Effect of phyllanthus niruri on metabolic parameters of patients with kidney stone: a perspective for disease prevention

ABSTRACT Phyllanthus niruri (P.niruri) or stone breaker is a plant commonly used to reduce stone risk, however, clinical studies on this issue are lacking. Objective: To prospectively evaluate the effect of P. niruri on the urinary metabolic parameters of patients with urinary lithiasis. Materials and Methods: We studied 56 patients with kidney stones <10mm. Clinical, metabolic, and ultrasonography assessment was conducted before (baseline) the use of P. niruri infusion for 12-weeks (P. niruri) and after a 12-week (wash out) Statistical analysis included ANOVA for repeated measures and Tukey's/McNemar's test for categorical variables. Significance was set at 5%. Results: Mean age was 44±9.2 and BMI was 27.2±4.4kg/m2. Thirty-six patients (64%) were women. There were no significant changes in all periods for anthropometric and several serum measurements, including total blood count, creatinine, uric acid, sodium, potassium, calcium, urine volume and pH; a significant increase in urinary potassium from 50.5±20.4 to 56.2±21.8 mg/24-hour (p=0.017); magnesium/creatinine ratio 58±22.5 to 69.1±28.6mg/gCr24-hour (p=0.013) and potassium/creatinine ratio 39.3±15.1 to 51.3±34.7mg/gCr24-hour (p=0.008) from baseline to wash out. The kidney stones decreased from 3.2±2 to 2.0±2per patient (p<0.001). In hyperoxaluria patients, urinary oxalate reduced from 59.0±11.7 to 28.8±16.0mg/24-hour (p=0.0002), and in hyperuricosuria there was a decrease in urinary uric acid from 0.77±0.22 to 0.54±0.07mg/24-hour (p=0.0057). Conclusions: P.niruri intake is safe and does not cause significant adverse effects on serum metabolic parameters. It increases urinary excretion of magnesium and potassium caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria. The consumption of P.niruri contributed to the elimination of urinary calculi.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

Introduction The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers. Materials and Methods Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. Results At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments. Conclusions The PSF score reduced following medical treatment in the majority of patients in this cohort. .

Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis / Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis

Con el propósito de comparar la posible relación entre las concentraciones urinarias de boro y las concentraciones de calcio, de magnesio y de fósforo en suero y orina de mujeres posmenopáusicas con y sin osteoporosis, seleccionamos 45 mujeres posmenopáusicas con más de 47 años de edad, divididas en dos subgrupos: grupo I mujeres posmenopáusicas clínicamente sanas y grupo II mujeres posmenopáusicas con osteoporosis, sin enfermedades renales, hepáticas o diabetes mellitus. Se determinó el boro (B), el fósforo (P), el calcio total (Ca) y el magnesio total (Mg) en la orina de dos horas por espectroscopia de emisión atómica con plasma acoplado por inducción (ICPA-ES), el calcio y el magnesio total en suero por espectroscopia de absorción atómica en llama (FAAS) y el fósforo inorgánico en suero y la creatinina en suero y orina por espectroscopia de absorción molecular. Los resultados obtenidos sugieren preliminarmente una diferencia significativa (p<0,05) en las concentraciones de boro y de fósforo en la orina de dos horas entre los grupos estudiados. El análisis de regresión lineal aplicado, sugiere relación entre el índice boro/creatinina y los índices calcio/creatinina, magnesio/creatinina y fósforo/creatinina en la orina de las mujeres posmenopáusicas con osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p <0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

Corpus of biochemical changes after death by potassium intoxication in rabbits / 法医学杂志

