sodium-bicarbonate and Urinary-Calculi

Topics: Citrates; Drug Administration Schedule; Humans; Hydrogen-Ion Concentration; Potassium Citrate; Radiography; Sodium Bicarbonate; Sodium Citrate; Ureteral Calculi; Uric Acid; Urinary Calculi

Medical treatment of cystinuria is often disappointing. Patients undergo frequent surgery, which is often followed by early relapse. The aim of our study was to evaluate the efficacy of medical treatment of cystinuria, to prevent formation or to reduce the numbers and dimensions of renal stones. Twenty cystinuric patients were treated with a combined approach, including cystine-binding drugs. Free and bound urine cystine levels were measured every 4 months. Drug dosage was adjusted to maintain free urine cystine level below 100 micromol/mmol creatinine. Eighteen patients completed the study; detection of new stones was reduced from 0.28 per year to 0.03 per year, and, in six patients, the numbers and dimensions of pre-existing renal stones were reduced. Surgery was required in one subject, and no relapse was observed 12 months afterwards. The dosage required to achieve target levels was closely correlated with patient body weight: older children required a lower dose. Medical management of cystinuria is feasible. The treatment must be personalised in children, as the amount of drug required is strictly dependent on body size.

Topics: Adolescent; Adult; Alkalies; Chelating Agents; Child; Child, Preschool; Cystine; Cystinuria; Diuretics; Drug Monitoring; Humans; Infant; Penicillamine; Potassium Citrate; Prospective Studies; Sodium Bicarbonate; Tiopronin; Urinary Calculi

We determined the efficacy of a contemporary medical regimen for treatment of cystinuria.. A total of 16 patients with cystinuria was followed for 7 to 141 months (mean 78.1). Standard therapy included hydration and alkalization. D-penicillamine or alpha-mercaptoproprionylglycine was added for failure of hydration and alkalization to prevent new stones or stone growth, or to cause dissolution. Captopril was added for failure of or intolerance to D-penicillamine or alpha-mercaptopropionylglycine. Radiography was performed every 6 to 12 months, at which time stone events were documented.. During hydration and alkalization 46 stone events occurred in 8 of 9 patients (1.6 events per patient-year). With addition of thiol derivatives 7 of 9 patients experienced 24 stone events, all 6 treated with hydration, alkalization and captopril experienced 10 events, and 4 of 5 treated with alkalization, thiols and captopril experienced 8 events (0.52, 0.71 and 0.54 events per patient-year, respectively). During a total treatment time of 104.1 patient-years 88 stone events occurred in 14 of 16 patients (0.84 events per patient-year).. D-penicillamine and alpha-mercaptopropionylglycine are effective in decreasing the rate of stone formation in patients in whom hydration and alkalization failed. While captopril may also be beneficial in this setting, it does not appear to be as effective as D-penicillamine or alpha-mercaptopropionylglycine, and it does not clearly add clinical benefit to those thiols. Our study demonstrates that patients with cystinuria are at high risk for recurrence when treated with any contemporary medical program. This natural history must be considered when evaluating the long-term efficacy of newer or alternative modes of medical and urological treatment.

Topics: Adolescent; Adult; Angiotensin-Converting Enzyme Inhibitors; Captopril; Child; Child, Preschool; Cystinuria; Diuretics; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Penicillamine; Potassium Citrate; Sodium Bicarbonate; Tiopronin; Urinary Calculi

The authors report a series of nine reno-ureteral obstructive uric acid calculi initially treated by percutaneous nephrostomy. After attempting stone dissolution by in situ alkalinization, they discuss the place of such a method among the various treatments for uric acid stones.

Topics: Aged; Bicarbonates; Humans; Hydrogen-Ion Concentration; Middle Aged; Nephrostomy, Percutaneous; Radiography; Sodium; Sodium Bicarbonate; Therapeutic Irrigation; Treatment Outcome; Uric Acid; Urinalysis; Urinary Calculi

Hyperuricemia and secondary urate nephropathy are uncommon in the paediatric setting outside of tumour lysis syndrome. We describe the case of a 12-year-old boy who presented at 3 years of age with acute renal failure. The cause of this remained unknown until the development of uric acid renal calculi 9 years later. This, and the availability of the previously unknown family history, provided the subsequent diagnosis of partial hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency. Detailed family history is important for early detection of this heterogeneous group of disorders. Early treatment may minimise long-term renal morbidity and mortality from renal insufficiency.

