Comparative risk of chronic kidney diseases in patients with urolithiasis and urological interventions: a longitudinal population-based study

Comparison of RLP and PCNL for large pelvis calculi with CKD

OBJECTIVES

To compare the effect and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) and percutaneous nephrolithotomy (PCNL) for large pelvis calculi with chronic kidney disease (CKD).

MATERIAL AND METHODS

Between June 2017 and July 2021, 62 patients with CKD and large renal pelvis calculi (>4 cm2) were treated with RLP. Another 62 patients receiving PCNL served as controls. The perioperative parameters were compared. All patients were followed up for at least 6 months with the stone-free rate and the recovery of renal function evaluated.

RESULTS

Significantly longer operation time (101.47 ± 9.25 vs 62.55 ± 7.54 min), less drop in hemoglobin level (0.90 ± 0.38 vs 2.13 ± 0.80 g/dl), staged operations (0% vs 12.9%), postoperative fever (3.23% vs 16.13%) and delayed bowel movement (3.23% vs 14.52), and shorter hospitalization time (3.90 ± 1.66 vs 4.72 ± 1.80 days) were observed in the RLP group (p < 0.05). The stone-free rates were 100% in the RLP group and 88.7% in the PCNL group at the 3-months follow-up (p < 0.05). The serum creatinine level was significantly lower in the RLP group at 24 h (2.81 ± 1.18 vs 3.00 ± 1.15 mg/dl) and 1 week (2.08 ± 1.13 vs 2.34 ± 1.01 mg/dl) postoperatively (p < 0.05).

CONCLUSIONS

Although associated with a longer operation time, RLP is a safer and more efficient surgical option for CKD patients with large pelvic stones than PCNL.

2022 Recommendations of the AFU Lithiasis Committee: Specific cases - chronic kidney disease, bilateral stones, and solitary kidney

Chronic kidney disease, diabetes and hypertension are risk factors of kidney function impairment. The relative risk of kidney failure is 1.52 in patients with urinary stone disease. The various techniques used to remove upper urinary tract stones generally do not alter kidney function in patients with normal kidney function and may sometimes improve kidney function or slow its deterioration in patients with kidney disease. Compared to the asynchronous treatment of bilateral renal and ureteral stones, concomitant treatment is associated with higher risk of anuria and the need of additional interventions, in the absence of postoperative stenting. For the treatment of solitary kidney stones, the absence of postoperative stenting increases the risk of postoperative anuria. Moreover, the multiplication of percutaneous nephrolithotomy access tracts increases the risk of bleeding and that of kidney function impairment. METHODOLOGY: These recommendations were developed according to two methods: the Clinical Practice Recommendations (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and their adaptability to the French context.

Complicated pyelonephritis associated with chronic renal stone disease

Purpose

This article reviews imaging manifestations of complicated pyelonephritis associated with chronic renal stones disease, in particular xanthogranulomatous pyelonephritis (XGP) and emphysematous pyelonephritis (EPN), as potential mimics of other renal diseases and malignances and provides helpful tips and differentiating features that may alert the radiologist to suspect a diagnosis of infection.

Materials and methods

A retrospective review of the records from 6 adult patients (5 females and 1 male, mean age 72,3 years) with diagnosis of XGP associated with chronic nephrolithiasis and 7 adult patients (6 females and 1 male, mean age 59,3 years) with diagnosis of EPN associated with chronic nephrolithiasis from January 2010 to January 2020 was carried out. Computed tomography urography (CTU) with at least an unenhanced scan, and the parenchymal and excretory phases after contrast medium administration performed at our Teaching Hospital were included. When available images related to conventional radiography, ultrasound (US) and magnetic resonance imaging of the same patients, the comparison with CTU images was carried out.

Conclusion

A possible diagnosis of XGP or EPN must always be taken into account when a pyelonephritis is associated with untreated kidney stones, especially whenever clinical presentation is atypical, current therapy is not effective and imaging shows features of dubious interpretation. Due to their rarity and atypical presentation, a multidisciplinary approach is required and an expert radiologist represents a key figure in the multidisciplinary team as he can help to differentiate between benign and malignant lesions and thus avoid unnecessary radical surgical procedures.

Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital

CONTEXT

While urolithiasis is epidemiologically and mechanistically linked to gout, urologic stone disease is not actively investigated in gout patients. Prevalence estimates on the coexistence of urolithiasis in gout have mostly relied on clinical history alone.

PURPOSE

To estimate the prevalence of urolithiasis among adult Filipinos with primary gout through clinical history and ultrasonography.

PATIENTS AND METHODS

Patients diagnosed with primary gout were consecutively enrolled from outpatient clinics of the University of the Philippines Manila-Philippine General Hospital. Clinical data including sex; current age; age at diagnosis, duration of and attack frequency of gout; comorbidities such as hypertension, chronic kidney disease, type 2 diabetes mellitus, and dyslipidemia; personal history of urolithiasis; family history of gout; presence of tophus and laboratory samples to assess general kidney function, serum uric acid level, and urine pH were obtained from each patient who was subsequently subjected to ultrasonographic examination for urolithiasis. Lithiasic and non-lithiasic patients were identified and compared aggregately in terms of the aforementioned features.

RESULTS

We recruited 121 patients, 86.8% of whom are male, and 37 (30.6%; 95% CI=23.1-39.3%) were identified to have urolithiasis of which only 12 (9.9%) had history consistent with urolithiasis and 30 (24.8%) were diagnosed solely through ultrasonography. None of the variables of interest were found to be statistically associated (P>0.05) with urologic stone formation.

CONCLUSION

Urolithiasis among adult Filipino patients with primary gout was found to be more prevalent in this study than previous estimates, which were based only on clinical history. We discovered that 25/37 (67.6%) of patients with urolithiasis denied history of urologic stone.

Frailty predicts a higher risk of incident urolithiasis in 525 368 patients with diabetes mellitus: a population-based study

OBJECTIVE

Patients with diabetes have an increased risk for urolithiasis, but the associated risk factors remain an active area of research. We investigated whether frailty influenced the probability of patients with diabetes developing urolithiasis.

RESEARCH DESIGN AND METHODS

Using data from the Longitudinal Cohort of Diabetic Patients from 2004 to 2010, we identified those without and with frailty based on a validated, modified FRAIL scale. Patients were followed until they developed urolithiasis, and we used Kaplan-Meier and Cox proportional hazard regression analyses to examine the relationship between frailty, its severity, and the risk of urolithiasis, accounting for demographic profiles, comorbidities, frailty status changes over follow-up, and medications, with risk competition by mortality.

RESULTS

Among 525 368 patients with diabetes, 64.4% were not frail, while 28.5%, 6.6%, and 0.6% had 1, 2, and ≥3 FRAIL items at baseline. After 4.2 years of follow-up, 13.4% experienced incident urolithiasis. Cox proportional hazard regression analysis showed that patients with diabetes having at least one FRAIL criterion exhibited a significantly higher risk for urolithiasis compared with non-frail patients (for 1, 2, and ≥3 items, hazard ratio (HR)s: 1.04, 1.23, and 1.46; 95% confidence intervals (CIs) 0.99 to 1.09, 1.12 to 1.35, and 1.12 to 1.91, respectively). This increase in urolithiasis risk remained significant if we restricted analyses to renal stones or recurrent urolithiasis as the study outcomes.

CONCLUSIONS

Frailty may pose a risk for incident urolithiasis in patients with diabetes. Treating frailty may potentially reduce their risk for urolithiasis.

Anticalcifying effect of Daucus carota in experimental urolithiasis in Wistar rats

Background

Urolithiasis is a burgeoning disease that results from pathological biomineralization. Daucus carota L. is a widely consumed food crop with reported nephroprotective and diuretic activity. Its potential for Ashmari bhedan (destruction of stone/calculi) or treatment of urinary calculi has been explored traditionally. However, no scientific evidence is available to prove its antiurolithiatic efficacy. Moreover, establishing the antiurolithiatic effects of D. carota, an extensively consumed commodity with numerous health benefits, would provide a beneficial dietary measure for the prevention and cure of urolithiasis.

Objective

The study aimed at investigating in vivo antiurolithiatic potential of hydroethanolic extract of D. carota roots against calcium oxalate urolithiasis.

Materials and methods

Ethylene glycol and ammonium chloride induced hyperoxaluria model of urolithiasis in male Wistar rats was used for the study. Urine and serum parameters and, kidney histopathology was used to determine the antilithic efficacy of D. carota root extract.

Results

D. carota extract significantly ameliorated abnormal urinary levels of calcium, oxalate, phosphate, magnesium, citrate, protein and uric acid in lithogenic rats. Serum BUN, creatinine and uric acid levels; and calcium, phosphate and oxalate deposition in kidney tissue were also rendered normal following D. carota treatment. D. carota extract also prevented oxidative stress mediated renal tissue degeneration both prophylactically and curatively.

Conclusion

This study suggests antiurolithiatic effect of D. carota roots, which can be attributed to its anticrystallization property, ability to ameliorate urine and serum biochemistry and renal cellularity.