OBJECTIVE@#To explore the objective evidence of the corpus biochemical changes in rabbits for postmortem diagnosis of potassium intoxication.@*METHODS@#Rabbits were sacrificed by Infusion of 0.3% KCl at full speed push or 1% KCl at 100 drip/min, respectively, with normal rabbits used as control. Cardiac blood and urine samples were collected before and after potassium infusion to examine the concentrations of various electrolytes (K+, Na+, Ca2+, Mg2+, Cl-, and HCO3-) and to observe the antemortem and postmortem biochemical changes.@*RESULTS@#The mean lethal infusion time in the 0.3%KCl group was longer than that in the 1% KCl group (P = 0.006). The serum concentration of K+ increased while the serum concentrations of Na+, Ca2+, Cl-, and HCO3- decreased after the infusion. There were no statistically significant differences in the whole blood concentration of K+ as well as the serum concentration of Mg2+ between the two groups (P = 0.062). There were statistically significant differences in the concentrations of whole blood K+, as well as serum Na+, Mg2+, and Cl-, but not in the serum K+, Ca2+, and HCO3-. There were no statistically significant differences seen in the urine volumes and the concentrations of all the urine electrolytes between the groups.@*CONCLUSION@#Examination of the concentrations of K+ both in the whole blood and serum, as well as Mg2+ in the serum may be helpful for postmortem diagnosis of potassium intoxication.

Urinary tubular enzyme excretion in children with nephrolithiasis and urolithiasis with hydronephrosis

Objective: Nephrolithiasis and urolithiasis are recurrent conditions associated with significant morbidity and economilc impact. Previous studies have suggested that cell- crystal interactions lead to tubular damage and/or dysfunction. To find further proof for these observations, a metabolic evaluation [including serum and urine biochemistry and urinary enzyme excretion] was done in children with nephrolithiasis and urolithiasis with hydronephrosis

Patients and Methods: This study included two groups: 10 normal children [controls] and 32 children with calcium oxalate urinary tract stones. The latter group was further subdivided into those with nephrolithiasis [n=12] and urolithiasis with hydronephrosis [n=20]. Levels of uric acid, oxalate, calcium, magnesium and inorganic phosphorus in 24-hour urine and serum were determined. Urinary N-acetyl-beta-D-glucosaminidase [NAG], beta-galactosidase [beta-GAL], beta-hexosaminidase [beta-Hex], angiotensin converting enzyme [ACE] and gamma glutamyl transferase [y-GT] levels were also determined colorimetrically

Results: Increases in urinary excretion of oxalate, calcium, magnesium and inorganic phosphorus were the major abnormalities found in stone forming patients. Elevated urinary NAG, beta-GAL, beta-Hex and ACE levels were also noted in patients compared with controls. Urinary excretion of oxalate, NAG, beta-GAL and ACE was significantly elevated in children with nephrolithiasis compared to those with urolithiasis and hydronephrosis

Conclusion: Abnormal urine biochemistry seems to have a role in the risk for urinary-tract stone formation in children. Hyperoxaluria can induce tubular cell injury mainly in proximal tubules, which is more pronounced in children with nephrolithiasis. The tubular injury manifested by enzymuria occurs before alteration of renal functions and blood biochemistry. Urinary tubular enzymes should be screened in children with urinary tract stones

Deficiência de magnésio e resistência à insulina em pacientes com diabetes mellitus tipo 2 / Magnesium deficiency and insulin resistance in patients with type 2 diabetes mellitus

O magnésio é um íon predominantemente intra-celular, que participa como co-fator de mais de 300 reações enzimáticas, dentre elas na atividade da tirosino-cinase. Sua deficiência pode aumentar a resistência periférica à insulina, especialmente em pacientes com síndrome metabólica e diabetes mellitus tipo 2 (DM2). Este trabalho avaliou, em 27 pacientes com DM2 descompensado, o conteúdo intra-celular de magnésio, correlacionando-o com índices laboratoriais de resistência insulínica e controle glicêmico. Hipomagnesemia foi encontrada em 75 por cento dos pacientes e déficit intra-celular em 30,8 por cento. Houve correlação negativa do Mg intra-celular (Mg IC) com HbA1 e com IMC. 59,2 por cento dos pacientes apresentaram HOMA IR > 3,5, e tendência para correlação negativa com o Mg IC, porém sem significância estatística. Apesar do número pequeno de pacientes, ressalta-se que uma vez que deficiência de magnésio é comum em pacientes com diabetes, sua relação com resistência insulínica deve ser mais estudada.

Fractional excretion magnesium (FE Mg) in systemic lupus erythematosus.