Topics: Acute Kidney Injury; Age of Onset; Allopurinol; Buffers; Cells, Cultured; Child; Enzyme Inhibitors; Erythrocytes; Female; Fibroblasts; Follow-Up Studies; Genetic Linkage; Greece; Heterozygote; Humans; Hyperuricemia; Hypoxanthine Phosphoribosyltransferase; Male; Pedigree; Skin; Sodium Bicarbonate; Time Factors; Treatment Outcome; Ultrasonography; Urinary Calculi

A 26-year-old female visited our hospital complaining left flank pain and macroscopic hematuria. She had been suffering ulcerative colitis and administered salazosulphapyridine and predonisolone from 17-year-old. Intravenous urography showed radiolucent multiple stones in the left renal pelvis. Three sessions of extracorporeal shock wave lithotripsy were performed after ureteral stenting. Although disintegration and discharge of the stones were satisfactory, bladder stone induced by ureteral stent was complicated. The extracted bladder stone showed a yellowish brown color and the surface was granular shape. Composition of the stone was acetyl sulphapyridine which was a metabolite of salazosulphapyridine. After maintenance of the urinary pH ranges between 6.5 and 7.5 by medication of sodium bicarbonate, the patient remains free of stone for 3 years. Drug induced urolithiasis originated from salazosulphapyridine is extremely rare. Satisfactory oral fluid intake and urinary alkalization are important for prevention of sulpha drugs calculi of urinary tract.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Colitis, Ulcerative; Female; Gastrointestinal Agents; Humans; Lithotripsy; Sodium Bicarbonate; Sulfapyridine; Sulfasalazine; Urinary Calculi

We determined the immediate efficacy of contemporary urological intervention for cystine stones and the impact of such intervention on the subsequent rate of recurrent stone formation.. A total of 31 cystinuric patients underwent selected intervention for 61 stone events. Patients were subsequently followed at 6 to 12-month intervals while being treated with standard medical therapy. Logistic regression models were used to correlate potential risk factors with the efficacy of the intervention in achieving a stone-free status. Kaplan-Meier estimates of the probability of recurrence-free survivals at 1 and 5 years were generated, and risk factors for stone recurrence were analyzed using the log rank test.. Overall stone-free rate was 86.9%, which was not significantly influenced by the initial stone burden or type of intervention selected. The probability of recurrence-free survival at 1 and 5 years was 0.73 and 0.27, respectively, and again this probability was independent of initial stone burden or type of intervention selected. Urinary cystine levels before intervention and post-procedure residual stone status also failed to impact significantly on the risk of recurrence. However, a stone-free result, in contrast to residual stones, prolonged the mean time to stone recurrence from 346 to 1,208 days.. While cystine stones are not amenable to all currently available minimally invasive therapeutic modalities, high stone-free rates can be achieved without the need for open surgery and as such cystinuric patients clearly benefit from contemporary intervention. When such intervention is used selectively, with consideration given primarily to stone burden and location, rates of recurrence will relate primarily to the natural history of the medically treated cystinuric patient, and not the type of intervention applied.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alkalies; Cystine; Cystinuria; Disease-Free Survival; Female; Follow-Up Studies; Humans; Lithotripsy; Logistic Models; Male; Middle Aged; Minimally Invasive Surgical Procedures; Potassium Citrate; Probability; Recurrence; Risk Factors; Sodium Bicarbonate; Urinary Calculi

