Simultaneous use of oxalate-degrading bacteria and herbal extract to reduce the urinary oxalate in a rat model: A new strategy

ABSTRACT 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 probiotic 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 received 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) reduced 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 oxalate degrading bacteria can be a new therapeutic approach to preventing the formation of kidney stones.

Trends in renal calculus composition and 24-hour urine analyses in patients with neurologically derived musculoskeletal deficiencies

ABSTRACT Purpose: To better characterize metabolic stone risk in patients with neurologically derived musculoskeletal deficiencies (NDMD) by determining how patient characteristics relate to renal calculus composition and 24-hour urine parameters. Materials and Methods: We performed a retrospective cohort study of adult patients with neurologically derived musculoskeletal deficiencies presenting to our multidisciplinary Kidney Stone Clinic. Patients with a diagnosis of NDMD, at least one 24-hour urine collection, and one chemical stone analysis were included in the analysis. Calculi were classified as primarily metabolic or elevated pH. We assessed in clinical factors, demographics, and urine metabolites for differences between patients who formed primarily metabolic or elevated pH stones. Results: Over a 16-year period, 100 patients with NDMD and nephrolithiasis were identified and 41 met inclusion criteria. Thirty percent (12 / 41) of patients had purely metabolic calculi. Patients with metabolic calculi were significantly more likely to be obese (median body mass index 30.3kg / m2 versus 25.9kg / m2), void spontaneously (75% vs. 6.9%), and have low urine volumes (100% vs. 69%). Patients who formed elevated pH stones were more likely to have positive preoperative urine cultures with urease splitting organisms (58.6% vs. 16.7%) and be hyperoxaluric and hypocitraturic on 24-hour urine analysis (37mg / day and 265mg / day versus 29mg / day and 523mg / day). Conclusions: Among patients with NDMD, metabolic factors may play a more significant role in renal calculus formation than previously believed. There is still a high incidence of carbonate apatite calculi, which could be attributed to bacteriuria. However, obesity, low urine volumes, hypocitraturia, and hyperoxaluria suggest an underrecognized metabolic contribution to stone formation in this population.

Seasonal variations in urinary calcium, volume, and vitamin D in kidney stone formers

ABSTRACT Objectives: To investigate the seasonal variations in urinary calcium, serum vitamin D, and urinary volume in patients with a history of nephrolithiasis. Materials and Methods: Patients included were those who completed a 24-hour urine metabolic evaluation on two occasions; one in summer (June-Aug) and one in winter (Nov-Jan), and who had not started any medications or been instructed on dietary modifications in the interval between the two tests that may have impacted the results. Patients were excluded if they were on thiazide diuretics or were taking calcium and / or Vitamin D supplementation. Welch's t-test was used to compare the difference in average summer and winter values. Unpaired Student t-test was used to compare baseline parameters (age, BMI), and Paired Student t-test was used to compare average seasonal measurements in men vs. women. Results: 136 patients were identified who were not taking calcium or vitamin D supplements or thiazide diuretics, and who were not instructed on dietary modifications in the interval between the two measured parameters. No significant differences were observed when comparing male to female baseline parameters of age or BMI (Table-1). Average 24-hour urine calcium was higher (226.60) in the winter than in summer (194.18) and was significant in males (p = 0.014) and females (p < 0.001). No significant seasonal difference was seen in 24-hour urine volume or serum vitamin D levels. Conclusions: Urinary calcium is higher in winter months compared to summer months. As such, tailoring medical preventative strategies to the time of year may be helpful.

Influence of nutritional status, laboratory parameters and dietary patterns upon urinary acid excretion in calcium stone formers / Influência do estado nutricional e dos parâmetros laboratoriais e dietéticos sobre a excreção urinária ácida em pacientes portadores de litíase cálcica

ABSTRACT Introduction: Obesity and Metabolic Syndrome (MS) are associated with low urinary pH and represent risk factors for nephrolithiasis, especially composed by uric acid. Acidogenic diets may also contribute to a reduction of urinary pH. Propensity for calcium oxalate precipitation has been shown to be higher with increasing features of the MS. Objective: A retrospective evaluation of anthropometric and body composition parameters, MS criteria and the dietary patterns of overweight and obese calcium stone formers and their impact upon urinary pH and other lithogenic parameters was performed. Methods: Data regarding anthropometry, body composition, serum and urinary parameters and 3-days dietary records were obtained from medical records of 102(34M/68F) calcium stone formers. Results: A negative correlation was found between urinary pH, waist circumference and serum uric acid levels (males). The endogenous production of organic acids (OA) was positively correlated with triglycerides levels and number of features of MS (males), and with glucose, uric acid and triglycerides serum levels, and number of features of MS (females). No significant correlations were detected between Net Acid Excretion (NAE) or Potential Renal Acid Load of the diet with any of the assessed parameters. A multivariate analysis showed a negative association between OA and urinary pH. Conclusion: The endogenous production of OA and not an acidogenic diet were found to be independently predictive factors for lower urinary pH levels in calcium stone formers. Hypercalciuric and/or hyperuricosuric patients presented higher OA levels and lower levels of urinary pH.

