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=== Dietary measures === {{See also|#Hypocitraturia|label1= Hypocitraturia}} Specific therapy should be tailored to the type of stones involved. Diet can have an effect on the development of kidney stones. Preventive strategies include some combination of dietary modifications and medications with the goal of reducing the excretory load of calculogenic compounds on the kidneys.<ref name=Parmar2004 /><ref name=Goldfarb1999 /><ref name=Finkielstein2006 /> Dietary recommendations to minimize the formation of kidney stones include: * increasing total fluid intake to achieve more than two liters per day of urine output;<ref name=AHRQ2012>{{cite journal |publisher=Agency for Healthcare Research and Quality |location=Rockvill, MD | vauthors = Fink HA, Wilt TJ, Eidman KE, Garimella PS, MacDonald R, Rutks IR, Brasure M, Kane RL, Monga M | title = Recurrent Nephrolithiasis in Adults: Comparative Effectiveness of Preventive Medical Strategies |journal=Comparative Effectiveness Reviews |number=61 | date = July 2012 | pmid = 22896859 }}</ref> * limiting [[cola]], including sugar-sweetened soft drinks;<ref name=Fink2013 /><ref name=AHRQ2012/><ref name="FerraroTaylor2013">{{cite journal | vauthors = Ferraro PM, Taylor EN, Gambaro G, Curhan GC | title = Soda and other beverages and the risk of kidney stones | journal = Clinical Journal of the American Society of Nephrology | volume = 8 | issue = 8 | pages = 1389–95 | date = August 2013 | pmid = 23676355 | pmc = 3731916 | doi = 10.2215/CJN.11661112 }}</ref> to less than one liter per week.<ref>{{cite web |url=http://www.kidney.org.au/ForPatients/Management/KidneyStones/tabid/838/Default.aspx |title=What are kidney stones? |website=kidney.org |access-date=19 August 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130514122900/http://kidney.org.au/ForPatients/Management/KidneyStones/tabid/838/Default.aspx |archive-date=14 May 2013 |df=dmy-all }}</ref> * limiting animal protein intake to no more than two meals daily (an association between animal [[Protein (nutrient)|protein]] and recurrence of kidney stones has been shown in men);<ref name=Taylor2006>{{cite journal | vauthors = Taylor EN, Curhan GC | title = Diet and fluid prescription in stone disease | journal = Kidney International | volume = 70 | issue = 5 | pages = 835–9 | date = September 2006 | pmid = 16837923 | doi = 10.1038/sj.ki.5001656 | doi-access = free }}</ref> * increasing citrate, including from lemon and [[lime juice]];<ref name="Gul_2014">{{cite journal | vauthors = Gul Z, Monga M | title = Medical and dietary therapy for kidney stone prevention | journal = Korean Journal of Urology | volume = 55 | issue = 12 | pages = 775–9 | date = December 2014 | pmid = 25512810 | pmc = 4265710 | doi = 10.4111/kju.2014.55.12.775 }}</ref> citric acid in its natural form, such as from citrus fruits, "prevents small stones from becoming 'problem stones' by coating them and preventing other material from attaching and building onto the stones";<ref>{{cite web |title=Citric Acid and Kidney Stones |url=https://www.uwhealth.org/files/uwhealth/docs/pdf/kidney_citric_acid.pdf |archive-url=https://web.archive.org/web/20100705033118/http://www.uwhealth.org/files/uwhealth/docs/pdf/kidney_citric_acid.pdf |archive-date=2010-07-05 |url-status=live |website=uwhealth.org}}</ref> citrate inhibits the formation of kidney stones on all phases[[Nucleation|{{emdash}}nucleation]], growth and aggregation{{emdash}}by raising the limit at which oxalate remain stable, slowing oxalate crystal growth, and notably, reducing crystal aggregation within the [[kidney tubules]];<ref name="pmid26439475"/> * increase alkaline load by consuming more fruits and vegetables (because uric acid crystals form in acidic environment);<ref name="Gul_2014"/> * reducing sodium intake is associated with a reduction in urine calcium excretion.<ref name="pmid38931286">{{cite journal |vauthors=Balawender K, Łuszczki E, Mazur A, Wyszyńska J |title=The Multidisciplinary Approach in the Management of Patients with Kidney Stone Disease-A State-of-the-Art Review |journal=Nutrients |volume=16 |issue=12 |date=June 2024 |page=1932 |pmid=38931286 |pmc=11206918 |doi=10.3390/nu16121932|doi-access=free }}</ref> Maintenance of dilute urine by means of vigorous fluid therapy is beneficial in all forms of kidney stones, so increasing urine volume is a key principle for the prevention of kidney stones. Fluid intake should be sufficient to maintain a urine output of at least {{convert|2|L|USoz|lk=on}} per day.<ref name=Qas2014>{{cite journal | vauthors = Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD | title = Dietary and pharmacologic management to prevent recurrent nephrolithiasis in adults: a clinical practice guideline from the American College of Physicians | journal = Annals of Internal Medicine | volume = 161 | issue = 9 | pages = 659–67 | date = November 2014 | pmid = 25364887 | doi = 10.7326/m13-2908 | doi-access = free }}</ref> A high fluid intake may reduce the likelihood of kidney stone recurrence or may increase the time between stone development without unwanted effects. Calcium binds with available oxalate in the [[gastrointestinal tract]], thereby preventing its absorption into the [[Circulatory system|bloodstream]]. Reducing oxalate absorption decreases kidney stone risk in susceptible people.<ref name=Heaney2006 /> Because of this, some doctors recommend increasing dairy intake so that its calcium content will serve as an oxalate binder'''.''' Taking calcium citrate tablets during or after meals containing high oxalate foods<ref name=Tiselius2003 /> may be useful if dietary calcium cannot be increased by other means as in those with lactose intolerance. The preferred calcium supplement for people at risk of stone formation is calcium citrate, as opposed to calcium carbonate, because it helps to increase urinary citrate excretion.<ref name=Finkielstein2006 /> Aside from vigorous oral hydration and eating more dietary calcium, other prevention strategies include avoidance of higher doses of supplemental {{nowrap|vitamin C}} (since [[ascorbate]] is metabolized to oxalate) and restriction of oxalate-rich foods such as [[List of common leaf vegetables|leaf vegetables]], [[rhubarb]], [[Soybean|soy products]] and [[chocolate]].<ref name=Taylor2004 /> However, no randomized, controlled trial of oxalate restriction has been performed to test the hypothesis that oxalate restriction reduces stone formation.<ref name=Tiselius2003 /> Some evidence indicates [[magnesium]] intake decreases the risk of symptomatic kidney stones.<ref name=Taylor2004 />
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