Stone Dissolution Research Articles

The effectiveness of avocado (Persea americana M.) leaves infusion as urinary stones dissolving in rats

Urolithiasis is a pathological condition marked by the formation of urinary stones (calculi) in the urinary tract. Avocado leaf ( Persea americana M.) contains substances that play crucial roles in the solubility of calcium in urinary stones, such as flavonoids, alkaloids, saponins, and magnesium. Empirically, avocado leaves are used to make urinating easier and break stones in the urinary tract. This study aims to determine the effect of avocado leaf infusion to dissolve urinary stones in white male rats. According to the experiment, 24 male white rats were divided into four groups; the negative control group (not given infusion), the 1 g/kg BW dose group, the 2 g/kg BW dose group, and the 3 g/kg BW dose group of avocado leaves infusion. The infusion was administered orally for seven consecutive days after 28 days of planting black silk thread as the stone core in the urinary tract. Then, the stone formed is taken. The weight and volume are measured. The urinary stones were tested qualitatively in terms of calcium and oxalate. The results showed that there were significant differences among treatment groups in weight and volume of urinary stones. The effect of bladder stone dissolving was best in the 3 g/kg BW group. The qualitative test also shows that urinary stones contain the same calcium and oxalate as urinary stones that form in humans. Avocado leaves infusion can have a urinary stone dissolving effect on white male rats. Increasing the dose of avocado leaves infusion increases its effectiveness as a urinary stone dissolution.

Effect of theobromine on dissolution of uric acid kidney stones

PurposeUric acid renal lithiasis has a high prevalence and a high rate of recurrence. Removal of uric acid stones can be achieved by several surgical techniques (extracorporeal shock wave lithotripsy, endoscopy, laparoscopy, open surgery). These stones can also be eliminated by dissolution within the kidneys, because the solubility of uric acid is much greater when the pH is above 6. At present, N-acetylcysteine with a urinary basifying agent is the only treatment proposed to increase the dissolution of uric acid stones. In this paper, we compare the effect of theobromine and N-acetylcysteine on the in vitro dissolution of uric acid calculi in artificial urine at pH 6.5.MethodsThe dissolution of uric acid renal calculi was performed in a temperature-controlled (37 °C) chamber. A peristaltic pump was used to pass 750 mL of synthetic urine (pH 6.5) through a capsule every 24 h. Stone dissolution was evaluated by measuring the change in weight before and after each experiment.ResultsN-acetylcysteine increased the dissolution of uric acid calculi, but the effect was not statistically significant. Theobromine significantly increased the dissolution of uric acid calculi. Both substances together had the same effect as theobromine alone. The addition of theobromine to a basifying therapy that uses citrate and/or bicarbonate is a potential new strategy for the oral chemolysis of uric acid stones.ConclusionTheobromine may prevent the formation of new stones and increase the dissolution of existing stones.

Mineral Content and Antiurolithiatic Analysis of Horse Gram Flour

Macrotyloma Uniflorum is commonly known as horse gram. It is found in India, Africa, Australia, and Srilanka. It is reported to have pharmaceutical applications like antioxidant, anticancer, and anti-diabetic. The present paper provides the information about the utility of horse gram as a cheap source of mineral content with anti-urolithiatic property. The phytochemical analyses were also carried out to determine the presence of secondary metabolites. Horse gram powder contains macro nutrients and micro nutrients. Calcium is the major mineral content followed by potassium. The studies suggest that the utilized natural biomass could be tapped as a source of mineral and carbohydrates. Horse gram seed powder comprises of highest carbohydrate content followed by phenol, sterol, terpenoid, and protein. Bio encapsulated Ag nano particles showed highest dissolution of struvite stones as compared to aqueous and ethanol extracts. Hence it could be suggested as a major ingredient in functional food.

Biomedical applications of L-alanine produced by Pediococcus acidilactici BD16 (alaD+).

