Medical Management of Urinary Stone Disease

Pak, Charles Y.C.

doi:10.1159/000080252

Cited by 53 publications

(24 citation statements)

References 35 publications

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“…Citrate is the most potent stone inhibitor (12,13). The mean normal urinary citrate excretion is 640 mg/24 hours of urine.…”

Section: Discussionmentioning

confidence: 99%

“…Hypocitraturia is usually found in patients with systemic acidosis, hypokalemia, unbalanced diets, and chronic diarrhea. The mechanism of action of citrate in the prevention of calcium urolithiasis relates to its ability to form a complex with calcium in urine as calcium citrate complex, which is more soluble than calcium oxalate (7,12,13). The calcium citrate complex prevents all forms of crystallization by inhibiting spontaneous nucleation of calcium oxalate and/or crystal growth of calcium phosphate and calcium oxalate, by retarding agglomeration of preformed calcium oxalate crystal, and by preventing heterogeneous nucleation of calcium oxalate; monosodium urate citrate also restores the inhibitory properties of Tamn-Horsfall protein (7).…”

Section: Discussionmentioning

confidence: 99%

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Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

et al. 2011

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Objective: To evaluate the preventive effects of alkaline citrate on stone recurrence as well as stone growth post-ESWL or PCNL in patients with calcium-containing stones. Materials and Methods: A total of 76 patients with calcium calculi who were stone-free or had residual stones less than 4 mm following ESWL and PCNL were enrolled. All patients were independently randomized into two groups. The treated group (N = 39) was given 81 mEq per day of oral potassium-sodium citrate (27 mEq three times a day), and the untreated group (N = 37) serving as controls. Blood, twenty-four hour urine analysis, and plain KUB were measured and compared at the baseline and after 12 months. Results: At baseline, hypocitraturia was found in 20 of 39 patients (46.05%) of Group I and 15 of 37 patients (40.5%) of Group II. At 12 months, hypocitraturia was found in 3 of 39 (7.69%) and 14 of 37 (37.83%) of Group I and Group II, respectively (p = 0.007). At the 12 month follow-up, of the stone-free group, 92.3% of the treated group and 57.7% of the control group were still stone free. Of the residual stone group, 30.8% and 9.1 % of treated and control group were stone-free, respectively. The increased stone size found in 7.7% and 54.5% of treated and control groups, respectively. Conclusion: Sodium-potassium citrate provides positive effects on stone-forming activities in calcium stone patients suffering from urolithiasis following treatment with ESWL and PCNL procedures at the 12-month follow-up. With the advantage of high efficiency and low morbidity rates, extracorporeal shock wave lithotripsy (ESWL) has become the therapy of choice for small renal stones. Percutaneous nephrolithotomy (PCNL) is also becoming the therapy of choice for large renal stones due to the less invasive procedure as compared to open nephrolithotomy. These therapies provide good results, associated with an acceptable rate of complications, but unfortunately they do not change the underlying metabolic abnormality. Stone recurrence is usually found after either treatment, even in those with a stone-free post-therapy status. In addition, retained stone fragments following those therapies may reaggregate or constitute a nucleus for new stone formation, thereby causing a high rate of stone growth (1-4). The patient's chances of first episode recurrent stone formation range between 27% and 50% (5,6). Medical treatment should therefore be considered following these interventions, in order to prevent further secondary treatments and hospitalizations. Among the metabolic disorders usually found in recurrent stone forming patients, hypocitraturia Clinical Urology

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“…Citrate is the most potent stone inhibitor (12,13). The mean normal urinary citrate excretion is 640 mg/24 hours of urine.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

et al. 2011

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“…After an initial episode of nephrolithiasis 60-80% of patients form at least one recurrent stone. Several strategies to decrease stone recurrence have been devised, including potassium citrate [7][8][9], thiazide diuretics [10], and reduction of dietary sodium (Na) [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Low Sodium Diet Decreases Stone Formation in Genetic Hypercalciuric Stone-Forming Rats

Krieger

Grynpas

VandenEynde

et al. 2019

Nephron

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Background: Urine (u) calcium (Ca) excretion is directly dependent on dietary sodium (Na) intake leading to the recommendation for Na restriction in hypercalciuric kidney stone formers. However, there is no direct evidence that limiting Na intake will reduce recurrent stone formation. Materials and Methods: We used genetic hypercalciuric stone-forming (GHS) rats, which universally form Ca phosphate (P) kidney stones, fed either a low Na (LNa, 0.05%) or normal Na (NNa, 0.4%) Na diet (D) for 18 weeks. Urine was collected at 6-week intervals. Radiographic analysis for stone formation and bone analyses were done at the conclusion of the study. Results: Mean uCa was lower with LNaD than NNaD as was uP and LNaD decreased mean uNa and uChloride. There were no differences in urine supersaturation (SS) with respect to calcium phosphate (CaP) or Ca oxalate (CaOx). However, stone formation was markedly decreased with LNaD by radiographic analysis. The LNaD group had significantly lower femoral anterior-posterior diameter and volumetric bone mineral density (vBMD), but no change in vertebral trabecular vBMD. There were no differences in the bone formation rate or osteoclastic bone resorption between groups. The LNaD group had significantly lower femoral stiffness; however, the ultimate load and energy to fail was not different. Conclusion: Thus, a low Na diet reduced uCa and stone formation in GHS rats, even though SS with respect to CaP and CaOx was unchanged and effects on bone were modest. These data, if confirmed in humans, support dietary Na restriction to prevent recurrent Ca nephrolithiasis.

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“…Some of the metabolic causes of stones are hypercalciuria, �linical Urolo�y �linical Urolo�y doi: 10.1590/S1677-55382010000500005 hypocitraturia, gouty diathesis, hyperoxaluria and hyperuricosuria (5). Idiopathic hypercalciuria (IH) is the most frequently detected metabolic disorder, varying according to the evaluated region (3,6).…”

Section: Introductionmentioning

confidence: 99%

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

et al. 2010

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Purpose: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). Materials and Methods:Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) -patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) -normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance ≥ 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. Results: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. Conclusion: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

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Medical Management of Urinary Stone Disease

Cited by 53 publications

References 35 publications

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy

Low Sodium Diet Decreases Stone Formation in Genetic Hypercalciuric Stone-Forming Rats

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

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