Salbutamol for analgesia in renal colic: study protocol for a prospective, randomised, placebo-controlled phase II trial (SARC).

BACKGROUND: Renal colic is the pain experienced by a patient when a renal calculus (kidney stone) causes partial or complete obstruction of part of the renal outflow tract. The standard analgesic regimes for renal colic are often ineffective; in some studies, less than half of patients achieve complete pain relief, and a large proportion of patients require rescue analgesia within 4 h. Current analgesic regimes are also associated with significant side effects including nausea, vomiting, drowsiness and respiratory depression. It has been hypothesised that beta adrenoreceptor agonists, such as salbutamol, may reduce the pain of renal colic. They have been shown to impact a number of factors that target the physiological causes of pain in renal colic (ureteric spasm and increased peristalsis, increased pressure at the renal pelvis and prostaglandin release with inflammation). There is biological plausibility and a body of evidence sufficient to suggest that this novel treatment for the pain of renal colic should be taken to a phase II clinical trial. The aim of this trial is to test whether salbutamol is an efficacious analgesic adjunct when added to the standard analgesic regime for patients presenting to the ED with subsequently confirmed renal colic. METHODS: A phase II, randomised, placebo-controlled trial will be performed in an acute NHS Trust in the East Midlands. Patients presenting to the emergency department with pain requiring IV analgesia and working diagnosis of renal colic will be randomised to receive standard analgesia ± a single intravenous injection of Salbutamol. Secondary study objectives will explore the feasibility of conducting a larger, phase III trial. DISCUSSION: The trial will provide important information about the efficacy of salbutamol as an analgesic adjunct in renal colic. It will also guide the development of a definitive phase III trial to test the cost and clinical effectiveness of salbutamol as an analgesic adjunct in renal colic. Salbutamol benefits from widespread use across the health service for multiple indications, extensive staff familiarity and a good side effect profile; therefore, its potential use for pain relief may have significant benefits for patient care. TRIAL REGISTRATION: ISRCTN Registry ISRCTN14552440 . Registered on 22 July 2019.

Calcium supplementation and kidney stone risk in osteoporosis: a systematic literature review.

OBJECTIVES: This paper aims to examine the risk of nephrolithiasis in patients with osteoporosis and calcium supplementation. METHODS: This work is based on the systematic review of studies retrieved by a sensitive search strategy in Medline and Embase (1991-2010), and the Cochrane Central register of Controlled Trials (CENTRAL) up to 2010. The abstracts of the annual scientific meetings of the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) (2008-2010) were also examined. The selection criteria were the following: patients with osteoporosis, on calcium supplementation alone or associated with other treatments for osteoporosis. We measured the likelihood of developing kidney stones, renal colic, changes in urinary sediment and serum parameters. We selected systematic literature reviews, randomised clinical trials (RCT) and cohort studies. RESULTS: We included 10 studies, 8 RCT and 2 cohort studies of moderate quality. All patients had osteoporosis (>8.000 patients), they were mostly women with a mean age of 50-70 years. Daily calcium doses varied from 120 mg up to 1.500 mg, and treatment duration from 3 days to 3 years. Changes in urinary sediment were found, but in general they were not clinically relevant. No cases of nephrolitiasis were found in more than a half of the included studies. In total there were 3 cases of kidney stone, 2 urinary tract calcifications, 16 cases of nephrolithiasis or urolithiasis, 4 of haematuria and 5 patients reporting kidney pain. CONCLUSIONS: According to our results, calcium supplements in the treatment of osteoporosis alone or in combination with another type of treatment does not significantly increase the risk of nephrolithiasis or renal colic.

[Migraine-induced kidney stones?]. / Nierensteine durch Migräne?

A 42-year old woman was referred for a metabolic evaluation after two episodes of kidney stones. Her laboratory results revealed a normal anion-gap metabolic acidosis, a marked hypocitraturia (0,6 mmol/24h; norm 1,6-4,5) and a urinary pH of 7,0 confirming renal tubular acidosis (RTA). We identified topiramate, our patient's medication for migraine, as the cause of the RTA. Topiramate, a carboanhydrase inhibitor leads to RTA of a mixed (proximal and distal) type and thus significantly increases the risk for kidney stones.