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Güzin Y, Yılmaz Ü, Devrim F, Dinçel N, Ünalp A. Kidney Stones in Epileptic Children Receiving Ketogenic Diet: Frequency and Risk Factors. Neuropediatrics 2023; 54:308-314. [PMID: 37257495 DOI: 10.1055/s-0043-1768987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although it is a valuable option for children with drug-resistant epilepsy, ketogenic diet (KD) therapy is associated with several side effects. The frequency of kidney stones and risk factors for their development in epileptic children receiving KD is unclear. The aim of this study was to determine the frequency and risk factors for the development of renal stones in children receiving KD therapy. METHODS A total of 95 patients receiving KD were identified. Of these, seven patients were excluded from the study due to the duration of KD being less than 12 months. The remaining 88 children were enrolled in the study. RESULTS Renal stones were detected in 15 patients (17%), of which 12 (73.3%) received potassium citrate treatment. Two (13.3%) patients needed lithotripsy despite receiving potassium citrate treatment, and one of these, who received potassium citrate treatment for 5 months, developed acute vesicourethral reflux and underwent surgery. No patient discontinued KD due to renal stone development. The serum uric acid concentrations and urine calcium/creatinine ratio did not change significantly over the 24-month follow-up period. Age, gender, etiology, age at seizure onset, duration of KD, mobility status, use of topiramate or zonisamide, and the number of antiepileptic drugs used were not significantly different between patients with and without kidney stones. CONCLUSION Renal stone appears to be a common adverse effect of KD therapy. Although adequate hydration and potassium citrate treatment are effective in most patients, lithotripsy and surgery may be required in a minority of patients.
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Affiliation(s)
- Yiğithan Güzin
- Department of Pediatric Neurology, University of Health Sciences Tepecik, Training and Research Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Department of Pediatric Neurology, Dr. Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Fatma Devrim
- Department of Pediatric Nephrology, University of Health Sciences Turkey, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Nida Dinçel
- Department of Pediatric Nephrology, University of Health Sciences Turkey, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Izmir, Turkey
| | - Aycan Ünalp
- Department of Pediatric Neurology, Dr. Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
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2
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Buckey JC, Thamer S, Lan M. Bone loss and kidney stone risk in weightlessness. Curr Opin Nephrol Hypertens 2023; 32:172-176. [PMID: 36683542 DOI: 10.1097/mnh.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Weightlessness increases both bone loss and kidney stone formation risk. The large interior volume of the International Space Station (ISS) has allowed for a mix of exercise devices to help maintain the skeleton. But space exploration is changing. Long stays on the ISS will be replaced by journeys in smaller spacecraft both to and around the Moon. Small private space stations are under development. This will limit the ability to do exercise countermeasures, which can increase both bone loss and kidney stone risk. This review examines this risk and how it can be minimized in this new era of spaceflight. RECENT FINDINGS Simple, low-mass, low-power ways to track bone loss and kidney stone risk in space are being researched. Tracking urinary calcium concentration in the first morning void and targeting additional countermeasures (e.g. bisphosphonates) to those who run consistently high levels is one promising approach. SUMMARY New exploration spacecraft would not have the room and capability to replicate the current 2 h, daily exercise countermeasure programme on the ISS. A monitoring approach, perhaps using urinary calcium as a marker, is needed to find those at greatest risk. This would allow countermeasures to be targeted individually and used efficiently.
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Affiliation(s)
| | | | - Mimi Lan
- Thayer School of Engineering at Dartmouth, Lebanon, New Hampshire, USA
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Adegeest CY, van Gent JAN, Stolwijk-Swüste JM, Post MWM, Vandertop WP, Öner FC, Peul WC, Wengel PVT. Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review. J Neurosurg Spine 2021; 36:632-652. [PMID: 34767527 DOI: 10.3171/2021.7.spine21537] [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: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.
