La auriculoterapia como terapia adyuvante en la litiasis renal / Auriculotherapy as adjuvant therapy in renal lithiasis

Introducción: La litiasis en la vía urinaria es una patología de consulta frecuente en Atención Primaria de Salud. Objetivo: Mencionar los puntos auriculares utilizados como prevención y tratamiento adyuvante en pacientes con litiasis renal. Método: En la Filial de Ciencias Médicas de Baracoa, Guantánamo, entre febrero y mayo de 2021 se realizó una búsqueda bibliográfica en las bases de datos SciELO, EMBASE y Dialnet. Se consultaron 42 artículos en español y se seleccionaron 19, los criterios de inclusión se basaron en publicaciones de los últimos 5 años, revisiones sistemáticas con texto completo y libre de pago. Resultados: se elaboró una monografía sobre los principales puntos auriculares con acción demostrada sobre los cálculos renales. Conclusiones: los puntos auriculares Riñón, Uréter, Vejiga, Shenmen y Subcortex son los más recomendados y la técnica más frecuente es la colocación de semillas de Cardo Santo.

The Effects of Aqueous Extract of Eryngium Campestre on Ethylene Glycol-Induced Calcium Oxalate Kidney Stone in Rats.

PURPOSE: This study aimed to evaluate the anti-inflammatory effect of E. campestre using the aqueous extracts, obtained from the aerial parts, on Ethylene Glycol (EG)-induced calcium oxalate kidney stone in rats. MATERIALS AND METHODS: 64 male Wistar rats were randomly divided into 8 groups. Group I was considered as negative control and received normal saline for 30 days, group II as kidney stone control received EG for 30 days, groups III to VI as prophylactic treatment received EG plus 100, 200 or 400 mg/kg extracts for 30 days and groups VI to VIII received EG as therapy from day one and 100, 200 or 400 mg/kg extract from the 15th day. On the 30thday from the start of induction, rats were euthanized. Blood was collected and the kidneys were immediately excised. Slides from each one's kidneys were prepared and stained with Hematoxylin & Eosin method. Also levels of interleukin-1 beta (IL-1?) and interleukin-6 (IL-6) were determined in rat's serum by competitive ELISA kit. RESULTS: E. campestre reduced IL-1? and IL-6 levels, showing a significant reduction for both cytokines in all prophylactic groups, especially at the dose of 400 mg/kg (P-value < .001). Moreover, IL-1? (p = .011) reduced significantly in the therapy groups in 400 mg/kg dose. Crystal count reduction was seen in all prophylactic and therapy groups in comparison with group II. CONCLUSION: These results suggest that the E. campestre extract has potent suppressive effect on pro-inflammatory cytokine production in rat. Also, E. campestre decreases crystal deposition in the kidney of the hyperoxaluric rat.

[Therapeutic compliance in patients with renal lithiasis and biochemical risk factors.] / Cumplimiento terapéutico en pacientes con litiasis renal con factores de riesgo bioquímico.

OBJECTIVE: To evaluate patient compliance with treatment for urinary lithiasis and to detect differences in adherence, causes of this behavior and associated factors. METHODS: We performed a retrospective study of 93 patients with positive urinary metabolic study (UMS) for lithogenic pathology, diagnosed between 2013 and 2015, gathering data from the digital medical records and a structured telephonic questionnaire in 75 of them. Results were analyzed using the X2 test. RESULTS: 68% of the patients were males. Median age 42.92 (12.17) years. Mean follow up was 2.65 years. Most frequent metabolic alterations were: Hyperoxaluria (42.7%), Hypercalciuria (33.3%) and hipocitraturia (30.7%). Most frequently prescribed drugs: Potassium citrate (70.7%), Thiazide diuretics (26.7%) and calcium supplements (15.1). 84.2% of the patients did not know their UMS and 29.8% did not know the treatment prescribed. 41.9% followed the doses prescribed less than 50% of the times. Dietetic treatment was abandoned by 65% of the patients and pharmacological treatment by 43.5%, mainly due to laziness (62.9% vs 46.2%). 72.6% of the compliant patients experienced improvement. We find a significant relationship between academic level and diagnosis knowledge (p=0.022) and treatment (p=0.036). There were no differences in compliance depending on the number of drugs taken. CONCLUSIONS: Despite urine metabolic study being well valued and treatment well tolerated therapeutic compliance is very low. Most patients would repeat or restart the treatment prescribed in case of recurrence. Diagnostic and therapeutic information provided was not understood.

