Urinary sulfated glycosaminoglycan insufficiency and chondroitin sulfate supplement in urolithiasis.

Familial members of urolithiasis have high risk for stone development. We observed the low sulfated glycosaminoglycan (GAG) excretion in urolithiasis patients and their descendants. In this study, we investigated urinary excretion of sulfated GAG, chondroitin sulfate (CS), heparan sulfate (HS) and hyaluronic acid (HA) in urolithiasis and their children, and explored the effect of CS and HA supplement in urolithic hyperoxaluric rats. The 24-hour urines were collected from urolithiasis patients (28) and their children (40), as well as healthy controls (45) and their children (33) to measure urinary sulfated GAG, CS, HS and HA excretion rate. Our result showed that urinary sulfated GAG and CS were diminished in both urolithiasis patients and their children, while decreased HS and increased HA were observed only in urolithiasis patients. Percentage of HS per sulfated GAG increased in both urolithiasis patients and their children. In hyperoxaluric rats induced by ethylene glycol and vitamin D, we found that CS supplement could prevent stone formation, while HA supplement had no effect on stone formation. Our study revealed that decreased urinary GAG and CS excretion are common in familial members of urolithiasis patients, and CS supplement might be beneficial in calcium oxalate urolithiasis prophylaxis for hyperoxaluric patients.

Lime powder regimen supplement alleviates urinary metabolic abnormalities in urolithiasis patients.

BACKGROUND: Urolithiasis has high recurrent rate after surgical removal within 3 years. Potassium citrate compound is used to prevent stone recurrence but it has intolerable gastrointestinal adverse effects. We conducted a phase 2 clinical study of lime power regimen (LPR), a limeade-based supplement containing potassium and citrate for 6 months period of treatment, to evaluate its effects on biochemical and clinical aspects of recurrent urolithiasis. METHODS: Seventy-four urolithiasis patients were randomly allocated to receive either LPR or placebo for 6 months in a double-blinded manner. Plasma and 24 h urine samples were collected to measure urinary pH, mineral excretion and urinary total antioxidant status , plasma for creatinine and plasma protein carbonyl, and stone for elemental analysis at the initiation and end-of-treatment (6 month). Adverse effects were recorded. RESULTS: Administration of LPR significantly increased urinary pH, citrate and potassium excretion. Urinary levels of calcium and oxalate, and plasma protein carbonyl content were reduced, while urinary total antioxidant status was elevated by LPR treatment. Urinary supersaturation was decreased and urinary protein excretion was ameliorated in LPR-treated patients. Gastrointestinal adverse effects were rarely observed. None of the participants developed stone recurrence for the duration of the trial. CONCLUSION: Lime power regimen is a potential drug to correct urinary metabolic disorders associated with urolithiasis in high risk stone recurrent patients. A phase 3 clinical trial is underway to validate anti-stone recurrence property of LPR in long-term treatment.

Urinary stone risk factors in the descendants of patients with kidney stone disease.

BACKGROUND: Evidence has indicated that immediate family members of nephrolithiasis patients had high opportunity to develop stones. However, they are usually not regarded to be at risk, since it is unclear if there are any lithogenic abnormalities found in non-stone-forming nephrolithiasis relatives. Our aim was to investigate urinary metabolic abnormalities in the children of nephrolithiasis patients, compared with the general population. METHODS: The 24-h urinary metabolic profile was studied for 28 calcium oxalate nephrolithiasis patients (NL) and 46 of their descendants (ND), as well as 40 non-stone-forming volunteers (V) and 34 of their descendants (VD). RESULTS: There was no difference between age, gender, and serum creatinine between NL vs. V (parental groups) and ND vs. VD (descendant groups). High urinary oxalate in nephrolithiasis and urinary calcium in their descendants was detected. In addition, an elevated urinary excretion rate of calcium, phosphate, protein, and albumin, along with low citrate excretion and high urinary supersaturation was observed in both the nephrolithiasis patients and their descendants. Approximate 17.8-24.4% of the nephrolithiasis descendants had a urinary supersaturation higher than the nephrolithiasis level, but none was found in VD group. The level of urinary supersaturation index was correlated with urinary protein and albumin excretion in nephrolithiasis family. CONCLUSION: It was demonstrated that nephrolithiasis offspring carried several urinary metabolic risks predisposing to stone formation which are similar to their parents, and about one in every five nephrolithiasis children had nephrolithiasis level urinary supersaturation.

Calcium oxalate crystallization index (COCI): an alternative method for distinguishing nephrolithiasis patients from healthy individuals.

Urinary supersaturation triggers lithogenic crystal formation. We developed an alternative test, designated calcium oxalate crystallization index (COCI), to distinguish nephrolithiasis patients from healthy individuals based on their urinary crystallization capability. The effect of urine volume, oxalate, phosphate, citrate, potassium, and sodium on COCI values was investigated. COCI values were determined in 24-hr urine obtained from nephrolithiasis patients (n=72) and matched healthy controls (n=71). Increases in urine oxalate and phosphate and decreases in urine volume and citrate resulted in significantly increased COCI values. The urinary COCI in nephrolithiasis patients was significantly higher than that in healthy individuals. Two healthy subjects who had elevated COCI values were found to have asymptomatic kidney calculi. The receiver operating characteristic analysis showed an area under the curve of the urinary COCI test of 0.9499 (95%CI: 0.9131-0.9868) for distinguishing between nephrolithiasis and healthy subjects. At the cutoff of 165 mg oxalate equivalence/day, the urinary COCI test provided sensitivity, specificity, and accuracy amounts of 83.33%, 97.18%, and 90.21%, respectively. Urinary COCI values were primarily dependent on urine volume, oxalate, and phosphate. The test provided high sensitivity and specificity for clinically discriminating nephrolithiasis patients from healthy controls. It might be used to detect individuals with asymptomatic kidney calculi.

Estimation of blood loss in transurethral resection of prostate (TUR-P) by urine-strip.

OBJECTIVES: Blood loss in transurethral resection ofprostate (TUR-P) operation is estimated by the difference between pre- and post-operative hemoglobin (Hb) concentration. The authors introduced a novel practical method to estimate blood loss in the patients who were surgically managed with TUR-P operation. MATERIAL AND METHOD: Complete blood count was collected pre-operative, immediate post-operative, and 24-hour post-operative to determine red blood cells and Hb concentration. Hemoglobin of irrigating fluid was measured by standard spectrophotometry and blood loss was estimated by the authors' calculation. Irrigating fluid was frozen and thawed to completely hemolyse the red blood cells, then it was tested by urine-strips and calculated for red cells using estimating cell ranges given by the product's prescription. The correlation between these indicators was evaluated. RESULTS: Calculated blood loss detected by spectrophotometric method has no correlation with immediate post-operative or 24-hour post-operative Hb concentration. However, it had a significant positive correlation with calculated blood loss by urine-strip technique (r = 0.897, p = 0.01). CONCLUSION: Urine-strip method can be used to estimate total blood loss in irrigating fluid in patients with TUR-P operation. This is practical and useful in immediate post-operative evaluation of blood loss to consider the need of blood transfusion.