Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Potential renal acid load and the risk of renal stone formation in a case–control study

Abstract

Objective:

The potential renal acid load (PRAL) in diet may have a key role in renal stone formation through its effect on calcium and citrate metabolism. We examined the association between calcium renal stone formation and the PRAL in a population-based case–control study.

Methods:

A group of 123 calcium renal stone formers was compared with an equal number of age- and sex-matched controls. Dietary history was obtained by 24-h recall. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated across quartiles of dietary intakes of PRAL.

Results:

Compared with those in the lowest quartiles of PRAL, we found an increased risk of renal stone formation for those in the highest quartile (Q4 OR=2.51, 95% CI 1.218–5.172). Regarding individual food patterns, we found a significant protection for a high consumption of vegetables (two or more servings/day; OR=0.526, 95% CI 0.288–0.962).

Conclusions:

A PRAL in diet and a reduced consumption of vegetables are associated with an increased risk of calcium renal stone formation. In renal stone formers consumption of plant foods should be encouraged in order to counterbalance the acid load derived from animal-derived foods.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Curhan GC, Willett WC, Rimm EB, Stampfer MJ . A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993; 328: 833–838.

    Article  CAS  Google Scholar 

  2. Trinchieri A, Mandressi A, Luongo P, Longo G, Pisani E . The influence of diet on urinary risk factors for stones in healthy subjects and idiopathic renal calcium stone formers. Br J Urol 1991; 67: 230–236.

    Article  CAS  Google Scholar 

  3. Remer T, Manz F . Potential renal acid load of foods and its influence on urine pH. J Am Diet Assoc 1995; 95: 791–797.

    Article  CAS  Google Scholar 

  4. Jacobs DR Jr, Steffen LM . Nutrients, foods, and dietary patterns as exposures in research: a framework for food synergy. Am J Clin Nutr 2003; 78 (3 Suppl), 508S–513S.

    Article  CAS  Google Scholar 

  5. Frassetto LA, Todd KM, Morris RC Jr, Sebastian A . Estimation of net endogenous noncarbonic acid production in humans from diet potassium and protein contents. Am J Clin Nutr 1998; 68: 576–583.

    Article  CAS  Google Scholar 

  6. Tannen RL . Effect of potassium on renal acidification and acid-base homeostasis. Semin Nephrol 1987; 7: 263–273.

    CAS  PubMed  Google Scholar 

  7. Demigné C, Sabboh H, Remsey C, Meneton P . Protective effects of high dietary potassium: nutritional and metabolic aspects. J Nutr 2004; 134: 2903–2906.

    Article  Google Scholar 

  8. Siener R, Glatz S, Nicolay C, Hesse A . The role of overweight and obesity in calcium oxalate stone formation. Obes Res 2004; 12: 106–113.

    Article  CAS  Google Scholar 

  9. Lemann JJr, Lennon EJ, Goodman AD, Litzow JR, Relman AS . The net balance of acid in subjects given large loads of acid or alkali. J Clin Invest 1965; 44: 507–517.

    Article  CAS  Google Scholar 

  10. Trinchieri A, Zanetti G, Currò A, Lizzano R . Effect of potential renal acid load of foods on calcium metabolism of renal calcium stone formers. Eur Urol 2001; 39 (Suppl 2), 33–36. discussion 36–7.

    Article  CAS  Google Scholar 

  11. Trinchieri A, Lizzano R, Marchesotti F, Zanetti G . Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers. Urol Res 2006; 34: 1–7.

    Article  CAS  Google Scholar 

  12. Pak CY . Citrate and renal calculi: an update. Miner Electrolyte Metab 1994; 20: 371–377.

    CAS  PubMed  Google Scholar 

  13. Mossetti G, Vuotto P, Rendina D, Numis FG, Viceconti R, Giordano F et al. Association between vitamin D receptor gene polymorphisms and tubular citrate handling in calcium nephrolithiasis. J Intern Med 2003; 253: 194–200.

    Article  CAS  Google Scholar 

  14. Okamoto N, Aruga S, Matsuzaki S, Takahashi S, Matsushita K, Kilamura T et al. Associations between renal sodium-citrate cotransporter (hNaDC-1) gene polymorphism and urinary citrate excretion in recurrent renal calcium stone formers and normal controls. Int J Urol 2007; 14: 344–349.

    Article  CAS  Google Scholar 

  15. Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U et al. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med 2002; 346: 77–84.

    Article  CAS  Google Scholar 

  16. Taylor EN, Fung TT, Curhan GC . DASH-style diet associates with reduced risk for kidney stones. J Am Soc Nephrol 2009; 20: 2253–2259.

    Article  CAS  Google Scholar 

  17. Taylor EN, Stampfer MJ, Mount DB, Curhan GC . DASH-style diet and 24-hour urine composition. Clin J Am Soc Nephrol 2010; 5: 2315–2322.

    Article  CAS  Google Scholar 

  18. Meschi T, Maggiore U, Fiaccadori E, Schianchi T, Bosi S, Adorni G et al. The effect of fruits and vegetables on urinary stone risk factors. Kidney Int 2004; 66: 2402–2410.

    Article  CAS  Google Scholar 

  19. Taylor EN, Curhan GC . Fructose consumption and the risk of kidney stones. Kidney Int 2008; 73: 207–212.

    Article  CAS  Google Scholar 

  20. Fink HA, Akornor JW, Garimella PS, MacDonald R, Cutting A, Rutks IR et al. Diet, fluid, or supplements for secondary prevention of nephrolithiasis: a systematic review and meta-analysis of randomized trials. Eur Urol 2009; 56: 72–80.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A Trinchieri.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trinchieri, A., Maletta, A., Lizzano, R. et al. Potential renal acid load and the risk of renal stone formation in a case–control study. Eur J Clin Nutr 67, 1077–1080 (2013). https://doi.org/10.1038/ejcn.2013.155

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.155

Keywords

This article is cited by

Search

Quick links