L-alanine possesses extensive physiological functionality and tremendous pharmacological significance, therefore could be considered as potential ingredient for food, pharmaceutical, and personal care products. However, therapeutic properties of L-alanine still need to be addressed in detail to further strengthen its utilization as a viable ingredient for developing natural therapeutics with minimum side effects. Thus, the present study was aimed to explore the anticipated therapeutic potential of L-alanine, produced microbially using a lactic acid bacterial strain Pediococcus acidilactici BD16 (alaD+) expressing L-alanine dehydrogenase enzyme. The anticipated therapeutic potential of L-alanine was assessed in terms of anti-proliferative, anti-bacterial, and anti-urolithiatic properties. Anti-bacterial assays revealed that L-alanine successfully inhibited growth and in vitro proliferation of important human pathogens including Enterococcus faecalis, Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Streptococcus mutans, and Vibrio cholerae in a concentration-dependent manner. Current investigation has also revealed its significant anti-proliferative potential against human lung adenocarcinoma (A549; IC50 7.32μM) and mammary gland adenocarcinoma (MCF-7; IC50 8.81μM) cells. The anti-urolithiatic potential of L-alanine was augmented over three different phases, viz., nucleation inhibition, aggregation inhibition, and oxalate depletion. Further, an in vitro cell culture-based kidney stone dissolution model using HEK293-T cells was also established to further strengthen its anti-urolithiatic potential. This is probably the first in vitro cell culture-based model which experimentally validates the immense therapeutic efficacy of L-alanine in treating urolithiasis disease. KEY POINTS: • Assessment of therapeutic potential of L-alanine produced by LAB. • L-alanine exhibited significant anti-proliferative and anti-bacterial activities. • L-alanine as potential anti-urolithiatic agent.

Quercus salicina Blume: Research Progress in Chemistry and Pharmacodynamics (1959-2021).

The crude extracts of different parts (leaves and shoots) of Quercus salicina Blume (QS) have shown considerable effect in urolithiasis. QS has been widely used in clinical practice and has attracted great research interest The relevant published literature, however, reveals only partial education of its chemical components and bio-active mechanisms, and only two review articles have summarized the QS research progress. In this review, a comprehensive and systematic review of chemistry and pharmacodynamics of QS was carried out using the international authoritative databases (1959-2021), focusing on phenols and flavonoids, and their effect such as urinary stone dissolution, anti-inflammatory, anti-diabetes, anti-bacterial, antioxidant, and anti-allergy activities as well as toxic effects. The aim of review is to provide the most recent and effective literature support for further basic research and application development.

Comparative evaluation of decalcifying agents for dissolution of pulp stones: An in vitro study.

Background:Despite constant advances in science, obscurity remains in the efficient removal of pulp stones to aid in successful root canal treatment. In this context, chemical means of dissolving pulp stones were explored.Aim:The aim of this study is to evaluate and to compare the efficacy of decalcifying agents on the dissolution of pulp stones.Materials and Methods:The study was divided into two groups for pulp stone analysis (21 samples) and dentin analysis (54 samples). Twenty-one pulp stones from patients aged 18–70 who underwent root canal treatment were collected and divided into three subgroups (n = 7) randomly. They were subjected to chemical treatment in a labeled glass container with 5 ml of the respective chemical agents, such as 17% ethylenediaminetetraacetic acid solution (positive control), no treatment (negative control), and newly developed Physiological Simulated Decalcifying Agent (PSDA). At the end of the study period (24 h), the samples were removed, rinsed with deionized water, and subjected to physical analysis, scanning electron microscopy (SEM), and Energy –dispersive X-ray spectroscopy (EDS) analysis. Under dentin analysis, 54 maxillary premolars scheduled for orthodontic extraction without caries or extensive restorations were selected, following which 2-mm thick transverse dentinal sections at the cementoenamel junction level were obtained and randomly divided into two groups for SEM (n = 21) and microhardness analysis (n = 33). The samples were subjected to respective chemical treatment groups similar to pulp stones for 24 h and analyzed using SEM, EDS, and microhardness analysis.Results:Postchemical treatment with the newly developed decalcifying solution, the pulp stones showed the absence of nodular crystallites and surface softening under SEM and a decrease in the calcium level under EDS analysis. Concerning the microhardness of dentin, no significant changes could be observed.Conclusion:The newly explored PSDA was found to be efficacious in the decalcification of pulp stones at a clinically relevant time of 24 h, without significantly affecting the structural integrity and the hardness values of dentin.

