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Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women

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Abstract

Calcium intake is believed to play an important role in the formation of kidney stones, but data on the risk factors for stone formation in women are limited. To examine the association between intake of dietary and supplemental calcium and the risk for kidney stones in women. Prospective cohort study with 12-year follow-up. Several U.S. states. 91,731 women participating in the Nurses' Health Study I who were 34 to 59 years of age in 1980 and had no history of kidney stones. Self-administered food-frequency questionnaires were used to assess diet in 1980, 1984, 1986, and 1990. The main outcome measure was incident symptomatic kidney stones. During 903,849 person-years of follow-up, 864 cases of kidney stones were documented. After adjustment for potential risk factors, intake of dietary calcium was inversely associated with risk for kidney stones and intake of supplemental calcium was positively associated with risk. The relative risk for stone formation in women in the highest quintile of dietary calcium intake compared with women in the lowest quintile was 0.65 (95% CI, 0.50 to 0.83). The relative risk in women who took supplemental calcium compared with women who did not was 1.20 (CI, 1.02 to 1.41). In 67% of women who took supplemental calcium, the calcium either was not consumed with a meal or was consumed with meals whose oxalate content was probably low. Other dietary factors showed the following relative risks among women in the highest quintile of intake compared with those in the lowest quintile: sucrose, 1.52 (CI, 1.18 to 1.96); sodium, 1.30 (CI, 1.05 to 1.62); fluid, 0.61 (CI, 0.48 to 0.78); and potassium, 0.65 (CI, 0.51 to 0.84). High intake of dietary calcium appears to decrease risk for symptomatic kidney stones, whereas intake of supplemental calcium may increase risk. Because dietary calcium reduces the absorption of oxalate, the apparently different effects caused by the type of calcium may be associated with the timing of calcium ingestion relative to the amount of oxalate consumed. However, other factors present in dairy products (the major source of dietary calcium) could be responsible for the decreased risk seen with dietary calcium.

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... The major role of fluid intake on the risk of urinary stone was well documented by epidemiological studies [3][4][5] and by an interventional study [6]. Fluid intake was inversely related to the risk of kidney stones with a relative risk of 0.71 in men and of 0.61-0.68 in women in the highest quintile of intake compared with those in the lowest quintile [3][4][5]. ...
... The major role of fluid intake on the risk of urinary stone was well documented by epidemiological studies [3][4][5] and by an interventional study [6]. Fluid intake was inversely related to the risk of kidney stones with a relative risk of 0.71 in men and of 0.61-0.68 in women in the highest quintile of intake compared with those in the lowest quintile [3][4][5]. An interventional study showed that a large intake of water is effective to reduce the risk of stone recurrences [6]. ...
... The epidemiological evidence was contradictory in that a positive correlation had been shown between animal protein consumption and new kidney stone formation in men but not women whereas sucrose intake was associated with new kidney stone formation in women but not in men [3][4][5]. ...
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Nutrients, vitamins, probiotics, and herbal products may be risk factors, or alternately, protect against the formation of urinary stones. The purpose of this review was to update knowledge of the role of nutraceuticals in renal stone formation. A systematic search of the relevant literature published in PubMed in the last ten years was conducted and a narrative review of the data from the included studies was done. Search screened 513 studies that were reduced to 34 after evaluation by title and abstract; other 38 studies were retrieved by references of the selected studies. Beverages high fluid intake confirmed protective effect; orange juice protective effect; apple or grapefruit juice not confirmed as risk factors; sugar-sweetened soda and punch increased risk of stone formation. Energy intake: very high energy intake increased risk factor for women (especially after menopause); dietary acid load increased risk at equal levels of energy intake. Macronutrients confirmed increased risk of high protein intake. Calcium and Oxalate: calcium intake protective effect; oxalate intake only modest increase of risk in men and older women. Metal cations zinc and iron intake no clear impact on the risk of stone formation, dietary copper increased risk; manganese intake reduced risk of stone formation. Fruits and Vegetables decreased risk. Vitamins B6 intake not associated to risk of stone formation; vitamin C intake increased risk in men; vitamin D or supplemental vitamin D intake not associated to increased risk in men and younger women, suggestion of a higher risk in older women; Probiotics Gut colonization with Oxalobacter formigenes associated to lower risk of stone formation, effect of oxalate-degraders probiotics on urinary oxalate equivocal. Herbal products efficacy of some herbal products demonstrated in some trials, more investigations needed to confirm their efficacy and safety.
... These studies have shed light on the gut-kidney axis in nephrolithiasis, but in most cases, failed to provide integration with clinical aspects of nephrolithiasis, and particularly nutrition. Nutritional imbalances, such as poor hydration, high salt, and animal protein and low calcium, fruit and vegetable (FAV) intake, are considered the main risk factors for calcium oxalate kidney stone disease [14,15]. Conversely, water therapy, adequate consumption of dairy products, FAVs, and low-salt low-animal protein diets are considered the pillars of non-pharmacological prevention of nephrolithiasis [16,17]. ...
... Regular consumption of foods with high calcium content, either from dairy or non-dairy sources, is known to be protective against the formation of calcium kidney stones, while consumption of calcium supplements should be discouraged in stone formers [14,15,118]. Restriction of dietary calcium intake proved less effective than salt and protein restriction in preventing kidney stone recurrence [62]. ...
... A high FAV intake is associated with reduced risk of incident kidney stones [14,15,128] and with a reduction of lithogenic potential in urine chemistry [129]. Thus, increasing FAV intake is regarded as one of the main non-pharmacologic prescriptions for reducing the risk of kidney stone recurrence [16,17]. ...
Article
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Recent studies have shown that patients with kidney stone disease, and particularly calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared with controls. The alterations of microbiota go far beyond the simple presence and representation of Oxalobacter formigenes, a well-known symbiont exhibiting a marked capacity of degrading dietary oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of nutrition in the modulation of microbiota composition, and their relevance for the modulation of lithogenic risk.
... In fact, a 6 g increase in daily dietary sodium chloride seems to be capable of increasing urinary calcium excretion by 40 mg/day [65,66]. Furthermore, a dietary salt intake >10 g/day was correlated to increased prevalence of hypercalciuria compared with recommended values [67]. ...
... Despite the strong rationale for considering magnesium a kidney stone inhibitor, the available literature is controversial. Early observational evidence showed no significant association between magnesium and the risk of stones [46,67], whereas Taylor et al., in 2004, demonstrated an inverse correlation between the risk of incident kidney stones and dietary magnesium intake [91]. ...
Article
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Nephrolithiasis is a common medical condition influenced by multiple environmental factors, including diet. Since nutritional habits play a relevant role in the genesis and recurrence of kidney stones disease, dietary manipulation has become a fundamental tool for the medical management of nephrolithiasis. Dietary advice aims to reduce the majority of lithogenic risk factors, reducing the supersaturation of urine, mainly for calcium oxalate, calcium phosphate, and uric acid. For this purpose, current guidelines recommend increasing fluid intake, maintaining a balanced calcium intake, reducing dietary intake of sodium and animal proteins, and increasing intake of fruits and fibers. In this review, we analyzed the effects of each dietary factor on nephrolithiasis incidence and recurrence rate. Available scientific evidence agrees on the harmful effects of high meat/animal protein intake and low calcium diets, whereas high content of fruits and vegetables associated with a balanced intake of low-fat dairy products carries the lowest risk for incident kidney stones. Furthermore, a balanced vegetarian diet with dairy products seems to be the most protective diet for kidney stone patients. Since no study prospectively examined the effects of vegan diets on nephrolithiasis risk factors, more scientific work should be made to define the best diet for different kidney stone phenotypes.
... No significant associations with incident stones were observed for high intake of dietary vitamin B6 and total vitamin D. Meta-analyses of total and supplemental vitamin C showed nonsignificantly increased risks of incident stones with moderate and substantial heterogeneity, respectively. The pooled results of 2 female cohorts [35,36] ...
