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1
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Mahomoodally MF, Coodian K, Hosenally M, Zengin G, Shariati MA, Abdalla AN, Alhazmi HA, Khuwaja G, Mohan S, Khalid A. Herbal remedies in the management of hyperuricemia and gout: A review of in vitro, in vivo and clinical evidences. Phytother Res 2024; 38:3370-3400. [PMID: 38655878 DOI: 10.1002/ptr.8211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
Gout, or hyperuricemia is a multifactorial and multi-faceted metabolic disease that is quite difficult to manage and/or treat. Conventional therapies such as non-steroidal anti-inflammatory drugs (NSAIDs) such as allopurinol, corticosteroids and colchicine amongst others, have helped in its management and treatment to some extent. This study aimed to compile and analyze the different herbal remedies used in the management of hyperuricemia and gout. A literature search was conducted from key databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar) using relevant keywords via the PRISMA model. Smilax riparia A.DC. from Traditional Chinese Medicine is used in many countries for its therapeutic effect on lowering serum urate levels. No single study was able to establish the efficacy of a specific traditionally used herb via in vitro, in vivo, and clinical studies. Patients were found to use a panoply of natural remedies, mainly plants to treat hyperuricemia and gout, which have been validated to some extent by in vitro, in vivo, and clinical studies. Nonetheless, further research is needed to better understand the ethnopharmacological relationship of such herbal remedies.
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Affiliation(s)
- Mohamad Fawzi Mahomoodally
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam
- School of Engineering & Technology, Duy Tan University, Da Nang, Vietnam
| | - Kaisavadee Coodian
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius
| | - Muzzammil Hosenally
- Department of Economics and Statistics, Faculty of Social Sciences & Humanities, University of Mauritius, Réduit, Mauritius
| | - Gokhan Zengin
- Department of Biology, Faculty of Science, Selcuk University, Konya, Turkey
| | - Mohammad Ali Shariati
- Semey Branch of the Institute, Kazakh Research Institute of Processing and Food Industry, Almaty, Kazakhstan
| | - Ashraf N Abdalla
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hassan A Alhazmi
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Gulrana Khuwaja
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Syam Mohan
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun, India
| | - Asaad Khalid
- Substance Abuse and Toxicology Research Center, Jazan University, Jazan, Saudi Arabia
- Medicinal and Aromatic Plants and Traditional Medicine Research Institute, National Center for Research, Khartoum, Sudan
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2
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Lemoine S, Dahan P, Haymann JP, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Medical management - from diagnosis to treatment. Prog Urol 2023; 33:911-953. [PMID: 37918992 DOI: 10.1016/j.purol.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
The morphological-compositional analysis of urinary stones allows distinguishing schematically several situations: dietary, digestive, metabolic/hormonal, infectious and genetic problems. Blood and urine testing are recommended in the first instance to identify risk factors of urinary stone disease in order to avoid recurrence or progression. The other objective is to detect a potential underlying pathology associated with high risk of urinary stone disease (e.g. primary hyperparathyroidism, primary or enteric hyperoxaluria, cystinuria, distal renal tubular acidosis) that may require specific management. Lifestyle-diet measures are the basis of the management of all stone types, but pharmacological treatments may be required. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU 2022] and their adaptability to the French context.
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Affiliation(s)
- S Lemoine
- Hospices Civils de Lyon, SFNDT, SP, Lyon, France
| | - P Dahan
- Nephrology Department, Clinique Saint-Exupéry, SFNDT, Toulouse, France
| | - J P Haymann
- Inserm, UMRS 1155 UPMC, Tenon Hospital, SP, Paris, France; Service d'Explorations Fonctionnelles Multidisciplinaires, Tenon Hospital, Paris, France
| | - P Meria
- Service d'Urologie, Hôpital Saint Louis, AP-HP-Centre Université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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3
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Shabani E, Khorshidi A, Sayehmiri K, Moradi K, Nabi Abdolyousefi E. The effect of nutritional factors on urolithiasis: A case-control study. J Med Life 2023; 16:1062-1069. [PMID: 37900086 PMCID: PMC10600667 DOI: 10.25122/jml-2022-0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/27/2023] [Indexed: 10/31/2023] Open
Abstract
Urolithiasis, a prevalent chronic kidney disease affecting all age groups, can be influenced by nutritional factors. The incidence of urolithiasis in Asian countries ranges from 1% to 19.1%, attributed to geographical and lifestyle differences. In Iran, several risk factors, including ethnicity, dietary habits, gender, and age, are associated with urolithiasis. This study aimed to assess the impact of nutritional factors on kidney and urinary tract stone formation. This case-control study enrolled 127 newly diagnosed urolithiasis patients, and 127 matched healthy participants between February to May 2017. Exclusion criteria included diabetes and acute or chronic renal failure. Data were collected using the Food Frequency Questionnaire (FFQ) and analyzed using chi-square and logistic regression tests. Water (95% CI: 0.09-0.89, OR=0.28), natural juices (95% CI: 0.10-0.65, OR=0.53), mineral water (95% CI: 0.05-0.64, OR=0.18), legumes (95% CI: 0.00-0.38, OR=0.032), butter, cream, or peppermint (95% CI: 0.09-0.95, OR=0.30), and ice cream (95% CI: 0.07-0.54, OR=0.203) had a significant protective effect against kidney and urinary tract stone formation. Conversely, tea consumption (95% CI: 1.15-7.99, OR=4.70), beverages (95% CI: 4.45-23.32, OR=23.32), coffee (95% CI: 1.63-11.78, OR=4.39), bread (95% CI: 1.1-10.59, OR=3.37), meat (95% CI: 1.01-8.01, OR=2.85), liver (95% CI: 3.37-488.90, OR=40.58), fish (95% CI: 2.89-216.39, OR=25.03), and various canned foods (95% CI: 1.34-10.25, OR=3.70) were significantly associated with kidney and urinary tract stone risk. These findings showed that the risk of urinary stones formation had a significant relationship with dietary habits. Therefore, the correct dietary pattern and sufficient fluid consumption may play an important role in preventing urinary stones.
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Affiliation(s)
- Ehsan Shabani
- Epidemiology Student Research Committee, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Khorshidi
- School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Kourosh Sayehmiri
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Kamran Moradi
- Department of Urology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Ehsan Nabi Abdolyousefi
- Genetic Student Research Center, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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Lambert K, Gardos R, Coolican H, Pickel L, Sung HK, Wang AYM, Ong AC. Diet and Polycystic Kidney Disease: Nutrients, Foods, Dietary Patterns, and Implications for Practice. Semin Nephrol 2023; 43:151405. [PMID: 37542985 DOI: 10.1016/j.semnephrol.2023.151405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Polycystic kidney disease (PKD) is a chronic, progressive hereditary condition characterized by abnormal development and growth of cysts in the kidneys and other organs. There is increasing interest in exploring whether dietary modifications may prevent or slow the disease course in people with PKD. Although vasopressin-receptor agonists have emerged as a novel drug treatment in advancing care for people with PKD, several recent landmark trials and clinical discoveries also have provided new insights into potential dietary-related therapeutic strategies. In this review, we summarize the current evidence pertaining to nutrients, foods, dietary patterns, cyst growth, and progression of PKD. We also describe existing evidence-based dietary care for people with PKD and outline the potential implications for advancing evidence-based dietary interventions. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.
