Potassium citrate therapy caused a sustained increase in urinary pH and potassium, and restored urinary citrate to normal levels. No significant changes occurred in urinary uric acid, oxalate, sodium or phosphorus levels. Owing to these physiological changes, uric acid solubility increased, urinary saturation of calcium oxalate decreased and the propensity for spontaneous nucleation of calcium oxalate was reduced to normal. Therefore, the Physicochemical environment of urine following treatment become less conductive to the crystallization of calcium oxalate or uric acid. Twenty six patients with uric acid nephrolithiasis with or without calcium nephrolithiasis underwent treatment and long-term preventive management (mean of 20.8 months) with potassium citrate. Urinary pH increased from acid (5.0-5.5) to normal (6.5-7.0) during treatment. During the period of preventive management, stones were not developed.
Calcium ; Calcium Oxalate ; Citric Acid ; Crystallization ; Humans ; Hydrogen-Ion Concentration ; Nephrolithiasis ; Oxalic Acid ; Phosphorus ; Potassium Citrate* ; Potassium* ; Solubility ; Uric Acid ; Urinary Calculi*

Aims: Citric acid is a commercially important acid that has many applications in varying sectors of industries. It is produced by various substrates through solid state or submerged fermentation. The capabilities of potato and rice as substrates for citric acid production using Aspergillus niger were tested in this experiment under submerged fermentation. Methodology and results: Potato and rice extract media were prepared and inoculated with A. niger and titrations were carried out to determine the amount of citric acid produced. It was shown that rice extract media proved more useful than potato extract media as it produced the highest citric acid production. Rice extract media was supplemented with varying concentrations of glucose and sucrose and 5% sucrose (w/v) proved to be the best as it produced the highest amount of citric acid. The rice extract media with 5% sucrose (w/v) were supplemented with varying concentrations of ammonium nitrate and ammonium sulphate and 0.25% ammonium nitrate proved more effective in citric acid production. A low pH (1.9-2.3) was found during the maximum production of citric acid. Conclusion, significance and impact of study: The results depict that potato and rice extract media can produce citric acid, hence providing an alternate substrate for citric acid production.
Citric Acid

PURPOSE: We compared the biochemical and clinical presentation of gouty diathesis in patients with uric acid and calcium nephrolithiasis MATERIALS AND METHODS: We retrospectively reviewed biochemical and clinical data from 69 gouty diathesis patients(48 with uric acid stones and 21 with calcium stones) and 57 normal subjects were performed at our institution. RESULTS: Demographic similarity between two groups was a male predominance. Gouty diathesis patients in both groups showed abnormally low urinary pH(<5.5) and propensity for hyperuricemia and hypertriglyceridemia. Gouty arthritis and hyperuricemia was found in 31% and 44% of those with uric acid stones whereas 9.5% and 23.8% in those with calcium stone respectively. In control group, 1 case presented with hyperuricemia and urinary pH at 6.3. Both urinary pH and citrate increased after potassium citrate treatment in both groups. CONCLUSIONS: The two groups of gouty diathesis with either uric acid stone or calcium stones have similar biochemical and clinical features that are characteristic of primary gout. Calcium stone formation in patients with hyperuricemia or persistent acidic urine may represent a latent form of gout. Patients with calcium stones and biochemical feature of gouty diathesis may manifest primary gouty. Both groups are responsive to potassium citrate treatment.
Arthritis, Gouty ; Calcium* ; Citric Acid ; Disease Susceptibility* ; Gout ; Humans ; Hydrogen-Ion Concentration ; Hypertriglyceridemia ; Hyperuricemia ; Male ; Nephrolithiasis ; Potassium Citrate ; Retrospective Studies ; Uric Acid*

