Dietary Calcium and Prevention of Calcium Stones: More or Less?

  • Jodi Antonelli
  • Margaret S. PearleEmail author


Prevention of stone disease is the key to breaking the cycle of recurrence, patient suffering, and mounting costs. Dietary modifications are an attractive means to prevent stone formation because they are generally well tolerated and inexpensive. Although urinary calcium is thought to play an important role in stone formation, since hypercalciuria comprises the most common metabolic abnormality identified in stone formers and approximately 70–80 % of stones contain calcium (Ca), the impact of dietary Ca on urinary Ca levels and risk of urinary stones remains controversial. Moreover, the effect of altering dietary Ca potentially impacts not only stone formation but also bone health. In this chapter we review the evidence regarding dietary Ca and its effects on urinary Ca and stone risk.


Kidney Kidney calculi Metabolic disease/urine Calcium/therapy 


  1. 1.
    Stamatelou KK, Francis ME, Jones CA, Nyberg LM, Curhan GC. Time trends in reported prevalence of kidney stones in the United States: 1976–1994. Kidney Int. 2003 May;63(5):1817–23.PubMedCrossRefGoogle Scholar
  2. 2.
    Peterson AC, Curtis LH, Shea AM, Borawski KM, Schulman KA, Scales CD Jr. Urinary diversion in patients with spinal cord injury in the United States. Urology. 2012 Dec;80(6):1247–51.PubMedCrossRefGoogle Scholar
  3. 3.
    Ljunghall S, Danielson BG. A prospective study of renal stone recurrences. Br J Urol. 1984 April;56(2):122–4.PubMedCrossRefGoogle Scholar
  4. 4.
    Trinchieri A, Ostini F, Nespoli R, Rovera F, Montanari E, Zanetti G. A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol. 1999 July;162(1):27–30.PubMedCrossRefGoogle Scholar
  5. 5.
    Pearle MS, Calhoun EA, Curhan GC, Urologic Diseases of America Project, et al. Urologic diseases in America project: urolithiasis. J Urol. 2005 March;173(3):848–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Saigal CS, Joyce G, Timilsina AR. Urologic Diseases in America Project: direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005 Oct;68(4):1808–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Pak CY. Should patients with single renal stone occurrence undergo diagnostic evaluation? J Urol. 1982 May;127(5):855–58.PubMedGoogle Scholar
  8. 8.
    Coe FL, Parks JH, Asplin JR. The pathogenesis and treatment of kidney stones. N Engl J Med. 1992 Oct 15;327(16):1141–52.PubMedCrossRefGoogle Scholar
  9. 9.
    Bushinsky DA. Nephrolithiasis. J Am Soc Nephrol. 1998 May;9(5):917–24.Google Scholar
  10. 10.
    Wilson DM. Clinical and laboratory approaches for evaluation of nephrolithiasis. J Urol. 1989 March;141(3 Pt 2):770.PubMedGoogle Scholar
  11. 11.
    Pak CY, Britton F, Peterson R, Ward D, Northcutt C, Breslau NA, et al. Ambulatory evaluation of nephrolithiasis: classification, clinical presentation and diagnostic criteria. Am J Med. 1980 July;69(1):19–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Hodgkinson A, Pyrah LN. The urinary excretion of calcium and inorganic phosphate in 344 patients with calcium stone of renal origin. Br J Surg. 1958 July;46(195):10–8.CrossRefGoogle Scholar
  13. 13.
    Parks JH, Coe FL. A urinary calcium-citrate index for the evaluation of nephrolithiasis. Kidney Int. 1986 July;30(1):85.PubMedCrossRefGoogle Scholar
  14. 14.
    Menon M. Calcium oxalate renal lithiasis: endocrinology and metabolism. In: Rajfer J, editor. Urologic endocrinology. Philadelphia: Saunders; 1986. p. 386.Google Scholar
  15. 15.
    Pak CY, Oata M, Lawrence EC, Snyder W. The hypercalciurias Causes, parathyroid functions, and diagnostic criteria. J Clin Invest. 1974 Aug;54(2):387–400.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Worcester EM, Coe FL. Clinical practice. Calcium kidney stones. N Engl J Med. 2010 Sep 2;363(10):954–63.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Albright F, Henneman P, Benedict PH, Forbes AP. Idiopathic hypercalciuria: a preliminary report. Proc R Soc Med. 1953 Dec;46(12):1077–81.PubMedCentralPubMedGoogle Scholar
  18. 18.
    Worcester EM, Coe FL. New insights into the pathogenesis of idiopathic hypercalciuria. Semin Nephrol. 2008 March;28(2):120–32.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    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 June;59(6):2290–8.PubMedGoogle Scholar
  20. 20.
    Pearle MS, Roehrborn CG, Pak CY. Meta-analysis of randomized trials for medical prevention of calcium oxalate nephrolithiasis. J Endourol. 1999 Nov;13(9):679–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Escribano J, Balaguer A, Pagone F, Feliu A, Roqué I Figuls M. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev. 2009;(1):CD004754.Google Scholar
  22. 22.
    Strauss AL, Coe FL, Deutsch L, Parks JH. Factors that predict relapse of calcium nephrolithiasis during treatment: a prospective study. Am J Med. 1982 Jan;72(1):17–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Adams ND, Gray RW, Lemann J Jr. The effects of oral CaCO3 loading and dietary calcium deprivation on plasma 1,25-dihydroxyvitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 1979 June;48(6):1008–16.PubMedCrossRefGoogle Scholar
