Kidney stone disease is a severe condition that can be characterized as the formation of crystal concretion within this organ. The complications can lead to renal failure, which is dangerous for a patient. In the case scenario, the development of the kidney stones of the 29 years old patient is facilitated by both genetic factors and the essence of the diet consumed by this individual in the past month. This paper aims to review the specifics of kidney stone formation and provide an explanation of the biochemical processes affecting this patient.
The genetic factors that contribute to the development of this illness described in the case scenario are the gene mutations and prevalence of some conditions in a specific population. Hence, the patient’s ethnicity can have a significant impact on the prospects of developing renal stones. A study by Groopman, Rasouly and Gharavi (2018) explored the prevalence of kidney disease among different populations and found that Jewish-Ashkenazi communities have a significantly higher prevalence of these conditions. These authors conclude that “mutations for autosomal recessive Alport syndrome (OMIM 203780), Fanconi anemia type C (OMIM 227645), and Zellweger syndrome (OMIM 614866)” is prevalent among the Jewish population (Groopman, Rasouly, & Gharavi, 2018, p. 83). The mutation of alleles alters the specifics of amino acid metabolism. This may be the factor that contributed to the development of kidney stone disease in this 29 years old patient.
Based on this information, one can conclude that the prevalence of the condition is correlated with genetics. However, it is not the only factor that one should review. According to Alelign and Petros (2018) “formation of kidney stones (calculogenesis) is a complex and multifactorial process including intrinsic (such as age, sex, and heredity) and extrinsic factors such as geography, climate, dietary, mineral composition, and water intake” (p. 2). The authors argue that the exclusion of animal protein as a component of the diet helps patients prevent stones in kidneys. The epigenetic characteristics that contribute to the increased risk of having kidney stones are also relevant in this scenario.
The amino acids, apart from glycine, that is considered as contributing factors to the development of stones in this 29 years old patient are glyoxylate and oxalate. This patient consumed large amounts of collagen from his jello and chicken diet, which contributes to the formation process of pyruvate and glyoxylate. A paper that describes the amino-acid composition of collagen is by Gauza-Włodarczyk, Kubisz, and Włodarczyk (2017) exploring the specifics of collagen. The author describes the composition of collagen, which contains nineteen amino acids. Among them, there is hydroxyproline, which is unique to collagen and cannot be found in other proteins. Therefore, among the dietary factors that increase the risk of developing stones in kidneys, researchers cite an increased intake of animal protein. In this case, the patient ate only jello and chicken. Hence, one of the recommendations is a decrease in the consumption of animal protein. Based on this, one can argue that the modification of diet would prevent and help reduce the symptoms that are a result of stones.
Animal studies support the fact that the increased intake of glycine and hydroxyproline leads to increased amounts of oxalate in the urine. A study by Letavernier et al. (2016) enhances the understanding of the problem since the authors study kidney stone formation in rats. The conclusions suggest that calcium, as well as D vitamin, have an impact on the process of stone formation. Supplementation of rats with B6 vitamin is considered an effective strategy towards mitigating the adverse effects of animal protein on the prospects of forming kidney stones. Kalicki et al. (2019) argue that their study supports this claim in cases of high animal protein intake. Vitamin B6 and moderate exercise appear to improve the various vital parameters of the subjects. Hence, people subjected to similar modifications in their dietary intake should be aware of the prospective issues accompanying similar changes.
Despite the fact that animal models support the claims that mixed evidence exists regarding the effectiveness of providing patients with kidney stones with B6, especially for the Jewish population. Clinical research supported these conclusions, for instance, Ferraro, Taylor, Gambaro, and Curhan (2018) argue that an increased intake of B6 vitamins in humans leads to an increased in the risks of having kidney stone disease. Although prior studies, especially those conducted on animals suggest that such an approach can reduce the presence of oxalate in the urine, suggesting a lower risk of stone formation, some authors refute this approach. Ferraro, Taylor, Gambaro, and Curhan (2018) state that previous studies produced conflicting results on this subject, requiring additional research. In the sample examined by the authors, the subjects who took vitamin B6 supplements are provided urine samples for testing.
The idea underlying the vitamin B6 approach is connected to the biochemical processes. The associating between the intake of this supplement and the decrees in the levels of oxalate is the primary implication. However, some researchers cited by Ferraro, Taylor, Gambaro, and Curhan (2018) argue that this can also affect the alanine-glyoxylate aminotransferase. Hence, more glyoxylate would be transformed into oxalate, resulting in a higher risk of kidney stones. In the case of this patient who was subjected to high protein intake, it is possible that the adverse effect of glyoxylate metabolism would further increase the risks.
The biochemistry that may underline the formation of stones in this patient’s case is connected to the specifics of oxalate functioning. In essence, this is an end product of metabolism that is associated with hyperoxaluria. The stones in the kidney, exposed to oxalate react through the process of reactive oxygen species, which results in stone formation. Hence, the damage caused by oxalate results in the adaptation of the kidney cells, which produces stones. In the case of this patient, the explored information provides an understanding of the fact that his genetics subjected him to a higher sensitivity regarding renal diseases. Additionally, the specifics of his diet containing large amounts of collagen, which is an animal protein allowed the amino acids to metabolize. The result is a significant concentration of oxalate, leading to kidney stones. Hydroxyproline and glycine amino acids are a part of this process, contributing to the increase of oxalate.
Overall, this research paper provided evidence suggesting that the 29-year-old Jewish patient developed large kidney stones both due to his diet and genetic specifies prevalent in his ethnicity. The findings from various studies suggest that kidney stones are a result of complex biochemical reactions. Rat studies and examination of human subjects produce conflicting results regarding the efficiency of vitamin B6 supplementation and its impact on the disease, especially when considering the populations genetically predisposed to this issue.
Alelign T, & Petros B (2018) Kidney stone disease: An update on current concepts, Advances in Urology, 2018: 1-12.
Ferraro P, Taylor E, Gambaro G, & Curhan G (2017) Vitamin B6 intake and the risk of incident kidney stones, Urolithiasis, 46(3): 265-270.
Gauza-Włodarczyk M, Kubisz L, & Włodarczyk, D (2017) Amino acid composition in the determination of collagen origin and assessment of physical factors effects, International Journal of Biological Macromolecules, 104(A): 987-991.
Groopman E, Rasouly H, & Gharavi A (2018) Genomic medicine for kidney disease, Nature Reviews Nephrology, 14(2): 83-104.
Kalicki B, Lewicka A, Jęderka K, Leśniak M, Marszałkowska-Jakubik J, & Lewicki S (2019) Vitamin B6 improves blood parameters in rats fed a protein-deficient diet and subjected to moderate, long-term exercise, Central European Journal Of Immunology, 44(1): 23-32.
Letavernier E, Verrier C, Goussard F, Perez J, Huguet L, & Haymann, J (2016) Calcium and vitamin D have a synergistic role in a rat model of kidney stone disease. Kidney International, 90(4): 809-817.