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Abstract
Renal tubular acidosis (RTA) is comprised of a diverse group of congenital or acquired diseases with the common denominator of defective renal acid excretion with protean manifestation, but in adults, recurrent kidney stones and nephrocalcinosis are mainly found in presentation. Calcium phosphate (CaP) stones and nephrocalcinosis are frequently encountered in distal hypokalemic RTA type I. Alkaline urinary pH, hypocitraturia, and, less frequently, hypercalciuria are the tripartite lithogenic factors in distal RTA (dRTA) predisposing to CaP stone formation; the latter 2 are also commonly encountered in other causes of urolithiasis. Although the full blown syndrome is easily diagnosed by conventional clinical criteria, an attenuated forme fruste called incomplete dRTA typically evades clinical testing and is only uncovered by provocative acid-loading challenges. Stone formers (SFs) that cannot acidify urine of pH < 5.3 during acid loading are considered to have incomplete dRTA. However, urinary acidification capacity is not a dichotomous but rather a continuous trait, so incomplete dRTA is not a distinct entity but may be one end of a spectrum. Recent findings suggest that incomplete dRTA can be attributed to heterozygous carriers of hypofunctional V-ATPase. The value of incomplete dRTA diagnosis by provocative testing and genotyping candidate genes is a valuable research tool, but it remains unclear at the moment whether they alter clinical practice and needs further clarification. No randomized controlled trials have been performed in SFs with dRTA or CaP stones, and until such data are available, treatment of CaP stones are centered on reversing the biochemical abnormalities encountered in the metabolic workup. SFs with type I dRTA should receive alkali therapy, preferentially in the form of K-citrate delivered judiciously to treat the chronic acid retention that drives both stone formation and bone disease.
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Rapid kV-switching single-source dual-energy CT ex vivo renal calculi characterization using a multiparametric approach: refining parameters on an expanded dataset. Abdom Radiol (NY) 2018; 43:1439-1445. [PMID: 28952007 DOI: 10.1007/s00261-017-1331-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We aimed to determine the best algorithms for renal stone composition characterization using rapid kV-switching single-source dual-energy computed tomography (rsDECT) and a multiparametric approach after dataset expansion and refinement of variables. METHODS rsDECT scans (80 and 140 kVp) were performed on 38 ex vivo 5- to 10-mm renal stones composed of uric acid (UA; n = 21), struvite (STR; n = 5), cystine (CYS; n = 5), and calcium oxalate monohydrate (COM; n = 7). Measurements were obtained for 17 variables: mean Hounsfield units (HU) at 11 monochromatic keV levels, effective Z, 2 iodine-water material basis pairs, and 3 mean monochromatic keV ratios (40/140, 70/120, 70/140). Analysis included using 5 multiparametric algorithms: Support Vector Machine, RandomTree, Artificial Neural Network, Naïve Bayes Tree, and Decision Tree (C4.5). RESULTS Separating UA from non-UA stones was 100% accurate using multiple methods. For non-UA stones, using a 70-keV mean cutoff value of 694 HU had 100% accuracy for distinguishing COM from non-COM (CYS, STR) stones. The best result for distinguishing all 3 non-UA subtypes was obtained using RandomTree (15/17, 88%). CONCLUSIONS For stones 5 mm or larger, multiple methods can distinguish UA from non-UA and COM from non-COM stones with 100% accuracy. Thus, the choice for analysis is per the user's preference. The best model for separating all three non-UA subtypes was 88% accurate, although with considerable individual overlap between CYS and STR stones. Larger, more diverse datasets, including in vivo data and technical improvements in material separation, may offer more guidance in distinguishing non-UA stone subtypes in the clinical setting.
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Prochaska M, Taylor E, Ferraro PM, Curhan G. Relative Supersaturation of 24-Hour Urine and Likelihood of Kidney Stones. J Urol 2018; 199:1262-1266. [PMID: 29132983 PMCID: PMC5911189 DOI: 10.1016/j.juro.2017.10.046] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE The relative supersaturation of calcium oxalate, calcium phosphate and uric acid is used clinically in kidney stone prevention. The magnitude of the association between relative supersaturation and stone risk requires further quantification. MATERIALS AND METHODS We performed a cross-sectional study using 24-hour urine collections from the NHS (Nurses' Health Study) I and II, and HPFS (Health Professionals Follow-up Study) cohorts to quantify the association between the relative supersaturation of calcium oxalate, calcium phosphate and uric acid, and the likelihood of stone formation. RESULTS The OR of being a stone former was 5.85 (95% CI 3.40-10.04) in NHS I, 6.38 (95% CI 3.72-11.0) in NHS II and 6.95 (95% CI 3.56-13.6) in HPFS for the highest category of calcium oxalate relative supersaturation compared with less than 1.0. The OR of being a stone former was 1.86 (95% CI 0.94-3.71) in NHS I, 4.37 (95% CI 2.68-7.10) in NHS II and 3.59 (95% CI 2.04-6.31) in HPFS for the highest category of calcium phosphate relative supersaturation compared with less than 1.0. For uric acid relative supersaturation the OR of being a stone former was 4.30 (95% CI 2.34-7.90) in NHS I and 2.74 (95% CI 1.71-4.40) in NHS II for the highest relative supersaturation category compared with less than 1.0. In HPFS the uric acid relative supersaturation was not significantly associated with the likelihood of stone formation. CONCLUSIONS The likelihood of being a stone former increases with higher relative supersaturation of calcium oxalate and calcium phosphate in men and women, and with higher relative supersaturation of uric acid in women.
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Affiliation(s)
- Megan Prochaska
- Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Eric Taylor
- Division of Renal Medicine and Channing Division of Network Medicine, Brigham, Massachusetts; Division of Nephrology and Transplantation, Maine Medical Center, Portland, Maine
| | - Pietro Manuel Ferraro
- Division of Nephrology, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Gary Curhan
- Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Li H, Zhang J, Long J, Shi J, Luo Y. Calcium-sensing receptor gene polymorphism (rs7652589) is associated with calcium nephrolithiasis in the population of Yi nationality in Southwestern China. Ann Hum Genet 2018; 82:265-271. [PMID: 29682741 DOI: 10.1111/ahg.12249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 01/09/2023]
Abstract
The calcium-sensing receptor (CaSR) gene plays an important role in regulating the Ca2+ balance and reducing the risk for calcium stones. In this study, we evaluated the association of CaSR polymorphisms with calcium nephrolithiasis in the population of Yi nationality in Southwestern China. Biochemical variables were evaluated in 624 calcium nephrolithiasis patients and 470 age-matched healthy controls without a history of nephrolithiasis. CaSR polymorphisms rs7652589, rs1501899, rs1801725 (Ala986Ser), rs1042636 (Arg990Gly) and rs1801726 (Gln1011Glu) were investigated between the calcium nephrolithiasis patients and healthy controls, using direct sequencing. Compared with the healthy controls, serum creatinine and 24-hour urine calcium levels were significantly higher in calcium nephrolithiasis patients. Among these five polymorphisms, the genotypic and allelic frequency distributions of rs7652589 SNP was significantly associated with the risk of calcium nephrolithiasis. However, there were no genotypic or allelic distribution differences for rs1501899, rs1801725, rs1042636, and rs1801726 polymorphisms between calcium nephrolithiasis patients and healthy controls. Moreover, the association between rs7652589 SNP genotypes and the biochemical variables was not found. Our study showed that CaSR rs7652589 polymorphism had a significant effect on the risk of developing calcium nephrolithiasis in the population of Yi nationality in Southwestern China.
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Affiliation(s)
- Hao Li
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jianhua Zhang
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jiang Long
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Jiarun Shi
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
| | - Yuhui Luo
- Department of Urology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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Susaeta R, Benavente D, Marchant F, Gana R. Diagnóstico y manejo de litiasis renales en adultos y niños. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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56
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Ludwig WW, Matlaga BR. Urinary Stone Disease: Diagnosis, Medical Therapy, and Surgical Management. Med Clin North Am 2018; 102:265-277. [PMID: 29406057 DOI: 10.1016/j.mcna.2017.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Clinical suspicion of urolithiasis should be evaluated with low-dose computed tomography as the first-line imaging modality for nonpregnant, adult patients. A period of observation may be appropriate for ureteral stones less than 10 mm, and medical expulsive therapy may be beneficial for facilitating passage of distal ureteral stones. Regardless of stone type, patients should adhere to a low-sodium diet and attempt to achieve a urine volume of more than 2.5 L daily. Individuals with calcium stones should maintain a normal calcium diet, and if stones persist, citrate therapy or thiazide diuretics in the setting of hypercalciuria may be indicated.
