Potassium Sodium Hydrogen Citrate Research Articles

Potassium sodium hydrogen citrate intervention on gut microbiota and clinical features in uric acid stone patients

The high recurrence rate of renal uric acid stone (UAS) poses a significant challenge for urologists, and potassium sodium hydrogen citrate (PSHC) has been proven to be an effective oral dissolution drug. However, no studies have investigated the impact of PSHC on gut microbiota and its metabolites during stone dissolution therapy. We prospectively recruited 37 UAS patients and 40 healthy subjects, of which 12 patients completed a 3-month pharmacological intervention. Fasting vein blood was extracted and mid-stream urine was retained for biochemical testing. Fecal samples were collected for 16S ribosomal RNA (rRNA) gene sequencing and short chain fatty acids (SCFAs) content determination. UAS patients exhibited comorbidities such as obesity, hypertension, gout, and dyslipidemia. The richness and diversity of the gut microbiota were significantly decreased in UAS patients, Bacteroides and Fusobacterium were dominant genera while Subdoligranulum and Bifidobacterium were poorly enriched. After PSHC intervention, there was a significant reduction in stone size accompanied by decreased serum uric acid and increased urinary pH levels. The abundance of pathogenic bacterium Fusobacterium was significantly downregulated following the intervention, whereas there was an upregulation observed in SCFA-producing bacteria Lachnoclostridium and Parasutterella, leading to a significant elevation in butyric acid content. Functions related to fatty acid synthesis and amino acid metabolism within the microbiota showed upregulation following PSHC intervention. The correlation analysis revealed a positive association between stone pathogenic bacteria abundance and clinical factors for stone formation, while a negative correlation with SCFAs contents. Our preliminary study revealed that alterations in gut microbiota and metabolites were the crucial physiological adaptation to PSHC intervention. Targeted regulation of microbiota and SCFA holds promise for enhancing drug therapy efficacy and preventing stone recurrence.Key points• Bacteroides and Fusobacterium were identified as dominant genera for UAS patients• After PSHC intervention, Fusobacterium decreased and butyric acid content increased• The microbiota increased capacity for fatty acid synthesis after PSHC intervention

Diagnosis of Uric Acid-Based Urine Sedimentation in the Bladder Using Dual-Energy CT.

Urine sedimentation in the bladder can occur in various circumstances and can lead to urinary obstruction/stasis with associated pain. It is usually diagnosed with an ultrasound; however, CT is also used to assess the amount and to further check for urinary stones. Depending on the composition, urine sedimentation and stones can be treated medically by alkalinisation of the urine with potassium sodium hydrogen citrate in the case of uric acid-based sedimentation/stones. Due to technical developments and improved material differentiation and characterisation in CT imaging, dual-energy CT allows for differentiation of uric acid from calcium, which can be used for sedimentation/stone composition analysis. Subsequently, treatment decisions can be made based on the findings in dual-energy CT.

Effect of Potassium Sodium Hydrogen Citrate Granule on The Wall

Objective: To observe the effect of potassium sodium hydrogen citrate Granule on the wall stone shell of preset ureteral stent before ureteroscopy. Methods: 263 cases of renal calculi treated in our hospital from January 2019 to June 2021 who needed ureteroscopy and successfully preset ureteral stent were investigated retrospectively. 129 cases of patients who took oral potassium sodium citrate granules 10g a day from preset ureteral stent and maintained pH between 7.6 ~ 8.0 until before ureteroscopy were classified into the experimental group, 134 patients without oral administration of any drugs were classified as the control group. The patients in the experimental group took Potassium Sodium Citrate Granules orally. The daily dose was 4 standard spoons, 1 spoonful in the morning, 1 spoonful at noon and 2 spoonfuls in the evening. Both groups of patients returned to the hospital for ureteroscopic lithotripsy after 3 weeks according to the doctor’s advice. After pulling out the ureteral stent tube during the operation, the two doctors observed whether there was wall attached stone shell on the surface of the ureteral stent tube and the thickness of the stone shell, and recorded it in a special notebook after unified opinions. Finally, weigh the weight of ureteral stent and completely scrape off the stone shell to obtain the weight of stone shell. Results: In the experimental group, 129 ureteral stents were pulled out, of which 7 showed thin stone shells and 4 showed thicker stone shells (the thickest part ≥ 1mm). The stone shell formation rate was 8.53%, and the average stone shell weight was 0.8521 ± 0.1952 G. In the control group, 134 ureteral stents were pulled out, including 21 thin stone shells and 9 thick stone shells. The stone shell formation rate was 22.39%, and the average stone shell weight was 1.7823 ± 0.1802 G. The ureteral stent was pulled out at one time in both groups. After oral administration of youlaite, there were significant differences in stone shell formation rate, stone shell thickness and stone shell weight between the two groups (P < 0.05). Conclusion: Potassium sodium hydrogen citrate granules can be used as an economic, effective and safe drug to reduce the formation of stone shell attached to ureteral stent and slow down the progress of stone shell thickness, which is worthy of clinical promotion.

The observation of the effect of sodium potassium citrate on prolonging the retention time of double J tube in vivo

Objective To explore the effect and mechanism of the extension of double-J tube in vivo retention time with sodium potassium citrate. Methods From March 2015 to July 2017, a total of 86 cases who underwent postoperative indwelling double-J tube for long time were selected. All patients were randomly divided into experimental and control groups, the experimental group with oral sodium potassium citrate postoperatively and the control group without special treatment. The differences of urinary scale and calculus of double-J tube were observed in 2, 4 and 6 months after catheterization, and the difficulty of tube extraction was determined. Results Indwelling double-J tube for 2 months, the double-J tube incidence rate of pulling out hard in the experimental group was 2.5%, the incidence rate in the control group was 2.2%, there was no statistical significant difference (P>0.05). Indwelling tube for 4 months, the incidence rate was 5.0% in the experimental group, and 9.1% for the control group.Indwelling tubes for six months, the incidence rate was 10.0% in the experimental group and 15.9% for the control group.The difference had statistical significance (P<0.01). The incidence rate of double-J tube wall stones was 80% in the experimental group, and 89.1% in the control group. The difference was statistically significant. Calcium oxalate and phosphate stones were the main components of the wall stones. Conclusions The difficulty to pull out of the double-J tube is positively correlated with the retention time in the body. Potassium sodium hydrogen citrate can significantly reduce the formation of calcium oxalate and phosphate stones in double-J tube wall, thus prolonging the retention time of double-J tube in vivo and reducing the difficulty of extubation. Key words: Catheters, Indwelling; Sildenafil Citrate

Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial

To evaluate the efficacy of oral dissolution therapy (ODT), shock wave lithotripsy (SWL), and combined SWL and ODT for medium-sized radiolucent renal stone (RLS). A randomized controlled trial for patients with medium-sized RLS, 1-2.5cm, ≤ 500 Hounsfield unit (HU). The ODT patients were counseled for oral potassiumsodium-hydrogen citrate (Uralyt-U®). The 2nd group underwent SWL and the last group had combined SWL and ODT. The primary outcome, stone-free rate (SFR) at 3months, was assessed by non-contrast computed tomography (NCCT). We defined complete response (success) if no residual fragment were detected by NCCT; partial response (failure) if there was a decrease in stone size, but presence of residual stones; no response if there was no change or increase in stone size (failure). 150 patients completed follow-up. The SFR at 1st month and 3rd month were, respectively; 16% and 50% in the ODT group, 10% and 46% in the SWL group, and 35% and 72% patients in combined group with (p = 0.03 and 0.003, respectively. The overall SFR for all groups was 66%. Combined treatment and initial response in first month follow-up were independent factors predicting SFR. In addition, combined treatment significantly decreased the overall stone volume (p = 0.03) and the need for additional stone management procedures after 3months (p = 0.01). Combined ODT and SWL treatment constitutes the most rapid and effective therapeutic approach for medium-sized RLS, decreasing overall stone volume as well as the number of SWL sessions needed in comparison to SWL therapy, alone.

Oral dissolution therapy for renal radiolucent stones, outcome, and factors affecting response: A prospective study.

Background:Urolithiasis is a widespread problem, that affects up to 10% of population. Uric acid stones come second to calcium stones in prevalence (around 10% of urolithiasis). Potassium citrate is currently the treatment of choice for urine alkalization with minimal side effects and high tolerability.Aims and Objectives:This study is trying to present the outcome of oral dissolution therapy (ODT) for treating radiolucent renal stones and evaluating factors affecting its success in a prospective manner.Materials and Methods:Between 2015 and 2018, 147 patients with solitary radiolucent renal stones were offered ODT using potassium sodium hydrogen citrate (K citrate). The study included patients diagnosed by noncontrast computed tomography (NCCT) with stone size of 5–30 mm in the longest dimension and attenuation less than 600 Hounsfield units (HU). Patient compliance, blood pressure, creatinine level, K level, and tolerance to side effects were followed up at days 3, 7, and 15 and then monthly for 3 months. Follow-up renal ultrasound at 6-week intervals and a final NCCT at the end of treatment. Successful dissolution was defined as complete stone dissolution or residual that measures up to 2 mm in maximum length. Data were collected, tabulated, and analyzed using Stata 12.0 software (Stata Corporation, College Station, TX, USA).Results:One hundred and thirty-nine patients were included in the analyses. The age was 45.1 ± 10.5 years. DJ stent was used in 47 (33.8%) patients. Overall response rate was 64.8%. The stone location within the kidney (pelvic or calyceal) showed no difference between responders and non-responders. Stone longest diameter was smaller in responders (17 ± 5.7 mm) versus 19.2 ± 6.1 mm in nonresponders (P value = 0.039). The mean stone attenuation value (HU) was also lower in responders (347.4 ± 68.5 HU) versus (428.9 ± 84.0 HU) in nonresponders with P < 0.001. DJ insertions seemed to have marginal effect on stone dissolution on univariate analysis but found insignificant in multivariate analysis.Conclusion:ODT is safe and effective in the treatment of radiolucent renal stones. The efficacy was affected by stone density and stone size with more tendencies to failure with bigger stones and denser stones. Double J stent insertion may facilitate dissolution rate. There was no effect of the baseline urinarypH, hyperuricemia, or stone location on the dissolution rate of the stones.

Medical dissolution therapy for kidney stone with low density on non-contrast computed tomography

Objective: To review the outcome of dissolution therapy in low-density urinary stones defined by nonenhanced computed tomography. Materials and Methods: The outcome of dissolution therapy in patients treated between May 2011 and July 2016 was retrospectively reviewed. Potassium sodium hydrogen citrate was used in cases with syone of <800 Hounsfield units determined by non-enhanced computed tomography. A decrease of 50% in the long axis of the stone was defined as partial dissolution. Cases with complete and partial stone dissolution were taken as the treatment success group whereas those who could not tolerate the treatment and who has less than 50% decrease in stone size were noted as treatment failure. The patients were compared with respect to age, body mass index, stone size, stone density, duration of treatment and follow-up, urine pH and serum uric acid levels. Results: Of 46 patients 31 completed the treatment course. A full response was obtained in 22 (71%) and a partial response in 4 (12.9%) cases. The basic factors found to affect the success of treatment were stone surface area, pre-treatment urine pH and serum uric acid levels. Conclusion: Low-density urinary stones can be successfully treated with dissolution therapy. In patients with radiolucent stones, the stone density should be measured by using non-enhanced computed tomograms. In cases examined with suitable stone density, dissolution treatment can be started without determining the exact type of the stone.

