RESUMO
Abstract Background: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.(AU)
Assuntos
Humanos , Síndrome Metabólica , Nefrolitíase/epidemiologia , Gota/fisiopatologia , Brasil/epidemiologia , Benzobromarona/efeitos adversos , Prevalência , Citrato de Potássio/efeitos adversos , Urolitíase/etiologiaRESUMO
BACKGROUND: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. METHODS: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. RESULTS: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. CONCLUSIONS: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.
Assuntos
Gota/complicações , Cálculos Renais/epidemiologia , Adulto , Doenças Assintomáticas/epidemiologia , Benzobromarona/uso terapêutico , Brasil/epidemiologia , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diuréticos/uso terapêutico , Dislipidemias/tratamento farmacológico , Feminino , Gota/tratamento farmacológico , Humanos , Hipoglicemiantes/uso terapêutico , Cálculos Renais/induzido quimicamente , Cálculos Renais/química , Cálculos Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Citrato de Potássio/uso terapêutico , Prevalência , Fatores Sexuais , Ultrassonografia , Uricosúricos/uso terapêuticoRESUMO
This meta-analysis summarizes the available evidence on the effectiveness of citrate supplement for preventing the recurrence of nephrolithiasis in patients undergoing extracorporeal shock wave lithotripsy (SWL). Electronic searches were conducted using Medline-PubMed, Web of Science, Embase, BVS (Scielo, Lilacs), and Google Scholar literature databases. The authors worked in pairs to select studies that met the following criteria: randomized controlled trials that were conducted in adults and assessed the effect of potassium citrate supplement before or after SWL therapy for urolithiasis. Our primary aim was to asses the stone-free rate among the groups included in the studies. Fixed effect was used in the meta-analysis with 95% confidence interval (95% CI). Heterogeneity was analyzed by the I 2 value. A total of 2505 references were initially selected. Of those, four were subjected to meta-analysis contributing five samples. These four studies included 374 participants who were followed for a period of 12 months after SWL. Mean potassium citrate dosage was approximately 55 mEq/day (18 mmol). The results showed that citrate supplement significantly protected against the recurrence of nephrolithiasis during 1 year after SWL [RR; 95% CI 0.21 (0.13, 0.31)]. The heterogeneity was not significant across the analyzed studies (p = 0.224). The quality of the analyzed studies was generally low. The available evidence shows that citrate supplement effectively reduces the recurrence of nephrolithiasis in patients undergoing SWL. However, statistical analysis of a larger trial conducted with methodological rigor is warranted.
Assuntos
Suplementos Nutricionais , Litotripsia , Nefrolitíase/prevenção & controle , Citrato de Potássio/uso terapêutico , Prevenção Secundária/métodos , Humanos , Nefrolitíase/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.
Assuntos
Antibacterianos/uso terapêutico , Gastrectomia , Coto Gástrico , Infecções por Helicobacter/terapia , Helicobacter pylori/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amoxicilina/uso terapêutico , Antiulcerosos/uso terapêutico , Quimioterapia Combinada/métodos , Esomeprazol/uso terapêutico , Feminino , Furazolidona/uso terapêutico , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Compostos Organometálicos/uso terapêutico , Posicionamento do Paciente/estatística & dados numéricos , Citrato de Potássio/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Obesity has been shown to be a risk factor for kidney stone formation. Obesity leads to insulin resistance which subsequently leads to low urinary pH. Low urinary pH is typically treated with potassium citrate. We determined if the response to potassium citrate for the treatment of low urinary pH and hypocitraturia varied when patients were stratified by body mass index. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with urolithiasis and concomitant hypocitraturia and low urinary pH as unique abnormalities upon metabolic evaluation treated exclusively with potassium citrate. Based on body mass index the cohort was divided into the 4 groups of normal weight, overweight, obese and morbidly obese. Metabolic data were compared among the 4 groups at baseline and subsequent followup visits up to 2 years. We compared urinary pH and citrate in absolute values and the relative changes in these parameters from baseline. Similarly, we compared the rates of potassium citrate treatment failure. RESULTS: A total of 125 patients with hypocitraturia and low urinary pH were included in this study. Median patient age was 61 years, 80 patients were male and median body mass index was 30.4 kg/m(2). Patients with a higher body mass index tended to be younger (p=0.010), and had a lower urinary citrate but higher sodium, oxalate and uric acid levels. Urinary pH was similar across body mass index groups. pH values and their absolute changes from baseline were lower as body mass index increased (p ≤0.001). Similarly, we noted an association between increasing body mass index category and lower urinary citrate levels accompanied by a statistically significant trend indicating lower absolute changes in citrate with increasing body mass index (p ≤0.001). Potassium citrate dose was increased more frequently among the higher body mass index groups. CONCLUSIONS: Patients with a higher body mass index presented with a lower increase in citrate excretion and urinary pH levels after they were started on potassium citrate, and they needed more frequent adjustments to their therapy.
