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Medairos R, Paloian NJ, Pan A, Moyer A, Ellison JS. Risk factors for subsequent stone events in pediatric nephrolithiasis: A multi-institutional analysis. J Pediatr Urol 2022; 18:26.e1-26.e9. [PMID: 34980558 DOI: 10.1016/j.jpurol.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Children with nephrolithiasis have a 50% risk of recurrence 3 years following an index urinary stone event. The American Urological Association guidelines for medical management of nephrolithiasis suggest metabolic evaluations be stratified according to risk of future stone events. However, no such risk stratification exists across the pediatric population with urinary stone disease. We aim to assess the risk factors among pediatric patients for a subsequent stone event (SSE). MATERIALS AND METHODS A retrospective review for children <17 years of age with a diagnosis of nephrolithiasis and at least one completed follow-up at two tertiary-care children's hospitals within our state between 2012 and 2017 was performed. Children with known monogenic stone disease were excluded as well as those with follow-up less than 1 year. SSEs following initial diagnosis and treatment for nephrolithiasis were defined as follows: subsequent surgical intervention, new stone on imaging, reported stone passage, or ED evaluation for renal colic. Clinical and demographic factors were compared between patients with and without SSEs and analyzed using univariate and multivariate analyses via Cox proportional hazard models. Survival curves for significant associations for SSEs were generated and evaluated using Log-Rank and Wilcoxon comparisons. RESULTS A total of 200 patients with median clinical follow-up of 2.9 years were analyzed. Median age was 11.5 years (IQR: 6.0-15.5), with 109 (54.5%) males and 91 (45.5%) females, 94 (47%) of whom had a relevant comorbidity. An SSE occurred in 82 patients (41.0%). Age >12 (HR 2.21, 95%CI 1.42-3.45), reported stone event prior to enrollment encounter (i.e. personal history of nephrolithiasis) (HR 1.82, 95%CI 1.14-2.89), and family history of nephrolithiasis (HR 1.62, 95%CI 1.05-2.51) were associated with SSE on univariate analysis while age >12 (HR 2.09, 95%CI 1.33-3.27) and personal history of nephrolithiasis (HR 1.63, 1.02-2.6) retained significance on multivariable analysis. Survival analysis shows increased risk of recurrence with accumulation of risk factors (Summary Figure). Sensitivity analysis accounting for missing family history data retained significance for all three variables. CONCLUSIONS Adolescent age and a personal history of nephrolithiasis are independent risk factors for SSE in children. Understanding these risk factors and the nature of SSE among the pediatric population can potentially enhance counseling for further metabolic work-up and tailored clinical follow-up.
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Affiliation(s)
- Robert Medairos
- Department of Urology, Division of Pediatric Urology, Children's Wisconsin, Milwaukee, WI, USA.
| | - Neil J Paloian
- Division of Pediatric Nephrology, Department of Pediatrics American Family Children's Hospital, Madison, WI, USA.
| | - Amy Pan
- Divison of Quantitative Health Services, Department of Pediatrics, Children's Wisconsin, Milwaukee, WI, USA.
| | - Andrea Moyer
- Department of Urology, Division of Pediatric Urology, Children's Wisconsin, Milwaukee, WI, USA.
| | - Jonathan S Ellison
- Department of Urology, Division of Pediatric Urology, Children's Wisconsin, Milwaukee, WI, USA.
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202
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Baccaglini W, Rodrigues AFS, Glina FPA, Dall'Aqua V, Glina S, Lopes Neto AC. Tranexamic Acid Use for Hemorrhagic Events Prevention in Percutaneous Nephrolithotomy: Systematic Review and Meta-analysis. J Endourol 2022; 36:906-915. [DOI: 10.1089/end.2021.0792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Willy Baccaglini
- Faculdade de Medicina do ABC, 125191, Urology, Santo Andre, SP, Brazil
| | | | - Felipe PA Glina
- Faculdade de Medicina do ABC, 125191, Urology, Santo Andre, SP, Brazil
| | - Vinicius Dall'Aqua
- Faculdade de Medicina do ABC, 125191, Urology, Av. Lauro Gomes, 2000, Santo Andre, Sao Paulo, Brazil, 09060-870
| | - Sidney Glina
- Faculdade de Medicina do ABC, 125191, Urology, Santo Andre, SP, Brazil
| | - Antonio Correa Lopes Neto
- Faculdade de Medicina do ABC, 125191, Urology , Rua Lauro Gomes, 2000, Santo Andre, SP, Brazil, 09060870
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203
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Scotland K, Tailly T, Chew BH, Bhojani N, Smith RD. Consensus Statement on Urinary Stone Treatment During A Pandemic: A Delphi Process from the Endourological Society TOWER Research Initiative. J Endourol 2022; 36:335-344. [PMID: 35019782 DOI: 10.1089/end.2021.0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had a significant impact on the care of patients with urolithiasis. Recommendations and prioritization of endourologic surgical procedures vary among regions and a comprehensive overall international directive is needed. We used the Delphi method to obtain international consensus on managing urolithiasis patients during the pandemic. METHODS A three-round Delphi process was used to elicit expert consensus (53 global key opinion leaders within the Endourological Society from 36 countries) on an extensive survey on management of endourologic patients in a pandemic. Questions addressed general management, inpatient and outpatient procedures, clinic visits, follow-up care and best practices for suspension and resumption of routine care. RESULTS Consensus was achieved in 64/84 (76%) questions. Key consensus findings included: consultations should be delivered remotely when possible. Invasive surgical procedures for urolithiasis patients should be reserved for high-risk situations (infection, renal failure, etc.). To prevent aerosolization, spinal anesthesia is preferred over general, whenever feasible. Treatment of asymptomatic renal stones should be deferred. Primary definitive treatment of obstructing or symptomatic stones (both renal and ureteral) is preferred over temporizing drainage. Extracorporeal shock wave lithotripsy should be continued for obstructive ureteral stones. There was consensus on treatment modalities and drainage strategies depending on location and size of the stone. CONCLUSION International endourologist members of the Endourological Society participated in this Delphi initiative to provide expert consensus on management of urolithiasis during a pandemic. These results can be applied currently and during a future pandemic.
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Affiliation(s)
- Kymora Scotland
- The University of British Columbia, 8166, 2775 Laurel Street, Vancouver, British Columbia, Canada, V6T 1Z4;
| | | | - Ben H Chew
- University of British Columbia, Urologic Sciences, Level 6, 2775 Laurel st., Level 6 - 2775 Laurel St, Vancouver, British Columbia, Canada, V5Z 1M9.,University of British Columbia, 8166, Urologic Sciences, 2775 Laurel St, Level 6, Vancouver, British Columbia, Canada, V5Z 1M9;
| | - Naeem Bhojani
- Centre Hospitalier de L'Universite de Montreal, 25443, Urology, 900 St. Denis street, Pavillon R, R08.474, Montreal, Quebec, Canada, H2X 0A9;
| | - R Daron Smith
- University College London Hospitals NHS Foundation Trust, 8964, Institute of Urology, 16-18 Westmoreland Street, London, United Kingdom of Great Britain and Northern Ireland, W1G 8PH;
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204
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Betz M. Whole Diet Approach to Calcium Oxalate Kidney Stone Prevention. J Ren Nutr 2022; 32:e11-e17. [PMID: 34980366 DOI: 10.1053/j.jrn.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Melanie Betz
- Chronic Kidney Disease Nutrition & Education Specialist, University of Chicago Medicine - Section of Nephrology, Chicago, Illinois.
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205
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Mazzucchi E, Berto FC, Denstedt J, Danilovic A, Batagello CA, Torricelli FC, Vicentini FC, Marchini GS, Srougi M, Nahas WC. Treatment of renal lower pole stones: an update. Int Braz J Urol 2022; 48:165-174. [PMID: 33861537 PMCID: PMC8691227 DOI: 10.1590/s1677-5538.ibju.2020.1023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fernanda C.G. Berto
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - John Denstedt
- Western University OntarioDivision of UrologyCanadaDivision of Urology, Western University Ontario, Canada
| | - Alexandre Danilovic
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Carlos Alfredo Batagello
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C.M. Torricelli
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Giovanni S. Marchini
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - Miguel Srougi
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
| | - William C. Nahas
- Faculdade de Medicina da Universidade de São PauloHospital das ClínicasDivisão de UrologiaSPBrasilSeção de Endourologia-Divisão de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil;
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206
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Selected Disorders of the Genitourinary System. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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207
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Al-Gonaim A, Jawhar A, El-Tholoth H, Almuaiqel M, AlZahrani T, Al-Akrash H, AlZahrani A. Urolithiasis and water intake in Saudi Arabia, is it a matter of quality or quantity? Urol Ann 2022; 14:132-134. [PMID: 35711490 PMCID: PMC9197004 DOI: 10.4103/ua.ua_105_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/28/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Methods: Results: Conclusion:
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208
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Ferraro PM, Cunha TDS, Taylor EN, Curhan GC. Temporal Trends of Dietary Risk Factors after a Diagnosis of Kidney Stones. Clin J Am Soc Nephrol 2022; 17:83-89. [PMID: 34799357 PMCID: PMC8763147 DOI: 10.2215/cjn.09200721] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Diet is an important contributor to kidney stone formation, but there are limited data regarding long-term changes in dietary factors after a kidney stone. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS We analyzed data from three longitudinal cohorts, the Health Professionals Follow-Up Study and Nurses' Health Study I and II, comparing changes in dietary factors in participants with and without kidney stones during follow-up. The daily intake of dietary calcium, supplemental calcium, animal protein, caffeine, fructose, potassium, sodium, oxalate, phytate, vitamin D, vitamin C, sugar-sweetened beverages, fluids, net endogenous acid production, and Dietary Approaches to Stop Hypertension score were assessed by repeat food frequency questionnaires and computed as absolute differences; a difference-in-differences approach was used to account for temporal changes using data from participants without kidney stones from the same calendar period. RESULTS Included were 184,398 participants with no history of kidney stones, 7095 of whom became confirmed stone formers. Several intakes changed significantly over time in stone formers, with some showing a relative increase up to 8 years later, including caffeine (difference in differences, 8.8 mg/d; 95% confidence interval [95% CI], 3.4 to 14.1), potassium (23.4 mg/d; 95% CI, 4.6 to 42.3), phytate (12.1 mg/d; 95% CI, 2.5 to 21.7), sodium (43.1 mg/d; 95% CI, 19.8 to 66.5), and fluids (47.1 ml/d; 95% CI, 22.7 to 71.5). Other dietary factors showed a significant decrease, such as oxalate (-7.3 mg/d; 95% CI, -11.4 to -3.2), vitamin C (-34.2 mg/d; 95% CI, -48.8 to -19.6), and vitamin D (-18.0 IU/d; 95% CI, -27.9 to -8.0). A significant reduction was observed in sugar-sweetened beverages intake of -0.5 (95% CI, -0.8 to -0.3) and -1.4 (95% CI, -1.8 to -1.0) servings per week and supplemental calcium of -105.1 (95% CI, -135.4 to -74.7) and -69.4 (95% CI, -95.4 to -43.4) mg/d for women from Nurses' Health Study I and II, respectively. Animal protein, dietary calcium, fructose intake, Dietary Approaches to Stop Hypertension score, and net endogenous acid production did not change significantly over time. CONCLUSIONS After the first episode of a kidney stone, mild and inconsistent changes were observed concerning dietary factors associated with kidney stone formation.
