Urinary pH and renal lithiasis.

Formation of calcium oxalate crystals, either as monohydrate or dihydrate, is apparently unrelated to urinary pH because the solubilities of these salts are practically unaltered at physiologic urinary pH values. However, a urinary pH <5.5 or >6.0 may induce uric acid or calcium phosphate crystals formation, respectively, which under appropriate conditions may induce the development of the calcium oxalate calculi. We assessed the relationship between the urinary pH and the formation of different types of calculi. A retrospective study in 1,478 patients was done. We determined the composition, macrostructure, and microstructure of the calculi and the urinary pH, 50.9% of calcium oxalate monohydrate unattached calculi were present in patients with urinary pH <5.5. We found that 34.1 and 41.5% of calcium oxalate dihydrate calculi were present in patients with urinary pH <5.5 and >6.0, respectively. Infectious calculi were found primarily in patients with urinary pH >6.0 (50.7%). Only calcium oxalate monohydrate papillary calculi were associated with urinary pH between 5.5 and 6.0 (43.1%). Urine of pH <5.5 shows an increased capacity to develop uric acid crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals. In contrast, urine of pH >6.0 has an increased capacity to develop calcium phosphate crystals, which can act as a heterogeneous nuclei of calcium oxalate crystals. Oxalate monohydrate papillary calculi were associated to pH between 5.5 and 6.0 because the injured papilla acts as a heterogeneous nucleant. Consequently, measurement of urinary pH may be used to evaluate the lithogen risk of given urine.

Study of potassium phytate effects on decreasing urinary calcium in rats.

BACKGROUND: Phytate as sodium salt has been used at high doses to treat stone-former patients with idiopathic hypercalciuria. The experimental and clinical hypocalciuric effects of dietary fiber have also been assigned to the presence of phytate as calcium-magnesium salt (phytin). As a consequence of the additional interest in phytate due to its capacity as crystallization inhibitor, now a study of the effects of potassium phytate on urinary calcium excretion is presented and compared with the effects caused by other phytate salts. METHODS: To study the effect of calcium-magnesium phytate, 36 Wistar rats (6 groups) were fed with a purified diet in which phytate was practically absent (4068.02 Reference Diet). Three groups were fed with increasing calcium amounts and with the same amount of phytin, each one corresponding to one control group. To study the effects of magnesium-potassium, sodium and potassium phytate salts, 48 Wistar rats (8 groups) were fed with UAR-A04 diet (a standard diet which contains 0.8% of phytin). Two control groups fed with low and high calcium amounts and 6 treated groups were formed. The effect of the dose of potassium phytate on urinary calcium was carried out using 2 additional groups of 6 Wistar rats each one fed with UAR-A04 diet and increasing amounts of potassium phytate. RESULTS: No significant changes in urinary calcium were observed when phytin (calcium-magnesium phytate) was supplied. The urinary calcium was clearly reduced by the three phytate salts assayed (magnesium-potassium, sodium, potassium), but the most significant decrease was noticed when the potassium phytate salt was administered. Phytate administration, independently of the salt or dose used, did not significantly affect the urinary oxalate. CONCLUSION: It can be clearly deduced that the effects of phytate on the urinary parameters, mainly calcium, fundamentally depend on the type of salt used. Thus, the most remarkable effects on urinary calcium reduction were caused by the potassium salt. Obviously, these findings must be confirmed in human studies.

Evaluación del nefelómetro Immage para la cuantificación de inmunoglobulinas IgG, IgA, IgM, y de proteína C reactiva, PCR / Evaluation of Immage nephelometer for quantification of immunolglobulins IgG, IgA, IgM and C reactive protein, CRP

