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Bargagli M, Anderegg MA, Fuster DG. Effects of thiazides and new findings on kidney stones and dysglycemic side effects. Acta Physiol (Oxf) 2024; 240:e14155. [PMID: 38698738 DOI: 10.1111/apha.14155] [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: 02/22/2024] [Revised: 04/08/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Thiazide and thiazide-like diuretics (thiazides) belong to the most frequently prescribed drugs worldwide. By virtue of their natriuretic and vasodilating properties, thiazides effectively lower blood pressure and prevent adverse cardiovascular outcomes. In addition, through their unique characteristic of reducing urine calcium, thiazides are also widely employed for the prevention of kidney stone recurrence and reduction of bone fracture risk. Since their introduction into clinical medicine in the early 1960s, thiazides have been recognized for their association with metabolic side effects, particularly impaired glucose tolerance, and new-onset diabetes mellitus. Numerous hypotheses have been advanced to explain thiazide-induced glucose intolerance, yet underlying mechanisms remain poorly defined. Regrettably, the lack of understanding and unpredictability of these side effects has prompted numerous physicians to refrain from prescribing these effective, inexpensive, and widely accessible drugs. In this review, we outline the pharmacology and mechanism of action of thiazides, highlight recent advances in the understanding of thiazide-induced glucose intolerance, and provide an up-to-date discussion on the role of thiazides in kidney stone prevention.
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Affiliation(s)
- Matteo Bargagli
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Manuel A Anderegg
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Swiss National Centre of Competence in Research (NCCR) Kidney.CH, University of Zürich, Zürich, Switzerland
- Department for Biomedical Research (DBMR), University of Bern, Bern, Switzerland
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2
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Zaidan N, Wang C, Chen Z, Lieske JC, Milliner D, Seide B, Ho M, Li H, Ruggles KV, Modersitzki F, Goldfarb DS, Blaser M, Nazzal L. Multiomics Assessment of the Gut Microbiome in Rare Hyperoxaluric Conditions. Kidney Int Rep 2024; 9:1836-1848. [PMID: 38899198 PMCID: PMC11184406 DOI: 10.1016/j.ekir.2024.03.004] [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: 12/11/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Hyperoxaluria is a risk factor for kidney stone formation and chronic kidney disease progression. The microbiome is an important protective factor against oxalate accumulation through the activity of its oxalate-degrading enzymes (ODEs). In this cross-sectional study, we leverage multiomics to characterize the microbial community of participants with primary and enteric hyperoxaluria, as well as idiopathic calcium oxalate kidney stone (CKS) formers, focusing on the relationship between oxalate degrading functions of the microbiome. Methods Patients diagnosed with type 1 primary hyperoxaluria (PH), enteric hyperoxaluria (EH), and CKS were screened for inclusion in the study. Participants completed a food frequency questionnaire recording their dietary oxalate content while fecal oxalate levels were ascertained. DNA and RNA were extracted from stool samples and sequenced. Metagenomic (MTG) and metatranscriptomic (MTT) data were processed through our bioinformatics pipelines, and microbiome diversity, differential abundance, and networks were subject to statistical analysis in relationship with oxalate levels. Results A total of 38 subjects were recruited, including 13 healthy participants, 12 patients with recurrent CKS, 8 with PH, and 5 with EH. Urinary and fecal oxalate were significantly higher in the PH and the EH population compared to healthy controls. At the community level, alpha-diversity and beta-diversity indices were similar across all populations. The respective contributions of single bacterial species to the total oxalate degradative potential were similar in healthy and PH subjects. MTT-based network analysis identified the most interactive bacterial network in patients with PH. Patients with EH had a decreased abundance of multiple major oxalate degraders. Conclusion The composition and inferred activity of oxalate-degrading microbiota were differentially associated with host clinical conditions. Identifying these changes improves our understanding of the relationships between dietary constituents, microbiota, and oxalate homeostasis, and suggests new therapeutic approaches protecting against hyperoxaluria.
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Affiliation(s)
- Nadim Zaidan
- Department of Medicine, Division of Nephrology, NYU Langone Medical Center, New York, New York, USA
| | - Chan Wang
- Department of Population Health, New York University School of Medicine, NYU Langone Health, New York, New York, USA
| | - Ze Chen
- Department of Population Health, New York University School of Medicine, NYU Langone Health, New York, New York, USA
| | - John C. Lieske
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn Milliner
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara Seide
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Melody Ho
- Department of Medicine, Division of Nephrology, NYU Langone Medical Center, New York, New York, USA
| | - Huilin Li
- Department of Population Health, New York University School of Medicine, NYU Langone Health, New York, New York, USA
| | - Kelly V. Ruggles
- Department of Medicine, Division of Precision Medicine, New York University School of Medicine, NYU Langone Health, New York, New York, USA
| | - Frank Modersitzki
- Department of Medicine, Division of Nephrology, NYU Langone Medical Center, New York, New York, USA
| | - David S. Goldfarb
- Department of Medicine, Division of Nephrology, NYU Langone Medical Center, New York, New York, USA
| | - Martin Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, New Jersey, USA
| | - Lama Nazzal
- Department of Medicine, Division of Nephrology, NYU Langone Medical Center, New York, New York, USA
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Steely A, Worcester E, Prochaska M. Contrasting Response of Urine Stone Risk to Medical Treatment in Calcium Oxalate versus Calcium Phosphate Stone Formers. KIDNEY360 2024; 5:228-236. [PMID: 38251931 PMCID: PMC10914189 DOI: 10.34067/kid.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Key Points Thiazide treatment successfully lowered urine calcium and both calcium oxalate and calcium phosphate supersaturations in both types of stone formers (SFs). Alkali therapy may not confer the same benefits on calcium phosphate SFs as it does on calcium oxalate SFs. Background Randomized controlled trials have shown that both thiazide diuretics and potassium citrate (K-Cit) can prevent calcium stone recurrence, but most participants formed calcium oxalate (CaOx) stones. While thiazides are expected to lower risk of calcium phosphate (CaP) stone formation, the effect of K-Cit on risk of CaP stone formation is unclear. Methods To study the effect of common calcium stone treatments, we analyzed the 24-hour urines of CaOx and CaP stone formers (SFs) by four treatment types: Lifestyle, K-Cit, Thiazide, or Both medications. Results Patients treated with thiazides reduced urine calcium in both CaOx (M =−74.4, SD =94.6 mg/d) and CaP (M =−102, SD =99.7 mg/d) SFs while those on K-Cit had no change in urine calcium. Among CaOx SFs, urine citrate rose in patients administered K-Cit with or without thiazide, but citrate did not rise significantly in CaP SFs. Urine pH rose in all CaOx SFs, but among CaP SFs, only rose in patients receiving K-Cit. CaOx supersaturation (SS) decreased in all patients who received Thiazide, and decreased among CaOx SFs treated with K-Cit. CaP SS decreased in both CaOx SFs (M =−0.46, SD =0.86) and CaP SFs (M =−0.76, SD =0.85) treated with Thiazide, except CaOx SFs who received Both. Patients treated with K-Cit alone increased CaP SS in CaOx SFs (M =0.25, SD =0.79). Conclusions Patients treated with Thiazide lowered urine calcium and SS in both stone groups. Patients treated with K-Cit had no significant changes in urine calcium and had a decrease in CaOx SS in CaOx SFs. The study raises questions about the best preventive treatment for patients with CaP stones and suggests that K-Cit may not confer the same benefits on CaP SFs as it does on CaOx SFs.
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Affiliation(s)
- Audrey Steely
- Department of Medicine, University of Chicago, Chicago, Illinois
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Li Q, Krieger NS, Yang L, Asplin J, Bushinsky DA. Magnesium Decreases Urine Supersaturation but Not Calcium Oxalate Stone Formation in Genetic Hypercalciuric Stone-Forming Rats. Nephron Clin Pract 2024; 148:480-486. [PMID: 38262368 DOI: 10.1159/000534495] [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: 07/05/2023] [Accepted: 09/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND/AIMS Hypercalciuria is the most common identifiable risk factor predisposing to CaOx stone formation. Increased oral magnesium intake may lead to decreased CaOx stone formation by binding intestinal Ox leading to decreased absorption and/or binding urinary Ox to decrease urinary supersaturation. This study assessed the effect of oral magnesium on 24-h urine ion excretion, supersaturation, and kidney stone formation in a genetic hypercalciuric stone-forming (GHS) rat model of human idiopathic hypercalciuria. METHODS When fed the oxalate precursor, hydroxyproline, every GHS rat develops CaOx stones. The GHS rats, fed a normal calcium and phosphorus diet supplemented with hydroxyproline to induce CaOx, were divided into three groups of ten rats per group: control diet with 4.0 g/kg MgO, low MgO diet (0.5 g/kg), and high MgO diet (8 g/kg). At 6 weeks, 24-h urines were collected, and urine chemistry and supersaturation were determined. Stone formation was quantified. RESULTS The GHS rats fed the low and high Mg diets had a significant reduction and increase, respectively, in urinary Mg compared to those fed the control diet. Dietary Mg did not alter urine Ca excretion while the low Mg diet led to a significant fall in urinary Ox. Urine supersaturation with respect to CaOx was significantly increased with low Mg, whereas urine supersaturation was significantly decreased with high Mg. There was no effect of dietary Mg on stone formation within 6 weeks of treatment. CONCLUSION Dietary magnesium decreases urine supersaturation but not CaOx stone formation in GHS rats.
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Affiliation(s)
- Qiaoli Li
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,
- PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,
| | - Nancy S Krieger
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine, Rochester, New York, USA
| | - Lee Yang
- Laboratory Corporation of America Holdings, Itasca, Illinois, USA
| | - John Asplin
- Laboratory Corporation of America Holdings, Itasca, Illinois, USA
| | - David A Bushinsky
- Division of Nephrology, Department of Medicine, University of Rochester School of Medicine, Rochester, New York, USA
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Siener R, Ernsten C, Speller J, Scheurlen C, Sauerbruch T, Hesse A. Intestinal Oxalate Absorption, Enteric Hyperoxaluria, and Risk of Urinary Stone Formation in Patients with Crohn's Disease. Nutrients 2024; 16:264. [PMID: 38257157 PMCID: PMC10821467 DOI: 10.3390/nu16020264] [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: 12/21/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
Nephrolithiasis is a common urologic manifestation of Crohn's disease. The purpose of this study was to investigate the clinical characteristics, intestinal oxalate absorption, and risk factors for urinary stone formation in these patients. In total, 27 patients with Crohn's disease and 27 healthy subjects were included in the present study. Anthropometric, clinical, and 24 h urinary parameters were determined, and the [13C2]oxalate absorption test was performed. Among all patients, 18 had undergone ileal resection, 9 of whom had a history of urinary stones. Compared to healthy controls, the urinary excretion values of calcium, magnesium, potassium, sulfate, creatinine, and citrate were significantly lower in patients with Crohn's disease. Intestinal oxalate absorption, the fractional and 24 h urinary oxalate excretion, and the risk of calcium oxalate stone formation were significantly higher in patients with urolithiasis than in patients without urolithiasis or in healthy controls. Regardless of the group, between 83% and 96% of the [13C2]oxalate was detected in the urine within the first 12 h after ingestion. The length of ileum resection correlated significantly with the intestinal absorption and urinary excretion of oxalate. These findings suggest that enteric hyperoxaluria can be attributed to the hyperabsorption of oxalate following extensive ileal resection. Oral supplementation of calcium and magnesium, as well as alkali citrate therapy, should be considered as treatment options for urolithiasis.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
| | - Charlotte Ernsten
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
| | - Jan Speller
- Department of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany;
| | - Christian Scheurlen
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; (C.S.); (T.S.)
| | - Tilman Sauerbruch
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany; (C.S.); (T.S.)
| | - Albrecht Hesse
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany; (C.E.); (A.H.)
