Citraturic, alkalinizing and antioxidative effects of limeade-based regimen in nephrolithiasis patients

Tosukhowong, Piyaratana; Yachantha, Chatchai; Sasivongsbhakdi, Thosaphol; Ratchanon, Supoj; Chaisawasdi, S.; Boonla, Chanchai; Tungsanga, Kriang

doi:10.1007/s00240-008-0141-9

Cited by 39 publications

(35 citation statements)

References 24 publications

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“…In renal stone formers a solution containing lime powder significantly increased urine citrate, potassium, and pH (Tosukhowong et al 2008 experimental M) (20).…”

Section: Lime Juicementioning

confidence: 99%

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Prezioso

Strazzullo

Lotti

et al. 2015

Arch Ital Urol Androl

159

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Objective: Diet interventions may reduce the risk of urinary stone formation and its recurrence, but there is no conclusive consensus in the literature regarding the effectiveness of dietary interventions and recommendations about specific diets for patients with urinary calculi. The aim of this study was to review the studies reporting the effects of different dietary interventions for the modification of urinary risk factors in patients with urinary stone disease. Materials and Methods: A systematic search of the Pubmed database literature up to July 1, 2014 for studies on dietary treatment of urinary risk factors for urinary stone formation was conducted according to a methodology developed a priori. Studies were screened by titles and abstracts for eligibility. Data were extracted using a standardized form and the quality of evidence was assessed. Results: Evidence from the selected studies were used to form evidencebased guideline statements. In the absence of sufficient evidence, additional statements were developed as expert opinions. Conclusions: General measures: Each patient with nephrolithiasis should undertake appropriate evaluation according to the knowledge of the calculus composition. Regardless of the underlying cause of the stone disease, a mainstay of conservative management is the forced increase in fluid intake to achieve a daily urine output of 2 liters. Hypercalciuria: Dietary calcium restriction is not recommended for stone formers with nephrolithiasis. Diets with a calcium content ≥ 1 g/day (and low protein-low sodium) could be protective against the risk of stone formation in hypercalciuric stone forming adults. Moderate dietary salt restriction is useful in limiting urinary calcium excretion and thus may be helpful for primary and secondary prevention of nephrolithiasis. A low-normal protein intake decrease calciuria and could be useful in stone prevention and preservation of bone mass. Omega-3 fatty acids and bran of different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. Hyperoxaluria: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. Hyperuricosuria: In patients with renal calcium stones SummaryNo conflict of interest declared. DOI: 10.4081/aiua.2015.2.105the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not cle...

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“…In renal stone formers a solution containing lime powder significantly increased urine citrate, potassium, and pH (Tosukhowong et al 2008 experimental M) (20).…”

Section: Lime Juicementioning

confidence: 99%

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Prezioso

Strazzullo

Lotti

et al. 2015

Arch Ital Urol Androl

159

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“…We have been investigated the clinical efficacy of lime juice and banana stem beverage as alternatives for UL treatment. We show that our inhouse limeade-based regimen, designated lime powder regimen (LPR), efficiently delivers citraturic, alkalinizing and antioxidative actions in nephrolithiasis patients [193]. Our preclinical and phase 1 clinical trial reveals that LPR inhibits COM crystal growth and attenuates oxidative stress in vitro and is capable of increasing urine citrate, pH and antioxidant capacity in healthy individuals [194].…”

