Dietary oxalate and calcium oxalate stones: a theoretical or real concern?

  • Kristina L. PennistonEmail author


Oxalate is the end product of several metabolic pathways in many life forms, including plants and humans. In humans and other animals, oxalate must be excreted because there is no biological need for oxalate. In humans, the ability to manage oxalate, which originates from both endogenous and exogenous sources, relies on control of its gastrointestinal absorption (in the case of exogenous oxalate), on the control of endogenous synthesis, and on renal oxalate handling. Because urinary oxalate excretion is a major cause of calcium oxalate urolithiasis, oxalate is of interest. Currently there are no pharmacologic agents designed to reduce oxalate biosynthesis, oxalate absorption, or renal oxalate excretion. While there are numerous nutrition-related strategies aimed at reducing high urine oxalate, there is debate about their effectiveness, largely due to lack of evidence in the biomedical literature.

In this chapter, the chemistry of oxalate is elucidated. Current medical management practices and their respective rationales are outlined, specifically focusing on areas of controversy.


Calcium oxalate Hyperoxaluria Oxalate Oxalic acid Urolithiasis 


  1. 1.
    Aliano NP, Ellis MD. Oxalic acid: a prospective tool for reducing Varroa mite populations in package bees. Exp Appl Acarol 2009;48:303–9.PubMedGoogle Scholar
  2. 2.
    Gillam DG, Coventry JF, Manning RH, Newman HN, Bulman JS. Comparison of two desensitizing agents for the treatment of cervical dentine sensitivity. Endod Dent Traumatol. 1997;13:36–9.PubMedGoogle Scholar
  3. 3.
    Lazzarini L, Salvadori O. A reassessment of the formation of the patina called scialbatura. Stud Conser. 1989;34:20–6.Google Scholar
  4. 4.
    Russ J, Loyd DH, Boutton TW. A paleoclimate reconstruction for southwestern Texas using oxalate residue from lichen as a paleoclimate proxy. Quart Int. 2000;67:29–36.Google Scholar
  5. 5.
    Caliskan M. The metabolism of oxalate. Turk J Zool. 2000;24:103–6.Google Scholar
  6. 6.
    Franceschi VR, Nakata PA. Calcium oxalate in plants: formation and function. Ann Rev Plant Biol. 2005;56:41–71.Google Scholar
  7. 7.
    Cailleau G, Braissant O, Verrecchia EP. Turning sunlight into stone: the oxalate-carbonate pathway in a tropical tree system. Biogeosciences. 2011;8:1755–67.Google Scholar
  8. 8.
    Beazley MJ, Rickman RD, Ingram DK, Boutton TW, Russ J. Natural abundances of carbon isotopes (14C, 13C) in lichens and calcium oxalate pruina: implications for archaeological and paleoenvironmental studies. Radiocarbon. 2002;44:675–83.Google Scholar
  9. 9.
    Freeman BC, Beattie GA. 2008. An overview of plant defenses against pathogens and herbivores. The Plant Health Instructor. doi:10.1094/PHI-I-2008-0226-01.Google Scholar
  10. 10.
    Monje PV, Baran EJ. Characterization of calcium oxalates generated as biominerals in cacti. Plant Physiol. 2002;128:707–13.PubMedCentralPubMedGoogle Scholar
  11. 11.
    Ma JF, Hiradate S, Matsumoto H. High aluminum resistance in buckwheat. Plant Physiol. 1998;117:753–9.PubMedCentralGoogle Scholar
  12. 12.
    Mithril C, Dragsted. LO. Safety evaluation of some wild plants in the New Nordic diet. Food Chem Toxicol. 2012;50:4461–7.PubMedGoogle Scholar
  13. 13.
    Harvard School of Public Health Nutrition Department’s file. 2013. Accessed 7 Aug 2013.
  14. 14.
    Cartery C, Faquer S, Karras A, Cointault O, Buscail L, Modesto A, et al. Oxalate nephropathy associated with chronic pancreatitis. Clin J Am Soc Nephrol. 2011;6:1895–902.PubMedGoogle Scholar
  15. 15.
    Fishbein GA, Micheletti RG, Currier JS, Singer E, Fishbein MC. Atherosclerotic oxalosis in coronary arteries. Cardiovasc Pathol. 2008;17:117–23.PubMedCentralPubMedGoogle Scholar
  16. 16.
    Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. P. 2. Overview of Calcium. In: Ross AC, Taylor CL, Yaktine AL, et al., editors. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press (US); 2011. Accessed 8 Aug 2013.