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Prochaska M, Menezes C, Ko BS, Coe F, Worcester E. Contribution of thick ascending limb and distal convoluted tubule to glucose-induced hypercalciuria in healthy controls. Am J Physiol Renal Physiol 2023; 325:F811-F816. [PMID: 37823200 PMCID: PMC10874680 DOI: 10.1152/ajprenal.00130.2023] [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: 05/15/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
Carbohydrates increase kidney stone risk and increase urine calcium and magnesium. We hypothesize that the effects of glucose as an allosteric modulator of calcium-sensing receptors may mediate this effect. Six healthy subjects were on a low-sodium diet before consuming 100 g of glucose beverage. Timed fasting (3) and postglucose (6) urine and blood samples were collected every 30 min. Urine composition and serum markers were measured and microvesicular abundance of tubular transport proteins (NHE3, NKCC2, NCC, and TRPV5) were quantified. Postglucose, serum glucose, and insulin rose rapidly with a parallel increase in calcium and magnesium excretion and no change in fractional excretion of sodium. Both serum parathyroid hormone (PTH) and urine TRPV5 fell in the postglucose periods. The rise in the calcium and magnesium excretion likely occurred primarily in the thick ascending limb where they are both under control of the calcium-sensing receptor. The fall in PTH and TRPV5 support the role of glucose as an allosteric modulator of calcium-sensing receptor.NEW & NOTEWORTHY Sugar increases urine calcium and magnesium as well as kidney stone and bone disease risk. Our study provided new insights into the underlying mechanism as we gave healthy subjects an oral glucose load and used newer tools such as fractional excretion of lithium, serum parathyroid hormone, and microvesicular abundance of tubular transport proteins to characterize the mechanism and identify the thick ascending limb with possible calcium-sensing receptor mediation as a likely contributor to this mechanism.
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Affiliation(s)
- Megan Prochaska
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Cameron Menezes
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Benjamin S Ko
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Fredric Coe
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Elaine Worcester
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
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Khargi R, Blake RM, Yaghoubian AJ, Canning C, Fang A, Connors C, Gallante B, Ricapito A, Khusid JA, Atallah WM, Gupta M. Drivers of calcium oxalate stone formation in the octogenarian population. World J Urol 2023; 41:3713-3721. [PMID: 37847263 DOI: 10.1007/s00345-023-04619-1] [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: 05/31/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION American Urological Association (AUA) guidelines suggest metabolic testing via 24-h urine studies in high-risk, interested first-time stone formers, and recurrent stone formers. If metabolic testing is not available or otherwise not feasible, clinicians may need to utilize empiric therapy. Debility and social barriers, particularly in the elderly population, may limit the practicality of metabolic testing, and therefore, empiric therapy is of particular importance. The aim of this study is to identify whether unique urinary metabolic abnormality profiles exist for octogenarians with calcium oxalate kidney stones, as this may guide empiric stone prevention therapy more precisely in this population. MATERIALS AND METHODS Patients with calcium oxalate stones from a single academic kidney stone center in New York, NY, were retrospectively identified in our prospectively managed database. Patient data, including demographic, clinical information, and baseline 24-h urine studies, were collected before initiating any treatment. Subjects were stratified by age (≤ 40, 41-59, 60-79, and ≥ 80 years) to compare the metabolic urinary abnormality profiles between octogenarians and other age groups. Subgroup analyses were also performed to compare results by gender and by the presence of underlying kidney dysfunction. Comparative statistical analysis was carried out using Chi-square tests, Mann-Whitney U tests, and t-tests where appropriate. RESULTS Hypocitraturia, low urine pH, and low urine volume were most common in older patients, particularly in octogenarians. Hypercalciuria, hypernatriuria, and hyperuricosuria were more apparent in younger groups. CONCLUSION With increasing age, hypocitraturia, low urine pH, and low urine volume were more prevalent on 24-h urine metabolic testing. We hypothesize increased comorbidity, including medical renal disease, polypharmacy, and dehydration are possible factors contributing to this unique profile. We suggest that empiric therapy targeted towards this profile is important in very elderly stone formers in whom 24-h urine testing may not be possible. Increased hydration, increased fruit and vegetable intake, and low-dose alkali therapy are easy measures to accomplish this.
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Affiliation(s)
- Raymond Khargi
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA.
| | - Ryan M Blake
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alan J Yaghoubian
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Caroline Canning
- Department of Urology, SUNY Downstate Health Sciences University, New York, USA
| | - Alexander Fang
- Department of Urology, SUNY Downstate Health Sciences University, New York, USA
| | - Christopher Connors
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Blair Gallante
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Anna Ricapito
- Department of Urology and Kidney Transplant, University of Foggia, Foggia, Italy
| | - Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, USA
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Siener R, Pitzer MS, Speller J, Hesse A. Risk Profile of Patients with Brushite Stone Disease and the Impact of Diet. Nutrients 2023; 15:4092. [PMID: 37764875 PMCID: PMC10534559 DOI: 10.3390/nu15184092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
This study examined the profile of patients and the impact of diet on the risk of brushite stone formation under controlled, standardized conditions. Sixty-five patients with brushite nephrolithiasis were enrolled in the study. Metabolic, dietary, and 24 h urinary parameters were collected under the habitual, self-selected diet of the patients and the balanced mixed, standardized diet. The [13C2]oxalate absorption, ammonium chloride, and calcium loading tests were conducted. All patients had at least one abnormality on the usual diet, with hypercalciuria (84.6%), increased urine pH (61.5%), and hyperphosphaturia (43.1%) being the most common. Absorptive hypercalciuria was present in 32.1% and hyperabsorption of oxalate in 41.2%, while distal renal tubular acidosis (dRTA) was noted in 50% of brushite stone formers. The relative supersaturation of brushite did not differ between patients with and without dRTA. Among all recent brushite-containing calculi, 61.5% were mixed with calcium oxalate and/or carbonate apatite. The relative supersaturation of brushite, apatite, and calcium oxalate decreased significantly under the balanced diet, mainly due to the significant decline in urinary calcium, phosphate, and oxalate excretion. Dietary intervention was shown to be effective and should be an integral part of the treatment of brushite stone disease. Further research on the role of dRTA in brushite stone formation is needed.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Maria Sofie Pitzer
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jan Speller
- Department of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Albrecht Hesse
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
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Morris EM, McGrath AP, Brejda J, Jewell DE. Relative supersaturation values distinguish between feline urinary and non-urinary foods and align with expected urine analytes contributions to uroliths. Front Vet Sci 2023; 10:1167840. [PMID: 37601750 PMCID: PMC10436620 DOI: 10.3389/fvets.2023.1167840] [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: 02/16/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Uroliths are concretions formed in the urinary tract. These can be problematic in humans and companion animals such as cats. Magnesium ammonium phosphate (struvite) and calcium oxalate (CaOx) are the most common forms of uroliths. The relative supersaturation (RSS) is a relative risk index of crystal formation. Here, an updated program for calculating RSS, EQUIL-HL21, was used to detect differences in RSS values when cats were fed foods formulated for urinary and non-urinary conditions. In addition, the contributions of urinary analytes to RSS values were examined via regression analyses. Methods Historical data from feeding trials including foods indicated for use in urinary or non-urinary conditions were analyzed for nutrient composition and urinary parameters. RSS was calculated by EQUIL-HL21. The relationship between RSS values calculated by EQUIL-HL21 and urinary analytes was examined by regression models, which were selected by R2 and stepwise methods. Results Cats that consumed urinary foods had significantly greater levels of urinary sodium and chloride compared with those that consumed non-urinary foods, consistent with the greater amounts of sodium and chloride in the urinary foods. Those that consumed non-urinary foods had higher urine pH, ammonium, potassium, phosphorus, magnesium, oxalate, citrate, and sulfate. Struvite RSS value and number of urinary crystals were significantly lower in cats fed the urinary foods. Mean CaOx RSS values were similar in both foods, though the number of CaOx crystals were significantly higher in cats that consumed non-urinary foods. A model predicting the natural log of struvite RSS values indicated that these values would increase with increasing urine pH, ammonium, chloride, calcium, phosphorus, and magnesium, and would decrease with increasing urine citrate and sulfate. CaOx RSS was predicted to increase as urinary chloride, calcium, and oxalates increased, and would decrease as urine pH, sodium, phosphorus, citrate, and sulfate increased. Discussion These analyses demonstrate that the EQUIL-HL21 program can accurately detect expected differences between foods formulated for urinary and non-urinary indications. Regression models showed the eight urinary analytes that, respectively, contribute to the predicted RSS values for struvite and CaOx.
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Affiliation(s)
| | | | - John Brejda
- Alpha Statistical Consulting, Inc., Lincoln, NE, United States
| | - Dennis E. Jewell
- Department of Grain Science and Industry, Kansas State University, Manhattan, KS, United States
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Anthony RM, Davidson S, MacLeay JM, Brejda J, Werness P, Jewell DE. Comparison of two software programs used to determine the relative supersaturation of urine ions. Front Vet Sci 2023; 10:1146945. [PMID: 37332737 PMCID: PMC10274322 DOI: 10.3389/fvets.2023.1146945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Relative supersaturation (RSS) values for urine crystals are a measure of the risk of urinary stone formation and have been shown to be lowered in foods shown to aid in the management of urolithiasis. In order to calculate RSS in pets, computer programs have been developed to calculate RSS and aid in the understanding of stone formation in veterinary medicine. However, some older programs have not been updated for use in animals, and the specific coefficients used are not publically available. One of the first RSS programs was developed in BASIC computer language and published in 1985 which was called EQUIL2. The EQUIL2 program was updated to a compiled version compatible with a PC platform. However, the formulas could not be read or altered. Methods This study evaluates a new program with known coefficients to the original EQUIL2 program. The RSS values of the two programs were compared through a t-test, calculating the r2 from correlation analysis, Lin's concordance correlation coefficient, and by a Bland-Altman analysis of outputs from the two programs using urine samples from healthy dogs and cats. Results and Discussion Our results show that for both magnesium ammonium phosphate (struvite) and calcium oxalate, the RSS values of the original program could be calculated from the new programs RSS values. Although the actual RSS values were different (as might be expected through the use of the updated coefficients and different thermodynamic stability constants in the calculations) the results were highly correlated, finding elevations and reductions in RSS proportionally in the same urine samples. The current work creates a foundation for using the modernized program to calculate RSS and provides a shared method for understanding the risk of struvite and calcium oxalate stone formation.
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Affiliation(s)
| | | | | | - John Brejda
- Alpha Statistical Consulting, Lincoln, NE, United States
| | - Peter Werness
- Consultant for Hill’s Pet Nutrition, Inc, Topeka, KS, United States
| | - Dennis E. Jewell
- Department of Grain Science and Industry, Kansas State University, Manhattan, KS, United States
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Dhayat NA, Bonny O, Roth B, Christe A, Ritter A, Mohebbi N, Faller N, Pellegrini L, Bedino G, Venzin RM, Grosse P, Hüsler C, Koneth I, Bucher C, Del Giorno R, Gabutti L, Mayr M, Odermatt U, Buchkremer F, Ernandez T, Stoermann-Chopard C, Teta D, Vogt B, Roumet M, Tamò L, Cereghetti GM, Trelle S, Fuster DG. Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence. N Engl J Med 2023; 388:781-791. [PMID: 36856614 DOI: 10.1056/nejmoa2209275] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Nephrolithiasis is one of the most common conditions affecting the kidney and is characterized by a high risk of recurrence. Thiazide diuretic agents are widely used for prevention of the recurrence of kidney stones, but data regarding the efficacy of such agents as compared with placebo are limited. Furthermore, dose-response data are also limited. METHODS In this double-blind trial, we randomly assigned patients with recurrent calcium-containing kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily or placebo once daily. The main objective was to investigate the dose-response effect for the primary end point, a composite of symptomatic or radiologic recurrence of kidney stones. Radiologic recurrence was defined as the appearance of new stones on imaging or the enlargement of preexisting stones that had been observed on the baseline image. Safety was also assessed. RESULTS In all, 416 patients underwent randomization and were followed for a median of 2.9 years. A primary end-point event occurred in 60 of 102 patients (59%) in the placebo group, in 62 of 105 patients (59%) in the 12.5-mg hydrochlorothiazide group (rate ratio vs. placebo, 1.33; 95% confidence interval [CI], 0.92 to 1.93), in 61 of 108 patients (56%) in the 25-mg group (rate ratio, 1.24; 95% CI, 0.86 to 1.79), and in 49 of 101 patients (49%) in the 50-mg group (rate ratio, 0.92; 95% CI, 0.63 to 1.36). There was no relation between the hydrochlorothiazide dose and the occurrence of a primary end-point event (P = 0.66). Hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level were more common among patients who received hydrochlorothiazide than among those who received placebo. CONCLUSIONS Among patients with recurrent kidney stones, the incidence of recurrence did not appear to differ substantially among patients receiving hydrochlorothiazide once daily at a dose of 12.5 mg, 25 mg, or 50 mg or placebo once daily. (Funded by the Swiss National Science Foundation and Inselspital; NOSTONE ClinicalTrials.gov number, NCT03057431.).