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Affiliation(s)
- Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy,Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tamara Da Silva Cunha
- Nephrology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eric N. Taylor
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts,Section of Nephrology, Veterans Affairs Maine Healthcare System, Augusta, Maine
| | - Gary C. Curhan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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209
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Whittamore JM, Hatch M. Oxalate Flux Across the Intestine: Contributions from Membrane Transporters. Compr Physiol 2021; 12:2835-2875. [PMID: 34964122 DOI: 10.1002/cphy.c210013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Epithelial oxalate transport is fundamental to the role occupied by the gastrointestinal (GI) tract in oxalate homeostasis. The absorption of dietary oxalate, together with its secretion into the intestine, and degradation by the gut microbiota, can all influence the excretion of this nonfunctional terminal metabolite in the urine. Knowledge of the transport mechanisms is relevant to understanding the pathophysiology of hyperoxaluria, a risk factor in kidney stone formation, for which the intestine also offers a potential means of treatment. The following discussion presents an expansive review of intestinal oxalate transport. We begin with an overview of the fate of oxalate, focusing on the sources, rates, and locations of absorption and secretion along the GI tract. We then consider the mechanisms and pathways of transport across the epithelial barrier, discussing the transcellular, and paracellular components. There is an emphasis on the membrane-bound anion transporters, in particular, those belonging to the large multifunctional Slc26 gene family, many of which are expressed throughout the GI tract, and we summarize what is currently known about their participation in oxalate transport. In the final section, we examine the physiological stimuli proposed to be involved in regulating some of these pathways, encompassing intestinal adaptations in response to chronic kidney disease, metabolic acid-base disorders, obesity, and following gastric bypass surgery. There is also an update on research into the probiotic, Oxalobacter formigenes, and the basis of its unique interaction with the gut epithelium. © 2021 American Physiological Society. Compr Physiol 11:1-41, 2021.
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Affiliation(s)
- Jonathan M Whittamore
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marguerite Hatch
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
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210
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Finger M, Finger E, Bellucci A, Malieckal DA. Medical management for the prevention of kidney stones. Postgrad Med J 2021; 99:postgradmedj-2021-140971. [PMID: 34930814 DOI: 10.1136/postgradmedj-2021-140971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022]
Abstract
The alarming fact is that approximately one out of every 10 of us will have a kidney stone during our lifetime. The increasing prevalence and associated costs of kidney stones have resulted in it being one of the most commonly encountered and impactful medical conditions. Contributing factors include, but are not limited to, diet, climate, genetics, medications, activity and underlying medical conditions. Symptoms generally parallel stone size. Treatment varies from supportive to procedural (invasive and non-invasive). Prevention remains the best way to avoid this condition especially given the high recurrence rate. First time stone formers require counselling regarding dietary adjustments. Certain risk factors ultimately require a more in-depth metabolic investigation, especially if stones are recurrent. Ultimately, management is defined by stone composition. Where appropriate, we review both pharmacologic and non-pharmacologic options. Pivotal to successful prevention is patient education and the encouragement of compliance with the appropriate regimen.
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Affiliation(s)
- Mark Finger
- Medicine-Nephrology, Northwell Health, Great Neck, New York, USA
| | - Evan Finger
- Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
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211
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Popovtzer B, Khusid JA, Bamberger JN, Lundon D, Gallante B, Sadiq AS, Atallah W, Lifshitz D, Gupta M. Do Infection-Associated Stone Subtypes Behave the Same Clinically? A Retrospective Bi-center Study. J Endourol 2021; 36:688-693. [PMID: 34913732 DOI: 10.1089/end.2021.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives Infection associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods We retrospectively reviewed the medical records of patients from two centers (one in the USA and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, post-operative fever, stone and urinary microbiology, and 24-hour urine studies. Results A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Though there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram negative bacteria were more common in the MAP stone cultures. Post-operative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p<0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences amongst metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined.
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Affiliation(s)
- Baruch Popovtzer
- Rabin Medical Center, 36632, Urology, Zeev Jabotinsky St 39, Petah Tikva, Israel, 49100;
| | - Johnathan Alexander Khusid
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574;
| | - Jacob N Bamberger
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W 59th St, Suite 4F, New York, New York, United States, 10029-6574;
| | - Dara Lundon
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019;
| | - Areeba Setara Sadiq
- Mount Sinai Health System, 5944, Urology, 425 W59th Street, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - David Lifshitz
- Rabin medical center, urology, Keren kayemet st, Petach Tikva, Israel, 65222;
| | - Mantu Gupta
- Mount Sinai Health System, 5944, Urology, 425 W. 59th Street, New York, New York, United States, 10019;
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Adrián Valverde M, Vaca RG, Orellana K, Delgado F. Incidental Leriche Syndrome in Horseshoe Kidney Disease: A Non-Classic Couple. Kans J Med 2021; 14:302-304. [PMID: 34888002 PMCID: PMC8647979 DOI: 10.17161/kjm.vol14.15670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Richard G Vaca
- Universidad Católica de Santiago de Guayaquil, School of Medicine, Guayaquil, Ecuador
| | - Kevin Orellana
- Universidad de Guayaquil, School of Medicine, Guayaquil, Ecuador
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213
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Heidari S, Shirazi F, Ghanipour Badelbuu S. Behavioural habits and underlying diseases associated with urolithiasis: A case–control study. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2021. [DOI: 10.1111/ijun.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Shiva Heidari
- Department of Nursing, Urmia Branch Islamic Azad University Urmia Iran
| | - Fatemeh Shirazi
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery Shiraz University of Medical Sciences Shiraz Iran
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214
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Tavasoli S, Borumandnia N, Basiri A, Taheri M. Effects of COVID-19 pandemics on urinary metabolites in kidney stone patients: our kidney stone prevention clinic experience. Environ Health Prev Med 2021; 26:112. [PMID: 34856919 PMCID: PMC8638224 DOI: 10.1186/s12199-021-01037-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/20/2021] [Indexed: 01/18/2023] Open
Abstract
Background The dietary habits and lifestyle changes during the COVID-19 pandemic could affect the urinary risk factors in kidney stone formers. In this study, we investigated the effects of the COVID-19 pandemic on 24-h urine metabolites, as a surrogate for dietary intake, in patients with kidney stones, in Tehran, Iran. Methods We evaluated the medical records of all patients with urolithiasis who visited in our stone prevention clinic from the beginning of COVID-19 in Iran to 1 year later (Feb 2020–Feb 2021) and compared it with the patients’ medical records in the same period a year before COVID-19 (Feb 2019–Feb 2020). Results The results of our stone prevention clinic showed a decrease in the number of visits during COVID-19. Twenty-four-hour urine urea, sodium, and potassium were significantly lower, and 24-h urine magnesium was significantly higher during COVID-19. Higher 24-h urine oxalate was only shown in patients with the first-time visit, whereas lower 24-h urine uric acid and citrate were only shown in patients with the follow-up visits. Conclusions COVID-19 pandemics may change some of the dietary habits of the patients, including lower salt, protein, and fruit and vegetable intake. Although economic issues, restricted access, or sanitation issues may be the reason for the undesirable dietary changes, the importance of a quality diet should be discussed with all patients, as possible. Since the number of patients visited in the stone clinic was lower during COVID-19, virtual visits could be an excellent alternative to motivate patients with kidney stones.
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Affiliation(s)
- Sanaz Tavasoli
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR, Iran.