RESUMO Introdução: A obesidade e a Síndrome Metabólica (SM) se associam a pH urinário ácido e representam fatores de risco para litíase renal, especialmente a úrica. Dietas acidogênicas também podem contribuir para a redução do pH urinário. Já foi demonstrado maior risco de precipitação de oxalato de cálcio em proporção aos critérios de SM. Objetivo: Avaliar retrospectivamente o impacto de parâmetros antropométricos, composição corporal, critérios de SM e padrão alimentar sobre o pH urinário e outros parâmetros litogênicos em pacientes com sobrepeso e obesos com litíase cálcica. Métodos: Foram coletados dados de antropometria, composição corporal, exames séricos e urinários, e registros alimentares (3 dias) de 102 (34M/68F) pacientes com litíase cálcica. Resultados: O pH urinário se correlacionou negativamente com a circunferência da cintura e ácido úrico sérico (homens). A produção endógena de ácidos orgânicos (AO) se correlacionou positivamente com os triglicérides séricos e o número de critérios de SM (homens), e com glicemia, ácido úrico, triglicérides e número de critérios para SM (mulheres). Não se observaram correlações significantes entre a excreção renal líquida de ácidos (NAE) e o potencial de carga ácida renal (PRAL) da dieta com nenhum dos parâmetros avaliados. Na análise de regressão multivariada, os AO apresentaram associação negativa significante com o pH urinário. Conclusão: A produção endógena de AO, e não um padrão de dieta acidogênica, foi o fator determinante independente para menores níveis de pH urinário em pacientes com litíase cálcica. Pacientes com hipercalciúria e/ou hiperuricosúria apresentaram maiores valores de AO e menores de pH urinário.

Doença de Crohn e cálculo renal: muito mais que coincidência? / Crohn’s disease and kidney stones: much more than coincidence?

RACIONAL: A doença de Crohn é uma doença inflamatória intestinal que pode estar associada a várias complicações e manifestações que são secundárias ao processo inflamatório de base. Em aproximadamente 30 por cento dos pacientes têm sido encontradas manifestações extra-intestinais. A nefrolitíase é uma delas e a formação de cálculos é mais comum nestes pacientes do que na população em geral, principalmente cálculos de oxalato de cálcio. OBJETIVOS: Avaliar os fatores metabólicos urinários potencialmente envolvidos na formação de cálculos renais em pacientes com doença de Crohn. MÉTODOS: Foram avaliados 29 pacientes com doença de Crohn atendidos no Ambulatório de Doenças Inflamatórias do Hospital de Clínicas da Universidade Estadual de Londrina, PR, no período de janeiro a dezembro de 2004. A avaliação metabólica incluiu medidas séricas e urinárias de substâncias relacionadas à litíase renal, ultra-sonografia de rins e vias urinárias e cálculo da supersaturação urinária para o oxalato de cálcio, ácido úrico e fosfato de cálcio. RESULTADOS: Dos 29 pacientes avaliados, 65,5 por cento eram do sexo feminino e 34,5 por cento do masculino. As principais alterações metabólicas urinárias encontradas foram 72,41 por cento de hipocitratúria, 41,4 por cento de hipomagnesiúria, 13,6 por cento de hiperoxalúria e 17,24 por cento de baixo volume urinário. Foram encontrados cálculos renais em 13 pacientes (44,8 por cento). Os pacientes submetidos a cirurgia intestinal, com ressecção ileal, apresentaram alterações na saturação urinária de oxalato e fosfato. Para a comparação das médias, utilizou-se o teste de Mann-Whitney e para determinar a associação entre as variáveis foi utilizado o teste do Qui-quadrado ou o teste exato de Fisher com um nível de significância de 5 por cento. CONCLUSÃO: A freqüência de pacientes com cálculos renais foi maior que a encontrada na população geral e acima do descrito em trabalhos similares. As alterações encontradas como...