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Affiliation(s)
- Nasser A Dhayat
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Olivier Bonny
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Beat Roth
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Andreas Christe
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Alexander Ritter
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Nilufar Mohebbi
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Nicolas Faller
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Lisa Pellegrini
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Giulia Bedino
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Reto M Venzin
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Philipp Grosse
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Carina Hüsler
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Irene Koneth
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Christian Bucher
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Rosaria Del Giorno
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Luca Gabutti
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Michael Mayr
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Urs Odermatt
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Florian Buchkremer
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Thomas Ernandez
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Catherine Stoermann-Chopard
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Daniel Teta
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Bruno Vogt
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Marie Roumet
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Luca Tamò
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Grazia M Cereghetti
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Sven Trelle
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Daniel G Fuster
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
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12
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Bargagli M, Pinto F, De Leonardis R, Ragonese M, Totaro A, Recupero S, Vittori M, Bassi P, Gambaro G, Ferraro PM. Determinants of renal papillary appearance in kidney stone formers: An in-depth examination. Arch Ital Urol Androl 2023; 95:10748. [PMID: 36924385 DOI: 10.4081/aiua.2023.10748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/20/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVES The aim of this study is to investi-gate the association between the urinary metabolic milieu and kidney stone recurrence with a validated papillary evaluation score (PPLA). MATERIALS AND METHODS We prospectively enrolled 30 stone for-mers who underwent retrograde intrarenal surgery procedures. Visual inspection of the accessible renal papillae was performed to calculate PPLA score, based on the characterization of ductal plugging, surface pitting, loss of papillary contour and Randall's plaque extension. Stone compositions, 24h urine collections and kidney stone events during follow-up were collected. Relative supersaturation ratios (RSS) for calcium oxalate (CaOx), brushite and uric acid were calculated using EQUIL-2. PPLA score > 3 was defined as high. RESULTS Median follow-up period was 11 months (5, 34). PPLA score was inversely correlated with BMI (OR 0.59, 95% CI 0.38, 0.91, p = 0.018), type 2 diabetes (OR 0.04, 95% CI 0.003, 0.58, p = 0.018) and history of recurrent kidney stones (OR 0.17, 95%CI 0.04, 0.75, p = 0.019). The associations between PPLA score, diabetes and BMI were not confirmed after excluding patients with uric acid stones. Higher PPLA score was associated with lower odds of new kidney stone events during follow-up (OR 0.15, 95% CI 0.02, 1.00, p = 0.05). No other significant correla-tions were found. CONCLUSIONS Our results confirm the lack of efficacy of PPLA score in phenotyping patients affected by kidney stone disease or in predicting the risk of stone recurrence. Larger, long-term studies need to be performed to clarify the role of PPLA on the risk of stone recurrence.
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Affiliation(s)
- Matteo Bargagli
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | - Francesco Pinto
- U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | - Rossella De Leonardis
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma.
| | - Mauro Ragonese
- U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | - Angelo Totaro
- U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | | | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome.
| | - PierFrancesco Bassi
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.C. Clinica Urologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
| | - Giovanni Gambaro
- Renal Unit, Department of Medicine, University-Hospital of Verona, Verona.
| | - Pietro Manuel Ferraro
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma; U.O.S. Terapia Conservativa della Malattia Renale Cronica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma.
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Siener R, Löhr P, Hesse A. Urinary Risk Profile, Impact of Diet, and Risk of Calcium Oxalate Urolithiasis in Idiopathic Uric Acid Stone Disease. Nutrients 2023; 15:nu15030572. [PMID: 36771279 PMCID: PMC9919786 DOI: 10.3390/nu15030572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The role of diet in the pathogenesis of uric acid (UA) nephrolithiasis is incompletely understood. This study investigated the effect of dietary intervention on the risk of UA stone formation under standardized conditions. Twenty patients with idiopathic UA stone disease were included in the study. Dietary intake and 24 h urinary parameters were collected on the usual diet of the patients and a standardized balanced mixed diet. Although urinary UA excretion did not change, the relative supersaturation of UA decreased significantly by 47% under the balanced diet primarily due to the significant increase in urine volume and pH. Urinary pH was below 5.8 in 85% of patients under the usual diet, and in 60% of patients under the balanced diet. The supersaturation of calcium oxalate declined significantly under the balanced diet due to the significant decrease in urinary calcium and oxalate excretion and the increase in urine volume. Dietary intervention is a key component in the management of UA nephrolithiasis. Urinary calcium and oxalate excretion should also be monitored in patients with pure UA calculi to reduce the risk of mixed stone formation with calcium oxalate. Lower urinary pH in UA stone patients can only be partially explained by diet.
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14
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The role of urinary supersaturations for lithogenic salts in the progression of autosomal dominant polycystic kidney disease. J Nephrol 2022; 36:1011-1018. [DOI: 10.1007/s40620-022-01540-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022]
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Siener R, Ernsten C, Bitterlich N, Alteheld B, Metzner C. Effect of Two Different Dietary Weight Loss Strategies on Risk Factors for Urinary Stone Formation and Cardiometabolic Risk Profile in Overweight Women. Nutrients 2022; 14:nu14235054. [PMID: 36501084 PMCID: PMC9736858 DOI: 10.3390/nu14235054] [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: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Overweight has been suggested to increase the risk of kidney stone formation. Although weight reduction might affect risk factors for urolithiasis, findings on the impact of different dietary weight loss strategies are limited. This randomized, controlled study evaluated the effect of a conventional energy-restricted modified diet with (MR group) or without meal replacement (C group) on risk factors for stone formation in overweight women without a history of urolithiasis. Of 105 participants, 78 were included into the per-protocol analysis. Anthropometric, clinical, biochemical, and 24 h urinary parameters were collected at baseline and after 12 weeks. Although both dietary interventions resulted in a significant weight reduction, relative weight loss and rate of responders were higher in the MR group. Weight loss improved cardiometabolic risk profile in both groups. Unfortunately, the benefit of decreased GPT activity in the C group was offset by a significant increase in homocysteine and a decline in GFR. While the relative supersaturation of calcium oxalate decreased significantly in both groups, a significant decline in serum uric acid concentration and relative supersaturation of uric acid was observed only in the MR group. Finally, the energy-restricted modified diet with meal replacement showed significant advantages over the energy-restricted modified diet alone.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence:
| | - Charlotte Ernsten
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Norman Bitterlich
- Independent Biostatistician, Draisdorfer Str. 21, 09114 Chemnitz, Germany
| | - Birgit Alteheld
- Department of Nutrition and Food Sciences, Nutritional Physiology, University of Bonn, 53115 Bonn, Germany
| | - Christine Metzner
- Bonn Education Association for Dietetics r. A., 50935 Cologne, Germany
- Clinic for Gastroenterology, Metabolic Disorders and Internal Intensive Medicine (Medical Clinic III), RWTH Aachen, 52074 Aachen, Germany
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Bianco J, Chu F, Bergsland K, Coe F, Worcester E, Prochaska M. What treatments reduce kidney stone risk in patients with bowel disease? Urolithiasis 2022; 50:557-565. [PMID: 35976425 PMCID: PMC9972896 DOI: 10.1007/s00240-022-01352-z] [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: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI -4.3 to -0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI -1.4 to 2.1) nor oxalate-focused advice (95% CI -1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.
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Affiliation(s)
- Julianna Bianco
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Francesca Chu
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Kristin Bergsland
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Fredric Coe
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Elaine Worcester
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Megan Prochaska
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Lin Z, Jayachandran M, Haskic Z, Kumar S, Lieske JC. Differences of Uric Acid Transporters Carrying Extracellular Vesicles in the Urine from Uric Acid and Calcium Stone Formers and Non-Stone Formers. Int J Mol Sci 2022; 23:ijms231710010. [PMID: 36077407 PMCID: PMC9456222 DOI: 10.3390/ijms231710010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Low urine pH and volume are established risk factors for uric acid (UA) stone disease (UASD). Renal tubular epithelial cells exposed to an acidic pH and/or UA crystals can shed extracellular vesicles (EVs) into the tubular fluid, and these EVs may be a pathogenic biomarker of UASD. Methods: Urinary EVs bearing UA transporters (SLC2A9, SLC17A3, SLC22A12, SLC5A8, ABCG2, and ZNF365) were quantified in urine from UA stone formers (UASFs), calcium stone formers (CSFs), and age-/sex-matched non-stone formers (NSFs) using a standardized and published method of digital flow cytometry. Results: Urinary pH was lower (p < 0.05) and serum and urinary UA were greater (p < 0.05) in UASFs compared with NSFs. Urinary EVs carrying SLC17A3 and SLC5A8 were lower (p < 0.05) in UASFs compared with NSFs. Urinary EVs bearing SLC2A9, SLC22A12, SLC5A8, ABCG2, and ZNF365 were lower (p < 0.05) in CSFs than UASFs, while excretion of SLC17A3-bearing EVs did not differ between groups. Conclusion: EVs bearing specific UA transporters might contribute to the pathogenesis of UASD and represent non-invasive pathogenic biomarkers for calcium and UA stone risk.
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Affiliation(s)
- Zhijian Lin
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - Muthuvel Jayachandran
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
- Division of Hematology Research, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - Zejfa Haskic
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjay Kumar
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
- Department of Life Science, School of Basic Sciences and Research, Sharda University, Greater Noida 201310, Uttar Pradesh, India
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN 55905, USA
- Correspondence: ; Tel.: +(507)-266-7960; Fax: +(507)-266-9315
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18
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Hall JA, Panickar KS, Brockman JA, Jewell DE. Cats with Genetic Variants of AGXT2 Respond Differently to a Dietary Intervention Known to Reduce the Risk of Calcium Oxalate Stone Formation. Genes (Basel) 2022; 13:791. [PMID: 35627178 PMCID: PMC9141165 DOI: 10.3390/genes13050791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
This study was completed to evaluate a genotype-specific nutritional intervention for reducing the risk of calcium oxalate stone formation. Serum metabolomic profiles and genotypes of 445 cats in the colony at Hill’s Pet Nutrition, Inc (Topeka, KS, USA)were assessed in a genome-wide association study, and revealed an association between genetic variants of alanine-glyoxylate aminotransferase 2 (AGXT2) and 2-oxoarginine. The most significant single nucleotide polymorphisms (SNP) associated with 2-oxoarginine was at position chrA1:212069607, [G/A] (p < 3.687 × 10−17). This SNP explained approximately 15% of the variance in 2-oxoarginine concentrations. The distribution of genotype frequencies was 0.07 AA, 0.39 AG, and 0.54 GG, with a mean relative 2-oxoarginine concentration for each genotype of 0.45 AA, 0.92 AG, and 1.27 GG, indicating a subtractive effect of the minor allele (A). Serum concentrations of two AGXT2 substrates, symmetric/asymmetric dimethylarginines (SDMA/ADMA) and β-aminoisobutyrate (BAIB) were also strongly associated with SNP chrA1:212069607 (p < 1.43 × 10−12 and p < 2.30 × 10−14, respectively). These two AGXT2 substrates were increased with the minor allele (A), indicating that the variant of the AGXT2 gene results in decreased aminotransferase activity. Additionally, the lifetime history of stone incidence showed that cats with the AA variant of AGXT2 SNP had a 2.515× increased incidence of stones compared with cats having the GG variant (p = 0.019). In a subsequent study assessing AGXT2 genotypes, cats (n = 10 GG, 4 AG, 9 AA) were fed control or test food (containing betaine at 0.500%, and the botanicals green tea, fenugreek and tulsi at 0.25, 0.025, and 0.0015%, respectively) in a cross-over study design. Stone risk analysis was conducted on urine samples after feeding control or test food for 28 days each. A calcium oxalate titration test (COT) was performed to assess the amount of added Ox−2 (per L) required to initiate calcium oxalate crystal formation. Cats with the GG variant of the AGXT2 SNP required more added oxalate to initiate urine crystal formation after consuming test food compared with control food, indicating a decreased risk of oxalate crystal formation in GG cats. In addition, urine oxalate concentrations showed an overall effect of test food independent of genotype (p = 0.0009), which resulted in lower oxalate concentrations after consuming test food compared with control food. These data indicate that cats with the GG-specific variant of AGXT2 should benefit from a reduced risk of calcium oxalate stone formation after consuming a betaine and botanical dietary enhancement.