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Dawood NB, Tseng CH, Nguyen DT, Yan KL, Livhits MJ, Leung AM, Yeh MW. Systems-Level Opportunities in the Management of Primary Hyperparathyroidism: An Informatics-based Assessment. J Clin Endocrinol Metab 2021; 106:e4993-e5000. [PMID: 34313755 DOI: 10.1210/clinem/dgab540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT), a leading cause of hypercalcemia and secondary osteoporosis, is underdiagnosed. OBJECTIVE This work aims to establish a foundation for an electronic medical record-based intervention that would prompt serum parathyroid hormone (PTH) assessment in patients with persistent hypercalcemia and identify care gaps in their management. METHODS A retrospective cohort study was conducted in a tertiary academic health system of outpatients with persistent hypercalcemia, who were categorized as having classic or normohormonal PHPT. Main outcome measures included the frequencies of serum PTH measurement in patients with persistent hypercalcemia, and their subsequent workup with bone mineral density (BMD) assessment, and ultimately, medical therapy or parathyroidectomy. RESULTS Among 3151 patients with persistent hypercalcemia, 1526 (48%) had PTH measured, of whom 1377 (90%) were confirmed to have classic (49%) or normohormonal (41%) PHPT. PTH was measured in 65% of hypercalcemic patients with osteopenia or osteoporosis (P < .001). At median 2-year follow-up, bone density was assessed in 275 (20%) patients with either variant of PHPT (P = .003). Of women aged 50 years or older with classic PHPT, 95 (19%) underwent BMD assessment. Of patients with classic or normohormonal PHPT, 919 patients (67%) met consensus criteria for surgical intervention, though only 143 (15%) underwent parathyroidectomy. CONCLUSION Within a large academic health system, more than half of patients with confirmed hypercalcemia were not assessed for PHPT, including many patients with preexisting bone disease. Care gaps in BMD assessment and medical or surgical therapy represent missed opportunities to avoid skeletal and other complications of PHPT.
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Affiliation(s)
- Nardeen B Dawood
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Chi-Hong Tseng
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Dalena T Nguyen
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Kimberly L Yan
- UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California, USA
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Aldaher HS, Kadhim SZ, Al-Roub NM, Alsadi AH, Salam DA, Tillo EA. Evaluating the understanding about kidney stones among adults in the United Arab Emirates. J Taibah Univ Med Sci 2021; 16:788-793. [PMID: 34690664 PMCID: PMC8498703 DOI: 10.1016/j.jtumed.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The prevalence of kidney stones is increasing worldwide. Multiple risk factors are believed to contribute to the development of kidney stones such as lifestyle, diet, and global warming. In the United Arab Emirates (UAE), there has been limited research exploring the prevalence and risk factors of kidney stones. This study attempts to assess the understanding and prevalence of kidney stones among adults in the UAE. Methods In this cross-sectional study, data were collected using a self-administered questionnaire, distributed among 515 participants (20–49 years old) from Abu Dhabi, Dubai, Ajman, and Sharjah states. IBM SPSS version 25 was used for data analysis. Results The mean of knowledge score was 56.4% (n = 500). There was no correlation between the knowledge of those who had experienced kidney stones and those who did not. Furthermore, a family history of kidney stones increased the risk of developing stones by 2.27 times. Among participants reporting signs, symptoms, diagnosis, and the management of kidney stones, the knowledge and understanding about kidney stones was high. However, the perceptions of the same cohort about dietary precautions were limited. While analysing the sources of knowledge, the Internet and mass media were twice as important as physicians in educating the population. Conclusion This study shows that the study cohort from the UAE population was aware of certain aspects of kidney stones but was quite naïve about its consequential risk factors. This highlights the importance of promoting education about kidney stones through health campaigns.
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Affiliation(s)
| | - Safa Z Kadhim
- University of Sharjah, College of Medicine, United Arab Emirates
| | - Nora M Al-Roub
- University of Sharjah, College of Medicine, United Arab Emirates
| | - Ahmed H Alsadi
- University of Sharjah, College of Medicine, United Arab Emirates
| | - Dana A Salam
- University of Sharjah, College of Medicine, United Arab Emirates
| | - Eva A Tillo
- University of Sharjah, College of Medicine, United Arab Emirates
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217
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Song S, Thomas IC, Ganesan C, Velaer KN, Chertow GM, Pao AC, Leppert JT. Twenty-four-hour Urine Testing and Urinary Stone Disease Recurrence in Veterans. Urology 2021; 159:33-40. [PMID: 34688771 DOI: 10.1016/j.urology.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/03/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine whether 24-hour urine testing in Veterans with USD (urinary stone disease) reduces or delays urinary stone recurrence. METHODS Cohort study of national health record data from Veterans Health Administration from 2007 through 2013. We utilized a study population of 130,129 Veterans with USD based on diagnostic or procedural codes and excluded those with USD claims in the 2 years before cohort entry. We then created a propensity-score matched cohort of 14,854 Veterans based on completion of 24-hour urine testing within 6 months of stone diagnosis. Primary outcome was time-to-next clinically significant stone event, defined as an emergency department visit, inpatient admission related to a urinary stone, or urologic stone procedure with 5-year follow up. RESULTS Of 14,854 Veterans in the propensity-score matched cohort, 8560 (57.6%) experienced a recurrent USD event. Completion of 24-hour urine testing was associated with a higher risk of developing a second stone event (hazard ratio [HR] 1.17, 95% confidence interval [95% CI] 1.12-1.22). Among Veterans with known recurrent disease, we examined time to a third stone event. In this cohort of 4736 patients, completion of 24-hour urine testing was not associated with a higher risk of developing a third stone event (HR 1.06, 95% CI 0.99-1.12). CONCLUSION Completion of 24-hour urine testing was not associated with a reduction in urinary stone recurrence. These findings challenge the validity of a longstanding recommendation in general medicine, nephrology, and urology practice.
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Affiliation(s)
- Shen Song
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA.
| | - I-Chun Thomas
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Calyani Ganesan
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Kyla N Velaer
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Alan C Pao
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - John T Leppert
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA; Department of Urology, Stanford University School of Medicine, Stanford, CA
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218
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Brower C, Rehani MM. Radiation risk issues in recurrent imaging. Br J Radiol 2021; 94:20210389. [PMID: 34161140 PMCID: PMC9328055 DOI: 10.1259/bjr.20210389] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
Millions of patients benefit from medical imaging every single day. However, we have entered an unprecedented era in imaging practices wherein 1 out of 125 patients can be exposed to effective dose >50 mSv from a single CT exam and 3 out of 10,000 patients undergoing CT exams could potentially receive cumulative effective doses > 100 mSv in a single day. Recurrent imaging with CT, fluoroscopically guided interventions, and hybrid imaging modalities such as positron emission tomography/computed tomography (PET/CT) is more prevalent today than ever before. Presently, we do not know the cumulative doses that patients may be receiving across all imaging modalities combined. Furthermore, patients with diseases with longer life expectancies are being exposed to high doses of radiation enabling radiation effects to manifest over a longer time period. The emphasis in the past on improving justification of imaging and optimization of technique and practice has proved useful. While that must continue, the current situation requires imaging device manufacturers to urgently develop imaging technologies that are safer for patients as high doses have been observed in patients where imaging has been justified through clinical decision-support and optimized by keeping doses below the national benchmark doses. There is a need to have a critical look at the fundamental principles of radiation protection as cumulative doses are likely to increase in the coming years.
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219
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Okada A, Matsumoto T, Ohshima H, Isomura T, Koga T, Yasui T, Kohri K, LeBlanc A, Spector E, Jones J, Shackelford L, Sibonga J. Bisphosphonate Use May Reduce the Risk of Urolithiasis in Astronauts on Long‐Term Spaceflights. JBMR Plus 2021; 6:e10550. [PMID: 35079672 PMCID: PMC8770998 DOI: 10.1002/jbm4.10550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/18/2021] [Indexed: 11/29/2022] Open
Abstract
Long‐duration spaceflight is associated with an increased risk of urolithiasis, and the pain caused by urinary calculi could result in loss of human performance and mission objectives. The present study investigated the risk of urolithiasis in astronauts during 6 months on the International Space Station, and evaluated whether the suppression of bone resorption by the bisphosphonate, alendronate (ALN), can reduce the risk. A total of 17 astronauts were included into the analysis: exercise using the advanced resistive exercise device (ARED) plus weekly oral 70 mg alendronate (ARED+ALN group, n = 7) was compared to resistive exercise alone (ARED group, n = 10). Urine volume decreased in both groups during spaceflight but recovered after return. The ARED group showed increased urinary calcium excretion from the 15th to 30th day of spaceflight, whereas urinary calcium was slightly decreased in the ARED+ALN group. Urinary N‐terminal telopeptide (NTX) and helical peptide (HP) of type I collagen, as bone resorption markers, were elevated in the ARED group during and until 0 days after spaceflight, while there was no elevation in these parameters in the ARED+ALN group. Urinary oxalate and uric acid excretion tended to be higher in the ARED group than in the ARED+ALN group during spaceflight. These results demonstrate that astronauts on long‐duration spaceflights may be at high risk for the formation of urinary calcium oxalate and calcium phosphate stones through increased urinary excretion of oxalate and uric acid, from degraded type I collagen, as well as of calcium from enhanced bone resorption. Our findings suggest that increased bone resorption during spaceflight, as a risk factor for urinary calculus formation, could be effectively prevented by an inhibitor of bone resorption. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Atsushi Okada
- Department of Nephro‐urology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences Tokushima University Tokushima Japan
| | | | - Tatsuya Isomura
- Institute of Medical Science Tokyo Medical University Tokyo Japan
| | - Tadashi Koga
- Department of Pharmacology St. Marianna University School of Medicine Kawasaki Japan
| | - Takahiro Yasui
- Department of Nephro‐urology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Kenjiro Kohri
- Department of Nephro‐urology Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Adrian LeBlanc
- Baylor College of Medicine‐ Center for Space Medicine Houston TX USA
| | | | - Jeffrey Jones
- Baylor College of Medicine‐ Center for Space Medicine Houston TX USA
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Filler G, Salerno F, McIntyre CW, de Ferris MEDG. Animal, Human, and 23Na MRI Imaging Evidence for the Negative Impact of High Dietary Salt in Children. CURRENT PEDIATRICS REPORTS 2021; 9:110-117. [PMID: 34567839 PMCID: PMC8449209 DOI: 10.1007/s40124-021-00249-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF THE REVIEW Conditions typically prevalent in adults such as hypertension, kidney stones, osteoporosis, and chronic kidney disease are increasing among adolescents and young adults (AYA). The purpose of this review is to describe the association of these conditions to a high salt diet among pediatric patients. RECENT FINDINGS We present animal, human, and 23Na MRI evidence associated with the negative impact of high dietary salt in children. Special focus is placed on novel 23Na MRI imaging which reveals the important concept of a third compartment for sodium storage in soft tissue. Finally, we make recommendations on who should not be on a low salt diet. SUMMARY A high salt intake predisposes children and AYA to considerable morbidity. We exhort the reader to engage in advocacy efforts to curve the incidence and prevalence of high salt-related life-limiting conditions.