... Calcium and vitamin D supplementation was controversial due to inconsistent meta-analyses of RCTs and observational studies. The NHS I [35] reported significantly increased risk among elderly women while others did not [36,61]. The author attributed the risk to not taking supplemental calcium with meals in that the beneficial effect of dietary calcium on oxalate could not be replicated under such circumstances. ...
Article
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Background: Dietary and lifestyle factors may play an important role in the increasing prevalence of nephrolithiasis. We aimed to review and quantify the associations between lifestyle factors and incident nephrolithiasis and suggest lifestyle changes for the primary prevention of nephrolithiasis. Methods: PubMed, EMBASE, and Cochrane Library were searched up to May 2019, for observational studies and randomized controlled trials (RCTs) that assessed modifiable lifestyle factors and risk of nephrolithiasis in adults. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were computed using a random effects model. The I2 statistic was employed to evaluate heterogeneity. Subgroup analysis, sensitivity analysis and meta-regression were also conducted whenever possible. Results: Fifty relevant articles with 1,322,133 participants and 21,030 cases in total were identified. Prominent risk factors for incident stones were body mass index (1.39,1.27-1.52), dietary sodium (1.38, 1.21-1.56), fructose, meat, animal protein, and soda. In contrast, protective factors included fluid intake (0.55, 0.51-0.60), a Dietary Approaches to Stop Hypertension (DASH) style diet (0.69, 0.64-0.75), alcohol (0.69, 0.56-0.85), water, coffee, tea, vegetables, fruits, dietary fiber, dietary calcium (0.83, 0.76-0.90), and potassium. Vitamin D (1.22, 1.01-1.49) and calcium (1.16, 1.00-1.35) supplementation alone increased the risk of stones in meta-analyses of observational studies, but not in RCTs, where the cosupplementation conferred significant risk. Conclusions: Several modifiable factors, notably fluid intake, dietary patterns, and obesity, were significantly associated with nephrolithiasis. Long-term RCTs are required to investigate the cost-effectiveness of dietary patterns for stone prevention. The independent and combined effects of vitamin D and calcium supplementation on nephrolithiasis need further elucidation.
... 49 Interestingly, a 12-year prospective study of 91,731 women without a history of kidney stones with 12-year follow-up suggested that high dietary calcium could reduce the risk of kidney stones, whereas the risk would be increased in women with high supplemental calcium. 50 The mechanism of the different results caused by different types of calcium on kidney stones has not been definitively determined, but it is likely that dietary calcium decreases the absorption of oxalate and is probably associated with the timing of calcium ingestion relative to the amount of oxalate consumed. Consequently, it is reasonable to speculate that the effect of supplemental calcium on kidney stone risk depends on whether supplements are received with or between meals. ...
... 53 While studies indicate the potential beneficial effects of dietary calcium intake on the reduction of the risk of kidney stones, individuals who consumed any amount of supplemental calcium had an increased risk for kidney stones compared with individuals who did not consume supplemental calcium. 50 A study performed in 53 postmenopausal women with 1,000 mg/d calcium (with 400 IU/d vitamin D) for 1 year showed a weak relationship with kidney stones formation; only one patient with urinary calculi was proved by ultrasonography. However, the small sample size and short clinical trial duration may contribute to lack of significant findings in this study. ...
Article
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Calcium is an important integrative component of the human body and critical for human health. It has been well established that calcium intake is helpful in the prevention and treatment of osteoporosis, which has become one of the most serious public health problems across the world. However, community-dwelling adults with and without osteoporosis are rarely concerned or even not aware of the potential side effects of high or inappropriate doses of calcium intake. Some recent studies have revealed that excessive calcium intake might increase the risks of cardiovascular diseases. The purpose of this article was to review the health benefits, costs, and consequences of calcium supplementation on osteoporosis/osteoporotic fractures, cardiovascular events, kidney stones, gastrointestinal diseases, and other important diseases. In the end, we suggest that calcium supplementation should be prescribed and taken cautiously, accounting for individual patients’ risks and benefits. Clearly, further studies are needed to examine the health effects of calcium supplementation to make any solid recommendations for people of different genders, ages, and ethnicities.
... Conversely, the intake of calcium supplements outside meals causes an increased risk of stone formation in patients taking calcium supplements [34]. Calcium intake outside meals results in a different effect than does calcium intake with other nutrients [45]. ...
... In an experiment, higher urinary calcium excretion occurred in rats fed high-fructose diets, unlike in rats fed high-starch diets [82,83]. An insufficient supply of dietary calcium is also a notable risk factor for both calcium oxalate and phosphate stone formation [34,45]. High salt intake has been associated with elevated urinary calcium excretion, because it reduces tubular reabsorption, which is an output of the free particle model on crystallization [84]. ...
Article
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Food intake plays a pivotal role in human growth, constituting 45% of the global economy and wellbeing in general. The consumption of a balanced diet is essential for overall good health, and a lack of equilibrium can lead to malnutrition, prenatal death, obesity, osteoporosis and bone fractures, coronary heart diseases (CHD), idiopathic hypercalciuria, diabetes, and many other conditions. CHD, osteoporosis, malnutrition, and obesity are extensively discussed in the literature, although there are fragmented findings in the realm of kidney stone diseases (KSD) and their correlation with food intake. KSD associated with hematuria and renal failure poses an increasing threat to healthcare infrastructures and the global economy, and its emergence in the Indian population is being linked to multi-factorial urological disorder resulting from several factors. In this realm, epidemiological, biochemical, and macroeconomic situations have been the focus of research, even though food intake is also of paramount importance. Hence, in this article, we review the corollary associations with the consumption of diverse foods and the role that these play in KSD in an Indian context.
... The Nurses' Health Study in the USA found that the relative risk of stone formation in women in the highest quintile of calcium intake was 0.65 compared with those in the lowest quintile. 33 In a single randomized prospective study, hyperoxaluria was shown to be significantly associated with dietary ascorbic acid intake and inversely associated with calcium intake. 32 A low animal fat diet was reported to reduce stone recurrence rates. ...
... 30,34 Calcium intake should not be restricted unless there are strong reasons due to the inverse relationship between dietary calcium and stone formation (LE:1, GR:A). 33,251 Calcium supplements are not recommended except in enteric hyperoxaluria (LE:1, GR:A). 34 Calcium stone formation can be reduced by restricting sodium and animal protein (LE:1, GR:A). ...
Article
The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline – consisting 43 clinical questions – and overview its key practical issues.
... With regard to other dietary factors, we found that higher meat intake was associated with an increased risk of kidney stones; however, previous prospective studies that have focused mainly on animal protein intake have produced inconsistent findings [9,[18][19][20]. Two randomised controlled trials have shown no reduction in kidney stone Fig. 4 -Cox proportional hazards models investigating the association between fruit, vegetable, and fibre intake, and the risk of developing incident kidney stones. ...
... CI = confidence interval; HR = hazard ratio. E U R O P E A N U R O L O G Y F O C U S X X X ( 2 0 1 9 ) X X X -X X X 7 EUF-732; No. of Pages 10 inconsistent [20,21,27,28]. We also found that higher consumption of fruit and fibre was associated with a significant risk reduction, as has been reported elsewhere in prospective studies [9,24] but not in the one small trial that assessed this in relation to recurrent kidney stones [22]. ...
