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Oswal M, Varghese R, Zagade T, Dhatrak C, Sharma R, Kumar D. Dietary supplements and medicinal plants in urolithiasis: diet, prevention, and cure. J Pharm Pharmacol 2023:7148056. [PMID: 37130140 DOI: 10.1093/jpp/rgac092] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/16/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Urolithiasis has been a major health concern for centuries, primarily owing to the limited treatment options in the physician's armamentarium. However, various studies have underscored a lesser incidence of urolithiasis in cohorts predominantly consuming fruits and vegetables. This article aims to review various dietary plants, medicinal herbs and phytochemicals in the prevention and management of urolithiasis. METHODS To provide context and evidence, relevant publications were identified on Google Scholar, PubMed and Science-Direct using keywords such as urolithiasis, nephrolithiasis, urolithiasis, renal stones, phytochemicals and dietary plants. RESULTS Growing bodies of evidence suggest the incorporation of plant-based foods, medicinal and herbal supplements, and crude drugs containing phytochemicals into the staple diet of people. The anti-urolithiatic activity of these plant bioactives can be attributed to their antioxidant, antispasmodic, diuretic, and inhibitory effect on the crystallization, nucleation and crystal aggregation effects. These mechanisms would help alleviate the events and symptoms that aid in the development and progression of renal calculi. In addition, it will also avoid the exacerbation of secondary disorders like inflammation and injury, which can initiate a vicious circle in turn worsening the disease progression. CONCLUSION In conclusion, the results presented in the review demonstrate the promising role of various dietary plants, medicinal and herbal supplements, and phytochemicals in preventing and managing the precipitation of uroliths. However, more conclusive and cogent evidence from preclinical and clinical studies is required to substantiate their safety, efficacy and toxicity profiles in humans.
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Affiliation(s)
- Mitul Oswal
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune Maharashtra, 411038, India
| | - Ryan Varghese
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune Maharashtra, 411038, India
| | - Tanmay Zagade
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune Maharashtra, 411038, India
| | - Chetan Dhatrak
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune Maharashtra, 411038, India
| | - Rohit Sharma
- Department of Rasa Shastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, Uttar Pradesh, India
| | - Dileep Kumar
- Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be) University, Pune Maharashtra, 411038, India
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Fakier S, Rodgers A. Exploring the Potential Relationship Between Phytate Ingestion, Urinary Phytate Excretion, and Renal Stone Risk in a Unique Human Model: No Hard Evidence in Support of Phytate as a Stone Inhibitor. J Ren Nutr 2020; 30:396-403. [PMID: 31928801 DOI: 10.1053/j.jrn.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/21/2019] [Accepted: 10/17/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Dietary phytate (IP6) enjoys a reputation as an inhibitor of calcium renal stone formation, although there are very few human studies to support this notion. In South Africa, urolithiasis occurs in the white (W) but is rare in the black (B) population. We undertook this unique human model to further investigate the IP6 theory. METHODS Healthy W and B males completed baseline food-frequency recall questionnaires. Dietary intake of IP6 was restricted for 18 days. An IP6 dietary supplement was ingested on days 15-18. Twenty-four-hour urinary phytate and other urinary components were determined. Relative supersaturations of calcium salts were calculated. The urinary metastable limit (MSL) of calcium oxalate (CaOx) and its crystallisation kinetics were determined experimentally. RESULTS Habitual dietary intake of IP6 and its urinary excretion were significantly higher in B than in W (1650 ± 202 vs. 640 ± 134 mg/d, P = .0002 and 1.13 ± 0.12 vs. 0.75 ± 0.13 μM, P <.05, respectively). In B, urinary phytate decreased significantly after 15 days of IP6 restriction, but in W, its excretion remained constant. After supplementation, urinary IP6 increased significantly in both groups reaching levels commensurate with the baseline value in B. No significant differences occurred in B in any of the routine urinary risk factors throughout the trial. However, in W, urinary citrate excretion increased on day 18 relative to day 0. There were no significant intragroup or intergroup changes in relative supersaturation, metastable limit, or crystallization kinetics. CONCLUSIONS Despite notable differences in the renal handling of ingested IP6, there were no changes in any of the well-established urinary risk factors for calcium renal stone formation in either of our uniquely different test groups. We conclude that, in the absence of hard evidence, claims that IP6 is a stone inhibitor remain unproven.
