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The tolerability of Potassium Citrate Tablet in patients with intolerance to Potassium Citrate Powder form.
Basiri, A, Taheri, F, Taheri, M
Urology journal. 2018;(1):16-20
Abstract
PURPOSE To assess the tolerability of Potassium Citrate (KCit) tablet in patients with kidney stones that were not able to use the powder form of this drug due to unfavorable salty taste and gastrointestinal complications. MATERIALS AND METHODS Twenty-three stone formers, with intolerance to potassium citrate powder form, which had referred to Labbafinejad stone preventive clinic (2015), have been included in this study. All of the patients took two Potassium citrate tablets (10 meq), three times a day for two weeks. Spot urine sample and the 24-hour urine collections were performed before and after KCit therapy. In addition, a visual analog taste scale was completed to gauge the taste and palatability of the KCit tablet in comparing with the powder form. RESULTS All of the patients claimed that they consumed the tablets as prescribed. The urine pH and the 24-hour citrate and potassium were significantly higher after the treatment. In addition, the mean visual analog scale score was significantly improved in KCit therapy with tablet form versus to powder type (good vs. terrible score). CONCLUSION Oral tolerance of KCit therapy is improved with the use of Potassium Citrate tablet, with beneficial effects on 24-hour urine citrate, potassium, and pH.
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A Double-Blind, Placebo Controlled, Randomized Phase 1 Cross-Over Study with ALLN-177, an Orally Administered Oxalate Degrading Enzyme.
Langman, CB, Grujic, D, Pease, RM, Easter, L, Nezzer, J, Margolin, A, Brettman, L
American journal of nephrology. 2016;(2):150-8
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Abstract
BACKGROUND Hyperoxaluria may result from increased endogenous production or overabsorption of dietary oxalate in the gastrointestinal tract leading to nephrolithiasis and, in some, to oxalate nephropathy and chronic kidney disease. ALLN-177 is an oral formulation of a recombinant, oxalate specific, microbial enzyme oxalate decarboxylase intended to treat secondary hyperoxaluria by degrading dietary oxalate in the gastrointestinal tract, thereby reducing its absorption and subsequent excretion in the urine. METHODS This double-blind, placebo controlled, randomized, cross-over, phase 1 study of ALLN-177 evaluated the tolerability of ALLN-177 and its effect on urinary oxalate excretion in 30 healthy volunteers with hyperoxaluria induced by ingestion of a high oxalate, low calcium (HOLC) diet. The primary end point was the difference in the mean 24-hour urinary oxalate excretion during the ALLN-177 treatment period compared with the placebo treatment period. RESULTS The daily urinary oxalate excretion increased in the study population from 27.2 ± 9.5 mg/day during screening to 80.8 ± 24.1 mg/day (mean ± SD) on the HOLC diet before introducing ALLN-177 or placebo therapy for 7 days. Compared to placebo, ALLN-177 treatment reduced urinary oxalate by 11.6 ± 2.7 mg/day, p = 0.0002 (least squares mean ± SD). CONCLUSIONS In healthy volunteers, with diet-induced hyperoxaluria treatment with ALLN-177, when compared to placebo, significantly reduced urinary oxalate excretion by degrading dietary oxalate in the gastrointestinal tract and thereby reducing its absorption. ALLN-177 may represent a new approach for managing secondary hyperoxaluria and its complications.
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Effects of Sex on Intra-Individual Variance in Urinary Solutes in Stone-Formers Collected from a Single Clinical Laboratory.
Perry, GM, Scheinman, SJ, Asplin, JR
PloS one. 2013;(6):e53637
Abstract
BACKGROUND/AIMS: Our work in a rodent model of urinary calcium suggests genetic and gender effects on increased residual variability in urine chemistries. Based on these findings, we hypothesized that sex would similarly be associated with residual variation in human urine solutes. Sex-related effects on residuals might affect the establishment of physiological baselines and error in medical assays. METHODS We tested the effects of sex on residual variation in urine chemistry by estimating coefficients of variation (CV) for urinary solutes in paired sequential 24-h urines (≤72 hour interval) in 6,758 females and 9,024 males aged 16-80 submitted to a clinical laboratory. RESULTS Females had higher CVs than males for urinary phosphorus overall at the False Discovery Rate (P<0.01). There was no effect of sex on CV for calcium (P>0.3). Males had higher CVs for citrate (P<0.01) from ages 16-45 and females higher CVs for citrate (P<0.01) from ages 56-80, suggesting effects of an extant oestral cycle on residual variance. CONCLUSIONS Our findings indicate the effects of sex on residual variance of the excretion of urinary solutes including phosphorus and citrate; differences in CV by sex might reflect dietary lability, differences in the fidelity of reporting or genetic differentiation in renal solute consistency. Such an effect could complicate medical analysis by the addition of random error to phenotypic assays. Renal analysis might require explicit incorporation of heterogeneity among factorial effects, and for sex in particular.
