Prophylactic and therapeutic properties of a sodium citrate preparation in the management of calcium oxalate urolithiasis: Randomized, placebo-controlled trial

Department of Chemistry, University of Cape Town, Cape Town 7701, South Africa.
Urological Research (Impact Factor: 1.39). 06/2005; 33(2):116-24. DOI: 10.1007/s00240-005-0466-6
Source: PubMed


The purpose of this study was to investigate the prophylactic and therapeutic effects of a hitherto untested preparation containing sodium citrate in the management of calcium oxalate urolithiasis. In this study, a host of calcium oxalate kidney stone risk factors was investigated using a randomised, placebo controlled, "within-patient" clinical trial. The trial involved four groups of subjects: healthy male controls, healthy female controls , calcium oxalate stone-forming males and calcium oxalate stone-forming females. There were 30 subjects in each group. Twenty subjects in each group ingested the preparation containing sodium citrate and ten subjects in each group ingested a placebo for 7 days. Collection of 24 h urines were carried out at baseline, at day 7 and day 10 (i.e. 3 days after suspension of drug/placebo ingestion). These were analysed for biochemical and physicochemical risk factors. They were also tested for their inhibitory properties in crystallization experiments. Data were statistically analyzed using analysis of variance (ANOVA). Key risk factors were significantly and beneficially altered across all groups after ingestion of the preparation. The pH and urinary citrate excretion increased while urinary oxalate and calcium excretions decreased, as did relative supersaturations of calcium oxalate and uric acid. In addition, inhibition of calcium oxalate crystallization increased. Beneficial carryover effects were observed for some risk factors. The results of this study have demonstrated, for the first time, that a sodium citrate-containing preparation favourably alters the risk factors for calcium oxalate urolithiasis.

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    • "Na-citrate also enhanced brushite and sodium saturation, but was not able to reduce urinary CaOx saturation. However, in a randomized, placebo controlled clinical trial, Allie-Hamaulay and Rodgers demonstrated that Na-citrate may alter the risk factors for CaOx stone [23]. Because Na-citrate is common and inexpensive, there is ample opportunity to investigate its efficacy as a preventive aid for CaOx stone formation. "

    Full-text · Article · Jan 2015
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    • "c o m / l o c a t e / c l i n c h i m nephrolithiasis could be adequate hydration and urine alkalization [13] [15]. Sodium citrate salts can inhibit nephrocalcinosis and calculi formation as a result of decreased urinary saturation [16], and this preparation alters the risk factors for calcium oxalate urolithiasis [17]. Urine alkalinization and stone liberalization were the most effective treatments for melamine-induced urinary calculi in infants [18]. "
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    ABSTRACT: Melamine (M), which is composed of multi-amine, has been used as a food additive to falsely increase protein contents. Furthermore, cyanuric acid (CA) is a derivative of melamine. It is known that these mixtures can cause renal toxicity. The objective of this study was to investigate the possible target cells during acute renal toxicity of melamine and cyanuric acid (MCA) mixture crystals in vivo. Rats were provided with a lethal dose of MCA (1:1; 400mg/kg) and observed after 0.5, 1, 3, 12, 24, and 48- hour (h) intervals. MCA caused degeneration/necrosis in the proximal tubules starting at 12h and increased at 24 and 48h. A small number of yellow-green crystals were observed in the dilated distal renal tubules at 48h post treatment. Ultrastructurally, pyknosis, mitochondrial vesicles, and cellular swelling were found in the proximal tubular cells at 0.5h. Small needle-like crystals in the cytoplasm and large crystals in the lumen of tubules indicated physical damage to the renal cells. These results clearly reveal that in the MCA-induced renal toxicity model, crystals are distributed to both the proximal and distal tubules in rats. The proximal tubular cells may be initially injured and subsequently block the distal tubules with MCA crystals during early acute intoxication.
    Full-text · Article · Jan 2014 · Clinica chimica acta; international journal of clinical chemistry
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    ABSTRACT: The therapeutic action of citrate in the management of calcium oxalate urolithiasis has been attributed to the depletion of free calcium ions by complexation of the latter by citrate itself. However, little attention has been given to the nature of such complexes and the chemical conditions which control their formation because it is very difficult to measure them in solution. We therefore modelled the theoretical formation of these complexes in urine following administration of a citrate-containing preparation, using a powerful speciation program, JESS (Joint Expert Speciation System), which has been widely used to model metal-ligand equilibria in biological systems but which has hitherto not been applied in urolithiasis research. This program has an extensive database of thermodynamic constants and is able to calculate mixed ligand speciation. Urine data obtained before and after citrate administration in four groups of subjects (male and female normals and stone formers) were used as input for JESS to calculate the speciation of calcium, citrate and oxalate. The program was also used to examine the effects of varying different urinary components on the nature and concentration of the various species. The speciation predicted the formation of a key calcium-citrate-phosphate species (previously unreported in urolithiasis research), which accounts for a significant percentage of the complexation of the free calcium. Moreover, the formation of this complex was found to be dependent on an increase in urinary pH rather than on an increase in urinary citrate concentration per se. The therapeutic action of citrate in the management of calcium oxalate urolithiasis is due to the formation of a pH dependent calcium-citrate-phosphate complex which reduces the concentration of the free calcium ion species, thereby reducing the risk of stone formation.
    Full-text · Article · Mar 2006 · Nephrology Dialysis Transplantation
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