Dietary Factors in Calcium Nephrolithiasis
■ Objective: To review dietary factors implicated in the pathogenesis of calcium nephrolithiasis and the pathophysiological mechanisms proposed for each. ■ Data sources: Data were obtained from English language articles published between 1950 and 1991 addressing the evaluation and therapy of patients with nephrolithiasis. The articles are indexed in the National Library of Medicine's MEDLINE data base. ■ Study selection: Studies selected for inclusion in this review were those that identified and discussed dietary factors in the pathophysiology of calcium nephrolithiasis. ■ Data extraction: References were reviewed by the authors with emphasis on study size, randomization, and statistical analysis. ■ Data synthesis: Renal stone formation is the result of genetic, metabolic, and environmental factors. The most important environmental factors relate to diet. Assessment of dietary sodium, calcium, phosphorus, oxalate, protein, fiber, fluid, and exogenous vitamins is mandatory in the initial evaluation of the patient with renal stones. Instruction to correct identified dietary excesses or deficiencies is the first therapeutic intervention for all patients, including those in whom additional drug therapy is ultimately required. ■ Conclusions: Nutritional intervention is central to the evaluation, therapy, and long-term monitoring of the patient with calcium nephrolithiasis.