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Urinary citrate as a marker of renal function in patients with autosomal dominant polycystic kidney disease. Int Urol Nephrol 2021; 54:873-881. [PMID: 34279821 DOI: 10.1007/s11255-021-02953-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Autosomal dominant polycystic kidney disease (ADPKD) is frequent to find low urinary citrate levels. Recently, it has been suggested that urinary citrate could be a marker of covert metabolic acidosis in chronic kidney disease. OBJECTIVE Our aim was to analyze relationship between urinary citrate levels, renal function, and serum bicarbonate in ADPKD patients. METHODS We determined citrate in 24-h collected urine from ADPKD patients and correlated with glomerular filtration rate (CKD-EPI equation) and serum bicarbonate concentration. RESULTS We included 120 patients, 60% men, eGFR was 71 ± 32 mL/min/1.73 m2. Urinary citrate/creatinine ratio was 195 ± 152 mg/gCr (range 1.2-689) with levels significantly higher in females. Urinary citrate lower than 300 mg/gCr was present in 75% of patients and when considering chronic kidney stages (CKD), we observed reduced levels in 48.8% in CKD1 stage, in 79.4% in CKD2 stage, in 96.2% in CKD3 stage, and in 94.7% of patients in CKD4 stage. Urinary citrate was correlated with serum creatinine (r = - 0.61, p < 0.001) and eGFR (r = 0.55, p < 0.001) in both gender. We did not find any correlation with serum bicarbonate. Using a general linear modeling analysis, we found as predictors of urinary citrate/creatinine ratio to glomerular filtration rate, gender, and age. Lower levels of urinary citrate were accompanied by a decline in urinary osmolality and in renal excretion of calcium and uric acid. In a subgroup of patients, we measured total kidney volume and we found an inverse correlation with urinary citrate levels that disappeared when it was corrected with glomerular filtration rate. CONCLUSIONS Urinary citrate is very frequently reduced in ADPKD patients being present from very early CKD stages. Their levels in urine are inversely correlated with glomerular filtration rate and it is not related with serum bicarbonate concentration. We think that it would be interesting to study urinary citrate as a marker of chronic kidney disease in ADPKD patients.
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Saponaro F, Marcocci C, Apicella M, Mazoni L, Borsari S, Pardi E, Di Giulio M, Carlucci F, Scalese M, Bilezikian JP, Cetani F. Hypomagnesuria is Associated With Nephrolithiasis in Patients With Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab 2020; 105:5830733. [PMID: 32369583 DOI: 10.1210/clinem/dgaa233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/30/2020] [Indexed: 01/04/2023]
Abstract
CONTEXT The pathogenesis of nephrolithiasis in primary hyperparathyroidism (PHPT) remains to be elucidated. The latest guidelines suggest parathyroidectomy in patients with asymptomatic PHPT with hypercalciuria (> 400 mg/d) and increased stone risk profile. OBJECTIVE The objective of this work is to evaluate the association of urinary stone risk factors and nephrolithiasis in patients with asymptomatic sporadic PHPT and its clinical relevance. DESIGN A total of 157 consecutive patients with sporadic asymptomatic PHPT were evaluated by measurement of serum and 24-hour urinary parameters and kidney ultrasound. RESULTS Urinary parameters were tested in the univariate analysis as continuous and categorical variables. Only hypercalciuria and hypomagnesuria were significantly associated with nephrolithiasis in the univariate and multivariate analysis adjusted for age, sex, body mass index, estimated glomerular filtration rate, parathyroid hormone, 25-hydroxyvitamin D, serum calcium, and urine volume (odds ratio, OR 2.14 [1.10-4.56]; P = .04; OR 3.06 [1.26-7.43]; P = .013, respectively). Hypomagnesuria remained associated with nephrolithiasis in the multivariate analysis (OR 6.09 [1.57-23.5], P = .009) even when the analysis was limited to patients without concomitant hypercalciuria. The urinary calcium/magnesium (Ca/Mg) ratio was also associated with nephrolithiasis (univariate OR 1.62 [1.27-2.08]; P = .001 and multivariate analysis OR 1.74 [1.25-2.42], P = .001). Hypomagnesuria and urinary Ca/Mg ratio had a better, but rather low, positive predictive value compared with hypercalciuria. CONCLUSIONS Hypomagnesuria and urinary Ca/Mg ratio are each associated with silent nephrolithiasis and have potential clinical utility as risk factors, besides hypercalciuria, for kidney stones in asymptomatic PHPT patients. The other urinary indices that have been commonly thought to be associated with kidney stones in PHPT are not supported by our results.