Section: Oxidative Stress In Urolithiasismentioning

confidence: 92%

Oxidative Stress in Urolithiasis

Boonla¹

2018

Reactive Oxygen Species (ROS) in Living Cells

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Oxygen is absolutely essential for the survival of our life. However, metabolic consumption of oxygen inevitably yields reactive oxygen species (ROS). Imbalance of ROS production and antioxidant capacity causes oxidative stress that potentially damages biomolecules leading to cell injury and death. In fact, ROS have two-faceted functions. Under physiologic condition, ROS function as signaling molecules and participate in maintaining redox balance. In pathology, ROS induce oxidative stress that critically involves in the development of several diseases including urolithiasis (UL). UL or urinary stone disease is a common urologic condition in all countries with progressively increasing prevalence. Most of UL are multifactorial with polygenic susceptibility and highly recurrent nature. Formation of urinary stones is driven by supersaturation of urinary lithogenic ions, and calcium oxalate (CaOx) is the most prevalent stone type. Oxidative stress clearly plays an active role in UL development. In vitro, lithogenic crystals induce ROS generation in renal tubular cells leading to oxidative stress, cell injury and release of inflammatory mediators. In nephrolithic rats, oxidative stress and CaOx deposit are gradually increased in the rats' kidneys. Intervention with antioxidants efficiently reduces oxidative damage and crystal deposits. Human studies show that patients with UL have increased oxidative stress and renal tubular injury relative to the non-stone-forming individuals. Increased oxidative lesions and inflammation are observed in the stone-containing kidneys of the patients. Furthermore, renal fibrosis mediated through tubular epithelial-mesenchymal transition is observed in kidneys of stone patients. Increased renal fibrosis is significantly associated with decreased kidney function. From therapeutic point of view, nutraceutical regimens that are able to reduce oxidative stress may be clinically useful alternatives for preventing stone formation and recurrence. This chapter has an intention to provide a basic knowledge of ROS generation and oxidative stress and up-to-date research findings of oxidative stress in UL based on the published articles as well as the author's studies.

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“…According to literature, oral doses of potassium citrate drug for treating kidney stone patients range 20-80 mEq for potassium content, and 30-110 mEq for citrate content [16][17][18][19]. Based on our research experiences and study by Ettinger et al [16], we opted to use 21 mEq potassium and 63 mEq citrate for treating Thai kidney stone patients [15,20,21].…”

mentioning

confidence: 98%

“…Additionally, lemon juice efficiently inhibited the intrarenal deposit of calcium oxalate crystals in the ethylene glycol-induced urolithic rat model [14]. We preliminarily treated 13 nephrolithiasis patients with our in-house lime powder regimen (LPR), and demonstrated that LPR effectively delivered citraturic, urine alkalinizing, and antioxidative effects [15].…”

mentioning

confidence: 99%

“…The difference between lemon juice and lemonade is that lemon juice is fresh juice squeezed from lemons, but lemonade (usually commercially available) is added with water and sugar to make a flavored taste. On the other side, LPR is made from fresh lime juice, which is produced by our research group [15]. According to literature, oral doses of potassium citrate drug for treating kidney stone patients range 20-80 mEq for potassium content, and 30-110 mEq for citrate content [16][17][18][19].…”

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confidence: 99%

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In vitro anti-lithogenic activity of lime powder regimen (LPR) and the effect of LPR on urinary risk factors for kidney stone formation in healthy volunteers

et al. 2015

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Hypocitraturia, hypokaliuria, and increased oxidative stress are common lithogenic risk factors found in nephrolithiasis patients, especially in Thailand. We previously developed lime powder regimen (LPR), and demonstrated that LPR delivered citraturic, alkalinizing, and antioxidative effects in kidney stone patients. In this study, in vitro anti-lithogenic activity, in vivo acute toxicity, and crossover-designed phase 1 trial (in 13 healthy volunteers) of LPR were investigated. LPR inhibited the growth of calcium oxalate monohydrate (COM) crystals in dose-dependent manner, and inhibited the intracellular production of reactive oxygen species (ROS) in COM-treated HK-2 cells. LPR did not significantly alter viability of HK-2 cells. No acute toxicity was detected in mice orally fed with LPR (10 g/kg). No adverse effect and complaint of LPR ingestion (5 g/dose) were observed in the tested volunteers. Plasma citrate was elevated at 30 min after LPR load, which was higher than the water load control. Plasma potassium was significantly elevated at 30 min after LPR load and remained high for 2 h, and at 2 h, it was significantly higher than the water load. Urinary citrate was significantly increased at 1 h after LPR load and remained high for 2 h, and at 2 h, it was significantly higher than the water load. Urinary potassium was significantly increased at 1 h after LPR load and remained high for 3 h, and its levels at 1, 2, and 3 h were significantly higher than the water load. Urinary total antioxidant status was significantly increased at 2 h after LPR load. In conclusion, LPR had an inhibitory effect on COM growth and exerted as antioxidant to attenuate ROS production in the COM-treated renal tubular cells. LPR provided citraturic, kaliuric, and antioxidative responses in healthy individuals without any adverse events. This suggests that LPR is well tolerated and safe for daily consumption.

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Citraturic, alkalinizing and antioxidative effects of limeade-based regimen in nephrolithiasis patients

Cited by 39 publications

References 24 publications

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Oxidative Stress in Urolithiasis

In vitro anti-lithogenic activity of lime powder regimen (LPR) and the effect of LPR on urinary risk factors for kidney stone formation in healthy volunteers

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