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Grases F, Tomàs Nadal F, Julià Florit F, Costa-Bauza A. Cystine Renal Calculi: New Aspects Related to Their Formation and Development. J Clin Med 2024; 13:2837. [PMID: 38792383 PMCID: PMC11122214 DOI: 10.3390/jcm13102837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Crystallization experiments of renal-calculi-forming compounds (calcium oxalate, calcium phosphates, uric acid) are normally performed by monitoring these processes during periods of time similar to the residence of urine inside the kidney. Nevertheless, cystine requires high supersaturation for its crystallization, and most experiments last for longer periods. It must be considered that at high supersaturation, the inhibitors of crystalline development have poor effects. Methods: The induction time of crystallization (ti) of cystine in experimental conditions similar to those of the formation of cystine renal calculi and the effect of different cystine-binding thiol agents was determined through turbidimetric measurements. We also studied the macro- and microstructure of 30 cystine kidney stones through stereoscopic microscopy and scanning electron microscopy. Results: Under the studied conditions, the ti in absence of crystallization inhibitors was 15 min, and the presence of 9 mM of penicillamine, tiopronin, or N-acetylcysteine totally inhibited crystallization, as their effects relate to the formation of complexes with cystine, although N-acetylcysteine also delayed cystine crystalline development and modified cystine crystal morphology. Cystine stones have traditionally been classified as smooth and rough. The study of their structure shows that all of them begin their formation from a few crystals that generate a compact radial structure. Their subsequent growth, depending on the renal cavity where they are located, gives rise to the rough structure in the form of large blocks of cystine crystals or the smooth structure with small crystals. Conclusions: To prevent the development of cystine renal stones, the formation of small crystals must be avoided by reducing urinary cystine supersaturation, with N-acetylcysteine being the most effective among the studied cystine-binding thiol agents. Also, the removal of cystine crystals through increased water intake and physical activity can be a very important preventive measure.
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Affiliation(s)
| | | | | | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain; (F.G.); (F.T.N.); (F.J.F.)
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Prot-Bertoye C, Jung V, Tostivint I, Roger K, Benoist JF, Jannot AS, Van Straaten A, Knebelmann B, Guerrera IC, Courbebaisse M. Effect of urine alkalization on urinary inflammatory markers in cystinuric patients. Clin Kidney J 2024; 17:sfae040. [PMID: 38510798 PMCID: PMC10953617 DOI: 10.1093/ckj/sfae040] [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: 11/22/2023] [Indexed: 03/22/2024] Open
Abstract
Background Cystinuria is associated with a high prevalence of chronic kidney disease (CKD). We previously described a urinary inflammatory-protein signature (UIS), including 38 upregulated proteins, in cystinuric patients (Cys-patients), compared with healthy controls (HC). This UIS was higher in Cys-patients with CKD. In the present observational study, we aimed to investigate the UIS in Cys-patients without CKD and patients with calcium nephrolithiasis (Lith-patients), versus HC and the effect of urine alkalization on the UIS of Cys-patients. Methods UIS was evaluated by nano-liquid chromatography coupled to high-resolution mass spectrometry in adult HC, Lith-patients and non-treated Cys-patients with an estimated glomerular filtration rate >60 mL/min/1.73 m2, and after a 3-month conventional alkalizing treatment in Cys-patients. Results Twenty-one Cys-patients [12 men, median age (interquartile range) 30.0 (25.0-44.0) years], 12 Lith-patients [8 men, 46.2 (39.5-54.2) years] and 7 HC [2 men, 43.1 (31.0-53.9) years] were included. Among the 38 proteins upregulated in our previous work, 11 proteins were also upregulated in Cys-patients compared with HC in this study (5 circulating inflammatory proteins and 6 neutrophil-derived proteins). This UIS was also found in some Lith-patients. Using this UIS, we identified two subclusters of Cys-patients (5 with a very high/high UIS and 16 with a moderate/low UIS). In the Cys-patients with very high/high UIS, urine alkalization induced a significant decrease in urinary neutrophil-derived proteins. Conclusion A high UIS is present in some Cys-patients without CKD and decreases under alkalizing treatment. This UIS could be a prognostic marker to predict the evolution towards CKD in cystinuria.