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Affiliation(s)
- Federica Saponaro
- Department of Pathology, University of Pisa, Pisa, Italy
- Endocrinology Unit, University of Pisa, Pisa, Italy
| | | | | | - Laura Mazoni
- Endocrinology Unit, University of Pisa, Pisa, Italy
| | | | - Elena Pardi
- Endocrinology Unit, University of Pisa, Pisa, Italy
| | | | | | - Marco Scalese
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - John P Bilezikian
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physician and Surgeons, Columbia University, New York, New York, US
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The role of zinc in urinary stone disease. Int Urol Nephrol 2018; 50:879-883. [PMID: 29344880 DOI: 10.1007/s11255-017-1784-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/29/2017] [Indexed: 01/26/2023]
Abstract
In recent years, the role of trace elements in lithogenesis has received steadily increasing attention. It is well documented that some trace elements can influence the morphology and speed of the crystallization process. Zinc has been found in significant amounts in calcium stones relative or organic stones (uric acid and cystine), probably substituting calcium in crystals because of their similarity in charge and size. High Zn levels are present in carbapatite of Randal's plaques suggesting that zinc could promote calcium phosphate deposition in the medullar interstitium. Large-scale epidemiological studies have found an association of increased dietary zinc intake with increased risk of nephrolithiasis in adults but not in adolescents. Most studies examining urinary zinc levels in adults have reported increased urinary Zn excretion in stone formers. In an experimental model of organic crystal formation produced by silencing xanthine dehydrogenase in Drosophila fly, maneuvers that reduce Zn excretion have shown to reduce crystal formation in the lumen of the Malpighian tubules. This is curious because this is not a model of calcium stone formation. Finally, zinc supplementation has been associated with increased admissions for urinary lithiasis in men, but no change in calcium stone formation in children. Perhaps, some of these contradicting findings can be explained in part by the in vitro effect of zinc on the type and amount of calcium phosphate formed: At low concentrations, Zn inhibited the crystal growth of dicalcium phosphate dihydrate, octacalcium phosphate, and apatite, and at higher concentrations, it promoted the formation of amorphous calcium phosphate. Thus, further studies are needed to see whether manipulation of Zn metabolism can inhibit calcium stone formation.
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Perinpam M, Ware EB, Smith JA, Turner ST, Kardia SLR, Lieske JC. Association of urinary citrate excretion, pH, and net gastrointestinal alkali absorption with diet, diuretic use, and blood glucose concentration. Physiol Rep 2017; 5:5/19/e13411. [PMID: 29038354 PMCID: PMC5641929 DOI: 10.14814/phy2.13411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 11/24/2022] Open
Abstract
Urinary citrate (Ucit) protects against urinary stone formation. Acid base status and diet influence Ucit. However, the effect of demographics, diet, and glucose metabolism on Ucit excretion, urinary pH (U‐pH) and net gastrointestinal alkali absorption (NAA) are not known. Twenty‐four hour urine samples, blood glucose, creatinine, and cystatin C were obtained from non‐Hispanic white sibships in Rochester, MN (n = 446; 64.5 ± 9 years; 58% female). Diet was assessed by a food frequency questionnaire. The impact of blood glucose, demographics and dietary elements on Ucit excretion, U‐pH, and NAA were evaluated in bivariate and multivariable models and interaction models that included age, sex, and weight. NAA significantly associated with Ucit and U‐pH. In multivariate models Ucit increased with age, weight, eGFRCys, and blood glucose, but decreased with loop diuretic and thiazide use. U‐pH decreased with serum creatinine, blood glucose, and dietary protein but increased with dietary potassium. NAA was higher in males and increased with age, weight, eGFRCys and dietary potassium. Significant interactions were observed for Ucit excretion with age and blood glucose, weight and eGFRCys, and sex and thiazide use. Blood glucose had a significant and independent effect on U‐pH and also Ucit. This study provides the first evidence that blood glucose could influence urinary stone risk independent of urinary pH, potentially providing new insight into the association of obesity and urinary stone disease.