Article
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Background Fluid intake and diet are thought to influence kidney stone risk. However, prospective studies have been limited to small samples sizes and/or restricted measures. Objective To investigate whether fluid intake and dietary factors are associated with the risk of developing a first kidney stone. Design, setting, and participants Participants were selected from UK Biobank, a population-based prospective cohort study. Outcome measurements and statistical analysis Cox proportional hazards models were used to investigate the association between fluid intake and dietary factors and the risk of a first incident kidney stone, ascertained from hospital inpatient records. Results and limitations After exclusion, 439 072 participants were available for the analysis, of whom 2057 had hospital admission with an incident kidney stone over a mean of 6.1 yr of follow-up. For every additional drink (200 ml) consumed per day of total fluid, the risk of kidney stones declined by 13% (hazard ratio [HR] = 0.87, 95% confidence interval [CI] 0.85–0.89). Similar patterns of associations were observed for tea, coffee, and alcohol, although no association was observed for water intake. Fruit and fibre intake was also associated with a lower risk (HR per 100 g increase of fruits per day = 0.88, 95% CI 0.83–0.93, and HR per 10 g fibre per day = 0.82, 95% CI 0.77–0.87), whereas meat and salt intake was associated with a higher risk (HR per 50 g increase in meat per week = 1.17, 95% CI 1.05–1.29, and HR for always vs never/rarely added salt to food = 1.33, 95% CI 1.12–1.58). Vegetable, fish, and cheese intake was not associated with kidney stone risk. Conclusions The finding that high intake of total fluid, fruit, and fibre was associated with a lower risk of hospitalisation for a first kidney stone suggests that modifiable dietary factors could be targeted to prevent kidney stone development. Patient summary We found that higher intake of total fluid, specifically tea, coffee, and alcohol (but not water), and consumption of fruit and foods high in fibre are linked with a reduced likelihood of developing kidney stones.
... 20 The rates of kidney stones and urinary retention were also higher among individuals with RTT, with the general population developing kidney stones at an annual rate of 0.5-1/1000 individuals and urinary retention in the female general population at an annual rate of 0.07/1000 individuals. 21,22 Likely due to our small sample size, kidney stones were not observed in the RTT patients in our study, however, their primary reason for presenting to a urologist was urinary retention, corroborating what was previously reported. ...
Article
Objectives: To describe the urologic sequalae of several rare congenital neuromuscular diseases. Methods: We retrospectively reviewed medical records at Gillette Specialty Healthcare (2014-18) of patients presenting to urology clinic with lower urinary tract symptoms and select rare congenital diseases: muscular dystrophy, spinal muscular atrophy, and Rett syndrome. Results: Muscular Dystrophies (n=19) are X-linked myogenic disorders characterized by progressive muscle wasting and weakness. Men present to the urologist at variable ages, typically with complaints of functional incontinence and normal cystometrograms (CMG); we manage them with oral anticholinergic medications, condom catheter or suprapubic catheter. Spinal Muscular Atrophy (n=6) is a rare autosomal recessive disease characterized by degeneration of the anterior horn cells in the spinal cord and motor nuclei in the lower brainstem leading to progressive muscle weakness and atrophy. Patients typically present with nephrolithiasis and urinary retention in late adolescence/early adulthood, but timing varies. Filling CMGs have been normal. We allow passive retention with intermittent catheterization and creation of catheterizable channels, when indicated. RettSyndrome(n=5) is a rare, non-inheritable genetic condition affecting females characterized by a brief period of normal development followed by loss of speech and purposeful hand use; there are characteristic behaviors. Patients present in early adulthood with complaints of urinary retention. We manage retention with permissive retention or sphincter chemodenervation. Conclusions: Several congenital neuromuscular conditions can cause lower urinary tract symptoms when these individuals become adults. We have discussed the clinical characteristics and management of select neurogenic and myogenic bladder conditions seen in adults with congenital conditions.
... In the prospective Nurses' Health Study, women who took supplemental calcium (1 to ≥500 mg/day) had a small but significant increase in the risk of incident symptomatic kidney stones (RR 1.20, 95% CI 1.02-1.41) compared to those who did not take supplements [56]. Women in the highest quintile of dietary calcium intake (median calcium 1,303 mg/day had, however, a lower risk (RR 0.65, 95% CI 0.50-0.83) ...
... Adequate Supply To The Growing Teeth And Bones As Well As To Bind With Meal-Oxalate And Prevent Their Absorption [13] ...
Article
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Urolithiasis (Ur) Is A Worldwide Problem That Affects All Groups Of Ages. Nearly 80% Of Renal Stones Are Calcium Oxalate (Cao) And 50% Of The Affected Patients Have Recurrent Disease Within 10 Years. Our Prospective Study Was Conducted Over 4 And ½ Years And Evaluated The Role Of Dietary Manipulation In Prophylaxis Against Cao Ur. A Total Of 212 Patients With Recurrent Cao Ur, Who Lacked Anatomical Or Metabolic Derangement, Were Subjected To A Practical And Specific Diet. The Latter Had: (A) Low Salt, Red-Meat And Green Leafy Vegetable, (B) Moderate Amounts Of Milk, Dairy Products, Poultry And Certain Fish-Items, And (C) High Water Intake (2 Liters/Day). A Total Of 66/70 (96%), 87/108(88%) And 146/167(87.4%) Patients Were Stone-Free By The End Of 1, 2 And 3 Years Of Follow Up. The Median Time For Stone-Free Duration Was 33 (28.7-37.3) Months. Adding A Thiazide And Allopurinol To The 19 Patients Who Had Failed Dietary Prophylaxis Prevented Stone Formation In 16 More Patients Leaving Only 3 True Failures. Four Patients Could Not Tolerate The Latter 2 Drugs For Allergy. In Conclusion; Our Practical Dietary Modification Can Aid In Prophylaxis Against Cao Ur. Keywords: Diet, Calcium Oxalate, Urolithiasis, Urinary Tract Stones, Prophylaxis
... High Na intake may increase the risk of gastric cancer (Hirohata and Kono, 1997;Tsugane, 2005). Some other ailments such as oesteoporosis (Cohen and Roe, 2000) and kidney stones (Curhan et al., 1997) have also been ascribed to high intake of Na, but more evidence is needed. For more information, refer to OSU (2016). ...
... In many adults and children, due the high caloric intake needed to maintain weight, dietary calcium content often exceeds the dietary reference intake. In case of suboptimal calcium intakes, this should be increased mainly by food intake and high calcium content drinks, which are better absorbed than oral tablets [29] and may be associated with lower risk for kidney stones [30]. ...
Article
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Bone disease is a frequent complication in adolescents and adults with cystic fibrosis (CF). Early detection and monitoring of bone mineral density and multidisciplinary preventive care are necessary from childhood through adolescence to minimize CF-related bone disease (CFBD) in adult CF patients. Approaches to optimizing bone health include ensuring adequate nutrition, particularly intake of calcium and vitamins D and K, addressing other secondary causes of low bone density such as hypogonadism, encouraging weight bearing exercise, and avoiding bone toxic medications. Of the currently available anti-resorptive or anabolic osteoporosis medications, only bisphosphonates have been studied in individuals with CF. Future studies are needed to better understand the optimal approach for managing CFBD.
... It plays a major role in central nervous system (CNS), by sending messages through nervous system and also helps in the expansion and contraction of muscles and blood vessels [28]. Dacryodes klaineana (Pierre) H.J.Lam Foods and supplements rich in Ca help improve bone health [33], control osteoporosis [34], prevent colon, rectum and prostate cancer [35; 36], reduce risk of cardiovascular diseases [37], lower blood pressure and hypertension [38; 39], prevent kidney stones [40], preeclampsia [41] and as well help in weight management [42]. ...
Article
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The importance of plant to human life is imperious, ranging from being used as food as well as shelter. There is a correlation between traditional uses of a plant and its activity in biological screening system. Dacryodes klaineana (DK) is a woody evergreen perennial with edible fruits in the family Buseraseae, which are widely applied in traditional folk medicine to treat painful menstruation, enema, cough and skin diseases. The aim of this is study was to determine the chemical and elemental composition of DK that are responsible for its activities as previously mentioned in its folkloric uses. Phytochemical screening and Mineral element composition of Dacryodes klaineana kernel was carried out using standard methods. Phytochemical screening result investigated showed that the kernel possessed some secondary metabolites which include tannins, flavonoids, alkaloids and cardiac glycosides. Despite saponins, free and combined anthraquinone being absent the presence of these secondary metabolites give credence to the fact that the seed kernel possess medicinal properties. Results obtained in the mineral analysis indicated the presence of some micro and macro nutrients such as Potassium (K), Calcium (Ca), Iron (Fe), Zinc (Zn) among others, are within the acceptable health range. The health benefits of these elements and phytochemicals cannot be ruled out, which makes DK an excellent source of minerals and secondary metabolites that should be embraced by nutraceutical and pharmaceutical industries.