Cystinuria is an autosomal recessive disorder, and primary manifestation is the repeated formation of cystine calculi. Little information is available regarding clinical course of pediatric cystinuria having followed into adulthood. We report our experience with the management and the clinical course on cystinuria in children, who have been followed up for relatively long time.. We retrospectively reviewed the records of all pediatric patients with cystinuria in whom urolithiasis was treated from 1970 to 1996.. A total of 15 pediatric patients with cystine calculi (9 boys, 6 girls) were treated in our hospital. Average age at diagnosis was 3 years 4 months old. Mean follow-up was 104 months. Stone location was upper urinary tract in 11 cases, bladder in 3 cases and both upper urinary tract and bladder in 1 case. Medical treatments including hydration, urine alkalization and dissolution therapy were performed in all patients. In three cases whose urinary cystine level ranged from 138 to 326 mg/gCr, cystine calculi were disappeared by medical therapy alone. In one of 3 cases vesicoureteral reflux was identified. Side effects were noticed in 30.0% of patients with tiopronin and in 85.7% of those with D-penicillamine, especially in 1 case with tiopronin nephrotic syndrome being noticed. Surgical procedures were performed in 13 patients (lithotomy: 17 calculi, endourology: 7 calculi and ESWL: 7 calculi). The stone free rate was 100% with lithotomy, 80 to 100% with endourology and 43% with ESWL at an average of 5.9 procedures. No complications were recognized after the surgical treatments. The stone events of 15 patients ranged from 0 to 1.5 (average 0.55). In all six patients followed up over the age of 20 years, stone recurrences were observed exclusively between 17 and 20 years of age.. Dissolution therapy is more effective for cystinuric patients in whom urinary cystine excretion is less than 330 mg/gCr. For those cases with low urinary cystine level it is necessary to evaluate structural abnormalities of the urinary tract to avoid stone recurrence. ESWL and endourology should be tried for pediatric cystinuria except for neonates and infants, considering its safety. The patients and their parents must have adequate knowledge about the disease itself and its management. Prevention of cystine calculi recurrences depends on patient compliance to the therapeutic regimens necessitating close follow up according to the clinical conditions, especially for those in pubertic or postpubertic age.

Topics: Adolescent; Adult; Child; Child, Preschool; Cystinuria; Female; Follow-Up Studies; Humans; Infant; Lithotripsy; Male; Methionine; Penicillamine; Retrospective Studies; Secondary Prevention; Sodium Bicarbonate; Tiopronin; Urinary Calculi; Urologic Surgical Procedures

Persistent residual calculi after therapy, i.e. extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL), as well as pyelo- and nephrolithotomy are big problems in the treatment of urolithiasis. Furthermore, the therapy of stones is problematic in patients with inadequate drainage, impaired kidney function, or with high risks against anaesthetics. Between 1991 and 1997 percutaneous antegrade chemolysis was carried out in eleven patients. In nine of them complete dissolution of stones was achieved. In two further cases, in which calcium oxalate was the main component of the stones, chemolysis was unsuccessful. Through our own cases and under consideration of the literature, we will show that percutaneous chemolysis in these cases is useful and effective in the treatment of urolithiasis.

Topics: Adult; Aged; Calcium Carbonate; Carbonates; Citrates; Drug Combinations; Female; Follow-Up Studies; Humans; Magnesium Oxide; Male; Middle Aged; Nephrostomy, Percutaneous; Recurrence; Retrospective Studies; Sodium Bicarbonate; Therapeutic Irrigation; Urinary Calculi

ESWL and PCN have modified the urinary stones therapy. Nevertheless these therapeutic procedures are not much effective in cystine stone because of its protein structure and frequent recurrences; these procedures need to be combined to achieve the best results. In cystine stones the lithochemolysis, performed following recent technique has shown excellent results, without complications and easy to apply.

