Dietary Guidelines to Reduce the Risk of Renal Stones

 

Dr. R. Kalai1*, B. Sasirekha2

1Lecturer in Nutrition, Rani Meyyammai College of Nursing, Annamalai University, Chidambaram-608002

Cuddalore District, Tamilnadu E mail:

2Tutor in nursing, Rani Meyyammai College of Nursing, Annamalai University, Chidambaram-608002

Cuddalore district, Tamilnadu

*Corresponding Author E-mail: proffkalaivt@gmail.com

 

ABSTRACT:

Kidney stones (urolithiasis or calculi) are found to be lodged in the urinary tract namely kidney, ureters, bladder or urethra. The production of protein metabolism leaves uric acid,phosphate  and oxalates, sodium, calcium and magnesium. A urine concentrate with calcium phosphate and ammonium phosphate predisposes stone formation. The occurrence of kidney stone may be an outcome of different nutritional status, dietary habits and environmental factor such as temperature and humidity and other factors of occupation, infection of urinary tract, hereditary, vitamin A and vitamin B6 deficiency and hyperthyroidism.  Dietary guidelines deals the foods included and avoided specifically based on the types of stones.

 

KEYWORDS: Kidney stone, urolithiasis, calculi, oxalic acid, Calcium Oxalate Stones,  dietaryguidelines.

 

 


INTRODUCTION:

Kidneys are located in the human body near rib cage. They not only clean the blood coming from heart. But also expel toxicants through urine.As for as kidneys are concerned the possibilities of stones are formed due to various  reasons which was mentioned below  by those who all are suffered by  this, they should have knowledge and understanding,about the type of kidney stone, reasons for kidney stones, consequences and dietary management.

 

Kidney stones are aect peoplewho are between 30 and 60 years of age. They aect men morethan women. It is estimated that renal colic (severe pain caused by a kidney stone) aects about 10-20% of men, and 3-5% of women. In India, 12% of the population is expected to have urinary stones, out of which 50% may end up with loss of kidneys or renal damage.(NaliniH.Sofia,  Manickavasakam and  Thomas M.Walter. 2016).

To lead healthy living, further formation of these stones could be avoided by proper care and management. The following information will help the public to aware, disseminate the knowledge with each other and avoid the further complications those who are suffered and not suffered.


What may be the reasons for kidney stones?

The factors contribute to the formation of stones are

1.            Climate: In warm climates, the urine volume is low and the urine is highly concentrated with urates, oxalates and calcium salts.

2.    Occupation: Those who are working under the sun perspire a lot may generally pass concentrated urine.

 

3.    Infection of the urinary tract: frequent infection of urinary tract may be one of the contributory causes. Pus cells and epithelial cells may form a focus around which the stone may be formed.

 

4.            Dietary habits : Persons consuming habitually foods rich in oxalates, calcium, purines and phosphates e.g.whole cereal flours (rich in phosphates), leafy vegetables (rich in calcium and oxalates), milk (rich in calcium and phosphates), tea (rich in oxalates), and meat (rich in purine and phosphates) may be predisposed to the formation of renal calculi. Excessive consumption of tea may be an important causative factor.

 

5.            Hereditary:  Defective metabolism of uric acid and oxalates may be of hereditary origin.

 

6. Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine (Swaminathan, M., 1998).

 

Types of urinary stones:

1.    Calcium Oxalate Stones / Calcium Phosphate Stones

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate ( Calcium Oxalate Stones) or phosphate (Calcium Phosphate Stones). These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.

 

Reason for Calcium stone formation

Ø Excessive intake of high calcium food in large amount

Ø Drinking hard water

Ø Excess vitamin D (Exposure or working under sunlight), which increases calcium absorption

Ø Prolonged immobilization (extended illness or disability), which increases calcium withdrawal from bone 

Ø Certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.

Ø people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery.

