Kidney stone disease and dietary factors

Henry Konjengbam, Sanjenbam Yaiphaba Meitei

Anthropological Review • Vol. 83(1), 65–73 (2020)

ANTHROPOLOGICAL REVIEW
Available online at: https://content.sciendo.com/anre
Journal homepage: www.ptantropologiczne.pl
Volume 83, 2020

Association of kidney stone disease with dietary

factors: a review

Henry Konjengbam, Sanjenbam Yaiphaba Meitei

Department of Anthropology, Manipur University, Manipur, India

Abstract: Kidney stone disease is one of the most common urologic disorders worldwide. The incidence of
kidney stones disease is increasing all over the world. It is a multifactorial disease accompanied by various
factors. The dietary factor is one of the most important risk factors for the formation and recurrence of
kidney stone disease. Formation and recurrence of kidney stone disease can be prevented by modifying our
day to day dietary habits. Fewer intakes of animal protein, higher intake of fluid, higher intake of fruits, and
higher intake of green leafy vegetables, which contain a low amount of oxalate, can prevent the formation
of kidney stones and recurrence of kidney stones. From this review, it may be presumed that the higher
prevalence rate of kidney stone disease in northeast India may be the dietary factors accompanied by envi-
ronmental and climatic conditions of the region.
Key words: kidney, urologic, animal protein, water, fruits, vegetables, oxalate, dietary, multifactorial, re-
currence.

Introduction alence rate of kidney stone is reported

from the Asian country i.e. 20.1% from
Kidney stone disease is one of the most Saudi Arabia (Bibl and Mayers 2001;
common diseases nowadays. It is the Reynolds 2005). 12% of the American
third most common urological disorder Men will develop a kidney stone at some
affecting both males and females but point of their lifetime (Bose et al. 2016).
more common among males. The prev- There is a chance of reoccurrence of kid-
alence rate of kidney stone disease all ney stone, if a person is once encoun-
over the world is approximately 10–15% tered with a kidney stone, the recur-
(Moe 2006). The prevalence rate of kid- rence rates of kidney stone after 10 year
ney stone disease has been increasing is 50% and 75% after 20 years (Lopez
in both sexes. It is also reported that and Hoppe 2010). Most of the kidney
Europe has a prevalence rate of 5–9%, stone is a calcium-containing stone, 75%
13–15% in the United States of Ameri- of the kidney stones are calcium oxalate
ca, 12% in Canada, but the highest prev- stones, (out of which 50% are of calci-
Review Article Received: December 5, 2019; Revised: February 8, 2020; Accepted: February 12, 2020
DOI: 10.2478/anre-2020-0005
© 2020 Polish Anthropological Society
66 Henry Konjengbam, Sanjenbam Yaiphaba Meitei

