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Trends in urinary stone composition in 23,182 stone analyses from 2011 to 2019: a high-volume center study in China. World J Urol 2021; 39:3599-3605. [PMID: 33779819 DOI: 10.1007/s00345-021-03680-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/20/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the distribution and dynamic trends in constituents of urinary stones in China. MATERIALS AND METHODS The composition of 23,182 stones were analyzed and then recorded between January 2011 and December 2019. The characteristics in terms of stone patient's gender, age and calendar year were analyzed. RESULTS Most stones (22,172, 95.64%) had several crystal components, among which 40.25% (8925/22,172) were mixtures with infection components. Calcium oxalate (CaOx) and uric acid (UA) stones were more commonly encountered in men, but calcium phosphate (CaP), magnesium ammonium phosphate (MAP) and carbonate apatite (CA) stones were more prevalent in women (p < 0.05). In males, the proportion of CaOx stones increased up to the age of 40, but subsequently decreased (p < 0.001). Interestingly, females showed an inverse trend regarding CaOx stones (p < 0.001). The proportion of UA stones increased with age (p < 0.001), and CA stones most frequently were recorded at age 20-49. Over the past 9 years, UA, CA, and MAP stones increased over time, whereas there was a tendency for CaOx stones to decrease (p < 0.05). CONCLUSIONS The scarcity of pure stones and a certain proportion of mixtures with infection stone components (e.g., mixtures of CaOx and CA) suggest that treatment directed against a single stone component is insufficient for effective recurrence prevention. Age and gender were significant determinants of stone composition, and according to the observed chronological trends, it seems that in the future, more UA, CA and MAP stones and fewer CaOx stones may be encountered in the studied population.
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Bell JR. Editorial Comment on: Reduced Dose Computed Tomography: The Effects of Voltage Reduction on Density Measurements of Urolithiasis by Pan et al. (From: Pan S, Su JJ, Syed J, et al. J Endourol 2019;33(8):682-686; DOI: 10.1089/end.2019.0149). J Endourol 2021; 35:950. [PMID: 31154853 DOI: 10.1089/end.2019.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John Roger Bell
- Department of Urology, University of Kentucky Medical Center, Lexington, Kentucky
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Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis 2020; 49:1-16. [PMID: 33048172 PMCID: PMC7867533 DOI: 10.1007/s00240-020-01217-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023]
Abstract
The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.
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Runolfsdottir HL, Lin TL, Goldfarb DS, Sayer JA, Michael M, Ketteridge D, Rich PR, Edvardsson VO, Palsson R. Are conventional stone analysis techniques reliable for the identification of 2,8-dihydroxyadenine kidney stones? A case series. Urolithiasis 2020; 48:337-344. [PMID: 32399606 DOI: 10.1007/s00240-020-01187-6] [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: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
We have recently encountered patients incorrectly diagnosed with adenine phosphoribosyltransferase (APRT) deficiency due to misidentification of kidney stones as 2,8-dihydroxyadenine (DHA) stones. The objective of this study was to examine the accuracy of stone analysis for identification of DHA. Medical records of patients referred to the APRT Deficiency Research Program of the Rare Kidney Stone Consortium in 2010-2018 with a diagnosis of APRT deficiency based on kidney stone analysis were reviewed. The diagnosis was verified by measurement of APRT enzyme activity or genetic testing. Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra of pure crystalline DHA and a kidney stone obtained from one of the confirmed APRT deficiency cases were generated. The ATR-FTIR spectrum of the kidney stone matched the crystalline DHA spectrum and was used for comparison with available infrared spectra of stone samples from the patients. Of 17 patients referred, 14 had sufficient data available to be included in the study. In all 14 cases, the stone analysis had been performed by FTIR spectroscopy. The diagnosis of APRT deficiency was confirmed in seven cases and rejected in the remaining seven cases. Comparison of the ATR-FTIR spectrum of the DHA stone with the FTIR spectra from three patients who did not have APRT deficiency showed no indication of DHA as a stone component. Misidentification of DHA as a kidney stone component by clinical laboratories appears common among patients referred to our program. Since current clinical protocols used to interpret infrared spectra for stone analysis cannot be considered reliable for the identification of DHA stones, the diagnosis of APRT deficiency must be confirmed by other methods.