 

 

           

2.            Struvitestones or infection stones

Struvite stones occur most frequently. Theses stones are composed of a single compound, magnesium ammonium phosphate (MgNH4PO4),and are often called infection stones which are mainly caused by urinary tract infections- not an association with any specific nutrients. Thus no specific diet therapy is involved. Struvite stones are usually large “stag-horn” stone that are removed surgically.

 

Uric Acid stones

Excess uric acid may be caused by some impairment with the metabolism of purine, from which uric acid is formed. This impairment occurs in diseases such as gout and can also occur in rapid tissue breakdown during wasting disease.

 

3.    Cystine stones are rare.

Cystine stones are the rarest kidney stones.  They are caused by a genetic metabolic defect in the renal reabsorption of the amino acid cysteine. This defect result is an accumulation of cysteine in the urine, a condition called cystinuria. It occurs rarely and only in children with this genetic history (SueRodwell Williams.2001).

 

What are the symptoms of kidney stones ?

Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.

 

If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body try to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.

 

If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.

Size of the kidney stones?

 

Kidney stores are less than 5mm in size such stones can be expelled through medication

 

If kidney stores are 6to7 mm size they could be removed using spiral instruments.

 

 

Dietary guidelines for  kidney stones:

v Enough drinking water

Drinking enough liquid is the most important to relieve kidney stones. If a person had kidney failure, health care professionals recommend the quantity of water according to their kidney condition.  People with cystine stones may need to drink even more. Talk with a health care professional about how much liquid you should drink. Drinking  8 glassses of water daily to keep urine dilute .Urine output exceeds  2liters /day is advisable(U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020)

 

v Fluid intake

Ingestion of large amounts of fluid in the form of beverages such as tender coconut water, barley water, fruit juices, and other soft drinks, will help to excrete over 2 litres of urine per day. A dilute urine prevents concentration of solids and the precipitation of crystals of urates, oxalates etc.

 

v To reduce sodium intake

If you had calcium oxalate stones or calcium phosphate stones consult a health care professional regarding quantity of sodium intake per day and type of diet according to our type of stones.

 

Now a day’s most of the peoples areconsuming too much sodium. Sodium is a part of salt. Sodium is in many canned, packaged, and fast foods. Sodium is also in many condiments, seasonings, and meats. Includingthis type of diet there is a chance of developing kidney stones increases due to intake of more sodium.

 

Ø Tips to help reduce your sodium intake:

Check the Percent Daily Value (%DV) for sodium on Nutrition Facts label, found on many foods. Low in sodium is 5% or less and high in sodium is 20% or more. Write down the quantity of sodium consuming each day and when eating out, ask about the sodium content in the food.Avoid processed and fast foods, canned soups and vegetables, and lunch meats.

 

Check labels for ingredients and hidden sodium, such asodium bicarbonate (the chemical name for baking soda), baking powder, which contains sodium bicarbonate and other chemicals - Disodium phosphate,    monosodium glutamate (MSG), Sodium alginate, sodium nitrate or nitrite.

 

To reduce sodium to help prevent kidney stones, avoid processed and fast foods, canned soups and vegetables, and lunch meats.

 

 

 

v To Limit the animal protein intake

Eating animal protein may increase your chances of developing kidney stones.To limit the eating of animal protein, includingbeef, chicken, and pork, especially organ meat.Eggs, fish and shellfish, milk, cheese, and other dairy products

 

To make sure getting enough protein each day, otherwise you may need to reduceanimal protein intakeconsult the health care professional about the quantity of animal protein intake

 

Consider replacing some of the meat and animal protein with some of these plant-based foods that are high in protein:legumes such as beans, dried peas, lentils, and peanuts, soy foods, such as soy milk, soy nut butter, and tofu, nuts and nut products, such as almonds and almond butter, cashews and cashew butter, walnuts, and sunflower seeds

 

IMPORTANT NOTE:

