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Can lemon juice be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia? A prospective randomized study

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Abstract

To investigate that lemon juice could be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia, 30 patients with hypocitraturic urinary calcium stones were enrolled into study. The patients were divided into three groups equally. Exactly 60 mEq/day fresh lemon juice (≈85 cc/day) and potassium citrate (60 mEq/day) were given to the patients of first and second group, respectively. Dietary recommendations were made for the third group. Blood and 24-h urine tests were performed before treatment and repeated 3 months later. The differences between demographic datas of groups were not significant. There was no significant difference between values of blood tests performed before and after treatment in all groups. Statistically significant differences were found between pre- and post-treatment urine values in each group. Although there was no significant difference between pre-treatment citrate levels of the groups. A significant difference was found between post-treatment citrate levels of the groups. There was 2.5-, 3.5- and 0.8-fold increase in urinary citrate level of lemon juice, potassium citrate and dietary recommendation groups, respectively. Urinary calcium level was decreased only in lemon juice and potassium citrate groups after treatment. While there was no significant difference between pre- and post-treatment urinary oxalate levels in all groups, a significant decrease in urinary uric acid levels was determined in all groups. We suggest that lemon juice can be an alternative in the treatment of urinary calcium stones in patients with hypocitraturia. Additionally, dietary recommendations can increase effectiveness of the treatment.

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References

  1. Pak CY (1987) Citrat and renal calculi. Miner Electrolyte Metab 13(4):257–266

    PubMed  CAS  Google Scholar 

  2. Nicar MJ, Skurla C, Sakhaee K, Pak CY (1983) Low urinary citrate excretion in nephrolithiasis. Urology 21(1):8–14. doi:10.1016/0090-4295(83)90113-9

    Article  PubMed  CAS  Google Scholar 

  3. Sakhaee K, Nicar M, Hill K, Pak CY (1983) Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone forming salt. Kidney Int 24(3):348–452. doi:10.1038/ki.1983.165

    Article  PubMed  CAS  Google Scholar 

  4. Preminger GM, Sakhaee K, Pak CY (1988) Alcali action on the urinary crystallization of calcium salts: contrasting responses to sodium citrate and potassium citrate. J Urol 139(2):240–242

    PubMed  CAS  Google Scholar 

  5. Preminger GM, Harvey JA, Pak CY (1985) Comperative efficacy of “specific” potassium citrate therapy versus conservative manegement in nephrolithiasis of mild to moderate severity. J Urol 130(4):658–661

    Google Scholar 

  6. Barcelo P, Wuhl O, Servitge E, Rausaud A (1993) Randomized double-blind study of potassium citrate in idiopathic hypocitraturic calcium nephrolithiasis. J Urol 150(6):1761–1764

    PubMed  CAS  Google Scholar 

  7. Souci SW, Fachmann W, Kraur H (1986/1987) Food composition and nutrition tables. Wissenschaftliche Verlagsgesellschaft mbH Stuttgart

  8. Seltzer MA, Low RK, McDonald M, Shami GS, Stoller ML (1996) Dietary manipulation with lemonade to treat hypocitraturic calcium nephrolithiasis. J Urol 156(3):907–909. doi:10.1016/S0022-5347(01)65659-3

    Article  PubMed  CAS  Google Scholar 

  9. Goldfarb DS, Aslin JR (2001) Effect of grapefruit juice on urinary lithogenicity. J Urol 166(1):263–267. doi:10.1016/S0022-5347(05)66142-3

    Article  PubMed  CAS  Google Scholar 

  10. Wabner CL, Pak CY (1993) Effect of orange juice consumption on urinary stone risk factors. J Urol 149(6):1405–1408

    PubMed  CAS  Google Scholar 

  11. Pearle MS, Lotan Y (2002) Urinary lithiasis: etiology, diagnosis and medical management. In: Walsh PC, Retik AB, Jr Vaughan, Wein AJ (eds) Campbell’s urolgy, vol 4, 8th edn. WB Saunders, Philadelphia, p 3252

    Google Scholar 

  12. Straub M, Hautmann RE (2005) Developments in stone prevention. Curr Opin Urol 15(2):119–126. doi:10.1097/01.mou.0000160627.36236.6b