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Affiliation(s)
- Caroline Prot-Bertoye
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie – Explorations fonctionnelles, Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, Paris, France
- CNRS ERL 8228 – Laboratoire de Physiologie Rénale et Tubulopathies, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
| | - Vincent Jung
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Isabelle Tostivint
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié Salpêtrière, Service de Néphrologie, Paris, France
- GRC 20 ARDELURO groupe de recherche clinique Analyse, Recherche, Développement et Evaluation en Endourologie et Lithiase Urinaire, Médecine Sorbonne Université, Paris, France
| | - Kevin Roger
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Jean-François Benoist
- Faculté de pharmacie, Université Paris Saclay, Orsay, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service de Biochimie métabolique, Paris, France
| | - Anne-Sophie Jannot
- Assistance Publique-Hôpitaux de Paris – Centre, Université Paris Cité, Hôpital Européen Georges Pompidou, Service d'informatique Médicale, Santé Publique et Biostatistiques, Paris, France. HeKA, Centre de recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Alexis Van Straaten
- Assistance Publique-Hôpitaux de Paris – Centre, Université Paris Cité, Hôpital Européen Georges Pompidou, Service d'informatique Médicale, Santé Publique et Biostatistiques, Paris, France. HeKA, Centre de recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Bertrand Knebelmann
- Faculté de médecine, Université Paris Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Service de Néphrologie, Paris, France
- INEM Unité Inserm U1151, Paris, France
| | - Ida Chiara Guerrera
- Proteomics Platform Necker, Université Paris Cité – Structure Fédérative de Recherche Necker, INSERM US24/CNRS UAR3633, Paris, France
| | - Marie Courbebaisse
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service de Physiologie – Explorations fonctionnelles, Paris, France
- Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte (MARHEA), Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Paris, France
- Association LUNNE Lithiases UriNaires Network, Paris, France
- Faculté de médecine, Université Paris Cité, Paris, France
- INEM Unité Inserm U1151, Paris, France
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Bhatt NP, Deshpande AV, Starkey MR. Pharmacological interventions for the management of cystinuria: a systematic review. J Nephrol 2024; 37:293-308. [PMID: 37957454 PMCID: PMC11043141 DOI: 10.1007/s40620-023-01795-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/26/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Cystinuria is a rare genetic kidney stone disease, with no cure. Current treatments involve lowering urinary cystine levels and increasing cystine solubility. This systematic review evaluates the available literature regarding non-surgical interventions for cystinuria. METHODS Key electronic databases were searched for studies that described the clinical management of cystinuria with high diuresis, alkalinizing agents and thiol-based drugs that were published between 2000 and 2022. Observational studies were included if they contained clinical investigation with at least one previous or current episode of cystine stones, urine cystine levels > 250 mg/L and patients being managed with urinary dilution, alkalinizing agents or other pharmacological agents. All included studies were assessed for study design, patient characteristics and outcomes. A qualitative and critical analysis was performed whereby study quality was assessed using Methodological Index for Non-Randomized Studies (MINORS). Two authors performed the quality assessment and excluded the studies with a low MINORS score. RESULTS Fourteen studies met the review inclusion and quality criteria. Of the fourteen studies, two reported treatment using alkalinizing agents, six reported treatment using thiol-based drugs, and six reported combination treatment using alkalinizing agents and thiol-based drugs. These studies indicated that first-line therapies, including high fluid intake and urinary alkalinization, increased urine volume to > 3 L/day and urinary pH > 7.0, and were associated with reduced urinary cystine levels and cystine stone formation. Second-line therapy with cystine-binding thiol drugs, such as tiopronin and D-penicillamine, reduced urinary cystine levels, cystine crystal volume and increased cystine solubility, resulting in decreased cystine stone formation and stone recurrence rate. Further, combined intervention with alkalinizing agents and thiol-based drugs synergistically reduced stone recurrence. CONCLUSION Cystinuria treatment may require a combined approach of high diuresis, alkalinization and pharmacological interventions with regular monitoring of urinary pH, cystine levels, cystine crystal volume and solubility. However, poor adherence to treatment is relatively frequent, hence the pressing urgency for improved therapies and treatments.
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Affiliation(s)
- Nirmal Prasad Bhatt
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Aniruddh Vijay Deshpande
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Australia
- Department of Surgery, Urology Unit, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Malcolm Ronald Starkey
- Department of Immunology, Central Clinical School, Monash University, Melbourne, VIC, Australia.
