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Category: Kidney Stone Diet

Diet for Stone Formers

Posted on by Dr. Ali Thwaini

Once a stone former. always a stone former!!

Urinary tract stones are the most common encounters in the field of urology. “Doctor, I’d rather give birth to 10 children than going through the pain of passing a stone!” Says many of my female stone patients.

Ureteric colic is an uninvited guest that barges in at any time. It is so severe at times that pilots, divers, and those operating heavy machinery, when suffering from a ureteric stone, aren’t allowed to resume their work until the stone has passed, for the fear of their lives and others.

Prevention is better than cure, and there are many, inexpensive and easily adaptable lifestyle modifications that wild help minimizing the chances of stone recurrence rate.

Below are some advice Preventing the Stone Formation

Water

60% of our bodies are made of it. It makes absolute sense to maintain a healthy water intake.

Drinking plenty of fluid is the most effective way of preventing the stone formation and reduces your risk of stone formation by almost one-third (30 to 40%). Not drinking enough can cause your urine to become concentrated, making stones more likely to form.

Try to drink two to three liters (four to six pints) of fluid (water or squash) each day. You should aim to keep your urine colourless throughout the day. This should give you a urine output of at least two liters (four pints)per day.

What about other fluids?

I, like many people, am addicted to caffeine. Whilst it has some benefits, it has its implications in stone formation, mainly increasing the Oxalate component of stones. Not to mention the fact that these fluids would actually deprive the body of water due to their diuretic effects.

Kidney Stone Diet Tips that may help:

  • Drink a large glass of water at specific times each day (e.g. when you get up, when you arrive at work, after using the toilet, etc);
  • Keep a bottle or jug of water by your side all day; you can flavour it with fruit squash;
  • Try to drink one glass of water every hour;
  • Add slices of lemon, lime or orange to cold water; this gives it a pleasant flavour and helps to make your urine less acidic;
  • Eat more fruit & vegetables because they contain a lot of water. Finally
  • Include moist/liquid foods in your diet (e.g. soup, stew & jelly).

Calcium:

Opposite to the traditional belief, reducing the amount of calcium in your diet can increase the risk of stone formation, by raising oxalate levels in your urine. A daily intake of up to 1000 mg per day is safe for calcium stone formers.

Most dietary calcium is found in dairy products (milk, yogurt, cream and cheese). A normal, varied diet will give you about 500 mg of calcium each day. The approximate calcium contents of dairy produce are:
• milk and yoghurt – 120 mg per 100 g
• soft cheese – 400 mg per 100 g
• hard cheeses – up to 1000 mg per 100 g

They were the numbers that will hopefully help you identify the right quantity of dairy products for daily consumption

If you have too much calcium excreted in your urine, the restriction might be of benefit here, but better consult your doctor

What about the other culprit? Oxalate

The majority of urinary tract stones are composed of calcium and oxalate. The latter is present and vast quantities of the following food items:

rhubarb, celery, spinach, beetroot and sesame seeds, all of which have large amounts of oxalate in them.

Black tea, chocolate, nuts (including peanut butter), cocoa and carob are all moderately high in oxalate.

Eating those items in moderation is the recommendation as most of them have lots of beneficial nutritional items.

Uric Acid Stones.

These are the second most common type of kidney stones. Historically they are related to large amounts of red meat consumption that could lead to gout, Hence the name Kings’ disease.

In addition to red meat the following items contain a large amount of uric acid and are butter taken in moderation by normal people and then matchless amounts by uric acid stone farmers:

• meat – all meats, including liver, heart, kidney, sweetbreads & meat extracts (e.g. Oxo)
• fish – especially anchovies, crab, fish roe, herring, mackerel, sardines, shrimps & whitebait
• others – yeast extracts (e.g. Bovril), beer, asparagus, cauliflower, mushrooms, peas, beans & spinach.

