A Fresh Look at Oral Chemolysis for Non-Symptomatic Kidney Stones—Comparative Research of Potassium Citrate and Allopurinol Combination—Is Treatment Possible Without Stone Analysis?
Abstract
1. Introduction
2. Material and Methods
2.1. Patients
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Türk, C.; Petřík, A.; Sarica, K.; Seitz, C.; Skolarikos, A.; Straub, M.; Knoll, T. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur. Urol. 2016, 69, 468–474. [Google Scholar] [CrossRef] [PubMed]
- Geraghty, R.M.; Davis, N.F.; Tzelves, L.; Lombardo, R.; Yuan, C.; Thomas, K.; Petrik, A.; Neisius, A.; Türk, C.; Gambaro, G.; et al. Best Practice in Interventional Management of Urolithiasis: An Update from the European Association of Urology Guidelines Panel for Urolithiasis 2022. Eur. Urol. Focus 2023, 9, 199–208. [Google Scholar] [CrossRef] [PubMed]
- Bernardo, N.O.; Smith, A.D. Chemolysis of urinarycalculi. Urol. Clin. N. Am. 2000, 27, 355–365. [Google Scholar] [CrossRef]
- Ettinger, B.; Pak, C.Y.; Citron, J.T.; Thomas, C.; Adams-Huet, B.; Vangessel, A. Potassium-magnesium citrate is an effective prophylaxis against recurrent calcium oxalate nephrolithiasis. J. Urol. 1997, 158, 2069–2073. [Google Scholar] [CrossRef] [PubMed]
- Lee, Y.H.; Huang, W.C.; Tsai, J.Y.; Huang, J.K. The efficacy of potassium citrate based medical prophylaxis for preventing upper urinary tract calculi: A midterm followup study. J. Urol. 1999, 161, 1453–1457. [Google Scholar] [CrossRef]
- Ettinger, B.; Tang, A.; Citron, J.T.; Livermore, B.; Williams, T. Randomized trial of allopurinol in the prevention of calcium oxalate calculi. N. Engl. J. Med. 1986, 315, 1386–1389. [Google Scholar] [CrossRef]
- Rudman, D.; Afforah, H.; Tuttle, E. Medical management of the patients with renal calculi. In American Urological Association Update Series; American Urological Association: Linthicum, MD, USA, 1983; Volume 2. [Google Scholar]
- Maneesh, S.; Kumar, P.; Prasanna, V.; Venkatesh, K. Results of urinary dissolution therapy for radiolucent calculi. Int. Braz. J. Urol. 2013, 39, 103–107. [Google Scholar] [CrossRef]
- Elsawy, A.A.; Elshal, A.M.; El-Nahas, A.R.; Elbaset, M.A.; Farag, H.; Shokeir, A.A. Can We Predict the Outcome of Oral Dissolution Therapy for Radiolucent Renal Calculi? A Prospective Study. J. Urol. 2018, 201, 350–357. [Google Scholar] [CrossRef]
- Burns, J.R.; Gauthier, J.F.; Finlayson, B. Dissolution kinetics of uric acid calculi. J. Urol. 1984, 131, 708–711. [Google Scholar] [CrossRef]
- Kursh, E.D.; Resnick, M.I. Dissolution of uric acid calculi with systemic alkalization. J. Urol. 1984, 132, 286–287. [Google Scholar] [CrossRef]
- Pearle, M.S.; Goldfarb, D.S.; Assimos, D.G.; Curhan, G.; Denu-Ciocca, C.J.; Matlaga, B.R.; Monga, M.; Penniston, K.L.; Preminger, G.M.; Turk, T.M.; et al. Medical management of kidney stones: AUA guideline. J. Urol. 2014, 192, 316–324. [Google Scholar] [CrossRef] [PubMed]
