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Balawender K, Łuszczki E, Mazur A, Wyszyńska J. The Multidisciplinary Approach in the Management of Patients with Kidney Stone Disease-A State-of-the-Art Review. Nutrients 2024; 16:1932. [PMID: 38931286 PMCID: PMC11206918 DOI: 10.3390/nu16121932] [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: 05/21/2024] [Revised: 06/15/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
Kidney stone disease has a multifactorial etiology, and evolving dietary habits necessitate continuous updates on the impact of dietary components on lithogenesis. The relationship between diseases influenced by lifestyle, such as obesity and diabetes, and kidney stone risk underscores the need for comprehensive lifestyle analysis. Effective management of kidney stones requires a multidisciplinary approach, involving collaboration among nutritionists, urologists, nephrologists, and other healthcare professionals to address the complex interactions between diet, lifestyle, and individual susceptibility. Personalized dietary therapy, based on each patient's unique biochemical and dietary profile, is essential and necessitates comprehensive nutritional assessments. Accurate dietary intake evaluation is best achieved through seven-day, real-time dietary records. Key factors influencing urinary risk include fluid intake, dietary protein, carbohydrates, oxalate, calcium, and sodium chloride. Personalized interventions, such as customized dietary changes based on gut microbiota, may improve stone prevention and recurrence. Current research suggests individualized guidance on alcohol intake and indicates that tea and coffee consumption might protect against urolithiasis. There is potential evidence linking tobacco use and secondhand smoke to increased kidney stone risk. The effects of vitamins and physical activity on kidney stone risk remain unresolved due to mixed evidence. For diseases influenced by lifestyle, conclusive evidence on targeted interventions for nephrolithiasis prevention is lacking, though preliminary research suggests potential benefits. Management strategies emphasize lifestyle modifications to reduce recurrence risks, support rapid recovery, and identify predisposing conditions, highlighting the importance of these changes despite inconclusive data.
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Affiliation(s)
- Krzysztof Balawender
- Institute of Medical Sciences, Medical College of Rzeszow University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland;
- Clinical Department of Urology and Urological Oncology, Municipal Hospital, Rycerska 4, 35-241 Rzeszow, Poland
| | - Edyta Łuszczki
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland; (E.Ł.); (J.W.)
| | - Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland;
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszow University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland; (E.Ł.); (J.W.)
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2
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Bhatt NP, Deshpande AV, Starkey MR. Pharmacological interventions for the management of cystinuria: a systematic review. J Nephrol 2024; 37:293-308. [PMID: 37957454 PMCID: PMC11043141 DOI: 10.1007/s40620-023-01795-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/26/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cystinuria is a rare genetic kidney stone disease, with no cure. Current treatments involve lowering urinary cystine levels and increasing cystine solubility. This systematic review evaluates the available literature regarding non-surgical interventions for cystinuria. METHODS Key electronic databases were searched for studies that described the clinical management of cystinuria with high diuresis, alkalinizing agents and thiol-based drugs that were published between 2000 and 2022. Observational studies were included if they contained clinical investigation with at least one previous or current episode of cystine stones, urine cystine levels > 250 mg/L and patients being managed with urinary dilution, alkalinizing agents or other pharmacological agents. All included studies were assessed for study design, patient characteristics and outcomes. A qualitative and critical analysis was performed whereby study quality was assessed using Methodological Index for Non-Randomized Studies (MINORS). Two authors performed the quality assessment and excluded the studies with a low MINORS score. RESULTS Fourteen studies met the review inclusion and quality criteria. Of the fourteen studies, two reported treatment using alkalinizing agents, six reported treatment using thiol-based drugs, and six reported combination treatment using alkalinizing agents and thiol-based drugs. These studies indicated that first-line therapies, including high fluid intake and urinary alkalinization, increased urine volume to > 3 L/day and urinary pH > 7.0, and were associated with reduced urinary cystine levels and cystine stone formation. Second-line therapy with cystine-binding thiol drugs, such as tiopronin and D-penicillamine, reduced urinary cystine levels, cystine crystal volume and increased cystine solubility, resulting in decreased cystine stone formation and stone recurrence rate. Further, combined intervention with alkalinizing agents and thiol-based drugs synergistically reduced stone recurrence. CONCLUSION Cystinuria treatment may require a combined approach of high diuresis, alkalinization and pharmacological interventions with regular monitoring of urinary pH, cystine levels, cystine crystal volume and solubility. However, poor adherence to treatment is relatively frequent, hence the pressing urgency for improved therapies and treatments.
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Affiliation(s)
- Nirmal Prasad Bhatt
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Aniruddh Vijay Deshpande
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
- Department of Surgery, Urology Unit, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Malcolm Ronald Starkey
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Segall M, Mousavi A, Eisner BH, Scotland K. Pharmacologic treatment of kidney stones: Current medication and pH monitoring. Actas Urol Esp 2024; 48:11-18. [PMID: 38043680 DOI: 10.1016/j.acuroe.2023.11.008] [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: 10/16/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.
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Affiliation(s)
- M Segall
- Escuela de Medicina Albert Einstein, Bronx, NY, USA
| | - A Mousavi
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA
| | - B H Eisner
- Servicio de Urología, Hospital General de Massachusetts, Boston, MA, USA
| | - K Scotland
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA.
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Courbebaisse M, Travers S, Bouderlique E, Michon-Colin A, Daudon M, De Mul A, Poli L, Baron S, Prot-Bertoye C. Hydration for Adult Patients with Nephrolithiasis: Specificities and Current Recommendations. Nutrients 2023; 15:4885. [PMID: 38068743 PMCID: PMC10708476 DOI: 10.3390/nu15234885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Nephrolithiasis affects around 10% of the population and is frequently associated with impaired dietary factors. The first one is insufficient fluid intake inducing reduced urine volume, urine supersaturation, and subsequently urinary lithiasis. Kidneys regulate 24 h urine volume, which, under physiological conditions, approximately reflects daily fluid intake. The aim of this study is to synthesize and highlight the role of hydration in the treatment of nephrolithiasis. Increasing fluid intake has a preventive effect on the risk of developing a first kidney stone (primary prevention) and also decreases the risk of stone recurrence (secondary prevention). Current guidelines recommend increasing fluid intake to at least at 2.5 L/day to prevent stone formation, and even to 3.5-4 L in some severe forms of nephrolithiasis (primary or enteric hyperoxaluria or cystinuria). Fluid intake must also be balanced between day and night, to avoid urinary supersaturation during the night. Patients should be informed and supported in this difficult process of increasing urine dilution, with practical ways and daily routines to increase their fluid intake. The liquid of choice is water, which should be chosen depending on its composition (such as calcium, bicarbonate, or magnesium content). Finally, some additional advice has to be given to avoid certain beverages such as those containing fructose or phosphoric acid, which are susceptible to increase the risk of nephrolithiasis.
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Affiliation(s)
- Marie Courbebaisse
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Institut Necker Enfants Malades, Inserm U1151, F-75015 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Simon Travers
- Équipe Biologie, Lip(Sys)2, EA7357, UFR de Pharmacie, Université Paris-Saclay, F-91400 Orsay, France
- Clinical Chemistry Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France
| | - Elise Bouderlique
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Arthur Michon-Colin
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Michel Daudon
- Department of Multidisciplinary Functional Explorations, Tenon Hospital, AP-HP, F-75019 Paris, France
| | - Aurélie De Mul
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Filière Maladies Rares OSCAR, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, F-69500 Bron, France
| | - Laura Poli
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Stéphanie Baron
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, F-75006 Paris, France
- CNRS ERL 8228—Laboratoire de Physiologie Rénale et Tubulopathies, F-75006 Paris, France
| | - Caroline Prot-Bertoye
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, F-75006 Paris, France
- CNRS ERL 8228—Laboratoire de Physiologie Rénale et Tubulopathies, F-75006 Paris, France
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Hughes T, Tzelves L, Somani BK. Cystine Stones: Developments in Minimally Invasive Surgery and Their Impact on Morbidity and Stone Clearance. Res Rep Urol 2023; 15:175-185. [PMID: 37303487 PMCID: PMC10254682 DOI: 10.2147/rru.s381190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023] Open
Abstract
Cystinuria is a rare genetic condition that is responsible for cystine stones. Besides stone recurrence, patients with cystine stones have reduced health-related quality of life, increased rates of chronic kidney disease and hypertension. Although lifestyle measures, medical therapy and close follow up are essential to reduce and monitor cystine stone recurrences, surgical intervention is frequently needed for most cystinuria patients. Shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and active surveillance all have a role, and technological advances in endourology are vital in achieving a stone-free status and to prevent recurrences. The complexity of managing cystine stones necessitates a multidisciplinary team discussion, patient involvement and an individualised approach in a specialist centre for optimum management. Thulium fibre laser and virtual reality may have an increasing role in the future of cystine stone management.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, Warwick Hospital, Warwick, UK
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Ene MA, Geavlete PA, Simeanu CE, Bulai CA, Ene CV, Geavlete BF. The effectiveness of citrates and pyridoxine in the treatment of kidney stones. J Med Life 2023; 16:856-861. [PMID: 37675156 PMCID: PMC10478649 DOI: 10.25122/jml-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/25/2023] [Indexed: 09/08/2023] Open
Abstract
The prevalence of nephrolithiasis is increasing across all demographic groups. Apart from the morbidity associated with an acute occurrence, preventative treatment is essential for stone disease, which can become a long-term problem. Simple interventions like fluid intake optimization and dietary modification are effective for most stone types. However, patients with specific metabolic abnormalities may require pharmaceutical therapy if lifestyle changes are insufficient to reduce the risk of stone recurrence. The treatment of citrates and/or pyridoxines may help eliminate or prevent recurrences of kidney stones, especially when they are composed of uric acid, calcium oxalate, calcium phosphate, or the latter two together. In cases of struvite stones, which often necessitate a surgical approach, acetohydroxamic acid emerges as a valuable second-line treatment option. Thiol-binding agents may be needed for cystinuria, as well as lifestyle modifications. Successful treatment reduces stone recurrence and the need to remove stones surgically.