Topics: Adult; Catheterization; Citrates; Citric Acid; Cystine; Female; Humans; Kidney Calculi; Kidney Pelvis; Male; Radiography; Sodium Bicarbonate; Sodium Hydroxide; Solutions; Ureteral Calculi; Urinary Calculi

The aim of the study was to compare the renal citrate excretion and the degree of urine saturation with calcium oxalate in patients with active calcium oxalate urolithiasis and in healthy subjects under basal conditions and after alkalization. There were 20 women before menopause with calcium stone disease aged 33.5 +/- 7.1 in the first group and 20 healthy women aged 32.3 +/- 7.6 in the second one. Sodium bicarbonate was administrated intravenously in a dose 16.8 g during 2 h. 24h excretion of calcium, magnesium and citrate, the degree of urine saturation with calcium oxalate and pH of urine before and after alkalization were evaluated. Hypocitraturia occurred in 45% of patients under basal conditions. The degree of urine saturation with calcium oxalate was significantly higher in women with nephrolithiasis (p < 0.01). A significant increase of citrate excretion (p < 0.001) and a decrease of calcium excretion (p < 0.05) after alkalization took place in both groups. The degree of urine saturation with calcium oxalate decreased significantly in patients with urolithiasis and in healthy subjects. During acute alkalosis, induced by sodium bicarbonate, increase of citrate excretion was observed in patients with urolithiasis in spite of hypocitraturia under basal conditions. This indicates that kidney function following alkalization is normal in "stone kidney". Significantly decreased saturation of urine with calcium oxalate was due to the decrease of calcium excretion and the increase of citrate excretion. In conclusion, the results show that the use of alkalizing factors in prevention of recurrent calcium urolithiasis is justifiable.

Topics: Adult; Calcium Oxalate; Citrates; Female; Humans; Hydrogen-Ion Concentration; Recurrence; Reference Values; Sodium Bicarbonate; Urinary Calculi

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.

Topics: Antacids; Australia; Calcium Carbonate; Calcium Oxalate; Child; Child, Preschool; Citrates; Citric Acid; Female; Humans; Infant; Male; Native Hawaiian or Other Pacific Islander; Oxalates; Retrospective Studies; Sodium Bicarbonate; Uric Acid; Urinary Calculi

The post-initiation enhancing activities of the non-genotoxic agent NaHCO3 and the genotoxic agent N-ethyl-N-(4-hydroxybutyl)nitrosamine (EHBN) in combination with uracil-induced urolithiasis were investigated in a rat bladder carcinogenesis model. Animals were treated with 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) for 4 weeks, and then 3% uracil was given for 3 weeks in the early (weeks 4-7), middle (weeks 8-11) or late (weeks 12-15) post-initiation phase. In addition, administration of 3% NaHCO3, 20 ppm EHBN or no chemical supplement was performed for the 13 weeks when the rats were not receiving BBN or uracil. NaHCO3 in sequential combination with early and middle stages uracil treatment strongly enhanced tumorigenesis in the urinary bladder, while EHBN treatment amplified lesion development at the middle stage only of uracil treatment. DNA synthesis and associated epithelial surface alterations observed by scanning electron microscopy tended to be increased in the NaHCO3 and EHBN groups without BBN initiation, independently of uracil treatment timing. The present results demonstrated that uracil-induced urolithiasis during the middle post-initiation phase is highly active in enhancing bladder tumor development under the influence of a promoter or carcinogen.

Topics: Animals; Bicarbonates; Body Weight; Butylhydroxybutylnitrosamine; Carcinogens; Drug Administration Schedule; Male; Rats; Rats, Inbred F344; Sodium; Sodium Bicarbonate; Uracil; Urinary Bladder; Urinary Bladder Neoplasms; 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

