Salubrious Effect of Vitamin E Supplementation on Renal Stone Forming Risk Factors in Urogenital Tuberculosis Patients

Abstract

The incidence of renal calculi has been evaluated to be 25% in urogenital tuberculosis patients. The stone could be caused due to the host, the pathogenic organism, or possibly by the treatment. Studies were carried out to find out the efficacy of vitamin E supplementation in reducing the risk of stone formation in renal tuberculosis patients. The study constituted four groups, Group I with 30 normal volunteers, the second group comprised of 36 renal tuberculosis patients (GuTb) a day before treatment. Third group comprised of 24 patients with regular anti tuberculosis drug regimen for sixty days. In the fourth group, 12 patients were treated with anti tuberculosis drug regimen along with supplementation of antioxidant vitamin E (200 mg/day) for sixty days. Hyperuricosuria and hypercalciuria were observed in group II and group III patients, along with increased excretion of oxalate and creatinine, accompanied by decreased excretion of inhibitors such as citrate and glycosaminoglycans (GAGs). Renal damage was evident with increased leakage of Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP) and gamma-Glutamyl transferase (gamma-GT) in renal tuberculosis patients. From the results of the above study, it is obvious that increased urinary oxalate levels leads to cellular damage in GuTb patients, which is a prerequisite for crystal retention as revealed by the elevated urinary marker enzymes. Antioxidant therapy prevents membrane injury thereby reducing the risk of stone formation. Hence vitamin E supplementation has a salubrious effect in preventing stone forming tendency with routine anti tuberculosis drug regimen.

Effects of vitamin E ingestion on plasma and urinary risk factors for calcium oxalate urolithiasis in two population groups having different stone-risk profiles: evidence of different physiological handling mechanisms

“…Elevated levels of this antioxidant are associated with the prevention of membrane injury and consequently, the risk of stone formation [22]. Our observation of a favourable increase in the level of plasma a-tocopherol in the white group is in agreement with previous studies that have shown enhancement of plasma antioxidant status following vitamin E ingestion [14,22].…”

“…However, our observation that urinary calcium and oxalate did not change after vitamin E supplementation is in contrast with other studies. A reduction in these parameters has been reported in hyperoxaluric kidney stone patients (298 IU, 90 days) [11] and in urogenital tuberculosis patients (298 IU, 60 days) [14,22] following ingestion of vitamin E. In another study on the effect of vitamins C and E on biomarkers of oxidative stress, the authors [51] demonstrated that baseline values are important when determining whether decreases per se have occurred or not. They commented that values are only likely to decrease if they are not already low.…”

“…Subjects were instructed to ingest one vitamin E capsule (DL-a-tocopheryl acetate, 400 IU) [Vitalfarm (Pty) Ltd, Cape Town, South Africa] per day immediately after their evening meal for 60 days [14,20,22]. We selected this dosage as previous studies using similar levels have detected effects on plasma and urinary risk factors [11,14,22,23].…”

“…We selected this dosage as previous studies using similar levels have detected effects on plasma and urinary risk factors [11,14,22,23]. The duration of the trial was based on two previous scientific studies that investigated the effect of vitamin E (200 mg, 298 IU) on renal stone risk factors in urogenital tuberculosis patients [14,22].…”

“…It has been recommended that at least one of the biomarkers (TBARS, MDA or isoprostanes) be determined when evaluating oxidative stress in humans and its association with disease [29]. Plasma vitamin E has been used as an additional measure [14,22]. In the present study, we determined urinary and plasma TBARS (MDA equivalents) using a spectrophotometric method (Spectronic Unicam Helios, Cambridge, England) based on a commercially available assay kit (OXI-TEK TBARS assay kit, Zeptometrix, Buffalo, New York), while plasma vitamin E was measured using reverse phase HPLC [30].…”