Does citrate prevent nephrocalcinosis in preterm neonates?

Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: An EAU Guidelines Update

BACKGROUND AND OBJECTIVE

The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence.

METHODS

A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023.

KEY FINDINGS AND LIMITATIONS

For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence.

Nephrocalcinosis in Neonates

Nephrocalcinosis occurs in as many as 40% of preterm neonates. Many causes and contributors predispose neonates to develop nephrocalcinosis, including metabolic, genetic, and iatrogenic factors. Because nephrocalcinosis can be a manifestation of an underlying genetic disorder, neonates with nephrocalcinosis must undergo an evaluation to identify and address contributors, to prevent further renal calcium deposition that can potentially lead to renal dysfunction. In this article, we review the epidemiology, pathogenesis, diagnosis, and evaluation of nephrocalcinosis in neonates. We also summarize the natural history of nephrocalcinosis of prematurity as well as the management of this condition.

Prostate cancer biomarker citrate detection using triaminoguanidinium carbon dots, its applications in live cells and human urine samples

Citrate is a tricarboxylate, plays vital role in prostate cancer (PC) and the level of citrate is an indicator for PC identification. Herein, triaminoguanidine carbon dots (TAG-CDs) prepared by one step hydrothermal method and used as a citrate receptor. Notably the TAG-CDs without alkaline treatment were highly fluorescent at pH 7 with high quantum yield (11.3%). TAG-CDs were characterized through TEM, XRD, FT-IR, UV-vis and spectrofluorimetry. It is noted that the average size was of 2.8 nm, the presence of highly disordered carbon, retain the functionality of TAG. The absorbance maxima obtained at 294 nm and good emitting response observed at 396 nm. The Y-aromaticity of receptor guanidinium moiety acts as Lewis acid and have peculiar interaction with Lewis base citrate via electrostatic interaction and also protons in the TAG participate hydrogen bonds with citrate, which causes quenching of TAG-CDs. From the obtained linear quenching equation the LOD was found to be 4 nM. The probe expressed high selectivity, high interference tolerance (500 - fold), fast response in 15 mins and good biocompatible. Finally, TAG-CDs utilized for the intracellular imaging of citrate in live MCF-7 cells, it showed good cytotoxicity and delivered contrast images in presence, absence of citrate. TAG-CDs detected the citrate level in human urine samples, the obtained results are validated with HPLC method.

Preparation of carbon dots-doped terbium phosphonate coordination polymers as ratiometric fluorescent probe for citrate detection

In this work, carbon dots-doped terbium phosphonate coordination polymers (CDs-GMP/Tb) were designed and prepared as ratiometric fluorescent probes for the detection of citrate. The as-prepared CDs-GMP/Tb are prepared and have the merits of high photostability, low toxicity, and excellent biocompatibility. The as-prepared CDs-GMP/Tb as ratiometric fluorescent probes also have better anti-interference ability and stability compared with the traditional single fluorescent probe. The surface morphology, fabrication, and spectroscopy were characterized through a variety of instruments. It confirms that the probes exhibited network structure doping carbon dots. With the addition of citrate, the fluorescence of GMP/Tb at 545 nm was significantly quenched, contrasting to the enhancement of fluorescence of CDs at 454 nm. Under optimum conditions, the detection limit for citrate was 0.47 μM, with a linear range of 0-200 μM between citrate concentrations and I₅₄₅/I₄₅₄. It has high sensitivity, selective, and rapid detection for citrate. The as-prepared CDs-GMP/Tb as ratiometric fluorescent probes were also used for imaging citrate in living cells. These experiment results showed that CDs-GMP/Tb as ratiometric fluorescent probes could be applied to trace citrate detection in the environmental and biological fields.

Dual-Surfactant-Capped Ag Nanoparticles as a Highly Selective and Sensitive Colorimetric Sensor for Citrate Detection

A colorimetric sensor for the detection of citrate ions is reported here using dual-surfactant-capped Ag nanoparticles (dual-AgNP sensor). A mixture of cetyl trimethyl ammonium bromide and a newly prepared gemini nonionic (GFEO) surfactant was used as a capping agent to synthesize dual-surfactant-capped Ag NPs for selective and sensitive citrate detection. The GFEO surfactant was designed with a specific chemical structure to provide strong binding with citrate for selective and sensitive detection. The developed dual-AgNP sensor showed extremely high selectivity toward citrate even in the presence of interfering species. Quantitative detection of citrate was carried out based on the changes in UV-vis absorbance and naked-eye readout. After optimization, the dual-AgNP sensor exhibited a visual detection limit of 25 μM and a low limit of detection of 4.05 nM with a UV-vis spectrometer. The developed citrate sensor performed well with a urine sample, with a high recovery of 99.6%. The prepared solution sensor was constructed on a paper-based analytical device.

