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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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2
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Bargagli M, Trelle S, Bonny O, Fuster DG. Thiazides for kidney stone recurrence prevention. Curr Opin Nephrol Hypertens 2024; 33:427-432. [PMID: 38606682 PMCID: PMC11139243 DOI: 10.1097/mnh.0000000000000990] [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] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Kidney stones are the most common condition affecting the kidney, and characterized by a high rate of recurrence. Thiazide and thiazide-like diuretics (thiazides) are commonly prescribed to prevent the recurrence of kidney stones. This review offers a comprehensive up-to-date assessment of the evidence supporting the use of thiazides for kidney stone recurrence prevention, highlights potential harms associated with treatment, and identifies areas of knowledge that require further investigation. RECENT FINDINGS The clinical routine to prescribe thiazides for kidney stone prevention has recently been challenged by the findings of the large NOSTONE trial that failed to show superiority of hydrochlorothiazide at doses up to 50 mg daily over placebo in preventing a composite of clinical or radiological recurrence in patients at high risk of recurrence. Yet, adverse events such as new onset diabetes mellitus and gout were more common in patients receiving hydrochlorothiazide compared to placebo. As demonstrated by a novel meta-analysis presented in this review encompassing all randomized placebo-controlled trials with thiazide monotherapy, current trial evidence does not indicate that thiazide monotherapy is significantly better than placebo in preventing kidney stone recurrence. SUMMARY Given the limited efficacy and possible adverse effects, we advocate for a restrictive use of thiazides for kidney stone recurrence prevention. Clearly, there remains a high unmet medical need for effective, targeted therapies to prevent recurrence of kidney stones.
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Affiliation(s)
- Matteo Bargagli
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital
| | - Sven Trelle
- CTU Bern, Department of Clinical Research, University of Bern, Bern
| | - Olivier Bonny
- Service of Nephrology, Fribourg State Hospital, University of Fribourg, Fribourg, Switzerland
| | - Daniel G. Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital
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3
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Tunnicliffe DJ, Mallett A, Cashmore B, Mullan A, Lloyd L, Yip A, Wickham I, Hassan H, Jose M. Update Thiazide Diuretic Evidence Review for CARI Guidelines Kidney Stones Recommendations. Kidney Int Rep 2024; 9:1145-1148. [PMID: 38707826 PMCID: PMC11068971 DOI: 10.1016/j.ekir.2024.02.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Affiliation(s)
- David J. Tunnicliffe
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Andrew Mallett
- Department of Renal Medicine, Townsville University Hospital, Douglas, Queensland, Australia
- College of Medicine and Dentistry, James Cook University, Douglas, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Queensland, Queensland, Australia
| | - Brydee Cashmore
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | - Adam Mullan
- Northland Renal Services, Te Tai Tokerau, Northland, New Zealand
| | - Lyn Lloyd
- Te Whatau Ora Health NZ Te Toka Tumai, Auckland, New Zealand
| | - Adela Yip
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
| | | | - Hicham Hassan
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Renal Medicine, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Matthew Jose
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Curhan GC, Goldfarb DS. Thiazide Use for the Prevention of Recurrent Calcium Kidney Stones. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00309. [PMID: 38099948 PMCID: PMC11108237 DOI: 10.2215/cjn.0000000000000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Gary C. Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David S. Goldfarb
- Nephrology Division, NYU Langone Health and NYU Grossman School of Medicine, New York, New York
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5
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Pasilan RM, Pawar N, Alawieh R, Hiremath S, Teakell J. Hydrochlorothiazide and Prevention of Kidney Stone Recurrence: A #NephJC Editorial on the NOSTONE Trial. Kidney Med 2023; 5:100739. [PMID: 37954501 PMCID: PMC10632949 DOI: 10.1016/j.xkme.2023.100739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Affiliation(s)
- Renz Michael Pasilan
- Department of Internal Medicine, Asian Hospital and Medical Center, Muntinlupa City, Philippines
| | - Nikita Pawar
- Department of Nephrology, Consultant Nephrologist, Wockhardt Super Specialty Hospital, Mumbai, India
