-
Urolithiasis Jul 2023A well-accepted strategy to prevent kidney stones is to increase urine volume by increasing oral intake of fluids, especially water, to lower supersaturation of the...
A well-accepted strategy to prevent kidney stones is to increase urine volume by increasing oral intake of fluids, especially water, to lower supersaturation of the relevant, relatively insoluble salts, and thereby lower the risk of precipitation. Randomized controlled trials have shown that this strategy works. It is inexpensive, safe, and intuitively attractive to patients. However, although any beverage can increase urine volume, and citrus juices can increase urine citrate content and pH, no beverage other than water has been clearly shown by randomized controlled trial to prevent kidney stones. We designed an innovative, palatable, low-calorie, high alkali citrate beverage to prevent kidney stones, called Moonstone. One packet of Moonstone powder, mixed in 500 ml of water, contains 24.5 meq of alkali citrate. We administered one packet twice a day to ten calcium stone formers. Moonstone resulted in an increase in mean 24-h urine citrate and urine pH, and a decrease in supersaturation of calcium oxalate in calcium stone formers compared to an equal volume of water. These changes, comparable to those seen in a prior study of a similar amount of (potassium-magnesium) citrate, will likely be associated with a clinically meaningful reduction in kidney stone burden in patients with calcium stones. The effect to increase urine pH would also be expected to benefit patients with uric acid and cystine stones, groups that we hope to study in a subsequent study. The study preparation was well tolerated and was selected as a preferred preventative strategy by about half the participants. Moonstone is an alternative, over-the-counter therapy for kidney stone prevention.
Topics: Humans; Citric Acid; Calcium; Kidney Calculi; Citrates; Water
PubMed: 37479949
DOI: 10.1007/s00240-023-01468-w -
IUCrData May 2020The crystal structure of di-ammonium potassium citrate, 2NH ·K·CHO , has been solved and refined using laboratory X-ray powder diffraction data and optimized using...
The crystal structure of di-ammonium potassium citrate, 2NH ·K·CHO , has been solved and refined using laboratory X-ray powder diffraction data and optimized using density functional theory. The KO coordination polyhedra are isolated. The ammonium cations and the hydro-phobic methyl-ene sides of the citrate anions occupy the spaces between the coordination polyhedra. Each hydrogen atom of the ammonium ions acts as a donor in a charge-assisted N-H⋯O, N-H⋯(O,O) or N-H⋯(O,O,O) hydrogen bond. There is an intra-molecular O-H⋯O hydrogen bond in the citrate anion between the hydroxide group and one of the terminal carboxyl-ate groups.
PubMed: 36337153
DOI: 10.1107/S2414314620006124 -
Applied Radiation and Isotopes :... Mar 2022This work consists of a first investigation of materials that could be used as ESR dosimeters with doses up to 5 Gy aiming possible applications that would include... (Review)
Review
This work consists of a first investigation of materials that could be used as ESR dosimeters with doses up to 5 Gy aiming possible applications that would include retrospective dosimetry or dosimetry in specific applications. The characteristics considered were radiological properties close to that of soft tissues, evaluated through their effective atomic number and mass attenuation coefficient, ESR signal dependence on the irradiation dose, sensitivity to dose in the range of ∼5 Gy when exposed to a 50 kV x-ray source and signal stability over a 30-day period. A total of 16 compounds of lithium, potassium and sodium were analyzed, including the already known dosimeter material, lithium formate. Among them, lithium carbonate, lithium phosphate, sodium formate, sodium acetate, sodium citrate, sodium dithionite, sodium carbonate, showed eligible characteristics. After analyzing the ESR dose-response curves, the molecules that showed greater sensitivity to radiation in descending order are: sodium formate, sodium acetate, sodium citrate and sodium dithionite, however, lower than lithium formate. Sodium formate and sodium citrate presented ESR signals with high stability, similar to lithium formate, with fading of ∼3% in 30 days, different from sodium acetate, which showed a 19% reduction. Sodium citrate also presents radiological properties close to soft tissue. Therefore, considering all properties, in the set of the new materials studied in this work, sodium citrate is a promising material for ESR dosimetry.
Topics: Electron Spin Resonance Spectroscopy; Lithium Compounds; Potassium Compounds; Radiation Dosimeters; Radiometry; Sodium Compounds
PubMed: 35063871
DOI: 10.1016/j.apradiso.2022.110105 -
Turkish Journal of Urology Nov 2020Since its introduction in the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has proven to be a minimally invasive and efficient procedure for the management... (Review)
Review
Since its introduction in the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has proven to be a minimally invasive and efficient procedure for the management of renal calculi. It is currently one of the most recommended treatments for small- and medium-sized stones (<20 mm) in most guidelines internationally. The recent coronavirus disease 2019 (COVID-19) outbreak could lead to a further increase in ESWL use as it avoids a general anesthetic and its potential complications in patients with COVID-19 infection. Most publications exhibit ESWL stone-free rates (SFRs) of 70%-80%; however, this is often not the case in many centers, with multiple factors affecting the efficacy of the intervention. Various stone and patient factors have been shown to influence the ESWL success. Stone position, density and size, skin-to-stone distance, and body-mass index contribute to SFRs. Modifications in the lithotripter design and revisions in the technique have also improved the SFRs over the years, with slower shock rates, power-ramping protocols, combined real-time ultrasound, and fluoroscopy imaging technology, all enhancing the efficacy. The adjuvant use of pharmacological agents, such as alpha-blockers, potassium citrate, and the emerging microbubble technology, has also been investigated and shown promising results. Arguably, the most significant determinant of the success of ESWL in a particular unit is how the lithotripsy service is set up and monitored. Careful patient selection, dedicated personnel, and post-treatment imaging review are essential for the optimization of ESWL. Through an analysis of the published studies, this review aimed to explore the measures that contribute to an effectual lithotripsy service in depth.
