Piedras en el riñón y cólico nefrítico

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Piedras en el riñón y cólico nefrítico

Notapor Fisio » Dom, 30 Nov 2014, 20:06

Asunto lamentablemente infraestudiado ya que no es un mercado prioritario de consumo crónico de fármacos y lo que interesa es la cirugía si la piedra es grande. La prevención es relativa a los estilos de vida y algunos suplementos dietéticos, así que nos jodemos. Se habla mucho de la adecuación del calcio, de la vitamina C o D, pero en realidad no se ha querido estudiar porque esto no da patentes.

Los cólicos le ocurrirán a un 10%-15% de la población, asociado a altas temperaturas y deshidratación, tasa muy alta de recurrencias (70% volverá a tener) y el dolor llega a superar el de un parto y un disparo. El 40% de piedras en el riñón recogidas por imagen son asintomáticas: correlación no implica causa y puede llevar a sobrediagnóstico. No son fáciles estos estudios y no hay muchos. Dejo este hilo para ir discutiendo este asunto.


Agua: es la primera y mejor medidia que conocemos: aumentar el consumo de agua reduce la recurrencia en más de un 50% respecto a los que siguen tomando el mismo volumen de agua.

Calcio

Increased calcium intake through diet or taking supplements, increases urinary excretion of calcium [16,18]. Therefore, one might expect an increase in risk of stone formation. However, with dietary calcium and calcium supplements taken with meals, calcium is able to bind with oxalate in the
intestine. This limits the absorption of oxalate, reducing the risk of calcium oxalate stone formation. When calcium supplements are not taken with meals, the benefit of intestinal binding with oxalate is lost, and the risk of urolithiasis may be elevated.


Vitamina D y calcio en mujeres postmenopáusicas

Calcium and vitamin D supplementation and risk of kidney stone formation in postmenopausal women.

Our findings showed that oral intake of calcium and vitamin D after 1 year has no effect on the urinary calcium excretion rate and the formation of kidney calculi in postmenopausal women

http://www.ncbi.nlm.nih.gov/pubmed/23689153


Ácido ascórbico


During 11 years of follow-up we ascertained 436 first incident cases of kidney stones. Ascorbic acid use was associated with a statistically significant 2-fold increased risk (Table). In contrast, multivitamin use was not associated with kidney stone risk (RR, 0.86 [95% CI, 0.62-1.19]).

In conclusion, our results indicate that high-dose ascorbic acid supplements—one of the most commonly used vitamin preparations—are associated with a dose-dependent 2-fold increased risk of kidney stone formation among men.

http://archinte.jamanetwork.com/article ... id=1568519




Riesgo de este estudio: la gente que reporta tomar altas dosis de vitamina C son más llamado a hacerse pruebas y puede haber inflado el resultado del uso de suplementos.


Bicarbonato

The effect of sodium bicarbonate upon urinary citrate excretion in calcium stone formers.

CONCLUSION:

This short-term study suggests that NaBic represents an effective alternative for the treatment of hypocitraturic calcium oxalate stone formers who cannot tolerate or afford the cost of KCit. In view of the increased sodium urate supersaturation, patients with pure uric acid stones and high urate excretion may be less suited for treatment with NaBic.


http://www.ncbi.nlm.nih.gov/pubmed/23602798


Zumo de granada en modelo experimental

CONCLUSION:

This experiment shows the protective effect of PJ in the EG-induced crystal depositions in renal tubules.


http://www.ncbi.nlm.nih.gov/pubmed/19025399

Zumo de limón

Lemon juice has protective activity in a rat urolithiasis model


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2194764/


Desgraciadamente, la ciencia de la salud hoy es lo que le interesa investigar a las farmacéuticas, a las empresas de biotecnología, y a las asociaciones de medicina que hacen procedimientos que les lucran. No la salud de la gente.
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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Dom, 30 Nov 2014, 22:15

Why oral calcium supplements may reduce renal stone disease: report of a clinical pilot study.
Williams CP1, Child DF, Hudson PR, Davies GK, Davies MG, John R, Anandaram PS, De Bolla AR.
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Abstract
AIMS:

To investigate whether increasing the daily baseline of gut calcium can cause a gradual downregulation of the active intestinal transport of calcium via reduced parathyroid hormone (PTH) mediated activation of vitamin D, and to discuss why such a mechanism might prevent calcium oxalate rich stones. To demonstrate the importance of seasonal effects upon the evaluation of such data.
METHODS:

Within an intensive 24 hour urine collection regimen, daily calcium supplementation (500 mg) was given to five stone formers for a 10 week period during a six month crossover study. In a further population of patients on follow up for previous renal stone disease, observations were made on 1066 24 hour urine samples collected over five years in respect of seasonal effects relevant to the interpretation of the study.
RESULTS:

