Investigation of the potential anti-urolithiatic activity of Alhagi maurorum (Boiss. ) grown wild in Al-Ahsa (Eastern Province), Saudi Arabia / Investigação da potencial atividade antiurolítica de Alhagi maurorum (Boiss. ) cultivado selvagem em Al-Ahsa (Província Oriental), Arábia Saudita

The potential of Alhagi maurorum (Boiss.) aqueous extract (AME), used in traditional medicine for treatment or prevention of urolithiasis, to dissolve calcium oxalate stones in vitro was evaluated. In order to determine the litholytic potential of the extract, Calcium oxalate urinary stones were incubated during 12 weeks under continuous shaking in the presence of AME, Rowanix or NaCl 9 g/mL solution were used as controls. After the incubation period, the residual weight of the treated calculi was determined and the rate of dissolution was calculated. The medium pH variation was measured and changes in the calcium oxalate crystals at the stone surface were assessed using a scanning electron microscope (SEM). The results showed a significant dissolution effect for the extract on the kidney calculi during the experimentation period. At the end of the experiment, the percentages of calculi weight decrease were 41.23, 4.97 and 55.67% for the extract, NaCl solution and Rowanix, respectively. Gas Chromatography analysis revealed mainly the presence of the following phyto-compounds: Cyclopropenone, 2,3-diphenyl; 1-Nonadecanol; methyl-alpha-D-mannopyranoside; cis-9-Hexadecenal. These compounds unarguably play crucial roles in the health care system especially in cancer treatment and many other diseases including urolithiasis. The urinary stone dissolution, independent of medium pH, could be attributed to formation of complexes between the phytochemical compounds in the extract and the calculi.

Foi avaliado o potencial do extrato aquoso (AME) de Alhagi maurorum (Boiss.), usado na medicina tradicional para tratamento ou prevenção de urolitíase, para dissolver cálculos de oxalato de cálcio in vitro. Para determinar o potencial litolítico do extrato, cálculos urinários de oxalato de cálcio foram incubados durante 12 semanas sob agitação contínua na presença de AME, Rowanix ou solução de NaCl 9 g/mL foram usados ​​como controles. Após o período de incubação, o peso residual dos cálculos tratados foi determinado e a taxa de dissolução foi calculada. A variação do pH médio foi medida e as alterações nos cristais de oxalato de cálcio na superfície da pedra foram avaliadas usando um microscópio eletrônico de varredura (MEV). Os resultados mostraram um efeito de dissolução significativo para o extrato sobre os cálculos renais durante o período de experimentação. Ao final do experimento, os percentuais de diminuição do peso dos cálculos foram de 41,23, 4,97 e 55,67% para o extrato, solução de NaCl e Rowanix, respectivamente. A análise por cromatografia gasosa revelou principalmente a presença dos seguintes fitocompostos: Ciclopropenona, 2,3-difenil; 1-Nonadecanol; metil-alfa-D-manopiranosídeo; cis-9-hexadecenal. Esses compostos indiscutivelmente desempenham papéis cruciais no sistema de saúde, especialmente no tratamento do câncer e de muitas outras doenças, incluindo urolitíase. A dissolução do cálculo urinário, independente do pH médio, pode ser atribuída à formação de complexos entre os compostos fitoquímicos do extrato e os cálculos.

Plants Used in Mexican Traditional Medicine for the Management of Urolithiasis: A Review of Preclinical Evidence, Bioactive Compounds, and Molecular Mechanisms.

Urolithiasis (UL) involves the formation of stones in different parts of the urinary tract. UL is a health problem, and its prevalence has increased considerably in developing countries. Several regions use plants in traditional medicine as an alternative in the treatment or prevention of UL. Mexico has known about the role of traditional medicine in the management of urinary stones. Mexican traditional medicine uses plants such as Argemone mexicana L., Berberis trifoliata Hartw. ex Lindl., Costus mexicanus Liebm, Chenopodium album L., Ammi visnaga (L.) Lam., Eysenhardtia polystachya (Ortega) Sarg., Selaginella lepidophylla (Hook. & Grev.) Spring, and Taraxacum officinale L. These plants contain different bioactive compounds, including polyphenols, flavonoids, phytosterols, saponins, furanochromones, alkaloids, and terpenoids, which could be effective in preventing the process of stone formation. Evidence suggests that their beneficial effects might be associated with litholytic, antispasmodic, and diuretic activities, as well as an inhibitory effect on crystallization, nucleation, and aggregation of crystals. The molecular mechanisms involving these effects could be related to antioxidant, anti-inflammatory, and antimicrobial properties. Thus, the review aims to summarize the preclinical evidence, bioactive compounds, and molecular mechanisms of the plants used in Mexican traditional medicine for the management of UL.