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Affiliation(s)
- Hrafnhildur L Runolfsdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Tzu-Ling Lin
- Department of Renal Medicine, University College London, London, UK
| | - David S Goldfarb
- Nephrology Section, VA New York Harbor Healthcare System, and Division of Nephrology, New York University Langone Medical Center, New York, NY, USA
| | - John A Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Mini Michael
- Renal Section, Department of Pediatrics, Texas Children's Hospital, and Baylor College of Medicine, Houston, TX, USA
| | - David Ketteridge
- Department of Genetics and Molecular Pathology, Women's and Children's Hospital, Adelaide, Australia
| | - Peter R Rich
- Department of Structural and Molecular Biology, University College London, London, UK
| | - Vidar O Edvardsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Children's Medical Center, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland.
| | - Runolfur Palsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Division of Nephrology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland.
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5
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Ferrero A, Chen B, Li Z, Yu L, McCollough C. Technical Note: Insertion of digital lesions in the projection domain for dual-source, dual-energy CT. Med Phys 2017; 44:1655-1660. [PMID: 28241103 DOI: 10.1002/mp.12185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/09/2017] [Accepted: 02/22/2017] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare algorithms performing material decomposition and classification in dual-energy CT, it is desirable to know the ground truth of the lesion to be analyzed in real patient data. In this work, we developed and validated a framework to insert digital lesions of arbitrary chemical composition into patient projection data acquired on a dual-source, dual-energy CT system. METHODS A model that takes into account beam-hardening effects was developed to predict the CT number of objects with known chemical composition. The model utilizes information about the x-ray energy spectra, the patient/phantom attenuation, and the x-ray detector energy response. The beam-hardening model was validated on samples of iodine (I) and calcium (Ca) for a second-generation dual-source, dual-energy CT scanner for all tube potentials available and a wide range of patient sizes. The seven most prevalent mineral components of renal stones were modeled and digital stones were created with CT numbers computed for each patient/phantom size and x-ray energy spectra using the developed beam-hardening model. Each digital stone was inserted in the dual-energy projection data of a water phantom scanned on a dual-source scanner and reconstructed with the routine algorithms in use in our practice. The geometry of the forward projection for dual-energy data was validated by comparing CT number accuracy and high-contrast resolution of simulated dual-energy CT data of the ACR phantom with experimentally acquired data. RESULTS The beam-hardening model and forward projection method accurately predicted the CT number of I and Ca over a wide range of tube potentials and phantom sizes. The images reconstructed after the insertion of digital kidney stones were consistent with the images reconstructed from the scanner, and the CT number ratios for different kidney stone types were consistent with data in the literature. A sample application of the proposed tool was also demonstrated. CONCLUSION A framework was developed and validated for the creation of digital objects of known mineral composition, and for inserting the digital objects into projection data from a commercial dual-source, dual-energy CT scanner. Among other applications, it will allow a systematic investigation of the impact of scan and reconstruction parameters on kidney stone dual-energy properties under rigorously controlled conditions.