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Effects of surgical position on patients' arterial blood gases during percutaneous nephrolithotomy.
Karami, H, Rezaei, AR, Mazloomfard, MM, Javanmard, B, Lotfi, B, Haji-Mohammadmehdi-Arbab, A
Urology journal. 2012;(3):553-6
Abstract
PURPOSE To compare arterial blood gas analysis of patients who underwent percutaneous nephrolithotomy (PCNL) in flank position under ultrasonography guidance with PCNL in prone and supine positions under fluoroscopic guidance. MATERIALS AND METHODS In a clinical trial, a total of 90 patients with no upper urinary tract abnormalities were candidate for the PCNL. They were assigned into three groups using pseudorandomization method (30 patients in each group). Patients in group 1 underwent ultrasonography-guided PCNL in flank position. Patients in groups 2 and 3 underwent fluoroscopic-guided PCNL in prone and supine positions, respectively. Arterial blood gas was taken just before and 20 minutes after repositioning. RESULTS The patients' mean age was 40.8 ± 6.9, 39.4 ± 10.6, and 37.2 ± 11.1 years in flank, prone, and supine positions, respectively (P = .69). The mean body mass index was 27.8 ± 3.4, 26.7 ± 4.7, and 28.1 ± 5.1 kg/m² in flank, prone, and supine positions, respectively (P = .21). Arterial oxygen pressure (PaO₂) increased significantly in flank (111.7 ± 43.8 to 132.8 ± 58.1 mmHg; P = .01) and prone (118.6 ± 50.2 to 134.6 ± 58.5 mmHg; P < .001) positions and decreased nonsignificantly in supine group (121.7 ± 64.5 to 119.7 ± 60.9 mmHg; P = .23). With surgical positioning, there were no significant changes demonstrated in PaCO₂ and serum concentration of HCO₃ in the flank, prone, and supine groups. CONCLUSION We could suggest that flank and prone positions could improve patients' oxygenation during PCNL procedure.
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Inversion, hydration and diuresis during extracorporeal shock wave lithotripsy: does it improve the stone-free rate for lower pole stone clearance?
Albanis, S, Ather, HM, Papatsoris, AG, Masood, J, Staios, D, Sheikh, T, Akhtar, S, Buchholz, N
Urologia internationalis. 2009;(2):211-6
Abstract
OBJECTIVE It was the aim of this study to assess the efficacy and safety of combined forced hydration and diuresis with limited inversion during shock wave lithotripsy (SWL) by comparing this treatment modality with conventional SWL for lower calyceal nephrolithiasis. PATIENTS AND METHODS In this prospective, non-randomized study, we included 100 patients with lower calyceal calculi RESULTS Clinical outcomes were available in 90 patients. Follow-up at 3 months showed that 83.3% of the patients belonging to the study group were rendered stone free, whereas 71.5% were stone free in the control (p > 0.05). Complications were minimal and not statistically significant. CONCLUSIONS Forced diuresis and inversion therapy is very well tolerated; however, the stone-free rate was not significantly improved.
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Tubeless percutaneous nephrolithotomy--should a stent be an integral part?