BACKGROUND: Crohn’s disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30 percent of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population. AIM: To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn’s disease. METHODS: We evaluated 29 patients with Crohn’s disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrassonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate. RESULTS: Twenty-nine of the evaluated patients were female or 65.5 percent and 34.5 percent were males. Among the metabolic urinary studied, we identified the following potential disturbances associated with nephrolithiasis: hypocitraturia in 21 patients (72.4 percent), hypomagnesuria in 12 (41.4 percent), hyperoxaluria in 4 (13.6 percent) and urinary volume low in 5 (17.2 percent). Renal stones were identified in 13 patients (44.8 percent). Oxalate urinary excretion was higher in patients submitted to bowel surgery and also in patients with ileum resection. The urinary supersaturation of calcium oxalate and brushita in patients with bowels surgery was higher than the other patients not submitted to any surgery. Data to compare patients who underwent to surgery or not were analyzed by Mann-Whitney test (U test), and Qui-square test or the accurate test of Fisher have been used to determine variables association. For all tests 5 percent...

Ingestäo de magnésio e densidade mineral óssea de pacientes litiásicos / Magnesium intake and bone mineral density in calcium stone forming patients

Tem sido sugerido que a reduçäo de densidade mineral óssea em mulheres na pós-menopausa pode se associar à menor ingestäo de magnésio (Mg). Pacientes litiásicos apresentam risco de perda de massa óssea devido à presença de hipercalciúria. O objetivo do presente estudo foi o de analisar retrospectivamente a ingestäo de Mg de 83 pacientes litiásicos hipercauciúricos, subdivididos de acordo com a densidade óssea em grupos osteopênico (n=37) e normal (n=46). A média de ingestäo de Mg foi significativamente maior no grupo osteopênico em relaçäo ao normal. A ingestäo de Mg näo se correlacionou com o T-score de coluna lombar ou colo do fêmur e nem com o valor de cálcio urinário em nenhum dos grupos. Os resultados sugerem que, apesar de as ingestöes de Mg terem sido abaixo do preconizado pela Recommended Dietary Allowances (RDA), näo se observou associaçäo entre reduçäo de densidade mineral óssea e ingestäo de Mg em pacientes litiásicos.(au)

Urolitiasis / Urolithiasis

Los cálculos renales eran considerados poco frecuentes en los niños hasta hace algunos años, cuando la radiografía simple de abdomen era el método de diagnóstico. Hoy en día, con la introducción del ecosonograma renal, la urolitiasis se detecta más frecuentemente y en edades más tempranas. Los dos tipos de calcificaciones asociadas con el tracto urinario son la urolitiasis y la nefrocalcinosis. La urolitiasis se refiere a la calcificación macroscópica en el sistema colector renal. La nefrocalcificación es la calcificación microscópica que se observa a nivel de los túbulos, del epitelio tubular o del intestino renal. Entre los diversos factores que pueden contribuir a la genésis de la nefrolitiasis se encuentran: los genéticos, climáticos, dietéticos, anatómicos, metabólicos, infecciosos, característicos individuales, etc. Los factores predisponentes más comunes en esta patología son la infección y las anomalías urológicas subyacentes. La asociación de los factores climáticos se establece porque cuando más cálido y más seco es el clima, más probable es que la persona tenga una orina concentrada en forma permanente y con mayor riesgo de formación de cálculos. En las regiones donde la exposición a los rayos solares es prolongada e intensa, la mayor producción de vitamina D en la población puede provocar un aumento de la absorción y excreción de calcio. Los factores dietéticos cobran importancia en zonas como la India, China, Oriente Medio y Sureste Asiático, donde la principal fuente de proteína es el cereal y los cálculos son relativamente frecuentes. Por último, existen algunos trabajos que intentan correlacionar marcadores genéticos, por ejemplo los antígenos del complejo HLA con la predisposición a nefrolitiasis

