The therapeutic effect of citrus aurantifolia swingle in idiopathic hypocitraturic calcium nephrolithiasis

Abstract

Background: Hypocitraturia is one of the main risks of stone appearance or renal stone recurrence that is
easily interfered. A sphere citrus fruit (Citrus aurantifolia Swingle) was reported to contain the highest
citrate compared to other citrus fruits.
Aims: We aimed to determine the effect of Citrus aurantifolia Swingle on the management of hypocitraturia,
compared with potassium citrate.
Materials and Methods: Seventy two patients with idiopathic calcium renal stone with hypocitraturia were
randomly divided into two groups, therapy and placebo groups. The first group was given potassium citrate
treatment (2x20 mEq/day), while the second one was given 2x1.5-g pure lactose. After 6 months,
patients without stomachache complaints were given 40ml citrus juice diluted in 2 glasses of water, taken
immediately after dinner for 10 days. Observation was done on risk factors in urine collected for 8, 16 and
24-hours, including volume, pH, potassium, magnesium, oxalate, citrate, calcium, sodium, phosphate,
sulphate, uric acid, ureum and creatinine. The setting of this study was 1 hospital in Yogyakarta and 2
hospitals in Jakarta.
Results: The increase of urine volume, pH, level and total citrate value, level and total potassium, and the
decrease of calcium ratio to citrate urine. The changes of those metabolite levels could lessen the chance
of colic and hematuria complaints, as seen after 6 months administation of potassium citrate. Similar
results were obtained from the administration of citrus juice, except for calcium level, which was not
decreased.
Conclusion: The administration of potassium citrate 2x20mEq/day in 6 months improved patient’s complaints
and occurrence of renal colic, while consumption of Citrus aurantifolia Swingle in idiopathic calcium renal
stone with hypocitraturia was concluded to increase the urine volume, pH level and total citrate value,
level and total potassium, and the decrease of calcium ratio to urine citrate.
Key word: renal stone- hypocitraturia- Citrus aurantifolia Swingle