- Bladder and Kidney Health Discovery Program, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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4
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Courbebaisse M, Travers S, Bouderlique E, Michon-Colin A, Daudon M, De Mul A, Poli L, Baron S, Prot-Bertoye C. Hydration for Adult Patients with Nephrolithiasis: Specificities and Current Recommendations. Nutrients 2023; 15:4885. [PMID: 38068743 PMCID: PMC10708476 DOI: 10.3390/nu15234885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Nephrolithiasis affects around 10% of the population and is frequently associated with impaired dietary factors. The first one is insufficient fluid intake inducing reduced urine volume, urine supersaturation, and subsequently urinary lithiasis. Kidneys regulate 24 h urine volume, which, under physiological conditions, approximately reflects daily fluid intake. The aim of this study is to synthesize and highlight the role of hydration in the treatment of nephrolithiasis. Increasing fluid intake has a preventive effect on the risk of developing a first kidney stone (primary prevention) and also decreases the risk of stone recurrence (secondary prevention). Current guidelines recommend increasing fluid intake to at least at 2.5 L/day to prevent stone formation, and even to 3.5-4 L in some severe forms of nephrolithiasis (primary or enteric hyperoxaluria or cystinuria). Fluid intake must also be balanced between day and night, to avoid urinary supersaturation during the night. Patients should be informed and supported in this difficult process of increasing urine dilution, with practical ways and daily routines to increase their fluid intake. The liquid of choice is water, which should be chosen depending on its composition (such as calcium, bicarbonate, or magnesium content). Finally, some additional advice has to be given to avoid certain beverages such as those containing fructose or phosphoric acid, which are susceptible to increase the risk of nephrolithiasis.
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Affiliation(s)
- Marie Courbebaisse
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Institut Necker Enfants Malades, Inserm U1151, F-75015 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Simon Travers
- Équipe Biologie, Lip(Sys)2, EA7357, UFR de Pharmacie, Université Paris-Saclay, F-91400 Orsay, France
- Clinical Chemistry Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France
| | - Elise Bouderlique
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Arthur Michon-Colin
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Michel Daudon
- Department of Multidisciplinary Functional Explorations, Tenon Hospital, AP-HP, F-75019 Paris, France
| | - Aurélie De Mul
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, Filière Maladies Rares OSCAR, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, F-69500 Bron, France
| | - Laura Poli
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
| | - Stéphanie Baron
- Faculté de Médecine, Université Paris Cité, F-75006 Paris, France
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, F-75006 Paris, France
- CNRS ERL 8228—Laboratoire de Physiologie Rénale et Tubulopathies, F-75006 Paris, France
| | - Caroline Prot-Bertoye
- Physiology—Functional Explorations Department, Georges Pompidou European Hospital, AP-HP, F-75015 Paris, France (C.P.-B.)
- Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte (MARHEA), F-75015 Paris, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphate, F-75015 Paris, France
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris Cité, F-75006 Paris, France
- CNRS ERL 8228—Laboratoire de Physiologie Rénale et Tubulopathies, F-75006 Paris, France
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Lemoine S, Dahan P, Haymann JP, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment. Prog Urol 2023; 33:911-953. [PMID: 37918992 DOI: 10.1016/j.purol.2023.08.004] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- S Lemoine
- Hospices Civils de Lyon, SFNDT, SP, Lyon, France
| | - P Dahan
- Nephrology Department, Clinique Saint-Exupéry, SFNDT, Toulouse, France
| | - J P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, SP, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, Paris, France
| | - P Meria
- Service d'Urologie, Hôpital Saint Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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6
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Mayayo-Vallverdú C, López de Heredia M, Prat E, González L, Espino Guarch M, Vilches C, Muñoz L, Asensi MA, Serra C, Llebaria A, Casado M, Artuch R, Garrabou G, Garcia-Roves PM, Pallardó FV, Nunes V. The antioxidant l-Ergothioneine prevents cystine lithiasis in the Slc7a9 -/- mouse model of cystinuria. Redox Biol 2023; 64:102801. [PMID: 37418888 PMCID: PMC10359938 DOI: 10.1016/j.redox.2023.102801] [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] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023] Open
Abstract
The high recurrence rate of cystine lithiasis observed in cystinuria patients highlights the need for new therapeutic options to address this chronic disease. There is growing evidence of an antioxidant defect in cystinuria, which has led to test antioxidant molecules as new therapeutic approaches. In this study, the antioxidant l-Ergothioneine was evaluated, at two different doses, as a preventive and long-term treatment for cystinuria in the Slc7a9-/- mouse model. l-Ergothioneine treatments decreased the rate of stone formation by more than 60% and delayed its onset in those mice that still developed calculi. Although there were no differences in metabolic parameters or urinary cystine concentration between control and treated mice, cystine solubility was increased by 50% in the urines of treated mice. We also demonstrate that l-Ergothioneine needs to be internalized by its transporter OCTN1 (Slc22a4) to be effective, as when administrated to the double mutant Slc7a9-/-Slc22a4-/- mouse model, no effect on the lithiasis phenotype was observed. In kidneys, we detected a decrease in GSH levels and an impairment of maximal mitochondrial respiratory capacity in cystinuric mice that l-Ergothioneine treatment was able to restore. Thus, l-Ergothioneine administration prevented cystine lithiasis in the Slc7a9-/- mouse model by increasing urinary cystine solubility and recovered renal GSH metabolism and mitochondrial function. These results support the need for clinical trials to test l-Ergothioneine as a new treatment for cystinuria.
