Perspectives nutritionnelles et métaboliques appliquées au traitement des lithiases rénales

Kidney stone diseases are frequently encountered in Western countries. Treatment is based on general dietary and pharmacological measures that can be applied to any category of lithiasis irrespective of the nature of the crystals that are involved in the process. These measures include a large consumption of water as beverage and treatments with drugs aimed at reducing the endogen synthesis of uric acid (xanthine oxidase inhibitors) and therefore its urinary excretion rate. Due to the high prevalence of obesity and overweight states in persons with nephrolithiasis and as both are key players in lithogenesis, it appears that caloric restricted diets should frequently be prescribed. Beyond these general recommendations, a personalized therapeutic approach should be applied in accordance with the chemical characteristics of kidney stones, the most common being due to the precipitation of calcium oxalate. In all situations, diets should be combined with pharmacological treatments. Alkalinisation of urine is required in both uric acid and cystinic lithiasis. In the latter, bicarbonates should be prescribed at doses largely greater than those usually recommended in persons with uric acid lithiasis.