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Chasan O, Mirioglu S, Artan AS, Gursu M, Kazancioglu R, Elcioglu OC. Assessment of metabolic risk factors for nephrolithiasis in patients with autosomal dominant polycystic kidney disease: a cross-sectional study. Clin Exp Nephrol 2023; 27:912-918. [PMID: 37493903 DOI: 10.1007/s10157-023-02378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Nephrolithiasis is more common in autosomal dominant polycystic kidney disease (ADPKD) than in the normal population. We aimed to investigate the anatomical and metabolic factors that may be associated with nephrolithiasis in patients with ADPKD METHODS: In this cross-sectional study, a total of 180 participants were included. Eighty-five patients with ADPKD [42 patients with nephrolithiasis (PKD N +) and 43 without nephrolithiasis (PKD N -)] were recruited. Forty-seven nephrolithiasis patients without ADPKD (N) and 48 healthy controls (HC) were selected as control groups. 24-h urine collections were measured in all participants. 24-h urine citrate, calcium, urate, oxalate, magnesium and sodium, serum electrolytes, and eGFRs were compared. RESULTS Total kidney volumes were not different between patients with PKD N + and PKD N -. Hypocitraturia was common in all patients with ADPKD (69.4%), and it was not different between PKD N + (76.2%) and PKD N- (62.8%). However, hypocitraturia was statistically higher in PKD N + and PKD N - than in N (38.3%) and HC (12.5%) (p<0.05). 24-h urine calcium, urate, and oxalate levels were similar between PKD N + and PKD N - CONCLUSIONS: Hypocitraturia was found to be significantly higher in patients with ADPKD than in healthy adults and other kidney stone patients.
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Affiliation(s)
- Onour Chasan
- Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
- Division of Endocrinology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Safak Mirioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
- Division of Nephrology, Department of Internal Medicine, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Meltem Gursu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Rumeyza Kazancioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey
| | - Omer Celal Elcioglu
- Division of Nephrology, Department of Internal Medicine, Bezmialem Vakif University School of Medicine, Adnan Menderes Blv Fatih, 34093, Istanbul, Turkey.
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Letavernier E, Flamant M, Marsault C, Haymann JP, Müller G, Villa L, Cloutier J, Traxer O, Daudon M. Lateralization of uric acid stones on the left side. CR CHIM 2022. [DOI: 10.5802/crchim.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Torres JA, Rezaei M, Broderick C, Lin L, Wang X, Hoppe B, Cowley BD, Savica V, Torres VE, Khan S, Holmes RP, Mrug M, Weimbs T. Crystal deposition triggers tubule dilation that accelerates cystogenesis in polycystic kidney disease. J Clin Invest 2019; 129:4506-4522. [PMID: 31361604 PMCID: PMC6763267 DOI: 10.1172/jci128503] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022] Open
Abstract
The rate of disease progression in autosomal-dominant (AD) polycystic kidney disease (PKD) exhibits high intra-familial variability suggesting that environmental factors may play a role. We hypothesized that a prevalent form of renal insult may accelerate cystic progression and investigated tubular crystal deposition. We report that calcium oxalate (CaOx) crystal deposition led to rapid tubule dilation, activation of PKD-associated signaling pathways, and hypertrophy in tubule segments along the affected nephrons. Blocking mTOR signaling blunted this response and inhibited efficient excretion of lodged crystals. This mechanism of "flushing out" crystals by purposefully dilating renal tubules has not previously been recognized. Challenging PKD rat models with CaOx crystal deposition, or inducing calcium phosphate deposition by increasing dietary phosphorous intake, led to increased cystogenesis and disease progression. In a cohort of ADPKD patients, lower levels of urinary excretion of citrate, an endogenous inhibitor of calcium crystal formation, correlated with increased disease severity. These results suggest that PKD progression may be accelerated by commonly occurring renal crystal deposition which could be therapeutically controlled by relatively simple measures.
