Serum antioxidant enzyme levels are decreased in patients with urinary calcium oxalate stones.

PURPOSE: To compare the serum antioxidant enzyme levels between patients with urinary stone disease and healthy volunteers to determine the effect of cellular oxidative stress on urinary calcium oxalate stones formation.Materials & Methods: A total of 51 patients with proven urinary calcium oxalate stones (female 35.3%, mean age: 49.3 years) and 37 healthy subjects (female 45.9%, mean age: 44.1 years) were included. The serum levels of antioxidant catalase, glutathione peroxidase, superoxide dismutase and lipid peroxidation were measured in serum samples taken from the peripheral venous circulation. RESULTS: Mean serum catalase level of patient group was insignificantly higher than healthy subjects (7.54 mmol- H2O2/mg/sec versus 6.16 mmolH2O2/mg/sec, respectively; P = .06) whereas mean superoxide dismutase level (1.56 U/ml versus 3.86 U/ml, P = .047), glutathione peroxidase level (6.70 U/ml versus 8.19 U/ml, P = .022) and lipid peroxidation level (2.35 nmol/ml versus 3.31 nmol/ml, P = .034) of patient group were significantly lower than healthy subjects. Patients with family history of urinary stone disease had significantly lower mean serumlevels of catalase (P = .037), superoxide dismutase (P = .047) and glutathione peroxidase (P = .01), compared with patients without family history. CONCLUSION: The findings of this study provide evidence regarding the role of oxidative stress in the development of urinary calcium oxalate stones. Future clinical trials are necessary to elucidate the actual mechanisms of the calcium oxalate stone formation in the environment with increased oxidative stress.

The impact of klotho gene polymorphisms on urinary tract stone disease.

OBJECTIVES: To investigate the effect of klotho gene and ß-glucuronidase activity on stone formation in patients with urinary tract stone disease (UTSD). METHODS: A total of 103 patients with UTSD and 102 controls with no specific urolithiasis history were enrolled into the study. G395A and C1818T polymorphisms of klotho gene were analyzed with PCR method. Serum levels of calcium and phosphorus and 24-h urine levels of ß-glucuronidase activity, calcium and phosphorus levels were measured biochemically. RESULTS: A total of 103 of patients were male (50.2 %) and 102 were female (49.8 %) (p 0.945). Twenty-four-hour urine levels of calcium were significantly higher in UTSD group, whereas no difference was observed in phosphorus levels (p < 0.001, p 0.074, respectively). As for the G395A polymorphism, type of GG was significantly higher in the patient group compared to the controls (p = 0.02), while GA genotype was significantly higher in the controls (p = 0.001). There was no significant difference in F352V and C1818T polymorphism between the patient and control groups. ß-glucuronidase activity was slightly lower in the patient group without significance (p 0.932).When patients with GG genotype and the rest were compared, there were no significant difference in all parameters. CONCLUSIONS: Any polymorphism altering the function of klotho gene may result with stone formation. We found that there are more GG sequences of G395A gene in patients with UTSD. That may be a polymorphism of klotho gene which results with stone formation. Further studies with more patients should be accomplished which are combining the genetic and epigenetic factors associated with urolithiasis and klotho gene to enlighten the etiology of this disease.

Identification of two novel mutations in adenine phosphoribosyltransferase gene in patients with 2,8-dihydroxyadenine urolithiasis.

Five mutations in the adenine phosphoribosyltransferase (APRT) gene have been described in Japanese patients with APRT deficiency. We investigated the APRT gene from three patients with APRT deficiency and two novel mutations, G133D and V84M, were determined.

Three-dimensional structure of human adenine phosphoribosyltransferase and its relation to DHA-urolithiasis.

In mammals, adenine phosphoribosyltransferase (APRT, EC 2.4.2.7) is present in all tissues and provides the only known mechanism for the metabolic salvage of adenine resulting from the polyamine biosynthesis pathway or from dietary sources. In humans, APRT deficiency results in serious kidney illness such as nephrolithiasis, interstitial nephritis, and chronic renal failure as a result of 2,8-dihydroxyadenine (DHA) precipitation in the renal interstitium. To address the molecular basis of DHA-urolithiasis, the recombinant human APRT was crystallized in complex with adenosine 5'-monophosphate (AMP). Refinement of X-ray diffraction data extended to 2.1 A resolution led to a final crystallographic R(factor) of 13.3% and an R(free) of 17.6%. This structure is composed of nine beta-strands and six alpha-helices, and the active site pocket opens slightly to accommodate the AMP product. The core of APRT is similar to that of other phosphoribosyltransferases (PRTases), although the adenine-binding domain is quite different. Structural comparisons between the human APRT and other "type I" PRTases of known structure revealed several important features of the biochemistry of PRTases. We propose that the residues located at positions corresponding to Leu159 and Ala131 in hAPRT are responsible for the base specificities of type I PRTases. The comparative analysis shown here also provides structural information for the mechanism by which mutations in the human APRT lead to DHA-urolithiasis.

