1. Prevention of Urinary Stones
by Diet & Food Supplements
Associate Professor of Pediatric Nephrology
Tabriz Children‘s Hospital
ghalehgolab@yahoo.com

2. Major risk factors for stone
formation include:
Dehydration
Diet (high-protein, high-salt diet)
Heredity

3. General Advices for almost all children
to prevent kidney stones:
• An Increase in Fluid Intake is recommended.
Therefore, an increase in urine output to more
than 1.5 L/m2/day is the single most
important aspect of stone prevention.
• Reducing Salt Intake to less than 2-3 g/day is
helpful for most children especially those at
risk for calcium, oxalate or uric acid stones.

4. To help prevent kidney stones, drink enough
water to keep your urine clear , and
preferably colorless.

5. Dietary choices can affect kidney stone development. Children may
need to change certain eating habits, such as drinking more fluids
and modifying their favorable diet.

6. The best ways to prevent or treat
kidney stones in children by diet
depends on the type of stone
produced and underlying causes :
Hypercalciuria
Hypocitraturia
Hyperoxaluria
Uric Acid Lithiasis
Cystinuria

7. Calcium Stones
• Sodium restricted Diet
• Patients should avoid vitamin C, A and D supplements.
• Citrate supplementation
• High protein intake increases calcium excretion; so all
patients should receive the Recommended Dietary
Allowance of protein for age.
• Any unusual excess of calcium intake should be curtailed.
• Calcium or Protein restriction is not recommended
because of the risk of osteopenia and increased intestinal
oxalate absorption.
• Because potassium depletion increases calciuria, patients
should receive adequate dietary Potassium, particularly if
they are taking diuretics.
Hypercalciuria
Hypocitraturia

8. Dietary Hyperoxaluria
(Calcium-Oxalate Stones)
• Normal people absorb < 5% of dietary oxalate.
• Foods rich in oxalate can  absorption 25 - 50%
• Low calcium diets  urinary oxalate excretion.
• Vitamin B6 supplementation is of limited value.
• Orthophosphate supplementation may help.

9. Hyperoxaluria Ca-Oxalate Stones
Limiting or avoiding high-oxalate foods:
Fruits:
Berries
‫تمشک‬ ‫و‬ ‫توت‬ ‫انواع‬
Concord or purple grapes
‫انگور‬ ‫انواع‬ ‫بعضی‬
Red Currants
،‫قرمز‬ ‫کشمش‬ ‫انواع‬
Figs
‫انجیر‬
Fruit cocktail
‫ها‬ ‫میوه‬ ‫وآب‬ ‫میوه‬ ‫مخلوط‬
Plums
‫درختی‬ ‫گوجه‬ ‫و‬ ‫آلو‬ ‫انواع‬
Tangerines
‫نارنگی‬
‫لیمو‬ ‫و‬ ‫پرتقال‬ ‫پوست‬
‫ارده‬ ‫و‬ ‫کنجد‬
‫آجیلی‬ ‫های‬ ‫دانه‬
(
‫زمینی‬ ‫بادام‬ ، ‫فندق‬
)
Beverages: Chocolate milk, Hot cocoa ، ‫ماالشعیر‬ ،‫کوال‬ ‫های‬ ‫نوشابه‬ ،‫چای‬ ، ‫قهوه‬
Vegetables:
‫سبز‬ ‫برگ‬ ‫شکل‬ ‫به‬ ‫سبزیجات‬
، ‫اسفناج‬ ‫مثل‬
، ‫کاسنی‬
‫جعفري‬
‫کرفس‬ ،
،
‫شاهي‬
،
‫كنگر‬
‫چغندر‬ ‫و‬ ‫لبو‬ ‫انواع‬
‫سویا‬
‫دار‬ ‫سبوس‬ ‫آرد‬ ، ‫گندم‬ ‫سبوس‬
‫فرنگی‬ ‫گوجه‬ ، ‫بادمجان‬ ، ‫کلم‬ ‫انواع‬
‫بامیه‬ ، ‫سبز‬ ‫فلفل‬
‫موسیر‬ ، ‫پیازچه‬
Rhubarb
‫ریواس‬

10. Uric Acid Lithiasis
• Hydration is always essential.
• Limiting dietary sodium intake may decrease urinary uric
acid (and calcium) excretion.
• If these measures fail or if patients have recurrent
symptoms, Base supplementation with citrate or
bicarbonate may be indicated.
• Dietary purine restriction is of limited value;
• most children do not consume significant quantities of
purine-rich animal-protein foods, such as: mushrooms,
meats, anchovies (fish), mussels (shellfish), goose, brain,
kidney, liver, cauliflower and asparagus (
‫مارچوبه‬
) .
• In the patient with a low urinary pH or confirmed
hyperuricosuria, dietary restriction of protein, purine and
sodium is indicated.
• Allopurinol is of limited value.
Urate Stones

11. Cystinuria
Prevention & Treatment of Cystin Stone includes:
• Encouragement to drink lots of fluids to help move
the stone along.
• Extra potassium citrate (Citrus Fruits)
Creating abundant urinary flow and urinary
alkalinization.
• In children, a regular diet to support growth is
recommended.
• Low-methionine diet (essentially a low-protein
diet) sometimes recommended in severe cases.
Cystine Stones

12. Struvite Stones
• Prevention of struvite stones rests on
prevention of Urinary Tract Infection.
• Encouragement to drink lots of fluids to
Create abundant urinary flow my help.