The role of diet in the pathogenesis and therapy of nephrolithiasis

The epidemic of nephrolithiasis in the developed world in the twentieth century is in part the result of the diet consumed in these affluent nations. High protein intake is probably the most important factor. The patients who develop nephrolithiasis may have an increased calciuric response to diet protein and perhaps to diet sodium. The benefits of dietary modification include not only a tendency to reduce urinary calcium excretion but also increased urinary citrate and reduced urinary oxalate excretion. High fluid intake is also an important component of the therapeutic armamentarium of the physician treating patients with recurrent stone formation. The benefit of dietary therapy in patients with recurrent stone formation has not as yet been rigorously tested in controlled studies. Furthermore, there are few valid clinical studies of various pharmacologic agents such as thiazides, phosphates, allopurinol, and citrate. In the absence of clear-cut advantage of any specific pharmacologic agent, it appears that many patients may benefit from dietary modification rather than embarking on a life-long use of medications to prevent stone recurrences.