Prevention of kidney stones

There are several types of kidney stones and the specific treatment for each differs to some degree.  Preventive measures that can be employed to decrease the incidence of urinary stone formation include:

1. Increase fluid intake (preferably water) to produce a urine volume of at least two liters per day, especially during the hot humid summer months.  This will result in a pale yellow urine.  If the voided urine is dark yellow, it is too concentrated and additional fluid intake is required.
2. Excess calcium in the urine predisposes to stone formation.  A low calcium diet and/or a thiazide diuretic, such as hydrochlorthiazide, will decrease urinary calcium excretion, but will also increase potassium excretion, perhaps requiring potassium supplementation.
3. Consume less than two grams of sodium (one level teaspoon of table salt) daily. Excess sodium intake results in excess sodium and calcium excretion.
4. Ingest a normal calcium diet (800-1200 mg/day). Persons who form calcium oxalate stones should consume adequate dietary calcium, not decrease the intake. Normally, calcium and oxalate in foods bind together in the intestine and are eliminated from the body as calcium oxalate. If there is insufficient calcium in the gut to bind oxalate, the excess oxalate will be absorbed by the body, excreted in the urine and there bind to calcium to form insolvent calcium oxalate stones.
5. Foods high in oxalate include spinach, potato chips, bran flakes, french fries, rhubarb, nuts, beets, nut butter and beer.
6. Persons forming calcium oxalate stones benefit from limiting dietary intake of foods high in oxalate.
7. Citrate and oxalate in the urine compete for calcium to which both can bing. Formed calcium citrate is much more soluble than calcium oxalate and it's formation in the urine helps prevent stone formation. Potassium citrate or sodium citrate can be prescribed for persons with abnormally low urinary citrate levels. Citrus juices such as orange juice or lemonade, that contain much citrate are useful for persons with low urinary citrate levels.
8. Potassium citrate and magnesium citrate alkalinizes the urine and maintain the ph between 6.0-7.0. This helps decrease the formation of oxalate, uric aide, and cystine stones. Dose of magnesium citrate= 500 mg/day.
9. Persons who excrete excess uric acid (derived from metabolism of body protein and purine nucleic acids) in the urine and persons with gout need to limit the amount of dietary protein to twelve ounces per day and to limit the amount of dietary organ meats (liver, kidney, pancreas, etc) which are high in nucleic acids. Twelve ounces of dietary protein (meat)= The size of 3 decks of cards.