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Affiliation(s)
- Andrea Ferrero
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Baiyu Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Zhoubo Li
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
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Cohen AJ, Borofsky MS, Anderson BB, Dauw CA, Gillen DL, Gerber GS, Worcester EM, Coe FL, Lingeman JE. Endoscopic Evidence That Randall's Plaque is Associated with Surface Erosion of the Renal Papilla. J Endourol 2016; 31:85-90. [PMID: 27824271 DOI: 10.1089/end.2016.0537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study was conducted to assess the reliability and precision of an endoscopic grading scale to identify renal papillary abnormalities across a spectrum of equipment, locations, graders, and patients. MATERIALS AND METHODS Intra- and interobserver reliability of the papillary grading system was assessed using weighted kappa scoring among 4 graders reviewing a single renal papilla from 50 separate patients on 2 occasions. Grading was then applied to a cohort of patients undergoing endoscopic stone removal procedures at two centers. Patient factors were compared with papillary scores on the level of the papilla, kidney, and patient. RESULTS Graders achieved substantial (kappa >0.6) intra- and inter-rater reliability in scored domains of ductal plugging, surface pitting, and loss of contour. Agreement for Randall's Plaque (RP) was moderate. Papillary scoring was then performed for 76 patients (89 kidneys, 533 papillae). A significant association was discovered between pitting and RP that held both within and across institutions. A general linear model was then created to further assess this association and it was found that RP score was a highly significant independent correlate of pitting score (F = 7.1; p < 0.001). Mean pitting scores increased smoothly and progressively with increasing RP scores. Sums of the scored domains were then calculated as a reflection of gross papillary abnormality. When analyzed in this way, a history of stone recurrence and shockwave lithotripsy were strongly predictive of higher sums. CONCLUSIONS Renal papillary pathology can be reliably assessed between different providers using a newly described endoscopic grading scale. Application of this scale to stone-forming patients suggests that the degree of RP appreciated in the papilla is strongly associated with the presence of pitting. It also suggests that patients with a history of recurrent stones and lithotripsy have greater burdens of gross papillary disease.
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Affiliation(s)
- Andrew J Cohen
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | - Michael S Borofsky
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Blake B Anderson
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | - Casey A Dauw
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Daniel L Gillen
- 3 Department of Statistics, Program in Public Health, and Department of Epidemiology, University of California , California, Irvine
| | - Glenn S Gerber
- 1 Section of Urology, Department of Surgery University of Chicago , Chicago, Illinois
| | | | - Fredric L Coe
- 4 Section of Nephrology, University of Chicago , Chicago, Illinois
| | - James E Lingeman
- 2 Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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7
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Mandel NS, Mandel IC, Kolbach-Mandel AM. Accurate stone analysis: the impact on disease diagnosis and treatment. Urolithiasis 2016; 45:3-9. [PMID: 27915396 DOI: 10.1007/s00240-016-0943-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022]
Abstract
This manuscript reviews the requirements for acceptable compositional analysis of kidney stones using various biophysical methods. High-resolution X-ray powder diffraction crystallography and Fourier transform infrared spectroscopy (FTIR) are the only acceptable methods in our labs for kidney stone analysis. The use of well-constructed spectral reference libraries is the basis for accurate and complete stone analysis. The literature included in this manuscript identify errors in most commercial laboratories and in some academic centers. We provide personal comments on why such errors are occurring at such high rates, and although the work load is rather large, it is very worthwhile in providing accurate stone compositions. We also provide the results of our almost 90,000 stone analyses and a breakdown of the number of components we have observed in the various stones. We also offer advice on determining the method used by the various FTIR equipment manufacturers who also provide a stone analysis library so that the FTIR users can feel comfortable in the accuracy of their reported results. Such an analysis on the accuracy of the individual reference libraries could positively influence the reduction in their respective error rates.
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Affiliation(s)
- Neil S Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA.
| | - Ian C Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA
| | - Ann M Kolbach-Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA
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8
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Ferrero A, Montoya JC, Vaughan LE, Huang AE, McKeag IO, Enders FT, Williams JC, McCollough CH. Quantitative Prediction of Stone Fragility From Routine Dual Energy CT: Ex vivo proof of Feasibility. Acad Radiol 2016; 23:1545-1552. [PMID: 27717761 DOI: 10.1016/j.acra.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 11/19/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphologic features from dual-energy computed tomography (CT) images and assess their relationship to stone fragility. MATERIALS AND METHODS Thirty-three calcified urinary stones were scanned with micro-CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low- and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. RESULTS The average stone volume was 300 mm3 (range: 134-674 mm3). The average comminution time measured ex vivo was 32 seconds (range: 7-115 seconds). Stone volume, dual-energy CT number ratio, and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2 = 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. CONCLUSIONS Dual-energy CT number ratios, volume, and morphologic metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy.