V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN

You have accessJournal of UrologyUrolithiasis & Endourology (V05)1 Sep 2021V05-04 STONE DISSOLUTION: CURRENT SAFE AND EFFECTIVE USE OF RENACIDIN Egor Parkhomenko, Vivian Williams, and Michael Kurtz Egor ParkhomenkoEgor Parkhomenko More articles by this author , Vivian WilliamsVivian Williams More articles by this author , and Michael KurtzMichael Kurtz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002012.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Struvite stones cause significant morbidity in urologic congenitalism. Though stone-free rates have improved with advanced endoscopic equipment, some anatomic circumstances make complete stone clearance impossible. Renacidin (Citric Acid, Glucono Delta-Lactone, and Magnesium Carbonate solution) to treat upper tract stones was popular in the 1960s, but after 6 deaths it was banned by the FDA and not re-approved until the 1990s. We wished to treat a patient in an extraordinary circumstance, which presented challenges as Renacidin therapy had not been used at our institution in 30 years. We present our experience and a step-by-step guide to infusion. METHODS: We conducted a literature review and collected national expert opinion. Key stakeholders from nursing, pharmacy, nephrology, infectious diseases, intensive care unit (ICU), and biomedical engineering developed a safe protocol for renacidin infusion. The patient was monitored on a 1:1 staff to patient ratio in the ICU initially. As the medication is in vials with non-sterile exteriors, pharmacy cleaned the vials and pooled it under a sterile hood. The biomedical engineering team recommended a gravity drip, elevated to 30 cm H2O above PCN tube entry site infused at 120 ml/hour (20 drips/minute) or 60 ml/hr (drop factor 10 drips/minute). A mock infusion was completed with a multidisciplinary team prior to the patient’s admission. A 27yF with severe scoliosis, reconstructed bladder, and tortuous ureter from prior ureterostomies leading to limited options for renal access had struvite stone recurrence after bilateral percutaneous nephrolithotomy. Bilateral nephrostomy tubes, an antegrade ureteral catheter, and a urethral catheter were placed. Daily electrolytes and urine cultures were drawn, and weekly CT scans performed to assess stone burden. Renacidin was infused unilaterally at full or half rate, depending on patient tolerance, during the day; nocturnal infusions were with normal saline. Continuous culture-directed IV antibiotics were administered throughout the infusion. RESULTS: Infusion was carried out for 60 days, initially on the left for 30 days (larger stone burden), and 30 days on the right. Total hospital stay was 71 days. The patient has been stone-free since end of Renacidin therapy for ∼150 days. There were no episodes of mucosal hemorrhage or sepsis. CONCLUSIONS: Renacidin infusion can be performed safely and effectively and may eliminate upper tract recurrent struvite stones in patients who have failed endoscopic therapy. An inpatient monitoring program and multidisciplinary collaboration is required for safe infusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e387-e387 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Egor Parkhomenko More articles by this author Vivian Williams More articles by this author Michael Kurtz More articles by this author Expand All Advertisement Loading ...

A Study to Assess Prevalence and Drug Utilization Pattern in Hepatic Impairment Patients with or without Comorbidities in a Tertiary Care Teaching Hospital

<p style="text-align: justify;"><strong>Background: </strong>The liver is the core of metabolic activity in the body. Around 50% of the classes of drugs are known to be hepatotoxic. Thus prescribing medications in patients with liver disease is indeed a challenging task.<strong> Objectives:</strong> To study the prevalence and to carry out the drug utilization evaluation of the therapy prescribed among hepatic impairment patients. <strong>Methodology:</strong> A prospective observational study was carried out for six months among inpatients of the medicine department of Chigateri district hospital. Patients were enrolled on the basis of inclusion criteria; data was collected using a data collection form and results were analyzed using MS Excel. <strong>Results: </strong>A total of 160 patients were enrolled, the most prevalent condition was alcoholic liver disease (<em>n</em>=66, 41.25%) followed by chronic liver disease (<em>n</em>=47, 29.38%) and hepatic encephalopathy (<em>n</em>=12, 7.5%). Out of 1466 drugs been prescribed, 795 drugs were used specifically for hepatic impairment. Drugs used to treat oedema (diuretics) were most commonly prescribed (<em>n</em>=198, 25%) followed by gall stone dissolution agents (<em>n</em>=124, 16%) and sugars (<em>n</em>=97, 12%). <strong>Conclusion: </strong>Alcoholic liver disease was the most prevalent hepatic condition, followed by chronic liver disease. The diuretics were the most widely used hepato-specific drugs among the patients. <p style="text-align: justify;"><strong>Key words:</strong> Drug utilization pattern, Hepatic impairment, Abstinence, Diuretics.

