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Bargagli M, Anderegg MA, Fuster DG. Effects of thiazides and new findings on kidney stones and dysglycemic side effects. Acta Physiol (Oxf) 2024; 240:e14155. [PMID: 38698738 DOI: 10.1111/apha.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Thiazide and thiazide-like diuretics (thiazides) belong to the most frequently prescribed drugs worldwide. By virtue of their natriuretic and vasodilating properties, thiazides effectively lower blood pressure and prevent adverse cardiovascular outcomes. In addition, through their unique characteristic of reducing urine calcium, thiazides are also widely employed for the prevention of kidney stone recurrence and reduction of bone fracture risk. Since their introduction into clinical medicine in the early 1960s, thiazides have been recognized for their association with metabolic side effects, particularly impaired glucose tolerance, and new-onset diabetes mellitus. Numerous hypotheses have been advanced to explain thiazide-induced glucose intolerance, yet underlying mechanisms remain poorly defined. Regrettably, the lack of understanding and unpredictability of these side effects has prompted numerous physicians to refrain from prescribing these effective, inexpensive, and widely accessible drugs. In this review, we outline the pharmacology and mechanism of action of thiazides, highlight recent advances in the understanding of thiazide-induced glucose intolerance, and provide an up-to-date discussion on the role of thiazides in kidney stone prevention.
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Affiliation(s)
- Matteo Bargagli
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Manuel A Anderegg
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
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Steely A, Worcester E, Prochaska M. Contrasting Response of Urine Stone Risk to Medical Treatment in Calcium Oxalate versus Calcium Phosphate Stone Formers. KIDNEY360 2024; 5:228-236. [PMID: 38251931 PMCID: PMC10914189 DOI: 10.34067/kid.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Key Points Thiazide treatment successfully lowered urine calcium and both calcium oxalate and calcium phosphate supersaturations in both types of stone formers (SFs). Alkali therapy may not confer the same benefits on calcium phosphate SFs as it does on calcium oxalate SFs. Background Randomized controlled trials have shown that both thiazide diuretics and potassium citrate (K-Cit) can prevent calcium stone recurrence, but most participants formed calcium oxalate (CaOx) stones. While thiazides are expected to lower risk of calcium phosphate (CaP) stone formation, the effect of K-Cit on risk of CaP stone formation is unclear. Methods To study the effect of common calcium stone treatments, we analyzed the 24-hour urines of CaOx and CaP stone formers (SFs) by four treatment types: Lifestyle, K-Cit, Thiazide, or Both medications. Results Patients treated with thiazides reduced urine calcium in both CaOx (M =−74.4, SD =94.6 mg/d) and CaP (M =−102, SD =99.7 mg/d) SFs while those on K-Cit had no change in urine calcium. Among CaOx SFs, urine citrate rose in patients administered K-Cit with or without thiazide, but citrate did not rise significantly in CaP SFs. Urine pH rose in all CaOx SFs, but among CaP SFs, only rose in patients receiving K-Cit. CaOx supersaturation (SS) decreased in all patients who received Thiazide, and decreased among CaOx SFs treated with K-Cit. CaP SS decreased in both CaOx SFs (M =−0.46, SD =0.86) and CaP SFs (M =−0.76, SD =0.85) treated with Thiazide, except CaOx SFs who received Both. Patients treated with K-Cit alone increased CaP SS in CaOx SFs (M =0.25, SD =0.79). Conclusions Patients treated with Thiazide lowered urine calcium and SS in both stone groups. Patients treated with K-Cit had no significant changes in urine calcium and had a decrease in CaOx SS in CaOx SFs. The study raises questions about the best preventive treatment for patients with CaP stones and suggests that K-Cit may not confer the same benefits on CaP SFs as it does on CaOx SFs.
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Affiliation(s)
- Audrey Steely
- Department of Medicine, University of Chicago, Chicago, Illinois
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Langman CB, Assimos D, Blank M, Calle J, Grauer A, Kausz A, Milliner D, Nazzal L, Smith K, Tasian G, Thompson A, Wood KD, Worcester E, Yang S, Malley MA, Knauf F, Lieske JC. End Point Considerations for Clinical Trials in Enteric Hyperoxaluria. Clin J Am Soc Nephrol 2023; 18:1637-1644. [PMID: 37342976 PMCID: PMC10723917 DOI: 10.2215/cjn.0000000000000234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
Enteric hyperoxaluria is a medical condition characterized by elevated urinary oxalate excretion due to increased gastrointestinal oxalate absorption. Causative features include fat malabsorption and/or increased intestinal permeability to oxalate. Enteric hyperoxaluria has long been known to cause nephrolithiasis and nephrocalcinosis, and, more recently, an association with CKD and kidney failure has been shown. Currently, there are no US Food and Drug Administration-approved therapies for enteric hyperoxaluria, and it is unclear what end points should be used to evaluate the efficacy of new drugs and biologics for this condition. This study represents work of a multidisciplinary group convened by the Kidney Health Initiative to review the evidence supporting potential end points for clinical trials in enteric hyperoxaluria. A potential clinical outcome is symptomatic kidney stone events. Potential surrogate end points include ( 1 ) an irreversible loss of kidney function as a surrogate for progression to kidney failure, ( 2 ) asymptomatic kidney stone growth/new stone formation observed on imaging as a surrogate for symptomatic kidney stone events, ( 3 ) urinary oxalate and urinary calcium oxalate supersaturation as surrogates for the development of symptomatic kidney stone events, and ( 4) plasma oxalate as a surrogate for the development of the clinical manifestations of systemic oxalosis. Unfortunately, because of gaps in the data, this Kidney Health Initiative workgroup was unable to provide definitive recommendations. Work is underway to obtain robust information that can be used to inform trial design and medical product development in this space.
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Affiliation(s)
- Craig B. Langman
- Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Dean Assimos
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melanie Blank
- Office of Therapeutic Products, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Juan Calle
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Dawn Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Lama Nazzal
- Department of Medicine, Division of Nephrology, New York University School of Medicine, NYU Langone Health, New York, New York
| | - Kimberly Smith
- Office of Medical Policy, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Greg Tasian
- University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aliza Thompson
- Division of Cardiology and Nephrology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Kyle D. Wood
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elaine Worcester
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Sixun Yang
- Division of Vaccines and Related Products Applications, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Nephrology, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Kowalczyk NS, Prochaska ML, Worcester EM. Metabolomic profiles and pathogenesis of nephrolithiasis. Curr Opin Nephrol Hypertens 2023; 32:490-495. [PMID: 37530089 PMCID: PMC10403267 DOI: 10.1097/mnh.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW Kidney stone disease is caused by supersaturation of urine with certain metabolites and minerals. The urine composition of stone formers has been measured to prevent stone recurrence, specifically calcium, uric acid, oxalate, ammonia, citrate. However, these minerals and metabolites have proven to be unreliable in predicting stone recurrence. Metabolomics using high throughput technologies in well defined patient cohorts can identify metabolites that may provide insight into the pathogenesis of stones as well as offer possibilities in therapeutics. RECENT FINDINGS Techniques including 1H-NMR, and liquid chromatography paired with tandem mass spectroscopy have identified multiple possible metabolites involved in stone formation. Compared to formers of calcium oxalate stones, healthy controls had higher levels of hippuric acid as well as metabolites involved in caffeine metabolism. Both the gut and urine microbiome may contribute to the altered metabolome of stone formers. SUMMARY Although metabolomics has offered several potential metabolites that may be protective against or promote stone formation, the mechanisms behind these metabolomic profiles and their clinical significance requires further investigation.