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Affiliation(s)
- Saajidah Fakier
- University of Cape Town, Cape Town, South Africa; Department of Chemistry, University of Cape Town, Cape Town, South Africa
| | - Allen Rodgers
- University of Cape Town, Cape Town, South Africa; Department of Chemistry, University of Cape Town, Cape Town, South Africa.
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Abstract
The classic definition of hypercalciuria, an upper normal limit of 200 mg/day, is based on a constant diet restricted in calcium, sodium, and animal protein; however, random diet data challenge this. Here our retrospective study determined the validity of the classic definition of hypercalciuria by comparing data from 39 publications analyzing urinary calcium excretion on a constant restricted diet and testing whether hypercalciuria could be defined when extraneous dietary influences were controlled. These papers encompassed 300 non-stone-forming patients, 208 patients with absorptive hypercalciuria type I (presumed due to high intestinal calcium absorption), and 234 stone formers without absorptive hypercalciuria; all evaluated on a constant restricted diet. In non-stone formers, the mean urinary calcium was well below 200 mg/day, and the mean for all patients was 127±46 mg/day with an upper limit of 219 mg/day. In absorptive hypercalciuria type I, the mean urinary calcium significantly exceeded 200 mg/day in all studies with a combined mean of 259±55 mg/day. Receiver operating characteristic curve analysis showed the optimal cutoff point for urinary calcium excretion was 172 mg/day on a restricted diet, a value that approximates the traditional limit of 200 mg/day. Thus, on a restricted diet, a clear demarcation was seen between urinary calcium excretion of kidney stone formers with absorptive hypercalciuria type I and normal individuals. When dietary variables are controlled, the classic definition of hypercalciuria of nephrolithiasis appears valid.
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Giocondi JL, El-Dasher BS, Nancollas GH, Orme CA. Molecular mechanisms of crystallization impacting calcium phosphate cements. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:1937-61. [PMID: 20308110 PMCID: PMC2944390 DOI: 10.1098/rsta.2010.0006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The biomineral calcium hydrogen phosphate dihydrate (CaHPO(4).2H(2)O), known as brushite, is a malleable material that both grows and dissolves faster than most other calcium minerals, including other calcium phosphate phases, calcium carbonates and calcium oxalates. Within the body, this ready formation and dissolution can play a role in certain diseases, such as kidney stone and plaque formation. However, these same properties, along with brushite's excellent biocompatibility, can be used to great benefit in making resorbable biomedical cements. To optimize cements, additives are commonly used to control crystallization kinetics and phase transformation. This paper describes the use of in situ scanning probe microscopy to investigate the role of several solution parameters and additives in brushite atomic step motion. Surprisingly, this work demonstrates that the activation barrier for phosphate (rather than calcium) incorporation limits growth kinetics and that additives such as magnesium, citrate and bisphosphonates each influence step motion in distinctly different ways. Our findings provide details of how, and where, molecules inhibit or accelerate kinetics. These insights have the potential to aid in designing molecules to target specific steps and to guide synergistic combinations of additives.