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Affiliation(s)
- Guido Filler
- Departments of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON E3-206N6A 5W9 Canada
- Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
| | - Fabio Salerno
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
- Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
| | - Christopher William McIntyre
- Departments of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Road East, London, ON E3-206N6A 5W9 Canada
- Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
- Children’s Health Research Institute, University of Western Ontario, London, Canada
- Lilibeth Caberto Kidney Clinical Research Unit, London, ON Canada
- Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Canada
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221
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Frazier RL, Huppmann AR. Educational Case: Urinary Stones. Acad Pathol 2021; 8:23742895211040209. [PMID: 34497867 PMCID: PMC8419563 DOI: 10.1177/23742895211040209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/08/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.
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Affiliation(s)
- Ryan L Frazier
- Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alison R Huppmann
- Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, SC, USA
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222
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Zhong J, Huang Z, Yang T, Wang G, Guo H, Li P, Zhang Y, Zhao Y, Liu J. The current status of preventive measures for urinary calculi in children. Ther Adv Urol 2021; 13:17562872211039581. [PMID: 34422114 PMCID: PMC8371722 DOI: 10.1177/17562872211039581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Urological calculus is a common disease in urology. Urological calculi are
generally more common in adults but have become more common in children in
recent years. Most existing studies focus on the prevention of urinary calculi
in adults; there are relatively few articles on calculi in children. Reported
preventive measures are not comprehensive enough, while the latest research
progress has not been updated. The pathogenesis and preventive measures
associated with urinary calculi have been the focus of research, but many
preventive measures still need further clarification. This article reviews the
progress on preventive measures for urinary calculi in children.
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Affiliation(s)
- Jiao Zhong
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Haixiang Guo
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yafei Zhang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yuan Zhao
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, P.R. China
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223
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Crivelli JJ, Wood KD, Assimos DG. Is It Time to Retire the Low-Oxalate Diet? No! J Endourol 2021; 35:1435-1437. [PMID: 34409855 DOI: 10.1089/end.2021.0576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Kyle D Wood
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Dean G Assimos
- Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
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224
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Reicherz A, Rausch P, Herout R, Noldus J, Bach P. An empirical study on hospital-based prevention of recurrent urinary stone disease in Germany. World J Urol 2021; 40:237-242. [PMID: 34406436 PMCID: PMC8813807 DOI: 10.1007/s00345-021-03813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Urinary stone disease is a common disease with a prevalence of 4.7% in Germany. The incidence increased over the last decades, and recurrence rates are up to 50% in the first 5 years after diagnosis. Adequate preventive measures can avoid up to 46% of stone recurrences. These numbers outline the importance of prevention. Especially among high-risk stone formers, specific diagnostics and measures are required. Published data indicate the divergence between the importance of prevention and its implementation in everyday clinical practice. This is the first survey among German urological departments highlighting medical care concerning the prevention of recurrent urinary stone disease, identifying challenges and providing recommendations for improvements. Methods Two hundred and seventy urological hospital departments in Germany were anonymously surveyed about measurements to prevent recurrent stone disease. The questionnaire comprised 23 items dealing with diagnostics, counselling, knowledge among doctors concerning preventive measures and difficulties in preventing recurrent urinary stone disease. Results Sixty-three urological departments (23.8%) answered the survey. The majority perform stone analysis at first and repeat events. Most patients with urinary stone disease receive general advice on preventive measures during their hospitalization. General recommendations focus on fluid intake and lifestyle changes. However, specific diets are infrequently recommended by inpatient urologists. Diagnostics to identify high-risk stone formers are mostly insufficient, and guideline-compliant urine tests are uncommon. Conclusion The quality of secondary prevention needs to improve considerably. The focus should be put on identifying high-risk stone formers and offering those patients specific counselling. Furthermore, general advice on dietary recommendations should be extended. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03813-3.
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Affiliation(s)
- Alina Reicherz
- Department of Urology, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Patricia Rausch
- Department of Urology, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Roman Herout
- Department of Urology, University Carl Gustav Carus, Dresden, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital Herne, Ruhr-University of Bochum, Hölkeskampring 40, 44625, Herne, Germany
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Meta-analysis of Clinical Microbiome Studies in Urolithiasis Reveal Age, Stone Composition, and Study Location as the Predominant Factors in Urolithiasis-Associated Microbiome Composition. mBio 2021; 12:e0200721. [PMID: 34372696 PMCID: PMC8406293 DOI: 10.1128/mbio.02007-21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To determine whether functionally relevant questions associated with the urinary or gut microbiome and urinary stone disease (USD) can be answered from metagenome-wide association studies (MWAS), we performed the most comprehensive meta-analysis of published clinical MWAS in USD to date, using publicly available data published prior to April 2021. Six relevant studies met inclusion criteria. For alpha-diversity, significant differences were noted between USD status, stone composition, sample type, study location, age, diet, and sex. For beta-diversity, significant differences were noted by USD status, stone composition, sample type, study location, antibiotic use (30 days and 12 months before sampling), sex, hypertension, water intake, body habitus, and age. Prevotella and Lactobacillus in the gut and urinary tract, respectively, were associated with healthy individuals, while Enterobacteriaceae was associated with USD in the urine and stones. Paradoxically, other Prevotella strains were also strongly associated with USD in the gut microbiome. When data were analyzed together, USD status, stone composition, age group, and study location were the predominant factors associated with microbiome composition. Meta-analysis showed significant microbiome differences based on USD status, stone composition, age group or study location. However, analyses were limited by a lack of public data from published studies, metadata collected, and differing study protocols. Results highlight the need for field-specific standardization of experimental protocols in terms of sample collection procedures and the anatomical niches to assess, as well as in defining clinically relevant metadata and subphenotypes such as stone composition.
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226
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Azimirad M, Tajbakhsh M, Yadegar A, Zali MR. Recurrent urinary tract infection with antibiotic-resistant Klebsiella pneumoniae in a patient with Crohn's disease: A case report. Clin Case Rep 2021; 9:e04531. [PMID: 34401151 PMCID: PMC8355749 DOI: 10.1002/ccr3.4531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 06/05/2021] [Accepted: 06/12/2021] [Indexed: 11/06/2022] Open
Abstract
Recurrent urinary tract infections with resistant strains of Klebsiella pneumoniae are a potential complication of the long-term use of immunosuppressive therapy in patients with Crohn's disease.
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Affiliation(s)
- Masoumeh Azimirad
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Mercedeh Tajbakhsh
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Abbas Yadegar
- Foodborne and Waterborne Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research CenterResearch Institute for Gastroenterology and Liver DiseasesShahid Beheshti University of Medical SciencesTehranIran
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227
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Agudelo J, Miller AW. A Perspective on the Metabolic Potential for Microbial Contributions to Urolithiasis. KIDNEY360 2021; 2:1170-1173. [PMID: 35368346 PMCID: PMC8786102 DOI: 10.34067/kid.0000492021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/21/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Jose Agudelo
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Aaron W. Miller
- Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Joshi A, Tallman JE, Calvert JK, Brewer T, Miller NL, Yang L, Asplin JR, Hsi RS. Complementary and Alternative Medicine Use in First-time and Recurrent Kidney Stone Formers. Urology 2021; 156:58-64. [PMID: 34293376 DOI: 10.1016/j.urology.2021.05.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the patterns of complementary and alternative medicine (CAM) among patients with kidney stones and analyze the alkali content of commonly used CAM therapies. METHODS We prospectively conducted structured interviews with patients who presented to a specialty stone clinic for the management of kidney stones. Open-ended questions were used to elicit information regarding CAM knowledge, formulation/dosing, and patterns of use. Several common CAM therapies were then analyzed for their alkali, organic anion, and sugar content. RESULTS Of 103 subjects, 82 (80%) patients reported knowledge of CAM and 52 (50%) reported using CAM. Patients with recurrent kidney stones were more likely to report using CAM than patients with first-time episodes (56% vs 26%, P = 0.04). Some respondents reported their condition decreased in severity or frequency since starting CAM therapy (17%) and improvements in pain (12%). Total alkali content per serving of the tested supplements was 0 mEq (Stonebreaker), 1.5 mEq (Ocean Spray Cranberry Juice Cocktail), 4.7 mEq (Lakewood Pure Cranberry Juice), 0.6 mEq (Braggs Apple Cider Vinegar), 11.9 mEq (LithoBalance), 9.5 mEq (Simply Grapefruit Juice), 19.8 mEq (KSP-Key Lime), and 20.2 mEq (KSP-Very Berry). CONCLUSION Patients with kidney stones may use CAM to alleviate symptoms or prevent recurrence. Commercially available CAM therapies may contain comparable alkali content to commonly prescribed citrate therapy. These data suggest that providers should be prepared to discuss the role of CAM with their patients.