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Sardari Masihi L, Borumandnia N, Taheri M, Basiri A, Imani H, Jalali S, Tavasoli S. Effect of two vitamin D repletion protocols on 24-h urine calcium in patients with recurrent calcium kidney stones and vitamin D deficiency: a randomized clinical trial. Eur J Med Res 2023; 28:246. [PMID: 37481570 PMCID: PMC10362614 DOI: 10.1186/s40001-023-01226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/13/2023] [Indexed: 07/24/2023] Open
Abstract
OBJECTIVES To evaluate the effects of two vitamin D repletion therapies (cholecalciferol) on serum levels of 25-hydroxyvitamin D (25(OH)D) and 24-h urine calcium in patients with recurrent calcium kidney stones and vitamin D deficiency (VDD). DESIGN, SETTING, PARTICIPANTS A parallel-group randomized controlled clinical trial on patients who referred to Labbafinejad kidney stone prevention clinic, Tehran, Iran. From 88 recurrent calcium stone formers, 62 patients completed the study. The age of participants was 18-70 years who had serum 25(OH)D levels of 10-20 ng/ml. INTERVENTION Participants received oral cholecalciferol 2000 IU daily for 12 weeks or 50,000 IU weekly for 8 weeks. MAIN OUTCOME MEASURES Study variables including 24-h urine calcium, supersaturations of calcium oxalate and calcium phosphate, serum 25(OH)D and parathyroid hormone were measured at the beginning of the study and after 12 weeks. RESULTS The 24-h urine calcium significantly increased in both groups (β = 69.70, p < 0.001), with no significant difference between treatments. Both groups showed no significant change in the supersaturation levels of calcium oxalate and calcium phosphate. Serum levels of 25(OH)D increased significantly (β = 12.53, p < 0.001), with more increase in the 50,000 IU group (β = 3.46, p = 0.003). Serum parathyroid hormone decreased in both groups (p < 0.001). CONCLUSIONS Although both treatment protocols increased 24-h urine calcium, they did not increase the supersaturation state of calcium oxalate or calcium phosphate. Trial registration IRCT20160206026406N4, 13/08/2019.
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Affiliation(s)
- Lilit Sardari Masihi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No.103, Shahid Jafari St., Pasdaran Ave., Tehran, 1666668111 Islamic Republic of Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No.103, Shahid Jafari St., Pasdaran Ave., Tehran, 1666668111 Islamic Republic of Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No.103, Shahid Jafari St., Pasdaran Ave., Tehran, 1666668111 Islamic Republic of Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Islamic Republic of Iran
| | - Saba Jalali
- Human Nutrition, Faculty of Land and Food Systems, University of British Columbia, Vancouver, CA USA
| | - Sanaz Tavasoli
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, No.103, Shahid Jafari St., Pasdaran Ave., Tehran, 1666668111 Islamic Republic of Iran
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Arnous MG, Vaughan L, Mehta RA, Schulte PJ, Lieske JC, Milliner DS. Characterization of Stone Events in Patients With Type 3 Primary Hyperoxaluria. J Urol 2023; 209:1141-1150. [PMID: 36888927 PMCID: PMC11034812 DOI: 10.1097/ju.0000000000003400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE Hallmarks of primary hyperoxaluria type 3 are nephrolithiasis and hyperoxaluria. However, little is known about factors influencing stone formation in this disease. We characterized stone events and examined associations with urine parameters and kidney function in a primary hyperoxaluria type 3 population. MATERIALS AND METHODS We retrospectively analyzed clinical, and laboratory data of 70 primary hyperoxaluria type 3 patients enrolled in the Rare Kidney Stone Consortium Primary Hyperoxaluria Registry. RESULTS Kidney stones occurred in 65/70 primary hyperoxaluria type 3 patients (93%). Among the 49 patients with imaging available, the median (IQR) number of stones was 4 (2, 5), with largest stone 7 mm (4, 10) at first imaging. Clinical stone events occurred in 62/70 (89%) with median number of events per patient 3 (2, 6; range 1-49). Age at first stone event was 3 years (0.99, 8.7). Lifetime stone event rate was 0.19 events/year (0.12, 0.38) during follow-up of 10.7 (4.2, 26.3) years. Among 326 total clinical stone events, 139 (42.6%) required surgical intervention. High stone event rates persisted for most patients through the sixth decade of life. Analysis was available for 55 stones: pure calcium oxalate accounted for 69%, with mixed calcium oxalate and phosphate in 22%. Higher calcium oxalate supersaturation was associated with increased lifetime stone event rate after adjusting for age at first event (IRR [95%CI] 1.23 [1.16, 1.32]; P < .001). By the fourth decade, estimated glomerular filtration rate was lower in primary hyperoxaluria type 3 patients than the general population. CONCLUSIONS Stones impose a lifelong burden on primary hyperoxaluria type 3 patients. Reducing urinary calcium oxalate supersaturation may reduce event frequency and surgical intervention.
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Affiliation(s)
- Muhammad G. Arnous
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Ramila A. Mehta
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Phillip J. Schulte
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn S. Milliner
- Divison of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Division of Pediatric Nephrology, Mayo Clinic, Rochester, MN USA
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Noonin C, Itsaranawet T, Thongboonkerd V. Calcium oxalate crystal-induced secretome derived from proximal tubular cells, not that from distal tubular cells, induces renal fibroblast activation. Eur J Med Res 2023; 28:150. [PMID: 37031165 PMCID: PMC10082508 DOI: 10.1186/s40001-023-01109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/24/2023] [Indexed: 04/10/2023] Open
Abstract
BACKGROUND Kidney stone disease (KSD) is commonly accompanied with renal fibrosis, characterized by accumulation and reorganization of extracellular matrix (ECM). During fibrogenesis, resident renal fibroblasts are activated to become myofibroblasts that actively produce ECM. However, such fibroblast-myofibroblast differentiation in KSD remained unclear. Our present study thus examined effects of secreted products (secretome) derived from proximal (HK-2) vs. distal (MDCK) renal tubular cells exposed to calcium oxalate monohydrate (COM) crystals on activation of renal fibroblasts (BHK-21). METHODS HK-2 and MDCK cells were treated with 100 µg/ml COM crystals under serum-free condition for 16 h. In parallel, the cells maintained in serum-free medium without COM treatment served as the control. Secretome derived from culture supernatant of each sample was mixed (1:1) with fresh serum-free medium and then used for BHK-21 culture for another 24 h. RESULTS Analyses revealed that COM-treated-HK-2 secretome significantly induced proliferation, caused morphological changes, increased spindle index, and upregulated fibroblast-activation markers (F-actin, α-SMA and fibronectin) in BHK-21 cells. However, COM-treated-MDCK secretome had no significant effects on these BHK-21 parameters. Moreover, level of transforming growth factor-β1 (TGF-β1), a profibrotic factor, significantly increased in the COM-treated-HK-2 secretome but not in the COM-treated-MDCK secretome. CONCLUSIONS These data indicate, for the first time, that proximal and distal tubular epithelial cells exposed to COM crystals send different messages to resident renal fibroblasts. Only the secretome derived from proximal tubular cells, not that from the distal cells, induces renal fibroblast activation after their exposure to COM crystals. Such differential effects are partly due to TGF-β1 secretion, which is induced by COM crystals only in proximal tubular cells.