Assuntos
Índice de Massa Corporal , Cálculos Renais/tratamento farmacológico , Cálculos Renais/metabolismo , Citrato de Potássio/uso terapêutico , Idoso , Ácido Cítrico/urina , Feminino , Humanos , Concentração de Íons de Hidrogênio , Cálculos Renais/classificação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Hypocitraturia is a known risk factor for nephrolithiasis, present in 20-60% of stone-forming patients. The administration of citrate or other alkali preparations has been demonstrated to benefit hypocitraturic stone formers. Dietary modifications that include citrate-containing fluids can be an alternative option to pharmacological agents. We aimed to systematically review, summarize and quantify available evidence on the effects of non-pharmacological interventions on urinary citrate and nephrolithiasis. METHODS: Manual and electronic database searches (MEDLINE/PubMed, Embase, Cochrane Library, Scopus, Scielo, LILACS) were performed for studies published up to July 2014. Two reviewers independently identified studies for inclusion and extracted data on study characteristics, outcomes and quality assessments. We included controlled studies with non-pharmacological interventions that assessed urinary citrate levels or nephrolithiasis pre- and post-intervention. Meta-analysis was performed by random effects and subgrouped by the type of intervention, and heterogeneity was analysed by I(2). RESULTS: Of the 427 studies identified, 13 studies were included (18 samples), involving 358 participants with a mean age of 43 ± 11.0 years across the studies. Interventions were grouped as commercial fruit juices, soft drinks, calcium-/magnesium-rich mineral water, high-fiber diet, low-animal-protein diet and plant extract. Almost half of the studies (6/13; 8/18 samples) reported effects in non-stone formers. Two studies included stone formers and non-stone formers. Commercial fruit juice interventions showed high I(2) (88.1%, P = 0.000) and an increase in citraturia levels ( 95% confidence interval) of 167.2 (65.4; 269) mg/day. Other types of intervention did not show important heterogeneity; however, pooled estimates were not significant. CONCLUSION: Our review indicates that further larger scale trials are required to analyze whether non-pharmacological interventions can increase urinary citrate levels and act in kidney stone prevention.
Assuntos
Citratos/urina , Dieta com Restrição de Proteínas , Cálculos Renais/prevenção & controle , Cálculos Renais/urina , Citrato de Potássio/uso terapêutico , HumanosRESUMO
We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Helicobacter pylori/efeitos dos fármacos , Infecções por Helicobacter/terapia , Coto Gástrico , Gastrectomia , Antibacterianos/uso terapêutico , Compostos Organometálicos/uso terapêutico , Resultado do Tratamento , Citrato de Potássio/uso terapêutico , Quimioterapia Combinada/métodos , Posicionamento do Paciente/estatística & dados numéricos , Esomeprazol/uso terapêutico , Furazolidona/uso terapêutico , Amoxicilina/uso terapêutico , Metaplasia , Antiulcerosos/uso terapêuticoRESUMO
Cervical and intracranial arterial evaluation is an important issue for acute ischemic stroke (IS). Objective Compare the use of the neurovascular ultrasound examination (NVUE) to digital subtraction angiography (DSA) in acute IS patients for diagnosing significant extracranial and intracranial arteriopathy. Method Nonconsecutive patients with IS or transient ischemic attack admitted within 12 hours of the onset of symptoms were evaluated retrospectively. Standardized NVUE and DSA were done in all patients within the first 120 hours of hospital admission. Results Twenty-four patients were included in the study. Compared to DSA, the NVUE demonstrated 94.7% sensitivity and 100% specificity for identifying symptomatic extracranial and/or intracranial arteriopathy. Conclusion The standardized NVUE technique demonstrated high sensitivity and specificity compared to DSA for diagnosing arterial abnormalities in acute IS patients. .