um hydroxyl phosphate in very small or immunity, increased susceptibility to

greater amounts), 10–20% is composed disease, impaired physical and mental
of magnesium ammonium phosphate, development, and reduced productivi-
5% are of urate, and 1–2% is of cystine ty, etc. A balanced diet is a kind of diet
(Bibl and Mayers 2001). The stone is that gives our body the nutrients that we
usually formed when the urine become need; it is important because our body
supersaturated with a specific substance needs proper nutrition to work effective-
such as calcium, oxalate, uric acid, or ly. A balanced diet includes fruits, veg-
cystine. Due to this supersaturation etables, grains, proteins, dairy, etc. but
of urine, the crystal particle grows and we need to consume all these diets in the
forms a solid particle known as stone, right proportion. Higher intake of fluids,
which can form in any part of the urinary mainly water, is also needed to keep our
tract except urethra, but most common- body fit and healthy because it will clean
ly formed inside the kidneys (Sutherland our body and excrete mainly in the form
et al. 1985; Trinchieri et al. 1999). The of urine with the help of the kidney. Kid-
incidence of kidney stones is increasing neys perform many crucial functions in
globally, with variation in gender, racial our body: maintaining overall fluid bal-
and geographical location. It is a multi- ance, regulating and filtering minerals
factorial disease accompanied by various from the blood, filtering waste materials
factors. Genetic factors are also respon- from food, medications, and toxic sub-
sible for the formation of kidney stones, stance. The objective of the present sys-
but the genes associated with kidney tematic review is to understand the effect
stones are still unclear. The dietary fac- of dietary factors, such as fluid intake and
tor is one of the most important factors protein or meat intake, as risk factors for
which are responsible for the formation kidney stone formation.
of urinary stone; diet can alter the com-
position of urine and affect the process Materials and Methods
of stone formation. The European Asso-
ciation of Urology’s guidelines suggest- Original research articles published in
ed that the daily intake of water should English language, related to kidney stone
attained at least 2.5L of urine volume disease and food habits were searched
in order to avoid from the formation of using search engine (Pubmed, Medline,
kidney stones and recurrence of kidney and Google Scholar). The search word in-
stone (Turk et al. 2018). Beside this, Mi- cluded “kidney stone”, “kidney stone and
tra et al. (2018) also suggested that wa- food habits”, “nephrolithiasis and dietary
ter intake of >3L per day will lower the factors”, “urolithiasis”, “fluid intake and
risk of kidney stones formation. urolithiasis” etc. The study covers the
Importance of balance diet: Nutrition published articles on or before October,
is the intake of food as per the dietary 2019, and which are available on the
requirement of the body to maintain public domain. A total number of 38 arti-
growth and health. Adequate and bal- cles related to search words were found.
anced nutrition is important for being Five articles were excluded as they were
healthy along with the regular physical not related to the objectives of the study,
activity. Poor or imbalanced nutrition thereby, 33 research articles are included
can affect health status such as reduced for the review.
 Kidney stone disease and dietary factors 67

Results and Discussion lower than the controls and thereby in-
creasing the urinary super-saturations
Increased fluids intake is one of the most of calcium oxalate and uric acid than
important dietary measures to prevent those of the controls. Therefore, water
the formation of kidney stones and to consumption was directly proportional
avert the recurrence of kidney stones. to urine volume and subsequently to the
Regular fluid intake of 2.5–3 liters per formation of kidney stones, but the in-
day, especially water, is recommended for vestigators did not quantify the optimal
the prevention of kidney stones (Borghi amount of water intake required to avoid
et al. 1996 and Turk et al. 2018). Where- the formation or recurrence of kidney
as increased intake of fluids, such as stone (Borghi et al. 1996). Another study
grapes juice, may increase the risk for de- also reported that drinking more quan-
veloping kidney stones due to the pres- tity of water is additionally beneficial
ence of high oxalate (Curhan et al. 1998) for stone formers whose stones are not
but Trinchieri et al. (2002) reported that calcium-based (Pak et al. 1980). Further,
the drinks containing grapefruits are not the Academy of Nutrition and Dietet-
the risk factors for the formation of kid- ics (AND) also recommends that stone
ney stones. And prevalence rate of kid- formers should drink enough fluids to
ney stones among those who drink water produce at least 2500 ml of urine daily.
with high fluorine content is 4.6 times High consumption of protein, pre-
higher than those of the fluorine-free wa- dominantly animal protein, is responsi-
ter (Singh et al. 2001). Other fluids such ble for the comparatively high prevalence
as coffee are also evident to be protec- rate of kidney stone formation. There is
tive in the VET (Vietnam Era Twin) twin a high correlation between the formation
study, those who drank 1200 ml or more of kidney stones, and non-vegetarian
of coffee daily were 60% less likely to food habits, a diet rich in animal protein
develop stones than non-coffee drinkers may increase the risk of kidney stones,
(Goldfarb et al. 2005). and however, vegetarian diet has a lower
Moreover, people who have drink risk for the formation of kidney stones
beers regularly have 53% reduction rate (Sandilya and Sandilya 2019). Consum-
in the formation of urinary stones. But ing the high amount of animal meat will
there was no trend in the grade of safety lead to the acidification of urine which
with increased drinking of beer (Krieg- may lead to the formation of calcium ox-
er et al. 1996 and Ferraro et al. 2013). alate stone in the urinary tract (Chandra-
Furthermore, a cross-sectional study jith et al. 2006), it could also alter the
conducted in Pakistan also reported that renal function or increasing the intesti-
the lack of drinking water and increasing nal absorption of calcium which will lead
body weight are the major risk factors for to the formation of calcium-based kidney
the formation of urinary stones (Jabbar stone (Licata et al. 1979). And also, the
et al. 2015). In a large 5-year study of consumption of meat with the combina-
case-control, it is also reported that large tion of protein-rich food had a significant
ingestion of water was the best prelimi- association with the prevalence of uri-
nary therapy to avoid stone recurrence. It nary tract stones (Basiri et al. 2009).
is evident that among the urinary stone Moreover, some studies also asso-
formers, urine volume was significantly ciated the intake of carbohydrates with
Table 1. Studies showing the association of dietary factors with the formation of kidney stone disease
68
Source Study design Country Sample Associated factors Outcome

