Eleven patients with uric acid nephrolithiasis(Five with uric acid stones alone and six with both uric acid and calcium stone) underwent long-term treatment(0.5 to 3.75 years, mean of 2.33 years) with potassium citrate(30 to 80 mEq/day. usually 60mEq/day). Urinary pH increased from low(5.0-6.0) to normal(6.5-7.0) during treatment. Urinary content of uric acid which was 584+/-150 mg, day. slightly increased to 595+/-163 mg/day following treatment. Serum content of uric acid which was 6.45+/-0.9 mg%, slightly decreased to 6.1+/-0.8 mg%. The protein matrix was round in all 11 cases. And 4 types of nucleus were found. which were ca. oxalate, ca. phosphate, dried blood and suture material During the period' (Jan. 1987-Mar. 1990) of preventive management(enough fluid intake. restiction of animal protein and Polycitra-K), no new stones were found.
Animals ; Calcium ; Humans ; Hydrogen-Ion Concentration ; Nephrolithiasis* ; Potassium Citrate* ; Potassium* ; Sutures ; Uric Acid*

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

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

We report the case of a female patient with incomplete distal renal tubular acidosis with nephrocalcinosis. She was admitted to the hospital because of acute pyelonephritis. Imaging studies showed dual medullary nephrocalcinosis. Subsequent evaluations revealed hypokalemia, hypocalcemia, hypercalciuria, and hypocitraturia with normal acid-base status. A modified tubular acidification test with NH4Cl confirmed a defect of urine acidification, which is compatible with incomplete distal tubular acidosis. We treated our patient with potassium citrate, which corrects hypokalemia and prevents further deposition of calcium salts.
Acidosis ; Acidosis, Renal Tubular ; Calcium ; Female ; Humans ; Hypercalciuria ; Hypocalcemia ; Hypokalemia ; Kidney ; Nephrocalcinosis ; Potassium Citrate ; Pyelonephritis ; Salts

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*

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*

A 52-year old woman, who had hypothyroidism associated with autoimmune thyroiditis for 5 years, was hospitalized for tingling sensation and muscle weakness of both lower extremities. Her initial laboratory findings showed severe hypokalemia, metabolic acidosis, and high titer of thyroid autoimmune antibodies. She was diagnosed of distal renal tubular acidosis by bicarbonate loading test (FEHCO(3)(-) <3.0 %) and renal calcifications on pre-enhanced CT scan. Since she had other symptoms of xerostomia and xerophthalmia, primary Sjogren's syndrome was diagnosed by Schirmer test, salivary scan, and serologic findings. She was treated with potassium citrate, potassium chloride, and hydroxychlorquine. Four months later, she has remained well with those treatments. There were only a few case reports about distal renal tubular acidosis associated with Sjogren's syndrome and autoimmune thyroiditis. In Korea, there has not been any report of such cases. Therefore, we report a case of distal renal tubular acidosis and Sjogren's syndrome in a patient with autoimmune thyroiditis.
Acidosis ; Acidosis, Renal Tubular ; Antibodies ; Female ; Humans ; Hypokalemia ; Hypothyroidism ; Korea ; Lower Extremity ; Muscle Weakness ; Potassium Chloride ; Potassium Citrate ; Sensation ; Sjogren's Syndrome ; Thyroid Gland ; Thyroiditis, Autoimmune ; Xerophthalmia ; Xerostomia

OBJECTIVE: To determine the efficacy and safety of sodium bicarbonate, citric acid, sodium citrate, and tartaric acid (compound drug) in comparison to potassium citrate in the treatment of kidney stones.

METHODS: Prospective randomized controlled trial of patients with kidney stones recruited from February to October 2011 at Out-patient Department was conducted. Ninety subjects, consented and eligible, were enrolled in this study. Random allocation of subjects into two groups was done using computer generated randomization. Subjects assigned to group I were treated with the compound drug(12 grams/day); while group II subjects were given potassium citrate(60mEq/day) for 6 weeks. Urinary pH levels were examined weekly and the effect of medical treatment on stone size changes was evaluated by ultrasonography every two weeks in the six-week treatment period. Intention to treat analysis was done with 95% confidence level(CI). Statistical analysis of results was determined using analysis of variance (ANOVA) with multiple repeated measures for between group urinary pH changes and chi square for between groups difference in stone size changes.

RESULTS: A total of 74 subjects completed the study with a dropout rate of 18%, which was mainly due to geographic and financial reasons. Demographic and baseline stone characteristics of both groups were not significantly different. Treatment outcome between the two groups based on stone size changes (in general and both radiolucent and radioopaque stones subgroups) did not show any significant statistic difference. The pH level changes over six-week treatment period between the two groups showed a total mean pH difference of 0.445, (95% CI: 0.213, 0.677), which was statistically significant (P<0.001) in favor of Group I. Both treatment regimens were well-tolerated with very few non-serious medication adverse effects.

CONCLUSION:  Urinary alkalinization with sodium bicarbonate, citric acid, sodium citrate, and tartaric acid is a well-tolerated and highly effective treatment resulting in dissolution of non-obstructing kidney stones and is comparable to the gold standard potassium citrate.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; KIDNEY CALCULI ; NEPHROLITHIASIS ; UROLOGIC DISEASES ; KIDNEY DISEASES ; SODIUM BICARBONATE ; CITRIC ACID ; SODIUM CITRATE ; TARTARIC ACID ; POTASSIUM CITRATE ; INORGANIC CHEMICALS ; ORGANIC CHEMICALS ; TREATMENT OUTCOME ; SAFETY

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*