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Affiliation(s)
- Chadanat Noonin
- Medical Proteomics Unit, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand
| | - Tanakorn Itsaranawet
- Biological Sciences Program, Mahidol University International College, Nakhon Pathom, 73170, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, 6th Floor - SiMR Building, 2 Wanglang Road, Bangkoknoi, 10700, Bangkok, Thailand.
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Aziz F, Jorgenson M, Garg N. Secondary oxalate nephropathy and kidney transplantation. Curr Opin Organ Transplant 2023; 28:15-21. [PMID: 36342385 DOI: 10.1097/mot.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE OF REVIEW Secondary hyperoxaluria is associated with poor kidney allograft outcomes after the kidney transplant. Calcium oxalate (CaOx) deposition is common in early allograft biopsies leading to acute tubular necrosis and poor kidney allograft function. Though treatment options for secondary hyperoxaluria are limited, it is crucial to identify patients at increased risk of oxalate nephropathy after the transplant. RECENT FINDINGS Recent data suggest that significant changes in renal replacement therapies and dietary modifications in high-risk patients can prevent kidney allograft damage from the calcium oxalate deposition leading to improve allograft outcomes. SUMMARY The accurate and timely diagnosis of secondary oxalate nephropathy in kidney transplant recipients is paramount to preserving graft function in the long-term. This review will discuss the incidence, risk factors, prevention, and management of oxalate nephropathy in the kidney allograft.
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Affiliation(s)
- Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
| | - Margaret Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health
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Hsi RS, Koyama T, Silver HJ, Goldfarb DS. Urinary supersaturation in a Randomized trial among Individuals with Nephrolithiasis comparing Empiric versus selective therapy (URINE): design and rationale of a clinical trial. Urolithiasis 2023; 51:28. [PMID: 36598705 PMCID: PMC9836785 DOI: 10.1007/s00240-022-01400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Clinical guidelines disagree on whether the identification of abnormal urine chemistries should occur before starting diet and medication interventions to prevent the recurrence of kidney stone events. We describe the rationale and design of the Urinary supersaturation in a Randomized trial among Individuals with Nephrolithiasis comparing Empiric versus selective therapy (URINE) study, a randomized trial comparing two multi-component interventions to improve urinary supersaturation. Participants are randomized (1:1 ratio) to the empiric or selective arm. The target sample size is 56 participants. Adults ≥ 18 years of age with idiopathic calcium stone disease and two symptomatic stone events within the previous 5 years. Exclusion criteria include systemic conditions predisposing to kidney stones and pharmacologic treatment for stone prevention at baseline. Participants in the empiric arm receive standard diet therapy recommendations, thiazide, and potassium citrate. Participants in the selective arm receive tailored diet and nutrient recommendations and medications based on baseline and 1-month follow-up of 24-h urine testing results. The primary endpoints are urinary supersaturations of calcium oxalate and calcium phosphate at 2 months of follow-up. Secondary endpoints include side effects, diet and medication adherence, and changes in 24-h urine volume, calcium, oxalate, citrate, and pH. Short-term changes in urinary supersaturation may not reflect changes in future risk of stone events. The URINE study will provide foundational data to compare the effectiveness of two prevention strategies for kidney stone disease.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi J Silver
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David S Goldfarb
- Nephrology Section, New York Harbor VAMC, St. Vincent's Hospital, New York, NY, USA
- NYU Langone Health and NYU Grossman School of Medicine, and New York Harbor VA Healthcare System, New York, NY, USA
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Specialist Care, Metabolic Testing, and Testing Completeness Among U.S. Veterans with Urinary Stone Disease. UROLOGY PRACTICE 2023; 10:49-56. [PMID: 36545539 PMCID: PMC9762689 DOI: 10.1097/upj.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose Recent observational studies reporting a lack of benefit from 24-hour urine testing for urinary stone disease (USD) prevention assumed testing included all components recommended from clinical guidelines. We sought to assess the completeness of 24-hour urine testing in the VA population. Materials and methods From the VHA Corporate Data Warehouse (2012-2019), we identified patients with USD (n=198,621) and determined those who saw a urologist and/or nephrologist, and received 24-hour urine testing within 12 months of their index USD encounter. Through Logical Observation Identifiers Names and Codes, we evaluated each collection's completeness, defined as including all of urine volume, calcium, oxalate, citrate, uric acid, and creatinine. We then fit a multilevel logistic regression model with random effects for VHA facility to evaluate factors associated with specialist follow-up, testing, and testing completeness. Results Specialist follow-up occurred in 54.3% and was stable over time. Testing occurred in 8.4%, declining from 9.3% in 2012 to 7.2% in 2019. Of tests performed, 54.6% were complete (43.7% increasing to 62.7% from 2012-2019). In adjusted analysis, there was high between-facility variation in specialist follow-up (median OR 2.0; 95% CI 1.7-2.0), testing (median OR 2.2, 95% CI 1.9-2.4), and testing completeness (median OR, 6.0, 95% CI 4.5-7.3). Individual facilities contributed 52% (intraclass correlation coefficient, 0.52; 95% CI, 0.44-0.57) towards the observed variation in testing completeness. Conclusions Approximately 1 in 12 U.S. Veterans with USD receive metabolic testing and half of these tests are complete. Addressing facility level variation in testing completeness may improve USD care.
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Zeng G, Zhu W, Robertson WG, Penniston KL, Smith D, Pozdzik A, Tefik T, Prezioso D, Pearle MS, Chew BH, Veser J, Fiori C, Deng Y, Straub M, Türk C, Semins MJ, Wang K, Marangella M, Jia Z, Zhang L, Ye Z, Tiselius HG, Sarica K. International Alliance of Urolithiasis (IAU) guidelines on the metabolic evaluation and medical management of urolithiasis. Urolithiasis 2022; 51:4. [DOI: 10.1007/s00240-022-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
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Gutbrod J, Keys McKay CC, Coe L, Bergsland K, Coe F, Worcester E, Prochaska M. Clinical Effectiveness of Calcium Oxalate Stone Treatments. Am J Nephrol 2022; 53:761-766. [PMID: 36412567 PMCID: PMC9877156 DOI: 10.1159/000527940] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lowering kidney stone risk and urine calcium oxalate supersaturation is a primary clinical focus for kidney stone prevention and can be achieved with multiple strategies. Common strategies include advice to increase fluid intake, restrict dietary sodium, or prescribing a thiazide-type diuretic. We investigated how physicians make these decisions in real-world practice and evaluate their efficacy based on 24-h urine collections. METHODS We reviewed medical charts for 203 kidney stone formers with idiopathic calcium stones from University of Chicago Kidney Stone Clinic between 2005 and 2020. Patients had three 24-h urines before an initial pre-treatment clinic visit and one follow-up 24-h urine. We analyzed changes in urine composition based on treatment advice using t tests and ANOVA. RESULTS Patients who received advice to increase fluid intake had lower urine volume at baseline (1.5 vs. 2.5 L/day, p < 0.001) and larger increase in urine volume at follow-up (0.6 vs. 0.1 L/day, p < 0.001) compared to those who did not receive the advice. Patients who were advised to restrict dietary sodium had a higher urine sodium at baseline (208 vs. 139 mEq/day, p < 0.001), a larger reduction in urine sodium (-28 vs. 13 mEq/day, p = 0.002), and larger reduction in urine calcium (-74 vs. -28 mg/day, p = 0.005) compared with those not advised to restrict dietary sodium. Patients started on a thiazide had a higher baseline urine calcium (281 vs. 213 mg/day) and larger reduction in urine calcium (-83 vs. -9 mg/day, p < 0.001) compared with patients not started on a thiazide. In combination, thiazide prescriptions with dietary sodium restriction reduced urine calcium by 99 mg/day and reduced calcium oxalate supersaturation from 8.0 to 5.5 and calcium phosphate supersaturation from 1.4 to 1.0. CONCLUSION Providers use 24-h urine data to guide treatment strategy decisions. These strategies achieved the intended effects on urine composition and lowered kidney stone risk.