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Affiliation(s)
- Jean A. Hall
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA
| | - Kiran S. Panickar
- Science & Technology Center, Hill′s Pet Nutrition, Inc., Topeka, KS 66617, USA; (K.S.P.); (J.A.B.)
| | - Jeffrey A. Brockman
- Science & Technology Center, Hill′s Pet Nutrition, Inc., Topeka, KS 66617, USA; (K.S.P.); (J.A.B.)
| | - Dennis E. Jewell
- Department of Grain Science and Industry, Kansas State University, Manhattan, KS 66506, USA;
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19
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Harmacek D, Pruijm M, Burnier M, Muller ME, Ghajarzadeh-Wurzner A, Bonny O, Zanchi A. Empagliflozin Changes Urine Supersaturation by Decreasing pH and Increasing Citrate. J Am Soc Nephrol 2022; 33:1073-1075. [PMID: 35387874 PMCID: PMC9161803 DOI: 10.1681/asn.2021111515] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Clinical Trial registry name and registration number: Empagliflozin and Renal Oxygenation in Healthy Volunteers (EMPA-REIN), NCT03093103.
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Affiliation(s)
- Dusan Harmacek
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland
| | - Michel Burnier
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie-Eve Muller
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Arlène Ghajarzadeh-Wurzner
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Bonny
- Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland.,Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Service of Nephrology, Department of Medicine, Fribourg State Hospital, Fribourg, Switzerland
| | - Anne Zanchi
- Service of Nephrology and Hypertension, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
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20
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Ferraro PM, Lopez F, Petrarulo M, Barbarini S, Curhan GC, Marangella M, Taylor EN. Estimating 24-hour urinary excretion using spot urine measurements in kidney stone formers. Nephrol Dial Transplant 2022; 37:2171-2179. [PMID: 35146503 PMCID: PMC9585473 DOI: 10.1093/ndt/gfab306] [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: 07/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background One limitation of the use of 24-hour collection is impracticality. We analysed the performance of spot urine measurements to estimate 24-hour excretion in patients with kidney stones. Methods A total of 74 adult patients from two centres performed a 24-hour urine collection. A sample of the last micturition was sent for spot urine analysis. Twenty patients were asked to collect two additional spot urine samples, one before dinner and the other after dinner. Urinary concentrations of creatinine, calcium, oxalate, uric acid, citrate and magnesium were measured in the 24-hour and each of the spot urine samples. Four approaches were used to estimate 24-hour urinary excretion, multiplying the ratio of the spot urinary analyte to creatinine concentration by (i) measured 24-hour urinary creatinine excretion (Prediction 1), (ii) estimated 24-hour urinary creatinine excretion (Prediction 2), (iii) assumed 1-g 24-hour urinary creatinine excretion (Prediction 3) or (iv) assumed 1.5-g 24-hour urinary creatinine excretion (Prediction 4). For each parameter we computed Lin's concordance correlation coefficients (CCCs), Bland–Altman plots and 95% limits of agreement. Results The performance of estimates obtained with Prediction 1 and Prediction 2 was similar, except for citrate and uric acid, for which Prediction 2 performed worse. Both approaches performed moderately well: citrate CCC {0.82 [95% confidence interval (CI) 0.75–0.90]}, oxalate [0.66 (95% CI 0.55–0.78)], magnesium [0.66 (95% CI 0.54–0.77)], calcium [0.63 (95% CI 0.50–0.75)] and uric acid [0.52 (95% CI 0.36–0.68)]. The performance of Predictions 3 and 4 was worse. Conclusions Although spot urine samples may hold promise for clinical and population-based research, at present they have limited utility in clinical practice. Measuring or estimating 24-hour creatinine, rather than assuming a given creatinine excretion, will be necessary in future studies of spot urine samples.
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Affiliation(s)
- Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fernando Lopez
- Tufts University School of Medicine, Department of Nephrology and Transplantation, Maine Medical Center, Portland, ME, USA
| | | | - Silvia Barbarini
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gary C Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Eric N Taylor
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Section of Nephrology, VA Maine Healthcare System, Augusta, ME, USA
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21
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Abraham A, Kavoussi NL, Sui W, Bejan C, Capra JA, Hsi R. Machine Learning Prediction of Kidney Stone Composition Using Electronic Health Record-Derived Features. J Endourol 2022; 36:243-250. [PMID: 34314237 PMCID: PMC8861926 DOI: 10.1089/end.2021.0211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives: To assess the accuracy of machine learning models in predicting kidney stone composition using variables extracted from the electronic health record (EHR). Materials and Methods: We identified kidney stone patients (n = 1296) with both stone composition and 24-hour (24H) urine testing. We trained machine learning models (XGBoost [XG] and logistic regression [LR]) to predict stone composition using 24H urine data and EHR-derived demographic and comorbidity data. Models predicted either binary (calcium vs noncalcium stone) or multiclass (calcium oxalate, uric acid, hydroxyapatite, or other) stone types. We evaluated performance using area under the receiver operating curve (ROC-AUC) and accuracy and identified predictors for each task. Results: For discriminating binary stone composition, XG outperformed LR with higher accuracy (91% vs 71%) with ROC-AUC of 0.80 for both models. Top predictors used by these models were supersaturations of uric acid and calcium phosphate, and urinary ammonium. For multiclass classification, LR outperformed XG with higher accuracy (0.64 vs 0.56) and ROC-AUC (0.79 vs 0.59), and urine pH had the highest predictive utility. Overall, 24H urine analyte data contributed more to the models' predictions of stone composition than EHR-derived variables. Conclusion: Machine learning models can predict calcium stone composition. LR outperforms XG in multiclass stone classification. Demographic and comorbidity data are predictive of stone composition; however, including 24H urine data improves performance. Further optimization of performance could lead to earlier directed medical therapy for kidney stone patients.
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Affiliation(s)
- Abin Abraham
- Department of Biological Sciences, Vanderbilt Genetics Institute, and Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nicholas L. Kavoussi
- Department of Urology and Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Address correspondence to: Nicholas L. Kavoussi, MD, Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37212, USA
| | - Wilson Sui
- Department of Urology and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cosmin Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John A. Capra
- Department of Biological Sciences, Vanderbilt Genetics Institute, and Center for Structural Biology, Vanderbilt University, Nashville, Tennessee, USA.,Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Ryan Hsi
- Department of Urology and Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Numerical characterization of astronaut CaOx renal stone incidence rates to quantify in-flight and post-flight relative risk. NPJ Microgravity 2022; 8:2. [PMID: 35091560 PMCID: PMC8799707 DOI: 10.1038/s41526-021-00187-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Changes in urine chemistry potentially alter the risk of renal stone formation in astronauts. Quantifying spaceflight renal stone incidence risk compared to pre-flight levels remains a significant challenge for assessing the appropriate vehicle, mission, and countermeasure design. A computational biochemistry model representing CaOx crystal precipitation, growth, and agglomeration is combined with a probabilistic analysis to predict the in- and post-flight CaOx renal stone incidence risk ratio (IRR) relative to pre-flight values using 1517 astronaut 24-h urine chemistries. Our simulations predict that in-flight fluid intake alone would need to increase from current prescriptions of 2.0–2.5 L/day to ~3.2 L/day to approach the CaOx IRR of the pre-flight population. Bone protective interventions would reduce CaOx risk to pre-flight levels if Ca excretion alone is reduced to <150 mg/day or if current levels are diminished to 190 mg/day in combination with increasing fluid intake to 2.5–2.7 L/day. This analysis provides a quantitative risk assessment that can influence the critical balance between engineering and astronaut health requirements.
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23
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Cornell LD, Amer H, Viehman JK, Mehta RA, Lieske JC, Lorenz EC, Heimbach JK, Stegall MD, Milliner DS. Posttransplant recurrence of calcium oxalate crystals in patients with primary hyperoxaluria: Incidence, risk factors, and effect on renal allograft function. Am J Transplant 2022; 22:85-95. [PMID: 34174139 PMCID: PMC8710184 DOI: 10.1111/ajt.16732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/30/2021] [Accepted: 06/19/2021] [Indexed: 01/25/2023]
Abstract
Primary hyperoxaluria (PH) is a metabolic defect that results in oxalate overproduction by the liver and leads to kidney failure due to oxalate nephropathy. As oxalate tissue stores are mobilized after transplantation, the transplanted kidney is at risk of recurrent disease. We evaluated surveillance kidney transplant biopsies for recurrent calcium oxalate (CaOx) deposits in 37 kidney transplants (29 simultaneous kidney and liver [K/L] transplants and eight kidney alone [K]) in 36 PH patients and 62 comparison transplants. Median follow-up posttransplant was 9.2 years (IQR: [5.3, 15.1]). The recurrence of CaOx crystals in surveillance biopsies in PH at any time posttransplant was 46% overall (41% in K/L, 62% in K). Higher CaOx crystal index (which accounted for biopsy sample size) was associated with higher plasma and urine oxalate following transplant (p < .01 and p < .02, respectively). There was a trend toward higher graft failure among PH patients with CaOx crystals on surveillance biopsies compared with those without (HR 4.43 [0.88, 22.35], p = .07). CaOx crystal deposition is frequent in kidney transplants in PH patients. The avoidance of high plasma oxalate and reduction of CaOx crystallization may decrease the risk of recurrent oxalate nephropathy following kidney transplantation in patients with PH. This study was approved by the IRB at Mayo Clinic.
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Affiliation(s)
- Lynn D. Cornell
- Division of Anatomic Pathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905
| | - Hatem Amer
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Jason K. Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 55905
| | - Ramila A. Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota 55905
| | - John C. Lieske
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Elizabeth C. Lorenz
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Julie K. Heimbach
- Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905
| | - Mark D. Stegall
- Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905
| | - Dawn S. Milliner
- Division of Nephrology, Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905
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24
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Clinical and Kidney Structural Characteristics of Living Kidney Donors With Nephrolithiasis and Their Long-term Outcomes. Transplant Direct 2021; 8:e1278. [PMID: 34966845 PMCID: PMC8710319 DOI: 10.1097/txd.0000000000001278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function.
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25
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Williams JC, Al-Awadi H, Muthenini M, Bledsoe SB, El-Achkar T, Evan AP, Coe F, Lingeman JE, Worcester EM. Stone morphology distinguishes two pathways of idiopathic calcium oxalate stone pathogenesis. J Endourol 2021; 36:694-702. [PMID: 34915736 PMCID: PMC9145590 DOI: 10.1089/end.2021.0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction About 1-in-11 Americans will experience a kidney stone, but underlying causes remain obscure. The objective of the present study was to separate idiopathic calcium oxalate stone formers by whether or not they showed positive evidence of forming a stone on Randall's plaque (RP). Materials and Methods In patients undergoing either percutaneous or ureteroscopic procedures for kidney stone removal, all stone material was extracted, and analyzed using micro computed tomographic imaging (micro CT), in order to identify those attached to RP. 24-hour urines were collected weeks after the stone removal procedure and off of medications that would affect urine composition. Endoscopic video was analyzed for papillary pathology (RP, pitting, plugging, dilated ducts, loss of papillary shape) by an observer blinded to the data on stone type. Percent papillary area occupied by RP and ductal plugging was quantified using image analytic software. Results Patients having even 1 stone on RP (N=36) did not differ from Non-RP patients (N=37) in age, sex, BMI, or other clinical characteristics. Compared to the Non-RP group, RP stone formers had more numerous but smaller stones, more abundant papillary RP, and fewer ductal plugs, both by quantitative measurement of surface area (on average, 3 times more plaque area, but only 41% as much plug area as Non-RP) and by semi-quantitative visual grading. Serum and blood values did not differ between RP and Non-RP stone formers by any measure. Conclusions Growth of many small stones on plaque seems the pathogenetic scheme for the RP stone forming phenotype, whereas the Non-RP phenotype stone pathogenesis pathway is less obvious. Higher papillary plugging in Non-RP suggests that plugs play a role in stone formation, and that these patients have a greater degree of papillary damage. Underlying mechanisms that create these distinctive phenotypes are presently unknown.