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Affiliation(s)
- Jennifer L. Giocondi
- Lawrence Livermore National Laboratory, Physical and Life Sciences, 7000 East Avenue, Livermore, CA 94550, USA
| | - Bassem S. El-Dasher
- Lawrence Livermore National Laboratory, Physical and Life Sciences, 7000 East Avenue, Livermore, CA 94550, USA
| | - George H. Nancollas
- Department of Chemistry, Natural Sciences Complex, University at Buffalo, State University of New York, Buffalo, NY 14260, USA
| | - Christine A. Orme
- Lawrence Livermore National Laboratory, Physical and Life Sciences, 7000 East Avenue, Livermore, CA 94550, USA
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Muñoz JA, López-Mesas M, Valiente M. Minimum handling method for the analysis of phosphorous inhibitors of urolithiasis (pyrophosphate and phytic acid) in urine by SPE-ICP techniques. Anal Chim Acta 2009; 658:204-8. [PMID: 20103096 DOI: 10.1016/j.aca.2009.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Accepted: 11/03/2009] [Indexed: 11/25/2022]
Abstract
Pyrophosphate (PPi) and phytic acid (IP6) are natural phosphorous compounds with growing interest in the biomedical field due to their ability as potential inhibitors of urolithiasis among others. Existing methodologies for their evaluation show inconveniences mainly associated with sample treatment, matrix interferences and lack of resolution. The objective of the present work is the validation of a new method to determine both inhibitors in urine samples selectively and its application to the diagnosis of lithiasic patients. After urine purification by an off-line anion exchange solid phase extraction (SPE), based in an appropriate acidic elution gradient, the phosphorous compounds were analyzed by (31)P measurements by inductively coupled plasma mass spectrometry (ICP-MS) in the purified urine extracts. Linear range and limit of detection obtained were adequate for the analysis of the physiological amounts of the compounds in urine. The method was successfully applied to human urine samples, resulting in adequate accuracy and precision and allowing for the analysis of phosphorus inhibitors of urolithiasis in urine. The method simplicity and high sample throughput leads to a clear alternative to current determinations of the mentioned species in urine. Moreover, PPi and IP6 concentrations found in patients suffering from oxalocalcic urolithiasic were significantly lower than those for healthy controls, supporting the fact that the risk for oxalocalcic urolithiasis increases when urinary phosphorus inhibitors decrease. Thus, speciation of phosphorus inhibitors of urolithiasis in urine of stone formers can be performed, which is of unquestionable value in diagnostic, treatment and monitoring of urolithiasis.
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Affiliation(s)
- Jose A Muñoz
- Grup de Tècniques de Separació en Química (GTS), UAB-Thermo Lab, Química Analítica, Departament de Química, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Escribano J, Balaguer A, Pagone F, Feliu A, Roqué I Figuls M. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev 2009; 2009:CD004754. [PMID: 19160242 PMCID: PMC7053686 DOI: 10.1002/14651858.cd004754.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Idiopathic hypercalciuria is an inherited metabolic abnormality characterised by excessive amounts of calcium excreted into the urine in patients with normal serum levels of calcium. The morbidity of hypercalciuria is related to kidney stone disease and bone demineralization. In children, hypercalciuria can cause recurrent haematuria, frequency-dysuria syndrome, urinary tract infection and abdominal and lumbar pain. Several pharmacological treatments have been described that can decrease the levels of urinary calcium or its index of urinary crystallization. OBJECTIVES To assess the benefits and harms of pharmacological interventions for preventing complications and decreasing urological symptoms in patients with idiopathic hypercalciuria. SEARCH STRATEGY We searched MEDLINE, EMBASE, the Cochrane Renal Group's specialised register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), handsearched relevant conference proceedings and reference lists of articles. SELECTION CRITERIA All randomised controlled trials (RCTs) and quasi-RCTS that compared any pharmacological intervention for preventing complications in idiopathic hypercalciuria, with placebo, other pharmacological intervention or a different administration mode or dose of the same treatment given for a minimum duration of four months and had a follow-up period of at least six months. DATA COLLECTION AND ANALYSIS Four authors assessed the studies for inclusion and extracted the data. Disagreements were resolved through discussion. Results were expressed as risk ratios (RR) with 95% confidence intervals (CI) or mean difference (MD). MAIN RESULTS Five studies (316 adult patients) were included. Four compared thiazides with standard treatment (periodic clinical follow-up and increased water intake) or specific dietary recommendations and one analysed the effect of thiazide plus a neutral potassium salt. There was a significant decrease in the number of new stone recurrences in those treated with thiazides (RR 1.61, 95% CI 1.33 to 1.96), although the follow-up periods varied. The stone formation rate also showed a statistically significant decrease in the patients treated with diuretics (MD -0.18, 95% CI -0.30 to -0.06). Thiazides plus potassium salts significantly decreased calciuria and vitamin D levels. AUTHORS' CONCLUSIONS There is some evidence that in patients with idiopathic hypercalciuria and recurrent stones, the addition of thiazides to a normal or modified diet for short to long periods (five months to three years) reduced the number of stone recurrences and decreased the stone formation rate. Thiazides and neutral potassium phosphate decreased calciuria in symptomatic patients with idiopathic hypercalciuria. There were no studies investigating the effect of pharmacological treatment on other clinical complications or asymptomatic idiopathic hypercalciuria.