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Affiliation(s)
- Wesley W Ludwig
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA.
| | - Brian R Matlaga
- Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Marburg 134, Baltimore, MD 21287, USA
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57
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Wei FF, Thijs L, Zhang ZY, Jacobs L, Yang WY, Salvi E, Citterio L, Cauwenberghs N, Kuznetsova T, E A Drummen N, Hara A, Manunta P, Li Y, Verhamme P, Allegaert K, Cusi D, Vermeer C, Staessen JA. The risk of nephrolithiasis is causally related to inactive matrix Gla protein, a marker of vitamin K status: a Mendelian randomization study in a Flemish population. Nephrol Dial Transplant 2018; 33:514-522. [PMID: 28340119 DOI: 10.1093/ndt/gfx014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/15/2017] [Indexed: 01/12/2023] Open
Abstract
Background Vitamin K (VK)-dependent γ-glutamate carboxylation and serine phosphorylation activate matrix Gla protein (MGP) to a potent locally acting inhibitor of calcification. Nephrolithiasis represents a process of unwanted calcification associated with substantial mortality and high recurrence rates. We hypothesized that the risk of nephrolithiasis increases with VK shortage, as exemplified by higher plasma levels of desphospho-uncarboxylated MGP (dp-ucMGP). Methods In 1748 randomly recruited Flemish individuals (51.1% women; mean age 46.8 years), we determined dp-ucMGP and the prevalence of nephrolithiasis at baseline (April 1996-February 2015) and its incidence during follow-up until March 2016. We estimated the multivariable-adjusted relative risk associated with the doubling of dp-ucMGP, using logistic or Cox regression. We did a Mendelian randomization analysis using four MGP genotypes as instrumental variables. Results With adjustments applied for sex, age and 24-h urinary volume and calcium excretion, the odds of having prevalent nephrolithiasis [n = 144 (8.2%)] associated with dp-ucMGP was 1.31 [95% confidence interval (CI) 1.04-1.64; P = 0.022]. dp-ucMGP levels were associated (P ≤ 0.001) with MGP variants rs2098435, rs4236 and rs2430692. In the Mendelian analysis, the causal odds ratio was 3.82 (95% CI 1.15-12.7; P = 0.029). The incidence of nephrolithiasis over 12.0 years (median) was 37 cases (0.2%). With similar adjustments as before, the hazard ratio in relation to dp-ucMGP was 2.48 (95% CI 1.71-3.61; P < 0.001). Additional adjustment for a nephrolithiasis propensity score produced consistent results. Conclusion Higher levels of inactive dp-ucMGP may be causally associated with the risk of nephrolithiasis. Whether or not VK deficiency plays a role in these observations remains to be firmly established.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Erika Salvi
- Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy
| | - Lorena Citterio
- Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute and School of Nephrology, University Vita-Salute San Raffaele, Milan, Italy
| | - Nicholas Cauwenberghs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Paolo Manunta
- Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute and School of Nephrology, University Vita-Salute San Raffaele, Milan, Italy
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peter Verhamme
- Research Unit of Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Allegaert
- Research Unit of Organ Systems, KU Leuven Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Daniele Cusi
- Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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58
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Cong X, Shen L, Gu X. Current opinions on nephrolithiasis associated with primary hyperparathyroidism. Urolithiasis 2018; 46:453-457. [PMID: 29350243 DOI: 10.1007/s00240-018-1038-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/10/2018] [Indexed: 12/23/2022]
Abstract
Nephrolithiasis is a common urological disease and could be secondary to primary hyperparathyroidism (PHPT). PHPT is traditionally characterised with hypercalcaemia. Recently, a normocalcemic PHPT has been officially recognised at the International Workshops. Regarding this new phenotype, nephrolithiasis is frequently found in studies that evaluate low bone mass. However, until now, no study on aetiology of nephrolithiasis considered normocalcemic PHPT. Hypercalciuria related to PHPT is considered as an important risk factor of stone formation in hypercalcemic PHPT, but the precise relationships between hypercalcemic PHPT and nephrolithiasis and between normocalcemic PHPT and nephrolithiasis remain unclear. In patients with hypercalcemic PHPT, after a surgical cure of PHPT, the renal calcium excretion and stone recurrence rate reduce but remain higher above health controls. This finding implies that abnormalities not caused by PHPT also probably affect stone formation. According to the new guideline, the presence of stones indicates the need for parathyroidectomy in patients with either hypercalcemic or normocalcemic PHPT unless contraindications exist. Patients with contraindications for parathyroidectomy or those who do not want to receive parathyroidectomy should be monitored for signs of disease progression and given of medical management. Moreover, due to decreased but significantly higher frequency of nephrolithiasis above those of healthy controls, patients with nephrolithiasis associated with PHPT after parathyroidectomy still should be motivated to explore strategies to prevent stone occurrence.
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Affiliation(s)
- Xiaoming Cong
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Luming Shen
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Xiaojian Gu
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
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59
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Khan AH, Imran S, Talati J, Jafri L. Fourier transform infrared spectroscopy for analysis of kidney stones. Investig Clin Urol 2018; 59:32-37. [PMID: 29333512 PMCID: PMC5754580 DOI: 10.4111/icu.2018.59.1.32] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/13/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the results of a chemical method of kidney stone analysis with the results of Fourier transform infrared (FT-IR) spectroscopy. Materials and Methods Kidney stones collected between June and October 2015 were simultaneously analyzed by chemical and FT-IR methods. Results Kidney stones (n=449) were collected from patients from 1 to 81 years old. Most stones were from adults, with only 11.5% from children (aged 3–16 years) and 1.5% from children aged <2 years. The male to female ratio was 4.6. In adults, the calcium oxalate stone type, calcium oxalate monohydrate (COM, n=224), was the most common crystal, followed by uric acid and calcium oxalate dihydrate (COD, n=83). In children, the most frequently occurring type was predominantly COD (n=21), followed by COM (n=11), ammonium urate (n=10), carbonate apatite (n=6), uric acid (n=4), and cystine (n=1). Core composition in 22 stones showed ammonium urate (n=2), COM (n=2), and carbonate apatite (n=1) in five stones, while uric acid crystals were detected (n=13) by FT-IR. While chemical analysis identified 3 stones as uric acid and the rest as calcium oxalate only. Agreement between the two methods was moderate, with a kappa statistic of 0.57 (95% confidence interval, 0.5–0.64). Disagreement was noted in the analysis of 77 stones. Conclusions FT-IR analysis of kidney stones can overcome many limitations associated with chemical analysis.
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Affiliation(s)
- Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sheharbano Imran
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Jamsheer Talati
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Lena Jafri
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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60
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Gouru VR, Pogula VR, Vaddi SP, Manne V, Byram R, Kadiyala LS. Metabolic evaluation of children with urolithiasis. Urol Ann 2018; 10:94-99. [PMID: 29416283 PMCID: PMC5791466 DOI: 10.4103/ua.ua_98_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study is to identify the prevalence of metabolic abnormalities in children with urolithiasis. Materials and Methods: This is a prospective study; all children below 15 years who are found to have urolithiasis were prospectively evaluated with relevant history, clinical examination, and urine and serum testing. Metabolic workup includes complete urine examination, urine culture and sensitivity, and 24-h urinary analysis (lithorisk profile). Results: A total of 55 patients are included in the study. Forty-two are boys and 13 are girls aged between from 8 months to 15 years. Thirty-three patients underwent stone analysis, primary composition of calcium oxalate stones in 19 (58%), ammonium urate in 4, dahlite in 3 and uric acid in 3, silicon oxide in 2, and struvite in 2 cases. Lithorisk profile was performed in 40 cases (72.7%). The pH range is 5.6–6.2. We noted hypercalciuria in 20 patients (50%), hyperuricosuria in 23 (57.5%), hyperoxaluria in 20 (50%), hypernatriuria in 26 (65%), hypocitraturia in 9 (23%), and hypomagnesuria in 3 (7.5%). Urine calcium-to-creatinine ratio >0.2 was found in 22 (55%) patients. Statistically significant association between hyperoxaluria and hyperuricosuria (P < 0.04, r = 0.32) and hypercalciuria and hyperuricosuria (P < 0.001, r = 0.51) found in this study. Hyperuricosuria is seen in 75% and 73% of patients with hypercalciuria and hyperoxaluria, respectively. Twenty-five children have both lithorisk profile and stone analysis. Hypercalciuria and hyperoxaluria were noted in 60% of calcium oxalate stone formers each. Elevated urinary calcium/creatinine ratio (>0.2) was seen in 73% of calcium oxalate stone formers. Conclusion: Because of high prevalence of metabolic risk factors and the significant risk of lifelong recurrence, all children with urolithiasis need complete evaluation with metabolic workup.
