Metabolic Risk Factors in Patients with Kidney Stones with and without Type 2 Diabetes

Background: In the past few decades, the prevalence of kidney stones in Western countries has increased in parallel with the growing overweight/obesity and type 2 diabetes mellitus rates. An increased insulin resistance in these patients explains, in part, the rising prevalence of uric acid stones. The objective of this retrospective study is to evaluate the metabolic abnormalities in type 2 diabetic and non-diabetic patients with kidney stones. All patients were evaluated following an ambulatory protocol for kidney stones. Methods: A total of 104 diabetic patients (age: 57.8 ± 11 years) and 130 non-diabetic (age: 52.1 ± 6.7 years) patients with kidney stones were selected. Higher rates of body mass index, hypertension, urinary tract infection, gout and hyperuricemia were observed in diabetic patients as compared to the non-diabetics, while similar rates were found for their family history of kidney stones. Results: Urinary pH was lower in diabetic patients than in non-diabetic patients. Metabolic abnormalities were detected in 95.2% and 81.5% of diabetic and non-diabetic, respectively. Unduly acidic urine pH was the most frequent abnormality in diabetic patients while hyperuricosuria was the second more common abnormality. On the other hand, in non-diabetics patients idiopathic hypercalciuria was the most common metabolic abnormality followed by hyperuricosuria. Conclusions: The main risk factor for lithogenesis in type 2 diabetes is unduly acidic urine pH, followed by hyperuricosuria and idiopathic hypercalciuria.

LABORATORY TRIAL OF PROTEIN DETERMINATION IN URINE USING DIFFERENT PH VALUES OF ACETIC ACID AND ACETATE BUFFER METHOD

The determination of protein in urine is important in clinical examination along with other parameters in urine. The presence of protein in urine can be interpreted that there is a disorder in kidney. Acid and heat coagulations method is still widely used in many areas to determine protein in urine. In this method, the characteristic of protein that will precipitate in the presence of acid or if exposed to heat is deployed to gain information about the amount of protein. The greater amount of protein, the more prominence is the coagulation. Urine pH also varies according to the condition, classic acidosis will give an acidic urine and the presence of ammonium producing bacteria can cause basic urine. In this research acetic acid method with 6% of CH3COOH and pH value of 2,9 and buffer acetic with pH 4,5 are used to determine the certain amount of protein (+3 value, corresponds with 2-4 mg/dL protein in urine) in varied pH values of urine samples. To compare the results, first in control urine with pH 6,8 the results of both methods is compared and shows no significant different, then the Kruskall-Wallis test is used to compare the results in other pH values to control and the test is shown also there are no significant difference. This shows that either acetic acid at pH 2,9 or acetic buffer at pH 4,5 can be used to determine protein amount in urine.

1466. Alkaline Urine: A Cause for Urinary Tract Infection Recurrence

Background Urinary tract infections (UTIs) are one of the most common indications for antibiotics in both the inpatient and outpatient setting. The purpose of this study was to examine the impact of urinary pH on recurrence of UTIs. A recent review article stated imaging should be considered for patients with a urinary pH of 7 or higher. This study examines the impact of pH on outcomes of patients with UTI to determine whether pH plays a role in recurrent infection and representations to the healthcare facility. Methods This was a retrospective chart review via the computerized patient record system. Patients over the age of 18 years who presented to the healthcare facility between January 1, 2005 to January 1, 2019 for treatment of UTIs were included in this study. Alkaline urine was defined as a urinary pH greater than or equal to 7, while acidic urine was defined as a urinary pH less than 7. Urease splitting organisms included Proteus spp., Providencia spp., and Morganella spp. Outcomes included recurrence and re-presentation to the healthcare facility within 30 days. Results A total of 793 patients were included in this study, of which 21.3% had alkaline urine. Patients with alkaline urine were more likely to have recurrence of UTI (8.3% vs. 4.3%). Patients with a catheter were more likely to have alkaline urine (30% vs 18%; P = 0.0005). As expected, alkaline urine was associated with a higher frequency of urease splitting organisms (19% in alkaline urine vs. 3% in acidic urine). Renal calculi were found in 3.6% of patients with alkaline urine; however, only 34.3% of patients with alkaline urine had imaging completed. The use of drugs which can alkalinize the urine did not differ significantly between groups. Conclusion Patients with an alkaline urinary pH were more likely to experience recurrence and readmission within 30 days. Imaging was performed in a minority of patients which may represent a potential target for stewardship programs. Alkaline urine may be a marker for urease splitting organisms and calculi formation. More widespread imaging may be able to detect stones, allowing for potential urologic intervention, preventing subsequent antibiotic courses and repeated healthcare presentations. Disclosures All authors: No reported disclosures.