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Affiliation(s)
- Mihai Andrei Ene
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
| | - Petrişor Aurelian Geavlete
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Cătălin Andrei Bulai
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Cosmin Victor Ene
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Florin Geavlete
- Department of Urology, Sf. Ioan Emergency Clinical Hospital, Bucharest, Romania
- Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Azer SM, Goldfarb DS. A Summary of Current Guidelines and Future Directions for Medical Management and Monitoring of Patients with Cystinuria. Healthcare (Basel) 2023; 11:healthcare11050674. [PMID: 36900678 PMCID: PMC10000469 DOI: 10.3390/healthcare11050674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Cystinuria is the most common genetic cause of recurrent kidney stones. As the result of a genetic defect in proximal tubular reabsorption of filtered cystine, increased urine levels of the poorly soluble amino acid result in recurrent cystine nephrolithiasis. Recurrent cystine stones not only adversely affect the quality of patients suffering from cystinuria but also may result in chronic kidney disease (CKD) from recurrent renal injury. Thus, the mainstay of medical management revolves around prevention of stones. Recently published consensus statements on guidelines for managing cystinuria were released from both the United States and Europe. The purpose of this review is to summarize guidelines for medical management of patients with cystinuria, to provide new insight into the utility and clinical significance of cystine capacity-an assay for monitoring cystinuria, and to discuss future directions for research on treatment of cystinuria. We discuss future directions, including the potential use of cystine mimetics, gene therapy, V2-receptor blockers, and SGLT2 inhibitors, topics which have not appeared in more recent reviews. It is notable that in the absence of randomized, controlled trials, the recommendations cited here and in the guidelines are based on our best understanding of the disorder's pathophysiology, observational studies, and clinical experience.
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Affiliation(s)
- Sarah M. Azer
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - David S. Goldfarb
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Langone Medical Center, Nephrology Section, New York Harbor VA Healthcare System, New York, NY 10010, USA
- Correspondence: ; Tel.: +1-212-686-7500 (ext. 3877); Fax: +1-212-951-6842
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8
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Fluid intake recommendations in urolithiasis and general advice to patients without metabolic risk factors. World J Urol 2023; 41:1251-1259. [PMID: 36692534 DOI: 10.1007/s00345-023-04285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
Urolithiasis is a highly prevalent global disease with substantially increasing incidence in the last two decades. Data from the literature suggests that 26%-50% of patients will have a recurrence within 10 years after an initial symptomatic stone episode. Therefore, interest has been raised in preventive strategies, aiming to modify the risk factors of stone recurrence by implementing dietary and lifestyle changes and specific medical treatments for stone formers, depending on their recurrence risk factors. Certain dietary factors are thought to contribute significantly to the increased incidence of urolithiasis, particularly a diet low in fiber and high in animal protein, fat, and sodium. Fluid intake is perhaps the most important and modifiable step in the prevention of urolithiasis, irrespective of stone composition. However, the amount of fluid to be consumed and the implications of various fluid types on stone formation are still controversial. In this article, the relationship between fluid intake, beverage types and stone formation-prevention will be discussed. Moreover, general dietary recommendations for patients without metabolic risk factors will be reviewed based on the current literature.
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9
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Case-based review of dietary management of cystinuria. World J Urol 2022; 41:1215-1220. [PMID: 36565321 DOI: 10.1007/s00345-022-04263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The currently recommended treatment strategy for cystine stone formers is based on a progressive approach that starts with the most conservative measures. In patients with cystinuria, increased patient compliance with dietary management and medical treatment is associated with fewer stone interventions. In this case-based review, the dietary management of cystine stone former was reviewed under the guidance of evidence-based medicine. METHODS The dietary management of the 13-year-old cystinuria patient, who underwent 18 endourological stone interventions, was reviewed in the light of evidence-based medicine. A literature search was performed in Pubmed, MEDLINE, Embase, and Cochrane Library databases according to PRISMA guidelines published from 1993 to September 2022. A total of 304 articles were included in this paper. RESULTS In managing patients with cystinuria, hyperhydration, and alkalinization of the urine with medical treatment, the rational use of cystine-binding drugs by taking into account individual situations has come to the fore. A limited study has argued that a vegetarian diet is effective as the alkaline load from fruits and vegetables can reduce the amount of alkalizing substances required to achieve urinary alkalinization above pH 7.5, making it particularly suitable for the dietary treatment of cystine stone disease. CONCLUSION Life-long follow-up with dietary modification, hyperhydration, and personalized medical therapy (alkalinization and cystine-binding drugs) are critical in preventing chronic kidney disease and kidney failure in cystinuria.
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Phenotypic characterization of a pediatric cohort with cystinuria and usefulness of newborn screening. Pediatr Nephrol 2022; 38:1513-1521. [PMID: 36227436 DOI: 10.1007/s00467-022-05732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cystinuria is an inherited metabolic disease involving the defective transport of cystine and the dibasic amino acids in the renal proximal tubules that causes the formation of stones in the urinary system. In our regional child health program, cystinuria is included in newborn metabolic screening. Our objectives are the phenotypic characterization of our cystinuric pediatric cohort and to present our experience in neonatal cystinuria screening. METHODS The study of clinical cases of pediatric patients diagnosed with cystinuria over a period of 32 years. All patients were studied at demographic, clinical, laboratory, radiological, and therapeutic levels. RESULTS We diagnosed 86 pediatric patients with cystinuria; 36% of them had the homozygous biochemical phenotype. 95.3% of the patients were detected by neonatal metabolic screening. We performed urine biochemical analyses of parents with additional diagnoses of 63 adult patients. The mean follow-up time was 16.8 ± 8.5 years. 11.6% of patients developed one or more episodes of urinary tract infection during that period. Chronic kidney disease, proteinuria, and hypertension were uncommon (1.2%). 10.5% developed kidney stones at the mean age of presentation of 7.78 ± 7.6 years; 33% were recurrent. The risk of developing lithiasis was higher for homozygous biochemical-phenotype patients. Hypercalciuria was a significant risk factor in the development of lithiasis. CONCLUSIONS Our clinical data suggest that diagnosing cystinuria through neonatal screening could be a useful strategy for the detection of presymptomatic cases, in order to establish preventive measures, as well as for the detection of relatives at risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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D'Ambrosio V, Capolongo G, Goldfarb D, Gambaro G, Ferraro PM. Cystinuria: an update on pathophysiology, genetics, and clinical management. Pediatr Nephrol 2022; 37:1705-1711. [PMID: 34812923 DOI: 10.1007/s00467-021-05342-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Cystinuria is the most common genetic cause of nephrolithiasis in children. It is considered a heritable aminoaciduria as the genetic defect affects the reabsorption of cystine and three other amino acids (ornithine, lysine, and arginine) in the renal proximal tubule. Patients affected by this condition have elevated excretion of cystine in the urine, and because of this amino acid's low solubility at normal urine pH, patients tend to form cystine calculi. To date, two genes have been identified as disease-causative: SLC3A1 and SLC7A9, encoding for the two subunits of the heterodimeric transporter. The clinical features of this condition are solely related to nephrolithiasis. The diagnosis is usually made during infancy or adolescence, but cases of late diagnosis are common. The goal of therapy is to reduce excretion and increase the solubility of cystine, through both modifications of dietary habits and pharmacological treatment. However, therapeutic interventions are not always sufficient, and patients often have to undergo several surgical procedures during their lives to treat recurrent nephrolithiasis. The goal of this literature review is to synthesize the available evidence on diagnosis and management of patients affected by cystinuria in order to provide physicians with a practical tool that can be used in daily clinical practice. This review also aims to shed some light on new therapy directions with the aim of ameliorating kidney outcomes while improving adherence to treatment and quality of life of cystinuric patients.
