Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria
- PMID: 25855777
- PMCID: PMC4657843
- DOI: 10.1681/ASN.2014121223
Effect of Potassium Citrate on Calcium Phosphate Stones in a Model of Hypercalciuria
Abstract
Potassium citrate is prescribed to decrease stone recurrence in patients with calcium nephrolithiasis. Citrate binds intestinal and urine calcium and increases urine pH. Citrate, metabolized to bicarbonate, should decrease calcium excretion by reducing bone resorption and increasing renal calcium reabsorption. However, citrate binding to intestinal calcium may increase absorption and renal excretion of both phosphate and oxalate. Thus, the effect of potassium citrate on urine calcium oxalate and calcium phosphate supersaturation and stone formation is complex and difficult to predict. To study the effects of potassium citrate on urine supersaturation and stone formation, we utilized 95th-generation inbred genetic hypercalciuric stone-forming rats. Rats were fed a fixed amount of a normal calcium (1.2%) diet supplemented with potassium citrate or potassium chloride (each 4 mmol/d) for 18 weeks. Urine was collected at 6, 12, and 18 weeks. At 18 weeks, stone formation was visualized by radiography. Urine citrate, phosphate, oxalate, and pH levels were higher and urine calcium level was lower in rats fed potassium citrate. Furthermore, calcium oxalate and calcium phosphate supersaturation were higher with potassium citrate; however, uric acid supersaturation was lower. Both groups had similar numbers of exclusively calcium phosphate stones. Thus, potassium citrate effectively raises urine citrate levels and lowers urine calcium levels; however, the increases in urine pH, oxalate, and phosphate levels lead to increased calcium oxalate and calcium phosphate supersaturation. Potassium citrate induces complex changes in urine chemistries and resultant supersaturation, which may not be beneficial in preventing calcium phosphate stone formation.
Keywords: hypercalciuria; kidney stones; mineral metabolism.
Copyright © 2015 by the American Society of Nephrology.
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References
-
- Bushinsky DA, Coe FL, Moe OW: Nephrolithiasis. In: The Kidney, edited by Brenner BM, Philadelphia, W.B. Saunders, 2012, pp 1455–1507
-
- Monk RD, Bushinsky DA: Kidney stones. In: Williams Textbook of Endocrinology, edited by Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, Philadelphia, W.B. Saunders, 2011, pp 1350–1367
-
- Monk RD, Bushinsky DA: Nephrolithiasis and nephrocalcinosis. In: Comprehensive Clinical Nephrology, edited by Frehally J, Floege J, Johnson RJ, St. Louis, Elsevier, 2010, pp 687–701
-
- Moe OW, Bonny O: Genetic hypercalciuria. J Am Soc Nephrol 16: 729–745, 2005 - PubMed
-
- Stechman MJ, Loh NY, Thakker RV: Genetics of hypercalciuric nephrolithiasis: Renal stone disease. Ann N Y Acad Sci 1116: 461–484, 2007 - PubMed
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