Long-Term Treatment of Calcium Nephrolithiasis with Potassium Citrate

Pak, Charles Y.C.; Fuller, Cindy J.; Sakhaee, Khashayar; Preminger, Glenn M.; Britton, Faye

doi:10.1016/s0022-5347(17)46962-x

Cited by 227 publications

(76 citation statements)

References 23 publications

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“…In the course of our two trials we observed recurrent stones in only 1 patient. This fact confirms the effective ness of alkali citrates for stone prophylaxis as previously demonstrated in long-term trials [9][10][11]. This form of therapy appears to be more effective and better tolerated than other approaches to metaphylaxis (e.g.…”

Section: Resultssupporting

confidence: 86%

Alkali Citrate for Preventing Recurrence of Calcium Oxalate Stones

Hauser¹,

Frick²,

Kunit³

1990

Eur Urol

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Section: Resultssupporting

confidence: 86%

Alkali Citrate for Preventing Recurrence of Calcium Oxalate Stones

Hauser¹,

Frick²,

Kunit³

1990

Eur Urol

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“…The relationship between hypocitraturia and urinary stone formation is well known in distal renal tubular acidosis, chronic diarrheal diseases, urinary tract infection, and in renal insufficiency, but is not clear in idiopathic pediatric Ca-Ox urinary stone disease [23,24]. Under normal conditions, citrate is freely filtered at the glomerulus with a 65-90% reabsorption rate, with almost no secretion by the tubulus [25].…”

Section: Discussionmentioning

confidence: 99%

Metabolic Risk Factors in Pediatric and Adult Calcium Oxalate Urinary Stone Formers: Is There Any Difference?

et al. 2003

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Objectives: Urolithiasis in children is recognized with an increasing frequency, while exact etiological factors remain to be determined. The aim of this study is to compare the metabolic risk factors and saturation of urine in pediatric and adult calcium oxalate (Ca-Ox) stone formers. Methods: A total of 33 pediatric (mean age: 6.8 ± 3.1 years) and 120 adult patients (mean age: 39.7 ± 5.7 years), with documented Ca-Ox urinary stone disease, underwent a comprehensive metabolic evaluation at our institution. Beside a broad serum analysis, concentrations of calcium, oxalate, magnesium, uric acid and citrate were measured in 24-hour collected urine. Saturation of urine was calculated by Marshall-Robertson’s nomograms. Results: Hypocitraturia, observed in 60.6%, and hypomagnesuria, detected in 39.4%, but not hypercalciuria, were the most common metabolic risk factors in the pediatric group. In adults, hypercalciuria still represented one of the major metabolic risk factors, detected in 44.1%, although hypocitraturia, observed in 45.8%, was the most prevalent metabolic risk factor, as it was in the pediatric group. Pediatric cases had significantly (p < 0.05) higher prevalence of hypocitraturia, hypomagnesuria and supersaturated urine when compared to adults. Metabolic abnormalities could be detected in a high percentage (82%) of primary and recurrent pediatric Ca-Ox stone formers, but not in primary adult stone formers. Conclusions: Metabolic risk factors significantly differ in pediatric and adult Ca-Ox stone formers. Hypocitraturia and hypomagnesuria seem to play a major role in stone formation, and metabolic abnormalities can be detected in a significant percentage of both primary and recurrent pediatric stone formers. Thus, a comprehensive metabolic evaluation is of utmost importance for all children with Ca-Ox stones.

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“…The inhibitory effect of citrate on calcium oxalate crystal growth and aggregation is also linked to a direct effect on the crystal surface (3,10). Consequently, and because of lack of significant adverse effects, citrate preparations are widely used in subjects with calcium oxalate nephrolithiasis (2,(11)(12)(13).…”

mentioning

confidence: 99%

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

et al. 2009

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Hypercalciuria is a common cause for stone formation in children. The aim was to delineate the role of urinary citrate in hypercalciuric children for protection against calcium stone formation. We evaluated random urine calcium, citrate, and creatinine in 149 controls, 78 hypercalciuric nonstone formers, and 34 hypercalciuric children with stone. Urine citrate/creatinine was highest in hypercalciuric nonstone formers 899 Ϯ 351 compared with controls 711 Ϯ 328 and stone formers 595 Ϯ 289 (p Ͻ 0.01 vs. both). Calcium/creatinine ratio was similar in hypercalciuric stone and nonstone formers, but significantly higher than controls. Consequently, urine Calcium/citrate ratio (mg/mg) increased from control 0.17 Ϯ 0.17 to 0.41 Ϯ 0.23 (p Ͻ 0.001) in hypercalciuric nonstone formers, and to 0.65 Ϯ 0.46 in stone formers (p Ͻ 0.001 compared with other groups). Area under receiver operating characteristic curve combined with multilevel risk analyses found calcium/citrate ratio of 0.326 to provide good discrimination between control and stone formers. We found 5th percentile for random urine citrate/creatinine ratio in school-aged children to be 176 mg/g, elevated urinary citrate excretion in hypercalciuric children to be protective against stone formation, and urine calcium/citrate ratio to be a good indicator for risk of stone formation. Whether intervention in hypercalciuric children to lower urine calcium/citrate Ͻ0.326 will provide protection against stone formation needs to be studied. (Pediatr Res 66: 85-90, 2009) T he incidence of urolithiasis in children has increased in recent years (1). The risk factors for urolithiasis commonly observed in children are low urine volume, increased urine calcium excretion, and low normal or decreased urinary citrate level (2). Citrate inhibits the spontaneous nucleation of calcium oxalate, crystal growth of calcium oxalate and calcium phosphate, and the heterogeneous nucleation of calcium oxalate by monosodium urate (3-8). Bisaz et al. (9) reported that citrate is responsible for 50% of the inhibitory activity against calcium phosphate precipitation in normal urine. The inhibitory effect of citrate on calcium oxalate crystal growth and aggregation is also linked to a direct effect on the crystal surface (3,10). Consequently, and because of lack of significant adverse effects, citrate preparations are widely used in subjects with calcium oxalate nephrolithiasis (2,11-13).In adult studies, Welshman and McGeown (14), Hobarth and Hofbauer (15) and Nikkila et al. (16) observed that urine calcium/citrate ratio was able to discriminate between stone formers and control population; the latter exhibiting a significantly lower calcium/citrate ratio. However, it was the impression in the above studies that the clinical use of urine calcium/citrate ratio was limited because of its wide range of variability and the influence of age and gender on urinary excretion of citrate. There is limited data on urine calcium/ citrate ratio in either healthy, hypercalciuric, or stone forming child...

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Long-Term Treatment of Calcium Nephrolithiasis with Potassium Citrate

Cited by 227 publications

References 23 publications

Alkali Citrate for Preventing Recurrence of Calcium Oxalate Stones

Alkali Citrate for Preventing Recurrence of Calcium Oxalate Stones

Metabolic Risk Factors in Pediatric and Adult Calcium Oxalate Urinary Stone Formers: Is There Any Difference?

Urine Calcium/Citrate Ratio in Children With Hypercalciuric Stones

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