Kidney Stones

Kidney stones are one of the most common disorders of the urinary tract, which affects 5-10% of the population.(2) Those who suffer this complaint have a 60-70% recurrence rate.  The majority of stones are made of calcium oxalate (approximately 70%), calcium phosphate, cystine, uric acid and struvite (stones derived from bacteria).(1,2)

 

Causes

 

Stones can only form when urine is super saturated with respect to its constituent crystals.  Super saturation means that the concentration of stone forming salts such as calcium oxalate, exceeds its saturability in the urine.   The formation of calcium oxalate nephrolithiasis depends on several factors.

 

  1. Hypercalciuria – hyperparathyroidism, renal tubular acidosis, sarcoidosis, vitamin D intoxication and idiopathic hypercalciuria are all causes of hypercalciuria.  This only represents 10% of patients with calcium oxalate stones.(2)
  2. Hyperoxaluria may be due to over production, from heredity disorders of metabolism or acquired from diet or intestinal disease. This can be reduced by vitamin B6 supplementation.(3)
  3. Adhesion crystals on the surface of renal epithelial cells.(3)
  4. Quantitative or qualitative deficits of inhibitors of crystallization in urine – the following nutrients can regulate this crystallization:-

a.    Myoinositil hexaphosphate (phytate) inhibits the crystallization of calcium salts (oxalate and phosphates) in biological fluids(4)
b.    Citrate binds and solubilizes calcium ions(5)
c.    Folic acid reduces uric acid production(6)

  1. Promoters of crystallisation – these are the following possibilities: (1, 3)

a.    Infection by nano bacteria
b.    Low urine citrate due to bowel disease, renal tubular acidosis and dietary indiscretions.
c.    Low urine pH promotes uric acid stones,
d.    High urine pH promotes calcium phosphate stones.

 

Infection stones or struvite calculi occur more frequently in women, infants and the elderly as these patients are at greater risk of urinary tract infections.  Microorganisms that possess urease activity increase this “infection stone” production.(1,3)

Cystine urolithiasis is the only clinical expression of cystinuria (possibly due to an autosomal recessive genetic deficit).  Cystine is poorly soluble in normal urine with a pH less than 6.8.  Increasing fluid intake and alkalizing urine to pH 7.5 with sodium bicarbonate or potassium citrate may be of some benefit.(3)

Uric acid stones are formed in patients with persistent acid urine and/or massively increased urinary uric acid excretion (> 1000mcg/day).  Alkalizing urine with potassium citrate or bicarbonate will help solubilize uric acid stones.(3)

The majority of patients (80%) form calcium oxalate stones.  These are not due to specific disease but to idiopathic hypercalciuria, hyperuricosuria, mild hyperoxaluria or hypocitruria.(3)

Signs & Symptoms

 

There are really no early warning signs or symptoms of kidney stones. The earliest symptom is often pain on urinating, or in the lower abdomen or the lower back, and/or blood in the urine. Other symptoms may include burning on urination or the need to urinate frequently, due to infection.(1,3)

Diagnosis

 

Diagnosis of kidney stones is confirmed by X-ray or MRI. Urine tests may be used to confirm the type of stones by examining the minerals present in the urine.(1,3)

Treatment – Standard

 

Treatment often depends on the type and size of the stones present. Smaller stones may pass normally with time – although passing of kidney stones can be painful. Larger stones may require medications to help dissolve the stones, or even shock waves (extracorporeal shock wave lithotripsy = ESWL) to break up the stones into smaller pieces for easier excretion in the urine.(1,3)

For stones lodged in the ureters, or larger stones in the kidneys, surgery may be required.(1,3)

Treatment - Complimentary Therapies

 

NUTRITIONAL CONSIDERATIONS

Quantitative or qualitative deficits of inhibitors of crystallization in urine – the following
nutrients can regulate this crystallization:

  • Myoinositol hexaphosphate (phytate) inhibits the crystallization of calcium salts (oxalate
    and phosphate) in biological fluids(4)
  • Folic acid reduces uric acid production(6)
  • Pyridoxal-5-phosphate reduces urinary oxalate excretion(3)
  • Magnesium supplementation reduces the formation of calcium stones(1)
  • Citrate supplementation in those suffering from hypocitruria will help prevent calcium
    oxalate crystallization. Citrate also binds and solubilizes calcium ions (5)
  • Potassium citrate supplement helps reduce calcium stone formation in patients with distal
    renal tubular acidosis(7)
  • Glycosaminoglycans are potent inhibitors of growth and aggregation of calcium oxalate
  • crystals. Supplementing with shark cartilage or chondroitin sulphate may be of advantage(8)