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Affiliation(s)
- Aditya Joshi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob E Tallman
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Joshua K Calvert
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Taylor Brewer
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicole L Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lee Yang
- Laboratory Corporation of America Holdings, Litholink Corporation, Itasca, Illinois
| | - John R Asplin
- Laboratory Corporation of America Holdings, Litholink Corporation, Itasca, Illinois
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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229
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Bamberger JN, Rosen DC, Khusid JA, Kaplan-Marans E, Gallante B, Kapoor A, Paranjpe I, Atashsokhan DJ, Atallah WM, Gupta M. The impact of metabolic syndrome components on urinary parameters and risk of stone formation. World J Urol 2021; 39:4483-4490. [PMID: 34264364 DOI: 10.1007/s00345-021-03790-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components. METHODS Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study. Patients were given a six point (0-5) Metabolic Syndrome Severity Score (MSSS) based on the number of co-occurring MS components and split into six respective groups. Baseline clinical characteristics and metabolic profiles were compared between groups. RESULTS Four-hundred-ninety-five patients were included in the study. Median age and median BMI was 58 years and 27.26 kg/m2, respectively. Several significant metabolic differences were noted, most notably a downward trend in median urinary pH (p < 0.001) and an upward trend in median urinary supersaturation uric acid (p < 0.001) across groups as MSSS increased. Multivariate analysis demonstrated an independent association between higher MSSS and increasing number of urinary abnormalities. A second multivariate analysis revealed that all MS components except hyperlipidemia were independently associated with low urinary pH. Additionally, obesity was independently associated with the greatest number of urinary abnormalities and had the strongest association with hyperuricosuria. CONCLUSIONS Prior research has attributed the strong association of nephrolithiasis and MS to high prevalence of UA nephrolithiasis and low urinary pH. Our findings indicate that all MS components with the exception of hyperlipidemia were independently associated with low urinary pH suggesting a mechanism independent from insulin resistance.
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Affiliation(s)
- Jacob N Bamberger
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,SUNY Downstate College of Medicine, Brooklyn, NY, USA.
| | - Daniel C Rosen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elie Kaplan-Marans
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Blair Gallante
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arjun Kapoor
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ishan Paranjpe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danie J Atashsokhan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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230
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Spradling K, Zhang CA, Pao AC, Liao JC, Leppert JT, Elliott CS, Conti SL. Risk of Postpartum Urinary Stone Disease in Women with History of Urinary Stone Disease During Pregnancy. J Endourol 2021; 36:138-142. [PMID: 34235965 DOI: 10.1089/end.2021.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the risk of postpartum urinary stone disease in women with a history of stone disease during pregnancy. METHODS Using the Optum® de-identified Clinformatics® Datamart we identified pregnant women with urinary stone disease in the United States between January 2003 to December 2017 by standardized ICD-9, ICD-10, and CPT code criteria. We limited the cohort to include women without evidence of urinary stone disease prior to pregnancy. We abstracted patient demographic characteristics, clinical risk factors for stone disease, and data for urinary stone disease encounters and related procedures after pregnancy. Encounters occurring within 1 year of pregnancy were excluded. Cox proportional hazard models were used to analyze for significance. RESULTS We identified a total of 1,395,783 pregnant women with a median postpartum follow-up of 4.0 years, including 5,971 (0.4%) women diagnosed with a urinary stone during pregnancy. Of these, 736 (12.3%) had an additional urinary stone diagnosis claim after pregnancy, compared with 13,275 (0.95%) women without a history of stone disease during pregnancy (p < 0.0001). In multivariable proportional hazards models urinary stone disease during pregnancy (HR 12.8, 95% CI [11.8 - 13.8]) was independently associated with a higher hazard of urinary stone disease after pregnancy. CONCLUSION Women urinary stone disease during pregnancy were more likely to present with recurrent urinary stone disease after pregnancy. Given the 1 in 8 chance of needing further care, women with history of stone disease during pregnancy may benefit from risk counseling, surveillance, or secondary prevention efforts in the postpartum period.
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Affiliation(s)
- Kyle Spradling
- Stanford University School of Medicine, 10624, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | | | - Alan C Pao
- Stanford University School of Medicine, 10624, Nephrology, 777 Welch Road, Suite DE, Palo Alto, California, United States, 94304;
| | - Joseph C Liao
- Stanford, Urology, 300 Pasteur Dr., S-287, Stanford, California, United States, 94305-5118;
| | - John T Leppert
- Stanford University School of Medicine, Urology, Room S-287, 300 Pasteur Drive, Stanford, California, United States, 94305;
| | - Christopher S Elliott
- Santa Clara Valley Medical Center, 14454, Urology, San Jose, California, United States;
| | - Simon L Conti
- Stanford Hospital and Clinics, 10623, Urology, 300 Pasteur Drive, Stanford, California, United States, 94305.,Stanford, Urology;
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231
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Undie CU, Nnana EI, Torporo KR. Composition of Uroliths seen in patients in Abuja, Nigeria: a single centre retrospective analysis of 155 stones. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Uroliths are stones formed in the urinary tract. Analysis of stones helps to identify risk factors for their development and prevention of recurrence. Standard stone analysis using modern technology is not routinely done in Nigeria. This study sought to determine the chemical composition of urinary stones seen in Abuja, Nigeria.
Methods
This was a retrospective study on composition of uroliths. Urinary stones surgically removed from 155 patients through minimal access surgical procedures between January 2015 and August 2019 were analysed. Optical crystallography and infrared spectroscopy were used to determine the chemical composition of the urinary stones.
Results
A total of 155 urinary stones were assembled from the patients. More stones were removed from male patients and the male to female ratio was 1.9:1. Stones were rare in the extremes of age. The predominant location (89.7%) of stones was in the upper urinary tract. All stones were of mixed composition with calcium oxalate accounting for 93.55%. Calcium oxalate, calcium phosphate and uric acid stones were more common in the upper tract, while 2 of the 3 struvite stones were found in the lower tract.
Conclusion
Stones found in this study were of mixed composition with the most common constituent being Calcium oxalate and the least common, struvite.
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232
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Sivaguru M, Saw JJ, Wilson EM, Lieske JC, Krambeck AE, Williams JC, Romero MF, Fouke KW, Curtis MW, Kear-Scott JL, Chia N, Fouke BW. Human kidney stones: a natural record of universal biomineralization. Nat Rev Urol 2021; 18:404-432. [PMID: 34031587 DOI: 10.1038/s41585-021-00469-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 02/04/2023]
Abstract
GeoBioMed - a new transdisciplinary approach that integrates the fields of geology, biology and medicine - reveals that kidney stones composed of calcium-rich minerals precipitate from a continuum of repeated events of crystallization, dissolution and recrystallization that result from the same fundamental natural processes that have governed billions of years of biomineralization on Earth. This contextual change in our understanding of renal stone formation opens fundamentally new avenues of human kidney stone investigation that include analyses of crystalline structure and stratigraphy, diagenetic phase transitions, and paragenetic sequences across broad length scales from hundreds of nanometres to centimetres (five Powers of 10). This paradigm shift has also enabled the development of a new kidney stone classification scheme according to thermodynamic energetics and crystalline architecture. Evidence suggests that ≥50% of the total volume of individual stones have undergone repeated in vivo dissolution and recrystallization. Amorphous calcium phosphate and hydroxyapatite spherules coalesce to form planar concentric zoning and sector zones that indicate disequilibrium precipitation. In addition, calcium oxalate dihydrate and calcium oxalate monohydrate crystal aggregates exhibit high-frequency organic-matter-rich and mineral-rich nanolayering that is orders of magnitude higher than layering observed in analogous coral reef, Roman aqueduct, cave, deep subsurface and hot-spring deposits. This higher frequency nanolayering represents the unique microenvironment of the kidney in which potent crystallization promoters and inhibitors are working in opposition. These GeoBioMed insights identify previously unexplored strategies for development and testing of new clinical therapies for the prevention and treatment of kidney stones.
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Affiliation(s)
- Mayandi Sivaguru
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Jessica J Saw
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Department of Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elena M Wilson
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.,School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amy E Krambeck
- Department of Urology, Mayo Clinic, Rochester, MN, USA.,Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael F Romero
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kyle W Fouke
- Jackson School of Geosciences, University of Texas at Austin, Austin, TX, USA
| | - Matthew W Curtis
- Carl Zeiss Microscopy LLC, One North Broadway, White Plains, NY, USA
| | | | - Nicholas Chia
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bruce W Fouke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,School of Molecular and Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA. .,Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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233
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Garbens A, Pearle MS. Causes and prevention of kidney stones: separating myth from fact. BJU Int 2021; 128:661-666. [PMID: 34192414 DOI: 10.1111/bju.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite high-level evidence supporting the use of pharmacotherapy therapy for the prevention of kidney stones, adherence to medications is often poor because of side-effects, inconvenience and cost. Furthermore, with a desire for more 'natural' products, patients seek dietary and herbal remedies over pharmacotherapy. However, patients are often unaware of the potential side-effects, lack of evidence and cost of these remedies. Therefore, in the present review we examine the evidence for a few of the commonly espoused non-prescription agents or dietary recommendations that are thought to prevent stone formation, including lemonade, fish oil (omega fatty acids), Phyllanthus niruri and the Dietary Approaches to Stop Hypertension (DASH) diet. While the present review includes only a few of the stone-modulating recommendations available to the lay community, we focussed on these four due to their prevalent use. Our goal is not to only dispel commonly held notions about stone disease, but also to highlight the lack of high-level evidence for many commonly utilised treatments.
