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Urolithiasis and comparison between Urosinal Syrup and zyloric Tablet

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  • 1. Overview • Introduction • Conditions causing stone formation • Types of kidney stones • Calcium salts • Uric acid • Mg ammonium PO4 • Cystine • Other (xanthine, etc.) • Laboratory investigations • Comparison Between Urosinal Syrup & Zyloric Tablets
  • 2. Urolithiasis • Urolithiasis is the condition where urinary stones are formed or located anywhere in the urinary system • The term nephrolithiasis (or "renal calculus") refers to stones that are in the kidney, • Ureterolithiasis refers to stones that are in the ureter. • The term cystolithiasis (or vesical calculi) refers to stones which form or have passed into the urinary bladder. • Stones are Composed of metabolic products present in glomerular filtrate • These products are in high conc.  Near or above maximum solubility
  • 3. Conditions causing kidney stone formation High conc. of metabolic products in glomerular filtrate Changes in urine pH Urinary stagnation Deficiency of stone-forming inhibitors in urine
  • 4. High conc. of metabolic products in glomerular filtrate is due to:  Low urinary volume (with normal renal function) due to restricted fluid intake  Increased fluid loss from the body  Increased excretion of metabolic products forming stones  High plasma volume (high filtrate level)  Low tubular reabsorption from filtrate
  • 5. Changes in urine pH is due to: • Bacterial infection • Precipitation of salts at different pH Urinary stagnation is due to: • Obstruction of urinary flow
  • 6. Deficiency of stone-forming inhibitors: Citrate, pyrophosphate, glycoproteins inhibit growth of calcium phosphate and calcium oxalate crystals In type I renal tubular acidosis, hypocitraturia leads to renal stones
  • 7. Kidney Stone type Population Circumstances Details Calcium oxalate 80% when urine is alkaline (ph>5.5) Some of the oxalate in urine is produced by the body. Calcium and oxalate in the diet play a part but are not the only factors that affect the formation of calcium oxalate stones. Dietary oxalate is an organic molecule found in many vegetables, fruits, and nuts. Calcium from bone may also play a role in kidney stone formation. Calcium phosphate 5-10% when urine is alkaline (high pH) : staghorn in renal pelvis (large) Uric acid 5-10% when urine is persistently acidic Diets rich in animal proteins and purines: substances found naturally in all food but especially in organ meats, fish, and shellfish. Struvite 10-15% infections in the kidney Preventing struvite stones depends on staying infection-free. Diet has not been shown to affect struvite stone formation. Cystine 1-2% rare genetic disorder Cystine, an amino acid (one of the building blocks of protein), leaks through the kidneys and into the urine to form crystals.
  • 8. Calcium salt stones  80% of kidney stones contain calcium  The type of salt depends on • Urine pH • Availability of oxalate  General appearance: • White, hard, radioopaque • Calcium PO4: staghorn in renal pelvis (large) • Calcium oxalate: present in ureter (small) Calcium oxalate stones
  • 9. Calcium salt stones Causes of calcium salt stones:  Hypercalciuria: • Increased urinary calcium excretion • Men: > 7.5 mmols/day • Women > 6.2 mmols/day • May or may not be due to hypercalcemia  Hyperoxaluria: • Causes the formation of calcium oxalates without hypercalciuria • Diet rich in oxalates • Increased oxalate absorption in fat malabsorption  Primary hyperoxaluria: • Due to inborn errors • Urinary oxalate excretion: > 400 mmols/day
  • 10. Calcium salt stones Treatment: • Treatment of primary causes such as infection, hypercalcemia, hyperoxaluria • Oxalate-restricted diet • Increased fluid intake • Acidification of urine (by dietary changes) • Calcium salt stones are formed in alkaline urine
  • 11. Uric acid stones • About 8% of renal stones contain uric acid • May be associated with hyperuricemia (with or without gout) • Form in acidic urine • General appearance: • Small, friable, yellowish • May form staghorn • Radiolucent (plain x-rays cannot detect) • Visualized by ultrasound or i.v. pyelogram
  • 12. Mg ammonium PO4 stones  About 10% of all renal stones contain Mg amm. PO4  Also called struvite kidney stones  Associated with chronic urinary tract infection • Microorganisms (such as from Proteus genus) that metabolize urea into ammonia • Causing urine pH to become alkaline and stone formation • Commonly associated with staghorn calculi • 75% of staghorn stones are of struvite type