role of urinary oxalate excretion in renal calculogenesis

The present study was undertaken with the aim to determine the role urinary oxalate excretion in renal lithiasis. The study was conducted on 60 renal calculus patients admitted in various Government Hospital of Lahore during the period from April to August 1996. Thirty normal subjects, with matched age and sex, were also included in this study, as a control group. Majority of the patients, 58 [97.7%], belonged to low and middle socio-economic classes. The mean daily excretion of oxalate in patients was significantly higher [P< 0.01] as compared to control group with a mean of 35.9 +/- 2.54 mg. moderate hyperoxaluria [24 hours oxalate excretion > 45 mg/day] was seen in significantly higher number of patients [25 out of 60], as compared to controls [5 out of 30]. The daily urinary oxalate was high in patients had pure calcium oxalate calcui and mixed calcium oxalate and uric acid calcui [with calcium oxalate as main component] as compared to patients with other renal calculi components. The ionic product of calcium oxalate was significantly higher [P< 0.01] in patients than controls. In the study the mean calcium excretion was 21.6% higher in the patients than the controls subjects, whereas oxalate excretion was 25% higher, which is statistically significant. These results suggest that increased oxalate excretion may be as important as increased calcium excretion in the aetiology of calcium oxalate calculus. The measurement of urinary oxalate and calcium is clearly useful in the management of calcium oxalate calculus formers

Valores de referência de parâmetros urinários envolvidos na litogênese / Reference values of urinary parameters that participate in lithogenesis

Neste trabalho determinamos em nossa populaçao, os valores normais de parâmetros urinários que participam na formaçao de cálculos renais, bem como de creatinina comparando-os com os relatados na literatura. Os valores em média + desvio padrao (X+DP) do grupo controle (N=200) e do grupo formador de cálculos (N=200) sao respectivamente: citrato (525 + 160 vs 263 + 90 mg/24h, p<0,05), cálcio (149 + 50 vs 223 + 80 mg/24h, p<0,05), ácido úrico (556 + 130 vs 620 + 160 mg/24h, p<0,05), sódio (192 + 60 vs 208 + 60 mEq/24h, p<0,05), potássio (37 + 10 vs 43 + 10 mEq/24h, p<0,05), magnésio (81 + 17 vs 67 + 25 mg/24h, p<0,05) e creatinina (1409 + 340 vs 1436 + 320 mg/24h, p<0,05). Os valores para o citrato, cálcio, ácido úrico, sódio e creatinina para as mulheres-controles neste trabalho foram similares, enquanto que os valores para o potássio foram maiores e para o magnésio foram menores que os valores descritos na literatura. Os homens-controle apresentaram todos os parâmetros mais elevados, exceto para o citrato e potássio que foram menores que os da literatura. Comparando estes resultados com os valores da literatura internacional, observamos diferenças significantes, realçando a necessidade em normalizar os valores de referência para distintas populaçoes de formadores de cálculos renais.

Avaliaçäo da saturaçäo urinária em pacientes com doença inflamatória intestinal / Evaluation of urinary saturation in patients with inflamatory bowel disease

A doença inflamatória intestinal (DII), como a doença de Crohn (DC) e a retocolite ulcerativa (RCU), pode associar-se à litogênese devido a hiperoxalúria entérica. Na avaliaçao metabólica de 12 pacientes DII (6 DC e 6 RCU), sendo 3 com litíase recente, nao se observou alteraçao significante da média de excreçao de cálcio, ácido úrico e oxalato versus pacientes com litíase (LIT) sem DII. Hipocitratúria foi evidenciada em 6112 (5O por cento) e hiperuricosúria em 3/12 (25 por cento) dos pacientes. Estes dados sugerem que pacientes DII, mesmo sem apresentar hiperoxalúria, podem expor-se a maior risco de formaçao de cálculos, devido à hiperuricosúria e também à hipocitratúria, possivelmente decorrente do quadro diarréico crônico.

Mecanismo de formaçäo de cálculos renais / Mechanisms of the formation of Renal Stones

Os autores fazem uma revisäo sobre os mecanismos que levam à formaçäo de cálculo renal, salientando as variáveis envolvidas neste processo, como a solubilidade urinária, o pH urinário e os inibidores da cristalizaçäo.

Nefrolitiasis: aspectos clínicos y epidemiológicos / Nephrolithiasis: epidemiologic and clinical features