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Affiliation(s)
- James C Williams
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Haider Al-Awadi
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Manognya Muthenini
- Indiana University School of Medicine, Department of Medicine, Indianapolis, Indiana, United States;
| | - Sharon B Bledsoe
- Indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Tarek El-Achkar
- Indiana University School of Medicine, Department of Medicine , Indianapolis, Indiana, United States;
| | - Andrew P Evan
- indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Fred Coe
- University of Chicago Pritzker School of Medicine, 12246, Medicine, Chicago, Illinois, United States;
| | - James E Lingeman
- Indiana University School of Medicine, Dept. of Urology, Indianapolis, Indiana, United States;
| | - Elaine M Worcester
- The University of Chicago, Section of Nephrology, Chicago, Illinois, United States;
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26
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Siener R, Hesse A. Effect of Black Tea Consumption on Urinary Risk Factors for Kidney Stone Formation. Nutrients 2021; 13:nu13124434. [PMID: 34959987 PMCID: PMC8708000 DOI: 10.3390/nu13124434] [Citation(s) in RCA: 9] [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: 11/21/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023] Open
Abstract
Copious fluid intake is the most essential nutritional measure in the treatment of urolithiasis, and is suggested to be a protective factor in the primary prevention of urinary stone formation. Although the intake of black tea contributes to daily fluid intake, the high oxalate content could outweigh the beneficial effect of urine dilution. The present study investigated the effect of black tea consumption on urinary risk factors for kidney stone formation. Ten healthy men received a standardized diet for a period of ten days. Subjects consumed 1.5 L/day of fruit tea (0 mg/day oxalate) during the 5-day control phase, which was replaced by 1.5 L/day of black tea (86 mg/day oxalate) during the 5-day test phase. Fractional and 24-h urines were obtained. The intake of black tea did not significantly alter 24-h urinary oxalate excretion. Urinary citrate, an important inhibitor of calcium stone formation, increased significantly, while the relative supersaturation of calcium oxalate, uric acid, and struvite remained unchanged. No significantly increased risk for kidney stone formation could be derived from the ingestion of black tea in normal subjects. Further research is needed to evaluate the impact of black tea consumption in kidney stone patients with intestinal hyperabsorption of oxalate.
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27
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Increased Water Viscosity Enhances Water Intake and Reduces Risk of Calcium Oxalate Stone Formation in Cats. Animals (Basel) 2021; 11:ani11072110. [PMID: 34359236 PMCID: PMC8300425 DOI: 10.3390/ani11072110] [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: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to determine if water with increased viscosity results in increased water intake, thus lowering the risk of urolithiasis in cats. Twelve healthy adult cats were fed pre-trial standard dry maintenance food for 1 week and then randomized into two groups for the study phase. The cats continued to receive the same food but were provided either control (deionized) water or viscous (1% methylcellulose) water for two months and then switched to the other water type for two months in a cross-over study design with repeated measures. Complete blood counts, serum chemistry profiles, and urinalysis were performed at the initiation of the study and again at 1, 2, 3, and 4 months. Daily water consumption and energy intake for each cat were recorded. Body weights were assessed weekly. Cats consuming 1% methylcellulose water with increased viscosity had increased water intake (p < 0.001; 25% and 21% higher at 28 and 56 days, respectively). Increased consumption of water resulted in lower urine specific gravity (p = 0.04), serum creatinine (p = 0.02), and blood urea nitrogen (p = 0.002) concentrations (without changing serum albumin, glucose, and calcium concentrations or serum osmolality) and decreased urine calcium concentration (p = 0.01) compared with cats consuming control water. In addition, the increased water intake increased (p = 0.05) resistance to oxalate crystal formation.
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28
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LITHOSCREEN: a comprehensive screening program and database for the assessment and treatment management of patients with kidney stones. Urolithiasis 2021; 49:387-397. [PMID: 34086105 DOI: 10.1007/s00240-021-01276-0] [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: 01/31/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
The aim of the LITHOSCREEN project was to construct a comprehensive screening program and database for recording and assessing the various risk factors for stone-formation in patients with urolithiasis. It is intended for use in Stone Clinics and is now being made available free of charge to researchers in the field who wish to maintain a comprehensive record of their patients' medical histories, demographic backgrounds, lifestyle activities, metabolic abnormalities, biochemical risk of forming stones of various types, diet histories, stone analysis and long-term treatment records. From the recorded data for each patient, the program automatically calculates numerous functions important in the understanding of the clinical and chemical risk factors for stone-formation, including the renal handling of the ions involved, various metabolic functions, the biochemical risk of forming kidney stones (PSF), the Tiselius Indices of the supersaturation of urine with respect to calcium oxalate and calcium phosphate, the projected effects of changing the composition of each patient's urinary composition on the risk of stone recurrence, and a program for analysing the diet of patients. It automatically produces one-page Summaries of each patient's biochemical and dietary records with abnormal values highlighted according to a "traffic-light" colour-coding system and generates charts designed to improve patient compliance with treatment in the form of colour-coded "Target Diagrams" showing (a) the patient's 24-h urine composition, (b) the patient's biochemical risk of forming stones of different types and (c) the composition of the patient's diet. The Summary pages and "Target Diagrams" are suitable for inclusion in the patient's Case Notes. LITHOSCREEN also produces charts projecting the effect of changing the composition of urine on the patient's biochemical risk of forming further stones. These graphs provide clues as to which urinary risk factors to target to reduce the patient's risk of stone recurrence.
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Berto S, Marangella M, De Stefano C, Milea D, Daniele PG. Critical Reappraisal of Methods for Measuring Urine Saturation with Calcium Salts. Molecules 2021; 26:molecules26113149. [PMID: 34070425 PMCID: PMC8197498 DOI: 10.3390/molecules26113149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Metabolic and physicochemical evaluation is recommended to manage the condition of patients with nephrolithiasis. The estimation of the saturation state (β values) is often included in the diagnostic work-up, and it is preferably performed through calculations. The free concentrations of constituent ions are estimated by considering the main ionic soluble complexes. It is contended that this approach is liable to an overestimation of β values because some complexes may be overlooked. A recent report found that β values could be significantly lowered upon the addition of new and so far neglected complexes, [Ca(PO4)Cit]4- and [Ca2H2(PO4)2]. The aim of this work was to assess whether these complexes can be relevant to explaining the chemistry of urine. Methods: The Ca-phosphate-citrate aqueous system was investigated by potentiometric titrations. The stability constants of the parent binary complexes [Cacit]- and [CaPO4]-, and the coordination tendency of PO43- toward [Ca(cit)]- to form the ternary complex, were estimated. βCaOx and βCaHPO4 were then calculated on 5 natural urines by chemical models, including or not including the [CaPO4]- and [Ca(PO4)cit]4- species. Results: Species distribution diagrams show that the [Ca(PO4)cit]4- species was only noticeable at pH > 8.5 and below 10% of the total calcium. β values estimated on natural urine were slightly lowered by the formation of [CaPO4]- species, whereas [Ca(PO4)cit]4- results were irrelevant. Conclusions: While [CaPO4]- species have an impact on saturation levels at higher pHs, the existence of ternary complex and of the dimer is rejected.
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Affiliation(s)
- Silvia Berto
- Dipartimento di Chimica, Università di Torino, via P. Giuria 7, 10125 Torino, Italy;
- Correspondence:
| | - Martino Marangella
- Fondazione Scientifica Mauriziana-Onlus, via Magellano 1, 10128 Torino, Italy;
| | - Concetta De Stefano
- Dipartimento di Scienze Chimiche, Biologiche, Farmaceutiche ed Ambientali, Università degli Studi di Messina, CHIBIOFARAM, Viale Ferdinando Stagno d’Alcontres 31, 98166 Messina, Italy; (C.D.S.); (D.M.)
| | - Demetrio Milea
- Dipartimento di Scienze Chimiche, Biologiche, Farmaceutiche ed Ambientali, Università degli Studi di Messina, CHIBIOFARAM, Viale Ferdinando Stagno d’Alcontres 31, 98166 Messina, Italy; (C.D.S.); (D.M.)
| | - Pier Giuseppe Daniele
- Dipartimento di Chimica, Università di Torino, via P. Giuria 7, 10125 Torino, Italy;
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30
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Calvó P, Costa-Bauzá A, Grases F, Hernandez Y, Sanchis P. Validation of a novel diagnostic test for assessing the risk of urinary uric acid crystallization. Clin Chim Acta 2021; 519:187-192. [PMID: 33964262 DOI: 10.1016/j.cca.2021.05.001] [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: 03/18/2021] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Uric acid (UA) kidney stones account for 10 to 11% of all kidney stones, and this percentage has increased over time. An accurate, rapid, simple, and low-cost test is needed to distinguish urine that is susceptible and resistant to the formation of UA crystals. The aim of this paper is to develop a test to assess the risk for UA crystallization (RUAC) and to validate its utility in routine clinical practice by analysis of urine samples of UA stone formers and healthy volunteers. PATIENTS AND METHODS Urine samples of 20 healthy adult volunteers and 54 active formers of UA stones were collected. Three samples were collected from each participant, with at least 7 days between each collection. The main lithogenic parameters for UA stones were determined, and an RUAC test was performed in all urine samples. RESULTS Our RUAC test reliably discriminated urine that was resistant and susceptible to the formation of UA crystals. This test had high specificity (94%) and a low percentage of false negatives. CONCLUSION The RUAC test described here had high diagnostic accuracy, low-cost, and a rapid assay time, that make this test an attractive screening tool for UA stone fomers follow-up.
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Affiliation(s)
- Paula Calvó
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Yumaira Hernandez
- Urology Service of Manacor Hospital, Manacor 07500, Balearic Islands, Spain.
| | - Pilar Sanchis
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
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31
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Krieger NS, Asplin J, Granja I, Chen L, Spataru D, Wu TT, Grynpas M, Bushinsky DA. Chlorthalidone with potassium citrate decreases calcium oxalate stones and increases bone quality in genetic hypercalciuric stone-forming rats. Kidney Int 2021; 99:1118-1126. [PMID: 33417997 PMCID: PMC8076055 DOI: 10.1016/j.kint.2020.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022]
Abstract
To study human idiopathic hypercalciuria we developed an animal model, genetic hypercalciuric stone-forming rats, whose pathophysiology parallels that of human idiopathic hypercalciuria. Fed the oxalate precursor, hydroxyproline, every rat in this model develops calcium oxalate stones. Using this rat model, we tested whether chlorthalidone and potassium citrate combined would reduce calcium oxalate stone formation and improve bone quality more than either agent alone. These rats (113 generation) were fed a normal calcium and phosphorus diet with hydroxyproline and divided into four groups: diets plus potassium chloride as control, potassium citrate, chlorthalidone plus potassium chloride, or potassium citrate plus chlorthalidone. Urine was collected at six, 12, and 18 weeks and kidney stone formation and bone parameters were determined. Compared to potassium chloride, potassium citrate reduced urinary calcium, chlorthalidone reduced it further and potassium citrate plus chlorthalidone even further. Potassium citrate plus chlorthalidone decreased urine oxalate compared to all other groups. There were no significant differences in calcium oxalate supersaturation in any group. Neither potassium citrate nor chlorthalidone altered stone formation. However, potassium citrate plus chlorthalidone significantly reduced stone formation. Vertebral trabecular bone increased with chlorthalidone and potassium citrate plus chlorthalidone. Cortical bone area increased with chlorthalidone but not potassium citrate or potassium citrate plus chlorthalidone. Mechanical properties of trabecular bone improved with chlorthalidone, but not with potassium citrate plus chlorthalidone. Thus in genetic hypercalciuric stone-forming rats fed a diet resulting in calcium oxalate stone formation, potassium citrate plus chlorthalidone prevented stone formation better than either agent alone. Chlorthalidone alone improved bone quality, but adding potassium citrate provided no additional benefit.
