RESUMO
Magnesium is one of the recommended treatments for calcium stone formers (CSFs) with hyperoxaluria. In this study, we compared the effect of magnesium oxide (MgO) or magnesium citrate (MgCit) with placebo on 24-hour urine (24-U) metabolites and the calcium oxalate supersaturation index (CaOx SS). In a randomized, double-blind, placebo-controlled clinical trial, 90 CSFs with idiopathic hyperoxaluria were recruited from a tertiary stone prevention clinic. Patients were randomly assigned into three groups: 120 mg MgO, 120 mg MgCit or placebo (supplements were taken three times per day, with meals). Finally, 76 patients were included in the final analysis. Analyses of 24-U were performed at baseline and after eight weeks. Study outcomes included changes in 24-U oxalate, magnesium, citrate, and CaOx SS. Dietary factors were controlled by 24-hour food recalls. Repeated measure ANOVA was used to compare the results. After the intervention, both MgO and MgCit supplements decreased 24-U oxalate excretion (-8.13±16.45 in the MgO group and -16.99±18.02 in the MgCit group) and CaOx SS compared to the placebo, with the effects of MgCit reaching statistical significance (p=0.011 and p=0.010, respectively). An increasing trend was observed for 24-U magnesium and citrate excretion without significant differences among groups. Interestingly, MgCit exhibited a significantly greater inhibitory effect on 24-U oxalate in patients with normal urine magnesium levels (p=0.021). Clinically, both MgO and MgCit reduced 24-U oxalate and CaOx SS compared to placebo. However, MgCit demonstrated a greater effect, especially in patients with normal urine magnesium levels.
Assuntos
Suplementos Nutricionais , Hiperoxalúria , Cálculos Renais , Óxido de Magnésio , Humanos , Óxido de Magnésio/uso terapêutico , Óxido de Magnésio/administração & dosagem , Feminino , Masculino , Cálculos Renais/urina , Cálculos Renais/prevenção & controle , Cálculos Renais/tratamento farmacológico , Cálculos Renais/metabolismo , Adulto , Hiperoxalúria/urina , Hiperoxalúria/tratamento farmacológico , Hiperoxalúria/complicações , Método Duplo-Cego , Fatores de Risco , Pessoa de Meia-Idade , Ácido Cítrico/urina , Compostos de Magnésio/uso terapêutico , Compostos de Magnésio/urina , Compostos de Magnésio/farmacologia , Compostos de Magnésio/administração & dosagem , Compostos OrganometálicosRESUMO
OBJECTIVES: To evaluate the effects of two vitamin D repletion therapies (cholecalciferol) on serum levels of 25-hydroxyvitamin D (25(OH)D) and 24-h urine calcium in patients with recurrent calcium kidney stones and vitamin D deficiency (VDD). DESIGN, SETTING, PARTICIPANTS: A parallel-group randomized controlled clinical trial on patients who referred to Labbafinejad kidney stone prevention clinic, Tehran, Iran. From 88 recurrent calcium stone formers, 62 patients completed the study. The age of participants was 18-70 years who had serum 25(OH)D levels of 10-20 ng/ml. INTERVENTION: Participants received oral cholecalciferol 2000 IU daily for 12 weeks or 50,000 IU weekly for 8 weeks. MAIN OUTCOME MEASURES: Study variables including 24-h urine calcium, supersaturations of calcium oxalate and calcium phosphate, serum 25(OH)D and parathyroid hormone were measured at the beginning of the study and after 12 weeks. RESULTS: The 24-h urine calcium significantly increased in both groups (ß = 69.70, p < 0.001), with no significant difference between treatments. Both groups showed no significant change in the supersaturation levels of calcium oxalate and calcium phosphate. Serum levels of 25(OH)D increased significantly (ß = 12.53, p < 0.001), with more increase in the 50,000 IU group (ß = 3.46, p = 0.003). Serum parathyroid hormone decreased in both groups (p < 0.001). CONCLUSIONS: Although both treatment protocols increased 24-h urine calcium, they did not increase the supersaturation state of calcium oxalate or calcium phosphate. Trial registration IRCT20160206026406N4, 13/08/2019.