Prevalencia de la composición química de uro litiasis en pacientes de clínicas privadas / Chemical composition prevalence of kidney stones in private clinic patients

Introducción: La litiasis urinaria, también denominada urolitiasis, es una enfermedad causada por la presencia de cálculos o litos en el interior de los riñones o de las vías urinarias (uréteres, vejiga). Los cálculos renales se componen de sustancias normales de la orina, pero por diferentes razones se han concentrado y solidificado en fragmentos de mayor o menor tamaño. Es una condición frecuente que afecta a más del 10% de la población, en la edad media de la vida y es más frecuente en los hombres. Predomina en personas con hábitos sedentarios o en personas con gran exposición al calor y deshidratación. El análisis por disolución de los cálculos renales nos permite evaluar la composición química del mismo y así tomar las medidas clínicas adecuadas para prevenir su formación y recurrencia. Objetivo: Describir cual es la composición química más frecuente de los litos urinarios en una clínica privada de la ciudad de Guatemala. Describir la frecuencia de presentación entre géneros y su prevalencia en los grupos de edad. Metodología: Diseño descriptivo, transversal. Se realizó el análisis por disolución del cálculo a 80 pacientes de una clínica privada. Se tomaron datos de género y edad de los pacientes. Resultados: De los 80 pacientes analizados se encontraron 75 litos urinarios compuestos por oxalato de calcio (93.75%), 4 de ácido úrico (5%) ,1 de cistina (1.25%) y 0 litos de estruvita (0%). En el estudio participaron 62 pacientes se sexo Masculino (77.5%) y 18 femeninas (22.5%), con un rango de edades de 18 a 80 años y una edad promedio de 41.4 años. Conclusión: La gran mayoría de los litos analizados en el estudio estaban compuestos de Oxalato de Calcio, lo cual concuerda con las estadísticas de la NHANES donde se afirma que aproximadamente el 80% están compuestos de este material. En esta serie se encontró que el 93.75% de los litos examinados eran de oxalato de calcio. El 76% de los pacientes con litos de oxalato de calcio son de sexo masculino y presentan una edad promedio de 46.4 años; en los litos compuestos por ácido úrico se encontró una prevalencia del 5% y el 100% de estos eran varones. Los conformados por cistina comprende solo el 1.25% encontrados en el 100% de estos en varones. No se encontraron litos de estruvita. Se concluyó que los pacientes de sexo masculino presentan mayor prevalencia en la formación de litos urinarios

Introduction: Urinary stones, also known as urolithiasis, is a disease caused by the presence of stones or calculi inside the kidneys or urinary tract (ureters, bladder). Kidney stones are made up of normal substances in the urine, but for different reasons they concentrate and solidified as fragments of various sizes. It is a common affection in more than 10% of the population in their middle age and is more common in men. Urinary stones are more prevalent in people with sedentary habits or those with high exposure to heat and dehydration. The analysis by dissolving kidney stones allows us to evaluate its chemical composition and thus take appropriate measures to prevent recurrence. Objective: The main objective was to analyze the chemical composition of urinary calculi in patients from a private clinic and find out the frequency of its occurrence between genders and age groups. Methodology: Descriptive, transversal study. Urinary calculi analysis of 80 patients performed. Gender and age data recorded. Results: Out of 80 samples analyzed, 75 urinary calculi composition was calcium oxalate (93.75%), 4 of uric acid (5%), 1 cystine (1.25%) and none of struvite (0%) found. The groups were composed of 62 males (77.5%) and 18 female (22.5%) with an age range between 18 and 80 years and an average age of 41.4 years. Conclusion: The baste majority of calculi analyzed in the study were composed of calcium oxalate, which is consistent with statistics from NHANES where approximately 80% of calculi are composed of calcium oxalate. In this study 93.75% of calculi examined were composed of calcium oxalate. Seventy-six (76%) of patients with calcium oxalate calculi are male with a median age of 46.4 years. Uric acid calculi were present in 5% and 100% of those found in males. Cystine calculi found had a prevalence of 1.25% with 100% in males and the struvite calculi were not found. It was concluded that male patients have a higher prevalence in formation of urinary calculi and oxalate ones predominate

Composición de las urolitiasis en pacientes cubanos por sexo / Composition of urolithiasis in Cuban patients by sex