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Affiliation(s)
- Charlotte Y Adegeest
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague
| | - Jort A N van Gent
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden
| | - Janneke M Stolwijk-Swüste
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht
| | - Marcel W M Post
- 3Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht.,4Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen
| | - William P Vandertop
- 5Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam
| | - F Cumhur Öner
- 6Department of Orthopedic Surgery, University Medical Center Utrecht; and
| | - Wilco C Peul
- 1Department of Neurosurgery, Leiden University Medical Center, Leiden.,2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
| | - Paula V Ter Wengel
- 2Department of Neurosurgery, Haaglanden Medical Center, The Hague.,7Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands
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Liao F, Zhu Z, Xiao C, Yuan J, Geng B, Hu J. Hydrogen sulfide inhibits calcium and phosphorus loss after fracture by negatively regulating glucocorticoid/glucocorticoid receptor α. Life Sci 2021; 274:119363. [PMID: 33737083 DOI: 10.1016/j.lfs.2021.119363] [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] [Received: 10/20/2020] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS Post-fracture calcium and phosphorus excretion is greater than influx, which might be caused by stress. Glucocorticoid is known to enhance calcium and phosphorous excretion, and hydrogen sulfide (H2S) has been shown to exert inhibitory effects on glucocorticoid. Therefore, this study explored whether H2S could inhibit calcium and phosphorus loss after fracture by regulating glucocorticoid and/or its receptor. MAIN METHODS The following properties were analyzed in rats with femur fractures: serum and urinary calcium and phosphorus (by colorimetry); bone turnover markers alkaline phosphatase, serum type 1 collagen amino terminal peptide, type 1 procollagen carboxy terminal peptide, and anti-tartaric acid phosphatase (by ELISA); factors related to calcium-phosphorus metabolism including glucocorticoid, parathyroid hormone, calcitonin, fibroblast growth factor 23, and 1,25(OH)2D3 (by ELISA); and sulfhydration of glucocorticoid receptor α in the kidney (by immunoprecipitation linked biotin-switch assay), after supplementing with mifepristone, the H2S donor GYY4137 or H2S generating enzyme inhibitors aminooxyacetic acid and propargylglycine. KEY FINDINGS Serum H2S decreased and glucocorticoid secretion increased in rats post-fracture. The glucocorticoid receptor inhibitor mifepristone partly blunted calcium and phosphorus loss. Furthermore, supplementation with GYY4137 reduced glucocorticoid secretion; inhibited glucocorticoid receptor α activity by sulfhydration; downregulated vitamin D 1α-hydroxylase expression; and upregulated 24-hydroxylase, calbindin-D28k, and sodium phosphate cotransporter 2a expression in the kidney; thereby inhibiting calcium and phosphorus loss induced by fracture. Moreover, inhibiting endogenous H2S generation showed opposite effects. SIGNIFICANCE Our findings suggest that H2S antagonized calcium and phosphorus loss after fracture by reducing glucocorticoid secretion and inhibiting glucocorticoid receptor α activity by sulfhydration.
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Affiliation(s)
- Feng Liao
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, PR China
| | - Zongdong Zhu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, PR China
| | - Chengwei Xiao
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, PR China
| | - Jiabin Yuan
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, PR China
| | - Bin Geng
- Hypertension Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Beijing 102308, PR China.
| | - Jiang Hu
- Department of Orthopaedics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610072, PR China.
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Waseda Y, Takazawa R, Kobayashi M, Yoshida S, Uchida Y, Kohno Y, Tsujii T. Successful outcomes of endoscopic lithotripsy in completely bedridden patients with symptomatic urinary calculi. Sci Rep 2020; 10:8839. [PMID: 32483237 PMCID: PMC7264317 DOI: 10.1038/s41598-020-65807-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/27/2020] [Indexed: 11/09/2022] Open
Abstract
Due to the aging population, the number of completely bedridden individuals is expected to increase, and such individuals are at high risk of developing urinary calculi. This retrospective study included 32 consecutive bedridden patients, who had undergone endoscopic lithotripsy between 2010 and 2019, and aimed to identify the treatment outcomes of endoscopic lithotripsy for bedridden patients. A total of 45 endoscopic lithotripsies were performed to treat stones (median cumulative diameter, 24 mm). The stone-free rate (SFR) < 4 mm and complete SFR (0 mm) were achieved in 81% and 63% of patients, respectively. Postoperatively, 10 patients (22%) developed symptoms of systemic inflammatory response syndrome, and three patients (7%) had bloodstream infections. Except for one patient (3%) having a retained ureteral stent ultimately died from septic shock, drainage tube-free discharge was achieved in all patients. The 2-year cumulative incidence of stone-related events, and overall mortality rate, were 18% and 27%, respectively. Endoscopic lithotripsy is well tolerated and is associated with a high success rate, even with severe comorbidities and a relatively large stone burden. Physicians should consider performing endoscopic lithotripsy in bedridden patients with symptomatic urinary calculi regardless of their relatively short life expectancy and the remote risk of perioperative mortality.