Effect of potassium citrate supplement on stone recurrence before or after lithotripsy: systematic review and meta-analysis.

This meta-analysis summarizes the available evidence on the effectiveness of citrate supplement for preventing the recurrence of nephrolithiasis in patients undergoing extracorporeal shock wave lithotripsy (SWL). Electronic searches were conducted using Medline-PubMed, Web of Science, Embase, BVS (Scielo, Lilacs), and Google Scholar literature databases. The authors worked in pairs to select studies that met the following criteria: randomized controlled trials that were conducted in adults and assessed the effect of potassium citrate supplement before or after SWL therapy for urolithiasis. Our primary aim was to asses the stone-free rate among the groups included in the studies. Fixed effect was used in the meta-analysis with 95% confidence interval (95% CI). Heterogeneity was analyzed by the I 2 value. A total of 2505 references were initially selected. Of those, four were subjected to meta-analysis contributing five samples. These four studies included 374 participants who were followed for a period of 12 months after SWL. Mean potassium citrate dosage was approximately 55 mEq/day (18 mmol). The results showed that citrate supplement significantly protected against the recurrence of nephrolithiasis during 1 year after SWL [RR; 95% CI 0.21 (0.13, 0.31)]. The heterogeneity was not significant across the analyzed studies (p = 0.224). The quality of the analyzed studies was generally low. The available evidence shows that citrate supplement effectively reduces the recurrence of nephrolithiasis in patients undergoing SWL. However, statistical analysis of a larger trial conducted with methodological rigor is warranted.

Therapy of nephrolithiasis: where is the evidence from clinical trials?

The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis.

Tratamento da nefrolitíase: onde está a evidência dos ensaios clínicos? / Therapy of nephrolithiasis: where is the evidence from clinical trials?

Resumo A prevalência da nefrolitíase está aumentando em todo o mundo e resulta em ônus significativo para o sistema de saúde. Novos estudos revelam que a formação de cálculos urinários está associada a várias morbidades graves. No entanto, poucos estudos observacionais ou ensaios clínicos randomizados de qualidade demonstraram que intervenções clínicas específicas diminuem a recorrência da nefrolitíase. Portanto, nesta revisão são analisadas as evidências disponíveis da terapia médica expulsiva para cálculos ureterais; avaliam-se os dados da terapêutica não farmacológica, incluindo modificações dietéticas e terapia à base de sucos cítricos; e discute-se a eficácia dos diuréticos tiazídicos no tratamento da hipercalciúria associada à nefrolitíase recorrente.

Abstract The prevalence of kidney stone disease is increasing worldwide with significant health and economic burden. Newer research is finding that stones are associated with several serious morbidities. Yet, few randomized clinical trials or high quality observational studies have assessed whether clinical interventions decrease the recurrence of kidney stones. Therefore, in this review we analyze the available evidence on medical expulsive therapy for ureteral stones; describe the evidence about non-pharmacological stone therapy including dietary modifications and citrus juice-based therapy; and discuss the efficacy of thiazide diuretics for the treatment of hypercalciuria in recurrent nephrolithiasis.

Efecto antiurolitiásico de una formulación de las plantas Herniaria glabra, Agropyron repens, Equisetum arvense y Sambucus nigra (Herbensurina®) en un modelo experimental de nefrolitiasis en ratas / Antiurolithiasic effect of a plant mixture of Herniaria glabra, Agropyron repens, Equisetum arvense and Sambucus nigra (Herbensurina®) in the prevention of experimentally induced nephrolithiasis in rats

