Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 786
Filtrar
1.
Expert Opin Pharmacother ; 21(1): 85-96, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31714803

RESUMO

Introduction: Urolithiasis is a common, highly recurrent disease with increasing prevalence worldwide. There are many dietary and pharmacological measures to prevent kidney stones.Areas covered: Herein, the authors explore medical expulsive therapy as well as pharmacological therapies to prevent/treat urolithiasis.Expert opinion: All stone formers should be advised to increase their fluid intake sufficiently to achieve a urine volume of at least 2.5 L/day. In the case of hypercalciuria, a thiazide diuretic should be prescribed while in cases of hypocitraturia, potassium citrate should be given. In the case of hyperoxaluria, the treatment depends on the type of hyperoxaluria. Pyridoxine or calcium supplements with a meal can be offered. For uric acid stone formers, alkali therapy is the standard of care whereas allopurinol can be beneficial in hyperuricosuric stone formers. For cystine stone formers, increased fluid intake, restriction of sodium and animal protein ingestion, and urinary alkalinization are the standard therapies used. Cystine binding thiol drugs such as tiopronin and D-penicillamine are reserved for patients where a conservative approach fails. For struvite stone formers, optimal management is the complete stone removal. Acetohydroxamic acid may be offered only after surgical options have been exhausted, for patients with residual stones but it has many side effects.


Assuntos
Cálculos Renais/prevenção & controle , Urolitíase/tratamento farmacológico , Alopurinol/administração & dosagem , Cálcio/administração & dosagem , Suplementos Nutricionais , Diuréticos/administração & dosagem , Humanos , Fatores de Risco
2.
Life Sci ; 244: 117232, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31884097

RESUMO

AIMS: This study was designed to reveal the role and underlying mechanism of excessive autophagy mediated by ERS via the PERK-eIF2α pathway in the apoptosis and formation of CaOx kidney stones. MAIN METHODS: Ethylene glycol (EG) was used to establish a rat model of CaOx kidney stones, and 100 mg/kg of ERS inhibitor 4-phenylbutyric acid (4-PBA) or 60 mg/kg of autophagy inhibitor chloroquine (CQ) was administered daily to the rats. Four weeks after administration, we collected blood and kidney tissues to analyze the occurrence of ERS and autophagy, apoptosis, renal function, renal tubular crystal deposition, and kidney damage, respectively. KEY FINDINGS: We observed that both 4-PBA and CQ treatment significantly inhibited the excessive autophagy and reduced apoptosis as well as decreasing p-PERK and p-eIF2α expressions. Meanwhile, the proportion of kidney weight, contents of creatinine and blood urea nitrogen, excretion of neutrophil gelatinase-associated lipocalin and kidney injury molecule 1, and renal tubular deposition were markedly down-regulated. SIGNIFICANCE: The findings in this study suggested that ERS induced excessive autophagy via the PERK-eIF2α pathway, regulating cell damage and apoptosis. ERS-mediated inhibition of excessive autophagy effectively protected kidney function and prevented the apoptosis and formation of kidney stones.


Assuntos
Lesão Renal Aguda/prevenção & controle , Apoptose , Autofagia , Estresse do Retículo Endoplasmático , Cálculos Renais/prevenção & controle , Túbulos Renais/fisiopatologia , Lesão Renal Aguda/patologia , Animais , Fator de Iniciação 2 em Eucariotos/metabolismo , Cálculos Renais/patologia , Masculino , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , eIF-2 Quinase/metabolismo
3.
Int Braz J Urol ; 45(6): 1249-1259, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808414

RESUMO

OBJECTIVE: Urinary stones with oxalate composition can cause kidney failure. Recent findings evidenced that probiotics are effective in reducing oxalate absorption in these subjects based on their high colonic absorption levels at baseline. The purpose of this study was to evaluate the effect of the simultaneous use of oxalate-degrading bacteria, Urtica dioica and T. terrestris extract in reducing urinary oxalate. MATERIALS AND METHODS: Anti-urolithiatic activity of Urtica dioica and T. terrestris extract and pro-biotic by using ethylene glycol induced rat model. In this study, 4 strains of Lactobacillus and 2 strains of Bifidobacterium and also 2 strains of L. paracasei (that showed high power in oxalate degrading in culture media) were used. Male Wistar rats were divided into four groups (n=6). The rats of group-I received normal diet (positive control group) and groups-II (negative control group), III, IV rats received diet containing ethylene glycol (3%) for 30 days. Groups III rats re-ceived Urtica dioica and T. terrestris extract. Groups IV rats received extracts + probiotic for 30 days. FINDINGS: The results show that the use of herbal extracts (Urtica dioica and T. terrestris) redu-ced the level of urinary oxalate and other parameters of urine and serum. Also, the accumulation of calcium oxalate crystals in the kidney tissue was significantly reduced. CONCLUSION: Considering that the formation of calcium oxalate crystals can cause inflammation and tissue damage in the kidney, the use of herbal extracts with oxalatedegrading bacteria can be a new therapeutic approach to preventing the formation of kidney stones.