Novel fluorescent probes for relay detection copper/citrate ion and application in cell imaging

Two novel fluorescent probes, 2‑(2'‑hydroxyphenyl)‑4‑(2'‑hydroxymethyl‑8‑quinolinamino)methyloxazole (L1), and 2‑(2'‑hydroxyphenyl)‑4‑(2'‑methyl‑8‑quinolinamino)methyloxazole (L2), exhibited colorimetric and "turn off" fluorometric response to Cu²⁺ ion in DMSO/H₂O solution (v/v = 1/1, 0.01 M, Tris-HCl buffer, pH 7.20) and the corresponding detection limit were found to be 2.14 × 10^-8 and 2.70 × 10^-8 M, which were much lower than drinking water permission concentrations by the United States Environmental Protection Agency (U.S. EPA) and World Health Organization (WHO). The L1-Cu²⁺ and L2-Cu²⁺ complexes ensemble detected citrate anions (CA) sequentially through fluorescence recovery response due to the extrusion of Cu²⁺ ion from the complexes. The binding processes were investigated by UV-vis, fluorescence, IR and DFT calculation. Furthermore, the vivo sensitivity experiments of Cu²⁺ ion and CA was demonstrated through fluorescence imaging in living cells.

Highly selective and sensitive macrocycle-based dinuclear foldamer for fluorometric and colorimetric sensing of citrate in water

The selective detection of citrate anions is essential for various biological functions in living systems. A quantitative assessment of citrate is required for the diagnosis of various diseases in the human body; however, it is extremely challenging to develop efficient fluorescence and color-detecting molecular probes for sensing citrate in water. Herein, we report a macrocycle-based dinuclear foldamer (1) assembled with eosin Y (EY) that has been studied for anion binding by fluorescence and colorimetric techniques in water at neutral pH. Results from the fluorescence titrations reveal that the 1·EY ensemble strongly binds citrate anions, showing remarkable selectivity over a wide range of inorganic and carboxylate anions. The addition of citrate anions to the 1·EY adduct led to a large fluorescence enhancement, displaying a detectable color change under both visible and UV light in water up to 2 μmol. The biocompatibility of 1·EY as an intracellular carrier in a biological system was evaluated on primary human foreskin fibroblast (HF) cells, showing an excellent cell viability. The strong binding properties of the ensemble allow it to be used as a highly sensitive, detective probe for biologically relevant citrate anions in various applications.

Proteinuria and hematuria in the neonate

PURPOSE OF REVIEW

Neonatal proteinuria and hematuria while not common can have potentially devastating consequences if left undiagnosed and untreated. It is important to distinguish between inherited and acquired causes of proteinuria to initiate appropriate and timely treatment. With regards to hematuria, it is critical to identify true hematuria from pseudo-hematuria to balance between thorough investigation and unnecessary laboratory work up. This review provides an overview of the common causes of hematuria and proteinuria in a neonate.

RECENT FINDINGS

The identification of genetic mutations in nephrotic syndrome has improved our understanding of the role of various proteins that play an important role in maintaining the glomerular filtration barrier. With the advancement in our ability to provide care for extreme premature neonates, the incidence of acute kidney injury has increased in these neonates along with proteinuria and hematuria.

SUMMARY

Persistent proteinuria after neonatal acute kidney injury would be of interest in regards to the risk of developing future chronic kidney disease and hypertension.

A tri-serine tri-lactone scaffold for the quantification of citrate in urine

Tri-serine tri-lactone based fluorescent sensors can discriminate structurally similar anions, including mono-, di- and tri-carboxylates with 100% correct classification.

Citrate salts for preventing and treating calcium containing kidney stones in adults

BACKGROUND

Kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.

OBJECTIVES

The objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.

DATA COLLECTION AND ANALYSIS

Two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

MAIN RESULTS

We included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).

AUTHORS' CONCLUSIONS

Citrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.

Selective sensing of citrate by a supramolecular ensemble formed by a phenazine copper(i) complex and a perylene diimide derivative

A PET based “off–on” fluorescent sensor for citrate has been developed, displaying low interference by other α-hydroxycarboxylates, dicarboxylates and monosaccharides.

Tris(triazole) tripodal receptors as selective probes for citrate anion recognition and multichannel transition and heavy metal cation sensing

The preparation and binding properties towards citrate anions and cations of two three-armed triazole based receptors are described.

