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Geriatric Nutrition

Articles on Geriatric Nutrition

Learn more about geriatric nutrition, senior health, and elderly care.

Kidney Stones in the Elderly “Kidney Stones in the Elderly” was written by Beverly Garden, RDN, LDN & edited/reviewed by Aly Bouzek, MS, RDN. Kidney stones are common in people of all ages. Men are at least twice as likely to develop kidney stones. In the US, approximately 6% of women and 11% of men will have a kidney stone at one point in their lifetime. (1) Over the past several years, we have seen the prevalence of kidney stones rise in the elderly. 10-20% of people with kidney stones are older than 65 years. This article will explain what kidney stones are, and we will discuss the causes, risk factors, symptoms, diagnosis, treatment, and diet recommendations for prevention. A special focus will be on kidney stones in the elderly. What Are Kidney Stones? Kidney stones are small, hard deposits of minerals or salts that have formed in one or both kidneys. Once the stones have developed, they travel from the kidneys to the bladder via ducts in the kidneys called the ureters. The stones are either excreted in the urine, or surgically removed if they are too large to pass naturally. Kidney stones vary in size from as small as a grain of sand to large enough to block the flow of urine. Kidney stones can be called by many different names. Some of the most common include: Renal stones Urinary stones Renal calculi Nephrolithiasis Urolithiasis Types of Kidney Stones There are 4 main types of kidney stones. Each stone name correlates to the substance that it is made of. Calcium Oxalate Stones Come in the form of calcium oxalate or calcium phosphate Most common type of kidney stone Linked to high-oxalate foods such as chocolate, spinach, potatoes, and nuts Uric Acid Stones Formed from monosodium urate crystals Often attributed to genetics, obesity, diet Can also occur in those who don’t drink enough water every day Struvite Stones These stones contain magnesium and ammonia Caused by urinary tract infections (UTIs) Can form quickly and grow very large More common in elderly due to higher incidence of UTIs Cystine Stones Rare and runs in families with a hereditary disorder called cystinuria (when amino acid, cystine, drains through kidneys and into urine Risk Factors for Kidney Stones in the Elderly There are several risk factors for kidney stones. These include: Personal History Those who have already had kidney stones have a greater risk of developing them in the future. Family History Those with family members who have had kidney stones or who have certain genetic markers are more likely to develop kidney stones. Obesity and/or Weight Gain A higher Body Mass Index (BMI) or waist measurement, and/or weight gain can increase the risk of kidney stone formation. Dietary Factors Dietary factors that can contribute to kidney stones include: Low water intake High salt and sugar intake High protein intake Low calcium intake High oxalate intake High purine intake (These will be discussed in more detail below) Hydration Those who don’t drink enough, live in warm, dry climates, or who sweat excessively may be at higher risk of stone formation. Kidney stone formation is more likely in conditions which cause dehydration, like chronic diarrhea or certain bowel or digestive diseases (like IBS). Certain Conditions Kidney stones are more common when certain diseases or conditions increase or decrease substances in the body. These include: Hypercalciuria (too much calcium in the urine) Diabetes Osteoporosis Gout Cysts on the kidney Parathyroid disease Irritable bowel disease Chronic diarrhea Metabolic disorders Hereditary conditions Gastric bypass surgery and other surgeries of the intestines UTIs Medications and Supplements Some people are more prone to kidney stones when on certain dietary supplements and medications, such as: Migraine medications Depression medications Seizure medications Diuretics (also called water pills) Antacids containing calcium (often used to treat osteoporosis) Antibiotics Laxatives (prolonged use) Vitamin D supplements in excess Vitamin C supplements Calcium supplements Older adults are more likely to have several chronic health conditions such as diabetes, chronic UTIs, and osteoporosis, which are known risk factors for kidney stones. Taking multiple medications and supplements to treat these conditions, can increase the risk of kidney stones. Symptoms of Kidney Stones in the Elderly A kidney stone usually doesn’t cause symptoms until it moves into the ureters or becomes relatively large. It is possible to pass a small stone in your urine and not know it due to experiencing little-to-no pain. Elderly are more likely to have no symptoms when compared to younger individuals. However, older adults are twice as likely to be hospitalized as a result of a kidney stone and have a higher risk of infection and sepsis. (2) Those with any