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Affiliation(s)
- Viola D'Ambrosio
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, Unit of Nephrology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - David Goldfarb
- Nephrology Section, VA, New York Harbor Healthcare System, New York, NY, USA
- Division of Nephrology, New York University Langone Medical Center, New York, NY, USA
| | - Giovanni Gambaro
- Department of Medicine, Division of Nephrology and Dialysis, Renal Unit, University of Verona, Verona, Italy
| | - Pietro Manuel Ferraro
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy.
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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Clark CS, Gnanappiragasam S, Thomas K, Bultitude M. Cystinuria: An Overview of Challenges and Surgical Management. Front Surg 2022; 9:812226. [PMID: 35784929 PMCID: PMC9243440 DOI: 10.3389/fsurg.2022.812226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
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Zhang Z, Zheng R, Zhu C, Geng H, Xu G. Lipidomics characterization of the lipid metabolism profiles in a cystinuria rat model: Precalculus damage in the kidney of cystinuria. Prostaglandins Other Lipid Mediat 2022; 162:106651. [PMID: 35680078 DOI: 10.1016/j.prostaglandins.2022.106651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022]
Abstract
Cystinuria is a genetic disorder of cystine transport, including defective protein b0,+AT (encoded by SLC7A9), and/or rBAT (encoded by SLC3A1). Patients present hyperexcretion of cystine in the urine, recurrent cystine lithiasis, and progressive decline in kidney function. Moreover, heterodimer transport is defective. To date, little omics data are accessible regarding this metabolic disease caused by membrane proteins. Since membrane function is closely related to changes in the lipidome, we decided to explore the changes in kidney tissue of a self-established cystinuria rat model by performing lipidomic analysis by LC-MS/MS. Our results demonstrated that Slc7a9 deficiency changed the lipid profile of the renal cortex and induced vital modifications in the lipidome, including major alterations in ChE, LPA, and PA. Among those alterations, this lipidomic study highlights the lipid changes that participate in inflammatory responses during cystinuria. As a result, lipid research, perhaps has great potential, for it may lead to the identification of novel therapeutic targets for the prevention and treatment of cystinuria.
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Affiliation(s)
- Zihan Zhang
- Shanghai Jiaotong University School of Medicine, China
| | - Rui Zheng
- Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China
| | - Caihua Zhu
- Shanghai Applied Protein Technology Co., Ltd., 201100, China
| | - Hongquan Geng
- Shanghai Jiaotong University School of Medicine, China; Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China.
| | - Guofeng Xu
- Shanghai Jiaotong University School of Medicine, China; Department of Pediatric Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, China.
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14
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Differences in renal cortex transcriptional profiling of wild-type and novel type B cystinuria model rats. Urolithiasis 2022; 50:279-291. [PMID: 35416493 PMCID: PMC9110498 DOI: 10.1007/s00240-022-01321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/03/2022] [Indexed: 11/20/2022]
Abstract
Cystinuria is a genetic disorder of cystine transport that accounts for 1–2% of all cases of renal lithiasis. It is characterized by hyperexcretion of cystine in urine and recurrent cystine lithiasis. Defective transport of cystine into epithelial cells of renal tubules occurs because of mutations of the transport heterodimer, including protein b0,+AT (encoded by SLC7A9) and rBAT (encoded by SLC3A1) linked through a covalent disulfide bond. Study generated a novel type B cystinuria rat model by artificially deleting 7 bp of Slc7a9 gene exon 3 using the CRISPR-Cas9 system, and those Slc7a9-deficient rats were proved to be similar with cystinuria in terms of genome, transcriptome, translation, and biologic phenotypes with no off-target editing. Subsequent comparisons of renal histopathology indicated model rats gained typical secondary changes as medullary fibrosis with no stone formation. A total of 689 DEGs (383 upregulated and 306 downregulated) were differentially expressed in the renal cortex of cystinuria rats. In accordance with the functional annotation of DEGs, the potential role of glutathione metabolism processes in the kidney of cystinuria rat model was proposed, and KEGG analysis results showed that knock-out of Slc7a9 gene triggered more biological changes which has not been studied. In short, for the first time, a rat model and its transcriptional database that mimics the pathogenesis and clinical consequences of human type B cystinuria were generated.
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15
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Tkaczyk M, Gadomska-Prokop K, Załuska-Leśniewska I, Musiał K, Zawadzki J, Jobs K, Porowski T, Rogowska-Kalisz A, Jander A, Kirolos M, Haliński A, Krzemień A, Sobieszczańska-Droździel A, Zachwieja K, Beck BB, Sikora P, Zaniew M. Clinical profile of a Polish cohort of children and young adults with cystinuria. Ren Fail 2021; 43:62-70. [PMID: 33349102 PMCID: PMC7758038 DOI: 10.1080/0886022x.2020.1860089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Cystinuria is an inherited disorder that results in increased excretion of cystine in the urine. It accounts for about 1–2% of pediatric kidney stones. In this study, we sought to identify the clinical characteristics of patients with cystinuria in a national cohort. Methods This was a retrospective study involving 30 patients from the Polish Registry of Inherited Tubulopathies. Initial data and that from a 6-month follow-up were analyzed. Mutational analysis was performed by targeted Sanger sequencing and, if applicable, MLPA analysis was used to detect large rearrangements. Results SLC7A9 mutations were detected in 15 children (50%; 10 males, 5 females), SLC3A1 mutations in 14 children (47%; 5 males, 9 females), and bigenic mutations in one male patient. The first clinical symptoms of the disease were detected at a median of 48 months of age (range 3–233 months). When individuals with different mutations were compared, there were no differences identified in gender, age of diagnosis, presence of UTI or urolithiasis, eGFR, calcium, or cystine excretion. The most common initial symptoms were urolithiasis in 26 patients (88%) and urinary tract infections in 4 patients (13%). Urological procedures were performed in 18 out of 30 (60%). Conclusions The clinical course of cystinuria is similar among patients, regardless of the type of genetic mutation. Most patients require surgery before diagnosis or soon after it. Patients require combined urological and pharmacological treatment for prevention of stone recurrence and renal function preservation.
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Affiliation(s)
- Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.,Division of Didactics in Pediatrics, Medical University of Łódź, Łódź, Poland
| | - Katarzyna Gadomska-Prokop
- Department of Nephrology, Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Iga Załuska-Leśniewska
- Department of Pediatric Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Kinga Musiał
- Department of Pediatric Nephrology, Medical University of Wrocław, Wrocław, Poland
| | - Jan Zawadzki
- Department of Nephrology, Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Pediatrics, Allergology and Nephrology, Military Medical Institute, Warsaw, Poland
| | - Tadeusz Porowski
- Department of Pediatrics and Nephrology, Medical University of Białystok, Białystok, Poland
| | - Anna Rogowska-Kalisz
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Anna Jander
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Meritrafat Kirolos
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Adam Haliński
- Department of Clinical Genetics and Pathology, University of Zielona Góra, Zielona Góra, Poland
| | - Aleksandra Krzemień
- Department of Pediatric Nephrology, Upper-Silesian Centre for Child's Health, Katowice, Poland
| | | | - Katarzyna Zachwieja
- Department of Pediatric Nephrology, Collegium Medicum Jagiellonian University, Krakow, Poland
| | - Bodo B Beck
- Institute of Human Genetics and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
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16
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Siener R. Nutrition and Kidney Stone Disease. Nutrients 2021; 13:1917. [PMID: 34204863 PMCID: PMC8229448 DOI: 10.3390/nu13061917] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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17
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Prot-Bertoye C, Daudon M, Tostivint I, Dousseaux MP, Defazio J, Traxer O, Knebelmann B, Courbebaisse M. [Cystinuria]. Nephrol Ther 2021; 17S:S100-S107. [PMID: 33910689 DOI: 10.1016/j.nephro.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/21/2022]
Abstract
Cystinuria is the most common monogenic nephrolithiasis disorder. Because of its poor solubility at a typical urine pH of less than 7, cystine excretion results in recurrent urinary cystine stone formation. A high prevalence of high blood pressure and of chronic kidney disease has been reported in these patients. Alkaline hyperdiuresis remains the cornerstone of the preventive medical treatment. To reach a urine pH between 7.5 and 8 and a urine specific gravity less than or equal to 1.005 should be the goal of medical treatment. D-penicillamine and tiopronin, two cysteine-binding thiol agents, should be considered as second line treatments with frequent adverse events that should be closely monitored.