| | - Rasha Alawieh
- Yale-Waterbury Internal Medicine Residency Program, Waterbury, CT
| | - Swapnil Hiremath
- Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, Canada
| | - Jade Teakell
- Department of Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, TX
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6
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Lemoine S, Dahan P, Haymann JP, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment. Prog Urol 2023; 33:911-953. [PMID: 37918992 DOI: 10.1016/j.purol.2023.08.004] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- S Lemoine
- Hospices Civils de Lyon, SFNDT, SP, Lyon, France
| | - P Dahan
- Nephrology Department, Clinique Saint-Exupéry, SFNDT, Toulouse, France
| | - J P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, SP, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, Paris, France
| | - P Meria
- Service d'Urologie, Hôpital Saint Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Anan G, Kikuchi D, Hirose T, Okada K, Mori T. Thiazide prescriptions are not associated with lower urolithiasis: a Japanese epidemiologic study. Int Urol Nephrol 2023; 55:2225-2226. [PMID: 37311852 DOI: 10.1007/s11255-023-03671-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Go Anan
- Department of Urology, Yotsuya Medical Cube, 7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
- Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Daisuke Kikuchi
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Takuo Hirose
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Department of Endocrinology and Applied Medical Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kouji Okada
- Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
- Division of Clinical Pharmaceutics and Pharmacy Practice, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takefumi Mori
- Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
- Division of Integrative Renal Replacement Therapy, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Stepanova N. Oxalate Homeostasis in Non-Stone-Forming Chronic Kidney Disease: A Review of Key Findings and Perspectives. Biomedicines 2023; 11:1654. [PMID: 37371749 DOI: 10.3390/biomedicines11061654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic kidney disease (CKD) is a significant global public health concern associated with high morbidity and mortality rates. The maintenance of oxalate homeostasis plays a critical role in preserving kidney health, particularly in the context of CKD. Although the relationship between oxalate and kidney stone formation has been extensively investigated, our understanding of oxalate homeostasis in non-stone-forming CKD remains limited. This review aims to present an updated analysis of the existing literature, focusing on the intricate mechanisms involved in oxalate homeostasis in patients with CKD. Furthermore, it explores the key factors that influence oxalate accumulation and discusses the potential role of oxalate in CKD progression and prognosis. The review also emphasizes the significance of the gut-kidney axis in CKD oxalate homeostasis and provides an overview of current therapeutic strategies, as well as potential future approaches. By consolidating important findings and perspectives, this review offers a comprehensive understanding of the present knowledge in this field and identifies promising avenues for further research.
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Affiliation(s)
- Natalia Stepanova
- State Institution «Institute of Nephrology of the National Academy of Medical Sciences of Ukraine», 04050 Kyiv, Ukraine
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Yu X, Sui Y, Xi Y, Zhang Y, Luo G, Long Y, Yang W. Semisynthesis, Biological Evaluation and Molecular Docking Studies of Barbatic Acid Derivatives as Novel Diuretic Candidates. Molecules 2023; 28:molecules28104010. [PMID: 37241751 DOI: 10.3390/molecules28104010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Barbatic acid, a compound isolated from lichen, has demonstrated a variety of biological activities. In this study, a series of esters based on barbatic acid (6a-q') were designed, synthesized, and evaluated for their diuretic and litholytic activity at a concentration of 100 μmol/L in vitro. All target compounds were characterized using 1H NMR, 13C NMR, and HRMS, and the spatial structure of compound 6w was confirmed using X-ray crystallography. The biological results showed that some derivatives, including 6c, 6b', and 6f', exhibited potent diuretic activity, and 6j and 6m displayed promising litholytic activity. Molecular docking studies further suggested that 6b' had an optimal binding affinity to WNK1 kinases related to diuresis, while 6j could bind to the bicarbonate transporter CaSR through a variety of forces. These findings indicate that some barbatic acid derivatives could be further developed into novel diuretic agents.