OBJETIVO: Determinar el efecto preventivo sobre la litiasis renal de una formulación botánica formada por Herniaria glabra, Agropyron repens, Equisetum arvense y Sambucus nigra en un modelo experimental de nefrolitiasis en ratas. MÉTODOS: Seis grupos de animales con seis ratas Wistar macho cada uno fueron inducidos a nefrolitiasis mediante el tratamiento con etilenglicol (EG) 0,75% y cloruro de amonio 1% durante tres días y posteriormente con EG durante 15 días más. Un grupo fue tratado con placebo (grupo control) y los otros grupos (grupos tratados) fueron tratados con 30 mg/Kg, 60 mg/Kg, 125 mg/Kg, 250 mg/kg y 500 mg/Kg de la formulación de extractos de plantas (FEP). Se midió el volumen de agua ingerida y de orina excretada durante 24 h en diferentes días del experimento y se determinó la diuresis, cristaluria y bioquímica. Se realizó el análisis histológico del riñón. La caracterización fitoquímica de la FEP se realizó mediante técnicas cromatográficas. RESULTADO: La cantidad de depósitos de cristales de oxalato de calcio (OxCa) de los animales tratados con 125 mg/Kg de la FEP y el número de microcalcificaciones en todos los grupos tratados con la FEP fue menor comparado con el grupo control, siendo las diferencias estadísticamente significativas (d. e. s.). La presencia de fibrosis subcapsular fue mayor en el grupo control que en los grupos tratados (d. e. s.). La diuresis de los grupos tratados con 125 mg/Kg y 500 mg/Kg de la FEP fue mayor que la del grupo control (d. e. s.). El análisis fitoquímico demostró la presencia de flavonoides, ácidos dicarboxílicos y saponinas. CONCLUSIONES: La administración de la FEP previene la formación de cristales de OxCa y de microcalcificaciones en el riñón y disminuye el riesgo de fibrosis subcapsular renal. La dosis de 125 mg/Kg de la FEP es la que presenta un mayor efecto sobre los parámetros estudiados

OBJECTIVE: To determine the effect of a botanical formulation of Herniaria glabra, Agropyron repens, Equisetum arvense, and Sambucus nigra as a preventive agent in an experimentally induced nefrolithiasis model in rats. METHODS: Six groups of six Wistar male rats each were induced for nefrolithiasis by treatment with 0.75% ethylene glycol (EG) and 1% ammonium chloride for three days and then EG only for 15 days. One group was treated with placebo (control group) and the other groups (treated groups) were treated with 30 mg/Kg, 60 mg/Kg, 125 mg/Kg, 250 mg/Kg and 500 mg/Kg of the plant extract formulation (PEF). 24-h urine and water samples were collected one day before EG administration and at 7, 13 and 18 days to determine diuresis, crystalluria and urine biochemistry. The kidneys were removed for histological analysis. The phytochemical characterization of PEF and each of its component plant extracts was performed using gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. RESULTS: Animals treated with 125 mg/Kg of the PEF had statistically significantly lower calcium oxalate crystals deposits content compared to the control group. All PEF doses statistically significantly decreased the number of microcalcifications compared to the control group. Furthermore, the number of kidneys affected by subcapsular fibrosis was statistically significantly higher in control group than in treated groups with the PEF. The diuresis of the 125 mg/Kg and 500 mg/Kg PEF-treated groups was statistically significantly higher than that of the control group. A phytochemical analysis demonstrated the presence of flavonoids, dicarboxylic acids and saponins. CONCLUSIONS: Treatment with PEF prevents deposits of calcium oxalate crystals formation and of microcalcifications in the kidney, and reduces the risk of fibrosis subcapsular. 125 mg/Kg of PEF is the dose that has a greater effect on the studied parameters

Prevention and treatment of nephrolithiasis: a review on the role of spa therapy.

The prevalence and incidence of nephrolithiasis is reported to be increasing across the world. It is a disease of increased urinary concentration of stone-forming salts. The physicochemical mechanism of stone formation includes precipitation, homogenous/heterogeneous nucleation, growth, aggregation and concretion of various modulators in urine. Necessary condition to develop stones is urinary supersaturation, due to reduced urinary volume or to an excesses solutes. Fluid intake is the main determinant of urine volume. Urine dilution can significantly decrease both the crystallization rate of the urinary salts and the aggregation of the crystals. A correct fluid intake can act on different effects: urinary tract washing, urinary volume increasing and dilution of solutes. In addition mineral waters have other particular features: greater diuretic effect, more important urinary dilution with solutes and microbial concentration reduction, urinary pH changes, superior washout effect due to mechanical effects and ureteral contractions. Adequate water intake is the most important conservative strategy in urolithiasis prevention; particularly hydropinotherapy with oligomineral water should be considered as an important instrument to prevent stones in subjects predisposed to the disease (family members of people suffering from kidney stones), to reduce relapses, and can help to eliminate residual fragments also after extracorporeal shock wave lithotripsy. It is recommended a management with increased mineral water intake to promote urine volume of at least 2.5L each day to prevent stone formation. Obviously water intake shall be varied in relation to the presence of contraindications or any diseases.