INTRODUCCIÓN: las urolitiasis implican morbilidad y costos económicos sustanciales. Para su manejo resulta fundamental una evaluación clínica y de laboratorio, que incluya el estudio de la composición química. OBJETIVO: determinar la frecuencia de presentación de los diferentes tipos de urolitiasis según su composición y su relación con el sexo de los sujetos. MÉTODOS: estudio descriptivo, transversal. Se incluyeron las urolitiasis de adultos cubanos, enviadas al Laboratorio de Fisiopatología Renal del Instituto de Nefrología para estudio de composición química, en el período 2001-2011. Las litiasis fueron analizadas con un espectroscopio infrarrojo modelo Philips PU9516. Los diferentes compuestos se identificaron mediante comparación con espectros de referencia. Toda la información fue procesada automatizada (SPSS 15.0.). Se utilizó análisis de distribución de frecuencias. Para probar la existencia de diferencias entre los sexos, en cuanto al tipo de litiasis, se emplearon los tests: de independencia y exacto de Fisher. RESULTADOS: de las 1851 litiasis analizadas, 1316 (71,1 %) eran litiasis simples. Las litiasis simples de oxalato de calcio constituyeron el 46,8 % del total. Dentro de las compuestas, las más frecuentes fueron las de oxalato de calcio más fosfato de calcio (24,7 %). La frecuencia de las litiasis de oxalato de calcio y ácido úrico resultó mayor entre los hombres (p= 0,00), y las de fosfato de calcio y de estruvita (p= 0,00), entre las mujeres. CONCLUSIONES: los cálculos cálcicos, fundamentalmente de oxalato de calcio monohidratado, son los más comunes en la población litiásica estudiada. Las litiasis de oxalato de calcio y ácido úrico son más comunes entre los hombres, mientras las de estruvita y fosfato de calcio lo son, entre las mujeres.

INTRODUCTION: urolithiasis imply significant morbidity and economic costs. For its management, it is fundamental to make clinical and lab evaluation including the study of the chemical composition. OBJECTIVE: to determine the frequency of occurrence of several types of urolithiasis according to their composition and relationship with the individual's sex. METHODS: descriptive and cross-sectional study that included urolithiasis of Cuban adults sent to the Renal Physiopathology Lab of the Institute of Nephrology for the study of chemical composition in the 2001-2011 period. A Philips PU9516 infrared spectroscope served to analyze lithiasis. The various compounds were identified by comparing them with the reference spectra. All the data were collected and processed with SPSS 15.0; the frequency distribution analysis. Independence test and Fisher's exact test were used to confirm the differences between sexes in terms of type of lithiasis. RESULTS: of 1815 analyzed lithiasis, 1316 (71.1 %) were simple. Simple calcium oxalate lithiasis represented 46.8 % of the total number. In the combinations, the most frequent were calcium oxalate plus calcium phosphate (24.7 %). The frequency of calcium oxalate and uric acid lithiasis was higher in men (p= 0.00 and those of calcium phosphate and struvite (p= 0.00) in women. CONCLUSIONS: calcium stones, mainly monohydrated calcium oxalate, are the most common in the studied lithiatic population. Calcium oxalate and uric acid are the commonest in men whereas struvite and calcium phosphate are more frequent in women.

Índice calcio creatinina en el diagnóstico de la hipercalciuria en población pediátrica litiásica / Calcium Creatinine Ratio in the Diagnosis of Hypercalciuria in Gallstone Pediatric Population

INTRODUCCIÓN: la hipercalciuria constituye el principal trastorno metabólico en la litiasis urinaria. Su diagnóstico implica recolección de orina de 24 horas con riesgo de errores y se ha utilizado el índice calcio creatinina como marcador de hipercalciuria. OBJETIVOS: determinar la validez de este indicador como marcador de hipercalciuria. MÉTODOS: se realizó un estudio descriptivo, transversal por la importancia del diagnóstico de la hipercalciuria y los desacuerdos en la utilidad del índice calcio creatinina y su punto de corte óptimo. Se estudiaron 1603 sujetos litiásicos cubanos entre 2 y 19 años, a los que se les mensuró calciuria de 24 horas e índice calcio creatinina de la segunda orina de la mañana. RESULTADOS: se obtuvo correlación positiva moderada entre las variables. Para los valores de corte tradicionales del índice calcio creatinina, la sensibilidad fue 95,7 % y 81,9 %, y la especificidad 48,3 % y 66,7 %, para niños y adolescentes, respectivamente. CONCLUSIONES: el índice calcio creatinina es útil como prueba de despistaje poblacional de hipercalciuria, sin embargo para la confirmación diagnóstica se requiere ineludiblemente la mensuración de la calciuria por recolección de orina de 24 horas.

