Renacidin: A Urinary Calculi Solvent

Ries, Sunčica; Malament, Maxwell

doi:10.1016/s0022-5347(17)65022-5

Cited by 26 publications

(4 citation statements)

References 6 publications

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“…Clinical success [9,10], however, went along with a series of major complications [11][12][13][14][15]. Some cases of death obviously associated with the use of renacidin [16][17][18][19], caused the US Food and Drug Adminis tration (FDA) to withdraw hemiacidrin from use in the upper urinary tract in the USA. Nemoy and Stamey [20] reviewed these cases of death and proved that complica-tions were caused by high intrapelvic perfusion pressure in cases of bacterial infection of the renal pelvic system.…”

mentioning

confidence: 99%

When Is the Indication of Percutaneous Chemolysis Justified?

Heimbach¹,

Winter²,

Hesse³

1995

Urol Int

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Persistent residual stone fragments after extracorporeal Shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with ‘Suby G’ solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone analysis revealed a predominant brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.

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confidence: 99%

When Is the Indication of Percutaneous Chemolysis Justified?

Heimbach¹,

Winter²,

Hesse³

1995

Urol Int

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“…Once in solution, Renacidin was stable for long periods and could be autoclaved or boiled without losing its potency. 8 In 1959, Dr. Mulvaney published the first study describing the in vitro properties of Renacidin (10% hemiacidrin) on 50 human calculi as well as in three human case reports. 9 He and his colleagues found that Renacidin sequestered 400% more mineral than any single organic acid alone, such as citric acid.…”

Section: Development and Introduction Of Hemiacidrin (Renacidin)mentioning

confidence: 99%

“…9,10 Based on Dr. Mulvaney's initial reports, several large case series with modest results were published using Renacidin irrigations to treat catheter encrustation and a variety of renal and bladder stones compositions, not just struvite (Table 1). 8,13,[15][16][17][18][19][20] This increase in clinical use also unveiled some limitations. First, because Renacidin solution contained high levels of magnesium and phosphate, its use was contraindicated in patients with advanced renal disease (creatinine clearance < 10 mL/min).…”

Section: Development and Introduction Of Hemiacidrin (Renacidin)mentioning

confidence: 99%

“…33 Finally, Mulvaney noted that most adverse events seemed to occur at night when nursing care was scarce, and his safety frustrations were echoed by multiple other authors. 3,8,17,23,34 Based on Mulvaney's comments, on August 8, 1963, less than 2 months after their first decision, the FDA approved Renacidin to ''prevent formation of and to dissolve calcifications in catheters in the urinary bladder.'' Interestingly, the ruling on the upper urinary tract remained in place until October 1990, when Renacidin was approved as an ''orphan drug'' for the treatment of renal and bladder calculi of the apatite or struvite variety (United-Guardian Inc., U.S. patent #4,962,208).…”

Section: Development and Introduction Of Hemiacidrin (Renacidin)mentioning

confidence: 99%

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The History of Kidney Stone Dissolution Therapy: 50 Years of Optimism and Frustration With Renacidin

González

Whiting²,

Canales³

2012

Journal of Endourology

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Background and Purpose: Over the last 50 years, chemolysis as a primary or adjuvant treatment for urinary stones has fallen in and out of favor. We review the literature for a historical perspective on the origins and chronology of Renacidin therapy, focusing on landmark studies and impracticalities that have seemingly condemned it to history. Materials and Methods: A MEDLINE search was performed on the topic of chemolysis of urinary calculi. Historical literature was reviewed with regard to stone composition, treatment modalities, outcomes, and complications. Results: A total of 61 articles were reviewed, 40 of which were case series, representing a total of 817 patients studied. Mulvaney first introduced Renacidin in 1959 as a modification of Suby and Albright's 1943 solution.Because of an overabundance of nonstandardized irrigation protocols, six deaths were reported in the early 1960s resulting in a Food and Drug Administration ban on the practice of upper urinary tract stone dissolution. Over time, Renacidin returned to the urologist's arsenal, appearing first as an adjunct to dissolve catheter and bladder calculi and later (1990) as an approved agent for renal pelvis and ureter use. This feat was almost singlehandedly the result of a successful hemiacidrin case series published in 1971 by Nemoy and Stamey. By using daily urine cultures, prophylactic antibiotics, and meticulous intrarenal pressure monitoring, Nemoy and Stamey virtually eliminated all major irrigation complications, paving the way for a flurry of studies. More importantly, they established the link between residual struvite stones, persistent infection, and recurrent staghorn stone formation. Conclusions: Dissolution of urinary calculi by chemolysis has been shown to be safe and effective if performed with sterile urine cultures, prophylactic antibiotics, and low intrapelvic pressures. The pioneers of this therapy are remembered for their attempts to develop an alternative to open surgery, and, in the process, solidified the ''stone-free'' concept for infection-based stones.

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