1
|
Demirtas F, Çakar N, Özçakar ZB, Akıncı A, Burgu B, Yalçınkaya F. Risk factors for recurrence in pediatric urinary stone disease. Pediatr Nephrol 2024; 39:2105-2113. [PMID: 38273078 PMCID: PMC11147915 DOI: 10.1007/s00467-024-06300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/24/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Children's urinary system stones may develop from environmental, metabolic, anatomical, and other causes. Our objective is to determine the recurrence and prognosis, demographic, clinical, and etiological characteristics of children with urolithiasis. METHODS Medical records of patients were evaluated retrospectively. Patients' demographic data and medical history, serum/urine biochemical and metabolic analysis, blood gas analysis, stone analysis, imaging findings, and medical/surgical treatments were recorded. RESULTS The study included 364 patients (male 187). Median age at diagnosis was 2.83 (IQR 0.83-8.08) years. The most common complaints were urinary tract infection (23%) and urine discoloration (12%). Sixty-two percent had a family history of stone disease. At least one metabolic disorder was found in 120 (88%) of 137 patients having all metabolic analyses: hypercalciuria was found in 45%, hypocitraturia in 39%, and hyperoxaluria in 37%. Anatomical abnormalities were detected in 18% of patients. Of 58 stones analyzed, 65.5% were calcium and 20.6% were cystine stones. Stone recurrence rate was 15% (55/364). Older age (> 5 years), family history of stone disease, stone size (≥ 5 mm), and urinary system anatomical abnormalities were significantly associated with stone recurrence (p = 0.027, p = 0.031, p < 0.001, and p < 0.001, respectively). In adjusted logistic regression analysis, stone size ≥ 5 mm (OR 4.85, 95% CI 2.53-9.3), presence of urinary system anatomical abnormalities (OR 2.89, 95% CI 1.44-5.78), and family history of stone disease (OR 2.41, 95% CI 1.19-4.86) had increased recurrence rate. CONCLUSIONS All children with urolithiasis should be evaluated for factors affecting stone recurrence. Children at higher risk of recurrence need to be followed carefully.
Collapse
Affiliation(s)
- Ferhan Demirtas
- Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
| | - Nilgün Çakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| | - Aykut Akıncı
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatoş Yalçınkaya
- Division of Pediatric Nephrology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
2
|
Klib M, Ghandour M, Wannous H. Urinary stone disease in Syrian children. Pediatr Nephrol 2023; 38:2699-2709. [PMID: 36662300 DOI: 10.1007/s00467-022-05860-3] [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: 08/22/2021] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pediatric urinary stone disease (USD) is a costly medical problem. This study aims to assess the clinical characteristics and outcomes of common and rare causes of pediatric USD. METHODS A retrospective descriptive cohort study included all children < 13 years of age with confirmed USD admitted to the Children's University Hospital in Damascus, Syria, from January 2013 to December 2019. The study sample was divided into two groups based on etiologies: common and rare causes groups. RESULTS We evaluated 235 patients; 147 of them were males, and the male-to-female ratio was 1.7:1. The common causes group consisted of 203 patients (mean age 3.52 ± 3.66 years) and mainly included metabolic disorders (45.5%) and anatomical abnormalities (22.3%), while the rare causes group included 32 cases (mean age 4.93 ± 4.08 years), 12 patients with uric acid stones (37.5%), 7 patients with cystinuria (21.9%), and primary hyperoxaluria in 5 patients (15.6%). In addition, 39.6% of study patients were born to consanguineous marriages. Sixty-two patients developed AKI, and eleven patients had chronic kidney disease (CKD). Patients with rare causes were more likely to have AKI, CKD, bilateral stones, and recurrent stones (P-value < 0.05). Stone analysis was performed on 83 patients, and the main stone types were calcium oxalate (34.9%), uric acid (14.4%), and struvite stones (12%). Surgery was the most performed treatment in 101 patients (56.7%). CONCLUSION Patients with rare causes of pediatric USD are at a higher risk for severe complications and require early diagnosis and management. The high rate of uric acid stones in our society requires further evaluation for possible underlying causes. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
Affiliation(s)
- Mohamad Klib
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Munir Ghandour
- Department of Internal Medicine, Al-Mouwasat University Hospital, Damascus University, Damascus, Syria
| | - Hala Wannous
- Department of Pediatric Nephrology, Children's University Hospital, Damascus University, Damascus, Syria
| |
Collapse
|
3
|
Ivandic E, Maric M, Elvedi-Gasparovic V, Fistrek Prlic M, Lamot L, Jelakovic B, Vukovic Brinar I. Typical course of cystinuria leading to untypical complications in pregnancy: A case report and review of literature. Front Med (Lausanne) 2023; 10:1097442. [PMID: 37089588 PMCID: PMC10117994 DOI: 10.3389/fmed.2023.1097442] [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: 11/13/2022] [Accepted: 03/03/2023] [Indexed: 04/25/2023] Open
Abstract
Cystinuria is a rare genetic disorder inherited by an autosomal recessive pattern which affects the transmembrane transporter for the base amino acid cystine. It has a general prevalence of 1 in 7000 with demographic variations. Patients with cystinuria have excessive urinary excretion of cystine, which can lead to the formation of stones. Up to 70% of patients will develop chronic kidney disease that can progress even to end-stage renal disease. Symptoms usually start in the first two decades of life with a typical presentation consisting of flank pain and renal colic, usually accompanied by urinary tract infection and deterioration of kidney function. Men are typically affected twice as often as women and have a more severe clinical course. Diagnosis is made by spectrophotometric analysis of the stones that are collected after spontaneous expulsion or medical intervention. Genetic testing is not mandatory but is recommended in uncertain cases or as a part of genetic counseling. Treatment consists of diet modification, alkalization of urine, and thiol-based therapies if other measures fail to prevent stone formation. In pregnancy, cystinuria with the formation of cystine stones represents a therapeutic challenge and requires a multidisciplinary approach consisting of an uro-nephrology team and a gynecologist. We present the case of a 34-year-old woman with cystinuria on whom the diagnosis was made by analysis of the expulsed stone. While her previous pregnancies were without complications, her third pregnancy was accompanied by frequent urinary tract infections, acute worsening of kidney function, and urological interventions during pregnancy due to the formation of new stones. Despite the complicated course, the pregnancy was successfully carried to term with the delivery of a healthy female child.
Collapse
Affiliation(s)
- Ema Ivandic
- Department of Nephrology, Arterial, Hypertension, Dialysis and Transplantation, University Clinical Hospital Zagreb, Zagreb, Croatia
- *Correspondence: Ema Ivandic,
| | - Marjan Maric
- Clinic of Urology, University Clinical Hospital Zagreb, Zagreb, Croatia
| | | | - Margareta Fistrek Prlic
- Department of Nephrology, Arterial, Hypertension, Dialysis and Transplantation, University Clinical Hospital Zagreb, Zagreb, Croatia
| | - Lovro Lamot
- Division of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Arterial, Hypertension, Dialysis and Transplantation, University Clinical Hospital Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Vukovic Brinar
- Department of Nephrology, Arterial, Hypertension, Dialysis and Transplantation, University Clinical Hospital Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| |
Collapse
|
4
|
Phenotypic characterization of a pediatric cohort with cystinuria and usefulness of newborn screening. Pediatr Nephrol 2022; 38:1513-1521. [PMID: 36227436 DOI: 10.1007/s00467-022-05732-w] [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: 07/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Cystinuria is an inherited metabolic disease involving the defective transport of cystine and the dibasic amino acids in the renal proximal tubules that causes the formation of stones in the urinary system. In our regional child health program, cystinuria is included in newborn metabolic screening. Our objectives are the phenotypic characterization of our cystinuric pediatric cohort and to present our experience in neonatal cystinuria screening. METHODS The study of clinical cases of pediatric patients diagnosed with cystinuria over a period of 32 years. All patients were studied at demographic, clinical, laboratory, radiological, and therapeutic levels. RESULTS We diagnosed 86 pediatric patients with cystinuria; 36% of them had the homozygous biochemical phenotype. 95.3% of the patients were detected by neonatal metabolic screening. We performed urine biochemical analyses of parents with additional diagnoses of 63 adult patients. The mean follow-up time was 16.8 ± 8.5 years. 11.6% of patients developed one or more episodes of urinary tract infection during that period. Chronic kidney disease, proteinuria, and hypertension were uncommon (1.2%). 10.5% developed kidney stones at the mean age of presentation of 7.78 ± 7.6 years; 33% were recurrent. The risk of developing lithiasis was higher for homozygous biochemical-phenotype patients. Hypercalciuria was a significant risk factor in the development of lithiasis. CONCLUSIONS Our clinical data suggest that diagnosing cystinuria through neonatal screening could be a useful strategy for the detection of presymptomatic cases, in order to establish preventive measures, as well as for the detection of relatives at risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
|
5
|
Yifan Z, Luming S, Wei C, Luwei X, Zheng X, Ruipeng J. Cystine crystal-induced reactive oxygen species associated with NLRP3 inflammasome activation: implications for the pathogenesis of cystine calculi. Int Urol Nephrol 2022; 54:3097-3106. [PMID: 36085346 DOI: 10.1007/s11255-022-03347-6] [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: 05/26/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate whether cystine crystal-induced production of reactive oxygen species (ROS) and activation of NLRP3 inflammasome contribute to cystine calculi formation. METHODS Slc7a9-knockout rats were created as cystine calculi animal models. Kidney histological examination using TEM and immunohistochemistry were performed. The protein expression of NLRP3 and IL-1β and the concentrations of oxidative stress markers such as ROS, MDA and H2O2 in kidney tissues were estimated. In parallel, HK-2 human renal proximal tubule cells were exposed to cystine crystals and NAC treatment. The protein and mRNA expression levels of NLRP3 were evaluated. Finally, cell apoptosis and cystine crystal adherence were also assessed. RESULTS Activation of the NLRP3 inflammasome and marked elevations in MDA, H2O2 and ROS levels were observed both in vivo and in vitro. In particular, the protein and mRNA expression of NLRP3 was significantly increased by cystine crystals, but could be restored by an inhibitor of ROS. In addition, cell apoptosis and cystine crystal adherence were promoted by the NLRP3 inflammasome. The expression of CD44, OPN and HA in HK-2 cells was markedly increased by cystine crystals, but could be decreased by NLRP3 siRNA treatment. CONCLUSION Notably, we found that the activation of NLRP3 by cystine crystal-induced ROS production was of major importance in the pathogenesis of cystine calculi formation.
