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Iqbal MW, Shin RH, Youssef RF, Kaplan AG, Cabrera FJ, Hanna J, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Should metabolic evaluation be performed in patients with struvite stones? Urolithiasis 2016; 45:185-192. [DOI: 10.1007/s00240-016-0893-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/18/2016] [Indexed: 11/28/2022]
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Torzewska A, Różalski A. In vitrostudies on the role of glycosaminoglycans in crystallization intensity during infectious urinary stones formation. APMIS 2013; 122:505-11. [DOI: 10.1111/apm.12191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/07/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Agnieszka Torzewska
- Department of Immunobiology of Bacteria; Institute of Microbiology; Biotechnology and Immunology, Faculty of Biology and Environmental Protection; University of Lodz; Lodz Poland
| | - Antoni Różalski
- Department of Immunobiology of Bacteria; Institute of Microbiology; Biotechnology and Immunology, Faculty of Biology and Environmental Protection; University of Lodz; Lodz Poland
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Prywer J, Torzewska A. Biomineralization of struvite crystals by Proteus mirabilis from artificial urine and their mesoscopic structure. CRYSTAL RESEARCH AND TECHNOLOGY 2010. [DOI: 10.1002/crat.201000344] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dominick MA, White MR, Sanderson TP, Van Vleet T, Cohen SM, Arnold LE, Cano M, Tannehill-Gregg S, Moehlenkamp JD, Waites CR, Schilling BE. Urothelial carcinogenesis in the urinary bladder of male rats treated with muraglitazar, a PPAR alpha/gamma agonist: Evidence for urolithiasis as the inciting event in the mode of action. Toxicol Pathol 2007; 34:903-20. [PMID: 17178691 DOI: 10.1080/01926230601072327] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Muraglitazar, a PPARalpha/gamma agonist, dose-dependently increased urinary bladder tumors in male Harlan Sprague-Dawley (HSD) rats administered 5, 30, or 50 mg/kg/day for up to 2 years. To determine the mode of tumor development, male HSD rats were treated daily for up to 21 months at doses of 0, 1, or 50 mg/kg while being fed either a normal or 1% NH4Cl-acidified diet. Muraglitazar-associated, time-dependent changes in urine composition, urothelial mitogenesis and apoptosis, and urothelial morphology were assessed. In control and treated rats fed a normal diet, urine pH was generally > or = 6.5, which facilitates formation of calcium-and magnesium-containing solids, particularly in the presence of other prolithogenic changes in rat urine. Urinary citrate, an inhibitor of lithogenesis, and soluble calcium concentrations were dose dependently decreased in association with increased calcium phosphate precipitate, crystals and/or microcalculi; magnesium ammonium phosphate crystals and aggregates; and calcium oxalate-containing thin, rod-like crystals. Morphologically, sustained urothelial cytotoxicity and proliferation with a ventral bladder predilection were noted in treated rats by month 1 and urinary carcinomas with a similar distribution occurred by month 9. Urothelial apoptotic rates were unaffected by muraglitazar treatment or diet. In muraglitazar-treated rats fed an acidified diet, urine pH was invariably < 6.5, which inhibited formation of calcium-and magnesium-containing solids. Moreover, dietary acidification prevented the urothelial cytotoxic, proliferative, and tumorigenic responses. Collectively, these data support an indirect pharmacologic mode of urinary bladder tumor development involving alterations in urine composition that predispose to urolithiasis and associated decreases in urine-soluble calcium concentrations.
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Affiliation(s)
- Mark A Dominick
- Department of Drug Safety Evaluation, Bristol-Myers Squibb Co., Evansville, Indiana 47721, USA.