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Affiliation(s)
- Joseph Gutbrod
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Lillian Coe
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kristin Bergsland
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Fredric Coe
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elaine Worcester
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Megan Prochaska
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
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13
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Bianco J, Chu F, Bergsland K, Coe F, Worcester E, Prochaska M. What treatments reduce kidney stone risk in patients with bowel disease? Urolithiasis 2022; 50:557-565. [PMID: 35976425 PMCID: PMC9972896 DOI: 10.1007/s00240-022-01352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI -4.3 to -0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI -1.4 to 2.1) nor oxalate-focused advice (95% CI -1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.
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Affiliation(s)
- Julianna Bianco
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Francesca Chu
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Kristin Bergsland
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Fredric Coe
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Elaine Worcester
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Megan Prochaska
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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14
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Dai JC, Pearle MS. Diet and Stone Disease in 2022. J Clin Med 2022; 11:jcm11164740. [PMID: 36012979 PMCID: PMC9410446 DOI: 10.3390/jcm11164740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Diet plays a central role in the development and prevention of nephrolithiasis. Although pharmacologic treatment may be required for some patients who are resistant to dietary measures alone, dietary modification may be sufficient to modulate stone risk for many patients. While there is no single specialized diet for stone prevention, several dietary principles and recommendations for stone prevention are supported by practice guidelines, including adequate fluid intake, modest calcium intake, low dietary sodium, and limited animal protein. In this review, we summarized the evidence supporting these dietary recommendations and reviewed the current literature regarding specific dietary components and comprehensive diets for stone prevention.
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15
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Ferraro PM, Lopez F, Petrarulo M, Barbarini S, Curhan GC, Marangella M, Taylor EN. Estimating 24-hour urinary excretion using spot urine measurements in kidney stone formers. Nephrol Dial Transplant 2022; 37:2171-2179. [PMID: 35146503 PMCID: PMC9585473 DOI: 10.1093/ndt/gfab306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background One limitation of the use of 24-hour collection is impracticality. We analysed the performance of spot urine measurements to estimate 24-hour excretion in patients with kidney stones. Methods A total of 74 adult patients from two centres performed a 24-hour urine collection. A sample of the last micturition was sent for spot urine analysis. Twenty patients were asked to collect two additional spot urine samples, one before dinner and the other after dinner. Urinary concentrations of creatinine, calcium, oxalate, uric acid, citrate and magnesium were measured in the 24-hour and each of the spot urine samples. Four approaches were used to estimate 24-hour urinary excretion, multiplying the ratio of the spot urinary analyte to creatinine concentration by (i) measured 24-hour urinary creatinine excretion (Prediction 1), (ii) estimated 24-hour urinary creatinine excretion (Prediction 2), (iii) assumed 1-g 24-hour urinary creatinine excretion (Prediction 3) or (iv) assumed 1.5-g 24-hour urinary creatinine excretion (Prediction 4). For each parameter we computed Lin's concordance correlation coefficients (CCCs), Bland–Altman plots and 95% limits of agreement. Results The performance of estimates obtained with Prediction 1 and Prediction 2 was similar, except for citrate and uric acid, for which Prediction 2 performed worse. Both approaches performed moderately well: citrate CCC {0.82 [95% confidence interval (CI) 0.75–0.90]}, oxalate [0.66 (95% CI 0.55–0.78)], magnesium [0.66 (95% CI 0.54–0.77)], calcium [0.63 (95% CI 0.50–0.75)] and uric acid [0.52 (95% CI 0.36–0.68)]. The performance of Predictions 3 and 4 was worse. Conclusions Although spot urine samples may hold promise for clinical and population-based research, at present they have limited utility in clinical practice. Measuring or estimating 24-hour creatinine, rather than assuming a given creatinine excretion, will be necessary in future studies of spot urine samples.
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Affiliation(s)
- Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fernando Lopez
- Tufts University School of Medicine, Department of Nephrology and Transplantation, Maine Medical Center, Portland, ME, USA
| | | | - Silvia Barbarini
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Eric N Taylor
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Section of Nephrology, VA Maine Healthcare System, Augusta, ME, USA
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16
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Numerical characterization of astronaut CaOx renal stone incidence rates to quantify in-flight and post-flight relative risk. NPJ Microgravity 2022; 8:2. [PMID: 35091560 PMCID: PMC8799707 DOI: 10.1038/s41526-021-00187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Changes in urine chemistry potentially alter the risk of renal stone formation in astronauts. Quantifying spaceflight renal stone incidence risk compared to pre-flight levels remains a significant challenge for assessing the appropriate vehicle, mission, and countermeasure design. A computational biochemistry model representing CaOx crystal precipitation, growth, and agglomeration is combined with a probabilistic analysis to predict the in- and post-flight CaOx renal stone incidence risk ratio (IRR) relative to pre-flight values using 1517 astronaut 24-h urine chemistries. Our simulations predict that in-flight fluid intake alone would need to increase from current prescriptions of 2.0–2.5 L/day to ~3.2 L/day to approach the CaOx IRR of the pre-flight population. Bone protective interventions would reduce CaOx risk to pre-flight levels if Ca excretion alone is reduced to <150 mg/day or if current levels are diminished to 190 mg/day in combination with increasing fluid intake to 2.5–2.7 L/day. This analysis provides a quantitative risk assessment that can influence the critical balance between engineering and astronaut health requirements.