In the group of patients on calcium supplements the following results were found. During calcium supplementation, the proportion of urine calcium to oxalate was higher (increased calcium to oxalate molar ratio), the 24 hour urine product of calcium and oxalate did not rise, and urine oxalate was lower during the first six weeks of supplementation. Twenty four hour urine calcium was 10.2% higher than baseline in the final four weeks of the 10 weeks of supplementation. Twenty four hour urine phosphate was 11.4% lower during the first six weeks of supplementation, but then rose while the patients were still on supplementation; renal tubular reabsorption of phosphate (TmP/GFR) mirrored the urine phosphate changes inversely. PTH was higher after stopping supplementation, but 1,25-(OH)2-cholecalciferol changes were not detected. In the 1066 urine samples collected over five years the following results were found. Calcium and oxalate excretion correlated positively and not inversely. Urine calcium and phosphate excretion were 5.5% and 2.5% higher, respectively, in "light" months of the year compared with "dark" months. A post summer decline in both urine calcium and urine phosphate was relevant to the interpretation of the study.
CONCLUSIONS:

Regular calcium supplementation does not raise the product of calcium and oxalate in urine and the proportion of oxalate to calcium is reduced. The underlying mechanisms of the changes seen in phosphate, calcium, and PTH and the observations on 1,25-(OH)2-cholecalciferol are not clear. Observed changes in phosphate could possibly be part of a calcium regulating feedback loop operating over a period of weeks. In evaluating these mechanisms background seasonal effects are important. It is possible that "programming" of the gut mucosa in terms of calcium transport is a major determinant of the relation between calcium and oxalate concentrations in urine and their relative abundance. Increased oral calcium, in association with a reduction of the relative proportion absorbed, may be pertinent to the prevention of calcium oxalate rich stones.

http://www.ncbi.nlm.nih.gov/pubmed/11271790




Intake of vitamins B6 and C and the risk of kidney stones in women.
Curhan GC1, Willett WC, Speizer FE, Stampfer MJ.
Author information

1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. gary.curhan@channing.harvard.edu

Abstract

Urinary oxalate is an important determinant of calcium oxalate kidney stone formation. High doses of vitamin B6 may decrease oxalate production, whereas vitamin C can be metabolized to oxalate. This study was conducted to examine the association between the intakes of vitamins B6 and C and risk of kidney stone formation in women. The relation between the intake of vitamins B6 and C and the risk of symptomatic kidney stones were prospectively studied in a cohort of 85,557 women with no history of kidney stones. Semiquantitative food-frequency questionnaires were used to assess vitamin consumption from both foods and supplements. A total of 1078 incident cases of kidney stones was documented during the 14-yr follow-up period. A high intake of vitamin B6 was inversely associated with risk of stone formation. After adjusting for other dietary factors, the relative risk of incident stone formation for women in the highest category of B6 intake (> or =40 mg/d) compared with the lowest category (<3 mg/d) was 0.66 (95% confidence interval, 0.44 to 0.98). In contrast, vitamin C intake was not associated with risk. The multivariate relative risk for women in the highest category of vitamin C intake (> or =1500 mg/d) compared with the lowest category (<250 mg/d) was 1.06 (95% confidence interval, 0.69 to 1.64). Large doses of vitamin B6 may reduce the risk of kidney stone formation in women. Routine restriction of vitamin C to prevent stone formation appears unwarranted.

http://www.ncbi.nlm.nih.gov/pubmed/10203369

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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Dom, 30 Nov 2014, 22:25

Effect of ascorbic acid consumption on urinary stone risk factors.
Traxer O1, Huet B, Poindexter J, Pak CY, Pearle MS.
Author information
Abstract
PURPOSE:

Ascorbic acid (AA) has been implicated as a risk factor for calcium oxalate stones due to its conversion to oxalate and potential acidifying properties. We evaluated the effect of AA consumption on urinary saturation of calcium oxalate (CaOx) and urinary pH.
MATERIALS AND METHODS:

A total of 12 normal subjects (NS) and 12 CaOx stone formers (SF) underwent 2, 6-day phases of study while maintained on a controlled metabolic diet. In each phase subjects ingested 1 gm AA or an identical appearing placebo twice daily. On the last 2 days of each phase 2, 24-hour urine collections were analyzed for pH and stone risk factors, and blood specimens were submitted for serum chemistry studies.
RESULTS:

No difference in urinary pH was found between placebo and AA phases in NS (6.02 versus 6.02) and SF (6.0 versus 6.0). However, urinary oxalate was statistically significantly higher in the AA versus placebo phase for NS (34.7 versus 28.5 mg, p = 0.008) and SF (41.0 versus 30.5 mg, p <0.001). Likewise, the CaOx relative saturation ratio was significantly higher in the AA versus placebo phase for both groups.
CONCLUSIONS:

Ingestion of 2 gm AA daily results in no change in urinary pH but a moderate though statistically significant increase in urinary oxalate in NS (20%) and SF (33%). Stone formers respond no differently to AA than normal subjects. We recommend limiting AA use to less than 2 gm daily in CaOx stone formers.


http://www.ncbi.nlm.nih.gov/pubmed/12853784
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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Lun, 01 Dic 2014, 00:15

Importance of magnesium in absorption and excretion of oxalate.
Zimmermann DJ1, Voss S, von Unruh GE, Hesse A.
Author information
Abstract
INTRODUCTION:

Magnesium treatment for calcium oxalate urolithiasis is discussed controversially. The aim of this study was to investigate the influence of magnesium supplementation on the oxalate absorption.
MATERIALS AND METHODS:

The [13C2]oxalate absorption test was always performed three times in 6 healthy volunteers under standardized conditions, with one 10-mmol magnesium supplement together with the labeled oxalate and with two 10-mmol magnesium supplements given in 12-hour intervals.
RESULTS:

The mean intestinal oxalate absorption under standard conditions was 8.6 +/- 2.83%. The oxalate absorption with one 10-mmol magnesium supplement was 5.2 +/- 1.40% and with two supplements 5.5 +/- 1.62%. Both decreases were statistically significant relative to the standard test, however, not significantly different from each other.
CONCLUSIONS:

The results show that magnesium administration decreases the oxalate absorption, when magnesium is taken together with oxalate. However, magnesium administration does not decrease the oxalate absorption, when magnesium and oxalate intake differ by 12 h.


http://www.ncbi.nlm.nih.gov/pubmed/15812215
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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Lun, 01 Dic 2014, 00:16

Arginina

Counteraction of oxalate induced nitrosative stress by supplementation of l-arginine, a potent antilithic agent.
Pragasam V1, Kalaiselvi P, Sumitra K, Srinivasan S, Varalakshmi P.
Author information
Abstract
BACKGROUND:

Our understanding of nitrosative stress in the process of urolithiasis is far from complete. Earlier studies carried out in our laboratory demonstrate the presence of nitrated THP in stone formers, l-arginine (l-arg) a precursor of nitric oxide (NO), attenuates the endothelial dysfunction caused by reactive nitrogen species. We investigated the role of l-arg in ethylene glycol (EG)-induced urolithic rat model and observed its antilithic and antioxidative properties.
METHODS:

Hyperoxaluria was induced using 0.75% EG in drinking water. l-arg [1.25 g/kg body weight] was given orally for a period of 28 days.
RESULTS:

EG-treated rats showed significant loss in body weight and increase in the activities of oxalate synthesizing enzymes such as glycollic acid oxidase in liver. Lactate dehydrogenase activity in liver and kidney was increased. The activity of the free radical producing enzyme xanthine oxidase, tissue oxalate and calcium levels were significantly increased in EG-treated rats. Depletion in the antioxidant enzymes, membrane bound ATPases and thiol status was observed in these rats. l-arg co-supplementation to EG-treated rats maintained the activities of the oxalate synthesizing enzymes and free radical producing enzymes with in the normal range. Tissue oxalate and calcium levels were also maintained near normal in l-arg treated hyperoxaluric rats. l-arg, by its cytoprotective effect, maintained the thiol status, thereby preserving the activities of the membrane bound ATPases and preventing proteinuria and subsequent weight loss in EG-treated rats.
CONCLUSION:

l-arg feeding prevents the retention of calcium oxalate crystals in hyperoxaluric rats by way of protecting the renal cells from oxidative injury and also by providing a second line of defense through the normalization of the oxalate metabolism. It reduces the risk of stone formation, by curtailing free radicals and hyperoxaluria as both of them have to work in close association to form stones.


http://www.ncbi.nlm.nih.gov/pubmed/15748613
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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Mar, 09 Dic 2014, 23:18

Randomized, Double-Blind Clinical Trial to Assess the Acute Diuretic Effect of Equisetum arvense (Field Horsetail) in Healthy Volunteers
In this double-blind, randomized clinical trial, 36 healthy male volunteers were randomly distributed into three groups () that underwent a three-step treatment. For four consecutive days, we alternately administered a standardized dried extract of Equisetum arvense (EADE, 900 mg/day), placebo (corn starch, 900 mg/day), or hydrochlorothiazide (25 mg/day), separated by a 10-day washout period. Each volunteer served as his own control, and the groups’ results were compared. We repeated the same evaluation after each stage of treatment to evaluate the safety of the drug. The diuretic effect of EADE was assessed by monitoring the volunteers’ water balance over a 24 h period. The E. arvense extract produced a diuretic effect that was stronger than that of the negative control and was equivalent to that of hydrochlorothiazide without causing significant changes in the elimination of electrolytes. There was no significant increase in the urinary elimination of catabolites. Rare minor adverse events were reported. The clinical examinations and laboratory tests showed no changes before or after the experiment, suggesting that the drug is safe for acute use. Further research is needed to better clarify the mechanism of diuretic action and the other possible pharmacological actions of this phytomedicine.


http://www.hindawi.com/journals/ecam/2014/760683/
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Re: Piedras en el riñón y cólico nefrítico

Notapor Fisio » Mié, 14 Oct 2015, 16:46

Suplementos de calcio aumentan el tamaño de las piedras en el riñón pese a disminuir el calcio y oxalatos en orina. Los suplementos de vitamina D los reducen.

24-hour urine collections and CT imaging scans from patients at their institution who had a history of kidney stones

http://www.sciencedaily.com/releases/20 ... 103619.htm
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