Assuntos
Hiperoxalúria/prevenção & controle , Oxalatos/urina , Extratos Vegetais/farmacologia , Probióticos/farmacologia , Tribulus/química , Urtica dioica/química , Animais , Nitrogênio da Ureia Sanguínea , Cálcio/análise , Creatinina/análise , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Túbulos Renais/química , Masculino , Ratos Wistar , Valores de Referência , Reprodutibilidade dos Testes , Fatores de Tempo
4.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31702984

RESUMO

INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Cálculos Renais/prevenção & controle , Farmacêuticos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Prestação Integrada de Cuidados de Saúde/organização & administração , Dieta , Estudos de Viabilidade , Feminino , Humanos , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Farmacêuticos/organização & administração , Projetos Piloto , Telemedicina/organização & administração , Adulto Jovem
5.
BMC Emerg Med ; 19(1): 48, 2019 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477062

RESUMO

BACKGROUND: No known data in the literature assessing practice of kidney stone prevention in the emergency department (ED) is available. OBJECTIVES: Assess patient perception and compliance to kidney stone prevention given within the emergency department. It also indirectly detects the attitude and practice patterns of primary care providers in kidney stone prevention. MATERIALS AND METHODS: This is a qualitative study done in a single institution from January 2018 to January 2019 that includes 99 patients that were diagnosed with kidney or ureteral stone in ED and were discharged home, all of them where stone formers. They were asked to fill a self- administered questionnaire when they are able to read, or interviewed by the resident within the ED when they are unable to read. RESULTS: The majority of patients (68%) did not receive any instructions about kidney stones prevention within the ED. Most of patients who follow instructions if it was given were educated (90%), had an insurance coverage (85%), and had an income higher than $1000 per month (76%), (p < 0.05). Seventy one percents of patients believe in the effectiveness of stone prevention if it was provided and most of them are interested in learning about these preventive strategies (82%). Reasons for not following the instructions about kidney stones prevention measures were the cost (53.1%) following by the lack of explanation by ED physicians (18.8%). The majority of patients (62.6%) prefer to receive kidney stones prevention measures from urologists. CONCLUSION: Most of patients in our institute did not receive kidney stones prevention measures in ED despite that they declared their interest in following these measures. Most of the time they did not adhere to those measures due to socioeconomic factors and lack of clarifications. If these instructions were given within the ED, it could lead to an acceptable compliance rate.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cálculos Renais/prevenção & controle , Cálculos Renais/psicologia , Relações Médico-Paciente , Adolescente , Adulto , Atitude do Pessoal de Saúde , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Sumários de Alta do Paciente Hospitalar/estatística & dados numéricos , Educação de Pacientes como Assunto , Médicos de Atenção Primária/psicologia , Inquéritos e Questionários , Adulto Jovem
6.
Urology ; 133: 57-66, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31374289

RESUMO

OBJECTIVE: To understand kidney stone patients' experiences with increasing fluid intake, common barriers to adherence, and technology-mediated intervention techniques that may improve adherence in this population. Increasing fluid intake to produce at least 2.5 L of urine daily is a well-established preventive strategy to reduce the risk of kidney stones. Unfortunately, adherence with this well-known and inexpensive recommendation is commonly below 50%. MATERIALS AND METHODS: Patients with a history of kidney stones were recruited to participate in semistructured focus groups about their experiences with increasing fluid intake. Inductive content analysis was used to extract themes from focus group transcripts. RESULTS: Themes from discussions with 19 patients described current fluid intake strategies, barriers to increasing fluid intake, and desirable features in a digital tool for promoting fluid intake. Common barriers to increasing fluid intake included work habits, travel, leisure activities, forgetting to drink, limited access to water, and not feeling thirsty. Patients had tried to increase fluid intake using strategies such as carrying a water bottle, identifying contextual cues for drinking, self-monitoring fluid intake, and seeking social support. Patients expressed interest in wearing sensors to improve fluid intake if the sensor was aesthetically pleasing, had guaranteed benefit and was able to connect to existing devices. The most acceptable location to wear a sensor was as a wristband or bracelet. CONCLUSION: The use of automated and semiautomated tracking technology in combination with evidence-based behavior change techniques should be explored in efforts to improve adherence to fluid intake recommendations.


