Calcitriol And Absorptive Hypercalciuria
The main component of kidney stones is calcium oxalate, and, to a lesser extent, calcium phosphate. Increased urinary calcium excretion or hypercalciuria is one of the main risk factors promoting calcium kidney stone formation. Early studies have demonstrated increased intestinal absorption of calcium in most cases of idiopathic hypercalciuria, defining absorptive hypercalciuria . Intestinal calcium absorption depends on the calcium intraluminal concentration , but the main factor responsible for transcellular calcium absorption is 1,25-dihydroxyvitamin D or calcitriol, the active form of vitamin D . Vitamin D, whether produced in the skin from 7-dehydrocholesterol or absorbed from the diet or supplements must actually be activated as 25-hydroxyvitamin D in the liver and then as calcitriol in the kidneys to exert its biological effects.
Calcitriol binds the vitamin D receptor in enterocytes and increases calcium transport across digestive epithelia through the gatekeeper transient receptor potential vanilloid 6 transporter .
Calcitriol also binds VDR in parathyroid cells, decreasing parathyroid hormone synthesis. PTH increases calcium influx through the gatekeeper TRPV5 in distal tubular kidney cells. Thus, PTH decrease by calcitriol may be associated with increased urine calcium excretion .
What Is Kidney Stones
Kidney stones are tiny pieces of minerals that form in the kidneys. These stones can lead to pain, kidney failure, and even death. Kidney stones are actually a form of crystals. As mentioned above, kidney stones are usually made up of calcium and oxalate. A number of factors can increase your risk of kidney stones, such as gender, race, age, and diet. If you notice any symptoms of kidney stones, you should immediately go to the emergency room. Kidney stones can be diagnosed with a simple urine test. X-rays may also be done to determine the exact location of the stones. If necessary, your doctor may perform a procedure to remove the stones.
How To Reduce The Risk Of Kidney Stones In Hyperoxaluria
It is very important in this discussion that an increased excretion of oxalic acid via the urine does not mean that one now also gets kidney stones, which is unfortunately always concluded. Many factors contribute to the development of a kidney stone, of which a chronically elevated oxalic acid level is just one.
Even people with primary hyperoxaluria, in which the liver constantly produces too much oxalic acid due to an enzyme defect, can reduce their risk of kidney stones, e.g. B. drinking 2 to 3 liters of water daily, taking base citrates , trying to take vitamin B6 as described above, take care of a good magnesium supply and take probiotics.
With regard to probiotics, it is known that there are probiotic bacteria that have oxalic acid-degrading properties, e.g. B. Enterococcus faecalis, and presumably also lactobacteria . The rehabilitation of the bodys own microbiome with suitable probiotics is also part of the holistic therapy concept.
The intake of base citrates is recommended as they can prevent the formation of calcium oxalates and thus the formation of kidney stones.
The risk of kidney stones may only increase if there is a magnesium deficiencyWhat is usually not considered in the connection between vitamin C and the risk of kidney stones is the magnesium status of the respective person.
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The Recommended Dietary Allowance
The recommended dietary allowance for vitamin C is based on the amount of vitamin C intake necessary to maintain neutrophil vitamin C concentration with minimal urinary excretion of vitamin C and is proposed to provide sufficient antioxidant protection . The recommended intake for smokers is 35 mg/day higher than for nonsmokers, because smokers are under increased oxidative stress from the toxins in cigarette smoke and generally have lower blood concentrations of vitamin C .
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Study Outcomes And Laboratory Tests
Patient information such as demographic and anthropometric data, past medical and drug history had been collected by physicians of Stone Prevention Clinic of Labbafinejad Hospital, as previously described .