Hematuria in the newborn

Microscopic and gross hematuria, while rare in healthy newborns, is more common in premature infants, particularly those cared for in the neonatal intensive care unit. Hematuria may be transient, but may require evaluation, investigation, and intervention in a timely manner. This article discusses the causes, workup, and treatment of the more common forms of newborn hematuria.

A new bis-tetraamine ligand with a chromophoric 4-(9-anthracenyl)-2,6-dimethylpyridinyl linker for glyphosate and ATP sensing

The synthesis of a new linear bis-tetraamine ligand L1, based on two 1,4,8,11-tetraazaundecane units grafted at the 2 and 6 positions of a pyridinyl linker substituted by an anthracenyl fluorophore in the para position, is described and anion complexation studies of L1 with anionic substrates are reported. The protonation pattern and the study of the binding properties of L1 in an aqueous medium with two anionic substrates, the nucleotide adenosine triphosphate (ATP) and the herbicide glyphosate (N-(phosphonomethyl)glycine, PMG), were investigated by means of potentiometry, NMR spectroscopy and absorption and emission spectroscopic techniques. To decipher the impact of the chromophoric linker on the complexation process and to highlight its optical properties, a comparison is established with its previously reported analog L2 devoid of the anthracenyl group. The results unambiguously show that the protonation and complexation properties are preserved despite the presence of the bulky linker, allowing for the use of L1 as a fluorescent sensor for ATP and PMG.

Selective detection of multicarboxylate anions based on "turn on" electron transfer by self-assembled molecular rectangles

Two new large molecular rectangles (4 and 5) were obtained by the reaction of two different dinuclear arene ruthenium complexes [Ru(2)(arene)(2)(OOOO)(2)Cl(2)] (arene = p-cymene; OOOO = 2,5-dihydroxy-1,4-benzoquinonato (2), 6,11-dihydroxy-5,12-naphthacene dionato (3)) with the unsymmetrical amide NN (N-[4-(pyridin-4-ylethynyl)phenyl]isonicotinamide) donor ligand 1 in methanol in the presence of AgO(3)SCF(3), forming tetranuclear cations of the general formula [Ru(4)(arene)(4)(NN)(2)(OOO O)(2)](4+). Both rectangles were isolated in good yields as triflate salts and were characterized by multinuclear NMR, ESI-MS, UV/Vis, and photoluminescence spectroscopy. The crystal structure of 5 was determined by X-ray diffraction. Luminescent rectangle 5 was used for anion sensing with an amide ligand as a hydrogen-bond donor and an arene-ruthenium acceptor as a signaling unit. Rectangle 5 strongly bound multicarboxylate anions, such as oxalate, tartrate, and citrate, in UV/Vis titration experiments in 1:1 ratios, in contrast to monoanions, such as F(-), Cl(-), NO(3)(-), PF(6)(-), CH(3)COO(-), and C(6)H(5)COO(-). The fluorescence titration experiment showed a large fluorescence enhancement of 5 upon binding to multicarboxylate anions, which could be attributed to blocking of the photoinduced electron transfer process from the arene-ruthenium moiety to the amidic donor in 5; this was likely to be a result of hydrogen bonding between the ligand and the anion. On the other hand, rectangle 5 was not selective towards any other anions. To the naked eye, multicarboxylate anions in a solution of 5 in methanol appear greenish upon irradiation with UV light.

Self-assembled arene-ruthenium-based rectangles for the selective sensing of multi-carboxylate anions

Novel arene-ruthenium [2+2] metalla-rectangles 4 and 5 have been synthesized by self-assembly using dipyridyl amide ligand 3 and arene-ruthenium acceptors (arene: benzoquinone (1), naphthacenedione (2)) and characterized by NMR spectroscopy and ESI-MS. The solid-state structure of 5 was determined by X-ray diffraction and shows encapsulated diethyl ether molecule in the rectangular cavity of 5. The luminescent 5 was further used for anion sensing with the amidic linkage serving as a hydrogen-bond donor site for anions and the ruthenium moiety serving as a signaling unit. A UV/Vis titration study demonstrated that although 5 interacts very weakly with common monoanions as well as with flexible dicarboxylate anions such as malonate and succinate, it displays significant binding affinity (K>10(3) in MeOH) for rigid multi-carboxylate anions such as oxalate, citrate, and tartrate, exhibiting a 1:1 stoichiometry. It has been suggested that 1:1 bidentate hydrogen bonding assisted by appropriate geometrical complementarity is mainly responsible for the increased affinity of 5 towards such anions. A fluorescence titration study revealed a large fluorescence enhancement of 5 upon binding to multi-carboxylate anions, which can be attributed to the blocking of the photoinduced electron-transfer process from the arene-Ru moiety to the amidic donor in 5 as a result of hydrogen bonding between the donor and the anion.