Dissolution Therapy versus Shock Wave Lithotripsy for Radiolucent Renal Stones in Children: A Prospective Study

We prospectively evaluated the efficacy of dissolution therapy and standard shock wave lithotripsy as a noninvasive modality for radiolucent renal stones in children. A total of 87 children with radiolucent renal calculi were included in study. Median age was 2.5 years (range 0.5 to 13). Computerized tomography was done to confirm a stone density of less than 500 HU. Median stone length was 12 mm (range 7 to 24). Patients were randomly divided into 2 groups. The medical group of 48 patients received potassium sodium hydrogen citrate at a dose of 1 mEq/kg per day for 1 to 3 months. The shock wave lithotripsy group of 39 patients were treated with a Lithotripter S (Dornier Medtech, Kennesaw, Georgia) while under general anesthesia. Complications in each group were recorded. Patients were considered stone free when imaging within 3 months showed no evidence of stones. The stone-free rate was 72.9% for dissolution therapy vs 82.1% after a single session of shock wave lithotripsy (p = 0.314). One patient per group experienced a pyelonephritis episode during followup (p = 0.698). Three of the 13 patients in whom medical regimens failed were noncompliant and 5 ingested the medication sporadically. Medical dissolution therapy is a well tolerated, effective treatment for radiolucent renal stones in children. It eliminates the need for shock wave lithotripsy in up to 73% of cases.

Clinical analysis of 41 children's urinary calculus and acute renal failure

To analyze the treatment of acute renal failure caused by irrational drug use. Data of 41 cases of acute renal failure seen from July 2008 to June 2012 in our hospital were reviewed. Bilateral renal parenchymas diffuse echo was found enhanced by ultrasound in all cases. Calculus image was not found by X-ray. All children had medical history of using cephalosporins or others. Alkalinization of urine and antispasmodic treatment were given to all children immediately, 17 children were treated with hemodialysis and 4 children accepted intraureteral cannula placement. In 24 children who accepted alkalinization of urine and antispasmodic treatment micturition could be restored within 24 hours, in 11 children micturition recovered after only one hemodialysis treatment and 2 children gradually restored micturition after hemodialysis twice, 4 children who accepted intraureteral cannula immediately restored micturition. In all children micturition recovered gradually after a week of treatment. Ultrasound examination showed that 39 children's calculus disappeared totally and renal parenchymas echo recovered to normal. The residual calculi with diameter less than 5 mm were found in 2 children, but they had no symptoms. The children received potassium sodium hydrogen citrate granules per os and were discharged from hospital. Ultrasound showed calculus disappeared totally one month later. Irrational drug use can cause children urolithiasis combined with acute renal failure, while renal dysfunction can reverse by drug withdrawal and early alkalinization of urine, antispasmodic treatment, intraureteral cannula or hemodialysis when necessary, most calculus can be expelled after micturition recovered to normal.

Percutaneous Nephrolithotomy in Children with Cystine Stone: Long-Term Outcomes from a Single Institution

We determined the effectiveness of percutaneous nephrolithotomy in children with cystine stones and present the long-term outcomes. We reviewed the data of 65 renal units in 51 children who underwent percutaneous nephrolithotomy for cystine stones between 2000 and 2012. Of the patients 19 (37%) had undergone ipsilateral renal surgery and 11 (22%) had undergone extracorporeal shock wave lithotripsy. Children were designated as being stone-free or having residual stone (any evidence of persistent stone fragments irrespective of size). Medical treatment with α-mercaptopropionylglycine, potassium citrate or potassium sodium hydrogen citrate was recommended for all patients after stone analysis. Median stone burden was 3.3 cm(2) (range 1 to 13) and median patient age was 6 years (1 to 17). Stone-free status was achieved in 41 renal units (63.1%). Stone-free status was increased to 73.8% with additional endoscopic procedures. The remaining patients with residual stones were followed. Complication rate was 15.4%. A total of 35 children (68.6%) receiving regular medical treatment were followed for a median of 95 months (range 6 to 136). The recurrence rate for children achieving stone-free status was 31.2%, and the regrowth rate for children with residual stones was 29.4%. Percutaneous nephrolithotomy is a safe and effective treatment for children with cystine stones. Our high recurrence and regrowth rates emphasize that our treatment schedule is inadequate to prevent recurrent cystine calculi. Additional investigation is needed to determine the optimal medical therapy for preventing recurrence and regrowth of cystine stones.

