Medical management of renal stone

Effects of Composite Probiotic Food on Urinary, Serum Biochemical and Oxidative Stress Parameters in a Urolithiatic Rat Model

Research background

Prevention, management or cure of diseases through dietary approaches is becoming increasingly important. Research suggests that probiotic, oxalate-degrading Lactobacillus species administered via a milk and cereal food can prevent kidney stones while also addressing nutritional deficiencies and maintaining essential calcium levels. This study investigates the effect of a composite probiotic milk beverage on urolithiatic rats.

Experimental approach

Probiotic milk-barley beverage (PMBB) was prepared by fermentation of milk enriched with barley (Hordeum vulgare) flour using starter culture containing oxalate-degrading probiotic strains (Lacticaseibacillus rhamnosus strains MTCC5945 and MTCC25062, Lactobacillus helveticus MTCC5463 and Lactiplantibacillus plantarum M11). Cumin and common salt were used as flavourings. Unfermented milk-barley base (C) served as control. Wistar rats were divided in four groups (N=6). Normal control (NC) group received normal rat diet, and to induce kidney stones, ethylene glycol (0.75 %) and ammonium chloride (1 %) were administered to the disease control (DC) group, PMBB and control (C) groups for 28 days. PMBB and C groups received 1 mL of probiotic milk and barley beverage and unfermented milk-barley base from day 15 to day 28. Indicators of urolithiasis were studied.

Results and conclusions

PMBB significantly (p<0.05) increased urine output, decreased urine oxalate concentrations and increased creatinine, calcium and uric acid concentrations. Serum parameters such as concentrations of calcium, uric acid, urea and creatinine increased significantly (p<0.05) in DC rats, but decreased significantly (p<0.05) in the PMBB group. In addition, serum concentrations of magnesium and osteopontin decreased more significantly in DC rats than in the PMBB ones. The increase in malondialdehyde and decrease in reduced glutathione concentrations observed in the DC group were significantly lower in the PMBB group. The histomorphology of the kidney tissue of DC rats showed calcium oxalate crystal aggregates in the tubules, indicators of renal injury, tubular dilatation, enlarged urinary space and shrunken glomeruli. The PMBB group showed an improvement in the renal histological architecture. Analysis of the caecal digesta of the rats showed a significantly (p<0.05) higher mass fraction of fatty acids (acetic and propionic) in the treatment group. The results show the potential of PMBB in the dietary control of urolithiasis.

Novelty and scientific contribution

This study focuses on the antiurolithiatic prospect of a composite probiotic milk beverage produced with oxalate-degrading culture. It also points to a new functional food form that shows promising health benefits in nutrition of patients with urolithiasis.

A Rare Case of Obstructive Uropathy in an Elderly Male From Rural India - A Case Report

Ureterocele is a rare congenital anomaly often believed to be caused due to incomplete dissolution of the Chwalla membrane. In this pathology, the distal end of the ureter is invaginated in the bladder and is dilated. We present a case of an 81-year-old male from rural India who came with complaints of hematuria and was diagnosed with ureterocele.

Efficacy of a Multicomponent Nutraceutical Formulation for the Prevention and Treatment of Urinary Tract Stones