Assuntos
Cálculos Renais , Deficiência de Vitamina D , Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Cálcio , Oxalato de Cálcio , Fosfatos de Cálcio , Colecalciferol/farmacologia , Irã (Geográfico) , Cálculos Renais/tratamento farmacológico , Hormônio Paratireóideo , Vitamina D , Deficiência de Vitamina D/tratamento farmacológico , VitaminasRESUMO
BACKGROUND: Hypercalciuria is one of the most important urinary risk factors in kidney stone formers. This study aimed to delineate the interaction of some demographic, serum, and urinary risk factors influencing 24-h urinary (24-U) calcium excretion. METHODS: This study was secondary data analysis, using data from 593 kidney stone patients referred to the Labbafinejad kidney stone prevention clinic from March 2015 to May 2019. The study considered serum, urinary and demographic factors that interact to influence 24-U calcium using path analysis. In addition to the direct impact of predictors on the 24-U calcium, this analysis considered the effects of the predictors on the 24-U calcium transmitted by a mediating variable named indirect effects. RESULTS: The results showed that age indirectly affected on 24-U calcium through 25-hydroxy vitamin D (25(OH)D), serum and 24-U creatinine. As well, weight had an indirect effect through 24-urine metabolites (creatinine, citrate, urea, and sodium). Among serum variables, PTH and creatinine significantly directly affected on 24-U calcium. In comparison, 25(OH)D and phosphorus appeared to influence 24-U calcium indirectly through serum parathormone. Regarding 24-U metabolites, sodium, urea, and citrate had a significant direct effect on 24-U calcium. Moreover, 24-U creatinine has a significant direct and indirect effect on 24-U calcium through citrate and urea as mediator variables. CONCLUSION: Serum 25(OH)D and phosphorus, along with age and weight, indirectly affected urinary calcium through a third variable. Other variables (PTH, serum creatinine, and 24-U sodium, urea, and citrate) showed a direct effect on 24-U calcium excretion.
Assuntos
Cálcio , Cálculos Renais , Humanos , Creatinina/urina , Cálculos Renais/urina , Ácido Cítrico/urina , Citratos , Ureia , Sódio , Fósforo , DemografiaRESUMO
Treatment with alpha-blockers has been used in many studies to facilitate stone clearance after extra-corporeal shock wave lithotripsy (ESWL), based on mediating ureteral wall relaxation. Ureteral wall edema is another barrier against the stone passage. We aimed to compare the effectiveness of boron supplement (due to its anti-inflammatory effect) and tamsulosin in the passage of stone fragments after ESWL. Eligible patients after ESWL were randomly assigned to two groups and were treated with boron supplement (10 mg/BD) or tamsulosin (0.4 mg per night) for 2 weeks. The primary outcome was the stone expulsion rate according to the remained fragmented stone burden. The secondary outcomes were the time of stone clearance, pain intensity, drug side effects, and the need for auxiliary procedures. In this randomized control trial, 200 eligible patients were treated with boron supplement or tamsulosin. Finally, 89 and 81 patients in the two groups completed the study, respectively. The expulsion rate was 46.6% in the boron and 38.7% in the tamsulosin group, which there was no statistically significant difference between the two groups (p = 0.003), as well as the time of stone clearance (7.47 ± 22.4 vs 6.52 ± 18.45, days, p = 0.648, respectively), after 2-week follow-up. Moreover, pain intensity was the same in both groups. No Significant side effects were reported in the two groups. Boron supplement could be effective as adjuvant medical expulsive therapy after ESWL with no significant side effects in short-term follow-up. Iranian Clinical Trial Registration number and date of registration: IRCT20191026045244N3, 07/29/2020.