Licata et al., 4 controls Increased risk of

Case control study USA High protein intake
1979 4 cases kidney stone

Borghi et al., 101 controls Increased risk of

Case control study Italy Low urine volume, low water intake
1996 199 cases kidney stones

Krieger et al., 392 controls Lower risk of kidney

Case control study USA Beer drinking
1996 240 cases stone formation

Curhan et al., Prospective cohort Increased risk of

USA 8 years of follow up Lower intake of fluid
1998 study kidney stone

Singh et al., Water containing high amount of

India Risk of kidney stone
2001 fluoride

Meschi et al., 12 controls Increased risk of calci-

Case control study Italy Limiting fruits and vegetables intake
2004 26 case with hypocitraturia um stone formation

Goldfarb et al., High intake of coffee, tea, fruits, and Lower risk of kidney
Twin study USA 7500
2005 vegetables stone formation

Higher risk of idio-

Nouvenne et 210 with idiopathic calcium
Henry Konjengbam, Sanjenbam Yaiphaba Meitei

Case study Italy Higher intake of salt rich food pathic calcium oxalate
al., 2010 oxalate stone disease
stone formation

Meschi et al., 143 cases High intake of protein and salt, low Increased risk of
Case control study Italy
2012 170 controls intake of fruits and vegetables kidney stone

Salmeh et al., 190 patients with kidney Increased risk of

Case study Iran Lower intake of fluids
2012 stone kidney stone
 Source Study design Country Sample Associated factors Outcome

Dai et al., 1019 cases High consumption of grains and oxalate Increased risk of kid-
Case control study China
2013 987 controls rich vegetables, low water intake ney stone disease

Shamsuddeen Saudi Lower intake of fluid, and improper diet Increased risk of kid-
Cross sectional study 50 cases
et al., 2013 Arabia and sedentary lifestyle ney stone formation

HPFS: 51529 males Restriction in dietary animal protein

Mendel et al., Lower risk of kidney
Cross sectional study USA NHS I: 121700 female nurses intake and increased intake of fruits and
2013 stone formation
NHS II: 116430 female nurses vegetables

Yasui et al., Low dietary intake of fruits and vege- Increased risk of kid-
Case study Japan 92797 with urolithiasis
2013 tables ney stone formation

Engaged in heavy work, history of uri-

Marak et 196 individuals out of 875 Higher risk of kidney
Household survey India nary tract infection, history of stressful
al.,2013 have kidney stone stone formation
events and lower intake water

Ferraro et al., 194095 participants (4462 Consumption of coffee, tea, beer, wine Lower risk of kidney
Cohort study USA
2013 cases) and orange juice stone formation

Jabbar et al., Less intake of fluid, increased weight/ Increased risk of

Case study Pakistan 101 cases
2015 obesity kidney stone
Kidney stone disease and dietary factors

Increased risk of
Amin et al., Retrospective descrip- High intake of animal meat, low water
Egypt 150 cases kidney stone and high
2017 tive research intake, high intake of caffeine
recurrence rate

Ryu et al., 27 cases Higher intake of carbohydrate, protein, Increased risk of

Case control study Korea
2018 20 controls and cereals stone formation

Sandilya and Higher risk of kidney

Retrospective study India 307 cases Increased intake of non-vegetarian food
Sandilya, 2019 stone formation
69
70 Henry Konjengbam, Sanjenbam Yaiphaba Meitei

