Academic journal article International Electronic Journal of Health Education

The Development of Kidney Stone Dietary Plans for Patient Education

Academic journal article International Electronic Journal of Health Education

The Development of Kidney Stone Dietary Plans for Patient Education

Article excerpt


Kidney stones are known to be among the most painful and prevalent urinary tract disorders. (1,2) More than a half million people per year visit the emergency room with renal colic, abdominal pain commonly caused by kidney stones. (1) Between 1976-1980 and 1988-1994, the prevalence of kidneys stones in the United States increased by 37 percent. (3) Currently in the United States about three million kidney stone events occur per year. (1) About five percent of American women and 12 percent of American men will have some type of kidney stone in their lifetime. (3) Studies have shown that the peak ages for forming stones are ages 20 and 50. (1) Calcium oxalate stones are the most common stone type accounting for about 80 percent of stones. (1-6)

Kidney stones are not only painful, but their diagnosis and treatment are expensive. Kidney stone patients may incur expenses from testing, medications, office visits, and possibly surgery for stone removal. (1) If the individual is able to pass the stones spontaneously, expenses may still be high because of resulting conditions including intense pain, bleeding, and obstruction of a kidney. (1) Estimates have been set at a spending level of $2.1 billion per year on kidney stone related problems. (3)

Kidney stones may not produce symptoms until they begin to move down the tubes (ureters) through which urine empties into the bladder. When this happens, the stones can block the flow of urine out of the kidneys. This causes swelling of the kidney or kidneys, causing pain, often severe. (7) Lack of water advances the accumulation of salts and minerals in urine resulting in formation of solid crystals that become kidney stones. (8) A major risk factor for kidney stones is dehydration.

Individuals having kidney stones must significantly increase hydration and adhere to a dietary intake plan that includes ample fiber and adequate calcium, and limits sodium intake, dietary oxalates, and animal proteins. If dietary intake includes foods that exacerbate the condition or does not include foods that assist with the alleviation of the condition, then medication is used to decrease urinary saturation of calcium oxalate and inhibit its crystallization. (4) Individuals not compliant with dietary recommendations after one calcium oxalate kidney stone have a 50 percent chance of forming more stones. (5) After a dietary treatment plan is followed for two months, follow-up testing is done to determine the effectiveness and compliance with the dietary changes. (9) In the absence of new stone formation or active disease, annual urine testing for kidney stones is recommended.

Customarily, the dietary treatment plan is to provide the individual with a list of foods to avoid without any recommendations for a planned diet that adheres to recommendations. If the 'foods to avoid' list is not successfully utilized by the patient, medication is started to decrease the number of repeated stone events. (2,3) Previous research indicated that individuals prefer and respond more positively to learning which foods and combinations of foods they can consume rather than learning only which foods they must avoid. (10)

Rationale for Diet Modification

Current research indicates highly concentrated urine results in supersaturation of calcium, oxalate, and uric acid. (6,11,12) Supersaturation of these elements greatly increases the risk of forming calcium oxalate stones. High urine calcium, known as hypercalciuria, increases the risk of forming stones and can contribute to osteoporosis. Studies have shown that a high oxalate intake coupled with low calcium intake increases the risk of calcium oxalate stones forming. (1-3) Subsequent studies have found that stone formers should not lower but should regulate their calcium intake to decrease the risk of stone formation and maintain adequate bone density. (2,3,5,6,11,12) This is especially important for older adults who are at higher risk for bone disease. …

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