Assuntos
Litotripsia , Cálculos Ureterais , Cálculos Urinários , Humanos , Tansulosina/uso terapêutico , Cálculos Ureterais/tratamento farmacológico , Boro/uso terapêutico , Irã (Geográfico) , Sulfonamidas/uso terapêutico , Cálculos Urinários/tratamento farmacológico , Litotripsia/efeitos adversos , Litotripsia/métodos , Resultado do TratamentoRESUMO
BACKGROUND: The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran. METHODS: We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020-Feb 2021) and compared it with the patients' medical records in the same period a year before COVID-19 (Feb 2019-Feb 2020). RESULTS: The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits. CONCLUSIONS: COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.
Assuntos
COVID-19 , Cálculos Renais , Humanos , Irã (Geográfico)/epidemiologia , Rim , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Pandemias , Fatores de Risco , SARS-CoV-2RESUMO
BACKGROUND: The prevalence and risk factors of urinary tract infection (UTI) in neonates with unexplained hyperbilirubinemia are not studied thoroughly. Since the prevalence of UTI is highly variable in different areas and countries, this study aimed to review the existing data of Iranian neonates with UTI presented with unexplained hyperbilirubinemia. METHODS: This study is a meta-analysis of Iranian newborns with unexplained hyperbilirubinemia. We identified all studies indexed in international (Web of Science, PubMed, Scopus, Google Scholar) and national (Science Information Database, Magiran) databases from 2000-2018. Search terms included: Urinary Tract Infections OR UTI AND urine OR culture OR microbio, jaundice OR icter OR hyperbili, AND Iran. RESULTS: Overall, 4210 neonates from 17 studies were included. The pooled prevalence of UTI in neonates with unexplained hyperbilirubinemia was 6.81% (95% CI: 4.86-8.77). Considering the subgroups analyses; the prevalence of UTI was higher in the prolonged vs. not-prolonged state (8.34% vs. 4.00%), low birth weight vs. normal birth weight (7.81% vs. 4.51%), and exclusive vs. non-exclusive breastfeeding (8.84% vs. 4.72%). Male gender and low birth weight increased the risk of UTI about two times compared to the female gender and normal birth weight, respectively. The results of the analyses in neonates with unconjugated hyperbilirubinemia also showed the above-mentioned subgroup differences. CONCLUSION: Due to considerable prevalence of UTI in neonates with unexplained hyperbilirubinemia and risk factors in this age group, investigation for UTI is essential for the workup in this situation.
RESUMO
INTRODUCTION: To study the prevalence of vitamin D deficiency in kidney stone formers and its predisposing factors and to assess the relationship between serum 25-Hydroxyvitamin D and urine metabolites. METHODS: Kidney stone formers were selected from the records of the kidney stone prevention clinic in Labbafinejad hospital, Tehran, Iran. Vitamin D deficiency was defined as 25-Hydroxyvitamin D < 20 ng/mL. The association between vitamin D deficiency and predisposing factors, serum, and urine metabolites was evaluated. RESULTS: In 1005 patients (66.4% men and 33.6% women), the prevalence of vitamin D deficiency was 44.8%. Vitamin D deficiency was more prevalent in patients under 50 years (P < .001) and patients with hyperparathyroidism (P < .05). The lowest prevalence of hyperparathyroidism was in the 25-Hydroxyvitamin D range of 40 to 49.9 ng/mL, followed by the range of 30 to 39.9 and 20 to 29.9 ng/mL. Patients with vitamin D deficiency had lower serum creatinine (P < .02), lower 24-hour urine calcium (P < .01), and lower 24-hour urine oxalate (P < .05). CONCLUSION: Iranian kidney stone formers have a relatively high prevalence of vitamin D deficiency. Our population seems to have different predisposing factors for vitamin D deficiency, i.e., higher prevalence among younger patients and no association between obesity and gender with vitamin D status. According to the parathyroid hormone, the favorable serum 25-Hydroxyvitamin D level was 20 to 49.9 ng/mL in our kidney stone formers.