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Affiliation(s)
- Caroline Prot-Bertoye
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Tostivint
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie-Paule Dousseaux
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Jérôme Defazio
- Association pour l'information et la recherche sur les maladies génétiques (AIRG-France), BP 78, 75261 Paris cedex 06, France
| | - Olivier Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Bertrand Knebelmann
- Service de néphrologie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - Marie Courbebaisse
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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18
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Takahashi T, Somiya S, Ito K, Kanno T, Higashi Y, Yamada H. The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years. J Clin Med 2021; 10:jcm10071336. [PMID: 33804827 PMCID: PMC8037008 DOI: 10.3390/jcm10071336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.
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Affiliation(s)
| | | | | | | | | | - Hitoshi Yamada
- Correspondence: ; Tel.: +81-75-572-6331; Fax: +81-75-571-8877
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19
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The Impact of Diet on Urinary Risk Factors for Cystine Stone Formation. Nutrients 2021; 13:nu13020528. [PMID: 33561968 PMCID: PMC7915598 DOI: 10.3390/nu13020528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the importance of dietary management of cystinuria, data on the contribution of diet to urinary risk factors for cystine stone formation are limited. Studies on the physiological effects of diet on urinary cystine and cysteine excretion are lacking. Accordingly, 10 healthy men received three standardized diets for a period of five days each and collected daily 24 h urine. The Western-type diet (WD; 95 g/day protein) corresponded to usual dietary habits, whereas the mixed diet (MD; 65 g/day protein) and lacto-ovo-vegetarian diet (VD; 65 g/day protein) were calculated according to dietary reference intakes. With intake of the VD, urinary cystine and cysteine excretion decreased by 22 and 15%, respectively, compared to the WD, although the differences were not statistically significant. Urine pH was significantly highest on the VD. Regression analysis showed that urinary phosphate was significantly associated with cystine excretion, while urinary sulfate was a predictor of cysteine excretion. Neither urinary cystine nor cysteine excretion was affected by dietary sodium intake. A lacto-ovo-vegetarian diet is particularly suitable for the dietary treatment of cystinuria, since the additional alkali load may reduce the amount of required alkalizing agents.
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20
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Wendt-Nordahl G. Metaphylaxe und medikamentöse Therapie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Cil O, Perwad F. α-Lipoic Acid (ALA) Improves Cystine Solubility in Cystinuria: Report of 2 Cases. Pediatrics 2020; 145:peds.2019-2951. [PMID: 32245805 DOI: 10.1542/peds.2019-2951] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 11/24/2022] Open
Abstract
Cystinuria is an autosomal recessive disorder characterized by excessive urinary excretion of cystine, resulting in recurrent cystine kidney stones, often presenting in childhood. Current treatment options for cystinuria include dietary and/or fluid measures and potassium citrate to reduce cystine excretion and/or increase solubility. Tiopronin and D-penicillamine are used in refractory cases to bind cystine in urine, albeit with serious side effects. A recent study revealed efficacy of nutritional supplement α-lipoic acid (ALA) treatment in preventing kidney stones in a mouse model of cystinuria. Here, we report 2 pediatric patients (6 and 15 years old) with cystinuria who received regular doses of ALA in addition to conventional therapy with potassium citrate. Both patients tolerated ALA without any adverse effects and had reduced frequency of symptomatic and asymptomatic kidney stones with disappearance of existing kidney stones in 1 patient after 2 months of ALA therapy. ALA treatment markedly improved laboratory markers of cystine solubility in urine with increased cystine capacity (-223 to -1 mg/L in patient 1 and +140 to +272 mg/L in patient 2) and decreased cystine supersaturation (1.7 to 0.88 in patient 1 and 0.64 to 0.48 in patient 2) without any changes in cystine excretion or urine pH. Our findings suggest that ALA improves solubility of cystine in urine and prevents stone formation in patients with cystinuria who do not respond to diet and citrate therapy.
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Affiliation(s)
- Onur Cil
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Farzana Perwad
- Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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22
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Eisner BH, Goldfarb DS, Baum MA, Langman CB, Curhan GC, Preminger GM, Lieske JC, Pareek G, Thomas K, Zisman AL, Papagiannopoulos D, Sur RL. Evaluation and Medical Management of Patients with Cystine Nephrolithiasis: A Consensus Statement. J Endourol 2020; 34:1103-1110. [PMID: 32066273 DOI: 10.1089/end.2019.0703] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder with both autosomal recessive and incompletely dominant inheritance. The disorder disrupts cystine and other dibasic amino acid transport in proximal tubules of the kidney, resulting in recurrent kidney stone formation. Currently, there are no consensus guidelines on evaluation and management of this disease. This article represents the consensus of the author panel and will provide clinicians with a stepwise framework for evaluation and clinical management of patients with cystinuria based on evidence in the existing literature. Materials and Methods: A search of MEDLINE®/PubMed® and Cochrane databases was performed using the following key words: "cystine nephrolithiasis," "cystinuria," "penicillamine, cystine," and "tiopronin, cystine." In total, as of May 2018, these searches yielded 2335 articles, which were then evaluated for their relevance to the topic of evaluation and management of cystinuria. Evidence was evaluated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: Twenty-five articles on the topic of cystinuria or cystine nephrolithiasis were deemed suitable for inclusion in this study. The literature supports a logical evaluation process and step-wise treatment approach beginning with conservative measures: fluid intake and dietary modification. If stone formation recurs, proceed to pharmacotherapeutic options by first alkalinizing the urine and then using cystine-binding thiol drugs. Conclusions: The proposed clinical pathways provide a framework for efficient evaluation and treatment of patients with cystinuria, which should improve overall outcomes of this rare, but highly recurrent, form of nephrolithiasis.
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Affiliation(s)
- Brian H Eisner
- Deparment of Urology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David S Goldfarb
- NYU Langone Health, New York, New York, USA.,NYU School of Medicine, New York, New York, USA
| | - Michelle A Baum
- Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Craig B Langman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - John C Lieske
- Mayo Clinic Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Gyan Pareek
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, and King's College, London, United Kingdom
| | - Anna L Zisman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | | | - Roger L Sur
- UC San Diego Health, San Diego, California, USA
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23
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Melessen IM, Henderickx MM, Merkx MM, van Etten-Jamaludin FS, Homan van der Heide JJ, Kamphuis GM. The effect of additional drug therapy as metaphylaxis in patients with cystinuria: a systematic review. MINERVA UROL NEFROL 2020; 72:427-440. [PMID: 32083421 DOI: 10.23736/s0393-2249.20.03704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To systematically review the effect of additional drug therapy as metaphylaxis in patients with cystinuria. EVIDENCE ACQUISITION A literature search of three databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA-guidelines enclosing articles published up to May 2019. A total of 1117 articles were screened. Thirty-four publications met the inclusion criteria for this review. EVIDENCE SYNTHESIS Male-female ratio in the studied cohorts was 49.9% - 50.1%. The majority of studies showed a positive effect in reducing stone events and/or urinary cystine excretion. D-Penicillamine showed success in 13/14 (92%) studies, whereas Tiopronin-treatment showed a reduction in all (8/8; 100%) studies. All studies on Captopril (4/4) showed a decrease, however not all significant. The same is true for studies on Thiols in combination with Captopril (2/2). Furthermore, Tiopronin showed less side effects compared to D-penicillamine, respectively 30% and 37%. Captopril showed the least adverse events, with one event in nine patients. CONCLUSIONS The evidence on benefit of additional drug therapy in patients with cystinuria is scarce. All studied medications showed an effect on stone event and urinary cystine excretion, when used in addition to hyperhydration, alkalization and a diet low on methionine. Based on this systematic review, no drug can be preferred over another. An important aspect in the choice of drug is the risk of side effects. Therefore, the choice of additional drug should be personalized for every patient where the risk of side effects should be taken into consideration.