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Affiliation(s)
- Kelly Lambert
- Nutrition and Dietetics, School of Medical, Indigenous and Health Science, University of Wollongong, Wollongong, New South Wales, Australia.
| | | | | | - Lauren Pickel
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hoon-Ki Sung
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China
| | - Albert Cm Ong
- Academic Nephrology Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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Dai JC, Pearle MS. Diet and Stone Disease in 2022. J Clin Med 2022; 11:jcm11164740. [PMID: 36012979 PMCID: PMC9410446 DOI: 10.3390/jcm11164740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Diet plays a central role in the development and prevention of nephrolithiasis. Although pharmacologic treatment may be required for some patients who are resistant to dietary measures alone, dietary modification may be sufficient to modulate stone risk for many patients. While there is no single specialized diet for stone prevention, several dietary principles and recommendations for stone prevention are supported by practice guidelines, including adequate fluid intake, modest calcium intake, low dietary sodium, and limited animal protein. In this review, we summarized the evidence supporting these dietary recommendations and reviewed the current literature regarding specific dietary components and comprehensive diets for stone prevention.
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6
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Liu S, Li S, Ho CT. Dietary bioactives and essential oils of lemon and lime fruits. FOOD SCIENCE AND HUMAN WELLNESS 2022. [DOI: 10.1016/j.fshw.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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7
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Ruggenenti P, Caruso MR, Cortinovis M, Perna A, Peracchi T, Giuliano GA, Rota S, Brambilla P, Invernici G, Villa D, Diadei O, Trillini M, Natali G, Remuzzi G. Fresh lemon juice supplementation for the prevention of recurrent stones in calcium oxalate nephrolithiasis: A pragmatic, prospective, randomised, open, blinded endpoint (PROBE) trial. EClinicalMedicine 2022; 43:101227. [PMID: 34977512 PMCID: PMC8683665 DOI: 10.1016/j.eclinm.2021.101227] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Standard diet with normal calcium and reduced animal proteins and salt content reduces stone recurrence in calcium oxalate nephrolithiasis. Whether lemon juice supplementation further reduces recurrence rate is unknown. METHODS In this single-centre, prospective, randomised, open, blinded endpoint trial (Clinical Trials gov NCT01217372) we evaluated the effects of fresh lemon juice supplementation (60 mL twice daily) versus no supplementation, on time to stone recurrence in 203 patients with recurrent idiopathic calcium oxalate nephrolithiasis who were all prescribed a standard diet. Patients were included between July 2009 and March 2017 at the Nephrology Unit of the Papa Giovanni XXIII hospital in Bergamo, Italy. Time to stone recurrence at 2 years of follow-up was the primary outcome. Analyses were by intention-to-treat. FINDINGS During two years of follow-up 21 of 100 patients randomised to lemon juice supplementation and 32 of 103 controls randomised to no supplementation had stone recurrence [HR (95% CI): 0·62 (0·35-1·07), p = 0·089]. Patient adherence to lemon juice supplementation, however, progressively decreased from 68% at one-year to 48% at two-year follow-up. At explorative analyses restricted at one-year follow-up, ten patients with supplementation versus 22 controls had stone recurrence [0·43 (0·20-0·89), p = 0·028]. After adjustment by age, sex and normo or hypocitraturia, the HR (95%) was still significant [0·45 (0·20-0·93), p = 0·036]. At six months, 24 hour urinary sodium excretion decreased by 8·60±65·68 mEq/24 h in patients receiving lemon juice supplementation and increased by 3·88±64·78 mEq/24 h in controls. Changes significantly differed between groups (p = 0·031). This difference was subsequently lost. Treatment was safe. In patients with lemon juice supplementation gastrointestinal disorders were more frequent (p<0·001). Renal and urinary tract disorders were similar between groups (p = 0·103). INTERPRETATION Explorative analyses suggest that fresh lemon juice supplementation to standard diet might prevent stone recurrence in patients with calcium-oxalate nephrolithiasis. However, treatment effect was likely reduced by progressively declining adherence to lemon juice supplementation. FUNDING This study received no funding.
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Affiliation(s)
- Piero Ruggenenti
- Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Maria Rosa Caruso
- Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Monica Cortinovis
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Annalisa Perna
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Tobia Peracchi
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giovanni Antonio Giuliano
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Stefano Rota
- Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Paolo Brambilla
- Unit of Radiology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuliana Invernici
- Unit of Gastroenterology and Digestive Endoscopy, Azienda Socio-Sanitaria Territoriale, Bergamo Est, Alzano Lombardo, Bergamo, Italy
| | - Davide Villa
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Olimpia Diadei
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Matias Trillini
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Grazia Natali
- Unit of Nephrology, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Clinical Research Center for Rare Diseases “Aldo & Cele Daccò”, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
- Corresponding author at: Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, Via Stezzano 87, 24126 Bergamo, Italy.
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8
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Garbens A, Pearle MS. Causes and prevention of kidney stones: separating myth from fact. BJU Int 2021; 128:661-666. [PMID: 34192414 DOI: 10.1111/bju.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite high-level evidence supporting the use of pharmacotherapy therapy for the prevention of kidney stones, adherence to medications is often poor because of side-effects, inconvenience and cost. Furthermore, with a desire for more 'natural' products, patients seek dietary and herbal remedies over pharmacotherapy. However, patients are often unaware of the potential side-effects, lack of evidence and cost of these remedies. Therefore, in the present review we examine the evidence for a few of the commonly espoused non-prescription agents or dietary recommendations that are thought to prevent stone formation, including lemonade, fish oil (omega fatty acids), Phyllanthus niruri and the Dietary Approaches to Stop Hypertension (DASH) diet. While the present review includes only a few of the stone-modulating recommendations available to the lay community, we focussed on these four due to their prevalent use. Our goal is not to only dispel commonly held notions about stone disease, but also to highlight the lack of high-level evidence for many commonly utilised treatments.
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Affiliation(s)
- Alaina Garbens
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA
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9
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Siener R. Nutrition and Kidney Stone Disease. Nutrients 2021; 13:1917. [PMID: 34204863 PMCID: PMC8229448 DOI: 10.3390/nu13061917] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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10
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Yau AA, Hindi J, Uribarri J. Recurrent Nephrolithiasis Causing Kidney Failure. Am J Kidney Dis 2021; 77:A18-A21. [PMID: 33752806 DOI: 10.1053/j.ajkd.2020.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Amy A Yau
- Division of Nephrology, Department of Medicine, Mount Sinai Hospital, New York, New York.
| | - Judy Hindi
- Division of Nephrology, Department of Medicine, Mount Sinai Hospital, New York, New York
| | - Jaime Uribarri
- Division of Nephrology, Department of Medicine, Mount Sinai Hospital, New York, New York
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11
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Zibaee E, Kamalian S, Tajvar M, Amiri MS, Ramezani M, Moghadam AT, Emami SA, Sahebkar A. Citrus species: A Review of Traditional Uses, Phytochemistry and Pharmacology. Curr Pharm Des 2020; 26:44-97. [PMID: 31775593 DOI: 10.2174/1381612825666191127115601] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/25/2019] [Indexed: 12/23/2022]
Abstract
The Citrus species from family Rutaceae has worldwide applications such as cardiovascular and gastrointestinal problems. Phytochemical investigations have shown that these plants have constituents including flavonoids, limonoids and carotenoids. There are many reports on a wide range of activities such as antiinflammatory, anti-oxidant, immunomodulatory, metabolic, cardiovascular and neuroprotective effects. In the current review, we discuss information regarding botany, phytochemistry, ethnobotany uses, traditional knowledge and pharmacological aspects of the Citrus species.