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Affiliation(s)
- Joaquin Escribano
- Department of Pediatrics, Hospital Universitari St Joan de Reus, Universitat Rovira i Virgili, St Joan s/n, Reus, Catalonia, Spain, 43201.
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Escribano J, Balaguer A, Feliu A, Pagone F, Roqué IFM. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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OTA S, YAMAGUCHI T, FUJITA Y. Spectrofluorometric determination of pyrophosphoric acid by utilizing condensation reaction between resorcinol and propionaldehyde. BUNSEKI KAGAKU 2004. [DOI: 10.2116/bunsekikagaku.53.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sanae OTA
- Osaka University of Pharmaceutical Sciences
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Abstract
Hyperoxaluria leads to increased calcium oxalate supersaturation and calcium oxalate stone formation. Excess oxalate can arise from endogenous overproduction as in primary hyperoxaluria or from dietary sources. In the last 15 years great strides have been made in the diagnosis and treatment of primary hyperoxaluria. However options still seem limited in treating the mild hyperoxaluria found in many stone formers. Inadequate knowledge of food oxalate content, the effect of dietary oxalate precursors on oxalate excretion, and the factors affecting handling of oxalate by the intestine prevent development of rational therapies for treatment of hyperoxaluria. Recent studies of oxalate degrading bacteria and renewed interest in the role of diet calcium in oxalate absorption may lead to better therapeutic strategies for hyperoxaluric calcium nephrolithiasis.
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Affiliation(s)
- John R Asplin
- University of Chicago and Litholink Corporation, 2250 W. Campbell Park Drive, Chicago, IL 60612, USA.
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10
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March JG, Simonet BM, Grases F. Determination of pyrophosphate in renal calculi and urine by means of an enzymatic method. Clin Chim Acta 2001; 314:187-94. [PMID: 11718694 DOI: 10.1016/s0009-8981(01)00695-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An enzymatic method for the determination of pyrophosphate which has been applied to renal calculi is described. The method involves the preconcentration of pyrophosphate using anionic exchange resin and development of the enzymatic reactions with the pyrophosphate retained on the resin. The study of calculi treatment according to calculi composition is also reported. The pyrophosphate content was dependent on the calculi composition. The highest amount of pyrophosphate was found in hydroxyapatite calculi (of the order of 10 microg/g), struvite and oxalate calculi showed a lower amount (the order was 2.5 and 4.5 microg/g, respectively) and was not detected in uric acid and cystine stones. The method was also successfully applied to the determination of pyrophosphate in human urine. For urinary pyrophosphate determination, a modification based on a clean-up of urine using activated carbon has been proposed. Pyrophosphate in human urine was of the order of 4 mg l(-1).
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Affiliation(s)
- J G March
- Department of Chemistry, University of Balearic Islands, Campus de la UIB, Ctra. Valldemossa km 7.5, E 07071 Palma de Mallorca, Spain.