kidney stone formation, i.e. high intake ful events, and those who take a fewer
of carbohydrate-rich food is directly pro- quantity of fluid especially water. It is
portional to the formation of urinary also reported that the prevalence rate of
stones (Meschi et al. 2012). Not only kidney stone disease in Manipur is 22.4%
this, other studies which are conducted which is extremely high. Moreover, from
in two different countries also supported a hospital-based study for 7 years and 3
the association of carbohydrate-rich food months also reported that the prevalence
with kidney stone disease, they reported rate of urolithiasis in Manipur is 11.6%
that kidney stone disease had a strong (Singh et al. 1978). In Assam, a retro-
significant correlation with higher intake spective study conducted among the pa-
of cereals, grains, and caffeine (Amin et tients admitted in a hospital also report-
al. 2017; Ryu et al. 2017). Coming to the ed that most of the patients of kidney
prevention of kidney stone formation, stone disease are found to be consuming
increase intake of fruits and vegetables more non – vegetarian diet (Sandilya and
lower the risk of kidney stone (Meschi Sandilya 2019).
et al. 2004; Salmeh et al. 2012; Yasui et The high prevalence rate of kidney
al. 2013; Mandel et al. 2013) whereas stone disease in North East India could be
green leafy vegetables which have high- the food habits of the people. The widely
er amount of oxalate contains are also and most consumed foods of North East
risk factors for the formation of kidney India are rice and animal meats (Maha-
stone, consumption of leafy vegetables jan et al. 2015), which contain a large
that contain high oxalate, more than number of carbohydrates and proteins
three times per day also resulted in the that can initiate the formation of kidney
formation of kidney stones in both men stone disease with less physical activity.
and women (Dai et al. 2013). Less phys- Besides this, there is also reported litera-
ical activity is also one of the major risk ture about the presence of a high amount
factors for the formation of kidney stone of fluoride in drinking water from North
disease. People who are more confined East India (Singh et al. 2008), which is
to the sedentary work and perform fewer also one of the risk factors for the forma-
physical activities work are more prone tion of kidney stones (Singh et al. 2001).
to the developing of kidney stones (Yasui Moreover, North East India as a whole
et al. 2008). Those who are performing is also in the stone forming belt of the
moderate physical activity less than 150 world (Lopez and Hoppe 2010). As per
minutes per week show a high prevalence the available data, there is a lack of liter-
of renal calculi like calcium oxalate and ature for kidney stone disease from the
uric acid when relating to other persons other states of North East India except
performing a physical activity more than Manipur and Assam. Therefore, further
150 minutes per week (Shamsudden et in-depth study on the formation of kid-
al. 2013). ney stone disease in northeast India is
Coming to North East India, Marak the need of the hour.
et al., (2013) reported that kidney stone
disease is significantly higher in those Conclusions
individuals who are more educated, en-
gaged in heavy-duty with history of uri- From this systematic review, the wide
nary tract infection and history of stress- occurrence of kidney stone disease all
 Kidney stone disease and dietary factors 71

over the world could relate with the food idea development, designing and draft-
habits of the people, it is evident that ing of the manuscript. All the authors
higher intake of animal protein, high- read and approved the final version of the
er consumption of carbohydrate-rich manuscript.
foods, lower intake of fluids especially
water, and lower intake of fruits and veg- Conflict of interest
etables are the major risk factors for the
formation of kidney stone disease. Con- The authors declare that there are no
sumption of a balanced diet, performing conflicts of interest regarding the publi-
regular physical activities, and avoiding cation of this manuscript.
drinking water, which contains a high
amount of fluorine, may contribute to Corresponding author
the prevention of kidney stone disease.
Sanjenbam Yaiphaba Meitei, Department
Utility and Limitations of the study of Anthropology, Manipur University,
Canchipur, Imphal, 795003 Manipur, In-
The present study attempts to under- dia
stand the effects of food habits espe- e-mail: sanyaimei@gmail.com
cially water intake and nutrients con-
sumption on the kidney stone disease. References
Though, there is individual variation
in the quantity of intake, it is pointed Amin AAS, Ibrahim NEM, Hassan ADA, Ham-
that less water intake, higher intake of mad ESM. 2017. Dietary habits among pa-
animal protein, higher consumption of tients with kidney stones: A retrospective
study. IOSR – JNHS 6 (3):48–55.
carbohydrate-rich foods and lower in-
Basiri A, Shakhssalim N, Khoshdel AR, Rad-
take of fruits and vegetables can enhance far MH, Pakmanesh H. 2009. Influential
the kidney stone formation. The study nutrients in urolithiasis incidence: pro-
also highlights the importance of having tein or meat? J Ren Nutr 19:396–400.
proper balanced diet to control the stone Bihl G, Meyers A. 2001. Recurrent renal
formation. At the same time, the study stone disease – advances in pathogene-
also has few limitations as it is purely sis and clinical management. The Lancet
based on different published articles, as 358:651–6.
a result the authors could not provide Borghi I, Meschi T, Amato F, Briganti A, No-
varini A, Giannini A. 1996. Urinary vol-
data to support or reject the proposition
ume, water and recurrences in idiopathic
claimed. Another limitation could be calcium nephrolithiasis: a 5-year random-
discounting articles related to climatic ized prospective study. J Urol 155:839–43.
and temperature variation of different Bose A, Monk RD, Bushinsky DA. 2016. Kid-
region in association with the formation ney Stones. Williams Textbook. Endocri-
of kidney stone. nology:1365–84.
Chandrajith R, Wijewardana G, Dissanayake
Authors’ Contributions CB, Abeygunasekera A. 2006. Biominer-
alogy of human urinary calculi (kidney
stones) from some geographic regions
HK was involved in the conception, lit-
of Sri Lanka. Environ Geochem Health
erature search, analysis and drafting of 28:393–9.
the manuscript. SYM was involved in the
72 Henry Konjengbam, Sanjenbam Yaiphaba Meitei