Tratamientos del dolor en la litiasis renal / No disponible

Las patologías más frecuentes en las consultas urológicas, con una repercusión socioeconómica a nivel mundial muy alta. El cólico nefrítico (CN) es la presentación clínica más frecuente de la litiasis renal y una de las principales urgencias urológicas. El tratamiento farmacológico más utilizado para el control del dolor son los AINEs, seguidos de una amplia gama de fármacos como los opiáceos, anticolinérgicos, analgésicos, etc. Las manipulaciones vertebrales también tienen un efecto analgésico, aunque es necesario estudios que proporcionen una mayor evidencia científica. Objetivos: En esta revisión se pretende analizar las diferentes estrategias terapéuticas sobre el dolor en la LR y valorar la efectividad de los distintos tratamientos. Material y Métodos: Se realizó una revisión sistemática con una muestra de análisis bibliográfico integrado por 25 artículos (n=25) que cumplieron los criterios de selección en dos fases de análisis, lo que supone un 13.02% del total de los artículos encontrados (n=192) y el 43,85% de los artículos que cumplieron los criterios de selección de inclusión y exclusión (n=57). Se usaron las bases de datos Embase.com, Science Direct y PEDro. Como palabras clave principales se usaron «nephrolithiasis», «osteopathic medicine» y «spinal manipulation». Posteriormente se usaron otros términos como «complementary medicine», «chiropractic» y «pharmacology». Resultados: Se analizaron 8 estudios en los que se utilizaron distintas técnicas para el tratamiento del dolor en la LR: AINEs, opiáceos, ansiolíticos, anticolinérgicos, analgésicos, calor, estimulación nerviosa transcutánea (TENS) y manipulaciones vertebrales. Conclusiones: El uso de los AINEs, tanto de manera aislada como en combinación con otros fármacos parece ser el tratamiento farmacológico más eficaz para paliar el dolor. Los opiáceos, tienen como contrapartida efectos adversos no deseados. En cuanto a las terapias físicas el uso del calor local y el TENS son capaces de disminuir el dolor. Las manipulaciones vertebrales son capaces de reducir el dolor a corto plazo, sin los efectos adversos de los fármacos, aunque son necesarios más estudios que demuestren la evidencia (AU)

No disponible

An improvement project within urological care.

PURPOSE: The purpose of this paper is to describe staff experiences in an on-going improvement project regarding patients with ureteral stones. DESIGN/METHODOLOGY/APPROACH: A qualitative descriptive study based on eight group interviews and 48 narratives, was performed. Data were analysed using qualitative content analysis. Trustworthiness was ensured by using a well-documented improvement process method during six months. FINDINGS: The results formed three categories: an absent comprehensive view; complexity; and vulnerability within the organisation. A holistic perspective regarding urological care at the micro-, meso- and macro-levels is needed to improve planning and caring processes. RESEARCH LIMITATIONS/IMPLICATIONS: This study includes one team (six members, different health professionals) within the same urology department. PRACTICAL IMPLICATIONS: Results show that staff need information, such as guidelines and support throughout the improvement work to deliver high-quality care. Moreover, there is a need for evidence-based guidelines at national level to support improvement work. SOCIAL IMPLICATIONS: Healthcare staff need to pay attention to all team member needs to improve urological care. Organisational and managerial aspect are needed to support clear and common goals regarding healthcare improvement work. ORIGINALITY/VALUE: Urological improvement projects, generally, are lacking, which is why this study is important to improve nephrolithiasis patient care.

Calcium nephrolithiasis induced by topiramate.

Topiramate is an approved drug to treat seizures, but its indications have been extended to other diseases of the nervous system and as an adjuvant to chronic pain. We present four cases of topiramate-induced nephrolithiasis from 2006-2012 in women whose treatment was prescribed for pain control and as a mood stabilizer at doses of 250-300 mg/day. In two cases, the lithiasis was caused by calcium phosphate (patite) and in the other two cases by oxalate and calcium phosphate. The most common metabolic alteration was an alkaline pH, followed by hypocitraturia. The drug was discontinued in two patient; it was reduced in one and was maintained in the fourth. An increase in fluid and potassium citrate intake was prescribed. In patients starting treatment with topiramate, an adequate control and prevention of nephrolithiasis should be performed due to the risk of mixed tubular acidosis and hypocitraturia. to the risk of mixed tubular acidosis and hypocitraturia.