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Affiliation(s)
- Xiang Yu
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Guizhou Joint Laboratory for International Cooperation in Ethnic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Yi Sui
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Yinkai Xi
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Yan Zhang
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Guoyong Luo
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Yi Long
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
| | - Wude Yang
- College of Pharmacy, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
- Guizhou Joint Laboratory for International Cooperation in Ethnic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550025, China
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Maisto M, Schiano E, Luccheo G, Luccheo L, Alfieri E, Piccolo V, Iannuzzo F, Di Lorenzo R, Tenore GC. Efficacy of a Multicomponent Nutraceutical Formulation for the Prevention and Treatment of Urinary Tract Stones. Int J Mol Sci 2023; 24:ijms24098316. [PMID: 37176022 PMCID: PMC10178978 DOI: 10.3390/ijms24098316] [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: 04/06/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Urolithiasis is a complex and multifactorial disease characterized by the formation of calculi at the urinary tract level. Conventional therapeutic prophylaxis relies on the use of Ca-blockers, alkalis, diuretics, and anti-edema agents, but their prolonged utilization is often limited by several side effects. In this scenario, the aim of the present work was the design of an innovative multi-component nutraceutical formulation (NF) for the management of urinary stones consisting of a synergistic combination of natural aqueous extracts of Oreganum vulgare L. (1% of saponin), Urtica dioica (0.8% of β-sitosterol), Phyllanthus niruri (15% of tannins w/w), and Ceterach officinarum in association with bromelain, K, and Mg citrate. To assess the potential of NF also in the treatment of uric acid (UA) stones, the effects on the expression of the cellular UA transporters OAT1 and URAT1 were investigated in a renal tubular cell line. In addition, the myorelaxant effect of NF was investigated in a human pulmonary artery smooth muscle cell (HPASMC) model resulting in a decreased muscle contractility of -49.4% (p < 0.01) compared to the control. The treatment with NF also showed a valuable inhibition of in vitro calcium-oxalate crystal formation, both in prevention (-52.3% vs. control, p < 0.01) and treatment (-70.8% vs. control, p < 0.01) experiments. Finally, an ischemic reperfusion rat model was used to evaluate the NF anti-edema effects, resulting in a reduction in the edema-related vascular permeability (Normalized Gray Levels, NGL = 0.40 ± 0.09, p < 0.01, -67.1% vs. untreated rats). In conclusion, the present NF has shown to be a promising natural alternative for managing urinary tract stones.
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Affiliation(s)
- Maria Maisto
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
| | - Elisabetta Schiano
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
| | - Gianni Luccheo
- Nutriphyt Lab, Anvest Health s.r.l., Via Gabriele Camozzi 12, 20152 Milan, Italy
| | - Luigi Luccheo
- Nutriphyt Lab, Anvest Health s.r.l., Via Gabriele Camozzi 12, 20152 Milan, Italy
| | - Ernesto Alfieri
- Nutriphyt Lab, Anvest Health s.r.l., Via Gabriele Camozzi 12, 20152 Milan, Italy
| | - Vincenzo Piccolo
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
| | - Fortuna Iannuzzo
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
| | - Ritamaria Di Lorenzo
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
| | - Gian Carlo Tenore
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 59, 80131 Naples, Italy
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Peerapen P, Thongboonkerd V. Kidney Stone Prevention. Adv Nutr 2023; 14:555-569. [PMID: 36906146 DOI: 10.1016/j.advnut.2023.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Kidney stone disease (KSD) (alternatively nephrolithiasis or urolithiasis) is a global health care problem that affects almost people in developed and developing countries. Its prevalence has been continuously increasing with a high recurrence rate after stone removal. Although effective therapeutic modalities are available, preventive strategies for both new and recurrent stones are required to reduce physical and financial burdens of KSD. To prevent kidney stone formation, its etiology and risk factors should be first considered. Low urine output and dehydration are the common risks of all stone types, whereas hypercalciuria, hyperoxaluria, and hypocitraturia are the major risks of calcium stones. In this article, up-to-date knowledge on strategies (nutrition-based mainly) to prevent KSD is provided. Important roles of fluid intake (2.5-3.0 L/d), diuresis (>2.0-2.5 L/d), lifestyle and habit modifications (for example, maintain normal body mass index, fluid compensation for working in high-temperature environment, and avoid cigarette smoking), and dietary management [for example, sufficient calcium at 1000-1200 mg/d, limit sodium at 2 or 3-5 g/d of sodium chloride (NaCl), limit oxalate-rich foods, avoid vitamin C and vitamin D supplements, limit animal proteins to 0.8-1.0 g/kg body weight/d but increase plant proteins in patients with calcium and uric acid stone and those with hyperuricosuria, increase proportion of citrus fruits, and consider lime powder supplementation] are summarized. Moreover, uses of natural bioactive products (for example, caffeine, epigallocatechin gallate, and diosmin), medications (for example, thiazides, alkaline citrate, other alkalinizing agents, and allopurinol), bacterial eradication, and probiotics are also discussed. Adv Nutr 2023;x:xx-xx.