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Affiliation(s)
- Andrea Ferrero
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Juan C Montoya
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Lisa E Vaughan
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Alice E Huang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Ian O McKeag
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Felicity T Enders
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
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9
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Bazin D, Leroy C, Tielens F, Bonhomme C, Bonhomme-Coury L, Damay F, Le Denmat D, Sadoine J, Rode J, Frochot V, Letavernier E, Haymann JP, Daudon M. Hyperoxaluria is related to whewellite and hypercalciuria to weddellite: What happens when crystalline conversion occurs? CR CHIM 2016. [DOI: 10.1016/j.crci.2015.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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10
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Guaifenesin stone matrix proteomics: a protocol for identifying proteins critical to stone formation. Urolithiasis 2016; 45:139-149. [PMID: 27435233 DOI: 10.1007/s00240-016-0907-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/06/2016] [Indexed: 01/22/2023]
Abstract
Drug-related kidney stones are a diagnostic problem, since they contain a large matrix (protein) fraction and are frequently incorrectly identified as matrix stones. A urine proteomics study patient produced a guaifenesin stone during her participation, allowing us to both correctly diagnose her disease and identify proteins critical to this drug stone-forming process. The patient provided three random midday urine samples for proteomics studies; one of which contained stone-like sediment with two distinct fractions. These solids were characterized with optical microscopy and Fourier transform infrared spectroscopy. Immunoblotting and quantitative mass spectrometry were used to quantitatively identify the proteins in urine and stone matrix. Infrared spectroscopy showed that the sediment was 60 % protein and 40 % guaifenesin and its metabolite guaiacol. Of the 156 distinct proteins identified in the proteomic studies, 49 were identified in the two stone-components with approximately 50 % of those proteins also found in this patient's urine. Many proteins observed in this drug-related stone have also been reported in proteomic matrix studies of uric acid and calcium containing stones. More importantly, nine proteins were highly enriched and highly abundant in the stone matrix and 8 were reciprocally depleted in urine, suggesting a critical role for these proteins in guaifenesin stone formation. Accurate stone analysis is critical to proper diagnosis and treatment of kidney stones. Many matrix proteins were common to all stone types, but likely not related to disease mechanism. This protocol defined a small set of proteins that were likely critical to guaifenesin stone formation based on their high enrichment and high abundance in stone matrix, and it should be applied to all stone types.
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11
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Ray ER, Rumsby G, Smith RD. Biochemical composition of urolithiasis from stone dust - a matched-pair analysis. BJU Int 2016; 118:618-24. [PMID: 26917210 DOI: 10.1111/bju.13448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine if the biochemical composition of a renal calculus can be measured from 'dust' obtained during laser fragmentation. PATIENTS AND METHODS This pilot study was set in a tertiary referral hospital between 2011 and 2013. Stone dust was aspirated through the ureteroscope during lasering and a stone fragment also retrieved. Both samples were analysed by Fourier transform infrared spectroscopy. Pairs of stone (standard) and dust were compared. They were deemed to match if both were of the same pure biochemical composition or if the predominant constituent was the same in mixed compositions, as this would not alter subsequent management. RESULTS Paired specimens were obtained from 97 ureteroscopies. The dust specimen was sufficient for analysis in 66/97 (68%) cases. Of these, the composition matched that of the stone in 49/66 (74%) cases. In 12/66 (18%) the biochemistry differed only in the relative proportions of each constituent, whilst 5/66 (8%) showed a complete mismatch. The overall sensitivity was 51% and specificity 97%. A limitation of the study is the small number of some stone types analysed (<5 each cystine, atazanavir, mixed uric acid/calcium oxalate). CONCLUSION We have demonstrated in this pilot study successful proof of principle. Further work is required initially to improve the number of sufficient dust specimens. This technique may offer an option when a stone cannot be retrieved ureteroscopically.