If calcium oxalate stones, avoid peanuts, soy foods, nuts and nut products, and sunflower seeds. Low sodium – Low potassium, Low phosphorus - prevents the stone formation

v Reduce the intake of oxalate foods

These foods helpto reduce the amount of oxalate in the urine (Gopalan. C., Rama Sastri, B. V  and Balasubramanian. 1995 )

 

Foods included

Foods restricted

Low-oxalate foods

Barley, Panivaragu, ragi, rice (parboiled, milled), rice flakes, rice puffed, samai, varagu, wheat flour, wheat vermicelli

Bengal gram, green gram, moth beans, peas (dry), peas roasted,

cabbage, spinach stalk, onion big, onion small, bitter gourd, bitter gourd small variety,

broad beans, tomato green, goose berry, melon musk, papaya ripe, peaches, plum, milk (cow’s), bamboo (tender shoots)

Nuts and nut products, peanuts, which are legumes, rhubarb, spinach, wheat bran

 

Foods recommended:

Bananas:  Rich in citrates there by breakdown oxalic acid in body

Pineapple juice; It contained enzyme which break down fibrins and prevents stone formation

Coconut water:  High in potassium magnesium

Vegetables:  carrots, Bitter gourd –rich in minerals

Fruits and juices:  Lemon:  rich citrate presents less favourablecalcium oxalate stone formation

 

High-oxalate foods

Horse gram, khesari dhal, Amaranth leaves, curry leaves, paruppukeerai , drumstic leaves, drumstick, spinach, plantain flower, plantain green, Almond, Cashew nuts , gingelly seeds, Amla, Tomato , Beet root, Wheat Germ, Soybean , Peanuts, Chocolate, cocoa,  coffee colas, peanut,  Black Indian Tea, Sweet Potatoes, Chikoo, grapes

Medium-oxalate foods

 Grapes, Celery, Green Pepper, Red Raspberries, Fruit Cake, Strawberries, Marmalade,Liver

 

High uric acid /purine content  foods

Cauliflower,brinjal, mushrooms, Pumpkin,

Mutton, chicken, fish, egg

 

high purine foods

 Meat, vegetables, beer, wine, shellfish mushroom

 

Cystine stones

 Limit intake of fish

 

v   Include enough calcium in your diet

Talk with a health care professional about how much calcium you should eat, especially if you had calcium stones. Even though calcium sounds like it would be the cause of calcium stones, it’s not. Calcium from food does not increase your risk of calcium oxalate stones. In fact, if you had calcium oxalate stones, the health care professional may tell you to have calcium every day to help prevent kidney stones and support strong bones.

Foods that are high in calcium include dairy products, such as low-fat milk and yogurt, and lactose-free milk with calcium.(U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020).

 

v Plan meals to lose weight

Studies have shown that being overweight increases the risk of kidney stones, particularly uric acid stones and foods that are low in carbohydrates can further increase the risk of uric acid stones. Consult a   dietitian for planning meals to lose weight.

 

Foods for renal stone remedies:

Ø Banana stem juice – is an efficient diuretic and also lithotriptic. Diuretic means, it collects urine faster in the bladder and hence the person passes more urine. This gives a flushing effect on stones.Lithotriptic means, it helps to crush stones into pieces, which are easily eliminated.

Ø Dose:
This home remedy in a dose of 10 ml is given two times a day, on empty stomach or 10 minutes before food, two times a day. The dose can be increased based on the severity of the diseaseand  doctor’s advice.

 

Ø Coconut water also helps in dissolving kidney stones because of the presence of potassium, which plays a key role in urine alkalizing and preventing formation of kidney stones.

 

Ø White radish benefits for curing stone. So  it is recommended for regular  consumption. Radish juice  more potent in treating and eliminating  kidney stone than if radish consumed in another form. For the treatment of kidney stones to drink half a glass of radish juice every day. Consuming radish juice before eating has beneficial to dissolve kidney stones.