Explorative Randomized Phase II Clinical Study of the Efficacy and Safety of Finafloxacin versus Ciprofloxacin for Treatment of Complicated Urinary Tract Infections

ABSTRACT The broad-spectrum C-8-cyano-fluoroquinolone finafloxacin displays enhanced activity under acidic conditions. This phase II clinical study compared the efficacies and safeties of finafloxacin and ciprofloxacin in patients with complicated urinary tract infection and/or pyelonephritis. A 5-day regimen with 800 mg finafloxacin once a day (q.d.) (FINA05) had results similar to those of a 10-day regimen with 800 mg finafloxacin q.d. (FINA10). Combined microbiological and clinical responses at the test-of-cure (TOC) visit were 70% for FINA05, 68% for FINA10, and 57% for a 10-day ciprofloxacin regimen (CIPRO10) in 193 patients (64 for FINA05, 68 for FINA10, and 61 for CIPRO10) of the microbiological intent-to-treat (mITT) population. Additionally, the clinical effects of ciprofloxacin on patients with an acidic urine pH (80% of patients) were reduced, whereas the effects of finafloxacin were unchanged. Finafloxacin was safe and well tolerated. Overall, 43.4% of the patients in the FINA05 group, 42.7% in the FINA10 group, and 54.2% in the CIPRO10 group experienced mostly mild and treatment-emergent but unrelated adverse events. A short-course regimen of 5 days of finafloxacin resulted in high eradication and improved clinical outcome rates compared to those for treatment with ciprofloxacin for 10 days. In contrast to those of ciprofloxacin, the clinical effects of finafloxacin were not reduced by acidic urine pH. Hospitalized adults were randomized 1:1:1 to finafloxacin treatment (800 mg q.d.) for either 5 or 10 days or to ciprofloxacin treatment (400 mg/500 mg b.i.d.) for 10 days with an optional switch from intravenous (i.v.) to oral administration at day 3. The primary endpoint was the combined microbiological and clinical response at the TOC visit in the microbiological intent-to-treat population. (This study has been registered at ClinicalTrials.gov under identifier NCT01928433.)

METABOLIC EVALUATION OF PATIENTS WITH RECURRENT AND MULTIPLE RENAL STONES: A PROSPECTIVE STUDY

ABSTRACTObjective: Renal stone disease has become an important clinical condition worldwide, and it results from a combination of several factors whichare biochemical, epidemiologic, and genetic in origin. Preventive measures are very important concerning stone disease and these measures greatlydepend on the type of stones. Performing a metabolic evaluation of stone patients to identify metabolic abnormality, if any, and treating the same helpsreduce the recurrence of stones. To identify and correct the metabolic risk factors of patients presenting with either recurrent, bilateral, or multiplestones and thereby reduce the recurrence of stones.Methods: A hospital-based prospective observational study, including collection of essential data of 100 patients and analyzing them for any metabolicabnormality.Results: Out of the 100 patients, 73 were males and 27 were females. The frequency of stone formation was high in the age group 51-60, eventhough age is not a significant factor. Only 55 patients underwent metabolic evaluation, in which 23 patients (41.8%) had a metabolic abnormality.The common abnormality found in this geographical area was hyperuricosuria (29.1%) followed by hypercalciuria (7.3%). Hypercalciuria was notstatistically significant, but hyperuricosuria and acidic urine pH were significant factors that contribute to stone formation.Conclusion: Metabolic evaluation is a must for renal stone patients which greatly help reduce the risk of stone recurrence. Hyperuricemia wasobserved to be the major abnormality followed by hypercalciuria. Acidic urine pH and low urine volume were other significant risk factors.Keywords: Nephrolithiasis, Metabolic evaluation, Hyperuricosuria, Hypercalciuria.

