Recent studies have shown that patients with kidney stone disease, and particularly
calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared
with controls. The alterations of microbiota go far beyond the simple presence and representation of
Oxalobacter formigenes, a well-known symbiont exhibiting a marked capacity of degrading dietary
oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal
microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role
of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor
hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known
risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis
in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of
nutrition in the modulation of microbiota composition, and their relevance for the modulation of
lithogenic risk.
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