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Affiliation(s)
- Vijayabhaskar Reddy Gouru
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Vedamurthy Reddy Pogula
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Surya Prakash Vaddi
- Department of Urology and Renal Transplantation, Virinchi Hospitals, Hyderabad, Telangana, India
| | - Venu Manne
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Ranadheer Byram
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
| | - Lalith Sagar Kadiyala
- Department of Urology and Renal Transplantation, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
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Najafi Z, Schwartz BF, Chandy AJ, Mahajan AM. A two-dimensional numerical study of peristaltic contractions in obstructed ureter flows. Comput Methods Biomech Biomed Engin 2017; 21:22-32. [PMID: 29271257 DOI: 10.1080/10255842.2017.1415333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The flow of urine from the kidneys to the bladder is accomplished via peristaltic contractions in the ureters. The peristalsis of urine through the ureter can sometimes be accompanied, more specifically, obstructed to a certain degree, by entities such as kidney stones. In this paper, 2D axisymmetric computational fluid dynamics simulations are carried out using the commercial code ANSYS FLUENT[Formula: see text], to model the peristaltic movement of the ureter with and without stone. The peristaltic movement was assumed to be a sinusoidal wave on the boundary of the ureter with a specific physiological velocity. While the first part of the study considers flow in the ureter with prescribed peristaltic contractions in absence of any obstruction, the second part compares the effect of varying obstructions (0, 5, 15, and 35%) in terms of spherical stones of different sizes. Pressure contours, velocity vectors, and profiles of pressure gradient magnitudes and wall shear stresses are presented along one bolus of the ureter, during contraction and expansion of the ureteral wall, in order to understand backflow, trapping and reflux phenomena, as well as monitor the health of the ureteral wall in the presence of any obstruction. The 35% ureteral obstruction case resulted in a significant backflow at the inlet in comparison to the other cases, and also a wall shear stress that was up to 20x larger than the case without any obstruction.
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Affiliation(s)
- Z Najafi
- a Department of Biomedical Engineering , University of Akron , Akron , OH , USA
| | - B F Schwartz
- b Division of Urology , Southern Illinois University School of Medicine , Springfield , IL , USA
| | - A J Chandy
- c Department of Mechanical Engineering , Indian Institute of Technology Bombay , Mumbai , India
| | - A M Mahajan
- a Department of Biomedical Engineering , University of Akron , Akron , OH , USA
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Jaskowiec TC, Grauer AL, Lee M, Rajnic S. No stone unturned: The presence of kidney stones in a skeleton from 19th century Peoria, Illinois. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2017; 19:18-23. [PMID: 29198396 DOI: 10.1016/j.ijpp.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/23/2017] [Indexed: 06/07/2023]
Abstract
During the excavation of the 19th century Peoria City Cemetery (Peoria, Illinois), a skeleton of a female, aged 20-30 years old, was found with large, bilateral calcified masses in the abdominal region. The masses were analyzed by Fourier transform infrared (FTIR) spectroscopy, and the results compared to published clinical data in an effort to determine the etiology of the stones. The calcified masses were determined to be staghorn struvite uroliths, which commonly result from chronic urinary tract infection and likely impacted the overall health of this individual.
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Affiliation(s)
- Thomas C Jaskowiec
- Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL 60660, United States.
| | - Anne L Grauer
- Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL 60660, United States
| | - Michael Lee
- Loyola University Chicago, 1032 W. Sheridan Rd, Chicago, IL 60660, United States
| | - Sean Rajnic
- University of Illinois Medical School, 1601 Parkview Avenue, Rockford, IL 61107, United States
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63
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Dhayat NA, Gradwell MW, Pathare G, Anderegg M, Schneider L, Luethi D, Mattmann C, Moe OW, Vogt B, Fuster DG. Furosemide/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers. Clin J Am Soc Nephrol 2017; 12:1507-1517. [PMID: 28775126 PMCID: PMC5586565 DOI: 10.2215/cjn.01320217] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, nonprovocative parameters in predicting incomplete distal renal tubular acidosis has not been studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide/fludrocortisone testing. RESULTS Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 8%. Sensitivity and specificity of the furosemide/fludrocortisone test were 77% and 85%, respectively, yielding a positive predictive value of 30% and a negative predictive value of 98%. Testing of several nonprovocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH <5.3 with a plasma potassium threshold >3.8 mEq/L yielded a negative predictive value of 98% with a sensitivity of 85% and a specificity of 77% for the diagnosis of incomplete distal renal tubular acidosis. CONCLUSIONS The furosemide/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of nonprovocative clinical parameters.
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Affiliation(s)
- Nasser A. Dhayat
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - Michael W. Gradwell
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - Ganesh Pathare
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
- Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland
| | - Manuel Anderegg
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
- Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland
| | - Lisa Schneider
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - David Luethi
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - Cedric Mattmann
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - Orson W. Moe
- Departments of Internal Medicine and Physiology, and the Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Bruno Vogt
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
| | - Daniel G. Fuster
- Division of Nephrology and Hypertension, Bern University Hospital, Bern, Switzerland
- Swiss National Centre of Competence in Research TransCure, University of Bern, Bern, Switzerland
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Knoll T, Bach T, Humke U, Neisius A, Stein R, Schönthaler M, Wendt-Nordahl G. [S2k guidelines on diagnostics, therapy and metaphylaxis of urolithiasis (AWMF 043/025) : Compendium]. Urologe A 2017; 55:904-22. [PMID: 27325405 DOI: 10.1007/s00120-016-0133-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Every tenth German citizen will suffer from at least one urinary calculus during the lifetime. The diagnostics, treatment and follow-up treatment of urolithiasis are, therefore, part of the daily routine practice for all urologists in hospitals and private practices as well as in many other disciplines, such as general practitioners, internists, nephrologists and pediatricians. Although the diagnostics and therapy have experienced substantial alterations over the last 10 years, the possibilities of metabolic diagnostics and secondary prevention for patients at risk are, unfortunately and unjustly, in many places very poorly represented. The present S2k guidelines, which for the first time were established in an interdisciplinary consensus process, represent the current practical recommendations and, whenever possible, use tables and algorithms in order to facilitate easy reference in the routine daily work. Last but not least, this greatly simplifies the measures for metaphylaxis.
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Affiliation(s)
- T Knoll
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland.
| | - T Bach
- Urologisches Zentrum Hamburg, Asklepios Klinikum Harburg, Hamburg, Deutschland
| | - U Humke
- Klinik für Urologie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - A Neisius
- Klinik für Urologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - R Stein
- Klinik für Urologie, Universitätsmedizin Mannheim, Mannheim, Deutschland
| | - M Schönthaler
- Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - G Wendt-Nordahl
- Urologische Klinik Sindelfingen, Klinikum Sindelfingen-Böblingen, Arthur-Gruber-Str. 70, 71065, Sindelfingen, Deutschland
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65
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Abou-Elela A. Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review. J Adv Res 2017; 8:513-527. [PMID: 28748117 PMCID: PMC5512151 DOI: 10.1016/j.jare.2017.04.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/16/2017] [Accepted: 04/25/2017] [Indexed: 12/31/2022] Open
Abstract
An in-depth comprehension of the epidemiology as well as pathophysiology of uric acid urolithiasis is important for the identification, treatment, and prophylaxis of calculi in these patients. Persistently low urinary pH, hyperuricosuria, and low urinary volume are the most important factors in pathogenesis of uric acid urolithiasis. Other various causes of calculus formation comprises of chronic diarrhea, renal hyperuricosuria, insulin resistance, primary gout, extra purine in the diet, neoplastic syndromes, and congenital hyperuricemia. Non-contrast-enhanced computed tomography is the radiologic modality of choice for early assessment of patients with renal colic. Excluding situations where there is acute obstruction, rising blood chemistry, severe infection, or unresolved pain, the initial management ought to be medical dissolution by oral chemolysis since this method has proved to be effective in most of the cases.
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Affiliation(s)
- A Abou-Elela
- Department Of Urology, Faculty Of Medicine, Cairo University, Kasr Al Ainy St., P.O. 11553, Cairo 11562, Egypt
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66
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Lomas DJ, Jaeger CD, Krambeck AE. Profile of the Ammonium Acid Urate Stone Former Based on a Large Contemporary Cohort. Urology 2017; 102:43-47. [DOI: 10.1016/j.urology.2016.10.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/13/2016] [Accepted: 10/14/2016] [Indexed: 11/25/2022]
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67
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The Role of the 24-Hour Urine Collection in the Prevention of Kidney Stone Recurrence. J Urol 2017; 197:1084-1089. [DOI: 10.1016/j.juro.2016.10.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 02/01/2023]
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68
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Abstract
There are several special situations in which urinary lithiasis presents management challenges to the urologist. An in-depth knowledge of the pathophysiology, unique anatomy, and treatment options is crucial in order to maintain good health in these patients. In this review, we summarize the current literature on the management of the following scenarios: bladder stones, stones in bowel disease, during pregnancy, in association with renal anomalies, with skeletal deformities, in urinary diversions, and in children.