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Affiliation(s)
- Majuran Perinpam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Erin B Ware
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - Stephen T Turner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Minnesota
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Tasian GE, Ross ME, Song L, Grundmeier RW, Massey J, Denburg MR, Copelovitch L, Warner S, Chi T, Killilea DW, Stoller ML, Furth SL. Dietary Zinc and Incident Calcium Kidney Stones in Adolescence. J Urol 2017; 197:1342-1348. [PMID: 27889417 PMCID: PMC5438256 DOI: 10.1016/j.juro.2016.11.096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE We determined the association between dietary zinc intake and incident calcium kidney stones in adolescents. We also examined the relationship between dietary zinc intake and urinary zinc excretion between cases and controls. MATERIALS AND METHODS We conducted a nested case-control study within a large pediatric health care system. Three 24-hour dietary recalls and spot urine chemistry analyses were obtained for 30 participants 12 to 18 years old with a first idiopathic calcium based kidney stone and 30 healthy controls matched for age, sex, race and month of enrollment. Conditional logistic regression models were used to estimate the association between daily zinc intake and incident calcium kidney stones, adjusting for dietary phytate, protein, calcium, sodium and oxalate. Multivariable linear regression was used to estimate the association between dietary and urine zinc, adjusting for urine creatinine and dietary phytate and calcium. RESULTS Cases had lower daily zinc intake (8.1 mg) than controls (10 mg, p = 0.029). Daily zinc intake of boys and girls with calcium stones was 2 mg and 1.2 mg less, respectively, than the daily intake recommended by the Institute of Medicine. Odds of incident stones were reduced by 13% for every 1 mg increase in daily zinc intake (OR 0.87, 95% CI 0.75-0.99). There was an estimated 4.5 μg/dl increase in urine zinc for every 1 mg increase in dietary zinc (p = 0.009), with weak evidence of a smaller increase in urine zinc in cases than in controls (interaction p = 0.08). CONCLUSIONS Decreased dietary zinc intake was independently associated with incident calcium nephrolithiasis in this population of adolescents.
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Affiliation(s)
- Gregory E Tasian
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Michelle E Ross
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lihai Song
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James Massey
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R Denburg
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lawrence Copelovitch
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven Warner
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas Chi
- Department of Urology, University of California, San Francisco, San Francisco
| | - David W Killilea
- Center for Nutrition and Metabolism, Children's Hospital Oakland Research Institute, Oakland, California
| | - Marshall L Stoller
- Department of Urology, University of California, San Francisco, San Francisco
| | - Susan L Furth
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Calcium oxalate urolithiasis in children: urinary promoters/inhibitors and role of their ratios. Eur J Pediatr 2016; 175:1959-1965. [PMID: 27730307 DOI: 10.1007/s00431-016-2792-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/17/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
UNLABELLED Diagnostic criteria for determination of inclination towards idiopathic calcium oxalate (CaOx) urolithiasis based on biochemical urine parameters are not sufficiently well defined in children. The aim of this study was to determine the risk of CaOx urolithiasis in children from concentrations of calcium, oxalate, citrate, and glycosaminoglycans in urine and their ratios, all standardized in respect to creatinine. We collected and analyzed 24-h urine samples of children with CaOx urolithiasis (n = 61) and compared with urine samples of matched control group of healthy children (n = 25). The study has showed that all stone formers have higher excretion of calcium (mmol/mmol creatinine), calcium/citrate (mol/mmol), and oxalate/(citrate × glycosaminoglycans) ratio (mol Ox × mol cr)/(mol Cit × g GAGs). ROC analysis of these variables gave criteria (>0.28, >1.07, and >0.08, respectively) for distinguishing stone formers from healthy children. Biochemical urine parameters and their ratios (calcium, calcium citrate, and oxalate/(citrate × glycosaminoglycans) enable one to discriminate idiopathic calcium oxalate stone formers from healthy children. Oxalate/(citrate × glycosaminoglycans) ratio per se can serve as an independent risk for stone formation. CONCLUSION Using biochemical urine parameters and their ratios such as calcium, calcium/citrate, and oxalate/(citrate × glycosaminoglycans) enables one to determine diagnostic criteria towards idiopathic calcium oxalate urolithiasis in children. What is known: • The role of urine calcium as a promoter in calcium oxalate urolithiasis is well established. • Seldom used calcium/citrate ratio is acknowledged as a risk factor for calcium/oxalate urolithiasis. What is new: • The values of calcium and citrate in clinically and genetically proven idiopathic calcium oxalate urolithiasis make calcium/citrate ratio useful for diagnostic purposes in such stone formers. • Rarely used calcium independent oxalate/(citrate x glycosaminoglycans) ratio serves as the second best high specificity marker for idiopathic calcium oxalate urolithiasis.
