The impact of potassium citrate therapy in the natural course of Medullary Sponge Kidney with associated nephrolithiasis

Cicerello, E.; Ciaccia, Matteo; Cova, Giandavide; Mangano, M.

doi:10.4081/aiua.2019.2.102

Cited by 9 publications

(9 citation statements)

References 10 publications

(14 reference statements)

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“…Stone composition shows that calcium oxalate is the main component of 76.2% of stones in males and 51.7% in females. Among crystalline phases, weddellite, which can be considered as a calciumdependent species [27][28][29][30] appears to be less frequent in MSK patients while hypercalciuria is often reported as a frequent finding among metabolic factors explaining stone formation [1,2,8,24,26]. However, in agreement with our data, other studies report a less frequent occurrence of hypercalciuria in MSK patients when compared to other stone formers [10].…”

Section: Discussionsupporting

confidence: 89%

“…Spontaneous stone passage is more frequent in men than in women (53.1% vs 34.7%, p < 0.000001). The high rate of stone activity in MSK patients may be explained by stasis in tubular ectasias, in addition to metabolic risk factors found as frequently as in other stone patients, mainly hypercalciuria and hypocitraturia, and less frequently hyperoxaluria and hyperuricosuria [2,10,26].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medullary sponge kidney: what kind of stones?

Daudon¹,

Frochot²,

Bazin³

et al. 2022

Comptes Rendus. Chimie

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Medullary sponge kidney (MSK) is an anomaly of the kidney with cystic enlargement of distal tubules generating stasis zones where calcium salt deposits may form and grow locally. From an epidemiological point of view, MSK is reported in 2% to more than 20% of calcium stone formers. The association of stasis and various metabolic disorders explains a high recurrence rate of stones in affected patients. The composition of stones has been poorly investigated. The aim of this study is to compare stone composition and morphology in MSK and non-MSK patients.Material and methods: 1036 stones from MSK patients and 31,494 stones from non-MSK patients were submitted to a morpho-constitutional analysis based on morphological typing under stereo microscope and precise characterization of chemical and crystalline phases by Fourier transform infrared spectroscopy. Results and discussion:Regarding patients, the male to female ratio was significantly lower in MSK vs non-MSK subjects (1.48 vs 2.09, p < 0.00001). The recurrence rate was significantly higher in MSK patients (85.0% vs 39.5% in non-MSK, p < 0.000001). Stones were more often spontaneously passed in MSK vs non-MSK subjects (45.7% vs 34.6%, p < 0.000001). Stones were mainly composed of calcium oxalate in both groups (66.3% vs 72.5%). However, the slight decrease in the occurrence of calcium oxalate stones was mainly supported by weddellite calculi, less frequent in MSK (17.0% vs 21.6% in non-MSK, p < 0.001). The main point was the high proportion of stones mainly composed of calcium phosphates: 28.9% in MSK vs 13.9% in non-MSK patients) with a high proportion of stones exhibiting a IVa2 morphology which is a marker for distal tubular acidification defect (12.1% in MSK vs 0.4% in non-MSK patients, p < 0.000001). Finally, while stones nucleated from a papillary Randall's plaque were found with a similar frequency in both groups, calcium phosphate nucleus was significantly more frequent in MSK than in non-MSK stones (68.8% vs 48.9%, p < 0.000001), suggesting a frequent initiation of stones from calcium phosphate plugs in distal tubules ectasias.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Medullary sponge kidney: what kind of stones?

Daudon¹,

Frochot²,

Bazin³

et al. 2022

Comptes Rendus. Chimie

View full text Add to dashboard Cite

show abstract

“…A majority of nephrolithiasis patients exhibited a decrease in citrate excretion. Alkali supplements are widely used for hypocitraturic recurrent nephrolithiasis patients to restore citrate excretion ( 47 , 48 ). Hydroxycitrate is a structural analog of citrate, which has been reported to show equivalent capacity in forming complexes with calcium, in order to inhibit crystallization ( 49 , 50 ).…”