Assuntos
Ingestão de Líquidos , Comportamentos Relacionados com a Saúde , Cálculos Renais/prevenção & controle , Cooperação do Paciente , Adolescente , Adulto , Idoso , Tecnologia Biomédica/instrumentação , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Smartphone , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
7.
J Urol ; 202(6): 1217-1223, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31430246

RESUMO

PURPOSE: High animal protein intake is a risk factor for nephrolithiasis. Whether plant based sources of protein are associated with kidney stone risk is not well studied. We examined the association of animal and plant protein intake with the risk of incident kidney stones in Shanghai, China. MATERIALS AND METHODS: Dietary intakes were obtained from a validated food frequency questionnaire at baseline. Self-reported stone events were ascertained at baseline and at followup visits. Multivariable Cox regression models were used to evaluate the associations of protein intake with the incident stone risk. RESULTS: During 319,211 and 696,950 person-years of followup 1,451 men and 1,202 women, respectively, reported incident stones. The average ± SD intake of animal and plant protein standardized to 2,000 kcal was 31.3 ± 13.7 and 48.4 ± 7.2 gm per day in women, and 30.8 ± 13.3 and 51.3 ± 7.6 gm per day, respectively, in men. On multivariable analysis participants in the highest quintiles of animal and nondairy animal protein intake showed an increased risk of incident stones compared to those in the lowest quintiles (HR 1.16, 95% CI 1.01-1.32, p=0.03 vs HR 1.14, 95% CI 1.01-1.30, p=0.04). Compared to the lowest quintile the highest intake quintiles of the animal-to-plant protein ratios and the nondairy animal-to-plant protein ratios were positively associated with stone risk (HR 1.17, 95% CI 1.03-1.33, p=0.02 and HR 1.20, 95% CI 1.06-1.36, p=0.005, respectively). No association was observed with plant protein intake (ptrend=0.14). CONCLUSIONS: In this population with a relatively low animal protein intake and a high plant protein intake, a greater animal protein intake was associated with a kidney stone risk. Increasing the proportion of plant protein relative to animal protein appeared protective against the risk.


Assuntos
Proteínas na Dieta/administração & dosagem , Comportamento Alimentar , Cálculos Renais/epidemiologia , Adulto , Idoso , China/epidemiologia , Proteínas na Dieta/efeitos adversos , Feminino , Humanos , Incidência , Cálculos Renais/etiologia , Cálculos Renais/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Autorrelato/estatística & dados numéricos
8.
Nutr Hosp ; 36(Spec No3): 70-74, 2019 Aug 27.
Artigo em Espanhol | MEDLINE | ID: mdl-31368343

RESUMO

Introduction: Cholelithiasis and kidney stones are frequent pathologies in developed countries. Gallstones can be pigmentary, cholesterol (75%) or mixed. Age, female sex, obesity, rapid weight loss, consumption of refined sugars, saturated fat, iron deficiency, vitamin D and low intake of fiber and vitamin C are factors associated with an increased risk of cholelithiasis. On the other hand, the intake of ω-3 fatty acids, oleic acid, calcium, magnesium, fiber, fruits and vegetables, dairy products, nuts, coffee, moderate consumption of alcohol, vitamin C supplements, physical exercise and a regular diet have a protective paper. The most frequent kidney stones are calcium oxalate followed by mixed ones (oxalate and calcium phosphate), struvite, uric acid and cystine. A high water intake is recommended (> 2.5 l / day), varying the type of recommended or unadvisable food depending on the type of calculus. In oxalic lithiasis it is recommended to reduce the consumption of meat, moderate that of spinach, Swiss chard, asparagus, chocolate and avoid excessive sodium intake. The administration of oxalate-degrading probiotics (Lactobacillus) may reduce intestinal absorption, although further studies are necessary to corroborate these results. In calcium phosphate acidifying diet is recommended and limit the consumption of coffee and tea. The prevention of uric calculus is based on hydration with alkalizing drinks and vegetarian diet, decreasing foods rich in purines (liver, kidney, fish eggs, anchovies, sardines and seafood) and in calculus of cystine diet is recommended alkalizing. Since the formation of struvite calculi is due to urinary infections, pharmacological treatment and the consumption of acidifying diets, moderation of the intake of phosphate-rich foods and limiting the contribution of fats and citrus fruits are necessary. The nutritional intervention is an effective measure in the prevention of biliary and renal lithiasis and prevent its recurrence.


