potassium-bicarbonate and Urinary-Calculi

Uric acid stone formation ordinarily is prevented by increases in the urinary pH after meals. This postprandial alkaline tide is lost in patients who make such calculi. Single dose, alternate day administration of an alkaline potassium salt will increase urinary pH and simulate this normal physiological mechanism. An important part of the regimen is patient self-monitoring to verify that the urinary pH increases to greater than 6.8, 1 1/2 to 2 hours after the medication is taken. In contrast to multiple dose daily regimens, this mode of base administration is tolerated better and easier to follow. In 17 patients, 7 with the recurrent gravel/colic syndrome and 10 with prior stones, this regimen abolished calculus formation during an average followup of 2 1/2 years. However, further studies are needed before this regimen can be recommended as standard therapy for uric acid stone prophylaxis.

Topics: Adult; Aged; Bicarbonates; Citrates; Citric Acid; Colic; Follow-Up Studies; Humans; Hydrogen-Ion Concentration; Kidney Diseases; Male; Potassium; Potassium Compounds; Recurrence; Self Care; Sodium; Sodium Bicarbonate; Time Factors; Uric Acid; Urinary Calculi

Sodium pyruvate, potassium pyruvate, pyruvic acid, sodium bicarbonate and potassium bicarbonate were added to a calcium-oxalate lithogenic diet (a glycolic-acid diet) in order to determine their effects in preventing lithogenicity. Male Wistar-strain rats who had been fed the glycolic-acid diet developed marked urinary calculi within four weeks. Rats in the sodium and potassium pyruvate groups had, however, almost no stones in the urinary system. Rats in the bicarbonate and pyruvic-acid groups showed slightly less effect than those in the pyruvate groups. Urinary oxalate excretion was high in all the groups during the experiment. The urinary oxalate concentration was relatively higher in the sodium-pyruvate group, and significantly higher in the potassium-pyruvate group, than in the glycolic-acid group. Urinary citrate excretion was high both in the pyruvate and bicarbonate groups; the urinary citrate concentration was, however, significantly higher in the pyruvate groups than in the bicarbonate groups at the fourth experimental week. The urinary calcium and magnesium concentrations were irrelevant to the diets administered. Therefore, it can be concluded that pyruvate salts inhibit urinary calculi formation, not by decreasing oxalate synthesis, but by increasing the urinary citrate concentration; bicarbonate salts work in the same manner, but a little less effectively.

Topics: Animals; Bicarbonates; Calcium; Citrates; Diet; Glycolates; Hydrogen-Ion Concentration; Kidney; Kidney Calculi; Magnesium; Male; Oxalates; Potassium Compounds; Pyruvates; Rats; Rats, Inbred Strains; Sodium; Sodium Bicarbonate; Urinary Calculi

The possibilities of local dissolution of uric acid calculi with Na hydrocarbonate, K carbonate and lithium carbonate were examined in vitro. The most promising results were obtained with lithium carbonate. The necessity for studies of the compound in laboratory animals before its use in humans is emphasized.

Topics: Bicarbonates; Hydrogen-Ion Concentration; Lithium; Lithium Carbonate; Potassium Compounds; Sodium; Sodium Bicarbonate; Solubility; Uric Acid; Urinary Calculi