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I found this question in Princeton Review Elite: It doesn't seem right.
Cystinuria is an autosomal recessive inherited condition that results in inadequate reabsorption of cystine in the proximal convoluted tubule, thus resulting in excess amounts of this basic amino acid in the urine. Which of the following treatments may help prevent the precipitation of cystine stones?
A. Urine acidification with cranberry juice
B. Urine alkalinization with potassium citrate
C. A diet rich in meat, fish, sausages, eggs, cheese and soy beans
D. Monitoring urine concentration and maintaining a high urine specific gravity
Explanation:
B. As mentioned in the question stem, cystine is a basic amino acid. Basic substances have increased solubility in basic solutions, therefore alkalinization of the urine would be expected to lead to increased cystine solubility and therefore decreased cystine stone precipitation (choice B is correct). Potassium citrate is commonly used in patients with cystinuria for this mechanism. Urine acidification would create the opposite conditions and would likely lead to increased cystine precipitation (choice A is wrong). Meat, fish, sausages, eggs and soy beans are all high-protein foods which would lead to increased amino acids and therefore increased cystine. The increased cystine concentration would lead to increased precipitation (choice C is incorrect). Patients with cystinuria are told to avoid these foods for that reason. Another method of decreasing cystine concentration would be to increase fluid consumption, effectively diluting the urine. Dilute urine has a lower specific gravity, and would decrease cystine precipitation (choice D is wrong).
Since when is a basic compound more soluble in a basic solution? Doesn't this violate the common ion effect? Wikipedia actually confirms the explanation given: http://en.wikipedia.org/wiki/Cystinuria#Treatment
So what's up with that?
Cystinuria is an autosomal recessive inherited condition that results in inadequate reabsorption of cystine in the proximal convoluted tubule, thus resulting in excess amounts of this basic amino acid in the urine. Which of the following treatments may help prevent the precipitation of cystine stones?
A. Urine acidification with cranberry juice
B. Urine alkalinization with potassium citrate
C. A diet rich in meat, fish, sausages, eggs, cheese and soy beans
D. Monitoring urine concentration and maintaining a high urine specific gravity
Explanation:
B. As mentioned in the question stem, cystine is a basic amino acid. Basic substances have increased solubility in basic solutions, therefore alkalinization of the urine would be expected to lead to increased cystine solubility and therefore decreased cystine stone precipitation (choice B is correct). Potassium citrate is commonly used in patients with cystinuria for this mechanism. Urine acidification would create the opposite conditions and would likely lead to increased cystine precipitation (choice A is wrong). Meat, fish, sausages, eggs and soy beans are all high-protein foods which would lead to increased amino acids and therefore increased cystine. The increased cystine concentration would lead to increased precipitation (choice C is incorrect). Patients with cystinuria are told to avoid these foods for that reason. Another method of decreasing cystine concentration would be to increase fluid consumption, effectively diluting the urine. Dilute urine has a lower specific gravity, and would decrease cystine precipitation (choice D is wrong).
Since when is a basic compound more soluble in a basic solution? Doesn't this violate the common ion effect? Wikipedia actually confirms the explanation given: http://en.wikipedia.org/wiki/Cystinuria#Treatment
So what's up with that?