Enteric hyperoxaluria secondary to small bowel resection: use of computer simulation to characterize urinary risk factors for stone formation and assess potential treatment protocols.

BACKGROUND AND PURPOSE: We used computer modeling to investigate the influence of physicochemical stone risk factors on urinary supersaturation (SS) of calcium oxalate (CaOx) in patients with severe hyperoxaluria, relative hypocalciuria, hypocitraturia, and CaOx nephrolithiasis after extensive small bowel resection, usually performed for Crohn's disease. We also simulated different treatment strategies, including oral calcium supplements and citrate, in such patients. MATERIALS AND METHODS: A baseline urine model was derived by consolidating data acquired by ourselves with those from another patient cohort. Calcium and oxalate excretions in this model were altered to obtain an extreme case. For comparison, additional models were based on published urine data from normal subjects (N) and idiopathic CaOx stone formers (SF). The Joint Expert Speciation System was used to simulate different urine situations based on reported compositional values. RESULTS: [Ca(2+)][Ox(2-)] ionic concentration products and SS(CaOx) are substantially higher in enteric hyperoxaluric patients than in N and SF, despite their relatively lower calcium excretions. Molar Ca:Ox ratios are substantially lower in enteric hyperoxalurics than in N and SF. Oral calcium supplements can reduce SS(CaOx), but monitoring is required to avoid exceeding a safe dosing threshold. A simple calculation can alert the clinician that this threshold is being approached or even exceeded. Increasing urinary pH and citrate decreases SS(CaOx) but not to the same extent as decreasing Ox excretion. CONCLUSIONS: Calcium supplements can help reduce stone risk in patients with severe enteric hyperoxaluria, but initial efforts should be directed toward reducing urinary oxalate by reducing dietary oxalate. Citrate therapy that increases both urine pH and urinary citrate provides an additional therapeutic benefit.

Nephrolithiasis: nutrition as cause or therapeutic tool.

Nephrolithiasis is a very common disease with an increasing prevalence among industrialized populations. Kidney stone formation is a complex phenomenon, involving genetic and metabolic patterns, and nutrition can play an important role in this match both as a promoter or as a protective factor. To promote a deeper knowledge of such a challenging disease, clinicians and researchers have met in Rome, Italy, last March 2013, at the International Congress "Nephrolithiasis: a systemic disorder" to discuss patho-physiology and possible treatment of kidney stones. During the meeting, a whole session was dedicated to nutrition, seen both as a cause or a therapeutic tool for nephrolithiasis. Due to its etiopathogenesis, nephrolithiasis is also an ideal model for a nutrigenetics and nutrigenomics approach. Nutrigenomics and nutrigenetic respectively study the effects of a dietary treatment on gene expression and, on the other hand, the impact of an inherited trait on the response to a specific dietary treatment.

The medicinal use of water in renal disease.

Although water is essential for life, its use for medicinal purposes is not universally accepted. We performed a comprehensive review of the literature to determine where the evolving state of knowledge lies regarding the benefits of water as a therapy for renal diseases. In the past two decades, water has emerged as a potential therapeutic agent in nephrolithiasis, chronic kidney disease (CKD), and polycystic kidney disease (PKD) in particular. In nephrolithiasis, the benefit of drinking water beyond that demanded by thirst is a cornerstone of therapy for both primary and secondary disease. In CKD, recent observational studies suggest a strong, direct association between preservation of renal function and fluid intake. In PKD, increased water intake slows renal cyst growth in animals via direct vasopressin suppression, and pharmacologic blockade of renal vasopressin-V2 receptors has recently been shown to be efficacious in retarding cyst growth in PKD patients. Although evidence is lacking to support increased water intake in the general population, available evidence indicates that individuals who are at risk for nephrolithiasis as well as those with CKD and PKD may benefit from 3 to 4 l of urine output each day, a level of excretion that is likely to be safe.

