Treatment Options
Dietary - Fluid Intake

• Coffee and Tea
• Alcohol
• Citrus Drinks

The single most important factor for the prevention of kidney stones, regardless of the stone composition, is to produce adequate volumes of urine. If the total urine volume is increased, the total concentration of crystals in the urine decreases, thereby, limiting the chance of these crystals binding together to form new kidney stones. Kidney stone patients should strive to produce at least two liters (two quarts) of urine per day. Therefore, hydration is of critical importance in patients with kidney stones.

While it is common knowledge that increasing a patient's fluid intake will also increase their urine output, there still remains some confusion as to the best means to do so. While water is easily accessible and inexpensive, there are many other suitable liquids, which can be used to augment a patient's fluid intake.

Some suggestions for easily increasing a person's fluid intake are as follows:
If possible, patients should have beverage containers easily accessible to them while at work or at home and every time the patient notices the beverage container, they should take at least a sip from it. At each meal, patients should try to drink at least one to two glasses of water with their food in addition to the beverages that they normally drink. Desserts and snacks which are low in water and high in salt, such as crackers, chips and pastries, should be avoided and should be replaced with foods that are high in water, such as fruits, melons, Jell-O and pudding.

For many patients it is not easy to determine whether or not their fluid intake is adequate. A good general rule of thumb is that if a patient's urine is clear, their fluid intake is adequate. If their urine becomes more yellow to brown, then they should strive to increase their fluid intake. Some patients who are highly motivated may wish to purchase urine dipsticks from their pharmacy or supermarket. Patients may check their level of urine concentration by checking the urinary specific gravity on the dipstick. Patients at risk for kidney stone formation should attempt to keep the urinary specific gravity less than 1.010.

Recently, there have been several scientific studies that have dispelled commonly held beliefs regarding certain beverages and the risk of recurrent kidney stone disease.
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Coffee and Tea
It has been long thought that recurrent kidney stone formers should avoid the intake of coffee and tea, as they both contain varying amounts of oxalate. It was also thought that the use of caffeinated beverages would lead to a relative degree of dehydration and increased kidney stone production. It has now been shown that the amount of oxalate in coffee and tea is actually relatively low and that caffeine affects a particular hormone in the kidney (antidiuretic hormone) in such a way that it leads to production of a more dilute urine thereby decreasing the risk of kidney stone formation. The data currently suggest that drinking a single 8 oz. cup of coffee per day can decrease a patient's risk of kidney stones by approximately 10%, while with tea, the rate drops by 8%.
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Alcohol
Another commonly held notion is that patients with kidney stone disease should avoid beverages containing alcohol, as this was also felt to cause an overall state of dehydration to the patient. Recent studies suggest that drinking mild to moderate amounts of alcohol daily, decreased the risk of kidney stone formation by affecting antidiuretic hormone in a mechanism similar to that of caffeine.

One recent study demonstrated that women who drink a single 8-oz. glass of wine per day decrease their relative risk of kidney stone formation by approximately 50%. Drinking mild to moderate amounts of beer and hard liquor also decrease the relative risk of kidney stone formation, but to a much less extent that that of wine.

Many people have often felt that avoiding dairy products, particularly milk, would decrease the risk of kidney stone formation. However, numerous studies have now shown that consumption of neither skim nor whole milk increases the risk of developing future kidney stones.
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Citrus Drinks
Beverages containing high amounts of citrate can be used to decrease the risk of kidney stone formation. Citrus drinks have a positive effect in the prevention of stones, as they increase urine volume as well as provide significant levels of urinary citrate. Studies focusing on the use of lemonade have shown that drinking several glasses of lemonade per day can significantly reduce the risk of future kidney stones. While cranberry juice has significantly less citrate levels than either lemonade or orange juice, citrate is often used as an additive to enhance the flavor of this juice. Therefore, cranberry juice is an excellent beverage to increase urine volume and urinary citrate levels.

There are numerous other beverages available to which citrate is used as an additive. Although the amount of citrate in these products is highly variable, the vast majority of these beverages would provide benefit in reducing the risk of kidney stones.
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