Long-Term Effects of Lemonade Therapyon Hypocitraturic Nephrolithiasis and StoneRecurrence: A Mini Review

Background: We sought to assess the strength of the evidence for long-term lemonade therapy on urinary citrate excretion and stone formation in patients with hypocitraturic nephrolithiasis. Context of the study: A literature search was conducted via PubMed (1970–June 2015) using the key terms “lemonade” and “hypocitraturic nephrolithiasis,” as well as the Medical Subject Headings “medical therapy,” “lemon juice,” and “potassium citrate”. We included peerreviewed articles with English abstracts if they reported a study of hypocitraturic nephrolithiasis that compared consumption of lemonade with pharmacological agents available on the market. Reasons for excluding potentially relevant articles included the lack of a study outcome of direct relevance to hypocitraturic nephrolithiasis and the absence of a direct comparison of lemonade with pharmacological agents. Results: From a total of 339 articles, we identified 51 potentially relevant studies. An examination of the full text of these articles resulted in the exclusion of 45 studies that did not meet the inclusion criteria. A final total of six publications were included in the review. One prospective study and five randomized controlled trials of 226 patients with hypocitraturic nephrolithiasis that compared lemonade with placebos or other regimens were included. Main findings: From this review of currently available published literature, evidence is lacking that lemonade therapy is effective for the prevention of hypocitraturic nephrolithiasis, although many studies show that lemonade can increase urinary citrate levels. Conclusion: There is a lack of evidence supporting lemonade therapy in the prevention of hypocitraturic nephrolithiasis.