BACKGROUND: Tubulointerstitial fibrosis is an index of clinical severity. FE Mg has been delineated to correlate directly with the magnitude of tubulointerstitial fibrosis in clinical setting of glomerulonephropathy. A correlation between FE Mg tubulointerstitial fibrosis has never been assessed in nephritis associated with systemic lupus erythematosus. MATERIAL AND METHOD: Thirty-six patients diagnosed of having lupus nephritis were included for the determination of renal functions namely creatinine clearance, FE Mg, urinary protein. Of these 36 patients, 18 patients were associated with intact tubulointerstitial structure (group I) and 18 age matched patients were associated with tubulointerstitial fibrosis (group II) RESULTS: The mean FE Mg observed in group I was 1.5 +/- 0.3 which differed significantly from that observed in group II; 2.6 +/- 1; p = 0.006. CCr, total urinary protein, systolic and diastolic pressure were not significantly different between the two groups. CONCLUSION: FE Mg is a sensitive marker for the detection of tubulointerstitial disease in lupus nephritis. It is useful in early screening of disease severity in systemic lupus erythematosus.

Impact of cyclosporin immunosuppression on serum magnesium and its fractional excretion in renal transplant recipients

To evaluate the effect of cyclosporine [CSA] on serum magnesium and its fractional excretion in renal transplant recipients. A cross sectional comparative study on 50 live related renal transplant recipients on CSA therapy with serum creatinine <2.0 mg/dl and 30 healthy controls. Serum creatinine, magnesium and its fractional excretion and CSA levels were monitored. Patients were followed at 6 months. The mean serum creatinine in patients was 1.41 +/- 0.42 mg/dl, cyclosporine 210 +/- 66 ng/ml at a dose of 4.8 +/- 1.4 mg/kg/day. The serum magnesium was 1.77 +/- 0.32mg/dl vs 1.98 +/- 0.17mg/dl in healthy controls [p<0.05].Fractional excretion was 5.05 +/- 2.53% in patients vs 2.8 +/- 1.05% in controls [p<0.05]. No correlation was found between CSA levels [100-400 ng/ml] and serum magnesium [r = 0.053] or FEMg% [r = 0.215]. Of the 50 recipients 27 [54%] had FEMg% in the control range. At 6 months follow up no difference in CSA levels was found between recipients with FEMg% in the normal range vs those with FEMg >5%. However, serum creatinine increased from 1.42 +/- 0.30 mg/dl to 1.68 +/- 0.82mg/dl [p< 0.05]. CSA therapy lowers serum magnesium as compared to healthy controls and there is marked increase in FEMg% in 50% of the patients. Patients with FEMg >5% developed renal function deterioration. FEMg% can thus be a good follow up marker of CSA chronic toxicity in stable transplant recipients

effect of urine and blood metabolic risk factors on calcium stone formation

In spite of vast improvements in urinary stone treatment [ESWL, PNL, ureteroscopy, etc.], metabolic workup concerning the existence of stone forming risk factors are of great importance and can lead to control and even prevention of urinary stone formation in these patients. In this analytical case-control study performed on 266 persons [110 normal persons [56 males and 54 females], 76 patients with one episode of stone formation [40 males and 36 females], and 80 patients with recurrent stone formation [40 males and 40 females]] aged between 30 to 45 [with art average of 37.6] in Shahid Doctor Labbafinejad Medical Center from May to July 1999, serum parameters and 24-hour urine parameters have been investigated and compared among the three groups. Results of this study revealed considerable differences in urinary calcium levels of these three groups, with and without considering sex [p<0.05]. Averages of 24-hour urinary calcium calculated for normal, one episode and recurrent stone formers in male groups were 159 +/- 43, 219 +/- 71, and 283 +/- 74 mg/24h respectively, and for normal, one episode and recurrent stone formers in female groups were 124 +/- 37, 190 +/- 58, and 287 +/- 152 mg/24h respectively. Although 24-hour urine citrate in females obviously showed higher values than males, there was no significant difference among the studied groups of the same sex. Levels of serum calcium, potassium and magnesium between groups of females and 24hour urine magnesium and phosphate levels between groups of males had statistical differences also [p<0.05 for all of the cases mentioned above]. According to the results obtained from this study, it was realized that in the studied society levels of 24-hour urinary calcium which are higher than 200 mg/ 24h [sensitivity 80%, specificity 94% and FPR 6.4%] and calcium creatinine ratios of 24-hour urine which are higher than 0.17 [sensitivity 7.5%, specificity 88.1% and FPR 11.9%] can be regarded as hypercalciuria. However, the results of this study should be confirmed by more general and extended studies

Asymptomatic hypercalciuria: prevalence and metabolic characteristics.