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Affiliation(s)
- Clara Mayayo-Vallverdú
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Genetics Section, Physiological Sciences Department, Health Sciences and Medicine Faculty, University of Barcelona, Barcelona, Spain.
| | - Miguel López de Heredia
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Prat
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Genetics Section, Physiological Sciences Department, Health Sciences and Medicine Faculty, University of Barcelona, Barcelona, Spain
| | - Laura González
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain
| | - Meritxell Espino Guarch
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Immunology Department, Sidra Medicine, Doha, Qatar
| | - Clara Vilches
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Institut de Ciències Fotòniques (ICFO), The Barcelona Institute of Science and Technology, 08860, Castelldefels, Barcelona, Spain
| | - Lourdes Muñoz
- SIMChem, Institute for Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain
| | - Miguel A Asensi
- Departamento de Fisiología. Universidad de Valencia-INCLIVA, Valencia, Spain
| | - Carmen Serra
- SIMChem, Institute for Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain
| | - Amadeu Llebaria
- SIMChem, Institute for Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain; MCS, Laboratory of Medicinal Chemistry, Institute for Advanced Chemistry of Catalonia (IQAC-CSIC), Barcelona, Spain
| | - Mercedes Casado
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain; Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Rafael Artuch
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain; Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Gloria Garrabou
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain; Muscle Research and Mitochondrial Function Laboratory, Cellex-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Internal Medicine Department-Hospital Clínic of Barcelona, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Pablo M Garcia-Roves
- Department of Physiological Sciences, School of Medicine and Health Sciences, Nutrition, Metabolism and Gene therapy Group Diabetes and Metabolism Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Federico V Pallardó
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) -CB06/07/0069 - CB06/07/0061 - CB06/07/0073 - CB06/07/1002 - Instituto de Salud Carlos III, Madrid, Spain; Departamento de Fisiología. Universidad de Valencia-INCLIVA, Valencia, Spain
| | - Virginia Nunes
- Human Molecular Genetics Laboratory, Gene, Disease and Therapy Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Genetics Section, Physiological Sciences Department, Health Sciences and Medicine Faculty, University of Barcelona, Barcelona, Spain.
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7
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Song Y, Zhao C, Li D. Research progress on renal calculus associate with inborn error of metabolism. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:169-177. [PMID: 37283101 DOI: 10.3724/zdxbyxb-2022-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Renal calculus is a common disease with complex etiology and high recurrence rate. Recent studies have revealed that gene mutations may lead to metabolic defects which are associated with the formation of renal calculus, and single gene mutation is involved in relative high proportion of renal calculus. Gene mutations cause changes in enzyme function, metabolic pathway, ion transport, and receptor sensitivity, causing defects in oxalic acid metabolism, cystine metabolism, calcium ion metabolism, or purine metabolism, which may lead to the formation of renal calculus. The hereditary conditions associated with renal calculus include primary hyperoxaluria, cystinuria, Dent disease, familial hypomagnesemia with hypercalciuria and nephrocalcinosis, Bartter syndrome, primary distal renal tubular acidosis, infant hypercalcemia, hereditary hypophosphatemic rickets with hypercalciuria, adenine phosphoribosyltransferase deficiency, hypoxanthine-guanine phosphoribosyltransferase deficiency, and hereditary xanthinuria. This article reviews the research progress on renal calculus associated with inborn error of metabolism, to provide reference for early screening, diagnosis, treatment, prevention and recurrence of renal calculus.
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Affiliation(s)
- Yuanming Song
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
| | - Changyong Zhao
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Daobing Li
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China.
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Azer SM, Goldfarb DS. A Summary of Current Guidelines and Future Directions for Medical Management and Monitoring of Patients with Cystinuria. Healthcare (Basel) 2023; 11:healthcare11050674. [PMID: 36900678 PMCID: PMC10000469 DOI: 10.3390/healthcare11050674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
Cystinuria is the most common genetic cause of recurrent kidney stones. As the result of a genetic defect in proximal tubular reabsorption of filtered cystine, increased urine levels of the poorly soluble amino acid result in recurrent cystine nephrolithiasis. Recurrent cystine stones not only adversely affect the quality of patients suffering from cystinuria but also may result in chronic kidney disease (CKD) from recurrent renal injury. Thus, the mainstay of medical management revolves around prevention of stones. Recently published consensus statements on guidelines for managing cystinuria were released from both the United States and Europe. The purpose of this review is to summarize guidelines for medical management of patients with cystinuria, to provide new insight into the utility and clinical significance of cystine capacity-an assay for monitoring cystinuria, and to discuss future directions for research on treatment of cystinuria. We discuss future directions, including the potential use of cystine mimetics, gene therapy, V2-receptor blockers, and SGLT2 inhibitors, topics which have not appeared in more recent reviews. It is notable that in the absence of randomized, controlled trials, the recommendations cited here and in the guidelines are based on our best understanding of the disorder's pathophysiology, observational studies, and clinical experience.