of the following symptoms (as they could indicate a kidney stone) should seek treatment right away: Intense, sharp pain in your side and back, which may come and go Painful urination Frequent urination or having trouble urinating Blood in urine or cloudy or clouding urine Urine with a strong odor Nausea and vomiting, particularly if it coincides with pain Fever and/or chills Pyuria (pus in urine) and diarrhea-- more common in elderly Diagnosis of Kidney Stones in the Elderly A doctor will most likely use several sources of information to diagnose a kidney stone. Some of these include: Medical history and physical examination Imaging tests such as an x-ray, CT scan and ultrasound Blood tests to check how well the kidneys are working and look for infection Urine tests to check for infection and measure the levels of minerals and salts that form kidney stones Lab analysis of passed stones Sometimes those who are passing a kidney stone are asked to urinate into a strainer, so a lab analysis can be done to determine what materials are in the stone. This will help the doctor determine the cause of the kidney stone and how to prevent stones in the future. Treatment of Kidney Stones in the Elderly Some kidney stones are small enough to eventually pass in the urine. Although this can be very painful, the doctor may decide treatment is not necessary and may recommend extra fluids to help flush out the stone through the urine. Medications However, medications may also be prescribed for the following reasons: Pain control: may be over-the-counter, or through an IV if in the emergency room or hospital Nausea and vomiting Medications to relax the ureter so the stone can pass Surgery Any of the following surgeries may be necessary if the stone is too large to pass, if it blocks the flow of urine, or if an infection is present. Shockwave lithotripsy High energy shockwaves are used to break up the stones, so they can more easily pass through the urinary tract. Ureteroscopy An ureteroscope is inserted through the urethra and the stones are removed or broken apart, so they can be passed in the urine. Percutaneous nephrolithotomy (PCNL) A surgeon enters through a tiny incision made in your back and uses a special instrument to locate and remove the stones (if they are too large, heavy, numerous, or difficult to reach via the above methods). Nutrition Recommendations to Prevent Kidney Stones in the Elderly The following guidelines may help prevent kidney stones in the elderly: Adequate fluids Eat less salt Weight management Eat enough calcium Avoiding excessive oxalate intake Avoid excessive protein Eat fruits and vegetables Avoid high vitamin C supplementation Avoid additional calcium supplements Avoid excessive purine intake Additional guidelines (herbal supplements, juices, caffeine, etc.) Whew! This is a long list. Follow along below as we dive deeper into each of these nutrition recommendations. Adequate Fluids It is important to drink enough fluids so that the concentration of waste products in the urine is lower. Frequent urination caused by drinking enough fluids helps flush out substances in the body that can lead to kidney stones. Paying extra attention to hydration is especially important for seniors, who often have lower urine output, have decreased sensations of thirst, and are more prone to dehydration. Water is a better choice of fluid than sugar-filled beverages such as soda or sports drinks, since added sugar has been shown to be a risk factor for some kidney stones. Drinking more fluid may not be recommended due to certain health conditions, such as problems with the heart or kidneys in older individuals. Please check with a healthcare professional about the right amount of fluid intake for you. Eat Less Salt High sodium diets have been linked to kidney stones. In addition to limiting salt added during cooking and at the table, cutting back on the following foods will help decrease sodium in your diet: Processed or smoked meats such as luncheon meats, sausage, bacon, and ham Canned foods such as soup Frozen meals Boxed food Fast food Snack foods such as potato chips and pretzels Seek the help of a registered dietitian if you’d like to learn more about sodium and how to lower it in your or your loved one’s diet. Weight Management Obesity has been found to be a risk factor for some types of kidney stones. Any weight loss efforts should first be discussed with a doctor, particularly in the elderly. Pursuing weight loss in older adults can be tricky for a few reasons: The elderly are at particular risk for malnutrition and its negative effects on the body. A diet too restrictive could cause more harm than good. (To learn more, check out our blog articles: “Understanding Protein Calorie Malnutrition” and “Chronic Malnutrition in Seniors”). Weight loss that is too rapid is a risk factor for kidney stones. High protein weight loss diets add to the risk of kidney stone formation. If your doctor recommends weight loss, then