- Gallioli, A.; De Lorenzis, E.; Boeri, L.; Delor, M.; Zanetti, S.P.; Longo, F.; Trinchieri, A.; Montanari, E. Clinical utility of computed tomography Hounsfield characterization for percutaneous nephrolithotomy: A cross-sectional study. BMC Urol. 2017, 17, 104. [Google Scholar] [CrossRef] [PubMed]
- Tsaturyan, A.; Bokova, E.; Bosshard, P.; Bonny, O.; Fuster, D.G.; Roth, B. Oral chemolysis is an effective, non-invasive therapy for urinary stone ssuspected of uric acid content. Urolithiasis 2020, 48, 501–507. [Google Scholar] [CrossRef]
- Diri, A.; Diri, B. Management of staghorn renal stones. Ren. Fail. 2018, 40, 357–362. [Google Scholar] [CrossRef]
- Fellström, B.; Backman, U.; Danielson, B.G.; Holmgren, K.; Johansson, G.; Lindsjö, M.; Ljunghall, S.; Wikström, B. Allopurinol treatment of renal calcium stone disease. Br. J. Urol. 1985, 57, 375–379. [Google Scholar] [CrossRef] [PubMed]
- Coe, F.L.; Raisen, L. Allopurinol treatment of uric-acid disorders in calcium-stone formers. Lancet 1973, 301, 129–131. [Google Scholar] [CrossRef]
- Xu, H.; Zisman, A.L.; Coe, F.L.; Worcester, E.M. Kidney stones: An update on current pharmacological management and future directions. Expert. Opin. Pharmacother. 2013, 14, 435–447. [Google Scholar] [CrossRef]
- Moe, O.W.; Xu, L.H.R. Hyperuricosuric calcium urolithiasis. J. Nephrol. 2018, 31, 189–196. [Google Scholar] [CrossRef]
- Ferraro, P.M.; Arrabal-Polo, M.Á.; Capasso, G.; Croppi, E.; Cupisti, A.; Ernandez, T.; Fuster, D.G.; Galan, J.A.; Grases, F.; Hoorn, E.J.; et al. A preliminary survey of practice pattern sacrossseveral European kidney stone centers and a call for action in developing shared practice. Urolithiasis 2019, 47, 219–224. [Google Scholar] [CrossRef]
- Williams, J.C., Jr.; Gambaro, G.; Rodgers, A.; Asplin, J.; Bonny, O.; Costa-Bauzá, A.; Ferraro, P.M.; Fogazzi, G.; Fuster, D.G.; Goldfarb, D.S.; et al. Urine and stone analysis for the investigation of the renal stone former: A consensus conference. Urolithiasis 2021, 49, 1–16. [Google Scholar] [CrossRef]
- Parks, J.H.; Goldfisher, E.; Asplin, J.R.; Coe, F.L. A single 24-hour urine collection is inadequate for the medical evaluation of nephrolithiasis. J. Urol. 2002, 167, 1607–1612. [Google Scholar] [CrossRef] [PubMed]
All Patients (n: 59) | Mean ± SD | PS (n: 27) | ALPS (n: 32) | p | |
---|---|---|---|---|---|
Age (years) | 45.5 ± 10.7 | 41 ± 10.1 | 49 ± 10.1 | 0.936 ** | |
Gender | 0.266 * | ||||
Female | n: 25 | 10 | 15 | ||
Male | n: 34 | 17 | 17 | ||
BMI (kg/m2) | 30.07 ± 3.9 | 28.1 ± 2.15 | 31.6 ± 4.21 | 0.009 ** | |
Stone location | |||||
Upper calyx | n:0 | ||||
Middle calyx | n:8 | 3 | 5 | ||
Renal pelvis | n:18 | 7 | 11 | ||
Lower calyx | n:33 | 16 | 17 | 0.894 * | |
Side of the stone | |||||
Right | n:31 | 14 | 17 | ||
Left | n:28 | 13 | 15 | 0.456 * | |
HU | 519.35 ± 95.8 | 544.5 ± 72.2 | 500.2 ± 108.1 | 0.120 ** | |
Opacity status | |||||
Non-opaque | 36 (61.0) | 15 | 21 | ||
Semi opaque | 23 (38.9) | 11 | 12 | 0.509 * | |
Stone skin distance (mm) | 10.22 ± 1.89 | 9.67 ± 1.9 | 10.65 ± 1.79 | 0.551 ** | |
Duration of treatment (month) | 9.54 ± 2.2 | 8.75 ± 1.86 | 10.1 ± 2.34 | 0.033 ** | |