In summary

Urinary tract stones are one of the most common presentations and Urology and emergency. Stone attacks are very painful and cuddly to potentially serious illness and lots of work and activity.

Prevention is better than cure. Modification of lifestyle has amends beneficial results. For any further information and treatment visit your local urologist for further information and advice

Pelvi-Ureteric Junction (PUJ) Obstruction

Posted on by Dr. Ali Thwaini

What is PUJ obstruction?

PUJ obstruction results from narrowing of the junction between the pelvis of the kidney and ureter, resulting in impedance to the flow of the urine from the kidney to the ureter.

The condition affects approximately one person in every 1000 adults and tends to occur more in men.

Most people have two kidneys, that filter the blood to remove waste products, which they excrete into the urine. Urine is carried from each kidney, through the ureter, to the bladder where it is stored.

As well as removing waste products, the kidney performs many vital functions, such as controlling fluid balance (how to dilute the blood is), regulating various salts or electrolytes in the bloodstream (eg: sodium, potassium, calcium, magnesium), maintaining the correct acidity of the blood, and regulating blood pressure.

Many different conditions can affect the kidney; one of which is PUJ obstruction that causes no symptoms or problems and is only discovered by chance when the patient is having a scan for another condition. Alternatively, it can cause:

• Recurrent episodes of loin pain which tends to worsen after drinking especially alcohol.

• Kidney infection (pyelonephritis).

• Kidney stones.

• Lump or swelling in the kidney area.

• Damage to the kidney as a result of either high pressure in the renal pelvis, kidney infection, or formation of kidney stones.

How is Diagnosis of PUJ Obstruction?

PUJ Obstruction

This includes blood tests, urine test,s and scans. CT scan is commonly used to assess the anatomy and the structure of the renal pelvis and a special nuclear medicine scan called MAG3 scan is used to confirm the obstruction and also to assess the function of the kidney.

If there is severe kidney infection as a result of the obstruction, then the kidney must be drained as a matter of urgency with insertion of a temporary ureteric stent or nephrostomy tube before any definitive treatment.

There are several treatment options for PUJ obstruction and these will be discussed with you; these include:

Active surveillance with careful observation with repeated scans.

Treatments for PUJ obstruction

The PUJ is the portion of the collecting system that connects the renal pelvis to the ureter. The standard treatment for pelvic ureteric junction obstruction is pyeloplasty.

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There are different ways to approach the kidney to perform the operation. These include via a flank incision, subcostal (under the rib) incision, transabdominal approach, or even sometimes through an incision in the back. 

Most commonly, however, this procedure is done using laparoscopy, or keyhole surgery.

Laparoscopy is a technique of performing a surgical operation using instruments inserted through narrow hollow tubes (‘ports’) rather than through a larger incision, as in traditional surgery. 

The result is shorter hospitalization and convalescence, often less bleeding and post-operative pain, and fewer wound complications.

Chronic prostatitis Symptoms

There’s a reason behind naming chronic prostatitis as chronic pelvic pain syndrome. This is usually due to the vague presentation and different manifestations in different men. This could be ranging in the form of penile tip pain or scrotal discomfort. Others could present with chronic low back pain and pain during ejaculation. This could be well associated with storage lower urinary tract symptoms.


Diet and stone disease:

Posted on by Dr. Ali Thwaini

About 1 in 10 people suffer from a kidney stone over the course of a lifetime.  Current evidence is suggesting that this percentage is on the rise!

If you suffer from kidney stones, you may need to follow a certain Kidney Stone Diet plan.  You would need to have some blood and urine tests to find out what kind of risk factors you may have. Based on the results, your diet changes and you may need medical treatment to prevent having kidney stones come back.  

Fluid intake

Increasing fluid intake is the essential to prevent stone formation. It reduces your risk of stone formation by almost one third!. Not drinking enough can cause your urine to become concentrated, making stones more likely to form.