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Affiliation(s)
- Paleerath Peerapen
- Medical Proteomics Unit, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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12
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Pham NYT, Owen JG, Singh N, Shaffi SK. The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. Cardiol Rev 2023; 31:99-107. [PMID: 34224450 DOI: 10.1097/crd.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of thiazide diuretics for the treatment of hypertension in patients with advance chronic kidney disease. Thiazides have been recommended as the first-line for the treatment of hypertension, yet their use has been discouraged in advanced chronic kidney disease (CKD), as they are suggested to be ineffective in advanced CKD. Recent data suggest that thiazide diuretics may be beneficial blood pressure control in addition to natriuresis in existing CKD. This review discusses the commercially available thiazides with a focus on thiazide pharmacology, most common adverse effects, clinical uses of thiazide diuretic, and the evidence for efficacy of thiazide use in advanced CKD.
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Affiliation(s)
- Ngoc-Yen T Pham
- From the University of New Mexico Hospitals, Albuquerque, NM
| | - Jonathan G Owen
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Namita Singh
- University of New Mexico Health Sciences Center, Albuquerque, NM
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Liu H, Cao M, Jin Y, Jia B, Wang L, Dong M, Han L, Abankwah J, Liu J, Zhou T, Chen B, Wang Y, Bian Y. Network pharmacology and experimental validation to elucidate the pharmacological mechanisms of Bushen Huashi decoction against kidney stones. Front Endocrinol (Lausanne) 2023; 14:1031895. [PMID: 36864834 PMCID: PMC9971497 DOI: 10.3389/fendo.2023.1031895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Kidney stone disease (KS) is a complicated disease with an increasing global incidence. It was shown that Bushen Huashi decoction (BSHS) is a classic Chinese medicine formula that has therapeutic benefits for patients with KS. However, its pharmacological profile and mechanism of action are yet to be elucidated. METHODS The present study used a network pharmacology approach to characterize the mechanism by which BSHS affects KS. Compounds were retrieved from corresponding databases, and active compounds were selected based on their oral bioavailability (≥30) and drug-likeness index (≥0.18). BSHS potential proteins were obtained from the Traditional Chinese Medicine Systems Pharmacology (TCMSP) database, whereas KS potential genes were obtained from GeneCards and OMIM, TTD, and DisGeNET. Gene ontology and pathway enrichment analysis were used to determine potential pathways associated with genes. The ingredients of BSHS extract were identified by the ultra-high-performance liquid chromatography coupled with quadrupole orbitrap mass spectrometry (UHPLC-Q/Orbitrap MS). The network pharmacology analyses predicted the potential underlying action mechanisms of BSHS on KS, which were further validated experimentally in the rat model of calcium oxalate kidney stones. RESULTS Our study found that BSHS reduced renal crystal deposition and improved renal function in ethylene glycol(EG)+ammonium chloride(AC)-induced rats, and also reversed oxidative stress levels and inhibited renal tubular epithelial cell apoptosis in rats. BSHS upregulated protein and mRNA expression of E2, ESR1, ESR2, BCL2, NRF2, and HO-1 in EG+AC-induced rat kidney while downregulating BAX protein and mRNA expression, consistent with the network pharmacology results. DISCUSSION This study provides evidence that BSHS plays a critical role in anti-KS via regulation of E2/ESR1/2, NRF2/HO-1, and BCL2/BAX signaling pathways, indicating that BSHS is a candidate herbal drug for further investigation in treating KS.