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Affiliation(s)
- Indra M Melessen
- Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maria M Merkx
- Department of Pharmacy, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
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24
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Yahyaoui R, Pérez-Frías J. Amino Acid Transport Defects in Human Inherited Metabolic Disorders. Int J Mol Sci 2019; 21:ijms21010119. [PMID: 31878022 PMCID: PMC6981491 DOI: 10.3390/ijms21010119] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023] Open
Abstract
Amino acid transporters play very important roles in nutrient uptake, neurotransmitter recycling, protein synthesis, gene expression, cell redox balance, cell signaling, and regulation of cell volume. With regard to transporters that are closely connected to metabolism, amino acid transporter-associated diseases are linked to metabolic disorders, particularly when they involve different organs, cell types, or cell compartments. To date, 65 different human solute carrier (SLC) families and more than 400 transporter genes have been identified, including 11 that are known to include amino acid transporters. This review intends to summarize and update all the conditions in which a strong association has been found between an amino acid transporter and an inherited metabolic disorder. Many of these inherited disorders have been identified in recent years. In this work, the physiological functions of amino acid transporters will be described by the inherited diseases that arise from transporter impairment. The pathogenesis, clinical phenotype, laboratory findings, diagnosis, genetics, and treatment of these disorders are also briefly described. Appropriate clinical and diagnostic characterization of the underlying molecular defect may give patients the opportunity to avail themselves of appropriate therapeutic options in the future.
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Affiliation(s)
- Raquel Yahyaoui
- Laboratory of Metabolic Disorders and Newborn Screening Center of Eastern Andalusia, Málaga Regional University Hospital, 29011 Málaga, Spain
- Grupo Endocrinología y Nutrición, Diabetes y Obesidad, Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- Correspondence:
| | - Javier Pérez-Frías
- Grupo Multidisciplinar de Investigación Pediátrica, Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain;
- Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain
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25
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Kum F, Wong K, Game D, Bultitude M, Thomas K. Hypertension and renal impairment in patients with cystinuria: findings from a specialist cystinuria centre. Urolithiasis 2019; 47:357-363. [PMID: 30805669 PMCID: PMC6647081 DOI: 10.1007/s00240-019-01110-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
Abstract
Higher blood pressures (mean systolic difference 16.8 mmHg) when compared to matched individuals are already reported in patients with calcium urolithiasis. We present the prevalence of hypertension and renal impairment in patients with cystinuria from our specialist single centre. We analysed our prospective database of adult patients with cystinuria who attend our cystinuria service. This included details of the medical and operative management of their disease. Descriptive statistics were used to analyse and present the data. 120 patients were included with a median age of 40 (19-76) years, 66 were male (55%) and 54 were female (45%). 54/120 patients (45%) were taking medications to prevent stone formation. 78% (94/120) patients reported having undergone one or more stone-related procedure. 59% (55/94) of these having required at least one PCNL or open procedure during their lifetime. Prevalence of hypertension was 50.8% (61/120), and double in males compared to females (62.1% vs. 37.0%, P = 0.0063). Mean baseline creatinine was 88.2 (49-153) µmol/l and eGFR was 77.6 (32-127) ml/min/1.73 m2. When categorized by CKD stage, only 24.6% (27% vs. 21%, M vs. F) patients had normal renal function (being an eGFR > 89 ml/min/1.73 m2). 57.6% patients were CKD stage 2 and 17.8% CKD stage 3. Females had a slightly greater incidence of renal impairment. All patients who have previously undergone a nephrectomy (n = 10) or have a poorly functioning kidney (n = 19) have renal impairment (CKD stage 2 or 3). Incidence of hypertension in patients with cystinuria is 51%, with a male preponderance. Only 25% of patients with cystinuria have normal renal function. This highlights the long-term cardiovascular and renal risks that the metabolic effects of cystinuria pose, in addition to the challenges of managing recurrent urolithiasis in a young population.
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Affiliation(s)
- Francesca Kum
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Kathie Wong
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - David Game
- Department of Nephrology, Guy's Hospital, 6th Floor Borough Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Matthew Bultitude
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK
| | - Kay Thomas
- Department of Urology, Guy's Hospital, 1st Floor Southwark Wing, Great Maze Pond, London, SE1 9RT, UK.
- King's College London Medical School, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK.
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26
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Taguchi K, Cho SY, Ng AC, Usawachintachit M, Tan YK, Deng YL, Shen CH, Gyawali P, Alenezi H, Basiri A, Bou S, Djojodemedjo T, Sarica K, Shi L, Singam P, Singh SK, Yasui T. The Urological Association of Asia clinical guideline for urinary stone disease. Int J Urol 2019; 26:688-709. [PMID: 31016804 DOI: 10.1111/iju.13957] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline - consisting 43 clinical questions - and overview its key practical issues.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.,Seoul National University Hospital, Seoul, Korea
| | - Anthony Cf Ng
- SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Manint Usawachintachit
- Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Yung-Khan Tan
- Urohealth Medical Clinic, Mt Elizabeth Hospital, Singapore
| | - Yao Liang Deng
- Department of Urology, Langdong Hospital and The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Cheng-Huang Shen
- Department of Urology, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Prem Gyawali
- Department of Urology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Abbas Basiri
- Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sopheap Bou
- Department of Urology, Royal Phnom Penh Hospital, Phnom Penh, Cambodia
| | - Tarmono Djojodemedjo
- Department of Urology, Soetomo General Academia Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Kemal Sarica
- Department of Urology, Kafkas University Medical School, Kars, Turkey
| | - Lei Shi
- Department of Urology, Yantai Yuhuangding Hospital and Medical School, Qingdao University, Yantai, China
| | | | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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27
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Moore SL, Cook P, de Coninck V, Keller EX, Traxer O, Dragos L, Shergill IS, Somani BK. Outcomes and Long-term Follow-up of Patients with Cystine Stones: a Systematic Review. Curr Urol Rep 2019; 20:27. [PMID: 30989375 DOI: 10.1007/s11934-019-0891-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Cystine stone patients can be difficult to manage with frequent recurrences. We performed a systematic review with a view to assessing interventions, compliance and their long-term outcomes. RECENT FINDINGS Ten retrospective observational studies (253 patients) assessed the outcomes and long-term follow-up of cystine stone patients. The mean length of follow-up was 9.6 years (range 3.5-21.8 years). The overall mean number of surgical procedures/patient was 5.7 (range 2-9.8/patient) with the overall mean number of surgical procedures/patient/year at 0.59 (range 0.22-1.32/patient/year). While open surgery has decreased over the last decade and PCNL has been stable, there seems to be a rise of RIRS during this period. Patients with cystine stones need periodic interventions for stone recurrences despite medical management, with limited data showing the impact on renal function. While the management is individualised, wide variability exists with often poor and incomplete patient data.
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Affiliation(s)
- Sacha L Moore
- North Wales Clinical Research Centre, Wrexham Maelor Hospital, Wrexham, Wales, UK.
| | - Paul Cook
- Department of Biochemical Pathology & Metabolic Medicine, University Hospital Southampton, Southampton, UK
| | | | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Department of Urology, Sorbonne Université, GRC n°20 Lithiase renale, AP-HP, Hôpital Tenon, Paris, F-75020, France
| | - Laurian Dragos
- Department of Urology, University of Medicine and Pharmacy Victor Babeş Timişoara, Timişoara, Romania
| | - Iqbal S Shergill
- Department of Urology, Wrexham Maelor Hospital and Clinical Director, North Wales Clinical Research Centre, Wrexham, Wales, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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28
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Effect of increasing doses of cystine-binding thiol drugs on cystine capacity in patients with cystinuria. Urolithiasis 2019; 47:549-555. [PMID: 30980122 DOI: 10.1007/s00240-019-01128-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Appropriate dosing of cystine-binding thiol drugs in the management of cystinuria has been based on clinical stone activity. When new stones form, the dose is increased. Currently, there is no method of measuring urinary drug levels to guide the titration of therapy. Increasing cystine capacity, a measure of cystine solubility, has been promoted as a method of judging the effects of therapy. In this study, we gave increasing doses of tiopronin or D-penicillamine, depending on the patients' own prescriptions, to ten patients with cystinuria and measured cystine excretion and cystine capacity. The doses were 0, 1, 2, 3 g per day, given in two divided doses, and administered in a random order. Going from 0 to 1 g/day led to an increase in cystine capacity from - 39.1 to 130.4 mg/L (P < 0.009) and decreased 24 h cystine excretion from 1003.9 to 834.8 mg/day (P = 0.039). Increasing the doses from 1 to 2 to 3 g/day had no consistent or significant effect to further increase cystine capacity or decrease cystine excretion. Whether doses higher than 1 g/day have additional clinical benefit is not clear from this study. Limiting doses might be associated with fewer adverse effects without sacrificing the benefit of higher doses if higher doses do not offer clinical importance. However, trials with stone activity as an outcome would be desirable.