The Relationship between Acidic Urinary pH and Overactive Bladder; Alkalization of Urine Improves the Symptoms of Overactive Bladder

Background: To determine association between urine pH and OAB symptoms and to determine if urinary alkalization improves overactive bladder (OAB) symptoms. Methods: 659 patients with OAB were enrolled in this study between June 2012 and May 2014. 329 patients (group 1) were included in the final analysis. 201 adults were used as a control group (group 2). 24-hour urinary pH and the validated Turkish version of the OAB-V8 questionnaire were performed in patients. A 24-hour urine pH <6.2 was considered acidic urine. In the second part, a diet program was performed for 4 weeks in 30 participants. Urine pH values and OAB-V8 scoring results were recorded before the diet program and 2 and 4 weeks after the diet program. Results: Acidic urinary pH was determined in 61.4% of patients with OAB. There was a significant association between the presence of acidic urine and OAB. Also, the OAB-V8 scores of patients were significantly higher in patients with acidic urine than nonacidic urine. OAB-V8 scores of patients showed statistically significant improvement after diet therapy (17.87 ± 6.52 vs. 10.43 ± 7.17; p < 0.001). Conclusions: We found that acidic urinary pH was closely associated with OAB, and alkalization of urine improved lower urinary tract symptoms. We suggest that urinary pH should be considered as a parameter in treatment planning of patients with OAB.

A PUBS Case in a Palliative Care Unit Experience

Purple urine bag syndrome (PUBS) is a rare condition in which purple discoloration of the collecting bag and its associated tubing occurs. It is considered a benign condition. PUBS is usually associated with urinary tract infection occurring in elderly bedridden women, with chronic urinary catheterization. This syndrome is usually reported to occur in alkaline urine, but here we describe a rare case of PUBS involving acidic urine.

Urinary Concentrations and Antibacterial Activities of Nitroxoline at 250 Milligrams versus Trimethoprim at 200 Milligrams against Uropathogens in Healthy Volunteers

ABSTRACTBecause of the increasing bacterial resistance of uropathogens against standard antibiotics, such as trimethoprim (TMP), older antimicrobial drugs, such as nitroxoline (NTX), should be reevaluated. This randomized crossover study investigated the urinary concentrations of parent drugs and their metabolites and their antibacterial activities (urinary inhibitory titers [UITs] and urinary bactericidal titers [UBTs]) against uropathogens at three different urinary pH values within 24 h in six healthy volunteers after a single oral dose of NTX at 250 mg versus TMP at 200 mg. In three additional volunteers, urinary bactericidal kinetics (UBK) were studied after oral administration of NTX at 250 mg three times a day. The mean urinary concentrations of NTX and NTX sulfate in 24 h were 0.012 to 0.507 mg/liter and 0.28 to 27.83 mg/liter, respectively. The mean urinary concentrations of TMP were 18.79 to 41.59 mg/liter. The antibacterial activity of NTX was higher in acidic urine than in alkaline urine, and that of TMP was higher in alkaline urine than in acidic urine. The UITs and UBTs of NTX were generally lower than those of TMP except for a TMP-resistantEscherichia colistrain, for which NTX showed higher UITs/UBTs than did TMP. UBK showed mainly bacteriostatic activity of NTX in urine. NTX exhibits mainly bacteriostatic activity and TMP also shows bactericidal activity in urine against susceptible strains. NTX is a more active antibacterial in acidic urine, and TMP is more active in alkaline urine. The cumulative effects of multiple doses or inhibition of bacterial adherence could not be evaluated. (This study has been registered at EudraCT under registration no. 2009-015631-32.)