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Yousefichaijan P, Cyrus A, Dorreh F, Rafeie M, Sharafkhah M, Frohar F, Safi F. Oral Zinc Sulfate as Adjuvant Treatment in Children With Nephrolithiasis: a Randomized, Double-Blind, Placebo-Controlled Clinical Trial. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e1445. [PMID: 26635934 PMCID: PMC4662834 DOI: 10.5812/ijp.1445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/22/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nephrolithiasis in children is associated with a high rate of complications and recurrence. OBJECTIVES Since some evidences reported that zinc has an important place amongst inhibitors of crystallization and crystal growth, we decided to assess the effectiveness of oral zinc sulfate as adjuvant treatment in children with nephrolithiasis. PATIENTS AND METHODS This was a randomized, double-blind, placebo-controlled clinical trial. 102 children in the age range 1 month to 11 years with first nephrolithiasis were recruited. Patients were randomly divided into two equal groups (intervention and control groups). Intervention group received conservative measures for stones and 1 mg/kg/day (maximum 20 mg/day) oral zinc sulfate syrup for 3 months. Control group received placebo in addition to conservative measures, also for 3 months. Patients were followed up by ultrasonography for 9 months, in 5 steps (at the end of 1st, 2nd, 3rd, 6th and 9th month after treatment) assessing size and number of stones in the kidneys. RESULTS Only at the end of the first month, the average number (intervention: 1.15 ± 3.78, control: 1.3 ± 2.84) (P = 0.001) and size (cm) (intervention: 0.51 ± 1.76, control: 0.62 ± 1.39) (P = 0.001) of stones was significantly lower in the intervention group, and in other points there was no significant therapeutic efficacy in oral zinc adjuvant treatment compared to conservative treatment alone. Also, during the 9-month follow-up, the number and size of stones in both groups decreased significantly (both: P < 0.0001) in a way that the decrease in the intervention group showed no difference with the control group. CONCLUSIONS Adjuvant treatment with zinc is not more effective than consecutive treatment in children with nephrolithiasis. However, further studies are recommended due to the lack of clinical evidence in this field.
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Affiliation(s)
- Parsa Yousefichaijan
- Department of Pediatric Nephrology, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Ali Cyrus
- Department of Surgery, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Fatemeh Dorreh
- Department of Pediatrics, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Mohammad Rafeie
- Department of Biostatistics and Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Mojtaba Sharafkhah
- Students Research Committee, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Faryar Frohar
- Department of Pediatric Nephrology, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Fatemeh Safi
- Department of Radiology, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
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Janssen C, Lo J, Jäger W, Moskalev I, Law A, Chew BH, Lange D. A high throughput, minimally invasive, ultrasound guided model for the study of catheter associated urinary tract infections and device encrustation in mice. J Urol 2014; 192:1856-63. [PMID: 24866596 DOI: 10.1016/j.juro.2014.05.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Catheter associated urinary tract infections are one of the most common health care associated infections. The condition is frequently complicated by encrustation, which blocks the catheter lumen. Preclinical research is limited by the lack of relevant high throughput and cost-effective animal models. Current models are restricted to female mice, associated with major transurethral loss of catheter materials during micturition, highly invasive and complex. We present an ultrasound guided, minimally invasive model that enables catheter associated urinary tract infection and catheter encrustation studies in each mouse gender. MATERIALS AND METHODS Catheter segments (4 mm) were implanted in murine bladders percutaneously in 15 males and 5 females, and transurethrally in 15 females using the Seldinger technique under ultrasound guidance. Proteus mirabilis was instilled intraluminally. Catheter encrustation was monitored by ultrasound. Bacteria were quantified in urine, and catheters and encrustation were analyzed on day 6 or 21. RESULTS Percutaneous and transurethral catheter implantations were performed in a mean ± SE 3.6 ± 0.8 vs 2.5 ± 0.5 minutes in all mice. Ultrasound confirmed that 100% and 66% of implanted catheters, respectively, remained indwelling during the study period. Catheter encrustation developed in P. mirabilis infected urine 48 hours after instillation and an increase with time was detected by ultrasound. Fourier transform spectroscopy of the encrustation confirmed a typical struvite spectrum. Control catheters remained sterile during 21 days. CONCLUSIONS Our minimally invasive, reproducible percutaneous technique is suitable for studying catheter associated urinary tract infection in each gender. Infecting urine with P. mirabilis generates a preclinical model of catheter encrustation within 3 days. The progression of encrustation can be monitored in vivo by ultrasound, making this image based model suitable for assessing novel antibacterial and anti-encrustation therapies.