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29
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Prot-Bertoye C, Lebbah S, Daudon M, Tostivint I, Jais JP, Lillo-Le Louët A, Pontoizeau C, Cochat P, Bataille P, Bridoux F, Brignon P, Choquenet C, Combe C, Conort P, Decramer S, Doré B, Dussol B, Essig M, Frimat M, Gaunez N, Joly D, Le Toquin-Bernard S, Méjean A, Meria P, Morin D, N'Guyen HV, Normand M, Pietak M, Ronco P, Saussine C, Tsimaratos M, Friedlander G, Traxer O, Knebelmann B, Courbebaisse M. Adverse events associated with currently used medical treatments for cystinuria and treatment goals: results from a series of 442 patients in France. BJU Int 2019; 124:849-861. [PMID: 30801923 DOI: 10.1111/bju.14721] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate medical treatments, in terms of adverse events (AEs) and therapeutic goals, in a large series of patients with cystinuria. PATIENTS AND METHODS Data from 442 patients with cystinuria were recorded retrospectively. Crystalluria was studied in 89 patients. A mixed-effects logistic regression model was used to estimate how urine pH, specific gravity and cysteine-binding thiols (CBT) correlate with risk of cystine crystalluria. RESULTS Alkalizing agents and CBT agents were given to 88.8% (n = 381) and 55.3% (n = 238) of patients, respectively. Gastrointestinal AEs were reported in 12.3%, 10.4% and 2.6% of patients treated with potassium bicarbonate, potassium citrate and sodium bicarbonate, respectively (P = 0.008). The percentages of patients who experienced at least one AE with tiopronin (24.6%) and with D-penicillamine (29.5%) were similar (P = 0.45). Increasing urine pH and decreasing urine specific gravity significantly reduced the risk of cystine crystalluria, whereas D-penicillamine and tiopronin treatments did not reduce this risk (odds ratio [OR] 1 for pH ≤6.5; OR 0.52 [95% confidence interval {95% CI} 0.28-0.95] for 7.0 <pH ≤7.5, P = 0.03; OR 0.26 [95% CI 0.13-0.53] for 7.5 < pH ≤8.0, P <0.001; OR 1 for specific gravity ≤1.005 OR 5.76 [95% CI 1.45-22.85] for 1.006 ≤ specific gravity ≤1.010, P = 0.01; and OR 11.06 [95% CI 2.76-44.26] for 1.011 ≤ specific gravity ≤ 1.014, P < 0.001). Increased urine pH significantly increased the risk of calcium phosphate crystalluria (OR 1 for pH≤ 6.5; OR 6.09 [95% CI 2.15-17.25] for pH >8.0, P <0.001). CONCLUSION Adverse events were frequent with D-penicillamine and tiopronin. Alkaline hyperdiuresis was well tolerated and reduced cystine crystalluria. Urine specific gravity ≤1.005 and urine pH >7.5, while warning about calcium-phosphate crystallization, should be the goals of medical therapy.
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Affiliation(s)
- Caroline Prot-Bertoye
- Department of Physiology, Functional Renal Explorations Department, AP-HP (Public Assistance Hospitals of Paris), Georges Pompidou European Hospital, Paris Descartes University, Paris, France.,INSERM UMRS 1138, Paris, France
| | - Saïd Lebbah
- Department of Biostatistics, AP-HP, Necker Hospital for Sick Children, Paris Descartes University, Medicine, Paris, France
| | - Michel Daudon
- Department of Physiology, Functional Renal Explorations Department, AP-HP, Tenon Hospital Pierre and Marie Curie University, INSERM UMR S 1155, Paris, France
| | - Isabelle Tostivint
- Department of Nephrology, AP-HP, Pitié-Salpétrière Hospital, Paris, France
| | - Jean-Philippe Jais
- Department of Biostatistics, AP-HP, Necker Hospital for Sick Children, Paris Descartes University, Paris, France.,Inserm UMRS 1138 team 22, Paris, France
| | - Agnés Lillo-Le Louët
- Department of Pharmacovigilance, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Clément Pontoizeau
- Functional Unit of Metabolomics, Functional Explorations Department, APHP, Necker Hospital for Sick Children, Paris Descartes University, Paris, France
| | - Pierre Cochat
- Department of Pediatrics, Hospices Civils de Lyon, Centre de Référence des Maladies Rénales Rares Néphrogones, Lyon, France
| | - Pierre Bataille
- Department of Nephrology, Boulogne-sur-Mer Hospital, Boulogne sur Mer, France
| | - Franck Bridoux
- Department of Neprhology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Pierre Brignon
- Department of Nephrology, Pasteur Hospital, Colmar, France
| | | | - Christian Combe
- Department of Nephrology, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | - Pierre Conort
- Department of Urology, AP-HP, Pitié-Salpétrière Hospital, Paris, France
| | - Stéphane Decramer
- Department of Nephrology and Internal Medicine, Toulouse University Children Hospital, Toulouse, France.,INSERM U1048, Toulouse, France
| | - Bertrand Doré
- Department of Urology, Poitiers University Hospital, Poitiers University, Poitiers, France
| | - Bertrand Dussol
- Department of Nephrology, AP-HM (Public Assistance Hospitals of Marseille), Conception Hospital, Aix-Marseille University, Marseille, France
| | - Marie Essig
- Department of Nephrology, Dialysis and Transplantation, Limoges University Hospital, Limoges University, Limoges, France.,INSERM UMR-S850, Limoges, France
| | - Marie Frimat
- Department of Nephrology, Claude Huriez University Hospital, Lille, France
| | | | - Dominique Joly
- Department of Nephrology, AP-HP, Necker Hospital for Sick Children, Paris Descartes University, Medicine, Paris, France
| | | | - Arnaud Méjean
- Department of Urology, AP-HP, Georges Pompidou European Hospital, Paris Descartes University, Medicine, Paris, France
| | - Paul Meria
- Department of Urology, AP-HP, Saint-Louis Hospital, Paris, France
| | - Denis Morin
- Department of Pediatrics (Pediatric Nephrology and Diabetology), Montpellier University Hospital, Montpellier, France.,CNRS, UMR 5203-INSERM U661, Montpellier, France
| | - Hung V N'Guyen
- Department of Urology, AP-HP, Saint-Louis Hospital, Paris, France
| | - Michel Normand
- Department of Nephrology, Private Saint-Martin Hospital, Pessac, France
| | - Michel Pietak
- Department of Urology, AP-HP, Georges Pompidou European Hospital, Paris, France
| | - Pierre Ronco
- Department of Nephrology and Dialysis, AP-HP, Tenon Hospital, Pierre and Marie Curie University, Paris, France.,INSERM Unit 702, Paris, France
| | - Christian Saussine
- Department of Urology, Strasbourg University Hospital, Strasbourg University, Strasbourg, France
| | - Michel Tsimaratos
- Department of Pediatrics, AP-HM, La Timone Hospital, Aix-Marseille University, Marseille, France
| | - Gérard Friedlander
- Department of Physiology, Functional Renal Explorations Department, AP-HP (Public Assistance Hospitals of Paris), Georges Pompidou European Hospital, Paris Descartes University, Paris, France.,INSERM U1151, Paris, France
| | - Olivier Traxer
- Department of Urology, AP-HP, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Bertrand Knebelmann
- Department of Nephrology, AP-HP, Necker Hospital for Sick Children, Paris Descartes University, Medicine, Paris, France
| | - Marie Courbebaisse
- Department of Physiology, Functional Renal Explorations Department, AP-HP (Public Assistance Hospitals of Paris), Georges Pompidou European Hospital, Paris Descartes University, Paris, France.,INSERM U1151, Paris, France
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30
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Cystinuria: genetic aspects, mouse models, and a new approach to therapy. Urolithiasis 2018; 47:57-66. [PMID: 30515543 DOI: 10.1007/s00240-018-1101-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 01/07/2023]
Abstract
Cystinuria, a genetic disorder of cystine transport, is characterized by excessive excretion of cystine in the urine and recurrent cystine stones in the kidneys and, to a lesser extent, in the bladder. Males generally are more severely affected than females. The disorder may lead to chronic kidney disease in many patients. The cystine transporter (b0,+) is a heterodimer consisting of the rBAT (encoded by SLC3A1) and b0,+AT (encoded by SLC7A9) subunits joined by a disulfide bridge. The molecular basis of cystinuria is known in great detail, and this information is now being used to define genotype-phenotype correlations. Current treatments for cystinuria include increased fluid intake to increase cystine solubility and the administration of thiol drugs for more severe cases. These drugs, however, have poor patient compliance due to adverse effects. Thus, there is a need to reduce or eliminate the risks associated with therapy for cystinuria. Four mouse models for cystinuria have been described and these models provide a resource for evaluating the safety and efficacy of new therapies for cystinuria. We are evaluating a new approach for the treatment of cystine stones based on the inhibition of cystine crystal growth by cystine analogs. Our ongoing studies indicate that cystine diamides are effective in preventing cystine stone formation in the Slc3a1 knockout mouse model for cystinuria. In addition to crystal growth, crystal aggregation is required for stone formation. Male and female mice with cystinuria have comparable levels of crystalluria, but very few female mice form stones. The identification of factors that inhibit cystine crystal aggregation in female mice may provide insight into the gender difference in disease severity in patients with cystinuria.