Assuntos
Colelitíase/prevenção & controle , Cálculos Biliares/prevenção & controle , Cálculos Renais/prevenção & controle , Fatores Etários , Deficiência de Ácido Ascórbico/complicações , Cálcio na Dieta , Colelitíase/química , Colelitíase/etiologia , Gorduras Insaturadas na Dieta/administração & dosagem , Exercício , Frutas , Cálculos Biliares/química , Cálculos Biliares/etiologia , Humanos , Ferro na Dieta , Cálculos Renais/química , Cálculos Renais/etiologia , Magnésio , Fatores Sexuais , Urolitíase/etiologia , Urolitíase/prevenção & controle
9.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266277

RESUMO

OBJECTIVES: The present study was carried out to evaluate the effectiveness of medical therapy with potassium citrate in preventing calculosis complicating Medullary Sponge Kidney (MSK) without renal acidification defects. MATERIALS AND METHODS: In a open, uncontrolled, retrospective analysis, 49 MSK patients with nephrolithiasis without renal tubular acidosis, underwent a complete metabolic evaluation and received potassium citrate therapy 4-6 g/day. The course of stone disease before and after citrate therapy was determined in each patient from a combination of clinical history, past records, radiographs and kidney ultrasound. The rate of new stone formation/pt/yr, of endourological and extracorporeal procedures, of urinary tract infection (UTI) and number of hospitalization before and after medical treatment were calculated. RESULTS: Metabolic anomalies (hypercalciuria, hypocitraturia, hyperuricuria and hyperoxaluria) were present in 83% of the patients. Follow-up before and after alkali citrate therapy was comparable (4.7+/-1.4 and 4.9+/-1.7 years respectively). Medical treatment significantly reduced rates of stone formation from 2.0+/-1.0 to 0.2+/-0.5 pt/yr, ureteroscopy (URS) from 0.9+/0.8 to 0.4+/-0.5 pt/yr, extratracoporeal lithotripsy (ESWL) from 1.1+/-0.8 to 0.4+/-0.6 pt/yr, urinary tract infections (UTIs) from 0.8+/-1.2 to 0.3+/-0.5 pt/yr and hospitalization from 1.1+/-0.6 to 0.2+/-0.3 pt/yr, p < 0.001. This effect was observed also in MSK patients without metabolic anomalies. In 35 patients the asymptomatic disappearance of calcium stones was also observed. CONCLUSIONS: Our study documents the effectiveness of potassium citrate therapy in preventing neprolithiasis in MSK patients also in the absence of distal tubular acidosis. It suggests that in MSK patients alkali citrate may promote calcium stone dissolution by oral administration.


Assuntos
Cálculos Renais/prevenção & controle , Rim em Esponja Medular/tratamento farmacológico , Nefrolitíase/prevenção & controle , Citrato de Potássio/uso terapêutico , Adolescente , Adulto , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Litotripsia/estatística & dados numéricos , Masculino , Rim em Esponja Medular/fisiopatologia , Pessoa de Meia-Idade , Citrato de Potássio/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento , Ureteroscopia/estatística & dados numéricos , Infecções Urinárias/epidemiologia , Adulto Jovem
11.
Food Funct ; 10(7): 3851-3867, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31250859