... However, the association between luid intake and kidney stone risk is not entirely clear. Several studies suggest that suf icient luid intake is an effective strategy to prevent kidney stones [12,[16][17][18]. Three meta-analyses concluded that water intake was associated with reduced kidney stone risk and long-term risk of recurrence [8,13,18]. ...
... An abnormality of urinary super-saturation is one of the main factors for the formation of kidney stones23. Individuals who consumed any amount of supplemental calcium had an increased risk for kidney stones compared with individuals who did not consume supplemental calcium [24]. ...
Article
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Adequate calcium intake is essential for the maintenance of bone health and the preservation of bone mineral density. The lay person believes that calcium is always good for health. Successful marketing and various clinical practice guidelines have made prescribing calcium supplements a billion dollar market in recent years. The aim of this study was to scan the literature and find out whether calcium supplements should be prescribed to all patients with fractures so as to improve their bone healing or should it be restricted to elderly post-menopausal females who have osteoporotic bones. The inference drawn was that dietary calcium is easier to absorb and may have beneficial effects as compared to calcium supplements and it should be limited to the total daily intake to 1000-1200 mg optimally from dietary sources. Calcium supplementation does not significantly reduce fracture risk in postmenopausal women but it reduces the risk of osteoporosis. It increases the risk of urolithiasis. A favourable role of calcium has been seen in postmenopausal women, elderly population, children and adolescents. Calcium is a double-edged sword, which may be both potentially crucial and perilous and hence should be prescribed with caution.
... For example, a higher intake of phytate was associated with a lower risk of nephrolithiasis in women (22) but not in men (24). On the other hand, the intake of animal protein has been associated with a higher risk of nephrolithiasis in men (25) but not in women (22,26), However, it has previously been demonstrated that the risk of kidney stones may vary by the type of protein intake: dairy protein is associated with a lower risk of stones in the NHS II cohort, whereas nondairy protein intake is associated with a slightly higher risk of stones in NHS I and HPFS (3). Finally, we cannot exclude that those findings were due to chance. ...
Article
Background: Diet plays an important role in kidney stone formation. Several individual components have been associated with the risk of kidney stone formation, but there is limited evidence regarding the role of healthful dietary patterns. Objective: To prospectively study the association between adherence to the Mediterranean diet and the risk of incident kidney stones. Methods: We conducted a longitudinal study using 3 different cohorts: the Health Professionals Follow-up Study (n = 42,902 men), the Nurses' Health Study I (n = 59,994 women), and the Nurses' Health Study II (n = 90,631 women). We assessed diet every 4 y using an FFQ and calculated adherence to a Mediterranean diet using the alternate Mediterranean diet score (aMED). A subgroup of 6077 participants provided ≥1 24-h urine sample, and urinary solute excretion was analyzed. We used Cox proportional hazards regression to examine the independent association between the aMED and incidence of kidney stones, adjusting for potential confounders. We used adjusted linear regression models to study the relation between aMED and urine composition. Results: During 3,316,633 person-years of follow-up, 6576 cases of incident kidney stones were identified. For participants in the highest aMED score category, the risk of developing a kidney stone was between 13% and 41% lower compared with participants in the lowest score (pooled HR: 0.72, 95% CI: 0.59, 0.87; P value for trend <0.001). A higher aMED score was associated with higher urinary citrate, magnesium, oxalate, phosphate, uric acid, volume, and pH, and lower urinary sodium, resulting in lower supersaturation for calcium oxalate, calcium phosphate, and uric acid. Conclusion: Adherence to a Mediterranean diet is associated with a lower risk of developing a kidney stone.
... A focus of these recommendations is the need for adequate urine volume, which was described by Borghi and colleagues in 1996 [2]. Calcium intake has been shown as a determinant of calcium oxalate stone formation, as well, with dietary calcium decreasing risk, while calcium supplementation increases this risk [18]. Higher dietary calcium and lower dietary oxalate both decrease absorption of oxalate into the urinary system, thereby decreasing the incident calcium oxalate stone risk [19]. ...
Article
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Low urine pH is a metabolic risk factor for stone formation. While medical therapy is typically prescribed (as urinary alkalinization), patients typically prefer dietary modifications. We aimed to assess capacity to alter urine pH with dietary management alone. We analyzed a retrospective cohort of stone formers seen between 2000 and 2015 with multiple 24-h urine collections (24hUC). Patients ≥ 18 years old with low urine pH (< 6.0) were included; those prescribed alkalinizing agents or thiazides were excluded. Demographic data, 24hUC parameters, and medications were abstracted. 24hUC was utilized to calculate gastrointestinal alkali absorption (GIAA). The primary outcome was urine pH ≥ 6.0 on second 24hUC. Predictors were selected utilizing multivariable logistic regression. The database consisted of 2197 stone formers; 224 of these met inclusion criteria. On second 24hUC, 124 (55.4%) achieved a favorable pH ≥ 6.0. On univariable analysis, a second pH ≥ 6.0 was associated with high initial pH, low initial sulfate, younger age, increase in citrate/GIAA/urine volume, and decrease in ammonium (P < 0.02). On multivariable analysis, high initial pH (OR = 23.64, P < 0.001), high initial GIAA (OR = 1.03, P = 0.001), lower initial sulfate (OR = 0.95, P < 0.001), increase in urine volume (OR = 2.19, P = 0.001), increase in GIAA (OR = 8.6, P < 0.001), increase in citrate (OR = 2.7, P = 0.014), decrease in ammonium (OR = 0.18, P < 0.001), and younger age (OR = 0.97, P = 0.025) were associated with a second pH ≥ 6.0. The analysis demonstrated a corrected AUC of 0.853. These data suggest that certain dietary recommendations (increases in urine volume, citrate, GIAA, and decreased acid load) may normalize urine pH in a select group of patients. This may allow urologists to counsel patients with low urine pH on possibility of success with dietary modification alone.
... These supplements significantly increase urinary calcium, potentially predisposing to calcium nephrolithiasis said Dr Naim Maalouf. In several observational and randomized prospective studies, including the large Women's Health Initiative randomized clinical trial, supplemental calcium and vitamin D significantly increased the incidence of nephrolithiasis [101]. Calcium supplement type (calcium carbonate vs. calcium citrate), dose, and timing of intake, all appear to influence KS risk. ...
Article
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A symposium on kidney stones and mineral metabolism held on December 2017 in Brussels, Belgium was the first international multidisciplinary conference of the International Collaborative Network on Kidney Stones and Mineral Metabolism. This meeting addressed epidemiology, underlying pathophysiological mechanisms, genetics, pathological, as well as clinical and research topics. The participants included clinicians and recognized experts in the field from Europe and the United States interacted closely during the symposium which promoted a chance to explore new frontiers in the field of kidney stone disease. This manuscript summarizes some of the major highlights of the meeting.
... Higher or improper intake of nutrients like calcium, animal protein, oxalate, sodium, sucrose, magnesium and potassium may predispose to kidney stone formation 24,[30][31][32][33][34] . ...