One of the major causes of mortality in poultry is urolithiasis. Although two of the major causes of urolithiasis have been defined, active and preventative treatments for this disease have not been extensively field tested. Previous research demonstrated that a diet acidified with NH4Cl was effective in preventing the formation of uroliths in 16-wk-old pullets. In the present study, experiments were designed to evaluate the effects of dietary acidification and alkalinization on preformed uroliths in mature laying hens. Urolithiasis was induced by feeding excess dietary Ca (in commercial layer ration) during pullet growout (6 to 18 wk of age) and during the early laying period (18 to 32 wk of age). At 32 wk of age birds were randomly divided into three diet treatment groups: a normal layer ration group, an acidified layer ration group (1% NH4Cl added); and an alkalinized layer ration group (1% NaHCO3 added). Each group received the respective diets until 52 wk of age, when the experiment was terminated. Blood gas analysis at 44 wk of age demonstrated that hens fed the acidified diet had significantly higher blood H+ concentrations, lower blood bicarbonate concentrations, and lower total blood carbon dioxide levels than hens fed the alkalinized layer ration. At 52 wk of age, hens fed the acidified layer ration had higher urinary H+ concentrations, higher blood H+ concentrations, and lower blood HCO3 and total CO2 concentrations than hens fed the normal and alkalinized layer rations. The acidified layer ration group had no uroliths present in their ureters (0% urolithiasis), whereas the normal and alkalinized layer ration groups had 8.3 and 13.1% incidences of urolithiasis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Ammonium Chloride; Animals; Bicarbonates; Chickens; Diet; Female; Kidney; Poultry Diseases; Sodium; Sodium Bicarbonate; Urinary Calculi

The effect of combining therapy with hydrochlorothiazide, allopurinol and systemic alkalization for urolithiasis with lower urinary pH was examined. A total of 90 patients were followed up for 1 to 3 years, the average follow up period being 18 months. The total stone disappearance rate was 60% (kidney stone), 74% (ureter stone) and 20% (bladder stone). Large amounts of thiazide diuretics, potassium and magnesium were intravenously administered to a patient with systemic alkalization at slow infusion speed, neither serious side effects nor complication occurred. This method is simple and an effective remedy. It is also very practical in the developing countries of the third world.

Topics: Adult; Aged; Allopurinol; Bicarbonates; Drug Therapy, Combination; Female; Humans; Hydrochlorothiazide; Hydrogen-Ion Concentration; Lactates; Lactic Acid; Male; Middle Aged; Sodium; Sodium Bicarbonate; 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

Three experiments were conducted to determine the effects of excess dietary calcium carbonate, phosphorus and urine acidifying and alkalizing salts on silica urolith formation in a model using rats fed dextrose-based diets containing 2% tetraethylorthosilicate (TES). Diets containing 2% TES lowered weight gains to 91-95% of gains made by rats fed non-TES diets. Urine silica concentrations of rats fed TES were generally in the range of 50-60 mg/dl. In experiment 1, rats fed TES with no additional dietary calcium carbonate had a silica urolith incidence of 35%. With additions of 1 and 2% calcium carbonate to the basal-TES diet, respective urolith incidences were 45 and 60% (r = 0.99, P less than 0.02). In experiment 2, monobasic sodium phosphate (MP) providing 0.2% additional phosphorus resulted in a mean urine pH of 6.42 and no uroliths. Dibasic sodium phosphate (DP) without and with 0.5% sodium bicarbonate (SB) resulted in respective urine pH values of 6.78 and 7.14 and urolith incidences of 15 and 20% (MP less than DP and DP + SB, P less than 0.05). However, the uroliths were small averaging less than 1 mg. In experiment 3, substitution of autoclaved egg albumin for casein, the protein source in experiments 1 and 2, resulted in urine pH of 7.45 and a silica urolith incidence of 46%. An equal-molar mixture of MP and DP providing an added 0.2% phosphorus resulted in a urine pH of 7.07 and reduced the urolith incidence to 4%, and 0.75% of dietary ammonium chloride either with or without the added 0.2% phosphorus gave urine acidification and complete protection from uroliths.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Oral; Animals; Bicarbonates; Body Weight; Calcium; Calcium Carbonate; Carbonates; Diet; Drug Interactions; Hydrogen-Ion Concentration; Magnesium; Male; Phosphorus; Rats; Rats, Inbred Strains; Silanes; Silicon; Silicon Dioxide; Sodium; Sodium Bicarbonate; Urinary Calculi

Following the introduction of one or two percutaneous nephrostomy drains, 16 obstructive uric acid calculi were treated by perfusion of excretory cavities with 14% sodium bicarbonate solution. Twelve calculi had dissolved within an average of 5 days, 1 required percutaneous lithotripsy because of incomplete dissolution and 3 were unaltered. Success of this treatment appears to be dependent on the total radiotransparency of calculi, a feature difficult to demonstrate. There were no reports of major complications. The only weakly invasive nature of alkalinization in situ makes it a method of choice to be reserved for obstructive calculi, and a therapeutic strategy is proposed.