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Van Vleet TR, White MR, Sanderson TP, Cohen SM, Cano M, Arnold LL, Waites CR, Schilling BE, Mitroka J, Dominick MA. Subchronic Urinary Bladder Effects of Muraglitazar in Male Rats1. Toxicol Sci 2006; 96:58-71. [PMID: 17132713 DOI: 10.1093/toxsci/kfl176] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Muraglitazar, a PPARalpha/gamma dual agonist, was dosed orally to rats once daily for 13 weeks to evaluate urinary and urothelial changes of potential relevance to urinary bladder tumorigenesis. Groups of 17 young or aged rats per sex were fed a normal or 1% NH4Cl-supplemented diet and were dosed with 0, 1, or 50 mg/kg muraglitazar. Lithogenic ions and sediment were profiled from freshly voided urine samples collected 24 h after dosing, and drug exposures were measured. Urinary citrate, oxalate, and epidermal growth factor (EGF) were assayed from 18-h urine collections. Urothelium was assessed by light microscopy, scanning electron microscopy, and BrdU and TUNEL immunohistochemistry. When fed a normal diet, urine pH was higher in males (above 6.5). Urine volume/body weight was greater in females. Urine soluble/total calcium and magnesium and phosphorus/creatinine ratios were lower in male rats fed a normal diet. Urine citrate levels were decreased and oxalate was increased in young male rats treated with 50 mg/kg muraglitazar compared to age/sex/diet-matched controls. No changes in urine sediment were detected 24 h after dosing. In young male rats treated with 50 mg/kg on normal diet, multifocal urothelial necrosis and proliferation were observed, whereas urothelial apoptosis and urine EGF levels were unchanged compared to age/sex/diet-matched controls. Urothelial necrosis and proliferation were not correlated to systemic or urinary drug exposures and were prevented by dietary acidification. These data suggest that muraglitazar-associated changes in urine composition predispose to urothelial cytotoxicity and proliferation in the urinary bladder of young male rats and that urine sediment must be profiled at multiple daily timepoints to fully qualify drug-induced changes in urine composition.
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Affiliation(s)
- Terry R Van Vleet
- Departments of Drug Safety Evaluation, Bristol-Myers Squibb Company, Mt Vernon, Indiana 47721, USA
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Jones DS, Djokic J, Gorman SP. Characterization and optimization of experimental variables within a reproducible bladder encrustation model and in vitro evaluation of the efficacy of urease inhibitors for the prevention of medical device-related encrustation. J Biomed Mater Res B Appl Biomater 2006; 76:1-7. [PMID: 16206254 DOI: 10.1002/jbm.b.30230] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study presents a reproducible, cost-effective in vitro encrustation model and, furthermore, describes the effects of components of the artificial urine and the presence of agents that modify the action of urease on encrustation on commercially available ureteral stents. The encrustation model involved the use of small-volume reactors (700 mL) containing artificial urine and employing an orbital incubator (at 37 degrees C) to ensure controlled stirring. The artificial urine contained sources of calcium and magnesium (both as chlorides), albumin and urease. Alteration of the ratio (% w/w) of calcium salt to magnesium salt affected the mass of encrustation, with the greatest encrustation noted whenever magnesium was excluded from the artificial urine. Increasing the concentration of albumin, designed to mimic the presence of protein in urine, significantly decreased the mass of both calcium and magnesium encrustation until a plateau was observed. Finally, exclusion of urease from the artificial urine significantly reduced encrustation due to the indirect effects of this enzyme on pH. Inclusion of the urease inhibitor, acetohydroxamic acid, or urease substrates (methylurea or ethylurea) into the artificial medium markedly reduced encrustation on ureteral stents. In conclusion, this study has described the design of a reproducible, cost-effective in vitro encrustation model. Encrustation was markedly reduced on biomaterials by the inclusion of agents that modify the action of urease. These agents may, therefore, offer a novel clinical approach to the control of encrustation on urological medical devices.
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Affiliation(s)
- David S Jones
- School of Pharmacy, The Queen's University of Belfast, Medical Biology Centre, Belfast BT9 7BL, Northern Ireland, UK.
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Suller MTE, Anthony VJ, Mathur S, Feneley RCL, Greenman J, Stickler DJ. Factors modulating the pH at which calcium and magnesium phosphates precipitate from human urine. ACTA ACUST UNITED AC 2006; 33:254-60. [PMID: 15981006 DOI: 10.1007/s00240-004-0458-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The factors controlling the rate at which crystalline bacterial biofilms develop on indwelling bladder catheters are poorly understood. It is known that normally the pH of voided urine (pHv) is lower than the pH at which calcium and magnesium phosphates come out of urine solution (pHn). In patients who develop infections with urease producing bacteria, however, the pHv rises above the pHn and precipitation of the phosphates occurs in the urine and the biofilm. The aim of this study was to examine ways of manipulating the pHn of urine so that more of its calcium and magnesium remain in solution under alkaline conditions. The experimental data show that pHn can be elevated by decreasing the calcium, magnesium and phosphate concentrations. Increasing the fluid intake of a human subject so that the urinary calcium fell from 120 mg/l to 25 mg/l, for example, resulted in the pHn increasing from 6.48 to 8.22. The addition of citrate to urine also produced a rise in the pHn. The daily consumption of 500 ml of fresh orange juice increased urinary citrate concentrations from 0.35 to around 1.21 mg/ml and the pHn rose from 7.24 to 8.2. The pHn of urine is thus a highly variable parameter. It can be manipulated by controlling the urinary concentrations of magnesium, calcium, phosphate and citrate ions. We suggest that increasing fluid intake with citrate containing drinks would reduce the extent of encrustation on catheters in patients infected with urease producing bacteria.
