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1.
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
2.
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
3.
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
4.
World J Urol ; 37(8): 1723-1731, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30554273

RESUMO

OBJECTIVE: To assess knowledge of both promoting and preventive dietary factors on nephrolithiasis in a diverse patient population. Precipitating factors of kidney stone disease include diet, lifestyle, socioeconomic status, and race/ethnicity. However, patient awareness of these influences is poorly described. MATERIALS AND METHODS: A 24-question survey, assessing intake-related risk factors for stone disease, was administered prospectively to 1018 patients. Responses were summarized with frequency and percent. Statistical comparisons were made using a propensity scoring method in order to account for potential confounding variables. Propensity scores were stratified into quintiles. Further analysis with multiple imputation was performed to account for any missing data in the survey. The results of the propensity-adjusted log-binomial regression model are presented as prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Respondents demonstrated limited knowledge of nutrient factors that influence stone development. However, most study participants (70.3%) reported a willingness to make lifestyle changes aimed at lowering their risk for stone disease. Respondents reporting previous nephrolithiasis education were less likely to report that diet had no effect on kidney stone formation (PR = 0.795, 95% CI 0.65, 0.96, p = 0.01) The type of physician who counseled the respondent had no association with patient knowledge for stone disease (PR = 0.83, 95% CI 0.63, 1.10, p = 0.2). CONCLUSIONS: Knowledge of diet-related risk factors for nephrolithiasis is limited among this population. Respondents who received prior education appeared to maintain the knowledge of dietary risk for nephrolithiasis. Participants also expressed a willingness to make requisite dietary changes if that information is provided. Given that most stone formers experience a recurrence, these findings highlight the need for more comprehensive patient education strategies on the modifiable risk factors for nephrolithiasis.


Assuntos
Atitude Frente a Saúde , Dieta , Conhecimentos, Atitudes e Prática em Saúde , Nefrolitíase/etiologia , Nefrolitíase/prevenção & controle , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Autorrelato
5.
Biomed Res Int ; 2018: 3061742, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30515390

RESUMO

Purpose: Coconut water has long been touted for its medicinal qualities including natural hydration. We sought to determine whether its consumption would induce changes to urinary lithogenic factors beyond changes in urine volume. Materials and Methods: After Institutional Review Board approval, volunteers with no prior history of nephrolithiasis were recruited. Each participant was randomized initially to either the coconut water or the water phase of the study. Participants kept meticulous food and fluid intake logs during the first phase of the study and were asked to replicate that diet for the second phase. For each phase the participant consumed 2L of either Taste of Nirvana® pure coconut water or tap water daily for four days. Participants were not restricted to consume additional fluid of their choice during their assigned study phase. During days 3 and 4 of each phase the participant collected a 24-hour urine specimen. Coconut water citrate and malate content were measured and were used along with the beverage pH to calculate the total alkali content of the coconut water. Supersaturation levels were calculated using Equil2. Nonparametric paired analysis using the Wilcoxon test was performed for statistical analysis. Results: There were 4 adult male and 4 adult female participants. Each individual's 24-hour urine collection had a creatinine excretion within 20% of the mean for each subject's four samples corroborating that all samples were collected properly. The two samples from each phase for each individual were averaged. The coconut water itself was also analyzed and it was calculated to have a total alkali content of 13.8 mEq/L. Consumption of coconut water significantly increased urinary citrate (29%, p=0.02), urinary potassium (130%, p=0.01), and urinary chloride (37%, p=0.03), without affecting urine pH (p=0.16) or volume beyond that of tap water (p=1.00). Conclusions: Coconut water consumption increases urinary potassium, chloride, and citrate in nonstone forming individuals.