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Affiliation(s)
- Elaheh Zibaee
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Safa Kamalian
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehrangiz Tajvar
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahin Ramezani
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali T Moghadam
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed A Emami
- Department of Traditional Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Halal Research Center of IRI, FDA, Tehran, Iran.,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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12
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Large T, Williams J, Asplin JR, Krambeck A. Using Low-Calorie Orange Juice as a Dietary Alternative to Alkali Therapy. J Endourol 2020; 34:1082-1087. [PMID: 32363926 DOI: 10.1089/end.2020.0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The pursuit of a dietary source to increase urine pH and citrate in stone formers has been ongoing for >30 years. Early evidence showed that orange juice (OJ) contains alkali and citrate, but high sugar and ascorbic acid content limited the use of OJ as a viable daily source of alkali. Recently, novel low-calorie OJs have emerged and could potentially be a better option. Methods: Beverages with high concentrations of alkali citrate and malate were identified using ion chromatography. Two low-calorie OJ beverages, in addition to crystal light lemonade beverage (CLLB), were chosen. Healthy volunteers (5 men, 5 women) drank 1 L of OJ or CLLB with 1 L water daily for 7 days, and then completed a 24-hour urinalysis. A washout week was instituted between trial weeks. The study design is a prospective randomized crossover control trial. A paired analysis using comparison of means was used to evaluate low-calorie OJ and CLLB. Volunteers had no prior history of kidney stones and maintained a journal with beverage compliance, side effect (SE), and dietary consumption data. Results: Tropicana 50 (TRP50), Kroger low-calorie OJ (KLCO), and CLLB were found to have a total alkali content of 56.60, 47.9, and 17.3 mEq/L, respectively, based on ion chromatography. Consumption of all three beverages raised urinary citrate (116.6 [-118 to 373, 177.9 [-3 to 359], 155.6 [-4 to 237] ▵mg/day 95% confidence interval) and urinary pH (0.25 [0.08-0.53], 0.74 [0.41-1.07 p < 0.05], 0.25 [0.25-0.64]), respectively, compared with water phase. Based on journal entries by volunteers, TRP50 had the most SEs (90% participants) felt to be a result of the artificial sweetener (Stevia®). Conclusion: Low-calorie OJs, and to a lesser extent CLLB, have alkali and citrate based on ion chromatography. Daily consumption by healthy volunteers of KLCO can raise urinary pH.
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Affiliation(s)
- Tim Large
- From Indiana University Department of Urology and Litholink Corporation, Laboratory Corporation of America Holdings, Indianapolis, Indiana, USA
| | - James Williams
- From Indiana University Department of Urology and Litholink Corporation, Laboratory Corporation of America Holdings, Indianapolis, Indiana, USA
| | - John R Asplin
- From Indiana University Department of Urology and Litholink Corporation, Laboratory Corporation of America Holdings, Indianapolis, Indiana, USA
| | - Amy Krambeck
- From Indiana University Department of Urology and Litholink Corporation, Laboratory Corporation of America Holdings, Indianapolis, Indiana, USA
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13
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Cheng JW, Wagner H, Asplin JR, Hodgkin G, Schlaifer A, Fargusson M, Fargusson J, Baldwin DD. The Effect of Lemonade and Diet Lemonade Upon Urinary Parameters Affecting Calcium Urinary Stone Formation. J Endourol 2020; 33:160-166. [PMID: 30585747 DOI: 10.1089/end.2018.0623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the effects of regular and diet lemonade upon urinary parameters affecting kidney stone formation. METHODS In this prospective blinded crossover study, 12 healthy participants consumed either 2 L of regular or diet lemonade daily while on a standardized low sodium moderate calcium diet. Twenty four-hour urine collections were obtained at baseline on the controlled diet only and on days 4 and 5 of each treatment phase. There was a 1-week washout period between regular and diet lemonade treatments. Primary outcomes were urine citrate, pH, and volume determined by 24-hour urine collections. Secondary outcomes included the supersaturation of calcium oxalate, calcium phosphate, and uric acid. RESULTS Urine volume was significantly higher with both regular and diet lemonade consumption compared with baseline values. Urinary citrate significantly increased from baseline with diet lemonade only. Urine pH was unchanged with both beverages. The supersaturation of calcium oxalate significantly decreased with diet lemonade only, whereas supersaturation of calcium phosphate decreased with both beverages. Daily consumption of 2 L of regular and diet lemonade resulted in an intake of 168.4 and 170.2 mEq of citrate but a total alkali intake of 12.2 and 16.0 mEq, respectively. Compared with diet lemonade, regular lemonade provided subjects with 805 additional calories and 225 g of sugar per day. CONCLUSIONS Diet lemonade may provide a low-calorie sugar-free cost-effective option for decreasing the risk of recurrent calcium nephrolithiasis through a significant increase in urine volume, increase in urinary citrate, and reduction in supersaturation of calcium oxalate and calcium phosphate.
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Affiliation(s)
- Julie W Cheng
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Hillary Wagner
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
| | - John R Asplin
- 2 Litholink Corporation, Laboratory Corporation of America Holdings, Chicago, Illinois
| | - Georgia Hodgkin
- 3 Department of Nutrition and Dietetics, Loma Linda University Health, Loma Linda, California
| | - Amy Schlaifer
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Michael Fargusson
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
| | - Joseph Fargusson
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
| | - D Duane Baldwin
- 1 Department of Urology, Loma Linda University Health, Loma Linda, California
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Chen L, Li M, Wu JL, Li JX, Ma ZC. Effect of lemon water soluble extract on hyperuricemia in a mouse model. Food Funct 2019; 10:6000-6008. [DOI: 10.1039/c9fo00509a] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Lemon is a healthy fruit with high medicinal value.
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Affiliation(s)
- Lin Chen
- College of Horticulture and Forestry Sciences
- Huazhong Agricultural University
- Key Laboratory of Horticultural Plant Biology
- Ministry of Education
- Wuhan 430070
| | - Ming Li
- College of Horticulture and Forestry Sciences
- Huazhong Agricultural University
- Key Laboratory of Horticultural Plant Biology
- Ministry of Education
- Wuhan 430070
| | - Jin-Long Wu
- College of Horticulture and Forestry Sciences
- Huazhong Agricultural University
- Key Laboratory of Horticultural Plant Biology
- Ministry of Education
- Wuhan 430070
| | - Jin-Xue Li
- Institute of Tropical and Subtropical Cash Crops
- Yunan Academy of Agricultural Sciences
- Baoshan
- China
| | - Zhao-Cheng Ma
- College of Horticulture and Forestry Sciences
- Huazhong Agricultural University
- Key Laboratory of Horticultural Plant Biology
- Ministry of Education
- Wuhan 430070
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15
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Shin S, Srivastava A, Alli NA, Bandyopadhyay BC. Confounding risk factors and preventative measures driving nephrolithiasis global makeup. World J Nephrol 2018; 7:129-142. [PMID: 30510912 PMCID: PMC6259033 DOI: 10.5527/wjn.v7.i7.129] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/10/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Nephrolithiasis is increasing in developed and developing countries at an alarming rate. With the global spike in kidney stone diseases, it is crucial to determine what risk factors are influencing the current global landscape for kidney stones. Our aims for this review are: to identity and analyze the four categories of risk factors in contributing to the global scale of stone formation: lifestyle, genetics, diet, and environment; and discuss preventative measures for kidney stone formation. We also performed data search through the published scientific literature, i.e., PubMed® and found that there is a significant link between lifestyle and obesity with cases of calcium stones. Food and Agriculture Organization of the United Nations and World Health Organization factor indicators for dietary intake and obesity, along with climate data were used to create the projected total risk world map model for nephrolithiasis risk. Complete global analyses of nephrolithiasis deplete of generalizations is nearly insurmountable due to limited sources of medical and demographic information, but we hope this review can provide further elucidation into confounding risk factors and preventative measures for global nephrolithiasis analysis.