Mandhani, A, Goyal, R, Vijjan, V, Dubey, D, Kapoor, R
The Journal of urology. 2007;(3 Pt 1):921-4
Abstract
PURPOSE We compared the outcome of tubeless percutaneous nephrolithotomy with or without Double-J(R) stent. MATERIALS AND METHODS From January 2004 to March 2006 patients with renal stones matched for age and stone size who underwent tubeless percutaneous nephrolithotomy were prospectively evaluated in 2 groups treated by 2 surgeons. Group 1 had a Double-J stent and group 2 did not. Inclusion criteria for tubeless percutaneous nephrolithotomy included contralateral normal kidney, intact pelvicaliceal system, complete stone clearance under fluoroscopy and single infracostal puncture. These groups were compared for analgesic requirement, hospital stay, and intraoperative and postoperative complications. RESULTS During a period of 27 months 52 patients (57 renal units) underwent tubeless percutaneous nephrolithotomy. Group 1 had 25 (28 renal units) and group 2 had 27 patients (29 renal units). Mean stone volume was 4.34 +/- 2.12 cm(3) in group 1 and 4.14 +/- 1.14 cm(3) in group 2. Mean pain score was 2.96 +/- 1.24 and 2.82 +/- 0.81 in groups 1 and 2, respectively. Analgesic (intramuscular or oral diclofenac sodium) requirement and mean hospital stay was comparable in groups 1 and 2, eg 170 +/- 110 vs 163.24 +/- 98.07 mg and 2.52 +/- 0.12 vs 2.35 +/- 0.12 days. Two patients in group 1 and 1 in group 2 had urinary leak from the percutaneous nephrolithotomy tract. Similarly 3 patients in group 1 had severe stent related problems and 1 required early removal of the Double-J stent. CONCLUSIONS Avoiding use of the Double-J stent may not compromise the safety of tubeless percutaneous nephrolithotomy.
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[Drinking mineral water in combined therapy of nephrolithiasis].
Neĭmark, AI, Davydov, AV, Bunkov, VV, Zhiliakova, LV, Ukrainskaia, LM
Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury. 2005;(3):32-4
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Percutaneous ultrasonic lithotripsy (PUL) after shock wave lithotripsy (SWL) failure.
Krambeck, AE, Krejci, KC, Patterson, DE, Leroy, AJ, Segura, JW
The Canadian journal of urology. 2004;(5):2383-9
Abstract
OBJECTIVE Shock wave lithotripsy (SWL) is an attractive initial treatment for nephrolithiasis. Unfortunately, a significant number of stones are resistant to SWL therapy and require subsequent percutaneous ultrasonic lithotripsy (PUL) for definitive treatment. Our objective was to determine if previous SWL had adverse effects on PUL success and if there were differences between the patients undergoing primary PUL and those undergoing PUL after SWL failure. MATERIALS AND METHODS In 2001, 108 PULs were performed at our institution, of which 40 (37%) were performed after SWL failure. Stone location, anesthesia time, stone composition and size, and complication rates were compared between patients who had PUL alone and those who underwent PUL after SWL failure. Anesthesia time was considered a reflection of technical difficulty of the case. RESULTS Stone composition differed between the SWL failure and primary PUL groups. Cystine stones were found to be more common in the ESWL failure group and calcium oxalate monohydrate stones more common in the primary PUL group. There was not a statistically significant difference in stone size, anesthesia time or complication rates, between the PUL alone and PUL after SWL failure groups. CONCLUSION PUL remains a reliable and safe treatment of nephrolithiasis. Prior SWL does not affect efficacy, technical difficulty, or postoperative complications of subsequent PUL. Based on our data, prior SWL should not be considered a negative factor in PUL outcomes. Stone composition should be considered a prognostic indicator of SWL failure and alert the surgeon that primary PUL may be indicated.
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The effects of potassium and magnesium supplementations on urinary risk factors of renal stone patients.