Assuntos
Ácido Cítrico/urina , Cocos/química , Malatos/urina , Água/administração & dosagem , Adulto , Álcalis/química , Bebidas , Cloretos/urina , Feminino , Humanos , Concentração de Íons de Hidrogênio/efeitos dos fármacos , Masculino , Nefrolitíase/prevenção & controle , Nefrolitíase/urina , Potássio/urina , Sistema Urinário/efeitos dos fármacos , Água/química
6.
Curr Opin Urol ; 28(5): 428-432, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29901459

RESUMO

PURPOSE OF REVIEW: The incidence of pediatric nephrolithiasis is on the rise, with a significant related morbidity and a concomitant relevant increase in healthcare costs. The purpose of this review is to portray the current epidemiology and cause of renal stones in children, to provide a framework for appropriate clinical evaluation on an individual basis, and a guidance regarding treatment and prevention for the significant risk of lifelong recurrence and deriving complications. RECENT FINDINGS: The early identification of modifiable risk factors and other abnormalities is essential, to prevent related morbidity, the onset of chronic kidney disease, and the associated increased risk of developing other diseases. The implementation of risk reduction strategies, including dietary modifications and targeted pharmacological therapies, will significantly influence stone recurrences and preserve renal function. SUMMARY: Future research is desirable, with the aim to strengthen personalized conservative management of pediatric nephrolithiasis as first-line treatment.


Assuntos
Dieta , Meio Ambiente , Nefrolitíase/epidemiologia , Alopurinol/uso terapêutico , Quelantes/uso terapêutico , Criança , Tratamento Conservador , Dietoterapia , Diuréticos/uso terapêutico , Diurético Poupador de Potássio/uso terapêutico , Inibidores Enzimáticos/uso terapêutico , Humanos , Nefrolitíase/prevenção & controle , Nefrolitíase/terapia , Penicilamina/uso terapêutico , Citrato de Potássio/uso terapêutico , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio/uso terapêutico , Tiopronina/uso terapêutico
7.
Nutrients ; 10(4)2018 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-29614726

RESUMO

The Mediterranean Dietary (MedDiet) Pattern has been linked to many beneficial health effects. This review summarizes the main findings of a prospective cohort study, the Seguimiento Universidad de Navarra (SUN) cohort, specifically focused on MedDiet and the risk of major chronic disease. It is an open cohort in which 22,786 Spanish university graduates have participated since 1999 until February 2018. Data on diet, lifestyle and clinical diagnosis are collected at baseline and every two years. After reviewing 21 publications from the SUN cohort on the effects of the MedDiet, we conclude that this cohort has provided good evidence that a high MedDiet adherence is associated with a reduced incidence of all-cause mortality, fatal and non-fatal major cardiovascular disease (CVD), type 2 diabetes, weight gain, metabolic syndrome, depression, cognitive decline, and nephrolithiasis. An inverse dose-response relationship was found for many of these associations. The MedDiet was also associated with lower average heart rate, a mitigation of the harmful effects of overweight/obesity on the risk of CVD, and an attenuation of the effects of obesity on type 2 diabetes. A suggestion that the MedDiet may enhance fertility was also found.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Disfunção Cognitiva/prevenção & controle , Depressão/prevenção & controle , Diabetes Mellitus Tipo 2/prevenção & controle , Dieta Mediterrânea , Nefrolitíase/prevenção & controle , Obesidade/prevenção & controle , Adulto , Inquéritos sobre Dietas , Comportamento Alimentar , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/prevenção & controle , Pessoa de Meia-Idade , Espanha
9.
J Urol ; 200(2): 375-381, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29499207

RESUMO

PURPOSE: Overactive bladder imposes a significant socioeconomic burden on the health care system. It is a commonly held belief that increased fluid intake (8 glasses of water per day) is beneficial for health. However, increased fluid intake exacerbates overactive bladder symptoms. Thus, it is imperative that clinicians appropriately educate patients for whom increased water intake may be detrimental (women with overactive bladder), in contrast to patients with comorbidities that necessitate increased water intake (nephrolithiasis). We systematically reviewed the literature to determine the potential health advantages of increased water intake and identify specific subpopulations that need increased hydration. MATERIALS AND METHODS: We systematically reviewed published articles from 1972 through 2017 on PubMed® and the Cochrane Library. The data were reviewed independently by 2 individuals. Studies were included if they explored water intake in relation to the risk of a particular disease. RESULTS: Level 1 evidence supported increased fluid intake in patients with nephrolithiasis. There was no available evidence to support increased fluid intake in patients with cardiovascular disease, constipation, venous thromboembolism, headaches, cognitive function or bladder cancer. Dehydration may exacerbate some conditions, specifically chronic constipation and headache intensity. Increased fluid intake may have a role in preventing stroke recurrence but not in preventing primary stroke. CONCLUSIONS: The available reviewed literature suggests no benefit to drinking 8 glasses of water per day in patients without nephrolithiasis. Also, excess fluid intake can exacerbate symptoms of overactive bladder.