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Affiliation(s)
- Claudia Janssen
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Joey Lo
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wolfgang Jäger
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Johannes Gutenberg University, Mainz, Germany
| | - Igor Moskalev
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrienne Law
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ben H Chew
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk Lange
- Stone Centre at Vancouver General Hospital, Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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Turney BW, Appleby PN, Reynard JM, Noble JG, Key TJ, Allen NE. Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Epidemiol 2014; 29:363-9. [PMID: 24752465 DOI: 10.1007/s10654-014-9904-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
The lifetime prevalence of kidney stones is around 10 % and incidence rates are increasing. Diet may be an important determinant of kidney stone development. Our objective was to investigate the association between diet and kidney stone risk in a population with a wide range of diets. This association was examined among 51,336 participants in the Oxford arm of the European Prospective Investigation into Cancer and Nutrition using data from Hospital Episode Statistics in England and Scottish Morbidity Records. In the cohort, 303 participants attended hospital with a new kidney stone episode. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and their 95 % confidence intervals (95 % CI). Compared to those with high intake of meat (>100 g/day), the HR estimates for moderate meat-eaters (50-99 g/day), low meat-eaters (<50 g/day), fish-eaters and vegetarians were 0.80 (95 % CI 0.57-1.11), 0.52 (95 % CI 0.35-0.8), 0.73 (95 % CI 0.48-1.11) and 0.69 (95 % CI 0.48-0.98), respectively. High intakes of fresh fruit, fibre from wholegrain cereals and magnesium were also associated with a lower risk of kidney stone formation. A high intake of zinc was associated with a higher risk. In conclusion, vegetarians have a lower risk of developing kidney stones compared with those who eat a high meat diet. This information may be important to advise the public about prevention of kidney stone formation.
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Affiliation(s)
- Benjamin W Turney
- Department of Urology, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK,
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Friedlander JI, Moreira DM, Hartman C, Elsamra SE, Smith AD, Okeke Z. Age-related changes in 24-hour urine composition must be considered in the medical management of nephrolithiasis. J Endourol 2014; 28:871-6. [PMID: 24571654 DOI: 10.1089/end.2014.0002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Over the past 50 years, there has been an upward shift in the age of peak incidence of stone disease, yet less is known regarding how the urinary biochemical profile changes with aging. Therefore, we sought to examine the relationship between age and 24-hour urine composition. METHODS We retrospectively reviewed a database of our tertiary care stone clinic patients seen from March 2002 to February 2012. Analysis of pretreatment 24-hour urine collections across age groups was performed using univariate analysis of variance and multivariate linear regression models adjusting for clinical and demographic factors and 24-hour urine parameters. RESULTS A total of 1115 patients were broken down into age groups consisting of <45 years (221; 19.7%), 45-54.9 years (270; 23.8%), 55-64.9 years (270; 24.6%), and ≥65 years (356; 31.9%). Univariate analysis found significant ascending trends with aging for mean body mass index, while mean urine pH, 24-hour calcium, uric acid (UA), ammonium, creatinine, and supersaturation (SS) of calcium oxalate (CaOx) and calcium phosphate (CaP) decreased with age (all P for trend <0.05). Adjusted multivariate analysis demonstrated that increased age was significantly associated with increased 24-hour citrate and SS UA, whereas increased age was significantly associated with decreased pH, 24-hour UA, creatinine, SS CaOx, and SS CaP (all P for trend <0.05). CONCLUSIONS There are numerous age-related changes in the metabolic profile as seen on 24-hour urine collection. This highlights the importance of evaluating stone-forming patients of all ages with 24-hour urine collections because both the type and degree of metabolic abnormality may change with age.
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Affiliation(s)
- Justin I Friedlander
- 1 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas
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Wu W, Yang D, Tiselius HG, Ou L, Liang Y, Zhu H, Li S, Zeng G. The characteristics of the stone and urine composition in Chinese stone formers: primary report of a single-center results. Urology 2014; 83:732-7. [PMID: 24485999 DOI: 10.1016/j.urology.2013.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/09/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess urine composition in Chinese patients with urolithiasis. METHODS Five hundred seven Chinese patients with urolithiasis from our center in southern China were included in this study. Analysis of stone composition was performed using infrared spectrometry. From all patients, 24-hour urine samples were collected for analysis of urinary variables. Some ion activity product risk indices were also calculated. RESULTS The major stone constituents in the 507 analyzed stones were as follows: calcium oxalate (78.3%), infection stone components (14.6%), uric acid (3.6%), and calcium phosphate (3.4%). Only 1 stone was composed of cystine (0.2%). Of all patients, 504 (99.4%) had 1 or several urinary metabolic abnormalities. Hypocitraturia was recorded in 93.9%, high sodium excretion in 58.6%, small urine volume in 45.6%, hyperoxaluria in 31.0%, hypercalciuria in 26.0%, hyperuricosuria in 19.3%, and hyperphosphaturia in 2.8%. Moreover, high sodium excretion was more frequent in men than women (59.2% vs 49.3%, P = .027), whereas hypercalciuria was more common in women (34.5% vs 20.4%, P <.001). High levels of urine sodium (187.7 ± 86.9 vs 179.8 ± 107.7 mmol/24h, P = .038) and phosphate (18.26 ± 8.36 vs 15.69 ± 11.14 mmol/24h, P <.001) were found in men than in women. Infection stones were significantly (P <.004) more common in women. Compared with noninfection stone formers, the occurrence of hypomagnesuria (P = .040) was more common in patients with infection stones. CONCLUSION The results of urinary risk factors for stone formation in this study might serve as a basis for design of recurrence prevention. It is of interest to note that some of the demonstrated abnormalities differ from that in reports from other countries.