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Affiliation(s)
- Jacob A. Torres
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Mina Rezaei
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Caroline Broderick
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Louis Lin
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Xiaofang Wang
- Mayo Clinic College of Medicine, Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Bernd Hoppe
- University Children’s Hospital Bonn, Division of Pediatric Nephrology, Bonn, Germany
| | - Benjamin D. Cowley
- University of Oklahoma Health Sciences Center, Department of Medicine, Section of Nephrology, Oklahoma City, Oklahoma, USA
| | - Vincenzo Savica
- University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
| | - Vicente E. Torres
- Mayo Clinic College of Medicine, Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Saeed Khan
- University of Florida, Department of Pathology, Gainesville, Florida, USA
| | | | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Thomas Weimbs
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
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Verschuren EHJ, Mohammed SG, Leonhard WN, Overmars-Bos C, Veraar K, Hoenderop JGJ, Bindels RJM, Peters DJM, Arjona FJ. Polycystin-1 dysfunction impairs electrolyte and water handling in a renal precystic mouse model for ADPKD. Am J Physiol Renal Physiol 2018; 315:F537-F546. [PMID: 29767557 DOI: 10.1152/ajprenal.00622.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The PKD1 gene encodes polycystin-1 (PC1), a mechanosensor triggering intracellular responses upon urinary flow sensing in kidney tubular cells. Mutations in PKD1 lead to autosomal dominant polycystic kidney disease (ADPKD). The involvement of PC1 in renal electrolyte handling remains unknown since renal electrolyte physiology in ADPKD patients has only been characterized in cystic ADPKD. We thus studied the renal electrolyte handling in inducible kidney-specific Pkd1 knockout (iKsp- Pkd1-/-) mice manifesting a precystic phenotype. Serum and urinary electrolyte determinations indicated that iKsp- Pkd1-/- mice display reduced serum levels of magnesium (Mg2+), calcium (Ca2+), sodium (Na+), and phosphate (Pi) compared with control ( Pkd1+/+) mice and renal Mg2+, Ca2+, and Pi wasting. In agreement with these electrolyte disturbances, downregulation of key genes for electrolyte reabsorption in the thick ascending limb of Henle's loop (TA;, Cldn16, Kcnj1, and Slc12a1), distal convoluted tubule (DCT; Trpm6 and Slc12a3) and connecting tubule (CNT; Calb1, Slc8a1, and Atp2b4) was observed in kidneys of iKsp- Pkd1-/- mice compared with controls. Similarly, decreased renal gene expression of markers for TAL ( Umod) and DCT ( Pvalb) was observed in iKsp- Pkd1-/- mice. Conversely, mRNA expression levels in kidney of genes encoding solute and water transporters in the proximal tubule ( Abcg2 and Slc34a1) and collecting duct ( Aqp2, Scnn1a, and Scnn1b) remained comparable between control and iKsp- Pkd1-/- mice, although a water reabsorption defect was observed in iKsp- Pkd1-/- mice. In conclusion, our data indicate that PC1 is involved in renal Mg2+, Ca2+, and water handling and its dysfunction, resulting in a systemic electrolyte imbalance characterized by low serum electrolyte concentrations.
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Affiliation(s)
- Eric H J Verschuren
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Sami G Mohammed
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Wouter N Leonhard
- Department of Human Genetics, Leiden University Medical Centre , Leiden , The Netherlands
| | - Caro Overmars-Bos
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Kimberly Veraar
- Department of Human Genetics, Leiden University Medical Centre , Leiden , The Netherlands
| | - Joost G J Hoenderop
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - René J M Bindels
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
| | - Dorien J M Peters
- Department of Human Genetics, Leiden University Medical Centre , Leiden , The Netherlands
| | - Francisco J Arjona
- Department of Physiology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center , Nijmegen , The Netherlands
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Vasudevan V, Samson P, Smith AD, Okeke Z. The genetic framework for development of nephrolithiasis. Asian J Urol 2016; 4:18-26. [PMID: 29264202 PMCID: PMC5730897 DOI: 10.1016/j.ajur.2016.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022] Open
Abstract
Over 1%–15% of the population worldwide is affected by nephrolithiasis, which remains the most common and costly disease that urologists manage today. Identification of at-risk individuals remains a theoretical and technological challenge. The search for monogenic causes of stone disease has been largely unfruitful and a technological challenge; however, several candidate genes have been implicated in the development of nephrolithiasis. In this review, we will review current data on the genetic inheritance of stone disease, as well as investigate the evolving role of genetic analysis and counseling in the management of nephrolithiasis.
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Affiliation(s)
- Vinaya Vasudevan
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Patrick Samson
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Arthur D Smith
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
| | - Zeph Okeke
- Smith Institute for Urology, Hofstra Northwell School of Medicine, Lake Success, NY, USA
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