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17
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Rhaman MM, Owens H, Powell DR, Hossain MA. Molecular Recognition of Biologically Relevant Anions with an Expanded Dinuclear Copper(II) Complex: An Efficient Sensor for Oxalate Anion in Aqueous Solution. ChemistrySelect 2021. [DOI: 10.1002/slct.202103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Md Mhahabubur Rhaman
- Department of Chemistry and Biochemistry Jackson State University 1400 John R. Lynch Street Jackson MS 39217 USA
| | - Harold Owens
- Department of Chemistry and Biochemistry Jackson State University 1400 John R. Lynch Street Jackson MS 39217 USA
| | - Douglas R. Powell
- Department of Chemistry and Biochemistry University of Oklahoma 660 Parrington Norman OK 37017 USA
| | - Md. Alamgir Hossain
- Department of Chemistry and Biochemistry Jackson State University 1400 John R. Lynch Street Jackson MS 39217 USA
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18
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Crivelli JJ, Wood KD, Assimos DG. Is It Time to Retire the Low-Oxalate Diet? No! J Endourol 2021; 35:1435-1437. [PMID: 34409855 DOI: 10.1089/end.2021.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Kyle D Wood
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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19
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Prochaska ML, Moe OW, Asplin JR, Coe FL, Worcester EM. Evidence for abnormal linkage between urine oxalate and citrate excretion in human kidney stone formers. Physiol Rep 2021; 9:e14943. [PMID: 34231328 PMCID: PMC9814525 DOI: 10.14814/phy2.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Animal models have demonstrated an interactive relationship between the epithelial anion exchanger SLC26A6 and transporter NaDC-1 that regulates citrate and oxalate homeostasis. This relationship is a potential mechanism to protect against kidney stones as higher urine oxalate is accompanied by higher urine citrate but it has not been explored in humans. METHODS We examined 24-h urine data on 13,155 kidney stone forming patients (SF) from separate datasets at the University of Chicago and Litholink, a national laboratory, and 143 non-kidney stone forming participants (NSF) to examine this relationship in humans. We used multivariate linear regression models to examine the association between oxalate and citrate in all study participants and separately in SF and NSF. RESULTS Higher urinary oxalate was associated with higher urinary citrate in both SF and NSF. In NSF, the multivariate adjusted urine citrate excretion was 3.0 (1.5-4.6) (mmol)/creatinine (mmol) per oxalate (mmol)/creatinine (mmol). In SF, the multivariate adjusted urine citrate excretion was 0.3 (0.2-0.4) (mmol)/creatinine (mmol) per oxalate (mmol)/creatinine (mmol). CONCLUSIONS Higher urinary oxalate excretion was associated with higher urinary citrate excretion and this effect was larger in non-kidney stone forming participants compared with those who form kidney stones.
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Affiliation(s)
| | - Orson W. Moe
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - John R. Asplin
- Litholink CorporationLaboratory Corporation of America® HoldingsItascaILUSA
| | - Fredric L. Coe
- Department of MedicineUniversity of Chicago MedicineChicagoILUSA
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20
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Krieger NS, Asplin J, Granja I, Chen L, Spataru D, Wu TT, Grynpas M, Bushinsky DA. Chlorthalidone with potassium citrate decreases calcium oxalate stones and increases bone quality in genetic hypercalciuric stone-forming rats. Kidney Int 2021; 99:1118-1126. [PMID: 33417997 PMCID: PMC8076055 DOI: 10.1016/j.kint.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
To study human idiopathic hypercalciuria we developed an animal model, genetic hypercalciuric stone-forming rats, whose pathophysiology parallels that of human idiopathic hypercalciuria. Fed the oxalate precursor, hydroxyproline, every rat in this model develops calcium oxalate stones. Using this rat model, we tested whether chlorthalidone and potassium citrate combined would reduce calcium oxalate stone formation and improve bone quality more than either agent alone. These rats (113 generation) were fed a normal calcium and phosphorus diet with hydroxyproline and divided into four groups: diets plus potassium chloride as control, potassium citrate, chlorthalidone plus potassium chloride, or potassium citrate plus chlorthalidone. Urine was collected at six, 12, and 18 weeks and kidney stone formation and bone parameters were determined. Compared to potassium chloride, potassium citrate reduced urinary calcium, chlorthalidone reduced it further and potassium citrate plus chlorthalidone even further. Potassium citrate plus chlorthalidone decreased urine oxalate compared to all other groups. There were no significant differences in calcium oxalate supersaturation in any group. Neither potassium citrate nor chlorthalidone altered stone formation. However, potassium citrate plus chlorthalidone significantly reduced stone formation. Vertebral trabecular bone increased with chlorthalidone and potassium citrate plus chlorthalidone. Cortical bone area increased with chlorthalidone but not potassium citrate or potassium citrate plus chlorthalidone. Mechanical properties of trabecular bone improved with chlorthalidone, but not with potassium citrate plus chlorthalidone. Thus in genetic hypercalciuric stone-forming rats fed a diet resulting in calcium oxalate stone formation, potassium citrate plus chlorthalidone prevented stone formation better than either agent alone. Chlorthalidone alone improved bone quality, but adding potassium citrate provided no additional benefit.
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Affiliation(s)
- Nancy S Krieger
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - John Asplin
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois, USA
| | - Ignacio Granja
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois, USA
| | - Luojing Chen
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Daiana Spataru
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David A Bushinsky
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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21
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Trautman CL, Van Cleve M, Sullivan EA, Ball CT, Cochuyt JJ, Porter I. Impact on urinary oxalate levels with use of ezetimibe. Endocrinol Diabetes Metab 2021; 4:e00221. [PMID: 33855221 PMCID: PMC8029507 DOI: 10.1002/edm2.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/27/2020] [Accepted: 12/15/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | - Colleen T. Ball
- Division of Biomedical Statistics and Informatics Mayo Clinic Florida Jacksonville FL USA
| | - Jordan J. Cochuyt
- Division of Biomedical Statistics and Informatics Mayo Clinic Florida Jacksonville FL USA
| | - Ivan Porter
- Division of Nephrology and Hypertension Mayo Clinic Florida Jacksonville FL USA
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22
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Prochaska M, Asplin J, Chapman A, Worcester E. Sex Differences of Kidney Stone Urine Risk Factors after Roux-en-Y Gastric Bypass. Am J Nephrol 2021; 52:173-176. [PMID: 33765680 DOI: 10.1159/000514455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure that is associated with higher risk of kidney stones after surgery. We examined urine composition in 18 men and women before and after RYGB to examine differences in kidney stone risk. METHODS Three 24-h urine collections were performed before and 1 year after RYGB. We analyzed mean urinary values for pre- and post-RYGB collections and compared men and women. RESULTS Seven men and eleven women completed pre- and post-RYGB urine collections. Pre-RYGB, men had higher calcium oxalate supersaturation (CaOx SS) (7.0 vs. 5.0, p = 0.04) compared with women. Post-RYGB, women had higher urine CaOx SS (13.1 vs. 4.6, p = 0.002), calcium phosphate supersaturation (1.04 vs. 0.59, p = 0.05), and lower urine volumes (1.7 vs. 2.7L, p < 0.001) compared with men. DISCUSSION/CONCLUSION There are important differences in urine composition by sex that may contribute to higher kidney stone risk in women after RYGB compared with men.
