URINARY SYSTEM STONE DISEASE AND POTASSIUM CITRATE
Stone disease is an important health problem due to its frequent recurrence and high incidence. It is seen more frequently in some societies due to geographical structural differences, racial differences and genetic structure. Turkish society is also one of the societies where stone disease is frequently seen due to the reasons mentioned above. Urinary system stones are hard formations seen in the kidneys or urinary tract. They form over time due to the crystallization and accumulation of substances that cannot be dissolved and excreted in the urine. If substances such as calcium oxalate or uric acid are present in the urine at higher concentrations than normally expected, a kidney stone forms. These substances can settle in the kidney in the form of crystals and over time they grow to form a kidney stone. Stones can move or be excreted from the body by moving down the urinary tract. However, stones that get stuck in any part of the urinary tract and obstruct the flow of urine generally cause the dreaded, severe typical kidney pain.
What Factors Affect the Formation of Kidney Stones?
Anatomical Abnormalities
- Ureteral Strictures
- UPJ Strictures (Ureteropelvic Junction Stricture)
- Ureterocele (a pouch formed from the ureter-bladder mucosa at the ureter-bladder junction, sagging into the bladder. It can complicate the flow of urine into the bladder, as well as obstruct the outflow of urine from the bladder. It’s a developmental defect and often seen with a dual collecting-draining system)
- Urethral Strictures
- Horseshoe Kidney B-
B-Environmental Factors
- Dietary Characteristics o Fluid Intake o Diet Rich in Calcium o Gout Disease
- Climatic And Geographical Characteristics
Genetic Factors
Nowadays, the prevalence of stone disease varies according to the geography of the country and other factors, but it is approximately 2-5%. The most common age group is 20-40 years old. It is observed 3 times more in men than in women.
The probability of recurrence in a person who has had a urinary system stone problem:
1st Year 10%
5th Year 35%
10th Year 50%
Prevalence of Kidney Stone Types
| Calcium oxalate, phosphate or both | %70-80 |
| Struvite (Infection) | %10-15 |
| Uric Acid | %5-10 |
| Cystine | %1 |
| Others (Xanthine, Silicate, Indinavir, Triamterene) | %1 |
Why Do We Form Stones in Our Kidneys?
Although there are many factors that play a role in stone formation in a person, the exact cause is not fully known.
- Genetic predisposition is one of the most important risk factors for stone formation. The risk of having stone disease in the family of a person with stone disease is between 10-40%.
- Geographic factors also affect stone formation. The rate of stone appearance is high in those living in mountainous, desert or tropical regions.
- Dietary habit is one of the most important risk factors for stone formation. A diet rich in proteins and carbohydrates and poor in fibrous foods increases the risk of stone disease. The risk decreases as the amount of water taken daily increases.
- Recurring urinary tract infections, some medications, some past intestinal surgeries, and some metabolic diseases such as gout also cause stone formation. It is thought that sedentary professions (desk workers) and stress also affect stone formation. The Role of Potassium Citrate in the Treatment of Kidney Stone Disease There are many medical and surgical treatment options for stone diseases. The most appropriate treatment option is chosen according to the size and structure of the stone; the patient's age, and health status.
Preventive role in the formation of kidney stones
Potassium citrate works as a urine alkalinizer, preventing the formation of kidney stones before they form.
It is effective in all types of stones except struvite stones.
POTASSIUM CITRATE MECHANISM OF ACTION
1) 1. By virtue of citrate, it alkalizes urine, preventing kidney stones that could form in an acidic environment.
2) 2. The combination of citrate and calcium prevents the formation of calcium stones.
1) Firstly, calcium and oxalate ions are required for the formation of a calcium oxalate (CaOx) stone.
2)To crystallize, two ion pairs need to come together to form CaOx salt
3) Crystallization can only begin when the ion pairs in the environment exceed a certain density.
4) The coming together of ion pairs formed above a certain density (nucleation) is the first step for the formation of a stone.
5)However, nucleation alone is not sufficient for stone formation. The formed nuclei also need to come together in an aggregation.
6) Eventually, the stone forms by aggregates piling up on top of each other or accumulating on other aggregates.
7)However, if citrate is in the environment, it can bind in a way that prevents the formation of the CaOx ion pair. This shows an effect that inhibits nucleation and aggregation formation.
8) The binding of citrate in this way has an inhibitory effect on nucleation and aggregation formation.
9) Citrate binds to the aggregates that will come together and form a stone, preventing the aggregates from coming together or growing on the aggregate as nucleation.
10) 12. With this inhibitory effect, citrate prevents stone formation.
DIET RECOMMENDATIONS FOR KIDNEY STONE
PATIENTS REDUCE OXALATE INTAKE
Foods rich in oxalate::
Spinach, Tomato, Mustard, Swiss Chard, Strawberry, Chocolate, Sweet Potato, Hazelnut, Peanut
REDUCE SODIUM
Foods rich in sodium:
Table Salt, Packaged Ready-to-Eat Foods, Food Additives, Fast Food, Delicatessen, Salad Dressings, Soy Sauce, Pickle Juice, Chips, Olives
LIMIT ANIMAL PROTEINS
Foods rich in calcium:
Red Meat, White Meat, Offal, Egg, Shellfish, Dairy Products
GET ENOUGH CALCIUM
Cheese, Almonds, Hazelnuts, Peanuts, Soybeans, Green Vegetables, Yogurt
GET ENOUGH FLUID
Drinking At Least 2.0 Lt Water Per Day Is Recommended. It Is Recommended to Stay Away from Tea, Coffee and Alcohol.
REFERENCES
1. Pak, C. (1987). Citrate and Renal Calculi. Mineral and Electrolyte Metabolism 13, 257-266.
2. Pak, C. (1985). Long-Term Treatment of Calcium Nephrolithiasis with Potassium Citrate. The Journal of Urology 134, 11-19.
3. Preminger, G.M., K. Sakhaee, C. Skurla and C.Y.C. Pak. (1985). Prevention of Recurrent Calcium Stone Formation with Potassium Citrate Therapy in Patients with Distal Renal Tubular Acidosis. The Journal of Urology 134, 20-23.
4. Pak, C.Y.C., K. Sakhaee and C. Fuller. (1986). Successful Management of Uric Acid Nephrolithiasis with Potassium Citrate. Kidney International 30, 422-428.
5. Hollander-Rodriguez, J et al. (2006). Hyperkalemia, American Family Physician, Vol. 73/No. 2.
6. Greenberg, A et al. (1998). Hyperkalemia: treatment options. Semen Nephrol. Jan; 18 (1): 46-57.