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Affiliation(s)
- M T E Suller
- Faculty of Applied Sciences, University of the West of England, Coldharbour Lane, Bristol, BS161QY, UK.
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Osther PJ, Poulsen AL, Steven K. Stone risk after bladder substitution with the ileal-urethral Kock reservoir. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2000; 34:257-61. [PMID: 11095084 DOI: 10.1080/003655900750041997] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The study was carried out to compare urinary biochemical and physicochemical environments in patients who had undergone bladder substitution with the ileal-urethral Kock reservoir, and who had no actual urinary infection, with those of healthy subjects. MATERIAL AND METHODS The participants were 23 male patients who had undergone bladder substitution with the ileal-urethral Kock reservoir and 25 healthy men. All subjects had sterile urine at the time of urine collection. Concentrations of calcium, magnesium, phosphorus, creatinine, citrate, oxalate, and ammonia in 24-h urine samples were measured. Estimates of ion activity products of calcium oxalate (CaOx), calcium phosphate (CaP), brushite (Bru), and magnesium ammonium phosphate (MAP) in urine were calculated according to Tiselius. RESULTS There was no significant difference in 24-h urinary volume between patients with a bladder substitute and the healthy controls. For most of the other measured values the results for patients differed significantly from those for controls. The most striking findings were markedly lower urinary excretion rates of citrate (p < 0.0001) and higher urine pH (p < 0.0001) in patients compared with controls. These findings were reflected in significantly higher levels of urinary supersaturation with respect to CaOx (p < 0.0001), CaP (p <0.0001), Bru (p < 0.0001) and MAP (stuvite) (p < 0.0001) in patients with a bladder substitute compared with healthy subjects. CONCLUSIONS Hypocitraturia seems to be the main risk factor for calcium stone formation in non-infected Kock reservoir patients, and citrate supplementation appears to be the most obvious choice for stone prophylaxis in patients with intestinal urinary diversion and recurrent renal stone formation.
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Affiliation(s)
- P J Osther
- Department of Urology, Odense University Hospital, Denmark.
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Abstract
Struvite calculi can be a debilitating affliction for which the cure is mainly surgical. If left untreated, infection-related calculi can cause failure to thrive, anemia, chronic renal insufficiency, renal failure and death. There has been much research aimed at non-surgical intervention and prevention of these calculi especially in this "non-invasive" era. The historic and current non-surgical treatment modalities of struvite calculi are discussed.
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Affiliation(s)
- B F Schwartz
- Department of Urology, University of California at San Francisco, USA
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10
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McLean RJC, Fortin D, Brown DA. Microbial metal-binding mechanisms and their relation to nuclear waste disposal. Can J Microbiol 1996. [DOI: 10.1139/m96-055] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The cell surface polymers of microorganisms readily bind a variety of metal ions, which enables the organisms to immobilize potentially toxic metal ions before they encounter the plasma membrane. Under appropriate chemical conditions, bound metal ions can form a variety of minerals that may be of major geological importance. Many studies have shown the occurrence of metal binding and biomineralization in nature, but detailed knowledge of the underlying mechanisms is lacking. The microbial influence of this binding may be indirect, such as physicochemical influences on the solution chemistry, Eh, and pH; or direct, when it is determined by the type of organisms present, their energy metabolism, and the structural and chemical characteristics of the cell surface and extracellular polymers. Metal binding by bacterial cell surfaces has several implications in nuclear waste disposal including adsorption of soluble radionuclides. A detailed knowledge of the chemical mechanisms of metal interactions with the microbial cell surface will enhance our understanding of the geochemical environment within a nuclear waste disposal vault.Key words: biomineralization, radionuclide immobilization, biofilm, bacterial cell surface.
