Medical and dietary interventions for preventing recurrent urinary stones in children

Kern, Adam; Grimsby, Gwen M.; Mayo, Helen; Baker, Linda A.

doi:10.1002/14651858.cd011252.pub2

Cited by 11 publications

(14 citation statements)

References 41 publications

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“…Potassium citrate binds with sodium in urine and decreases sodium level in urine, increases pH of urine, and ultimately reduces stone formation [ 21 ]. These results were in line with available studies [ 11 , 12 , 20 ]. Potassium citrate is effective in treatment of pediatric urolithiasis.…”

Section: Discussionsupporting

confidence: 93%

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Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

Shen

Zhang²

2018

Med Sci Monit

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BackgroundUrine solute supersaturation leads to the formation of urinary tract caliceal stones. Many parameters can be involved in the supersaturation of solutes in urine, such as pH. Uric acid has pKa ≤5.5, and it is solubilized at pH ≥5.5. The objective of the study was to evaluate the effects of potassium citrate and lemonade supplementation in pediatric patients with urolithiasis.Material/MethodsA total of 126 children who had lower ureteral stones calculi and fragments with severe colic pain participated in this cross-over study. Children drank lemonade (2 mEq/kg/day citrate) in 3 divided doses for 5 days. After a 15-day washout period, children drank 2 mEq/kg/day of potassium citrate in 3 divided doses for 5 days. On the sixth of the day of individual intervention, a 24-h urine sample was collected and evaluated for pH, urine volume, citrate level, uric acid level, magnesium, phosphorus, potassium, and sodium. Urinary parameters for 1-day urine collection measurements after each supplementation were compared with baseline using the Mann-Whitney test following Tukey post hoc test at 95% confidence level.ResultsPotassium citrate supplementation resulted in reduction of sodium concentration (p=0.0337; q=3.76) and increased pH of urine (p=0.0118; q=4.389). However, urine volume, citrate level, and uric acid level, as well as elemental magnesium, phosphorus, and potassium, remained unchanged after 5 days of supplementation with potassium citrate or lemonade.ConclusionsPotassium citrate supplementation is an effective therapy for preventing pediatric urolithiasis, with acceptable adverse effects.

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Section: Discussionsupporting

confidence: 93%

“…A high fluid intake prevents caliceal stones formation by decreasing supersaturation and citrate prevents caliceal stones formation by ionization of urinary calcium [ 10 ]. Lemons, oranges, and grapes are recommended in pediatric urolithiasis [ 11 , 12 ]. Lemonade has 110 mg/kg calcium and 490 g/kg citric acid.…”

Section: Introductionmentioning

confidence: 99%

Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

Shen

Zhang²

2018

Med Sci Monit

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“…The rationale for using citrate salts in kidney stone disease was explained in previous paragraphs and was based on four main issues: (1) citrate salts are rapidly absorbed through the intestine and equally rapidly filtered in the urine; (2) citrate forms calcium citrate complexes, which in turn increase solubility and decrease the amount of free calcium in urine; (3) citrate acts as an inhibitor of CaOx and CaP crystal growth and aggregation, and (4) in the intestine, the complexation between calcium and citrate reduces enteric absorption of calcium, and therefore renal excretion. A recent systematic review has demonstrated that citrate-based therapy reduced recurrent calcium urinary stone formation compared to controls (placebo, usual care) [135]; however, evidence was limited in children [136].…”

Section: Medical Management Of Patients With Metabolic Bone Diseasmentioning

confidence: 99%

Role of Citrate in Pathophysiology and Medical Management of Bone Diseases

et al. 2019

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Citrate is an intermediate in the “Tricarboxylic Acid Cycle” and is used by all aerobic organisms to produce usable chemical energy. It is a derivative of citric acid, a weak organic acid which can be introduced with diet since it naturally exists in a variety of fruits and vegetables, and can be consumed as a dietary supplement. The close association between this compound and bone was pointed out for the first time by Dickens in 1941, who showed that approximately 90% of the citrate bulk of the human body resides in mineralised tissues. Since then, the number of published articles has increased exponentially, and considerable progress in understanding how citrate is involved in bone metabolism has been made. This review summarises current knowledge regarding the role of citrate in the pathophysiology and medical management of bone disorders.

