as well as treatment of underlying bone mineral disease.
... The independent health benefits of magnesium supplementation are unclear. Although there has been no association found in women, [52,53] higher dietary magnesium was linked to a 30% decreased incidence of stone formation in men. [51] Limiting the potassium intake may lead to more calcium being excreted in urine. ...
... Consuming potassium-rich meals, such as fruits and vegetables, acts as an alkali load, increasing the excretion of citrate through the urine. The incidence of kidney stones is negatively correlated with higher potassium intake in men and older women, [52,54] but not in younger women, [53] Generally speaking, potassium citrate is regarded as a relatively secure and often utilised preventive for reducing stone recurrence, [55] In this trial, potassium citrate therapy did not appear to lower the recurrence rate. This might be connected to being impacted by the Liu et al., [56] result. ...
... The combined impact of dietary sodium restriction and animal protein restriction on lowering urinary calcium excretion is strongly supported by randomized trial results [57] . Observational studies discovered that sodium consumption is positively and independently associated with the development of new kidney stones in women but not in men [52,54] . It is unknown what part dietary oxalate plays in the development of calcium oxalate nephrolithiasis. ...
... The major role of fluid intake on the risk of urinary stone was well documented by epidemiological studies [3][4][5] and by an interventional study [6]. Fluid intake was inversely related to the risk of kidney stones with a relative risk of 0.71 in men and of 0.61-0.68 in women in the highest quintile of intake compared with those in the lowest quintile [3][4][5]. ...
... The major role of fluid intake on the risk of urinary stone was well documented by epidemiological studies [3][4][5] and by an interventional study [6]. Fluid intake was inversely related to the risk of kidney stones with a relative risk of 0.71 in men and of 0.61-0.68 in women in the highest quintile of intake compared with those in the lowest quintile [3][4][5]. An interventional study showed that a large intake of water is effective to reduce the risk of stone recurrences [6]. ...
... The epidemiological evidence was contradictory in that a positive correlation had been shown between animal protein consumption and new kidney stone formation in men but not women whereas sucrose intake was associated with new kidney stone formation in women but not in men [3][4][5]. ...
Nutrients, vitamins, probiotics, and herbal products may be risk factors, or alternately, protect against the formation of urinary stones. The purpose of this review was to update knowledge of the role of nutraceuticals in renal stone formation. A systematic search of the relevant literature published in PubMed in the last ten years was conducted and a narrative review of the data from the included studies was done. Search screened 513 studies that were reduced to 34 after evaluation by title and abstract; other 38 studies were retrieved by references of the selected studies. Beverages high fluid intake confirmed protective effect; orange juice protective effect; apple or grapefruit juice not confirmed as risk factors; sugar-sweetened soda and punch increased risk of stone formation. Energy intake: very high energy intake increased risk factor for women (especially after menopause); dietary acid load increased risk at equal levels of energy intake. Macronutrients confirmed increased risk of high protein intake. Calcium and Oxalate: calcium intake protective effect; oxalate intake only modest increase of risk in men and older women. Metal cations zinc and iron intake no clear impact on the risk of stone formation, dietary copper increased risk; manganese intake reduced risk of stone formation. Fruits and Vegetables decreased risk. Vitamins B6 intake not associated to risk of stone formation; vitamin C intake increased risk in men; vitamin D or supplemental vitamin D intake not associated to increased risk in men and younger women, suggestion of a higher risk in older women; Probiotics Gut colonization with Oxalobacter formigenes associated to lower risk of stone formation, effect of oxalate-degraders probiotics on urinary oxalate equivocal. Herbal products efficacy of some herbal products demonstrated in some trials, more investigations needed to confirm their efficacy and safety.
... These studies have shed light on the gut-kidney axis in nephrolithiasis, but in most cases, failed to provide integration with clinical aspects of nephrolithiasis, and particularly nutrition. Nutritional imbalances, such as poor hydration, high salt, and animal protein and low calcium, fruit and vegetable (FAV) intake, are considered the main risk factors for calcium oxalate kidney stone disease [14,15]. Conversely, water therapy, adequate consumption of dairy products, FAVs, and low-salt low-animal protein diets are considered the pillars of non-pharmacological prevention of nephrolithiasis [16,17]. ...
... Regular consumption of foods with high calcium content, either from dairy or non-dairy sources, is known to be protective against the formation of calcium kidney stones, while consumption of calcium supplements should be discouraged in stone formers [14,15,118]. Restriction of dietary calcium intake proved less effective than salt and protein restriction in preventing kidney stone recurrence [62]. ...
... A high FAV intake is associated with reduced risk of incident kidney stones [14,15,128] and with a reduction of lithogenic potential in urine chemistry [129]. Thus, increasing FAV intake is regarded as one of the main non-pharmacologic prescriptions for reducing the risk of kidney stone recurrence [16,17]. ...
Recent studies have shown that patients with kidney stone disease, and particularly calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared with controls. The alterations of microbiota go far beyond the simple presence and representation of Oxalobacter formigenes, a well-known symbiont exhibiting a marked capacity of degrading dietary oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of nutrition in the modulation of microbiota composition, and their relevance for the modulation of lithogenic risk.
... No significant associations with incident stones were observed for high intake of dietary vitamin B6 and total vitamin D. Meta-analyses of total and supplemental vitamin C showed nonsignificantly increased risks of incident stones with moderate and substantial heterogeneity, respectively. The pooled results of 2 female cohorts [35,36] ...
... Calcium and vitamin D supplementation was controversial due to inconsistent meta-analyses of RCTs and observational studies. The NHS I [35] reported significantly increased risk among elderly women while others did not [36,61]. The author attributed the risk to not taking supplemental calcium with meals in that the beneficial effect of dietary calcium on oxalate could not be replicated under such circumstances. ...
Background:
Dietary and lifestyle factors may play an important role in the increasing prevalence of nephrolithiasis. We aimed to review and quantify the associations between lifestyle factors and incident nephrolithiasis and suggest lifestyle changes for the primary prevention of nephrolithiasis.
Methods:
PubMed, EMBASE, and Cochrane Library were searched up to May 2019, for observational studies and randomized controlled trials (RCTs) that assessed modifiable lifestyle factors and risk of nephrolithiasis in adults. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were computed using a random effects model. The I2 statistic was employed to evaluate heterogeneity. Subgroup analysis, sensitivity analysis and meta-regression were also conducted whenever possible.
Results:
Fifty relevant articles with 1,322,133 participants and 21,030 cases in total were identified. Prominent risk factors for incident stones were body mass index (1.39,1.27-1.52), dietary sodium (1.38, 1.21-1.56), fructose, meat, animal protein, and soda. In contrast, protective factors included fluid intake (0.55, 0.51-0.60), a Dietary Approaches to Stop Hypertension (DASH) style diet (0.69, 0.64-0.75), alcohol (0.69, 0.56-0.85), water, coffee, tea, vegetables, fruits, dietary fiber, dietary calcium (0.83, 0.76-0.90), and potassium. Vitamin D (1.22, 1.01-1.49) and calcium (1.16, 1.00-1.35) supplementation alone increased the risk of stones in meta-analyses of observational studies, but not in RCTs, where the cosupplementation conferred significant risk.
Conclusions:
Several modifiable factors, notably fluid intake, dietary patterns, and obesity, were significantly associated with nephrolithiasis. Long-term RCTs are required to investigate the cost-effectiveness of dietary patterns for stone prevention. The independent and combined effects of vitamin D and calcium supplementation on nephrolithiasis need further elucidation.
... In fact, a 6 g increase in daily dietary sodium chloride seems to be capable of increasing urinary calcium excretion by 40 mg/day [65,66]. Furthermore, a dietary salt intake >10 g/day was correlated to increased prevalence of hypercalciuria compared with recommended values [67]. ...
... Despite the strong rationale for considering magnesium a kidney stone inhibitor, the available literature is controversial. Early observational evidence showed no significant association between magnesium and the risk of stones [46,67], whereas Taylor et al., in 2004, demonstrated an inverse correlation between the risk of incident kidney stones and dietary magnesium intake [91]. ...