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11
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Editorial. J Urol 1996. [DOI: 10.1097/00005392-199601000-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sarangapani S, Cavedon K, Gage D. An improved model for bacterial encrustation studies. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1995; 29:1185-91. [PMID: 8557720 DOI: 10.1002/jbm.820291005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A comparative evaluation of various biomaterials for their resistance to bacterial colonization and encrustation in infected urine is an important area in urological biomaterials research. This article describes an in vitro dynamic perfusion system that allows four reactors containing 24 1-in. catheter samples (6 per reactor) to be simultaneously perfused at a constant flow rate by synthetic urine. A common urease-producing urinary pathogen, Proteus mirabilis, was maintained at a level of 10(6) colony-forming units/mL for 7 days in the dynamic perfusion reactors. The pH and bacterial population were monitored every 24 h and the percentage of encrustation on latex and hydrogel-coated commercial catheter materials gave reproducible results in three different runs, 15.2 +/- 3.65% and 13.8 +/- 2.58%, respectively. A major issue of inlet clogging due to ascending bacteria or ammonia has been rectified using a dismountable inlet assembly. An incubator coupled with a cooling system allowed accurate temperature maintenance of 37 degrees C in all four reactors. Results from scanning electron microscopy of some latex samples are also presented.
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Wang YH, Grenabo L, Hedelin H, Pettersson S. The effects of sodium citrate and oral potassium citrate on urease-induced crystallization. BRITISH JOURNAL OF UROLOGY 1994; 74:409-15. [PMID: 7820416 DOI: 10.1111/j.1464-410x.1994.tb00414.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To study the effects of citrate on urease-induced crystallization in human urine. MATERIALS AND METHODS Urine samples were collected from seven healthy volunteers with no history of urinary tract infection or stone disease. Citrate was removed from the urine samples by decomposition with citrate lyase. Citrate was then added to the urine in increasing concentrations. Oral potassium citrate was given to the volunteers and their urine was collected. The samples were incubated with urease and the crystallization induced was observed by the Coulter counter technique, by using an optical microscope and by precipitated material analysis. RESULTS The initiation of crystallization was markedly delayed by both the addition of citrate to the urine and after the ingestion of citrate. Crystal growth and the resulting precipitation of both calcium and magnesium showed a concentration-dependent reduction when citrate was added up to a concentration of 4 mM. Crystal growth and precipitation of calcium and magnesium were also significantly decreased by oral citrate intake. CONCLUSION Citrate added to the urine or taken orally markedly delays urease-induced crystallization in human urine.
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Affiliation(s)
- Y H Wang
- Department of Surgery, Sahlgrenska sjukhuset, University of Göteborg, Sweden
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15
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Repeated use of Bacillus subtilis cell walls for copper binding. World J Microbiol Biotechnol 1994; 10:472-4. [DOI: 10.1007/bf00144475] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/1994] [Accepted: 03/16/1994] [Indexed: 11/24/2022]
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Dumanski AJ, Hedelin H, Edin-Liljegren A, Beauchemin D, McLean RJ. Unique ability of the Proteus mirabilis capsule to enhance mineral growth in infectious urinary calculi. Infect Immun 1994; 62:2998-3003. [PMID: 8005688 PMCID: PMC302911 DOI: 10.1128/iai.62.7.2998-3003.1994] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Struvite (MgNH4PO4.6H2O) calculi are a common complication of Proteus mirabilis urinary tract infections. Although urease is a major virulence factor in calculus formation, the polysaccharide capsule (CPS) of this organism also enhances struvite crystallization and growth in vitro (L. Clapham, R. J. C. McLean, J. C. Nickel, J. Downey, and J. W. Costerton, J. Crystal Growth 104:475-484, 1990). We obtained purified CPS, of known structure and varying anionic character, from P. mirabilis ATCC 49565 and several other organisms. Artificial urine was added to CPS, and the pH was elevated from 5.8 to 8.5 by the addition of urease or titration with 0.25 M NH4OH to induce struvite crystallization. Crystallization was measured by particle counting (Coulter counter), and the morphology (crystal habit) was examined by phase-contrast microscopy. In the presence of partially anionic P. mirabilis CPS, struvite formation occurred at a lower pH than in the absence of CPS or in the presence of other neutral, partially anionic, or anionic CPS. At pH 7.5 to 8.0, significantly more struvite crystals formed in the presence of P. mirabilis CPS than under other experimental conditions. With the exception of one polymer (curdlan) which did not bind Mg2+, enhancement of struvite formation by CPS polymers was inversely proportional to their Mg2+ binding ability. We speculate that the structure and partial anionic nature of P. mirabilis CPS enable it to enhance struvite formation by weakly concentrating Mg2+ ions during struvite crystal formation. This illustrates a new virulence aspect of bacterial CPS during infection.