Uric acid stone disease.

The trend in uric acid stone formation appears to be on the rise again throughout much of the world. This is thought secondary to diet, body habitus, and social reasons. Uric acid stone disease has a rich and fascinating medical history and probably is the oldest known stone disease. Uric acid stone disease is strongly linked to the purine metabolic pathway, and its treatment is primarily medical. Uric acid stone disease can be prevented and these are one of the few urinary tract stones that can be dissolved successfully. Surgical intervention with uric acid stone disease represents a failure of medical therapy and a whole host of modern, minimally invasive methods are available for treating patients with this disease. Finally, uric acid nephrolithiasis is associated with a variety of inborn errors of metabolism based on mutations of key enzymes in the purine metabolic pathways. This review of uric acid stone formation will start with historical consideration, review basic biochemistry, and physiology and then focus upon specific clinical scenarios. The discussions will be heavily referenced for those interested in greater details.

Uropathogens and urinary tract concretion formation and catheter encrustations.

Infection stones (ammonium magnesium phosphate) and catheter encrustations have a common cause-urease producing microorganisms. With their rapid growth and frequent recurrences, infection stones are among the most troublesome of urinary system stones. For many patients with a long-term indwelling catheter, encrustations can be a severe problem. Urine composition is important, because, urine calcium enhances the crystallization process and urine citrate inhibits it. The role of non-urease producing microorganisms in stone forming processes is not well understood. Stones can now be successfully treated with a low morbidity index by percutaneous stone surgery or extracorporeal shock wave lithotripsy (ESWL) and recurrence of stone formation is then avoided by prolonged antibiotic treatment and oral citrate. Catheter encrustations and damage caused by ammonia released during urease activity can, however, be a serious problem in patients with indwelling catheters and our remedies are unsatisfactory.

Detection of mutations in adenine phosphoribosyltransferase (APRT) deficiency using the LightCycler system.

We have applied an established technique, the polymerase chain reaction (PCR) with LightCycler technology, to a single disease with well-defined mutations. This assay produces results within only 30 min by combining PCR and fluorescence detection in one tube without electrophoretic band detection. In this study, we found 2,8-dihydroxyadenine (DHA) lithiasis in Japanese patients who were heterozygous for Japanese-type (type II) adenine phosphoribosyltransferase (APRT) deficiency (APRT*J). These patients, from a family with 2,8-DHA lithiasis, had a heterozygous mutation in the J region of the APRT gene. We demonstrated that the present system, using LightCycler technology, was simple, rapid, and reliable for detecting known mutations, and capable of identifying heterozygous and homozygous mutations in this family with APRT deficiency.

Control of urinary risk factors of stones by betulin and lupeol in experimental hyperoxaluria.

Urolithiasis, the process of formation of stones in the kidney and the urinary tract, is the major clinical manifestation of hyperoxaluria. Crystal deposition, as indicated by increased stone-forming constituents in urine, such as calcium, oxalate and uric acid, and decreased concentration of inhibitors, such as magnesium and glycosaminoglycans, was observed in pyridoxine-deficient hyperoxaluric rats. Renal tubular damage was indicated by increased excretion of enzymes such as alkaline phosphatase, lactate dehydrogenase, gamma-glutamyl transferase, beta-glucuronidase and N-acetyl glucosaminidase. Fibrinolytic activity was found to be reduced. Administration of pentacyclic triterpenes such as lupeol and its structural analogue betulin to hyperoxaluric rats minimised the tubular damage and reduced the markers of crystal deposition in the kidneys. In this connection, lupeol was found to be more effective than betulin.

N-acetyl-beta-D-glucosaminidase excretion in healthy children and in pediatric patients with urolithiasis.

Hyperoxaluria was reported to induce renal damage, probably due to toxic effects on renal tubules. Such tubular damage might be expressed by an increase in urinary excretion of marker enzymes such as N-acetyl-beta-D-glucosaminidase (NAG). We set out to examine a possible relationship between the excretion of NAG and that of urinary lithogenic and stone-inhibitory substances by analyzing 24-h urine specimens from 56 children with urolithiasis and 25 healthy children with normal renal function and without a history of urolithiasis. The NAG excretion was higher in patients with urolithiasis (3.5 +/- 0.51 U/g creatinine) as compared with healthy subjects (1.33 +/- 0.14 U/g creatinine, P < 0.05). A positive correlation between NAG and oxalate excretion was observed in female patients (r = 0.56: P < 0.01). In conclusion, the increase in urinary NAG in children with urolithiasis might express renal tubular damage. It seemed, however, not to be specifically related to the excretion of a single lithogenic substance.

