Citric Acid and Kidney Stones

What is it?
Citric acid, is an organic acid found in many fruits and fruit juices. Unlike minerals
and vitamins, it is not crucial in the human diet. However, it protects us against
kidney stones.
How does it work?
Citrate binds with calcium in the urine, reducing the amount of calcium available to
form calcium oxalate stones. It also prevents tiny calcium oxalate crystals that are
already in the kidneys from growing and attaching together into larger stones. It also
makes the urine less acidic, which prevents the development of both calcium oxalate
and uric acid stones.
* Citric acid should not to be confused with Vitamin C or ascorbic acid.
What are the best food sources of citric acid?
Citric acid is found mostly in citrus fruits and fruit juices. Lemon and lime juice,
straight from the fruit, contain the highest concentration of citric acid. Other sources
include oranges, grapefruits and berries (except blueberries). Pharmacological sources
of citric acid, prescribed as potassium citrate are also extremely effective in treatment
of kidney stones. However, treatment has gastrointestinal side effects such as bloating
and diarrhea. It is costly and up to 3 doses might be required daily. (Taken only as
prescribed by your physician)
Food source
Lemon juice from fruit
Lime juice from fruit
Grapefruit juice, RTC
Orange juice, RTC
Orange juice from fruit
Lemonade, RTC
Lemonade, crystallized, sugar-free

Grams of Citric acid/ 4 oz

5.8 g
5.5 g
3g
2g
1.1 g
0.7 g
0.3 g

-Ready to consume= RTC

1 lemon/lime provides 2 oz juice
*4 ounces of pure lemon juice/ day is the same as, 32 ounces or ready-to-consume
lemonade/ day
In addition to increasing your citric acid consumption, it is necessary to increase fluid
intake, in the form of water, diluted lemon juice in water, sugar- free lemonade etc. (at
least 10 8- ounce glasses daily). Stay away from sugary foods and Vit C, as they
increase the risk of kidney stone formation.

*Increase your fluid intake to prevent kidney stones.

Easy tips to increase your citric acid intake:
1. Freeze lemon in your ice cube tray. Use these cubes for sprucing
up plain water. Remember to drink at least 10 glasses of fluid daily
to keep your urine diluted enough to prevent stones.
2. Liven up your salads with some lemon juice. Most fruits and
vegetables contain small amounts of citric acid, so this will only help you! You
can even add lemon juice to steamed or sauted vegetables.
3. Spruce up your water with lemon juice. Dilute 2 oz lemon juice with 8 oz
water, once in the morning and once in the evening to reach your goal of 4 oz
lemon juice daily.
4. Stock up on reduced sugar lemonade! Drink low calorie, reduced
sugar lemonade such as Crystal Light, Minute Maid and Tropicana
Light. (32 oz recommended daily). You can even try homemade
lemonade by squeezing 4 ounces (1/2 cup) of lemon juice in a cold
pitcher of water. Add minimal sugar, or sugar substitutes such as honey.
You can even try ready-to-consume orange or grapefruit juice.
5. Squeeze lemon juice on meats. Lemon juice can add flavor to fish,
marinades or any type of meat.

Resources1. Koff S, Paquette E. Comparison between lemonade and Potassium Citrate and
impact on urine pH and 24- hour urine parameters in patients with kidney
stone formation. Urology. 2007;69(6):1013-1016.
2. Penniston K. Quantitative Assessment of Citric Acid in Lemon Juice, Lime
Juice, and Commercially- Available Fruit Juice Products. Journal of
Endourology. 2008; 22 (3)
3. Steele T, Penniston K. Lemonade Therapy Increases Urinary Citrate and Urine
Volumes in Patients with Recurrent Calcium Oxalate Stone Formation.
Urology. 2007;70(5):856-860.
4. Penniston K. Citric Acid and Kidney Stones. UW Hospital Metabolic Stone
Clinic.

Preparedby:TanviDalal,RutgersUniversity,2015