Also, be careful of sugar. Lemon juice concentrate 4 oz per day mixed with water can be considered. Alkali citrate can be prescribed and is available over-the-counter. Alkali citrate can be given with a mineral s , such as sodium, potassium or magnesium to help prevent stone formation. The aim is to increase urine citrate for prevention of calcium stones and increase urine pH or make urine less acidic or more alkaline, for prevention of uric acid and cystine stones.
The goal is to keep pH in balance. Speak with a doctor or other healthcare professional about which treatment options are right for you, including over-the-counter products and home remedies. People with kidney disease may need to watch their intake of sodium, potassium or other minerals, depending on the stage of kidney disease or other factors. In addition to calcium oxalate stones, another common type of kidney stones is uric acid stones.
Red meat, organ meats, and shellfish have high concentrations of a natural chemical compound known as purines. Higher uric acid excretion leads to lower overall urine pH, which means the urine is more acidic. The high acid concentration of the urine makes it easier for uric acid stones to form.
To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low fat dairy products. Limit sugar-sweetened foods and drinks, especially those that contain high fructose corn syrup.
Limit alcohol because it can increase uric acid levels in the blood and avoid crash diets for the same reason. Eating less animal-based protein and eating more fruits and vegetables will help decrease urine acidity and this will help reduce the chance for stone formation. How common are kidney stones? Each year, more than half a million people go to emergency rooms for kidney stone problems.
It is estimated that one in ten people will What are uric acid stones? A uric acid stone is a type of kidney stone, which is a hard object that is made from chemicals in the urine. After formation, the stone may What are struvite stones? Struvite stones are caused by infections in the upper urinary tract. A kidney stone is a hard object that is made from chemicals in the urine Drug stones?
Conversion from calcium oxalate to calcium phosphate stones? Having prescribed potassium, do we not want to monitor for serious increase in serum potassium; some patients are older, some diabetic, some take ACE or ARB medications, some age or change drugs over the years we treat them. Do we not want to diagnose primary hyperparathyroidism?
You cannot without serum testing and 24 hour urine testing to be sure calcium excretion is not low. If we do not obtain and measure 24 hour urine samples, how can we know anything? Some patients may have very high urine citrate levels. Some may have very high urine pH values. Here and there urine oxalate is very high, from primary hyperoxaluria, or occult malabsorption syndromes, or very odd food habits.
Moreover, people do not always take their citrate. Fall in urine ammonia in relation to urine sulfate, and rise in urine potassium assure one they are taking the drug. No one really questions that alkali salts will raise urine pH, nor that raising urine pH will reduce uric acid supersaturation and prevent stones.
It is common practice. I doubt anyone will pay for or perform an RCT to test this question. Uric acid is a large flat mainly hydrophobic molecule with most of its charge on a single proton receptor site. The pKa of the proton receptor site is about 5. Given these facts we can calculate uric acid supersaturation from the urine concentration of total uric acid and the pH, along with minor adjustments for the effects of ionic strength on the pKa.
High supersaturation will lead to a snowstorm of uric acid crystals. Raising urine pH to above 6 will generally reduce supersaturation below 1 and end uric acid stone formation.
There is a lot of uric acid excreted every day, so uric acid stones can grow rapidly. Uric acid gravel has an orange red color and is often seen. When alkali are given, the gravel goes away only to come back if patients miss doses. The absence of new stones is obvious. Who can be sure of stone composition without stone analysis? Even during treatment of someone who has produced uric acid stones, calcium oxalate or calcium phosphate stones may begin. So people know the stone type, and proceed by custom.
Uric acid stones are common in diabetics and people with reduced renal function; potassium loads are potentially dangerous. The amounts of alkali needed can be variable, and the only reliable way to ascertain is 24 hour urine testing. Likewise for compliance. Therefore routine practice monitors before and during potassium citrate treatment of uric acid stones.
IN this situation, no one has and probably no one will propose a trial of alkali for uric acid stones. But, there is an almost exact parallel situation for calcium phosphate stones, yet such certainty as pertains to uric acid stones certainly does not exist.
Calcium cannot combine with mono-valent phosphate but only with the divalent form. The pKa for dissociation of the second proton of phosphoric acid is about 6. Given the molarities of total phosphate, calcium, citrate — which binds calcium — and other ligands that have modest effects, the supersaturation of brushite — the usual initial urine CaP phase — can be calculated as well as we can calculate the supersaturation for uric acid.
Like uric acid, phosphate and calcium are abundant in urine, so the amount of crystal that can be produced in a day is similar to that of uric acid. Therefore stones can, and do, form rapidly and become large. As in the case of uric acid, high urine CaP supersaturation can produce snows storms of crystallization; though certainly not common, patients can recognize this as white urine.
On physical chemical grounds, to lower CaP supersaturation below one and keep it there is to prevent CaP stones as surely as one prevents uric acid stones by raising urine pH and lowering supersaturation below one. Why, then, is not this treatment as self evident as alkali for uric acid stones?
Acid loads raise urine calcium losses and can be detrimental to bone mineral balance. Higher protein intake is a possible way to lower pH, but not all kidneys respond to acid with a prompt fall in pH. In some cases urine ammonium ion excretion will rise. In others, acid retention may occur. Urine calcium will tend to rise. We can lower CaP below 1 with fluids and measures — reduced diet sodium and thiazide — that reduce urine calcium, and we can monitor supersaturation as we monitor urine pH and uric acid supersaturation.
However, these measures may be difficult to achieve. Thiazide is not always tolerated, reduced salt diet not always maintained. Citrate is a powerful inhibitor of crystals, and it would be good to know if it were beneficial for the CaP stone former. Hi Dr Coe. I have mostly uric acid stones with a tiny bit of oxylate. I have tried potassium citrate, sodium bicarbonate and moonstone. I am dairy free and get very little calcium.
My urologist said to try citracal calcium 2 times a day. It has zinc, manganese , copper and D. Will this supplement prevent uric acid stones? Hi Holly, Uric acid crystals form at low urine pH and dissolve at a higher one so anything you do to raise pH will stop them. Crystal Light lemonade will raise urine pH, a diet rich in veggies and fruits will help — try putting both together.
Calcium citrate is also fine and the calcium will be good for bones. If you cannot tolerate potassium citrate or sodium bicarbonate as treatments, perhaps you could tolerate smaller amounts to use on top of the lemonade — one OTC sodium bicarbonate 4 times a day is not much but this would give you about 20 mEq of alkali.
Mix and match till urine pH is about 6 in a 24 hour collection. Regards, Fred Coe. Besides drinking a lot more water, could you impart one other recommendation to lessen the chances of another stone? Magnesium and B6 are often mentioned. Thank you. Mike Davitt. Hi Mike, The only reasonable approach is to get fully evaluated. I presume you have long harbored stone risks and the move has brought them into the daylight.
Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. This series is coordinated by Corey D. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. May 1, Issue. Author disclosure: No relevant financial affiliations. Clinical Question Do citrate salts treat and prevent calcium-containing kidney stones in adults? Evidence-Based Answer Citrate supplementation reduces stone size to less than 5 mm and prevents new stone formation when compared with placebo or no intervention.
Practice Pointers In the United States, the prevalence of symptomatic kidney stones is 8. Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue.
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