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Affiliation(s)
- Alaina Garbens
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, TX, USA
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234
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Global Variations in the Mineral Content of Bottled Still and Sparkling Water and a Description of the Possible Impact on Nephrological and Urological Diseases. J Clin Med 2021; 10:jcm10132807. [PMID: 34198985 PMCID: PMC8267898 DOI: 10.3390/jcm10132807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Kidney stone disease (KSD) is a complex disease. Besides the high risk of recurrence, its association with systemic disorders contributes to the burden of disease. Sufficient water intake is crucial for prevention of KSD, however, the mineral content of water might influence stone formation, bone health and cardiovascular (CVD) risk. This study aims to analyse the variations in mineral content of bottled drinking water worldwide to evaluate the differences and describes the possible impact on nephrological and urological diseases. The information regarding mineral composition (mg/L) on calcium, bicarbonate, magnesium, sodium and sulphates was read from the ingredients label on water bottles by visiting the supermarket or consulting the online shop. The bottled waters in two main supermarkets in 21 countries were included. The evaluation shows that on a global level the mineral composition of bottled drinkable water varies enormously. Median bicarbonate levels varied by factors of 12.6 and 57.3 for still and sparkling water, respectively. Median calcium levels varied by factors of 18.7 and 7.4 for still and sparkling water, respectively. As the mineral content of bottled drinking water varies enormously worldwide and mineral intake through water might influence stone formation, bone health and CVD risk, urologists and nephrologists should counsel their patients on an individual level regarding water intake.
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235
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Panunzio A, Tafuri A, Princiotta A, Gentile I, Mazzucato G, Trabacchin N, Antonelli A, Cerruto MA. Omics in urology: An overview on concepts, current status and future perspectives. Urologia 2021; 88:270-279. [PMID: 34169788 DOI: 10.1177/03915603211022960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent technological advances in molecular biology have led to great progress in the knowledge of structure and function of cells and their main constituents. In this setting, 'omics' is standing out in order to significantly improve the understanding of etiopathogenetic mechanisms of disease and contribute to the development of new biochemical diagnostics and therapeutic tools. 'Omics' indicates the scientific branches investigating every aspect of cell's biology, including structures, functions and dynamics pathways. The main 'omics' are genomics, epigenomics, proteomics, transcriptomics, metabolomics and radiomics. Their diffusion, success and proliferation, addressed to many research fields, has led to many important acquisitions, even in Urology. Aim of this narrative review is to define the state of art of 'omics' application in Urology, describing the most recent and relevant findings, in both oncological and non-oncological diseases, focusing the attention on urinary tract infectious, interstitial cystitis, urolithiasis, prostate cancer, bladder cancer and renal cell carcinoma. In Urology the majority of 'omics' applications regard the pathogenesis and diagnosis of the investigated diseases. In future, its role should be implemented in order to develop specific predictors and tailored treatments.
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Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.,Department of Neuroscience, Imaging and Clinical Science, Physiology and Physiopathology division, "G. D'Annunzio" University, Chieti, Italy
| | - Alessandro Princiotta
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Ilaria Gentile
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nicolò Trabacchin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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236
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Lovegrove CE, Geraghty RM, Yang B, Brain E, Howles S, Turney B, Somani B. Natural history of small asymptomatic kidney and residual stones over a long-term follow-up: systematic review over 25 years. BJU Int 2021; 129:442-456. [PMID: 34157218 DOI: 10.1111/bju.15522] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To systematically review the natural history of small asymptomatic kidney and residual stones, as the incidental identification of small, asymptomatic renal calculi has risen with increasing use of high-resolution imaging. MATERIALS AND METHODS We reviewed the natural history of small asymptomatic kidney and residual stones using the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched MEDLINE, Scopus, EMBASE, EBSCO, Cochrane library and Clinicaltrials.gov using themes of 'asymptomatic', 'nephrolithiasis', 'observation', 'symptoms', 'admission', 'intervention' and similar allied terms for all English language articles from 1996 to 2020 (25 years). Inclusion criteria were studies with ≥50 patients, stones ≤10 mm, and a mean follow-up of ≥24 months. Primary outcomes were occurrence of symptoms, emergency admission, and interventions. RESULTS Our literature search returned 2247 results of which 10 papers were included in the final review. Risk of symptomatic episodes ranged from 0% to 59.4%. Meta-analysis did not identify any significant difference in the likelihood of developing symptoms when comparing stones <5 mm to those >5 mm, nor those <10 mm to those >10 mm. Risk of admission varied from 14% to 19% and the risk of intervention from 12% to 35%. Meta-analysis showed a significantly decreased likelihood of intervention for stones <5 vs >5 mm and <10 vs >10 mm. Studies had variable risk of bias due to heterogeneous reporting of outcome measures with significant likelihood that observed differences in results were compatible with chance alone (Symptoms: I2 =0%, Cochran's Q = 3.09, P = 0.69; Intervention: I2 =0%, Cochran's Q = 1.76, P = 0.88). CONCLUSIONS The present systematic review indicates that stone size is not a reliable predictor of symptoms; however, risk of intervention is greater for stones >5mm vs <5 mm and >10 vs <10 mm. This review will inform urologists as they discuss management strategies with patients who have asymptomatic renal stones and offer insight to committees during the development of evidence-based guidelines.
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Affiliation(s)
- Catherine E Lovegrove
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Robert M Geraghty
- Department of Urology, Freeman Hospital, UK.,Translational and Clinical Research Institute, Faculty of Medical Sciences, International Centre for Life, Newcastle University, UK
| | - Bingyuan Yang
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - Sarah Howles
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK.,Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Ben Turney
- Department of Urology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Surgical Sciences, University of Oxford Nuffield, Oxford, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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237
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Xue X, Liu Z, Li X, Lu J, Wang C, Wang X, Ren W, Sun R, Jia Z, Ji X, Chen Y, He Y, Ji A, Sun W, Zhang H, Merriman TR, Li C, Cui L. The efficacy and safety of citrate mixture vs sodium bicarbonate on urine alkalization in Chinese primary gout patients with benzbromarone: a prospective, randomized controlled study. Rheumatology (Oxford) 2021; 60:2661-2671. [PMID: 33211886 PMCID: PMC8213434 DOI: 10.1093/rheumatology/keaa668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/22/2020] [Indexed: 12/27/2022] Open
Abstract
Objectives To compare the efficacy and safety of citrate mixture and sodium bicarbonate on urine alkalization in gout patients under benzbromarone treatment. Methods A prospective, randomized, parallel controlled trial was conducted among 200 gout patients in the dedicated gout clinic of the Affiliated Hospital of Qingdao University. The participants were randomly divided into two groups (1:1), sodium bicarbonate group (3 g/day) and citrate mixture group (7 g/day). All patients were prescribed with 25 mg/day benzbromarone at initiation and maintained at a dose of 50 mg/day. Clinical and biochemical data were collected at each follow-up time point (baseline, weeks 2, 4, 8 and 12). Results A total of 182 patients completed the 12-week urine alkalization study. The urine pH value of both groups increased significantly from the baseline to the final follow-up time point (sodium bicarbonate group, 5.50–6.00, P < 0.05; citrate mixture group, 5.53–5.93, P < 0.05). While the comparisons regarding urine pH between treatment groups showed no significant differences for each time point. The estimated glomerular filtration rate (eGFR) dropped significantly after 12 weeks’ trial in the sodium bicarbonate group (P < 0.01), while it was comparable between baseline and the last follow-up (P > 0.05) in the citrate mixture group. Results of urine analysis showed that the incident rate of occult blood in the sodium bicarbonate group was higher than that in the citrate mixture group (38 vs 24%, P < 0.05), accompanied by a similar occurrence of kidney stones. After 12-week follow-up, the frequency of twice gout flare in the citrate mixture group was significantly lower than that in sodium bicarbonate group (4 vs 12%, P = 0.037). No treatment-emergent adverse events occurred. Conclusion The efficacy of citrate mixture on urine alkalization is comparable to sodium bicarbonate under benzbromarone treatment without significant adverse events. Citrate mixture is superior to sodium bicarbonate in lowering the incidence of urine occult blood and the frequency of gout attacks. Trial registration Registered with ChiCTR (http://www.chictr.org.cn), No. ChiCTR1800018518.
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Affiliation(s)
- Xiaomei Xue
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Zhen Liu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xinde Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Jie Lu
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China.,Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Can Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xuefeng Wang
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Wei Ren
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Ruixia Sun
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Zhaotong Jia
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Xiaopeng Ji
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Ying Chen
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Yuwei He
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Aichang Ji
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
| | - Wenyan Sun
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Tony R Merriman
- Institute of Metabolic Diseases, Qingdao University, Qingdao, China.,Department of Biochemistry, University of Otago, Dunedin, New Zealand.,Division of Clinical Immunology and Rheumatology, University of Alabama Birmingham, Birmingham, AL, USA
| | - Changgui Li
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China.,Institute of Metabolic Diseases, Qingdao University, Qingdao, China
| | - Lingling Cui
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Shandong Provincial Key Laboratory of Metabolic Diseases and Qingdao Key Laboratory of Gout, Qingdao, China
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The impact of smart technology on adherence rates and fluid management in the prevention of kidney stones. Urolithiasis 2021; 50:29-36. [PMID: 34115205 DOI: 10.1007/s00240-021-01270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Smart technology (ST) can enhance chronic disease management, yet little is known about the benefits of ST on kidney stone prevention. Our aim was to prospectively evaluate the impact of ST on follow-up adherence rates and urine output (UOP) in patients with nephrolithiasis. Kidney stone patients with low UOP (< 2.5 L/24 h) were randomized into three intervention groups: (1) standard dietary/medical counseling alone (control), (2) control + smartphone fluid management application (app), and (3) control + smart water bottle (bottle). Demographics, adherence rates, kidney stone events, and 24 h urine data were collected and analyzed at baseline, 3-6, and 12 months. We randomized 111 patients (37 per group), of which 20 (55%), 8 (26%), and 10 (33%) patients completed the 12 month follow-up in the control, app, and bottle groups respectively. Control group patients were the most likely to adhere to follow-up (p = 0.004). Overall mean UOP increased by 0.4 L in each group (p < 0.05), with no difference in mean baseline 24 h UOP (1.6 L) and 12 month 24 h UOP (2.0 L) between groups (p > 0.05). Twenty-nine percent of patients achieved a daily UOP goal of > 2.5 L across the treatment groups (p < 0.001). In this prospective study, the 24 h UOP improved across all groups compared to baseline, although adherence to follow-up remained low. Furthermore, the use of ST did not further augment UOP, underscoring the importance of dietary/medical counseling for kidney stone prevention.