Jaipakdee, S, Prasongwatana, V, Premgamone, A, Reungjui, S, Tosukhowong, P, Tungsanga, K, Suwantrai, S, Noppawinyoowong, C, Maskasame, S, Sriboonlue, P
Journal of the Medical Association of Thailand = Chotmaihet thangphaet. 2004;(3):255-63
Abstract
The effects of potassium and magnesium supplementation on urinary risk factors for renal stone disease were studied in 61 renal stone patients. The subjects were divided into four groups and supplemented for a period of one month with potassium chloride (KCl, Group 1), potassium sodium citrate (K Na citrate, Group 2), magnesium glycine (Mg glycine, Group 3) and potassium magnesium citrate (K Mg citrate, Group 4) with a daily dose of 42 mEq potassium, 21 mEq magnesium or sodium and 63 mEq citrate, accordingly. The results showed that serum potassium and magnesium of all four groups normalized after the supplementation. Though urinary potassium significantly increased in all three groups supplemented with elemental potassium containing solutions [i.e. KCl (p < 0.001), K Na citrate (p < 0.001) and K Mg citrate (p < 0.001)] only K Na citrate and K Mg citrate, caused a significant increase in urinary pH and citrate but decrease in calcium. Supplementation with Mg glycine in Group 3 although caused a significant increase in urinary magnesium, its effects on urinary pH, citrate and calcium, however, were similar to KCl, in that they caused a significant decrease in urinary pH without any change in urinary citrate or calcium. Supplementation with K Mg citrate in Group 4 seems to have given the best results, as far as lowering stone risk factors in that it caused an increase in urinary pH, potassium and citrate and decreased calcium excretions similar to K Na citrate in Group 2. In addition, K Mg citrate also caused the enrichment of urine with magnesium, another inhibitor of calcium-containing stones. Although the four supplements had no effect on urinary saturation of calcium oxalate salt, their effects on the saturations of brushite (CaHPO4 x 2H2O), octacalcium phosphate (Ca8H2 (PO4)6 x 5H2O) and uric acid were clearly associated with changes in urinary pH. Therefore, in Group 1 and 3, subjects having a decrease in urinary pH, also experienced a significant increase in uric acid saturation. Though the saturation of brushite and octacalcium phosphate in Group 2 and 4 and the sodium acid urate in Group 2 were significantly increased, these urinary risk factors could be overcome, however, by the concomitant increase in urinary citrate. The present results demonstrate that for those stone vulnerable subjects having a high risk of potassium and magnesium depletion, to obtain the best therapeutic results, they should be provided supplementations of both potassium and magnesium together and also in the forms that would result in the delivery of an alkali loading effect.
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Intravenous pamidronate prevents femoral bone loss and renal stone formation during 90-day bed rest.
Watanabe, Y, Ohshima, H, Mizuno, K, Sekiguchi, C, Fukunaga, M, Kohri, K, Rittweger, J, Felsenberg, D, Matsumoto, T, Nakamura, T
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2004;(11):1771-8
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Abstract
UNLABELLED Long-term bed rest has potential risks of bone loss and renal stone formation. We examined the effects of resistive exercise and intravenous pamidronate on BMD, bone turnover, urinary calcium, and renal stone formation in 25 healthy males during 90-day bed rest. Pamidronate prevented femoral bone loss and renal stone formation, but resistive exercise showed little effects. INTRODUCTION Long-term bed rest increases the risks of bone loss and urinary stone formation. Resistive exercise increases bone formation, and bisphosphonates reduce bone resorption. However, the effects of muscle exercise and bisphosphonates have not been examined side-by-side. The objectives of this study are to compare the effects of pamidronate with resistive exercise on BMD and renal stone formation during prolonged bed rest. MATERIALS AND METHODS Twenty-five male white volunteers, 26-45 years of age, were randomly assigned to the control (n = 9), exercise (n = 9), and pamidronate (n = 7) groups and underwent 90-day 6 degrees head-down tilt bed rest. Exercise group performed squats and heel raises on a flywheel device for 30 minutes every 3 days. Pamidronate (60 mg) was administered intravenously 14 days before bed rest. BMD of the head, forearm, lumbar spine, and proximal femur; biochemical bone markers; calcium (Ca) metabolism; and abdominal radiographs were examined during 90 days of bed rest and 360 days of reloading. RESULTS In controls, proximal femoral BMD decreased, and bone resorption markers and urinary Ca increased during bed rest, along with development of renal stones in two of nine subjects. Resistive exercise increased bone formation but was unable to prevent femoral BMD decrease and increases in bone resorption and urinary Ca during bed rest, with formation of renal stones in four of nine subjects. Pamidronate maintained femoral BMD, reduced bone resorption and urinary Ca, and completely prevented renal stone formation. CONCLUSIONS Resistive exercise increased bone formation but could not reduce bone resorption and the risk of renal stones. In contrast, inhibition of bone resorption by pamidronate could preserve bone mineral and reduce the risk of renal stone formation during prolonged bed rest.