  24. 24.
    Widrow SH, Levinsky NG. The effect of parathyroid extract on renal tubular calcium reabsorption in the dog. J Clin Invest. 1962 Dec;41:2151–9.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Agus ZS, Gardner LB, Beck LH, Goldberg M. Effects of parathyroid hormone on renal tubular reabsorption of calcium, sodium, and phosphate. Am J Physiol. 1973 May;224(5):1143–8.PubMedGoogle Scholar
  26. 26.
    Bleich HL, Moore MJ, Lemann J Jr, Adams ND, Gray RW. Urinary calcium excretion in human beings. N Engl J Med. 1979 Sep 6;301(10):535–41PubMedCrossRefGoogle Scholar
  27. 27.
    Coe FL, Favus MJ, Crockett T, Strauss AL, Parks JH, Porat A, et al. Effects of low-calcium diet on urine calcium excretion, parathyroid function and serum 1,25(OH)2D3 levels in patients with idiopathic hypercalciuria and in normal subjects. Am J Med. 1982 Jan;72(1):25–32.PubMedCrossRefGoogle Scholar
  28. 28.
    Worcester EM, Gillen DL, Evan AP, Parks JH, Wright K, Trumbore L et al. Evidence that postprandial reduction of renal calcium reabsorption mediates hypercalciuria of patients with calcium nephrolithiasis. Am J Physiol Renal Physiol. 2007 Jan;292(1):66–75.CrossRefGoogle Scholar
  29. 29.
    Borghi L, Meschi T, Maggiore U, Prati B. Dietary therapy in idiopathic nephrolithiasis. Nutr Rev. 2006 July;64(7 Pt 1):301–12.PubMedCrossRefGoogle Scholar
  30. 30.
    Gomes SA, dos Reis LM, Noronha IL, Jorgetti V, Heilberg IP. RANKL is a mediator of bone resorption in idiopathic hypercalciuria. Clin J Am Soc Nephrol. 2008 Sep;3(5):1446–52.PubMedCrossRefGoogle Scholar
  31. 31.
    Heilberg IP, Weisinger JR. Bone disease in idiopathic hypercalciuria. Curr Opin Nephrol Hypertens. 2006 July;15(4):394–402.PubMedCrossRefGoogle Scholar
  32. 32.
    Heller HJ, Zerwekh JE, Gottschalk FA, Pak CY. Reduced bone formation and relatively increased bone resorption in absorptive hypercalciuria. Kidney Int. 2007 Apr;71(8):808–15.PubMedCrossRefGoogle Scholar
  33. 33.
    Holmes RP, Goodman HO, Assimos DG. Contribution of dietary oxalate to urinary oxalate excretion. Kidney Int. 2001 Jan;59(1):270–6.PubMedCrossRefGoogle Scholar
  34. 34.
    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 June;79(6):1226–9.PubMedCrossRefGoogle Scholar
  35. 35.
    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 Mar 25;328(12):833–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Taylor EN, Stampfer MJ, Curhan GC. Dietary factors and the risk of incident kidney stones in men: new insights after 14 years of follow-up. J Am Soc Nephrol. 2004 Dec;15(12):3225–32.PubMedCrossRefGoogle Scholar
  37. 37.
    Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ. Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med. 1997 Apr 1;126(7):497–504.PubMedCrossRefGoogle Scholar
  38. 38.
    Curhan GC, Willett WC, Knight EL, Stampfer MJ. Dietary factors and the risk of incident kidney stones in younger women: Nurses’ Health Study II. Arch Intern Med. 2004 Apr 26;164(8):885–95.PubMedCrossRefGoogle Scholar
  39. 39.
    Taylor EN, Curhan GC. Dietary calcium from dairy and nondairy sources, and risk of symptomatic kidney stones. J Urol. 2013 October;190(4):1255–9.Google Scholar
  40. 40.
    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 Jan 10;346(2):77–84.PubMedCrossRefGoogle Scholar
  41. 41.
    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 July;56(1):72–80.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Heller HJ, Doerner MF, Brinkley LJ, Adams-Huet B, Pak CY. Effect of dietary calcium on stone forming propensity. J Urol. 2003 Feb;169(2):470–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Matsumoto ED, Heller HJ, Adams-Huet B, Brinkley LJ, Pak CY, Pearle MS. Effect of high and low calcium diets on stone forming risk during liberal oxalate intake. J Urol. 2006 July;176(1):132–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Pak CY, Odvina CV, Pearle MS, Sakhaee K, Peterson RD, Poindexter JR, et al. Effect of dietary modification on urinary stone risk factors. Kidney Int. 2005 Nov;68(5):2264–73.PubMedCrossRefGoogle Scholar
  45. 45.
    Pak CY, Heller HJ, Pearle MS, Odvina CV, Poindexter JR, Peterson RD et al. Prevention of stone formation and bone loss in absorptive hypercalciuria by combined dietary and pharmacological interventions. J Urol. 2003 Feb;169(2):465–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006 Feb 16;354(7):669–83.PubMedCrossRefGoogle Scholar
  47. 47.
    Wallace RB, Wactawski-Wende J, O’Sullivan MJ, Larson JC, Cochrane B, Gass M, et al. Urinary tract stone occurrence in the Women’s Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr. 2011 July;94(1):270–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Domrongkitchaiporn S, Sopassathit W, Stitchantrakul W, Prapaipanich S, Ingsathit A, Rajatanavin R. Schedule of taking calcium supplement and the risk of nephrolithiasis. Kidney Int. 2004 May;65(5):1835–41.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA

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