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Affiliation(s)
- Sarah M. Azer
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - David S. Goldfarb
- Department of Medicine, NYU Grossman School of Medicine, New York, NY 10016, USA
- NYU Langone Medical Center, Nephrology Section, New York Harbor VA Healthcare System, New York, NY 10010, USA
- Correspondence: ; Tel.: +1-212-686-7500 (ext. 3877); Fax: +1-212-951-6842
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9
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Case-based review of dietary management of cystinuria. World J Urol 2022; 41:1215-1220. [PMID: 36565321 DOI: 10.1007/s00345-022-04263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The currently recommended treatment strategy for cystine stone formers is based on a progressive approach that starts with the most conservative measures. In patients with cystinuria, increased patient compliance with dietary management and medical treatment is associated with fewer stone interventions. In this case-based review, the dietary management of cystine stone former was reviewed under the guidance of evidence-based medicine. METHODS The dietary management of the 13-year-old cystinuria patient, who underwent 18 endourological stone interventions, was reviewed in the light of evidence-based medicine. A literature search was performed in Pubmed, MEDLINE, Embase, and Cochrane Library databases according to PRISMA guidelines published from 1993 to September 2022. A total of 304 articles were included in this paper. RESULTS In managing patients with cystinuria, hyperhydration, and alkalinization of the urine with medical treatment, the rational use of cystine-binding drugs by taking into account individual situations has come to the fore. A limited study has argued that a vegetarian diet is effective as the alkaline load from fruits and vegetables can reduce the amount of alkalizing substances required to achieve urinary alkalinization above pH 7.5, making it particularly suitable for the dietary treatment of cystine stone disease. CONCLUSION Life-long follow-up with dietary modification, hyperhydration, and personalized medical therapy (alkalinization and cystine-binding drugs) are critical in preventing chronic kidney disease and kidney failure in cystinuria.
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10
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Smeulders N, Cho A, Alshaiban A, Read K, Fagan A, Easty M, Minhas K, Barnacle A, Hayes W, Bockenhauer D. Shockwaves and the Rolling Stones: An Overview of Pediatric Stone Disease. Kidney Int Rep 2022; 8:215-228. [PMID: 36815103 PMCID: PMC9939363 DOI: 10.1016/j.ekir.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Urinary stone disease is a common problem in adults, with an estimated 10% to 20% lifetime risk of developing a stone and an annual incidence of almost 1%. In contrast, in children, even though the incidence appears to be increasing, urinary tract stones are a rare problem, with an estimated incidence of approximately 5 to 36 per 100,000 children. Consequently, typical complications of rare diseases, such as delayed diagnosis, lack of awareness, and specialist knowledge, as well as difficulties accessing specific treatments also affect children with stone disease. Indeed, because stone disease is such a common problem in adults, frequently, it is adult practitioners who will first be asked to manage affected children. Yet, there are unique aspects to pediatric urolithiasis such that treatment practices common in adults cannot necessarily be transferred to children. Here, we review the epidemiology, etiology, presentation, investigation, and management of pediatric stone disease; we highlight those aspects that separate its management from that in adults and make a case for a specialized, multidisciplinary approach to pediatric stone disease.
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Affiliation(s)
- Naima Smeulders
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Abdulelah Alshaiban
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Katharine Read
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Aisling Fagan
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Marina Easty
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Kishore Minhas
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alex Barnacle
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Wesley Hayes
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Renal Medicine, University College London, London, UK,Correspondence: Detlef Bockenhauer, Department of Renal Medicine, University College London, London, UK.