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31
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Sorokin I, Pearle MS. Medical therapy for nephrolithiasis: State of the art. Asian J Urol 2018; 5:243-255. [PMID: 30364650 PMCID: PMC6197179 DOI: 10.1016/j.ajur.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/08/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Massachusetts, Worcester, MA, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Charles and Jane Pak Center for Mineral Metabolism and Bone Research, UT Southwestern Medical Center, Dallas, TX, USA
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32
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Abstract
PURPOSE OF REVIEW Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.
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33
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Affiliation(s)
- Scott V. Wiener
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Marshall L Stoller
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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34
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Bicarbonate : de la physiologie aux applications thérapeutiques pour tout clinicien. Nephrol Ther 2018; 14:13-23. [DOI: 10.1016/j.nephro.2017.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 11/17/2022]
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35
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Knoll T, Bach T, Humke U, Neisius A, Stein R, Schönthaler M, Wendt-Nordahl G. [S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium]. Urologe A 2017; 55:904-22. [PMID: 27325405 DOI: 10.1007/s00120-016-0133-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.
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Affiliation(s)
- T Knoll
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland.
| | - T Bach
- Urologisches Zentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - U Humke
- Klinik für Urologie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - A Neisius
- Klinik für Urologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - R Stein
- Klinik für Urologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - M Schönthaler
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - G Wendt-Nordahl
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland
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36
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Ticinesi A, Nouvenne A, Borghi L, Meschi T. Water and other fluids in nephrolithiasis: State of the art and future challenges. Crit Rev Food Sci Nutr 2017; 57:963-974. [PMID: 25975220 DOI: 10.1080/10408398.2014.964355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adequate hydration, as to maintain urinary volume over 2 L/day, has long been considered as the cornerstone medical prescription for preventing nephrolithiasis. However, scientific evidence about what kind of water stone formers should drink and about the effects of other beverages on urinary stone risk factors is sometimes unclear. Moreover, the recommendation that water therapy prevents kidney stone recurrence relies on only one randomized controlled trial, even if more epidemiologic and basic science studies seem to support this assumption. Therefore, in this review we analyze current evidence that support water therapy in nephrolithiasis and we highlight the possible effects of different types of water and other beverages on lithogenic risk, giving some practical recommendations for what stone formers should be advised to prevent recurrence.
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Affiliation(s)
- Andrea Ticinesi
- a Department of Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - Antonio Nouvenne
- a Department of Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - Loris Borghi
- a Department of Clinical and Experimental Medicine , University of Parma , Parma , Italy
| | - Tiziana Meschi
- a Department of Clinical and Experimental Medicine , University of Parma , Parma , Italy
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37
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Sidhu A, Mittal A, Negroni-Balasquide X, Constantinescu A, Kozakowski K. Case Report: Cystinuria and Polycystic Kidney Disease. Pediatrics 2016; 138:peds.2016-0674. [PMID: 27940671 DOI: 10.1542/peds.2016-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/24/2022] Open
Abstract
Cystinuria and polycystic kidney disease are 2 genetic disorders that affect the genitourinary tract but rarely together. This case report presents 2 pediatric patients diagnosed with polycystic kidney disease and cystinuria requiring surgical treatment. Both subjects presented acutely with stone disease. Imaging studies and stone analysis established the diagnoses. Although coexistence of these 2 conditions is rare, cystinuria should be considered in the differential diagnosis when evaluating patients with cystic disease who develop renal calculi.
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38
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Dion M, Ankawi G, Chew B, Paterson R, Sultan N, Hoddinott P, Razvi H. CUA guideline on the evaluation and medical management of the kidney stone patient - 2016 update. Can Urol Assoc J 2016; 10:E347-E358. [PMID: 28096919 DOI: 10.5489/cuaj.4218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Marie Dion
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ghada Ankawi
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ben Chew
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nabil Sultan
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patti Hoddinott
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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39
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Combining field effect scanning electron microscopy, deep UV fluorescence, Raman, classical and synchrotron radiation Fourier transform Infra-Red Spectroscopy in the study of crystal-containing kidney biopsies. CR CHIM 2016. [DOI: 10.1016/j.crci.2015.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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40
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41
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Doré B, Meria P. A great contributor to the French urological science: Michel Daudon. CR CHIM 2016. [DOI: 10.1016/j.crci.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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42
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Abstract
Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.
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How should patients with cystine stone disease be evaluated and treated in the twenty-first century? Urolithiasis 2015; 44:65-76. [PMID: 26614112 DOI: 10.1007/s00240-015-0841-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
Cystinuria continues to be one of the most challenging stone diseases. During the latest decades our knowledge of the molecular basis of cystinuria has expanded. Today 160 different mutations in the SLC3A1 gene and 116 in the SLC7A9 gene are listed. The full implications of type A, B or AB status are not yet fully understood but may have implications for prognosis, management and treatment. Despite better understanding of the molecular basis of cystinuria the principles of recurrence prevention have remained essentially the same through decades. No curative treatment of cystinuria exists, and patients will have a life long risk of stone formation, repeated surgery, impaired renal function and quality of life. Therapy to reduce stone formation is directed towards lowering urine cystine concentration and increasing cystine solubility. Different molecules that could play a role in promoting nucleation and have a modulating effect on cystine solubility may represent new targets for cystinuria research. Investigation of newer thiol-containing drugs with fewer adverse effects is also warranted. Determining cystine capacity may be an effective tool to monitor the individual patient's response. Compliance in cystinuric patients concerning both dietary and pharmacological intervention is poor. Frequent clinical follow-up visits in dedicated centres seem to improve compliance. Cystinuric patients should be managed in dedicated centres offering the complete range of minimal invasive treatment modalities, enabling a personalized treatment approach in order to reduce risk and morbidity of multiple procedures.
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York NE, Borofsky MS, Lingeman JE. Risks associated with drug treatments for kidney stones. Expert Opin Drug Saf 2015; 14:1865-77. [PMID: 26600291 DOI: 10.1517/14740338.2015.1100604] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Renal stones are one of the most painful medical conditions patients experience. For many they are also a recurrent problem. Fortunately, there are a number of drug therapies available to treat symptoms as well as prevent future stone formation. AREAS COVERED Herein, we review the most common drugs used in the treatment of renal stones, explaining the mechanism of action and potential side effects. Search of the Medline databases and relevant textbooks was conducted to obtain the relevant information. Further details were sourced from drug prescribing manuals. Recent studies of drug effectiveness are included as appropriate. EXPERT OPINION Recent controversies include medical expulsive therapy trials and complex role of urinary citrate in stone disease. Future directions in research will involve new medical therapies for stone prevention, for example new drugs for hyperoxaluria.