Nephrolithiasis is a common medical condition influenced by multiple environmental factors, including diet. Since nutritional habits play a relevant role in the genesis and recurrence of kidney stones disease, dietary manipulation has become a fundamental tool for the medical management of nephrolithiasis. Dietary advice aims to reduce the majority of lithogenic risk factors, reducing the supersaturation of urine, mainly for calcium oxalate, calcium phosphate, and uric acid. For this purpose, current guidelines recommend increasing fluid intake, maintaining a balanced calcium intake, reducing dietary intake of sodium and animal proteins, and increasing intake of fruits and fibers. In this review, we analyzed the effects of each dietary factor on nephrolithiasis incidence and recurrence rate. Available scientific evidence agrees on the harmful effects of high meat/animal protein intake and low calcium diets, whereas high content of fruits and vegetables associated with a balanced intake of low-fat dairy products carries the lowest risk for incident kidney stones. Furthermore, a balanced vegetarian diet with dairy products seems to be the most protective diet for kidney stone patients. Since no study prospectively examined the effects of vegan diets on nephrolithiasis risk factors, more scientific work should be made to define the best diet for different kidney stone phenotypes.
... The most common, non-pharmacological tool for the prevention of any kind of kidney stones, independently of composition, remains fluid therapy [4]. Fluid intake was found to be inversely related to the risk of kidney stones, with a relative risk of 0.71 in men and of 0.61-0.68 in women [5,6]. A large intake of water is effective in reducing the risk of stone recurrences, provided that it induces a urine volume greater than 2 L per day. ...
Complementary and alternative medicine (CAM) is often implemented in kidney stone patients. It consists of preparations including different ingredients, such as herbs, probiotics, and vitamins, often together with alkali, that are classified within the dietary supplementation category. The majority of dietary supplements claiming to treat or prevent kidney stones contain ingredients with conflicting or no scientific evidence to support their claims. Clinicians should advise stone formers that the effects of most supplements are unknown or unstudied in humans and that the absence of evidence does not imply absence of potential harm. Unfortunately, the CAM preparation consists of a mix of different molecules, often including alkali, with different potential mechanisms of action and, even when favorable results are reported, the role of the single molecules cannot be assessed. Despite all these concerns, CAM products remain quite popular among kidney stone patients. The scarce knowledge in this field prevents one from recommending CAM products in daily clinical practice; only a weak suggestion for their use in kidney stone patients may be reasonable.
... Το µαγνήσιο αντιδρά µε το οξαλικό και µπορεί να αποτρέψει την εντερική απορρόφηση οξαλικών καθώς και να µειώσει τον υπερκορεσµό οξαλικού ασβεστίου στα ούρα (40). Η χορήγησή του ως συµπλήρωµα µπορεί να είναι χρήσιµη στη θεραπεία σε παιδιά µε δευτεροπαθή υπεροξαλουρία (41). ...
Paediatriki (ISSN: 0377-2551) 2022;85(3):200-213 Background Urolithiasis in children is not a common disease in developed countries. However, in recent years its incidence has been steadily increasing, while wrong diagnosis can lead to chronic kidney disease. Methods: Extensive literature review in the international databases PubMed and Scopus took place, in which the key terms used were "pediatric urolithiasis", "epidemiology", "metabolic factors", "pathophysiology". Results: Metabolic, genetic, anatomical, dietary, and environmental factors are to blame for this increase. The typical clinical symptomatology of renal colic that characterizes lithiasis in adults is present in only 50% of children with urolithiasis. Microscopic or macroscopic hematuria is the most common finding and affects up to 90% of patients. In younger children the main symptom may be only recurrent urinary tract infections. The majority of renal stones in children are calcium oxalate or calcium phosphate. Conclusions: Urolithiasis is a significant problem with increasing frequency in childhood, which requires the pediatrician to be alert for early diagnosis. Investigation of possible anatomical abnormalities is required, as well as a thorough metabolic control to avoid recurrences. Patients should be monitored frequently by specialists and depending on the underlying cause, the appropriate intervention should be performed.
... However, in the present survey study, substantial proportion of the urologists advised their patients to follow general recommendations (adequate fluid intake, salt restriction, protein restriction, and oxalate-restricted diet), rather than more specific recommendations. Moreover, neither calcium-restricted diet nor oxalate restriction diet have ever shown a benefit with respect to recurrence of calcium stones [33][34][35]. Additionally, more than half of the participants preferred to convey this information verbally to their patients rather than a structured patient informing process. ...
Although stone disease is an important health problem with high incidence and recurrence rates, it is a preventable disease. Attitudes and practices of urologists regarding the prevention of recurrence continue to be a subject of debate. In this context, an online survey study was conducted involving 305 urologists from 57 different countries. The first 7 questions collected demographic data about the urologists and the remaining 23 questions were about the recurrence and metabolic evaluation, medical treatment, and follow-up of urinary stone disease. Most urologists (85.2%) thought that metabolic examination was important. Approximately one-third of the participants (34.1%) performed 24-hour urine analysis and stone analysis was ordered by 87.5% of the urologists. Metabolic analysis was performed for all patients by 14.7% of the participants. For pediatric patients this rate was 68.5%, and for adults with recurrence the rate was 81.6%. Reasons cited by the urologists for not performing metabolic analysis included not feeling confident doing so (18.3%), having limited facilities in their hospital (26.5%), having an excessive daily workload (31.8%), patient-related factors (27.5%), and referring patients to other departments for metabolic evaluation (20.9%). Although majority of the responding urologists do consider the metabolic analysis as vital important, they seemed not to be willing to perform these tests with the same degree of enthusiasm in their daily practice. Our results show that urologists need support in performing and interpreting 24-hour urine analysis, improving their knowledge levels, and communicating with patients. Urology residency training should focus more on the prevention of urinary stone recurrence in addition to the surgical training.
... Furthermore, it has been demonstrated that a reduction of 6 g/d in salt intake could reduce heart stroke incidence by 24% and CHD by 18% [7]. High salt intake is also associated with increased risk of other diseases such as renal diseases, stomach cancer, osteoporosis and obesity [8][9][10][11]. For example, the risk of obesity in adults will increase by 26% as a result of an increase in salt intake by 1 g/d (odds ratio, 1.26; 95% CI, 1.16-1.37; P<0.0001) [12]. ...
Introduction:
evaluating the sodium content of staple foods is essential for implementing a salt reduction strategy. In Morocco, bread is a major contributor to sodium intake. However, currently few studies have been carried out to assess the salt content in bread. Our study aimed to estimate the sodium and salt content of white bread available in artisanal and industrial bakeries in the twelve regions of Morocco.
Methods:
it is a cross-sectional study of the sodium content of white bread available for sale in artisanal and industrial bakeries in Morocco (N=120). Inductively coupled plasma mass spectrometry (ICP-MS) was used to quantify the sodium content of the bread. The percentage of samples meeting the recommendations and bread contribution to the daily salt intake was calculated.
Results:
the results of our study show that the mean levels of sodium and salt added to bread samples were 5.7 ± 1.5 g/Kg and 14.5 ± 3.7 g/Kg, respectively. With an average of 4.4 ± 0.5 g/Kg and 11.2 ± 1.2 g/Kg for artisanal bread and an average of 7.0 ± 0.8 g/Kg and 17.8 ± 2.1 g/Kg for industrial bread, respectively. Daily salt intake from bread consumption (500 g/d/person) is estimated at 5.6 g/d (52.8% of total salt intake) for artisanal bread and 8.9 g/d (84% of total salt intake) for industrial bread.
Conclusion:
bread salt content in Morocco exceeds the recommended threshold of the national federation of bakery and pastry and health authorities. Further efforts are necessary to increase knowledge and awareness of bakers and to teach them how to reduce salt content without affecting the flavor and the quality of their products.