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Affiliation(s)
- Haizhao Liu
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Min Cao
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yutong Jin
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Beitian Jia
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Liming Wang
- State Key Laboratory of Component-Based Chinese Medicine, Tianjin Key Laboratory of TCM Chemistry and Analysis, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mengxue Dong
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lu Han
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Joseph Abankwah
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jianwei Liu
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tao Zhou
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Baogui Chen
- Wuqing Hospital of Traditional Chinese Medicine Affiliated with Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yiyang Wang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Yiyang Wang, ; Yuhong Bian,
| | - Yuhong Bian
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- *Correspondence: Yiyang Wang, ; Yuhong Bian,
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14
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Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study. J Clin Med 2022; 11:jcm11123304. [PMID: 35743377 PMCID: PMC9225296 DOI: 10.3390/jcm11123304] [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: 04/26/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used the Taiwan National Health Insurance Research Database to find patients with a hypertension diagnosis who accepted antihypertensive treatment from 2000 to 2017. The patients were further classified into thiazide users and nonthiazide users. Multivariable Cox regression analysis and Kaplan-Meier survival analysis were performed to estimate the adjusted hazard ratios (aHRs) and cumulative probability of fractures. After 1:1 propensity score matching by sex, age, urbanization level of place of residence, income, comorbidities, and medications, there were 18,483 paired thiazide users and non-users, respectively. The incidence densities of fractures (per 1000 person-months) were 1.82 (95% CI: 1.76-1.89) and 1.99 (95% CI: 1.92-2.06) in the thiazide and nonthiazide groups, respectively. The results indicated a lower hazard ratio for fractures in thiazide users (aHR = 0.93, 95% CI: 0.88-0.98). Kaplan-Meier survival analysis revealed a significantly lower cumulative incidence of fractures in the thiazide group (log-rank test; p = 0.0012). In conclusion, our results reveal that thiazide use can reduce fracture risk. When antihypertensive agents are being considered, thiazide may be a better choice if the patient is at heightened risk of fracture.
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D'Ambrosio V, Moochhala S, Unwin RJ, Ferraro PM. Why is diagnosis, investigation and improved management of kidney stone disease important? Non-pharmacological and pharmacological treatments for nephrolithiasis. Expert Rev Clin Pharmacol 2022; 15:407-414. [PMID: 35612529 DOI: 10.1080/17512433.2022.2082943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Progress in the medical treatment and management of nephrolithiasis has been limited to date and continues to depend on urinary metabolic screening to assess excretion of the main stone constituents, factors determining stone solubility and precipitation, and on dietary and lifestyle recommendations. AREAS COVERED In this review, we try to highlight some of the broader aspects of kidney stone disease in relation to recent epidemiological and pathophysiological findings, and emerging new treatments. Specifically, this review will cover recent evidence on the association between metabolic risk factors and kidney stone disease, dietary risk factors and dietary interventions to prevent kidney stones, and how genomics, metabolomics and proteomics may improve diagnosis and treatment of this troublesome, if rarely fatal, condition. PubMed was used to identify the most suitable references according to our search strategy; only full manuscripts were included. EXPERT OPINION What is emerging is that kidney stone disease is not an isolated disorder, but is systemic in nature with links to important and common co-morbidities such as diabetes, hypertension, cardiovascular disease, and chronic kidney disease. These associations support the need to take nephrolithiasis seriously as a medical condition and to adopt a more holistic approach to its investigation and treatment.