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PIERRATOS ANDREAS, DHARAMSI NAFISA, CARR LESLEYK, IBANEZ DOMINIQUE, JEWETT MICHAELA, HONEY RJOHND. HIGHER URINARY POTASSIUM IS ASSOCIATED WITH DECREASED STONE GROWTH AFTER SHOCK WAVE LITHOTRIPSY. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67012-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ANDREAS PIERRATOS
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - NAFISA DHARAMSI
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - LESLEY K. CARR
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - DOMINIQUE IBANEZ
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - MICHAEL A.S. JEWETT
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
| | - R. JOHN D’A. HONEY
- From the Department of Medicine, Humber River Regional Hospital, Division of Urology, St. Michael’s Hospital, Division of Urology, Sunnybrook and Women’s Health Sciences Centre, Division of Urology, Toronto Hospital and University of Toronto, Toronto, Ontario, Canada
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HIGHER URINARY POTASSIUM IS ASSOCIATED WITH DECREASED STONE GROWTH AFTER SHOCK WAVE LITHOTRIPSY. J Urol 2000. [DOI: 10.1097/00005392-200011000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Domínguez Domínguez M, Reina Ruiz C, Blasco Hernández P, Espinosa Olmedo J, Conde Sánchez JM, Vega Toro P, García Pérez M. [Absorptive hypercalciuria type III or caused by renal loss of phosphates]. Actas Urol Esp 2000; 24:219-22. [PMID: 10870228 DOI: 10.1016/s0210-4806(00)72435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Contribution of a retrospective series of 16 patients with type II absorptive hypercalciuria over a total of 1.041 patients undergoing metabolic study due to relapsing renal lithiasis. Clinical history of lithiasis, biochemistry prior to treatment and instituted therapy were examined in all cases. Stones composition, radiologic appearance of lithiasis and evolution of biochemical parameters after medical treatment with a mixture of phosphates were also studied.
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Heilberg IP. Update on dietary recommendations and medical treatment of renal stone disease. Nephrol Dial Transplant 2000; 15:117-23. [PMID: 10607782 DOI: 10.1093/ndt/15.1.117] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- I P Heilberg
- Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Breslau NA, Heller HJ, Reza-Albarrán AA, Pak CY. Physiological effects of slow release potassium phosphate for absorptive hypercalciuria: a randomized double-blind trial. J Urol 1998; 160:664-8. [PMID: 9720517 DOI: 10.1016/s0022-5347(01)62749-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE We examined the physiological effects and tolerance of UroPhos-K, a slow release neutral form of potassium phosphate (155 mg. phosphate and 8 mEq. potassium per tablet) in patients with absorptive hypercalciuria. MATERIALS AND METHODS A total of 31 patients with absorptive hypercalciuria were studied at baseline and after 3 months of treatment with 4 tablets twice daily of UroPhos-K or placebo (identical in appearance) in a prospective randomized, placebo controlled, double-blind trial during a 4-day inpatient study with a daily constant metabolic diet containing 400 mg. calcium, 100 mEq. sodium and 800 mg. phosphate. RESULTS Treatment with UroPhos-K did not cause significant gastrointestinal side effects, increase fasting serum potassium or phosphorus, or reduce hemoglobin or creatinine clearance. It reduced urinary calcium excretion from 277 +/- 72 to 166 +/- 43 mg. per day (p < 0.001), associated with a reduction in serum 1,25-dihydroxyvitamin D concentration from 50 +/- 11 to 42 +/- 9 pg./ml. (p < 0.001). Indexes of intestinal calcium absorption and markers of bone turnover also decreased modestly. None of these changes was seen in the placebo group. CONCLUSIONS In patients with absorptive hypercalciuria UroPhos-K seems to correct hypercalciuria by a combination of reduced intestinal absorption, bone resorption and improved renal calcium reabsorption. The drug is well tolerated compared to placebo.