Assuntos
Desidratação/prevenção & controle , Ingestão de Líquidos/fisiologia , Nefrolitíase/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Bexiga Urinária Hiperativa/complicações , Comorbidade , Desidratação/etiologia , Desidratação/fisiopatologia , Progressão da Doença , Humanos , Nefrolitíase/epidemiologia , Educação de Pacientes como Assunto , Seleção de Pacientes , Recomendações Nutricionais , Recidiva , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Bexiga Urinária Hiperativa/economia , Bexiga Urinária Hiperativa/epidemiologia
10.
Urolithiasis ; 46(5): 453-457, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29350243

RESUMO

Nephrolithiasis is a common urological disease and could be secondary to primary hyperparathyroidism (PHPT). PHPT is traditionally characterised with hypercalcaemia. Recently, a normocalcemic PHPT has been officially recognised at the International Workshops. Regarding this new phenotype, nephrolithiasis is frequently found in studies that evaluate low bone mass. However, until now, no study on aetiology of nephrolithiasis considered normocalcemic PHPT. Hypercalciuria related to PHPT is considered as an important risk factor of stone formation in hypercalcemic PHPT, but the precise relationships between hypercalcemic PHPT and nephrolithiasis and between normocalcemic PHPT and nephrolithiasis remain unclear. In patients with hypercalcemic PHPT, after a surgical cure of PHPT, the renal calcium excretion and stone recurrence rate reduce but remain higher above health controls. This finding implies that abnormalities not caused by PHPT also probably affect stone formation. According to the new guideline, the presence of stones indicates the need for parathyroidectomy in patients with either hypercalcemic or normocalcemic PHPT unless contraindications exist. Patients with contraindications for parathyroidectomy or those who do not want to receive parathyroidectomy should be monitored for signs of disease progression and given of medical management. Moreover, due to decreased but significantly higher frequency of nephrolithiasis above those of healthy controls, patients with nephrolithiasis associated with PHPT after parathyroidectomy still should be motivated to explore strategies to prevent stone occurrence.


Assuntos
Hipercalcemia/etiologia , Hipercalciúria/etiologia , Hiperparatireoidismo Primário/complicações , Nefrolitíase/etiologia , Densidade Óssea , Cálcio/sangue , Cálcio/urina , Progressão da Doença , Humanos , Hipercalcemia/epidemiologia , Hipercalcemia/prevenção & controle , Hipercalcemia/urina , Hipercalciúria/epidemiologia , Hipercalciúria/prevenção & controle , Hipercalciúria/urina , Hiperparatireoidismo Primário/epidemiologia , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/urina , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/urina , Paratireoidectomia , Recidiva
11.
Pediatr Diabetes ; 19(2): 329-332, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28737266

RESUMO

OBJECTIVE: To determine the frequency of nephrolithiasis as a complication of diabetic ketoacidosis (DKA) in pediatrics. METHODS: We performed a retrospective chart review of patients with DKA admitted to a pediatric hospital between January 2009 and July 2016. We identified patients with nephrolithiasis during admission for DKA. RESULTS: We identified 395 episodes of DKA over 7.5 years. Nephrolithiasis developed as a complication of DKA in 3 of those admissions (0.8%). All three patients with nephrolithiasis were males with new onset type 1 diabetes, aged 11 to 16.5 years. They all developed symptoms of nephrolithiasis after transition to subcutaneous insulin. One patient had subsequent worsening acidosis that required an additional 24 hours of IV insulin administration. CONCLUSIONS: Nephrolithiasis is a rare complication of pediatric DKA, and should be considered in children with DKA who develop hematuria, flank pain, or suprapubic pain. Nephrolithiasis can increase insulin resistance due to increased pain and inflammation, so these patients should be monitored closely for recurrence of DKA. As patients with diabetes have increased risk of chronic kidney disease and nephrolithiasis can cause kidney injury, risk factors for nephrolithiasis should be identified and addressed to avoid subsequent kidney damage.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/complicações , Nefropatias Diabéticas/complicações , Nefrolitíase/complicações , Adolescente , Criança , Estudos de Coortes , Terapia Combinada , Diabetes Mellitus Tipo 1/tratamento farmacológico , Cetoacidose Diabética/epidemiologia , Cetoacidose Diabética/prevenção & controle , Cetoacidose Diabética/terapia , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/prevenção & controle , Nefropatias Diabéticas/terapia , Registros Eletrônicos de Saúde , Feminino , Hidratação , Hospitais Pediátricos , Humanos , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/uso terapêutico , Incidência , Injeções Subcutâneas , Insulina/administração & dosagem , Insulina/uso terapêutico , Masculino , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/terapia , Estudos Retrospectivos , Rhode Island/epidemiologia , Risco , Prevenção Secundária
12.
Trials ; 18(1): 424, 2017 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-28893306