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Affiliation(s)
- Nancy S Krieger
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
| | - John Asplin
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois, USA
| | - Ignacio Granja
- Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois, USA
| | - Luojing Chen
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Daiana Spataru
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester School of Medicine, Rochester, New York, USA
| | - Marc Grynpas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - David A Bushinsky
- Division of Nephrology, Department of Medicine University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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32
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Prochaska M, Asplin J, Chapman A, Worcester E. Sex Differences of Kidney Stone Urine Risk Factors after Roux-en-Y Gastric Bypass. Am J Nephrol 2021; 52:173-176. [PMID: 33765680 DOI: 10.1159/000514455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure that is associated with higher risk of kidney stones after surgery. We examined urine composition in 18 men and women before and after RYGB to examine differences in kidney stone risk. METHODS Three 24-h urine collections were performed before and 1 year after RYGB. We analyzed mean urinary values for pre- and post-RYGB collections and compared men and women. RESULTS Seven men and eleven women completed pre- and post-RYGB urine collections. Pre-RYGB, men had higher calcium oxalate supersaturation (CaOx SS) (7.0 vs. 5.0, p = 0.04) compared with women. Post-RYGB, women had higher urine CaOx SS (13.1 vs. 4.6, p = 0.002), calcium phosphate supersaturation (1.04 vs. 0.59, p = 0.05), and lower urine volumes (1.7 vs. 2.7L, p < 0.001) compared with men. DISCUSSION/CONCLUSION There are important differences in urine composition by sex that may contribute to higher kidney stone risk in women after RYGB compared with men.
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Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - John Asplin
- Litholink, Laboratory Corporation of America Holdings, Itasca, Illinois, USA
| | - Arlene Chapman
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elaine Worcester
- Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
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Tran TVM, Li X, Adams-Huet B, Maalouf NM. Impact of age and renal function on urine chemistry in patients with calcium oxalate kidney stones. Urolithiasis 2021; 49:495-504. [PMID: 33582830 DOI: 10.1007/s00240-021-01254-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/30/2021] [Indexed: 12/22/2022]
Abstract
Nephrolithiasis is associated with an increased risk of chronic kidney disease, and its incidence varies with age. However, little is known on the combined impact of aging and declining renal function on urinary risk factors for calcium oxalate stone formation. A retrospective analysis was performed on 24-h urine collections from 993 calcium oxalate stone-forming patients. We first tested for interactions between age and creatinine clearance on various urinary determinants of calcium oxalate nephrolithiasis, and then examined their separate and combined effects in univariable and multivariable analyses adjusting for demographic and biochemical covariates. We identified significant interactions between age and creatinine clearance in predicting 24-h urine pH, calcium, and citrate. In view of the small number of stone formers with low creatinine clearance, we limited further regression analyses to patients with creatinine clearance ≥ 60 mL/min. In multivariable analyses, urine citrate, oxalate, and total volume were positively correlated with age, whereas urine pH, citrate, calcium, oxalate, total volume, and RSR of calcium oxalate all significantly decreased with lower creatinine clearance. A decrease in creatinine clearance from 120 to 60 mL/min was associated with clinically significant decreases in the daily excretion rate of citrate (by 188 mg/day), calcium (by 33 mg/day), and oxalate (by 4 mg/day), and in RSR calcium oxalate (by 1.84). Age and creatinine clearance are significant and independent predictors of several urinary determinants of calcium oxalate nephrolithiasis. The impacts of aging and declining renal function should be considered during the management of calcium oxalate stone-forming patients.
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Affiliation(s)
- Triet Vincent M Tran
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8885, USA
| | - Xilong Li
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8885, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Beverley Adams-Huet
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8885, USA.,Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-8885, USA. .,Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
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Singh P, Viehman JK, Mehta RA, Cogal AG, Hasadsri L, Oglesbee D, Olson JB, Seide BM, Sas DJ, Harris PC, Lieske JC, Milliner DS. Clinical characterization of primary hyperoxaluria type 3 in comparison to types 1 and 2: a retrospective cohort study. Nephrol Dial Transplant 2021; 37:869-875. [PMID: 33543760 DOI: 10.1093/ndt/gfab027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Primary hyperoxaluria type 3 (PH3) is caused by mutations in the HOGA1 gene. PH3 patients often present with recurrent urinary stone disease (USD) in first decade of life, but prior reports suggested PH3 may have a milder phenotype in adults. The current study characterized clinical manifestations of PH3 across the decades of life in comparison to PH1 and PH2. METHODS Clinical information was obtained from the Rare Kidney Stone Consortium Primary Hyperoxaluria Registry (PH1 n = 384; PH2 n = 51; PH3 n = 62). RESULTS PH3 patients presented with symptoms at a median 2.7 yrs old compared to PH1 (4.9 yrs) and PH2 (5.7 yrs) (p = 0.14). Nephrocalcinosis was present at diagnosis in 4 (7%) PH3 patients while 55 (89%) had stones. Median urine oxalate excretion was lowest in PH3 patients compared to PH1 and PH2 (1.1 vs 1.6 and 1.5 mmol/day/1.73m2, respectively, p < 0.001) while urine calcium was highest in PH3 (112 vs 51 and 98 mg/day/1.73m2 in PH1 and PH2, respectively, p < 0.001). Stone events per decade of life were similar across the age span and the 3 PH types. At 40 years of age, 97% of PH3 patients had not progressed to ESKD compared to 36% PH1 and 66% PH2 patients. CONCLUSIONS Patients with all forms of PH experience lifelong stone events often beginning in childhood. Kidney failure is common in PH1 but rare in PH3. Longer term follow up of larger cohorts will be important for a more complete understanding of the PH3 phenotype.
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Affiliation(s)
- Prince Singh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Jason K Viehman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrea G Cogal
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Linda Hasadsri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Devin Oglesbee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Julie B Olson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara M Seide
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - David J Sas
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn S Milliner
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
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35
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Effect of parathyroidectomy on renal stone recurrence. Urolithiasis 2021; 49:327-334. [PMID: 33420577 DOI: 10.1007/s00240-020-01239-x] [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: 10/04/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Parathyroidectomy (PTX) is routinely performed in hypercalciuric renal stone patients with primary hyperparathyroidism (PHPT). However, some data indicate a persistent stone activity following PTX, raising the issue of the link between PHPT and stone disease. We performed an observational study on 30 renal stone patients diagnosed with PHPT. Patients were selected among 1448 hypercalciuric patients referred in our department for a diagnostic evaluation. Patients with no parathyroid surgery or any biological follow-up were excluded. Clinical and biological data (including 24-h urine collection and a calcium load test) were collected before and within 12 months following surgery. Stone recurrence was evaluated by direct phone contact (median 43 months). Comparison of biological data before and after surgery showed a significant decrease of ionized calcium and serum parathyroid hormone after PTX. All stones contained calcium-dependent species such as carbapatite, brushite or dihydrate calcium oxalate. Urine saturation indexes and calciuria significantly decreased after surgery (from 9.9 to 5.9 mmol/d, p < 0.0001), but a persistent hypercalciuria was detected in 47% of patients. The other stone risk factors including diuresis stayed similar. Stone activity that was increasing (from 0.20-0.30 to 0.50-0.75/year) the 2 years before PTX, significantly decreased after surgery [0.05-0.15/year (p < 0.001)]. PTX in calcium-dependent renal stone formers with PHPT significantly decreases both stone recurrence and urine saturation indexes. However, PTX unmasked an underlying renal stone disease related to idiopathic hypercalciuria in half of patients with a remaining stone activity, testifying the need for patient's follow-up to prevent stone recurrence.
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36
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Prochaska M, Worcester E. Risk Factors for Kidney Stone Formation following Bariatric Surgery. ACTA ACUST UNITED AC 2020; 1:1456-1461. [PMID: 34085046 DOI: 10.34067/kid.0004982020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
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Affiliation(s)
- Megan Prochaska
- Section of Nephrology, University of Chicago, Chicago, Illinois
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37
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D'Costa MR, Kausz AT, Carroll KJ, Ingimarsson JP, Enders FT, Mara KC, Mehta RA, Lieske JC. Subsequent urinary stone events are predicted by the magnitude of urinary oxalate excretion in enteric hyperoxaluria. Nephrol Dial Transplant 2020; 36:2208-2215. [PMID: 33367720 DOI: 10.1093/ndt/gfaa281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/12/2022] Open
Abstract
Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. Therefore, we assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. Mean ± standard deviation age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had one or more stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. Thus, these data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group. BACKGROUND Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. METHODS We assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. RESULTS Mean ± SD age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had ≥1 stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. CONCLUSIONS These data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group.
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Affiliation(s)
- Matthew R D'Costa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,USA
| | | | | | | | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,USA
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Marangella M, Petrarulo M, Vitale C, Daniele P, Sammartano S. LITHORISK.COM: the novel version of a software for calculating and visualizing the risk of renal stone. Urolithiasis 2020; 49:211-217. [PMID: 33245396 PMCID: PMC8113166 DOI: 10.1007/s00240-020-01228-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
Estimation of state of saturation with stone-forming salt represents a reliable tool to assess the overall risk. The available methods are based on computer-assisted ab initio calculations. Our earlier method URSUS was subsequently substituted by Lithorisk®, a software including visualization of risk profiles. Unfortunately, Lithorisk does not adapt to new versions of Windows® and Macintosh® Apple, neither runs on smartphones or tablets. We propose a novel version of the software which can be directly used online on any device equipped by different operating systems. Upon online connection and after registration, the software is ready for unlimited accesses, in either Italian, English or French. After digiting input variables (urea and creatinine also included) in a fixed dashboard, state of saturation is promptly given. In addition to state of saturation (ß) with calcium oxalate, brushite and uric acid, ß struvite and cystine are available. Both input variables and ß results are graphically depicted as green or red horizontal bars to indicate recommended values. The software was implemented with equations allowing to omit sulphate and ammonium excretion for users with difficult access to these measurements. This simplified version, tested for ßCaOx and ßBsh on 100 urine samples showed close correlation with the full version. The software gives a list of total and free concentrations and soluble complex species distribution. Results can be printed or saved as PDF. So, we propose an easily accessible software to estimate state of saturation usable on any operating system and personal device.
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Affiliation(s)
| | | | - Corrado Vitale
- Nephrology and Dialysis Unit, Mauriziano Hospital, Turin, Italy
| | | | - Silvio Sammartano
- Department of Inorganic Analytical and Physical Chemistry, Messina, Italy
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Rodriguez A, Cunha TDS, Rodgers AL, Gambaro G, Ferraro PM. Comparison of Supersaturation Outputs from Different Programs and Their Application in Testing Correspondence with Kidney Stone Composition. J Endourol 2020; 35:687-694. [PMID: 33050741 DOI: 10.1089/end.2020.0894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Relative supersaturation (SS) for calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA) has been used for assessing urinary crystallization and estimated by programs, including EQUIL, Joint Expert Speciation System (JESS), and Lithorisk. We compared outputs from these programs and their correspondence with stone composition. Materials and Methods: SS of CaOx, CaP, and UA, using EQUIL, JESS, and Lithorisk were calculated from stone-forming patients. Pearson correlation coefficients were used to ascertain the correspondence between the outputs. Fractional regression models evaluated the relationship between SS and the percentage of each compound in the stones. Results: Two hundred eleven patients were included. Pearson correlation coefficients for CaOx (r ≥ 0.96), CaP (r ≥ 0.99), and UA SS (r ≥ 0.99) showed a high correspondence between all programs. We observed a significant correspondence between CaOx SS and the percentage of CaOx dihydrate in the stone (p < 0.001), as well as between the percentage of brushite and apatite and CaP SS. UA SS showed the strongest correspondence with the percentage of UA in the stones (p < 0.001). Conclusions: Good correlation between EQUIL, JESS, and Lithorisk was observed and good correspondence with stone composition. The magnitude of the association demonstrated by fractional regression models supports evidence for applying SS in clinical practice.