Stone Dissolution: Current Safe and Effective Use of Renacidin

Abstract Introduction: Struvite stones cause significant morbidity in urologic congenitalism. Although stone-free rates have improved with advances in endoscopy, some anatomic circumstances make co...

Spatial modeling of susceptibility to subsidence using machine learning techniques

Land subsidence is a hazard that results from conditioning factors that cause environmental change and generate social and economic impacts. Some of these factors may increase dissolution of calcareous stones, change groundwater storage, or stem from mining, faulting, and seismic activity. Semnan Plain, Iran is experiencing land subsidence that, along with secondary impacts like surface fissures, is becoming increasingly troublesome. This study modeled land subsidence and created a susceptibility map using multivariate adaptive regression spline (MARS), mixture discriminant analysis (MDA), and boosted regression tree (BRT) machine-learning methods. Analysis of satellite imagery, documents reporting past subsidence, and a contemporary field survey identified 65 sinkholes on Semnan Plain. Twelve conditioning factors were selected for analysis from a review of the scholarly literature, field investigation, and data availability. The three methods were used to model subsidence from a training subset of the known sites. The models were validated with the remaining subset of subsidence locations. Finally, susceptibility maps were used to predict other sites that are highly likely to see subsidence. Receiver operating characteristic curves and the area under the curves (AUC) were applied to assess the accuracies of the maps. AUC values (0.637, 0.783, and 0.712 for the BRT, MARS, and MDA models respectively) showed that MARS generated the most accurate model, MDA generated the second most accurate, and BRT’s was the least accurate model. Subsidence susceptibility maps as produced here can be useful, meaningful, and functional tools for local and regional planners and policy makers involved in land use planning, resource management, and hazard mitigation.

Alkalinization of the Urine and Lowering of Urine Uric Acid Content in Diabetic Patients with a Low Urine PH Results in Prevention and Dissolution of Uric Acid Stones - A Case Report and A Retrospective Outcome Study

Alkalinization of the Urine and Lowering of Urine Uric Acid Content in Diabetic Patients with a Low Urine PH Results in Prevention and Dissolution of Uric Acid Stones - A Case Report and A Retrospective Outcome Study

EVALUATION OF IN-VITRO ACTIVITY OF AERIAL PART OF BARANJASIF (Achillea millefolium Linn.) EXTRACTS

Hasah al-Kulya (renal calculi) is one of the leading problems affecting kidney. Recurrence of kidney stone formation is approximately 50%, after 2-3 years of recovery. This makes the prevention of its recurrence an essential problem to address. Despite substantial progress in medical therapy, there is no drug with satisfactory effect. Furthermore, the drugs those are being used for its treatment have many side effects. Baranjasif (Achillea millefolium Linn.) is one of the drugs used in Unani Medicine that has been extensively used for the management of urolithiasis. The aim of this study is to evaluate the lithotriptic action of Baranjasif in-vitro. In this study, calcium oxalate stones were prepared experimentally followed by the preparation of semipermeable membrane by dissolving the outer shell of egg in 2M HCl overnight. Calcium oxalate stones weighing 10mg were then allowed to react with 7 extracts of A. millefolium L. viz, Pet-ether, Chloroform, Ethyl Acetate, Methanol, Acetone, Hydro-alcohol and Aqueous by packing them together in semipermeable membrane. The reaction was performed on three different concentrations of each extract i.e., 50 mg, 100 mg and 150 mg. In addition to 7 groups, two more groups were taken, i) a negative group containing only the stone of weight 10 mg and ii) standard group consisting of stone weighing 10 mg and cystone (in concentrations of 50 mg, 100 mg and 150 mg). Statistical methods like mean standard deviation, percentage dissolution, percentage inhibition, IC and Pearson's correlation were applied to understand the extent of dissolution of stones 50 in each group. The study advocates that Baranjasif reveals lithotriptic activity comparable to standard drug. The efficacy of the drug is directly proportional to its concentration. Ethyl acetate extract of the plant showed the most promising results.