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Affiliation(s)
- Samuel Shin
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC 20422, United States
| | - Aneil Srivastava
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC 20422, United States
- George Washington University, Washington, DC 20052, United States
| | - Nazira A Alli
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC 20422, United States
| | - Bidhan C Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC 20422, United States
- George Washington University, Washington, DC 20052, United States
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16
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Ungjaroenwathana W, Chiramongkolsiri T, Dissayabutra T, Boonla C, Prapunwattana P, Tungsanga K, Tosukhowong P. Lime powder regimen supplement alleviates urinary metabolic abnormalities in urolithiasis patients. Nephrology (Carlton) 2018; 24:791-797. [PMID: 30225852 DOI: 10.1111/nep.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urolithiasis has high recurrent rate after surgical removal within 3 years. Potassium citrate compound is used to prevent stone recurrence but it has intolerable gastrointestinal adverse effects. We conducted a phase 2 clinical study of lime power regimen (LPR), a limeade-based supplement containing potassium and citrate for 6 months period of treatment, to evaluate its effects on biochemical and clinical aspects of recurrent urolithiasis. METHODS Seventy-four urolithiasis patients were randomly allocated to receive either LPR or placebo for 6 months in a double-blinded manner. Plasma and 24 h urine samples were collected to measure urinary pH, mineral excretion and urinary total antioxidant status , plasma for creatinine and plasma protein carbonyl, and stone for elemental analysis at the initiation and end-of-treatment (6 month). Adverse effects were recorded. RESULTS Administration of LPR significantly increased urinary pH, citrate and potassium excretion. Urinary levels of calcium and oxalate, and plasma protein carbonyl content were reduced, while urinary total antioxidant status was elevated by LPR treatment. Urinary supersaturation was decreased and urinary protein excretion was ameliorated in LPR-treated patients. Gastrointestinal adverse effects were rarely observed. None of the participants developed stone recurrence for the duration of the trial. CONCLUSION Lime power regimen is a potential drug to correct urinary metabolic disorders associated with urolithiasis in high risk stone recurrent patients. A phase 3 clinical trial is underway to validate anti-stone recurrence property of LPR in long-term treatment.
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Affiliation(s)
| | | | - Thasinas Dissayabutra
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chanchai Boonla
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Phisit Prapunwattana
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyaratana Tosukhowong
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Munankarmi NN, Rana N, Bhattarai T, Shrestha RL, Joshi BK, Baral B, Shrestha S. Characterization of the Genetic Diversity of Acid Lime ( Citrus aurantifolia (Christm.) Swingle) Cultivars of Eastern Nepal Using Inter-Simple Sequence Repeat Markers. PLANTS 2018; 7:plants7020046. [PMID: 29895800 PMCID: PMC6027463 DOI: 10.3390/plants7020046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022]
Abstract
Acid lime (Citrus aurantifolia (Christm.) Swingle) is an important fruit crop, which has high commercial value and is cultivated in 60 out of the 77 districts representing all geographical landscapes of Nepal. A lack of improved high-yielding varieties, infestation with various diseases, and pests, as well as poor management practices might have contributed to its extremely reduced productivity, which necessitates a reliable understanding of genetic diversity in existing cultivars. Hereby, we aim to characterize the genetic diversity of acid lime cultivars cultivated at three different agro-ecological gradients of eastern Nepal, employing PCR-based inter-simple sequence repeat (ISSR) markers. Altogether, 21 polymorphic ISSR markers were used to assess the genetic diversity in 60 acid lime cultivars sampled from different geographical locations. Analysis of binary data matrix was performed on the basis of bands obtained, and principal coordinate analysis and phenogram construction were performed using different computer algorithms. ISSR profiling yielded 234 amplicons, of which 87.18% were polymorphic. The number of amplified fragments ranged from 7–18, with amplicon size ranging from ca. 250–3200 bp. The Numerical Taxonomy and Multivariate System (NTSYS)-based cluster analysis using the unweighted pair group method of arithmetic averages (UPGMA) algorithm and Dice similarity coefficient separated 60 cultivars into two major and three minor clusters. Genetic diversity analysis using Popgene ver. 1.32 revealed the highest percentage of polymorphic bands (PPB), Nei’s genetic diversity (H), and Shannon’s information index (I) for the Terai zone (PPB = 69.66%; H = 0.215; I = 0.325), and the lowest of all three for the high hill zone (PPB = 55.13%; H = 0.173; I = 0.262). Thus, our data indicate that the ISSR marker has been successfully employed for evaluating the genetic diversity of Nepalese acid lime cultivars and has furnished valuable information on intrinsic genetic diversity and the relationship between cultivars that might be useful in acid lime breeding and conservation programs in Nepal.
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Affiliation(s)
- Nabin Narayan Munankarmi
- Central Department of Biotechnology, Tribhuvan University (CDBt-TU), GPO Box 44613, Kirtipur, Kathmandu, Nepal.
- Molecular Biotechnology Unit, Faculty of Science, Nepal Academy of Science and Technology (NAST), GPO Box 3323, Khumaltar, Lalitpur, Nepal.
| | - Neesha Rana
- Molecular Biotechnology Unit, Faculty of Science, Nepal Academy of Science and Technology (NAST), GPO Box 3323, Khumaltar, Lalitpur, Nepal.
| | - Tribikram Bhattarai
- Central Department of Biotechnology, Tribhuvan University (CDBt-TU), GPO Box 44613, Kirtipur, Kathmandu, Nepal.
| | - Ram Lal Shrestha
- Nepal Agriculture Research Council (NARC), GPO Box 5459, Khumaltar, Lalitpur, Nepal.
| | - Bal Krishna Joshi
- Nepal Agriculture Research Council (NARC), GPO Box 5459, Khumaltar, Lalitpur, Nepal.
| | - Bikash Baral
- Department of Biochemistry, University of Turku, FIN-20014 Turku, Finland.
| | - Sangita Shrestha
- Molecular Biotechnology Unit, Faculty of Science, Nepal Academy of Science and Technology (NAST), GPO Box 3323, Khumaltar, Lalitpur, Nepal.
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Shen J, Zhang X. Potassium Citrate is Better in Reducing Salt and Increasing Urine pH than Oral Intake of Lemonade: A Cross-Over Study. Med Sci Monit 2018; 24:1924-1929. [PMID: 29605825 PMCID: PMC5894568 DOI: 10.12659/msm.909319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Urine solute supersaturation leads to the formation of urinary tract caliceal stones. Many parameters can be involved in the supersaturation of solutes in urine, such as pH. Uric acid has pKa ≤5.5, and it is solubilized at pH ≥5.5. The objective of the study was to evaluate the effects of potassium citrate and lemonade supplementation in pediatric patients with urolithiasis. MATERIAL AND METHODS A total of 126 children who had lower ureteral stones calculi and fragments with severe colic pain participated in this cross-over study. Children drank lemonade (2 mEq/kg/day citrate) in 3 divided doses for 5 days. After a 15-day washout period, children drank 2 mEq/kg/day of potassium citrate in 3 divided doses for 5 days. On the sixth of the day of individual intervention, a 24-h urine sample was collected and evaluated for pH, urine volume, citrate level, uric acid level, magnesium, phosphorus, potassium, and sodium. Urinary parameters for 1-day urine collection measurements after each supplementation were compared with baseline using the Mann-Whitney test following Tukey post hoc test at 95% confidence level. RESULTS Potassium citrate supplementation resulted in reduction of sodium concentration (p=0.0337; q=3.76) and increased pH of urine (p=0.0118; q=4.389). However, urine volume, citrate level, and uric acid level, as well as elemental magnesium, phosphorus, and potassium, remained unchanged after 5 days of supplementation with potassium citrate or lemonade. CONCLUSIONS Potassium citrate supplementation is an effective therapy for preventing pediatric urolithiasis, with acceptable adverse effects.