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Affiliation(s)
- Adrián Rodriguez
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Tamara da Silva Cunha
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allen L Rodgers
- Division of Chemistry, University of Cape Town, Cape Town, South Africa
| | - Giovanni Gambaro
- Renal Unit, Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
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40
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Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis 2020; 49:1-16. [PMID: 33048172 PMCID: PMC7867533 DOI: 10.1007/s00240-020-01217-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023]
Abstract
The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.
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Tefft KM, Byron JK, Hostnik ET, Daristotle L, Carmella V, Frantz NZ. Effect of a struvite dissolution diet in cats with naturally occurring struvite urolithiasis. J Feline Med Surg 2020; 23:269-277. [PMID: 32705911 PMCID: PMC8008402 DOI: 10.1177/1098612x20942382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the study was to determine the efficacy of the low struvite relative supersaturation diet in dissolution of feline struvite cystoliths. METHODS This was a prospective, open-label, two-center study. Twelve client-owned cats were enrolled based on the radiographic appearance of their uroliths and urinalysis parameters. Cats were fed the test diet exclusively for up to 56 days. Cats were radiographed every other week until radiographic evidence of dissolution occurred or the end of the study period was reached. Cats with radiographically apparent uroliths at the end of the study period underwent cystotomy for stone retrieval and analysis. RESULTS Nine of the 12 cats completed the study. Eight experienced radiographic dissolution; seven of these had complete dissolution within the first month of treatment. One cat, whose owner declined cystotomy after partial dissolution at day 56, had complete radiographic resolution at 70 days of treatment. Two calcium oxalate urolith cores were removed from a cat that had partial radiographic dissolution. CONCLUSIONS AND RELEVANCE The test diet was successful in dissolving suspected struvite cystoliths. As this diet is suitable for maintenance feeding of adult cats, it may be a suitable choice for long-term prevention of feline struvite urolithiasis.
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Affiliation(s)
- Karen M Tefft
- Department of Clinical Sciences, North Carolina State University, Raleigh, NC, USA
| | - Julie K Byron
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
| | - Eric T Hostnik
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, USA
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42
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Zisman AL, Coe FL, Cohen AJ, Riedinger CB, Worcester EM. Racial Differences in Risk Factors for Kidney Stone Formation. Clin J Am Soc Nephrol 2020; 15:1166-1173. [PMID: 32561654 PMCID: PMC7409744 DOI: 10.2215/cjn.12671019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/15/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Incidence of kidney stone disease is rising. It is not known whether mechanisms of stone formation differ across racial groups. Our objective was to identify differing lithogenic risk factors across racial groups in idiopathic nephrolithiasis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a retrospective cohort study evaluating metabolic risk factors in black and age-matched white idiopathic stone formers at our tertiary referral center. We compared serum and urine metabolic risk factors pre- and post-treatment across racial groups using analysis of covariance. Generalized linear modeling was used to build regression models for risk of stone formation in both groups. RESULTS Among 117 black and 172 white stone formers, urine volume was lower in black stone formers (1.4±0.8 versus 2.0±0.8 L/d, P<0.001). Urine calcium was lower in black stone formers (116±70 versus 217±115 mg/d, P<0.001). Supersaturations for calcium oxalate were similar among the groups, whereas calcium phosphate supersaturation was higher in white stone formers, and uric acid supersaturation was higher in black stone formers. Electrolyte free water clearance was significantly lower in black stone formers (207±780 versus 435±759 ml/d, P=0.02). In the subgroup of 77 black patients and 107 white patients with post-treatment evaluations, urine volume rose significantly and similarly in both groups. Urine sodium was unchanged in whites but increased in blacks by 40 mmol/d (95% confidence interval, 32 to 48 mmol/d). Electrolyte free water clearance remained lower in black stone formers (385±891 versus 706±893 ml/d, P=0.02). Post-treatment supersaturations were similar across the groups except for calcium phosphate, which improved with treatment in whites. CONCLUSIONS Black stone formers have lower 24-hour urine calcium excretion and urine volume. Increases in urine volume with treatment were associated with increased solute, but not free water, excretion in black stone formers.
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Affiliation(s)
- Anna L Zisman
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
| | - Fredric L Coe
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
| | - Andrew J Cohen
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland
| | | | - Elaine M Worcester
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois
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43
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Bargagli M, Dhayat NA, Anderegg M, Semmo M, Huynh-Do U, Vogt B, Ferraro PM, Fuster DG. Urinary Lithogenic Risk Profile in ADPKD Patients Treated with Tolvaptan. Clin J Am Soc Nephrol 2020; 15:1007-1014. [PMID: 32527945 PMCID: PMC7341771 DOI: 10.2215/cjn.13861119] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Nephrolithiasis is a common health problem in autosomal dominant polycystic kidney disease (ADPKD) and significantly contributes to patient morbidity. Recently, Tolvaptan has been introduced for the treatment of ADPKD, but whether it is associated with alterations of the urinary lithogenic risk profile remains unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted an analysis of participants enrolled in the Bern ADPKD registry, a prospective observational cohort study. Twenty-four-hour urine analyses were performed at baseline and then at yearly follow-ups. Relative supersaturation ratios for calcium oxalate, brushite, and uric acid were calculated with the program EQUIL2. Unadjusted and multivariable mixed-effects linear regression models, adjusted for age, sex, body mass index, eGFR, net acid excretion, and height-adjusted total kidney volume, were used to assess the association of Tolvaptan with urinary parameters relevant for kidney stone formation. The maximum individual follow-up time was 3 years, median follow-up time 1.9 years, and cumulative follow-up time 169 years. RESULTS In total, 125 participants (38 with and 87 without Tolvaptan treatment) were included in the analysis. In multivariable analysis, Tolvaptan treatment was associated [adjusted estimate of the difference between Tolvaptan and no Tolvaptan; 95% confidence interval (CI)] with lower urine relative supersaturation ratios for calcium oxalate (-0.56; 95% CI, -0.82 to -0.3; P<0.001), brushite (-0.33; 95% CI, -0.54 to -0.11; P=0.004), and uric acid (-0.62; 95% CI, -0.88 to -0.37; P<0.001), and with higher urine citrate in mmol/mmol creatinine per day (0.25; 95% CI, 0.05 to 0.46; P=0.02) and calcium in mmol/mmol creatinine per day (0.31; 95% CI, 0.09 to 0.53; P=0.006) excretion. In addition, Tolvaptan treatment was associated with lower net acid excretion in mEq/mmol creatinine per day (-0.54; 95% CI, -0.90 to -0.17; P=0.004) and higher net gastrointestinal alkali absorption in mEq/mmol creatinine per day (0.57; 95% CI, 0.26 to 0.88; P<0.001). CONCLUSIONS Tolvaptan treatment is associated with a significantly improved urinary lithogenic risk profile in patients with ADPKD.
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Affiliation(s)
- Matteo Bargagli
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nasser A Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuel Anderegg
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mariam Semmo
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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44
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Sromicki J, Hess B. Simple dietary advice targeting five urinary parameters reduces urinary supersaturation in idiopathic calcium oxalate stone formers. Urolithiasis 2020; 48:425-433. [PMID: 32524204 PMCID: PMC7495994 DOI: 10.1007/s00240-020-01194-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Abstract
Among 208 kidney stone patients referred within 2 years, 75 patients (66 men, nine women) with truly idiopathic calcium oxalate stones (ICSF) were recruited. Dietary advice (DA) aimed at (1) urine dilution, (2) reduced crystallization promotion (lowering oxalate), and (3) increased crystallization inhibition (increasing citrate). We recommended higher intakes of fluid and calcium with meals/snacks (reducing intestinal oxalate absorption) as well as increased alkali and reduced meat protein (acid) for increasing urinary citrate. The intended effects of DA were elevations in urine volume, calcium (U-Ca) and citrate (U-Cit) as well as reductions in oxalate (U-Ox) and uric acid (U-UA). We retrospectively calculated an adherence score (AS), awarding + 1 point for parameters altered in the intended direction and − 1 point for opposite changes. Calcium oxalate supersaturation (CaOx-SS) was calculated using Tiselius’ AP(CaOx) index EQ. DA induced changes (all p < 0.0001) in urine volume (2057 ± 79 vs. 2573 ± 71 ml/day) and U-Ca (5.49 ± 0.24 vs. 7.98 ± 0.38 mmol/day) as well as in U-Ox (0.34 ± 0.01 vs. 0.26 ± 0.01 mmol/day) and U-UA (3.48 ± 0.12 vs. 3.13 ± 0.10 mmol/day). U-Cit only tendentially increased (3.07 ± 0.17 vs. 3.36 ± 0.23 mmol/day, p = 0.06). DA induced a 21.5% drop in AP(CaOx) index, from 0.93 ± 0.05 to 0.73 ± 0.05 (p = 0.0005). Decreases in CaOx-SS correlated with AS (R = 0.448, p < 0.0005), and highest AS (+ 5) always indicated lowering of CaOx-SS. Thus, simple DA can reduce CaOx-SS which may be monitored by AS.
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Affiliation(s)
- Juri Sromicki
- Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park and University of Zurich, Bellariastrasse 38, CH-8038, Zurich, Switzerland
- Department of Cardiac, Vascular and Thoracic Surgery, University Hospital, CH-8091, Zurich, Switzerland
| | - Bernhard Hess
- Internal Medicine and Nephrology, Kidney Stone Center Zurich, Klinik Im Park and University of Zurich, Bellariastrasse 38, CH-8038, Zurich, Switzerland.
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45
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Wang X, Bhutani G, Vaughan LE, Enders FT, Haskic Z, Milliner D, Lieske JC. Urinary monocyte chemoattractant protein 1 associated with calcium oxalate crystallization in patients with primary hyperoxaluria. BMC Nephrol 2020; 21:133. [PMID: 32293313 PMCID: PMC7161151 DOI: 10.1186/s12882-020-01783-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/23/2020] [Indexed: 01/18/2023] Open
Abstract
Background Patients with primary hyperoxaluria (PH) often develop kidney stones and chronic kidney disease. Noninvasive urine markers reflective of active kidney injury could be useful to gauge the effectiveness of ongoing treatments. Methods A panel of biomarkers that reflect different nephron sites and potential mechanisms of injury (clusterin, neutrophil gelatinase-associated lipocalin (NGAL), 8-isoprostane (8IP), monocyte-chemoattractant protein 1(MCP-1), liver-type fatty acid binding protein (L-FABP), heart-type fatty acid binding protein (H-FABP), and osteopontin (OPN)) were measured in 114 urine specimens from 30 PH patients over multiple visits. Generalized estimating equations were used to assess associations between biomarkers and 24 h urine excretions, calculated proximal tubular oxalate concentration (PTOx), and eGFR. Results Mean (±SD) age at first visit was 19.5 ± 16.6 years with an estimated glomerular filtration rate (eGFR) of 68.4 ± 21.0 ml/min/1.73m2. After adjustment for age, sex, and eGFR, a higher urine MCP-1 concentration and MCP-1/creatinine ratio was positively associated with CaOx supersaturation (SS). Higher urine NGAL and NGAL/creatinine as well as OPN and OPN/creatinine were associated with higher eGFR. 8IP was negatively associated with PTOx and urinary Ox, but positively associated with CaOx SS. Conclusion In PH patients greater urine MCP-1 and 8IP excretion might reflect ongoing collecting tubule crystallization, while greater NGAL and OPN excretion may reflect preservation of kidney mass and function. CaOx crystals, rather than oxalate ion may mediate oxidative stress in hyperoxaluric conditions. Further studies are warranted to determine whether urine MCP-1 excretion predicts long term outcome or is altered in response to treatment.