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11
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Phenotypic characterization of a pediatric cohort with cystinuria and usefulness of newborn screening. Pediatr Nephrol 2022; 38:1513-1521. [PMID: 36227436 DOI: 10.1007/s00467-022-05732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cystinuria is an inherited metabolic disease involving the defective transport of cystine and the dibasic amino acids in the renal proximal tubules that causes the formation of stones in the urinary system. In our regional child health program, cystinuria is included in newborn metabolic screening. Our objectives are the phenotypic characterization of our cystinuric pediatric cohort and to present our experience in neonatal cystinuria screening. METHODS The study of clinical cases of pediatric patients diagnosed with cystinuria over a period of 32 years. All patients were studied at demographic, clinical, laboratory, radiological, and therapeutic levels. RESULTS We diagnosed 86 pediatric patients with cystinuria; 36% of them had the homozygous biochemical phenotype. 95.3% of the patients were detected by neonatal metabolic screening. We performed urine biochemical analyses of parents with additional diagnoses of 63 adult patients. The mean follow-up time was 16.8 ± 8.5 years. 11.6% of patients developed one or more episodes of urinary tract infection during that period. Chronic kidney disease, proteinuria, and hypertension were uncommon (1.2%). 10.5% developed kidney stones at the mean age of presentation of 7.78 ± 7.6 years; 33% were recurrent. The risk of developing lithiasis was higher for homozygous biochemical-phenotype patients. Hypercalciuria was a significant risk factor in the development of lithiasis. CONCLUSIONS Our clinical data suggest that diagnosing cystinuria through neonatal screening could be a useful strategy for the detection of presymptomatic cases, in order to establish preventive measures, as well as for the detection of relatives at risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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12
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D'Ambrosio V, Capolongo G, Goldfarb D, Gambaro G, Ferraro PM. Cystinuria: an update on pathophysiology, genetics, and clinical management. Pediatr Nephrol 2022; 37:1705-1711. [PMID: 34812923 DOI: 10.1007/s00467-021-05342-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Cystinuria is the most common genetic cause of nephrolithiasis in children. It is considered a heritable aminoaciduria as the genetic defect affects the reabsorption of cystine and three other amino acids (ornithine, lysine, and arginine) in the renal proximal tubule. Patients affected by this condition have elevated excretion of cystine in the urine, and because of this amino acid's low solubility at normal urine pH, patients tend to form cystine calculi. To date, two genes have been identified as disease-causative: SLC3A1 and SLC7A9, encoding for the two subunits of the heterodimeric transporter. The clinical features of this condition are solely related to nephrolithiasis. The diagnosis is usually made during infancy or adolescence, but cases of late diagnosis are common. The goal of therapy is to reduce excretion and increase the solubility of cystine, through both modifications of dietary habits and pharmacological treatment. However, therapeutic interventions are not always sufficient, and patients often have to undergo several surgical procedures during their lives to treat recurrent nephrolithiasis. The goal of this literature review is to synthesize the available evidence on diagnosis and management of patients affected by cystinuria in order to provide physicians with a practical tool that can be used in daily clinical practice. This review also aims to shed some light on new therapy directions with the aim of ameliorating kidney outcomes while improving adherence to treatment and quality of life of cystinuric patients.
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Affiliation(s)
- Viola D'Ambrosio
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, Unit of Nephrology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - David Goldfarb
- Nephrology Section, VA, New York Harbor Healthcare System, New York, NY, USA
- Division of Nephrology, New York University Langone Medical Center, New York, NY, USA
| | - Giovanni Gambaro
- Department of Medicine, Division of Nephrology and Dialysis, Renal Unit, University of Verona, Verona, Italy
| | - Pietro Manuel Ferraro
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy.
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
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13
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A case of early onset cystinuria in a 4-month-old girl. CEN Case Rep 2021; 11:216-219. [PMID: 34669168 DOI: 10.1007/s13730-021-00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Cystinuria is an autosomal recessive disorder characterized by a decrease in the reabsorption of cystine and dibasic amino acids (lysine, ornithine, and arginine) in the renal proximal tubule. It presents with recurrent urolithiasis. Cystinuria accounts for 6-8% of all pediatric urolithiasis. The age of onset is typically 10-30 years. Here, we report a case of early-onset cystinuria. A 4-month-old girl presented with hematuria. We noticed multiple renal calculi in ultrasonography and abdominal computerized tomography scans. The diagnosis was cystinuria with urinary calculus analysis and urinary amino acid analysis. The patient was treated with urine alkalinization and cystine chelating drugs. Gene analysis showed a P482L heterozygous mutation from her mother, and an A70V heterozygous mutation from her father, in the SLC7A9 gene. This gene encodes a putative subunit of the neutral and basic amino acid transport protein, BAT1. Although cystinuria is an autosomal recessive disease, there have been previous reports of P482L heterozygous mutations greatly suppressing cystine reabsorption and causing cystinuria symptoms. Therefore, the highly influential P482L mutation of the SLC7A9 gene may have contributed to the onset of this autosomal recessive disease at an extremely young age.