... [14][15] However, some observational studies found that decreasing the calcium intake can lower the risk of rst stone. [32] [33] But in the long run, we believe that the control of kidney stones by reducing calcium intake is dispensable, given the complex formation [34] causes that calcium intake may have no effect on this. For example, the microbiome play a role. ...
Kidney stone is a common disease nowadays, whose main component is calcium oxalate. A large amount of people eagerly to supply calcium from the dietary food, however, they are still afraid of kidney stone. In addition, some patients with kidney stones are suggested to decrease the calcium intake but there are newly search which recommends to not cut down it. We wondered whether the kidney stones are associated with calcium intake in daily life. This study investigates the relation between calcium intake and kidney stone. We supposed that the calcium intake is linked to kidney stone. People, who participated in the NHANES, from 2015 to 2018, were included and they were screened by the constraints. Multi-variable logistic regression was used to assess the association between calcium intake and kidney stone, adjusting for other confounding factors. At the same time, to conduct stratification studies, we took calcium intake as a continuous variable and classification variables respectively. In the muti-variate analysis, calcium in food had no connection with kidney stone([odds ratio] 0.9999, [confidence interval] 0.9998-1.001 in model 3 which is fully adjusted. During the trend test, there was no prominent difference from calcium quality from Q1 to Q4 in those 3 models and the muti-variate analysis separated by confounding factors might affect the result according to the univariate analysis, we found there was no disparity. So, we conclude that having the history of kidney stone is no connection with calcium intake.
... Es importante para la compresión de los datos venezolanos aquí reportados reconocer el carácter multifactorial del origen de la hipocitraturia, al respecto, en la génesis de la baja concentración de citrato urinario están involucrados eventos como la acidosis tubular distal completa o incompleta; los síndromes diarreicos crónicos; la depleción crónica de potasio; la acidosis metabólica que pueden generar algunas dieta como las ricas en proteína de origen animal, por la carga acida que representan o dietas pobres en alimentos fuente de alcalis; y el hiperaldosteronismo primario por la hipokalemia crónica y expansión de volumen sodio dependiente, variables todas que deben ser el objeto de futuras investigaciones sobre hipocitraturia en el paciente venezolano con nefrolitiasis, por no haber sido incluidas en el presente reporte. Sin embargo, se presume que la dieta, fundamentalmente la baja ingesta de fluidos, calcio, potasio y fibras, y la alta ingesta de sodio, azúcar y proteína (la preferida por muchos venezolanos) es la causa de la elevada proporción de sujetos estudiados con este trastorno metabólico [21][22][23][24][25][26][27] . Como ocurre con este y otros estudios la hipocitraturia en la nefrolitiasis se puede presentar, tanto como alteración única o en asociación con otras anormalidades bioquímicas, entre las que se señalan a la hipercalciuria, la hiperuricosuria, la hiperoxaluria, la hiperkalemia, la hipernatruria y la hipomagnesuria, todas alteraciones consideras a jugar un papel clave en la formación de cálculos renales y en algunos casos autores de insuficiencia renal. ...
La enfermedad por SARS-CoV-2 o COVID-19 es una patología nueva y sobre la que aún falta mucho por conocer, este virus puede afectar diferentes sistemas y órganos, por lo que, con el objetivo de conocer las manifestaciones oftalmológicas descritas hasta ahora en estos pacientes, se realizó una búsqueda sistemática de la literatura en PubMed-Medline y Google Scholar con las palabras clave < > < > < > obteniendo un total de 471 artículos, de los cuales se seleccionaron 31. Se encontró que la principal manifestación oftalmológica es la conjuntivitis, que puede estar hasta en un 10% de los pacientes. Se encontraron reportes de manifestaciones neuroftalmológicas, principalmente las parálisis oculomotoras así mismo se han descrito casos de oclusiones vasculares. Los casos reportados sugieren un neurotropismo viral y mecanismos de lesión endotelial como causantes de estos cuadros.
... Kidney stone disease is common in the general population, with a prevalence higher than 10% in the most recent National Health and Nutrition Examination Survey [1]; it is also characterized by high recurrence rates [2]. A number of genetic [3] and environmental [4] factors are thought to play a role in its pathogenesis, including fluid intake, [5,6] dietary calcium [7][8][9], animal protein [10] and adherence to a Dietary Approach to Stop Hypertension-style diet [11]. Men are more than twice as likely to be affected as women, although this gap seems to be decreasing [1]. ...
Background
Men are at higher risk of developing stones compared with women; however, recent data suggest a changing epidemiology with women being relatively more affected than before.
Methods
To estimate the proportion of excess risk among men, we analyzed data from large cohorts (Health Professionals Follow-up Study and Nurses’ Health Study I and II). Kidney stone incidence rates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) generated with age-adjusted Cox proportional regression models. Mediation analysis estimated the excess risk for men explained by risk factors, including waist circumference, high blood pressure, diabetes, use of thiazides, and dietary intakes. 24-h urine composition was also examined.
Results
The analysis included 268 553 participants, contributing 5 872 249 person-years of follow-up. 10 302 incident stone were confirmed, and the overall incidence rate was 271 and 159 per 100 000 person-years for men and women, respectively. The age-adjusted HR was 2.32 (95% CI 2.20, 2.45), and the risk of stones was consistently higher across categories of age (HRs ranging from 2.02 to 2.76) for men compared with women. The risk remained higher among men, but tended to decrease over time (48.1%), while it increased among women. Urine supersaturations for calcium oxalate and uric acid were higher among men, primarily because of higher oxalate (26.3%), uric acid (16.3%), phosphate (23.5%), and lower pH.
Conclusions
The risk of kidney stones is higher among men and this difference is only partly explained by lifestyle risk factors; differences in urine chemistries explain a substantial fraction of the excess risk.
... A significant relation between calcium stone formation and salt intake was first showed in a cohort study conducted by Curhan et al. [74]. Some studies conducted in further years did not succeed in confirming these results. ...
Kidney stone disease is an oldest known and widespread medical condition characterised by its high prevalence in all over the world. Literature suggests that around 9–12% of population in industrialised countries have kidney stone disease in their lives with the 30–50% of reoccurrence rate. Because of high prevalence, recurrent and unpredictable nature of stone formation and its predominance mainly in adults contributes to the substantial impact on society, individual and health care system. In light of these trends, it’s imperative to use optimum preventive strategies to reduce the burden of kidney stone disease on individual and society. The aetiology of kidney stone disease is a multifactorial and it’s related to diet, environmental factors, genetics, metabolic syndromes and various life style factors. Its noteworthy that dietary and life style modification are the major contributors in the prevention of kidney stone reoccurrence. Dietary interventions aim to reduce the urinary abnormalities known to promote lithogenesis. Therefore, modification in the dietary factors is appealing way to patients and physicians in the treatment and prevention of stone recurrence as it is relatively inexpensive and safe. So, the present chapter is focusing on the role of dietary supplements in prevention of renal stones.
... The result of a prospective cohort study on 91,731 women suggested an increased risk of kidney stones in patients receiving non-dietary calcium supplementation (RR: 1.20, 95% CI: 1.02-1.41) (Curhan et al., 1997). Additionally, other potential adverse effects of calcium supplementation such as constipation, metabolic syndrome, and age-related macular degeneration were reported (Kakigi et al., 2015;Noe et al., 2015;Prince et al., 2006). ...
... In addition, the risk of stone formation is not low because of the chronic lack of fluid intake caused by gastrostomy management. [13][14][15] Moreover, since the patient was vomiting, an abdominal computed tomography scan was performed in the emergency room, which enabled the diagnosis of ureter stones. In this case, poorly controlled status epilepticus occurred despite the implantation of a vagus nerve stimulator. ...
Introduction
Epilepsy has a variety of seizure-inducing factors. Epileptic seizures caused by renal colic are extremely rare.
Case presentation
A 22-year-old woman with intractable epilepsy was brought to our hospital as an emergency case, because of vomiting and status epilepticus. She had implanted a vagus nerve stimulator in the left anterior chest at the age of 20 years. Computed tomography showed a ureter stone in the right distal ureter. On the second day of hospitalization, ureteroscopic lithotripsy was performed under general anesthesia. The patient’s seizures were controlled to a frequency of once a month or less in the four months after discharge.
