What are the functional medicine approaches for managing nephrolithiasis (kidney stones)?

From the Guidelines

Functional medicine support for kidney stones should prioritize increased fluid intake to achieve at least 2 L of urine per day to prevent recurrent nephrolithiasis. This approach is based on the recommendation by the American College of Physicians (ACP) [ 1 ], which suggests that increased fluid intake is a crucial step in preventing the recurrence of kidney stones.

Key Components of Functional Medicine Support

• Increase water intake to at least 2-3 liters daily to dilute stone-forming substances in urine
• Adopt a diet low in oxalate and moderate in animal protein, while increasing citrate-rich foods like lemons, limes, and oranges
• Consider supplementing with magnesium citrate, vitamin B6, and potassium citrate to inhibit stone formation, as these supplements can help alter urinary chemistry to create less favorable conditions for crystal formation [ 1 ]
• Reduce sodium intake to below 2,300mg daily and limit added sugars, especially fructose, to minimize the risk of stone recurrence

Pharmacologic Management

For patients with active disease in which increased fluid intake fails to reduce the formation of stones, pharmacologic monotherapy with a thiazide diuretic, citrate, or allopurinol may be recommended [ 1 ]. This approach can help prevent recurrent nephrolithiasis by reducing the concentration of lithogenic factors and increasing the concentration of inhibitors of stone formation.

Additional Considerations

• Consider adding probiotics containing Oxalobacter formigenes to improve oxalate metabolism
• Use anti-inflammatory herbs like turmeric for acute pain management and apply heat to the affected area
• Maintain normal dietary calcium intake, as it can help bind to oxalate in the gut and reduce its absorption [ 1 ]

From the FDA Drug Label

A fluid intake sufficient to yield a daily urinary output of at least 2 liters and the maintenance of a neutral or, preferably, slightly alkaline urine are desirable to (1) avoid the theoretical possibility of formation of xanthine calculi under the influence of therapy with allopurinol tablets and (2) help prevent renal precipitation of urates in patients receiving concomitant uricosuric agents The dose of allopurinol tablets recommended for management of recurrent calcium oxalate stones in hyperuricosuric patients is 200 to 300 mg/day in divided doses or as the single equivalent Clinical experience suggests that patients with recurrent calcium oxalate stones may also benefit from dietary changes such as the reduction of animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake, as well as an increase in oral fluids and dietary fiber

Kidney Stones Functional Medicine Support:

• The recommended dose of allopurinol for managing recurrent calcium oxalate stones is 200-300 mg/day.
• Patients may also benefit from dietary changes, including reducing animal protein, sodium, refined sugars, oxalate-rich foods, and excessive calcium intake.
• Increasing oral fluids and dietary fiber may also be helpful.
• A daily urinary output of at least 2 liters and a neutral or slightly alkaline urine pH are desirable to help prevent renal precipitation of urates 2 2.

From the Research

Kidney Stones Functional Medicine Support

• The formation of kidney stones can be influenced by various factors, including hypocitraturia, which is a common biochemical alteration in calcium stone formation in adults and children 3.
• Dietary modifications can play a crucial role in preventing kidney stone recurrence, including high intake of fluids and fruits, especially citrus, sodium and protein restriction, and normal calcium intake 3, 4, 5.
• Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently 3, 6.
• Increasing fluid intake to produce at least 2.5 L of urine daily is a well-established preventive strategy to reduce the risk of kidney stones, and digital health technology may be used to improve adherence to this recommendation 7.
• Lifestyle modifications, such as increased fluid intake, and pharmaceutical therapy, such as thiazide diuretics, allopurinol, or citrates, may be recommended for patients with recurrent calcium stones 4, 5.
• Management of kidney stone disease requires a comprehensive approach, including medical history, basic laboratory evaluation, and imaging, as well as tailored preventive measures based on individual risk factors 4, 5.