Hypercalciuria is of continuing interest as a risk factor for kidney stones in children. We screened 592 healthy Turkish children (308 boys, 284 girls, aged 3 month-16 years) for hypercalciuria by measurement of urinary calcium/creatinine (UCa/Cr) ratio in the second-morning urine samples. Hypercalciuria was noted in 17 children (2.9%), 9 of them were boy and 8 of them were girl. Oral calcium-loading test could only be done in 7 children who were diagnosed as having hypercalciuria, and it revealed absorptive hypercalciuria in 2 cases and renal hypercalciuria in no cases. The frequency of a family history of urolithiasis in asymptomatic hypercalciuric children was 50%. Median UCa/Cr ratios and urinary magnesium/creatinine (UMg/Cr) ratios were 0.11 and 0.10 and the 97th percentiles were 0.32 and 0.23 respectively. The UCa/Cr ratio in second-morning urine samples was correlated with the UMg/Cr ratio (r = 0.44) and was independent of age and sex.

Hypocitraturia in metabolically active calcium nephrolithiasis

Hypocitraturia is presumed to contribute to calcium stone formation. In this study, 52 patients with active calcium urolithiasis have been subjected to infrared spectrophotometric urolith analysis an collection of a 24-hour urinary sample for measurement of citrate, pH, calcium phosphorus, magnesium uric acid and oxalate. A venous blood sample was also taken for the measurement of calcium, potassium, uric acid, sodium phosphorus, carbon dioxide and creatinine levels. 93.3% of these patients had definite hypocitraturia, either as an isolated anomaly in 11.5% of patients or in association with hyperoxaluria and hyperuricosuria. When hypocitraturia was diagnosed more than half of the patients suffered from the severe form. Hypocitraturia in Egyptian metabolically active stone formers exceeds any known universal levels

Trace elements and electrolytes in patients with urinary tract calculi

Eighty nine male patients with urinary calculi and thirty male subjects as control group were studied and exploring for presence of some trace elements and electrolytes in urinary calculi to determine the role of these elements in the pathogenesis of urolithiasis. The patients were subdivided into 2 groups: bilharzial group [54 patients] and non bilharzial group [35 patients]. Calcium in serum and urine of patients were significantly higher than that the control group. Calcium was present as predominant element in all stone except uric acid stone. Phosphates in serum was significantly lower than the control group, while in urine was slightly low. Phosphate in stone was high in magnesium ammonium phosphate especially in non bilharzial group. Magnesium in serum and urine showed no significant difference between control and patients group. Magnesium was low in all types of stone with exception of calcium magnesium ammonium phosphate stones. Zinc in serum and urine was significantly lower in patients than control group. Zinc in all groups of stones was low. Copper in bilharzial group showed a highly significant increase in the level of serum when compared with the control group. But copper in urine showed no difference between control and other groups. Small amount of copper was present in all types of stones. magnesium and molybedenum were not detected in serum, urine and stones. uric acid was significantly higher in serum and urine of patients than control group. Serum patient albumin and A/G ratio were significantly low in all groups of patients when compared to the control group. Urinay calcium/magnesium ratio was significantly low in control than in patients. Serum sodium was low in all groups of patients. Serum potassium was high in all groups of patients. Recurrent stone were liable for infection more than de. novo stone and so treatment of infection is essential

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.

Comparison between the excretion of some metallic elements in normal and parasitized human

Twenty four hours urine samples from a total of 50 normal healthy individuals [30 males and 20 unmarried females] and a total of 70 parasitized patients [40 urinary schistosomiasis males and 30 trichomoniasis females] were analysed for zinc, copper, iron, calcium, magnesium, potassium and sodium. The results showed that urinary schistosomiasis leads to increased zinc, iron, calcium, magnesium and potassium levels but decreases the excretion of sodium, where as trichomoniasis leads to increase the excretion of zinc and sodium but decrease the excretion of copper. No significant differences were found in the biochemical element excretion between filtered and unfiltered urine samples during both infections