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Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - John Asplin
- Litholink, Laboratory Corporation of America Holdings, Itasca, Illinois, USA
| | - Arlene Chapman
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elaine Worcester
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
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Prochaska M, Worcester E. Risk Factors for Kidney Stone Formation following Bariatric Surgery. ACTA ACUST UNITED AC 2020; 1:1456-1461. [PMID: 34085046 DOI: 10.34067/kid.0004982020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
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Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago, Chicago, Illinois
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24
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Crivelli JJ, Mitchell T, Knight J, Wood KD, Assimos DG, Holmes RP, Fargue S. Contribution of Dietary Oxalate and Oxalate Precursors to Urinary Oxalate Excretion. Nutrients 2020; 13:nu13010062. [PMID: 33379176 PMCID: PMC7823532 DOI: 10.3390/nu13010062] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 02/07/2023] Open
Abstract
Kidney stone disease is increasing in prevalence, and the most common stone composition is calcium oxalate. Dietary oxalate intake and endogenous production of oxalate are important in the pathophysiology of calcium oxalate stone disease. The impact of dietary oxalate intake on urinary oxalate excretion and kidney stone disease risk has been assessed through large cohort studies as well as smaller studies with dietary control. Net gastrointestinal oxalate absorption influences urinary oxalate excretion. Oxalate-degrading bacteria in the gut microbiome, especially Oxalobacter formigenes, may mitigate stone risk through reducing net oxalate absorption. Ascorbic acid (vitamin C) is the main dietary precursor for endogenous production of oxalate with several other compounds playing a lesser role. Renal handling of oxalate and, potentially, renal synthesis of oxalate may contribute to stone formation. In this review, we discuss dietary oxalate and precursors of oxalate, their pertinent physiology in humans, and what is known about their role in kidney stone disease.
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Affiliation(s)
| | | | | | | | | | - Ross P. Holmes
- Correspondence: ; Tel.: +1-(205)-996-8765; Fax: +1-(205)-934-4933
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Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis 2020; 49:1-16. [PMID: 33048172 PMCID: PMC7867533 DOI: 10.1007/s00240-020-01217-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023]
Abstract
The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.
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26
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Zisman AL, Coe FL, Cohen AJ, Riedinger CB, Worcester EM. Racial Differences in Risk Factors for Kidney Stone Formation. Clin J Am Soc Nephrol 2020; 15:1166-1173. [PMID: 32561654 PMCID: PMC7409744 DOI: 10.2215/cjn.12671019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Incidence of kidney stone disease is rising. It is not known whether mechanisms of stone formation differ across racial groups. Our objective was to identify differing lithogenic risk factors across racial groups in idiopathic nephrolithiasis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective cohort study evaluating metabolic risk factors in black and age-matched white idiopathic stone formers at our tertiary referral center. We compared serum and urine metabolic risk factors pre- and post-treatment across racial groups using analysis of covariance. Generalized linear modeling was used to build regression models for risk of stone formation in both groups. RESULTS Among 117 black and 172 white stone formers, urine volume was lower in black stone formers (1.4±0.8 versus 2.0±0.8 L/d, P<0.001). Urine calcium was lower in black stone formers (116±70 versus 217±115 mg/d, P<0.001). Supersaturations for calcium oxalate were similar among the groups, whereas calcium phosphate supersaturation was higher in white stone formers, and uric acid supersaturation was higher in black stone formers. Electrolyte free water clearance was significantly lower in black stone formers (207±780 versus 435±759 ml/d, P=0.02). In the subgroup of 77 black patients and 107 white patients with post-treatment evaluations, urine volume rose significantly and similarly in both groups. Urine sodium was unchanged in whites but increased in blacks by 40 mmol/d (95% confidence interval, 32 to 48 mmol/d). Electrolyte free water clearance remained lower in black stone formers (385±891 versus 706±893 ml/d, P=0.02). Post-treatment supersaturations were similar across the groups except for calcium phosphate, which improved with treatment in whites. CONCLUSIONS Black stone formers have lower 24-hour urine calcium excretion and urine volume. Increases in urine volume with treatment were associated with increased solute, but not free water, excretion in black stone formers.
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Affiliation(s)
- Anna L Zisman
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
| | - Fredric L Coe
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
| | - Andrew J Cohen
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Elaine M Worcester
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
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27
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Sui W, Hancock J, Asplin JR, Gould ER, Hsi RS. Nephrolithiasis and Elevated Urinary Ammonium: A Matched Comparative Study. Urology 2020; 144:77-82. [PMID: 32544550 DOI: 10.1016/j.urology.2020.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the associations between elevated urinary ammonium and clinical characteristics of kidney stone formers. A 24-hour urine test is recommended in high-risk patients to identify urinary abnormalities and select interventions to reduce the recurrence risk. While elevations in urine ammonium may be seen in acidosis, diarrhea, high protein diets or due to pathogenic bacteria, the clinical characteristics of these patients have not been previously described. METHODS We retrospectively identified adult patients with kidney stone disease who completed a 24-hour urine at our institution between 2006 and 2017. Patients with elevated urinary ammonium were identified (n = 121) and matched 1:1 by age and sex to controls for an overall cohort of n = 242. Differences in medical and surgical history, 24-hour urine analytes and stone composition were compared. RESULTS Among 3625 24-hour urine studies screened, 7.1% of patients showed high urinary ammonium. In our study cohort, patients with elevated urinary ammonium also showed higher urine volume, oxalate, calcium, uric acid, sodium, chloride, and sulfate. Clinically, these patients had higher body mass index, and more often had a history of recurrent urinary tract infections, diabetes, gout, bowel resection, and urinary reconstruction history. Struvite stones tended to be more common in the elevated ammonium group vs control (n = 7 vs 1, P = .07). CONCLUSION Elevated urinary ammonium among kidney stone patients is relatively uncommon. However, these patients have higher rates of comorbid metabolic conditions, urinary tract infections, and bowel surgery. This finding should prompt further review of the patient's history and may help direct prevention strategies.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Joel Hancock
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - John R Asplin
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, IL
| | - Edward R Gould
- Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
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Sromicki J, Hess B. Simple dietary advice targeting five urinary parameters reduces urinary supersaturation in idiopathic calcium oxalate stone formers. Urolithiasis 2020; 48:425-433. [PMID: 32524204 PMCID: PMC7495994 DOI: 10.1007/s00240-020-01194-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
Among 208 kidney stone patients referred within 2 years, 75 patients (66 men, nine women) with truly idiopathic calcium oxalate stones (ICSF) were recruited. Dietary advice (DA) aimed at (1) urine dilution, (2) reduced crystallization promotion (lowering oxalate), and (3) increased crystallization inhibition (increasing citrate). We recommended higher intakes of fluid and calcium with meals/snacks (reducing intestinal oxalate absorption) as well as increased alkali and reduced meat protein (acid) for increasing urinary citrate. The intended effects of DA were elevations in urine volume, calcium (U-Ca) and citrate (U-Cit) as well as reductions in oxalate (U-Ox) and uric acid (U-UA). We retrospectively calculated an adherence score (AS), awarding + 1 point for parameters altered in the intended direction and − 1 point for opposite changes. Calcium oxalate supersaturation (CaOx-SS) was calculated using Tiselius’ AP(CaOx) index EQ. DA induced changes (all p < 0.0001) in urine volume (2057 ± 79 vs. 2573 ± 71 ml/day) and U-Ca (5.49 ± 0.24 vs. 7.98 ± 0.38 mmol/day) as well as in U-Ox (0.34 ± 0.01 vs. 0.26 ± 0.01 mmol/day) and U-UA (3.48 ± 0.12 vs. 3.13 ± 0.10 mmol/day). U-Cit only tendentially increased (3.07 ± 0.17 vs. 3.36 ± 0.23 mmol/day, p = 0.06). DA induced a 21.5% drop in AP(CaOx) index, from 0.93 ± 0.05 to 0.73 ± 0.05 (p = 0.0005). Decreases in CaOx-SS correlated with AS (R = 0.448, p < 0.0005), and highest AS (+ 5) always indicated lowering of CaOx-SS. Thus, simple DA can reduce CaOx-SS which may be monitored by AS.