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Affiliation(s)
- Jing Shen
- Department of Pediatric Surgery, Hangzhou Amcare Women's and Children's Hospital, Hangzhou, Zhejiang, China (mainland)
| | - Xicheng Zhang
- Department of Internal Medicine, The First People's Hospital of Tongxiang, Tongxiang, Zhejiang, China (mainland)
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Mehmood A, Zhao L, Wang C, Nadeem M, Raza A, Ali N, Shah AA. Management of hyperuricemia through dietary polyphenols as a natural medicament: A comprehensive review. Crit Rev Food Sci Nutr 2017; 59:1433-1455. [PMID: 29278921 DOI: 10.1080/10408398.2017.1412939] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hyperuricemia, a condition due to high serum uric acid level and is notorious to health. It is considered to be a potent risk factor for gout and dramatically associated in the development of many chronic diseases such as malignant tumor, cardiovascular disorders and renal failure. Modern innovative medicinal and therapeutic interventions are underlying these days to combat hyperuricemia. Previously reported studies revealed the significant impact of dietary polyphenols (e.g. anthocyanins, phenolic acids, flavonoids etc.) against hyperurecemia disorder. Dietary plant polyphenols, unlike anti- hyperuricemic agents, are not reported to have any side effects in curing hyperuricemia. The current comprehensive review figure outs the use of dietary polyphenols as a natural remedy for the management of hyperuricemia. The sources, affiliated pathways, mode of actions and factors affecting their efficiency to prevent hyperuricemia are deeply discussed in this article. Additionally, limitations and suggestions regarding previously reported studies are also highlighted.
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Affiliation(s)
- Arshad Mehmood
- a Beijing Advance Innovation Center for Food Nutrition and Human Health , Beijing Technology and Business University , Beijing , China.,b Beijing Engineering and Technology Research Center of Food Additives , School of Food and Chemical Engineering, Beijing Technology and Business University , Beijing , China.,c Institute of Food Science and Nutrition, University of Sargodha , Sargodha , Pakistan
| | - Lei Zhao
- a Beijing Advance Innovation Center for Food Nutrition and Human Health , Beijing Technology and Business University , Beijing , China.,b Beijing Engineering and Technology Research Center of Food Additives , School of Food and Chemical Engineering, Beijing Technology and Business University , Beijing , China
| | - Chengtao Wang
- a Beijing Advance Innovation Center for Food Nutrition and Human Health , Beijing Technology and Business University , Beijing , China.,b Beijing Engineering and Technology Research Center of Food Additives , School of Food and Chemical Engineering, Beijing Technology and Business University , Beijing , China
| | - Muhammad Nadeem
- c Institute of Food Science and Nutrition, University of Sargodha , Sargodha , Pakistan
| | - Ali Raza
- a Beijing Advance Innovation Center for Food Nutrition and Human Health , Beijing Technology and Business University , Beijing , China.,b Beijing Engineering and Technology Research Center of Food Additives , School of Food and Chemical Engineering, Beijing Technology and Business University , Beijing , China
| | - Nawazish Ali
- a Beijing Advance Innovation Center for Food Nutrition and Human Health , Beijing Technology and Business University , Beijing , China.,b Beijing Engineering and Technology Research Center of Food Additives , School of Food and Chemical Engineering, Beijing Technology and Business University , Beijing , China
| | - Amjad Abbas Shah
- c Institute of Food Science and Nutrition, University of Sargodha , Sargodha , Pakistan
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Rahman F, Birowo P, Widyahening IS, Rasyid N. Effect of citrus-based products on urine profile: A systematic review and meta-analysis. F1000Res 2017; 6:220. [PMID: 28529700 PMCID: PMC5428529 DOI: 10.12688/f1000research.10976.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/26/2022] Open
Abstract
Background. Urolithiasis is a disease with high recurrence rate, 30-50% within 5 years. The aim of the present study was to learn the effects of citrus-based products on the urine profile in healthy persons and people with urolithiasis compared to control diet and potassium citrate. Methods. A systematic review was performed, which included interventional, prospective observational and retrospective studies, comparing citrus-based therapy with standard diet therapy, mineral water, or potassium citrate. A literature search was conducted using PUBMED, COCHRANE, and Google Scholar with "citrus or lemonade or orange or grapefruit or lime or juice" and "urolithiasis" as search terms. For statistical analysis, a fixed-effects model was conducted when p > 0.05, and random-effects model was conducted when p < 0.05. Results. In total, 135 citations were found through database searching with 10 studies found to be consistent with our selection criteria. However, only 8 studies were included in quantitative analysis, due to data availability. The present study showed a higher increased in urine pH for citrus-based products (mean difference, 0.16; 95% CI 0.01-0.32) and urinary citrate (mean difference, 124.49; 95% CI 80.24-168.74) compared with a control group. However, no differences were found in urine volume, urinary calcium, urinary oxalate, and urinary uric acid. From subgroup analysis, we found that citrus-based products consistently increased urinary citrate level higher than controls in both healthy and urolithiasis populations. Furthermore, there was lower urinary calcium level among people with urolithiasis. Conclusions. Citrus-based products could increase urinary citrate level significantly higher than control. These results should encourage further research to explore citrus-based products as a urolithiasis treatment.
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Affiliation(s)
- Fakhri Rahman
- Department of Urology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia
| | - Indah S. Widyahening
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10310, Indonesia
- Centre for Clinical Epidemiology & Evidence-based Medicine, Dr. Cipto Mangunkusumo National General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, 10430, Indonesia
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Epidemiology of stone disease across the world. World J Urol 2017; 35:1301-1320. [PMID: 28213860 DOI: 10.1007/s00345-017-2008-6] [Citation(s) in RCA: 563] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/24/2017] [Indexed: 01/20/2023] Open
Abstract
Nephrolithiasis is a highly prevalent disease worldwide with rates ranging from 7 to 13% in North America, 5-9% in Europe, and 1-5% in Asia. Due to high rates of new and recurrent stones, management of stones is expensive and the disease has a high level of acute and chronic morbidity. The goal of this study is to review the epidemiology of stone disease in order to improve patient care. A review of the literature was conducted through a search on Pubmed®, Medline®, and Google Scholar®. This review was presented and peer-reviewed at the 3rd International Consultation on Stone Disease during the 2014 Société Internationale d'Urologie Congress in Glasgow. It represents an update of the 2008 consensus document based on expert opinion of the most relevant studies. There has been a rising incidence in stone disease throughout the world with a narrowing of the gender gap. Increased stone prevalence has been attributed to population growth and increases in obesity and diabetes. General dietary recommendations of increased fluid, decreased salt, and moderate intake of protein have not changed. However, specific recommended values have either changed or are more frequently reported. Geography and environment influenced the likelihood of stone disease and more information is needed regarding stone disease in a large portion of the world including Asia and Africa. Randomized controlled studies are lacking but are necessary to improve recommendations regarding diet and fluid intake. Understanding the impact of associated conditions that are rapidly increasing will improve the prevention of stone disease.
