**14. Effect of vitamins on urolithiasis**

The role of vitamins in the formation of stone is still uncertain. But according to literature review, vitamins with higher risk of causing urolithiasis are ascorbic acid (vitamin C), pyridoxine (vitamin B6) and calcitriol (vitamin D). A study conducted by Broadus et al., reported that the subjects with increased calcium excretion had high levels of vitamin D in their blood sample which lead to increased absorption of calcium in the intestine. Excluding some special cases, it's not suggestible to give supplementations of vitamin D particularly with combination of calcium to kidney stone patients [86]. High intake of vitamin C (ascorbic acid) has become a widespread practice all over the world as ascorbic acid helps in wound healing and preventing degenerative diseases. Vitamin C is a precursor of oxalate and it may increase excretion of oxalate in urine which a risk factor for calculi formation [87]. Intake of vitamin C around 1300–1500 mg/day is acceptable, if intake increases more than 1500 mg/day it will lead to initiation of crystal formation in urine [88]. Among vitamin B complex Vitamin B6 paly a vital role in reduction of risk of stone formation. Vitamin B6 (Pyridoxine) involves in the metabolism of oxalate, so deficiency of pyridoxine may lead to increased production of

endogenous oxalic acid. Intake of Vitamin B6 around 40–50 mg/day in diet will eventually help to reduce excretion of oxalic acid in urine and reduce the risk of urolithiasis [89, 90]. In a summary, with regards to vitamins adequate amount of all the vitamins should be consumed through the diet as they a play important role in metabolism of vital biomolecules and also helps to maintain good health status of an individual. Kidney stone patients should avoid excess in take of ascorbic acid, and vitamin D supplementations as these have been reported as risk factors for urolithiasis. The patients can be advised to take good amount of pyridoxine as it is considered to reduce the risk of stone formation.

### **15. Conclusion**

The prevalence of kidney stone disease has increased in recent years as a result of modification in eating and life style habits. Changes in urinary composition and urinary saturation is the initial step for stone formation. So, focusing on reducing urinary saturation may help to reduce the initiation of urolithiasis. Various preventive measures are available which could reduce the burden of stone disease. Among all, dietary interventions show promising results in reducing the risk of stone formation as diet shows its direct impact on urinary composition. Among various types of stones, the most prominent stones such as calcium oxalate/phosphate and uric acid stones shows direct association with diet. According to our review of literature diet containing animal protein will increase urinary uric acid concentration which favours the uric acid stone formation. Diet with high oxalate content will increases urinary oxalate and combine with calcium to form calcium oxalate stones. Less fluid intake is one of the major risk factors for urolithiasis as fluid will help to dilute urine and reduce the saturation of urine. Considering these facts avoiding the foods with increased risk of stone formation and consuming balanced diet in kidney stone formers will help to reduce the reoccurrence and eventually help to reduce the prevalence of disease.

#### **16. Summary**

Urolithiasis is a highly prevalent disease with its increased rate in recent years across the world. A change in food habits and intake of high calorie food is one of the main reasons for increased prevalence of kidney stone disease. The main aim of focusing on dietary interventions is to reduce urinary lithogenic risk factors such as increased calciuria, uricosuria, phosphaturia and low urinary pH. According to literature survey it's advisable to cut down high intake of animal protein and excess salt intake as animal protein increases uric acid concentration in urine and salt will increase mineral content of urine. Intake of high calorie food should also be reduced as it's involved in increasing saturation of urine and it may also lead to other health complications such as metabolic syndromes. High intake of aerated or carbonated drinks should be avoided in kidney stone formers as they contain high amount of sugar (Fructose). Along with reduction in consumption of above-mentioned food items it's equally important to consume food items which helps to alkaline the urine and reduce the risk of stone formation. According the literature survey it's advisable to consume good amount of green leafy vegetables with less oxalate content. Adequate amount of vitamins have to be taken in diet as their absence may lead to some deficiency manifestations in an individual. Excess consumption of vitamins such as vitamin D and C should be avoided as they may increase the risk of stone formation. In addition to diet, intake of high quantity of water will help to dilute

*Role of Dietary Supplements in Prevention of Renal Stones: An Update DOI: http://dx.doi.org/10.5772/intechopen.101661*

the urine sample and reduce urinary saturation. As some food items still shows contradictory results on stone formation, so more studies have to be conducted in this regard considering higher population in order to establish the relation of these food items in stone formation which will eventually help to reduce the burden of stone formation.
