How Effective Is Citrate for Kidney Stones?

Uric acid is a product of oxidative decomposition of purine bases and has no physiological function in the human body. The main sources of human purines are diet, tissue breakdown and de novo synthesis. Uric acid is the end product of human purine metabolism.

Urate stones

Uric acid is a product of oxidative decomposition of purine bases and has no physiological function in the human body. The main sources of human purines are

Uric acid is a product of oxidative decomposition of purine bases and has no physiological function in the human body. The main sources of human purines are diet, tissue breakdown and de novo synthesis. Uric acid is the end product of human purine metabolism. Under normal circumstances, it is mainly excreted by the kidney, and about 2/3 of the rest are excreted through the intestine, skin, hair, etc.

1. Drink plenty of water

It is recommended that patients with high uric acid should take more than 2000ml of daily fluid to help eliminate uric acid and prevent stones.

Second, a sufficient amount of vitamins and minerals.

People with high uric acid eat more alkaline foods such as vegetables and fruits. Milk and noodles are also alkaline foods. Eating more of these foods can dilute the uric acid concentration in the body.

Eat more fruits and vegetables:

1. Tomatoes. Tomatoes contain rich ingredients such as dietary fiber, pectin, citric acid, malic acid, vitamins, potassium, and phosphorus, and have various effects. Secondly, it can also cleanse the intestines, relieve fever, improve hypertension and potassium. Tomatoes can alkalize urine and dissolve more uric acid.

2. Celery. Celery is rich in carotene, vitamin B1, vitamin B2, vitamin C, potassium, sodium, magnesium, dietary fiber and many other ingredients, which can promote uric acid excretion. Potassium can not only effectively prevent the accumulation of uric acid, but also lower blood pressure. It is also effective for hypertension caused by gout complications.

3, in the diet, we must pay attention to try not to consume high purine foods, low purine diet to prevent gout, many people know, but patients with high uric acid need to eat less sweets, too many sweets can also cause hyperuricemia.

Third, it is recommended that patients with high uric acid should choose the most suitable for patients with high uric acid. ^[1]

Conservative therapy of urate stones

Drugs can dissolve urate stones, which is an effective and inexpensive treatment, and should be listed as the first choice. Corresponding to the mechanism of uric acid formation, the conservative treatment of urate stones also includes 3 aspects:

(1) Increase urine output: Daily urine output is generally required to be above 2000ml, which is beneficial for treatment and prevention. Studies have shown that drinking 1,200 ml of orange juice per day is equivalent to taking 60 mmol of potassium citrate, which can increase the urine pH from 5.7 to 6.5. At the same time, the citrate content in urine increased from 571 mg / d to 952 mg / d. It can prevent and cure urate stones and calcium-containing stones.

(2) Alkaliization of urine: Alkaliization of urine is the most effective method of lysolysis. During the medication, urine pH should be monitored 2-3 times a day to maintain it between 6 and 6.54, and excessive alkalization should be avoided. If pH> 7.0, phosphate in the urine is easy to crystallize and precipitate, forming phosphate stones. According to calculations, when the alkalizing effect is good, the dissolution rate of pure urate stones can reach 1 cm / month.

(3) Reduction of uric acid: including reducing the intake of high-purine foods, taking allopurinol, and prohibiting drinking. Allopurinol can significantly reduce uric acid levels in hematuria. The drug can cause rash, fever, acute gout, etc. Long-term application can increase the content of xanthine and hypoxanthine in the body, and there may be stones of corresponding components. The usual dose is 300mg / d, and it can be taken in divided or one-time administration.

Methods to alkalize urine

Oral method: Commonly used drugs are sodium bicarbonate, potassium citrate and citric acid mixture, and the dosage depends on the urine pH.

Intravenous infusion method: This method dissolves stones quickly, but requires hospitalization. Commonly used drugs are sodium lactate solution and 5% sodium bicarbonate solution. It is necessary to closely observe blood pressure and other conditions during use to prevent various complications caused by water and sodium retention. The above two methods are contraindicated in those with urinary tract obstruction.

Local perfusion method: suitable for patients who cannot tolerate systemic medication or who already carry urinary fistulas and catheters. Acute urinary tract infection is contraindicated. Commonly used drugs are sodium bicarbonate and trimethylolamino (THAM) methane solutions. This method dissolves the stone quickly, and the perfusion pressure should be <1.96-2.45kpa during operation.

Urate stone surgery

Most urate stones can be cured by conservative treatment. Only a few urate stones that are large or accompanied by urinary tract obstruction or mixed with other components and have poor lytic stone effect need surgical treatment. Extracorporeal shock wave lithotripsy and various in vivo lithotripsy have a good lithotripsy effect on urate stones. Alkaline drugs should be used before and after treatment.

The reasons are as follows:

The alkaline environment can reduce the surface energy of stones and improve the efficiency of lithotripsy.

After the stone is broken, the medicine is more likely to work.

Small stones may remain after rubble. Uric acid stones generally do not require open surgery.

Urate stone prevention

(1) General prevention: It can increase urine output, control diet, and reduce intake of high-protein and high-purine foods. This also has a preventive effect on calcium oxalate stones.

(2) Specific prevention: Patients with gout should use alkaline drugs to maintain urine pH between 6 and 6.5 regardless of whether uric acid is increased in hematuria to prevent stone formation. If the amount of uric acid excreted in 24 hours is> 750mg, it is not suitable to use uric acid drugs to prevent the uric acid concentration in urine from being too high. Studies have shown that allopurinol prevents urate stone formation in patients with hyperuricemia and hyperuricemia. However, for patients with simple mild elevated blood uric acid and no gout symptoms, prophylactic allopurinol is generally not recommended. Only general prevention is sufficient. Tumor patients undergoing radiotherapy and chemotherapy can easily form urate stones and should be given preventive treatment. The method is to start allopurinol a few days before radiotherapy or chemotherapy to avoid gout and urate stone formation.