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Affiliation(s)
- Yuma Waseda
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
| | - Ryoji Takazawa
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan.
| | - Masaki Kobayashi
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
| | - Satoshi Yoshida
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
| | - Yusuke Uchida
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
| | - Yusuke Kohno
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
| | - Toshihiko Tsujii
- Department of Urology, Kidney Stone Center, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-Ohtsuka, Toshima-ku, Tokyo, Japan
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Hargens AR, Vico L. Long-duration bed rest as an analog to microgravity. J Appl Physiol (1985) 2016; 120:891-903. [PMID: 26893033 DOI: 10.1152/japplphysiol.00935.2015] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/12/2016] [Indexed: 11/22/2022] Open
Abstract
Long-duration bed rest is widely employed to simulate the effects of microgravity on various physiological systems, especially for studies of bone, muscle, and the cardiovascular system. This microgravity analog is also extensively used to develop and test countermeasures to microgravity-altered adaptations to Earth gravity. Initial investigations of bone loss used horizontal bed rest with the view that this model represented the closest approximation to inactivity and minimization of hydrostatic effects, but all Earth-based analogs must contend with the constant force of gravity by adjustment of the G vector. Later concerns about the lack of similarity between headward fluid shifts in space and those with horizontal bed rest encouraged the use of 6 degree head-down tilt (HDT) bed rest as pioneered by Russian investigators. Headward fluid shifts in space may redistribute bone from the legs to the head. At present, HDT bed rest with normal volunteers is the most common analog for microgravity simulation and to test countermeasures for bone loss, muscle and cardiac atrophy, orthostatic intolerance, and reduced muscle strength/exercise capacity. Also, current physiologic countermeasures are focused on long-duration missions such as Mars, so in this review we emphasize HDT bed rest studies with durations of 30 days and longer. However, recent results suggest that the HDT bed rest analog is less representative as an analog for other important physiological problems of long-duration space flight such as fluid shifts, spinal dysfunction and radiation hazards.
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Affiliation(s)
- Alan R Hargens
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California; and Institut National de la Santé et de la Recherche Médicale Unité 1059, University of Lyon, St-Etienne, France
| | - Laurence Vico
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California; and Institut National de la Santé et de la Recherche Médicale Unité 1059, University of Lyon, St-Etienne, France
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Soueidan M, Bartlett SJ, Noureldin YA, Andersen RE, Andonian S. Leisure time physical activity, smoking and risk of recent symptomatic urolithiasis: Survey of stone clinic patients. Can Urol Assoc J 2015; 9:257-62. [PMID: 26316909 DOI: 10.5489/cuaj.2879] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION We explore relationships between selected lifestyle factors and recent (≤6 months) symptomatic urolithiasis (RSU). METHODS Surveys querying socio-demographic, medical history, physical activity, diet and smoking were administered to a convenience sample of stone clinic patients at a tertiary care hospital. Leisure time physical activity (LTPA) was assessed with the International Physical Activity Questionnaire (long form). Multivariate logistic regression was used to identify associations between risk factors and RSU. RESULTS Of the 163 participants, most were male (64%) and white (78%), with a mean (standard deviation) age of 56.3 (14.2) years. The mean body mass index (BMI) was 27.3 (5.4) kg/m(2) and 57 (35%) patients reported RSU. No significant (p < 0.05) differences were observed between participants with and without RSU in age, sex, ethnicity, BMI, or diet. Of the cohort, 52 (35%) participants met physical activity guidelines for walking (29%), moderate (27%) or vigorous activity (29%). LTPA did not differ significantly by RSU status. Compared to those without RSU, participants with RSU had higher rates of smoking (7% vs. 21%, p = 0.02 and had 8.5 (95% confidence interval 2.2-32.2) times the odds of being current smokers after controlling for sex, diet, and LTPA. CONCLUSIONS Physical inactivity and smoking are common among stone clinic patients, though LPTA was not associated with RSU. Study limitations include its small sample size, selection bias, and reliance on self-reported RSU (recall bias). In addition, participants may have already been following dietary recommendations to prevent urolithiasis recurrence. Nonetheless, current smoking was a potent predictor of RSU. When desired, smokers should be referred for smoking cessation.