Ideally you should drink at least two (preferably three) litres of fluid, mostly water, each day. You should aim to keep your urine colourless throughout the day. This should give you a urine output of at least two litres (four pints) per day.

 If certain rare stones, you will need to drink enough to produce more than four litres of urine each day, but thankfully these are not common.

You can drink tea, coffee & alcohol in moderation, but most of your fluid intake should be water or squash. We recommend that you drink one or two glasses of water before going to bed, and on getting up in the morning.

Tips to help you increase your fluid intake are:

  • A large glass of water in the morning 
  • keep a bottle or jug of water by your side all day; you can flavour it with fruit squash;
  • try to drink one glass of water every hour;
  • add slices of lemon, lime or orange to cold water; this gives it apleasant flavour and helps to make your urine less acidic;
  • eat more fruit & vegetables because they contain a lot of water;and
  • include moist / liquid foods in your diet (e.g. soup, stew & jelly).

Food and stone formation?

What you eat does play a part in stone formation.

It is essential to have a well-balanced diet, avoiding too many calories. This should include fresh fruit, salad and vegetables, low-fat dairy produce, and whole grain products such as bread or cereals.

A high fibre intake is helpful, although you should not eat wheat bran because of its high oxalate content.

Is calcium in my diet bad for stones?

Interestingly, reducing the amount of calcium in your diet can increase the risk of stone formation, by raising oxalate levels in your urine. A daily intake of up to 1000 mg per day is safe for calcium stone formers.

Most dietary calcium is found in dairy products (milk, yoghurt, cream and cheese). A normal, varied diet will give you about 500 mg of calcium each day. The approximate calcium contents of dairy produce are:

  • milk and yoghurt – 120 mg per 100 g
  • soft cheese – 400 mg per 100 g
  • hard cheeses – up to 1000 mg per 100 g

If you have too much calcium in your urine, you may benefit from restricting your calcium intake, but you should discuss this with your urologist, specialist nurse or GP.

Does oxalate intake play a part in stone formation?

Yes. You should try to avoid oxalate-rich foods to keep the oxalate levels in your urine at a normal level. You should avoid eating rhubarb, celery, spinach, beetroot and sesame seeds, all of which have a very high oxalate content.

Black tea, chocolate, nuts (including peanut butter), cocoa and carob are all moderately high in oxalate. You should take them in moderation but you do not need to exclude them completely. See below for further information.

Should I restrict my salt intake?

Yes. A high salt intake can increase calcium stone formation. Do not add salt to your food at the table: use pepper, herbs, spices or vinegar as alternative flavourings. You can, however, add a small amount of salt to your food during cooking.

You should limit your intake to between 2300 and 3000 mg/day (approximately one teaspoonful of salt).

Try to eat foods with a low salt content. Avoid tinned, packet or processed foods (e.g. soups, salted crisps or nuts, tinned meats, meat paste, smoked fish and fish paste), all of which have a high salt content.

Is there anything else I can do to help myself?

It is important to reduce your weight if you are overweight. Increased physical activity should be part of any weight-reducing programme. Remember to drink plenty of fluid and avoid getting dehydrated if you sweat a lot during exercise.

Are there any other tests you can do to find out why I have made stones?

Yes. All patients who have had a kidney stone should have blood tests to check their kidney function, and make sure that their uric acid and calcium levels are not raised.

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In high-risk stone formers (young patients and those who have had repeated stones), two 24-hour urine samples should be collected to 

measure the level of several chemicals in your urine. Your urologist, specialist nurse or GP can tell you more about this.

Is there anything I can do to prevent certain types of stone?

Calcium oxalate stones (pictured)
Only 10 – 15% of oxalate in your urine comes from Kidney Stone Diet intake. It is not, therefore, necessary to eliminate oxalate-containing foods completely from your diet. You should, however, aim for a moderate (and sensible) intake of oxalates.

