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Finger M, Finger E, Bellucci A, Malieckal DA. Medical management for the prevention of kidney stones. Postgrad Med J 2021; 99:postgradmedj-2021-140971. [PMID: 34930814 DOI: 10.1136/postgradmedj-2021-140971] [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: 08/10/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022]
Abstract
The alarming fact is that approximately one out of every 10 of us will have a kidney stone during our lifetime. The increasing prevalence and associated costs of kidney stones have resulted in it being one of the most commonly encountered and impactful medical conditions. Contributing factors include, but are not limited to, diet, climate, genetics, medications, activity and underlying medical conditions. Symptoms generally parallel stone size. Treatment varies from supportive to procedural (invasive and non-invasive). Prevention remains the best way to avoid this condition especially given the high recurrence rate. First time stone formers require counselling regarding dietary adjustments. Certain risk factors ultimately require a more in-depth metabolic investigation, especially if stones are recurrent. Ultimately, management is defined by stone composition. Where appropriate, we review both pharmacologic and non-pharmacologic options. Pivotal to successful prevention is patient education and the encouragement of compliance with the appropriate regimen.
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Affiliation(s)
- Mark Finger
- Medicine-Nephrology, Northwell Health, Great Neck, New York, USA
| | - Evan Finger
- Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
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Rahman IA, Nusaly IF, Syahrir S, Nusaly H, Mansyur MA. Association between metabolic syndrome components and the risk of developing nephrolithiasis: A systematic review and bayesian meta-analysis. F1000Res 2021; 10:104. [PMID: 34804491 PMCID: PMC8577060 DOI: 10.12688/f1000research.28346.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/20/2022] Open
Abstract
Background: There is increasing evidence that nephrolithiasis is a systemic disease, as opposed to an isolated urinary metabolic problem, after considerable links were found between nephrolithiasis and systemic diseases such as hypertension, obesity, dyslipidemia, and insulin resistance. The interplay between these four factors defines metabolic syndrome (MetS). In this review we aim to clarify the associations of MetS and its components to kidney stone incident. Methods: Online databases of EMBASE, MEDLINE, and Google Scholar were searched from January 1998 up to October 2020 to identify observational studies examining the association between metabolic syndrome components and kidney stone incident. Bayesian random-effects meta-analysis and meta-regression were performed to observe the association. Linear dose-response analysis was conducted to shape the direction of the association. Data analysis was performed using STATA, and R statistics. Results: A total of 25 potentially relevant studies (n = 934,588 participants) were eventually identified. The pooled results suggested that metabolic syndrome was associated with an increased risk of nephrolithiasis with an odds ratio (OR) of 1.769 (95% CI: 1.386 - 2.309). The summary OR of hypertension and dyslipidemia for developing nephrolithiasis were 1.613 (95% CI: 1.213 - 2.169) and 1.586 (95% CI: 1.007 - 2.502) respectively. The presence of diabetes mellitus and obesity had an OR of 1.552 (95% CI: 1.027 - 2.344) and 1.531 (95% CI: 1.099 - 2.109) respectively. Our results revealed that the increasing number of MetS traits will increase the risk of developing nephrolithiasis, the higher the fasting plasma glucose, and body mass index, the higher the risk of kidney stones incident. Conclusions: Our results suggest that hypertension, diabetes, obesity and dyslipidemia are associated with increased risk of developing nephrolithiasis. Linear significant association between MetS components and nephrolithiasis were revealed in our study which reinforced the notion that should be considered a systemic disorder.
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Affiliation(s)
- Ilham Akbar Rahman
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90222, Indonesia
| | - Ilham Fauzan Nusaly
- Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90222, Indonesia
| | - Syakri Syahrir
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Harry Nusaly
- Department of Urology, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Makbul Aman Mansyur
- Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
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Kaushik J, Tandon S, Bhardwaj R, Kaur T, Singla SK, Kumar J, Tandon C. Delving into the Antiurolithiatic Potential of Tribulus terrestris Extract Through -In Vivo Efficacy and Preclinical Safety Investigations in Wistar Rats. Sci Rep 2019; 9:15969. [PMID: 31685914 PMCID: PMC6828970 DOI: 10.1038/s41598-019-52398-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/14/2019] [Indexed: 01/14/2023] Open
Abstract
Modern treatment interventions for kidney stones are wrought with side-effects, hence the need for alternative therapies such as plant-based medicines. We have previously documented through in vitro studies that statistically optimized aqueous extract of Tribulus terrestris (Zygophyllaceae family) possesses antiurolithic and antioxidant potential. This provides strong scientific foundation to conduct in vivo efficacy and preclinical safety studies to corroborate and lend further proof to its ability to prevent and cure kidney stones. The preventive and curative urolithiatic efficacy in experimentally induced nephrolithiatic Wistar rats, along with preclinical toxicity was evaluated following oral administration of statistically optimized aqueous extract of T. terrestris. Treatment showed augmented renal function, restoration of normal renal architecture and increase in body weight. Microscopic analysis of urine revealed excretion of small sized urinary crystals, demonstrating that treatment potentially modulated the morphology of renal stones. Tissue enzymatic estimation affirmed the antioxidant efficacy of treatment with reduced free radical generation. Significant upregulation of p38MAPK at both the gene and protein level was noted in hyperoxaluric group and interestingly treatment reversed it. Acute oral toxicity study established the Median Lethal Dose (LD50) to be greater than 2000 mg/kg body weight (b.wt.) No observed adverse effect level (NOAEL) by repeated oral toxicity for 28 days at 750 mg/kg b.wt. was noted. This study lends scientific evidence to the safe, preventive and curative potential of statistically optimized aqueous extract of T. terrestris at a dose of 750 mg/kg b.wt. and suggests that the extract shows promise as a therapeutic antiurolithic agent.