Collapse
Affiliation(s)
- Zhang Yifan
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Shen Luming
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, 121#, Jiangjiayuan, Nanjing, 210000, China
| | - Chen Wei
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Xu Luwei
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Xu Zheng
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Jia Ruipeng
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China.
| |
Collapse
|
6
|
Maiti P, Saren U, Chakraborty U, Singha T, Paul S, Paul PK. Comparative and Selective Interaction of Amino Acid d-Cysteine with Colloidal Gold Nanoparticles in the Presence of a Fluorescent Probe in Aqueous Medium. ACS OMEGA 2022; 7:29013-29026. [PMID: 36033694 PMCID: PMC9404198 DOI: 10.1021/acsomega.2c02725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/01/2022] [Indexed: 05/20/2023]
Abstract
In this communication, we report the comparative and selective interaction of amino acid d-cysteine (d-Cys) with citrate caped gold nanoparticles (Au NPs) in the presence of a fluorescent dye, rhodamine B (RhB), in aqueous solution. Au NPs of size 27.5 nm could almost fully quench the steady-state fluorescence emission of RhB at their optimum concentrations in the mixed solution. The interactions of d-Cys, l-Cys, all other relevant d- and l-amino acids, neurotransmitters, and other relevant biological compounds with the Au NPs/RhB mixed solution have been explored by monitoring the fluorescence recovery efficiencies from the almost fully quenched state of RhB fluorescence via a simple steady-state spectrofluorometric method. The higher fluorescence recovery for the interaction of d-Cys with the Au NPs/RhB mixed system is accompanied by a distinct color change (red-wine to bluish-black) of the assay medium after the reaction compared to that of all other interfering compounds considered in this work. The sensitivity of this fluorometric response lies in a broad linear range of concentrations of d-Cys and the limit of detection (LOD) is found to be 4.2 nM, which is low compared to many other methods available in the literature. The different degrees of interaction of d-Cys and l-Cys with the Au NPs/RhB mixed sample have been further explored by circular dichroism (CD) spectroscopy and Fourier transform infrared (FTIR) spectroscopy. The selective interaction of d-Cys with the proposed Au NPs/RhB mixed system is also found to be correlated with interparticle cross-linking and aggregations of nanoparticles by the analysis of ζ potential and dynamic light scattering (DLS) study, transmission electron microscopy (TEM), atomic force microscopy (AFM), UV-vis absorption spectroscopy etc. The proposed interaction mechanism is further studied with a normal human urine sample to elucidate that the optimized combination of Au NPs and RhB may be realized as an efficient platform for detection of the amino acid d-Cys in a real biosample via a simple fluorometric approach.
Collapse
Affiliation(s)
- Pradip Maiti
- Department
of Physics, Jadavpur University, Jadavpur, Kolkata 700032, India
| | - Ujjal Saren
- Department
of Physics, Jadavpur University, Jadavpur, Kolkata 700032, India
| | - Utsav Chakraborty
- Department
of Physics, Jadavpur University, Jadavpur, Kolkata 700032, India
| | - Tanmoy Singha
- Department
of Physics, Jadavpur University, Jadavpur, Kolkata 700032, India
| | - Sharmistha Paul
- West
Bengal State Council of Science and Technology, Department of Science and Technology and Biotechnology, Vigyan Chetana Bhavan, Sector-I, Salt Lake, Kolkata 700064, India
| | - Pabitra Kumar Paul
- Department
of Physics, Jadavpur University, Jadavpur, Kolkata 700032, India
- , . Phone: +91-9477631142 (M), +91-33-24138917 (O). Fax:
+91-33-24138917 (O)
| |
Collapse
|
7
|
D'Ambrosio V, Capolongo G, Goldfarb D, Gambaro G, Ferraro PM. Cystinuria: an update on pathophysiology, genetics, and clinical management. Pediatr Nephrol 2022; 37:1705-1711. [PMID: 34812923 DOI: 10.1007/s00467-021-05342-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/22/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Cystinuria is the most common genetic cause of nephrolithiasis in children. It is considered a heritable aminoaciduria as the genetic defect affects the reabsorption of cystine and three other amino acids (ornithine, lysine, and arginine) in the renal proximal tubule. Patients affected by this condition have elevated excretion of cystine in the urine, and because of this amino acid's low solubility at normal urine pH, patients tend to form cystine calculi. To date, two genes have been identified as disease-causative: SLC3A1 and SLC7A9, encoding for the two subunits of the heterodimeric transporter. The clinical features of this condition are solely related to nephrolithiasis. The diagnosis is usually made during infancy or adolescence, but cases of late diagnosis are common. The goal of therapy is to reduce excretion and increase the solubility of cystine, through both modifications of dietary habits and pharmacological treatment. However, therapeutic interventions are not always sufficient, and patients often have to undergo several surgical procedures during their lives to treat recurrent nephrolithiasis. The goal of this literature review is to synthesize the available evidence on diagnosis and management of patients affected by cystinuria in order to provide physicians with a practical tool that can be used in daily clinical practice. This review also aims to shed some light on new therapy directions with the aim of ameliorating kidney outcomes while improving adherence to treatment and quality of life of cystinuric patients.
Collapse
Affiliation(s)
- Viola D'Ambrosio
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Sciences, Unit of Nephrology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - David Goldfarb
- Nephrology Section, VA, New York Harbor Healthcare System, New York, NY, USA
- Division of Nephrology, New York University Langone Medical Center, New York, NY, USA
| | - Giovanni Gambaro
- Department of Medicine, Division of Nephrology and Dialysis, Renal Unit, University of Verona, Verona, Italy
| | - Pietro Manuel Ferraro
- Dipartimento Di Scienze Mediche E Chirurgiche, U.O.S. Terapia Conservativa Della Malattia Renale Cronica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, U.O.C. Nefrologia, 00168, Rome, Italy.
- Dipartimento Universitario Di Medicina E Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| |
Collapse
|
8
|
Zeng X, Wei S, Hu J, Gou L, Wu L, Hou X. Novel "Turn-On" Luminescent Chemosensor for Arginine by Using a Lanthanide Metal-Organic Framework Photosensitizer. Anal Chem 2022; 94:10271-10277. [PMID: 35804490 DOI: 10.1021/acs.analchem.2c01913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Arginine is considered as a biomarker of cystinuria and other diseases, and thus, it is of urgency to develop a simple and rapid method with high sensitivity and selectivity for arginine detection to meet the demand of on-site analysis and bedside diagnosis. In this work, a lanthanide metal-organic framework, La(TATB), was prepared using a triazine-based planar ligand, 4,4',4″-s-triazine-2,4,6-triyltribenzoate (H3TATB), and lanthanide ion (La3+). La(TATB) can be used as a highly photosensitive agent to activate molecular oxygen to 1O2 to achieve efficient photosensitive oxidation of arginine accompanied by strong blue fluorescence emission under 302 nm UV irradiation. Due to the porous structure and high specific surface area of La(TATB), short-life 1O2 can effectively approach and react with amino acid substrate molecules, thus leading to higher sensitivity than other systems. Therefore, the "turn-on" fluorescence sensing of trace arginine can be realized, with a measured linear response range of 10-20,000 nM and a limit of detection as low as 7 nM. This method can be used for the detection of trace arginine in urine, which is conducive to the bedside diagnosis and rapid screening of cystinuria and other diseases. The proposed method not only expands the application scope of Ln-MOFs but also provides a new construction strategy for "turn-on" luminescence sensors.
Collapse
Affiliation(s)
- Xiaoliang Zeng
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China.,State Grid Sichuan Electric Power Research Institute, Chengdu, Sichuan 610041, China
| | - Siqi Wei
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China
| | - Jing Hu
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China
| | - Lichen Gou
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China
| | - Li Wu
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China
| | - Xiandeng Hou
- Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610064, China.,College of Chemistry and Key Lab of Green Chem & Tech of MOE, Sichuan University, Chengdu, Sichuan 610064, China
| |
Collapse
|
9
|
Clark CS, Gnanappiragasam S, Thomas K, Bultitude M. Cystinuria: An Overview of Challenges and Surgical Management. Front Surg 2022; 9:812226. [PMID: 35784929 PMCID: PMC9243440 DOI: 10.3389/fsurg.2022.812226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
|
10
|
Quiroz Madarriaga Y, Badenes Gallardo A, Llorens de Knecht E, Motta Lang G, Palou Redorta J, Bujons Tur A. Can cystinuria decrease the effectiveness of RIRS with high-power ho:yag laser in children? Outcomes from a tertiary endourology referral center. Urolithiasis 2022; 50:229-234. [PMID: 35084538 DOI: 10.1007/s00240-022-01301-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Cystinuria, which is the cause of cystine urolithiasis, accounts for 2-6% of all urinary stones in children, has a low prevalence with a high recurrence rate, making this metabolic disorder a therapeutic challenge in pediatric population. The aim of this work is evaluate the efficacy and safety of retrograde intra-renal surgery (RIRS) in pediatric patients with cystinuria and kidney stones smaller than 2 cm. Prospective study of 64 stones treated in 22 retrograde intra-renal surgeries (RIRS) in cystinuric pediatric patients with renal or proximal ureteral stones less than 2 cm. Average age of 9.5 years. The following data were analyzed: demographics, stone characteristics and surgical data with intra- and postoperative complications. Location of the stones was 68.7% in the calyces, 20.3% in the renal pelvis, and 9.3% in the ureteropelvic junction; 41% of cases had multiple locations. The average cystinuria level before the procedure was 825 mg/dL. The anatomy of 73% of the interventions increased the difficulty of flexible ureteroscopy and decreased stone free rates, because distorted renal anatomy was present: sclerosis of the pelvis or infundibulum, abnormal calyceal dilations, or excluded calyces. Intraoperative complications occurred in 18.2% of the procedures. Reno-vesical ultrasound was performed in all patients in the first postoperative month, with an SFR of 59%. Cystinuric patients are a challenge for pediatric urologists, decreasing the effectiveness of RIRS. However, it could be better treatment than SWL and with fewer complications than PCNL in the pediatric population with this disease.
