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. Author manuscript; available in PMC: 2024 Jul 10.
Published in final edited form as: Nat Rev Urol. 2022 Sep 20;19(12):695–707. doi: 10.1038/s41585-022-00647-5

Table 1 ∣.

Common dietary risk factors for calcium and uric acid stones

Dietary risk factor Mechanism Urinary aberrationa Specific
stone risk
Fluid intake insufficient to maintain suitably low urine supersaturation Concentrated urine Increased urine supersaturation for crystal formation All types of stones
Intake of bicarbonate precursors insufficient to compensate for acidogenic foods in diet High dietary acid load inducing bone resorption and increased renal citrate reabsorption Hypercalciuria
Hypocitraturia
Overly acidic urine
CaOx, CaPhos, uric acid
Excessive intake of salt (as NaCl) Expansion of extracellular volume and decreased renal calcium reabsorption in nephron Hypercalciuria CaOx, CaPhos
Excessive calcium supplementation (above the DRI)b Increased intestinal calcium absorption Hypercalciuria CaOx, CaPhos
Excessive vitamin D supplementation (above the DRI)c Increased intestinal calcium absorption Hypercalciuria CaOx, CaPhos
Vitamin D intake insufficient to maintain normal limits Secondary hyperparathyroidism and bone resorption Hypercalciuria CaOx, CaPhos
Calcium intake insufficient to meet needs for bone, especially in the context of increased dietary protein intake Rise in calcitriol production Hypercalciuria CaOx, CaPhos
Calcium intake insufficient to compensate for oxalate load in the diet, especially in the context of malabsorption Increased intestinal absorption of dietary oxalate Hyperoxaluria CaOx
Excessive vitamin C supplementation (>2,000 mg/day) Increased biosynthesis of oxalate
Excessive intake of animal-derived purines Increased uric acid biosynthesis Hyperuricosuria Uric acid

CaOx, calcium oxalate; CaPhos, calcium phosphate; DRI, dietary reference intake. aAssessed using 24-h urine collection. bDRI for calcium is 1,200 mg/day for adults >19 years of age. cDRI for vitamin D is 600 International Units (15 mcg)/day for adults.