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Affiliation(s)
- Jyoti Kaushik
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Simran Tandon
- Amity Institute of Molecular Medicine & Stem Cell Research, Amity University Uttar Pradesh, Noida, India
| | - Rishi Bhardwaj
- Department of Biophysics, Panjab University, Chandigarh, India
| | - Tanzeer Kaur
- Department of Biophysics, Panjab University, Chandigarh, India
| | | | - Jitender Kumar
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Chanderdeep Tandon
- Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India.
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Ali SN, Dayarathna TK, Ali AN, Osumah T, Ahmed M, Cooper TT, Power NE, Zhang D, Kim D, Kim R, St Amant A, Hou J, Tailly T, Yang J, Luyt L, Spagnuolo PA, Burton JP, Razvi H, Leong HS. Drosophila melanogaster as a function-based high-throughput screening model for antinephrolithiasis agents in kidney stone patients. Dis Model Mech 2018; 11:dmm.035873. [PMID: 30082495 PMCID: PMC6262805 DOI: 10.1242/dmm.035873] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/25/2018] [Indexed: 01/24/2023] Open
Abstract
Kidney stone disease involves the aggregation of stone-forming salts consequent to solute supersaturation in urine. The development of novel therapeutic agents for this predominantly metabolic and biochemical disorder have been hampered by the lack of a practical pre-clinical model amenable to drug screening. Here, Drosophila melanogaster, an emerging model for kidney stone disease research, was adapted as a high-throughput functional drug screening platform independent of the multifactorial nature of mammalian nephrolithiasis. Through functional screening, the therapeutic potential of a novel compound commonly known as arbutin that specifically binds to oxalate, a key component of kidney calculi, was identified. Through isothermal titration calorimetry, high-performance liquid chromatography and atomic force microscopy, arbutin was determined to interact with calcium and oxalate in both free and bound states, disrupting crystal lattice structure, growth and crystallization. When used to treat patient urine samples, arbutin significantly abrogated calculus formation in vivo and outperformed potassium citrate in low pH urine conditions, owing to its oxalate-centric mode of action. The discovery of this novel antilithogenic compound via D. melanogaster, independent of a mammalian model, brings greater recognition to this platform, for which metabolic features are primary outcomes, underscoring the power of D. melanogaster as a high-throughput drug screening platform in similar disorders. This is the first description of the use of D. melanogaster as the model system for a high-throughput chemical library screen. This article has an associated First Person interview with the first authors of the paper.
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Affiliation(s)
- Sohrab N Ali
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Thamara K Dayarathna
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Aymon N Ali
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Tijani Osumah
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mohamed Ahmed
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Tyler T Cooper
- Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nicholas E Power
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Dongxing Zhang
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 5B9, Canada
| | - Dajung Kim
- Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Rachel Kim
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada.,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada
| | - Andre St Amant
- Department of Chemistry, University of Santa Barbara, CA 93106, USA
| | - Jinqiang Hou
- Department of Chemistry, Western University, London, ON N6A 3K7, Canada
| | - Thomas Tailly
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Jun Yang
- Department of Mechanical and Materials Engineering, Western University, London, ON N6A 5B9, Canada
| | - Len Luyt
- Department of Chemistry, Western University, London, ON N6A 3K7, Canada
| | - Paul A Spagnuolo
- Faculty of Food Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jeremy P Burton
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada
| | - Hon S Leong
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 4V2, Canada .,Translational Prostate Cancer Research Laboratory, Lawson Health Research Institute, London, ON N6A 4V2, Canada.,Department of Urology, Mayo Clinic, Rochester, MN 55905, USA
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