  17. 17.
    Knapp EL. Factors influencing the urinary excretion of calcium in normal persons. J Clin Invest. 1947;26:182–202.PubMedCentralGoogle Scholar
  18. 18.
    Trinchieri A. Diet and renal stone formation. Minerva Med. 2013;104:41–54.PubMedGoogle Scholar
  19. 19.
    Dunlop JC. The excretion of oxalate acid in urine, and its bearing on the pathological condition known as oxaluria. J Pathol Bacteriol. 1896;3:389–429.Google Scholar
  20. 20.
    Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int. 2001;59:270–6.PubMedGoogle Scholar
  21. 21.
    Freel RW, Hatch M, Green M, Soleimani M. Ileal oxalate absorption and urinary oxalate excretion are enhanced in Slc26a6 null mice. Am J Physiol Gastrointest Liver Physiol. 2006;290:19–28.Google Scholar
  22. 22.
    Liu RH. Dietary bioactive compounds and their health implications. J Food Sci. 2013;78:A18–25.PubMedGoogle Scholar
  23. 23.
    Martino HS, Martin BR, Weaver CM, Bressan J, Esteves EA, Costa NM. Zinc and iron bioavailability of genetically modified soybeans in rats. J Food Sci. 2007;72:689–95.Google Scholar
  24. 24.
    Baldwin H. An experimental study of oxaluria, with special reference to its fermentive origin. J Exp Med. 1900;5:27–46.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Shah J, Whitfield HN. Urolithiasis through the ages. BJU Int. 2002;89:801–10.PubMedGoogle Scholar
  26. 26.
    Robijn S, Hoppe B, Vervaet BA, D’Haese PC, Verhulst A. Hyperoxaluria: a gut-kidney axis? Kidney Int. 2011;80:1146–58.PubMedGoogle Scholar
  27. 27.
    Holmes RP, Kennedy M. Estimation of the oxalate content of foods and daily oxalate intake. Kidney Int. 2000;57:1662–7.PubMedGoogle Scholar
  28. 28.
    Taylor EN, Curhan GC. Determinants of 24-hour urinary oxalate excretion. Clin J Am Soc Nephrol. 2008;3:1453–60.PubMedGoogle Scholar
  29. 29.
    Hallson PC, Rose GA. Crystalluria in normal subjects and in stone formers with and without thiazide and cellulose phosphate treatment. Br J Urol. 1976;48:515–24.PubMedGoogle Scholar
  30. 30.
    Lopez M, Hoppe B. History, epidemiology and regional diversities of urolithiasis. Pedatr Nephrol. 2010;25:49–59.Google Scholar
  31. 31.
    Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Twenty-four-hour urine chemistries and the risk of kidney stones among women and men. Kidney Int. 2001;59:2290–8.PubMedGoogle Scholar
  32. 32.
    Curhan GC, Taylor EN. 24-h uric acid excretion and the risk of kidney stones. Kidney Int. 2008;73:489–96.PubMedGoogle Scholar
  33. 33.
    Worcester EM. Stones from bowel disease. Endocrinol Metab Clin North Am. 2002;31:979–99.PubMedGoogle Scholar
  34. 34.
    Juuti M, Heinonen OP, Alhava EM. Seasonal variation in urinary excretion of calcium, oxalate, magnesium and phosphate on free and standard mineral diet in men with urolithasis. Scand J Urol Nephrol. 1981;15:137–41.PubMedGoogle Scholar
  35. 35.
    Robertson WG, Peacock M, Marshall RW, Speed R, Nordin BE. Seasonal variations in the composition of urine in relation to calcium stone-formation. Clin Sci Mol Med. 1975;49:597–602.PubMedGoogle Scholar
  36. 36.
    Finlayson B. Physiochemical aspects of urolithiasis. Kidney Int. 1978;13:344–60.PubMedGoogle Scholar
  37. 37.
    Robertson WG, Peacock M, Heyburn PJ, Marshall DH, Clark PB. Risk factors in calcium stone disease of the urinary tract. Br J Urol. 1978;50:449–54.PubMedGoogle Scholar
  38. 38.
    Robertson WG, Peacock M. The cause of idiopathic calcium stone disease: hypercalciuria or hyperoxaluria? Nephron. 1980;26:105–10.PubMedGoogle Scholar
  39. 39.
    Rodgers A. Aspects of calcium oxalate crystallization: theory, in vitro studies, and in vivo implementation. J Am Soc Nephrol. 1999;10:S351–4.PubMedGoogle Scholar
  40. 40.