El presente estudio tuvo como objetivo conocer la incidencia y características de la nefrolitiasis en un medio hospitalario. Durante abril de 1985 y enero de 1989 se atendieron en los consultorios externos del Hospital Cayetano Heredia 110,610 pacientes, de los cuales 245 correspondieron a pacientes con diagnóstico de nefrolitiasis. Se presentan las características epidemiológicas, clínicas y evolutivas de estos pacientes. Se encuentrán una incidencia de 2.2 por mil, mayor a las reportadas en la literatura. No hubo diferencia entre sexos. El 77.2 por ciento de los pacientes estan comprendidos entre los grupos productivos de la población lo cual produce un impacto socioeconómico importante. El 18 por ciento de los pacientes tiene algún familiar de primer grado con nefrolitiasis. El tiempo de enfermedad promedio fue 2.2 años, el 10 por ciento de los pacientes fueron asintomáticos, los síntomas más frecuentes fueron el cólico renal y la hematuria macroscópica, la puño percusión lumbar positiva y los puntos renoureterales positivos estuvieron presentes en un tercio de los pacientes. En el sedimento urinario se halló hematuria en un 40 por ciento y cristaluria en el 41 por ciento. La depuración de creatinina estuvo disminuída en el 41 por ciento de los pacientes no existiendo diferencia entre sexos. En la pielografía el 94 por ciento de los cálculos fue radiopaco, la localización más frecuente de los cálculos fue en el ureter distal y pélvis, cálculo coraliforme se presentó en el 29 por ciento de los pacientes y en su mayoría fueron mujeres. Los cálculos más frecuentes fueron los mixtos de calcio y los de oxalato de calcio más fosfato de calcio. La complicación más frecuente fue la infección urinaria. Se encuentra una alta tasa de procedimientos quirúrgicos. En el análisis de regresión múltiple se encuentra que el antecedente de haber eliminado un cálculo espontaneamente es el único factor predictivo para una nueva eliminación y que la localización y el tamaño del cálculo tienen relación con la necesidad de cirugía

Measurements of urinary state of saturation with respect to calcium oxalate and brushite (CaHPO4.2H2O) in renal stone formers.

Urinary supersaturation with respect to calcium oxalate and/or brushite (CaHPO4.2H2O) is critical for the formation of calcium stones. The aim of this study is to use concentration product ratio (CPR) as a tool to assess the state of urine saturation with respect to calcium oxalate and brushite. One 24-h urine specimen from each of 16 healthy city dwellers (GI), 18 healthy villagers (GII) and 28 villagers with renal stones (GIII) was collected and analyzed for calcium, sodium, potassium, phosphate, uric acid, citrate and oxalate. The CPRs of calcium and oxalate and of calcium and phosphate before and after equilibration of the urine with the corresponding seeding crystals were also determined. Urinary volume and the excretion rate of calcium, potassium, uric acid, citrate and oxalate of GII and of sodium, phosphate, uric acid and citrate of GIII were significantly less than those of GI. The CPRs for calcium oxalate and brushite were 2.9 +/- 0.3 and 1.7 +/- 0.2 for GI, 2.7 +/- 0.2 and 1.3 +/- 0.1 for GII and 2.5 +/- 0.2 and 1.1 +/- 0.1 for GIII, respectively. The CPR values indicated that urine of all groups was generally supersaturated with respect to calcium oxalate salt (CPRs were above 1) and were not different among the groups. With regard to brushite, urine was also supersaturated but the state of supersaturation was less than that of calcium oxalate. Furthermore, instead of being supersaturated, brushite in many urine specimens of GIII was undersaturated and its mean CPR was even significantly less than that of GI (P less than 0.01).

Urinary constituents in an endemic area of stones and renal tubular acidosis in northeastern Thailand.

Nephrolithiasis and endemic renal distal tubular acidosis are common in northeastern Thailand. The etiology is still unknown. It is generally accepted that urine electrolytes influence the capacity of urine to inhibit or promote renal and also bladder stones. The purpose of this study was to analyse the composition of the urine in the indigenous population in the northeast area and compare their values with data obtained from a group of age matched adults, living in Bangkok. Twenty-four hour urine samples from 23 normal adult villagers from six villages within the province of Khon Kaen and 34 normal adults living in Bangkok were collected, and the daily excretion of creatinine, uric acid, calcium and inorganic phosphate, sodium, potassium, chloride, magnesium and oxalate were assayed. Daily urinary sodium, potassium, chloride and phosphate of the villagers were significantly lower than those of Bangkokians. No difference in the urinary excretion of calcium, magnesium, uric acid, oxalate and creatinine was found. The Na/Ca, and Ca/PO4 ratios of villagers were significantly lower than those of the Bangkok subjects. The villagers excreted significantly lower amounts of Na in the face of relatively higher urinary Ca. The above data, combined with our previous study showing the low values of urinary citrate in the villagers in the same areas, strongly indicate that the indigeneous population is at high risk in developing urolithiasis. The causes for these electrolyte abnormalities are still unknown. Low contents of the major electrolytes in their diets might play an important role. Low phosphate output indicates low protein diets.(ABSTRACT TRUNCATED AT 250 WORDS)