Urolithiasis is a complex and multifactorial disease characterized by the formation of calculi at the urinary tract level. Conventional therapeutic prophylaxis relies on the use of Ca-blockers, alkalis, diuretics, and anti-edema agents, but their prolonged utilization is often limited by several side effects. In this scenario, the aim of the present work was the design of an innovative multi-component nutraceutical formulation (NF) for the management of urinary stones consisting of a synergistic combination of natural aqueous extracts of Oreganum vulgare L. (1% of saponin), Urtica dioica (0.8% of β-sitosterol), Phyllanthus niruri (15% of tannins w/w), and Ceterach officinarum in association with bromelain, K, and Mg citrate. To assess the potential of NF also in the treatment of uric acid (UA) stones, the effects on the expression of the cellular UA transporters OAT1 and URAT1 were investigated in a renal tubular cell line. In addition, the myorelaxant effect of NF was investigated in a human pulmonary artery smooth muscle cell (HPASMC) model resulting in a decreased muscle contractility of -49.4% (p < 0.01) compared to the control. The treatment with NF also showed a valuable inhibition of in vitro calcium-oxalate crystal formation, both in prevention (-52.3% vs. control, p < 0.01) and treatment (-70.8% vs. control, p < 0.01) experiments. Finally, an ischemic reperfusion rat model was used to evaluate the NF anti-edema effects, resulting in a reduction in the edema-related vascular permeability (Normalized Gray Levels, NGL = 0.40 ± 0.09, p < 0.01, -67.1% vs. untreated rats). In conclusion, the present NF has shown to be a promising natural alternative for managing urinary tract stones.

Association Between Kidney Stone and Dental Calculus in a Saudi Population: A Cross-Sectional Study

OBJECTIVE

To investigate the correlation between dental calculus and kidney stones, and to identify the risk factors associated with the presence of these conditions.

METHODS

This study was carried out at the medical city, King Saud University, Riyadh, Saudi Arabia between 2020 and 2021. The study included 141 participants (70 with kidney stones and 71 with controls). The dental plaque and calculus indices were used to record plaque and calculus scores, respectively. All information was statistically investigated and the level of significance was set at p<0.05.

RESULTS

The plaque and calculus indices were significantly higher in the control group when compared to the kidney stone group (p<0.05). A weak positive correlation between age and the calculus index in the kidney stone group was revealed (r=0.31, p=0.01). However, only within the age group 36-55, the results showed that the control group had a significantly higher calculus index than that of the kidney stone group (p=0.02). The married patients with kidney stones scored a significantly higher plaque index than the unmarried patients (p=0.03).

CONCLUSION

The dental plaque and calculus indices were lower in the kidney stone group than those of the non-kidney stone group. Therefore, the clinical observation of dental plaque and calculus may not be indicators of kidney stones. However, within the kidney stone group, elderly and married patients could be at a higher risk for developing dental calculus and plaque, respectively.

Symptomatic kidney stones in an anuric patient on dialysis: A case report

INTRODUCTION

Renal colic is a colicky-type of flank pain that can commonly be presented in patients undergoing dialysis especially if they are anuric considering the fact that there are multiple controversies and little published experience on this topic, we found it very important to report this case. We also aimed to increase awareness and emphasize the importance of renal colic in anuric patients on dialysis.

CASE DESCRIPTION

We herein report a case of a 42-year old man with a chief complaint of bilateral colic flank pain, He had developed end stage renal disease due to ADPKD and was on hemodialysis since the past 5 years. Previously, he went through a series of workup but was left undiagnosed. Abdomen-pelvic and chest CT scan without contrast was performed showing bilateral renal pelvic stones and some nephrocalcinosis in both kidneys. bilateral ureteroscopy was performed and bilateral DJ was installed for a total of 6 weeks and extracorporeal shock wave lithotripsy was done. With prompt diagnosis, the patient was pain free and stone free before discharge. The patient is also reported to be stone free 6 months after the procedure.

CONCLUSION

Patients on dialysis are still capable of forming symptomatic renal tract stones even if they are anuric.

Efficacy of Herbmed Plus in urolithic rats: An experimental study

Background

In Ayurveda, several herbs and formulations are available for the treatment of Urolithiasis. However, they are not systematically evaluated for their safety, efficacy, indication and limitations. Herbmed Plus is one such herbal formulation that has been known for the management of urinary tract disorders. An attempt has been made to evaluate its efficacy on Urolithiasis.

Objective

To evaluate the efficacy and safety of Herbmed Plus in urolithic rats.

Materials and methods

A total of 60 Wistar albino rats were used for this study. The male and female rats were divided into five groups: disease control, test (dose 90 mg/kg), standard I (Cystone), standard II (Alkaston insta) and normal control (six in each group). Urolithiasis was induced using ethylene glycol 0.75% in drinking water for 28 days. The rats with urinary oxalate crystals were dosed with oral test or standard treatments for 28 days.