Conclusion
We encountered a rare case of the frequency of status epilepticus increased by renal colic due to a ureter stone. Ureteroscopic lithotripsy was effective in controlling the frequency of status epilepticus increased by renal colic.
... 11,34 Diet kalsium mengurangi absorbsi oksalat dan ekskresi kalsium sebesar 16%, sedangkan peningkatan ekskresi oksalat dimungkinkan oleh perbedaan waktu antara masukan diet oksalat dengan masukan diet kalsium, sehingga oksalat kehilangan kesempatan mengikat kalsium pada lumen intestinal. 35 Kebiasaan makan sitrat berpengaruh terhadap risiko sedimen kalsium oksalat dalam urin (r s = 0,450), kebiasaan makan jarang memiliki POR sebesar 10,99 (95% CI = 3,533 -34,218) dan kebiasaan cukup memiliki POR sebesar 3,04 (95% CI = 0,931 -9,903) lebih besar dari subjek dengan kebiasaan makan sumber asam sitrat sering terhadap sedimen kalsium oksalat. Hasil ini disebabkan oleh asam sitrat memiliki peran sebagai inhibitor terhadap supersaturasi kalsium dan sedimen kalsium oksalat dalam urin. ...
Background: Water hardness containing calcium mineral (Ca2+) is supposed to increase absorption in intestinal lumen and calcium excretion (hyper-calciuria) of urine. Alkalic conditioned urine can cause changes of saturation concentration to become calcium supersaturation leading to the crystalization of calcium oxalate.
Objective: To identify the relationship between drinking water hardness, drinking and eating habit to calcium level and urine calcium oxalate sediment.
Method: The study was observational with cross sectional design. Examination analysis of drinking water hardness (mg/l), level of urine calcium (mg/dl) and calcium oxalate sediment of first/morning urine samples of 128 elementary school students (6-12 years old) was carried out using one-stage cluster random sampling technique at Sidowangi Subdistrict of Kajoran, District of Magelang, Central Java. Data of drinking and eating habit for bestial protein, vegetable protein, calcium and phospor, uric acid, oxalic acid and citric acid of the subject of the study were obtained from interview using questionnaires and food frequency forms. Data analysis used Stata version 8.0 program for windows at significance level. p<0.05.
Result: Ave0rage value and main deviation of drinking water hardness was 66.75 + 8.36, level of urine was 10.43 + 6.40 and there were 52 subjects (40.63%) with calcium oxalate crystal. The result of statistical analysis showed that drinking water hardness did not affect level of urine calcium (rs =0.004; p=0.967; POR=1,017; 95% CI=0.476-2.172) and calcium oxalate sediment (rs=-0.007; p=0.937; POR=0.972; 95% CI= 0.480-1,969). Drinkinghabit (p=0.007; POR=3.509; 95% CI=1.339-8.802) and eating habit of citric acid sources (adequate p=0.066; POR=3.037; 95%CI=0.931-9,903, less p=0.000; POR=10,996; 95% CI=3.533-34.218) were 2 predisposition variables of calcium oxalate sediment status.
Conclusion: Drinking water hardness had no effect to level of urine calcium and calcium oxalate sediment. Drinking habit and eating habit for citric acid sources were 2 most determining factors, i.e. as protection or inhibitor of calcium oxalate crystalization formation.
Keywords: water hardness, calcium level, calcium oxalate sediment
... 11,34 Diet kalsium mengurangi absorbsi oksalat dan ekskresi kalsium sebesar 16%, sedangkan peningkatan ekskresi oksalat dimungkinkan oleh perbedaan waktu antara masukan diet oksalat dengan masukan diet kalsium, sehingga oksalat kehilangan kesempatan mengikat kalsium pada lumen intestinal. 35 Kebiasaan makan sitrat berpengaruh terhadap risiko sedimen kalsium oksalat dalam urin (r s = 0,450), kebiasaan makan jarang memiliki POR sebesar 10,99 (95% CI = 3,533 -34,218) dan kebiasaan cukup memiliki POR sebesar 3,04 (95% CI = 0,931 -9,903) lebih besar dari subjek dengan kebiasaan makan sumber asam sitrat sering terhadap sedimen kalsium oksalat. Hasil ini disebabkan oleh asam sitrat memiliki peran sebagai inhibitor terhadap supersaturasi kalsium dan sedimen kalsium oksalat dalam urin. ...
... 17,[29][30][31] The kidney reabsorbs less filtered calcium due to a suppression of parathyroid hormone caused by an elevated level of 1,25-dihydroxyvitamin D. 17,30 Calcium and vitamin D supplements are also routinely recommended for pregnant women and can further contribute to hypercalciuria. 32,33 Urine pH is also higher during pregnancy due to a progesterone-induced chronic respiratory alkalosis. 15,16 Hypercalciuria and higher urine pH during pregnancy explain the propensity toward calcium phosphate stones. ...
Rationale & Objective
There are several well-known anatomical and physiological changes during pregnancy that could contribute to kidney stone formation, but evidence that they increase the risk of kidney stones during pregnancy is lacking. We determined whether there was an increased risk of a first-time symptomatic kidney stone during and after pregnancy.
Study Design
A population-based matched case-control study.
Setting & Participants
945 female first-time symptomatic kidney stone formers aged 15-45 years and 1,890 age-matched female controls in Olmsted County, MN, from 1984-2012. The index date was the date of onset of a symptomatic kidney stone for both the case and her matched controls.
Exposure
The primary exposure was pregnancy with assessment for variation in risk across different time intervals before, during, and after pregnancy. Medical records were manually reviewed to determine the conception and delivery dates for pregnancies.
Outcome
Medical record–validated first-time symptomatic kidney stone.
Analytical Approach
Conditional and unconditional multivariable logistic regression analysis.
Results
Compared with nonpregnant women, the odds of a symptomatic kidney stone forming in women was similar in the first trimester (OR, 0.92; P = 0.8), began to increase during the second trimester (OR, 2.00; P = 0.007), further increased during the third trimester (OR, 2.69; P = 0.001), peaked at 0 to 3 months after delivery (OR, 3.53; P < 0.001), and returned to baseline by 1 year after delivery. These associations persisted after adjustment for age and race or for diabetes mellitus, hypertension, and obesity. These results did not significantly differ by age, race, time period, or number of prior pregnancies. Having a prior pregnancy (delivery date > 1 year ago) was also associated with a first-time symptomatic kidney stone (OR, 1.27; P = 0.01).
Limitations
Observational study design in a predominantly White population. The exact timing of stone formation cannot be determined.
Conclusions
Pregnancy increases the risk of a first-time symptomatic kidney stone. This risk peaks close to delivery and then improves by 1 year after delivery, though a modest risk of a kidney stone still exists beyond 1 year after delivery.
... Hypercalciuria and high levels of urine P cause NC, and therefore oral vitamin D and phosphate may be major causes for developing NC in XLH patients treated with conventional therapy [12,[31][32][33]. The degree of NC varies from histologically subtle forms such as NC or Randall's plaque, which may not be detected by echography to advanced NC that is visible by X-rays [12,34]. High echoic dots in the renal medulla should be assessed as mild NC although the echographic grading scale of NC judges them 0 (no abnormalities). ...
Objectives:
X-linked hypophosphatemic rickets (XLH) is a congenital fibroblast growth factor (FGF)23-related metabolic bone disease that is treated with active vitamin D and phosphate as conventional therapies. Complications of these therapies include nephrocalcinosis (NC) caused by excessive urine calcium and phosphate concentrations. Recently, an anti-FGF23 antibody, burosumab, was developed and reported to be effective in poorly-controlled or severe XLH patients. This study aimed to reveal the impact of switching treatments in relatively well-controlled XLH children with the Rickets Severity Scale less than 2.0.
Methods:
The effects of the two treatments in eight relatively well-controlled XLH children with a mean age of 10.4 ± 1.9 years were compared retrospectively for the same treatment duration (31 ± 11 months) before and after the baseline.
