Diet and Kidney Stones: The Ideal Questionnaire

Diet frequently contributes to patients' urinary stone disease. It is important to determine when this is the case and when it is not, as failure to do so may delay the implementation of other, more appropriate therapies. When diet is thought to be involved, one of two approaches may be taken: (1) provide a general list of all possible dietary factors that influence the risk for all types of stones and let the patient decide which dietary change(s) are needed; or (2) prescribe specific modifications that address each patient's need for change and their personal characteristics (i.e., urinary risk factors, type(s) of stones they have formed, dietary preferences, nutrient needs, etc.). The latter of these approaches is "minimally invasive" and is thus consistent with the goal of other therapies. However, this approach requires a rigorous appraisement of each patient's diet and linkage, when possible, to urinary and other stone risk factors. When the collaboration of a registered dietitian nutritionist or other nutrition professional experienced in dietary assessment is not available, screeners or questionnaires may be useful. Unfortunately, there is no such tool that is validated for identifying dietary stone risk factors. The development of a brief, 40-item, stone-specific food screener is described. While further validation is needed, it may provide the basis for a standardized instrument that could be used more broadly; desired features of such an instrument are described. Patient Summary: Personalized nutrition therapy is useful in mitigating the effects or recurrence risk of many chronic diseases. It is also useful in stone disease, a condition with highly variable risk expression, even among patients who form the same types of stones. A standardized and validated stone-specific dietary assessment tool would be valuable in clinical management and in research studies involving the description of patients' diets and dietary intervention.