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69
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Xu LHR, Adams-Huet B, Poindexter JR, Maalouf NM, Moe OW, Sakhaee K. Temporal Changes in Kidney Stone Composition and in Risk Factors Predisposing to Stone Formation. J Urol 2017; 197:1465-1471. [PMID: 28111301 DOI: 10.1016/j.juro.2017.01.057] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 01/30/2023]
Abstract
PURPOSE The prevalence of kidney stones has increased globally in recent decades. However, studies investigating the association between temporal changes in the risk of stone formation and stone types are scarce. We investigated temporal changes in stone composition, and demographic, serum and urinary parameters of kidney stone formers from 1980 to 2015. MATERIALS AND METHODS We retrospectively analyzed the records of 1,516 patients diagnosed with either calcium or uric acid stones at an initial visit to a university kidney stone clinic from 1980 to 2015. RESULTS From 1980 to 2015, the proportion of uric acid stones in all stone formers increased from 7% to 14%. While age and body mass index increased with time in both uric acid and calcium stone formers, uric acid stone formers were consistently older and had a higher body mass index and lower urinary pH than calcium stone formers. The proportion of females with stones has increased over time but the increase in female gender was more prominent among calcium stone formers. Urinary pH, phosphorus, oxalate and sodium increased with time in calcium stone formers but remained unchanged in uric acid stone formers. After accounting for various parameters of stone risk, the strongest clinical discriminant of uric acid vs calcium stones was urinary pH. Limitations of this study include the retrospective single center design and the available number of patients with stone analysis. CONCLUSIONS From 1980 to 2015, the proportion of uric acid stones increased significantly. With time, there were proportionately more female calcium stone formers but not uric acid stone formers. Urinary pH is the most prominent factor distinguishing uric acid from calcium stones.
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Affiliation(s)
- Li Hao Richie Xu
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Beverley Adams-Huet
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, Texas; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John R Poindexter
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Naim M Maalouf
- Division of Mineral Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Orson W Moe
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Khashayar Sakhaee
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, University of Texas Southwestern Medical Center, Dallas, Texas; Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas.
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70
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Schwaderer AL, Wolfe AJ. The association between bacteria and urinary stones. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:32. [PMID: 28217697 DOI: 10.21037/atm.2016.11.73] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urinary stone disease (USD) is an increasing clinical problem in both children and adults. One in ten individuals will experience a urinary stone, yet the mechanisms responsible for urinary stones remain largely unknown. Bacteria have long been recognized to contribute to struvite urinary stones; however, the role of bacteria in the development of the more common calcium oxalate (CaOx) and calcium phosphate (CaPhos) stones has not been extensively investigated. However, several findings do indicate a possible association between urinary stones and bacteria, including the high rate of urinary tract infections (UTI) in urinary stone patients and multiple case series of culture-positive urinary stones, including stones composed of CaOx or CaPhos. New technology, such as next generation sequencing, may be used to lend additional insight regarding the association between urinary stones and bacteria. In 2015, we published the initial bacterial sequencing results from five urinary stones, from which we sequenced multiple types of bacterial DNA. Whether these bacteria are causal, disease modifying or passively present remains to be determined. However, initial exploration of underlying mechanisms for this association indicate that bacteria aggregate selectively to crystals, that their presence is associated with increased clumping of crystals, and that they stimulate incorporation of proteins into the stone matrix.
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Affiliation(s)
- Andrew L Schwaderer
- The Research Institute at Nationwide Children's Hospital, Center for Clinical and Translational Research, Columbus, OH, USA;; Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Chicago, IL, USA
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71
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Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29:715-734. [PMID: 27456839 PMCID: PMC5080344 DOI: 10.1007/s40620-016-0329-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
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Affiliation(s)
- Giovanni Gambaro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Fredric Coe
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - Orson Moe
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, USA
| | - Elen Worcester
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - Noor Buchholz
- Department of Urological Surgery, Sobeh's Vascular and Medical Center, Dubai, UAE
| | - David Bushinsky
- Department of Nephrology, Medical Center, University of Rochester, Rochester, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, USA
| | - Pietro Manuel Ferraro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniel Fuster
- Department of Nephrology, University of Bern, Bern, Switzerland
| | - David S Goldfarb
- Department of Nephrology, New York Harbor VA Health Care System, New York, USA
| | | | - Bernard Hess
- Department of Internal Medicine and Nephrology, Klinik Im Park Hospital, Zurich, Switzerland
| | - John Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Martino Marangella
- Department of Nephrology, A.S.O Ordine Mauriziano Hospital, Turin, Italy
| | - Dawn Milliner
- Department of Nephrology, Mayo Clinic, Rochester, USA
| | - Glen M Preminger
- Department of Urology, Duke University Medical Center, Durham, USA
| | | | - Khashayar Sakhaee
- Southwestern Medical Center, Mineral Metabolism Research, University of Texas, Dallas, USA
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indiana, USA
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Buhler AV, Huynh P, Low P, Von M. Possible Drug-Associated Sialolithiasis From the Bicarbonate Anhydrase Inhibitor Topiramate: A Case Report and Literature Review. J Oral Maxillofac Surg 2016; 74:2447-2452. [DOI: 10.1016/j.joms.2016.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
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73
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Daudon M, Dessombz A, Frochot V, Letavernier E, Haymann JP, Jungers P, Bazin D. Comprehensive morpho-constitutional analysis of urinary stones improves etiological diagnosis and therapeutic strategy of nephrolithiasis. CR CHIM 2016. [DOI: 10.1016/j.crci.2016.05.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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74
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Najafi Z, Gautam P, Schwartz BF, Chandy AJ, Mahajan AM. Three-Dimensional Numerical Simulations of Peristaltic Contractions in Obstructed Ureter Flows. J Biomech Eng 2016; 138:2541046. [PMID: 27464354 DOI: 10.1115/1.4034307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Indexed: 11/08/2022]
Abstract
Ureteral peristalsis can be considered as a series of waves on the ureteral wall, which transfers the urine along the ureter toward the bladder. The stones that form in the kidney and migrate to the ureter can create a substantial health problem due to the pain caused by interaction of the ureteral walls and stones during the peristaltic motion. Three-dimensional (3D) computational fluid dynamics (CFD) simulations were carried out using the commercial code ansys fluent to solve for the peristaltic movement of the ureter, with and without stones. The effect of stone size was considered through the investigation of varying obstructions of 5%, 15%, and 35% for fixed spherical stone shape. Also, an understanding of the effect of stone shape was obtained through separate CFD calculations of the peristaltic ureter with three different types of stones, a sphere, a cube, and a star, all at a fixed obstruction percentage of 15%. Velocity vectors, mass flow rates, pressure gradients, and wall shear stresses were analyzed along one bolus of urine during peristalsis of the ureteral wall to study the various effects. It was found that the increase in obstruction increased the backflow, pressure gradients, and wall shear stresses proximal to the stone. On the other hand, with regard to the stone shape study, while the cube-shaped stones resulted in the largest backflow, the star-shaped stone showed highest pressure gradient magnitudes. Interestingly, the change in stone shape did not have a significant effect on the wall shear stress at the obstruction level studied here.
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75
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Rendina D, De Filippo G, Gianfrancesco F, Muscariello R, Schiano di Cola M, Strazzullo P, Esposito T. Evidence for epistatic interaction between VDR and SLC13A2 genes in the pathogenesis of hypocitraturia in recurrent calcium oxalate stone formers. J Nephrol 2016; 30:411-418. [PMID: 27639591 DOI: 10.1007/s40620-016-0348-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/30/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Genetic factors play a key role in the pathogenesis of hypocitraturia, a common risk factor for nephrolithiasis. The Na+-dicarboxylate cotransporter NaDC1, encoded by the sodium-dicarboxylate cotransporter (SLC13A2) gene, is a major determinant of urinary citrate excretion and its biological functions are regulated also by the vitamin D/Vitamin D receptor (VDR) biological system. The aim of this case-control study was to evaluate the possible epistatic interaction between VDR rs731236and SLC13A2 rs11567842 allelic variants in the pathogenesis of hypocitraturia. METHODS Recurrent calcium-oxalate stone formers (SF) with or without hypocitraturia and healthy controls (C) were genotyped. Gene-gene interactions were estimated by the 1.0 software package of multifactor dimensionality reduction (MDR). RESULTS The prevalence of VDR TT and SLC13A2 GG genotypes was higher in hypocitraturic SF compared to C (odds ratio [OR] 3.24, 95 % confidence interval [CI] 1.38-7.60 for VDR TT vs. VDR tt and OR 4.06, 95 % CI 1.75-9.42 for SLC13A2 GG vs. SLC13A2 AA ). MDR analysis indicated a significant interaction between VDR TT and SLC13A2 GG in hypocitraturic SF compared to C [OR 3.81 (2.11-6.88)]. These data are compatible with an epistatic interaction between the VDR TT and SLC13A2 GG genotypes with a significant impact on the magnitude of the effect (suppressive effect). CONCLUSIONS These results point to an epistatic interaction between the VDR and the SLC13A2 alleles in the pathogenesis of idiopathic hypocitraturia in calcium-oxalate SF.