Topics: Aged; Bicarbonates; Combined Modality Therapy; Female; Humans; Lithotripsy; Male; Nephrostomy, Percutaneous; Perfusion; Sodium; Sodium Bicarbonate; Uric Acid; Urinary Calculi

Historically, cystine stone chemolysis has been approached with 2 different categories of compounds--alkalizing agents (sodium bicarbonate and tromethamine) and, more recently, protonated thiols and disulfide compounds (alpha-mercaptopropionylglycine, N-acetylcysteine and penicillamine). To establish the relative efficacy of these agents an in vitro model was devised that simulates the clinical setting. The optimal molar concentrations for sodium bicarbonate, N-acetylcysteine and tromethamine were determined initially and then compared at these strengths. Lastly, a variety of solution combinations were made to determine if a synergistic effect could be demonstrated. Results of this study demonstrate that the combination of acetylcysteine, a protonated thiol, with the strong alkalizing agent sodium hydroxide yields the most effective solution for chemolysis of cystine stones. The mechanism of action is believed to occur by a synergistic combination of the pH dependent increase in cystine solubility, with a simultaneously occurring thiol disulfide interchange.

Topics: Acetylcysteine; Bicarbonates; Cystine; Drug Synergism; Humans; Sodium; Sodium Bicarbonate; Sodium Hydroxide; Tromethamine; Urinary Calculi

An in vitro model was devised to evaluate the efficacy of the different irrigating solutions utilized for local dissolution of uric acid stones. Tris (hydroxymethyl) aminomethane proved to be several times faster than sodium bicarbonate in dissolving uric acid calculi. The maximal dissolution rate was obtained when the highest pH (10.5) of Tris buffer was used in concentrations at or above 0.2 M. This makes the commercially available THAM-E an optimal choice. Stones averaging 1 cm. in diameter were dissolved in less than 48 hours when this compound was used. Sodium bicarbonate should only be used in solutions with concentrations lower than 0.2 M and pH below 9, if some dissolution is to be attempted. Concentrations and pH's above these levels will coat the stones with hard shells of sodium urate, making it impossible to dissolve them. The in vitro findings were confirmed in vivo in a limited study in pigs with human uric acid calculi surgically placed in their kidneys. Our results indicate how to make the best use of the solutions clinically available in order to obtain total dissolution of uric acid stones in short periods of time. We recommend the use of a 0.3 molar concentration of this buffer (THAM-E) at flow rates of about 50 cc per hour.

Topics: Animals; Bicarbonates; Humans; Hydrogen-Ion Concentration; Sodium; Sodium Bicarbonate; Swine; Therapeutic Irrigation; Time Factors; Tromethamine; Uric Acid; 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

Dissolution of uric acid calculi was studied in vitro. Calculated rate constants were then applied to an in vivo situation. The time required for complete dissolution of a uric acid calculus in a patient on oral alkali therapy can be estimated. Sodium bicarbonate, acetylcysteine, [tris(hydroxymethyl)aminomethane] and [tris(hydroxymethyl)aminomethane]-E were tested for relative effectiveness in dissolving uric acid calculi in vitro. In patients who require irrigation for dissolution of uric acid calculi [tris(hydroxymethyl)-aminomethane] is the preferred agent.

Topics: Acetylcysteine; Bicarbonates; Electrolytes; Humans; Hydrogen-Ion Concentration; In Vitro Techniques; Kinetics; Sodium Bicarbonate; Sodium Chloride; Solubility; Tromethamine; Uric Acid; Urinary Calculi

Topics: Adolescent; Adult; Aged; Bicarbonates; Child; Cystinuria; Female; Fluid Therapy; Follow-Up Studies; Homozygote; Humans; Male; Middle Aged; Penicillamine; Sodium Bicarbonate; Urinary Calculi