RESUMO

Renal epithelial cell injury is a key step in inducing kidney stone formation. However, research on the role of cell repair in the prevention and treatment of kidney stones is limited. In this study, the repair effect of degraded Porphyra yezoensis polysaccharide (PYP) on oxidative stress-mediated intracellular damage triggered by oxalate in human kidney proximal tubular epithelial (HK-2) cells was investigated, and the influence of molecular weight (Mw) on the repair ability of PYP was elucidated. Polysaccharides with different Mws were prepared by degrading PYP with hydrogen peroxide. Four degraded fractions, namely, PYP1, PYP2, PYP3, and PYP4, were successfully obtained with Mws of 576.2, 49.54, 12.65, and 4.020 kDa, respectively. A damaged cell model was established using 2.6 mmol L-1 oxalate to injure HK-2 cells. Various Mws of PYPs were used to repair the damaged cells. The repair mechanism of PYPs against oxalate-induced oxidative stress was examined by evaluating cell proliferation and physiological function recovery. Our study revealed that PYPs increased the viability of oxalate-injured HK-2 cells and restored their morphological characteristics and cytoskeleton. PYPs reduced the levels of oxalate-mediated lactase dehydrogenase release, reactive oxygen species generation, and intracellular Ca2+, the loss of mitochondrial membrane potential, the number of cells arrested in S phase, the expression of 8-hydroxy-desoxyguanosine and poly ADP ribose polymerase, lysosomal damage, and the number of apoptotic cells. The PYP fraction with low Mw presented an increased repair activity against cellular damage induced by oxalate. The resistance of the repaired renal cells to crystal adhesion and aggregation was stronger than that of the damaged cells. PYPs might inhibit the formation of kidney stones by repairing damaged cells and inhibiting crystal adhesion and aggregation. We concluded that PYP with low Mw could be used as a potential therapeutic agent against renal stone formation and recurrence.


Assuntos
Lesão Renal Aguda/tratamento farmacológico , Células Epiteliais/efeitos dos fármacos , Oxalatos/efeitos adversos , Estresse Oxidativo/efeitos dos fármacos , Polissacarídeos/química , Polissacarídeos/farmacologia , Porphyra/química , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Cálcio/metabolismo , Ciclo Celular/efeitos dos fármacos , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Humanos , Cálculos Renais/prevenção & controle , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Peso Molecular , Oxirredução , Espécies Reativas de Oxigênio/metabolismo
12.
Oxid Med Cell Longev ; 2019: 5305014, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31178964

RESUMO

Females develop kidney stones less frequently than males do. However, it is unclear if this gender difference is related to altered estrogen/estrogen receptor (ER) signaling. Here, we found that ER beta (ERß) signals could suppress hepatic oxalate biosynthesis via transcriptional upregulation of the glyoxylate aminotransferase (AGT1) expression. Results from multiple in vitro renal cell lines also found that ERß could function via suppressing the oxalate-induced injury through increasing the reactive oxygen species (ROS) production that led to a decrease of the renal calcium oxalate (CaOx) crystal deposition. Mechanism study results showed that ERß suppressed oxalate-induced oxidative stress via transcriptional suppression of the NADPH oxidase subunit 2 (NOX2) through direct binding to the estrogen response elements (EREs) on the NOX2 5' promoter. We further applied two in vivo mouse models with glyoxylate-induced renal CaOx crystal deposition and one rat model with 5% hydroxyl-L-proline-induced renal CaOx crystal deposition. Our data demonstrated that mice lacking ERß (ERßKO) as well as mice or rats treated with ERß antagonist PHTPP had increased renal CaOx crystal deposition with increased urinary oxalate excretion and renal ROS production. Importantly, targeting ERß-regulated NOX2 with the NADPH oxidase inhibitor, apocynin, can suppress the renal CaOx crystal deposition in the in vivo mouse model. Together, results from multiple in vitro cell lines and in vivo mouse/rat models all demonstrate that ERß may protect against renal CaOx crystal deposition via inhibiting the hepatic oxalate biosynthesis and oxidative stress-induced renal injury.


Assuntos
Oxalato de Cálcio/metabolismo , Receptor beta de Estrogênio/metabolismo , Cálculos Renais/metabolismo , Rim/metabolismo , Fígado/metabolismo , Estresse Oxidativo/fisiologia , Animais , Feminino , Células HEK293 , Células Hep G2 , Humanos , Rim/patologia , Cálculos Renais/patologia , Cálculos Renais/prevenção & controle , Fígado/patologia , Masculino , Camundongos , Camundongos Knockout
13.
Urologiia ; (2): 113-118, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162912

RESUMO

The use of alkaline mineral waters leads to alkalization of urine and an increase in level of urinary citrate, which represent important factor inhibiting the formation of urinary stones. Combination of alkaline mineral waters with citrates facilitates the achievement of target urine pH level not only during dissolution therapy, but also during recurrence prevention. Alkalization of urine and reducing of the influence of alimentary factor dont preclude drug therapy. Patients should be counselled about complex strategies aimed to modifiable risk factors for urinary stone disease.