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“…Kan ve idrarın analizi metabolik değerlendirmenin önemli bir parçasıdır, ancak risk değerlendirmesinin ne kadar kapsamlı olması gerektiği taş tipi ve hastalığın ciddiyeti tarafından belirlenir. Postoperatif dönemde uygun hastalarda medikal tedavi ile koruma yapılması taş nüksünü azaltmaktadır (21)(22)(23). İyi yönetilen bir koruyucu tıbbi tedavi sayesinde, taş oluşum aktivitesi vakaların %80' inden fazlasında durdurulabilir (22).…”

Section: Discussionunclassified

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

et al. 2020

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Bu çalışmada üriner sistem taşı olup müdahale öyküsü bulunanlarla primer hastaların preoperatif ve peri-operatif sonuçlarını karşılaştırmayı amaçladık. Gereç ve Yöntemler: Lokal etik kurul onayı alındıktan sonra Ekim 2018-Ocak 2019 tarihlerinde her iki merkezde üriner sistem taşı nedeniyle ameliyat edilen hastalar içerisinden şok dalga litotripsi veya taş cerrahisi öyküsü olmayan 152 primer hasta Grup 1, müdahale öyküsü olan 232 hasta ise Grup 2 olarak çalışmaya alındı. Bulgular: Demografik özellikler iki grupta benzer bulundu. Düşük sosyoekonomik düzey ve düşük eğitim düzeyi olanlar büyük çoğunluğu oluşturmaktaydı. Son 1 yılda yapılan BT görüntüleme sayısı sekonder hastalarda istatistiksel olarak daha fazlaydı (p<0,001). Grup I'de üreter taşları çoğunluğu oluşturmaktayken; Grup 2'de böbrek taşları istatistiksel olarak daha fazlaydı. Taş sayısı primer hastalarda daha düşüktü (p<0,001). Uygulanan baskın prosedür Grup 1'de ureterorenoskopi (URS), Grup 2'de retrograd intrarenal cerrahiydi (RİRC) (p<0,001). Primer hastaların başarı oranı daha yüksek bulundu (p=0,015). Postoperatif medikal tedavi verilenler sekonder hastalarda daha yüksek bulundu (p<0,001). Her iki grup arasında beslenme ve fiziksel aktivite alışkanlığı alışkanlıkları açısından istatistiksel farklılık gözlenmezken; sigara kullananlar Grup 2'de daha yüksek orandaydı (sırasıyla %44,1,%52,2, p=0,044). Sonuç: Üriner sistem taş hastalarının yaklaşık yarısı hayatları boyunca tekrar nüks etmektedir. Sekonder olan bu grupta taş sayısı ve rezidüel fragman kalma ihtimali daha yüksek bulundu. Taşların yerleşimi de sekonder grupta sıklıkla böbrekte olduğu için başarı göreceli olarak daha az bulundu. Taş protokollü bilgisayarlı tomografinin ve postoperatif medikal tedavinin sekonder hastalarda kullanımı daha fazla bulundu. Daha önce taş öyküsü bulunmasının bu konuda etkili olduğunu düşünmekteyiz. Sonuç olarak, sekonder taş hastalarının yönetimi daha zorlu görünmektedir.

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Medical and dietary interventions for preventing recurrent urinary stones in children

Cited by 11 publications

References 41 publications

Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study

Role of Citrate in Pathophysiology and Medical Management of Bone Diseases

Üriner Sistem Taşlarında Önceki Müdahalelerin Preoperatif Faktörlere ve Postoperatif Sonuçlara Etkisi: İki Merkezli Analiz

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