Curhan G.C, Willett W, Speizer F, Stampfer Meschi T, Maggiore U, Fiaccadori E, Schianchi

M. 1998. Beverage use and risk for kid- T, Bosi S, Adorni G, Ridolo E, Guerra A,
ney stones in women. Ann Intern Med Allegri F, Novarini A, Borghi L. 2004. The
128:77–84. effects of fruits and vegetables on urinary
Dai M, Zhao A, Liu A, You L, Wang P. 2013. stone risk factors. Kidney Int 66:2402–10.
Dietary factors and risk of kidney stone: Meschi T, Nouvenne A, Ticinesi A, Prati B,
A case-control study in Southern China. J Guerra A, Allegri F, Pigna F, Soldati L,
Ren Nutr 23(2): e21-e28.Ferraro P.M, Tay- Vezzoli G, Gambaro G, Lauretani F, Mag-
lor E.N, Gambaro G, Curhan G.C. 2013. gio M, Borghi L. 2012. Dietary habits in
Soda and other beverages and the risk women with recurrent idiopathic calcium
of kidney stones. Clin J Am Soc Nephrol nephrolithiasis. J Transl Med 10:63.
8(8):1389–95. Moe OW. 2006. Kidney stones: Pathophysi-
Goldfarb D, Fischer M, Keich Y, Goldberg J. ology and medical management. Lancet
2005. A twin study of genetic and dietary 367:333–44.
influences on nephrolithiasis: a report Nouvenne A, Meschi T, Prati B, Guerra A, Al-
from the Vietnam Era Twin (VET) regis- legri F, Vezzoli G, Soldati L, Gambaro G,
try. Kidney Int 67:1053–61. Maggiore U, Borghi L. 2010. Effects of a
Jabbar F, Asif M, Dutani H, Hussain A, Malik low – salt diet on idiopathic hypercalciuria
A, Kamal MA, Rasool M. 2015. Assess- in calcium oxalate stone formers: a 3-mo
ment of the role of general, biochemical randomized controlled trial. Am J Clin
and family history characteristics in kid- Nutr 91:565–70.
ney stones formation. Saudi J Biol Sci Pak C, Sakhaee K, Crowther C, Brinkley L.
22:65–8. 1980. Evidence justifying a high fluid in-
Krieger JN, Kronmal RA, Coxon V, Wortley P, take in treatment of nephrolithiasis. Ann
Thompson L, Sherrard DJ. 1996. Dietary Intern Med 93(1 part 1):36–39.
and behavioural risk factors for urolithia- Reynolds TM. 2005. Chemical pathology
sis: Potential implications for prevention. clinical investigation and management of
AJKD 28:195–201. nephrolithiasis. J Clin Pathol 58:134–40.
Licata AA, Bou E, Bartter FC, Cox J. 1979. Ef- Ryu HY, Lee YK, Park J, Son H, Cho SY. 2017.
fects of dietary protein on urinary calcium Dietary risk factors for urolithiasis in Ko-
in normal subjects and in patients with rea: A case – control pilot study. Investig
nephrolithiasis. Metabolism 28:895–900. Clin Urol 59:106–11.
Lopez M, Hoppe B. 2010. History, epidemiol- Salmeh F, Yaghoubi T, Zakizadeh M, Yag-
ogy and regional diversities of urolithia- houbian M, Shahmohammadi S. 2012.
sis. Pediatr Nephrol 25:49–59. Evaluation of health behaviours in pa-
Mahajan S, Papang JS, Datta KK. 2015. Meat tients with kidney stone sari/Iran. Intern J
consumption in North – East India: Pat- Urol Nurs 6:17–21.
tern, Opportunities and Implications. J Sandilya A, Sandilya P. 2019. A demographic
Anim Res 5(1):37–45. study of urolithiasis in patients attending
Mandel EI, Taylor EN, Curhan GC. 2013. tertiary urological hospital in Dibrugarh,
Dietary and lifestyle factors and medical Assam, India. IJRMS 7 (2):417–20.
conditions associated with urinary citrate Shamsudden SB, Bano R, Shammari EA,
excretion. Clin J Am Soc Nephrol 8:901–8. Enezi SHA. 2013. Riskfactorsof renal cal-
Marak A, Shantibala K, Singh ATH, Singh culi. IOSR–JDMS 11(6):90–5.
NRK, Singh SL. 2013. Urolithiasis: Prev- Singh AK, Bhagowati S, Das TK, Yubbe D,
alence and related factors in a rural area Rahman B, Nath M, Obing P, Singh WSK,
of Manipur. Int J Med Sci Public Health 2 Renthlei CZ, Pachuau L, Thakur R. 2008.
(4):957–60. Assessment of Arsenic, Fluorine, Iron, Ni-
trate and heavy Metals in Drinking Water
 Kidney stone disease and dietary factors 73