 

Ø Studies conducted at national Institute of Nutrition, Hyderabad (1985) showed that L- tartaric acid a component of tamarind is an inhibitor of urolithiosis or Urinary calculi  (Srilakshmi. B. 2003).

 

Ø The tamarind’s healing action comes from its antioxidants (including tartaric acid, which gives the fruit its sour taste).The “Nutrition Research” journal states that “consumption of tamarind offers protection against kidney stones.”

 

Ø Citric acid is protective and protected you are against forming new kidney stones. Citric acid makes urine less favorable for the formation of stones. In its natural form, such as from citrus fruits, citric acid does not alkalinize the urine as citrate (from medication) does. Rather, it prevents small stones from becoming “problem stones” by coating them and preventing other material from attaching and building onto the stones.  Citric acid is most prevalent in citrus fruits and juices. Of these fruits, lemons and limes have the most citric acid. While oranges, grapefruits, and berries also contain appreciable amounts, lemons and limes will most significantly contribute to the citric acid content of your urine.(http://www.thealthbenefitsof.com/16-white-radish-benefits-for-health-and-nutritional- content/).

 

Ø Cardamom is an excellent pain killer. It also has relaxing effect over muscles. It helps to relax the bladder and urethral sphincters so as to initiate urination. It also helps to reduce the pain that is caused due to urinary calculi and urine retention.

 

Ø Studies have shown that the Dietary Approaches to Stop Hypertension (DASH) diet can reduce the risk of kidney stones. The DASH diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein.( Taylor EN, Fung TT, Curhan GC. 2009).

 

CONCLUSION:

Many factors contribute the formation of kidney stones which was related to the nature of the urine itself or to the condition of the urinary tract environment. The four major stones formed are calcium, uric acid, struvite and cystine stones. Dietary measures vary according to the composition of stone. Dietary therapies are specific for types of stones the increased intake of water and other fluid dilute the urine and avoid the further formation of stone. People who are more physical activity and those who are working under the sun and warm climates need additional fluids. Dietary guidelines help the people aware, manage and avoid further complications due tothese types of stone.

 

REFERENCES:

1.     Gopalan. C., Rama Sastri, B. V  andBalasubramanian. 1995.  Nutritive Value of Indian Foods, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India.

2.     Srilakshmi. B. (2003).  Dietetics, Second edition, New Age International (P), Ltd, Bangalore. Pg: 223-229.

3.     Sue Rodwell Williams.2001.  Basic Nutrition Diet Therapy., Eleventh Edition,  Harcourt (India) private Limited, pg: 411-416.

4.     Swaminathan, M. Advanced text book on Food and Nutrition, volume 11 , 1998.The Bangalore Printing and Publishing Co, LTD, Bangalore.pg: 222—224.

5.     Taylor EN, Fung TT, Curhan GC. DASH-style diet associates with reduced risk for kidney stones. Journal of the American Society of Nephrology. 2009;20 (10):2253–2259.

6.     U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015-2020 dietary guidelines for Americans. 8th Edition. December 2015. health.gov/dietaryguidelines/2015/guidelines/ . Accessed September 26, 2016.

7.     NaliniH.Sofia,  Manickavasakam and  Thomas M.Walter. 2016
prevalence and risk factors of kidney stone (pdf download available). available from:].GJRA - global journal for research analysis x 185 volume-5, issue-3, ISSN No 2277 - 8160http://www.researchgate.net/publication/299543144 (assessed  Aug 5, 2017)

8.     8.http://www.thealthbenefitsof.com/16-white-radish-benefits-for-health-and-nutritional- content/.s

 

 

 

 

 

 

 

 

Received on 16.09.2017           Modified on 04.10.2017

Accepted on 25.10.2017         © A&V Publications all right reserved

Int. J. Nur. Edu. and Research. 2018; 6(1): 73-77.

DOI: 10.5958/2454-2660.2018.00018.2