Cadmium exposure can lead to renal tubular damage and cause calcification in the kidneys.
Nutrients that improve its excretion may be warranted. Nutrients that may help include
Lipoic acid, quercetin, cysteine, and zinc.(10)

NUTRITIONAL TREATMENT

1.    Increase fluid intake to 2.5 - 3 litres water per day.(4)
2.    Reduce animal protein intake to (1g/kg body weight per day).(1)
3.    Avoid alcohol, and caffeine beverages eg. Coffee, Coke and cola drinks, and guarana.(1)
4.    Increase intake of fruit and vegetables and high fibre foods.(1)
5.    Reduce high salt intake as it increases the excretion of calcium.(1)

6.    Reduce oxalate rich foods: Beet tops, celery, carrots, chocolate, cucumber, grapefruit, kale, peanuts, sweet potato and peppers. If these foods are eaten take magnesium with the meal.  This will help solubilize oxalate salts.(1)
7.    Supplementation is essential the following nutrients are of importance.

(a)    Pyridoxal-5-phosphate reduces urinary oxalate excretion.(3)
(b)    Magnesium supplementation reduces the formation of calcium stones.(1)
(c)    Citrate supplementation in those suffering from hypocitruria will help prevent calcium oxalate crystallization.(5)
(d)    Potassium citrate helps reduce calcium stone formation in patients with distal renal tubular acidosis.(7)
(e) Glycosaminoglycans are potent inhibitors of growth and aggregation of calcium oxalate crystals.  Supplementing with shark cartilage or chondroitin sulphate may be of advantage here.(8)
(f)    Cadmium exposure can lead to renal tubular damage and cause calcification in the kidneys.  Nutrients that improve its excretion may be warranted.  Nutrients that may help include Lipoic acid, quercetin, cysteine, and zinc.(10)

8.    Extensive use of antibiotics (trimethroprim, sulfamethoxazole) may alter bowel flora and increase risk of kidney stones.   Antibiotics destroy the bacterial organism oxalobacter formigenis that resides in the bowel and helps lower oxalate levels from food.(1)
9.   Urinary tract infections need to be treated.  High dose vitamin C and minerals such as zinc, vitamin B5, B6, and quercetin can improve immune response.(1)

PRIMARY NUTRITIONAL SUPPLEMENT OPTIONS  


Magnesium

150 mg 3 x/day

(solubilizes oxalate)


Folinic acid 

800-1200mcg/day

(decreases oxalate excretion)


Vitamin B12  

1,000-1,500 mcg/day

(decreases oxalate excretion)

Pyridoxal-5-Phosphate

40-60mg/day

(decreases oxalate excretion)
Glycine

600mg/day between meals

(urinary alkalizer, increases solubility uric
acid stones)


Potassium phosphate

900 mg/day(

(urinary alkalizer, increases solubility uric

acid stones) 


Citric acid   

450mg/day

(urinary alkalizer, increases solubility uric
acid stones)


Iron   

75mg/day

(reduces uric acid formation)


Shark Cartilage  

300-500mg/day

(inhibitor of calcium oxalate crystallisation)


SECONDARY NUTRITIONAL SUPPLEMENT OPTIONS


If due to infection use


Probiotics  daily 

(probiotic, support immunity)


Quercetin  

1,000-1,500mg/day

(immune support)


Rutin 

800-1,200mg/day

(immune support)


Bromelain

250-375mg/day

(immune support)


D-Mannose 

500-1,500mg/day

(urinary tract support)

If due to heavy metal exposure eg. cadmium use


Glutathione 

500mg/day (metal chelator)

Parsley

180mg/day (metal chelator)


Pine bark 

600mg/day (metal chelator)


Glutamine 

150mg/day (metal chelator)

Cysteine

150mg/day (metal chelator)

Quercetin

1,500mg/day (metal chelator)


Rutin

1,200mg/day (metal chelator)

Bromelain
375mg/day   (metal chelator)

R-Lipoic acid 

400-600mg/day (metal chelator)

Related Conditions

 

For additional information on Kidney Stones or if you  have any further questions, please do not hesitate to contact the Bio Concepts’ Technical Team on 1800 077 113 or send us an email. We will respond with 24 business hours to your inquiry.

 

REFERENCES AVAILABLE ON REQUEST