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Affiliation(s)
- Michael Soueidan
- Division of Urology, McGill University Health Centre, Montreal, QC
| | - Susan J Bartlett
- Faculty of Medicine, McGill University; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, QC
| | - Yasser A Noureldin
- Division of Urology, McGill University Health Centre, Montreal, QC; ; Department of Urology, Benha University Hospital, Benha University, Benha, Egypt
| | - Ross E Andersen
- School of Physical Education and Kinesiology, Faculty of Education, McGill University, Montreal, QC
| | - Sero Andonian
- Division of Urology, McGill University Health Centre, Montreal, QC
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Grases F, Rodriguez A, Costa-Bauza A, Saez-Torres C, Rodrigo D, Gómez C, Mir-Perello C, Frontera G. Factors Associated With the Lower Prevalence of Nephrolithiasis in Children Compared With Adults. Urology 2015; 86:587-92. [PMID: 26144339 DOI: 10.1016/j.urology.2015.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the reasons behind the lower prevalence of kidney stones in children by assessing urinary lithogenic parameters in healthy children, healthy adults, and 3 groups of stone-former patients. METHODS The study subjects included 75 healthy adults, 105 healthy children, 62 patients with previous calcium oxalate monohydrate papillary stones, 120 patients with previous calcium oxalate monohydrate unattached stones, and 248 patients with previous calcium oxalate dihydrate stones. Twenty-four-hour urine samples were collected, and the urinary lithogenic parameters were measured. RESULTS Calcium, magnesium, and phosphorous concentration differed significantly between healthy children and adults. Except citrate, all solute/creatinine ratios differed between healthy children and adults. However, these differences were much more important in the cases of calcium and magnesium. The calcium/creatinine ratio was 2-fold lower, whereas the magnesium/creatinine ratio was 2-fold higher, in healthy children than that in healthy adults (P <.001 each). The calcium/creatinine ratio was higher and the citrate/creatinine ratio lower in calcium oxalate dihydrate stone formers than that in healthy adults. CONCLUSION Ratios of calcium and magnesium to creatinine, as well as morphoanatomic factors and lifestyle habits, may explain the lower prevalence of nephrolithiasis in children than those in adults.
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Affiliation(s)
- Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain.
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain; Department of Pediatric Nephrology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Cristina Gómez
- Laboratory Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Concepcion Mir-Perello
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain; Department of Pediatric Nephrology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases University Hospital, Palma de Mallorca, Spain
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Smith S, Abrams S, Davis-Street J, Heer M, O'Brien K, Wastney M, Zwart S. Fifty Years of Human Space Travel: Implications for Bone and Calcium Research. Annu Rev Nutr 2014; 34:377-400. [DOI: 10.1146/annurev-nutr-071813-105440] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S.M. Smith
- Biomedical Research and Environmental Sciences Division, NASA Lyndon B. Johnson Space Center, Houston, Texas 77058;
| | - S.A. Abrams
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030;
| | - J.E. Davis-Street
- Chevron Services Company, Corporate Health and Medical, Houston, Texas 77002;
| | - M. Heer
- Profil, 41460 Neuss, Germany;
- University of Bonn, Department of Nutrition and Food Science, Nutrition Physiology, 53115 Bonn, Germany
| | - K.O. O'Brien
- Cornell University, Division of Nutritional Sciences, Ithaca, New York 14853;
| | - M.E. Wastney
- Metabolic Modeling Services, West Lafayette, Indiana 47906;
| | - S.R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, Texas 77058;
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Smith SM, McCoy T, Gazda D, Morgan JLL, Heer M, Zwart SR. Space flight calcium: implications for astronaut health, spacecraft operations, and Earth. Nutrients 2012; 4:2047-68. [PMID: 23250146 PMCID: PMC3546622 DOI: 10.3390/nu4122047] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/13/2012] [Accepted: 12/10/2012] [Indexed: 11/21/2022] Open
Abstract
The space flight environment is known to induce bone loss and, subsequently, calcium loss. The longer the mission, generally the more bone and calcium are lost. This review provides a history of bone and calcium studies related to space flight and highlights issues related to calcium excretion that the space program must consider so that urine can be recycled. It also discusses a novel technique using natural stable isotopes of calcium that will be helpful in the future to determine calcium and bone balance during space flight.