Collapse
Affiliation(s)
| | | | - Erika Llorens de Knecht
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Guilherme Motta Lang
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Joan Palou Redorta
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| | - Anna Bujons Tur
- Urology Department, Fundació Puigvert, Carrer de Cartagena, 340-350, 08025, Barcelona, Spain
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize recent findings in kidney gene therapy while proposing cystinuria as a model kidney disease target for genome engineering therapeutics. RECENT FINDINGS Despite the advances of gene therapy for treating diseases of other organs, the kidney lags behind. Kidney-targeted gene delivery remains an obstacle to gene therapy of kidney disease. Nanoparticle and adeno-associated viral vector technologies offer emerging hope for kidney gene therapy. Cystinuria represents a model potential target for kidney gene therapy due to its known genetic and molecular basis, targetability, and capacity for phenotypic rescue. SUMMARY Although gene therapy for kidney disease remains a major challenge, new and evolving technologies may actualize treatment for cystinuria and other kidney diseases.
Collapse
Affiliation(s)
- Jennifer L. Peek
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN 37232
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232
| | - Matthew H. Wilson
- Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN 37232
- Department of Pharmacology, Vanderbilt University, Nashville, TN 37232
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN 37232
- Department of Veterans Affairs, Tennessee Valley Health Services, Nashville, TN, 37212
| |
Collapse
|
12
|
Apgar TL, Sanders CR. Compendium of causative genes and their encoded proteins for common monogenic disorders. Protein Sci 2022; 31:75-91. [PMID: 34515378 PMCID: PMC8740837 DOI: 10.1002/pro.4183] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 01/19/2023]
Abstract
A compendium is presented of inherited monogenic disorders that have a prevalence of >1:20,000 in the human population, along with their causative genes and encoded proteins. "Simple" monogenic diseases are those for which the clinical features are caused by mutations impacting a single gene, usually in a manner that alters the sequence of the encoded protein. Of course, for a given "monogenic disorder", there is sometimes more than one potential disease gene, mutations in any one of which is sufficient to cause phenotypes of that disorder. Disease-causing mutations for monogenic disorders are usually passed on from generation to generation in a Mendelian fashion, and originate from spontaneous (de novo) germline founder mutations. In the past monogenic disorders have often been written off as targets for drug discovery because they sometimes are assumed to be rare disorders, for which the meager projected financial payoff of drug discovery and development has discouraged investment. However, not all monogenic diseases are rare. Here, we report that that currently available data identifies 72 disorders with a prevalence of at least 1 in 20,000 humans. For each, we tabulate the gene(s) for which mutations cause the spectrum of phenotypes associated with that disorder. We also identify the gene and protein that most commonly causes each disease. 34 of these disorders are caused exclusively by mutations in only a single gene and encoded protein.
Collapse
Affiliation(s)
- Tucker L. Apgar
- Department of Biochemistry and Center for Structural BiologyVanderbilt University School of Medicine Basic SciencesNashvilleTennesseeUSA
| | - Charles R. Sanders
- Department of Biochemistry and Center for Structural BiologyVanderbilt University School of Medicine Basic SciencesNashvilleTennesseeUSA
| |
Collapse
|
13
|
Tkaczyk M, Gadomska-Prokop K, Załuska-Leśniewska I, Musiał K, Zawadzki J, Jobs K, Porowski T, Rogowska-Kalisz A, Jander A, Kirolos M, Haliński A, Krzemień A, Sobieszczańska-Droździel A, Zachwieja K, Beck BB, Sikora P, Zaniew M. Clinical profile of a Polish cohort of children and young adults with cystinuria. Ren Fail 2021; 43:62-70. [PMID: 33349102 PMCID: PMC7758038 DOI: 10.1080/0886022x.2020.1860089] [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] [Indexed: 11/17/2022] Open
Abstract
Background Cystinuria is an inherited disorder that results in increased excretion of cystine in the urine. It accounts for about 1–2% of pediatric kidney stones. In this study, we sought to identify the clinical characteristics of patients with cystinuria in a national cohort. Methods This was a retrospective study involving 30 patients from the Polish Registry of Inherited Tubulopathies. Initial data and that from a 6-month follow-up were analyzed. Mutational analysis was performed by targeted Sanger sequencing and, if applicable, MLPA analysis was used to detect large rearrangements. Results SLC7A9 mutations were detected in 15 children (50%; 10 males, 5 females), SLC3A1 mutations in 14 children (47%; 5 males, 9 females), and bigenic mutations in one male patient. The first clinical symptoms of the disease were detected at a median of 48 months of age (range 3–233 months). When individuals with different mutations were compared, there were no differences identified in gender, age of diagnosis, presence of UTI or urolithiasis, eGFR, calcium, or cystine excretion. The most common initial symptoms were urolithiasis in 26 patients (88%) and urinary tract infections in 4 patients (13%). Urological procedures were performed in 18 out of 30 (60%). Conclusions The clinical course of cystinuria is similar among patients, regardless of the type of genetic mutation. Most patients require surgery before diagnosis or soon after it. Patients require combined urological and pharmacological treatment for prevention of stone recurrence and renal function preservation.
Collapse
Affiliation(s)
- Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland.,Division of Didactics in Pediatrics, Medical University of Łódź, Łódź, Poland
| | - Katarzyna Gadomska-Prokop
- Department of Nephrology, Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Iga Załuska-Leśniewska
- Department of Pediatric Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
| | - Kinga Musiał
- Department of Pediatric Nephrology, Medical University of Wrocław, Wrocław, Poland
| | - Jan Zawadzki
- Department of Nephrology, Transplantation and Hypertension, Children's Memorial Health Institute, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Pediatrics, Allergology and Nephrology, Military Medical Institute, Warsaw, Poland
| | - Tadeusz Porowski
- Department of Pediatrics and Nephrology, Medical University of Białystok, Białystok, Poland
| | - Anna Rogowska-Kalisz
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Anna Jander
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Meritrafat Kirolos
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Łódź, Poland
| | - Adam Haliński
- Department of Clinical Genetics and Pathology, University of Zielona Góra, Zielona Góra, Poland
| | - Aleksandra Krzemień
- Department of Pediatric Nephrology, Upper-Silesian Centre for Child's Health, Katowice, Poland
| | | | - Katarzyna Zachwieja
- Department of Pediatric Nephrology, Collegium Medicum Jagiellonian University, Krakow, Poland
| | - Bodo B Beck
- Institute of Human Genetics and Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| |
Collapse
|
14
|
Kovaříková S, Maršálek P, Vrbová K. Cystinuria in Dogs and Cats: What Do We Know after Almost 200 Years? Animals (Basel) 2021; 11:2437. [PMID: 34438894 PMCID: PMC8388795 DOI: 10.3390/ani11082437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/08/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
The purpose of this review is to summarize current knowledge on canine and feline cystinuria from available scientific reports. Cystinuria is an inherited metabolic defect characterized by abnormal intestinal and renal amino acid transport in which cystine and the dibasic amino acids ornithine, lysine, and arginine are involved (COLA). At a normal urine pH, ornithine, lysine, and arginine are soluble, but cysteine forms a dimer, cystine, which is relatively insoluble, resulting in crystal precipitation. Mutations in genes coding COLA transporter and the mode of inheritance were identified only in some canine breeds. Cystinuric dogs may form uroliths (mostly in lower urinary tract) which are associated with typical clinical symptoms. The prevalence of cystine urolithiasis is much higher in European countries (up to 14% according to the recent reports) when compared to North America (United States and Canada) where it is approximately 1-3%. Cystinuria may be diagnosed by the detection of cystine urolithiasis, cystine crystalluria, assessment of amino aciduria, or using genetic tests. The management of cystinuria is aimed at urolith removal or dissolution which may be reached by dietary changes or medical treatment. In dogs with androgen-dependent cystinuria, castration will help. In cats, cystinuria occurs less frequently in comparison with dogs.
Collapse
Affiliation(s)
- Simona Kovaříková
- Department of Animal Protection and Welfare and Veterinary Public Health, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
| | - Petr Maršálek
- Department of Animal Protection and Welfare and Veterinary Public Health, Faculty of Veterinary Hygiene and Ecology, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
| | - Kateřina Vrbová
- Faculty of Veterinary Medicine, University of Veterinary Sciences, 612 42 Brno, Czech Republic;
| |
Collapse
|
15
|
Prot-Bertoye C, Daudon M, Tostivint I, Dousseaux MP, Defazio J, Traxer O, Knebelmann B, Courbebaisse M. [Cystinuria]. Nephrol Ther 2021; 17S:S100-S107. [PMID: 33910689 DOI: 10.1016/j.nephro.2020.03.001] [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: 01/28/2020] [Accepted: 03/01/2020] [Indexed: 10/21/2022]
Abstract
Cystinuria is the most common monogenic nephrolithiasis disorder. Because of its poor solubility at a typical urine pH of less than 7, cystine excretion results in recurrent urinary cystine stone formation. A high prevalence of high blood pressure and of chronic kidney disease has been reported in these patients. Alkaline hyperdiuresis remains the cornerstone of the preventive medical treatment. To reach a urine pH between 7.5 and 8 and a urine specific gravity less than or equal to 1.005 should be the goal of medical treatment. D-penicillamine and tiopronin, two cysteine-binding thiol agents, should be considered as second line treatments with frequent adverse events that should be closely monitored.
Collapse
Affiliation(s)
- Caroline Prot-Bertoye
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
| | - Michel Daudon
- Service de physiologie-explorations fonctionnelles, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Isabelle Tostivint
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie-Paule Dousseaux
- Service de néphrologie, hôpital de la Pitié-Salpêtrière, 149, boulevard de l'Hôpital, 75013 Paris, France
| | - Jérôme Defazio
- Association pour l'information et la recherche sur les maladies génétiques (AIRG-France), BP 78, 75261 Paris cedex 06, France
| | - Olivier Traxer
- Service d'urologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Bertrand Knebelmann
- Service de néphrologie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - Marie Courbebaisse
- Service de physiologie - explorations fonctionnelles rénales et métaboliques, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
16
|
Takahashi T, Somiya S, Ito K, Kanno T, Higashi Y, Yamada H. The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years. J Clin Med 2021; 10:jcm10071336. [PMID: 33804827 PMCID: PMC8037008 DOI: 10.3390/jcm10071336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.
Collapse
Affiliation(s)
| | | | | | | | | | - Hitoshi Yamada
- Correspondence: ; Tel.: +81-75-572-6331; Fax: +81-75-571-8877
| |
Collapse
|
17
|
The Impact of Diet on Urinary Risk Factors for Cystine Stone Formation. Nutrients 2021; 13:nu13020528. [PMID: 33561968 PMCID: PMC7915598 DOI: 10.3390/nu13020528] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Despite the importance of dietary management of cystinuria, data on the contribution of diet to urinary risk factors for cystine stone formation are limited. Studies on the physiological effects of diet on urinary cystine and cysteine excretion are lacking. Accordingly, 10 healthy men received three standardized diets for a period of five days each and collected daily 24 h urine. The Western-type diet (WD; 95 g/day protein) corresponded to usual dietary habits, whereas the mixed diet (MD; 65 g/day protein) and lacto-ovo-vegetarian diet (VD; 65 g/day protein) were calculated according to dietary reference intakes. With intake of the VD, urinary cystine and cysteine excretion decreased by 22 and 15%, respectively, compared to the WD, although the differences were not statistically significant. Urine pH was significantly highest on the VD. Regression analysis showed that urinary phosphate was significantly associated with cystine excretion, while urinary sulfate was a predictor of cysteine excretion. Neither urinary cystine nor cysteine excretion was affected by dietary sodium intake. A lacto-ovo-vegetarian diet is particularly suitable for the dietary treatment of cystinuria, since the additional alkali load may reduce the amount of required alkalizing agents.
Collapse
|
18
|
Vinit N, Khoury A, Lopez P, Heidet L, Botto N, Traxer O, Boyer O, Blanc T, Lottmann HB. Extracorporeal Shockwave Lithotripsy for Cystine Stones in Children: An Observational, Retrospective, Single-Center Analysis. Front Pediatr 2021; 9:763317. [PMID: 34869121 PMCID: PMC8636798 DOI: 10.3389/fped.2021.763317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose: Cystinuria is a genetic disorder characterized by a defective reabsorption of cystine and dibasic amino acids leading to development of urinary tract calculi from childhood onward. Cystine lithiasis is known to be resistant to fragmentation. The aim was to evaluate our long-term experience with extracorporeal shockwave lithotripsy (ESWL) used as first-line urological treatment to treat cystine stones in children. Methods: We retrospectively reviewed the charts of all children who underwent ESWL for cystine stone. We assessed the 3-month stone-free rate, according to age, younger (group 1) or older (group 2) than 2 years old. Results: Between 2003 and 2016, 15 patients with a median (IQR) age at first treatment of 48 (15-108) months underwent ESWL in monotherapy. Median age was, respectively, 15 and 108 months in each group. The median (IQR) stone burden was 2,620 (1,202-8,265) mm3 in group I and 4,588 (2,039-5,427) mm3 in group II (p = 0.96). Eleven patients had bilateral calculi. ESWL was repeated on average 2.4 times, with a maximum of 4 for patients of group I, and 4.8 times, with a maximum of 9 for group II (p > 0.05). ESWL in monotherapy was significantly more efficient to reach stone-free status for children under 2 years of age: 83% vs. 6.2% (p = 0.040). The median (IQR) follow-up of the study was 69 (42-111) months. Conclusion: ESWL appears as a valid urological option for the treatment of cystine stones, in young children. Even if cystine stones are known to be resistant to fragmentation, we report 83% of stone-free status at 3 months with ESWL used in monotherapy in children under 2 years old with cystinuria. In older children, the success rate is too low to recommend ESWL as a first line approach.
Collapse
Affiliation(s)
- Nicolas Vinit
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Antoine Khoury
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Pauline Lopez
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurence Heidet
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France
| | - Nathalie Botto
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Olivier Traxer
- Department of Urology, Tenon Hospital, APHP, Paris, France.,Groupe de Recherche Clinique sur la Lithiase Urinaire (GRC no 20), Tenon Hospital, Sorbonne Université, Paris, France.,Sorbonne Université, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Reference Center for Inherited Renal Disease (MARHEA), Necker-Enfants Malades Hospital, APHP, Paris, France.,INSERM UMR 1163, Laboratory of Inherited Kidney Diseases, Imagine Institute, Université de Paris, Paris, France.,Université de Paris, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France.,Université de Paris, Paris, France.,INSERM U1151-CNRS UMR 8253, Université de Paris, Paris, France
| | - Henri B Lottmann
- Department of Pediatric Surgery and Urology, Necker-Enfants Malades Hospital, APHP, Paris, France
| |
Collapse
|
19
|
Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A, Bultitude M, Capolongo G, Cerkauskiene R, Daudon M, Doizi S, Gillion V, Gràcia-Garcia S, Halbritter J, Heidet L, van den Heijkant M, Lemoine S, Knebelmann B, Emma F, Levtchenko E. Cystinuria: clinical practice recommendation. Kidney Int 2020; 99:48-58. [PMID: 32918941 DOI: 10.1016/j.kint.2020.06.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary cystine excretion leads to the formation of cystine stones because of the low solubility of cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities), conservative treatment (hydration, dietetic, alkalinization, and cystine-binding drugs), follow-up, self-monitoring, complications (renal failure and hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with cystinuria, including diagnosis, surgery, and medical treatment.
Collapse
Affiliation(s)
- Aude Servais
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France.
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luca Dello Strologo
- Renal Transplant Clinic, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK; The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France
| | - Aurelia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares, Filière ORKID, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Giovanna Capolongo
- Unit of Nephrology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Michel Daudon
- UMR S 1155 and Physiology Unit, AP-HP, Hôpital Tenon, Sorbonne Université and INSERM, Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Paris, France
| | - Valentine Gillion
- Département de Néphrologie adulte, Cliniques universitaires Saint Luc, Bruxelles, Belgium
| | - Silvia Gràcia-Garcia
- Laboratory of Renal Lithiasis, Clinical Laboratories, Fundació Puigvert, Barcelona, Spain
| | - Jan Halbritter
- Division of Nephrology, Department of Endocrinology, Nephrology, and Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Laurence Heidet
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Marleen van den Heijkant
- Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandrine Lemoine
- Nephrology and Renal Function Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Elena Levtchenko
- Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | | |
Collapse
|
20
|
Asi T, Dogan HS, Bozaci AC, Citamak B, Altan M, Tekgul S. A single center's experience in pediatric cystine stone disease management: what changed over time? Urolithiasis 2020; 48:493-499. [PMID: 32556828 DOI: 10.1007/s00240-020-01200-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/06/2020] [Indexed: 11/29/2022]
Abstract
The authors aimed to evaluate the factors affecting clinical outcomes of cystine stone disease in children and to understand the change in disease management over time. Between January 1991 and September 2017, the demographic and clinical data of pediatric patients with documented cystine stone disease were retrospectively analyzed. Patients with at least 12-month follow-up were included. Disease management and clinical outcomes were compared between the first and second 35 patients managed during the study's time frame. A total of 70 patients were included. The female to male ratio was 30/40. The mean age and follow-up period was 29.8 ± 40.1 months and 106.5 ± 56 months, respectively. The mean initial procedure number to treat the first stone episode was 2.4 ± 1.6. Single stone and single affected site were significant predictors for stone clearance. Overall, patients underwent a mean of 5.5 procedure during their follow-up. Recurrence was detected in 71.4% (50/70) of patients. Residual fragments and non-compliance to medical treatment after the initial intervention were significant predictors for recurrence within shorter interval period. 31.4% (22/70) of patients had renal atrophy during follow-up. They were older at the initial diagnosis and had average urine pH lower than 7.5. The first 35 patients had more open procedures. Still, they had more recurrence rate and tend to have more renal atrophy. As a conclusion, cystine stone disease has a recurrent course in children. Stone and fragments entirely removed (SaFER) concept with all minimally invasive methods available and strict follow-up should be the basis for any management plan.
Collapse
Affiliation(s)
- Tariq Asi
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
| | - Hasan Serkan Dogan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ali Cansu Bozaci
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Burak Citamak
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Mesut Altan
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Serdar Tekgul
- Department of Urology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| |
Collapse
|
21
|
Melessen IM, Henderickx MM, Merkx MM, van Etten-Jamaludin FS, Homan van der Heide JJ, Kamphuis GM. The effect of additional drug therapy as metaphylaxis in patients with cystinuria: a systematic review. MINERVA UROL NEFROL 2020; 72:427-440. [PMID: 32083421 DOI: 10.23736/s0393-2249.20.03704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To systematically review the effect of additional drug therapy as metaphylaxis in patients with cystinuria. EVIDENCE ACQUISITION A literature search of three databases (MEDLINE, Embase and the Cochrane Library) was performed according to the PRISMA-guidelines enclosing articles published up to May 2019. A total of 1117 articles were screened. Thirty-four publications met the inclusion criteria for this review. EVIDENCE SYNTHESIS Male-female ratio in the studied cohorts was 49.9% - 50.1%. The majority of studies showed a positive effect in reducing stone events and/or urinary cystine excretion. D-Penicillamine showed success in 13/14 (92%) studies, whereas Tiopronin-treatment showed a reduction in all (8/8; 100%) studies. All studies on Captopril (4/4) showed a decrease, however not all significant. The same is true for studies on Thiols in combination with Captopril (2/2). Furthermore, Tiopronin showed less side effects compared to D-penicillamine, respectively 30% and 37%. Captopril showed the least adverse events, with one event in nine patients. CONCLUSIONS The evidence on benefit of additional drug therapy in patients with cystinuria is scarce. All studied medications showed an effect on stone event and urinary cystine excretion, when used in addition to hyperhydration, alkalization and a diet low on methionine. Based on this systematic review, no drug can be preferred over another. An important aspect in the choice of drug is the risk of side effects. Therefore, the choice of additional drug should be personalized for every patient where the risk of side effects should be taken into consideration.
Collapse
Affiliation(s)
- Indra M Melessen
- Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maria M Merkx
- Department of Pharmacy, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Guido M Kamphuis
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| |
Collapse
|
22
|
Beckermann TM, Welch RC, Williams FM, Mortlock DP, Sha F, Ikizler TA, Woodard LE, Wilson MH. CRISPR/Cas9 engineering of albino cystinuria Type A mice. Genesis 2020; 58:e23357. [PMID: 32078250 DOI: 10.1002/dvg.23357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 01/27/2023]
Abstract
Cystinuria Type A is a relatively common genetic kidney disease occurring in 1 in 7,000 people worldwide that results from mutation of the cystine transporter rBAT encoded by Slc3a1. We used CRISPR/Cas9 technology to engineer cystinuria Type A mice via genome editing of the C57BL/6NHsd background. These mice are an improvement on currently available models as they are on a coisogenic genetic background and have a single defined mutation. In order to use albinism to track Cas9 activity, we co-injected gRNAs targeting Slc3a1 and tyrosinase (Tyr) with Cas9 expressing plasmid DNA into mouse embryos. Two different Slc3a1 mutational alleles were derived, with homozygous mice of both demonstrating elevated urinary cystine levels, cystine crystals, and bladder stones. We used whole genome sequencing to evaluate for potential off-target editing. No off-target indels were observed for the top 10 predicted off-targets for Slc3a1 or Tyr. Therefore, we used CRISPR/Cas9 to generate coisogenic albino cystinuria Type A mice that could be used for in vivo imaging, further study, or developing new treatments of cystinuria.
Collapse
Affiliation(s)
- Thomas M Beckermann
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard C Welch
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Felisha M Williams
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Mortlock
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
| | - Feng Sha
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Talat A Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee
| | - Lauren E Woodard
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Health Services, Nashville, Tennessee
| | - Matthew H Wilson
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Veterans Affairs, Tennessee Valley Health Services, Nashville, Tennessee.,Department of Pharmacology, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
23
|
Rezaee ME, Rule AD, Pais VM. What are the main challenges to the pharmacological management of cystinuria? Expert Opin Pharmacother 2019; 21:131-133. [PMID: 31724887 DOI: 10.1080/14656566.2019.1691522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael E Rezaee
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Vernon M Pais
- Section of Urology, Department of Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
| |
Collapse
|
24
|
Cui R, Wan Y, Ji G, Liu Z. A highly selective and sensitive fluorescent sensor based on Tb 3+-functionalized MOFs to determine arginine in urine: a potential application for the diagnosis of cystinuria. Analyst 2019; 144:5875-5881. [PMID: 31486467 DOI: 10.1039/c9an01204d] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A unique metal-organic framework with the formula [Cd4(H2L)2(L)·H2O]·3H2O (H4L = 5,5'-(1H-1,2,4-triazole-3,5-diyl)diisophthalic acid) was successfully constructed under solvothermal conditions. The frameworks with multiple free Lewis base sites and Lewis acid sites exhibited easily sensitized properties. After the encapsulation of Tb3+ cations, the as-synthesized Tb3+@Cd-MOF demonstrated strong luminescence induced by the efficient energy transfer from the bridging ligands to the Tb3+ cations, with the potential to serve as a chemical sensor. Interestingly, Tb3+@Cd-MOF was proven to be a very promising and highly selective and sensitive luminescent platform for the quantitative detection of arginine, which is the biomarker of cystinuria. The fluorescent probe presented high selectivity to arginine in urine with strong luminescence quenching. Furthermore, a convenient fluorescence-based test paper for the visual detection of arginine in applications was prepared. For the first time, arginine was quantified and monitored in urine by a highly efficient recyclable fluorescent sensor based on Tb3+-functionalized MOF hybrids, which may be a potential candidate for the further development of clinical diagnostic tools.
Collapse
Affiliation(s)
- Ruixue Cui
- Inner Mongolia Key Laboratory of Chemistry and Physics of Rare Earth Materials, School of Chemistry and Chemical Engineering, Inner Mongolia University, Hohhot 010021, P.R. China.
| | - Yongyan Wan
- Inner Mongolia Key Laboratory of Chemistry and Physics of Rare Earth Materials, School of Chemistry and Chemical Engineering, Inner Mongolia University, Hohhot 010021, P.R. China.
| | - Guanfeng Ji
- Inner Mongolia Key Laboratory of Chemistry and Physics of Rare Earth Materials, School of Chemistry and Chemical Engineering, Inner Mongolia University, Hohhot 010021, P.R. China.
| | - Zhiliang Liu
- Inner Mongolia Key Laboratory of Chemistry and Physics of Rare Earth Materials, School of Chemistry and Chemical Engineering, Inner Mongolia University, Hohhot 010021, P.R. China.
| |
Collapse
|
25
|
Kobayashi Y, Cordonier CEJ, Noda Y, Nagase F, Enomoto J, Kageyama T, Honma H, Maruo S, Fukuda J. Tailored cell sheet engineering using microstereolithography and electrochemical cell transfer. Sci Rep 2019; 9:10415. [PMID: 31320678 PMCID: PMC6639316 DOI: 10.1038/s41598-019-46801-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
Postoperative adhesion and occlusion remain a serious issue associated with various surgeries, including endoscopic surgery, in which proliferated fibrous tissues stick to adjacent tissues and often cause severe complications. Cell sheet engineering has emerged as an effective approach not only for cell transplantation but also for the treatment of postoperative adhesion and occlusion. However, as the tissues in the body, such as middle ear and small intestine, and typical operative sites are non-flat and spatially complicated, tailored cell sheets with three-dimensional (3D) configurations may lead to widespread use of this approach. In the present study, we used microstereolithography, biocompatible gold plating, and electrochemical cell detachment to achieve this purpose. Various objects with dimensions ranging from millimeter- to micrometer-scale were fabricated with photocurable resin using lab-made equipment for microstereolithography. To coat the fabricated objects with a thin gold layer, conventional cyanide-based gold plating was unusable because it severely damaged almost all cells. Electroless non-cyanide gold plating we prepared was cytocompatible and suitable for electrochemical cell detachment. Cell sheets on the gold-plated substrate could be directly transplanted into a mouse intraperitoneally using electrochemical cell detachment. We further demonstrated that cell sheets grown on gold-coated 3D objects were rapidly detached along with the desorption of electroactive-oligopeptide monolayer and transferred to a surrounding hydrogel. This approach may provide a promising strategy to prepare and directly transplant tailor-made cell sheets with suitable configurations.
Collapse
Affiliation(s)
- Yuka Kobayashi
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | | | - Yohei Noda
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | - Fuminori Nagase
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | - Junko Enomoto
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | - Tatsuto Kageyama
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | - Hideo Honma
- Faculty of Engineering, Kanto Gakuin University, 1162-2 Ogikubo, Odawara, 250-0022, Japan
| | - Shoji Maruo
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan
| | - Junji Fukuda
- Faculty of Engineering, Yokohama National University, 79-5 Tokiwadai, Hodogaya-ku, Yokohama, 240-8501, Japan.
| |
Collapse
|
26
|
Moore SL, Cook P, de Coninck V, Keller EX, Traxer O, Dragos L, Shergill IS, Somani BK. Outcomes and Long-term Follow-up of Patients with Cystine Stones: a Systematic Review. Curr Urol Rep 2019; 20:27. [PMID: 30989375 DOI: 10.1007/s11934-019-0891-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Cystine stone patients can be difficult to manage with frequent recurrences. We performed a systematic review with a view to assessing interventions, compliance and their long-term outcomes. RECENT FINDINGS Ten retrospective observational studies (253 patients) assessed the outcomes and long-term follow-up of cystine stone patients. The mean length of follow-up was 9.6 years (range 3.5-21.8 years). The overall mean number of surgical procedures/patient was 5.7 (range 2-9.8/patient) with the overall mean number of surgical procedures/patient/year at 0.59 (range 0.22-1.32/patient/year). While open surgery has decreased over the last decade and PCNL has been stable, there seems to be a rise of RIRS during this period. Patients with cystine stones need periodic interventions for stone recurrences despite medical management, with limited data showing the impact on renal function. While the management is individualised, wide variability exists with often poor and incomplete patient data.
Collapse
Affiliation(s)
- Sacha L Moore
- North Wales Clinical Research Centre, Wrexham Maelor Hospital, Wrexham, Wales, UK.
| | - Paul Cook
- Department of Biochemical Pathology & Metabolic Medicine, University Hospital Southampton, Southampton, UK
| | | | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Olivier Traxer
- Department of Urology, Sorbonne Université, GRC n°20 Lithiase renale, AP-HP, Hôpital Tenon, Paris, F-75020, France
| | - Laurian Dragos
- Department of Urology, University of Medicine and Pharmacy Victor Babeş Timişoara, Timişoara, Romania
| | - Iqbal S Shergill
- Department of Urology, Wrexham Maelor Hospital and Clinical Director, North Wales Clinical Research Centre, Wrexham, Wales, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
| |
Collapse
|
27
|
Yifan Z, Luwei X, Kai L, Liuhua Z, Yuzheng G, Ruipeng J. Protective effect of salvianolic acid B against oxidative injury associated with cystine stone formation. Urolithiasis 2019; 47:503-510. [PMID: 30778619 DOI: 10.1007/s00240-019-01114-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
The aim of this study was to investigate the role of oxidative stress in cystine crystal formation and whether salvianolic acid B, a natural antioxidant, could prevent cystine-mediated oxidative injury in vivo and in vitro. The levels of oxidative stress and antioxidase activity in cystine stone patients were assessed. Then, the oxidative stress exerted by cystine on human kidney-2 (HK-2) cell viability and biochemical parameters including antioxidase activity and antioxidant protein expression were evaluated, and the protective action of salvianolic acid B was also examined. Finally, salvianolic acid B was tested to determine whether it could prevent or reduce renal crystal formation in Slc7a9 knockout mice. The activity levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) were decreased, and the amount of malondialdehyde (MDA) was increased in patients with cystine stones compared with people without cystine stones (p < 0.05). Significant reductions in cell viability, antioxidase activity and antioxidant protein expression levels were found in the cystine group compared with controls. However, such oxidative injuries were prevented by salvianolic acid B. In the animal study, loose crystals with white spots were seen in the renal parenchyma, bilateral renal pelvis and bladders in the Slc7a9 knockout group. In contrast, no renal crystals were seen in the control group, and markedly fewer crystals with significantly higher antioxidase activity and diminished oxidative stress were detected in the salvianolic acid B group. Cystine cytotoxicity in vitro and cystine stone formation in vivo were associated with oxidative stress, and salvianolic acid B could protect against cystine stone-induced injury.
Collapse
Affiliation(s)
- Zhang Yifan
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Xu Luwei
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Liang Kai
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Zhou Liuhua
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Ge Yuzheng
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China
| | - Jia Ruipeng
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, China.
| |
Collapse
|
28
|
Cystinuria: genetic aspects, mouse models, and a new approach to therapy. Urolithiasis 2018; 47:57-66. [PMID: 30515543 DOI: 10.1007/s00240-018-1101-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 01/07/2023]
Abstract
Cystinuria, a genetic disorder of cystine transport, is characterized by excessive excretion of cystine in the urine and recurrent cystine stones in the kidneys and, to a lesser extent, in the bladder. Males generally are more severely affected than females. The disorder may lead to chronic kidney disease in many patients. The cystine transporter (b0,+) is a heterodimer consisting of the rBAT (encoded by SLC3A1) and b0,+AT (encoded by SLC7A9) subunits joined by a disulfide bridge. The molecular basis of cystinuria is known in great detail, and this information is now being used to define genotype-phenotype correlations. Current treatments for cystinuria include increased fluid intake to increase cystine solubility and the administration of thiol drugs for more severe cases. These drugs, however, have poor patient compliance due to adverse effects. Thus, there is a need to reduce or eliminate the risks associated with therapy for cystinuria. Four mouse models for cystinuria have been described and these models provide a resource for evaluating the safety and efficacy of new therapies for cystinuria. We are evaluating a new approach for the treatment of cystine stones based on the inhibition of cystine crystal growth by cystine analogs. Our ongoing studies indicate that cystine diamides are effective in preventing cystine stone formation in the Slc3a1 knockout mouse model for cystinuria. In addition to crystal growth, crystal aggregation is required for stone formation. Male and female mice with cystinuria have comparable levels of crystalluria, but very few female mice form stones. The identification of factors that inhibit cystine crystal aggregation in female mice may provide insight into the gender difference in disease severity in patients with cystinuria.
Collapse
|
29
|
Mohammadi M, Shohani A, Khorami H, Nouri Mahdavi K, IzadPanahi MH, Alizadeh F, Azizi M. The effect of selenium supplementation on cystine crystal volume in patients with cystinuria. Biomedicine (Taipei) 2018; 8:26. [PMID: 30474607 PMCID: PMC6254100 DOI: 10.1051/bmdcn/2018080426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/22/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cystinuria as an autosomal recessive sickness is a relatively rare disease. Formation of cystine stones indicates cystinuria. Few studies are considered the cysteine crystal volume in management of cystinuria. Selenium may inhibit organization of crystal stone, growth and stone aggregation. Since the role of selenium on inhibition of cystine crystal formation is not known, the aim of this study was to evaluate the effect of selenium supplementation on cystine crystals volume in patients with cystinuria. MATERIALS AND METHODS This double-blind clinical trial study was conducted on 48 patients in Al-Zahra hospital, Isfahan, Iran from 2015 to 2017. These patients received selenium (200 mg/ daily) for 6 weeks. The urine crystal volume was evaluated before and after treatment. Data were entered SPSS and analyzed by Paired sample T test, Spearman and Pearson coefficient correlation. P- value < 0.05 was considered significant. RESULTS In current study, mean cystine crystal volume before and after treatment was 6787.4 ± 11902.6 and 3110.9 ± 7225.4, respectively. Significant difference was observed before and after treatment in terms of cystine crystal volume (p < 0.001). No relation was observed between the mean cystine crystal volume with sex, age and type of medical procedures (p > 0.05). CONCLUSION In this study, selenium treatment affected cystine crystal volume. It seems that selenium had the potential value to alleviate the volume of cystine crystal. Therefore, since reducing of cystine crystal volume decreases crystal formation, selenium may be effective to cure patients with cystinuria. However, age, sex and type of medical procedures did not affect cysteine crystal volume.
Collapse
Affiliation(s)
- Mehrdad Mohammadi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Amin Shohani
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Hatef Khorami
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Kia Nouri Mahdavi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Mohammad hossein IzadPanahi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Farshid Alizadeh
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| | - Mohammad Azizi
- Isfahan Kidney Transplantation Research Center, Department of Urology, Alzahra Research Centers, Isfahan University of Medical Science Isfahan Iran
| |
Collapse
|
30
|
Bignall ONR, Dixon BP. Management of Hematuria in Children. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2018; 4:333-349. [PMID: 30128264 PMCID: PMC6097192 DOI: 10.1007/s40746-018-0134-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose of Review This paper provides a review of the diagnostic evaluation of both microscopic and gross hematuria, as well as an update on the pathogenesis, clinical features, and treatment strategies for several diseases of the kidneys and urinary tract in which hematuria is a prominent finding. The goal is to provide pediatric providers with a framework through which appropriate and expeditious referral to subspecialty care may be made for definitive treatment. Recent Findings Although there has been great heterogeneity in published treatment strategies for many causes of hematuria, the Kidney Diseases Improving Global Outcomes (KDIGO) initiative has recently set forth guidelines for glomerular diseases in particular to provide evidence-based strategies for treatment. In addition, recent advances in the understanding of molecular pathogenesis and long-term clinical outcomes for other non-glomerular diseases has led to updates in treatment strategies summarized in this review. Summary As the pediatric primary care provider is often the first point of contact for children with microscopic or gross hematuria, updated knowledge as to the epidemiology and management of several of the various causes of hematuria will improve the care of children by both avoiding extraneous testing and interventions and implementing definitive care (either by expectant management and reassurance or by subspecialty referral) in a timely manner.
Collapse
Affiliation(s)
- O N Ray Bignall
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center
| | - Bradley P Dixon
- Renal Section, Department of Pediatrics, University of Colorado School of Medicine
| |
Collapse
|
31
|
Diagnosis and management of non-calcium-containing stones in the pediatric population. Int Urol Nephrol 2018; 50:1191-1198. [PMID: 29846891 DOI: 10.1007/s11255-018-1883-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/28/2018] [Indexed: 10/16/2022]
Abstract
Compared to adults, urolithiasis is less common in children, with a definite rise in incidence, especially among young adults (Tasian et al. in Clin J Am Soc Nephrol 11:488, 2016). In the last 25 years, the incidence in children has increased by approximately 6-10% annually, for reasons still unknown, with an associated significant increase in related health care-related expenditures (Hyams and Matlaga in Transl Androl Urol 3(3):278-83, 2014). It has been shown that there is twice as high a risk of chronic kidney disease (CKD) or end stage renal disease (ESRD) in stone formers compared to non-stone formers (Tasian et al. 2016). While calcium-containing stones are by far the most common category of stone encountered in both children and adults, non-calcium stones are more common in children than adults and have been shown in several studies to be associated with greater morbidity and lower renal function than calcium stones (Issler et al. in BMC Nephrol 18(1):136, 2017; Gambaro et al. in J Urol 198:268-273, 2017). This could be related to the challenges in the management of non-calcium-containing stones due to associated infection or metabolic derangements, further leading to recurrence and loss of renal function. There is currently a gap in our understanding of how to appropriately and effectively encounter and manage patients with non-calcium-containing stones, as such cases are encountered less frequently. Identification of stone composition and appropriate management is very important to reduce serious complications and recurrence, especially in non-calcium stones. We present a review of diagnosis and management of non-calcium-containing stones in the pediatric population, in hopes of providing more clarity to providers and promoting a consideration of non-calcium stone composition with all children presenting with urolithiasis.
Collapse
|
32
|
Moore SL, Somani BK, Cook P. Journey of a cystinuric patient with a long-term follow-up from a medical stone clinic: necessity to be SaFER (stone and fragments entirely removed). Urolithiasis 2018; 47:165-170. [PMID: 29696300 PMCID: PMC6420894 DOI: 10.1007/s00240-018-1059-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/10/2018] [Indexed: 12/05/2022]
Abstract
There is a lack of studies looking at the longitudinal follow-up of patients with cystine stones. We wanted to assess the journey of cystinuric patients through our specialist metabolic stone clinic to improve the understanding of episodes, interventions and current outcomes in this patient cohort. After ethical approval, all patients who attended our metabolic stone clinic from 1994 to 2014 with at least one cystine stone episode were included in our study. Data were retrospectively analysed for patient demographics, stone episodes or intervention, clinical parameters and patient compliance. Over a period of 21 years, 16 patients with a median age of 15.5 years underwent a mean follow-up of 8.6 years (1–21 years). The mean number of surgical interventions was 3.1 (1–8/patient), but patients who were stone free after their first treatment had lower recurrences (p = 0.91) and lower number of interventions during their follow-up (2.7/patient, compared to those who were not stone free at 4/patient). During their follow-up period, patients with < 3 interventions had a significantly better renal function than those with ≥ 3 surgical interventions (p = 0.04). Additionally, linear regression analysis showed that eGFR was demonstrated to decline with increasing numbers of stone episodes (r2 = 0.169). It was also noted that patients who began early medical management remained stone free during follow-up compared to those who had medical management after ≥ 2 stone episodes, of whom all had a recurrent episode. Our long-term longitudinal study of cystine stone formers highlights that patients who are stone free and receive early metabolic stone screening and medical management after their initial presentation have the lowest recurrence rates and tend to preserve their renal function. Hence, prompt referral for metabolic assessment, and the stone and fragments entirely removed (SaFER) principles are key to preventing stone episodes and improving long-term function.
Collapse
Affiliation(s)
- Sacha L Moore
- University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
| | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK. .,University of Southampton, Southampton, UK.
| | - Paul Cook
- Medical Stone Clinic, University Hospital Southampton NHS Trust, Southampton, UK
| |
Collapse
|
33
|
Affiliation(s)
- Scott V. Wiener
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Marshall L Stoller
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
34
|
Thiol Starvation Induces Redox-Mediated Dysregulation of Escherichia coli Biofilm Components. J Bacteriol 2017; 200:JB.00389-17. [PMID: 29038256 DOI: 10.1128/jb.00389-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/06/2017] [Indexed: 11/20/2022] Open
Abstract
A hallmark of bacterial biofilms is the production of an extracellular matrix (ECM) that encases and protects the community from environmental stressors. Biofilm formation is an integral portion of the uropathogenic Escherichia coli (UPEC) life cycle. Approximately 2% of UPEC isolates are cysteine auxotrophs. Here, we investigated how cysteine homeostasis impacted UPEC UTI89 strain biofilm formation and, specifically, the production of the ECM components curli and cellulose. Cysteine auxotrophs produced less cellulose and slightly more curli compared to wild-type (WT) strains, and cysteine auxotrophs formed smooth, nonrugose colonies. Cellulose production was restored in cysteine auxotrophs when YfiR was inactivated. YfiR is a redox-sensitive regulator of the diguanylate cyclase, YfiN. The production of curli, a temperature-regulated appendage, was independent of temperature in UTI89 cysteine auxotrophs. In a screen of UPEC isolates, we found that ∼60% of UPEC cysteine auxotrophs produced curli at 37°C, but only ∼2% of cysteine prototrophic UPEC isolates produced curli at 37°C. Interestingly, sublethal concentrations of amdinocillin and trimethoprim-sulfamethoxazole inhibited curli production, whereas strains auxotrophic for cysteine continued to produce curli even in the presence of amdinocillin and trimethoprim-sulfamethoxazole. The dysregulation of ECM components and resistance to amdinocillin in cysteine auxotrophs may be linked to hyperoxidation, since the addition of exogenous cysteine or glutathione restored WT biofilm phenotypes to mutants unable to produce cysteine and glutathione.IMPORTANCE Uropathogenic Escherichia coli (UPEC) bacteria are the predominant causative agent of urinary tract infections (UTIs). UTIs account for billions of dollars of financial burden annually to the health care industry in the United States. Biofilms are an important aspect of the UPEC pathogenesis cascade and for the establishment of chronic infections. Approximately 2% of UPEC isolates from UTIs are cysteine auxotrophs, yet there is relatively little known about the biofilm formation of UPEC cysteine auxotrophs. Here we show that cysteine auxotrophs have dysregulated biofilm components due to a change in the redox state of the periplasm. Additionally, we show the relationship between cysteine auxotrophs, biofilms, and antibiotics frequently used to treat UTIs.
Collapse
|
35
|
Yuruk E, Tuken M, Gonultas S, Colakerol A, Cakir OO, Binbay M, Sarica K, Muslumanoglu AY. Retrograde intrarenal surgery in the management of pediatric cystine stones. J Pediatr Urol 2017; 13:487.e1-487.e5. [PMID: 28262541 DOI: 10.1016/j.jpurol.2017.01.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of retrograde intrarenal surgery (RIRS) in the treatment of pediatric cystine stones. STUDY DESIGN Data of the pediatric patients who underwent RIRS for kidney stones were retrospectively evaluated. A total of 14 children with cystine stones managed with RIRS were identified. In addition to the patient demographics and stone characteristics, all retrospectively obtained operative data were evaluated and discussed in detail, with an emphasis on the success and complication rates. RESULTS Mean age of the 14 cases was 10.9 ± 2.2 years (range: 7-15). Mean stone size was 13.6 ± 2.4 mm (range: 10-18) (Summary table). Of these stones, four were located in the renal pelvis, three were in the lower, three were in the middle and the remaining four were located in upper calyx. Ureteral access sheath was used in 12 (85.7%) patients. The double-J ureteral stent was placed pre-operatively in one case and was inserted postoperatively in 12 cases. Mean operation time was 38.2 ± 7.2 min (range: 30-50). Complications were observed in two cases: mild ureteral laceration in the first and fever on the second postoperative day in the second patient. All of the patients were stone free on sonographic evaluation at the 4-week follow-up evaluation. Although potassium citrate treatment was initiated in 11 patients, tiopronin treatment was initiated in four patients for recurrence prophylaxis during long-term follow-up. During a mean follow-up period of 25.7 ± 5.2 months, stone recurrence was noted in one patient. DISCUSSION Treatment of patients with cystine stones is challenging, due to high risk of rapid recurrence in the presence of residual fragments. Besides allowing complete stone clearance in all cases in the current series, RIRS is a highly reproducible method that can be safely performed, even in recurrences. The major limitations of the current study were low number of patients and short follow-up period. CONCLUSION The results clearly indicated that RIRS is a safe treatment modality in the management of pediatric cystine stones.
Collapse
Affiliation(s)
- E Yuruk
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey.
| | - M Tuken
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - S Gonultas
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - A Colakerol
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - O O Cakir
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - M Binbay
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - K Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - A Y Muslumanoglu
- Department of Urology, Bagcilar Research and Training Hospital, Istanbul, Turkey
| |
Collapse
|
36
|
Plante G, Ouimet D, Robitaille R. Easy-to-use equations for the estimation of urine relative saturation in the assessment of risk of recurrence in urinary stones formers. Clin Biochem 2017; 50:794-796. [DOI: 10.1016/j.clinbiochem.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/02/2017] [Accepted: 03/21/2017] [Indexed: 11/28/2022]
|
37
|
de Rojas T, Aparicio C, de Lucas C, Martinez B, Gil-Fournier B, Ramiro-León S. Cystinuria in a patient with 19q12q13.1 deletion. CEN Case Rep 2017; 5:67-69. [PMID: 28509170 DOI: 10.1007/s13730-015-0193-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 08/06/2015] [Indexed: 01/20/2023] Open
Abstract
Cystinuria is a genetic cause of kidney stones with a prevalence of 1 in 7000 births. So far, two genes have been described responsible for this disorder (SLC3A1 and SLC7A9). We report a patient with an SLC7A9 gene mutation located in 19q13.1 on one allele and with a 19q12q13 region deletion on the other allele. The characteristic clinical features of the 19q13.1 microdeletion syndrome include facial dysmorphism, signs of ectodermal dysplasia, growth retardation, neurologic features and genitourinary anomalies. Cystinuria has not yet been described as part of this syndrome, although one of its responsible genes (SLC7A9) is in the same genomic location. The index case is a 6-year-old male presented with distinctive facial features, cutis aplasia of the scalp, rudimentary teeth, microcephaly, intrauterine and postnatal growth retardation, psychomotor developmental delay, speech delay, epilepsy, inguinal hernias and cystinuria. An array-CGH analysis was performed, finding a large deletion of the 19q12q13.11 cytobands, which affects 19 genes. Two of them are involved in the 19q13.11 deletion syndrome and another affected gene is SLC7A9, responsible for type B cystinuria. Sanger sequencing was performed as well, detecting a heterozygous mutation of the SLC7A9 gene, located in 19q13.1. As far as we know, this is the first described case of cystinuria in a patient with SLC7A9 gene mutation located in 19q13.1 on one allele and with 19q12q13 region deletion on the other allele. Although this patient can be classified as a type B heterozygote and, therefore, his renal prognosis is not severe, the occasional nephrolithiasis found in such patients justifies a close follow-up with regular testing of urinary cystine excretion. We suggest that the recessive behavior of this case, explains the clinical features regarding cystinuria. We propose that in the face of patients affected of a phenotype matchable with 19q13.11 syndrome and cystinuria, a mutational or sequencing study of the SLC7A9 gene should be performed to allow an early onset of diagnosis and treatment.
Collapse
Affiliation(s)
- Teresa de Rojas
- Department of Nephrology, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain.
| | - Cristina Aparicio
- Department of Nephrology, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Carmen de Lucas
- Department of Nephrology, Hospital Infantil Universitario Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Beatriz Martinez
- Department of Neurology, Hospital Universitario de Getafe, Madrid, Spain
| | | | | |
Collapse
|
38
|
Kim JH, Park E, Hyun HS, Lee BH, Kim GH, Lee JH, Park YS, Kang HG, Ha IS, Cheong HI. Genotype and Phenotype Analysis in Pediatric Patients with Cystinuria. J Korean Med Sci 2017; 32:310-314. [PMID: 28049243 PMCID: PMC5219998 DOI: 10.3346/jkms.2017.32.2.310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/16/2016] [Indexed: 11/22/2022] Open
Abstract
Cystinuria is an inherited disorder characterized by defective renal reabsorption of cystine and dibasic amino acids leading to nephrolithiasis. This study was conducted to analyze the genotypes and phenotypes of pediatric patients with cystinuria. Eight children from Seoul National University Hospital and Asan Medical Center presenting with cystinuria from January 2003 to June 2016 were retrospectively analyzed. Mutational studies were performed by direct sequencing. Two of the 8 were male and 6 were female. The median ages at onset and diagnosis were 1.5 (range, 0.3-13.6) and 2.6 (range, 0.7-16.7) years, respectively. The median followed up was 7.7 (range, 3.4-14.0) years. Mutational analyses were performed in 7 patients and revealed biallelic SLC3A1 mutations (AA genotype) in 4 patients, a single heterozygous SLC3A1 mutation (A- genotype) in 1 patient, biallelic SLC7A9 mutations (BB genotype) in 1 patient, and a single heterozygous SLC7A9 mutation (B- genotype) in 1 patient. Two of the mutations were novel. No genotype-phenotype correlations were observed, except for earlier onset age in patients with non-AA genotypes than in patients with the AA genotype. All patients suffered from recurrent attacks of symptomatic nephrolithiasis, which lead to urologic interventions. At the last follow-up, 3 patients had a mild-to-moderate degree of renal dysfunction. This is the first study of genotypic and phenotypic analyses of patients with cystinuria in Korea.
Collapse
Affiliation(s)
- Ji Hyun Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Eujin Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Hye Sun Hyun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Beom Hee Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Gu Hwan Kim
- Medical Genetics Center, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Joo Hoon Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Young Seo Park
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Research Coordination Center for Rare Diseases, Seoul National University Hospital, Seoul, Korea
| | - Il Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
- Research Coordination Center for Rare Diseases, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
39
|
Carvalho-Salemi J, Moreno L, Michael M. Medical Nutrition Therapy for Pediatric Kidney Stone Prevention, Part One. J Ren Nutr 2017; 27:e5-e8. [DOI: 10.1053/j.jrn.2016.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022] Open
|
40
|
Mohebbi N, Ferraro PM, Gambaro G, Unwin R. Tubular and genetic disorders associated with kidney stones. Urolithiasis 2016; 45:127-137. [DOI: 10.1007/s00240-016-0945-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/22/2016] [Indexed: 02/08/2023]
|
41
|
Dion M, Ankawi G, Chew B, Paterson R, Sultan N, Hoddinott P, Razvi H. CUA guideline on the evaluation and medical management of the kidney stone patient - 2016 update. Can Urol Assoc J 2016; 10:E347-E358. [PMID: 28096919 DOI: 10.5489/cuaj.4218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Marie Dion
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ghada Ankawi
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ben Chew
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nabil Sultan
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patti Hoddinott
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
42
|
Yamaçake KGR, Marchini GS, Reis S, Danilovic A, Vicentini FC, Torricelli FCM, Srougi M, Mazzucchi E. The challenge of cystine and struvite stone formers: clinical, metabolic and surgical assessment. Int Braz J Urol 2016; 42:977-985. [PMID: 27622279 PMCID: PMC5066895 DOI: 10.1590/s1677-5538.ibju.2015.0741] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/21/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose: To compare the clinical, metabolic, and calculi characteristics of cystine and struvite stone patients after percutaneous nephrolithotripsy (PCNL). Material and Methods: Between January/2006-July/2013, 11 cystine stone patients were treated in our clinic. Of those, 3 were excluded due to incomplete follow-up. Eight cystine stone patients (2 with bilateral disease; 10 renal units-RU) were considered for further analysis. A cohort of 8 struvite stone formers (10RU) was matched having the same age, gender, body mass index (BMI) and Guys stone score. Analyzed parameters comprised demographic data, serum/urinary metabolic evaluation and surgical outcomes. Results: Both groups had 6 female patients. Groups were similar in regards to age, gender, BMI, stone burden, and serum creatinine (p=NS). All patients had PCNL as the first surgical treatment modality. Stone free rate (SFR) after the first PCNL tended to be lower (0%) in the cystine compared to the struvite group (40%)(p=0.08). Final SFR after secondary procedures increased to 70% in cystine and 80% in struvite patients (p=1.0); mean number of procedures to achieve stone free status was higher in the first group (3.57 vs. 2.0;p=0.028). Hypocitraturia was found in all patients, but struvite cases presented with lower mean urinary citrate levels (p=0.016). Other common abnormalities were elevated urinary pH (cystine 75% and struvite 62.5%;p=1.0) and low urinary volume (62.5%,37.5%;p=0.63). Conclusion: Multiple interventions and suboptimal stone free rates are trait of the significant stone burden of struvite and cystine patients. Underlying metabolic abnormalities characterized by increased urinary pH, hypocitraturia and low urinary volume are often encountered in both populations.
Collapse
Affiliation(s)
- Kleiton G R Yamaçake
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Giovanni S Marchini
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Sabrina Reis
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Alexandre Danilovic
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Fábio C Vicentini
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Fábio C M Torricelli
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Miguel Srougi
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Eduardo Mazzucchi
- Seção de Endourologia, Divisão de Urologia do Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| |
Collapse
|
43
|
Hu L, Yang Y, Aloysius H, Albanyan H, Yang M, Liang JJ, Yu A, Shtukenberg A, Poloni LN, Kholodovych V, Tischfield JA, Goldfarb DS, Ward MD, Sahota A. l-Cystine Diamides as l-Cystine Crystallization Inhibitors for Cystinuria. J Med Chem 2016; 59:7293-8. [PMID: 27409142 DOI: 10.1021/acs.jmedchem.6b00647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
l-Cystine bismorpholide (1a) and l-cystine bis(N'-methylpiperazide) (1b) were seven and twenty-four times more effective than l-cystine dimethyl ester (CDME) in increasing the metastable supersaturation range of l-cystine, respectively, effectively inhibiting l-cystine crystallization. This behavior can be attributed to inhibition of crystal growth at microscopic length scale, as revealed by atomic force microscopy. Both 1a and 1b are more stable than CDME, and 1b was effective in vivo in a knockout mouse model of cystinuria.
Collapse
Affiliation(s)
- Longqin Hu
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States
| | - Yanhui Yang
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States
| | - Herve Aloysius
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States
| | - Haifa Albanyan
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States
| | - Min Yang
- Department of Genetics, Rutgers, The State University of New Jersey , Piscataway, New Jersey 08854, United States
| | - Jian-Jie Liang
- Dassault Systemes BioVIA Corp , San Diego, California 92121, United States
| | - Anthony Yu
- Molecular Design Institute, Department of Chemistry, New York University , New York, New York 10003, United States
| | - Alexander Shtukenberg
- Molecular Design Institute, Department of Chemistry, New York University , New York, New York 10003, United States
| | - Laura N Poloni
- Molecular Design Institute, Department of Chemistry, New York University , New York, New York 10003, United States
| | - Vladyslav Kholodovych
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey , 160 Frelinghuysen Road, Piscataway, New Jersey 08854, United States.,High Performance and Research Computing, Office of Advanced Research Computing, Rutgers, The State University of New Jersey , Piscataway, New Jersey 08854, United States
| | - Jay A Tischfield
- Department of Genetics, Rutgers, The State University of New Jersey , Piscataway, New Jersey 08854, United States
| | - David S Goldfarb
- Nephrology Division, NYU Langone Medical Center , New York, New York 10016, United States
| | - Michael D Ward
- Molecular Design Institute, Department of Chemistry, New York University , New York, New York 10003, United States
| | - Amrik Sahota
- Department of Genetics, Rutgers, The State University of New Jersey , Piscataway, New Jersey 08854, United States
| |
Collapse
|
44
|
How should patients with cystine stone disease be evaluated and treated in the twenty-first century? Urolithiasis 2015; 44:65-76. [PMID: 26614112 DOI: 10.1007/s00240-015-0841-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/05/2015] [Indexed: 02/02/2023]
Abstract
Cystinuria continues to be one of the most challenging stone diseases. During the latest decades our knowledge of the molecular basis of cystinuria has expanded. Today 160 different mutations in the SLC3A1 gene and 116 in the SLC7A9 gene are listed. The full implications of type A, B or AB status are not yet fully understood but may have implications for prognosis, management and treatment. Despite better understanding of the molecular basis of cystinuria the principles of recurrence prevention have remained essentially the same through decades. No curative treatment of cystinuria exists, and patients will have a life long risk of stone formation, repeated surgery, impaired renal function and quality of life. Therapy to reduce stone formation is directed towards lowering urine cystine concentration and increasing cystine solubility. Different molecules that could play a role in promoting nucleation and have a modulating effect on cystine solubility may represent new targets for cystinuria research. Investigation of newer thiol-containing drugs with fewer adverse effects is also warranted. Determining cystine capacity may be an effective tool to monitor the individual patient's response. Compliance in cystinuric patients concerning both dietary and pharmacological intervention is poor. Frequent clinical follow-up visits in dedicated centres seem to improve compliance. Cystinuric patients should be managed in dedicated centres offering the complete range of minimal invasive treatment modalities, enabling a personalized treatment approach in order to reduce risk and morbidity of multiple procedures.
Collapse
|
45
|
Elfadil GA, Ibrahim ME, Elmugadam AA, Ahmed SA. Urinary cystine calculi and detection of polymorphism in the SLC3A1 gene in Sudanese children. J Taibah Univ Med Sci 2014. [DOI: 10.1016/j.jtumed.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
46
|
Shim M, Park HK. Multimodal treatments of cystine stones: an observational, retrospective single-center analysis of 14 cases. Korean J Urol 2014; 55:515-9. [PMID: 25132945 PMCID: PMC4131079 DOI: 10.4111/kju.2014.55.8.515] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/07/2014] [Indexed: 11/26/2022] Open
Abstract
Purpose To document the experiences of a single institution in evaluating the clinical courses and treatment outcomes of patients with cystine stones. Materials and Methods The clinical data of 14 patients with cystine stones who were treated at our institution from March 1994 to July 2012 were reviewed. These data included age at first visit, gender, family history, body mass index, presence of a single kidney, stone locations, stone burden, routine urinalysis, and culture. In addition, we also analyzed data on surgery, shock wave lithotripsy, medical treatment, stone recurrence or regrowth, and overall treatment success rates. Results The mean age of our patients at their first visit was 19.6±5.0 years, and eight patients were males. The median stone burden and mean urine pH before each surgery were 6.5 cm2 and 6.5±0.9, respectively. Two patients had a family history of cystine stones. Patients underwent surgery an average of 2.7 times. The median interval between surgeries was 27.3 months, and 1 open surgery, 12 percutaneous nephrolithotomies, and 25 ureterorenoscopies were performed. Potassium citrate or sodium bicarbonate was used in nine cases. D-Penicillamine was continuously used in three patients. Patients had an average incidence of 3.2 recurrences or regrowth of stones during the median follow-up period of 60.5 months. Conclusions Patients with cystine stones have high recurrence or regrowth rates and relatively large stone burdens. Adequate treatment schedules must therefore be established in these cases to prevent possible deterioration of renal function.
Collapse
Affiliation(s)
- Myungsun Shim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Keun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
47
|
Cystinuria: Current Diagnosis and Management. Urology 2014; 83:693-9. [DOI: 10.1016/j.urology.2013.10.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 09/23/2013] [Accepted: 10/08/2013] [Indexed: 11/20/2022]
|
48
|
Abstract
Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.
Collapse
|
49
|
|
50
|
Synergistic mutations in SLC3A1 and SLC7A9 leading to heterogeneous cystinuria phenotypes: pitfalls in the diagnostic workup. Pediatr Nephrol 2014; 29:155-9. [PMID: 24045899 DOI: 10.1007/s00467-013-2617-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/24/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cystinuria is an inherited disorder of a renal tubular amino acid transporter and leads to increased cystine excretion with the risk of urinary stone formation. Phenotypical classification is based on urinary amino acid concentration as type I (silent), type non-I (hyper-excretors), mixed or untyped. Genotypic classification is based on mutations in SLC3A1 (type A) or SLC7A9 (type B). CASE-DIAGNOSIS/TREATMENT We present six family members with a complex phenotypic profile based on mutations in both genes. The index patient presents a known homozygous mutation (p.T189M) in SLC3A1 and a homozygous mutation (c.225C > T) in SLC7A9. Based on a bioinformatics analysis and published findings, we considered p.T189M to be pathogenic and initially classified c.225C > T as a silent variant. However, segregation analysis detected homozygosity for p.T189M also in non-affected individuals, whereas homozygous c.225C > T segregated with the phenotype. RNA studies confirmed c.225C > T to cause aberrant splicing. CONCLUSIONS Based on our findings, we conclude that c.225C > T in SLC7A9 determines the clinical phenotype in this family, whereas additional SLC3A1 mutations aggravate the phenotype in heterozygotes for c.225C > T in SLC7A9 without resulting in cystinuria in the homozygous state. Our results underline the need for careful biochemical characterization of family members of an index case of cystinuria. Genetic analysis of both cystinuria genes may be necessary due to the synergistic effects of mutations in two genes.
Collapse
|