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Can the manipulation of urinary pH by beverages assist with the prevention of stone recurrence? Urolithiasis 2015; 44:51-6. [PMID: 26614113 DOI: 10.1007/s00240-015-0844-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
The formation of various types of stones in the urinary tract is strongly influenced by urinary pH. An acidic urinary pH promotes the crystallization of uric acid and cystine, respectively. Moreover, changes in systemic acid-base homeostasis alter urinary excretion of citrate, an important inhibitor of calcium oxalate stone formation. The effect of beverages on urinary pH and citrate excretion is mainly determined by the presence of bicarbonate and citrate. The bicarbonate content of mineral water can replace alkalization therapy with potassium citrate and contribute to urine inhibitory power by increasing urinary pH and citrate excretion. Citrus juices are rich sources of citrate. Oral citrate is absorbed in the intestine and nearly completely metabolized to bicarbonate, providing an alkali load, which in turn increases urinary pH and citrate excretion. However, data from observational and interventional studies on the effect of different types of citrus juices on the risk of urinary stone formation are conflicting. In conclusion, favourable changes in urinary pH and citrate excretion can be attained by various beverages. However, the long-term efficacy of certain beverages for the recurrence prevention of different types of stones has yet to be determined.
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Phillips R, Hanchanale VS, Myatt A, Somani B, Nabi G, Biyani CS, Cochrane Kidney and Transplant Group. Citrate salts for preventing and treating calcium containing kidney stones in adults. Cochrane Database Syst Rev 2015; 2015:CD010057. [PMID: 26439475 PMCID: PMC9578669 DOI: 10.1002/14651858.cd010057.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Kidney stones affect people worldwide and have a high rate of recurrence even with treatment. Recurrences are particularly prevalent in people with low urinary citrate levels. These people have a higher incidence of calcium phosphate and calcium oxalate stones. Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation. Despite the widespread use of oral citrate therapy for prevention and treatment of calcium oxalate stones, the evidence to support its clinical efficacy remains uncertain. OBJECTIVES The objective of this review was to determine the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones. SEARCH METHODS We searched the Cochrane Kidney and Transplant Specialised Register to 29 July 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed the efficacy and adverse events associated with citrate salts for the treatment and prevention of calcium containing kidney stones in adults treated for a minimum of six months. DATA COLLECTION AND ANALYSIS Two authors assessed studies for inclusion in this review. Data were extracted according to predetermined criteria. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. MAIN RESULTS We included seven studies that included a total of 477 participants, most of whom had oxalate stones. Of these, three studies (247 participants) compared potassium citrate with placebo or no intervention; three (166 participants) compared potassium-sodium citrate with no intervention; and one (64 participants) compared potassium-magnesium citrate with placebo. Overall, quality of the reporting of the included studies was considered moderate to poor, and there was a high risk of attrition bias in two studies.Compared with placebo or no intervention, citrate therapy significantly reduced the stone size (4 studies, 160 participants: RR 2.35, 95% CI 1.36 to 4.05). New stone formation was significantly lower with citrate therapy compared to control (7 studies, 324 participants: RR 0.26, 95% CI 0.10 to 0.68). The beneficial effect on stone size stability was also evident (4 studies, 160 participants: RR 1.97, 95% CI 1.19 to 3.26). Adverse events were reported in four studies, with the main side effects being upper gastrointestinal disturbance and one patient reported a rash. There were more gastrointestinal adverse events in the citrate group; however this was not significant (4 studies, 271 participants: RR 2.55, 95% CI 0.71 to 9.16). There were significantly more dropouts due to adverse events with citrate therapy compared to control (4 studies, 271 participants: RR 4.45, 95% CI 1.28 to 15.50). The need for retreatment was significantly less with citrate therapy compared to control (2 studies, 157 participants: RR 0.22, 95% CI 0.06 to 0.89). AUTHORS' CONCLUSIONS Citrate salts prevent new stone formation and reduce further stone growth in patients with residual stones that predominantly contain oxalate. The quality of reported literature remains moderate to poor; hence a well-designed statistically powered multi-centre RCT is needed in order to answer relevant questions concerning the efficacy of citrate salts.
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Affiliation(s)
- Rebecca Phillips
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill HospitalDepartment of UrologyCastle RdCottinghamUKHU16 5JQ
| | | | - Andy Myatt
- Hull and East Yorkshire Hospitals NHS Trust, Castle Hill HospitalDepartment of UrologyCastle RdCottinghamUKHU16 5JQ
| | - Bhaskar Somani
- University Hospitals Southampton NHS TrustDepartment of UrologySouthamptonUK
| | - Ghulam Nabi
- University of DundeeSection of Academic Urology, Division of Imaging and TechnologyDundeeScotlandUKDD1 9SY
| | - C Shekhar Biyani
- St James's University HospitalDepartment of UrologyLeedsUKLS9 7TF
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Escribano J, Balaguer A, Roqué i Figuls M, Feliu A, Ferre N, Cochrane Kidney and Transplant Group. Dietary interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev 2014; 2014:CD006022. [PMID: 24519664 PMCID: PMC10660327 DOI: 10.1002/14651858.cd006022.pub4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Idiopathic hypercalciuria is an inherited metabolic abnormality that is characterised by excessive amounts of calcium excreted in the urine by people whose calcium serum levels are normal. Morbidity associated with idiopathic hypercalciuria is chiefly related to kidney stone disease and bone demineralisation leading to osteopenia and osteoporosis. Idiopathic hypercalciuria contributes to kidney stone disease at all life stages; people with the condition are prone to developing oxalate and calcium phosphate kidney stones. In some cases, crystallised calcium can be deposited in the renal interstitium, causing increased calcium levels in the kidneys. In children, idiopathic hypercalciuria can cause a range of comorbidities including recurrent macroscopic or microscopic haematuria, frequency dysuria syndrome, urinary tract infections and abdominal and lumbar pain. Various dietary interventions have been described that aim to decrease urinary calcium levels or urinary crystallisation. OBJECTIVES Our objectives were to assess the efficacy, effectiveness and safety of dietary interventions for preventing complications in idiopathic hypercalciuria (urolithiasis and osteopenia) in adults and children, and to assess the benefits of dietary interventions in decreasing urological symptomatology in children with idiopathic hypercalciuria. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register (23 April 2013) through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. SELECTION CRITERIA We included all randomised controlled trials (RCTs) and quasi-RCTs that investigated dietary interventions aimed at preventing complications of idiopathic hypercalciuria, compared with placebo, no intervention, or other dietary interventions regardless of route of administration, dose or amount. DATA COLLECTION AND ANALYSIS Studies were assessed for inclusion and data extracted using a standardised data extraction form. We calculated risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI). MAIN RESULTS We included five studies (379 adult participants) that investigated a range of interventions. Lack of similarity among interventions investigated meant that data could not be pooled. Overall, study methodology was not adequately reported in any of the included studies. There was a high risk of bias associated with blinding (although it seems unlikely that outcomes measures were unduly influenced by lack of intervention blinding), random sequence generation and allocation methodologies were unclear in most studies, but selective reporting bias was assessed as low.One study (120 participants) compared a low calcium diet with a normal calcium, low protein, low salt diet for five years. There was a significant decrease in numbers of new stone recurrences in those treated with the normal calcium, low protein, low salt diet (RR 0.77, 95% CI 0.61 to 0.98). This diet also led to a significant decrease in oxaluria (MD 78.00 µmol/d, 95% CI 26.48 to 129.52) and the calcium oxalate relative supersaturation index (MD 1.20 95% CI 0.21 to 2.19).One study (210 participants) compared a low salt, normal calcium diet with a broad diet for three months. The low salt, normal calcium diet decreased urinary calcium (MD -45.00 mg/d, 95% CI -74.83 to -15.17) and oxalate excretion (MD -4.00 mg/d, 95% CI -6.44 to -1.56).A small study (17 participants) compared the effect of dietary fibre as part of a low calcium, low oxalate diet over three weeks, and found that although calciuria levels decreased, oxaluria increased. Phyllanthus niruri plant substrate intake was investigated in a small subgroup with hypercalciuria (20 participants); there was no significant effect on calciuria levels occurred after three months of treatment.A small cross-over study (12 participants) evaluating the changes in urinary supersaturation indices among patients who consumed calcium-fortified orange juice or milk for one month found no benefits for participants.None of the studies reported any significant adverse effects associated with the interventions. AUTHORS' CONCLUSIONS Long-term adherence (five years) to diets that feature normal levels of calcium, low protein and low salt may reduce numbers of stone recurrences, decrease oxaluria and calcium oxalate relative supersaturation indexes in people with idiopathic hypercalciuria who experience recurrent kidney stones. Adherence to a low salt, normal calcium level diet for some months can reduce calciuria and oxaluria. However, the other dietary interventions examined did not demonstrate evidence of significant beneficial effects.No studies were found investigating the effect of dietary recommendations on other clinical complications or asymptomatic idiopathic hypercalciuria.