Efficacy of potassium sodium hydrogen citrate intervention on risk factors for sedimented stone of double “J” catheter

Objective To study the effect and mechanism of potassium sodium hydrogen citrate for reducing the risk of sedimented stone of the double “J” catheter.Methods 123 postoperative cases of double “J” catheter in bodies were divided into odd number and even number two groups randomly.The cases of odd number group were treated with potassium sodium hydrogen citrate and those of even number group were given no treatment.The difference of sedimented stone of double “J” catheter was compared between two groups by ultrasonography,plain abdominal radiograph or macroscopic observation.Results The incidence of sedimented stone of the double “J” catheter in odd number group and even number group was 6.7％ and 19.8 ％ respectively with the difference being significant (P ＜ 0.05 ).Conclusion Potassium sodium hydrogen citrate has an significant depressant effect for reducing the risk of sedimented stone of the double “J” catheter. Key words: Potassium sodium hydrogen citrate; Double “J” catheter; Sedimented stone

Comprehensive therapy of the infant urinary calculus induced by melamine

Objective To explore the comprehensive therapy of infants with urinary calculus induced by melamine.Methods Clinical data of 228 infants(aged from 4 months to 3 years,mean age 11 months)with urinary calculus induced by melamine were analyzed. Bilateral renal calculi were found in 144 cases and one-side renal calculus in 54 cases,of which the diameter ranged from 0.5-2.5 cm.Ureteral calculi with moderate to severe hydronephrosis were found in 15 cases,of which the diameter ranged from 0.4-1.1 cm. Bladder calculi with urinary retention were found in 5 cases and urethral calculi with urinary retention in 10 cases,of which the diameter ranged from 0.5-1.3 cm. All the urinary calculi were confirmed by B-uhrasound examination and CT. Group 1 : Of the 15 cases with acute renal failure, 13 underwent shattering and dissolving renal and ureternal calculus by pelvis clysis with alkalinity drug, detaining double J tubes through ureteroscope. After operation, these patients were treated with alkalinity drugs. Two cases were treated by percutaneous nephrostomy guided by B ultrasound and underwent shattering and dissolving renal calculus by intermittent pelvis clysis with alkinity drug. Group 2:15 cases of ureteral calculus with serious nephrohydrops underwent shattering and detaining double J tubes through ureteroscope, then treated with alkalinity drug. Group 3:15 cases of infant bladder and urethral caleus with acute urinary retention were treated by EMS through ureterscope per urethra. Group 4: The rest 183 cases without urinary obstruction received 1-8 week'surine alkalization therapy. Among them, 113 cases received sodium bicarbonate 0.15 g twice per day,23 cases received potassium sodium hydrogen citrate 2.4g/d, and 47 cases received 10% potassium citrate solution 5 ml 3 times per day. Sixty-one cases who were of no effect with alkalinity drug were treated by extracorporeal shock wave lithotripsy (ESWL) and dissolving calculus with sodium bicarbonate. During treatment with alkalinity drug, urine Ph was observed by urine analysis once per day.When it exceeded 7.5, alkalinity drug. Was withdrawn. All the patients were followed up for 1 to 3 months. Statistical analysis was done with the SPSS 13.0 software. ResultsHyperdiuresis emerged 12-24 h after operation in group 1. The duration of hyperdiuresis was 24-72 h with the urine volume of 800-2500 ml/24h. Urine volume revived gradually 48--96h after operation while serum BUN and Cr revived 1-5 d after operation. Four cases with renal and ureteral calculus became almost stone-free in 1-2 weeks and 14 cases became completely stone-free in 2-4 weeks after operation. Patients of group 2 became completely stone-free in 1-2 weeks. Patients of group 3 were cured by one EMS session through ureterscope per urethra and smooth urination was seen immediately after operation. No retained calculus in the bladder and urethra was found by B ultrasound 3 days later. In the sodium bicarbonate group, 4 cases became completely stone-free in 2 weeks, 18 cases in 4 weeks, 15cases in 13 weeks. The stones lessened and faded in 34 cases and had no changes in 42 cases. In the potassiun sodium hydrogen citrate group, 4 cases became completely stone-free in 1 weeks, 7 cases in 2 weeks, 10 cases in 4 weeks, 2 cases in 6 weeks. In the potassium citrate group, 3 cases became completely stone-free in 1 weeks, 5 cases in 2 weeks, 16 cases in 4 weeks, 11 cases in 8 weeks. The stones lessened and faded in 8 cases in 8 weeks and had no changes in 4 cases. The efficacy of the sodium bicarbonate group was significantly different with the efficacy of the citrate group (P=0. 001). No significant difference was found between the potassium sodium hydrogen citrate group and the potassium citrate solution group(P=0. 372). ConclusionsConservative treatment should be employed mainly in the earlier stage for the infant urinary calculus induced by melamine . When the diagnosis of acute renal failure, moderate to severe hydronephrosis and acute lower urinary tract obstruction are established, surgical intervention should be the main method to relieve obstruction, protect renal function and resume normal rnicturition. With the development of the characteristics of the stones later,the oral dissolution therapy with alkalirtity drug could not dissolve the calculi and ESWL should be employed. Key words: Urinary calculi; Infants; Melamine; Combined modality therapy