Xanthine urolithiasis in a dachshund.

Calculi were located in the kidneys, the ureters and the bladder of a two-year-old male dachshund. The yellow-greenish calculi developed as a result of impaired transformation of xanthine to uric acid resulting in an increased concentration of xanthine in the urine. The cause of the impaired catabolism of xanthine was probably a disorder of the xanthine oxidase enzyme, which catalyses the transformation of xanthine to uric acid.

A germline mutation abolishing the original stop codon of the human adenine phosphoribosyltransferase (APRT) gene leads to complete loss of the enzyme protein.

Adenine phosphoribosyltransferase (APRT) is a purine metabolic enzyme and a homozygous deficiency in this enzyme causes 2,8-dihydroxyadenine urolithiasis. Various germline abnormalities have been described, but we report here a unique type of germline mutation in a homozygous individual (SY) who had excreted 2,8-dihydroxyadenine crystals. In SY, TCA was substituted for the physiological stop codon TGA. This base substitution generates a new HinfI restriction site, and, using the polymerase chain reaction and subsequent digestion by this enzyme, it was confirmed that SY is homozygous for the base substitution. This base change is unique in that it generates an open reading frame that extends to the poly(A) addition site. The amount of mRNA in transformed B cells from SY was approximately a quarter of that in control subjects and no APRT proteins were detected. In eukaryotes, unlike in prokaryotes, no rescue systems for defective polypeptide termination caused by a missing stop codon have been found. Therefore, the outcome of the defect of SY is unclear from present knowledge about termination of polypeptide synthesis. Investigations into the mechanisms of the absence of protein in the cells of SY may lead to a better understanding of the physiological and nonphysiological termination of polypeptide synthesis in eukaryotic cells.

Enhanced renal vitamin-K-dependent gamma-glutamyl carboxylase activity in experimental rat urolithiasis.

OBJECTIVE: To detect the role of the enzyme gamma-glutamyl carboxylase in an experimental stone-forming condition. METHODS: Urolithiasis was induced in experimental rats by (i) oral feeding of 1% ethylene glycol (EG) and (ii) feeding a calculus-producing diet containing 3% sodium glycolate. RESULTS: A significant enhancement in the activity of renal vitamin-K-dependent gamma-glutamyl carboxylase was observed in both groups of experimental urolithic rats. Dicoumarol as well as EG treatment enhanced the accumulation of the endogenous substrate for the enzyme. The carboxylase activity was stimulated by sodium oxalate as well as calcium oxalate in vitro. A positive correlation was observed between lipid peroxidation and the renal gamma-glutamyl carboxylase activity. CONCLUSION: The enhanced carboxylase activity observed in the hyperoxaluric condition is suggested to be due to stimulation of the enzyme by oxalate/calcium oxalate, increased concentration of endogenous carboxylase substrate and lipid peroxidation.

[Urinary urease activity in urolithiasis patients]. / Ureaznaia aktivnost' mochi u bol'nykh mochekamennoi bolezn'iu.

Urease activity (UA) and the ability of the urine to form crystals (AFC) were assessed in the urine from 149 urolithiasis patients and 11 healthy controls. Patients with primary uroliths had high UA and AFC in 17-18% of the cases, in recurrent urolithiasis this percentage was 29-35%. The speed of phosphate and oxalate crystals formation as well as formation of renal calculus correlated with UA and UA levels. Thus, UA and AFC may be employed as criteria in prognostication of the duration of phosphate and oxalate lithogenesis.

Detection of Proteus mirabilis urease gene in urinary calculi by polymerase chain reaction.

BACKGROUND: Urea-splitting microorganisms cannot always be detected by stone or urine culture in patients with infection stones. Detection of genetic elements within the calculi by the polymerase chain reaction (PCR) may be a useful alternative. In this study, we assessed the usefulness of the PCR method in detecting the urease gene specific to Proteus mirabilis in urinary calculi. METHODS: Thirty-eight metabolic stones (calcium oxalate and/or calcium phosphate, uric acid, or cystine) and 49 struvite stones were examined. The PCR was applied with DNA extracted by boiling pulverized stone pieces. RESULTS: Of the 87 stones, PCR demonstrated the presence of the P. mirabilis urease elements ureC1 and ureC2 in 17, all of which were struvite. Stone culture and urine culture had been performed in 22 and 46 struvite stone cases, respectively, and the PCR was positive in all of the 10 culture-positive calculi and also in two calculi from which P. mirabilis was not isolated. CONCLUSION: PCR was reliable and convenient for detecting P. mirabilis in desiccated struvite calculi. Study to detect other species such as Ureaplasma or Corynebacterium would be useful in elucidating the role of bacterial infection in the formation of these stones.

