<p><strong>In pediatric patients with calcium-based stones and low or relatively low urinary citrate, clinicians should recommend a diet rich in fruits and vegetables. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>In children with calcium-based stones and hypocitraturia, a diet rich in fruits and vegetables is recommended to increase dietary alkali, largely through potassium salts of organic anions. This reduces net acid load and increases urinary citrate, an important inhibitor of calcium stone formation that complexes calcium and inhibits crystal growth and aggregation. This recommendation aligns with adult guidelines, which encourage increased intake of fruits and vegetables and other measures that reduce net dietary acid load.</p>
<p>Adult metabolic studies show that removing fruits and vegetables can markedly lower urinary citrate, while diets characterized by higher fruit/vegetable intake (e.g., DASH-style diets) are associated with more favorable urinary profiles and lower kidney stone risk.<sup>150, 159</sup> Pediatric-specific trial data evaluating food-based alkali strategies are limited, but the mechanistic rationale is highly translatable from that of adults because citrate handling and acid-base effects of dietary alkali are conserved across age groups.</p>