Results:
Actual doses of alfacalcidol and phosphate as conventional therapy were 150.9 ± 43.9 ng/kg and 27.5 ± 6.3 mg/kg per day, respectively. Renal echography revealed spotty NC in 8/8 patients, but no aggravation of NC was detected by switching treatments. Switching treatments increased TmP/GFR (p=0.002) and %TRP (p<0.001), and improved the high urine calcium/creatinine ratio to the normal range (p<0.001) although both treatments controlled disease markers equally. Additionally, low intact parathyroid hormone during conventional therapy was increased within the normal range by switching treatments.
Conclusions:
Our results suggest that a high dose of alfacalcidol was needed to control the disease, but it caused hypercalciuria and NC. We concluded that switching treatments in relatively well-controlled XLH children improved renal phosphate reabsorption and decreased urine calcium extraction, and may have the potential to prevent NC.
... Regarding calcium supplements, dietary calcium consumption from foods is safe. Problems may derive from supplements (51). In addition, dietary calcium protects against renal lithiasis, where a significant factor among others is the renal excretion of oxalates given that dietary calcium creates complexes with oxalates which are eliminated from the intestine (52). ...
During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28-50% below that of age-matched peers at 12–18 months post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI.
Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions.
Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine (HeSCoSPRM) convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines.
This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.
... Also significant is the fact that a poorly balanced diet may condition hypercalciuria. Nevertheless, it has not been unequivocally determined whether the supply of calcium in the diet directly affects its excretion or the formation of calcium deposits in the urinary tract (CurHan et al. 1993(CurHan et al. , 1997. 168 The relationship between low calcium content in the diet and the risk of urolithiasis has been proven (BorGHi et al. 2002, martini, HeilBerG 2002. ...
... A similar study in the Nurses' Health Study I examined medical records from a random sample of ninety women who reported kidney stone. The records confirmed the diagnosis for all except 1 participant (98 %) (18) . Survey participants who answered yes to 'Have you/Has sample person (SP) ever had a kidney stone?' were considered to have a history of nephrolithiasis. ...
Objective
We evaluate the association between the Dietary Inflammatory Index (DII) and kidney stones.
Design
We performed a cross-sectional analysis using data from National Health and Nutrition Examination Survey. Dietary intake information was assessed using first 24-HR dietary recall interviews, and the Kidney Conditions was presented by questionnaire. The primary outcome was to investigate the association between DII and incidence of kidney stones, and the secondary outcome was to assess the association between DII and nephrolithiasis recurrence.
Setting
The National Health and Nutrition Examination Survey (NHANES), 2007-2016.
Participants
The study included 25984 NHANES participants, whose data on DII and kidney stones were available, of whom 2439 reported a history of kidney stones.
Results
For the primary outcome, after fully multivariate adjustment, DII score is positively associated with the risk of kidney stones (OR = 1.07; 95% CI: [1.04–1.10]). Then, compared Q4 with Q1, a significant 38% increased likelihood of nephrolithiasis was observed. (OR=1.38; 95% CI: [1.19–1.60]). For the secondary outcome, the multivariate regression analysis showed that DII score is positively correlated with nephrolithiasis recurrence (OR=1.07; 95% CI: [1.00–1.15]). The results noted that higher DII scores (Q3 and Q4) are positively associated with a significant 48% and 61% increased risk of nephrolithiasis recurrence compared with the reference after fully multivariate adjustment. (OR=1.48; 95% CI: [1.07–2.05]; OR=1.61; 95% CI: [1.12–2.31]).
Conclusions
Our findings revealed that increased intake of pro-inflammatory diet, as a higher DII score, is correlated with increased odds of kidney stones incidence and recurrence.
... [5,6] In the absence of an identifiable metabolic factor, increasing fluid intake, restricting salt, and animal protein intake are the commonly recommended preventative strategies. [7][8][9][10] Lately, the understanding of the relationship between gut microbiome and nephrolithiasis has provided new insights into the pathways for preventing kidney stones. In the literature, the terms "microbiome" and "microbiota" are sometimes interchangeably used. ...
The incidence of nephrolithiasis is increasing worldwide. Understanding how gut microbiome influences oxalate homeostasis has the potential to offer new strategies to prevent nephrolithiasis. The literature was reviewed to gather the evidence on the association between gut microbiome, hyperoxaluria and nephrolithiasis, and to identify the therapeutic interventions focused on the gut microbiome that could decrease hyperoxaluria and prevent nephrolithiasis. Gut microbiome is constituted by a plethora of microbiota including Oxalobacter formigenes (Oxf) and lactobacilli. Oxf can degrade dietary oxalate and induce enteral oxalate secretion. Animal studies suggested an association between oral Oxf supplementation and a decrease in hyperoxaluria. However, human studies have showed inconsistent results. Oral supplementation of lactobacilli did not show benefit in decreasing the hyperoxaluria. Antibiotic exposure, by affecting the gut microbiome, has been associated with an increase in nephrolithiasis. In vivo studies suggest fecal transplantation as a potential treatment option for reducing nephrolithiasis, but needs further evaluation in clinical studies. The current evidence suggests an association between gut microbiome and nephrolithiasis. However, the strategies focused on modulating gut microbiome for decreasing hyperoxaluria and preventing nephrolithiasis need further research. Judicious use of antibiotics in those predisposed to nephrolithiasis offers a preventative strategy for decreasing nephrolithiasis.
... Adequate dietary calcium and taking supplemental calcium with food may lower urine oxalate levels because the calcium binds with dietary oxalate in the gut and the oxalate-calcium complex is unabsorbed and excreted by the gut. [76][77][78] Some providers have also recommended reducing dietary fat intake to reduce fatty acids in the gut and the effect of enteric hyperoxaluria. To our knowledge, this has not been formally studied in modern RYGB procedures but has been shown to be effective in early malabsorptive procedures, such as jejunoileal bypass. ...
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
... 34 These include cardiovascular disease, renal calculi, dyspepsia, constipation and malabsorption of medication such as levothyroxine. [35][36][37] It is well recognised that in adults, severe vitamin D deficiency can cause osteomalacia, most likely when serum 25-hydroxyvitamin D (25(OH) vitamin D) level falls below 15 ng/mL. In this case, replacing vitamin D is advised. ...
With increasing longevity of the population globally, the prevalence of osteoporosis will rise, associated with significant morbidity, disability and increased mortality. Adequate intake of calcium, vitamin D, increasing physical activity, a strategy of avoiding falls, cessation of smoking and avoiding excessive alcohol intake are pivotal in maintaining healthy bones in all age groups. Oral bisphosphonates remain the most cost-effective first line of treatment. Better methods of identifying patients with high fracture risk is needed as there is adequate effective treatment for osteoporosis.
... For example, a higher intake of phytate was associated with a lower risk of nephrolithiasis in women (22) but not in men (24). On the other hand, the intake of animal protein has been associated with a higher risk of nephrolithiasis in men (25) but not in women (22,26), However, it has previously been demonstrated that the risk of kidney stones may vary by the type of protein intake: dairy protein is associated with a lower risk of stones in the NHS II cohort, whereas nondairy protein intake is associated with a slightly higher risk of stones in NHS I and HPFS (3). Finally, we cannot exclude that those findings were due to chance. ...
Background:
Diet plays an important role in kidney stone formation. Several individual components have been associated with the risk of kidney stone formation, but there is limited evidence regarding the role of healthful dietary patterns.
Objective:
To prospectively study the association between adherence to the Mediterranean diet and the risk of incident kidney stones.
Methods:
We conducted a longitudinal study using 3 different cohorts: the Health Professionals Follow-up Study (n = 42,902 men), the Nurses' Health Study I (n = 59,994 women), and the Nurses' Health Study II (n = 90,631 women). We assessed diet every 4 y using an FFQ and calculated adherence to a Mediterranean diet using the alternate Mediterranean diet score (aMED). A subgroup of 6077 participants provided ≥1 24-h urine sample, and urinary solute excretion was analyzed. We used Cox proportional hazards regression to examine the independent association between the aMED and incidence of kidney stones, adjusting for potential confounders. We used adjusted linear regression models to study the relation between aMED and urine composition.