Assuntos
Cálculos Renais/dietoterapia , Cálculos Renais/prevenção & controle , Águas Minerais/uso terapêutico , Ácido Cítrico/metabolismo , Ácido Cítrico/urina , Ingestão de Líquidos , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/química , Recidiva , Fatores de Risco , Prevenção Secundária , Solubilidade , Ácido Úrico/química , Ácido Úrico/metabolismo
14.
EBioMedicine ; 45: 231-250, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202812

RESUMO

BACKGROUND: Epidemiological evidence of over 9000 people suggests that daily intake of vinegar whose principal bioactive component is acetic acid is associated with a reduced risk of nephrolithiasis. The underlying mechanism, however, remains largely unknown. METHODS: We examined the in vitro and in vivo anti-nephrolithiasis effects of vinegar and acetate. A randomized study was performed to confirm the effects of vinegar in humans. FINDINGS: We found individuals with daily consumption of vinegar compared to those without have a higher citrate and a lower calcium excretion in urine, two critical molecules for calcium oxalate (CaOx) kidney stone in humans. We observed that oral administration of vinegar or 5% acetate increased citrate and reduced calcium in urinary excretion, and finally suppressed renal CaOx crystal formation in a rat model. Mechanism dissection suggested that acetate enhanced acetylation of Histone H3 in renal tubular cells and promoted expression of microRNAs-130a-3p, -148b-3p and -374b-5p by increasing H3K9, H3K27 acetylation at their promoter regions. These miRNAs can suppress the expression of Nadc1 and Cldn14, thus enhancing urinary citrate excretion and reducing urinary calcium excretion. Significantly these mechanistic findings were confirmed in human kidney tissues, suggesting similar mechanistic relationships exist in humans. Results from a pilot clinical study indicated that daily intake of vinegar reduced stone recurrence, increased citrate and reduced calcium in urinary excretion in CaOx stone formers without adverse side effects. INTERPRETATION: Vinegar prevents renal CaOx crystal formation through influencing urinary citrate and calcium excretion via epigenetic regulations. Vinegar consumption is a promising strategy to prevent CaOx nephrolithiasis occurrence and recurrence. FUND: National Natural Science Foundations of China and National Natural Science Foundation of Guangdong Province.


Assuntos
Ácido Acético/administração & dosagem , Epigênese Genética/genética , Cálculos Renais/dietoterapia , Nefrolitíase/dietoterapia , Adulto , Animais , Cálcio/urina , Oxalato de Cálcio/urina , Claudinas/genética , Transportadores de Ácidos Dicarboxílicos/genética , Epigênese Genética/efeitos dos fármacos , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Histonas/genética , Humanos , Cálculos Renais/genética , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Nefrolitíase/genética , Nefrolitíase/prevenção & controle , Nefrolitíase/urina , Transportadores de Ânions Orgânicos Dependentes de Sódio/genética , Ratos , Recidiva , Simportadores/genética
15.
Nutrients ; 11(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31137803

RESUMO

Kidney stone disease should be viewed as a systemic disorder, associated with or predictive of hypertension, insulin resistance, chronic kidney disease and cardiovascular damage. Dietary and lifestyle changes represent an important strategy for the prevention of kidney stone recurrences and cardiovascular damage. A full screening of risk factors for kidney stones and for cardiovascular damage should be recommended in all cases of calcium kidney stone disease, yet it is rarely performed outside of stone specialist clinics. Many patients have a history of kidney stone disease while lacking a satisfactory metabolic profile. Nonetheless, in a real-world clinical practice a rational management of kidney stone patients is still possible. Different scenarios, with different types of dietary approaches based on diagnosis accuracy level can be envisaged. The aim of this review is to give patient-tailored dietary suggestions whatever the level of clinical and biochemistry evaluation. This can help to deliver a useful recommendation, while avoiding excessive dietary restrictions especially when they are not based on a specific diagnosis, and therefore potentially useless or even harmful. We focused our attention on calcium stones and the different scenarios we may find in the daily clinical practice, including the case of patients who reported renal colic episodes and/or passed stones with no information on stone composition, urinary risk factors or metabolic cardiovascular risk factors; or the case of patients with partial and incomplete information; or the case of patients with full information on stone composition, urinary risk factors and metabolic cardiovascular profile.