Section: Physicochemical Mechanism Of Kidney Stone Formationmentioning

confidence: 99%

Recent advances on the mechanisms of kidney stone formation (Review)

et al. 2021

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Kidney stone disease is one of the oldest diseases known to medicine; however, the mechanisms of stone formation and development remain largely unclear. Over the past decades, a variety of theories and strategies have been developed and utilized in the surgical management of kidney stones, as a result of recent technological advances. Observations from the authors and other research groups suggest that there are five entirely different main mechanisms for kidney stone formation. Urinary supersaturation and crystallization are the driving force for intrarenal crystal precipitation. Randall's plaques are recognized as the origin of calcium oxalate stone formation. Sex hormones may be key players in the development of nephrolithiasis and may thus be potential targets for new drugs to suppress kidney stone formation. The microbiome, including urease-producing bacteria, nanobacteria and intestinal microbiota, is likely to have a profound effect on urological health, both positive and negative, owing to its metabolic output and other contributions. Lastly, the immune response, and particularly macrophage differentiation, play crucial roles in renal calcium oxalate crystal formation. In the present study, the current knowledge for each of these five aspects of kidney stone formation is reviewed. This knowledge may be used to explore novel research opportunities and improve the understanding of the initiation and development of kidney stones for urologists, nephrologists and primary care.

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“…Furthermore, this food supplement contains potassium and magnesium citrates, although previous studies did not favor potassium citrate therapy. However, potassium can moderate the concentration of sodium in urine and promote the elevation of citrate, which acts to correct urinary pH and acidity, possibly contributing to an increase in calcium solubility and, then, interfere with some stages of crystallization in urine (14)(15)(16)(17). This food supplement is, then, able to act into two different pathways: diuresis increasing and inhibition of nucleation, growth and aggregation of calcium oxalate crystals.…”

Section: Role Of Phytotherapy In the Management Of Urinary Stones And Mechanism Of Actionmentioning

confidence: 99%

Phyllanthus niruri and Chrysanthellum americanum in association with potassium and magnesium citrates are able to prevent symptomatic episode in patients affected by recurrent urinary stones: A prospective study

Cai

Tiscione

Puglisi

et al. 2021

Arch Ital Urol Androl

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Objective: The aim of this study is to evaluate the efficacy of a food supplement containing Phyllanthus niruri and Chrysanthellum americanum in association with potassium and magnesium citrates in the treatment and prophylaxis of urinary stones. Materials and methods: Eighty-two patients (mean age 49.7 ± 11.2) with history of urinary stones received this food supplement, one capsule a day for 6 months. Each administration contained a combination of the following ingredients: 244 mg Potassium citrate, 735 mg Magnesium citrate, Phyllanthus (Phyllantus niruri) herb d.e. 15% mg Tannins 220 mg, Chrysanthellum (Chrysanthellum americanum Vatke) plant d.e. ¼ 55 mg. After 6 months, all patients underwent urologic visit, urinalysis, imaging and quality of life (QoL) questionnaires evaluation. Each patient was also evaluated by computed tomography (CT) scan at baseline and at 6 months. Result: From January 2018 to March 2019, 82 patients (mean age 49.7 ± 11.2) completed the follow-up period and were analyzed. Fifty patients showed lower stone dimensions (60.9%). The average stone size was 0.9 mm, with a significant reduction in comparison with the baseline (-6.7 mm ± 3 mm) (p < 0.001). Forty-nine patients (59.7%) did not show any symptomatic episode with an improving in QoL (+0.4 ± 0.1) (p < 0.001) in comparison with the baseline. At the end of the follow-up period, 27 patients out of 82 were stone-free (32.9%). Moreover, we report a significant reduction of patients with asymptomatic bacteriuria (ABU) between the baseline and the end of the follow-up evaluation (p < 0.001). Conclusions: In conclusion, this food supplement is able to improve quality of life in patients with urinary stones, reducing symptomatic episodes and the prevalence of ABU.

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The impact of potassium citrate therapy in the natural course of Medullary Sponge Kidney with associated nephrolithiasis

Cited by 9 publications

References 10 publications

Medullary sponge kidney: what kind of stones?

Medullary sponge kidney: what kind of stones?

Recent advances on the mechanisms of kidney stone formation (Review)

Phyllanthus niruri and Chrysanthellum americanum in association with potassium and magnesium citrates are able to prevent symptomatic episode in patients affected by recurrent urinary stones: A prospective study

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