of North Eastern India. Himalayan Ecolo- Confalonieri S. 2002. Effect of acute load
gy 16 (1):6–12. of grapefruit juice on urinary excretion of
Singh PP, Barjatiya MK, Dhing S, Bhatnagar citrate and urinary risk factors for renal
R, Kothari S, Dhar V. 2001. Evidence stone formation. Digest Liver Dis 34(Sup-
suggesting that high intake of fluoride pl.2):s160–3.
provokes nephrolithiasis in tribal popula- Turk C, Neisius A, Petrik A, Seitz C, Skolar-
tions. J Urol Res 29:238–44. ikos A, Thomas K. 2018. EAU Guidelines
Singh PP, Singh LBK, Prasad SN, Singh MG. Edn. Presented at the EAU Annual Con-
1978. Urolithiasis in Manipur (North gress London. ISBN 978-94-92671-01-1.
Eastern region of India), Incidence and Yasui T, Iguchi M, Suzuki S, Kohri K. 2008.
Chemical compositions of stones. Am J Prevalence and epidemiological charac-
Clin Nutr 31(9):1519–25. teristics of urolithiasis in Japan: National
Sutherland JW, Parks JH, Coe FL. 1985. Re- trends between 1965 and 2005. Urology
currence after a single renal stone in a 71:209–13.
community practice. Miner Electrolyte Yasui T, Okada A, Hamamota S, Hirose M,
Metab 11:267–9. Ando R, Kubota Y, Tozawa K, Hayashi Y,
Trinchieri A, Ostini F, Nespoli R, Rovera F, Gao B, Suzuki S, Kohri K. 2013. The as-
Montanari E, Zanetti G. 1999. A prospec- sociation between the incidence of uro-
tive study of recurrence rate and risk fac- lithiasis and nutrition based on Japanese
tors for recurrence after a first renal stone. National Health and Nutrition Surveys.
J Urol 162:27–30. Urolithiasis 41:217–24.
Trinchieri A, Lizzano R, Bernardini P, Nicola
M, Pozzoni F, Romano A.L., Serrago M.P.,
 © 2020. This work is published under
http://creativecommons.org/licenses/by-nc-nd/3.0 (the
“License”). Notwithstanding the ProQuest Terms and
Conditions, you may use this content in accordance with the
terms of the License.