PubMed: 33135997
DOI: 10.5152/tud.2020.20441 -
Applied Microbiology and Biotechnology Dec 2024The high recurrence rate of renal uric acid stone (UAS) poses a significant challenge for urologists, and potassium sodium hydrogen citrate (PSHC) has been proven to be...
The high recurrence rate of renal uric acid stone (UAS) poses a significant challenge for urologists, and potassium sodium hydrogen citrate (PSHC) has been proven to be an effective oral dissolution drug. However, no studies have investigated the impact of PSHC on gut microbiota and its metabolites during stone dissolution therapy. We prospectively recruited 37 UAS patients and 40 healthy subjects, of which 12 patients completed a 3-month pharmacological intervention. Fasting vein blood was extracted and mid-stream urine was retained for biochemical testing. Fecal samples were collected for 16S ribosomal RNA (rRNA) gene sequencing and short chain fatty acids (SCFAs) content determination. UAS patients exhibited comorbidities such as obesity, hypertension, gout, and dyslipidemia. The richness and diversity of the gut microbiota were significantly decreased in UAS patients, Bacteroides and Fusobacterium were dominant genera while Subdoligranulum and Bifidobacterium were poorly enriched. After PSHC intervention, there was a significant reduction in stone size accompanied by decreased serum uric acid and increased urinary pH levels. The abundance of pathogenic bacterium Fusobacterium was significantly downregulated following the intervention, whereas there was an upregulation observed in SCFA-producing bacteria Lachnoclostridium and Parasutterella, leading to a significant elevation in butyric acid content. Functions related to fatty acid synthesis and amino acid metabolism within the microbiota showed upregulation following PSHC intervention. The correlation analysis revealed a positive association between stone pathogenic bacteria abundance and clinical factors for stone formation, while a negative correlation with SCFAs contents. Our preliminary study revealed that alterations in gut microbiota and metabolites were the crucial physiological adaptation to PSHC intervention. Targeted regulation of microbiota and SCFA holds promise for enhancing drug therapy efficacy and preventing stone recurrence. KEY POINTS: • Bacteroides and Fusobacterium were identified as dominant genera for UAS patients • After PSHC intervention, Fusobacterium decreased and butyric acid content increased • The microbiota increased capacity for fatty acid synthesis after PSHC intervention.
Topics: Humans; Citric Acid; Potassium Citrate; Sodium Citrate; Potassium; Uric Acid; Gastrointestinal Microbiome; Sodium; Citrates; Bacteroides; Butyric Acid
PubMed: 38183479
DOI: 10.1007/s00253-023-12953-y -
Journal of the American Society of... Aug 2023Lower serum bicarbonate levels, even within the normal range, are strongly linked to risks of cardiovascular disease in CKD, possibly by modifying vascular function. In... (Randomized Controlled Trial)
Randomized Controlled Trial
SIGNIFICANCE STATEMENT
Lower serum bicarbonate levels, even within the normal range, are strongly linked to risks of cardiovascular disease in CKD, possibly by modifying vascular function. In this randomized, controlled trial, treatment with sodium bicarbonate (NaHCO 3 ) did not improve vascular endothelial function or reduce arterial stiffness in participants with CKD stage 3b-4 with normal serum bicarbonate levels. In addition, NaHCO 3 treatment did not reduce left ventricular mass index. NaHCO 3 did increase plasma bicarbonate levels and urinary citrate excretion and reduce urinary ammonium excretion, indicating that the intervention was indeed effective. NaHCO 3 therapy was safe with no significant changes in BP, weight, or edema. These results do not support the use of NaHCO 3 for vascular dysfunction in participants with CKD.
BACKGROUND
Lower serum bicarbonate levels, even within the normal range, are strongly linked to risks of cardiovascular disease in CKD, possibly by modifying vascular function. Prospective interventional trials with sodium bicarbonate (NaHCO 3 ) are lacking.
METHODS
We conducted a randomized, double-blind, placebo-controlled trial examining the effect of NaHCO 3 on vascular function in 109 patients with CKD stage 3b-4 (eGFR 15-44 ml/min per 1.73 m 2 ) with normal serum bicarbonate levels (22-27 mEq/L). Participants were randomized 1:1 to NaHCO 3 or placebo at a dose of 0.5 mEq/lean body weight-kg per day for 12 months. The coprimary end points were change in brachial artery flow-mediated dilation (FMD) and change in aortic pulse wave velocity over 12 months.
RESULTS
Ninety patients completed this study. After 12 months, plasma bicarbonate levels increased significantly in the NaHCO 3 group compared with placebo (mean [SD] difference between groups 1.35±2.1, P = 0.003). NaHCO 3 treatment did not result in a significant improvement in aortic pulse wave velocity from baseline. NaHCO 3 did result in a significant increase in flow-mediated dilation after 1 month; however, this effect disappeared at 6 and 12 months. NaHCO 3 resulted in a significant increase in 24-hour urine citrate and pH and a significant decrease in 24-hour urine ammonia. There was no significant change in left ventricular mass index, ejection fraction, or eGFR with NaHCO 3 . NaHCO 3 treatment was safe and well-tolerated with no significant changes in BP, antihypertensive medication, weight, plasma calcium, or potassium levels.
CONCLUSION
Our results do not support the use of NaHCO 3 for vascular dysfunction in participants with CKD and normal serum bicarbonate levels.
Topics: Humans; Sodium Bicarbonate; Bicarbonates; Cardiovascular Diseases; Pulse Wave Analysis; Prospective Studies; Renal Insufficiency, Chronic; Double-Blind Method
PubMed: 37228030
DOI: 10.1681/ASN.0000000000000161