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Diet and Kidney Stones: Myths and Realities

Massini, Lisa A. MS, RD; Han, Haewook PhD, RD; Seifter, Julian MD; Dwyer, Johanna T. DSc, RD

doi: 10.1097/NT.0000000000000014
Clinical Nutrition

Nephrolithiasis, or kidney stones, is the presence of renal calculi caused by a disruption in the balance between salt solubility and precipitation in the kidneys, usually because of dehydration or certain genetic predispositions. The lifetime prevalence of kidney stones in the United States is 12% among men and 7% among women. There are many myths regarding the relationship between diet and risk of various types of kidney stones, which are addressed in this article. Conclusions are as follows: All individuals should avoid very high or very low total intakes of calcium. Stone formers should optimize fluid intake to increase urine volume and decrease stone risk. All individuals should aim for the dietary reference intake (DRI) for vitamin C, and those prone to oxalate stones should avoid excessive dietary supplementation. Eating amounts of protein near the DRI does not increase risk of stone recurrence, even if protein is from animal sources. Consumption of fruits and vegetables (at least 5 servings/day) may decrease risk for kidney stones. Follow the dietary recommendations that accompany kidney stone medications to maximize their efficacy. Strive for the DRIs for magnesium and potassium because they appear to be protective against kidney stones. Hyperuricosuric patients can reduce their uric acid excretion and increase their urinary pH by reducing purine intake.

Diet may be part of the answer to preventing and treating those painful kidney stones

Lisa A. Massini, MS, RD, is a recent graduate of Tufts University and Frances Stern Nutrition Center Master of Science/Dietetic Internship Program, Boston, Massachusetts. She is from the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, and and Tufts Medical Center, Boston, Massachusetts.

Haewook Han, PhD, RD, is renal nutrition specialist, Harvard Vanguard Medical Associates, Boston, Massachusetts. She provided an expert testimony regarding the relationship between diet and kidney stones.

Julian Seifter, MD, is director, Renal Medical Student Education, and associate professor, Harvard University Medical School and Brigham and Women’s Hospital, Boston, Massachussetts. He provided an expert testimony regarding the pathophysiology of kidney stones and assisted in the critical revision of the manuscript.

Johanna T. Dwyer, DSc, RD, is professor, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University; professor, Tufts Medical Center, Department of Public Health and Family Medicine, Tufts University School of Medicine; and senior scientist, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts; and affiliated with the Office of Dietary Supplements, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland. She assisted in the conception and design as well as critical revision of the manuscript.

The authors have no conflicts of interest to disclose.

Correspondence: Lisa A. Massini, MS, RD, 949 Bruce Ave, Clearwater Beach, FL 33767 (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins