Probiotics in the prevention and treatment of calcium oxalate kidney stones: mechanisms and therapeutic potential

Background and Aim: Urinary tract stones are the third common urinary tract disease that may lead to renal failure. Kelussia odoratissima is traditionally used in the treatment of kidney stones in Chaharmahal va Bakhtiari region. This study was designed to investigate in vitro effect of crude extract and fractions of K. odoratissima on kidney stones (calcium oxalate and calcium phosphate). Materials and Methods: A total of 70% ethanolic extract of K. odoratissima was prepared by maceration method followed by liquid–liquid extraction with hexane, chloroform, ethyl acetate, and saturated n-butanol to get four fractions. Calcium oxalate and calcium phosphate were synthesized and then were treated with hydroalcoholic extract and fractions. Their effects on the dissolution of generated stone were assayed by calcium kit. The stones were synthesized and confirmed by fourier-transform infrared technique. Results: Results showed that total extract and its fractions had significant potency to dissolve calcium oxalate and calcium phosphate crystals. The results indicate the higher potency of fractions containing nonpolar compounds to dissolve calcium phosphate and calcium oxalate stones compared to the fractions containing polar compounds. n-butanolic fraction had the least effect and hexane fraction had the greatest effect on the calcium phosphate stones. Furthermore, the total extract has less dissolution ability, compared to the fractions. Conclusion: The obtained results of this study exhibited that the use of K. odoratissima extract and its fractions could help to dissolve urinary stones. Therefore, it can be effective in prevention and treatment of kidney stones on people who are prone to the formation of calcium oxalate and phosphate stones. Abbreviations Used: Caox: Calcium Oxalate, Caph: Calcium Phosphate, K. odoratissima: Kelussia odoratissima Mozaff

Beverages, diet, and prevention of kidney stones.

Application of Artificial Intelligence to Patient-Targeted Health Information on Kidney Stone Disease

Dünya çapında nefrolitiazisin prevalansı ve insidansının giderek arttığı bildirilmektedir. Son yıllarda nefrolitiazis alanında önemli ilerlemeler kaydedilmiştir. Taş oluşum nedenleri ve spesifik moleküler defektler daha kapsamlı olarak ortaya konulmaktadır. İdrar yoğunluğunun yanında idrarda çözünen kristallerin miktarı da böbrek taşı oluşumunda etkilidir. İdrar hacminin azalmasıyla birlikte idrardaki çözünen maddelerin saturasyanu değişir ve taş oluşum riski artar. İdrarda okzalat ve fosfor gibi bazı maddelerin yüksek düzeyi ile böbrek taşları oluşabilmektedir. Genler, metabolik ve çevresel etmenler idrar bileşimini etkileyebilmekte ve taş oluşum riskini arttırabilmektedir. Diyet de böbrek taş oluşumuna neden olabilen ya da taş oluşumunu önleyebilen bir etmendir. Diyet uygulamasındaki değişiklikler ise böbrek taşlarının tedavisinde ve önlenmesinde anahtar bir rol oynayabilmektedir. Böbrek taşlarının ortaya çıkışının ya da yenilenmesinin önlenmesinde idrar süper saturasyonunun azaltılması önemlidir. Bu yüzden idrar hacmi 2-2.5 litre olana kadar sıvı alımının arttırılması hedeflenmelidir. Diyetteki okzalat miktarı arttığında veya kalsiyum düşük olduğunda ortaya çıkabilen hiperoksalüri, kalsiyum okzalat taşı oluşumu için risk etmenidir. Gereksiz diyetsel kalsiyum kısıtlamalarından kaçınmak ve okzalattan zengin besinleri diyette kontrol altına almak böbrek taşının önlenmesi için önemlidir. Artmış diyet sodyum alımı, kalsiyum renal tübüler geri emilimini azaltarak böbrek taşı için risk etmeni olan hiperkalsiüriyi tetikleyebileceği için, diyetle sodyum alımının düzenlemesine gidilebilmektedir. Bu yüzden böbrek taşı oluşumunu ve tekrarlamasını önleyebilmek adına çevresel etmenlerden özellikle beslenmenin de kontrol altına alınması gerekebilmektedir.

EFFECTS OF CALCIUM AND MAGNESIUM ON URINARY OXALATE EXCRETION AFTER OXALATE LOADS

The Role of Randall’s Plaques in the Pathogenesis of Calcium Stones

Background: Calcium oxalate renal stones are the most predominant cases of renal stones, their formation is more complex and no specific cause for the stone can be identified so called 'idiopathic'. This study was designed to analyze the metabolic and biochemical alterations in serum, urine and their relation to pathophysiology of calcium oxalate stone formation Patients and Methods : In this study, individuals have been classified into three groups: Group (A) included (29) apparently healthy persons of non calcium oxalate stone formers aged (20-35 years), group (B) included (16) patients with calcium oxalate renal stone aged (20-35 years) and group(C) included (15) patients with calcium oxalate renal stone aged (40-70 years). Fasting serum, random urine and 24hours urine samples were collected from all individuals to determine urine volume, creatinine clearance, serum and urine levels of calcium, phosphate ,uric acid ,zinc, copper and serum levels of total cholesterol, high density lipoproprotien-cholesterol and urea . Results: Calcium oxalate stone formers group (B) exhibited significantly decreased serum levels of uric acid (P=0.015),zinc (P=0.031) with increased serum level of total cholesterol(P=0.034) when compared to similar age group of healthy control ,group (A). Urinary parameters in calcium oxalate stone formers also showed significantly increased levels of 24-hour urine calcium(P=0.05) and urine calcium: creatinine ratio (P=0.05)when compared to healthy control. While, older age calcium oxalate stone formers, group (C) showed significantly decreased urine volume (P=0.015)with increased kidney stone size(P=0.03) when compared to younger age calcium oxalate stone formers, group (B). Conclusions: Level of urinary calcium and urine volume are the most important urinary factors in enhancing calcium oxalate stone formation. While the observed changes in biochemical measurements of serum in calcium oxalate stone formers may indicate a probable metabolic relation in pathogenesis of this disease.

THE EFFICACY OF DIETARY INTERVENTION ON URINARY RISK FACTORS FOR STONE FORMATION IN RECURRENT CALCIUM OXALATE STONE PATIENTS

The purpose of the present study was to compare the clinical characteristics of "pure" uric acid (UA) stone formers with that of "pure" calcium oxalate (CaOx) stone formers and to determine whether renal handling of UA, urinary pH, and urinary excretion of promoters and inhibitors of stone formation were different between the two groups. Study subjects comprised 59 patients identified by records of stone analysis: 30 of them had "pure" UA stones and 29 had "pure" CaOx nephrolithiasis. Both groups underwent full outpatient evaluation of stone risk analysis that included renal handling of UA and urinary pH. Compared to CaOx stone formers, UA stone formers were older (53.3 +/- 11.8 years vs. 44.5 +/- 10.0 years; P = 0.003); they had higher mean weight (88.6 +/- 12.5 kg vs. 78.0 +/- 11.0 kg; P = 0.001) and body mass index (29.5 +/- 4.2 kg/m(2) vs. 26.3 +/- 3.5 kg/m(2); P = 0.002) with a greater proportion of obese subjects (43.3% vs. 16.1%; P = 0.01). Patients with "pure" UA lithiasis had significantly lower UA clearance, UA fractional excretion, and UA/creatinine ratio, with significantly higher serum UA. The mean urinary pH was significantly lower in UA stone formers compared to CaOx stone formers (5.17 +/- 0.20 vs. 5.93 +/- 0.42; P < 0.0001). Patients with CaOx stones were a decade younger, having higher 24-h urinary calcium excretion (218.5 +/- 56.3 mg/24 h vs. 181.3 +/- 57.1 mg/24 h; P = 0.01) and a higher activity product index for CaOx [AP (CaOx) index]. Overweight/obesity and older age associated with low urine pH were the principal characteristic of "pure" UA stone formers. Impairment in urate excretion associated with increased serum UA was also another characteristic of UA stone formers that resembles patients with primary gout. Patients with pure CaOx stones were younger; they had a low proportion of obese subjects, a higher urinary calcium excretion, and a higher AP index for CaOx.

MP41-14 IMPACT OF URINE PH ON URINARY SUPERSATUATION OF CALCIUM OXALATE

Change in Inhibitory Potential in Urine of Hyperuricosuric Calcium Oxalate Stone Formers Effected by Allopurinol and Orthophosphates