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Affiliation(s)
- Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University of Naples, via Pansini 5, 80131, Naples, Italy.
| | - Gianpaolo De Filippo
- Institute of Genetics and Biophysics "Adriano Buzzati-Traverso", Italian National Research Council, Naples, Italy
| | | | - Riccardo Muscariello
- Department of Clinical Medicine and Surgery, Federico II University of Naples, via Pansini 5, 80131, Naples, Italy
| | - Michele Schiano di Cola
- Department of Clinical Medicine and Surgery, Federico II University of Naples, via Pansini 5, 80131, Naples, Italy
| | - Pasquale Strazzullo
- Department of Clinical Medicine and Surgery, Federico II University of Naples, via Pansini 5, 80131, Naples, Italy
| | - Teresa Esposito
- AP-HP, CHU Bicêtre, Service de Médecine des Adolescents, Le Kremlin-Bicêtre, France
- IRCCS INM Neuromed, Pozzilli, IS, Italy
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Kriegshauser JS, Silva AC, Paden RG, He M, Humphreys MR, Zell SI, Fu Y, Wu T. Ex Vivo Renal Stone Characterization with Single-Source Dual-Energy Computed Tomography: A Multiparametric Approach. Acad Radiol 2016; 23:969-76. [PMID: 27212607 DOI: 10.1016/j.acra.2016.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/09/2015] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
Abstract
RATIONALE AND OBJECTIVES We aimed to investigate a multiparametric approach using single-source dual-energy computed tomography (ssDECT) for the characterization of renal stones. MATERIALS AND METHODS ssDECT scans were performed at 80 and 140 kVp on 32 ex vivo kidney stones of 3-10 mm in a phantom. True composition was determined by infrared spectroscopy to be uric acid (UA; n = 14), struvite (n = 7), cystine (n = 7), or calcium oxalate monohydrate (n = 4). Measurements were obtained for up to 52 variables, including mean density at 11 monochromatic keV levels, effective Z, and multiple material basis pairs. The data were analyzed with five multiparametric algorithms. After omitting 8 stones smaller than 5 mm, the remaining 24-stone dataset was similarly analyzed. Both stone datasets were also analyzed with a subset of 14 commonly used variables in the same fashion. RESULTS For the 32-stone dataset, the best method for distinguishing UA from non-UA stones was 97% accurate, and for distinguishing the non-UA subtypes was 72% accurate. For the 24-stone dataset, the best method for distinguishing UA from non-UA stones was 100% accurate, and for distinguishing the non-UA subtypes was 75% accurate. CONCLUSION Multiparametric ssDECT methods can distinguish UA from non-UA stones of 5 mm or larger with 100% accuracy. The best model to distinguish the non-UA renal stone subtypes was 75% accurate. Further refinement of this multiparametric approach may increase the diagnostic accuracy of separating non-UA subtypes and assist in the development of a clinical paradigm for in vivo use.
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Abergel S, Peyronnet B, Seguin P, Bensalah K, Traxer O, Freund Y. Management of urinary stone disease in general practice: A French Delphi study. Eur J Gen Pract 2016; 22:103-10. [DOI: 10.3109/13814788.2016.1149568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandra Abergel
- Department of Family Medicine, Simone Veil Health Science Centre, University of Versailles Saint Quentin en Yvelines, France
- Department of Emergency Medicine, Rennes University Hospital, University of Rennes, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, University of Rennes, Rennes, France
| | - Philippe Seguin
- Department of Emergency Medicine, Rennes University Hospital, University of Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, University of Rennes, Rennes, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, Pierre and Marie Curie University, Paris, France
| | - Yonathan Freund
- Department of Emergency Medicine and Surgery, Pitie-Salpetriere Hospital, Pierre et Marie Curie University, Paris, France
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Hara A, Yang WY, Petit T, Zhang ZY, Gu YM, Wei FF, Jacobs L, Odili AN, Thijs L, Nawrot TS, Staessen JA. Incidence of nephrolithiasis in relation to environmental exposure to lead and cadmium in a population study. ENVIRONMENTAL RESEARCH 2016; 145:1-8. [PMID: 26613344 DOI: 10.1016/j.envres.2015.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Abstract
Whether environmental exposure to nephrotoxic agents that potentially interfere with calcium homeostasis, such as lead and cadmium, contribute to the incidence of nephrolithiasis needs further clarification. We investigated the relation between nephrolithiasis incidence and environmental lead and cadmium exposure in a general population. In 1302 participants randomly recruited from a Flemish population (50.9% women; mean age, 47.9 years), we obtained baseline measurements (1985-2005) of blood lead (BPb), blood cadmium (BCd), 24-h urinary cadmium (UCd) and covariables. We monitored the incidence of kidney stones until October 6, 2014. We used Cox regression to calculate multivariable-adjusted hazard ratios for nephrolithiasis. At baseline, geometric mean BPb, BCd and UCd was 0.29µmol/L, 9.0nmol/L, and 8.5nmol per 24h, respectively. Over 11.5 years (median), nephrolithiasis occurred in 40 people. Contrasting the low and top tertiles of the distributions, the sex- and age-standardized rates of nephrolithiasis expressed as events per 1000 person-years were 0.68 vs. 3.36 (p=0.0016) for BPb, 1.80 vs. 3.28 (p=0.11) for BCd, and 1.65 vs. 2.95 (p=0.28) for UCd. In continuous analysis, with adjustments applied for sex, age, serum magnesium, and 24-h urinary volume and calcium, the hazard ratios expressing the risk associated with a doubling of the exposure biomarkers were 1.35 (p=0.015) for BPb, 1.13 (p=0.22) for BCd, and 1.23 (p=0.070) for UCd. In conclusion, our results suggest that environmental lead exposure is a risk factor for nephrolithiasis in the general population.
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Affiliation(s)
- Azusa Hara
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Thibault Petit
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yu-Mei Gu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Fang-Fei Wei
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Augustine N Odili
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences University of Abuja, Nigeria
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, University of Hasselt, Belgium
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; R&D Group VitaK, Maastricht University, Maastricht, The Netherlands.
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Tailly T, Larish Y, Nadeau B, Violette P, Glickman L, Olvera-Posada D, Alenezi H, Amann J, Denstedt J, Razvi H. Combining Mean and Standard Deviation of Hounsfield Unit Measurements from Preoperative CT Allows More Accurate Prediction of Urinary Stone Composition Than Mean Hounsfield Units Alone. J Endourol 2016; 30:453-9. [PMID: 26597058 DOI: 10.1089/end.2015.0209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The mineral composition of a urinary stone may influence its surgical and medical treatment. Previous attempts at identifying stone composition based on mean Hounsfield Units (HUm) have had varied success. We aimed to evaluate the additional use of standard deviation of HU (HUsd) to more accurately predict stone composition. METHODS We identified patients from two centers who had undergone urinary stone treatment between 2006 and 2013 and had mineral stone analysis and a computed tomography (CT) available. HUm and HUsd of the stones were compared with ANOVA. Receiver operative characteristic analysis with area under the curve (AUC), Youden index, and likelihood ratio calculations were performed. RESULTS Data were available for 466 patients. The major components were calcium oxalate monohydrate (COM), uric acid, hydroxyapatite, struvite, brushite, cystine, and CO dihydrate (COD) in 41.4%, 19.3%, 12.4%, 7.5%, 5.8%, 5.4%, and 4.7% of patients, respectively. The HUm of UA and Br was significantly lower and higher than the HUm of any other stone type, respectively. HUm and HUsd were most accurate in predicting uric acid with an AUC of 0.969 and 0.851, respectively. The combined use of HUm and HUsd resulted in increased positive predictive value and higher likelihood ratios for identifying a stone's mineral composition for all stone types but COM. CONCLUSIONS To the best of our knowledge, this is the first report of CT data aiding in the prediction of brushite stone composition. Both HUm and HUsd can help predict stone composition and their combined use results in higher likelihood ratios influencing probability.