Outcomes of dissolution therapy and monitoring for stone disease: should we do better?

Surgical management is the cornerstone of urolithiasis treatment, but high recurrence rates and associated complications necessitate the existence of medical treatment options, aiming at dissolution of kidney stones and prevention of recurrence. The purpose of this review is to present the most recent knowledge existing in scientific literature, regarding dissolution therapy and ways of monitoring nephrolithiasis patients. A number of laboratory studies have been performed testing experimental treatments (tolvaptan, chlorthalidone, atorvastatin, a-lipoic acid, glucosaminoglycans, plant extracts), to reduce kidney stone formation and cellular damage and showed encouraging results. Uric acid stones is the main target of dissolution therapy, but until last years, existing level of evidence was low. A number of prospective and randomized studies, proved the efficacy and safety of oral chemolysis for radiolucent stones and associated prognostic features of success. Tolvaptan and a-Lipoic acid were also tested in patients with cystinuria and resulted in reduction of recurrence. Finally, some new diagnostic markers are suggested as tests for the monitoring of urolithiasis patients, with satisfying accuracy and discriminative ability. Medical dissolution therapy for nephrolithiasis is an effective option, especially for patients with radiolucent/uric acid stones. In the future, we need clinical trials to confirm the encouraging results of pilot studies testing several agents for patients with cystinuria.

An in vitro screening potential traditional medicinal plants for nephrolithiasis

BackgroundToday, the attention of researchers has been drawn to the use of medicinal plant for the treatment of kidney stones. The aim of this study was to investigate the effect of five plants used in traditional medicine on the dissolution of calcium oxalate and calcium phosphate stones. Then, the ability of more effective plants to dissolve stones collected from patients after Percutaneous Nephrolithotripsy was investigated.MethodsThe aerial part of plants were extracted by maceration method. The synthesized stones in laboratory were incubated with different concentrations of the extract. Next, the concentrations of calcium oxalate and calcium phosphate were measured by a calcium kit and BT 3000. The effect of the extract with the best activity on the stones collected from the patients was also studied. The composition of clinical stones was determined by colorimetric method. The total phenolic content (TPC) of the extracts was determined.ResultsThe highest dissolution of calcium oxalate stones was observed by the G. struthium extract and the highest dissolution of calcium phosphate stones by the A. euchroma and A. officinalis root extracts. The dissolution percentage of clinical stones by the A. euchroma extract was significantly higher than other extract (P < 0.05). The highest TPC was observed in A. euchroma extract (P < 0.05).ConclusionThe A. euchroma extract exhibited the greatest dissolution activity on laboratory calcium oxalate and calcium phosphate stones as well as clinical stones made of high amounts of calcium oxalate. Therefore, the extract can be effective in preventing and treating kidney stones.

Choledochal cyst as an important risk factor for pediatric gallstones in low-incidence populations: A single-center review

Gallstones are uncommon in infants and children and Asian children are thought to have very low risk. Diagnoses have increased in recent years with the widespread use of ultrasonography (USG). This study aimed to review our experience with risk factors, complications, and treatment of pediatric gallstones in low-incidence populations. We retrospectively reviewed patients younger than 18 years old diagnosed with gallstones using USG between November 2006 and December 2012 in a tertiary referral hospital in Taiwan. Demographic information including age and sex, follow-up period, USG findings, predisposing factors, complications, treatment approaches and outcomes were recorded. Ninety-eight children with gallstones diagnosed with USG were enrolled and reviewed in our study. Females comprised 55% of patients, with no specific gender tendency. No risk factor could be identified in 30.8% of patients. The most common risk factors were cephalosporin (CS) use, presence of a choledochal cyst (CC), and spherocytosis. CS use was not associated with a higher dissolution rate. The presence of type IVa CC implied a high rate of gallstone recurrence after Roux-en-Y hepaticojejunostomy. Complications were seen in 22.4% of patients, but only two needed emergency stone removal. Expectant management was performed in 61% of patients and 62.5% of them achieved spontaneous resolution; the stone dissolution rate was not lower than in the group treated with ursodeoxycholic acid (UDCA). Stone size was significantly decreased after UDCA use if resolution did not occur. Pediatric gallstones showed high resolution rate, and the clinical course was largely benign. CS use was the most common risk factor and did not predict a higher dissolution rate. Type IVa CC was also an important risk factor associated with a high recurrence rate. Conservative treatment and oral UDCA may be reasonable strategies in most patients, unless complications are present.

Comparative Study of the Treatment of Kidney Stone with Upupa Epops, Cissus Adanta Roxb and Cissus Javana DC in the Urinary Medium

Kidney stone is a very common disease suffered by many peoples. It causes health problems such as severe pain, urinary obstruction and infection that adversely affect well being individuals. It may be treated by using allopathic and herbal drugs, lithotripsy, open surgery etc. Medicinal plants are also used for such treatment. These plants are less side effect and more economic. In this article, chemoinhibitory effects of Upupa epops, Cissus adnata Roxb and Cissus javana DC for calcium phosphate (CP) stone and calcium oxalate(CaOX) stone formation in the aqueous and urinary media is studied. Kidney stone is treated with Hoopoe, Cissus adnata Roxb and Cissus javana DC in the urinary medium. The comparative study shows the inhibitory effect of the mixture of Hoopoe and Cissus javana DC for CP and CaOX stones in the aqueous and urinary media is higher and also the digestion or dissolution of kidney stone is higher by this mixture in the urinary medium.

Effect of Cucumis melo Seeds and Allopurinol on Litholytic and Renal Histological Profile in Male Rats

Introduction: Kidney stones are the 3rd major health problem affecting the urological system. Industrial chemical ethylene glycol can generate calcium oxalate crystals in kidneys. Allopurinol has been used to treat the hyperuricemia but can be effective against calcium oxalate kidney stones too. Seeds of Cucumis melo were traditionally utilized as antioxidant and diuretic, so can be studied as litholytic agent against stones as well. Aims &amp; Objectives: To assess and compare the litholytic effect of ethanolic extract of Cucumis melo seeds against ethylene glycol induced urolithiasis with allopurinol in rats. Place and Duration of study: This experimental study was conducted in Pharmacology Department of FPGMI, Lahore for the period of 2 months. Material &amp; Methods: Four groups of 10 rats in each group were made. Calcium oxalate urinary stones were induced by 0.75% ethylene glycol for 28 days in male rats. Groups 1&amp;2 served as negative and positive control while experimental groups 3&amp;4 received Allopurinol 50mg/kg and Cucumis melo seed’s ethanolic extract (EECMS) in dose of 400mg/kg from 15th day to 28th day respectively. At the end of study, kidney weight, urinary calcium, oxalate and phosphorus along with histological examination of kidneys were used as measuring criteria of litholytic effect of seeds of Cucumis melo and was compared to allopurinol. Data analysis was performed using SPSS 20.0 &amp; presented in mean±s.d .Post-hoc Tukey’s test and ANOVA were used for comparison between data groups Results: After 13 days of treatment experimental groups Groups 3 (Allopurinol 50mg/kg) and 4 (EECMS 400mg/kg) showed remarkable decreased mean urinary calcium, oxalate, phosphorus levels( mg/dl) and kidney weights(gm) of urinary calcium(10.55±1.53, 8.28±1.42), oxalate (18.3±0.78, 17.58±1.38), phosphorus (4.3±0.85, 3.59±1.49) and reduced kidney weights(1.43±0.22, 1.37±0.29) respectively(p value &lt;0.001) as compared to diseased control group 2. Thus exhibiting Cucumis melo seed’s ethanolic extract has better litholytic role than allopurinol which also proved to be efficacious. Histopathological examination of kidney also showed dissolution of calcium oxalate stones. Conclusion: Seeds of Cucumis melo extract have better litholytic effect on calcium oxalate kidney stones than allopurinol with improvement noted in the renal histological profile.

Febuxostat Promoted Dissolution of Radiolucent Nephrolithiasis in Patients with Hyperuricemia.

