Does urinary oxalate interfere with the inhibitory role of glycosaminoglycans and semisynthetic sulfated polysaccharides in calcium oxalate crystallization?

Age-Specific Excretion of Calcium, Oxalate, Citrate, and Glycosaminoglycans and Their Ratios in Healthy Children and Children with Urolithiasis

We analyzed children with urolithiasis with age- and gender-matched healthy children. Calcium (mmol/mmol creatinine) and the calcium/citrate ratio (mol/mmol) are the only variables that differentiate children before puberty from healthy children (ROC analysis confirmed only calcium/citrate as a significant variable with cut-off value > 0.84). Peri-pubertal children are distinguished from age- and gender-matched healthy children by the following variables: citrate (mmol/mol creatinine), calcium/citrate (mol/mmol), oxalate/glycosaminoglycans (mmol/g), oxalate/citrate ratios (mmol/mmol) and oxalate/(citrate × glycosaminoglycans) (mol oxalate × mol creatinine)/(mol citrate × g glycosaminoglycans). All variables were confirmed by ROC analysis with cut-off values ≤ 327.87, >1.02, >11.24, >0.12 and >0.03, respectively. These results indicate a different risk of urinary stones development before puberty vs. pubertal/postpubertal children and increasing importance (deficiency) of citrate and glycosaminoglycans in such children. J48 classifier confirmed the importance of the oxalate/(citrate × glycosaminoglycans) and the calcium/citrate ratios (Ox/Cit × GAG 0.22 and Cit/GAG 0.612) with the practically applicable classification tree for distinguishing between pubertal/postpubertal children with urolithiasis with age- and gender-matched healthy children.

Physico-chemical alterations of urine in experimental hyperoxaluria: a biochemical approach with fucoidan

Urinary supersaturation-induced crystal formation has been attributed as one of the key factor for the pathogenesis/progression of lithogenesis. This study was aimed at investigating whether fucoidan, a naturally occurring sulfated glycosaminoglycan, could ameliorate the biochemical changes in urine induced by stone formation. Two groups of male albino Wistar rats (120+/-20 g) received 0.75% ethylene glycol (EG) for 28 days to induce hyperoxaluria, and one of them received sulfated polysaccharides (fucoidan from Fucus vesiculosus, 5 mg kg(-1), s.c.), commencing from the 8(th) day of the experimental period. One group was maintained as normal control group and another group served as drug control, which received sulfated polysaccharides. The urine collected from all the groups was analysed for changes in pH, volume, oxalate, calcium, phosphorus, uric acid, magnesium, citric acid and glycosaminoglycans. Urinary crystals were analysed with a light microscope. Renal tissues were studied under polarized light for deposition of crystals and also analysed for their oxalate and calcium content. The changes in extracellular matrix on crystal deposition were also evaluated. The urinary pH and volume were altered in rats treated with EG along with an increase in weight of the kidney. Further, administration of EG to rats increased the supersaturation of urine by escalating the levels of the stone-forming constituents, such as oxalate, calcium, phosphorus and uric acid, which was completely restored by fucoidan treatment. The decrease in the inhibitors, like citrate, magnesium and glycosaminoglycans, in urine was prevented by the co-treatment with fucoidan. In hyperoxaluric rats, there was an increased excretion of calcium oxalate monohydrate crystals in urine along with crystal deposition in renal tissues; this was prevented by fucoidan treatment. Fucoidan administration reversed even the tissue levels of calcium and oxalate. The increased accumulation of collagen and expression of transforming growth factor-beta(1) in hyperoxaluria was normalized on fucoidan administration. These results suggest that the physico-chemical alterations in urine produced during hyperoxaluria can be reversed by fucoidan administration.

Clinical association with urinary glycosaminoglycans and urolithiasis

OBJECTIVES

To determine the clinical association between urinary glycosaminoglycan (GAG) concentration and kidney stone disease.

METHODS

Thirty-five patients (14 women and 21 men) with a history of stone disease and 37 controls (13 women and 24 men) were evaluated for urinary GAG concentration. By using a new dye-binding assay, the total GAG concentration in the urine was measured and corrected to urinary creatinine levels (micrograms of GAG per milligram creatinine).

RESULTS

The mean urinary GAG concentration in those with stones was significantly lower (31.5 +/- 2.6 microg GAG/mg creatinine) than in the controls (43.8 +/- 3.8 microg GAG/mg creatinine, P = 0.01). Male patients with stones also had a significantly lower mean GAG concentration (26.1 +/- 1.8) than did the female patients (39.6 +/- 5.3, P = 0.009). The mean GAG concentration between ureteral (n = 13) versus renal (n = 22), single (n = 19) versus multiple (n = 16), family history (n = 11) versus no family history (n = 24), large (n = 13) versus small (n = 20), and the presence (n = 22) versus absence (n = 13) of residual stones did not show any significant differences. However, patients with recurrent stone formation (n = 21) had significantly lower mean GAG levels (26.4 +/- 1.6) compared with those with single stone formation (n = 14; 39.2 +/- 5.5, P = 0.01).

CONCLUSIONS

Lower urinary GAG levels are more common in patients with stone formation. This may play a more determinant role in male patients and those with recurrent stone formation.

Crystal±macromolecule interactions in urolithiasis: lessons from healthy biomineralization systems

Recent advances in understanding the molecular level mechanisms that control biomineralization and organic-inorganic interactions in urolithiasis are reviewed, and the validity of drawing parallels between them are considered. The multifunctional nature of many biomineralization molecules, particularly proteins, and the different roles they play in and out of solution suggest avenues for resolving the apparent paradox that urinary macromolecules have been observed both to inhibit and to promote stone formation.