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Affiliation(s)
- Thomas Tailly
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Yaniv Larish
- 2 Division of Urology, Lenox Hill Hospital , New York, New York
| | - Brandon Nadeau
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - Philippe Violette
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Leonard Glickman
- 4 Division of Urology, Hackensack University Medical Center , Hackensack, New Jersey
| | - Daniel Olvera-Posada
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Husain Alenezi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Justin Amann
- 3 Department of Radiology, The University of Western Ontario , London, Ontario, Canada
| | - John Denstedt
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, The University of Western Ontario , St-Joseph's Healthcare, London, Ontario, Canada
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81
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Association of estimated glomerular filtration rate with 24-h urinalysis and stone composition. Urolithiasis 2015; 44:319-25. [DOI: 10.1007/s00240-015-0837-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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82
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Singh P, Enders FT, Vaughan LE, Bergstralh EJ, Knoedler JJ, Krambeck AE, Lieske JC, Rule AD. Stone Composition Among First-Time Symptomatic Kidney Stone Formers in the Community. Mayo Clin Proc 2015; 90:1356-65. [PMID: 26349951 PMCID: PMC4593754 DOI: 10.1016/j.mayocp.2015.07.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/07/2015] [Accepted: 07/10/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the variation in kidney stone composition and its association with risk factors and recurrence among first-time stone formers in the general population. PATIENTS AND METHODS Medical records were manually reviewed and validated for symptomatic kidney stone episodes among Olmsted County, Minnesota, residents from January 1, 1984, through December 31, 2012. Clinical and laboratory characteristics and the risk of symptomatic recurrence were compared between stone compositions. RESULTS There were 2961 validated first-time symptomatic kidney stone formers. Stone composition analysis was obtained in 1508 (51%) at the first episode. Stone formers were divided into the following mutually exclusive groups: any brushite (0.9%), any struvite (0.9%), any uric acid (4.8%), and majority calcium oxalate (76%) or majority hydroxyapatite (18%). Stone composition varied with clinical characteristics. A multivariable model had a 69% probability of correctly estimating stone composition but assuming calcium oxalate monohydrate stone was correct 65% of the time. Symptomatic recurrence at 10 years was approximately 50% for brushite, struvite, and uric acid but approximately 30% for calcium oxalate and hydroxyapatite stones (P<.001). Recurrence was similar across different proportions of calcium oxalate and hydroxyapatite (P for trend=.10). However, among calcium oxalate stones, 10-year recurrence rate ranged from 38% for 100% calcium oxalate dihydrate to 26% for 100% calcium oxalate monohydrate (P for trend=.007). CONCLUSION Calcium stones are more common (93.5% of stone formers) than has been previously reported. Although clinical and laboratory factors associate with the stone composition, they are of limited utility for estimating stone composition. Rarer stone compositions are more likely to recur.
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Affiliation(s)
- Prince Singh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Lisa E Vaughan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | | | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
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Pachaly MA, Baena CP, Buiar AC, de Fraga FS, Carvalho M. Effects of non-pharmacological interventions on urinary citrate levels: a systematic review and meta-analysis. Nephrol Dial Transplant 2015; 31:1203-11. [DOI: 10.1093/ndt/gfv303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/16/2015] [Indexed: 11/12/2022] Open
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84
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Jairath A, Parekh N, Otano N, Mishra S, Ganpule A, Sabnis R, Desai M. Oxalobacter formigenes: Opening the door to probiotic therapy for the treatment of hyperoxaluria. Scand J Urol 2015; 49:334-7. [DOI: 10.3109/21681805.2014.996251] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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85
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Blanco F, Lumbreras F, Serrat J, Siener R, Serranti S, Bonifazi G, López-Mesas M, Valiente M. Taking advantage of hyperspectral imaging classification of urinary stones against conventional infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:126004. [PMID: 25478869 DOI: 10.1117/1.jbo.19.12.126004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/24/2014] [Indexed: 05/15/2023]
Abstract
The analysis of urinary stones is mandatory for the best management of the disease after the stone passage in order to prevent further stone episodes. Thus the use of an appropriate methodology for an individualized stone analysis becomes a key factor for giving the patient the most suitable treatment. A recently developed hyperspectral imaging methodology, based on pixel-to-pixel analysis of near-infrared spectral images, is compared to the reference technique in stone analysis, infrared (IR) spectroscopy. The developed classification model yields >90% correct classification rate when compared to IR and is able to precisely locate stone components within the structure of the stone with a 15 µm resolution. Due to the little sample pretreatment, low analysis time, good performance of the model, and the automation of the measurements, they become analyst independent; this methodology can be considered to become a routine analysis for clinical laboratories.
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Affiliation(s)
- Francisco Blanco
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
| | - Felipe Lumbreras
- Universitat Autònoma de Barcelona, Computer Vision Center & Department of Computer Science, 08193 Bellaterra, Spain
| | - Joan Serrat
- Universitat Autònoma de Barcelona, Computer Vision Center & Department of Computer Science, 08193 Bellaterra, Spain
| | - Roswitha Siener
- University Stone Centre, Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Silvia Serranti
- Sapienza-Università di Roma, Dipartimento di Ingegneria Chimica Materiali Ambiente (DICMA), 00184 Roma, Italy
| | - Giuseppe Bonifazi
- Sapienza-Università di Roma, Dipartimento di Ingegneria Chimica Materiali Ambiente (DICMA), 00184 Roma, Italy
| | - Montserrat López-Mesas
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
| | - Manuel Valiente
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
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A correlation study between macro- and micro-analysis of pediatric urinary calculi. J Pediatr Urol 2014; 10:1267-72. [PMID: 25155408 DOI: 10.1016/j.jpurol.2014.06.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim was investigate the relationship between macro- and micro-compositions of pediatric urinary stones by using two combined analytical techniques: Fourier transform infrared spectroscopy (FT-IR) and inductively coupled plasma-optical emission spectrometry (ICP-OES). MATERIALS AND METHODS A total of 74 consecutive urinary calculi were collected from children. Each stone was divided into two equal portions. One part was analyzed by FT-IR to determine mineralogical composition. The second part underwent analysis by ICP-OES to determine the heavy metals and trace elements contents. The association between mineralogical components and elemental contents was evaluated. RESULTS The percentages of mineralogical components of the stones were 78.3% calcium oxalate monohydrate, 63.5% calcium oxalate dihydrate, 24.3% ammonium urate, 13.5% uric acid, 10.9% dahllite, 12.1% brushite, 8.1% ammonium calcium phosphate, 8.1% struvite, 4.5% cysteine, and 2.7% were xanthine. There were seven elements with significant different high concentrations; magnesium, sulfur, strontium, lead, chromium, calcium, and phosphorous. High calcium-containing stones had significant higher contents of magnesium, lead, strontium, and zinc (p<0.05) than low calcium-containing stones. Phosphate stones had significant contents of magnesium, strontium, zinc and chromium when compared to other stones (p<0.05). CONCLUSIONS Pediatric urinary stones have variable biochemical structures. The stones contained many significant heavy metals and trace elements in different concentrations, and phosphate stones enclosed most of the heavy and trace elements.
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Metabolic evaluation of urinary lithiasis: what urologists should know and do. World J Urol 2014; 33:171-8. [PMID: 25414063 DOI: 10.1007/s00345-014-1442-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Urolithiasis is a complex medical entity and regroups several different types of stones, each caused by a multitude of dietary imbalances or metabolic anomalies. In order to better assess the stone-forming patient, urologists should be competent in performing a thorough metabolic work-up. MATERIALS AND METHODS We reviewed the litterature in order to provide an appropriate overview of the various components of the metabolic evaluation, including stone analysis, biochemistry tests, and urine collection. CONCLUSION Performing a metabolic evaluation allows precise intervention in order to treat and mainly prevent stone disease.