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Affiliation(s)
- Scott M. Smith
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Torin McCoy
- Human Health and Performance Directorate, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Daniel Gazda
- Wyle Science, Technology & Engineering Group, Houston, TX 77058, USA; E-Mail:
| | - Jennifer L. L. Morgan
- Oak Ridge Associated Universities/NASA Post-Doctoral Fellow, NASA Lyndon B. Johnson Space Center, Houston, TX 77058, USA; E-Mail:
| | - Martina Heer
- Profil, 41460 Neuss, Germany; E-Mail:
- University of Bonn, 53115 Bonn, Germany
| | - Sara R. Zwart
- Division of Space Life Sciences, Universities Space Research Association, Houston, TX 77058, USA; E-Mail:
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Ikeda C, Saito Y, Sukigara S, Sakuma H, Sugai K, Komaki H, Sasaki M. Effects of low-dose hydrochlorothiazide on urolithiasis and bone metabolism in severely disabled individuals: a pilot study. Brain Dev 2011; 33:400-5. [PMID: 20702052 DOI: 10.1016/j.braindev.2010.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 11/26/2022]
Abstract
To clarify the effects of hydrochlorothiazide (HCT) on calcium metabolism in subjects with severe motor and intellectual disabilities (SMID), we examined four patients (16-48years old) with a history of urolithiasis and/or bone fracture and increased urinary calcium/creatinine ratio (U-Ca/Cr). U-Ca/Cr, blood markers of bone turnover, and bone-mineral density (BMD) were measured before and after administration of low-dose HCT (0.25-0.5mg/kg/day). Three months after the initiation of HCT, U-Ca/Cr decreased in all patients, but this effect was less evident at 9-18months. Bone-turnover marker of bone-specific alkaline phosphatase also showed a tendency to decrease, but BMD remained unchanged during the follow-up period. In SMID patients, HCT is beneficial for the treatment of hypercalciuria but its effects can be transient in certain cases. HCT may also ameliorate the increase in bone turnover, but its effects on the prevention of bone fractures remain uncertain. Hyponatremia is the most frequent and significant adverse effect of HCT, for which a close observation is mandatory in HCT application for patients with SMID.
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Affiliation(s)
- Chizuru Ikeda
- Department of Child Neurology, National Center Hospital of Neurology and Psychiatry, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi-cho, Kodaira, Tokyo 187-8551, Japan
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13
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Abstract
As we approach the end of the first 50 years of human space travel, much has been learned about adaptation to microgravity and the risks associated with extended-duration space exploration. As the frequency and duration of flights grew, nutrition issues became more critical and the questions to be answered became more complex: What are the nutrient requirements for space travelers? Can nutrients be used as tools to mitigate the negative effects of space travel on humans? How does nutrition interrelate with other physiological systems (such as muscle, bone, and cardiovascular system) and their adaptation to microgravity? Much research has been done over the decades in both actual spaceflight and ground-based analogs. We review here much of what is known, and highlight areas of ongoing research and concerns for future exploration of the Moon, Mars, and beyond.