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Affiliation(s)
| | - Shabbir Moochhala
- Department of Renal Medicine, Royal Free Hospital Trust and Division of Medicine, University College London UK
| | - Robert J Unwin
- Department of Renal Medicine, Royal Free Hospital Trust and Division of Medicine, University College London UK
| | - Pietro M Ferraro
- Università Cattolica del Sacro Cuore, Roma, Italia.,U.O.S. Terapia Conservativa della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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16
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Nicoli F, Dito G, Guabello G, Longhi M, Corbetta S. Hypercalciuria in Postmenopausal Women With Reduced Bone Mineral Density Is Associated With Different Mineral Metabolic Profiles: Effects of Treatment With Thiazides and Anti-resorptives. Front Med (Lausanne) 2021; 8:780087. [PMID: 34977081 PMCID: PMC8714925 DOI: 10.3389/fmed.2021.780087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022] Open
Abstract
Hypercalciuria may represent a challenge during the workup for osteoporosis management. The present study aimed: (1) to describe the phenotype associated with hypercalciuria in vitamin D-sufficient (serum 25 hydroxyvitamin D (25OHD) > 20 ng/ml) patients with osteopenia/osteoporosis; (2) to analyze the effects of thiazides and anti-resorptive drugs on urine calcium excretion (UCa), mineral metabolic markers, and bone mineral density. Seventy-seven postmenopausal women with hypercalciuria (Uca > 4.0 mg/kg body weight/24 h on two determinations) were retrospectively evaluated in a real-life setting. Median UCa was 5.39 (4.75–6.70) mg/kg/24 h. Kidney stones occurred in 32.9% of patients, who had median UCa similar to that of patients without kidney stones. Clustering analysis considering the three variables, such as serum calcium, phosphate, and parathormone (PTH), identified two main clusters of hypercalciuric patients. Cluster 1 (n = 13) included patients with a primary hyperparathyroidism-like profile, suggesting a certain degree of autonomous PTH secretion from parathyroid glands. Within cluster 2 (n = 61), two subgroups were recognized, cluster 2A (n = 18) that included patients with relatively increased PTH and normophosphatemia, and cluster 2B (n = 43) that included patients with the normal mineral profile. After a follow-up of 33.4 ± 19.6 months, 49 patients treated with thiazidic diuretics (TZD) were reevaluated; 20 patients were treated with hydrochlorothiazide (HCT; 12.5–37.5 mg/day), 29 with indapamide (IND; 1.50–3.75 mg/day). Any significant difference could be detected in all the parameters both basal and treated conditions between patients treated with HCT or IND. TZD induced a mean 39% reduction in UCa and 63.3% of patients obtained Uca < 4.0 mg/kg/24 h, independent of their mineral metabolic profile. Moreover, TZD induced a significant decrease in PTH levels. TZD-treated patients normalizing UCa experienced an increase in bone mineral densities when concomitantly treated with anti-resorptives, while any gain could be observed in TZD-treated patients with persistent hypercalciuria. Finally, multiple regression analysis showed that UCa reduction was at least in part related to denosumab treatment. In conclusion, in postmenopausal osteoporotic women, hypercalciuria is associated with kidney stones in about one-third of patients and with a wide range of impaired PTH secretion, determining a diagnostic challenge. TZD efficiently reduces UCa and normalization contributes to increasing anti-resorptives positive effect on bone mineral density.
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Affiliation(s)
- Federico Nicoli
- Department of Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giorgia Dito
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Matteo Longhi
- Rheumatology Unit, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sabrina Corbetta
- Endocrinology and Diabetology Service, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- *Correspondence: Sabrina Corbetta ; orcid.org/0000-0001-8140-3175
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Zhong J, Huang Z, Yang T, Wang G, Guo H, Li P, Zhang Y, Zhao Y, Liu J. The current status of preventive measures for urinary calculi in children. Ther Adv Urol 2021; 13:17562872211039581. [PMID: 34422114 PMCID: PMC8371722 DOI: 10.1177/17562872211039581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Urological calculus is a common disease in urology. Urological calculi are
generally more common in adults but have become more common in children in
recent years. Most existing studies focus on the prevention of urinary calculi
in adults; there are relatively few articles on calculi in children. Reported
preventive measures are not comprehensive enough, while the latest research
progress has not been updated. The pathogenesis and preventive measures
associated with urinary calculi have been the focus of research, but many
preventive measures still need further clarification. This article reviews the
progress on preventive measures for urinary calculi in children.