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Affiliation(s)
- Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Dong Yang
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Hans-Göran Tiselius
- Division of Urology, Department of Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lili Ou
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Yeping Liang
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Hanliang Zhu
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Shujue Li
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, China.
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Perry GML, Scheinman SJ, Asplin JR. Effects of Sex on Intra-Individual Variance in Urinary Solutes in Stone-Formers Collected from a Single Clinical Laboratory. PLoS One 2013; 8:e53637. [PMID: 23840293 PMCID: PMC3686766 DOI: 10.1371/journal.pone.0053637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
Abstract
Background/Aims Our work in a rodent model of urinary calcium suggests genetic and gender effects on increased residual variability in urine chemistries. Based on these findings, we hypothesized that sex would similarly be associated with residual variation in human urine solutes. Sex-related effects on residuals might affect the establishment of physiological baselines and error in medical assays. Methods We tested the effects of sex on residual variation in urine chemistry by estimating coefficients of variation (CV) for urinary solutes in paired sequential 24-h urines (≤72 hour interval) in 6,758 females and 9,024 males aged 16–80 submitted to a clinical laboratory. Results Females had higher CVs than males for urinary phosphorus overall at the False Discovery Rate (P<0.01). There was no effect of sex on CV for calcium (P>0.3). Males had higher CVs for citrate (P<0.01) from ages 16–45 and females higher CVs for citrate (P<0.01) from ages 56–80, suggesting effects of an extant oestral cycle on residual variance. Conclusions Our findings indicate the effects of sex on residual variance of the excretion of urinary solutes including phosphorus and citrate; differences in CV by sex might reflect dietary lability, differences in the fidelity of reporting or genetic differentiation in renal solute consistency. Such an effect could complicate medical analysis by the addition of random error to phenotypic assays. Renal analysis might require explicit incorporation of heterogeneity among factorial effects, and for sex in particular.
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Affiliation(s)
- Guy M. L. Perry
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
- * E-mail:
| | - Steven J. Scheinman
- Department of Medicine, SUNY Upstate Medical University, Syracuse, New York, United States of America
| | - John R. Asplin
- Litholink Corporation, Chicago, Illinois United States of America
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Hong YH, Dublin N, Razack AH, Mohd MA, Husain R. Urinary Metabolic Evaluation of Stone Formers—A Malaysian Perspective. Urology 2012; 80:529-34. [DOI: 10.1016/j.urology.2012.02.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/16/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
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Mufti UB, Nalagatla SK. Nephrolithiasis in Autosomal Dominant Polycystic Kidney Disease. J Endourol 2010; 24:1557-61. [DOI: 10.1089/end.2010.0093] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Uwais B. Mufti
- Urology Unit, NHS Lanarkshire, Monklands, Wishaw, and Hairmyres General Hospitals, Lanarkshire, United Kingdom
| | - Sarath K. Nalagatla
- Urology Unit, NHS Lanarkshire, Monklands, Wishaw, and Hairmyres General Hospitals, Lanarkshire, United Kingdom
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15
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Electrophoretic separation and characterization of urinary glycosaminoglycans and their roles in urolithiasis. Carbohydr Res 2007; 342:79-86. [DOI: 10.1016/j.carres.2006.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/25/2006] [Accepted: 11/01/2006] [Indexed: 11/19/2022]
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Trinchieri A, Lizzano R, Marchesotti F, Zanetti G. Effect of potential renal acid load of foods on urinary citrate excretion in calcium renal stone formers. ACTA ACUST UNITED AC 2006; 34:1-7. [PMID: 16425021 DOI: 10.1007/s00240-005-0001-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2005] [Accepted: 08/23/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to investigate the influence of the potential renal acid load (PRAL) of the diet on the urinary risk factors for renal stone formation. The present series comprises 187 consecutive renal calcium stone patients (114 males, 73 females) who were studied in our stone clinic. Each patient was subjected to an investigation including a 24-h dietary record and 24-h urine sample taken over the same period. Nutrients and calories were calculated by means of food composition tables using a computerized procedure. Daily PRAL was calculated considering