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Affiliation(s)
- Scott M Smith
- Human Adaptation and Countermeasures Division, National Aeronautics and Space Administration, Johnson Space Center, Houston, Texas 77058, USA
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Okada A, Ohshima H, Itoh Y, Yasui T, Tozawa K, Kohri K. Risk of renal stone formation induced by long-term bed rest could be decreased by premedication with bisphosphonate and increased by resistive exercise. Int J Urol 2008; 15:630-5. [DOI: 10.1111/j.1442-2042.2008.02067.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zerwekh JE, Odvina CV, Wuermser LA, Pak CYC. Reduction of Renal Stone Risk by Potassium-Magnesium Citrate During 5 Weeks of Bed Rest. J Urol 2007; 177:2179-84. [PMID: 17509313 DOI: 10.1016/j.juro.2007.01.156] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Indexed: 11/17/2022]
Abstract
PURPOSE Exposure to the microgravity environment of space increases the risk of kidney stone formation, particularly for calcium oxalate and uric acid stones. This study was performed to evaluate the efficacy of potassium alkali as potassium-magnesium citrate in reducing renal stone risk and bone turnover. MATERIALS AND METHODS This study was performed as a double-blind, placebo controlled trial. We studied 20 normocalciuric subjects randomized to either placebo or potassium-magnesium citrate (42 mEq potassium, 21 mEq magnesium, 63 mEq citrate per day) before and during 5 weeks of strict bed rest. The study was performed in the General Clinical Research Center and under a controlled dietary regimen composed of 100 mEq of sodium, 800 mg of calcium, 0.8 gm/kg animal protein and 2,200 kcal per day. Two 24-hour urine collections were obtained under oil each week for assessment of stone risk parameters and relative saturation of calcium oxalate, brushite and undissociated uric acid. Blood was also collected for determination of serum immunoreactive parathyroid hormone and vitamin D metabolites. RESULTS Bed rest promoted a rapid increase in urinary calcium excretion of approximately 50 mg per day in both groups. Despite this increase subjects treated with potassium-magnesium citrate demonstrated significant decreases in the relative saturation of calcium oxalate and in the concentration of undissociated uric acid compared to placebo. Immunoreactive parathyroid hormone, serum 1,25-dihydroxyvitamin D and intestinal calcium absorption all decreased in both groups with no difference in response between the 2 treatment arms. CONCLUSIONS Provision of alkali as potassium-magnesium citrate is an effective countermeasure for the increased risk of renal stone disease associated with immobilization. Despite an increase in urine calcium concentration, the relative saturation of calcium oxalate decreased due to citrate chelation of calcium and the concentration of undissociated uric acid decreased due to the significant increase in urine pH.
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Affiliation(s)
- Joseph E Zerwekh
- Center for Mineral Metabolism and Clinical Research, and the Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Watanabe Y, Ohshima H, Mizuno K, Sekiguchi C, Fukunaga M, Kohri K, Rittweger J, Felsenberg D, Matsumoto T, Nakamura T. Intravenous pamidronate prevents femoral bone loss and renal stone formation during 90-day bed rest. J Bone Miner Res 2004; 19:1771-8. [PMID: 15476576 DOI: 10.1359/jbmr.040811] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Revised: 05/24/2004] [Accepted: 06/11/2004] [Indexed: 11/18/2022]
Abstract
UNLABELLED Long-term bed rest has potential risks of bone loss and renal stone formation. We examined the effects of resistive exercise and intravenous pamidronate on BMD, bone turnover, urinary calcium, and renal stone formation in 25 healthy males during 90-day bed rest. Pamidronate prevented femoral bone loss and renal stone formation, but resistive exercise showed little effects. INTRODUCTION Long-term bed rest increases the risks of bone loss and urinary stone formation. Resistive exercise increases bone formation, and bisphosphonates reduce bone resorption. However, the effects of muscle exercise and bisphosphonates have not been examined side-by-side. The objectives of this study are to compare the effects of pamidronate with resistive exercise on BMD and renal stone formation during prolonged bed rest. MATERIALS AND METHODS Twenty-five male white volunteers, 26-45 years of age, were randomly assigned to the control (n = 9), exercise (n = 9), and pamidronate (n = 7) groups and underwent 90-day 6 degrees head-down tilt bed rest. Exercise group performed squats and heel raises on a flywheel device for 30 minutes every 3 days. Pamidronate (60 mg) was administered intravenously 14 days before bed rest. BMD of the head, forearm, lumbar spine, and proximal femur; biochemical bone markers; calcium (Ca) metabolism; and abdominal radiographs were examined during 90 days of bed rest and 360 days of reloading. RESULTS In controls, proximal femoral BMD decreased, and bone resorption markers and urinary Ca increased during bed rest, along with development of renal stones in two of nine subjects. Resistive exercise increased bone formation but was unable to prevent femoral BMD decrease and increases in bone resorption and urinary Ca during bed rest, with formation of renal stones in four of nine subjects. Pamidronate maintained femoral BMD, reduced bone resorption and urinary Ca, and completely prevented renal stone formation. CONCLUSIONS Resistive exercise increased bone formation but could not reduce bone resorption and the risk of renal stones. In contrast, inhibition of bone resorption by pamidronate could preserve bone mineral and reduce the risk of renal stone formation during prolonged bed rest.