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Affiliation(s)
- Joaquin Escribano
- Hospital Universitari St Joan de ReusDepartment of PediatricsUniversitat Rovira i VirgiliSt Joan s/nReusCataloniaSpain43201
| | - Albert Balaguer
- Universitat Internacional de CatalunyaDepartment of Pediatrics. Hospital General de Catalunya.C/ Pedro I Pons, 1Sant Cugat de VallésBarcelonaCATALONIASpain08195
| | - Marta Roqué i Figuls
- CIBER Epidemiología y Salud Pública (CIBERESP)Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau)Sant Antoni Maria Claret 171Edifici Casa de ConvalescènciaBarcelonaCatalunyaSpain08041
| | - Albert Feliu
- Hospital Universitari St Joan de ReusDepartment of PediatricsUniversitat Rovira i VirgiliSt Joan s/nReusCataloniaSpain43201
| | - Natalia Ferre
- Universitat Rovira i VirgiliPediatric Research Unit, School of MedicineSant Lloreç, 21TarragonaSpain43201
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Rodgers AL, Webber D, de Charmoy R, Jackson GE, Ravenscroft N. Malic acid supplementation increases urinary citrate excretion and urinary pH: implications for the potential treatment of calcium oxalate stone disease. J Endourol 2013; 28:229-36. [PMID: 24059642 DOI: 10.1089/end.2013.0477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Raising urinary pH and citrate excretion with alkali citrate therapy has been a widely used treatment in calcium nephrolithiasis. Citrate lowers ionized Ca(+2) concentrations and inhibits calcium salt precipitation. Conservative alternatives containing citrate such as fruit juices have been investigated and recommended. Any compound that induces systemic alkalosis will increase citraturia. Malate, a polycarboxylic anion like citrate, is a potential candidate for chelating Ca(+2) and for inducing systemic alkalinization. We undertook to investigate these possibilities. MATERIALS AND METHODS Theoretical modeling of malic acid's effects on urinary Ca(+2) concentration and supersaturation (SS) of calcium salts was achieved using the speciation program JESS. Malic acid (1200 mg/day) was ingested for 7 days by eight healthy subjects. Urines (24 hours) were collected at baseline and on day 7. They were analyzed for routine lithogenic components, including pH and citrate. Chemical speciation and SS were calculated in both urines. RESULTS Modeling showed that complexation between calcium and malate at physiological concentrations of the latter would have no effect on SS. Administration of the supplement induced statistically significant increases in pH and citraturia. The calculated concentration of Ca(+2) and concomitant SS calcium oxalate (CaOx) decreased after supplementation, but these were not statistically significant. SS for the calcium phosphate salts hydroxyapatite and tricalcium phosphate increased significantly as a consequence of the elevation in pH, but values for brushite and octacalcium phosphate did not change significantly. CONCLUSIONS We speculate that consumption of malic acid induced systemic alkalinization leading to reduced renal tubular reabsorption and metabolism of citrate, and an increase in excretion of the latter. The decrease in SS(CaOx) was caused by enhanced complexation of Ca(+2) by citrate. We conclude that malic acid supplementation may be useful for conservative treatment of calcium renal stone disease by virtue of its capacity to induce these effects.
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Affiliation(s)
- Allen L Rodgers
- Department of Chemistry, University of Cape Town , Cape Town, South Africa
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Ho CY, Chen YH, Wu PY, Chang CH, Chen HY, Man KM, Shen JL, Tsai FJ, Lin WY, Lee YJ, Chen WC. Effects of commercial citrate-containing juices on urolithiasis in a Drosophila model. Kaohsiung J Med Sci 2013; 29:488-93. [DOI: 10.1016/j.kjms.2013.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 08/10/2012] [Indexed: 11/28/2022] Open
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Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Adv Chronic Kidney Dis 2013; 20:165-74. [PMID: 23439376 DOI: 10.1053/j.ackd.2012.12.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 11/15/2012] [Accepted: 12/05/2012] [Indexed: 12/18/2022]
Abstract
We summarize the data regarding the associations of individual dietary components with kidney stones and the effects on 24-hour urinary profiles. The therapeutic recommendations for stone prevention that result from these studies are applied where possible to stones of specific composition. Idiopathic calcium oxalate stone-formers are advised to reduce ingestion of animal protein, oxalate, and sodium while maintaining intake of 800 to 1200 mg of calcium and increasing consumption of citrate and potassium. There are few data regarding dietary therapy of calcium phosphate stones. Whether the inhibitory effect of citrate sufficiently counteracts increasing urine pH to justify more intake of potassium and citrate is not clear. Reduction of sodium intake to decrease urinary calcium excretion would also be expected to decrease calcium phosphate stone recurrence. Conversely, the most important urine variable in the causation of uric acid stones is low urine pH, linked to insulin resistance as a component of obesity and the metabolic syndrome. The mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion. For cystine stones, restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine. Reduction of urine sodium results in less urine cystine. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones because the amino acid cystine is soluble in more alkaline urine. Because of their infectious origin, diet has no definitive role for struvite stones except for avoiding urinary alkalinization, which may worsen their development.