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Affiliation(s)
- Eleanor R Ray
- Department of Urology, University College Hospital London, London, UK.
| | - Gill Rumsby
- Department of Biochemistry, University College Hospital London, London, UK
| | - R Daron Smith
- Department of Urology, University College Hospital London, London, UK
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12
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Torricelli FCM, Brown R, Berto FCG, Tarplin S, Srougi M, Mazzucchi E, Monga M. Nomogram to predict uric acid kidney stones based on patient's age, BMI and 24-hour urine profiles: A multicentre validation. Can Urol Assoc J 2015; 9:E178-82. [PMID: 26085876 DOI: 10.5489/cuaj.2682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We performed a multicentre validation of a nomogram to predict uric acid kidney stones in two populations. METHODS We reviewed the kidney stone database of two institutions, searching for patients with kidney stones who had stone composition analysis and 24-hour urine collection from January 2010 to December 2013. A nomogram to predict uric acid kidneys stones based on patient age, body mass index (BMI), and 24-hour urine collection was tested. Receiver-operating curves (ROC) were performed. RESULTS We identified 445 patients, 355 from Cleveland, United States, and 90 from Sao Paulo, Brazil. Uric acid stone formers were 7.9% and 8.9%, respectively. Uric acid patients had a significantly higher age and BMI, as well as significant lower urinary calcium than calcium stone formers in both populations. Uric acid had significantly higher total points when scored according to the nomogram. ROC curves showed an area under the curve of 0.8 for Cleveland and 0.92 for Sao Paulo. The cutoff value that provided the highest sensitivity and specificity was 179 points and 192 for Cleveland and Sao Paulo, respectively. Using 180 points as a cutoff provided a sensitivity and specificity of 87.5% and 68% for Cleveland, and 100% and 42% for Sao Paulo. Higher cutoffs were associated with higher specificity. The main limitation of this study is that only patients from high volume hospitals with uric acid or calcium stones were included. CONCLUSION Predicting uric acid kidneys stone based on a nomogram, which includes only demographic data and 24-hour urine parameters, is feasible with a high degree of accuracy.
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Affiliation(s)
| | - Robert Brown
- Department of Urology, The Cleveland Clinic, Cleveland, OH
| | - Fernanda C G Berto
- Department of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sarah Tarplin
- Department of Urology, The Cleveland Clinic, Cleveland, OH
| | - Miguel Srougi
- Department of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Mazzucchi
- Department of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Manoj Monga
- Department of Urology, The Cleveland Clinic, Cleveland, OH
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13
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Wood KD, Stanasel IS, Koslov DS, Mufarrij PW, McLorie GA, Assimos DG. Changing stone composition profile of children with nephrolithiasis. Urology 2013; 82:210-3. [PMID: 23561713 DOI: 10.1016/j.urology.2013.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/11/2013] [Accepted: 02/18/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine if this trend toward calcium phosphate stone formation exists in children. METHODS This is a retrospective study of medical records of 179 children managed at our medical center from 1992-2010 for whom stone analysis and other pertinent laboratory data were available. A comparison of patients managed from 1992-2000 (P1) and 2001-2010 (P2) was undertaken. Statistical analysis included nonparametric tests. RESULTS There were no significant differences in the mean age of the 2 cohorts. During both periods, boys comprised a significantly higher proportion during the first decade of life, whereas girls comprised a significantly higher proportion during the second decade. A higher percentage of patients had calcium oxalate (CaOx) stones in P1 compared to P2 (60% vs 47%, P = .0019). There was a significant increase in the percentage of patients having calcium phosphate stones in P2 compared to P1 (27% vs 18.5%, P = .008). Twenty-seven patients had recurrent stones. A comparison of the compositions of the first and last stones of patients within this group demonstrated an increasing proportion of brushite stones (3.7% vs 11.1%, P = .04). Twenty-four hour urine testing results were similar for those with CaOx and calcium phosphate stones. CONCLUSION An increasing proportion of children have calcium phosphate calculi. Brushite stones are more prevalent in children with recurrent stone events. The impetus of these shifts is not readily apparent.