RESUMO

BACKGROUND: The pivotal role of vitamin D (vit D) in skeletal health is well known. Neonatal vit D storage at birth is dependent on maternal levels, and newborns receive 50-70% of their mother's 25-hydroxyvitamin D [25(OH)D]. Deficiency of vit D can lead to prematurity bone disease, with an incidence of up to 55% in infants weighing < 1000 g. The aim of this study is to assess the effectiveness of monitored supplementation of vit D in a population of preterm infants. METHODS/DESIGN: Preterm infants born at 24-32 weeks of gestation will be recruited within the first 7 days of life. Depending on the type of feeding, and after reaching partial enteral feeding or at 7 days of life, vit D supplementation will consist of 500 IU and an additional 150-300 IU/kg included in human milk fortifiers (if fed exclusively with breast milk) or 190 IU/kg in milk formulas. Subjects will be randomised to either monitored (with an option of dose modification based on 25(OH)D levels as per protocol) or standard therapy up to 52 weeks of post-conceptional age (PCA). The primary outcome measure will be the number of neonates with deficiency or excess levels of 25(OH)D at 40 ±2 weeks of PCA. Additional 25(OH)D levels will be measured at birth, at 4 and 8 weeks of age, and/or at 35 and 52 ±2 weeks of PCA. Secondary objectives will include the incidence of osteopenia, nephrocalcinosis and nephrolithiasis. Serum parameters of calcium phosphorus metabolism will also be measured. DISCUSSION: Despite multiple years of research and numerous publications, there is still a lack of consensus in regard to how much vit D infants should receive and how long they should receive it. Because 80% of calcium and phosphorus placental transfer occurs between 24 and 40 weeks of gestation, preterm infants are especially prone to adverse effects of vit D insufficiency. However, both inadequate and excessive amounts of vit D may be unsafe and lead to serious health issues. The results of our study may shed new light on these concerns and contribute to optimising vit D supplementation. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03087149 . Registered on 15 March 2017.


Assuntos
Colecalciferol/administração & dosagem , Suplementos Nutricionais , Recém-Nascido Prematuro , Nascimento Prematuro , Deficiência de Vitamina D/tratamento farmacológico , Biomarcadores/sangue , Doenças Ósseas Metabólicas/epidemiologia , Doenças Ósseas Metabólicas/prevenção & controle , Colecalciferol/efeitos adversos , Protocolos Clínicos , Suplementos Nutricionais/efeitos adversos , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro/sangue , Nefrocalcinose/epidemiologia , Nefrocalcinose/prevenção & controle , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Polônia/epidemiologia , Nascimento Prematuro/sangue , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Deficiência de Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia
13.
G Ital Nefrol ; 34(4): 51-60, 2017 Aug 01.
Artigo em Italiano | MEDLINE | ID: mdl-28762682