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14
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Kovaříková S, Maršálek P, Vrbová K. Cystinuria in Dogs and Cats: What Do We Know after Almost 200 Years? Animals (Basel) 2021; 11:2437. [PMID: 34438894 PMCID: PMC8388795 DOI: 10.3390/ani11082437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this review is to summarize current knowledge on canine and feline cystinuria from available scientific reports. Cystinuria is an inherited metabolic defect characterized by abnormal intestinal and renal amino acid transport in which cystine and the dibasic amino acids ornithine, lysine, and arginine are involved (COLA). At a normal urine pH, ornithine, lysine, and arginine are soluble, but cysteine forms a dimer, cystine, which is relatively insoluble, resulting in crystal precipitation. Mutations in genes coding COLA transporter and the mode of inheritance were identified only in some canine breeds. Cystinuric dogs may form uroliths (mostly in lower urinary tract) which are associated with typical clinical symptoms. The prevalence of cystine urolithiasis is much higher in European countries (up to 14% according to the recent reports) when compared to North America (United States and Canada) where it is approximately 1-3%. Cystinuria may be diagnosed by the detection of cystine urolithiasis, cystine crystalluria, assessment of amino aciduria, or using genetic tests. The management of cystinuria is aimed at urolith removal or dissolution which may be reached by dietary changes or medical treatment. In dogs with androgen-dependent cystinuria, castration will help. In cats, cystinuria occurs less frequently in comparison with dogs.
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Affiliation(s)
- Simona Kovaříková
- Department of Animal Protection and Welfare and Veterinary Public Health, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
| | - Petr Maršálek
- Department of Animal Protection and Welfare and Veterinary Public Health, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
| | - Kateřina Vrbová
- Faculty of Veterinary Medicine, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
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15
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Prot-Bertoye C, Daudon M, Tostivint I, Dousseaux MP, Defazio J, Traxer O, Knebelmann B, Courbebaisse M. [Cystinuria]. Nephrol Ther 2021; 17S:S100-S107. [PMID: 33910689 DOI: 10.1016/j.nephro.2020.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/21/2022]
Abstract
Cystinuria is the most common monogenic nephrolithiasis disorder. Because of its poor solubility at a typical urine pH of less than 7, cystine excretion results in recurrent urinary cystine stone formation. A high prevalence of high blood pressure and of chronic kidney disease has been reported in these patients. Alkaline hyperdiuresis remains the cornerstone of the preventive medical treatment. To reach a urine pH between 7.5 and 8 and a urine specific gravity less than or equal to 1.005 should be the goal of medical treatment. D-penicillamine and tiopronin, two cysteine-binding thiol agents, should be considered as second line treatments with frequent adverse events that should be closely monitored.
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Affiliation(s)
- Caroline Prot-Bertoye
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Tostivint
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie-Paule Dousseaux
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Jérôme Defazio
- Association pour l'information et la recherche sur les maladies génétiques (AIRG-France), BP 78, 75261 Paris cedex 06, France
| | - Olivier Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Bertrand Knebelmann
- Service de néphrologie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - Marie Courbebaisse
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
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16
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Takahashi T, Somiya S, Ito K, Kanno T, Higashi Y, Yamada H. The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years. J Clin Med 2021; 10:jcm10071336. [PMID: 33804827 PMCID: PMC8037008 DOI: 10.3390/jcm10071336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.
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Affiliation(s)
| | | | | | | | | | - Hitoshi Yamada
- Correspondence: ; Tel.: +81-75-572-6331; Fax: +81-75-571-8877
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17
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The Impact of Diet on Urinary Risk Factors for Cystine Stone Formation. Nutrients 2021; 13:nu13020528. [PMID: 33561968 PMCID: PMC7915598 DOI: 10.3390/nu13020528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the importance of dietary management of cystinuria, data on the contribution of diet to urinary risk factors for cystine stone formation are limited. Studies on the physiological effects of diet on urinary cystine and cysteine excretion are lacking. Accordingly, 10 healthy men received three standardized diets for a period of five days each and collected daily 24 h urine. The Western-type diet (WD; 95 g/day protein) corresponded to usual dietary habits, whereas the mixed diet (MD; 65 g/day protein) and lacto-ovo-vegetarian diet (VD; 65 g/day protein) were calculated according to dietary reference intakes. With intake of the VD, urinary cystine and cysteine excretion decreased by 22 and 15%, respectively, compared to the WD, although the differences were not statistically significant. Urine pH was significantly highest on the VD. Regression analysis showed that urinary phosphate was significantly associated with cystine excretion, while urinary sulfate was a predictor of cysteine excretion. Neither urinary cystine nor cysteine excretion was affected by dietary sodium intake. A lacto-ovo-vegetarian diet is particularly suitable for the dietary treatment of cystinuria, since the additional alkali load may reduce the amount of required alkalizing agents.
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18
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Vinit N, Khoury A, Lopez P, Heidet L, Botto N, Traxer O, Boyer O, Blanc T, Lottmann HB. Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis. Front Pediatr 2021; 9:763317. [PMID: 34869121 PMCID: PMC8636798 DOI: 10.3389/fped.2021.763317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children. Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old. Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15-108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202-8,265) mm3 in group I and 4,588 (2,039-5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42-111) months. Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.