Radiolucent Renal Stones in Children: Combined Use of Shock Wave Lithotripsy and Dissolution Therapy

To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones. This study included 24 children (10 girls and 14 boys) with radiolucent renal stones. Of the 24 patients, 5 presented with bilateral renal stones, 8 with multiple stones, 4 with staghorn stones, and 7 with a solitary renal stone. Their age range was 2-12 years (mean 6.3 +/- 2.8). The stone size range was 12-65 mm in the largest diameter. All patients were treated with combined extracorporeal shock wave lithotripsy (ESWL) and medical therapy in the form of urinary alkalization using potassium sodium hydrogen citrate and allopurinol for the treatment of hyperuricosuria. Before ESWL, 3 patients had a percutaneous nephrostomy tube inserted and 2 patients had a ureteral stent placed to relieve obstruction. ESWL was performed with a Siemens Lithostar using either general anesthesia or intravenous sedation. The follow-up period after stone clearance was 12-36 months (mean 26 +/- 7.2). The stone-free rate of 100% was achieved in all 24 patients after 3 months of combined use of extracorporeal shock wave lithotripsy and dissolution therapy. Combined ESWL and dissolution therapy accelerated stone clearance and delayed stone recurrence. The use of ESWL and medical therapy as a combined modality is a safe and effective treatment of radiolucent renal stones in children.

Extracorporeal Shock Wave Lithotripsy of Impacted Radiolucent Stone at the Right Pyeloureteric Junction and Oral Dissolution Therapy in a Patient With Transplanted Liver: A Case Report

Extracorporeal shock wave lithotripsy (ESWL) is a safe, effective method to treat urinary lithiasis. The success rate in ESWL depends on stone location, size, number, and fragility as well as calceal anatomy and patency of the urinary tract. An association of calcineurin inhibitors and uric acid urolithiasis has been reported in renal allograft recipients, but the mechanism remains unknown. Herein we have reported the case of 68-year-old male patient who developed cryptogenic cirrhosis and underwent liver transplantation. Seven years after transplantation, the patient was admitted to the hospital with right renal colic. An 8.9-mm radiolucent stone at the pyeloureteric junction was associated with moderate consecutive hydronephrosis. The second stone was located in a lower renal calyx. After a failed attempt at retrograde ureteral stenting, we performed a percutaneous nephrostomy. Antegrade pyelography with following ESWL treatment resulted in disintegration of the obstructive stone at the pyeloureteric junction. Afterward, we performed antegrade placement of a double-J stent. Residual stones in the lower renal calyx were successfully treated with a 3-month course of oral intake of a dissolution agent—potassium sodium hydrogen citrate. In this case, we have discussed ESWL and oral dissolution therapy of radiolucent stones in a hydronephrotic right kidney, which resulted in stone-free disease after 3 months of combined therapy. There was neither clinical nor biochemical damage to the transplanted liver.