RESUMO

Citrate is a tricarboxylic acid and an intermediate metabolite of Krebs cycle. It contributes to oxidative metabolism of both kidney and liver. Alkaline sodium or potassium salts have the potential to increase alkaline reserve. In the kidney citrate is completely filtered at the glomerulus, undergoing to 10-40% tubular resorption. Renal insufficiency, even early, metabolic acidosis, potassium depletion induce hypocitraturia. Its importance in nephrolithiasis stems from its ability to form soluble complexes with calcium and to interfere with crystal formation, thus exerting a dual inhibition, thermodynamic and kinetic. Moreover, its alkalizing property has shown benefits of bone mineralization. The alkalizing effect is also useful in uric acid and cystine stone disease. Hypocitraturia has a significant incidence in the course of calcium nephrolithiasis, either secondary to aforementioned causes, or in idiopathic and/or familial forms. Citrate is used in the prevention of stone recurrences and given as tripotassic or potassium-magnesium salt, 0.1 mmol/kg/day in 2-3 dosages. In uric acid disease, in addition to prevention, it can induce dissolution of renal stones, provided urine pH is maintained at higher than 6.5 values. As concerns its effects on bone, it was shown to induce both decreases in marker of bone resorption and increases in bone mineral density.


Assuntos
Ácido Cítrico/uso terapêutico , Nefrolitíase/prevenção & controle , Ácido Cítrico/metabolismo , Cristalização , Humanos , Cálculos Renais/tratamento farmacológico
14.
Eur Urol Focus ; 3(1): 10-12, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28720352

RESUMO

The global prevalence of nephrolithiasis has progressively increased over the past several decades. Kidney stone disease without treatment is a recurrent illness that represents a major health burden across the globe with associated economic costs.


Assuntos
Nefrolitíase/prevenção & controle , Prevenção Secundária/métodos , Tratamento Conservador , Dieta , Ingestão de Líquidos , Humanos , Nefrolitíase/tratamento farmacológico
15.
Pediatr Diabetes ; 18(5): 327-331, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28568353

RESUMO

Prior to 1971, type Ia glycogen storage disease was marked by life-threatening hypoglycemia, lactic acidosis, severe failure to thrive, and developmental delay. With the introduction of continuous feeds in the 1970s and cornstarch in the 1980s, the prognosis improved, but complications almost universally developed. Changes in the management of type Ia glycogen storage disease have resulted in improved metabolic control, and this manuscript reviews the increasing evidence that complications can be delayed or prevented with optimal metabolic control as previously was seen in diabetes.


Assuntos
Doença de Depósito de Glicogênio Tipo I/terapia , Medicina de Precisão , Insuficiência Renal/prevenção & controle , Adenoma/complicações , Adenoma/prevenção & controle , Adulto , Criança , Terapia Combinada , Doença de Depósito de Glicogênio Tipo I/sangue , Doença de Depósito de Glicogênio Tipo I/complicações , Doença de Depósito de Glicogênio Tipo I/diagnóstico , Humanos , Hipoglicemia/complicações , Hipoglicemia/prevenção & controle , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/prevenção & controle , Nefrocalcinose/complicações , Nefrocalcinose/prevenção & controle , Nefrolitíase/complicações , Nefrolitíase/prevenção & controle , Osteoporose/complicações , Osteoporose/prevenção & controle , Prognóstico , Insuficiência Renal/complicações
16.
Microb Pathog ; 109: 287-291, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28624518

RESUMO

Nephrolithiasis is a condition marked by the presence or formation of stones in kidneys. Several factors contribute to kidney stones development such as environmental conditions, type of dietary intake, gender and gastrointestinal flora. Most of the kidney stones are composed of calcium phosphate and calcium oxalate, which enter in to the body through diet. Both sources of oxalates become dangerous when normal flora of gastrointestinal tract is disturbed. Oxalobacter and Lactobacillus species exist symbiotically in the human gut and prevent stone formation by altering some biochemical pathways through production of specific enzymes which help in the degradation of oxalate salts. Both Oxalobacter and Lactobacillus have potential probiotic characteristics for the prevention of kidney stone formation and this avenue should be further explored.