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Affiliation(s)
- Kyle D Wood
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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14
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Blaschko SD, Miller J, Chi T, Flechner L, Fakra S, Kahn A, Kapahi P, Stoller ML. Microcomposition of human urinary calculi using advanced imaging techniques. J Urol 2013; 189:726-34. [PMID: 23021997 PMCID: PMC4124914 DOI: 10.1016/j.juro.2012.09.098] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Common methods of commercial urolithiasis analysis, such as light microscopy and Fourier transform infrared spectroscopy, provide limited or no information on the molecular composition of stones, which is vital when studying early stone pathogenesis. We used synchrotron radiation based microfocused x-ray fluorescence, x-ray absorption and x-ray diffraction advanced imaging techniques to identify and map the elemental composition, including trace elements, of urinary calculi on a μm (0.0001 cm) scale. MATERIALS AND METHODS Human stone samples were obtained during serial percutaneous nephrolithotomy and ureteroscopy procedures. A portion of each sample was sent for commercial stone analysis and a portion was retained for synchrotron radiation based advanced imaging analysis. RESULTS Synchrotron radiation based methods of stone analysis correctly identified stone composition and provided additional molecular detail on elemental components and spatial distribution in uroliths. Resolution was on the order of a few μm. CONCLUSIONS Knowledge of all elements present in lithogenesis at this detail allows for better understanding of early stone formation events, which may provide additional insight to prevent and treat stone formation.
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Affiliation(s)
- Sarah D. Blaschko
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Joe Miller
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Thomas Chi
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Lawrence Flechner
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Sirine Fakra
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Arnold Kahn
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Pankaj Kapahi
- Department of Urology, University of California-San Francisco (SDB, JM, TC, LF, MLS), San Francisco, Advanced Light Source, Lawrence Berkeley National Laboratory (SF), Berkeley and Buck Institute for Research on Aging (AK, PK), Novato, California
| | - Marshall L. Stoller
- Correspondence: Department of Urology, University of California-San Francisco, 400 Parnassus Ave., A610, San Francisco, California 94143 (telephone: 415-476-1611; FAX: 415-476-8849; )
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Kaiser J, Stĕpánková K, Koř istková T, Šedo O, Melnyk G, Hartl M, Paloušek D, Kuc̆era J. Determination of the cause of selected canine urolith formation by advanced analytical methods. J Small Anim Pract 2012; 53:646-51. [DOI: 10.1111/j.1748-5827.2012.01292.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- J. Kaiser
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
| | - K. Stĕpánková
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- Department of Chemistry, Faculty of Science; Masaryk University; Kotlá̌rská 2 611 37 Brno Czech Republic
| | - T. Koř istková
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- Laboratory Specializing in Urinary Stones Analyses, Calculi®; Vránova 172, P.O. Box 20 621 00 Brno Czech Republic
| | - O. Šedo
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- Core Facility - Proteomics, CEITEC - Central European Institute of Technology; Masaryk University; Kamenice 753/5 Bohunice Brno Czech Republic
| | - G. Melnyk
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- GE Sensing & Inspection Technologies GmbH, phoenix
- x-ray; Niels-Bohr-Str. 7 D-31515 Wunstorf Germany
| | - M. Hartl
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- nstitute of Machine and Industrial Design, Faculty of Mechanical Engineering; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
| | - D. Paloušek
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- nstitute of Machine and Industrial Design, Faculty of Mechanical Engineering; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