Foods which are especially high in oxalates should be consumed sparingly. The following foods are known have a high oxalate content:

  • tea & coffee (more than two to three cups per day)
  • nuts (e.g. almonds), sesame seeds & nut products (e.g. peanut butter)
  • cocoa & chocolate
  • some fruit (figs, tangerines,plums, berries & currants)
  • rhubarb
  • soy products (tofu, soy milk, soycheese & soy ice cream)
  • some vegetables (celery, spinach,leeks, okra, parsley & beetroot)Uric acid stonesYou should try to limit your dietary intake of purines. These are naturally- occurring chemicals, found in most foods, which are broken down by the body into uric acid.The main dietary sources of purines are:
  • meat – all meats, including liver, heart, kidney, sweetbreads & meat extracts (e.g. Oxo)
  • fish – especially anchovies, crab, fish roe, herring, mackerel, sardines, shrimps & whitebait
  • others – yeast extracts (e.g. Bovril), beer, asparagus, cauliflower, mushrooms, peas, beans & spinach.Uric acid levels are often higher in people who are overweight, so losing weight can help you. Taking the drug allopurinol, which lowers uric acid levels in the blood, has not been shown to help in reducing the risk of uric acid stones.Calcium phosphate stonesDietary changes have little effect on the formation of calcium phosphate stones. All the general advice above is valid but you should avoid taking anything to alkalinise your urine.Cranberry juice may be beneficial because it acidifies your urine and lowers urine oxalate levels slightly.Struvite (“triple phosphate”) stonesThese are seen mostly in women after the menopause, and are usually due to infection in your urine. The bacteria involved (Proteus species) produce an enzyme (urease) which splits urea in your urine to form ammonia. This makes the urine highly alkaline, encouraging the formation of calcium,magnesium, ammonium (“triple”) phosphate stones. Once these stones form, they encourage further infection, resulting in a “vicious circle” ofrapid stone growth.A high fluid intake, low-dose antibiotics (as necessary) and acidification of the urine are all effective, but the main aim is to get rid of all your stones, which eliminates the potential for recurrent urinary infections.Drugs (urease inhibitors) are available that block the enzyme produced by the bacteria, but they are not normally used because of the high-risk of major side-effects.Cystine stones (cystinuria)Simple, basic measures remain the most important way of preventing cystine stone formation:
    • increase your fluid intake – you must drink enough fluid to produce two or three litres of urine per day; this usually means you need to get up at night to drink water
    • modify your diet – reduce your intake of methionine (from which cystine is formed) by cutting your animal protein intake
    • alkalinise your urine – this
      encourages cystine to dissolve in your
      urine. We normally do this using
      potassium citrate; this tastes
      unpleasant, and some patients can
      only tolerate it by flavouring it with fruit juice
    monitor your urine acidity (pH) – using special pH dipsticks, to be sure that your urine stays alkaline. Your urologist or specialist nurse can supply you with theseDrugs are available for the treatment of cystine stones, but are only used in patients with:
    • very rapid & frequent stone formation;
    • a frequent need for surgical intervention; or
    • poor compliance with, or a poor response to, the measures above.Drug treatment must be very closely monitored for side-effects; the agents used include:
    • tiopronin (-mercaptopropionylglycine, ThiolaTM or AcadioneTM) – this is not licensed in the UK but it is available under special agreement. It binds to cystine molecules forming a more soluble compound which is easily excreted in the urine
    • d-penicillamine (DistamineTM) – the same mode of action as tiopronin but with a higher risk of side-effects
    • captopril (CapotenTM) – normally used to treat high blood pressure but relatively ineffective, and only used if the drugs above are unsuitable.What sources have we used to prepare this leaflet?This leaflet uses information from consensus panels and other evidence- based sources including:
    • https://www.kidney.org/atoz/content/dietthe British Association of Urological Surgeonsthe Department of Health (England);
    • the Cochrane Collaboration; and
    • the National Institute for Health and Care Excellence (NICE).

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