Results

All the animals appeared normal and showed no clinical signs of toxicity. None of the groups reported mortality or adverse effect on body weight and food consumption. The treatment with test drug showed improvement in the SGPT level and urine output (5.4 vs 3.47 mL/24 h). A drastic reduction in number of crystals were observed in male 0.5 vs 22 and female rats 0 vs 22.7 in test and disease group. The kidney lactate dehydrogenase, alkaline phosphatase, urinary phosphorus and calcium oxalate level decreased in the test and standard drug groups as compared to disease groups. Microscopy of the urine samples showed reduction in the number of crystals after treatment compared to the urolithic group. Increase in citrate levels in urine in all the treatment groups indicated anti-urolithiatic activity. The test group showed a 69.70% recovery in males and 47.57% recovery in female rats compared to the disease control group.

Conclusion

Herbmed Plus showed a significant reduction in oxalate synthesizing enzymes suggesting anti-urolithiatic activity and anti-inflammatory and regenerative property in cellular injury caused by crystal deposits.

The effect of the body mass index on the types of urinary tract stones

Objectives:

Urinary tract stones are a common public health problem worldwide. In addition, identifying the composition of stones is important for the further metabolic evaluation of patients. We conducted this study to further correlate the relationship between body mass index (BMI) and different compositions of urinary tract stones.

Materials and Methods:

A retrospective study of 433 patients who underwent urinary tract stone analysis via Fourier-transform infrared spectroscopy at King Khalid University Hospital in Riyadh from May 2015 to June 2017 was performed. Their BMI at the time of stone analysis was recorded.

Results:

A total of 433 stones were analyzed by the statistical data analysis software. The BMI was classified according to the WHO classification. We divided our patients into seven age groups. Most patients were between the age group of 35 and 44 years and were overweight. The incidence of calcium oxalate, carbonate apatite, and uric acid stones was higher in patients with a BMI above thirty than in patients with a lower BMI. However, cystine stones were more common in normal-weight patients.

Conclusions:

In this study, we found that the incidence of certain types of stones, such as calcium oxalate, cystine, and uric acid stones, in Saudi Arabia can be predicted by BMI measurement.

Caffeine in Kidney Stone Disease: Risk or Benefit?

Kidney stone disease is a global health care problem, with a high recurrence rate after stone removal. It is thus crucial to develop effective strategies to prevent the formation of new or recurrent stones. Caffeine is one of the main components in caffeinated beverages worldwide (i.e., coffee, tea, soft drinks, and energy drinks). Previous retrospective and prospective studies have reported contradictory effects of caffeine on kidney stone risk. Although it has a diuretic effect on enhancing urinary output, it may slightly increase the stone risk index. However, 3 large cohorts have suggested a preventive role of caffeine in kidney stone disease. In addition, a recent in vitro study has addressed relevant mechanisms underlying the preventive role of caffeine against stone pathogenesis. This review summarizes the relevant data from previous evidence and discusses the association between caffeine consumption and kidney stone risk reduction.

Kidney stones: pathophysiology, diagnosis and management

The prevalence of kidney stones is increasing, and approximately 12 000 hospital admissions every year are due to this condition. This article will use a case study to focus on a patient diagnosed with a calcium oxalate kidney stone. It will discuss the affected structures in relation to kidney stones and describe the pathology of the condition. Investigations for kidney stones, differential diagnosis and diagnosis, possible complications and prognosis, will be discussed. Finally, a detailed account of management strategies for the patient with kidney stones will be given, looking at pain management, medical procedures and dietary interventions.

Kidney stone nano-structure - Is there an opportunity for nanomedicine development?