Pre-treatment 24 h urine collection (mg/24 hrs) | |||||
Creatinine (mg) | 472.6 ± 57.1 | 475.6 ± 52.5 | 470.3 ± 61.4 | 0.790 *** | |
Uric acid (mg) | 446.85 ± 102.4 | 463.5 ± 79.3 | 434 ± 117.1 | 0.549 *** | |
Calcium (mg) | 172.6 ± 42 | 170.6 ± 50.7 | 174.1 ± 44.8 | 0.807 ** | |
Citrate (mg) | 552 ± 130 | 531.1 ± 141.4 | 568.1 ± 122.7 | 0.347 ** | |
Oksalat (mg) | 29.09 ± 5.4 | 28.6 ± 5.08 | 29.4 ± 5.72 | 0.797 *** | |
Sodium (mEq) | 134.1 ± 17.2 | 134.2 ± 17 | 134.04 ± 17.7 | 0.981 ** | |
Potassium (mEq) | 35.61 ± 10.7 | 35.5 ± 11.5 | 35.7 ± 10.3 | 0.934 ** | |
Phosphate (mg) | 552.7 ± 130.8 | 582.4 ± 152.3 | 529.9 ± 109.1 | 0.362 *** |
All Patients (n: 59) | PS (n: 27) | ALPS (n: 32) | p | |
---|---|---|---|---|
Stone size before treatment (mm) | 11.08 ± 2.11 | 11.01 ± 2.27 | 11.1 ± 2.03 | 0.816 ** |
Stone size after treatment (mm) | 8.43 ± 3.42 | 9.34 ± 2.27 | 7.73 ± 3.99 | 0.281 *** |
p < 0.001 * | <0.001 * | <0.001 * | ||
Urea (BUN) before treatment | 25.51 ± 6.26 | 24.68 ± 5.51 | 26.15 ± 6.81 | 0.435 ** |
Urea(BUN) after treatment | 27.6 ± 5.96 | 26.44 ± 4.0 | 28.5 ± 7.05 | 0.235 ** |
p < 0.026 * | 0.259 * | 0.049 * | ||
Pre-treatment creatinine | 0.76 ± 0.15 | 0.74 ± 0.13 | 0.78 | 0.351 ** |
Post-treatment creatinine | 0.82 ± 0.18 | 0.80 ± 0.17 | 0.83 | 0.654 ** |
p < 0.014 * | 0.058 * | 0.123 * | ||
Pre-treatment GFR | 100.65 ± 15.05 | 103.39 ± 15.26 | 98.54 | 0.297 *** |
Post-treatment GFR | 96.2 ± 19.84 | 99.1 ± 20.72 | 94.06 | 0.277 *** |
p < 0.010 **** | 0.040 * | 0.01 * | ||
Pre-treatment urine ph | 5.89 ± 0.37 | 5.97 ± 0.37 | 5.83 ± 0.36 | 0.292 *** |
Post-treatment urine ph | 6.27 ± 0.29 | 6.37 ± 0.31 | 6.20 ± 0.26 | 0.189 *** |
p < 0.001 **** | <0.001 * | <0.001 * |
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Coşkun, A.; Can, U.; Çanakçı, C.; Can, M. A Fresh Look at Oral Chemolysis for Non-Symptomatic Kidney Stones—Comparative Research of Potassium Citrate and Allopurinol Combination—Is Treatment Possible Without Stone Analysis? J. Clin. Med. 2025, 14, 3970. https://doi.org/10.3390/jcm14113970
Coşkun A, Can U, Çanakçı C, Can M. A Fresh Look at Oral Chemolysis for Non-Symptomatic Kidney Stones—Comparative Research of Potassium Citrate and Allopurinol Combination—Is Treatment Possible Without Stone Analysis? Journal of Clinical Medicine. 2025; 14(11):3970. https://doi.org/10.3390/jcm14113970
Chicago/Turabian StyleCoşkun, Alper, Utku Can, Cengiz Çanakçı, and Murat Can. 2025. "A Fresh Look at Oral Chemolysis for Non-Symptomatic Kidney Stones—Comparative Research of Potassium Citrate and Allopurinol Combination—Is Treatment Possible Without Stone Analysis?" Journal of Clinical Medicine 14, no. 11: 3970. https://doi.org/10.3390/jcm14113970
APA StyleCoşkun, A., Can, U., Çanakçı, C., & Can, M. (2025). A Fresh Look at Oral Chemolysis for Non-Symptomatic Kidney Stones—Comparative Research of Potassium Citrate and Allopurinol Combination—Is Treatment Possible Without Stone Analysis? Journal of Clinical Medicine, 14(11), 3970. https://doi.org/10.3390/jcm14113970