Results:
During 3,316,633 person-years of follow-up, 6576 cases of incident kidney stones were identified. For participants in the highest aMED score category, the risk of developing a kidney stone was between 13% and 41% lower compared with participants in the lowest score (pooled HR: 0.72, 95% CI: 0.59, 0.87; P value for trend <0.001). A higher aMED score was associated with higher urinary citrate, magnesium, oxalate, phosphate, uric acid, volume, and pH, and lower urinary sodium, resulting in lower supersaturation for calcium oxalate, calcium phosphate, and uric acid.
Conclusion:
Adherence to a Mediterranean diet is associated with a lower risk of developing a kidney stone.
... The patient-oriented study protocol evaluated extreme and subacute (~1 week) dietary sodium modulations; the downstream changes induced by these sodium diets may not be as dramatic chronically. However, our epidemiology studies reflect population level associations between dietary sodium and calcium excretion (as a proxy for chronic sodium intake) and kidney stones and support prior work that showed dietary sodium restriction reduces the incidence of kidney stones (46). The patient-oriented study was not a true balance study; sequestering participants in a clinical research center for weeks to ensure complete balance in sodium, potassium, and calcium intake and output was not feasible. ...
Context
Complex relationships between aldosterone and calcium homeostasis have been proposed.
Objective
To disentangle the influence of aldosterone and intra-vascular volume on calcium physiology.
Design
Patient-oriented and epidemiology studies.
Setting
Clinical research center and nationwide cohorts.
Participants/Interventions
Patient-oriented study (n=18): Participants were evaluated after completing a sodium-restricted (RES) diet to contract intravascular volume and after a liberalized-sodium (LIB) diet to expand intravascular volume. Cross-sectional studies (n=3755): the association between 24h urinary sodium and calcium excretion and risk for kidney stones was assessed.
Results
Patient-oriented study: Compared to a RES-diet, a LIB-diet suppressed renin activity (LIB: 0.3 [0.1, 0.4] vs. RES: 3.1 [1.7, 5.3] ng/mL/hr; P<0.001) and plasma aldosterone (LIB: 2.0 [2.0, 2.7] vs. RES: 20.0 [16.1, 31.0] vs. ng/dL; P<0.001), but increased calciuria (LIB: 238.4 ± 112.3 vs. RES: 112.9 ± 60.8 mg/24hr; P<0.0001) and decreased serum calcium (LIB: 8.9 ± 0.3 vs. RES: 9.8 ± 0.4 mg/dL; P<0.0001). Epidemiology study: Mean urinary calcium excretion was higher with greater urinary sodium excretion. Compared to a urinary sodium excretion of <120 mEq/day, a urinary sodium excretion of ≥220 mEq/day was associated with a higher risk for having kidney stones in women [RR=2.02 (95% CI 1.19, 3.43)] and men [RR=1.92 (95% CI 1.19, 3.08)].
Conclusions
High dietary sodium intake suppresses aldosterone, decreases serum calcium, and increases calciuria and the risk for developing kidney stones. Our findings help disentangle the influences of volume from aldosterone on calcium homeostasis, and provide support for the recommendation to restrict dietary sodium for kidney stone prevention.
... Однако исследования последних лет показали, что добавки минерала также не способны снизить риск возникновения переломов. Бесконтрольное же их употребление способствует избыточной минерализации различных тканей и органов вплоть до кальциноза, образования камней в почках и желчном пузыре, развития нарушений сердечно-сосудистой системы и желудочно-кишечного тракта, возникновения злокачественной опухоли [9][10][11][12][13][14][15][16]. ...
... In the prospective Nurses' Health Study, women who took supplemental calcium (1 to ≥500 mg/day) had a small but significant increase in the risk of incident symptomatic kidney stones (RR 1.20, 95% CI 1.02-1.41) compared to those who did not take supplements [56]. Women in the highest quintile of dietary calcium intake (median calcium 1,303 mg/day had, however, a lower risk (RR 0.65, 95% CI 0.50-0.83) ...
... Adequate Supply To The Growing Teeth And Bones As Well As To Bind With Meal-Oxalate And Prevent Their Absorption [13] ...
Urolithiasis (Ur) Is A Worldwide Problem That Affects All Groups Of Ages. Nearly 80% Of Renal Stones Are Calcium Oxalate (Cao) And 50% Of The Affected Patients Have Recurrent Disease Within 10 Years. Our Prospective Study Was Conducted Over 4 And ½ Years And Evaluated The Role Of Dietary Manipulation In Prophylaxis Against Cao Ur. A Total Of 212 Patients With Recurrent Cao Ur, Who Lacked Anatomical Or Metabolic Derangement, Were Subjected To A Practical And Specific Diet. The Latter Had: (A) Low Salt, Red-Meat And Green Leafy Vegetable, (B) Moderate Amounts Of Milk, Dairy Products, Poultry And Certain Fish-Items, And (C) High Water Intake (2 Liters/Day). A Total Of 66/70 (96%), 87/108(88%) And 146/167(87.4%) Patients Were Stone-Free By The End Of 1, 2 And 3 Years Of Follow Up. The Median Time For Stone-Free Duration Was 33 (28.7-37.3) Months. Adding A Thiazide And Allopurinol To The 19 Patients Who Had Failed Dietary Prophylaxis Prevented Stone Formation In 16 More Patients Leaving Only 3 True Failures. Four Patients Could Not Tolerate The Latter 2 Drugs For Allergy. In Conclusion; Our Practical Dietary Modification Can Aid In Prophylaxis Against Cao Ur. Keywords: Diet, Calcium Oxalate, Urolithiasis, Urinary Tract Stones, Prophylaxis
... High Na intake may increase the risk of gastric cancer (Hirohata and Kono, 1997;Tsugane, 2005). Some other ailments such as oesteoporosis (Cohen and Roe, 2000) and kidney stones (Curhan et al., 1997) have also been ascribed to high intake of Na, but more evidence is needed. For more information, refer to OSU (2016). ...
... In many adults and children, due the high caloric intake needed to maintain weight, dietary calcium content often exceeds the dietary reference intake. In case of suboptimal calcium intakes, this should be increased mainly by food intake and high calcium content drinks, which are better absorbed than oral tablets [29] and may be associated with lower risk for kidney stones [30]. ...
Bone disease is a frequent complication in adolescents and adults with cystic fibrosis (CF). Early detection and monitoring of bone mineral density and multidisciplinary preventive care are necessary from childhood through adolescence to minimize CF-related bone disease (CFBD) in adult CF patients. Approaches to optimizing bone health include ensuring adequate nutrition, particularly intake of calcium and vitamins D and K, addressing other secondary causes of low bone density such as hypogonadism, encouraging weight bearing exercise, and avoiding bone toxic medications. Of the currently available anti-resorptive or anabolic osteoporosis medications, only bisphosphonates have been studied in individuals with CF. Future studies are needed to better understand the optimal approach for managing CFBD.
... 20 The rates of kidney stones and urinary retention were also higher among individuals with RTT, with the general population developing kidney stones at an annual rate of 0.5-1/1000 individuals and urinary retention in the female general population at an annual rate of 0.07/1000 individuals. 21,22 Likely due to our small sample size, kidney stones were not observed in the RTT patients in our study, however, their primary reason for presenting to a urologist was urinary retention, corroborating what was previously reported. ...
Objectives:
To describe the urologic sequalae of several rare congenital neuromuscular diseases.
Methods:
We retrospectively reviewed medical records at Gillette Specialty Healthcare (2014-18) of patients presenting to urology clinic with lower urinary tract symptoms and select rare congenital diseases: muscular dystrophy, spinal muscular atrophy, and Rett syndrome.