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Affiliation(s)
- Yukiko Watanabe
- Test Facilities Operation and Maintenance Section, Space Station Engineering Department, Advanced Engineering Services, Co., Ltd., Ibaraki, Japan
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Smith SM, Davis-Street JE, Fesperman JV, Calkins DS, Bawa M, Macias BR, Meyer RS, Hargens AR. Evaluation of treadmill exercise in a lower body negative pressure chamber as a countermeasure for weightlessness-induced bone loss: a bed rest study with identical twins. J Bone Miner Res 2003; 18:2223-30. [PMID: 14672358 DOI: 10.1359/jbmr.2003.18.12.2223] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Counteracting bone loss is required for future space exploration. We evaluated the ability of treadmill exercise in a LBNP chamber to counteract bone loss in a 30-day bed rest study. Eight pairs of identical twins were randomly assigned to sedentary control or exercise groups. Exercise within LBNP decreased the bone resorption caused by bed rest and may provide a countermeasure for spaceflight. INTRODUCTION Bone loss is one of the greatest physiological challenges for extended-duration space missions. The ability of exercise to counteract weightlessness-induced bone loss has been studied extensively, but to date, it has proven ineffective. We evaluated the effectiveness of a combination of two countermeasures-treadmill exercise while inside a lower body negative pressure (LBNP) chamber-on bone loss during a 30-day bed rest study. MATERIALS AND METHODS Eight pairs of identical twins were randomized into sedentary (SED) or exercise/LBNP (EX/LBNP) groups. Blood and urine samples were collected before, several times during, and after the 30-day bed rest period. These samples were analyzed for markers of bone and calcium metabolism. Repeated measures ANOVA was used to determine statistical significance. Because identical twins were used, both time and group were treated as repeated variables. RESULTS Markers of bone resorption were increased during bed rest in samples from sedentary subjects, including the collagen cross-links and serum and urinary calcium concentrations. For N-telopeptide and deoxypyridinoline, there were significant (p < 0.05) interactions between group (SED versus EX/LBNP) and phase of the study (sample collection point). Pyridinium cross-links were increased above pre-bed rest levels in both groups, but the EX/LBNP group had a smaller increase than the SED group. Markers of bone formation were unchanged by bed rest in both groups. CONCLUSIONS These data show that this weight-bearing exercise combined with LBNP ameliorates some of the negative effects of simulated weightlessness on bone metabolism. This protocol may pave the way to counteracting bone loss during spaceflight and may provide valuable information about normal and abnormal bone physiology here on Earth.
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Affiliation(s)
- Scott M Smith
- Human Adaptation and Countermeasures Office, NASA Lyndon B. Johnson Space Center, Houston, Texas 77058, USA.
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Abstract
There is a growing body of evidence from the National Aeronautics and Space Administration and the Russian space program showing that humans exposed to the microgravity environment of space have a greater risk for developing renal stones. Increased bone resorption and the attendant hypercalciuria and hyperphosphaturia contribute significantly to raising the urinary state of saturation with respect to the calcium salts, namely calcium oxalate and calcium phosphate. In addition, other environmental and dietary factors may adversely affect urine composition and increase stone formation risk during space flight. For example, reductions in urinary volume, pH, and citrate contribute to raising stone formation risk. In addition to raising the risk for calcium stone formation, this metabolic profile is conducive to the formation of uric acid stones. Although observations to date have suggested that there may actually be a reduced food intake during the early phase of flight, crew members on longer-duration flights may increase food intake and be at increased risk for stone formation. Taken together, these findings support the use of nutritional recommendations for crew members that would serve to reduce the stone-forming propensity of the urinary environment. Pharmacologic intervention should be directed at raising urinary volumes, diminishing bone losses, and preventing reductions in urinary pH and citrate. Success in reducing the risk for stone formation in astronauts would also be of potential major benefit to the estimated 20 million Americans with nephrolithiasis.
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Affiliation(s)
- Joseph E Zerwekh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA.