Fasting blood samples were taken from patients and blood serums were separated for the analyses. The 24-hour urine samples were collected with hydrochloric acid 6N as the preservative. Serum 25 D and parathormone were measured by the electrochemiluminescent method . Serum or urine urea, Cr, Ca, phosphorous, sodium , potassium, uric acid, magnesium , citrate and oxalate concentrations were analyzed as reported previously -style and low-oxalate diets. Am J Kidney Dis. 2014 63:456-63.). Relative Supersaturations of CaOx , Ca phosphate and uric acid were calculated using LithoRisk software , using measured 24-hour urine metabolites.
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Should I Cut Out All Foods That Have Oxalate Or Calcium
No, this is a common mistake. Some people think that cutting out all foods that have oxalate or all foods with calcium will keep stones from forming. However, this approach is not healthy. It can lead to poor nutrition and can cause other health problems. A better plan? Eat and drink calcium and oxalate-rich foods together during a meal. Doing this helps oxalate and calcium bind to one another in the stomach and intestines before reaching the kidneys, making it less likely for kidney stones to form in the urine.
Plan Your Plate For Kidney Stones
Does Vitamin C Cause Kidney Stones
Drinking more than a few cups of coffee every day can increase your risk of kidney stones. Vitamin C is an antioxidant that can reduce your risk of getting them. There are also plenty of other foods that contain vitamin C, but not all of them are as rich in it as coffee is. Vitamin C is found in a wide variety of fruits and vegetables, but coffee is the best source of it.
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What Are The Signs Of A Kidney Stone
A kidney stone is a solid mass in your kidney. They can cause a wide range of symptoms, including pain, nausea, vomiting, and blood in your urine. However, some people do not experience any symptoms. If you experience these symptoms, they may be a sign that you have a kidney stone. If youve recently noticed any of the following, you should see your doctor. Pain in the side of your stomach that is constantPain in the lower back or groinBlood in your urinePain that begins suddenly
Vitamin C And Kidney Stones
High doses of vitamin C can increase your risk of the most common type of kidney stone, calcium oxalate.Kidney stones happen when waste accumulates and clumps together in your kidneys, causing pain and difficulty urinating. More than half a million people seek emergency care for kidney stones every year, according to the National Kidney Foundation.
Since the kidneys partly convert the vitamin C you ingest into oxalate, an excess could increase the risk of calcium oxalate kidney stones, according to research from 2015 .
Generally speaking, the vitamin C people get from food isnt likely to be high enough to lead to kidney stones.
However, vitamin C supplements could increase the risk. A 2013 study on 23,355 men found that those who took vitamin C supplements experienced double the rate of kidney stones.
To help minimize the risk of kidney stones, the National Institutes of Health recommends that adults consume no more than
Our bodies cant make vitamin C. Instead, we get it from food or supplements.
Vitamin C offers a number of important benefits for the body, including:
- helping wounds heal
- keeping blood vessels, skin, bones, and cartilage healthy
- improving absorption of other nutrients
A severe vitamin C deficiency can lead to scurvy, a condition that can cause serious complications throughout the body.
A persons levels of vitamin C can also change quickly if they take a supplement or the vitamin is given intravenously.
- red and green bell peppers
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What Are The Symptoms Of Kidney Stones
Kidney stones are crystalline deposits that form in your kidneys. Most people do not have a problem with kidney stones, but some do. If you have kidney stones, they are usually passed through the urine without causing any symptoms. Some people will have pain when passing the stones. Others may have blood in the urine.
Vitamin D Repletion In Stone Formers With Hypercalciuria
| The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. |
| First Posted : February 15, 2011Results First Posted : October 23, 2012Last Update Posted : October 23, 2012 |
- History of nephrolithiasis as per medical record
- Urinary calcium excretion between 150 and 400 mg/day
- 25D deficiency or insufficiency within 3 months of enrollment
Exclusion Criteria:
- Pregnant women, since the optimal dose of vitamin D supplementation in this population has not been rigorously studied.
- Known uric acid, cystine, or struvite stone disease . An exception to this is patients who have passed both uric acid and calcium stones, or patients who have passed stones of mixed composition .