Results:
Muscular Dystrophies (n=19) are X-linked myogenic disorders characterized by progressive muscle wasting and weakness. Men present to the urologist at variable ages, typically with complaints of functional incontinence and normal cystometrograms (CMG); we manage them with oral anticholinergic medications, condom catheter or suprapubic catheter. Spinal Muscular Atrophy (n=6) is a rare autosomal recessive disease characterized by degeneration of the anterior horn cells in the spinal cord and motor nuclei in the lower brainstem leading to progressive muscle weakness and atrophy. Patients typically present with nephrolithiasis and urinary retention in late adolescence/early adulthood, but timing varies. Filling CMGs have been normal. We allow passive retention with intermittent catheterization and creation of catheterizable channels, when indicated. RettSyndrome(n=5) is a rare, non-inheritable genetic condition affecting females characterized by a brief period of normal development followed by loss of speech and purposeful hand use; there are characteristic behaviors. Patients present in early adulthood with complaints of urinary retention. We manage retention with permissive retention or sphincter chemodenervation.
Conclusions:
Several congenital neuromuscular conditions can cause lower urinary tract symptoms when these individuals become adults. We have discussed the clinical characteristics and management of select neurogenic and myogenic bladder conditions seen in adults with congenital conditions.
... However, the association between luid intake and kidney stone risk is not entirely clear. Several studies suggest that suf icient luid intake is an effective strategy to prevent kidney stones [12,[16][17][18]. Three meta-analyses concluded that water intake was associated with reduced kidney stone risk and long-term risk of recurrence [8,13,18]. ...
The prevalence of nephrolithiasis is increasing worldwide. The composition of the urine plays a central role in the pathogenesis and progression of kidney stones and can be influenced by diet, lifestyle, genetic predisposition and acquired diseases. Epidemiological studies demonstrated a link between kidney stones and obesity, metabolic syndrome and insulin resistance. Inflammatory processes and influences by the microbiome are also currently being discussed. This article summarizes the major risk factors for nephrolithiasis and outlines the derived treatment options for recurrent nephrolithiasis, which include general measures and pharmacological metaphylaxis. This article concentrates on the most common type of stone, calcium nephrolithiasis but also gives a review of less common kidney stone diseases.
When treating the vast majority of patients, urolithiasis, also known as nephrolithiasis, is still the main issue that needs to be addressed. Urolithiasis is also known as nephrolithiasis. According to estimates, there are three to four times as many men as women who suffer from this condition. Around the age of 70, the likelihood of developing kidney stones increases to about 12% for men, whereas it is only 5% for women. Diet and environment are just two of the variables that may contribute to kidney stone development. Kidney stones are a serious health issue that affects a lot of developed nations. Right now, the difficult problem that needs to be solved is how to lessen the severe symptoms of acute passage.
Effective nutritional-metabolic support strategies are of interest to athletes, coaches, and physicians prescribing various supplements. Dietary deficiencies in macronutrients, vitamins, and minerals of the right type can interfere with training adaptation, while in athletes who eat a balanced diet, physiological training adaptation can be enhanced. Therefore, in the event of a lack of specific nutrients, athletes are forced to use various supplements, but will individual combinations of them be safe for the body as a whole and effective for improving athletic performance? The paper analyzes and summarizes studies on the compatibility of some supplements and the safety and efficacy of such combinations in sports, in particular: the compatibility of vitamins E and C, vitamin D and calcium, creatine and caffeine, branched chain amino acids (isoleucine, leucine and valine).
Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.
Hot flashes are common in breast cancer survivors because they can occur as a result of natural aging, surgery, or medications used in the treatment of cancer. Unfortunately, some survivors will have to cope with bothersome hot flashes for years even after completing cancer-directed therapies, and these symptoms can detrimentally impact life quality in multiple domains. Many drug and non-drug interventions have been studied in recent decades, and some are quite effective at reducing the frequency and severity of hot flashes. This chapter provides a succinct overview of supportive care strategies for dealing with hot flashes, the data behind each approach, and important information about toxicities that may occur as a result of therapies.
Nefroloji, temel olarak böbrek hastalıklarıyla ilgilenen bir tıp bilimi dalıdır. Nephros böbrekler, -ology çalışma anlamına gelen Yunanca kökenli bir terimdir. Türkçede böbrek kelimesinin kökeni araştırıldığında, Orhun Yazıtlarında kaburga ve kalça arasındaki boşluğun adının “bögür” olarak geçtiği görülür. Uygurca tıp metinlerindeki kullanımı bügür’dür. Eski Türkçeden beri kullanılagelen bögür kelimesi “böbrek, böğür, yan” anlamındadır. Türkçenin tarihi dönemlerinde, Karahanlıcada bögür, Çağataycada ise bögr şeklindedir. Dîvânu Lugâti't-Türk’te (1070, Kaşgarlı Mahmut) bögür, böbrek adı olarak geçmektedir. 1400’den önce Osmanlı Döneminde muhtemelen böğür kelimesine -ek eki getirilerek böğrek kelimesi böbrek anlamında kullanılmıştır. Halk arasında hâlâ organın bulunduğu yerle ilişkilendirilmek için böğür kelimesi yaygın kullanılsa da, günümüzde artık böbrek olarak ifade edilmektedir.
Günümüzde epidemiyolojik çalışmalar, böbreklerimizi olumsuz etkilediğini bildiğimiz diabetes mellitus, hipertansiyon, obezite, aterosklerotik kalp hastalığı, romatolojik hastalıklar ve kanser gibi sağlık problemlerinin sıklığının giderek arttığını göstermektedir. Ayrıca bunlara primer böbrek hastalıkları ve sekonder olarak böbreği tutan başka birçok sistemik hastalığı da ekleyince günlük hekimlik pratiğinde böbrek rahatsızlığı şüphesi olan ya da bu tanı ile tedavi-izlem altında olan bir çok hasta ile karşılaşmaya devam edeceğimizi öngörebiliriz.
Böbrekler sıvı, elektrolit, asit ve baz dengesini düzenleyen, ilaçlar ve toksinler dahil bir çok endojen ve eksojen atık ürünleri ve fazla sıvıyı kandan filtreleyen karmaşık kan damarı ve tübül ağına sahip boşaltım sisteminin yaşam için hayati önem taşıyan organıdırlar. Nefroloji uzmanları; böbrek yetmezliği, hipertansiyon, elektrolit (sodyum, potasyum, kalsiyum, fosfor vb.) bozuklukları ve idrar anormalliklerinin (hematüri ve proteinüri vb.) nedenlerinin araştırılması, tedavi ve takibi, ayrıca kullandığımız ilaçlara bağlı böbrek toksisitesinin olumsuz etkilerinin önlenmesi konularında rol alırlar.
Kronik böbrek hastalığı dünyada ve Türkiye’de giderek artan önemli bir halk sağlığı sorunu haline gelmiştir. Böbrek hastalığı farkındalığını arttırmak için Uluslararası Nefroloji Derneği (ISN) ile Uluslararası Böbrek Vakıfları Federasyonunun (IFKF) ortak girişimiyle 9 Mart 2006 tarihinde ilk kez “Dünya Böbrek Günü” kutlanmıştır ve o günden bu yana her yıl Mart ayının 2. perşembe günü tüm dünyada “Dünya Böbrek Günü” olarak kutlanmaya devam edilmektedir. Kronik böbrek hastalığının en önemli nedeni diabetes mellitustur. Ülkemizde yapılan taramalara göre erişkinlerde kronik böbrek hastalığı sıklığı %15.7 (~7.5 milyon kişi), böbrek hastalıklarının farkındalığı ise %1.6 düzeyinde tahmin edilmekte ve sorunun boyutunun tahmin edilenin çok üzerinde olduğu görülmektedir. Hâlen tüm dünyada 2 milyondan fazla kişi diyalize girmekte ve böbrek nakli tedavileri ile yaşamını sürdürmektedir. Önümüzdeki 10 yıl içinde bu sayının ikiye katlanacağı, tedavi maliyetlerinin 1.5 trilyon doları aşacağı hesaplanmaktadır. Dolayısıyla temel olarak böbrek sağlığımızı korumak için gerekli önlemleri almak, yani koruyucu hekimlik her zaman daha önemlidir. Kronik böbrek hastalığından korunmak için bireyler; düzenli egzersiz yapmalı, sağlıklı beslenmeli, vücut ağırlığını korumalı, tuzu azaltmalı, yeterli sıvı almalı, sigara içmemeli, alkolden uzak durmalı, ağrı kesici ilaçlardan hekim önerisi olmadığı sürece kaçınmalı, kan basıncını ve kan glukozunu düzenli olarak ölçtürmeli ve risk grubunda ise böbreklerini düzenli olarak kontrol ettirmelidirler.