Assuntos
Oxalato de Cálcio/metabolismo , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/microbiologia , Cálcio/metabolismo , Oxalato de Cálcio/urina , Fosfatos de Cálcio/metabolismo , Dieta , Suplementos Nutricionais , Trato Gastrointestinal/metabolismo , Humanos , Cálculos Renais/prevenção & controle , Lactobacillus/metabolismo , Nefrolitíase/prevenção & controle , Oxalatos/metabolismo , Oxalobacter formigenes/metabolismo , Probióticos/uso terapêutico
17.
Arch. esp. urol. (Ed. impr.) ; 70(1): 91-102, ene.-feb. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-160324

RESUMO

Los cálculos renales se forman en general como consecuencia de la combinación de determinados factores, algunos relacionados con la composición de la orina (concentración de sustancias litógenas, déficit de inhibidores de la cristalización, presencia de nucleantes heterogéneos) y otros con la morfoanatomía renal (estasis urinaria, cavidades de baja eficacia urodinámica, deformaciones morfoanatómicas, lesiones del tejido papilar renal). De hecho, la composición, macroestructura y microestructura del cálculo dependerán claramente de los factores que lo han inducido. Por esta razón, disponer del cálculo renal convenientemente estudiado y clasificado simplifica el diagnóstico y posibilita un enfoque terapéutico más eficaz ya que se dirige directamente a corregir los factores etiológicos responsables de la litiasis. En esta publicación revisamos los principales factores etiológicos implicados en la formación de cada tipo de cálculo y las medidas profilácticas que pueden adoptarse para su adecuada corrección. Los cálculos renales más frecuentes se han clasificado en los siguientes tipos: cálculos de oxalato cálcico monohidrato papilares, cálculos de oxalato cálcico monohidrato de cavidad, cálculos de oxalato cálcico dihidrato, cálculos mixtos de hidroxiapatita/oxalato cálcico, cálculos de carboxiapatita/hidroxiapatita, cálculos de brushita, cálculos de estruvita/carboxiapatita, cálculos de ácido úrico, cálculos de ácido úrico/oxalato cálcico monohidrato y cálculos de cistina. En ocasiones, sin embargo, no se dispone del cálculo para su estudio, en cuyo caso el único camino a seguir consiste en utilizar toda la información disponible (historial clínico, hábitos de vida, datos radiológicos), junto con la información bioquímica urinaria básica, para identificar y corregir cuantos factores etiológicos relacionados con la litiasis renal se hayan identificado (AU)


Renal calculi are generally formed as a result of the combination of certain factors, some related to urine composition (concentration of lithogenic substances, deficiency of crystallization inhibitors, presence of heterogeneous nucleants) and others with renal morphology and anatomy (urinary tract stasis, low urodynamic efficiency cavities, morpho-anatomic deformations, renal papillary tissue lesions). In fact, the composition, macrostructure and microstructure of the calculus will clearly depend on the factors that have induced it. For this reason, the appropriate study and classification of the renal calculi simplifies the diagnosis and allows a more effective therapeutic approach since it can be oriented to directly correct the etiological factors responsible for stone formation. In this article, we review the main etiological factors involved in the formation of each type of calculus and the prophylactic measures that can be adopted for proper correction. The most frequent kidney stones have been classified into the following types: calcium oxalate monohydrate papillary calculi, calcium oxalate monohydrate non-papillary calculi, calcium oxalate dihydrate calculi, mixed hydroxyapatite/ calcium oxalate calculi, carboxyapatite/hydroxyapatite calculi, brushite calculi, struvite/carboxyapatite calculi, uric acid calculi, uric acid/calcium oxalate monohydrate calculi, and cystine calculi. Occasionally, however, the calculus is not available for study, in which case the only way forward is to use all available information (clinical history, life habits, radiological data), together with basic biochemical information, to identify and correct all etiological factors related to renal lithiasis that have been identified (AU)


Assuntos
Humanos , Urolitíase/prevenção & controle , Cálculos Urinários/prevenção & controle , Nefrolitíase/prevenção & controle , Fatores de Risco , Cálculos Renais/classificação , Oxalato de Cálcio/análise , Ácido Úrico/análise , Hidroxiapatitas/análise
18.
J Endourol ; 31(2): 135-140, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28049356