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Affiliation(s)
- N A Breslau
- Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, USA
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Breslau NA, Heller HJ, Reza-Albarrán AA, Pak CY. Physiological effects of slow release potassium phosphate for absorptive hypercalciuria: a randomized double-blind trial. J Urol 1998; 160:664-8. [PMID: 9720517 DOI: 10.1097/00005392-199809010-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined the physiological effects and tolerance of UroPhos-K, a slow release neutral form of potassium phosphate (155 mg. phosphate and 8 mEq. potassium per tablet) in patients with absorptive hypercalciuria. MATERIALS AND METHODS A total of 31 patients with absorptive hypercalciuria were studied at baseline and after 3 months of treatment with 4 tablets twice daily of UroPhos-K or placebo (identical in appearance) in a prospective randomized, placebo controlled, double-blind trial during a 4-day inpatient study with a daily constant metabolic diet containing 400 mg. calcium, 100 mEq. sodium and 800 mg. phosphate. RESULTS Treatment with UroPhos-K did not cause significant gastrointestinal side effects, increase fasting serum potassium or phosphorus, or reduce hemoglobin or creatinine clearance. It reduced urinary calcium excretion from 277 +/- 72 to 166 +/- 43 mg. per day (p < 0.001), associated with a reduction in serum 1,25-dihydroxyvitamin D concentration from 50 +/- 11 to 42 +/- 9 pg./ml. (p < 0.001). Indexes of intestinal calcium absorption and markers of bone turnover also decreased modestly. None of these changes was seen in the placebo group. CONCLUSIONS In patients with absorptive hypercalciuria UroPhos-K seems to correct hypercalciuria by a combination of reduced intestinal absorption, bone resorption and improved renal calcium reabsorption. The drug is well tolerated compared to placebo.
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Affiliation(s)
- N A Breslau
- Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, USA
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17
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Affiliation(s)
- C Y Pak
- University of Texas Southwestern Medical Center, Center for Mineral Metabolism and Clinical Research, Dallas 75235-8885, USA
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Heller HJ, Reza-Albarrán AA, Breslau NA, Pak CY. Sustained reduction in urinary calcium during long-term treatment with slow release neutral potassium phosphate in absorptive hypercalciuria. J Urol 1998; 159:1451-5; discussion 1455-6. [PMID: 9554331 DOI: 10.1097/00005392-199805000-00006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We tested whether UroPhos-K, a new slow release neutral form of potassium phosphate (155 mg. phosphate, 8 mEq. potassium per tablet) in a dose of 4 tablets twice daily would produce a sustained hypocalciuric response and maintain bone mass in patients with absorptive hypercalciuria, a major cause of nephrolithiasis characterized by excessive intestinal calcium absorption accompanied in some patients by excessive bone loss. MATERIALS AND METHODS A total of 25 patients with absorptive hypercalciuria were studied in a 4-year, prospective, open trial with UroPhos-K at yearly intervals during a 4-day inpatient physiological study with a constant metabolic diet containing 400 mg. calcium, 100 mEq. sodium and 800 mg. phosphate daily. RESULTS Treatment with UroPhos-K caused a sustained, marked reduction in urinary calcium (264 to 181 mg. daily). Fractional 47calcium absorption decreased modestly (74.0 to 64.6%) commensurate with a reduction in serum 1,25-dihydroxyvitamin D (42 to 34 pg./ml.). Intact parathyroid hormone increased within the normal range (30 to 42 pg./ml.). Bone mineral density was stable at the lumbar spine, femoral neck and distal third of the radius. CONCLUSIONS UroPhos-K may provide a long-term alternative for hypercalciuric patients in whom thiazide therapy fails.
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Affiliation(s)
- H J Heller
- Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas 75235-8885, USA
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19
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Pak CY. Southwestern Internal Medicine Conference: Medical Management of Nephrolithiasis—A New, Simplified Approach for General Practice. Am J Med Sci 1997. [DOI: 10.1016/s0002-9629(15)40097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Parks JH, Coward M, Coe FL. Correspondence between stone composition and urine supersaturation in nephrolithiasis. Kidney Int 1997; 51:894-900. [PMID: 9067927 DOI: 10.1038/ki.1997.126] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Supersaturation (SS) with respect to calcium oxalate monohydrate (COM), brushite (Br) and uric acid (UA), obtained in three 24-hour pretreatment urine samples from patients with stone disease were compared to the mineral composition of stones passed by the same patients to determine whether sparse urine SS measurements accurately reflect the long-term average SS values in the kidney and final urine. Among males and females elevation of SS above same sex normals corresponded to composition. As well, treatments that reduced stone rates also reduced these SS values. The degree of calcium phosphate (CaP) admixture was accurately matched by shifting magnitudes of COM and Br SS. As well, increasing CaP content was associated with falling urine citrate and rising urine pH, suggesting renal tubular acidosis. We conclude that sparse urine SS measurements accurately track stone admixtures, and are a reliable index of average renal and urine SS.