Assuntos
Cálculos Renais , Deficiência de Vitamina D , Cálcio , Causalidade , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Cálculos Renais/diagnóstico , Cálculos Renais/epidemiologia , Masculino , Hormônio Paratireóideo , Prevalência , Vitamina D , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologiaRESUMO
PURPOSE: To determine the effect of a probiotic supplement containing native Lactobacillus acidophilus (L. acidophilus) and Bifidobacterium animalis lactis (B. lactis) on 24-hour urine oxalate in recurrent calcium stone formers with hyperoxaluria. Moreover, the in-vitro oxalate degradation capacity and the intestinal colonization of consumed probiotics were evaluated. MATERIALS AND METHODS: The oxalate degrading activity of L. acidophilus and B. lactis were evaluated in-vitro. The presence of oxalyl-CoA decarboxylase (oxc) gene in the probiotic species was assessed. One hundred patients were randomized to receive the probiotic supplement or placebo for four weeks. The 24-hour urine oxalate and the colonization of consumed probiotics were assessed after weeks four and eight. RESULTS: Although the oxc gene was present in both species, only L. acidophilus had a good oxalate degrading activity, in-vitro. Thirty-four patients from the probiotic and thirty patients from the placebo group finished the study. The urine oxalate changes were not significantly different between groups (57.21 ± 11.71 to 49.44 ± 18.14 mg/day for probiotic, and 56.43 ± 9.89 to 50.47 ± 18.04 mg/day for placebo) (P = .776). The probiotic consumption had no significant effect on urine oxalate, both in univariable (P = .771) and multivariable analyses (P = .490). The consumed probiotics were not detected in the stool samples of most participants. CONCLUSION: Our results showed that the consumption of a probiotic supplement containing L. acidophilus and B. lactis did not affect urine oxalate. The results may be due to a lack of bacterial colonization in the intestine.
Assuntos
Bifidobacterium animalis , Hiperoxalúria , Cálculos Renais , Probióticos , Bifidobacterium animalis/metabolismo , Cálcio , Método Duplo-Cego , Humanos , Cálculos Renais/terapia , Lactobacillus/metabolismo , Lactobacillus acidophilus/metabolismo , Oxalatos/metabolismo , Probióticos/uso terapêuticoRESUMO
OBJECTIVES: To investigate potential oxalate-degrading bacteria, including Oxalobacter formigenes, Lactobacillus (Lac) and Bifidobacterium (Bif) genera, and Oxalyl-CoA decarboxylase (oxc) encoding Lac (LX) and Bif (BX) species in participants with recurrent calcium kidney stones, and their correlation with 24-h urine oxalate. PARTICIPANTS AND METHODS: Stool and 24-h urine samples were collected from 58 patients with urolithiasis (29 cases with and 29 without hyperoxaluria) and 29 healthy controls. Absolute quantitation and relative abundance of the bacteria were measured by real-time PCR. The relationship between the investigated bacteria and 24-h urine oxalate were assessed statistically. RESULTS: The count per gram of stool and relative abundance of O. formigenes, Lac, Bif, LX and BX and the number of participants carrying O. formigenes, LX and BX bacteria were not significantly different between the groups; however, the relative abundance of O. formigenes in the kidney stone group was lower than in healthy controls (P = 0.035). More healthy controls were O. formigenes-positive compared with participants in the kidney stone group (P = 0.052). The results of the linear regression model, including all study participants, showed that the presence of O. formigenes could decrease 24-h urine oxalate (ß = -8.4, P = 0.047). Neither Lac and Bif genera nor LX and BX species were correlated with calcium stones or urine oxalate. CONCLUSION: These results emphasize the role of O. formigenes in kidney stone formation and its role in hyperoxaluria, which may be independent of kidney stone disease. Moreover, our results suggest that, although some Lac and Bif strains have oxalate-degrading potential, they may not be among the major oxalate-degrading bacteria of the gut microbiome.
