Dietary Manipulation With Lemonade to Treat Hypocitraturic Calcium Nephrolithiasis

Department of Urology, University of California, San Francisco 94143-0738, USA.
The Journal of Urology (Impact Factor: 4.47). 10/1996; 156(3):907-9. DOI: 10.1016/S0022-5347(01)65659-3
Source: PubMed


Pharmacological treatment of hypocitraturic calcium nephrolithiasis requires as many as 12 tablets, or numerous crystal packages or liquid supplements taken throughout the day. In addition to added cost, this cumbersome regimen decreases patient compliance, which may increase stone recurrence rates. We evaluated the urinary biochemical effects of dietary citrate supplementation in hypocitraturic calcium stone formers in an attempt to decrease or eliminate the need for pharmacological therapy.
A total of 12 patients who were either noncompliant with or intolerant of pharmacological citrate therapy supplemented their routine diet with citrate in the form of lemonade, consisting of 4 ounces of reconstituted lemon juice (5.9 gm. citric acid) mixed with tap water to a total volume of 2 l. and consumed at uniform intervals throughout the day. Urine specimens (24-hour) were obtained for biochemical analysis after 6 days of lemonade therapy and compared to pre-lemonade baseline values.
Of the 12 patients 11 had increased urinary citrate levels during lemonade therapy (average 204 mg. per day). Average levels increased from 142 mg. daily (range less than 10 to 293) at baseline to 346 mg. daily (range 89 to 814) after treatment (p < 0.001). Daily total urinary volumes were similar (2.7 versus 2.9 l.). Seven of 12 patients became normocitraturic while consuming lemonade. Urinary calcium excretion decreased an average of 39 mg. daily, while oxalate excretion was unchanged. The lemonade mixture was well tolerated. Two patients complained of mild indigestion that did not require cessation of therapy.
Citrate supplementation with lemonade increased urinary citrate levels more than 2-fold without changing total urinary volume. Lemon juice, which contains nearly 5 times the concentration of citric acid compared to orange juice, is an inexpensive and well tolerated dietary source of citrate. Lemonade therapy may improve patient compliance, and may be useful as adjunctive treatment for patients with hypocitraturic calcium nephrolithiasis.

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    • "This alkali charge, in addition to alkalinizing the urine, also affects citrate reabsorption from the kidney. On the other hand, citrate is found together with protein in lemonade (Seltzer et al. 1996; Aras et al. 2008). The lack of alkalinizing ability of lemonade is probably due to the protons present, which neutralize the effect of the citrate (Kang et al. 2007). "
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    ABSTRACT: Fruit and vegetable juices containing citrate may be recommended as an alternative in mild to moderate level hypocitraturic calcium stone formers who cannot tolerate pharmacological treatment. Tomato has been proved a citrate-rich vegetable. Tomato juice usage as citrate sources in hypocitraturic recurrent stone formers were evaluated in the light of the results of studies on orange and lemon juices. Ten 100 ml samples were prepared from three different tomato types processed through a blender. These samples were examined in terms of citrate, oxalate, calcium, magnesium, and sodium contents. No difference was detected between the parameters tested in three different tomato juices. Fresh tomato juice may be useful in hypocitraturic recurrent stone formers due to its high content of citrate and magnesium, and low content of sodium and oxalate. As the three different types of tomatoes did not differ in terms of citrate, magnesium, sodium, and oxalate content, they may be useful for clinical use if also supported by clinical studies.
    Full-text · Article · Jun 2010 · International Journal of Food Sciences and Nutrition
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    • "l . 2006 ) . In this concept , we demonstrated that citrate also promotes the apoptotic cell death of UVB - irradiated B16 cells . Citrate supplementation improves urinary citrate levels more than 2 - fold without changing total urinary volume , and may be useful as adjunctive treatment for patients with hypocitra - turic calcium nephrolithiasis ( Seltzer et al . 1996 ) . Furthermore , high concentrations of citrate inhibit phosphofructokinase , the pyruvate dehydrogenase complex , and succinate dehydrogenase of the TCA cycle ( Halabe Bucay 2007 ) . Recently , it has been suggested that administering citrate to cancer patients might slow metabolism via the inhibition of glycolysis , and thus might im"
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    ABSTRACT: Ultraviolet (UV) radiation is a major risk factor for the development of melanoma. Recent studies have reported that the intake of citrate-containing juices may reduce the risk of cancer. Thus, we investigated the effects of citrate on UVB-irradiated B16 murine melanoma cells. B16 cells had more evident apoptotic features with the combination of citrate/UVB than by citrate or UVB alone; cell death of HaCaT human keratinocytes was not observed with citrate/UVB. Western blot analysis demonstrated that citrate/UVB led to phosphorylation of the stress signaling proteins, such as c-Jun N-terminal kinase (JNK) and p38 mitogen-activated protein kinase (MAPK). Furthermore, citrate/UVB caused activation of caspase-9/-3 as well as cleavage of poly(ADP-ribose) polymerase (PARP). Correspondingly, cell cycle analysis showed that citrate/UVB clearly increased the sub-G0/G1 phase, which indicated apoptotic cell death of B16 cells. Therefore, our study has demonstrated that sub-lethal doses of citrate enhanced the apoptotic cell death of melanoma cells under UVB irradiation. From these results, we suggest that citrate might reduce the risk of developing melanoma induced by UVB.
    Full-text · Article · Dec 2009 · Pharmazie
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    • "Whereas Wabner and Pak (1993) observed an increase in urinary oxalate excretion, we could not confirm a change in urinary oxalate excretion in healthy subjects (Hesse et al, 1993). The intake of lemon juice, with a nearly five times higher citrate concentration compared to orange juice, led to a two-fold rise in urinary citrate levels in patients with hypocitraturic calcium nephrolithiasis (Seltzer et al, 1996, CE IIa). Moreover, studies on the effect of fluids containing lithogenic agents which may increase the risk of stone formation have been carried out. "
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    ABSTRACT: A low urine volume is an important risk factor in urinary stone formation. The present article summarizes available data from epidemiological and clinical studies to elucidate the impact of fluid intake and urine volume on the risk of urinary stone formation and the prevention of stone recurrence. A review of the literature shows that an increased urine volume achieved by a high fluid intake exerts an efficacious preventive effect on the onset and recurrence of urinary stones. A high water intake and urine dilution results in a marked reduction in saturation of lithogenous salts. The type of fluids should be carefully selected to achieve the appropriate change of urine composition depending on stone composition. A sufficient intake of fluid is one of the most important preventive measures for stone recurrence.
    Preview · Article · Jan 2004 · European Journal of Clinical Nutrition
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