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Moreira DM, Friedlander JI, Carons A, Hartman C, Leavitt DA, Smith AD, Okeke Z. Association of serum biochemical metabolic panel with stone composition. Int J Urol 2014; 22:195-9. [DOI: 10.1111/iju.12632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel M Moreira
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
| | - Justin I Friedlander
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
- Department of Urology; Fox Chase/Einstein Urologic Institute and Einstein Healthcare Network; Philadelphia Pennsylvania USA
| | - Akinwunmi Carons
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
| | - Christopher Hartman
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
| | - David A Leavitt
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
| | - Arthur D Smith
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
| | - Zeph Okeke
- The Arthur Smith Institute for Urology; Hosftra North Shore-LIJ School of Medicine; New Hyde Park New York USA
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Zhang J, Fuster DG, Cameron MA, Quiñones H, Griffith C, Xie XS, Moe OW. Incomplete distal renal tubular acidosis from a heterozygous mutation of the V-ATPase B1 subunit. Am J Physiol Renal Physiol 2014; 307:F1063-71. [PMID: 25164082 DOI: 10.1152/ajprenal.00408.2014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Congenital distal renal tubular acidosis (RTA) from mutations of the B1 subunit of V-ATPase is considered an autosomal recessive disease. We analyzed a distal RTA kindred with a truncation mutation of B1 (p.Phe468fsX487) previously shown to have failure of assembly into the V1 domain of V-ATPase. All heterozygous carriers in this kindred have normal plasma HCO3- concentrations and thus evaded the diagnosis of RTA. However, inappropriately high urine pH, hypocitraturia, and hypercalciuria were present either individually or in combination in the heterozygotes at baseline. Two of the heterozygotes studied also had inappropriate urinary acidification with acute ammonium chloride loading and an impaired urine-blood Pco2 gradient during bicarbonaturia, indicating the presence of a H+ gradient and flux defects. In normal human renal papillae, wild-type B1 is located primarily on the plasma membrane, but papilla from one of the heterozygote who had kidney stones but not nephrocalcinosis showed B1 in both the plasma membrane as well as diffuse intracellular staining. Titration of increasing amounts of the mutant B1 subunit did not exhibit negative dominance over the expression, cellular distribution, or H+ pump activity of wild-type B1 in mammalian human embryonic kidney-293 cells and in V-ATPase-deficient Saccharomyces cerevisiae. This is the first demonstration of renal acidification defects and nephrolithiasis in heterozygous carriers of a mutant B1 subunit that cannot be attributable to negative dominance. We propose that heterozygosity may lead to mild real acidification defects due to haploinsufficiency. B1 heterozygosity should be considered in patients with calcium nephrolithiasis and urinary abnormalities such as alkalinuria or hypocitraturia.
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Affiliation(s)
- Jianning Zhang
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel G Fuster
- Department of Nephrology and Hypertension and Institute of Biochemistry and Molecular Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Mary Ann Cameron
- Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry Quiñones
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Carolyn Griffith
- Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Xiao-Song Xie
- McDermott Center of Human Development, University of Texas Southwestern Medical Center, Dallas, Texas; and
| | - Orson W Moe
- Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Physiology, University of Texas Southwestern Medical Center, Dallas, Texas;
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Wumaner A, Keremu A, Wumaier D, Wang Q. Variation in urinary stone composition between adult Uyghur and Han patients with urolithiasis in Xinjiang, China. Urology 2014; 84:772-8. [PMID: 25109561 DOI: 10.1016/j.urology.2014.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/20/2014] [Accepted: 04/26/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze variations in urinary stone composition between Uyghur and Han patients with urolithiasis in Xinjiang, China, and to explore the possible factors associated with urinary stone composition in Uyghur and Han patients. MATERIALS AND METHODS We analyzed the components of urinary stones in 317 adults (152 Uyghur and 165 Han) with urolithiasis admitted to our hospital from March 2009 to June 2011. Urinary stones were collected by endoscopic or open surgical procedures and analyzed by infrared spectroscopy. Also analyzed were clinical data, including patient's age, sex, geographic distribution, blood tests, and urine tests. Logistic regression was performed to analyze the association between stone components and the clinical characteristics of the patients. RESULTS There were significant differences between Uyghur and Han patients in age, geographic distribution, serum concentrations of uric acid, potassium, and phosphorus, urine magnesium concentrations, 24-hour volumes of urine, and in stone components of calcium oxalate monohydrate, calcium oxalate dihydrate plus carbapatite, and uric acid. Differences in sex, family history, complications, sites of calculi, or other blood and urine test results were not significant. Logistic regression analysis revealed that geographic location, ethnicity, blood potassium concentration, and urine volume were significantly correlated with the calcium oxalate dihydrate plus carbapatite component of urinary stones. CONCLUSION Urinary stone composition differs between Uyghur and Han patients with urolithiasis, possibly as a result of geographic distribution.
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Affiliation(s)
- Aikebaier Wumaner
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Aziguli Keremu
- Department of Clinical Laboratory, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China
| | - Dilixiati Wumaier
- Department of Urology First People's Hospital of Kashi, Kashi, Xinjiang, China
| | - Qing Wang
- Department of Urology, People's Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, Xinjiang, China.
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Friedlander JI, Moreira DM, Hartman C, Elsamra SE, Smith AD, Okeke Z. Comparison of the metabolic profile of mixed calcium oxalate/uric acid stone formers to that of pure calcium oxalate and pure uric acid stone formers. Urology 2014; 84:289-94. [PMID: 24929942 DOI: 10.1016/j.urology.2014.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the metabolic profile of patients who form mixed calcium oxalate (CaOx)/uric acid (UA) stones to those of pure CaOx and pure UA stone formers. METHODS We performed a retrospective review of 232 patients, with both stone composition analysis and 24-hour urine collection, seen between March 2002 and April 2012. Analysis of 24-hour urine constituents across the 3 stone groups (pure UA, pure CaOx, and mixed CaOx/UA) was performed using univariate analysis of variance and multivariate linear regression models adjusting for clinical and demographic factors and 24-hour urine collection elements. RESULTS A total of 27 patients (11.6%) had mixed CaOx/UA, 122 (52.6%) had pure CaOx, and 83 (35.8%) had pure UA calculi. Univariate analysis demonstrated significant differences between mixed CaOx/UA patients and pure CaOx patients for urine pH (mixed, 5.63 ± 0.49 vs pure, CaOx 5.93 ± 0.51; P = .009) and supersaturation (SS) UA (mixed, 1.84 ± 1.09 vs pure, CaOx 1.26 ± 0.93; P = .01), and a significant difference between mixed CaOx/UA patients and pure UA patients for SS CaOx (mixed, 7.18 ± 4.23 vs pure, UA 4.90 ± 2.96; P = .005). Multivariate analysis demonstrated that mixed CaOx/UA patients had no significant difference in SS CaOx as compared with pure CaOx patients (difference, -0.27; P = .66), whereas at the same time had no significant difference in SS UA as compared with pure UA patients (-0.07; P = .69). CONCLUSION The metabolic profile of patients who form mixed CaOx/UA stones demonstrates abnormalities that promote both CaOx and UA stone formation. Dietary and medical management for this group of patients should address treatment of both defects.
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Affiliation(s)
- Justin I Friedlander
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY.
| | - Daniel M Moreira
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Christopher Hartman
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Sammy E Elsamra
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Arthur D Smith
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Zeph Okeke
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
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Everything you need to know about distal renal tubular acidosis in autoimmune disease. Rheumatol Int 2014; 34:1037-45. [PMID: 24682397 PMCID: PMC4107275 DOI: 10.1007/s00296-014-2993-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/14/2014] [Indexed: 11/24/2022]
Abstract
Renal acid–base homeostasis is a complex process, effectuated by bicarbonate reabsorption and acid secretion. Impairment of urinary acidification is called renal tubular acidosis (RTA). Distal renal tubular acidosis (dRTA) is the most common form of the RTA syndromes. Multiple pathophysiologic mechanisms, each associated with various etiologies, can lead to dRTA. The most important consequence of dRTA is (recurrent) nephrolithiasis. The diagnosis is based on a urinary acidification test. Potassium citrate is the treatment of choice.
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Kirejczyk JK, Porowski T, Filonowicz R, Kazberuk A, Stefanowicz M, Wasilewska A, Debek W. An association between kidney stone composition and urinary metabolic disturbances in children. J Pediatr Urol 2014; 10:130-5. [PMID: 23953243 DOI: 10.1016/j.jpurol.2013.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine kidney stone composition in children and to correlate stone fractions with urinary pH and metabolic urinary risk factors. PATIENTS AND METHODS We studied 135 pediatric patients with upper urinary tract lithiasis in whom excreted or extracted stones were available for analyses. Composition of stones was analyzed. A 24-hour urine assessment included volume, pH and daily excretions of calcium, oxalate, uric acid, cystine, creatinine, phosphate, magnesium and citrate. RESULTS Calcium oxalate was the major component of 73% stones, followed by struvite (13%) and calcium phosphate (9%). Uric acid was present in almost half of stones, but in rudimentary amounts. The calcium oxalate content in calculi showed a strong relationship with calciuria, and moderate association with oxaluria, magnesuria and acidification of urine. The percent content of struvite presented reverse and lower correlations with regard to the above parameters. Calcium phosphate stone proportion had low associations with urinary risk factors. CONCLUSIONS Calciuria, oxaluria, magnesuria and low urine pH exerted the biggest influence on calcium oxalate content in pediatric renal stones. Relationships of urinary risk factors with calculi calcium phosphate content were of unclear significance. Urinary citrate excretion did not significantly correlate with kidney stone composition in children.