| | - J. Kuc̆era
- X-ray Micro CT and Nano CT Research Group, CEITEC - Central European Institute of Technology; Brno University of Technology; Technická 2896/2 616 69 Brno Czech Republic
- Veterinary Clinic PET; B̌eloruská 2 625 00 Brno Czech Republic
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Abstract
Kidney stones composed predominantly (50% or more) of calcium phosphate constitute up to 10% of all stones and 15%-20% of calcium stones, 80% of which are composed of calcium oxalate. Calcium phosphate is a minor component of up to 30% of calcium oxalate stones as well. The cause of calcium phosphate stones is often obscure but most often related to a high urine pH. Some patients with calcium phosphate stones may have incomplete renal tubular acidosis. Others have distal renal tubular acidosis characterized by hyperchloremic acidosis, hypocitraturia, and high urine pH. The use of carbonic anhydrase inhibitors such as acetazolamide, topiramate, and zonisamide leads to a similar picture. Treatment options to specifically prevent calcium phosphate stone recurrence have not been tested in clinical trials. Increases in urine volume and restriction of sodium intake to limit calcium excretion are important. Citrate supplementation is probably effective, although the concomitant increase in urine pH may increase calcium phosphate supersaturation and partially offset the inhibition of crystallization resulting from the increased urine citrate excretion and the alkali-associated reduction in urine calcium excretion. Thiazides lower urine calcium excretion and may help ensure the safety of citrate supplementation.
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Affiliation(s)
- David S Goldfarb
- Nephrology Section, New York Harbor Department of Veterans Affairs Healthcare System, New York, NY 10010, USA.
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Gnessin E, Mandeville JA, Handa SE, Lingeman JE. Changing composition of renal calculi in patients with musculoskeletal anomalies. J Endourol 2011; 25:1519-23. [PMID: 21810030 DOI: 10.1089/end.2010.0698] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Calculi from patients with musculoskeletal (MS) anomalies who are largely immobile and prone to urinary infections have been traditionally composed primarily of struvite and carbonate apatite. Because of substantial improvements in the care of these patients in recent decades, stone etiology may have shifted from infectious to metabolic. We assessed the composition of renal calculi and metabolic characteristics in a contemporary cohort of patients with MS anomalies who underwent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Retrospective analysis of patients who underwent PCNL between April 1999 and June 2009 and had follow-up 24-hour urine studies was performed. Patients with MS anomalies included spinal cord injury, myelomeningocele, muscular dystrophy, multiple sclerosis, cerebral palsy, or other clinical syndromes causing kyphoscoliosis and contractures. RESULTS Our cohort included 33 patients with MS anomalies and 334 consecutive patients as a control group who underwent PCNL and had metabolic workup. Stones were infectious in etiology in 18.4% and 6.2% in MS and control groups, respectively. Thus, most patients harbored stones of metabolic origin. Metabolic stones in the MS group were composed of 52.7% hydroxyapatite, 10.5% calcium oxalate, 7.9% brushite, 2.6% uric acid, 0% cystine, and 7.9% other. Metabolic stones in the control group were 50.5% calcium oxalate, 16.4% hydroxyapatite, 11.5% brushite, 10.8% uric acid, 4.3% cystine, and 0.3% other. Mean 24-hour urine values for patients with metabolic stones in MS/control groups were volume 2.18/1.87 L/d, pH 6.78/6.05, calcium to creatinine ratio 220/151 mg/g, and oxalate 44.8/39.5 mg/d. CONCLUSIONS Although patients with MS anomalies are traditionally thought to harbor infection-related calculi, most will be found to have calculi of metabolic etiology. The incidence of calcium phosphate stones is high in this group of patients, perhaps reflecting their high urinary pH.
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Affiliation(s)
- Ehud Gnessin
- Department of Urology, Indiana University Health Physicians, Indianapolis, Indiana, USA
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