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Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Antoine Khoury
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurence Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, APHP, Paris, France.,Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Tenon Hospital, Sorbonne Université, Paris, France.,Sorbonne Université, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Henri B Lottmann
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
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19
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Nelson CP, Kurtz MP, Venna A, Cilento BG, Baum MA. Pharmacological Dilutional Therapy Using the Vasopressin Antagonist Tolvaptan for Young Patients With Cystinuria: A Pilot Investigation. Urology 2020; 144:65-70. [DOI: 10.1016/j.urology.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 12/11/2022]
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20
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Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A, Bultitude M, Capolongo G, Cerkauskiene R, Daudon M, Doizi S, Gillion V, Gràcia-Garcia S, Halbritter J, Heidet L, van den Heijkant M, Lemoine S, Knebelmann B, Emma F, Levtchenko E. Cystinuria: clinical practice recommendation. Kidney Int 2020; 99:48-58. [PMID: 32918941 DOI: 10.1016/j.kint.2020.06.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary cystine excretion leads to the formation of cystine stones because of the low solubility of cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities), conservative treatment (hydration, dietetic, alkalinization, and cystine-binding drugs), follow-up, self-monitoring, complications (renal failure and hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with cystinuria, including diagnosis, surgery, and medical treatment.
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Affiliation(s)
- Aude Servais
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France.
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luca Dello Strologo
- Renal Transplant Clinic, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK; The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France
| | - Aurelia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares, Filière ORKID, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Giovanna Capolongo
- Unit of Nephrology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Michel Daudon
- UMR S 1155 and Physiology Unit, AP-HP, Hôpital Tenon, Sorbonne Université and INSERM, Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Paris, France
| | - Valentine Gillion
- Département de Néphrologie adulte, Cliniques universitaires Saint Luc, Bruxelles, Belgium
| | - Silvia Gràcia-Garcia
- Laboratory of Renal Lithiasis, Clinical Laboratories, Fundació Puigvert, Barcelona, Spain
| | - Jan Halbritter
- Division of Nephrology, Department of Endocrinology, Nephrology, and Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Laurence Heidet
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Marleen van den Heijkant
- Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandrine Lemoine
- Nephrology and Renal Function Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Elena Levtchenko
- Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Courbebaisse M, Prot-Bertoye C, Daudon M. [Nephrolithiasis: From mechanisms to preventive medical treatment]. Nephrol Ther 2020; 16:65-75. [PMID: 32122798 DOI: 10.1016/j.nephro.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Renal lithiasis is a frequent pathology (prevalence ranging from 10 to 12% in France) and a recurrent condition. It is associated with chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, especially if it is associated with nephrocalcinosis and/or is part of a monogenic disease (1.6% of lithiasis in adults, including 1% of cystinuria). In order to understand the pathophysiology of the nephrolithiasis, the analysis of stones (morphological and by infrared spectrophotometry) as well as a minimal biological evaluation including crystalluria must be carried out. Calcium nephrolithiasis is the most common form (more than 80%). Its preventive medical treatment relies on simple hygienic dietetics: non-alkaline hyperdiuresis greater than 2liters/day, normalization of calcium intakes (1g/day to be distributed over the three meals), restriction of sodium intakes (6g/day) and of protein intakes (0.8-1g/kg of theoretical weight/day), and avoidance of foods rich in oxalate. If there is a hypercalciuria (greater than 0.1mmol/kg of theoretical weight/day with normal calcium intakes), its mechanism should be explored with an oral calcium load test. In the absence of primary hyperparathyroidism, thiazide diuretics can be prescribed, taking care to prevent hypokalemia and iatrogenic hypocitraturia. The treatment of uric acid lithiasis includes alkaline hyperdiuresis (urinary pH 6.2 to 6.8). Allopurinol is only justified if the urinary excretion of uric acid exceeds 4mmol/day. With a well-managed medical treatment, more than 80% of recurrent lithiasis can be stopped, making nephrolithiasis one of the kidney diseases the more accessible to the preventive medical treatment.
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Affiliation(s)
- Marie Courbebaisse
- Service de physiologie-explorations fonctionnelles, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75006 Paris, France; Inserm, U1151, 149, rue de Sèvres, 75015 Paris, France; CNRS, UMR 8253, 149, rue de Sèvres, 75015 Paris, France; Institut Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Caroline Prot-Bertoye
- Service de physiologie-explorations fonctionnelles, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75006 Paris, France; Centre de recherche des cordeliers, Inserm UMRS1138, 75006 Paris, France; Sorbonne université, Paris, France; CNRS, ERL8228, 75006 Paris, France
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, AP-HP, 75020 Paris, France
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