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Affiliation(s)
- Juri Sromicki
- Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park and University of Zurich, Bellariastrasse 38, CH-8038, Zurich, Switzerland
- Department of Cardiac, Vascular and Thoracic Surgery, University Hospital, CH-8091, Zurich, Switzerland
| | - Bernhard Hess
- Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park and University of Zurich, Bellariastrasse 38, CH-8038, Zurich, Switzerland.
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Kumar P, Patel M, Thomas V, Knight J, Holmes RP, Mitchell T. Dietary Oxalate Induces Urinary Nanocrystals in Humans. Kidney Int Rep 2020; 5:1040-1051. [PMID: 32647761 PMCID: PMC7335953 DOI: 10.1016/j.ekir.2020.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/09/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Crystalluria is thought to be associated with kidney stone formation and can occur when urine becomes supersaturated with calcium, oxalate, and phosphate. The principal method used to identify urinary crystals is microscopy, with or without a polarized light source. This method can detect crystals above 1 μm in diameter (microcrystals). However, analyses of calcium oxalate kidney stones have indicated that crystallite components in these calculi are 50–100 nm in diameter. Recent studies have suggested that nanocrystals (<200 nm) elicit more injury to renal cells compared to microcrystals. The purpose of this study was to determine whether (i) urinary nanocrystals can be detected and quantified by nanoparticle tracking analysis (NTA, a high-resolution imaging technology), (ii) early-void urine samples from healthy subjects contain calcium nanocrystals, and (iii) a dietary oxalate load increases urinary nanocrystal formation. Methods Healthy subjects consumed a controlled low-oxalate diet for 3 days before a dietary oxalate load. Urinary crystals were isolated by centrifugation and assessed using NTA before and 5 hours after the oxalate load. The morphology and chemical composition of crystals was assessed using electron microscopy, Fourier-transform infrared spectroscopy (FTIR), and ion chromatography-mass spectrometry (IC–MS). Results Urinary calcium oxalate nanocrystals were detected in pre-load samples and increased substantially following the oxalate load. Conclusion These findings indicate that NTA can quantify urinary nanocrystals and that meals rich in oxalate can promote nanocrystalluria. NTA should provide valuable insight about the role of nanocrystals in kidney stone formation.
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Affiliation(s)
- Parveen Kumar
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mikita Patel
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Vinoy Thomas
- Department of Materials Science and Engineering, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Knight
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ross P Holmes
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tanecia Mitchell
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rimer JD, Sakhaee K, Maalouf NM. Citrate therapy for calcium phosphate stones. Curr Opin Nephrol Hypertens 2020; 28:130-139. [PMID: 30531474 DOI: 10.1097/mnh.0000000000000474] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Calcium phosphate (CaP) stones represent an increasingly encountered form of recurrent nephrolithiasis, but current prophylactic medical regimens are suboptimal. Although hypocitraturia is a well-described risk factor for CaP stones, strategies that enhance citrate excretion have not consistently been effective at reducing CaP saturation and stone recurrence. This review summarizes the role of citrate therapy in CaP nephrolithiasis. RECENT FINDINGS Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate-calcium complexes, and inhibition of CaP nucleation, crystal growth and crystal aggregation. Recent in-vitro studies demonstrate that citrate delays CaP crystal growth through distinct inhibitory mechanisms that depend on supersaturation and citrate concentration. The impact of pharmacological provision of citrate on CaP saturation depends on the accompanying cation: Potassium citrate imparts a significant alkali load that enhances citraturia and reduces calciuria, but could worsen urine pH elevation. Conversely, citric acid administration results in minimal citraturia and alteration in CaP saturation. SUMMARY Citrate, starting at very low urinary concentrations, can significantly retard CaP crystal growth in vitro through diverse mechanisms. Clinically, the net impact on CaP stone formation of providing an alkali load during pharmacological delivery of citrate into the urinary environment remains to be determined.
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Affiliation(s)
- Jeffrey D Rimer
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, Texas
| | - Khashayar Sakhaee
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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31
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Urinary supersaturation on fractioned urine collections: which urine sample can explain better the variability observed on 24-h urine? A proof-of-concept study. Urolithiasis 2020; 48:403-408. [PMID: 31980850 DOI: 10.1007/s00240-020-01177-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
Due to the difficulty of collecting 24-h urines in the stone-forming patient, some authors have suggested other types of urine collection, but their usefulness is not yet well studied. The objective of this study is to evaluate the variation of urinary supersaturation (SS) throughout the day and to analyze whether timed urine collections offer accurate information. 48 urine samples were collected from 12 young adults. Each 24-h urine was collected on 7 2-h urine fractions and a 10-h overnight sample. Solute concentrations and SS for calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA) were determined. Linear regression and relative importance of predictors were used to determine the percentage of R2 attributed to each timed collection (individual SS). 43 24-h urine samples were included in the study. The highest SS values were: for CaOx, night period and first morning urine; for CaP, between 2 and 6 pm and at night; for UA, between 8 am and 12 pm. For CaOx, the SS from the samples between 8 pm and 8 am accounted for more than 40% of the R2; for CaP, the results were more equally distributed throughout the day, and for UA, the SS values from 12 to 4 pm accounted for more than 45% of the observed variability. In conclusion, urinary SS varies throughout the day, being higher for CaOx and CaP at night, and in the early morning for UA. For CaOx and UA, the overnight and 12-4 pm urine samples, respectively, contribute most to the variability observed in the SS of 24-h urine.
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Linking 24-h urines to clinical phenotypes: what alternatives does the future bring? Curr Opin Urol 2019; 30:177-182. [PMID: 31834081 DOI: 10.1097/mou.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The 24-h urine test is recommended as part of the metabolic evaluation for patients with nephrolithiasis to guide preventive interventions. However, this test may be challenging to interpret and has limits in its predictive ability. In this review, we summarize and discuss the most recent research on the opportunities and challenges for utilizing urinary biomarkers for kidney stone prevention. RECENT FINDINGS Contemporary studies utilizing the 24-h urine test have improved our understanding of how to better administer testing and interpret test results. Beyond the standard panel of 24-h urine parameters, recent applications of proteomics and metabolomics have identified protein and metabolic profiles of stone formers. These profiles can be assayed in future studies as potential biomarkers for risk stratification and prediction. Broad collaborative efforts to create large datasets and biobanks from kidney stone formers will be invaluable for kidney stone research. SUMMARY Recent advances in our understanding of kidney stone risk have opened opportunities to improve metabolic testing for kidney stone formers. These strategies do not appear to be mutually exclusive of 24-h urine testing but instead complementary in their approach. Finally, large clinical datasets hold promise to be leveraged to identify new avenues for stone prevention.