- Hypercalcemia at baseline
- Acute stone event or gross hematuria within the past 2 months
- Recent stone intervention within the past 1 month
- Suspected or known secondary causes of hypercalciuria, such as primary hyperparathyroidism, sarcoidosis, hyperthyroidism, or malignancy
- Addition or dose change of medicines potentially affecting urinary calcium since the baseline 24hour urine collection
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Risk Factors For Kidney Stones
Approximately 1 in 10 people will develop kidney stones. While anyone can develop kidney stones, the following will increase your risk:
- Dehydration due to dry climate or from intense exercise or you simply don’t drink enough water
- Metabolic conditions such as cystinuria, oxaluria or gout
- Use of certain drugs such as protease inhibitors, antibiotics, some diuretics and calcium-based antacids
- Diseases or surgery of the digestive tract including inflammatory bowel disease and gastric bypass surgery
- A diet rich in salt, protein, refined sugars and soft drinks
- You have had kidney stones in the past
- Family history of kidney stones
- Structural abnormalities in the kidney such as ureteropelvic junction obstruction, urinary diversion surgery, horseshoe kidney
- You have polycystic kidney disease or another cystic kidney disease
- Your urine contains high levels of cystine, oxalate, uric acid or calcium
If kidney stones are suspected, your health care provider will order tests to determine if you have kidney stones and to develop a treatment plan. Treatment will depend on how large the stone is, its makeup, whether it is blocking your urinary tract and the degree of pain it is causing.
Is Ginger Good For Kidney Stones
Ginger has vitamin C, magnesium and other minerals that on regular consumption in the form of ginger tea can dissolve and prevent kidney stone formation. Ginger teas flush the kidneys and promote healthy blood pressure and also act as renal tonics to flush extra toxins and prevent bacteria build-up.
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Vitamin C Reduces Sugar Levels
Glucose and vitamin C have very similar molecular structures. They both compete in the body for the biochemical pumps that transport them into the cells.
This means that enough vitamin C reduces your sugar levels⦠and this may reduce your risk or developing kidney stones.
Itâs interesting that our bodies were designed to convert glucose to ascorbic acid. The problem is that this process depends on having an enzyme that most people are missing.
This is one of the reasons why ascorbic acid is more than a vitamin.
Even With A High Dose There Is No Increased Risk Of Kidney Stones
It is also interesting that an earlier and much larger study on this subject came up with a completely different result. At that time, the participant group consisted of more than 45,000 men between the ages of 40 and 75 who were under the scientific observation of researchers from the Harvard School of Public Health over a period of 6 years.
The conclusion of this study read: Our results show no connection between the daily intake of vitamin C and the risk of kidney stones not even when the vitamin C is taken in high doses, with high doses of 1500 mg and more per day were meant.
Three years later a study was published that was carried out over 14 years with more than 85,000 women: The result was that women who took more than 1500 mg of vitamin C per day did not have a higher risk of kidney stones than women who consumed less than 250 mg. It is therefore of no use in terms of kidney stones to restrict vitamin C intake in any way, the researchers conclude.
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A Dozen Ways To Reduce Your Risk Of Kidney Stones
1. Maximize fluid intake. Especially drink fruit and vegetable juices. Orange, grape and carrot juices are high in citrates which inhibit both a buildup of uric acid and also stop calcium salts from forming.
2. Control urine pH. Slightly acidic urine helps prevent urinary tract infections, dissolves both phosphate and struvite stones, and will not cause oxalate stones. And of course one way to make urine slightly acidic is to take vitamin C.
3. Avoid excessive oxalates by not eating rhubarb, spinach, chocolate, or dark tea or coffee.
4. Lose weight. Being overweight is associated with substantially increased risk of kidney stones.
5. Calcium is probably not the real culprit. Low calcium may itself cause calcium stones .
6. Most kidney stones are compounds of calcium and yet many Americans are calcium deficient. Instead of lowering calcium intake, reduce excess dietary phosphorous by avoiding carbonated soft drinks, especially colas. Cola soft drinks contain excessive quantities of phosphorous as phosphoric acid. This is the same acid that is used by dentists to dissolve tooth enamel before applying bonding resins.