Assuntos
Bebidas , Cálcio na Dieta/administração & dosagem , Ingestão de Líquidos , Exercício , Cálculos Renais/prevenção & controle , Comportamento de Redução do Risco , Bebidas/efeitos adversos , Cálcio na Dieta/efeitos adversos , Cálcio na Dieta/metabolismo , Humanos , Cálculos Renais/epidemiologia , Cálculos Renais/metabolismo , Fatores de Proteção , Medição de Risco , Fatores de Risco
16.
Urol Clin North Am ; 46(2): 303-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961862

RESUMO

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Diagnóstico por Imagem/economia , Equipamentos Descartáveis/economia , Custos de Cuidados de Saúde , Humanos , Invenções/economia , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Terapia a Laser/economia , Terapia a Laser/instrumentação , Litotripsia/economia , Nefrolitíase/economia , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Fibras Ópticas/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação
17.
Am J Physiol Renal Physiol ; 316(6): F1282-F1292, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-30995115

RESUMO

According to recent studies, kidney stones are associated with metabolic syndrome. We focused on brown adipocytes and ß3-stimulant-induced brown-like adipocytes to investigate how these adipocytes influence kidney stone disease. For the interscapular brown adipose tissue (iBAT) removal experiment, mice were subjected to either iBAT removal or sham operation (X-BAT group or sham group), and, after 3 wk, renal crystal deposition was induced by intra-abdominal injection of glyoxylate (GOX) for 6 days. For the ß3-stimulant experiment, mice were administered intra-abdominal injections of the ß3-stimulant (ß3-group) or saline (control group) for 6 days. Thereafter, renal crystal deposition was induced by intra-abdominal injection of GOX for 6 days. iBAT removal decreased the expression of Sod1 and increased that of chemokine (C-C motif) ligand 2 (Ccl2), EGF module-containing mucin-like receptor 1 (Emr1), and tumor necrosis factor (Tnf) in the kidneys. Renal crystal deposition was 2.06-fold higher in the X-BAT group than in the sham group. The ß3-stimulant caused differentiation of white adipocytes into brown-like adipocytes. In the kidneys of the ß3-group, the expression of Ccl2 and Emr1 decreased and that of Sod1 increased. Renal crystal deposition was 0.17-fold lower in the ß3-group than in the control group. In summary, iBAT removal promoted kidney inflammation and renal crystal formation. ß3-Stimulant-induced brown-like adipocytes reduced inflammation and improved antioxidant action in the kidneys, which suppressed renal crystal formation. This is the first report on the therapeutic role of brown and brown-like adipocytes for kidney stone formation.


Assuntos
Adipócitos Marrons/efeitos dos fármacos , Adipogenia/efeitos dos fármacos , Tecido Adiposo Marrom/efeitos dos fármacos , Agonistas de Receptores Adrenérgicos beta 3/farmacologia , Dioxóis/farmacologia , Cálculos Renais/prevenção & controle , Receptores Adrenérgicos beta 3/efeitos dos fármacos , Adipócitos Marrons/metabolismo , Adipócitos Marrons/ultraestrutura , Tecido Adiposo Marrom/metabolismo , Tecido Adiposo Marrom/cirurgia , Tecido Adiposo Marrom/ultraestrutura , Animais , Proteínas de Ligação ao Cálcio/metabolismo , Quimiocina CCL2/metabolismo , Cristalização , Modelos Animais de Doenças , Glioxilatos , Mediadores da Inflamação/metabolismo , Cálculos Renais/metabolismo , Cálculos Renais/patologia , Masculino , Camundongos Endogâmicos C57BL , Receptores Adrenérgicos beta 3/metabolismo , Receptores Acoplados a Proteínas-G/metabolismo , Transdução de Sinais , Superóxido Dismutase-1/metabolismo
18.
Int J Mol Med ; 43(4): 1611-1622, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30720053