Effect of lupeol, a pentacyclic triterpene, on urinary enzymes in hyperoxaluric rats.

Investigations were undertaken to study the role of lupeol, a pentacyclic triterpene from Crataeva nurvala stem bark, in calcium oxalate experimental rat urolithiasis. A 2% solution of ammonium oxalate was administered by gastric intubation for inducing hyperoxaluric condition in adult male rats of Wistar strain. The duration of treatment was for 15 days. This resulted in increased urinary excretion of oxalate associated with reduction in citrate and glycosaminoglycans. The urinary marker enzymes which indicate renal tissue damage namely--lactate dehydrogenase, inorganic pyrophosphatase, alkaline phosphatase, gamma glutamyl transferase, beta-glucuronidase and N-acetyl beta-D glucosaminidase were found to be elevated. Lupeol administration (25 mg/kg body weight/day) reduced significantly the renal excretion of oxalate. It also reduced the extent of renal tubular damage as evidenced from the decreased levels of the above enzymes in urine. Such a reduction is likely to be beneficial in minimizing the deposition of stone-forming constituents in the kidney which provides antilithic effect.

Cytosolic compartmentalization of hepatic alanine:glyoxylate aminotransferase in patients with aberrant peroxisomal biogenesis and its effect on oxalate metabolism.

Two patients with atypical manifestations of aberrant peroxisomal biogenesis are described. Contrary to previous studies, which had shown that Zellweger syndrome patients usually have normal levels of urinary oxalate excretion, the patients in the present study had evidence of abnormal oxalate metabolism in the form of hyperoxaluria and, in one of the patients, calcium oxalate urolithiasis. Activity of the liver-specific peroxisomal enzyme alanine:-glyoxylate aminotransferase (AGT), which is a major determinant of the level of endogenous oxalate synthesis in humans, was normal in one patient and markedly supranormal in the other. Using the technique of post-embedding protein A-colloidal gold immunoelectron microscopy, AGT was found to be mainly cytosolic in the livers of both patients, with significant amounts also localized in the nuclei. In a small minority of the hepatocytes of one patient, who was homozygous for the more common (major) AGT allele, large numbers of unidentified fibrillar arrays were found in the cytosol, which labelled heavily for immunoreactive AGT. The background cytosolic AGT labelling was markedly reduced in such cells when compared to the majority of cells that did not contain fibrils. In the other patient, who was heterozygous for the major and minor AGT alleles, there appeared to be low levels of mitochondrial AGT labelling. In the light of these data, the possible metabolic function of cytosolic AGT in the livers of panperoxisomal disease patients is discussed.

Alteraciones en la actividad del calcio-magnesio ATPasa en la membrana de los eritrocitos en pacientes litiasicos con hipercalciuria / Alterations in the calcium-magnesium activity ATPase in the membrane of the erytrosites in lithiasic patients with hypercalciuria

La CaMgATPasa es una enzima involucrada en los movimientos de calcio a través de las membranas biológicas. Nosotros testeamos la actividad de dicha enzima en membranas de eritrocitos de 17 pacientes hipercalciúricos y la comparamos con 8 controles sanos. Los pacientes con hipercalciuria tuvieron una actividad de CaMgATPasa que fue significativamente superior a los controles (18,02 2,83 vs 14,69 1,78 nM . mg-1 p<0,01). La excreción de urinaria de calcio en 24 hs (UCa.V) estuvo directa y significativamente relacionada con la actividad de la enzima (UCa.V: 36,31 x CaMgATPasa - 371,08 r:0,65 p<0,05) sólo en pacientes con hipercalciuria. Cuando agrupamos los pacientes acorde al diagnóstico fisiopatológico en hipercalciuria absortiva (HCA) e hipercalciuria renal (HCRT) encontramos que la actividad enzimática estuvo sólo significativamente elevada en aquellos portadores de HCA al compararlos con los controles (19,17 3,49 vs 14,68 1,79 nM . mg-1 .min-1 p<0,025).No encontramos diferencias estadísticamente significativas entre HCRT y controles (16,83 1,99nM . mg-1 . min-1; p:NS) y en HCRT vs HCA (p<0,14). Concluimos que las alteraciones en el transporte de calcio en la hipercalciuria dependería de anormalidades en la actividad de la CaMgATPasa

