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Medical dissolution of struvite nephrolithiasis using amino acid preparation in dogs.

A new chemolytic therapy with amino acid preparation was tried for use on struvite renal stones in two dogs, which were admitted to Azabu University Veterinary Teaching Hospital. No other special diet, for the purpose of dissolving the stones, was fed during the treatment. Dissolution of the stones began at week 1, and no stone was detected on radiography at week 4 in both cases. The amino acid preparation thereafter has been administered every 2-3 days to prevent formation of the stones. After 6 months from treatment, complete dissolution was confirmed, and no relapse has been observed. Therefore, it is concluded that chemolytic therapy with amino acid preparation might be useful for the treatment of nephrolithiasis with struvite renal stones in dogs.

Animals↗

Effect of supplementation of dry cat food with D,L-methionine and ammonium chloride on struvite activity product and sediment in urine.

Feeding dry foods supplemented with urine acidifier (D,L-methionine (Met) or ammonium chloride) decreased urinary pH and struvite activity product in clinically normal cats. As a result, the number of struvite crystals in urine was greatly reduced. Supplementation with 3% Met but not 1% Met caused decrease in the urinary concentration of sediment, which resulted from a reduction in the HCl-soluble fraction. The concentration of HCl-insoluble sediment was not affected by supplementation with the urine acidifier.

Ammonium Chloride↗

Removal of struvite to prevent problems associated with its accumulation in wastewater treatment works.

Deposition of struvite within the infrastructure of wastewater treatment works can cause significant operating difficulties. A laboratory-scale, two-stage, continuously stirred tank reactor was developed to remove struvite to prevent problems associated with its deposition. Before any experimental work was conducted, the mixing regime within the system was determined using a pH-tracer response method. Perfect mixing conditions were achieved once the stirring speed reached 500 rpm. Experiments were conducted examining the effects of various process parameters such as retention time, pH, recycling rate, and ammonium concentration. By increasing the hydraulic retention time, the residual magnesium concentration decreased, with the optimum conditions occurring at 125 minutes.

Corrosion↗

Effects of dietary potassium citrate supplementation on urine pH and urinary relative supersaturation of calcium oxalate and struvite in healthy dogs.

OBJECTIVE: To assess the effect of dietary potassium citrate supplementation on the urinary pH, relative supersaturation of calcium oxalate and struvite (defined as the activity product/solubility product of the substance), and concentrations of magnesium, ammonium, phosphate, citrate, calcium, and oxalate in dogs. ANIMALS: 12 healthy adult dogs. PROCEDURE: Canned dog food was fed to dogs for 37 days. Dogs were randomly allocated to 3 groups and fed test diets for a period of 8 days. Study periods were separated by 6-day intervals. During each study period the dogs were fed either standard diet solus (control) or standard diet plus 1 of 2 types of potassium citrate supplements (150 mg potassium citrate/kg of body weight/d) twice daily. Urinary pH, volume and specific gravity, relative supersaturation of calcium oxalate and struvite, and concentrations of magnesium, ammonium, phosphate, calcium, oxalate, and citrate were assessed for each treatment. RESULTS: Mean urine pH was not significantly affected by dietary potassium citrate supplementation, although urine pH did increase by 0.2 pH units with supplementation. Diets containing potassium citrate maintained a higher urine pH for a longer part of the day than control diet. Three Miniature Schnauzers had a significantly lower urinary relative calcium oxalate supersaturation when fed a diet supplemented with potassium citrate, compared with control diet. CONCLUSIONS AND CLINICAL RELEVANCE: Dietary potassium citrate supplementation has limited effects on urinary variables in most healthy dogs, although supplementation results in maintenance of a higher urine pH later in the day. Consequently, if supplementation is introduced, dogs should be fed twice daily and potassium citrate should be given with both meals or with the evening meal only.

Animals↗

Struvite penile urethrolithiasis in a pygmy sperm whale (Kogia breviceps).