    Article  PubMed  Google Scholar 

  13. Parivar F, Low RK, Stoller ML (1996) The influence of diet on urinary stone disease. J Urol 155(2):432–440. doi:10.1016/S0022-5347(01)66411-5

    Article  PubMed  CAS  Google Scholar 

  14. Curhan GC, Willett WC, Rimm EB, Stampfer MJ (1993) A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 25;328(12):833–838

    Google Scholar 

  15. Curhan GC, Willett WC, Speizer FE, Spiegelman D, Stampfer MJ (1997) Comparison of dietary calcium with supplemental calcium and other nutrients as factors affecting the risk for kidney stones in women. Ann Intern Med 126(7):497–504

    PubMed  CAS  Google Scholar 

  16. Tekin A, Tekgul S, Atsu N, Bakkaloglu M, Kendi S (2002) Oral potassium citrate treatment for idiopathic hypocitruria in children with calcium urolithiasis. J Urol 168(6):2572–2574. doi:10.1016/S0022-5347(05)64218-8

    Article  PubMed  CAS  Google Scholar 

  17. Hofbauer J, Hobarth K, Szabo N, Marberger M (1994) Alkali citrate prophylaxis in idiopathic recurrent calcium oxalate urolithiasis a prospective randomized study. Br J Urol 73(4):362–365

    Article  PubMed  CAS  Google Scholar 

  18. Hauser W, Frick J, Kunit G (1990) Alkali citrate for preventing recurrence of calcium oxalate stones. Eur Urol 17(3):248–251

    PubMed  CAS  Google Scholar 

  19. Preminger GM, Sakhaee K, Skurla C, Pak CY (1985) Prevention of recurrent calcium stone formation with potassium citrate therapy in patients with distal renal tubular acidosis. J Urol 134(1):20–23

    PubMed  CAS  Google Scholar 

  20. Kang DE, Sur RL, Haleblian GE (2007) Long-term lemonade based dietary manipulation in patients with hypocitraturic nephrolithiasis. J Urol 177(4):1358–1362. doi:10.1016/j.juro.2006.11.058

    Article  PubMed  Google Scholar 

  21. Hönow R, Laube N, Schneider A, Kessler T, Hesse A (2003) Influence of grapefruit, orange and apple-juice consumption on urinary variables and risk of crystallization. Br J Nutr 90(2):295–300. doi:10.1079/BJN2003897

    Article  PubMed  CAS  Google Scholar 

  22. Koff SG, Paquetta EL, Cullen J (2007) Comparison between lemonade and potassium citrate and impact on urine pH and 24-hour urine parameters in patients with kidney stone formation. Urology 69(6):1013–1016. doi:10.1016/j.urology.2007.02.008

    Article  PubMed  Google Scholar 

  23. Odvina CV (2006) Comparative value of orange juice versus lemonade in reducing stone-forming risk. Clin J Am Soc Nephrol 1(6):1269–1274

    Article  PubMed  CAS  Google Scholar 

  24. Simpson DP (1983) Citrate excretion: a window on renal metabolism. Am J Physiol 244(3):F223–F234 Review

    PubMed  CAS  Google Scholar 

  25. Sakhaee K, Alpern R, Poindexter J, Pak CY (1992) Citraturic response to oral citric acid load. J Urol 147(4):975–976

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Bakirkoy Research and Training Hospital, Istanbul, Turkey

    Bekir Aras, Nadir Kalfazade, Volkan Tuğcu, Eray Kemahlı, Bedi Özbay, Hakan Polat & Ali İhsan Taşçı

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  1. Bekir Aras
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  2. Nadir Kalfazade
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  3. Volkan Tuğcu
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  4. Eray Kemahlı
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  5. Bedi Özbay
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  6. Hakan Polat
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  7. Ali İhsan Taşçı
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Correspondence to Bekir Aras.

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Aras, B., Kalfazade, N., Tuğcu, V. et al. Can lemon juice be an alternative to potassium citrate in the treatment of urinary calcium stones in patients with hypocitraturia? A prospective randomized study. Urol Res 36, 313–317 (2008). https://doi.org/10.1007/s00240-008-0152-6

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  • DOI: https://doi.org/10.1007/s00240-008-0152-6

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