Assuntos
Bifidobacterium/metabolismo , Cálcio , Hiperoxalúria/microbiologia , Cálculos Renais/microbiologia , Lactobacillus/metabolismo , Oxalatos/metabolismo , Oxalobacter formigenes/metabolismo , Adulto , Cálcio/análise , Carboxiliases/metabolismo , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Cálculos Renais/química , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
Purpose: A few experimental and observational studies have reported that atorvastatin prevents calcium oxalate stone formation. Our study is the first to investigate the effect of atorvastatin on 24-hour urinary metabolites, urinary malondialdehyde (U-MDA) (an oxidative stress marker) and urinary neutrophil gelatinase-associated lipocalin (U-NGAL) (a renal tubular injury marker) in patients with calcium stones and hyperoxaluria. Materials and Methods: This randomized, double-blind, placebo-controlled, parallel-group clinical trial included 32 adults with recurrent calcium stone formation and hyperoxaluria. All participants received a 3-month course of either atorvastatin (20 mg/d) or placebo of an identical shape. Both groups received the usual nutritional care based on the European Association of Urology guidelines. Results: Twenty-eight participants completed the study. Serum levels of total and low-density lipoprotein cholesterol decreased in the atorvastatin group, and these changes were significantly different between groups (p<0.001). No statistically significant differences were observed between intergroup changes of the 24-hour urinary metabolite analysis, the U-MDA to creatinine ratio and the U-NGAL to creatinine ratio. Conclusions: Atorvastatin administration at a dose of 20 mg/d for 3 months did not affect 24-hour urinary metabolite, U-MDA and U-NGAL levels in recurrent calcium stone formers. However, this study could not disprove the preventive role of atorvastatin in kidney stone formation. Future studies should consider a larger sample size, longer follow-up, different drug doses, and measurements of multiple biomarkers of oxidative stress and tubular injury.
Assuntos
Atorvastatina/administração & dosagem , Cálculos Renais/tratamento farmacológico , Adulto , Cálcio/análise , Método Duplo-Cego , Feminino , Humanos , Cálculos Renais/química , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do TratamentoRESUMO
Introduction: The effect of using high dose pomegranate extract on sepsis and its safety is not clarified. Considering the fact that proper immune and inflammatory responses are needed to cope with infection, the aim of current study was to assess the effect of high dose pomegranate extract consumption on oxidative and inflammatory responses after disease induction in rat model of sepsis. METHODS: Sepsis was induced by Cecal Ligation and Perforation (CLP) surgery. Adult male Wistar rats were divided into three groups of eight animals: Sham; CLP and POMx [consumed POMx (250 mg of pomegranate fruit extract/kg/day) for four weeks before CLP]. RESULTS: Peritoneal neutrophil myeloperoxidase activity was significantly lower in POMx compared with Sham and CLP groups (p < 0.01 and p < 0.05, respectively). Although antioxidant enzymes were higher in POMx group after sepsis induction, lower serum total antioxidant status (TAS) (p < 0.01 compared with both CLP and Sham groups) and higher liver thiobarbituric acid reactive species (TBARS) levels were observed in this group (p < 0.01 and p < 0.05, compared with Sham and CLP groups, respectively). CONCLUSION: High dose POMx consumption prior to sepsis induction, suppressed the vital function of neutrophils in early hours after sepsis initiation, resulting in higher oxidative stress. These findings indicate that caution should be made in using high dose pomegranate products. The main message of current study is that such useful compounds as antioxidants including pomegranate juice which have beneficial effects on general health status may have detrimental effects if misused or used in high doses.
Assuntos
Extratos Vegetais/uso terapêutico , Punica granatum , Sepse , Animais , Modelos Animais de Doenças , Masculino , Neutrófilos , Estresse Oxidativo , Peroxidase , Ratos , Ratos Wistar , Sepse/tratamento farmacológicoRESUMO
ABSTRACT Purpose: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear. Materials and Methods: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed. Results: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH. Conclusions: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.
