Effects of dietary fat on the urinary risk factors of calcium stone disease

Oxalate content of silver beet leaves (Beta vulgaris var. cicla) at different stages of maturation and the effect of cooking with different milk sources

The work presented here indicates that people who have a tendency to develop kidney stones should avoid consuming regrowth and developed silver beet (Beta vulgaris var. cicla) leaves. Soluble oxalate contents of leaves range from 58% of the total oxalate for the mature leaves up to 89% for the regrowth tissue, with regrowth tissue containing the highest levels of soluble oxalate at 7267+/-307 mg/100 g of dry matter (DM). Leaves cooked in milk contained significantly (p<0.05) lower levels of soluble oxalate compared to the leaves that were cooked in water. Leaves cooked in low fat milk contained significantly lower levels (p<0.05) of soluble oxalate (1.9%) than leaves cooked in standard milk (5.3%) or cream (6.3%). To maximize the reduction of soluble oxalate during the cooking of high oxalate foods such as spinach and silver beet, a low fat milk cooking medium with neutral pH should be utilized.

Metabolic evaluation of stone disease patients: a practical approach

The high success rates of extracorporeal shockwave lithotripsy and endourological techniques, together with their ease of use, in the treatment of urinary stones often overshadow the importance of the metabolic component of stone disease. It is my opinion that the prevention of further stones complements management of the acute episode. This review summarizes a variety of approaches to the measurement and manipulation of individual risk factors in recurrent urinary stone disease.

Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers

BACKGROUND

High protein intake is an accepted risk factor for renal stone disease. Whether meat protein intake affects oxaluria, however, remains controversial in healthy subjects and in stone formers. This study was designed (1) to test the oxaluric response to a meat protein load in male recurrent idiopathic calcium stone formers (ICSFs) with and without mild metabolic hyperoxaluria (MMH and non-MMH, respectively), as well as in healthy controls, and (2) to seek for possible disturbed vitamin B(6) metabolism in MMH, in analogy with primary hyperoxaluria.

METHODS

Twelve MMH, 8 non-MMH, and 13 healthy males were studied after five days on a high meat protein diet (HPD; 700 g meat/fish daily) following a run-in phase of five days on a moderate protein diet (MPD; 160 g meat/fish daily). In both diets, oxalate-rich nutrients were avoided, as well as sweeteners and vitamin C-containing medicines. Twenty-four-hour urinary excretion of oxalate was measured on the last day of each period, along with 4-pyridoxic acid (U(4PA)) and markers of protein intake, that is, urea, phosphate, uric acid, and sulfate. Serum pyridoxal 5' phosphate (S(P5P)) was measured after protein loading.

RESULTS

Switching from MPD (0.97 +/- 0.18 g protein/kg/day) to HPD (2.26 +/- 0.38 g protein/kg/day) led to the expected rise in the urinary excretion rates of all markers of protein intake in all subjects. Concurrently, the mean urinary excretion of oxalate increased in ICSFs taken as a whole (+73 +/- 134 micromol/24 h, P = 0.024) as well as in the MMH subgroup (+100 +/- 144 micromol/24 h, P = 0.034) but not in controls (-17 +/- 63 micromol/24 h). In seven ICSFs (4 MMH and 3 non-MMH) but in none of the healthy controls (P = 0.016, chi square), an increment in oxaluria was observed and considered as significant based on the intra-assay coefficient of variation at our laboratory (8.5%). There was no difference in S(P5P)nd U(4PA)etween the groups after protein loading.

CONCLUSION

Approximately one third of ICSFs with or without so-called MMH are sensitive to meat protein in terms of oxalate excretion, as opposed to healthy subjects. Mechanisms underlying this sensitivity to meat protein remain to be elucidated and do not seem to involve vitamin B(6) deficiency.