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Affiliation(s)
- Nadya E York
- a Department of Urology , Indiana University School of Medicine , 1801 North Senate Blvd., Suite 220, Indianapolis , IN 46202 , USA
| | - Michael S Borofsky
- a Department of Urology , Indiana University School of Medicine , 1801 North Senate Blvd., Suite 220, Indianapolis , IN 46202 , USA
| | - James E Lingeman
- a Department of Urology , Indiana University School of Medicine , 1801 North Senate Blvd., Suite 220, Indianapolis , IN 46202 , USA
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45
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Parr JM, Desai D, Winkle D. Natural history and quality of life in patients with cystine urolithiasis: a single centre study. BJU Int 2015. [DOI: 10.1111/bju.13169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Justin M. Parr
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
| | - Devang Desai
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Department of Urology; Mater Hospital Brisbane; Brisbane Queensland Australia
| | - David Winkle
- School of Medicine; The University of Queensland; Brisbane Queensland Australia
- Department of Urology; Mater Hospital Brisbane; Brisbane Queensland Australia
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46
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Sfoungaristos S, Gofrit ON, Yutkin V, Pode D, Duvdevani M. Prevention of renal stone disease recurrence. A systematic review of contemporary pharmaceutical options. Expert Opin Pharmacother 2015; 16:1209-18. [DOI: 10.1517/14656566.2015.1037740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Prot-Bertoye C, Lebbah S, Daudon M, Tostivint I, Bataille P, Bridoux F, Brignon P, Choquenet C, Cochat P, Combe C, Conort P, Decramer S, Doré B, Dussol B, Essig M, Gaunez N, Joly D, Le Toquin-Bernard S, Méjean A, Meria P, Morin D, N'Guyen HV, Noël C, Normand M, Pietak M, Ronco P, Saussine C, Tsimaratos M, Friedlander G, Traxer O, Knebelmann B, Courbebaisse M. CKD and Its Risk Factors among Patients with Cystinuria. Clin J Am Soc Nephrol 2015; 10:842-51. [PMID: 25717071 DOI: 10.2215/cjn.06680714] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 01/12/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Cystinuria is an autosomal recessive disorder affecting renal cystine reabsorption; it causes 1% and 8% of stones in adults and children, respectively. This study aimed to determine epidemiologic and clinical characteristics as well as comorbidities among cystinuric patients, focusing on CKD and high BP. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective study was conducted in France, and involved 47 adult and pediatric nephrology and urology centers from April 2010 to January 2012. Data were collected from 442 cystinuric patients. RESULTS Median age at onset of symptoms was 16.7 (minimum to maximum, 0.3-72.1) years and median diagnosis delay was 1.3 (0-45.7) years. Urinary alkalinization and cystine-binding thiol were prescribed for 88.8% and 52.2% of patients, respectively, and 81.8% had at least one urological procedure. Five patients (1.1%, n=4 men) had to be treated by dialysis at a median age of 35.0 years (11.8-70.7). Among the 314 patients aged ≥16 years, using the last available plasma creatinine, 22.5% had an eGFR≥90 ml/min per 1.73 m(2) (calculated by the Modification of Diet in Renal Disease equation), whereas 50.6%, 15.6%, 7.6%, 2.9%, and 0.6% had an eGFR of 60-89, 45-59, 30-44, 15-29, and <15, respectively. Among these 314 patients, 28.6% had high BP. In multivariate analysis, CKD was associated with age (odds ratio, 1.05 [95% confidence interval, 1.03 to 1.07]; P<0.001), hypertension (3.30 [1.54 to 7.10]; P=0.002), and severe damage of renal parenchyma defined as a past history of partial or total nephrectomy, a solitary congenital kidney, or at least one kidney with a size <10 cm in patients aged ≥16 years (4.39 [2.00 to 9.62]; P<0.001), whereas hypertension was associated with age (1.06 [1.04 to 1.08]; P<0.001), male sex (2.3 [1.3 to 4.1]; P=0.003), and an eGFR<60 ml/min per 1.73 m(2) (2.7 [1.5 to 5.1]; P=0.001). CONCLUSIONS CKD and high BP occur frequently in patients with cystinuria and should be routinely screened.
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Affiliation(s)
- Caroline Prot-Bertoye
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Saïd Lebbah
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Daudon
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Isabelle Tostivint
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Bataille
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Franck Bridoux
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Brignon
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Choquenet
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Cochat
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Combe
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Conort
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Stéphane Decramer
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Doré
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Dussol
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Marie Essig
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Nicolas Gaunez
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Dominique Joly
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Sophie Le Toquin-Bernard
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Arnaud Méjean
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Paul Meria
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Denis Morin
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Hung Viet N'Guyen
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Noël
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Normand
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Pietak
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Pierre Ronco
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Christian Saussine
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michel Tsimaratos
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Gérard Friedlander
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Olivier Traxer
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Bertrand Knebelmann
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Marie Courbebaisse
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material.
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48
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Gul Z, Monga M. Medical and dietary therapy for kidney stone prevention. Korean J Urol 2014; 55:775-9. [PMID: 25512810 PMCID: PMC4265710 DOI: 10.4111/kju.2014.55.12.775] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/11/2014] [Indexed: 12/03/2022] Open
Abstract
The prevalence of kidney stone disease is increasing, and newer research is finding that stones are associated with several serious morbidities. These facts suggest that emphasis needs to be placed not only on stone treatment but also stone prevention. However, there is a relative dearth of information on dietary and medical therapies to treat and avoid nephrolithiasis. In addition, studies have shown that there are many misconceptions among both the general community and physicians about how stones should be managed. This article is meant to serve as a review of the current literature on dietary and drug therapies for stone prevention.
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Affiliation(s)
- Zeynep Gul
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Manoj Monga
- The Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH, USA
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Bourderioux M, Nguyen-Khoa T, Chhuon C, Jeanson L, Tondelier D, Walczak M, Ollero M, Bekri S, Knebelmann B, Escudier E, Escudier B, Edelman A, Guerrera IC. A New Workflow for Proteomic Analysis of Urinary Exosomes and Assessment in Cystinuria Patients. J Proteome Res 2014; 14:567-77. [DOI: 10.1021/pr501003q] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | | | | | - Ludovic Jeanson
- INSERM/UMR
S933, Université Pierre et Marie Curie, 75005 Paris, France
| | | | | | - Mario Ollero
- INSERM
U955, Université Paris−Est Créteil Val-de-Marne, 94010 Créteil, France
| | - Soumeya Bekri
- Department
of Biochemistry, CHU Charles Nicolle, 76000 Rouen, France
| | | | - Estelle Escudier
- INSERM/UMR
S933, Université Pierre et Marie Curie, 75005 Paris, France
| | - Bernard Escudier
- Department
of Medical Oncology, Institut Gustave Roussy, 94805 Villejuif, France
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50
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Livrozet M, Vandermeersch S, Mesnard L, Thioulouse E, Jaubert J, Boffa JJ, Haymann JP, Baud L, Bazin D, Daudon M, Letavernier E. An animal model of type A cystinuria due to spontaneous mutation in 129S2/SvPasCrl mice. PLoS One 2014; 9:e102700. [PMID: 25048459 PMCID: PMC4105406 DOI: 10.1371/journal.pone.0102700] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/21/2014] [Indexed: 11/19/2022] Open
Abstract
Cystinuria is an autosomal recessive disease caused by the mutation of either SLC3A1 gene encoding for rBAT (type A cystinuria) or SLC7A9 gene encoding for b0,+AT (type B cystinuria). Here, we evidenced in a commonly used congenic 129S2/SvPasCrl mouse substrain a dramatically high frequency of kidney stones that were similar to those of patients with cystinuria. Most of 129S2/SvPasCrl exhibited pathognomonic cystine crystals in urine and an aminoaciduria profile similar to that of patients with cystinuria. In addition, we observed a heterogeneous inflammatory infiltrate and cystine tubular casts in the kidney of cystinuric mice. As compared to another classical mouse strain, C57BL/6J mice, 129S2/SvPasCrl mice had an increased mortality associated with bilateral obstructive hydronephrosis. In 129S2/SvPasCrl mice, the heavy subunit rBAT of the tetrameric transporter of dibasic amino acids was absent in proximal tubules and we identified a single pathogenic mutation in a highly conserved region of the Slc3a1 gene. This novel mouse model mimicking human disease would allow us further pathophysiological studies and may be useful to analyse the crystal/tissue interactions in cystinuria.
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Affiliation(s)
- Marine Livrozet
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
| | - Sophie Vandermeersch
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
| | - Laurent Mesnard
- Department of Physiology and Biophysics, Cornell University, Ithaca, New York, United States of America
| | | | - Jean Jaubert
- Institut Pasteur, Mouse Functional Genetics Unit, Paris, France
- CNRS URA 2578, Paris, France
| | - Jean-Jacques Boffa
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
- Néphrologie, AP-HP, Hôpital Tenon, Paris, France
| | - Jean-Philippe Haymann
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, Paris, France
| | - Laurent Baud
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, Paris, France
| | - Dominique Bazin
- CNRS-LCMCP- Sorbonne Universités UPMC Univ Paris 06, Collège de France, Paris, France
| | - Michel Daudon
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, Paris, France
| | - Emmanuel Letavernier
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 702, Paris, France
- INSERM, UMR S 702, Paris, France
- Explorations Fonctionnelles Multidisciplinaires, AP-HP, Hôpital Tenon, Paris, France
- * E-mail:
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