A avaliação cervical e intracraniana é uma etapa importante no AVC isquêmico (AVCi) agudo. Objetivo Comparar o uso do ultrassom neurovascular (USNV) com técnica padronizada e a angiografia digital (AD) em paciente com AVCi agudo no diagnóstico de doença arterial significativa extra e/ou intracraniana. Método Pacientes com AVCi e AIT admitidos em até 12 horas do início dos sintomas foram retrospectivamente avaliados. Todos os pacientes foram submetidos a USNV e AD padronizado em até 120 horas da admissão. Resultados Vinte e quatro pacientes foram incluídos no estudo. Em comparação com a AD, o USNV apresentou sensibilidade de 94,7% e especificidade de 100% para o diagnóstico de doença arterial significativa extra e/ou intracraniana. Conclusão O uso de técnica padronizada de USNV demonstrou elevada sensibilidade e especificidade para o diagnóstico de doença arterial significativa extra e intracraniana quando comparado a AD. .
Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Citratos/uso terapêutico , Cistite Intersticial/tratamento farmacológico , Cistite Intersticial/urina , Citrato de Potássio/uso terapêutico , Cistite Intersticial/complicações , Concentração de Íons de Hidrogênio , Manejo da Dor , Indução de Remissão , Inquéritos e Questionários , Transtornos do Sono-Vigília/etiologiaRESUMO
BACKGROUND: The aim of this study was to investigate the effect of arginine and fluoride on the reduction of erosive wear. METHODS: Bovine enamel blocks were randomly allocated into four groups (n = 20) and exposed to: ESPR group (8% arginine, 1450 ppm sodium monofluorophosphate, calcium carbonate and titanium dioxide); ESen group (1450 ppm sodium monofluorophosphate, 5% potassium citrate); positive control PC group (1500 ppm sodium monofluorophosphate) and negative control NC group (water). The samples were submitted to six alternating cycles of demineralization-remineralization (cola, 10 minutes; artificial saliva, 1 hour, respectively). Before and between cyclic demineralization and remineralization, blocks were treated with slurries of the respective toothpastes or water (1 minute). Erosive tissue loss was analysed by microhardness and profilometry. Data were analysed by ANOVA and Tukey tests for individual comparisons among the groups (p < 0.05). RESULTS: In microhardness, the ESPR (217.46 ± 55.45) group was significantly better than the other treatment groups (PC = 302.76 ± 96.10; ESen = 315.56 ± 74.56; p < 0.001). The ESPR group showed a similar loss to NC group (NC = 210.8 ± 49.98; p = 0.991). The mean erosion depth (+/- SE, µm) was detected between NC (14.37 ± 1.72) and dentifrices tested (ESPR (4.11 ± 1.34), ESen group (7.64 ± 1.61) and PC (8.20 ± 2.19) (p = 0.000). CONCLUSIONS: From the results of the present study, the effectiveness of Sensitive Pro Relief in the prevention of erosive surface loss seems to be attributed to the possible effect of the arginine associated with fluoride.
Assuntos
Arginina/farmacologia , Fluoretos/farmacologia , Fosfatos/farmacologia , Erosão Dentária/prevenção & controle , Cremes Dentais/farmacologia , Animais , Carbonato de Cálcio/farmacologia , Bovinos , Esmalte Dentário/efeitos dos fármacos , Dureza , Citrato de Potássio/farmacologia , Distribuição Aleatória , Saliva Artificial , Fluoreto de Sódio/farmacologia , Remineralização Dentária/métodos , Cremes Dentais/químicaRESUMO
Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a biochemical common alteration in calcium stone formation in adults and especially in children. The acid pH (systemic, tubular and intracellular) is the main determinant of citrate excretion in the urine. While the etiology of hypocitraturia is idiopathic in most patients with kidney stones, there are a number of causes for this abnormality including distal renal tubular acidosis, hypokalemia, diets rich in animal protein and / or diets low in alkali and certain drugs, such as acetazolamide, topiramate, ACE inhibitors and thiazides. Dietary modifications that benefit these patients include high intake of fluids and fruits, especially citrus, sodium and protein restriction, with normal calcium intake. Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently. Adverse effects are low and are referred to the gastrointestinal tract. While there are various preparations of citrate (potassium citrate, sodium citrate, potassium citrate, magnesium) in our country is available only potassium citrate powder that is useful to correct both the hypocitraturia and the low urinary pH and reduce markedly the recurrence of kidney stones.