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Gout
Published in Charles Theisler, Adjuvant Medical Care, 2023
Citric acid is used to make the urine less acidic. Less acidic urine helps the kidneys get rid of uric acid and thus helps to prevent gout and certain types of kidney stones (urate). Potassium citrate is a citric acid supplement commonly used to prevent and treat gout flare-ups by lowering blood uric acid levels. At a dose of 3 gm/day for 12 weeks, uric acid levels were significantly reduced.17
Nephrolithiasis: etiology, stone composition, medical management, and prevention
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
HCTZ 25–50 mg qd-bid or chlorthalidone 12.5–25 mg (up to 100 mg) qd: Start with small dose, titrate as neededAdminister concomitant potassium citrateMay need >2 years for effect.
Relationships Between Potassium and Cancer
Published in Maryce M. Jacobs, Vitamins and Minerals in the Prevention and Treatment of Cancer, 2018
Maryce M. Jacobs, Roman J. Pienta
Cooling and Marrack25 described a case in which a woman complained of passing water through the rectum for five years. Sigmoidoscopy and barium enema failed to reveal any evidence of a tumor. The symptoms persisted and eight years later she entered the hospital after complaining of vomiting, abdominal discomfort and failure to pass fecal matter for 4 days. She continued to pass rectal fluid at 4 to 6 pints per day. Her serum potassium level was 2.2 mEq/L and was not improved by oral administration of 144 grams of potassium citrate. Electrolyte determination of the rectal fluid showed a tenfold increase in potassium over sodium. Sigmoidoscopy revealed a granulomatous polypoid mass and a hemicolectomy was performed to remove a villous tumor of the sigmoid colon. All electrolytes returned to normal after removal of the tumor.
Clinical profile of a Polish cohort of children and young adults with cystinuria
Published in Renal Failure, 2021
Marcin Tkaczyk, Katarzyna Gadomska-Prokop, Iga Załuska-Leśniewska, Kinga Musiał, Jan Zawadzki, Katarzyna Jobs, Tadeusz Porowski, Anna Rogowska-Kalisz, Anna Jander, Merit Kirolos, Adam Haliński, Aleksandra Krzemień, Aleksandra Sobieszczańska-Droździel, Katarzyna Zachwieja, Bodo B. Beck, Przemysław Sikora, Marcin Zaniew
Data on treatment were available for 28 patients (Table 1). The majority (89%) had their fluid intake increased after a clinical diagnosis was made, which is recommended as a standard prevention for stone formation in cystinuria. In 3 patients (10.7%), no dietary restrictions (i.e., a low salt diet and reduced protein intake) were advised. Among pharmacological treatments, potassium citrate was the most commonly prescribed (in 24 patients; 85.7%). Captopril and tiopronin were given to 10 (35.7%) and 4 (14.3%) patients, respectively. Standard initial potassium citrate dosage was 0.5 mEq/kg/day. Parents were instructed to adjust dosage to maintain a high urine pH of 7.7–8.0 at a final dose of 1–1.1 mEq/kg/day. Captoprilum was given at a dosage of 0.5–1.0 mg/kg/day. Triopronin was administered with an initial dose of 15 mg/kg/day dose and finally ranged 300–900 mg (5–30 mg/kg/day).
Rising occurrence of hypocitraturia and hyperoxaluria associated with increasing prevalence of stone disease in calcium kidney stone formers
Published in Scandinavian Journal of Urology, 2020
Ramy F. Youssef, Jeremy W. Martin, Khashayar Sakhaee, John Poindexter, Sharmin Dianatnejad, Charles D. Scales, Glenn M. Preminger, Michael E. Lipkin
The contemporary cohort was associated with increased rates of hypocitraturia, which was particularly associated with obesity. Hypocitraturia is a common metabolic abnormality present in 20–60% of stone formers [25]. Potassium citrate (Kcit) is given to increase urinary pH and restore citrate to normal levels [26]. Obese patients with hypocitraturia have been associated with decreased responsiveness to Kcit, requiring more frequent doses to maintain a normal citrate level. The mechanism underlying this increase in hypocitraturia, particularly in obese patients, is likely related to diet and lifestyle changes. The diet of obese patients may differ from non-obese patients, with greater animal protein intake and decreased citrus fruits, vegetables, and fiber, all promoting hypocitraturia. However, the underlying mechanisms between obesity and hypocitraturia are not fully elucidated.
What are the main challenges to the pharmacological management of cystinuria?
Published in Expert Opinion on Pharmacotherapy, 2020
Michael E. Rezaee, Andrew D. Rule, Vernon M. Pais
The goal of pharmacological treatment for cystinuria is to increase the solubility of cystine in the urine. American Urological Association (AUA) guidelines recommend a combination of behavior modification and urinary alkalization as first-line therapy for cystinuria [6]. A urine pH of 7.0 to 7.5 should be targeted to help prevent cystine stone formation [6]. Potassium citrate is commonly prescribed to achieve urinary alkalization. Typical dosing for ranges from 60 to 90 mEq divided into 3–4 daily doses or extended-release formulations with twice-daily dosing [5,6]. Potassium citrate is generally well-tolerated, but can cause nausea and other gastrointestinal symptoms if not taken with food [5]. In addition, patients on potassium citrate need to be monitored for hyperkalemia and over-alkalization of their urine (pH > 7.5), the latter of which can potentially predispose patients to calcium phosphate stone formation [6]. More intensive pharmacological management is used for patients who continue to form cystine stones or are unable to achieve cystine urinary concentrations < 250 mg/L at an acceptable pH despite behavior modification and urinary alkalization.