Effect of antibiotic treatment on Oxalobacter formigenes colonization of the gut microbiome and urinary oxalate excretion

The incidence of kidney stones is increasing in the US population. Oxalate, a major factor for stone formation, is degraded by gut bacteria reducing its intestinal absorption. Intestinal O. formigenes colonization has been associated with a lower risk for recurrent kidney stones in humans. In the current study, we used a clinical trial of the eradication of Helicobacter pylori to assess the effects of an antibiotic course on O. formigenes colonization, urine electrolytes, and the composition of the intestinal microbiome. Of 69 healthy adult subjects recruited, 19 received antibiotics for H. pylori eradication, while 46 were followed as controls. Serial fecal samples were examined for O. formigenes presence and microbiota characteristics. Urine, collected serially fasting and following a standard meal, was tested for oxalate and electrolyte concentrations. O. formigenes prevalence was 50%. Colonization was significantly and persistently suppressed in antibiotic-exposed subjects but remained stable in controls. Urinary pH increased after antibiotics, but urinary oxalate did not differ between the control and treatment groups. In subjects not on antibiotics, the O. formigenes-positive samples had higher alpha-diversity and significantly differed in Beta-diversity from the O. formigenes-negative samples. Specific taxa varied in abundance in relation to urinary oxalate levels. These studies identified significant antibiotic effects on O. formigenes colonization and urinary electrolytes and showed that overall microbiome structure differed in subjects according to O. formigenes presence. Identifying a consortium of bacterial taxa associated with urinary oxalate may provide clues for the primary prevention of kidney stones in healthy adults.

Acute and Chronic Hyponatremia

Hyponatremia is the most common electrolyte disorder in clinical practice. Catastrophic complications can occur from severe acute hyponatremia and from inappropriate management of acute and chronic hyponatremia. It is essential to define the hypotonic state associated with hyponatremia in order to plan therapy. Understanding cerebral defense mechanisms to hyponatremia are key factors to its manifestations and classification and subsequently to its management. Hypotonic hyponatremia is differentiated on the basis of urine osmolality, urine electrolytes and volume status and its treatment is decided based on chronicity and the presence or absence of central nervous (CNS) symptoms. Proper knowledge of sodium and water homeostasis is essential in individualizing therapeutic plans and avoid iatrogenic complications while managing this disorder.

Abstract P093: Sex-stratified Associations Of Urine Electrolytes With 10th & 90th Percentiles Of Systolic Blood Pressure Distribution

Introduction: Electrolytes intake influence systolic blood pressure (SBP). Studies often explore the association of urine electrolytes with the conditional mean difference of SBP, but limited data exist on the sex-specific associations of urine electrolytes’ excretion with low and high end SBP distribution. We examined the sex-stratified association of urine electrolytes with the 10th and 90th percentiles of SBP. Methods: We pooled 9,804 person-visits (n =1467 participants) data of 24-hour urine electrolytes and SBP from three cohorts in coastal Bangladesh. We created sex-stratified restricted cubic spline (RCS) plots from quantile regression for illustrating the associations of urine sodium (Na), potassium (K), calcium (Ca), and magnesium (Mg) excretion with the 10th and 90th percentile of SBP distribution, adjusted for age, body mass index, physical activity, smoking, alcohol consumption, sleep hours, religion, household wealth, cohort ID, and seasonality. Four knots at the 5th, 35th, 65th, and 95th percentiles of each electrolyte distribution were used to create RCS plots. Results: We found linear positive associations for urine Na with 10th and 90th percentiles of SBP for males, but such association for the 10th percentile of SBP for females was less steep. Negative associations were found between urine K and SBP for males for the 90th percentile of SBP; no such association was found for the 10th percentile of SBP. Linear negative associations were found between urine Mg and SBP for males for both the 10th and 90th percentile of SBP distributions, but not for females. There was no association of urine Ca and SBP for both sexes for the 10th percentile of SBP, but negative associations existed for the 90th percentile of SBP for males. Conclusion: Sex-specific associations of urine electrolytes and SBP varied for the low and high end of SBP distribution. Males with higher SBP could benefit from high urine K, Ca, and Mg, representing high intakes of these minerals. However, such benefits may not be present for females.

Effects of Intravenous Magnesium Sulfate on Calcium-Regulating Hormones, Plasma and Urinary Electrolytes in Healthy Horses

