Can lemon juice dissolve kidney stones?

Lemon Juice and Kidney Stone Dissolution

Lemon juice does not dissolve existing kidney stones, but it may help prevent new stone formation in patients with hypocitraturia by increasing urinary citrate levels. 1

Key Evidence on Lemon Juice Efficacy

No Stone Dissolution Capability

• Lemon juice cannot dissolve stones that have already formed—this is a common misconception that lacks scientific support 2, 3
• The only stones that can be dissolved through oral therapy are uric acid stones, which require alkalinization with potassium citrate or sodium bicarbonate to achieve a urine pH of 7.0-7.2, not lemon juice 1

Potential Preventive Role (Limited Evidence)

• One retrospective study of 11 patients showed that long-term lemonade therapy increased urinary citrate levels by a mean of 383 mg/day and reduced stone formation rate from 1.00 to 0.13 stones per patient per year, though this did not reach statistical significance 4
• This same study found lemonade therapy less effective than potassium citrate (which increased citrate by 482 mg/day) 4
• The evidence quality is low—no randomized controlled trials support lemonade therapy for stone prevention 2, 3

Evidence-Based Recommendations from Guidelines

First-Line Prevention Strategies

The American College of Physicians recommends increased fluid intake to achieve at least 2 liters of urine output daily as the primary intervention for preventing recurrent kidney stones. 1

When Fluid Intake Fails

• If increased fluid intake alone is insufficient, pharmacologic monotherapy with thiazide diuretics, citrate (potassium citrate), or allopurinol is recommended for preventing recurrent calcium stones 1
• Potassium citrate remains the first-line pharmacological therapy for documented hypocitraturia 5, 6

Beverage Selection Guidance

• Orange juice showed no association with stone risk in observational studies 5
• Grapefruit juice should be avoided as it increases stone formation risk by 40% 7, 5, 8
• Coffee and tea (both caffeinated and decaffeinated) are associated with reduced stone risk 7, 5

Critical Clinical Pitfalls

Common Misconceptions

• Patients often seek "natural" remedies like lemon juice believing they can dissolve stones, but two-thirds of dietary supplements claiming to treat kidney stones contain ingredients with conflicting or absent scientific evidence 3
• The citrate in lemon juice is far less concentrated and less bioavailable than pharmaceutical potassium citrate 4

What Actually Works

• For uric acid stones specifically, oral chemolysis with potassium citrate or sodium bicarbonate (targeting pH 7.0-7.2) has an 80.5% success rate 1
• For calcium stones, no oral therapy dissolves existing stones—only prevention strategies work 1

Practical Approach

• Prioritize adequate hydration (2-2.5 liters of urine output daily) over specific beverage choices 7, 5, 6
• If a patient has documented hypocitraturia and wants to try lemonade therapy before pharmaceutical citrate, it may be considered as a reasonable alternative, but expectations should be managed regarding its limited efficacy compared to potassium citrate 4
• Monitor 24-hour urine citrate levels to assess whether any intervention (including lemonade) is actually increasing urinary citrate 6, 4