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Affiliation(s)
- A J Dumanski
- Department of Microbiology & Immunology, Queen's University, Kingston, Ontario, Canada
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17
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Boevé ER, Cao LC, Verkoelen CF, Romijn JC, de Bruijn WC, Schröder FH. Glycosaminoglycans and other sulphated polysaccharides in calculogenesis of urinary stones. World J Urol 1994; 12:43-8. [PMID: 8012415 DOI: 10.1007/bf00182050] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Naturally occurring glycosaminoglycans (GAGs) and other, semisynthetic, sulphated polysaccharides are thought to play an important role in urolithiasis. Processes involved in urinary stone formation are crystallization and crystal retention. Oxalate transport and renal tubular cell injury are determining factors in these processes. In this article experimental results concerning the possible mechanisms of action of GAGs and other sulphated polysaccharides are reviewed. GAGs are inhibitors of crystal growth and agglomeration and possibly also of nucleation. They can prevent crystal adherence, correct an abnormal oxalate flux and prevent renal tubular cell damage.
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Affiliation(s)
- E R Boevé
- Department of Urology, Academic Hospital Dijkzigt, The Netherlands
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18
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Cicerello E, Merlo F, Gambaro G, Maccatrozzo L, Fandella A, Baggio B, Anselmo G. Effect of alkaline citrate therapy on clearance of residual renal stone fragments after extracorporeal shock wave lithotripsy in sterile calcium and infection nephrolithiasis patients. J Urol 1994; 151:5-9. [PMID: 8254832 DOI: 10.1016/s0022-5347(17)34858-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The natural history of post-extracorporeal shock wave lithotripsy residual stone fragments (clearance, growth and aggregation) is incompletely known, even though they are believed to constitute a risk in terms of new stone formation and persistent infection of the urinary tract. We addressed this issue and the hypothesis that alkaline citrate therapy improves residual stone fragment clearance in a 12-month followup study. There were 40 sterile calcium and 30 struvite stone patients with residual fragments after extracorporeal shock wave lithotripsy (diameter less than 5 mm.) consecutively enrolled and randomly assigned to a citrate therapy (6 to 8 gm. per day) or control (hygienic measures only) group. Infection stone patients also received adequate antibiotic therapy throughout the study. Among the patients in the untreated sterile group 21% and 32% were stone-free at 6 and 12 months, respectively. In the infection group these figures were 27% and 40%, respectively. Among the untreated sterile calcium stone patients in whom clearance was not achieved a high percentage experienced residual fragment growth or reaggregation. Citrate therapy significantly improved the stone clearance rate in the sterile (at 6 and 12 months 65% and 74% were stone-free, respectively) and infection (71% and 86%, respectively) stone patients, and prevented residual fragment growth or reaggregation in subjects in whom clearance was not achieved. The data show that growth and persistence are common in the natural history of residual stone fragments. Citrate ameliorated the outcome of these residual fragments by reducing the growth or agglomeration, and by increasing the clearance rate in calcium oxalate and in infection stone patients.
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Affiliation(s)
- E Cicerello
- Department of Urology, Treviso General Hospital, Italy
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Spirnak JP, Lubke WL, Thompson IM, Lopez M. Dystrophic bladder wall calcifications following intravesical BCG treatment for superficial transitional cell carcinoma of bladder. Urology 1993; 42:89-92. [PMID: 8328131 DOI: 10.1016/0090-4295(93)90350-j] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bacillus Calmette-Guerin has been established as one of the most active agents for the treatment of superficial transitional cell carcinoma of the bladder. Although complications do occur with this agent, they are usually transient and mild. Two cases are herein reported in which dystrophic calcification of the urinary bladder occurred following BCG therapy; one had a diffuse and severe complication. This complication can occur with other intravesical agents, and methods for management are reported.