Massive urolithiasis of the penile urethra was observed in an adult pygmy sperm whale (Kogia breviceps) stranded on Topsail Island, North Carolina, USA. Calculi occupied the urethra from just distal to the sigmoid flexure to the tip of the penis for a length of 43 cm. A urethral diverticulum was present proximal to the calculi. The major portion of the multinodular urolith weighed 208 g and was 16 cm long x 3.7 cm diameter at the widest point. The urolith was composed of 100% struvite (magnesium ammonium phosphate) and on culture yielded Klebsiella oxytoca, a urease-positive bacterium occasionally associated with struvite urolith formation in domestic animals. Reaction to the calculi was characterized histologically by moderate multifocal to coalescing plasmacytic balanitis and penile urethritis. Role of the urethrolithiasis in the whale's stranding is speculative but could have involved pain or metabolic perturbations such as uremia or hyperammonemia.

Animals↗

Proteus mirabilis viability after lithotripsy of struvite calculi.

PURPOSE: We tested the hypotheses that Proteus mirabilis viability of struvite calculi differs after exposure to different lithotripsy modalities and that the photothermal mechanism of holmium:YAG lithotripsy is antibacterial. MATERIALS AND METHODS: Human calculi of known struvite composition (greater than 90% magnesium ammonium phosphate hexohydrate) were incubated with P. mirabilis. Calculi were randomly distributed and fragmented with no lithotripsy (controls), or shock wave, intracorporeal ultrasonic, electrohydraulic, pneumatic, holmium:YAG or pulsed dye laser lithotripsy. After lithotripsy fragments were sonicated and specimens were serially plated for 48 hours at 38C. Bacterial counts and the rate of bacterial sterilization were compared. RESULTS: Median bacterial counts (colony-forming units per ml.) were 8 x 10(6) in controls and 3 x 10(6) in shock wave, 3 x 10(7) in ultrasonic, 4 x 10(5) in electrohydraulic, 8 x 10(6) in pneumatic, 5 x 10(4) in holmium:YAG and 1 x 10(6) in pulsed dye laser lithotripsy cases (p <0.001). The rate of bacterial sterilization was 50% for holmium:YAG lithotripsy treated stones versus 0% for each of the other cohorts (p <0.01). CONCLUSIONS: P. mirabilis viability varies among lithotrites. The photothermal mechanism of holmium:YAG lithotripsy is antibacterial.

Humans↗

Struvite scale formation and control.

Struvite scale formation is a major operational issue at both conventional and biological nutrient removal wastewater treatment plants. Factors affecting the formation of struvite scales were investigated including supersaturation, pH and pipe material and roughness. A range of control methods have been investigated including low fouling materials, pH control, inhibitor and chemical dosing. Control methods exist to reduce scale formation although each has its advantages and disadvantages.

Chemical Precipitation↗

Ammonium nitrogen removal from slurry-type swine wastewater by pretreatment using struvite crystallization for nitrogen control of anaerobic digestion.

Precipitation of ammonium together with phosphate and magnesium is a possible alternative for lowering the nitrogen content of wastewater. In this study we examine the removal of ammonium nitrogen and phosphorus from slurry-type swine wastewater containing high concentrations of nutrients by the addition of phosphoric acid along with either calcium oxide or magnesium oxide, which leads to the crystallization of insoluble salts such as hydroxyapatite and struvite. The struvite crystallization method showed a high capacity for the removal of nitrogen when magnesium oxide and phosphoric acid were used as the magnesium and phosphate sources, respectively. When it was applied to swine wastewater containing a high concentration of nitrogen, the injection molar ratio of Mg2+:NH4+:PO4(3-) that gave maximum ammonium nitrogen removal was 3.0:1.0:1.5.

Animals↗

Citric acid (solution R) irrigation in the treatment of refractory infection (struvite) stone disease: is it useful?