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Affiliation(s)
- Jiao Zhong
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Haixiang Guo
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yafei Zhang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yuan Zhao
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, P.R. China
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Kovaleva EV, Eremkina AK, Krupinova JA, Mirnaya SS, Kim IV, Kuznetzov NS, Andreeva EN, Karonova TL, Kryukova IV, Mudunov AM, Sleptcov IV, Melnichenko GA, Mokrysheva NG, Dedov II. [Review of clinical practice guidelines for hypoparathyroidism]. ACTA ACUST UNITED AC 2021; 67:68-83. [PMID: 34533015 DOI: 10.14341/probl12800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/06/2022]
Abstract
Hypoparathyroidism is a rare disorder characterized by the absent or inappropriately decreased serum parathyroid hormone in the parathyroid glands, which is accompanied by impaired calcium-phosphorus metabolism.The main etiology of hypoparathyroidism remains damage or removal of the parathyroid glands during neck surgery. In view of the incidence of thyroid cancer, primary hyperparathyroidism and other pathologies of the neck organs, which radical treatment can lead to the parathyroid gland impairment, an increased number of patients with hypoparathyroidism is expected. Autoimmune hypoparathyroidism is the second most common form of the disease, usually occurring as part of type 1 autoimmune polyglandular syndrome. Autoimmune hypoparathyroidism usually occurs in childhood and is characterized by a severe course of the disease, especially in the case of concomitant malabsorption syndrome.Chronic hypoparathyroidism of any etiology requires lifelong multicomponent therapy, as well as careful monitoring and an individual approach to choose the optimal treatment strategy. In the absence of adequate follow-up, the risks of long-term complications significantly increase, particularly in the renal, cardiovascular systems; in the soft tissues and in the brain, it could lead to visual disturbances; pathology of the musculoskeletal system with a decreased bone remodeling and a potential risk of fractures, as well as to the neurocognitive disorders and an impaired health-related quality of life.Timely diagnosis, rational medical therapy and management strategy may reduce the risks of short-term and long-term complications, frequency of hospitalizations and disability of patients, as well as improve the prognosis.This review covers the main issues of Russian guidelines for the management of chronic hypoparathyroidism, approved in 2021, including laboratory and instrumental evaluation, treatment approaches and follow-up. This guidelines also include the recommendations for special groups of patients: with acute hypocalcemia, hypoparathyroidism during pregnancy.
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Affiliation(s)
| | | | | | | | - I V Kim
- Endocrinology Research Center
| | | | | | - T L Karonova
- National Medical Research Center. V. A. Almazova
| | - I V Kryukova
- Moscow Regional Research Clinical Institute. M.F. Vladimirskogo
| | - A M Mudunov
- National Medical Research Center of Oncology named after V.I. N.N. Blokhin
| | - I V Sleptcov
- Clinic of high medical technologies. N.I. Pirogov St. Petersburg State University
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Luft FC, Sällström J. Amiloride and Calciuria. Nephrol Dial Transplant 2021; 37:205-207. [PMID: 34264323 DOI: 10.1093/ndt/gfab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Friedrich C Luft
- Experimental and Clinical Research Center, Charité Medical Faculty, Berlin, Germany
| | - Johan Sällström
- Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
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Zou GJ, Huang WB, Sun XY, Tang GH, Ouyang JM. Carboxymethylation of Corn Silk Polysaccharide and Its Inhibition on Adhesion of Nanocalcium Oxalate Crystals to Damaged Renal Epithelial Cells. ACS Biomater Sci Eng 2021; 7:3409-3422. [PMID: 34170660 DOI: 10.1021/acsbiomaterials.1c00176] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to explore the repair effect of carboxymethyl-modified corn silk polysaccharide (CSP) on oxidatively damaged renal epithelial cells and the difference in adhesion between cells and calcium oxalate crystals. The CSP was degraded and modified through carboxymethylation. An oxidatively damaged cell model was constructed by oxalate damage to human kidney proximal tubular epithelial (HK-2) cells. Then, the damaged cells were repaired by modified polysaccharides, and the changes in biochemical indexes and adhesion ability between cells and crystals before and after repair were detected. Four modified polysaccharides with carboxyl group (-COOH) contents of 3.92% (CSP0), 7.75% (CCSP1), 12.90% (CCSP2), and 16.38% (CCSP3) were obtained. Compared with CSP0, CCSPs had stronger antioxidant activity, could repair damaged HK-2 cells, and could reduce phosphorylated serine eversion on the cell membrane, the expression of osteopontin (OPN) and Annexin A1, and crystal adhesion. However, its effect on the expression of hyaluronic acid synthase was not substantial. The carboxymethyl modification of the CSP can improve its ability to repair cells and inhibit crystal adhesion and aggregation. A high carboxymethylation degree results in strong polysaccharide activity. CCSPs are expected to reduce the risk of kidney stone formation and recurrence.
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Affiliation(s)
- Guo-Jun Zou
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
| | - Wei-Bo Huang
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
| | - Xin-Yuan Sun
- Department of Urology, Guangzhou Institute of Urology, Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510230, Guangdong, China
| | - Gu-Hua Tang
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
| | - Jian-Ming Ouyang
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
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