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Affiliation(s)
- J P Spirnak
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas
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20
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Wang YH, Grenabo L, Hedelin H, McLean RJ, Nickel JC, Pettersson S. Citrate and urease-induced crystallization in synthetic and human urine. UROLOGICAL RESEARCH 1993; 21:109-15. [PMID: 8503146 DOI: 10.1007/bf01788828] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effects of citrate on the different phases of urease-induced crystallization were studied using Coulter counter techniques and optical microscopy. Citrate increased urine pH and markedly delayed the initiation of the crystallization (nucleation) in both human and synthetic urine. In synthetic urine, particle aggregation and especially particle growth were delayed and inhibited by citrate. In human urine, aggregation was distinctly inhibited by citrate. It appears that the susceptibility of urine to form crystals in the presence of urease activity is influenced by its citrate concentration.
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Affiliation(s)
- Y H Wang
- Department of Urology, Sahlgrenska sjukhuset, University of Göteborg, Sweden
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21
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Edin-Liljegren A, Grenabo L, Hedelin H, Larsson P, Pettersson S. Influence of Escherichia coli on urease-induced crystallisation in human urine. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1993; 27:163-7. [PMID: 8351467 DOI: 10.3109/00365599309181243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Urease was added to urines inoculated with Escherichia coli 24 hours earlier and to control urines not inoculated with E. coli. The inoculation did not change the concentration of the measured urine components. The urease-induced ammonium ion production and pH increase was reduced in E. coli-inoculated urines compared to control urines. This suggests that E. coli can inhibit urease. The precipitation of both phosphate and magnesium on glass rods inserted in the urine was reduced with 40-50% in the E. coli-inoculated urines. The results demonstrate that E. coli can influence urease-induced crystallisation.
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Affiliation(s)
- A Edin-Liljegren
- Department of Urology, Sahlgrenska sjukhuset, University of Göteborg, Sweden
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Downey JA, Nickel JC, Clapham L, McLean RJ. In vitro inhibition of struvite crystal growth by acetohydroxamic acid. BRITISH JOURNAL OF UROLOGY 1992; 70:355-9. [PMID: 1450840 DOI: 10.1111/j.1464-410x.1992.tb15787.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Struvite (MgNH4PO46H2O) crystals were produced by Proteus mirabilis growth in artificial urine, in the presence and absence of the urease inhibitor, acetohydroxamic acid (AHA). In the absence of AHA, struvite crystals assumed an "X-shaped" or dendritic crystal habit due to rapid growth along their 100 axis. When AHA was present, crystal growth, as monitored by phase contrast light microscopy, was greatly slowed, and the crystals assumed an octahedral crystal habit. Scanning electron microscopy revealed that crystals grown in the presence of AHA were pitted on their surface. This pitting was absent in control samples. While most of this inhibition by AHA was due to lowered urease activity, some crystal growth inhibition occurred in struvite produced in the absence of urease activity through NH4OH titration of artificial urine. We conclude that while AHA is primarily a urease inhibitor, it may also disrupt struvite growth and formation directly through interference with the molecular growth processes on crystal surfaces.
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Affiliation(s)
- J A Downey
- Department of Urology, Queen's University, Kingston, Canada
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Michelacci YM, Boim MA, Bergamaschi CT, Rovigatti RM, Schor N. Possible role for chondroitin sulfate in urolithiasis: in vivo studies in an experimental model. Clin Chim Acta 1992; 208:1-8. [PMID: 1638745 DOI: 10.1016/0009-8981(92)90018-l] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The effect of chondroitin sulfate upon the growth of calcium oxalate crystals was measured in vivo by using an experimental model in rats. Adult male Wistar rats were treated by chronic i.p. injections of chondroitin sulfate solutions (1, 5 or 10 mg in 0.3 ml of saline, every 2 days). This treatment led to a dose-dependent increase in the urinary chondroitin sulfate concentration. Urolithiasis was induced by the introduction of a calcium oxalate seed into the bladder of the animals. Urine samples were collected and the calculi formed were removed after 42 days. The chondroitin sulfate concentration have decreased in the lithiasic urines, as compared to controls and higher chondroitin sulfate doses correlated with larger calculi. The presence of chondroitin sulfate in the matrices of stones obtained from chondroitin sulfate-treated animals suggested that there was some adsorption of chondroitin sulfate on to the growth sites of the calcium oxalate crystals. In contrast to the chondroitin sulfate effect observed in vitro, which inhibits the growth of calcium oxalate crystals, our results suggest that in vivo chondroitin sulfate promotes the growth of stones in the urinary tract.