the mineral and protein composition of foods, the mean intestinal absorption rate for each nutrient and the metabolism of sulfur-containing amino acids. Sodium, potassium, calcium, magnesium, phosphate, oxalate, urate, citrate, and creatinine levels were measured in the urine. The mean daily PRAL was higher in male than in female patients (24.1+/-24.0 vs 16.1+/-20.1 mEq/day, P=0.000). A significantly (P=0.01) negative correlation (R=-0.18) was found between daily PRAL and daily urinary citrate, but no correlation between PRAL and urinary calcium, oxalate, and urate was shown. Daily urinary calcium (R=0.186, P=0.011) and uric acid (R=0.157, P=0.033) were significantly related to the dietary intake of protein. Daily urinary citrate was significantly related to the intakes of copper (R=0.178, P=0.015), riboflavin (R=0.20, P=0.006), piridoxine (R=0.169, P=0.021) and biotin (R=0.196, P=0.007). The regression analysis by stepwise selection confirmed the significant negative correlation between PRAL and urinary citrate (P=0.002) and the significant positive correlation between riboflavin and urinary citrate (P=0.000). Urinary citrate excretion of renal stone formers (RSFs) is highly dependent from dietary acid load. The computation of the renal acid load is advisable to investigate the role of diet in the pathogenesis of calcium stone disease and it is also a useful tool to evaluate the lithogenic potential of the diet of the individual patient.
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Abstract
BACKGROUND AND PURPOSE Hypocitraturia, an important risk factor for calcium oxalate nephrolithiasis, is the result of numerous factors. We studied citrate excretion by patients with and without stones consuming normal and controlled formula diets. SUBJECTS AND METHODS Subjects with and without a history of calcium oxalate stones (N = 101 per group) provided two or three 24-hour urine specimens during consumption of self-selected diets. Data also were collected on subsets of subjects consuming formula (Ensure) diets. Citrate was determined using the citrate lyase method of Petrarulo and associates, and values for multiple specimens were averaged. The data were adjusted for creatinine excretion and examined on a per-day basis. RESULTS The mean citrate excretion of the non-stone formers was slightly but not significantly higher than that of the stone formers (442 +/- 217 versus 378 +/- 153 mg/g of creatinine). All statistical analyses revealed highly significant differences between, but not within, individuals, a result compatible with a genetic influence. In the normal population, 5% of subjects had a citrate excretion <200 mg/g of creatinine, whereas this result was seen in 34% of the stone-forming subjects. When the subjects consumed a formula diet, women in both groups had much higher citrate excretion than when on a self-selected diet, but little difference was seen in the men. The patterns of citrate recovery suggest low, intermediate, and high excretors. In the normal population, 15% of subjects excreted <340 mg/g of creatinine, whereas this was true of 43% of the stone-forming subjects. Analysis of six families suggested three excretor phenotypes, with a codominant pattern of inheritance. CONCLUSION These findings imply a genetic influence on citrate excretion, as has already been demonstrated for calcium excretion. Further studies of genetic influences on calcium oxalate stone formation are warranted.
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Affiliation(s)
- Ojas Shah
- Department of Urology, Wake Forest University Health Sciences Center, Winston-Salem, North Carolina 27157, USA.
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Abstract
BACKGROUND There is a growing body of evidence regarding the association between cystic fibrosis (CF) and nephrolithiasis and the role that Oxalobacter formigenes may have in that association. METHODS We performed a MEDLINE search of "cystic fibrosis and nephrolithiasis" and "Oxalobacter formigenes." Epidemiological and experimental evidence and possible mechanisms explaining the association were critically reviewed. RESULTS Of patients with CF, 3.0% to 6.3% are affected with nephrolithiasis, a percentage greater than that of age-matched controls without CF, in whom the rate is 1% to 2%. Studies have suggested possible mechanisms for the association, including hyperuricosuria, hyperoxaluria, primary defects in calcium handling caused by mutation of the CF transmembrane regulator (CFTR), hypocitraturia, and lack of colonization with O formigenes, an enteric oxalate-degrading bacterium. The absence of colonization could be related to frequent courses of antibiotics. CONCLUSION Although the incidence of stones in patients with CF may be increased compared with controls without CF, many possible mechanisms are implicated. The relative contributions of these mechanisms remain uncertain. Future directions may include specific identification of lithogenic risks and therapy aimed at stone prevention in this population.