RESUMO

INTRODUCTION: We sought to determine the rate of and factors associated with patient nonadherence to prescribed follow-up after uncomplicated ureteroscopy. MATERIALS AND METHODS: The records of 247 consecutive patients who underwent ureteroscopy at a tertiary referral center from November 2010 to February 2016 were reviewed. Bivariate and multivariate analyses were performed to determine the impact of demographic, procedural, socioeconomic, and environmental factors on the rate of compliance with secondary prevention counseling. RESULTS: Forty-five patients (18.5%) were lost to scheduled follow-up for secondary prevention counseling after ureteroscopy. Lost to counseling rates were broad based and not associated with traditional predictors of poor follow-up such as age, gender, marital status, and distance traveled. On multivariate analysis, compared with those using commercial insurance, patients with Medicare (odds ratio [OR] for follow-up 0.48, 95% confidence interval [CI] 0.21, 1.1 p = 0.095) and Medicaid (OR for follow-up 0.25, 95% CI 0.1, 0.6, p < 0.001) were less likely to be adherent to prescribed follow-up. CONCLUSIONS: Nearly one in five patients will be lost to follow-up for secondary prevention counseling after ureteroscopy. Lack of follow-up may prevent the diagnosis of postoperative complications and limit the ability to counsel patients on stone prevention. Efforts to improve follow-up following ureteroscopy should focus on including more postoperative counseling in the preoperative period and a more individualized approach to specific patient populations, particularly those with a lower socioeconomic status.


Assuntos
Perda de Seguimento , Nefrolitíase , Cooperação do Paciente/estatística & dados numéricos , Ureteroscopia/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrolitíase/diagnóstico , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Razão de Chances , Estudos Retrospectivos
19.
Ren Fail ; 39(1): 120-129, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28085537

RESUMO

OBJECTIVE: To examine the effect of an aqueous extract of Radix Paeoniae Alba (RPA) on the formation of calcium oxalate (CaOx) stones and the potential mechanism underlying the effect. MATERIALS AND METHODS: An in vitro assay was used to determine whether the RPA extract prevents the formation of CaOx or promotes CaOx dissolution. We also investigated the efficacy of the extract in vivo as a preventive and therapeutic agent for experimentally induced CaOx nephrolithiasis in rats. Various biochemical, molecular, and histological parameters were assessed in kidney tissue and urine at the end of the in vivo experiment. RESULTS: Significant dissolution of formed crystals (8.99 ± 1.43) and inhibition of crystal formation (2.55 ± 0.21) were observed in vitro after treatment with 64 mg/mL of the RPA extract compared with a control treatment (55.10 ± 4.98 and 54.57 ± 5.84, respectively) (p < .05). In preventive protocols, the RPA extract significantly reduced urinary and renal oxalate levels and increased urinary calcium and citrate levels compared to the control. In addition, the RPA preventive protocol significantly decreased osteopontin expression, renal crystallization, and pathological changes compared to the control. These changes were not observed in rats on the therapeutic protocol. CONCLUSIONS: RPA is a useful agent that prevents the formation of CaOx kidney stones.


Assuntos
Oxalato de Cálcio , Rim , Nefrolitíase , Paeonia , Extratos Vegetais/farmacologia , Animais , Oxalato de Cálcio/química , Oxalato de Cálcio/urina , Cristalização , Modelos Animais de Doenças , Rim/metabolismo , Rim/patologia , Nefrolitíase/tratamento farmacológico , Nefrolitíase/metabolismo , Nefrolitíase/prevenção & controle , Osteopontina/metabolismo , Fitoterapia/métodos , Ratos , Resultado do Tratamento , Agentes Urológicos/farmacologia
20.
Crit Rev Food Sci Nutr ; 57(5): 963-974, 2017 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-25975220

RESUMO

Adequate hydration, as to maintain urinary volume over 2 L/day, has long been considered as the cornerstone medical prescription for preventing nephrolithiasis. However, scientific evidence about what kind of water stone formers should drink and about the effects of other beverages on urinary stone risk factors is sometimes unclear. Moreover, the recommendation that water therapy prevents kidney stone recurrence relies on only one randomized controlled trial, even if more epidemiologic and basic science studies seem to support this assumption. Therefore, in this review we analyze current evidence that support water therapy in nephrolithiasis and we highlight the possible effects of different types of water and other beverages on lithogenic risk, giving some practical recommendations for what stone formers should be advised to prevent recurrence.


Assuntos
Água Potável/administração & dosagem , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Bebidas , Hidratação/métodos , Humanos , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco
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