Article
An age-old syndrome which possesses not only multifactorial etiological origins but also often associated with high rate of remission-rebound frequency during its management time is kidney stone (termed as urolithiasis). In Ayurveda, this syndrome is called as mutrakricchra and it is one of the most distressing syndromes among the group of urinary disorder conditions attached to human beings till today. even Acharya Sushruta, a pioneer in the art of surgery, described the root causes and management of urolithiasis. In modern medical practice, plenty of management/treatment options are available which starts from the use of uresis-promoting agent to dietary or nutritional supplement intake. Approaches developed by amalgamating the ayurvedic concept/principle with modern medical practice is a promising strategy and even welcome addition for urolithiasis management. This review provides a comprehensive insight on how the amalgamation of ayurvedic concept with modern medical practice helps in urolithiasis management. © 2018 Indian Drug Manufacturers' Association. All rights reserved.
... As it has been in the tables above, the sample ZRS2A2 which is known as African processed locust beans (also known as irú) is very rich in magnesium, aluminum, (Taubes G., 1998, Nelson, 2000. Thus processed locust beans is nutritious and even more advantageous than seasonings because the elements obtain in processed locust beans are in appropriate proportion that our body system need while the "seasonings" is dangerous to our health in the sense that it contains high concentration of Na and Br of values 25.8% and 35.8ppm respectively which can later cause high blood pressure, congestive heart failure, cardiovascular disease, cirrhosis, or kidney disease (Denton D, 1995, Curhan G. C. 1997, Chrysant G. S, 2000 due to the high intake of NaBr. ...
Conference Paper
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The analysis of some biological samples was performed by the use of Neutron Activation Analysis (NAA). This research was carried out using Nigeria Research Reactor one (NIRR-1) facility in the Center for Energy Research and Training, Ahmadu Bello University, Zaria (CERT).The aims of the research are to determine radionuclides, the concentrations, and to find the differentiating factors for those analyzed samples. It was deduced from the result obtained that the radionuclides of some elements with their concentrations were present in each of the biological samples and from same result, we also concluded that the use of the sample ZRS2A2 which is African processed locust beans (also known as irú) should be adopted as food seasonings (i.e. spice) instead of the sample ZYCAB2 (i.e. seasonings) owing to what they contained. And again sample ZRS8A3 which is known as Pumpkin leaf should be using as vegetable in food in place of the sample ZRS6B3, that is, African spinach because of its significance.
... 220formation[34,45]. High salt intake has been associated with elevated urinary calcium excretion by 221 reducing tubular reabsorption which is an output of free particle model on crystallization[84]. ...
Preprint
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Food intake plays a pivotal role in human growth, which necessarily contributes 45% of the global economy and wellbeing in general. Consumption of balanced food is elementary for overall good health while a shift of equilibrium can lead to malnutrition, prenatal death, obesity, osteoporosis and bone fractures, coronary heart diseases (CHD), idiopathic hypercalciuria, diabetes and many more. Though CHD, osteoporosis, malnutrition, obesity are being classified thoroughly in the literature, there are fragmented findings in the regime of kidney stone diseases (KSD) and the correlation with food intake therein. KSD associated with hematuria and renal failure poses an increasing threat to the healthcare and global economy while its emergence of Indian populations is being affected with multi-factorial urological disorder resulting from several factors. In this realm, epidemiological, biochemical, macroeconomic situations been portrayed when food intake is also a paramount importance which rarely been forecasted. Hence, in this article we will be reviewing the corollary connotation with diverse food consumption and the efficacy it plays in KSD extrapolating in Indian context.
... The result of a prospective cohort study on 91,731 women suggested an increased risk of kidney stones in patients receiving non-dietary calcium supplementation (RR: 1.20, 95% CI: 1.02-1.41) (Curhan et al., 1997). Additionally, other potential adverse effects of calcium supplementation such as constipation, metabolic syndrome, and age-related macular degeneration were reported (Kakigi et al., 2015;Noe et al., 2015;Prince et al., 2006). ...
... A significant relation between calcium stone formation and salt intake was first showed in a cohort study conducted by Curhan et al. [74]. Some studies conducted in further years did not succeed in confirming these results. ...
Chapter
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Kidney stone disease is an oldest known and widespread medical condition characterised by its high prevalence in all over the world. Literature suggests that around 9–12% of population in industrialised countries have kidney stone disease in their lives with the 30–50% of reoccurrence rate. Because of high prevalence, recurrent and unpredictable nature of stone formation and its predominance mainly in adults contributes to the substantial impact on society, individual and health care system. In light of these trends, it’s imperative to use optimum preventive strategies to reduce the burden of kidney stone disease on individual and society. The aetiology of kidney stone disease is a multifactorial and it’s related to diet, environmental factors, genetics, metabolic syndromes and various life style factors. Its noteworthy that dietary and life style modification are the major contributors in the prevention of kidney stone reoccurrence. Dietary interventions aim to reduce the urinary abnormalities known to promote lithogenesis. Therefore, modification in the dietary factors is appealing way to patients and physicians in the treatment and prevention of stone recurrence as it is relatively inexpensive and safe. So, the present chapter is focusing on the role of dietary supplements in prevention of renal stones.
... They are uncommon before the age of 20 years, however, their incidence rises between the age of 20 and 30 years and then remain constant until the age of 70 years after which the incidence falls again. 6,7 Men are at greater risk of developing kidney stones as they are two to four times more common in men than women. 8 Although stones may be asymptomatic but the common symptoms include flank pain, nausea, vomiting, urinary tract obstruction and infections. ...
Article
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p class="abstract"> Background: Nephrolithiasis is the 3rd most common clinical problem worldwide. The dietary and fluid intake factors play an important role in its causation. The present study was conducted to determine the dietary and fluid intake habits in patients presented with nephrolithiasis to Ayub Teaching Hospital, Abbottabad. Methods: This cross-sectional study enrolled 140 patients by convenient sampling. The study was carried out at the Urology ward of Ayub Teaching Hospital, Abbottabad from June 2017 to June 2018. In this study, a self-maintained structured questionnaire was used to interview 140 patients admitted in both male and female urology ward of Ayub Teaching Hospital, Abbottabad. The questionnaire covered the fluid intake and dietary habits of patients with relevance to determinants such as the number of glasses per day, level of education, physical activity, the occupation of patients and source of drinking water. Data was collected through questionnaires and was analyzed using SPSS-23. Results: Total of 140 patients were enrolled, 80 (57.1%) were males whereas 60 (42.9%) were females. Most of them, i.e. 116 (82.9%) were from rural areas, 132 (94.3%) belonged to poor socioeconomic status, 60 (42.9%) patients used the tap water for drinking and 80 (57.1%) had vegetables in their daily diet. Most 100 (71.4%) of them were illiterate, 92 (65.7%) working indoor and 60 (42.9%) drinking 5 to 10 glasses per day. Conclusions: The study highlights the poor dietary and fluid intake habits of patients presenting with nephrolithiasis. </p
... Also significant is the fact that a poorly balanced diet may condition hypercalciuria. Nevertheless, it has not been unequivocally determined whether the supply of calcium in the diet directly affects its excretion or the formation of calcium deposits in the urinary tract (CurHan et al. 1993(CurHan et al. , 1997. 168 The relationship between low calcium content in the diet and the risk of urolithiasis has been proven (BorGHi et al. 2002, martini, HeilBerG 2002. ...
... In addition, the risk of stone formation is not low because of the chronic lack of fluid intake caused by gastrostomy management. [13][14][15] Moreover, since the patient was vomiting, an abdominal computed tomography scan was performed in the emergency room, which enabled the diagnosis of ureter stones. In this case, poorly controlled status epilepticus occurred despite the implantation of a vagus nerve stimulator. ...
Article
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Introduction Epilepsy has a variety of seizure-inducing factors. Epileptic seizures caused by renal colic are extremely rare. Case presentation A 22-year-old woman with intractable epilepsy was brought to our hospital as an emergency case, because of vomiting and status epilepticus. She had implanted a vagus nerve stimulator in the left anterior chest at the age of 20 years. Computed tomography showed a ureter stone in the right distal ureter. On the second day of hospitalization, ureteroscopic lithotripsy was performed under general anesthesia. The patient’s seizures were controlled to a frequency of once a month or less in the four months after discharge. Conclusion We encountered a rare case of the frequency of status epilepticus increased by renal colic due to a ureter stone. Ureteroscopic lithotripsy was effective in controlling the frequency of status epilepticus increased by renal colic.