Assuntos
Humanos , Masculino , Feminino , Idoso , Vitamina D/uso terapêutico , Deficiência de Vitamina D/etiologia , Deficiência de Vitamina D/tratamento farmacológico , Vitaminas/uso terapêutico , Cálcio/urina , Urolitíase/urina , Hormônio Paratireóideo/sangue , Vitamina D/administração & dosagem , Vitamina D/sangue , Estudos Retrospectivos , Suplementos Nutricionais , Hipercalciúria/complicações , Pessoa de Meia-IdadeRESUMO
PURPOSE: Adherence to preventive recommendations improves clinical outcomes and is compulsory for long-term prevention in urolithiasis patients. Service quality can affect patients' adherence to treatment and care. The purpose of this paper is to compare perceived service quality, using the SERVQUAL model, between urolithiasis patients who were nonadherent to their follow-up visits and those who were adherent, in a stone prevention clinic, Tehran, Iran. DESIGN/METHODOLOGY/APPROACH: This was a cross-sectional study on patients with urolithiasis referred to the Shahid-Labbafinejad Hospital stone prevention clinic between 2010 and 2014. All patients withdrawing from follow-up visits were selected as the nonadherent group. Patients with follow-up visits were randomly selected and appointed as the adherent group. Data included demographic, service quality (assessed using the SERVQUAL) and a questionnaire about the reason for withdrawal from follow-up visits. Man-Whitney U test, χ2 and binary logistic regression were used for data analyses. FINDINGS: In total, 531 nonadherent and 51 adherent patients entered the study. SERVQUAL results revealed that patients' expectations were significantly higher than their perceptions in all five service quality dimensions in both groups. The adherent group had better-quality scores. Responsibility, assurance and empathy scores significantly increased patient adherence odds. RESEARCH LIMITATIONS/IMPLICATIONS: Uni-center design; missing data, such as socioeconomic status and disease severity, which may influence treatment adherence; and missing data regarding adherence to medication and dietary advice were limitations. PRACTICAL IMPLICATIONS: Service quality needs to be improved in all dimensions. ORIGINALITY/VALUE: Since responsiveness, assurance and empathy dimensions determined patients' adherence, giving special attention to these dimensions could improve patient adherence.
Assuntos
Assistência Ambulatorial/organização & administração , Atitude Frente a Saúde , Cooperação do Paciente/estatística & dados numéricos , Prevenção Primária/organização & administração , Qualidade da Assistência à Saúde , Urolitíase/prevenção & controle , Centros Médicos Acadêmicos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Estatísticas não ParamétricasRESUMO
PURPOSE: Hypercalciuria is one of the risk factors for calcium kidney stone formation (the most common type of urinary stones). Although vitamin D deficiency is prevalent among urolithiasis patients, the effect of vitamin D supplementation on urine calcium in these patients is still unclear. MATERIALS AND METHODS: In this retrospective study, medical and laboratory tests records of 26 patients with recurrent calcium kidney stones and vitamin D deficiency treated with 50000IU vitamin D per week for 8-12 weeks were analyzed. The changes in 24-hour urine calcium (24-h Ca), serum 25-hydroxyvitamin D (25 (OH) D), serum parathormone (PTH), other 24-hour urine metabolites and calculated relative supersaturations of calcium oxalate (CaOxSS), calcium phosphate (CaPSS) and uric acid (UASS) were assessed. Moreover, correlations between changes in 24-h Ca and other aforementioned variables were assessed. RESULTS: Serum 25 (OH) D and 24-h Ca increased after vitamin D supplementation, while serum PTH decreased (p < 0.001, for all analyses). The levels of 24-hour urine sodium and urea increased significantly (p = 0.005 and p = 0.031, respectively). The levels of CaOxSS and CaPSS increased, but the changes were not significant (p = 0.177, and p = 0.218, respectively). There were no correlations between the changes in 24-h Ca and serum 25 (OH) D or PTH. CONCLUSIONS: The result of current study suggests that although urine Ca increased in vitamin D supplemented patients, this increase was not associated with the increase in serum vitamin D and may be due to other factors such as dietary factors. Further randomized clinical trials considering other factors associated with urine Ca are warranted.