  • 13. Cystine stones • A rare type of kidney stone • Due to homozygous cystinuria • Form in acidic urine • Soluble in alkaline urine • Faint radio-opaque Treatment: • Increased fluid intake • Alkalinization of urine (by dietary changes) • Penicillamine (binds to cysteine to form a compound more soluble than cystine)
  • 14. Laboratory investigations of kidney stones If stone has formed and removed:  Chemical analysis of stone helps to: • Identify the cause • Advise patient on prevention and future recurrence
  • 15. Laboratory investigations of kidney stones If stone has not formed: • This type of investigation identifies causes that may contribute to stone formation Serum calcium and uric acid analysis Urinalysis: volume, calcium, oxalates and cystine levels Urine pH > 8 suggests urinary tract infection (Mg amm. PO4) Urinary tract imaging: Ultrasound and i.v. pyelogram
  • 16. Comparison Between Urosinal Syrup & Zyloric Tablet Urosinal Syrup Zyloric Tablet
  • 17. Name of the product Urosinal Zyloric Tablets Composition Barley Salt 500 mg Potassium Nitrate500 mg Solanum nigrum (Leaves)125 mg Solanum nigrum Berries 62.5 mg Preservatives BaseQ.S Allopurinol 100 mg , Excipents Lactose Maize Starch Povidone Magnesium Stearate Purified Water Pharmaceutical form Syrup:120 ml (Tablets) 100 & 300 mg Indications Urinary Bladder Ailments, Kidney Disorders, Liver Disorders, Urinary Retention indicated for reducing urate/uric acid formation in conditions where urate/uric acid deposition has already occurred (e.g. gouty arthritis, skin tophi, nephrolithiasis) or is a predictable clinical risk (e.g. treatment of malignancy potentially leading to acute uric acid nephropathy).
  • 18. Name of the product Urosinal Zyloric Tablets Pharmacodynamic It lowers the level of uric acid in the body, and alleviates gout and rheumatism. Mechanism not known Allopurinol is a xanthine- oxidase inhibitor. Allopurinol and its main metabolite oxipurinol lower the level of uric acid in plasma and urine by inhibition of xanthine oxidase, the enzyme catalyzing the oxidation of hypoxanthine to xanthine and xanthine to uric acid. In addition to the inhibition of purine catabolism in some but not all hyperuricaemic patients, de novo purine biosynthesis is depressed via feedback inhibition of hypoxanthine-guanine phosphoribosyltransferase. Other metabolites of allopurinol include allopurinol- riboside and oxipurinol-7 riboside.
  • 19. Name of the product Urosinal Zyloric Tablets Pharmacokinetics Not Known Allopurinol is active when given orally and is rapidly absorbed from the upper gastrointestinal tract. Allopurinol is negligibly bound by plasma proteins and therefore variations in protein binding are not thought to significantly alter clearance. Estimates of bioavailability vary from 67% to 90%. Peak plasma levels of allopurinol generally occur approximately 1.5 hours after oral administration of Zyloric, but fall rapidly and are barely detectable after 6 hours. Approximately 20% of the ingested allopurinol is excreted in the faeces. Elimination of allopurinol is mainly by metabolic conversion to oxipurinol by xanthine oxidase and aldehyde oxidase, with less than 10% of the unchanged drug excreted in the urine. Allopurinol has a plasma half-life of about 1 to 2 hours
  • 20. Name Of The product Urosinal Zyloric Tablets Dosage Children: 2.5 ml (half a teaspoonful) mixed with milk or Sharbat Bazoori in the morning and in the evening. Adults: 5 ml (one teaspoonful) mixed with milk or sharbat Bazoori in the morning and in the evening Children: Children under 15 years: 10 to 20 mg/kg bodyweight/day up to a maximum of 400 mg daily. Use in children is rarely indicated, except in malignant conditions (especially leukaemia) and certain enzyme disorders such as Lesch- Nyhan syndrome. Adults: In the absence of specific data, the lowest dosage which produces satisfactory urate reduction should be used. i.e 100mg/day Contraindications Not Reported Zyloric should not be administered to individuals known to be hypersensitive to allopurinol or to any of the components of the formulation.
  • 21. Name Of The product Urosinal Zyloric Tablets Interaction with other medicinal products Not Known Salicylates and uricosuric agents decrease its activity Chlorpropamide increased risk of prolonged hypoglycaemic activity Theophylline: Inhibition of the metabolism of theophylline Frequency of skin rash increases patients receiving ampicillin or amoxicillin concurrently with allopurinol Side Effects No side effects reported Skin reactions are the most common reactions and may occur at any time during treatment. They may be pruritic, maculopapular, sometimes

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