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Affiliation(s)
- Xiangling Wang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gauri Bhutani
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Zejfa Haskic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Dawn Milliner
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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46
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Milliner DS, McGregor TL, Thompson A, Dehmel B, Knight J, Rosskamp R, Blank M, Yang S, Fargue S, Rumsby G, Groothoff J, Allain M, West M, Hollander K, Lowther WT, Lieske JC. End Points for Clinical Trials in Primary Hyperoxaluria. Clin J Am Soc Nephrol 2020; 15:1056-1065. [PMID: 32165440 PMCID: PMC7341772 DOI: 10.2215/cjn.13821119] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patients with primary hyperoxaluria experience kidney stones from a young age and can develop progressive oxalate nephropathy. Progression to kidney failure often develops over a number of years, and is associated with systemic oxalosis, intensive dialysis, and often combined kidney and liver transplantation. There are no therapies approved by the Food and Drug Association. Thus, the Kidney Health Initiative, in partnership with the Oxalosis and Hyperoxaluria Foundation, initiated a project to identify end points for clinical trials. A workgroup of physicians, scientists, patients with primary hyperoxaluria, industry, and United States regulators critically examined the published literature for clinical outcomes and potential surrogate end points that could be used to evaluate new treatments. Kidney stones, change in eGFR, urine oxalate, and plasma oxalate were the strongest candidate end points. Kidney stones affect how patients with primary hyperoxaluria feel and function, but standards for measurement and monitoring are lacking. Primary hyperoxaluria registry data suggest that eGFR decline in most patients is gradual, but can be unpredictable. Epidemiologic data show a strong relationship between urine oxalate and long-term kidney function loss. Urine oxalate is reasonably likely to predict clinical benefit, due to its causal role in stone formation and kidney damage in CKD stages 1-3a, and plasma oxalate is likely associated with risk of systemic oxalosis in CKD 3b-5. Change in slope of eGFR could be considered the equivalent of a clinically meaningful end point in support of traditional approval. A substantial change in urine oxalate as a surrogate end point could support traditional approval in patients with primary hyperoxaluria type 1 and CKD stages 1-3a. A substantial change in markedly elevated plasma oxalate could support accelerated approval in patients with primary hyperoxaluria and CKD stages 3b-5. Primary hyperoxaluria type 1 accounts for the preponderance of available data, thus heavily influences the conclusions. Addressing gaps in data will further facilitate testing of promising new treatments, accelerating improved outcomes for patients with primary hyperoxaluria.
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Affiliation(s)
| | | | - Aliza Thompson
- Division of Cardiovascular and Renal Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | | | - John Knight
- Department of Urology, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Melanie Blank
- Division of Cardiovascular and Renal Products, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Sixun Yang
- Division of Vaccines and Related Products Applications, Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland
| | - Sonia Fargue
- Department of Urology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Gill Rumsby
- University College London Hospitals, London, United Kingdom
| | - Jaap Groothoff
- Department of Pediatric Nephrology, University of Amsterdam Medical Center, Amsterdam, Netherlands
| | | | | | - Kim Hollander
- Oxalosis and Hyperoxaluria Foundation, New Paltz, New York
| | - W Todd Lowther
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John C Lieske
- Division of Nephrology, Mayo Clinic, Rochester, Minnesota
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47
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Rimer JD, Sakhaee K, Maalouf NM. Citrate therapy for calcium phosphate stones. Curr Opin Nephrol Hypertens 2020; 28:130-139. [PMID: 30531474 DOI: 10.1097/mnh.0000000000000474] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Calcium phosphate (CaP) stones represent an increasingly encountered form of recurrent nephrolithiasis, but current prophylactic medical regimens are suboptimal. Although hypocitraturia is a well-described risk factor for CaP stones, strategies that enhance citrate excretion have not consistently been effective at reducing CaP saturation and stone recurrence. This review summarizes the role of citrate therapy in CaP nephrolithiasis. RECENT FINDINGS Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate-calcium complexes, and inhibition of CaP nucleation, crystal growth and crystal aggregation. Recent in-vitro studies demonstrate that citrate delays CaP crystal growth through distinct inhibitory mechanisms that depend on supersaturation and citrate concentration. The impact of pharmacological provision of citrate on CaP saturation depends on the accompanying cation: Potassium citrate imparts a significant alkali load that enhances citraturia and reduces calciuria, but could worsen urine pH elevation. Conversely, citric acid administration results in minimal citraturia and alteration in CaP saturation. SUMMARY Citrate, starting at very low urinary concentrations, can significantly retard CaP crystal growth in vitro through diverse mechanisms. Clinically, the net impact on CaP stone formation of providing an alkali load during pharmacological delivery of citrate into the urinary environment remains to be determined.
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Affiliation(s)
- Jeffrey D Rimer
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, Texas
| | - Khashayar Sakhaee
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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48
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Ware EB, Smith JA, Zhao W, Ganesvoort RT, Curhan GC, Pollak M, Mount DB, Turner ST, Chen G, Shah RJ, Kardia SL, Lieske JC. Genome-wide Association Study of 24-Hour Urinary Excretion of Calcium, Magnesium, and Uric Acid. Mayo Clin Proc Innov Qual Outcomes 2019; 3:448-460. [PMID: 31993563 PMCID: PMC6978610 DOI: 10.1016/j.mayocpiqo.2019.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives The urinary excretion of organic and inorganic substances and their concentrations have attracted extensive attention for their role in the pathogenesis of urinary stone disease. The urinary excretion of specific factors associates with sex and age and seems to have a hereditary component, but the precise genomic determinants remain ill-defined. Methods Genome-wide association studies previously conducted in 3 cohorts (Genetic Epidemiology Network of Arteriopathy study, January 1, 2006, through December 31, 2012; the combined Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study, January 1, 1994, through December 31, 2003; and the Prevention of Renal and Vascular End-stage Disease study, January 1, 1997, through December 31, 1998) were combined into meta-analyses to evaluate genetic associations with available urinary phenotypes relevant to stone pathogenesis (calcium, magnesium, and uric acid excretion; total urine volume). Results One region on chromosome 9q21.13 showed strong evidence of an association with urinary magnesium excretion. The strongest signal in this region was near TRPM6, whose protein product mediates magnesium transport in the colon and kidney, and C9orf40, C9orf41, NMRK1, and OSTF1 (rs1176815; P=1.70×10–14, with each copy of the A allele corresponding to a daily 5.29-mg decrease in magnesium excretion). The single nucleotide polymorphism (SNP) that achieved genome-wide significance for calcium excretion (rs17216707 on chromosome 20; P=1.12×10–8) was previously associated with fibroblast growth factor 23 levels, which regulate phosphorus and vitamin D metabolism. Urine volume and uric acid excretion did not have any genome-wide significant SNPs. Conclusion Common variants near genes important for magnesium metabolism and bone health associate with urinary magnesium and calcium excretion.
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Key Words
- BMI, body mass index
- CKD, chronic kidney disease
- FGF23, fibroblast growth factor 23
- GDUL, Genetic Determinants of Urinary Lithogenicity
- GENOA, Genetic Epidemiology Network of Arteriopathy
- GWAS, Genome-wide association study
- HPFS, Health Professionals Follow-up Study
- NHS, Nurses’ Health Study
- PREVEND, Prevention of Renal and Vascular End-stage Disease
- QQ, quantile-quantile
- SNP, single nucleotide polymorphism
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Affiliation(s)
- Erin B. Ware
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Jennifer A. Smith
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Ron T. Ganesvoort
- Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Gary C. Curhan
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Martin Pollak
- Renal Division, Beth Israel Deaconess Medical Center, Boston, MA
| | - David B. Mount
- Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
- Renal Division, Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Stephen T. Turner
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Guotao Chen
- Department of Nephrology, The People’s Hospital of Bishan District, Chongqing City, China
| | - Ronak Jagdeep Shah
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sharon L.R. Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - John C. Lieske
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Correspondence: Address to John C. Lieske, MD, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905.
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49
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Idiopathic calcium nephrolithiasis with pure calcium oxalate composition: clinical correlates of the calcium oxalate dihydrate/monohydrate (COD/COM) stone ratio. Urolithiasis 2019; 48:271-279. [PMID: 31506762 DOI: 10.1007/s00240-019-01156-8] [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: 04/05/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
Pure calcium oxalate is the most frequent type of idiopathic kidney stone composition. Fourier transform infrared spectroscopy (FT-IR) allows to detect the ratio of calcium oxalate dihydrate (COD) and monohydrate (COM) crystals in stones, but the clinical significance of this parameter remains uncertain. The objective of this observational study was to verify the association of clinical and laboratory parameters of kidney stone disease with COD/COM ratio in a group of 465 (322 M, age 46 ± 14) patients suffering from idiopathic calcium nephrolithiasis with pure calcium oxalate stones (≥ 97%). Each participant underwent a complete clinical examination, serum chemistry, 24-h urine collection for the determination of the profile of lithogenic risk, and had stones analyzed by FT-IR. Most (62%) of the stones had a COD/COM ratio ≤ 0.25, and the urine chemistry of the corresponding patients showed a low prevalence of urinary metabolic abnormalities. With increasing COD/COM ratio intervals (0-0.25, 0.26-0.50, 0.51-0.75, 0.76-1), a significant association was observed for the number of urological procedures, serum calcium, 24-h urinary calcium excretion, prevalence of hypercalciuria and relative calcium oxalate supersaturation, and a negative trend was detected for the age of the first stone episode (all p values < 0.05). A linear regression model showed that the only parameters significantly associated with COD/COM ratio were 24-h urinary calcium excretion (standardized β = 0.464, p < 0.001) and urine pH (standardized β = 0.103, p = 0.013). In pure calcium oxalate idiopathic stones, COD/COM ratio may reflect the presence of urinary metabolic risk factors, and represent a guide for the prescription of urinary analyses.
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50
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D'Costa MR, Haley WE, Mara KC, Enders FT, Vrtiska TJ, Pais VM, Jacobsen SJ, McCollough CH, Lieske JC, Rule AD. Symptomatic and Radiographic Manifestations of Kidney Stone Recurrence and Their Prediction by Risk Factors: A Prospective Cohort Study. J Am Soc Nephrol 2019; 30:1251-1260. [PMID: 31175141 DOI: 10.1681/asn.2018121241] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Meaningful interpretation of changes in radiographic kidney stone burden requires understanding how radiographic recurrence relates to symptomatic recurrence and how established risk factors predict these different manifestations of recurrence. METHODS We recruited first-time symptomatic stone formers from the general community in Minnesota and Florida. Baseline and 5-year follow-up study visits included computed tomography scans, surveys, and medical record review. We noted symptomatic recurrence detected by clinical care (through chart review) or self-report, and radiographic recurrence of any new stone, stone growth, or stone passage (comparing baseline and follow-up scans). To assess the prediction of different manifestations of recurrence, we used the Recurrence of Kidney Stone (ROKS) score, which sums multiple baseline risk factors. RESULTS Among 175 stone formers, 19% had symptomatic recurrence detected by clinical care and 25% detected by self-report; radiographic recurrence manifested as a new stone in 35%, stone growth in 24%, and stone passage in 27%. Among those with a baseline asymptomatic stone (54%), at 5 years, 51% had radiographic evidence of stone passage (accompanied by symptoms in only 52%). Imaging evidence of a new stone or stone passage more strongly associated with symptomatic recurrence detected by clinical care than by self-report. The ROKS score weakly predicted one manifestation-symptomatic recurrence resulting in clinical care (c-statistic, 0.63; 95% confidence interval, 0.52 to 0.73)-but strongly predicted any manifestation of symptomatic or radiographic recurrence (5-year rate, 67%; c-statistic, 0.79; 95% confidence interval, 0.72 to 0.86). CONCLUSIONS Recurrence after the first stone episode is both more common and more predictable when all manifestations of recurrence (symptomatic and radiographic) are considered.
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Affiliation(s)
| | | | | | | | | | - Vernon M Pais
- Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
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