INTRODUCTION &amp; OBJECTIVES: Nephrolithiasis associated renal damage is an important potential contributor to the risk of CKD and has been investigated by numerus studies. Metabolic disorders such as hypercalciuria, hyperoxaluria and hypocitraturia are commonly diagnosed in calcium oxalate stone formers. The objective of this study is to compare the presence of meta- bolic disorders in calcium oxalate stone formers with CKD and normal renal function. MATERIALS &amp; METHODS: A prospective study on 111 patients with calcium oxalate urolithiasis was performed between January 2022 and July 2024. All patients underwent serum creatinine testing and eGFR calculation and metabolic evaluation with 24h-urine collection one month after endourological treatment or spontaneous stone elimination. The rate of hypercalciuria, hy- peroxaluria and hypocitraturia in relation to CKD was analyzed. We define CKD as either kidney damage or a decreased glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2. RESULTS: CKD was found in 20(18%) of all patient, 11(9.9%) male and 9(8.1%) female. The incidence of CKD is high in patients with more than one recurrence- 12.6% vs 5.4%( first recurrence); 8(40%) of patient with family history of stone desease are with CKD. ; The most common comorbidity in patients with CKD is hypertension-10(50%). CKD was found in 0.9% of patient with hyperuricosuria, 9.9% of hypocitraturia, 9% of hyperoxaluria-high and moderate and 7.2% of hypercalciuria. CONCLUSIONS: The results of our study suggest that calcium oxalate urolithiasis is associated with higher risk of CKD. The number of stone episodes is associated with a decrease in kidney function. Metabolic disorders such as hypercalciuria, hyperoxaluria and hypocitraturia are commonly found in calcium oxalate stone formers with CKD. Identification of risk factors for stone recurrence and intervention with appropriate treatment may prevent or reduce recurrence rates and risk of ESRD.

Using 24-Hour Urinalysis to Predict Stone Type

Whether idiopathic calcium oxalate (CaOx) stone formers form inner medullary collecting duct (IMCD) crystal deposits bears on pathogenetic mechanisms of stone formation. In prior work, using light and transmission electron microscopy, we have found no IMCD crystal deposits. Here, we searched serial sections of papillary biopsies from a prior study of 15 idiopathic calcium oxalate stone formers, 4 intestinal bypass patients with CaOx stones, and 4 non-stone-forming subjects, and biopsies from an additional hitherto unreported 15 idiopathic calcium oxalate stone formers and 1 bypass patient using polarized light oil immersion optics, for deposits overlooked in our original study. We found no IMCD deposits in any of 1,500 serial sections from the 30 idiopathic calcium oxalate stone formers, nor in 87 additional sections from a frozen idiopathic calcium oxalate stone former biopsy sample processed without exposure to aqueous solutions. Among 4 of the 5 bypass patients but in none of the 30 idiopathic calcium oxalate stone formers or 4 normal stone formers, we found tiny birefringent thin crystalline overlays on scattered IMCD cell membranes. We also found IMCD lumen deposits in two bypass patients that contained mixed birefringent and nonbirefringent crystals, presumably CaOx and apatite. In the bypass patients, we observed focal apical IMCD cell hyaluronan staining, which was absent in idiopathic calcium oxalate stone formers. The absence of any IMCD deposits in 1,500 serial sections of biopsies from 30 idiopathic calcium oxalate stone formers allows us to place the upper limit on the probability of their occurrence at approximately 0.002 and place the lower limit of their size at the resolution of the optics (<0.2 mu). The tiny deposits in bypass patients may be the initial crystal lesion.

Aims: To isolate, characterize, and quantify the 23-kD calcium oxalate monohydrate (COM) binding protein in the urine of controls and calcium oxalate stone formers and to study its role in kidney stone formation. Methods: Calcium oxalate crystals were prepared and allowed to interact with human control kidney homogenate as well as urine of controls and calcium oxalate stone formers. EDTA extract was used for the separation of the 23-kD COM-binding protein (partially purified). This partially purified 23-kD COM-binding protein was further separated by DEAE-cellulose column chromatography. SDS-PAGE confirmed the molecular weight. An antibody was raised against the renal 23-kD COM-binding protein in rabbits. The 23-kD COM-binding protein was quantified in the urine from controls and stone formers by ELISA. Thiol group quantification, oxalate-binding assay, and calcium oxalate crystal nucleation and aggregation were performed. Morphological changes of the calcium oxalate crystals induced by the urinary 23-kDa protein were determined using scanning electron microscopy. The expression of this protein using different concentrations of oxalate was also determined in an in vitro model. Results: The urinary excretion of the 23-kD COM-binding protein varies between 0.5 and 1.5 mg/24 h in controls, while in stone former its excretion was found to range from 5 to 7 mg/24 h. The protein isolated from urine was found to inhibit crystal nucleation and aggregation in controls, while the protein isolated from stone formers exhibited less inhibitory activity with reduced thiol groups. The 23-kD COM-binding protein derived from control urine formed COM crystals and intertwined calcium oxalate dihydrate crystals in a crystal growth system, while protein isolated from stone formers’ urine induced aggregation of COM crystals. This protein expression was found to be increased with increasing concentration of oxalate in renal epithelial cells of the African green monkey kidney (VERO) cell line. Conclusions: Increased expression and excretion of the 23-kD protein was observed in oxalate stress conditions, and in stone formers this protein exhibited a promoting activity. The increased excretion of this protein with promoting activity favors the lithogenic process in stone formers.