    Caspary WF, Tonissen J, Lankisch PG. ‘Enteral’ hyperoxaluria. Effect of cholestyramine, calcium, neomycin, and bile acids on intestinal oxalate absorption in man. Acta Hepatogastroenterol (Stuttg). 1977;24:193–200.Google Scholar
  41. 41.
    Smith LH, Fromm H, Hofmann AF. Acquired hyperoxaluria, nephrolithiasis, and intestinal disease. Description of a syndrome. N Engl J Med. 1972;286:1371–5.PubMedGoogle Scholar
  42. 42.
    Nordenvall B, Backman L, Larsson L, Tiselius HG. Effects of calcium, aluminum, magnesium and cholestyramine on hyperoxaluria in patients with jejunoileal bypass. Acta Chir Scand. 1983;149:93–8.PubMedGoogle Scholar
  43. 43.
    Emmett M, Guirl MJ, Santa Ana CA, Porter JL, Neimark S, Hofmann AF, et al. Conjugated bile acid replacement therapy reduces urinary oxalate excretion in short bowel syndrome. Am J Kidney Dis. 2003;41:230–7.PubMedGoogle Scholar
  44. 44.
    Siener R, Petzold J, Bitterlich N, Alteheld B. Metzner C. Determinants of urolithiasis in patients with intestinal fat malabsorption. Urology. 2013;81:17–24.PubMedGoogle Scholar
  45. 45.
    Rankin AC, Walsh SB, Summers SA, Owen MP, Mansell MA. Acute oxalate nephropathy causing late renal transplant dysfunction due to enteric hyperoxaluria. Am J Transplant. 2008;8:1755–8.PubMedGoogle Scholar
  46. 46.
    Miyaoka R, Monga M. Use of traditional Chinese medicine in the management of urinary stone disease. Int Braz J Urol. 2009;35:396–405.PubMedGoogle Scholar
  47. 47.
    Siener R, Jansen B, Watzer B, Hesse A. Effect of n-3 fatty acid supplementation on urinary risk factors for calcium oxalate stone formation. J Urol. 2011;185:719–24.PubMedGoogle Scholar
  48. 48.
    Lange J, Mufarrij P, Easter L, Knight J, Holmes R, Assimos D. The impact of fish oil supplementation on endogenous oxalate synthesis and urinary oxalate excretion. J Urol. 2013;189:e925.Google Scholar
  49. 49.
    Mydlik M, Derzsiova K. Vitamin B6 and oxalaic acid in clinical nephropathy. J Ren Nutr. 2010;20:S95–102.PubMedGoogle Scholar
  50. 50.
    Ortiz-Alvarado O, Miyaoka R, Kriedberg C, Moeding A, Stessman M, Monga M. Pyridoxine and dietary counseling for the management of idiopathic hyperoxaluria in stone-forming patients. Urology. 2011;77:1054–8.PubMedGoogle Scholar
  51. 51.
    Dahiya T, Pundir CS. In vivo oxalate degradation by liposome encapsulated oxalate oxidase in rat model of hyperoxaluria. Indian J Med Res. 2013;137:136–41.PubMedGoogle Scholar
  52. 52.
    Sahin N. Oxalotrophic bacteria. Res Microbiol. 2003;154:399–407.PubMedGoogle Scholar
  53. 53.
    Liebman M, Al-Wahsh IA. Probiotics and other key determinants of dietary oxalate absorption. Adv Nutr. 2011;2:254–60.PubMedCentralPubMedGoogle Scholar
  54. 54.
    Abratt VR, Reid SJ. Oxalate-degrading bacteria of the human gut as probiotics in the management of kidney stone disease. Adv Appl Microbiol. 2010;72:63–87.PubMedGoogle Scholar
  55. 55.
    Lieske JC, Goldfarb DS, De Simone C, Regnier C. Use of a probiotic to decrease enteric hyperoxaluria. Kidney Int. 2005;68:1244–9.PubMedGoogle Scholar
  56. 56.
    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.PubMedCentralPubMedGoogle Scholar
  57. 57.
    Lieske JC, Tremaine WJ, De Simone C, O’Connor HM, Li X, Bergstralh EJ, et al. Diet, but not oral probiotics, effectively reduces urinary oxalate excretion and calcium oxalate supersaturation. Kidney Int. 2010;78:1178–85.PubMedGoogle Scholar
  58. 58.