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Affiliation(s)
- Eric M Gibney
- University of Colorado Health Sciences Center, Denver, CO, USA
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Abstract
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.
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Affiliation(s)
- Erdal Erturk
- Department of Urology, University of Rochester, Rochester, New York, USA
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Grampsas SA, Chandhoke PS, Fan J, Glass MA, Townsend R, Johnson AM, Gabow P. Anatomic and metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease. Am J Kidney Dis 2000; 36:53-7. [PMID: 10873872 DOI: 10.1053/ajkd.2000.8266] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The prevalence of nephrolithiasis is considerably greater in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the general population. We evaluated anatomic and metabolic factors that may be associated with an increased prevalence of nephrolithiasis in patients with ADPKD. We compared anatomic parameters among ADPKD patients with or without nephrolithiasis as diagnosed by ultrasonography, whereas metabolic factors were determined by 24-hour urinary chemical analysis. Patients with ADPKD and nephrolithiasis had more renal cysts (P < 0.05) and a larger predominant renal cyst size (P < 0.005) than patients without nephrolithiasis. Concurrently, individual stone-forming kidneys had a greater cyst number (P < 0.05) and a significantly larger predominant cyst size (P < 0.01) compared with kidneys without stones. Patients with ADPKD and nephrolithiasis had a significantly lower creatinine clearance than those without nephrolithiasis (68.7 +/- 8.6 versus 94.8 +/- 5.4 mL/min, respectively; P < 0.05). Twenty-four-hour urinary analysis showed that patients with ADPKD and nephrolithiasis had significantly lower urinary volumes (P < 0. 05), and levels of urinary phosphate (P < 0.05), magnesium (P < 0. 005), and potassium (P < 0.05). Although not statistically significant, patients with ADPKD with stones tended to have lower levels of urinary citrate, and both groups showed a high percentage (range, 49% to 60%) of patients with hypocitraturia. Our data are consistent with the hypothesis that patients with ADPKD who develop nephrolithiasis do so because of increased intrarenal anatomic obstruction, as well as lower levels of such urinary inhibitors of stones as magnesium and citrate.
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Affiliation(s)
- S A Grampsas
- Departments of Surgery (Urology), Medicine (Renal Diseases)/Denver Health, and Radiology, University of Colorado Health Sciences Center, Denver, CO, USA
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Abstract
The effects of vitamin A deficiency on urolithiasis were investigated in male rats. A vitamin A-deficient diet caused important changes in the composition of the urine of the treated rats when compared with controls. One of the main effects was a decrease in the concentration of urinary glycosaminoglycans and zinc in the rats receiving the vitamin A-deficient diet. Significant differences were also found in plasma vitamin E and in the relation of vit E/vit A between treated and control groups but, in general, with no important differences in vitamin A. Nevertheless, significant differences in kidney content of vitamin A were observed between both groups. On the other hand, lesions of the cuboidal epithelium that covers the papillae in rats treated with the vitamin A-deficient diet were severe when compared with controls. The vitamin A and E plasma levels in urolithiasic humans were also investigated and compared with those found in a control group. No significant differences were observed in plasma vitamin A levels; nevertheless a significant increase in vitamin E and in the vit E/vit A ratio was clearly observed. These results could be related to a possible deficit of vitamin A in kidneys of stone formers, this being one of the diverse factors that can contribute to urolith development. Moreover, the deficit of important urinary crystallization inhibitors normally found in stone-formers, such as pyrophosphate and phytate, can also be related to the presence of low levels of renal vitamin A which prevents the enzymatic degradation of such inhibitors.
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Affiliation(s)
- F Grases
- Department of Chemistry, University of Balearic Islands, Palma de Mallorca, Spain
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Cao LC, Boevé ER, de Bruijn WC, Kok DJ, de Water R, Deng G, Schröder FH. Glycosaminoglycans and semisynthetic sulfated polysaccharides: an overview of their potential application in treatment of patients with urolithiasis. Urology 1997; 50:173-83. [PMID: 9255284 DOI: 10.1016/s0090-4295(97)00227-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L C Cao
- Department of Urology, Erasmus University Rotterdam, The Netherlands
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Affiliation(s)
- H O Goodman
- Department of Urology, Bowman Gray School of Medicine, Winston-Salem, North Carolina
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