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Huang K, Peng Z, Zha C, Li W, Deng G, Chen X, Luo Y, Ji Z, Wang Q, Jiang K. Inflammatory factors and the risk of urolithiasis: a bidirectional Mendelian randomization study. Front Med (Lausanne) 2024; 11:1432275. [PMID: 39021826 PMCID: PMC11251917 DOI: 10.3389/fmed.2024.1432275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background Urolithiasis is a prevalent condition encountered in urology. Over the past decade, its global incidence has been on an upward trajectory; paired with a high recurrence rate, this presents considerable health and economic burdens. Although inflammatory factors are pivotal in the onset and progression of urolithiasis, their causal linkages remain elusive. Method Mendelian randomization (MR) is predicated upon genome-wide association studies (GWASs). It integrates bioinformatics analyses to reveal causal relationships between exposures and outcomes, rendering it an effective method with minimized bias. Drawing from a publicly accessible GWAS meta-analysis comprising 8,293 samples, we identified 41 genetic variations associated with inflammatory cytokines as instrumental variables. Outcome data on upper urinary tract stones, which included renal and ureteral stones (9,713 cases and 366,693 controls), and lower urinary tract stones, including bladder and urethral stones (1,398 cases and 366,693 controls), were derived from the FinnGen Consortium R9 dataset. By leveraging the bidirectional MR methodology, we aimed to decipher the causal interplay between inflammatory markers and urolithiasis. Results Our study comprehensively elucidated the association between genetic inflammatory markers and urolithiasis via bidirectional Mendelian randomization. Post-MR analysis of the 41 genetic inflammation markers revealed that elevated levels of circulating interleukin-2 (IL-2) (OR = 0.921, 95% CI = 0.848-0.999) suggest a reduced risk for renal stone disease, while heightened stem cell growth factor beta (SCGF-β) (OR = 1.150, 95% CI = 1.009-1.310) and diminished macrophage inflammatory protein 1 beta (MIP-1β) (OR = 0.863, 95% CI = 0.779-0.956) levels suggest an augmented risk for lower urinary tract stones. Furthermore, renal stone disease appeared to elevate IL-2 (β = 0.145, 95% CI = 0.013-0.276) and cutaneous T cell-attracting chemokine (CTACK) (β = 0.145, 95% CI = 0.013-0.276) levels in the bloodstream, whereas lower urinary tract stones were linked to a surge in interleukin-5 (IL-5) (β = 0.142, 95% CI = 0.057-0.226), interleukin-7 (IL-7) (β = 0.108, 95% CI = 0.024-0.192), interleukin-8 (IL-8) (β = 0.127, 95% CI = 0.044-0.210), growth regulated oncogene alpha (GRO-α) (β = 0.086, 95% CI = 0.004-0.169), monokine induced by interferon-gamma (MIG) (β = 0.099, 95% CI = 0.008-0.191) and macrophage inflammatory protein 1 alpha (MIP-1α) (β = 0.126, 95% CI = 0.044-0.208) levels. Conclusion These discoveries intimate the instrumental role of IL-2 in the onset and progression of upper urinary tract stones. SCGF-β and MIP-1β influence the development of lower urinary tract stones. Urolithiasis also impacts the expression of cytokines such as IL-2, CTACK, IL-5, IL-7, IL-8, GRO-α, MIG, and MIP-1α. There is a pressing need for further investigation to ascertain whether these biomarkers can be harnessed to prevent or treat urolithiasis.
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Affiliation(s)
| | - Zheng Peng
- Guizhou Medical University, Guiyang, China
| | - Cheng Zha
- Guizhou Medical University, Guiyang, China
| | - Wei Li
- Guizhou Medical University, Guiyang, China
| | | | - Xiaolong Chen
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Yuting Luo
- Guizhou University of Traditional Chinese Medicine, Guiyang, China
| | | | - Qing Wang
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China
| | - Kehua Jiang
- Guizhou Medical University, Guiyang, China
- Department of Urology, Guizhou Provincial People’s Hospital, Guiyang, China
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Tian Y, Han G, Zhang S, Ding Z, Qu R. The key role of major and trace elements in the formation of five common urinary stones. BMC Urol 2024; 24:114. [PMID: 38816700 PMCID: PMC11138091 DOI: 10.1186/s12894-024-01498-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Urolithiasis has emerged as a global affliction, recognized as one of the most excruciating medical issues. The elemental composition of stones provides crucial information, aiding in understanding the causes, mechanisms, and individual variations in stone formation. By understanding the interactions between elements in various types of stones and exploring the key role of elements in stone formation, insights are provided for the prevention and treatment of urinary stone disease. METHODS This study collected urinary stone samples from 80 patients in Beijing. The chemical compositions of urinary stones were identified using an infrared spectrometer. The concentrations of major and trace elements in the urinary stones were determined using Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS), respectively. The data were processed using correlation analysis and Principal Component Analysis (PCA) methods. RESULTS Urinary stones are categorized into five types: the calcium oxalate (CO) stone, carbonate apatite (CA) stone, uric acid (UA) stone, mixed CO and CA stone, and mixed CO and UA stone. Ca is the predominant element, with an average content ranging from 2.64 to 27.68% across the five stone groups. Based on geochemical analysis, the high-content elements follow this order: Ca > Mg > Na > K > Zn > Sr. Correlation analysis and PCA suggested significant variations in the interactions between elements for different types of urinary stones. Trace elements with charges and ionic structures similar to Ca may substitute for Ca during the process of stone formation, such as Sr and Pb affecting the Ca in most stone types except mixed stone types. Moreover, the Mg, Zn and Ba can substitute for Ca in the mixed stone types, showing element behavior dependents on the stone types. CONCLUSION This study primarily reveals distinct elemental features associated with five types of urinary stones. Additionally, the analysis of these elements indicates that substitutions of trace elements with charges and ion structures similar to Ca (such as Sr and Pb) impact most stone types. This suggests a dependence of stone composition on elemental behavior. The findings of this study will enhance our ability to address the challenges posed by urinary stones to global health and improve the precision of interventions for individuals with different stone compositions.
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Affiliation(s)
- Yu Tian
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China
| | - Guilin Han
- Institute of Earth Sciences, China University of Geosciences, No. 29 Xueyuan Road, Haidian District, Beijing, 100083, China.
- Frontiers Science Center for Deep-time Digital Earth, Institute of Earth Sciences, China University of Geosciences, Beijing, 100083, China.
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, Beijing, 100191, China.
| | - Ziyang Ding
- Institute of Earth Sciences, China University of Geosciences, No. 29 Xueyuan Road, Haidian District, Beijing, 100083, China
- Frontiers Science Center for Deep-time Digital Earth, Institute of Earth Sciences, China University of Geosciences, Beijing, 100083, China
| | - Rui Qu
- Institute of Earth Sciences, China University of Geosciences, No. 29 Xueyuan Road, Haidian District, Beijing, 100083, China
- Frontiers Science Center for Deep-time Digital Earth, Institute of Earth Sciences, China University of Geosciences, Beijing, 100083, China
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Xia K, Xu Y, Qi Q, Huang Q, Yao R, Zhang J, Hao Z. Establishment of a new predictive model for the recurrence of upper urinary tract stones. Int Urol Nephrol 2023; 55:2411-2420. [PMID: 37436572 DOI: 10.1007/s11255-023-03698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To construct a nomogram for evaluation of the recurrence risk of upper urinary tract stones in patients. METHODS We retrospectively reviewed the clinical data of 657 patients with upper urinary tract stones and divided them into stone recurrence group and non-recurrence group. Blood routine, urine routine, biochemical, and urological CT examinations were searched from the electronic medical record, relevant clinical data were collected, including age, BMI, stones number and location, maximum diameter, hyperglycemia, hypertension, and relevant blood and urine parameters. The Wilcoxon rank-sum test, independent sample t test, and Chi-square test were used to preliminarily analyze the data of the two groups, then LASSO and logistic regression analysis were used to find out the significant difference indicators. Finally, R software was used to draw a nomogram to construct the model, and ROC curve was drawn to evaluate the sensitivity and specificity. RESULTS The results showed that multiple stones (OR: 1.832, 95% CI 1.240-2.706), bilateral stones (OR: 1.779, 95% CI 1.226-2.582), kidney stones (OR: 3.268, 95% CI 1.638-6.518), and kidney ureteral stones (OR: 3.375, 95% CI 1.649-6.906) were high risk factors. And the stone recurrence risk was positively correlated with creatinine (OR: 1.012, 95% CI 1.006-1.018), urine pH (OR: 1.967, 95% CI 1.343-2.883), Apo B (OR: 4.189, 95% CI 1.985-8.841) and negatively correlated with serum phosphorus (OR: 0.282, 95% CI 0.109-0.728). In addition, the sensitivity and specificity of the prediction model were 73.08% and 61.25%, diagnosis values were greater than any single variable. CONCLUSION The nomogram model can effectively evaluate the recurrence risk of upper urinary stones, especially suitable for stone postoperative patients, to help reduce the possibility of postoperative stone recurrence.
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Affiliation(s)
- Kaiguo Xia
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Yuexian Xu
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Qiao Qi
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Qingfeng Huang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Rui Yao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Junzhi Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
- Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China.
- Anhui Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China.
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Chen T, Qian B, Zou J, Luo P, Zou J, Li W, Chen Q, Zheng L. Oxalate as a potent promoter of kidney stone formation. Front Med (Lausanne) 2023; 10:1159616. [PMID: 37342493 PMCID: PMC10278359 DOI: 10.3389/fmed.2023.1159616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 06/23/2023] Open
Abstract
Kidney stones are among the most prevalent urological diseases, with a high incidence and recurrence rate. Treating kidney stones has been greatly improved by the development of various minimally invasive techniques. Currently, stone treatment is relatively mature. However, most current treatment methods are limited to stones and cannot effectively reduce their incidence and recurrence. Therefore, preventing disease occurrence, development, and recurrence after treatment, has become an urgent issue. The etiology and pathogenesis of stone formation are key factors in resolving this issue. More than 80% of kidney stones are calcium oxalate stones. Several studies have studied the formation mechanism of stones from the metabolism of urinary calcium, but there are few studies on oxalate, which plays an equally important role in stone formation. Oxalate and calcium play equally important roles in calcium oxalate stones, whereas the metabolism and excretion disorders of oxalate play a crucial role in their occurrence. Therefore, starting from the relationship between renal calculi and oxalate metabolism, this work reviews the occurrence of renal calculi, oxalate absorption, metabolism, and excretion mechanisms, focusing on the key role of SLC26A6 in oxalate excretion and the regulatory mechanism of SLC26A6 in oxalate transport. This review provides some new clues for the mechanism of kidney stones from the perspective of oxalate to improve the understanding of the role of oxalate in the formation of kidney stones and to provide suggestions for reducing the incidence and recurrence rate of kidney stones.
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Affiliation(s)
- Tao Chen
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Biao Qian
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Junrong Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Peiyue Luo
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Jun Zou
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Wei Li
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Qi Chen
- The First Clinical College, Gannan Medical University, Ganzhou, Jiangxi, China
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
- Key Laboratory of Urology and Andrology of Ganzhou, Ganzhou, Jiangxi, China
| | - Liying Zheng
- Department of Graduate, The First Affiliated Hospital of Ganna Medical University, Ganzhou, Jiangxi, China
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Peerapen P, Thongboonkerd V. Kidney Stone Prevention. Adv Nutr 2023; 14:555-569. [PMID: 36906146 DOI: 10.1016/j.advnut.2023.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Kidney stone disease (KSD) (alternatively nephrolithiasis or urolithiasis) is a global health care problem that affects almost people in developed and developing countries. Its prevalence has been continuously increasing with a high recurrence rate after stone removal. Although effective therapeutic modalities are available, preventive strategies for both new and recurrent stones are required to reduce physical and financial burdens of KSD. To prevent kidney stone formation, its etiology and risk factors should be first considered. Low urine output and dehydration are the common risks of all stone types, whereas hypercalciuria, hyperoxaluria, and hypocitraturia are the major risks of calcium stones. In this article, up-to-date knowledge on strategies (nutrition-based mainly) to prevent KSD is provided. Important roles of fluid intake (2.5-3.0 L/d), diuresis (>2.0-2.5 L/d), lifestyle and habit modifications (for example, maintain normal body mass index, fluid compensation for working in high-temperature environment, and avoid cigarette smoking), and dietary management [for example, sufficient calcium at 1000-1200 mg/d, limit sodium at 2 or 3-5 g/d of sodium chloride (NaCl), limit oxalate-rich foods, avoid vitamin C and vitamin D supplements, limit animal proteins to 0.8-1.0 g/kg body weight/d but increase plant proteins in patients with calcium and uric acid stone and those with hyperuricosuria, increase proportion of citrus fruits, and consider lime powder supplementation] are summarized. Moreover, uses of natural bioactive products (for example, caffeine, epigallocatechin gallate, and diosmin), medications (for example, thiazides, alkaline citrate, other alkalinizing agents, and allopurinol), bacterial eradication, and probiotics are also discussed. Adv Nutr 2023;x:xx-xx.
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Affiliation(s)
- Paleerath Peerapen
- Medical Proteomics Unit, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Kim SH, Tae JH, Chang IH, Kim TH, Myung SC, Nguyen TT, Choi J, Kim JH, Kim JW, Lee YS, Choi SY. Changes in patient perceptions regarding ChatGPT-written explanations on lifestyle modifications for preventing urolithiasis recurrence. Digit Health 2023; 9:20552076231203940. [PMID: 37780059 PMCID: PMC10540569 DOI: 10.1177/20552076231203940] [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: 07/14/2023] [Accepted: 09/09/2023] [Indexed: 10/03/2023] Open
Abstract
Purpose Artificial Intelligence (AI) imitating human-like language, such as ChatGPT, has impacted lives throughout various multidisciplinary fields. However, despite these innovations, it is unclear how well its implementation will assist patients in clinical situations. We evaluated changes in patient perceptions regarding AI before and after reading a ChatGPT-written explanation. Materials and methods In total, 24 South Korean patients receiving urolithiasis treatment were surveyed through questionnaires. The ChatGPT explanatory note was provided between the first and second questionnaires, detailing lifestyle modifications for preventing urolithiasis recurrence. The study questionnaire was the Korean version of the General Attitudes toward Artificial Intelligence Scale, including positive and negative attitude items. Wilcoxon signed-rank tests were accomplished to compare questionnaire scores before and after receiving the explanatory note. A linear regression analysis with stepwise elimination was used to assess variable (demographic data) accuracy in predicting outcomes. Results There were significant differences between total negative questionnaire scores pre- and post-surveys of ChatGPT, but not in the positive scores. Among variables, only education level significantly influenced mean score differences in the negative questionnaires. Conclusions The negative perception change among urolithiasis patients after receiving the explanatory note provided by the AI chatbot program was observed, evidencing that patients with lower education levels expressed a more negative response. The explanatory note provided by the AI chatbot program could provoke an adverse change in AI perception. Negative human responses must be considered to improve and adapt new technology in health care. Only through changing patient perspectives will upgraded AI technology integrate into medical healthcare.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Tae
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Soon Chul Myung
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Tuan Thanh Nguyen
- Department of Urology, Cho Ray Hospital, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Joongwon Choi
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jung Hoon Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Smeulders N, Cho A, Alshaiban A, Read K, Fagan A, Easty M, Minhas K, Barnacle A, Hayes W, Bockenhauer D. Shockwaves and the Rolling Stones: An Overview of Pediatric Stone Disease. Kidney Int Rep 2022; 8:215-228. [PMID: 36815103 PMCID: PMC9939363 DOI: 10.1016/j.ekir.2022.11.017] [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: 09/14/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Urinary stone disease is a common problem in adults, with an estimated 10% to 20% lifetime risk of developing a stone and an annual incidence of almost 1%. In contrast, in children, even though the incidence appears to be increasing, urinary tract stones are a rare problem, with an estimated incidence of approximately 5 to 36 per 100,000 children. Consequently, typical complications of rare diseases, such as delayed diagnosis, lack of awareness, and specialist knowledge, as well as difficulties accessing specific treatments also affect children with stone disease. Indeed, because stone disease is such a common problem in adults, frequently, it is adult practitioners who will first be asked to manage affected children. Yet, there are unique aspects to pediatric urolithiasis such that treatment practices common in adults cannot necessarily be transferred to children. Here, we review the epidemiology, etiology, presentation, investigation, and management of pediatric stone disease; we highlight those aspects that separate its management from that in adults and make a case for a specialized, multidisciplinary approach to pediatric stone disease.
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Affiliation(s)
- Naima Smeulders
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alexander Cho
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Abdulelah Alshaiban
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Katharine Read
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Aisling Fagan
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Marina Easty
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Kishore Minhas
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Alex Barnacle
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Wesley Hayes
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK
| | - Detlef Bockenhauer
- Great Ormond Street Hospital National Health Service Foundation Trust, London, UK,Department of Renal Medicine, University College London, London, UK,Correspondence: Detlef Bockenhauer, Department of Renal Medicine, University College London, London, UK.
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8
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Wang K, Ge J, Han W, Wang D, Zhao Y, Shen Y, Chen J, Chen D, Wu J, Shen N, Zhu S, Xue B, Xu X. Risk factors for kidney stone disease recurrence: a comprehensive meta-analysis. BMC Urol 2022; 22:62. [PMID: 35439979 PMCID: PMC9017041 DOI: 10.1186/s12894-022-01017-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Kidney stone disease (KSD) is a common illness that causes an economic burden globally. It is easy for patients to relapse once they have suffered from this disease. The reported recurrence rate of KSD ranged from 6.1% to 66.9%. We performed this meta-analysis to identify various potential risk factors for the recurrence of KSD. Methods The PubMed, Embase and Web of Science databases were searched using suitable keywords from inception to Mar 2022. A total of 2,663 records were collected initially. After screening the literature according to the inclusion and exclusion criteria, 53 articles (40 retrospective studies; 13 prospective studies) including 488,130 patients were enrolled. The study protocol was registered with PROSPERO (No. CRD42020171771). Results The pooled results indicated that 12 risk factors including younger age (n = 18), higher BMI (n = 16), family history of kidney stones (n = 12), personal history of kidney stones (n = 11), hypertension (n = 5), uric acid stone (n = 4), race of Caucasian (n = 3), suspected kidney stone episode before the first confirmed stone episode (n = 3), surgery (n = 3), any concurrent asymptomatic (nonobstructing) stone (n = 2), pelvic or lower pole kidney stone (n = 2), and 24 h urine test completion (n = 2) were identified to be associated with KSD recurrence. In the subgroup analysis, patients with higher BMI (OR = 1.062), personal history of nephrolithiasis (OR = 1.402), or surgery (OR = 3.178) had a higher risk of radiographic KSD recurrence. Conclusions We identified 12 risk factors related to the recurrence of KSD. The results of this analysis could serve to construct recurrence prediction models. It could also supply a basis for preventing the recurrence of KSD. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01017-4.
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Affiliation(s)
- Kai Wang
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jing Ge
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Wenlong Han
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Dong Wang
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Yinjuan Zhao
- Collaborative Innovation Center of Sustainable Forestry in Southern China, College of Forestry, Nanjing Forestry University, Nanjing, 210037, Jiangsu Province, China
| | - Yanhao Shen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jiexun Chen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Dongming Chen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jing Wu
- Department of Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Ning Shen
- China Exposomics Institute (CEI) Precision Medicine Co. Ltd, Shanghai, 200120, China
| | - Shuai Zhu
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
| | - Bin Xue
- Department of Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
| | - Xianlin Xu
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
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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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