Intravenous magnesium sulfate (MgSO4) is used in equine practice to treat hypomagnesemia, dysrhythmias, neurological disorders, and calcium dysregulation. MgSO4 is also used as a calming agent in equestrian events. Hypercalcemia affects calcium-regulating hormones, as well as plasma and urinary electrolytes; however, the effect of hypermagnesemia on these variables is unknown. The goal of this study was to investigate the effect of hypermagnesemia on blood parathyroid hormone (PTH), calcitonin (CT), ionized calcium (Ca2+), ionized magnesium (Mg2+), sodium (Na+), potassium (K+), chloride (Cl-) and their urinary fractional excretion (F) after intravenous administration of MgSO4 in healthy horses. Twelve healthy female horses of 4-18 years of age and 432-600 kg of body weight received a single intravenous dose of MgSO4 (60 mg/kg) over 5 minutes, and blood and urine samples were collected at different time points over 360 minutes. Plasma Mg2+ concentrations increased 3.7-fold over baseline values at 5 minutes and remained elevated for 120 minutes (P < 0.05), Ca2+ concentrations decreased from 30-60 minutes (P < 0.05), but Na+, K+ and Cl- concentrations did not change. Serum PTH concentrations dropped initially to rebound and remain elevated from 30 to 60 minutes, while CT concentrations increased at 5 minutes to return to baseline by 10 minutes (P < 0.05). The FMg, FCa, FNa, FK, and FCl increased, while urine osmolality decreased from 30-60 minutes compared baseline (P < 0.05). Experimental hypermagnesemia alters calcium-regulating hormones (PTH, CT), reduces plasma Ca2+ concentrations, and increases the urinary excretion of Mg2+, Ca2+, K+, Na+ and Cl- in healthy horses. This information has clinical implications on the short-term effects of hypermagnesemia on calcium-regulating hormones as well as plasma and urine electrolytes.

Effect of antibiotic treatment on Oxalobacter formigenes colonization of the gut microbiome and urinary oxalate excretion

Background: The incidence of kidney stones is increasing in the US population. Oxalate, a major factor for stone formation, is degraded by gut bacteria reducing its intestinal absorption. Intestinal O. formigenes colonization has been associated with a lower risk for recurrent kidney stones in humans. In the current study, we used a clinical trial of the eradication of Helicobacter pylori to assess the effects of an antibiotic course on O. formigenes colonization, urine electrolytes, and the composition of the intestinal microbiome. Methods: Of 69 healthy adult subjects recruited, 19 received antibiotics for H. pylori eradication, while 46 were followed as controls. Serial fecal samples were examined for O. formigenes presence and microbiota characteristics. Urine, collected serially fasting and following a standard meal, was tested for oxalate and electrolyte concentrations. Results: O. formigenes prevalence was 50%. Colonization was significantly and persistently suppressed in antibiotic-exposed subjects but remained stable in controls. Urinary pH increased after antibiotics, but urinary oxalate did not differ between the control and treatment groups. The O. formigenes-positive samples had higher alpha-diversity and significantly differed in Beta-diversity from the O. formigenes-negative samples. Specific taxa varied in abundance in relation to urinary oxalate levels.Conclusions: These studies identified significant antibiotic effects on O. formigenes colonization and urinary electrolytes and showed that overall microbiome structure differed in subjects according to O. formigenes presence. Identifying a consortium of bacterial taxa associated with urinary oxalate may provide clues for the primary prevention of kidney stones in healthy adults.

Short-Term Stability of Urine Electrolytes: Effect of Time and Storage Conditions

The purpose of this investigation was to quantify the effects of storage temperature and duration on the assessment of urine electrolytes. Twenty-one separate human urine specimens were analyzed as baseline and with the remaining specimen separated into eight vials, two in each of the following four temperatures: 22, 7, −20, and −80 °C. Each specimen was analyzed for urine electrolytes (sodium, potassium, and chloride) after 24 and 48 hr. After 24 hr, no significant difference was detected from baseline in urine sodium, potassium, and chloride at all four storage temperatures (p > .05). Similarly, after 48 hr, urine sodium, potassium, and chloride were not significantly different from baseline in all four storage temperatures (p > .05). In conclusion, these data show that urine specimens analyzed for urine sodium, chloride, and potassium are stable up to 48 hr in temperatures ranging from deep freezing to room temperature.

Significance of hypernatremia due to SARS-CoV-2 associated ARDS in critically ill patients

Background and ObjectivesSARS-CoV-2-induced ARDS is a new entity that should be characterized as it appears to be different from standard ARDS. Hypernatremia is a biological alteration that seems to occur very often in this population without any clear cause. The present study aims to clarify the possible causes of hypernatremia and evaluate its impact on patient outcome.Patients and MethodsWe conducted a retrospective one-day prevalence study in 2 intensive care units, which only treated COVID-19 patients with moderate to severe ARDS. We measured blood and urine electrolytes in all the patients. Patients with chronic renal failure or renal replacement therapy were excluded from the study. Hypernatremia was defined as plasma sodium levels above 145 mmol/L.ResultsInclusion criteria were met in 17 out of 24 patients. Hypernatremia was present in 52% patients. All had a natriuresis higher than 20 mmol/L and a urine osmolality above 600 mOsm/L. Hypernatremia was acquired in ICU as all the patients had a normal serum sodium level at admission.ConclusionThe incidence of hypernatremia was elevated and appears to be linked to significant insensible water losses. This should trigger us to optimize the maintenance fluid therapy in critically ill patients with SARS-CoV-2-induced ARDS.