Diğer mesleklerden insan sağlığı ile uğraştığı için daha kutsal sayılan hekimlik mesleğinin bir diğer özelliği ise sürekli yenilenme ihtiyacının olmasıdır. Modern tıp çağında teşhis ve tanı yöntemleri, görüntüleme teknikleri, cerrahi ve robotik müdahaleler, girişimsel işlemler, özellikle moleküler düzeydeki bilimsel gelişmeler yaygınlaşmaktadır. Bununla birlikte hastadan anamnez almanın ve muayene etmenin yani hastayı dinlemenin, yakınmalarını doğru yorumlamanın ilk önceliğimiz olduğu unutulmamalıdır. Çünkü Hipokrat hekimliği döneminden beri “Hastalık yoktur, hasta vardır.” ilkesi hiç değişmemiştir. Böbrek hastalıklarında da, hastalığın özelliği olan semptom ve bulgular hiçbir zaman hastalar arasında aynı ölçüde görülmemektedir.
Литогенният илеус е една от най-редките причини за тънкочревна непроходимост като се предизвиква от преминаването на конкремент през холецисто-ентерална фистула, причиняващ пълен стоп в отделите на гастро-интестиналния тракт. Най-честата локализация на обтурацията е терминалният илеум, поради по-тесния лумен и забавената перисталтика. Литогенният илеус се среща по-често при жени в напреднала възраст (>65). Съотношението жени спрямо мъже е 3.5:1. Смъртността при този вид механична тънкочревна обструкция е сравнително висока (12-27%), поради напредналата възраст, тежкото общо състояние, забавянето на диагнозата и придружаващата патология. Златен стандарт при диагностицирането е провеждането на КТ на коремни органи, при което най-често се установява триадата на Rigler: пневмобилия, тънкочревен илеус и конкременти в гастро-интестиналния тракт. Представяме случай на 77 годишна жена с оплаквания от гадене, седемдневно повръщане, болка в десен коремен фланг, дехидратация и астено-адинамичен синдром.
Despite advances in systemic and local therapy, liver resection remains the gold standard in the treatment of liver metastases from colorectal cancer. The liver resection is determined by the size of the metastases, the number, location, residual liver volume, the presence of portal hypertension and previous chemotherapy. ALPPS (associating liver partition and portal vein ligation for staged hepatectomy) is a strategy designed for patients who are considered unresectable. The procedure consists of transection of the liver parenchyma, combined with ligation of the left / right portal branch during the first stage and in the second stage right / left hepatectomy, after verification of the hypertrophy of the contralateral liver. ALPPS is more often the subject of patients who need a right hepatectomy and there is not enough residual volume on the left. The time between the first and second stage of surgery is between seven and ten days, with ALPPS allowing an increase in total liver volume of approximately 20%, increasing the future liver remnant by up to 80%. This procedure belongs to the two-stage liver resections, with the ligation or selective embolization of the left / right portal branch, as the transection (complete / partial) of the liver aims at the faster hypertrophy of the residual liver parenchyma due to the rupture of the intrahepatic collaterals.
Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have devastating consequences on morbidity and mortality. In this article, we review the pathogenesis and diagnostic approach to postmenopausal osteoporosis. We review available nonpharmacologic and pharmacologic therapies and we discuss their clinical efficacy and complications, with a detailed discussion of atypical femur fractures and osteonecrosis of the jaw.
The incidence and prevalence of kidney stones have increased over the past four decades. However, the diagnosis of ‘kidney stone’ can range from an incidental asymptomatic finding of limited clinical significance to multiple painful episodes of ureteral obstruction with eventual kidney failure. Some general strategies may be useful to prevent the recurrence of kidney stones. In particular, greater attention to kidney stone classification, approaches to assessing the risk of recurrence and individualized prevention strategies may improve the clinical care of stone formers. Although there have been some advances in approaches to predicting the recurrence of kidney stones, notable challenges remain. Studies of kidney stone prevalence, incidence and recurrence have reported inconsistent findings, in part because of the lack of a standardized stone classification system. A kidney stone classification system based on practical and clinically useful measures of stone disease may help to improve both the study and clinical care of stone formers. Any future kidney stone classification system should be aimed at distinguishing asymptomatic from symptomatic stones, clinically diagnosed symptomatic stone episodes from self-reported symptomatic stone episodes, symptomatic stone episodes that are confirmed from those that are suspected, symptomatic recurrence from radiographic recurrence (that is, with radiographic evidence of a new stone, stone growth or stone disappearance from presumed passage) and determine stone composition based on mutually exclusive categories.
Nephrolithiasis (kidney stones, urolithiasis) is the formation of stone-like concretions in the urinary system caused by the precipitation of calcium, phosphate, urate, and other molecules. The incidence and prevalence of nephrolithiasis among adults in the USA have been increasing for 30 years. According to the National Health and Nutrition Examination Survey (NHANES 2007–2010), current prevalence is estimated at 8.8% among adults as compared to a prevalence of 5.2% in 1994. More than $5.3billion is spent directly and indirectly on treatment for nephrolithiasis annually in the USA. Kidney stones are more prevalent in men than women with a lifetime risk of 12% in men and 6% in women. As many as 20% of patients present with renal colic and require urological intervention.
The female athlete triad (Triad) is comprised of three interrelated conditions: low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. These three conditions occur on a spectrum ranging from optimal health to the end-stage outcomes of eating disorders, amenorrhea, and osteoporosis. The Triad is very common in athletes across all sports, but it is particularly prevalent in sports which emphasize leanness. Sports medicine physicians should be comfortable screening for all three components of the Triad. The end-outcomes of the Triad have long-lasting and serious health ramifications, so prompt identification and early treatment is crucial. Treatment should involve a multi-disciplinary approach that focuses on optimizing all facets of the Triad. If disordered eating or an eating disorder is diagnosed, the treatment team should include care from a mental health professional. First-line treatment for the Triad should focus on increasing or restoring energy availability using nonpharmacologic approaches. Return-to-play decision making for patients with the Triad can be complex. Clinicians may refer to the 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play for a risk assessment tool, which can assist with clinical decision making. There is increasing research which demonstrates the existence of a parallel condition in male athletes, characterized by low energy availability, hypogonadotropic hypogonadism, and decreased bone mineral density. Prevention efforts are important and should focus on increasing awareness of the Triad and fostering a healthy approach to exercise and nutrition at home and at school.
Urinary oxalate is considered to play a crucial role in the formation of renal stones. In this respect hyperoxaluria constitutes a special problem, mainly because of the specific physicochemical properties of oxalate. The appropriate management of patients with this disorder must be based on a thorough understanding of the absorption, metabolism and excretion of oxalate. Different reasons for high oxalate excretion as well as analytical problems and our current therapeutic possibilities are covered in this review.
Three hundred and ninety-two stone formers were investigated to exclude systemic disorders and to define the presence of haematological and urinary abnormality commonly associated with stone disease. Increased urinary excretion of calcium, oxalate or uric acid was found in 40% and there was more than one abnormality in 16% of the patients. The dietary habit of stone formers did not differ significantly from that of control subjects. Dietary advice to increase the consumption of fibre and reduce the consumption of sugar, refined carbohydrates and animal protein produced a significant reduction in the urinary excretion of calcium, oxalate and uric acid. We consider that reduction of the nutrient density of the diet by this means is the first line of management of idiopathic stone formers.