    Pang R, Linnes MP, O’Connor HM, Li X, Bergstralh E, Lieske JC. Controlled metabolic diet reduces calcium oxalate supersaturation but not oxalate excretion after bariatric surgery. Urology. 2012;80:250–4.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Taylor EN, Curhan GC. Oxalate intake and the risk for nephrolithiasis. J Am Soc Nephrol. 2007;18:2198–204.PubMedGoogle Scholar
  60. 60.
    Penniston KL, Wojciechowski KF, Nakada SY. Dietary oxalate: what’s important and what isn’t for patients with calcium oxalate stones? J Urol. 2011;185:e824–5.Google Scholar
  61. 61.
    Pak CY, Adams-Huet B, Poindexter JR, Pearle MS, Peterson RD, Moe OW. Rapid communication: relative effect of urinary calcium and oxalate on saturation of calcium oxalate. Kidney Int. 2004;66:2032–7.PubMedGoogle Scholar
  62. 62.
    Maalouf NM, Adams Huet B, Pasch A, Lieske JC, Asplin JR, Siener R, et al. Variability in urinary oxalate measurements between six international laboratories. Nephrol Dial Transplant. 2011;26:3954–9.Google Scholar
  63. 63.
    Penniston KL, Jones AN, Nakada SY, Hansen KE. Vitamin D repletion does not alter urinary calcium excretion in healthy postmenopausal women. BJU Int. 2009;104:1512–6.PubMedCentralPubMedGoogle Scholar
  64. 64.
    Massey LK. Food oxalate: factors affecting measurement, biological variation, and bioavailability. J Am Diet Assoc. 2007;107:1191–4.PubMedGoogle Scholar
  65. 65.
    Wu GD, Chen J, Hoffmann C, Bittinger K, Chen YY, Keilbaugh SA, et al. Linking long-term dietary patterns with gut microbial enterotypes. Science. 2011;334:105–8.PubMedCentralPubMedGoogle Scholar
  66. 66.
    Flint HJ. The impact of nutrition on the human microbiome. Nutr Rev. 2012;70:S10–3.PubMedGoogle Scholar
  67. 67.
    Barner HH, Gallimore EJ. The metabolism of oxalic acid in the animal body. Biochem J. 1940;34:144–8.Google Scholar
  68. 68.
    Talapatra SK, Ray SC, Sen KC. Calcium assimilation in ruminants on oxalate-rich diet. J Agri Sci. 1948;38:163–73.Google Scholar
  69. 69.
    Morris MP, Garcia-Rivera J. The destruction of oxalate by rumen contents of cows. J Dairy Sci. 1955;38:1169.Google Scholar
  70. 70.
    Allison MJ, Cook HM. Oxalate degradation by microbes of the large bowel of herbivores: the effect of dietary oxalate. Science. 1981;212:675–6.PubMedGoogle Scholar
  71. 71.
    Knauf F, Ko N, Jiang Z, Robertson WG, Van Itallie CM, Anderson JM, et al. Net intestinal transport of oxalate reflects passive absorption and SLC26A6-mediated secretion. J Am Soc Nephrol. 2011;22:2247–55.PubMedGoogle Scholar
  72. 72.
    Knight J, Jiang J, Wood KD, Holmes RP, Assimos DG. Oxalate and sucralose absorption in idiopathic calcium oxalate stone formers. Urology. 2011;78:e9–13.PubMedGoogle Scholar
  73. 73.
    Voss S, Hesse A, Zimmerman DJ, Sauerbruch T, von Unruh GE. Intestinal oxalate absorption is higher in idiopathic calcium oxalate stone formers than in healthy controls: measurements with the [(13)C2] oxalate absorption test. J Urol. 2006;175:1711–5.PubMedGoogle Scholar
  74. 74.
    Penniston KL, Nakada SY. Effect of dietary changes on urinary oxalate excretion and calcium oxalate supersaturation in patients with hyperoxaluric stone formation. Urology. 2009;73:484–9.PubMedGoogle Scholar
  75. 75.
    Lange JN, Wood KD, Mufarrij PW, Callahan MF, Easter L, Knight J, et al. The impact of dietary calcium and oxalate ratios on stone risk. Urology. 2012;79:1226–9.PubMedGoogle Scholar
  76. 76.
    Voss S, Zimmerman DJ, Hesse A, von Unruh GE. The effect of oral administration of calcium and magnesium on intestinal oxalate absorption in humans. Isotopes Environ Health Stud. 2004;40:199–205.PubMedGoogle Scholar
  77. 77.