... 11,34 Diet kalsium mengurangi absorbsi oksalat dan ekskresi kalsium sebesar 16%, sedangkan peningkatan ekskresi oksalat dimungkinkan oleh perbedaan waktu antara masukan diet oksalat dengan masukan diet kalsium, sehingga oksalat kehilangan kesempatan mengikat kalsium pada lumen intestinal. 35 Kebiasaan makan sitrat berpengaruh terhadap risiko sedimen kalsium oksalat dalam urin (r s = 0,450), kebiasaan makan jarang memiliki POR sebesar 10,99 (95% CI = 3,533 -34,218) dan kebiasaan cukup memiliki POR sebesar 3,04 (95% CI = 0,931 -9,903) lebih besar dari subjek dengan kebiasaan makan sumber asam sitrat sering terhadap sedimen kalsium oksalat. Hasil ini disebabkan oleh asam sitrat memiliki peran sebagai inhibitor terhadap supersaturasi kalsium dan sedimen kalsium oksalat dalam urin. ...
Article
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Background: Water hardness containing calcium mineral (Ca2+) is supposed to increase absorption in intestinal lumen and calcium excretion (hyper-calciuria) of urine. Alkalic conditioned urine can cause changes of saturation concentration to become calcium supersaturation leading to the crystalization of calcium oxalate. Objective: To identify the relationship between drinking water hardness, drinking and eating habit to calcium level and urine calcium oxalate sediment. Method: The study was observational with cross sectional design. Examination analysis of drinking water hardness (mg/l), level of urine calcium (mg/dl) and calcium oxalate sediment of first/morning urine samples of 128 elementary school students (6-12 years old) was carried out using one-stage cluster random sampling technique at Sidowangi Subdistrict of Kajoran, District of Magelang, Central Java. Data of drinking and eating habit for bestial protein, vegetable protein, calcium and phospor, uric acid, oxalic acid and citric acid of the subject of the study were obtained from interview using questionnaires and food frequency forms. Data analysis used Stata version 8.0 program for windows at significance level. p<0.05. Result: Ave0rage value and main deviation of drinking water hardness was 66.75 + 8.36, level of urine was 10.43 + 6.40 and there were 52 subjects (40.63%) with calcium oxalate crystal. The result of statistical analysis showed that drinking water hardness did not affect level of urine calcium (rs =0.004; p=0.967; POR=1,017; 95% CI=0.476-2.172) and calcium oxalate sediment (rs=-0.007; p=0.937; POR=0.972; 95% CI= 0.480-1,969). Drinkinghabit (p=0.007; POR=3.509; 95% CI=1.339-8.802) and eating habit of citric acid sources (adequate p=0.066; POR=3.037; 95%CI=0.931-9,903, less p=0.000; POR=10,996; 95% CI=3.533-34.218) were 2 predisposition variables of calcium oxalate sediment status. Conclusion: Drinking water hardness had no effect to level of urine calcium and calcium oxalate sediment. Drinking habit and eating habit for citric acid sources were 2 most determining factors, i.e. as protection or inhibitor of calcium oxalate crystalization formation. Keywords: water hardness, calcium level, calcium oxalate sediment
... 11,34 Diet kalsium mengurangi absorbsi oksalat dan ekskresi kalsium sebesar 16%, sedangkan peningkatan ekskresi oksalat dimungkinkan oleh perbedaan waktu antara masukan diet oksalat dengan masukan diet kalsium, sehingga oksalat kehilangan kesempatan mengikat kalsium pada lumen intestinal. 35 Kebiasaan makan sitrat berpengaruh terhadap risiko sedimen kalsium oksalat dalam urin (r s = 0,450), kebiasaan makan jarang memiliki POR sebesar 10,99 (95% CI = 3,533 -34,218) dan kebiasaan cukup memiliki POR sebesar 3,04 (95% CI = 0,931 -9,903) lebih besar dari subjek dengan kebiasaan makan sumber asam sitrat sering terhadap sedimen kalsium oksalat. Hasil ini disebabkan oleh asam sitrat memiliki peran sebagai inhibitor terhadap supersaturasi kalsium dan sedimen kalsium oksalat dalam urin. ...
... 17,[29][30][31] The kidney reabsorbs less filtered calcium due to a suppression of parathyroid hormone caused by an elevated level of 1,25-dihydroxyvitamin D. 17,30 Calcium and vitamin D supplements are also routinely recommended for pregnant women and can further contribute to hypercalciuria. 32,33 Urine pH is also higher during pregnancy due to a progesterone-induced chronic respiratory alkalosis. 15,16 Hypercalciuria and higher urine pH during pregnancy explain the propensity toward calcium phosphate stones. ...
Article
Rationale & Objective There are several well-known anatomical and physiological changes during pregnancy that could contribute to kidney stone formation, but evidence that they increase the risk of kidney stones during pregnancy is lacking. We determined whether there was an increased risk of a first-time symptomatic kidney stone during and after pregnancy. Study Design A population-based matched case-control study. Setting & Participants 945 female first-time symptomatic kidney stone formers aged 15-45 years and 1,890 age-matched female controls in Olmsted County, MN, from 1984-2012. The index date was the date of onset of a symptomatic kidney stone for both the case and her matched controls. Exposure The primary exposure was pregnancy with assessment for variation in risk across different time intervals before, during, and after pregnancy. Medical records were manually reviewed to determine the conception and delivery dates for pregnancies. Outcome Medical record–validated first-time symptomatic kidney stone. Analytical Approach Conditional and unconditional multivariable logistic regression analysis. Results Compared with nonpregnant women, the odds of a symptomatic kidney stone forming in women was similar in the first trimester (OR, 0.92; P = 0.8), began to increase during the second trimester (OR, 2.00; P = 0.007), further increased during the third trimester (OR, 2.69; P = 0.001), peaked at 0 to 3 months after delivery (OR, 3.53; P < 0.001), and returned to baseline by 1 year after delivery. These associations persisted after adjustment for age and race or for diabetes mellitus, hypertension, and obesity. These results did not significantly differ by age, race, time period, or number of prior pregnancies. Having a prior pregnancy (delivery date > 1 year ago) was also associated with a first-time symptomatic kidney stone (OR, 1.27; P = 0.01). Limitations Observational study design in a predominantly White population. The exact timing of stone formation cannot be determined. Conclusions Pregnancy increases the risk of a first-time symptomatic kidney stone. This risk peaks close to delivery and then improves by 1 year after delivery, though a modest risk of a kidney stone still exists beyond 1 year after delivery.
... Hypercalciuria and high levels of urine P cause NC, and therefore oral vitamin D and phosphate may be major causes for developing NC in XLH patients treated with conventional therapy [12,[31][32][33]. The degree of NC varies from histologically subtle forms such as NC or Randall's plaque, which may not be detected by echography to advanced NC that is visible by X-rays [12,34]. High echoic dots in the renal medulla should be assessed as mild NC although the echographic grading scale of NC judges them 0 (no abnormalities). ...
Article
Full-text available
Objectives: X-linked hypophosphatemic rickets (XLH) is a congenital fibroblast growth factor (FGF)23-related metabolic bone disease that is treated with active vitamin D and phosphate as conventional therapies. Complications of these therapies include nephrocalcinosis (NC) caused by excessive urine calcium and phosphate concentrations. Recently, an anti-FGF23 antibody, burosumab, was developed and reported to be effective in poorly-controlled or severe XLH patients. This study aimed to reveal the impact of switching treatments in relatively well-controlled XLH children with the Rickets Severity Scale less than 2.0. Methods: The effects of the two treatments in eight relatively well-controlled XLH children with a mean age of 10.4 ± 1.9 years were compared retrospectively for the same treatment duration (31 ± 11 months) before and after the baseline. Results: Actual doses of alfacalcidol and phosphate as conventional therapy were 150.9 ± 43.9 ng/kg and 27.5 ± 6.3 mg/kg per day, respectively. Renal echography revealed spotty NC in 8/8 patients, but no aggravation of NC was detected by switching treatments. Switching treatments increased TmP/GFR (p=0.002) and %TRP (p<0.001), and improved the high urine calcium/creatinine ratio to the normal range (p<0.001) although both treatments controlled disease markers equally. Additionally, low intact parathyroid hormone during conventional therapy was increased within the normal range by switching treatments. Conclusions: Our results suggest that a high dose of alfacalcidol was needed to control the disease, but it caused hypercalciuria and NC. We concluded that switching treatments in relatively well-controlled XLH children improved renal phosphate reabsorption and decreased urine calcium extraction, and may have the potential to prevent NC.
... Regarding calcium supplements, dietary calcium consumption from foods is safe. Problems may derive from supplements (51). In addition, dietary calcium protects against renal lithiasis, where a significant factor among others is the renal excretion of oxalates given that dietary calcium creates complexes with oxalates which are eliminated from the intestine (52). ...
Article
During the acute and chronic phase of spinal cord injury (SCI) bone turnover and structure are affected. Bone mineral density of lower limbs is decreased up to 28-50% below that of age-matched peers at 12–18 months post injury. Coexisting secondary etiologies of osteoporosis may be present, and during ageing additional loss of bone occurs. All these compose a complex canvas of bone impairment after spinal cord injury and make the therapeutical approach challenging. The risk of fragility fractures is increased after the 2nd decade post SCI affecting the functionality and quality of life of individuals with SCI. Diagnostic flaws, lack of a ranking system to categorize the degree of bone impairment similar to the one of World Health Organization, and evidence-based clinical guidelines for management in SCI requires interdisciplinary cooperation and appropriate planning of future research and interventions. Spinal Cord Section of Hellenic Society of Physical Rehabilitation Medicine (HeSCoSPRM) convened an expert panel working group on bone and spinal cord injury at the Pan-Hellenic Congress 2018 of PRM in Athens Greece, to establish an evidence-based position statement for bone loss in individuals with SCI of traumatic or non-traumatic etiology. This was reviewed by an International Task Force and used to create S1 Guidelines. This first version S1 guideline will work towards to provide help with prophylactic basic osteoporosis therapy diagnostic and therapeutic decisions in acute and chronic phase and rehabilitation countermeasures against osteoporosis related with spinal cord injury.
... A similar study in the Nurses' Health Study I examined medical records from a random sample of ninety women who reported kidney stone. The records confirmed the diagnosis for all except 1 participant (98 %) (18) . Survey participants who answered yes to 'Have you/Has sample person (SP) ever had a kidney stone?' were considered to have a history of nephrolithiasis. ...
Article
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Objective We evaluate the association between the Dietary Inflammatory Index (DII) and kidney stones. Design We performed a cross-sectional analysis using data from National Health and Nutrition Examination Survey. Dietary intake information was assessed using first 24-HR dietary recall interviews, and the Kidney Conditions was presented by questionnaire. The primary outcome was to investigate the association between DII and incidence of kidney stones, and the secondary outcome was to assess the association between DII and nephrolithiasis recurrence. Setting The National Health and Nutrition Examination Survey (NHANES), 2007-2016. Participants The study included 25984 NHANES participants, whose data on DII and kidney stones were available, of whom 2439 reported a history of kidney stones. Results For the primary outcome, after fully multivariate adjustment, DII score is positively associated with the risk of kidney stones (OR = 1.07; 95% CI: [1.04–1.10]). Then, compared Q4 with Q1, a significant 38% increased likelihood of nephrolithiasis was observed. (OR=1.38; 95% CI: [1.19–1.60]). For the secondary outcome, the multivariate regression analysis showed that DII score is positively correlated with nephrolithiasis recurrence (OR=1.07; 95% CI: [1.00–1.15]). The results noted that higher DII scores (Q3 and Q4) are positively associated with a significant 48% and 61% increased risk of nephrolithiasis recurrence compared with the reference after fully multivariate adjustment. (OR=1.48; 95% CI: [1.07–2.05]; OR=1.61; 95% CI: [1.12–2.31]). Conclusions Our findings revealed that increased intake of pro-inflammatory diet, as a higher DII score, is correlated with increased odds of kidney stones incidence and recurrence.
... Adequate dietary calcium and taking supplemental calcium with food may lower urine oxalate levels because the calcium binds with dietary oxalate in the gut and the oxalate-calcium complex is unabsorbed and excreted by the gut. [76][77][78] Some providers have also recommended reducing dietary fat intake to reduce fatty acids in the gut and the effect of enteric hyperoxaluria. To our knowledge, this has not been formally studied in modern RYGB procedures but has been shown to be effective in early malabsorptive procedures, such as jejunoileal bypass. ...
Article
Kidney stones are painful, common, and increasing in incidence. Obesity and bariatric surgery rates are also on the rise in the United States. Although bariatric surgery is associated with improvements in metabolic outcomes, malabsorptive bariatric surgery procedures are also associated with increased risk of kidney stones. Restrictive bariatric surgeries have not been associated with kidney-stone risk. Higher risk of kidney stones after malabsorptive procedures is associated with postsurgical changes in urine composition, including high urine oxalate, low urine citrate, and low urine volume. Certain dietary recommendations after surgery may help mitigate these urine changes and reduce risk of kidney stones. Understanding risk of kidney stones after surgery is essential to improving patient outcomes after bariatric surgery.
... 34 These include cardiovascular disease, renal calculi, dyspepsia, constipation and malabsorption of medication such as levothyroxine. [35][36][37] It is well recognised that in adults, severe vitamin D deficiency can cause osteomalacia, most likely when serum 25-hydroxyvitamin D (25(OH) vitamin D) level falls below 15 ng/mL. In this case, replacing vitamin D is advised. ...
Article
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With increasing longevity of the population globally, the prevalence of osteoporosis will rise, associated with significant morbidity, disability and increased mortality. Adequate intake of calcium, vitamin D, increasing physical activity, a strategy of avoiding falls, cessation of smoking and avoiding excessive alcohol intake are pivotal in maintaining healthy bones in all age groups. Oral bisphosphonates remain the most cost-effective first line of treatment. Better methods of identifying patients with high fracture risk is needed as there is adequate effective treatment for osteoporosis.
... [5,6] In the absence of an identifiable metabolic factor, increasing fluid intake, restricting salt, and animal protein intake are the commonly recommended preventative strategies. [7][8][9][10] Lately, the understanding of the relationship between gut microbiome and nephrolithiasis has provided new insights into the pathways for preventing kidney stones. In the literature, the terms "microbiome" and "microbiota" are sometimes interchangeably used. ...
Article
The incidence of nephrolithiasis is increasing worldwide. Understanding how gut microbiome influences oxalate homeostasis has the potential to offer new strategies to prevent nephrolithiasis. The literature was reviewed to gather the evidence on the association between gut microbiome, hyperoxaluria and nephrolithiasis, and to identify the therapeutic interventions focused on the gut microbiome that could decrease hyperoxaluria and prevent nephrolithiasis. Gut microbiome is constituted by a plethora of microbiota including Oxalobacter formigenes (Oxf) and lactobacilli. Oxf can degrade dietary oxalate and induce enteral oxalate secretion. Animal studies suggested an association between oral Oxf supplementation and a decrease in hyperoxaluria. However, human studies have showed inconsistent results. Oral supplementation of lactobacilli did not show benefit in decreasing the hyperoxaluria. Antibiotic exposure, by affecting the gut microbiome, has been associated with an increase in nephrolithiasis. In vivo studies suggest fecal transplantation as a potential treatment option for reducing nephrolithiasis, but needs further evaluation in clinical studies. The current evidence suggests an association between gut microbiome and nephrolithiasis. However, the strategies focused on modulating gut microbiome for decreasing hyperoxaluria and preventing nephrolithiasis need further research. Judicious use of antibiotics in those predisposed to nephrolithiasis offers a preventative strategy for decreasing nephrolithiasis.