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239
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Xiang A, Nourian A, Ghiraldi E, Friedlander JI. Improving Compliance with 24-H Urine Collections: Understanding Inadequacies in the Collection Process and Risk Factors for Poor Compliance. Curr Urol Rep 2021; 22:38. [PMID: 34086154 DOI: 10.1007/s11934-021-01057-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition. RECENT FINDINGS Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations. Studies show conflicting data of compliance regarding patient age and gender. Physicians must understand the difficulties regarding 24-h urine collections including patient compliance, variability between collections, and complexities with interpretation to best utilize this tool in guiding clinical management for the treatment of nephrolithiasis.
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Affiliation(s)
- Alice Xiang
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Alex Nourian
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Eric Ghiraldi
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Justin I Friedlander
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA.
- Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.
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LITHOSCREEN: a comprehensive screening program and database for the assessment and treatment management of patients with kidney stones. Urolithiasis 2021; 49:387-397. [PMID: 34086105 DOI: 10.1007/s00240-021-01276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
The aim of the LITHOSCREEN project was to construct a comprehensive screening program and database for recording and assessing the various risk factors for stone-formation in patients with urolithiasis. It is intended for use in Stone Clinics and is now being made available free of charge to researchers in the field who wish to maintain a comprehensive record of their patients' medical histories, demographic backgrounds, lifestyle activities, metabolic abnormalities, biochemical risk of forming stones of various types, diet histories, stone analysis and long-term treatment records. From the recorded data for each patient, the program automatically calculates numerous functions important in the understanding of the clinical and chemical risk factors for stone-formation, including the renal handling of the ions involved, various metabolic functions, the biochemical risk of forming kidney stones (PSF), the Tiselius Indices of the supersaturation of urine with respect to calcium oxalate and calcium phosphate, the projected effects of changing the composition of each patient's urinary composition on the risk of stone recurrence, and a program for analysing the diet of patients. It automatically produces one-page Summaries of each patient's biochemical and dietary records with abnormal values highlighted according to a "traffic-light" colour-coding system and generates charts designed to improve patient compliance with treatment in the form of colour-coded "Target Diagrams" showing (a) the patient's 24-h urine composition, (b) the patient's biochemical risk of forming stones of different types and (c) the composition of the patient's diet. The Summary pages and "Target Diagrams" are suitable for inclusion in the patient's Case Notes. LITHOSCREEN also produces charts projecting the effect of changing the composition of urine on the patient's biochemical risk of forming further stones. These graphs provide clues as to which urinary risk factors to target to reduce the patient's risk of stone recurrence.
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241
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Siener R. Nutrition and Kidney Stone Disease. Nutrients 2021; 13:1917. [PMID: 34204863 PMCID: PMC8229448 DOI: 10.3390/nu13061917] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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242
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Borin JF, Knight J, Holmes RP, Joshi S, Goldfarb DS, Loeb S. Plant-Based Milk Alternatives and Risk Factors for Kidney Stones and Chronic Kidney Disease. J Ren Nutr 2021; 32:363-365. [PMID: 34045136 PMCID: PMC8611107 DOI: 10.1053/j.jrn.2021.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/13/2021] [Accepted: 03/22/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives. DESIGN AND METHODS Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry. RESULTS The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk. CONCLUSION As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry.
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Affiliation(s)
- James F Borin
- Department of Urology, New York University and New York Harbor VA Healthcare System, New York, New York.
| | - John Knight
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ross P Holmes
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shivam Joshi
- Division of Nephrology, Department of Medicine, New York University and New York Harbor VA Healthcare System, New York, New York
| | - David S Goldfarb
- Division of Nephrology, Department of Medicine, New York University and New York Harbor VA Healthcare System, New York, New York
| | - Stacy Loeb
- Department of Urology, New York University and New York Harbor VA Healthcare System, New York, New York
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243
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Brinkman JE, Large T, Nottingham CU, Stoughton C, Krambeck AE. Clinical and Metabolic Correlates of Pure Stone Subtypes. J Endourol 2021; 35:1555-1562. [PMID: 33573466 DOI: 10.1089/end.2020.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are multiple stone types, with each forming under different urinary conditions. We compared clinical and metabolic findings in pure stone formers (SFs) to understand whether there are consistent factors that differentiate these groups in terms of underlying etiology and potential for empiric treatment. Materials and Methods: Pure SFs based on infrared spectroscopic analysis of stones obtained at our institution between January 2002 and July 2018 with a corresponding 24-hour urinalysis were retrospectively evaluated. Results: One hundred twenty-one apatite (AP), 54 brushite (BRU), 50 calcium oxalate (CaOx) dihydrate, 104 CaOx monohydrate, and 82 uric acid (UA) patients were analyzed. AP, BRU, and CaOx dihydrate patients were younger than CaOx monohydrate and UA patients. The UA patients had the highest male predominance (76.8%), whereas AP patients were predominantly female (80.2%). UA was most associated with diabetes mellitus (45.3%), and CaOx monohydrate with cardiovascular disease (27.2%) and malabsorptive gastrointestinal conditions (19.2%). BRU patients had the highest prevalence of primary hyperparathyroidism (17%). AP, BRU, and CaOx dihydrate patients demonstrated high rates of hypercalciuria (66.1%, 79.6%, 82%). AP and BRU patients had the highest urinary pH. AP patients exhibited the highest rate of hypocitraturia, whereas CaOx dihydrate patients exhibited the lowest (55.4%, 30%). CaOx monohydrate patients had the highest rate of hyperoxaluria (51.9%). UA patients had the lowest urinary pH. There were no observable differences in the rates of hyperuricosuria or hypernatriuria. Conclusions: These results demonstrate that pure stone composition correlates with certain urinary and clinical characteristics. These data can help guide empiric clinical decision making.
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Affiliation(s)
- John E Brinkman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christa Stoughton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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244
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Tan HT, Yi WT, Shi L, Wang WT, Lin CH. Clinical application of percutaneous nephrolithotomy in a patient with kyphoscoliosis. J Int Med Res 2021; 49:300060520987937. [PMID: 33499720 PMCID: PMC7844462 DOI: 10.1177/0300060520987937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case report describes the performance of ultrasound-guided percutaneous nephrolithotomy in a 50-year-old woman who had scoliosis with kyphosis and a history of tuberculosis of the lumbar spine. The operation was performed with the patient under general anesthesia and in the prone position. Residual stones were found in the right lower kidney calyx postoperatively, resulting in a second-phase surgery using the same approach 2 weeks later. All stones were successfully removed during the second surgery. No complications occurred in either operation, and the patient recovered well. This study suggests that ultrasound-guided percutaneous nephrolithotomy is a safe and effective approach in treating renal calculi in patients with scoliosis.
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Affiliation(s)
- Hao-Tian Tan
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Wen-Ting Yi
- Department of Medical Laboratory, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Lei Shi
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Wen-Ting Wang
- Department of Central Laboratory, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Chun-Hua Lin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Tzelves L, Chatzikrachtis N, Lazarou L, Mourmouris P, Pinitas A, Tsirkas K, Petropoulos O, Berdempes M, Feretzakis G, Glykas I, Fragkoulis C, Varkarakis I, Skolarikos A. Fragility index of urological literature regarding medical expulsive treatment. World J Urol 2021; 39:3741-3746. [PMID: 33978811 DOI: 10.1007/s00345-021-03725-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The role of medical expulsive treatment (MET) is controversial. Fragility index is an additional metric to assess randomized controlled trials (RCTs) outcome validity and indicates how many patients would be required to convert a trial from being statistically significant, to not significant. The larger is the FI, the better the trial's data. The aim of this study is to assess FI of RCTs regarding MET for ureteral stones. MATERIALS AND METHODS A systematic literature search was performed. RCTs, reporting stone expulsion as a dichotomous outcome, showing statistical significance were eligible. FI (the number of patients needed to change from a non-event to event group, to lose statistical significance) and Fragility quotient (FI divided by total sample size), were calculated while Pearson's correlation and Mann-Whitney U test were used as appropriate. RESULTS Thirty-six RCTs were eligible, with median FI = 3.5 and fragility quotient = 0.042, median sample size = 81, median journal impact factor = 1.73 and median reported p value = 0.008. In 33.3% of the studies, number of patients lost during follow-up was larger than FI, while in 13.89% of the studies, FI was 0, indicating use of inappropriate statistical method. Pearson's correlation showed significant positive association between FI and sample size (r = 0.981), number of events (r = 0.982) and impact factor (r = 0.731), while no association was found with p value or publication year. CONCLUSIONS In this analysis, a calculated FI of 3.5 indicates that findings from RCTs on MET for ureteral stones are fragile and should be interpreted in combination with clinical thinking and expertise.