Se presenta la evaluación del nefelómetro Immage (Beckman Instruments) para la cuantificación de inmunoglobulinas IgG, IgA, IgM y de proteína C reactiva, PCR. Los resultados de imprecisión intraserie son inferiores al 5,6 por ciento para todas las concentraciones de inmunoglobulinas e inferiores al 5 por ciento para imprecisión interserie; para PCR los resultados de coeficiente de variación son aceptables según el error máximo tolerable. La inexactitud relativa alcanzada (IgA 5,6 por ciento, IgM 10,1 por ciento, IgG 5 por ciento) cumple los objetivos basados en criterios biológicos; para PCR la desviación obtenida es inferior a un sexto del intervalo de referencia. Los resultados obtenidos para inmunoglobulinas y PCR por el nefelómetro Immage y Array 360 indica que no son transferibles. Según el protocolo de Haeckel, se estudia la contaminación de inmunoglobulinas y los resultados indican que no existe contaminación. No existe transferabilidad de resultados de inmunoglobulinas estudiadas entre los especímenes de suero y plasma: para PCR sólo es posible para concentraciones superiores a 1 mg/dl. El estudio de practicabilidad muestra importantes mejoras. En resumen, los avances integrados en el nefelómetro Immage permiten considerarlo un buen nefelómetro para utilizar en la práctica clínica (AU)

Urinary phytate in calcium oxalate stone formers and healthy people--dietary effects on phytate excretion.

The phytate urinary levels in a group of active calcium oxalate stone formers were studied and compared with those found in healthy people. Urinary phytate was significantly lower for stone formers. If deficit of the capacity to inhibit crystallization of calcium salts is considered an important factor related to calcium stone formation, the excretion of low phytate amounts could be an important risk factor in the development of this type of renal calculi. The influence of dietary phytate on urinary excretion was also studied. Clearly maintenance of a phytate-free diet significantly decreased the urinary excretion of phytate (about 50% after 36 h). This demonstrated the importance of dietary phytate in maintaining adequate urinary levels to permit effective crystallization inhibition of calcium salts and consequently preventing renal stone development.

Urinary lithogen risk test: usefulness in the evaluation of renal lithiasis treatment using crystallization inhibitors (citrate and phytate).

OBJECTIVES: This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate. METHODS: Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment. RESULTS: An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5. CONCLUSION: From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.

Urinary lithogen risk test: usefulness in the evaluation of renal lithiasis treatment using crystallization inhibitors (citrate and phytate).

OBJECTIVES: This paper presents the results of a test to globally determine the urinary risk factor of calcium stone formation in the evaluation of treatments using crystallization inhibitors, such as citrate and phytate. METHODS: Three groups of active calcium oxalate stone-formers have been selected. The lithogen urinary risk was determined using a specially designed disposable test before any medical treatment. After evaluation group I did not receive any treatment, group II was treated with potassium citrate and group III with a phytate-rich dietary complement. When 15 days had elapsed, the test to evaluate the risk of urinary calcium stone formation was applied again to the three groups. The main lithogenic biochemical parameters of each tested urine were also determined before and after treatment. RESULTS: An important number of calcium oxalate stone-formers with high urinary risk factor (positive test) became negative after medical treatment (52% of the citrate-treated patients and 50% of the phytate-treated patients), but only 7% of the untreated patients (1 patient) showed a decrease in their urinary risk factor for calcium stones (negative test) after 15 days had elapsed. When the treatment was not effective, in an important number of cases, the urine contained high levels of calcium or showed pH values greater than 6.5. CONCLUSION: From the obtained results it can be concluded that the test is useful to evaluate the efficacy of a given renal lithiasis medical treatment, and also the efficacy of the treatment of calcium oxalate renal lithiasis using crystallization inhibitors, such as citrate and phytate, in an important number of cases.

Simple test to evaluate the risk of urinary calcium stone formation.

A simple test to evaluate the capacity of a urine to crystallize calcium salts is presented. The test is based on the fact that if a non-protected non-renewed surface remains in contact with a urine, sooner or later the contained supersaturated substances crystallize on it. Thus, by using an adequate surface, it is possible to derive a period within which a normal urine does not crystallize whereas a lithogenic urine induces the growth of calcium salts. The test was applied to urines of oxalocalcic stone-formers and healthy people and showed an excellent discrimination between clearly abnormal and healthy urines. Semiologic analysis of the data is also included.

[Urinary lithiasis composed of silica]. / Litiasis urinaria de silice.

We present a case of urinary silica (silicon dioxide) lithiasis in a patient without a background of medication use justifying the formation of this calculus. We review the literature on this type of lithiasis and comment on some aspects of the metabolism of silica connected with urolithiasis.