IRB approval was obtained. The metabolic needs of pregnant participants were determined, and standardized diet administered with Boost shakes and unlimited water. 24-hour urine collections were obtained during the third trimester, post-partum, and post-lactation. Subjects remained on the controlled diet for 24-hour prior to and during the collection. Standard statistical analysis was performed.

RESULTS:

Of 18 patients, 6 had a de novo stone event during pregnancy. Of these, 83% were composed of calcium phosphate. Stone events with calcium phosphate presented later than calcium oxalate. Stone-formers had an intra-partum body mass index greater than non-stone formers (33.1 vs 26.7, P <.05). All participants had hypercalciuria, but stone-formers were found to have a nearly 2X greater urine calcium compared to non-stone formers on their controlled diet (392.1 vs 205.9, P <.05). Post-partum, we observed a decrease in urine calcium, citrate, pH, and supersaturation of calcium oxalate and phosphate (P <.05).

CONCLUSION:

This is the first study to identify lithogenic changes during pregnancy in de novo stone formers on a standardized diet. We show that stone-formers have primarily calcium phosphate stones. They also have an elevated body mass index and are significantly more hypercalciuric without other demonstratable lithogenic differences compared to non-stone formers. Post-partum, we demonstrate reduction in intra-partum lithogenicity that may mitigate stone risk. These data suggest an underlying mechanism exists in stone formers that increases urine calcium above what would be expected in gestational hypercalciuria.

2024-02-01·The Journal of urology

Alkaline Water: Help or Hype for Uric Acid and Cystine Urolithiasis?

Article

作者: McCormac, Amanda ; Asplin, John ; Vu, Minh-Chau ; Bhatt, Rohit ; Piedras, Paul ; Rojhani, Allen ; Clayman, Ralph V. ; Lavasani, Seyed Amiryaghoub M. ; Patel, Roshan M. ; Landman, Jaime ; Cumpanas, Andrei D. ; Gorgen, Antonio R. H. ; Tano, Zachary E.

Purpose::

The consumption of alkaline water, water with an average pH of 8 to 10, has been steadily increasing globally as proponents claim it to be a healthier alternative to regular water. Urinary alkalinization therapy is frequently prescribed in patients with uric acid and cystine urolithiasis, and as such we analyzed commercially available alkaline waters to assess their potential to increase urinary pH.

Materials and Methods::

Five commercially available alkaline water brands (Essentia, Smart Water Alkaline, Great Value Hydrate Alkaline Water, Body Armor SportWater, and Perfect Hydration) underwent anion chromatography and direct chemical measurements to determine the mineral contents of each product. The alkaline content of each bottle of water was then compared to that of potassium citrate (the gold standard for urinary alkalinization) as well as to other beverages and supplements used to augment urinary citrate and/or the urine pH.

Results::

The pH levels of the bottled alkaline water ranged from 9.69 to 10.15. Electrolyte content was minimal, and the physiologic alkali content was below 1 mEq/L for all brands of alkaline water. The alkali content of alkaline water is minimal when compared to common stone treatment alternatives such as potassium citrate. In addition, several organic beverages, synthetic beverages, and other supplements contain more alkali content than alkaline water, and can achieve the AUA and European Association of Urology alkali recommendation of 30 to 60 mEq per day with ≤ 3 servings/d.

Conclusions::

Commercially available alkaline water has negligible alkali content and thus provides no added benefit over tap water for patients with uric acid and cystine urolithiasis.

2024-01-01·Urology practice

Understanding the Barriers to Preventive Pharmacological Therapy Use in Older Patients With Urinary Stone Disease

Article

作者: Shahinian, Vahakn B. ; Crivelli, Joseph J. ; Krampe, Noah ; Asplin, John R. ; Hsi, Ryan S. ; Hollingsworth, John M. ; Oerline, Mary K.

INTRODUCTION:

Despite compelling clinical trial evidence and professional society guideline recommendations, prescription rates of preventative pharmacological therapy (PPT) for urinary stone disease are low. We sought to understand how patient- and clinician-level factors contribute to the decision to prescribe PPT after an index stone event.

METHODS:

We identified Medicare beneficiaries with urinary stone disease who had a 24-hour urine collection processed by a central laboratory. Among the subset with a urine chemistry abnormality (ie, hypercalciuria, hypocitraturia, hyperuricosuria, or low urine pH), we determined whether PPT was prescribed within 6 months of their collection. After assigning patients to the clinicians who ordered their collection, we fit multilevel models to determine how much of the variation in PPT prescription was attributable to patient vs clinician factors.

RESULTS:

Of the 11,563 patients meeting inclusion criteria, 33.6% were prescribed PPT. There was nearly sevenfold variation between the treating clinician with the lowest prescription rate (11%) and the one with the highest (75%). Nineteen percent of this variation was attributable to clinician factors. After accounting for measured patient differences and clinician volume, patients had twice the odds of being prescribed PPT if they were treated by a nephrologist (odds ratio [OR], 2.15; 95% CI, 1.79-2.57) or a primary care physician (OR, 1.78; 95% CI, 1.22-2.58) compared to being treated by a urologist.

CONCLUSIONS:

These findings suggest that the type of clinician whom a patient sees for his stone care determines, to a large extent, whether PPT will be prescribed.

项与 Litholink Corp. 相关的新闻（医药）

2024-01-17

·drugs

Commercially Available Alkaline Water Not Likely to Prevent Kidney Stones

WEDNESDAY, Jan. 17, 2024 -- Commercially available alkaline water is not likely to provide benefit over tap water for patients with uric acid and cystine urolithiasis, according to a study published in the February issue of The Journal of Urology . Paul Piedras, from the University of California at Irvine, and colleagues analyzed five commercially available alkaline waters to assess their potential to increase urinary pH compared to potassium citrate, the gold standard for urinary alkalinization. The researchers found that the pH levels of the bottled alkaline water ranged from 9.69 to 10.15. For all brands, electrolyte content was minimal and the physiologic alkali content was below 1 mEq/L. Compared with potassium citrate, the alkali content of alkaline water is minimal. Other organic beverages, synthetic beverages, and supplements contain more alkali content than alkaline water and can achieve the American Urological Association and European Association of Urology alkali recommendation of 30 to 60 mEq per day with no more than three servings per day. "Commercially available alkaline water has negligible alkali content and thus provides no added benefit over tap water for patients with uric acid and cystine urolithiasis," the authors write. One author disclosed employment with Litholink, a subsidiary of LabCorp. Abstract/Full Text Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions. Posted January 2024 More news resources FDA Medwatch Drug Alerts Daily MedNews News for Health Professionals New Drug Approvals New Drug Applications Drug Shortages Clinical Trial Results Generic Drug Approvals Subscribe to our newsletter Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

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