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Affiliation(s)
- Jan K Kirejczyk
- Department of Pediatric Surgery, Medical University of Bialystok, Poland.
| | - Tadeusz Porowski
- Department of Pediatric Nephrology, Medical University of Bialystok, Poland
| | - Renata Filonowicz
- Department of Pediatric Nephrology, Medical University of Bialystok, Poland
| | - Anna Kazberuk
- Department of Pediatric Nephrology, Medical University of Bialystok, Poland
| | - Marta Stefanowicz
- Department of Pediatric Nephrology, Medical University of Bialystok, Poland
| | - Anna Wasilewska
- Department of Pediatric Nephrology, Medical University of Bialystok, Poland
| | - Wojciech Debek
- Department of Pediatric Surgery, Medical University of Bialystok, Poland
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94
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Liu Y, Qu M, Carter RE, Leng S, Ramirez-Giraldo JC, Jaramillo G, Krambeck AE, Lieske JC, Vrtiska TJ, McCollough CH. Differentiating calcium oxalate and hydroxyapatite stones in vivo using dual-energy CT and urine supersaturation and pH values. Acad Radiol 2013; 20:1521-5. [PMID: 24200478 PMCID: PMC3963806 DOI: 10.1016/j.acra.2013.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Knowledge of urinary stone composition can guide therapeutic intervention for patients with calcium oxalate (CaOx) or hydroxyapatite (HA) stones. In this study, we determined the accuracy of noninvasive differentiation of these two stone types using dual-energy CT (DECT) and urine supersaturation (SS) and pH values. MATERIALS AND METHODS Patients who underwent clinically indicated DECT scanning for stone disease and subsequent surgical intervention were enrolled. Stone composition was determined using infrared spectroscopy. DECT images were processed using custom-developed software that evaluated the ratio of CT numbers between low- and high-energy images. Clinical information, including patient age, gender, and urine pH and supersaturation profile, was obtained from electronic medical records. Simple and multiple logistic regressions were used to determine if the ratio of CT numbers could discriminate CaOx from HA stones alone or in conjunction with urine supersaturation and pH. RESULTS Urinary stones (CaOx n = 43, HA n = 18) from 61 patients were included in this study. In a univariate model, DECT data, urine SS-HA, and urine pH had an area under the receiver operating characteristic curve of 0.78 (95% confidence interval [CI] 0.66-0.91, P = .016), 0.76 (95% CI 0.61-0.91, P = .003), and 0.60 (95% CI 0.44-0.75, P = .20), respectively, for predicting stone composition. The combination of CT data and the urinary SS-HA had an area under the receiver operating characteristic curve of 0.79 (95% CI 0.66-0.92, P = .007) for correctly differentiating these two stone types. CONCLUSIONS DECT differentiated between CaOx and HA stones similarly to SS-HA, whereas pH was a poor discriminator. The combination of DECT and urine SS or pH data did not improve this performance.
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Affiliation(s)
- Yu Liu
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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95
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Moreira DM, Friedlander JI, Hartman C, Elsamra SE, Smith AD, Okeke Z. Differences in 24-Hour Urine Composition Between Apatite and Brushite Stone Formers. Urology 2013; 82:768-72. [DOI: 10.1016/j.urology.2013.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/30/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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96
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Stone Compositions in Turkey: An Analysis According to Gender and Region. Urology 2013; 82:532-7. [DOI: 10.1016/j.urology.2013.04.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 03/29/2013] [Accepted: 04/07/2013] [Indexed: 11/19/2022]
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97
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Asplin JR, Penniston K, Goldfarb DS. Monosodium urate stones are rare, and urine pH is not low in cystinuria. Am J Kidney Dis 2013; 62:179-80. [PMID: 23773841 DOI: 10.1053/j.ajkd.2013.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/08/2013] [Indexed: 11/11/2022]
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98
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Rendina D, De Filippo G, De Pascale F, Zampa G, Muscariello R, De Palma D, Ippolito R, Strazzullo P. The changing profile of patients with calcium nephrolithiasis and the ascendancy of overweight and obesity: a comparison of two patient series observed 25 years apart. Nephrol Dial Transplant 2013; 28 Suppl 4:iv146-51. [PMID: 23595293 DOI: 10.1093/ndt/gft076] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Epidemiological data indicate an increasing incidence and prevalence of nephrolithiasis (NL) worldwide in the last few decades. METHODS The aim of this study was to compare the clinical and biochemical profiles of recurrent stone formers referred to a Kidney Stone Centre from March 1983 to June 1986 with the one featured by patients seen 25 years later in the same geographical area, Campania, southern Italy. RESULTS Idiopathic calcium stone formers made up the large majority of the patient population in both series. Those examined in 2008-11 showed higher age at the onset of NL, higher prevalence of overweight/obesity and higher urinary excretion of oxalate and phosphate compared with those seen in 1983-86. The differences in the urinary biochemical variables remained significant upon accounting for age, gender, creatinine clearance and body mass index (BMI), and were not observed in patients with primary hyperparathyroidism enrolled in the same periods. A greater prevalence of uric acid stone formers was also observed in the 2008-11 population. CONCLUSIONS The massive epidemics of overweight/obesity and the substantial modifications of dietary habits over the last few decades in most Western countries may be the factors underlying the changing clinical and biochemical profiles of patients with recurrent NL.
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Affiliation(s)
- Domenico Rendina
- Department of Clinical and Experimental Medicine, Federico II University Medical School, Naples, Italy
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99
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Ferraro PM, D'Addessi A, Gambaro G. When to suspect a genetic disorder in a patient with renal stones, and why. Nephrol Dial Transplant 2013; 28:811-20. [PMID: 23291371 DOI: 10.1093/ndt/gfs545] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Nephrolithiasis is a common disorder, with a rising prevalence in the general population. Its pathogenesis is still unclear, but a role for genetics has long been recognized, especially in cases of the more common calcium nephrolithiasis. Although relatively rare, monogenic causes of hypercalciuria and nephrolithiasis do exist and their timely recognition is important from a prognostic and therapeutic viewpoint. This article reviews the clinical and laboratory findings characterizing inherited causes of nephrolithiasis with a view to helping clinicians to recognize and manage these rare conditions.
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Affiliation(s)
- Pietro Manuel Ferraro
- Division of Nephrology, Department of Internal Medicine and Medical Specialties, Columbus-Gemelli University Hospital, Catholic University, Rome, Italy
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100
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Cho ST, Jung SI, Myung SC, Kim TH. Correlation of metabolic syndrome with urinary stone composition. Int J Urol 2012; 20:208-13. [PMID: 23020870 DOI: 10.1111/j.1442-2042.2012.03131.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Accepted: 07/27/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the correlation between metabolic syndrome and the distribution of stone components in patients with urolithiasis. METHODS Between January 2007 and December 2010, renal or ureteral stones were collected from 712 patients (432 males, 280 females) who underwent surgical intervention at three hospitals in South Korea. Metabolic syndrome was defined according to the latest definition of the International Diabetes Federation, using ethnicity- and sex-specific cut-off values for central obesity. Patients were assessed by factors used in metabolic syndrome. All urinary stones were analyzed using infrared spectrophotometry and categorized according to their main component. RESULTS The patients' mean age was 55.9 years (range 19-93 years). Of the 712 patients, 347 (48.7%; 205 males, 142 females) had a diagnosis of metabolic syndrome. Calcium oxalate (71.5%), uric acid (15.3%), carbonate apatite (8.0%) and struvite (4.1%) calculi were found as the main stone components. Overall, the proportion of uric acid calculi was markedly higher in patients with rather than without metabolic syndrome (19.6 vs 11.2%; P=0.002). However, the proportion of calcium oxalate, carbonate apatite and struvite calculi did not differ between the two groups. The multivariable-adjusted odds ratio for uric acid calculi according to the metabolic syndrome components indicated that the presence of metabolic syndrome was associated with a 93% increased odds ratio of uric acid calculi compared with the absence of metabolic syndrome. Impaired fasting glucose and hypertriglyceridemia were independent risk factors for uric acid calculi. CONCLUSIONS Metabolic syndrome is associated with a significantly increased risk of uric acid calculi development, especially those with impaired fasting glucose and hypertriglyceridemia.
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Affiliation(s)
- Sung Tae Cho
- Department of Urology, College of Medicine, Hallym University, Gwangju, Korea
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