Prospective randomized clinical trial comparing phytotherapy with potassium citrate in management of minimal burden (≤8 mm) nephrolithiasis

Effect of Prunus cerasus (Sour Cherry) on Nephrolithiasis in Children: The First Noninferiority Two-Arm Randomized Clinical Trial

OBJECTIVE

 The present study evaluated the effect of Prunus cerasus (sour cherry) on children with nephrolithiasis.

METHOD

 We conducted a randomized noninferiority controlled trial to evaluate the therapeutic efficacy of P. cerasus among children with nephrolithiasis. Subjects in the intervention group received 1.25 mL/kg of cherry concentrate once daily for 2 months, while the control group received 1 mL/kg Polycitra-K, which consists of 220 g citrate potassium and 68 g citric acid in 1000 mL sterile water. The major outcome was sonographically determined number and sizes of kidney stones, which were assessed before and after the trial.

RESULTS

 Sixty-eight children completed the study. At trial onset, both groups were similar in baseline characteristics (P >.05). In within-group analysis, the number of stones significantly decreased in both groups (P <05). After 2 months, the number of nephrolithiasis was 1.55 ± 0.49 and 1.47 ± 0.67 in the control and intervention groups, respectively (P value=.56). The percentage of change in calculi number was 44.11 ± 11.12 and 38.14 ± 14.08 in the control and intervention groups, respectively (P value=.08). At the end of the study, the urine pH was 6.46 ± 0.99 and 6.14 ± 0.83 in the control and intervention groups, respectively (P value=.19). Urine calcium and uric acid concentrations were 32.00 ± 12.32 and 28.95 ± 10.96 mg/mm (P value=.68) and 24.11 ± 10.58 and 30.03 ± 11.39 mg/mm (P value=.012) in control and intervention groups, respectively.

CONCLUSION

 Our clinical data supported the efficacy of sour cherry in the treatment of nephrolithiasis compared to Polycitra-K. Future randomized controlled trials are needed to confirm the present observation.

Citrate salts for preventing and treating calcium containing kidney stones in adults

BACKGROUND

Kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain.

OBJECTIVES

The objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones.

SEARCH METHODS

We searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months.

DATA COLLECTION AND ANALYSIS

Two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes.

MAIN RESULTS

We included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89).

AUTHORS' CONCLUSIONS

Citrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.

Recent finding and new technologies in nephrolitiasis: a review of the recent literature

This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy.

Hypouricemic effect of the methanol extract from Prunus mume fruit in mice

CONTEXT

The fruit of the Prunus mume Sieb. et Zucc (Rosaceae) is used as a health food or medicinal material in traditional herb medicine for a long time in Eastern Asian countries.

OBJECTIVE

Our present study investigated the hypouricemic effect of the methanol extract from P. mume fruit (MPMF) in mice with potassium oxonate-induced hyperuremia.

MATERIALS AND METHODS

Effect of MPMF (35, 70 and 140 mg/kg, p.o.) administrated for 7 days on the serum, liver, urinary uric acid levels and liver xanthine oxidase (XO) activity were assessed in mice.

RESULTS

Hyperuricemic mice induced by potassium oxonate demonstrated an elevation in serum and liver uric acid levels (11.0 mg/dL and 0.52 mg/g tissue) and a reduction in urinary uric acid levels (49.9 mg/dL). Oral administration of 140 mg/kg MPMF for 7 days reversed the abnormalities in serum, liver and urinary uric acid levels (7.1 mg/dL, 0.37 mg/g tissue and 69.7 mg/dL, respectively). In addition, 70 and 140 mg/kg MPMF (3.1 and 2.9 nmol/min per mg protein) inhibited liver XO activity compared with hyperuricemic mice (3.9 nmol/min per mg protein).

DISCUSSION AND CONCLUSION

The results indicated that the beneficial hypouricaemic effect of MPMF may be mediated, at least in part, by inhibiting XO activity in the liver. Our study suggests that P. mume and its extracts may have a considerable potential for development as an anti-gout agent for clinical application.