Therapeutic target
Prevention of stone recurrence (recurrence of urinary stones).
Therapy recommendations
Reduction of risk factors
- Disease-related risk factors
- Hypercalcemia (excess calcium)
- Hypercalciuria (increased calcium excretion in the urine).
- Hyperoxaluria (increased excretion of oxalic acid in the urine), primary as well as secondary to various diseases such as Crohn’s disease, pancreatic insufficiency (pancreatic weakness), etc.
- Hyperparathyroidism (parathyroid hyperfunction), primary (pHPT).
- Renal tubular acidosis (RTA) – genetic defect of the kidney (defect of H+ ion secretion in the tubular system of the kidney).
- Medication
- Vitamin D intoxication (e.g. due torickets prophylaxis/prevention of bone softening in children).
In about 70% of affected patients, no risk factors can be detected which is why they are counted as so-called idiopathic calcium oxalate stone formers.
Nutritional therapy
- Fluid intake 2.5-3 l / day
- Diet with decreased intake of sodium (increased sodium intake leads to increased loss of calcium through the kidney) and proteins (increase excretion of calcium through the urine)
- Adjust calcium intake to 800-1,200 mg/day – restriction in the consumption of cheese and vegetables (broccoli, fennel, spinach, kale).
- Magnesium-rich food such as rice, legumes, spinach; drink magnesium-containing mineral water (magnesium inhibits the formation of calcium oxalate stones).
- Avoid foods rich in oxalic acid / oxalate (chard, spinach, rhubarb, block chocolate, cocoa powder).
- Alkaline-rich, alkalizing diet with potatoes, vegetables, salads, legumes and fruits; dietary supplements with alkalizing (basic) mineral compounds potassium citrate, magnesium citrate and calcium citrate, as well as vitamin D and zinc (zinc contributes to the normal acid-base balance).
Active substances of metaphylaxis
- If there is a need for metabolic correction, therapy using alkali citrates or sodium bicarbonate is considered the first choice.
Surgical therapy
- Parathyroidectomy (removal of parathyroid glands) – in the presence of primary hyperparathyroidism/parathyroid hyperfunction (elevated serum calcium; laboratory diagnosis: determination of intact parathyroid hormone).