    Zimmerman DJ, Voss S, von Unruh GE, Hesse A. Importance of magnesium in absorption and excretion of oxalate. Urol Int. 2005;74:262–7.Google Scholar
  78. 78.
    Massey L. Magnesium therapy for nephrolithiasis. Magnes Res. 2005;18:123–6.PubMedGoogle Scholar
  79. 79.
    Borghi L, Nouvenne A, Meschi T. Probiotics and dietary manipulations in calcium oxalate nephrolithiasis: two sides of the same coin? Kidney Int. 2010;78:1063–5.PubMedGoogle Scholar
  80. 80.
    Weese JS, Weese HE, Yuricek L, Rousseau J. Oxalate degradation by intestinal lactic acid bacteria in dogs and cats. Vet Microbiol. 2004;101:161–6.PubMedGoogle Scholar
  81. 81.
    Rampton DS, Kasidas GP, Rose GA, Sarner M. Oxalate loading test: a screening test for steatorrhoea. Gut. 1979;20:1089–94.PubMedGoogle Scholar
  82. 82.
    Steiner MS, Morton RA. Nutritional and gastrointestinal complications of the use of bowel segments in the lower urinary tract. Urol Clin North Am. 1991;18:743–54.PubMedGoogle Scholar
  83. 83.
    Naya Y, Ito H, Masai M, Yamaguchi K. Effect of dietary intake on urinary oxalate excretion in calcium oxalate stone formers in their forties. Eur Urol. 2000;37:140–4.PubMedGoogle Scholar
  84. 84.
    Naya Y, Ito H, Masaai M, Yamaguchi K. Association of dietary fatty acids with urinary oxalate excretion in calcium oxalate stone-formers in their fourth decade. BJU Int. 2002;89:842–6.PubMedGoogle Scholar
  85. 85.
    Bailly GG, Norman RW, Thompson C. Effects of dietary fat on the urinary risk factors of calcium stone disease. Urology. 2000;56:40–4.PubMedGoogle Scholar
  86. 86.
    Taylor EN, Curhan GC. Body size and 24-hour urine composition. Am J Kidney Dis. 2006;48:905–15.PubMedGoogle Scholar
  87. 87.
    Eisner BH, Eisenberg ML, Stoller ML. Relationship between body mass index and quantitative 24-hour urine chemistries in patients with nephrolithiasis. Urology. 2010;75:1289–93.PubMedGoogle Scholar
  88. 88.
    Baxmann AC, De O G Mendonca C, Heilberg IP. Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int. 2003;63:1066–71.PubMedGoogle Scholar
  89. 89.
    Massey LK, Liebman M, Kynast-Gales SA. Ascorbate increases human oxaluria and kidney stone risk. J Nutr. 2005;135:1673–7.PubMedGoogle Scholar
  90. 90.
    Harris KS, Richardson KE. Glycolate in the diet and its conversion to urinary oxalate in the rat. Invest Urol. 1980;18:106–9.PubMedGoogle Scholar
  91. 91.
    Ribaya JD, Gershoff SN. Factors affecting endogenous oxalate synthesis and its excretion in feces and urine in rats. J Nutr. 1982;112:2161–9.PubMedGoogle Scholar
  92. 92.
    Taylor EN, Curhan GC. Fructose consumption and the risk of kidney stones. Kidney Int. 2008;73:207–12.PubMedGoogle Scholar
  93. 93.
    Nguyen NU, Dumoulin G, Henriet MT, Regnard J. Increase in urinary calcium and oxalate after fructose infusion. Horm Metab Res. 1995;27:155–8.PubMedGoogle Scholar
  94. 94.
    Traxer O, Huet B, Poindexter J, Pak CY, Pearle MS. Effect of ascorbic acid consumption on urinary stone risk factors. J Urol. 2003;170:397–401.PubMedGoogle Scholar
  95. 95.
    Thomas LD, Elinder CG, Tiselius HG, Wolk A, Akesson A. Ascorbic acid supplements and kidney stone incidence among men: a prospective study. JAMA Intern Med. 2013;173:386–8.PubMedGoogle Scholar
  96. 96.
    Knight J, Assimos DG, Easter L, Holmes RP. Metabolism of fructose to oxalate and glycolate. Horm Metab Res. 2010;42:868–73.PubMedCentralPubMedGoogle Scholar
  97. 97.
    Bray GA. Energy and fructose from beverages sweetened with sugar or high-fructose corn syrup pose a health risk for some people. Adv Nutr. 2013;4:220–5.PubMedGoogle Scholar
  98. 98.