Estudio randomizado a doble ciegas con Renalof en pacientes portadores de litaiasis renal de oxalato de calcio / Randomized double-blind study with Renalof in patients with calcium oxalate renal lithiasis

Con el objetivo de evaluar la eficacia y seguridad de la terapia con Renalof en pacientes portadores de urolitiasis cálcica, para la desaparición y/o disminución de litiasis cálcica, se realizó un ensayo clínico controlado, aleatorizado fase III, en 2 grupos en paralelos a doble ciegas con placebo. Se eligieron pacientes de 18 a 65 años de edad, portadores de litiasis menor de 10 mm, a los cuales se les indicó un esquema de tratamiento con un producto natural producido por laboratorio español Catálisis SA, en dosis de 1 cápsula 3 veces al día durante 3 meses, con un seguimiento clínico-radiológico, tomográfico y ecográfico mensuales, que registraron los efectos adversos. Como criterio principal de evaluación se tomó el tamaño y número del cálculo con respuesta favorable cuando el tamaño del cálculo disminuyó o desapareció. Se aleatorizaron a 110 pacientes para recibir Renalof (n=52) y placebo (n=58). La disminución de los cálculos fueron de 7,7 porciento, para el grupo con Renalof y de 0 porciento en el placebo al tercer mes, mientras que la desaparición de los cálculos fue del 86,5 porciento de respuesta al tercer mes con Renalof. La media del número de cólicos disminuyó a los 3 meses, solo el 0,4 ± 1,3 para el grupo de Renalof. Se concluye que el Renalof es un producto eficiente en la destrucción o disminución de los cálculos cálcicos renoureterales, sin efectos adversos(AU)

A double-blind, randomized, placebo-controlled, parallel group phase III clinical trial was conducted with the purpose of evaluating the effectiveness and safety of Renalof to remove and/or reduce calcium lithiasis in patients with calcium urolithiasis. The patients chosen were aged 18-65 and had stones smaller than 10 mm. These patients were treated with a natural product manufactured by the Spanish laboratory Catalisis SA, in a dosage of 1 capsule 3 times a day during 3 months, and monthly clinical, radiological, tomographic and echographic follow-up to record adverse effects. The main evaluation criterion was the size and number of the calculi, with favorable response when they either disappeared or their size was reduced. 110 patients were randomized to Renalof (n=52) and placebo (n=58). Stone size reduction was 7.7 percent for the Renalof group and 0 percent for the placebo group by the third month, whereas the stone disappearance response was 86.5 percent by the third month for the Renalof group. The mean number of colics decreased by the third month, with only 0.4 ± 1.3 for the Renalof group. It was concluded that Renalof is an efficient product for the destruction or reduction of calcium renoureteral calculi, with no adverse effects(AU)

Estudio randomizado a doble ciegas con Renalof en pacientes portadores de litaiasis renal de oxalato de calcio / Randomized double-blind study with Renalof in patients with calcium oxalate renal lithiasis

Con el objetivo de evaluar la eficacia y seguridad de la terapia con Renalof en pacientes portadores de urolitiasis cálcica, para la desaparición y/o disminución de litiasis cálcica, se realizó un ensayo clínico controlado, aleatorizado fase III, en 2 grupos en paralelos a doble ciegas con placebo. Se eligieron pacientes de 18 a 65 años de edad, portadores de litiasis menor de 10 mm, a los cuales se les indicó un esquema de tratamiento con un producto natural producido por laboratorio español Catálisis SA, en dosis de 1 cápsula 3 veces al día durante 3 meses, con un seguimiento clínico-radiológico, tomográfico y ecográfico mensuales, que registraron los efectos adversos. Como criterio principal de evaluación se tomó el tamaño y número del cálculo con respuesta favorable cuando el tamaño del cálculo disminuyó o desapareció. Se aleatorizaron a 110 pacientes para recibir Renalof (n=52) y placebo (n=58). La disminución de los cálculos fueron de 7,7 porciento, para el grupo con Renalof y de 0 porciento en el placebo al tercer mes, mientras que la desaparición de los cálculos fue del 86,5 porciento de respuesta al tercer mes con Renalof. La media del número de cólicos disminuyó a los 3 meses, solo el 0,4 ± 1,3 para el grupo de Renalof. Se concluye que el Renalof es un producto eficiente en la destrucción o disminución de los cálculos cálcicos renoureterales, sin efectos adversos

