Alkalinizing Agents: A Review of Prescription, Over-the-Counter, and Medical Food Supplements.

Introduction Kidney stones affect 1 in every 11 people in the United States each year. There is a significant high recurrence rate without a stone prevention protocol. Alkali citrate is beneficial in decreasing stone recurrence, but due to the cost and gastrointestinal side effects there is a low adherence rate. This study aims to serve as a review of some of the most commonly used alkalizing over‐ the‐ counter supplements that are advertised to prevent and treat kidney stones. Methods Data was gathered by a comprehensive online literature search and company inquiries for kidney stone prevention supplements. An additional informal poll of the authors selected supplements that are most commonly taken by their patients. A total of eight supplements were evaluated for cost, alkali equivalent provided, dosing and regulatory information. Results Eight of the most commonly used supplements were reviewed with a focus on alkalizing agents. Information reviewed revealed dosing recommendations resulting in decreased citrate alkali equivalents per day compared to prescription‐strength potassium citrate. Cost, peer‐reviewed study results and regulatory data were reviewed, tabulated and analyzed. Cost per alkali equivalent was substantially decreased for each supplement compared to the prescribed drug. All supplements were found to be readily available online. Conclusion Over‐ the‐ counter alkalizing agents are available to patients and may be an appropriate alternative to cost prohibitive potassium citrate when treating urolithiasis patients. Additional testing will be necessary in the future to determine the efficacy of these supplements in the treatment and prevention of urinary stone disease

Global Variations in the Mineral Content of Bottled Still and Sparkling Water and a Description of the Possible Impact on Nephrological and Urological Diseases

Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake

Social Determinants of Kidney Stone Disease: The Impact of Race, Income and Access on Urolithiasis Treatment and Outcomes.

The medical and surgical management of kidney stones is one of the most common functions of the urologist. Management choices are often nuanced, involving the decision to embark on one surgical plan among several options. As the wider medical community critically evaluates the care we provide to an increasingly diverse population, it will be important to examine patient outcomes with a particular focus on ensuring equitable care. This review examines the influence of social parameters on the care of kidney stone patients. The dearth of literature in this area warrants rigorous studies on the relationship between race as well as socioeconomic status and the management of kidney stone disease

Uropathogens Preferrentially Interact with Conditioning Film Components on the Surface of Indwelling Ureteral Stents Rather than Stent Material

Despite routine implementation in urology, indwelling ureteral stents pose as a nidus for infection. Conditioning film accumulates on stents, which prime pathogen adhesion, promoting infectious biofilm formation. However, the extent to which conditioning film components play a role in facilitating bacterial adhesion and biofilm formation remains largely unknown. Here, we examined the interaction of previously identified stent-bound conditioning film components (fibrinogen, uromodulin, and albumin) with bacterial uropathogens. Cytoscopically removed stents were incubated with common uropathogens (Escherichia coli, Enterococcus faecalis, and Staphylococcus aureus). Immunofluorescent double staining was performed to study the localization of uropathogens relative to stent-bound conditioning film proteins. Conditioning film components were identified on the external stent surface with some deposition in the inner lumen. Bacteria co-localized with fibrinogen, uromodulin, and albumin, suggesting a potential mechanism for stent-associated infections. Here, we determine strong co-localization between common uropathogenic bacterial species with prominent conditioning film components on ureteral stents. Further functional validation of interactions amongst these uropathogens and conditioning film proteins may enhance clinical management for stent-associated infections and development of improved stent technologies.Medicine, Faculty ofOther UBCNon UBCUrologic Sciences, Department ofReviewedFacult

Safety and Efficacy of Simultaneous Bilateral Percutaneous Nephrolithotomy

A retrospective review was conducted to evaluate intraoperative and patient outcomes following simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL). Target stone characteristics, operative time, hospitalization length, post-operative complications, blood loss, opioid use, pain, and stone-free rates were evaluated. In total, 42 patients with large renal stones (>20 mm²) were identified for this study, and 38% of them achieved stone-free status with no residual fragments apparent on post-operative day one CT imaging. The maximum mean residual fragment size was 3.67 mm² and average number of residual fragments following the procedures was 1.63. The rates of blood loss, post-operative complications, opioid use, and pain from the study cohort were similar to the reported outcomes of studies conducted by others. The potential benefits of a single procedure and anesthesia to treat bilateral stone burdens, lower total pain medication prescribed, and lower hospital costs render SB-PCNL as an attractive option in the treatment of bilateral kidney stones.Medicine, Faculty ofAlumniNon UBCUrologic Sciences, Department ofReviewedFacult

The Evolution of Kidney Stone Information Available to Patients: Interest Trends of Social Media

PurposeTo identify what information kidney stone patients want and the resources they use to find it, and to evaluate kidney stone-related smartphone apps based on their actionability, understandability, quality, and reliability. MethodsGoogle Trends was used to assess searches related to kidney stones and related smartphone applications (apps) from 2019 to 2021. A questionnaire aimed at ascertaining where patients obtain kidney stone-related information was posted on popular Facebook groups and one Reddit group. Seven popular kidney stone-related apps were evaluated for reliability, quality, actionability, and understandability. Univariate statistical analysis, search volume index, and descriptive statistics were used to assess correlations and impact of variables on outcomes of interest. ResultsBetween 2019 and 2021, the peak search volume index of kidney stones was in the summer and winter. Questionnaire participants obtain most information from their doctor (45%), Reddit and Facebook groups (43%), YouTube (9%), and smartphone apps (4%). 23% reported using a kidney stone app at least once to obtain information. The average smartphone app overall has poor reliability (2.43, P <0.001) and quality (1.96, P = 0.039) and poor review of treatment options with side effects (1.36, P = 0.689), and does not encourage shared decision-making (2.57, P = 0.162). Poor actionability was found in all apps, and good understandability was found in 6 of the 7 apps. ConclusionWhile physicians are still the most-used resource for patients, patients are increasingly using online platforms and smartphone applications. Urologists should consider engaging kidney stone patients through such platforms to provide reliable educational information

Regulation of Stem Cell Pluripotency and Differentiation Involves a Mutual Regulatory Circuit of the Nanog, OCT4, and SOX2 Pluripotency Transcription Factors With Polycomb Repressive Complexes and Stem Cell microRNAs

Coordinated transcription factor networks have emerged as the master regulatory mechanisms of stem cell pluripotency and differentiation. Many stem cell-specific transcription factors, including the pluripotency transcription factors, OCT4, NANOG, and SOX2 function in combinatorial complexes to regulate the expression of loci, which are involved in embryonic stem (ES) cell pluripotency and cellular differentiation. This review will address how these pathways form a reciprocal regulatory circuit whereby the equilibrium between stem cell self-renewal, proliferation, and differentiation is in perpetual balance. We will discuss how distinct epigenetic repressive pathways involving polycomb complexes, DNA methylation, and microRNAs cooperate to reduce transcriptional noise and to prevent stochastic and aberrant induction of differentiation. We will provide a brief overview of how these networks cooperate to modulate differentiation along hematopoietic and neuronal lineages. Finally, we will describe how aberrant functioning of components of the stem cell regulatory network may contribute to malignant transformation of adult stem cells and the establishment of a "cancer stem cell" phenotype and thereby underlie multiple types of human malignancies