BACKGROUND

Kidney stone analysis techniques are well-established in the field of materials characterization and provide information for the chemical composition and structure of a sample. Nanomedicine, on the other hand, is a field with an increasing rate of scientific research, a big budget and increasingly developing market. The key scientific question is if there is a possibility for the development of a nanomedicine to treat kidney stones.

MAJOR CONCLUSIONS

The main calculi characterization techniques such as X-ray Diffraction and Fourier Transform Infrared Spectroscopy can provide information about the composition of a kidney stone but not for its nanostructure. On the other hand, Small Angle X-ray Scattering and Nitrogen Porosimetry can show the nanostructural parameters of the calculi. The combination of the previously described parameters can be used for the development of nano-drugs for the treatment of urolithiasis, while no such nano-drugs exist yet.

GENERAL SIGNIFICANCE

In this study, we focus on the most well-known techniques for kidney stone analysis, the urolithiasis management and the search for possible nanomedicine for the treatment of kidney stone disease. We combine the results from five different analysis techniques in order to represent a three dimensional model and we propose a hypothetical nano-drug with gold nanoparticles. This article is part of a Special Issue entitled "Recent Advances in Bionanomaterials" Guest Editor: Dr. Marie-Louise Saboungi and Dr. Samuel D. Bader.

The usefulness of xuefu zhuyu tang for patients with angina pectoris: a meta-analysis and systematic review

Objective. To evaluate the efficacy of Xuefu Zhuyu Tang (XFZYT) for treating angina pectoris (AP). Methods. Six databases were searched (up to December, 2013). Eligible randomized controlled trials (RCTs) evaluating the efficiency of XFZYT plus traditional antianginal medications (TAMs) compared with TAMs alone in patients with AP were included. The outcomes were relief of anginal symptoms (RAS) and improvement of electrocardiogram (ECG) and blood high-density lipoprotein cholesterol (HDL-C) level. Result. Finally 14 RCTs were included. There were evidences that XFZYT combined with TAMs was more effective in improving RAS (RR = 1.29; 95% CI = [1.20, 1.38]), ECG (RR = 1.37; 95% CI = [1.22, 1.54]), and blood HDL-C level (MD = 0.29 mmol/L; 95% CI = [0.23, 0.35]) compared with TAMs alone. Our meta-analysis also showed the pooled number needed to treat (NNT) of the group with stable angina pectoris (SAP) was smaller in improving RAS (4.2 versus 5.7) and ECG (3.1 versus 5.5) compared with the group with both SAP and unstable angina pectoris (UAP). Conclusion. Combination therapy with XFZYT and TAMs is more effective in treating AP compared with TAMs alone. And XFZYT may be a more suitable choice for the treatment of SAP. However, the findings should be interpreted with caution due to the mediocre methodological quality of the included RCTs.

Dissolution therapy versus shock wave lithotripsy for radiolucent renal stones in children: a prospective study

PURPOSE

We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children.

MATERIALS AND METHODS

A total of 87 children with radiolucent renal calculi were included in study. Median age was 2.5 years (range 0.5 to 13). Computerized tomography was done to confirm a stone density of less than 500 HU. Median stone length was 12 mm (range 7 to 24). Patients were randomly divided into 2 groups. The medical group of 48 patients received potassium sodium hydrogen citrate at a dose of 1 mEq/kg per day for 1 to 3 months. The shock wave lithotripsy group of 39 patients were treated with a Lithotripter S (Dornier Medtech, Kennesaw, Georgia) while under general anesthesia. Complications in each group were recorded. Patients were considered stone free when imaging within 3 months showed no evidence of stones.

RESULTS

The stone-free rate was 72.9% for dissolution therapy vs 82.1% after a single session of shock wave lithotripsy (p = 0.314). One patient per group experienced a pyelonephritis episode during followup (p = 0.698). Three of the 13 patients in whom medical regimens failed were noncompliant and 5 ingested the medication sporadically.

CONCLUSIONS

Medical dissolution therapy is a well tolerated, effective treatment for radiolucent renal stones in children. It eliminates the need for shock wave lithotripsy in up to 73% of cases.