Assuntos
Cálcio/urina , Urolitíase/urina , Deficiência de Vitamina D , Vitamina D/uso terapêutico , Vitaminas/uso terapêutico , Idoso , Suplementos Nutricionais , Feminino , Humanos , Hipercalciúria/complicações , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Estudos Retrospectivos , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/tratamento farmacológico , Deficiência de Vitamina D/etiologiaRESUMO
Oxalate is a common component of many foods typically present as a salt of oxalic acid, which will be excreted in the urine. Hyperoxaluria is known to be a considerable risk factor for urolithiasis, and formation of oxalate kidney stone. Oxalate degradation by the probiotic anaerobic bacterium Oxalobacter formigenes DSM 4420 has high yield and efficiency both in the human colon helping to prevent hyperoxaluria and disorders such as the development of kidney stones and as a novel approach in reducing the high concentration of foodstuff oxalate content such as tea, coffee, and nuts. For determining the effective factors to enhance high concentration oxalate biodegradation activity of Oxalobacter formigenes DSM 4420 Plackett-Burman screening design was applied to evaluate the impact of 10 process variables. After determining the main factors by screening design, a response surface methodology was used to find suitable treatment combination for oxalate biodegradation by this probiotic. A second-order quadratic model estimated that the highest biodegradation of 60.2% was achieved in presence of 1.35 (g/L) inulin, 36.56 (g/L) glucose, 26 (mmol/L) ammonium oxalate, and pH 6. In other word, the optimum point showed that in the above condition the high concentration of ammonium oxalate content of 26 mmoL/L will reach to 9.95 mmoL/L. Reconfirmation experiment showed the validity of predicted optimum conditions. A surface model using the RSM and optimizing this model using the GA technique, resulted in a useful method of finding an optimal set of process parameters.
RESUMO
PURPOSE: Magnesium plays numerous vital roles in human's body. It is known as a protective factor in stone formation by binding to oxalate in the intestinal and urinary system, and decreasing its absorption and crystallization, respectively. Due to controversies about the association between the 24-h urine magnesium and other urine metabolites in different studies, this study was designed to find a clear answer to this question. METHODS: In this retrospective cross-sectional study, data from 24-h urinalysis of the calcium stone-forming (CSF) patients were assessed. The correlation between 24-h urine (24-U) magnesium to creatinine ratio (Mg/Cr) with other 24-U metabolites to creatinine ratio was assessed, using Spearman correlation test. The association between 24-U magnesium and 24-U oxalate was also studied in a multivariate logistic regression model. RESULTS: Among 965 patients, the level of Mg/Cr showed a direct association with all other 24-U metabolite to Cr ratio (p-value < 0.001 for all analyses). The result of multivariate regression analysis showed that the higher quartile of 24-U oxalate (> 47 mg/24 h) increased the odds of 24-U magnesium more than 75 mg/24 h (data median) (OR 1.89, 95% CI 1.14-3.13) comparing with the lower quartile of 24-U oxalate (≤ 26 mg/24 h). CONCLUSIONS: In a routine dietary habit, since rich sources of magnesium contain a high amount of oxalate at the same time, it is not surprising that magnesium level in 24-h urinalysis showed a direct association with 24-h urine oxalate.
Assuntos
Cálcio , Cálculos Renais , Rim , Magnésio , Eliminação Renal , Adulto , Cálcio/metabolismo , Cálcio/urina , Correlação de Dados , Creatinina/análise , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Irã (Geográfico)/epidemiologia , Rim/metabolismo , Rim/fisiopatologia , Cálculos Renais/química , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Cálculos Renais/urina , Magnésio/metabolismo , Magnésio/urina , Masculino , Pessoa de Meia-Idade , Oxalatos/metabolismo , Oxalatos/urina , Estudos Retrospectivos , Urinálise/métodosRESUMO
Urolithiasis is a common, highly recurrent disease with increasing prevalence worldwide. The association between vitamin D and calcium stones has often been investigated on the basis of the role of vitamin D in calcium homeostasis. Currently, there is no consensus on the management of vitamin D deficiency in patients with renal calculi, because of controversies about the relationship between vitamin D and calcium stones. However, the vitamin D deficiency is shown to be highly prevalent among kidney stone formers, and some studies found a higher prevalence in stone formers compared with non-stone formers. This article attempts to review the relationship between calcium stones and vitamin D, and propose a mechanism for the association between vitamin D deficiency and calcium-based calculi according to the substantial role of inflammation and oxidative stress in calcium stone formation and also the pro-inflammatory effect of vitamin D deficiency.
