Increased production and reduced urinary buffering of acid in uric acid stone formers is ameliorated by pioglitazone

Kidney International
Naim M MaaloufKhashayar Sakhaee

Abstract

Idiopathic uric acid nephrolithiasis is characterized by an overly acidic urine pH caused by the combination of increased acid production and inadequate buffering of urinary protons by ammonia. A large proportion of uric acid stone formers exhibit features of the metabolic syndrome. We previously demonstrated that thiazolidinediones improved the urinary biochemical profile in an animal model of the metabolic syndrome. In this proof-of-concept study, we examined whether the thiazolidinedione pioglitazone can also ameliorate the overly acidic urine in uric acid stone formers. Thirty-six adults with idiopathic uric acid nephrolithiasis were randomized to pioglitazone 30 mg/day or matching placebo for 24 weeks. At baseline and study end, participants underwent collection of blood and 24-hour urine in an inpatient research unit while consuming a fixed metabolic diet, followed by assessment of the ammoniagenic response to an acute oral acid load. Twenty-eight participants completed the study. Pioglitazone treatment improved features of the metabolic syndrome. Pioglitazone also reduced net acid excretion and increased urine pH (5.37 to 5.59), the proportion of net acid excreted as ammonium, and ammonium excretion in response to an acu...Continue Reading

Citations

Oct 17, 2019·International Journal of Molecular Sciences·Hong Sheng ChengNguan Soon Tan
May 14, 2020·Current Opinion in Nephrology and Hypertension·Triet Vincent M Tran, Naim M Maalouf
Sep 29, 2019·Journal of Clinical Medicine·Chan Jung LiuHo Shang Huang
Dec 18, 2020·Current Opinion in Urology·Lazaros TzelvesAndreas Skolarikos
Mar 9, 2021·Seminars in Nephrology·Emmanuel Adomako, Orson W Moe

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