it is a good idea to seek the guidance of a registered dietitian to accomplish weight loss safely and also helps to minimize the risk of kidney stones. Eat Enough Calcium and Avoid Excessive Oxalate Since calcium stones are made up of calcium oxalate, your first thought may be to avoid foods containing higher levels of calcium. However, doing so may actually increase the risk for developing kidney stones. If prone to calcium oxalate stones, it is recommended to eat a diet higher in calcium and lower in oxalate. This is because high calcium foods bind to oxalate before it can make it to the kidneys to form a stone. Examples of high calcium foods with low levels of oxalate include: Dairy products such as milk, yogurt and cheese Calcium fortified milk substitutes such as almond milk, soy milk, and rice milk Calcium-fortified juices Calcium-fortified cereals Vegetables such as kale, broccoli, collard greens, and turnip greens White beans Salmon Examples of high oxalate foods to reduce in your diet include: Rhubarb Spinach Strawberries Tea Dried beans and peas Nuts Wheat bran Beets Chocolate Avoid Excessive Protein Although it is important to get adequate protein in the diet, excessive protein intake can cause the kidneys to release more calcium, which can increase kidney stone formation. Examples of high protein foods to eat in moderation include: Meats (pork, beef, lamb, etc.) Poultry Eggs Seafood Dairy Eat Your Fruits and Veggies! Kidney stone formation is less likely with a diet rich in fruits and vegetables. Eating plenty of fruits and vegetables will result in your urine having less acid, making kidney stone formation less likely. Avoid High Doses of Vitamin C For adults 50 years of age and older, the recommended dietary intake of Vitamin C is 90 mg/day for men and 75 mg/day for women. Vitamin C supplement intake of 1000 mg/day or more may cause an increase in the production of oxalate in the body, which can be a risk factor for kidney stones. Age Total Dietary Vitamin C Men 50 years and older 90 mg/day Women 50 years and older 75 mg/day Avoid Extra Calcium Supplements Those taking too high of a calcium supplement are at a high risk for developing kidney stones. The Recommended Dietary Allowance (RDA) for calcium for men and women over 70 years old is 1200 mg. Avoid Excessive Purine Intake Those susceptible to uric acid kidney stones may be advised to follow a LOW purine diet. Examples of HIGH purine foods include: Red meat Organ meats such as liver Beer/alcoholic beverages Shellfish Sardines Anchovies Other Dietary Factors to Consider Keep reading to learn a bit more about additional dietary factors to consider when it comes to kidney stones in the elderly (and at any age). Herbal Supplements Insufficient studies have been completed to recommend any herbal supplement to prevent or treat kidney stones. Cranberry Juice Cranberry juice may help prevent UTI’s (which in turn could lower the risk of kidney stones), but it has not been shown to directly lower the risk of kidney stones. Apple Cider Vinegar Apple cider vinegar may help prevent kidney stones because it creates an environment that makes it difficult for bacteria to grow, thus decreasing the risk of a UTI (and decreasing the risk of kidney stones). Be sure to consult your healthcare provider before taking. Citrates Citrates are found in citrus fruits (lemon, limes, oranges) and melons and may help prevent kidney stones. Coffee Coffee has been shown to reduce the risk of kidney stones. Vitamin B6 Vitamin B6 may help prevent kidney stones in people with high urine oxalate levels. Want to learn even more about kidney stone nutrition? Melanie Betz MS, RD, CSR, CSG, The Kidney Dietitian, has a 6-week course that will help you feel confident when it comes to eating for kidney stone prevention. Check out Melanie’s VIP Kidney Stone Nutrition School now*! *As an affiliate, I receive a commission on qualifying purchases at no additional cost to you. Conclusion Kidney stones in the elderly is a growing concern. Older adults with kidney stones have a higher rate of infection, sepsis, and hospitalization than younger adults. Multiple factors can contribute to kidney stones in the elderly. Some factors are difficult to change or cannot be changed. For example, diagnosed health problems such as diabetes, osteoporosis and digestive problems. Certain medications can also contribute to kidney stones, but may be necessary to manage chronic conditions. When looking to prevent or decrease kidney stones, some risk factors can be controlled, such as: Eating a diet high in fruits, vegetables, and calcium Eating moderate amounts of salt, sugar, and protein Staying hydrated Additionally, avoiding excessive calcium and vitamin C supplements, and being aware of oxalates (if needed) can help prevent or decrease kidney stones in the elderly. Check with your health care team before making changes to your diet or fluid intake.

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