7. Take a magnesium supplement of at least the US RDA of 300-400 mg/day. More may be desirable in order to maintain an ideal 1:1 balance of magnesium to calcium. Many people eating “modern” processed-food diets do not consume optimal quantities of magnesium.
10. Persons with cystine stones should follow a low methionine diet and use buffered vitamin C.
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FALLACY #3: ITS BETTER TO TAKE MORE VITAMINS AND MINERALS THAN TOO LITTLE. YOUR BODY WILL PASS OUT THE EXCESS ANYWAY
Vitamin C tends to fall into this category of over-enthusiastic use. Most people think its fine to take as much Vitamin C as they want, said Prof Rosenbloom. I know people who take 10,000mg a day when the upper tolerable limit is 2,000mg a day, she said.
There are repercussions for doing so. Excessively large amounts of Vitamin C have been occasionally linked to hyperoxaluria, a condition where there is too much oxalate in the urine, said Kong. The excess oxalate can combine with calcium to form crystals and possibly, kidney stones. Otherwise, the most common side effects reported include diarrhoea, nausea and vomiting.
Kong also warned against an excessive calcium intake. It can harm the kidneys and reduce absorption of other essential minerals like magnesium and iron, she said, adding that fat-soluble vitamins such as A, D, E, and K are stored longer in the fatty tissues and the liver, and can lead to increased risks of toxicity if consumed excessively.
If youre not sure what the maximum safe limits of the vitamins and minerals are, check here.
FALLACY #4: ITS OK TO TAKE THOSE JUST-EXPIRED GLUCOSAMINE TABLETS
Keeping to the expiry date isnt the only thing to ensure your vitamins effectiveness. Png advised to keep them in a cool and dry place, or refrigerated once opened.
FALLACY #5: ITS OK TO TAKE YOUR SUPPLEMENTS ALL IN ONE GO
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And High Levels Of Calcium Can Result In Kidney Stones
According to Gallagher, hypercalciuria can contribute to kidney stones, he explained in a statement. That excess calcium in the urine can form salts that crystallize, resulting in kidney stones, the experts at Cincinnati Childrens Hospital Medical Center explain. The use of calcium and vitamin D supplementation may not be as benign as previously thought, Gallagher said.
Symptoms of kidney stones include severe pain on either side of your lower back, a stomach ache that doesnt go away, blood in the urine, nausea, vomiting, fever, chills, or urine that smells bad or looks cloudy, per the National Kidney Foundation .
Sensitivity To Vitamin D And Kidney Stones
Many patients affected by absorptive hypercalciuria and kidney stones have calcitriol serum levels within the normal range. It has been hypothesized that these patients are more sensitive to vitamin D, and genetic studies suggested have a linkage between the VDR gene locus coding for the vitamin D receptor and idiopathic calcium stone formation . Some groups identified VDR polymorphisms associated with kidney stone formation, but these results have not been confirmed in large populations . It seems unlikely that the most frequent VDR polymorphisms play an important role in kidney stone formation . It has also been proposed that VDR could be more expressed in kidney stone formers tissues, and a high VDR expression has been shown in hypercalciuric patients leucocytes . In contrast, another group did not provide evidence for VDR overexpression in patients affected by hypercalciuria and urolithiasis . Since vitamin D signalling depends on VDR, but also other transcription factors such as retinoid X receptors, other pathways may explain a higher sensitivity to vitamin D, but the underlying mechanisms remain unknown. At last, vitamin D metabolites may also increase phosphate intestinal absorption . The roles of cholecalciferol and calcitriol in calcium phosphate stone formation remain to be determined.
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