OBJECTIVE: Citric acid, in varying concentrations, has been used in the dissolution treatment of struvite renal calculi. Solution R (Uro-trainer), which contains 6% citric acid, is a solution licensed for use in the management of struvite stone disease in the UK. We report our experience. METHODS: 23 kidneys in 22 patients (10 male and 12 female patients, mean age 45, range 15-60 years) underwent solution R irrigation following debulking of the stone with percutaneous nephrolithotomy (n = 20), ureteroscopy and shock wave lithotripsy (n = 2) combined with open procedures (n = 4) between 1994 and 1998. The original stone configuration consisted of 14 staghorn, 4 partial staghorn and 5 large burden stones. Irrigation was performed through a nephrostomy tube (n = 20) or in a retrograde fashion (n = 3) using a closed infusion pump system (40 ml/h). The response to treatment was checked using a nephrostogram and/or plain X-ray. RESULTS: In 6 (26%) kidneys, after an average duration of 2 (1-5) days, irrigation had to be abandoned due to loin pain, leak or sepsis. The average duration of irrigation was 6.4 (1-20) days. At the end of irrigation, a total of 4 (17.4%) kidneys had complete radiographic clearance, while the stone was reduced to calyceal dust in 3 (13%). Partial response was seen in 11 (47.8%) and no response in 5 (21.8%) kidneys. Following additional alternative intervention(s) in 6 (26%) kidneys (4 with partial and 2 with no response) further clearance was achieved in 3 (13%) and calyceal dust status in 3 (13%). The response was better if the stone was reduced to less than 10mm prior to irrigation. At the mean follow-up of 2.44 (1-4) years, of 13 kidneys with stone clearance or calyceal dust, 9 suffered recurrence or re-growth, 5 of which required further interventions. Only 4 (17.4%) of 23 kidneys remained stone free. CONCLUSIONS: In patients with complex stone disease, adjuvant solution R irrigation can reduce the stone burden. There is a considerable potential for side effects necessitating close monitoring for sepsis and electrolyte abnormalities. However, the overall success rate for solution R is limited.

Adolescent↗

[Struvite stone dietetics: 1. Effect of different feed rations on the urine pH value of cats].

In this investigation the base excess of cat foods (sum of alkalogenic compounds calcium, magnesium, sodium and potassium minus sum of acidifying compounds phosphorus, chloride, methionine and cysteine; base excess in mmol/kg dry matter = Ca*2+Mg*2+Na+K-(met(-)+cys)*2-P*2-Cl) as a method of predicting the influence of food on the urinary pH was tested. The base excess and the effect on urinary pH (feeding experiment with 4 to 6 adult cats per trial) was determined in 10 commercial cat foods (3 moist, 3 dry type foods, 4 struvite diets) as well as the influence of several additives (CaCl2, CaCO3, Ca-lactate, CaHPO4, phosphoric acid in 2 doses, NH4Cl, ascorbic acid). After the intake of commercial cat foods the mean urine pH ranged between 6.58 and 7.89, after the intake of struvite diets it ranged between 6.36 and 7.57. The addition of Ca-carbonate or -lactate led to a significant increase of urine pH, Ca-phosphate and ascorbic acid had no effect, while Ca-Chloride, phosphoric acid and ammonium chloride led to a decrease. There was a highly significant correlation between the base excess in the food (x; mmol/kg dry matter) and the mean urine pH (y; y = 6.72 + 0.0021 x; r = 0.96**).

Animal Feed↗

Effect of extracorporeal shock wave lithotripsy on bacterial viability. Relationship to the treatment of struvite stones.

The aim of this study was to determine whether extracorporeal shock wave lithotripsy (ESWL) affected the viability of the infecting bacteria within a simulated struvite stone matrix. A strain, Proteus mirabilis 28cii, was prepared in three forms: (1) suspended in saline and urine, (2) artificially encapsulated by suspending in agar beads and (3) artificially encapsulated and mineralised by suspending in agar beads with calcium carbonate crystals. The preparations were placed in capped vials partially immersed in degassed water and held in the focal point of the Siemens Lithostar and given 1,000 shocks. Subsequent viability testing showed that bacteria suspended in urine were greatly affected by shock treatments (55% loss in viability), but incorporation into agar beads negated this effect (even if the cells were exposed to 2000 shocks). Mineralisation of the beads with calcium carbonate crystals caused a decrease in viability of 82% that was significantly different from controls. However, this still left 2.3 X 10(8) viable organisms (82% of 2.8 X 10(8], easily enough to form the focus for further infections. A series of control experiments carried out using an ultrasonic cell sonicator probe gave comparable results to those obtained with ESWL. These results demonstrate the ESWL treatment of infected stones must be accompanied by antimicrobial coverage.