Renal calcification in very low birth weight infants

BACKGROUND

Renal calcification in preterm infants has been described frequently. The etiologic factors have not yet been fully clarified. The objective of this study was to evaluate the incidence of and risk factors for renal calcification in our population.

METHODS

We retrospectively reviewed the charts of very low birth weight preterm infants during a 1-year period. Renal ultrasound scans were performed at term or before discharge and at a corrected age of 1 year.

RESULTS

Six infants (6%) had renal calcification at term or before discharge compared with 96 who did not. Factors significantly associated with renal calcification included gestational age (26 weeks vs. 29 weeks, p=0.006), birth weight (851 g vs. 1141 g, p=0.004), duration of mechanical ventilation (69 days vs. 29 days, p=0.002), length of intensive care (72 days vs. 41 days, p=0.013), furosemide therapy (33% vs. 3%, p=0.027), and dexamethasone therapy (50% vs. 2% p=0.001). Birth weight and dexamethasone therapy had significant independent association after stepwise logistic regression analysis. Sex, oliguria, acidosis, duration of oxygen therapy, length of hospital stay, nutrition status, and nephrotoxic drugs did not differ between the two groups. Three of the six infants had spontaneous remission of renal calcification, whereas two patients without the finding in neonatal stage had renal calcification at a corrected age of 1 year.

CONCLUSION

The incidence of renal calcification in very low birth weight infants in this study was relatively low, and the calcification was transient in one-half of the infants. Extremely premature, sick infants requiring long-term ventilation, and those receiving furosemide or dexamethasone were more likely to have renal calcification. Clinicians should be aware that renal calcification may develop beyond the neonatal stage.

Exposure to furosemide as the strongest risk factor for nephrocalcinosis in preterm infants

BACKGROUND

The objective of this study was to determine which of the many risk factors for nephrocalcinosis (NC) in preterm infants are most relevant.

METHODS

In 55 neonates born before 32 completed weeks of gestation, parameters relevant to NC were analyzed. Median birthweight was 1010 g (range 500-2070 g). Fifteen (27%) asymptomatic children had ultrasonographic NC.

RESULTS

In multivariate analysis the strongest independent risk factor was furosemide therapy above 10 mg per kg bodyweight cumulative dose, with a 48-fold increased risk of NC (odds ratio confidence interval 4.0-585, P < 0.01). The risk of NC was 1.65-fold higher per 100 g lower weight (1.07-2.56, P= 0.02) and 4.5-fold higher per mmol/l of urinary calcium concentration (1.14-17.7, P= 0.03). Many other risk factors were only significant in univariate analysis (gestational age, mechanical ventilation, infection, broncho-pulmonary dysplasia, blood transfusions, intraventricular hemorrhage, surfactant therapy, vasopressors, phenobarbital or caffeine, duration of hospital stay), indicating an indirect effect only. Other parameters of calcium and phosphate homeostasis were not significant, possibly due to standardized supplementation.

CONCLUSION

We suggest that in preterm infants, furosemide should be prescribed with caution and close monitoring of calcium excretions is advisable. Some guidelines for infant respiratory distress syndrome now favor calcium-sparing thiazides if diuretics are considered.

Nephrocalcinosis in preterm neonates

The prevalence of nephrocalcinosis (NC) in preterm neonates in recent reports is 7-41%. The wide range in prevalence is a consequence of different study populations and ultrasound equipment and criteria, in addition to a moderate interobserver variation. NC in preterm neonates has a multifactorial aetiology, consisting of low gestational age and birth weight, often in combination with severe respiratory disease, and occurs as a result of an imbalance between stone-promoting and stone-inhibiting factors. A limited number of histological studies suggest that calcium oxalate crystals play an important role in NC in premature neonates. In 85% of children resolution of NC occurs in the first years of life. Prematurity, per se, is associated with high blood pressure, relatively small kidneys, and (distal) tubular dysfunction. In addition, NC in preterm neonates can have long-term sequelae for glomerular and tubular function. Long-term follow-up of blood pressure and renal function of prematurely born children, especially with neonatal NC, is recommended. Prevention of NC with (low) oral doses of citrate has not resulted in a significant decrease in the prevalence of NC; a higher citrate dosage deserves further study. Future research pertaining to prevention of NC in preterm neonates is crucial.

A europium luminescence assay of lactate and citrate in biological fluids

Ratiometric methods of analysis have been developed for the selective determination of lactate or citrate in microlitre samples of human serum, urine or prostate fluids following comparison of anion binding affinities for a family of nine luminescent europium(III) complexes.