    Eilliott SS, Keim NL, Stern JS, Teff K, Havel PJ. Fructose, weight gain, and the insulin resistance syndrome. Am J Clin Nutr. 2002;76:911–22.Google Scholar
  99. 99.
    Marriott BP, Cole N, Lee E. National estimates of dietary fructose intake increased from 1977–2004 in the United States. J Nutr. 2009;139:1228S–35S.PubMedGoogle Scholar
  100. 100.
    Nguyen QV, Kalin A, Drouve U, Casez JP, Jaeger P. Sensitivity to meat protein intake and hyperoxaluria in idiopathic calcium stone formers. Kidney Int. 2001;59:2273–81.PubMedGoogle Scholar
  101. 101.
    Knight J, Jiang J, Assimos DG, Holmes RP. Hydroxyproline ingestion and urinary oxalate and glycolate excretion. Kidney Int. 2006;70:1929–34.PubMedCentralPubMedGoogle Scholar
  102. 102.
    Knight J, Easter LH, Neiberg R, Assimos DG, Holmes RP. Increased protein intake on controlled oxalate diets does not increase urinary oxalate excretion. Urol Res. 2009;37:63–8.PubMedCentralPubMedGoogle Scholar
  103. 103.
    Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol. 1999;10:840–5.PubMedGoogle Scholar
  104. 104.
    Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. J Urol. 1996;155:1847–51.PubMedGoogle Scholar
  105. 105.
    Kaelin A, Casez JP, Jaeger P. Vitamin B6 metabolites in idiopathic calcium stone formers: no evidence for a link to hyperoxaluria. Urol Res. 2004;32:61–8.PubMedGoogle Scholar
  106. 106.
    Rao TV, Choudhary VK. Effect of pyridoxine (vitamin B6) supplementation on calciuria and oxaluria levels of some normal healthy persons and urinary stone patients. Indian J Clin Biochem. 2005;20:166–9.PubMedCentralPubMedGoogle Scholar
  107. 107.
    Rattan V, Sidhu H, Vaidyanathan S, Thind SK, Nath R. Effect of combined supplementation of magnesium oxide and pyridoxine in calcium-oxalate stone formers. Urol Res. 1994;22:161–5.PubMedGoogle Scholar
  108. 108.
    Edwards P, Nemat S, Rose GA. Effects of oral pyridoxine upon plasma and 24-hour urinary oxalate levels in normal subjects and stone forms with idiopathic hypercalciuria. Urol Res. 1990;18:393–6.PubMedGoogle Scholar
  109. 109.
    Siener R, Alteheld B, Terjung B, Junghans B, Bitterlich N, Stehle P, et al. Change in the fatty acid pattern of erythrocyte membrane phospholipids after oral supplementation of specific fatty acids in patients with gastrointestinal diseases. Eur J Clin Nutr. 2010;64:410–8.PubMedGoogle Scholar
  110. 110.
    Buck AC, Davied RL, Harrison T. The protective role of eicosapentaenoic acid (EPA) in the pathogenesis of nephrolithiasis. J Urol. 1991;146:188–94.PubMedGoogle Scholar
  111. 111.
    Hammarsten G. Dietetic therapy in the formation of calcium oxalate calculi in the urinary passage. Acta Physiol. 1938;80:165–75.Google Scholar
  112. 112.
    Prieto RM, Fiol M, Perello J, Estruch R, Ros E, Sanchis P, Grases F. Effects of Mediterranean diets with low and high proportions of phytate-rich foods on the urinary phytate excretion. Eur J Nutr. 2010;49:321–6.PubMedGoogle Scholar
  113. 113.
    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. 2002;66:2402–10.Google Scholar
  114. 114.
    Eisner BH, Asplin JR, Goldfarb DS, Ahmad A, Stoller ML. Citrate, malate and alkali content in commonly consumed diet sodas: implications for nephrolithiasis treatment. J Urol. 2010;183:2419–23.PubMedGoogle Scholar
  115. 115.
    Baia Lda C, Baxmann AC, Moreira SR, Holmes RP, Heilberg IP. Noncitrus alkaline fruit: a dietary alternative for the treatment of hypocitraturic stone formers. J Endourol. 2012;26:1221–6.PubMedGoogle Scholar
  116. 116.
    Aras B, Kalfazade N, Tuqcu V, Kemahli E, Ozbay B, Polat H, et al. Can lemon juice be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia? A prospective randomized study. Urol Res. 2008;36:313–7.PubMedGoogle Scholar

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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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