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Baia LDC, Baxmann AC, Moreira SR, Holmes RP, Heilberg IP. Noncitrus alkaline fruit: a dietary alternative for the treatment of hypocitraturic stone formers. J Endourol 2012; 26:1221-6. [PMID: 22500592 DOI: 10.1089/end.2012.0092] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Fruits and vegetables are natural suppliers of potassium, bicarbonate, or bicarbonate precursors such as citrate, malate and others-hence, possessing potential effects on citraturia. We aimed to compare the acute effects of a noncitrus (melon) fruit vs citric ones (orange and lime) on citraturia and other lithogenic parameters. PATIENTS AND METHODS Two-hour urine samples were collected from 30 hypocitraturic stone-forming patients after an overnight fast and 2, 4, and 6 hours after the consumption of 385 mL (13 oz) of either freshly squeezed orange juice (n=10), freshly blended melon juice (n=10), or freshly squeezed lime juice (n=10). Urinary citrate, potassium, pH, and other lithogenic parameters were determined and net gastrointestinal alkali absorption (NGIA) was calculated. Potential renal acid load (PRAL) and pH from juices were determined. RESULTS Significant and comparable increases of mean urinary citrate were observed in all groups, whereas mean urinary potassium, pH, and NGIA were significantly increased only after consumption of melon and orange juices. The pH of melon juice was higher and the PRAL value was more negative compared with orange juice, indicating a higher alkalinity. CONCLUSIONS These findings suggested that melon, a noncitrus source of potassium, citrate, and malate, yielded an increase in urinary citrate excretion equivalent to that provided by orange, and hence represents another dietary alternative for the treatment of hypocitraturic stone-formers. Despite its low potassium content, lime also produced comparable increases in citraturia possibly because of its high citric acid content.
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Olweny EO, Pearle MS. Citrate Therapy for Calcium and Uric Acid Stones. Urolithiasis 2012. [DOI: 10.1007/978-1-4471-4387-1_89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Agarwal MM, Singh SK, Mavuduru R, Mandal AK. Preventive fluid and dietary therapy for urolithiasis: An appraisal of strength, controversies and lacunae of current literature. Indian J Urol 2011; 27:310-9. [PMID: 22022052 PMCID: PMC3193729 DOI: 10.4103/0970-1591.85423] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Regulation of fluid and dietary intake habits is essential in comprehensive preventive management of urolithiasis. However, despite large body of epidemiological database, there is dearth of good quality prospective interventional studies in this regard. Often there is conflict in pathophysiological basis and actual clinical outcome. We describe conflicts, controversies and lacunae in current literature in fluid and dietary modifications in prevention of urolithiasis. Adequate fluid intake is the most important conservative strategy in urolithiasis-prevention; its positive effects are seen even at low volumes. Of the citrus, orange provides the most favorable pH changes in the urine, equivalent to therapeutic alkaline citrates. Despite being richest source of citrate, lemon does not increase pH significant due to its acidic nature. Fructose, animal proteins and fats are implicated in contributing to obesity, which is an established risk factor for urolithiasis. Fructose and proteins also contribute to lithogenecity of urine directly. Sodium restriction is commonly advised since natriuresis is associated with calciuresis. Calcium restriction is not advisable for urolithiasis prevention. Adequate calcium intake is beneficial if taken with food since it reduces absorption of dietary oxalate. Increasing dietary fiber does not protect against urolithiasis. Evidence for pyridoxine and magnesium is not robust. There is no prospective interventional study evaluating effect of many dietary elements, including citrus juices, carbohydrate, fat, dietary fiber, sodium, etc. Due to lack of good-quality prospective interventional trials it is essential to test the findings of pathophysiological understanding and epidemiological evidence. Role of probiotics and phytoceuticals needs special attention for future research.
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Affiliation(s)
- Mayank Mohan Agarwal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kurtz MP, Eisner BH. Dietary therapy for patients with hypocitraturic nephrolithiasis. Nat Rev Urol 2011; 8:146-52. [PMID: 21321574 DOI: 10.1038/nrurol.2011.9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Citrate is an inhibitor of urinary stone formation. Clinical and in vitro data suggest that increasing urine citrate levels will decrease the precipitation of calcium stones. Historically, low urinary citrate has been treated with oral potassium citrate or sodium citrate supplementation, but recent studies have shown the potential of dietary interventions to raise urine citrate levels. Dietary therapy with commercial or homemade beverages is attractive to patients who would prefer nonpharmacological intervention. To date, several drinks have shown promise but no single beverage has been found to consistently raise urine citrate levels in a reproducible fashion. Further research is necessary to develop the ideal dietary therapy for hypocitraturic calcium nephrolithiasis.
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Affiliation(s)
- Michael P Kurtz
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Yilmaz E, Batislam E, Kacmaz M, Erguder I. Citrate, oxalate, sodium, and magnesium levels in fresh juices of three different types of tomatoes: evaluation in the light of the results of studies on orange and lemon juices. Int J Food Sci Nutr 2010; 61:339-45. [PMID: 20113185 DOI: 10.3109/09637480903405570] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fruit and vegetable juices containing citrate may be recommended as an alternative in mild to moderate level hypocitraturic calcium stone formers who cannot tolerate pharmacological treatment. Tomato has been proved a citrate-rich vegetable. Tomato juice usage as citrate sources in hypocitraturic recurrent stone formers were evaluated in the light of the results of studies on orange and lemon juices. Ten 100 ml samples were prepared from three different tomato types processed through a blender. These samples were examined in terms of citrate, oxalate, calcium, magnesium, and sodium contents. No difference was detected between the parameters tested in three different tomato juices. Fresh tomato juice may be useful in hypocitraturic recurrent stone formers due to its high content of citrate and magnesium, and low content of sodium and oxalate. As the three different types of tomatoes did not differ in terms of citrate, magnesium, sodium, and oxalate content, they may be useful for clinical use if also supported by clinical studies.
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Affiliation(s)
- Erdal Yilmaz
- Department of Urology, Faculty of Medicine, University of Kirikkale, Turkey.
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Eisner BH, Asplin JR, Goldfarb DS, Ahmad A, Stoller ML. Citrate, malate and alkali content in commonly consumed diet sodas: implications for nephrolithiasis treatment. J Urol 2010; 183:2419-23. [PMID: 20403610 DOI: 10.1016/j.juro.2010.02.2388] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE Citrate is a known inhibitor of calcium stone formation. Dietary citrate and alkali intake may have an effect on citraturia. Increasing alkali intake also increases urine pH, which can help prevent uric acid stones. We determined citrate, malate and total alkali concentrations in commonly consumed diet sodas to help direct dietary recommendations in patients with hypocitraturic calcium or uric acid nephrolithiasis. MATERIALS AND METHODS Citrate and malate were measured in a lemonade beverage commonly used to treat hypocitraturic calcium nephrolithiasis and in 15 diet sodas. Anions were measured by ion chromatography. The pH of each beverage was measured to allow calculation of the unprotonated anion concentration using the known pK of citric and malic acid. Total alkali equivalents were calculated for each beverage. Statistical analysis was done using Pearson's correlation coefficient. RESULTS Several sodas contained an amount of citrate equal to or greater than that of alkali and total alkali as a lemonade beverage commonly used to treat hypocitraturic calcium nephrolithiasis (6.30 mEq/l citrate as alkali and 6.30 as total alkali). These sodas were Diet Sunkist Orange, Diet 7Up, Sprite Zero, Diet Canada Dry Ginger Ale, Sierra Mist Free, Diet Orange Crush, Fresca and Diet Mountain Dew. Colas, including Caffeine Free Diet Coke, Coke Zero, Caffeine Free Diet Pepsi and Diet Coke with Lime, had the lowest total alkali (less than 1.0 mEq/l). There was no significant correlation between beverage pH and total alkali content. CONCLUSIONS Several commonly consumed diet sodas contain moderate amounts of citrate as alkali and total alkali. This information is helpful for dietary recommendations in patients with calcium nephrolithiasis, specifically those with hypocitraturia. It may also be useful in patients with low urine pH and uric acid stones. Beverage malate content is also important since malate ingestion increases the total alkali delivered, which in turn augments citraturia and increases urine pH.
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Affiliation(s)
- Brian H Eisner
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.
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