Alteraciones en la actividad del calcio-magnesio ATPasa en la membrana de los eritrocitos en pacientes litiasicos con hipercalciuria / Alterations in the calcium-magnesium activity ATPase in the membrane of the erytrosites in lithiasic patients with hypercalciuria

La CaMgATPasa es una enzima involucrada en los movimientos de calcio a través de las membranas biológicas. Nosotros testeamos la actividad de dicha enzima en membranas de eritrocitos de 17 pacientes hipercalciúricos y la comparamos con 8 controles sanos. Los pacientes con hipercalciuria tuvieron una actividad de CaMgATPasa que fue significativamente superior a los controles (18,02 2,83 vs 14,69 1,78 nM . mg-1 p<0,01). La excreción de urinaria de calcio en 24 hs (UCa.V) estuvo directa y significativamente relacionada con la actividad de la enzima (UCa.V: 36,31 x CaMgATPasa - 371,08 r:0,65 p<0,05) sólo en pacientes con hipercalciuria. Cuando agrupamos los pacientes acorde al diagnóstico fisiopatológico en hipercalciuria absortiva (HCA) e hipercalciuria renal (HCRT) encontramos que la actividad enzimática estuvo sólo significativamente elevada en aquellos portadores de HCA al compararlos con los controles (19,17 3,49 vs 14,68 1,79 nM . mg-1 .min-1 p<0,025).No encontramos diferencias estadísticamente significativas entre HCRT y controles (16,83 1,99nM . mg-1 . min-1; p:NS) y en HCRT vs HCA (p<0,14). Concluimos que las alteraciones en el transporte de calcio en la hipercalciuria dependería de anormalidades en la actividad de la CaMgATPasa

Alteraciones en la actividad del calcio-magnesio ATPasa en la membrana de los eritrocitos en pacientes litiasicos con hipercalciuria / Alterations in the calcium-magnesium activity ATPase in the membrane of the erytrosites in lithiasic patients with hypercalciuria

La CaMgATPasa es una enzima involucrada en los movimientos de calcio a través de las membranas biológicas. Nosotros testeamos la actividad de dicha enzima en membranas de eritrocitos de 17 pacientes hipercalciúricos y la comparamos con 8 controles sanos. Los pacientes con hipercalciuria tuvieron una actividad de CaMgATPasa que fue significativamente superior a los controles (18,02 2,83 vs 14,69 1,78 nM . mg-1 p<0,01). La excreción de urinaria de calcio en 24 hs (UCa.V) estuvo directa y significativamente relacionada con la actividad de la enzima (UCa.V: 36,31 x CaMgATPasa - 371,08 r:0,65 p<0,05) sólo en pacientes con hipercalciuria. Cuando agrupamos los pacientes acorde al diagnóstico fisiopatológico en hipercalciuria absortiva (HCA) e hipercalciuria renal (HCRT) encontramos que la actividad enzimática estuvo sólo significativamente elevada en aquellos portadores de HCA al compararlos con los controles (19,17 3,49 vs 14,68 1,79 nM . mg-1 .min-1 p<0,025).No encontramos diferencias estadísticamente significativas entre HCRT y controles (16,83 1,99nM . mg-1 . min-1; p:NS) y en HCRT vs HCA (p<0,14). Concluimos que las alteraciones en el transporte de calcio en la hipercalciuria dependería de anormalidades en la actividad de la CaMgATPasa

Application of polymerase chain reaction-single strand conformation polymorphism analysis to the diagnosis and screening of adenine phosphoribosyltransferase deficiency.

Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis is a rapid and sensitive method used to identify point mutations in a given sequence of genomic DNA. We applied this method to the diagnosis of adenine phosphoribosyltransferase (APRT) deficiency, which is an autosomal recessive hereditary disease leading to 2,8-dihydroxyadenine urolithiasis. Genomic APRT genes were amplified and labeled simultaneously with [alpha-32P]dCTP (cytidine triphosphate) by PCR. When run in a 6% polyacrylamide gel containing 10% glycerol, two types of mutant genes-APRT*QO and APRT*J-gave bands clearly distinct from those of the equivalent normal APRT genes. Using this method we diagnosed both homozygotes and heterozygotes for defective APRT genes. On screening 80 Japanese individuals for polymorphism or mutations by PCR-SSCP we did not find any alterations leading to a false positive diagnosis. These findings suggest that PCR-SSCP, in addition to being rapid and sensitive, is a useful diagnostic method which is highly specific in detecting mutant APRT genes in the Japanese population.