A double-blind, randomized, placebo-controlled, parallel group phase III clinical trial was conducted with the purpose of evaluating the effectiveness and safety of Renalof to remove and/or reduce calcium lithiasis in patients with calcium urolithiasis. The patients chosen were aged 18-65 and had stones smaller than 10 mm. These patients were treated with a natural product manufactured by the Spanish laboratory Catalisis SA, in a dosage of 1 capsule 3 times a day during 3 months, and monthly clinical, radiological, tomographic and echographic follow-up to record adverse effects. The main evaluation criterion was the size and number of the calculi, with favorable response when they either disappeared or their size was reduced. 110 patients were randomized to Renalof (n=52) and placebo (n=58). Stone size reduction was 7.7 percent for the Renalof group and 0 percent for the placebo group by the third month, whereas the stone disappearance response was 86.5 percent by the third month for the Renalof group. The mean number of colics decreased by the third month, with only 0.4 ± 1.3 for the Renalof group. It was concluded that Renalof is an efficient product for the destruction or reduction of calcium renoureteral calculi, with no adverse effects

[Experience in phytotherapy in nephrolithiasis patients after extracorporeal shock-wave lithotripsy].

Our study of efficacy of Prolit-septo phytotherapy following extracorporeal shock-wave lithotripsy (ESWLT) in patients with nephrolithiasis has demonstrated that Prolit-septo noticeably reduces the time of evacuation from the urinary tract of the destructed stone fragments as well as renal colic incidence and renal inflammation exacerbation.

Adjuvant therapy after surgical stone management.

The aim of this article was to review the most widely researched adjuvant medical therapies for the surgical management of urolithiasis. Articles were identified and reviewed from PubMed and Medline databases with MeSH headings focusing on the various surgical treatments of urolithiasis and adjuvant therapy. Additional articles were retrieved from references and conference proceedings. Surgical treatments reviewed included shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy. Adjuvant therapy was considered medical or complementary therapy as an adjunct to these surgical interventions. Adjuvant therapy for the surgical management of urolithiasis has been documented to increase stone-free rates, reduce stone remission rates, prevent renal damage, and decrease postoperative morbidity. A variety of agents have been studied, ranging from antioxidants to alpha-blockers and to alkalinizing agents. Additionally, there is increasing interest in complementary adjuvant therapy (ie, acupuncture). Adjuvant therapy is a fertile area for research in the surgical management of urolithiasis. The optimal agents have yet to be determined and therefore further investigation is warranted and necessary.

Assessment of citrate concentrations in citrus fruit-based juices and beverages: implications for management of hypocitraturic nephrolithiasis.

BACKGROUND AND PURPOSE: Dietary intake of citrate in the form of citrus juices (eg, lemonade, orange juice) will enhance urinary citrate excretion, a valuable benefit for patients with hypocitraturic calcium oxalate nephrolithiasis. While information on citrate concentrations in select citrus juices is available, data on citrate concentrations of commercially available beverages (juice and otherwise) are limited. Using nuclear magnetic resonance spectroscopy (1H NMR), we report citrate concentrations of several beverages to help guide dietary recommendations aimed at increasing urinary citrate excretion and correcting hypocitraturia. METHODS: Citrate concentrations of a squeezed lemon, several fruit juices, and common beverages were measured using 1H NMR. Spectra for each sample were obtained in duplicate; citrate peak was identified, measured, and quantified and compared with the citrate concentration in the juice of 1 medium lemon. RESULTS: Quantitative analysis revealed the highest concentration of citrate was in grapefruit juice (64.7 mmol/L), followed in decreasing concentrations by lemon juice (47.66 mmol/L), orange juice (47.36 mmol/L), pineapple juice (41.57 mmol/L), reconstituted lemonade (38.65 mmol/L), lemonade flavored Crystal Light (38.39 mmol/L), ready to consume not from concentrate lemonade (38.24 mmol/L), cranberry juice (19.87 mmol/L), lemon-flavored Gatorade (19.82 mmol/L), homemade lemonade (17.42 mmol/L), Mountain Dew (8.84 mmol/L), and Diet 7Up (7.98 mmol/L), respectively. CONCLUSIONS: According to 1H NMR, all of the tested "natural" citrus juices have high concentrations of citrate (38.3-67.4 mmol/L), with grapefruit juice having the highest concentration of the beverages chosen. Lemonade flavored Crystal Light had the highest concentration of citrate in the nonjuice category of tested beverages. In patients with mild to moderate hypocitraturia, dietary supplementation with citrus-based juices may be an effective alternative to medical management while not requiring large serving sizes. Further prospective studies are warranted to evaluate the clinical significance of these findings.