PURPOSE: Citrate is a well recognized inhibitor of the formation of calcium oxalate and calcium phosphate stones. Hypocitraturia is a common etiology of recurrent calcium nephrolithiasis, with an incidence of 19 to 63%. Potassium citrate therapy can be a useful therapeutic approach for the management of calcium nephrolithiasis. But pharmacological treatment of hypocitraturic calcium nephrolithiasis requires taking too many tablets, or numerous crystal package or liquid supplements throughout the day. This cumbersome regimen often decreases patient compliance. We administered dietary citrate via lemon juice to stone former and evaluated the change of citrate levels. MATERIALS AND METHODS: The prospective study included 7 women and 8 men with documented recurrent or multiple urinary stone disease. None of the subjects suffered from renal impairment, urinary tract infection and other metabolic disorder. Controls comprised 6 voluntary men. They had no previous stone history and no evidence of stone. Patients ingested total 1 liter of lemon juice(containing 4.0gm/L.citrate) divided at 6 hours interval without strict diet restriction. Urine specimens were obtained for urinary citrate levels after 2-3days of lemon juice therapy and compared to pre-lemon juice baseline values. RESULTS: All 15 patient showed increased urinary citrate levels during lemon juice therapy. Average urinary citrate levels increased from 146+/-109mg/day at baseline to 453+/-226mg/day during treatment(p<0.05). Urinary citrate levels during treatment increased up to those of control group(351+/-265mg/day) and did not show significant difference (p>0.05). Urinary pH increased from 5.9+/-0.4 at baseline to 6.8+/-0.6 during treatment(p<0.05). No patient complained of gastrointestinal discomforts. CONCLUSIONS: Citrate supplementation with lemon juice increased urinary citrate levels and urinary pH. Lemon juice is well tolerated dietary source of citrate and would be beneficial in the control of calcium urolithiasis.
Calcium ; Calcium Oxalate ; Citric Acid* ; Diet ; Female ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Male ; Nephrolithiasis ; Patient Compliance ; Potassium Citrate ; Prospective Studies ; Tablets ; Urinary Calculi ; Urinary Tract Infections ; Urolithiasis*

PURPOSE: To study the effects of long-term treatment with potassium magnesium citrate and vitamin B-6 prophylaxis (Urikind-KM6; 1,100-mg potassium citrate, 375-mg magnesium citrate, and 20-mg pyridoxine hydrochloride/5 mL) every 8 hours over 3 years. MATERIALS AND METHODS: A total of 247 patients with recurrent idiopathic hypocitraturia with or without hyperuricosuria and randomized controls were studied prospectively for 3 years. The total patients were divided into three groups. Control group 1 consisted of 61 patients (24.7%) who had moderate to severe hypocitraturia with or without hyperuricosuria and were recurrent stone formers but discontinued prophylaxis because of drug intolerance within 1 month of therapy. Control group 2 constituted 53 patients (21.5%) who were first-time stone formers and who had mild hypocitraturia with or without hyperuricosuria and were not put on prophylactic therapy and were followed for 3.16+/-0.08 years. Control group 3 constituted 133 patients (54.8%) who were recurrent stone formers who had moderate to severe hypocitraturia with or without hyperuricosuria and were put on prophylaxis therapy and were followed for 3.16+/-0.08 years. All patients were followed up at 6-month intervals. RESULTS: Potassium magnesium citrate prophylaxis produced a sustained increase in 24-hour urinary citrate excretion from initially low values (221.79+/-13.39 mg/dL) to within normal to high limits (604.04+/-5.00 mg/dL) at the 6-month follow-up. Urinary pH rose significantly from 5.62+/-0.2 to 6.87+/-0.01 and was maintained at 6.87+/-0.01. The stone recurrence rate declined from 3.23+/-1.04 per patient per year to 0.35+/-0.47 per patient per year. CONCLUSIONS: Potassium magnesium citrate prophylaxis was effective in reducing the recurrence of calcium oxalate and phosphate urolithiasis.
Calcium Oxalate* ; Citric Acid* ; Follow-Up Studies ; Humans ; Hydrogen-Ion Concentration ; Magnesium* ; Potassium Citrate ; Potassium* ; Prospective Studies ; Pyridoxine ; Recurrence ; Urolithiasis* ; Vitamins*