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Affiliation(s)
- Y M Michelacci
- Departamento de Bioquímica, Escola Paulista de Medicina, São Paulo, Brazil
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McLean RJ, Lawrence JR, Korber DR, Caldwell DE. Proteus mirabilis biofilm protection against struvite crystal dissolution and its implications in struvite urolithiasis. J Urol 1991; 146:1138-42. [PMID: 1895441 DOI: 10.1016/s0022-5347(17)38026-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Proteus mirabilis biofilm formation, struvite (MgNH4PO4.6H2O) crystal formation and dissolution in an artificial urine mixture were monitored using computer-enhanced microscopy (CEM) and a 1 x 3 mm. glass flow cell. Image analysis showed that P. mirabilis biofilm formation did not occur to any extent at macroenvironment flow rates greater than two mL/h (equivalent to a microenvironment flow rate of less than 5 microns./sec). Essentially, cells attached to glass surfaces, grew slowly and divided. Daughter cells were generally released directly into the medium where they could then presumably colonize other regions. Microcolonies formed by the adhesion of aggregates of cells from the medium, and over time grew into biofilms. Struvite crystallization due to urease activity and pH elevation above neutrality, was preceded by the deposition of organic matter on the glass surface, followed by the appearance of a number of tiny (one to two microns.) crystals. Crystals forming within a biofilm at low dilution rates took on a characteristic twinned or "X-shaped" appearance (crystal habit) indicative of a rapid growth rate. Those forming outside the biofilm took on a more tabular appearance reflecting their slower growth. When the macroenvironment flow rate of artificial urine (initial pH 5.8) in the glass flow cell was increased from two mL/h to four mL/h, struvite crystals not associated with biofilms dissolved within five to 10 min. Crystals entrapped within the P. mirabilis biofilm withstood flow rates up to 200 mL/h presumably due to the maintenance of an alkaline Mg-saturated microenvironment within the biofilm. These observations may suggest a mechanism by which struvite calculi can grow in spite of neutral or acidic urine pH and resist mild acidification therapy.
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Affiliation(s)
- R J McLean
- Department of Urology, Queen's University, Kingston, Ontario, Canada
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25
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McLean RJ, Downey J, Clapham L, Wilson JW, Nickel JC. Pyrophosphate inhibition of Proteus mirabilis-induced struvite crystallization in vitro. Clin Chim Acta 1991; 200:107-17. [PMID: 1663844 DOI: 10.1016/0009-8981(91)90082-n] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Struvite (MgNH4PO4.6H2O) crystals, the major mineral component of infectious urinary calculi, were produced in vitro by growth of a clinical isolate of Proteus mirabilis in artificial urine. P. mirabilis growth and urease-induced struvite production were monitored by phase contrast light microscopy and measurements of urease activity, pH, ammonia concentrations, turbidity, and culture viability. In the absence of pyrophosphate, struvite crystals appeared within 3-5 h due to the urease-induced elevation of pH and initially assumed a planar or 'X-shaped' crystal habit (morphology) characteristic of rapid growth. When pyrophosphate was present, initial precipitation and crystal appearance were significantly impaired and precipitates were largely amorphous. When crystals did appear (usually after 7 or 8 h) they were misshapen or octahedral in shape indicative of very slow growth. X-ray diffraction and Fourier transform infrared spectroscopy (FTIR) identified all crystals as struvite. Trace contaminates of carbonate-apatite (Ca10(PO4)6CO3) or newberyite (MgHPO4.H2O) were produced only in the absence of pyrophosphate. P. mirabilis viability and culture pH elevation were unaffected by the addition of pyrophosphate, whereas urease activity and ammonia concentrations were marginally reduced. Struvite could also be produced chemically by titration of the artificial urine with NH4OH. If pyrophosphate was present during titration, the same inhibitory effect on crystal growth occurred, so it is unlikely that urease inhibition is important. Lowering of pyrophosphate concentration from 13-0.45 mumol/l did not reduce its inhibitory activity so it is unlikely to act by chelating free Mg2+. We propose that pyrophosphate inhibits struvite growth principally through direct interference with the chemical mechanisms involved in crystal nucleation and growth, because of its effectiveness at very low concentrations.
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Affiliation(s)
- R J McLean
- Department of Urology, Queen's University, Kingston, Ontario, Canada
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