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Affiliation(s)
- Lada Beara-Lasic
- Nephrology Division, NYU Langone Medical Center, New York Harbor Veterans Affairs Healthcare System, New York, New York and
| | - David S Goldfarb
- Nephrology Division, NYU Langone Medical Center, New York Harbor Veterans Affairs Healthcare System, New York, New York and .,Department of Medicine and Physiology, New York University School of Medicine, New York, New York
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Ferraro PM, Arrabal-Polo MÁ, Capasso G, Croppi E, Cupisti A, Ernandez T, Fuster DG, Galan JA, Grases F, Hoorn EJ, Knauf F, Letavernier E, Mohebbi N, Moochhala S, Petkova K, Pozdzik A, Sayer J, Seitz C, Strazzullo P, Trinchieri A, Vezzoli G, Vitale C, Vogt L, Unwin RJ, Bonny O, Gambaro G. A preliminary survey of practice patterns across several European kidney stone centers and a call for action in developing shared practice. Urolithiasis 2019; 47:219-224. [PMID: 30848320 DOI: 10.1007/s00240-019-01119-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 02/08/2019] [Indexed: 11/24/2022]
Abstract
Currently an evidence-based approach to nephrolithiasis is hampered by a lack of randomized controlled trials. Thus, there is a need for common platforms for data sharing and recruitment of patients to interventional studies. A first step in achieving this objective would be to share practice methods and protocols for subsequent standardization in what is still a heterogeneous clinical field. Here, we present the results of a pilot survey performed across 24 European clinical kidney stone centers. The survey was distributed by a voluntary online questionnaire circulated between June 2017 and January 2018. About 46% of centers reported seeing on average 20 or more patients per month. Only 21% adopted any formal referral criteria. Centers were relatively heterogeneous in respect of the definition of an incident stone event. The majority (71%) adopted a formal follow-up scheme; of these, 65% included a follow-up visit at 3 and 12 months, and 41% more than 12 months. In 79% of centers some kind of imaging was performed systematically. 75% of all centers performed laboratory analyses on blood samples at baseline and during follow-up. All centers performed laboratory analyses on 24-h urine samples, the majority (96%) at baseline and during follow-up. There was good correspondence across centers for analyses performed on 24-h urine samples, although the methods of 24-h urine collection and analysis were relatively heterogeneous. Our survey among 24 European stone centers highlights areas of homogeneity and heterogeneity that will be investigated further. Our aim is the creation of a European network of stone centers sharing practice patterns and hosting a common database for research and guidance in clinical care.
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Affiliation(s)
- Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italy. .,Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Miguel Ángel Arrabal-Polo
- Lithotripsy and Endourology Unit, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Giovambattista Capasso
- Division of Nephrology, Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Thomas Ernandez
- Service of Nephrology, University hospital of Geneva, Geneva, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juan Antonio Galan
- Urolithiasis and Endourology Unit, General University Hospital, Alicante, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research, Palma de Mallorca, Spain
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus medical center, Rotterdam, The Netherlands
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Nilufar Mohebbi
- Division of Nephrology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | | | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Agnieszka Pozdzik
- Nephrology Clinic, Hôpital Brugmann, Kidney Stones Clinic, Centre Hospitalier Universitaire, Université Libre de Bruxelles, Brussels, Belgium
| | - John Sayer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, NE7 7DN, Newcastle, UK.,Institute of Genetic Medicine, Newcastle University, Central Parkway, NE1 3BZ, Newcastle, UK.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle, NE4 5PL, UK
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Währinger Gurtel 18-20 in, 1090, Vienna, Austria
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - Giuseppe Vezzoli
- Nephrology and Dialysis Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Vitale
- Nephrology and Dialysis Unit, AO Ordine Mauriziano, Torino, Italy
| | - Liffert Vogt
- Amsterdam Cardiovascular Sciences, Dept of Internal Medicine, section Nephrology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert J Unwin
- Kidney and Urology Centre, Royal Free Hospital, London, UK
| | - Olivier Bonny
- Service of Nephrology, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Giovanni Gambaro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Via G. Moscati 31, 00168, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
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Mitchell T, Kumar P, Reddy T, Wood KD, Knight J, Assimos DG, Holmes RP. Dietary oxalate and kidney stone formation. Am J Physiol Renal Physiol 2018; 316:F409-F413. [PMID: 30566003 PMCID: PMC6459305 DOI: 10.1152/ajprenal.00373.2018] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Dietary oxalate is plant-derived and may be a component of vegetables, nuts, fruits, and grains. In normal individuals, approximately half of urinary oxalate is derived from the diet and half from endogenous synthesis. The amount of oxalate excreted in urine plays an important role in calcium oxalate stone formation. Large epidemiological cohort studies have demonstrated that urinary oxalate excretion is a continuous variable when indexed to stone risk. Thus, individuals with oxalate excretions >25 mg/day may benefit from a reduction of urinary oxalate output. The 24-h urine assessment may miss periods of transient surges in urinary oxalate excretion, which may promote stone growth and is a limitation of this analysis. In this review we describe the impact of dietary oxalate and its contribution to stone growth. To limit calcium oxalate stone growth, we advocate that patients maintain appropriate hydration, avoid oxalate-rich foods, and consume an adequate amount of calcium.
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Affiliation(s)
- Tanecia Mitchell
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Parveen Kumar
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Thanmaya Reddy
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Kyle D Wood
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - John Knight
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
| | - Ross P Holmes
- Department of Urology, University of Alabama at Birmingham , Birmingham, Alabama
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36
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Ferraro PM, Ticinesi A, Meschi T, Rodgers A, Di Maio F, Fulignati P, Borghi L, Gambaro G. Short-Term Changes in Urinary Relative Supersaturation Predict Recurrence of Kidney Stones: A Tool to Guide Preventive Measures in Urolithiasis. J Urol 2018; 200:1082-1087. [PMID: 29940247 DOI: 10.1016/j.juro.2018.06.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Kidney stone disease is characterized by a relatively high rate of recurrence. In our study we analyzed the association between relative supersaturation and the risk of stone recurrence. Additionally, we examined the association between the risk of recurrence and changes in relative supersaturation and urinary composition after 1 week of medical treatment. MATERIALS AND METHODS We performed a post hoc analysis of data from a previously published randomized controlled trial comparing the effect of 2 diets in 120 men with recurrent calcium oxalate stones and hypercalciuria. Baseline and followup 24-hour urine parameters were used to calculate the relative supersaturation of calcium oxalate, calcium phosphate and uric acid using the EQUIL2, JESS and LithoRisk computer programs. Cox models were used to calculate the estimated association between each baseline relative supersaturation, and 1-week changes and the risk of recurrence during followup. RESULTS During a 5-year followup 35 patients (34%) experienced recurrence. A reduction in calcium oxalate relative supersaturation at 1 week was significantly associated with a lower risk of recurrence using the EQUIL2 calculation (for every 10% reduction from baseline HR 0.92, 95% CI 0.86-1.00, p = 0.044). However, there was no association for relative supersaturation calculated by other methods or for the relative supersaturation of other salts. Changes in the 24-hour urine excretion of citrate, potassium and magnesium were significantly associated with a risk of recurrence. CONCLUSIONS In recurrent stone formers with hypercalciuria baseline values and changes in the relative supersaturation of calcium oxalate may be associated with the risk of recurrence. Changes in urinary citrate, potassium and magnesium following dietary intervention may also be predictive.
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Affiliation(s)
- Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma and Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma and Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Allen Rodgers
- Department of Chemistry, University of Cape Town, Cape Town, South Africa
| | - Federica Di Maio
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pierluigi Fulignati
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Loris Borghi
- Department of Medicine and Surgery, University of Parma and Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giovanni Gambaro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
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