No abstract available.
Citric Acid* ; Nephritis*

PURPOSE: It has previously been reported that citrate, thiazide, allopurinol and magnesium (CTAM) have inhibitory effects on calcium oxalate crystallization, but the effects of CTAM on the matrix proteins of stones in vivo has not been studied. Using an ethylene glycol-induced urolithiasis model, we investigated the effects of CTAM on renal crystallization and the expression of osteopontin (OPN), which is an important stone matrix protein. MATERIALS AND METHODS: Adult Sprague-Dawley rats (200-250gm) were divided randomly into 6 groups of 10 rats. Group 1 was left untreated, and served as a control. Group 2 (CID group) was fed 0.8% ethylene glycol and 1% ammonium chloride (crystal-inducing diet, CID) in drinking water for 4 weeks. Groups 3, 4, 5 and 6 (CTAM groups) were fed the same CID as group 2, but were also treated with either potassium citrate or hydrochlorothiazide or allopurinol or magnesium hydroxide, for 4 weeks, respectively. We biochemically analyzed the 24-hour urine and serum samples. The renal calcium content was measured by atomic absorption. The kidneys were histologically examined for crystal deposit with HandE staining, and for OPN expression with immunohistochemical staining. RESULTS: The grade of calcium oxalate crystal deposits, and renal calcium content, were significantly decreased in the CTAM groups compared to the CID group, which also correlated with the decreased expression of OPN proteins in the kidneys of the CTAM-treated rats. CTAM were all effective in preventing calcium oxalate crystal formation, and decreasing the expression of OPN in rat kidneys. CONCLUSIONS: Our results suggest that CTAM are effective in preventing calcium oxalate stone formation, and that OPN plays an important role in calcium oxalate nephrolithiasis.
Absorption ; Administration, Oral* ; Adult ; Allopurinol* ; Ammonium Chloride ; Animals ; Calcium Oxalate* ; Calcium* ; Citric Acid* ; Crystallization ; Diet ; Drinking Water ; Ethylene Glycol ; Hand ; Humans ; Hydrochlorothiazide ; Kidney ; Magnesium Hydroxide ; Magnesium* ; Nephrolithiasis ; Osteopontin* ; Potassium Citrate ; Rats* ; Rats, Sprague-Dawley ; Urolithiasis*

PURPOSE: Hypocitraturia is cited as one of the risk factors promoting stone formation or recurrence of nephrolithiasis. We estimated the relationship between hypocitraturia and other metabolic abnormalities, such as hypercalciuria, hyperuricosuria and hyperoxaluria. The effects of potassium citrate medication were also investigated. MATERIALS AND METHODS: We selected 706 renal stone patients with hypocitraturia (<320mg/day), who had received extracorporeal shock wave lithotripsy (ESWL) treatment, and examined the relationship between hypocitraturia and other metabolic abnormalities according to sex and age. We also examined the increment effect of urinary citrate and stone-free rate following potassium citrate (Urocitra(R)) medication. RESULTS: Complicated hypocitraturia (coexistence with other metabolic abnormalities) was found in 332 of the 706 patients (47.0%). Of the 706 patients, 242 (34.3%), 112 (15.9%) and 33 (4.7%) had hyperoxaluria, hyperuricosuria and hypercalciuria, respectively. Complicated hypocitraturia was higher in the male than female subjects, and was statistically significant (50.4% vs. 39.8%). In 287 (77%) of the 373 patients who received potassium citrate treatment, the urinary citrate level was increased. The mean urinary citrate level was significantly increased (142.5 vs. 336.2 mg/day) (p<0.01), but the stone free rate was not following the citrate treatment. CONCLUSIONS: Potassium citrate was effective in increasing the urinary citrate level. However, prophylactic effects of potassium citrate against recurrent nephrolithiasis must be proved by appropriate comparative studies.
Citric Acid ; Female ; Humans ; Hypercalciuria ; Hyperoxaluria ; Lithotripsy ; Male ; Nephrolithiasis* ; Potassium Citrate ; Recurrence ; Risk Factors ; Shock

Urolithiasis is an uncommon complication in renal transplantation. We report a case of hypocitraturia-related ureteral steinstrasse which was spontaneously formed in a renal transplant recipient. The patient who underwent renal transplantation was admitted with acute pyelonephritis. Hydronephrosis in the transplanted kidney and multiple stones (steinstrasse) in the distal ureter were incidentally found on computed tomography scanning. After a failed attempt of ureteroscopic removal of stones, the patient underwent open ureterolithotomy and ureteroureterostomy. On stone analysis, carbonate apatite was confirmed. Urinary citric acid levels were decreased to 127.6 mg/day. Potassium citrate was administered to prevent stone recurrence by increasing urinary citrate excretion. No recurrence of stones was shown six months later. Urolithiasis in renal transplant recipients requires a high index of suspicion. Hypocitraturia can increase the risk for urolithiasis. Rapid recognition by careful surveillance, prompt removal of stones, and precautionary efforts to prevent recurrence are needed.
Carbon ; Citric Acid ; Humans ; Hydronephrosis ; Kidney ; Kidney Transplantation ; Potassium Citrate ; Pyelonephritis ; Recurrence ; Transplantation* ; Ureter* ; Urolithiasis

No abstract available.
Citric Acid ; Otitis Media, Suppurative