INTRODUCTION: hypercalciuria is the main metabolic disorder in urolithiasis. Diagnosis involves collecting urine for 24 hours with risk of errors and calcium creatinine ratio has been used as a marker of hypercalciuria. OBJECTIVES: determine the validity of this indicator as a hypercalciuria marker. METHODS: a cross-sectional descriptive study was conducted due to the importance of the diagnosis of hypercalciuria and disagreements on the utility of calcium creatinine ratio and optimal cutoff. 1603 Cuban lithiasic subjects were studied. Their age ranged between 2 and 19 years. 24 hour urinary calcium and calcium- creatinine ratio of the second morning urine were studied. RESULTS: moderate positive correlation between variables was obtained. For values of traditional cutting of calcium creatinine ratio, sensitivity was 95.7% and 81.9%, and specificity 48.3% and 66.7% for children and adolescents, respectively. CONCLUSIONS: calcium creatinine ratio is useful as evidence of population screening for hypercalciuria, however for diagnostic confirmation the measurement of urinary calcium is inevitably required by collecting urine for 24 hours.

Estudo clínico-epidemiológico da urolitíase obstrutiva em caprinos e ovinos / Clinical-epidemiological study of obstructive urolithiasis in sheep and goats

Considerando-se a importância clínica e econômica da urolitíase obstrutiva para a produção de pequenos ruminantes, objetivou-se desenvolver um estudo dessa enfermidade em caprinos e ovinos. Para tanto, utilizou-se dados dos prontuários de 62 animais atendidos no período de 2001 a 2011, considerando-se variáveis epidemiológicas, clínicas, urinálise, hemograma, funções hepática, renal e muscular, glicose, perfil sérico de cálcio, fósforo e magnésio, além da análise da composição química dos urólitos, compondo o estudo descritivo. A urolitíase obstrutiva observada em 5,1% dos animais estudados. A espécie ovina foi a mais acometida, assim como as raças Santa Inês e Dorper. A maior ocorrência da doença se deu em animais com menos de três anos, no período seco, criados sob regime intensivo, cuja dieta era a base de concentrados (ad libitum) e forragem. Dos acometidos 43,6% receberam alta, 40,3% foram a óbito e 16,1% foram eutanaziados. Dentre os achados clínicos mais frequentes observou-se alterações da micção; desidratação; congestão das mucosas conjuntivas; sinais de dor; diminuição ou ausência de motilidade ruminal; taquicardia; alterações do comportamento e do apetite e; taquipnéia. Nos exames laboratoriais observou-se leucocitose com desvio à esquerda regenerativo nos caprinos, hiperfibrinogemia, valores da creatinina e da uréia elevados, enzimas GGT e CK também elevadas, hiperglicemia e, níveis de Ca, P e Mg desbalanceados. A urina apresentou-se turva, com hematúria, proteinúria, acidúria e alcalinúria, além de baixa densidade. No tocante a sedimentoscopia observou-se o aumento de hemácias e leucócitos, células do epitélio uretral e renal, além de bactérias. Houve predominância de oxalato na composição dos urólitos, porém 8,33% dos urólitos eram compostos de penicilina. A urolitíase obstrutiva acomete mais animais confinados, alimentados com dietas desbalanceadas a base de concentrado. Os exames laboratoriais mostraram ser importantes para o diagnóstico de urolitíase obstrutiva.

The present work aimed to conduct a study of clinical, epidemiological and laboratory data of 62 sheep and goats from 2001 up to 2011. During this period, it was found that the disease was predominant in sheep with 83.7% of the animals, while for the caprine, it occurred in 16.3%. The most predominant races in sheep were the Santa Ines, in ovine with 71.7% and SRD, in caprine, with 33.33%. There was a predominance in animals less than three years old. In both species, the highest occurrence was found in the dry season with 67.9%. Most animals (75.8%) were kept under intensive farming, with a diet based on concentrate and forage (88.7%) and 85.5% received mineral supplementation. The predominant clinical si gns were apathy, pain, dehydration, conjunctive hyperemic mucosa, tachycardia, tachypnea, anorexia, dysuria and anuria. The mortality rate was very high with 40.3% of the animals dying and 16.1% being sacrificed. In the haemogram, leukocytosis was observed with regenerative deviation to the left in goats, and hyperfibrinogenemia. In serum biochemistry, increased urea and creatinine was found which led the animals to a perspective of azotenia and increase of GGT and CK enzymes. The serum levels of calcium, phosphorus and magnesium, were beyond the normal patterns for the species with low Ca and high P and Mg levels. The findings of urinalysis revealed hematuria in 72.2% of animals with acid pH of urine (44.4%) as well as alkaline (55.56%). In the sedimentoscopy, erythrocytes predominated in 66.6% of the samples, epithelial cells in 66.6% of the samples and crystals of various compositions. Regarding the composition of urolites, it was found that 62.5% was oxalate, 8.32% phosphate and 8.33% penicillin. In the conclusion of this study, it was observed that the obstructive urolithiasis is a disease of poor prognosis and can lead to loss of valuable livestock animals, and therefore, serious losses in production.