Chapter
Nephrolithiasis (kidney stones, urolithiasis) is the formation of stone-like concretions in the urinary system caused by the precipitation of calcium, phosphate, urate, and other molecules. The incidence and prevalence of nephrolithiasis among adults in the USA have been increasing for 30 years. According to the National Health and Nutrition Examination Survey (NHANES 2007–2010), current prevalence is estimated at 8.8% among adults as compared to a prevalence of 5.2% in 1994. More than $5.3billion is spent directly and indirectly on treatment for nephrolithiasis annually in the USA. Kidney stones are more prevalent in men than women with a lifetime risk of 12% in men and 6% in women. As many as 20% of patients present with renal colic and require urological intervention.
Article
Over-the-counter (OTC) products such as pharmaceuticals, dietary supplements, vitamins, and herbal remedies are widely available and copiously used by older adults for health maintenance and symptom management. Owing to physiology, multimorbidity, and polypharmacy, this population is particularly vulnerable to inappropriate use of OTC products, adverse effects, and drug interactions. While OTC pharmaceuticals are bound by FDA-approved standards, dietary supplements are regulated differently, resulting in variable quality and increased possibility for adulteration. Internationally, standards for OTC products vary widely. Accessible educational information, improved provider-patient communication, and revision of regulatory policy could improve safety for older adult users of OTC products.
Chapter
Hot flashes are common in breast cancer survivors because they can occur as a result of natural aging, surgery, or medications used in the treatment of cancer. Unfortunately, some survivors will have to cope with bothersome hot flashes for years even after completing cancer-directed therapies, and these symptoms can detrimentally impact life quality in multiple domains. Many drug and non-drug interventions have been studied in recent decades, and some are quite effective at reducing the frequency and severity of hot flashes. This chapter provides a succinct overview of supportive care strategies for dealing with hot flashes, the data behind each approach, and important information about toxicities that may occur as a result of therapies.
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Nefroloji, temel olarak böbrek hastalıklarıyla ilgilenen bir tıp bilimi dalıdır. Nephros böbrekler, -ology çalışma anlamına gelen Yunanca kökenli bir terimdir. Türkçede böbrek kelimesinin kökeni araştırıldığında, Orhun Yazıtlarında kaburga ve kalça arasındaki boşluğun adının “bögür” olarak geçtiği görülür. Uygurca tıp metinlerindeki kullanımı bügür’dür. Eski Türkçeden beri kullanılagelen bögür kelimesi “böbrek, böğür, yan” anlamındadır. Türkçenin tarihi dönemlerinde, Karahanlıcada bögür, Çağataycada ise bögr şeklindedir. Dîvânu Lugâti't-Türk’te (1070, Kaşgarlı Mahmut) bögür, böbrek adı olarak geçmektedir. 1400’den önce Osmanlı Döneminde muhtemelen böğür kelimesine -ek eki getirilerek böğrek kelimesi böbrek anlamında kullanılmıştır. Halk arasında hâlâ organın bulunduğu yerle ilişkilendirilmek için böğür kelimesi yaygın kullanılsa da, günümüzde artık böbrek olarak ifade edilmektedir. Günümüzde epidemiyolojik çalışmalar, böbreklerimizi olumsuz etkilediğini bildiğimiz diabetes mellitus, hipertansiyon, obezite, aterosklerotik kalp hastalığı, romatolojik hastalıklar ve kanser gibi sağlık problemlerinin sıklığının giderek arttığını göstermektedir. Ayrıca bunlara primer böbrek hastalıkları ve sekonder olarak böbreği tutan başka birçok sistemik hastalığı da ekleyince günlük hekimlik pratiğinde böbrek rahatsızlığı şüphesi olan ya da bu tanı ile tedavi-izlem altında olan bir çok hasta ile karşılaşmaya devam edeceğimizi öngörebiliriz. Böbrekler sıvı, elektrolit, asit ve baz dengesini düzenleyen, ilaçlar ve toksinler dahil bir çok endojen ve eksojen atık ürünleri ve fazla sıvıyı kandan filtreleyen karmaşık kan damarı ve tübül ağına sahip boşaltım sisteminin yaşam için hayati önem taşıyan organıdırlar. Nefroloji uzmanları; böbrek yetmezliği, hipertansiyon, elektrolit (sodyum, potasyum, kalsiyum, fosfor vb.) bozuklukları ve idrar anormalliklerinin (hematüri ve proteinüri vb.) nedenlerinin araştırılması, tedavi ve takibi, ayrıca kullandığımız ilaçlara bağlı böbrek toksisitesinin olumsuz etkilerinin önlenmesi konularında rol alırlar. Kronik böbrek hastalığı dünyada ve Türkiye’de giderek artan önemli bir halk sağlığı sorunu haline gelmiştir. Böbrek hastalığı farkındalığını arttırmak için Uluslararası Nefroloji Derneği (ISN) ile Uluslararası Böbrek Vakıfları Federasyonunun (IFKF) ortak girişimiyle 9 Mart 2006 tarihinde ilk kez “Dünya Böbrek Günü” kutlanmıştır ve o günden bu yana her yıl Mart ayının 2. perşembe günü tüm dünyada “Dünya Böbrek Günü” olarak kutlanmaya devam edilmektedir. Kronik böbrek hastalığının en önemli nedeni diabetes mellitustur. Ülkemizde yapılan taramalara göre erişkinlerde kronik böbrek hastalığı sıklığı %15.7 (~7.5 milyon kişi), böbrek hastalıklarının farkındalığı ise %1.6 düzeyinde tahmin edilmekte ve sorunun boyutunun tahmin edilenin çok üzerinde olduğu görülmektedir. Hâlen tüm dünyada 2 milyondan fazla kişi diyalize girmekte ve böbrek nakli tedavileri ile yaşamını sürdürmektedir. Önümüzdeki 10 yıl içinde bu sayının ikiye katlanacağı, tedavi maliyetlerinin 1.5 trilyon doları aşacağı hesaplanmaktadır. Dolayısıyla temel olarak böbrek sağlığımızı korumak için gerekli önlemleri almak, yani koruyucu hekimlik her zaman daha önemlidir. Kronik böbrek hastalığından korunmak için bireyler; düzenli egzersiz yapmalı, sağlıklı beslenmeli, vücut ağırlığını korumalı, tuzu azaltmalı, yeterli sıvı almalı, sigara içmemeli, alkolden uzak durmalı, ağrı kesici ilaçlardan hekim önerisi olmadığı sürece kaçınmalı, kan basıncını ve kan glukozunu düzenli olarak ölçtürmeli ve risk grubunda ise böbreklerini düzenli olarak kontrol ettirmelidirler. Diğer mesleklerden insan sağlığı ile uğraştığı için daha kutsal sayılan hekimlik mesleğinin bir diğer özelliği ise sürekli yenilenme ihtiyacının olmasıdır. Modern tıp çağında teşhis ve tanı yöntemleri, görüntüleme teknikleri, cerrahi ve robotik müdahaleler, girişimsel işlemler, özellikle moleküler düzeydeki bilimsel gelişmeler yaygınlaşmaktadır. Bununla birlikte hastadan anamnez almanın ve muayene etmenin yani hastayı dinlemenin, yakınmalarını doğru yorumlamanın ilk önceliğimiz olduğu unutulmamalıdır. Çünkü Hipokrat hekimliği döneminden beri “Hastalık yoktur, hasta vardır.” ilkesi hiç değişmemiştir. Böbrek hastalıklarında da, hastalığın özelliği olan semptom ve bulgular hiçbir zaman hastalar arasında aynı ölçüde görülmemektedir.
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