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Affiliation(s)
- J H Parks
- Department of Medicine, University of Chicago, Illinois, USA
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Abstract
The development of diagnostic protocols that identify specific risk factors for calcium oxalate nephrolithiasis has led to the formulation of directed medical regimens that are aimed at correcting the underlying metabolic disturbances. Initiation of these treatment programs has reduced markedly the rate of stone formation in the majority of patients who form stones. This article discusses the rationale that underlies the choice of medical therapy for the various pathophysiologic causes of calcium oxalate nephrolithiasis and the appropriate use of available medications.
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Affiliation(s)
- L A Ruml
- Center for Mineral Metabolism and Clinical Research, University of Texas, Southwestern Medical Center, Dallas, USA
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Pak CYC. Role of Medical Approach in the Management of Stone Disease. Int J Urol 1996. [DOI: 10.1111/j.1442-2042.1996.tb00345.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Clarke A, Rowe P, Black N. Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England? J Epidemiol Community Health 1996; 50:545-50. [PMID: 8944863 PMCID: PMC1060348 DOI: 10.1136/jech.50.5.545] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVE To see whether a shorter postoperative length of stay (LOS) for a major procedure, abdominal hysterectomy for benign conditions, was associated with health outcome, the use of formal and lay care after discharge, cost, and satisfaction. DESIGN Prospective cohort study. SETTING Three hospitals in London and three in Hertfordshire and Bedfordshire. PATIENTS A total of 363 women undergoing total abdominal hysterectomy with or without oophorectomy: 112 with a short postoperative LOS (five days or less) and 251 with a standard LOS (six days or more). MAIN OUTCOME MEASURES Wound infection within 10 days and six weeks; change in general health status (Nottingham health profile) after six weeks; general health and change in social activity (lifestyle index) three months after surgery. Mean cost difference for hospitals, use of formal and lay care after discharge, and patient satisfaction. RESULTS Short LOS was associated with benefits: a lower risk of wound infection in the first 10 days (odds ratio 0.44; p = 0.03) and no deterioration in physical mobility (measured using the NHP) after six weeks- and with adverse outcomes: constipation six weeks later (OR 0.48; p < 0.001) and moderate or severe urinary symptoms six weeks (OR 0.69; p < 0.004) and three months (OR 0.65; p < 0.008) later. On multivariate analysis, the only outcome to remain significantly associated with LOS was physical mobility after six weeks (p = 0.024). There was no significant difference between short and standard stay women as regards their use of formal or lay care after discharge from hospital. The mean cost of hospital care was Pounds251 (in 1992) less for short than for standard stay patients. Most women (73% at six weeks) felt their LOS was appropriate. Short stay women were more likely to feel it was too short, though the difference was not statistically significant. CONCLUSIONS Short postoperative stays do not seem to be associated with any adverse outcomes and result in modest financial saving to the health service. There is potential for greater use of early discharge.
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Affiliation(s)
- A Clarke
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine
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Pak CY. Role of medical approach in the management of stone disease. Int J Urol 1996; 3:S63-6. [PMID: 24304028 DOI: 10.1111/j.1442-2042.1996.tb00090.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the management of stone disease, the medical approach concerned with the prevention of stone recurrence is equally as important as the surgical removal of stones. The application of medical approach requires an understanding of the pathophysiology of stone formation. A wide variety of physiological or environmental disturbances have been identified in stone-forming patients. They include hypercalciuria, hypocitraturia, undue urinary acidity and hyperuricosuria. Reliable diagnostic protocols have been developed which are based on the presence of above derangements. The prophylactic treatment programs are directed at the correction or amelioration of underlying environmental disturbances. Conservative measures include a high fluid intake, dietary sodium and oxalate restriction, dietary calcium restriction (in absorptive hypercalciuria and primary hyperparathyroidism), and moderate animal protein restriction. Specific medical treatments chosen for discussion are thiazide, slow-release neutral potassium phosphate, potassium citrate and potassium magnesium citrate.
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Affiliation(s)
- C Y Pak
- Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA
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