Assuntos
Oxalato de Cálcio/metabolismo , Cálculos Renais , Deficiência de Vitamina D , Vitamina D/metabolismo , Humanos , Inflamação , Cálculos Renais/complicações , Cálculos Renais/metabolismo , Estresse Oxidativo , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/imunologia , Deficiência de Vitamina D/metabolismoRESUMO
Increased urinary oxalate is considered a major risk factor in the formation of calcium oxalate kidney stones. Gut microbiota may reduce the risk of stone formation. Anyway, the first step for any research about monitoring of oxalate content (both in vitro and in vivo) is a determination of its concentration, while there are different methods reported in the literature for oxalate content determination. In this research, the main reported methods including titration with two titrators (potassium permanganate, and NaOH) as well as enzymatic method (oxalate assay kit) are presented and compared for the measurement of oxalate in both inoculated and non-inoculated media.
RESUMO
INTRODUCTION: This study was aimed to evaluate the correlation of body mass index (BMI), waist circumference (WC), and waist-stature ratio (WSR) with urinary composition in urolithiasis patients. MATERIALS AND METHODS: Medical reports of 1410 urolithiasis patients referred to a tertiary in Tehran, from 2010 to 2015, were reviewed. Collected data included WC, BMI, and WSR, 24-hour urine composition, and the first-morning urine pH. Urinary relative supersaturation of calcium oxalate, calcium phosphate, and uric acid were calculated. Linear correlation and logistic regression models were used for study analyses. RESULTS: A total of 511 records were reviewed. In the women, supersaturation of calcium oxalate significantly correlated with BMI, WC, and WSR. Supersaturation of uric acid significantly correlated with WC. Using regression analyses, BMI and WSR were associated with greater supersaturation of calcium oxalate abnormality, which persisted after adjustment for confounding factors (odds ratio, 1.080; 95% confidence interval, 1.001 to 1.166 for BMI; odds ratio, 1.053; 95% confidence interval, 1.001 to 1.108 for WSR). Larger WC accompanied abnormal values for supersaturation of calcium oxalate; however, the model was marginally significant (odds ratio, 1.032; 95% confidence interval, 1.000 to 1.065; P = .05) in multivariable analysis. In the men on the other hand, none of the obesity indexes were associated with the supersaturation measures. CONCLUSIONS: Although both obesity and abdominal obesity correlated with supersaturation of calcium oxalate, mostly by changes in urine volume and pH in women, none of those indexes showed significant correlation with urine composition in the men population of our study.
Assuntos
Índice de Massa Corporal , Obesidade Abdominal/urina , Urolitíase/urina , Circunferência da Cintura , Razão Cintura-Estatura , Adulto , Oxalato de Cálcio/urina , Fosfatos de Cálcio/urina , Estudos Transversais , Feminino , Humanos , Concentração de Íons de Hidrogênio , Irã (Geográfico) , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores Sexuais , Ácido Úrico/urina , UrinaRESUMO
The study was designed to determine the effect of thirty days of pomegranate extract oral supplementation on plasma inflammatory and oxidative stress biomarkers as well as serum metabolic profiles, in overweight and obese individuals. In this randomized, double-blind, placebo-controlled study 48 obese and overweight participants were randomly assigned to receive either 1000 mg of pomegranate extract, or a placebo, daily for 30 days. At baseline, and after 30 days of treatment, anthropometric parameters, dietary intake, plasma concentrations of malondialdehyde, interleukin-6 and hyper sensitive-C reactive protein and levels of serum lipids, glucose and insulin were assessed. Thirty days of PE supplementation resulted in a significant decrease in mean serum levels of glucose, insulin, total cholesterol, LDL-C, and plasma MDA, IL-6 and hs-CRP. HDL-C significantly increased following the PE versus the PL intervention. Our study suggests that pomegranate extract consumption may reduce complications linked with obesity.