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Jones JA, Johnston S, Campbell M, Miles B, Billica R. Endoscopic surgery and telemedicine in microgravity: developing contingency procedures for exploratory class spaceflight. Urology 1999; 53:892-7. [PMID: 10223479 DOI: 10.1016/s0090-4295(99)00024-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The risk of a urinary calculus during an extended duration mission into the reduced gravity environment of space is significant. For medical operations to develop a comprehensive strategy for the spaceflight stone risk, both preventive countermeasures and contingency management (CM) plans must be included. METHODS A feasibility study was conducted to demonstrate the potential CM technique of endoscopic ureteral stenting with ultrasound guidance for the possible in-flight urinary calculus contingency. The procedure employed the International Space Station/Human Research Facility ultrasound unit for guide wire and stent localization, a flexible cystoscope for visual guidance, and banded, biocompatible soft ureteral stents to successfully stent porcine ureters bilaterally in zero gravity (0g). RESULTS The study demonstrated that downlinked endoscopic surgical and ultrasound images obtained in 0g are comparable in quality to 1g images, and therefore are useful for diagnostic clinical utility via telemedicine transmission. CONCLUSIONS In order to be successful, surgical procedures in 0g require excellent positional stability of the operating surgeon, assistant, and patient, relative to one another. The technological development of medical procedures for long-duration spaceflight contingencies may lead to improved terrestrial patient care methodology and subsequently reduced morbidity.
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Affiliation(s)
- J A Jones
- National Aeronautics and Space Administration/Johnson Spacecraft Center and University of Texas Medical Branch Aerospace Medicine Program, Houston, Texas 77058, USA
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Ruml LA, Dubois SK, Roberts ML, Pak CY. Prevention of hypercalciuria and stone-forming propensity during prolonged bedrest by alendronate. J Bone Miner Res 1995; 10:655-62. [PMID: 7610938 DOI: 10.1002/jbmr.5650100420] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The bone loss and hypercalciuria induced by immobilization or the decreased gravitational forces of space are well described. Using a model of bedrest immobilization, the ability of a potent aminobisphosphonate, alendronate, to avert hypercalciuria and stone-forming propensity was tested. Sixteen male subjects participated in a randomized, placebo-controlled trial in which they received either 20 mg of alendronate or placebo 2 weeks prior to and during 3 weeks of strict bedrest. Parameters of bone and calcium metabolism and urinary crystallization of stone-forming salts were measured before and at the end of bedrest. In the placebo group, bedrest increased urinary calcium (209 +/- 47 to 267 +/- 60 mg/day, p < 0.01) and the saturation of calcium phosphate. Before bedrest, the alendronate group had a significantly lower serum calcium (8.8 +/- 0.4 vs. 9.6 +/- 0.5 mg/dl, p < 0.01) and higher serum PTH (62.4 +/- 33.1 vs. 23.1 +/- 7.5 pg/ml, p < 0.01) compared with the placebo group. Moreover, the alendronate group had a lower urinary calcium (75 +/- 41 mg/day) and saturation of calcium oxalate and calcium phosphate. These effects of alendronate were sustained during bedrest. Following bedrest in the alendronate group, urinary calcium rose to 121 +/- 50 mg/day, a value less than that in the placebo group before or during bedrest. Similarly, urinary saturation of calcium oxalate and calcium phosphate rose with bedrest in the alendronate-treated patients but remained lower than values obtained in placebo-treated patients before or during bedrest. Alendronate inhibits bone mineral loss and averts the hypercalciuria and increased propensity for the crystallization of stone-forming calcium salts which occurs during 3 weeks of strict bedrest.
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Affiliation(s)
- L A Ruml
- Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, USA
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Abstract
Exposure to the microgravity environment of space produces a number of physiological changes of metabolic and environmental origin that could increase the potential for renal stone formation. Metabolic, environmental and physicochemical factors that influence renal stone risk potential were examined in 24-hour urine samples from astronauts 10 days before launch and on landing day to provide an immediate postflight assessment of these factors. In addition, comparisons were made between male and female crewmembers, and between crewmembers on missions of less than 6 days and those on 6 to 10-day missions. Results suggest that immediately after space flight the risk of calcium oxalate and uric acid stone formation is increased as a result of metabolic (hypercalciuria, hypocitraturia, pH) and environmental (lower urine volume) derangements, some of which could reflect residual effects of having been exposed to microgravity.
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Affiliation(s)
- P A Whitson
- Biomedical Operations and Research Branch, NASA/Johnson Space Center, Houston, Texas 77058
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