Humans↗

Primary dissolution therapy of struvite calculi.

Percutaneous nephrostomy and hemiacidrin were used as primary treatment of magnesium ammonium phosphate calculi in 32 surgical candidates. Of 28 patients who actually received hemiacidrin 24 (85 per cent) had successful treatment (no surgery necessary), including 19 (68 per cent) who had total stone dissolution. There were no significant complications. Patients have been followed for 3 months to 7 years. Percutaneous nephrostomy with hemiacidrin infusion is another possible treatment in the growing alternatives available for patients with urinary struvite calculi.

Citrates↗

Hemiacidrin irrigation in the management of struvite calculi: long-term results.

Renacidin (10 per cent hemiacidrin) irrigation has been used in the management of renal struvite calculi in 25 patients. Of these patients 22 were free of stone after irrigation: 16 after dissolution of residual stone fragments postoperatively, 4 after prophylactic postoperative irrigation and 2 after primary, nonsurgical percutaneous dissolution. Recurrent urinary tract infections owing to the original urease-producing bacteria occurred in 14 per cent of these patients and recurrent nephrolithiasis occurred in 9 per cent during an average followup period of 66 months.

Adult↗

Phosphorus removal from a real anaerobic supernatant by struvite crystallization.

In this paper the phosphorus removal from a real anaerobic supernatant through the crystallization of struvite and or hydroxyapatite was investigated. A comparison between experimental results on phosphorus crystallization carried out in a fluidized-bed reactor (FBR) on a bench-scale and on a half-scale plant is presented, together with a double saturational model able to describe all experimental results, independent of the different geometry of the reactors, the distinct contact times and the unlike products obtained. Experimental results show that removal efficiencies are very satisfactory, and the maximum phosphorus removal is of 80%.

Anaerobiosis↗

Treatment options in struvite stones.

Urinary calculi have plagued man over the centuries. The epidemiology and pathogenesis of infection have been studied. The curative treatment remains problematic. Without therapy, a vicious cycle of stone formation occurs. This results in renal damage and even death. Multimodality therapy is the key. Nonoperative treatment leads to progressive renal damage. The combination of maximal surgical ablation and medical therapy is synergistic. The combination of PCNL-ESWL has not appeared to produce ill effects. PCNL-ESWL is a less morbid surgical alternative than open surgical procedures. Adjunctive medical therapy, such as culture-specific antibiotics and urease inhibitors, complements surgical ablation by reducing the morbidity with persistent UTIs and stone recurrence. The urologist today must approach struvite staghorns with a vast armamentarium of surgical and medical techniques. Each patient requires a unique solution.

Humans↗

Medical dissolution of canine struvite uroliths.

Medical therapy is an effective method of canine struvite urolith dissolution. Recommendations include (1) eradication or control of urinary tract infection (if present), (2) use of calculolytic diets, and (3) administration of urease inhibitors to patients with persistent urinary tract infection caused by urease-producing microbes.

Animals↗

Rem nut ion exchange plus struvite precipitation process.

Nutrients control technologies from wastewater are based on destructive technologies which defer the problem fromthe diluted liquid-phase (effluent) to a more concentrated waste (sludge) in the case of phosphates, or to nitrogen gas and/or volatile compounds in the case of ammonia. The REM NUT process allows for simultaneous removal of phosphate and ammonium ions by selective ion exchange and recovery by chemical precipitation in the form of struvite (magnesium ammonium phosphate) from the spent exchangers regeneration eluates. In the paper revised versions of the REM NUT process, i.e., P-driven layouts, are presented and cost effectiveness is compared to chemical precipitation based on the use of ferric chloride.

Chemical Precipitation↗