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Affiliation(s)
- Lazaros Tzelves
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Chatzikrachtis
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Lazarou
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourmouris
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Pinitas
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kimon Tsirkas
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Orestis Petropoulos
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos Berdempes
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Feretzakis
- Department of Quality Control, Research and Continuing Education, Sismanogleio General Hospital, 15126, Marousi, Greece
| | - Ioannis Glykas
- Department of Urology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | | | - Ioannis Varkarakis
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- Second Department of Urology, Sismanogleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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246
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Lopes AC, Dall'Aqua V, Carrera RV, Molina WR, Glina S. Intra-renal pressure and temperature during ureteroscopy: Does it matter? Int Braz J Urol 2021; 47:436-442. [PMID: 33284547 PMCID: PMC7857755 DOI: 10.1590/s1677-5538.ibju.2020.0428] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Antonio Corrêa Lopes
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Vinícius Dall'Aqua
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
| | - Raphael V Carrera
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Wilson R Molina
- Department of Urology, Endourology Group Kansas University Medical Center, Kansas, US
| | - Sidney Glina
- Departamento de Urologia, Divisão de Endourologia, Faculdade de Medicina do ABC, Santo Andre, SP, Brasil
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247
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Bhatt V, White MD, Listman J, Feustel PJ, Howe A, Kogan BA. Variation in Urinary Stone Parameters Throughout the Day and the Effect of Increased Fluid and Citrate Supplementation. J Endourol 2021; 35:1548-1554. [PMID: 33637013 DOI: 10.1089/end.2020.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Because 24-hour urine collections are cumbersome, many studies have evaluated the use of spot urine samples as a substitute, mostly finding poor concordance between the two. Daily variation in stone parameters probably contributes to the lack of concordance, but specific variation in various stone parameters is not well delineated. The variations likely lead to peaks and troughs, which can increase the risk of stone formation. Methods: We prospectively recruited 20 nonstone-forming patients, recording their total fluid intake over 24 hours and collecting voids at first morning, 9 to 10 A.M., 1 to 2 P.M., and 4 to 5 P.M. for evaluation of pH, specific gravity, calcium, citrate, and creatinine. Participants were then asked to double their fluid intake and take a daily True Lemon supplement over the course of the next 3 days. Urine was recollected postintervention. Results: Baseline [citrate]/[creatinine] increased throughout the day such that the 5 P.M. level was significantly higher compared with first void (0.58 vs 0.42, p = 0.027); [calcium]/[creatinine] daily variation was not statistically significant, but showed a distinct pattern that was present in both sets of collections. Daily [calcium]/[citrate] variation was significantly (p = 0.004) and consistently highest in the early morning on both day 1 (0.43) and day 4 (0.45). There was no significant variation in specific gravity and pH. Increasing fluid intake and citrate supplementation increase the daily variation in pH and [citrate]/[creatinine], but did not increase the values compared with their respective preintervention void times. There was also no detectable postintervention effect on [Ca]/[creatinine] or specific gravity. Conclusions: Urinary citrate concentration follows a circadian pattern, while urinary calcium has a diurnal excretion pattern. [Calcium]:[citrate] is highest in the early morning, indicating a high-risk time of day for stone formation. Spot urine samples identify a key time of day, which 24-hour urine collections may miss, for clinical monitoring.
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Affiliation(s)
- Vikas Bhatt
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Mark D White
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - James Listman
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Paul J Feustel
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Adam Howe
- Division of Urology, Albany Medical College, Albany, New York, USA
| | - Barry A Kogan
- Division of Urology, Albany Medical College, Albany, New York, USA
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248
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Sienes Bailo P, Santamaría González M, Izquierdo Álvarez S, Lahoz Alonso R, Serrano Frago P, Bancalero Flores JL. A study of crystalluria: effectiveness of including hygienic-dietary recommendations in laboratory reports. ADVANCES IN LABORATORY MEDICINE 2021; 2:109-120. [PMID: 37359207 PMCID: PMC10197420 DOI: 10.1515/almed-2020-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/24/2020] [Indexed: 06/28/2023]
Abstract
Objectives To assess the effectiveness of incorporating hygienic-dietary recommendations in laboratory reports in reducing the incidence of renal colic (RC). A study was performed to compare the incidence of RC in two groups of patients who had suffered at least a crystalluria event associated with the risk of urolithiasis. Recommendations were only incorporated in the laboratory reports of one group. Methods A retrospective observational study. The study sample was composed of patients who had at least an episode of crystalluria associated with a higher risk of urolithiasis. The laboratory reports of patients in Group A (n=1,115), treated in 2017, did not include any hygienic-dietary recommendations, whereas patients in Group B (n=1,692), treated in 2018, received hygienic-dietary recommendations through their laboratory reports. χ2 and Mann-Whitney U test were used to assess differences based on sex, age, and type of urinary crystals. Results The incidence of RC was 2.02 times higher in group A (2.24%) than in group B (1.12%). No significant differences were observed in the incidence of RC based on the type of urinary crystal. The incidence of RC was substantially higher in patients who suffered at least an event of crystalluria associated with a higher risk for urolithiasis as compared to the general population during the same period (0.46%, consistently with the incidence rates reported in the literature). Conclusions The incorporation of messages alerting on the risk of urolithiasis and the inclusion of hygienic-dietary recommendations in laboratory reports may be useful for reducing the incidence of RC.
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Affiliation(s)
- Paula Sienes Bailo
- Service of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | - Raquel Lahoz Alonso
- Service of Clinical Biochemistry, Miguel Servet University Hospital, Zaragoza, Spain
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Kavouras SA, Suh HG, Vallet M, Daudon M, Mauromoustakos A, Vecchio M, Tack I. Urine osmolality predicts calcium-oxalate crystallization risk in patients with recurrent urolithiasis. Urolithiasis 2021; 49:399-405. [PMID: 33635363 DOI: 10.1007/s00240-020-01242-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/21/2020] [Indexed: 12/23/2022]
Abstract
Our aim was to investigate the validity of osmolality from 24-h urine collection in examining the risk for calcium-oxalate (CaOx) kidney stone formation in patients with recurrent urolithiasis. Three hundred and twelve subjects (males/females: 184/128) from France with a history of recurrent kidney stones from confirmed or putative CaOx origin were retrospectively included in the study (46 ± 14 years, BMI: 25.3 ± 5.0 kg·m-2). Tiselius' crystallization risk index (CRI) was calculated based on urinary calcium, oxalate, citrate, magnesium, and volume from 24-h samples. The diagnostic ability of 24-h urine osmolality to classify patients as high risk for kidney stone crystallization was examined through the receivers operating characteristics analysis. High risk for CaOx crystallization was defined as CRI > 1.61 and > 1.18, for males and females, respectively. The accuracy of urine osmolality to diagnose risk of CaOx stone formation (AUC, area under the curve) for females was 84.6%, with cut-off point of 501 mmol·kg-1 (sensitivity: 83.3%, specificity: 76.0%). Males had AUC of 85.8% with threshold of 577 mmo·kg-1 (sensitivity: 85.5%, specificity: 77.6%). A negative association was found between 24-h urine volume and osmolality (r = - 0.63, P < 0.001). Also, a positive association was found between 24-h urine osmolality and CRI (r = 0.65, P < 0.001), as well as urea excretion with CRI (r = 0.37, P < 0.001). In conclusion, urine osmolality > 501 and > 577 mmol·kg-1, in female and in male, respectively, was associated with a risk for CaOx kidney stone formation in patients with a history of recurrent urolithiasis. Thus, when CaOx origin is confirmed or suspected, 24-h urine osmolality provides a simple way to define individualized target of urine dilution to prevent urine crystallization and stone formation.
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Affiliation(s)
| | - Hyun-Gyu Suh
- Hydration Science Lab, University of Arkansas, Fayetteville, AR, USA
| | - Marion Vallet
- Service des Explorations Fonctionnelles Physiologiques and INSERM 1048, CHU de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Michel Daudon
- Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, AP-HP, Paris, France
| | - Andy Mauromoustakos
- Agricultural Statistics Laboratory, University of Arkansas, Fayetteville, AR, USA
| | | | - Ivan Tack
- Service des Explorations Fonctionnelles Physiologiques and INSERM 1048, CHU de Toulouse, Université Paul Sabatier, Toulouse, France.
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Wiessmeyer JR, Ozimek T, Struck JP, Hupe MC, Willig J, Merseburger AS, Kramer MW. Comprehensive Nomogram for Prediction of the Uric Acid Composition of Ureteral Stones as a Part of Tailored Stone Therapy. Eur Urol Focus 2021; 8:291-296. [PMID: 33589393 DOI: 10.1016/j.euf.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Oral chemolitholysis is a noninvasive therapy for uric acid (UA) stones. Proper patient selection is crucial for success of the therapy. OBJECTIVE To develop a nomogram for prediction of UA stones using parameters gathered during emergency work-up for flank pain. DESIGN, SETTING, AND PARTICIPANTS A single-center cohort (459 patients) with singular ureteral stones and available stone analysis was retrospectively reviewed for radiological, urinary, and serological findings indicating UA stones. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A Mann-Whitney U test or Kruskal-Wallis test was applied for univariate analysis. Categorical variables were compared using a χ2 test. Binary logistic regression of significant parameters was performed to design the nomogram. RESULTS AND LIMITATIONS Univariate analysis revealed statistically significant differences in parameters between predominantly UA and non-UA groups, including median age (60 yr, interquartile range [IQR] 51.5-70.5 vs 51 yr, IQR 39-62; p < 0.001), body mass index (30.0 kg/m2, IQR 27.25-35.0 vs 26.6 kg/m2, IQR 24.0-30.467; p < 0.001), stone density (435.0 HU, IQR 329.0-528.0 vs 750.0 HU, IQR 548.0-995.0; p < 0.001), serum UA (437.5 μmol/l, IQR 374.25-478.0 vs 321.0 μmol/l, IQR 273.0-377.0; p < 0.001), and urine pH (5.5, IQR 5.0-5.5 vs 6.0, IQR 5.5-6.5; p < 0.001). Radiolucency was more frequent in the predominantly UA group (88.60% vs 32.70%; p < 0.001). Multivariate binary logistic regression confirmed age, body mass index, stone density, serum UA, urine pH, and radiolucency as independent predictors of UA stones and these parameters were used to design the nomogram. CONCLUSIONS We present a nomogram for the prediction of uric acid stones. PATIENT SUMMARY We developed a nomogram as a simple tool with potential to be useful in patient counseling regarding chemolitholysis as a tailored stone treatment for uric acid urinary stones.
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Affiliation(s)
- Judith R Wiessmeyer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Julian P Struck
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Marie C Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Johannes Willig
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Axel S Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Mario W Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
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