This study aimed to investigate the efficacy and safety of febuxostat in patients with radiolucent nephrolithiasis. From March 2016 to June 2018, data of 96 patients with radiolucent nephrolithiasis and hyperuricemia who referred to the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. These patients were divided into allopurinol 300mg/d (control), febuxostat 40mg/d (F40) and 80mg/d (F80) groups respectively. All patients took potassium citrate as a combination treatment and had been followed up for at least 6 months. Before treatment and on after 1st, 3rd and 6th month, complete blood count, serum uric acid (sUA), hepatic and renal function as well as ultrasound were carried out. Arthritic and gastrointestinal symptoms were also monitored. Computed tomography was performed before treatment and 6 months after medication. Compared with allopurinol group, F40 group showed no difference in urate-lowering effect, while F80 had the best effect across all the visits (P<0.01). At 6th month, 25(83.3%) cases of F80 group achieved sUA<6mg/ dL, which was better than allopurinol group (18 cases, 58.1%) and F40 group (17 cases, 58.6%). In the dissolution effect of radiolucent calculi, F80 had the best effect, followed by F40 and then allopurinol (P<0.05). No statistical difference was observed in adverse events among three groups. Febuxostat significantly decreased sUA, promoted radiolucent stone dissolution and reduced the total stone number, whereas it did not increase the adverse events.

In vitro litholytic activity of extracts and phenolic fractions of some medicinal plants on urinary stones

Objective: This study was carried out to evaluate the efficiency of plant extracts used in traditional medicine on the dissolution of oxalo-calcic and cystine stones. Also, the efficiency of phenolic fractions (Tannins and Flavonoids) for the plants that gave us the best stone dissolution rate. Subjects and methods: Kidney stone of oxalo-calcic and cystine stones were incubated in vitro for 8 weeks in the presence of five plants extracts (hydro-ethanolic and aqueous extracts). NaCl solution (0,9 %) used as negative control and sodium citrate solution at 3 mM/L as a positive control. The studied plants were Herniaria hirsuta L. aerial parts, Opuntia ficus-indica L. flowers, Zea mays L. stigmata, Ammi visnaga L. seeds and Ziziphus lotus L. fruits. After 2, 4, 6 and 8 weeks the stones were weighed after 18 h drying at 40°C and the dissolution rate of the stones and the pH of the solution were measured.Results: After eight weeks, all the plant extracts and phenolic fractions had revealed a significant effect to dissolve oxalo-calcic and cystine stones in comparison to the control solutions. The best result of cystine stones was showed with aqueous extract of H. hirsuta aerial parts which had a dissolution rate of 88,91 %. Concerning the dissolution rate of oxalo-calcic stones the aqueous extract of Z. mays had the best results with 68 % against 19 % for the sodium citrate solution. The dissolution rate of the fractions studied showed a better result for Z. mays flavonoids fraction toward oxalo-calcic stones, and Z. mays tannins fraction for cystine stones. The pH undergoes a non-negligible linear increase over the eight weeks for all extracts and phenolic fractions and both kidney stones.Conclusion: The tested plants' extracts and the phenolic fractions for the plants that gave us the best stone dissolution rate were able to dissolve oxalo-calcic and cystine stones. To confirm the efficiency of these plant extracts on the treatment of oxalo-calcic and cystine stones multiple in vivo tests could be made.

Hexametaphosphate as a potential therapy for the dissolution and prevention of kidney stones.

The incidence of kidney stones is increasing worldwide, and recurrence is common (50% within 5 years). Citrate, the current gold standard therapy, which is usually given as potassium or sodium salts, is used because it raises urine pH and chelates calcium, the primary component of up to 94% of stones. In this study hexametaphosphate (HMP), a potent calcium chelator, was found to be 12 times more effective at dissolving calcium oxalate, the primary component of kidney stones, than citrate. HMP was also observed to be effective against other common kidney stone components, namely calcium phosphate and struvite (magnesium ammonium phosphate). Interestingly, HMP was capable of raising the zeta potential of calcium oxalate particles from -15.4 to -34.6 mV, which may prevent stone growth by aggregation, the most rapid growth mechanism, and thus avert occlusion. Notably, HMP was shown to be up to 16 times as effective as citrate at dissolving human kidney stones under simulated physiological conditions. It may thus be concluded that HMP is a promising potential therapy for calcium and struvite kidney stones.