RESUMO

Treatment targeting osteopontin (OPN) and monocyte chemoattractant protein 1 (MCP­1) has been recognized as a novel approach in renal crystal formation. The present study was designed to investigate the suppressive effects of metformin on nephrolithiasis formation and its potential mechanism. The cytotoxicity of metformin on MDCK and HK­2 cells was determined using a Cell Counting Kit­8 assay in vitro. Subsequently, the mRNA transcription and protein expression levels of MCP­1 and OPN were detected by reverse transcription­quantitative­polymerase chain reaction analysis, western blot analysis and ELISA. Male Sprague­Dawley rats were divided into a control group, ethylene glycol (EG) group and EG + metformin group. The expression levels of MCP­1 and OPN and crystal formations were evaluated in renal tissues following an 8­week treatment period. In vitro, metformin significantly inhibited the production of MCP­1 and OPN induced by oxalate at the mRNA and protein expression levels. In vivo, increased expression levels of MCP­1 and OPN were detected in the EG group compared with the controls, and this upregulation was reversed in the EG + metformin group. Renal crystal deposition in the EG + metformin group was markedly decreased compared with that in the EG group. Therefore, the results of the study suggest that metformin suppressed urinary crystal deposit formation, possibly by mediating the expression of inflammatory mediators OPN and MCP­1.


Assuntos
Quimiocina CCL2/metabolismo , Cálculos Renais/tratamento farmacológico , Cálculos Renais/prevenção & controle , Metformina/uso terapêutico , Osteopontina/metabolismo , Animais , Peso Corporal/efeitos dos fármacos , Morte Celular/efeitos dos fármacos , Quimiocina CCL2/genética , Modelos Animais de Doenças , Cães , Etilenoglicol , Humanos , Cálculos Renais/sangue , Cálculos Renais/urina , Células Madin Darby de Rim Canino , Masculino , Metformina/farmacologia , Osteopontina/genética , Oxalatos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Sprague-Dawley , Regulação para Cima/efeitos dos fármacos
19.
Nephron ; 142(2): 147-158, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726853

RESUMO

BACKGROUND: Urine (u) calcium (Ca) excretion is directly dependent on dietary sodium (Na) intake leading to the recommendation for Na restriction in hypercalciuric kidney stone formers. However, there is no direct evidence that limiting Na intake will reduce recurrent stone formation. MATERIALS AND METHODS: We used genetic hypercalciuric stone-forming (GHS) rats, which universally form Ca phosphate (P) kidney stones, fed either a low Na (LNa, 0.05%) or normal Na (NNa, 0.4%) Na diet (D) for 18 weeks. Urine was collected at 6-week intervals. Radiographic analysis for stone formation and bone analyses were done at the conclusion of the study. RESULTS: Mean uCa was lower with LNaD than NNaD as was uP and LNaD decreased mean uNa and uChloride. There were no differences in urine supersaturation (SS) with respect to calcium phosphate (CaP) or Ca oxalate (CaOx). However, stone formation was markedly decreased with LNaD by radiographic analysis. The LNaD group had significantly lower femoral anterior-posterior diameter and volumetric bone mineral density (vBMD), but no change in vertebral trabecular vBMD. There were no differences in the bone formation rate or osteoclastic bone resorption between groups. The LNaD group had significantly lower femoral stiffness; however, the ultimate load and energy to fail was not different. CONCLUSION: Thus, a low Na diet reduced uCa and stone formation in GHS rats, even though SS with respect to CaP and CaOx was unchanged and effects on bone were modest. These data, if confirmed in humans, support dietary Na restriction to prevent recurrent Ca nephrolithiasis.


Assuntos
Hipercalciúria/genética , Cálculos Renais/prevenção & controle , Sódio na Dieta/administração & dosagem , Animais , Ratos
20.
Manchester; The National Institute for Health and Care Excellence (NICE); Jan. 2019. 33 p.
Monografia em Inglês | BIGG | ID: biblio-1010393

RESUMO

This guideline covers assessing and managing renal and ureteric stones. It aims to improve the detection, clearance and prevention of stones, so reducing pain and anxiety, and improving quality of life.


Assuntos
Humanos , Cálculos Renais/diagnóstico , Cálculos Renais/terapia , Cálculos Ureterais/diagnóstico , Cálculos Ureterais/terapia , Cálculos Renais/prevenção & controle , Cálculos Ureterais/prevenção & controle , Ureterolitíase , Manejo da Dor
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA