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Bergelson I, Walker C, Frank EL, Steinberg R. Felbamate urolithiasis. BMJ Case Rep 2023; 16:e253883. [PMID: 38129082 DOI: 10.1136/bcr-2022-253883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Drug-induced nephrolithiasis is an important consideration in recurrent stone formers with polypharmacy. While felbamate nephrolithiasis has previously been published in the paediatric population, we present the oldest published case of a felbamate stone in an adult, a man in his 30s with Lennox-Gastaut syndrome. Even with moderate dosing, high drug serum levels can occur. Performing at least one stone analysis remains a critical component to care in these patients. Urologists should have a high index of suspicion for drug stone when stone analysis returns indeterminate characterisation in the absence of infection. Close communication with neurology is key to preventing recurrent stone disease.
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Affiliation(s)
- Ilana Bergelson
- Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, lowa, USA
| | - Chance Walker
- Department of Pathology, University of Utah Health, Salt Lake City, Utah, USA
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
| | - Elizabeth L Frank
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA
- University of Utah Health, Salt Lake City, Utah, USA
| | - Ryan Steinberg
- Department of Urology, The University of Iowa Hospitals and Clinics, Iowa City, lowa, USA
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2
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Lasorsa F, Caliolo C, Silecchia A, Laricchiuta N, Raguso M, Ditonno P, Lucarelli G. Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2165. [PMID: 38138268 PMCID: PMC10745114 DOI: 10.3390/medicina59122165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: In recent years, the prevalence of pediatric urolithiasis has increased in North America and Western countries, though it is endemic in developing countries. The aim of this study is to describe the experience of a tertiary pediatric referral center in the surgical management of pediatric urolithiasis. Materials and Methods: We retrospectively reviewed the experience of patients ≤ 16 years old affected by urinary stones who underwent surgery. Results: From April 2021 to September 2023, 31 pediatric patients underwent surgical procedures for stone diseases at our department: 13 preschool-aged (1-5 years) and 18 school-aged (6-16 years) children. During this period, 12 URSs, 17 RIRSs, and 2 PCNLs were recorded. Five patients had residual fragments at first, so three of them underwent a second endourological lithotripsy (2 RIRSs and 1 URS). Complete clearance was finally achieved in 27 patients. The stone composition was evaluated in 25 cases. Conclusions: Numerous innovations in the surgical treatment of pediatric urolithiasis have resulted from the development of smaller devices and new technology. Our results show how, in experienced centers, retrograde and percutaneous lithotripsy are safe and effective procedures for use in pediatric populations.
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Affiliation(s)
- Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Claudia Caliolo
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Antonia Silecchia
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Nicola Laricchiuta
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Michele Raguso
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
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3
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Carmen Tong CM, Ellison JS, Tasian GE. Pediatric Stone Disease: Current Trends and Future Directions. Urol Clin North Am 2023; 50:465-475. [PMID: 37385708 DOI: 10.1016/j.ucl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Pediatric nephrolithiasis is less common in children than in adults but the incidence has been rising rapidly, and it is now a public health and economic burden in the United States. There are challenges unique to children that should be taken into consideration when evaluating and managing pediatric stone disease. In this review, we present the current research on risk factors, emerging new technologies for treatment of stones and recent investigations on prevention of stones in this population.
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Affiliation(s)
- Ching Man Carmen Tong
- Department of Pediatric Urology, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 318, Birmingham, AL 35233, USA.
| | - Jonathan S Ellison
- Department of Urology, Medical College of Wisconsin, Children's Hospital of Wisconsin and Medical College of Wisconsin, 9000 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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4
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Dobrek L. Lower Urinary Tract Disorders as Adverse Drug Reactions-A Literature Review. Pharmaceuticals (Basel) 2023; 16:1031. [PMID: 37513941 PMCID: PMC10383968 DOI: 10.3390/ph16071031] [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: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
A potential complication of pharmacotherapy for a given patient is the possibility of various side effects of drugs, which are manifested in many ways and constitute iatrogenic causes of diseases. Among the systemic side effects of drugs, there are also those involving the urinary tract, although these are less reported in the literature. The use of numerous drugs-especially of anticholinergics or drugs with anticholinergic potential, opioid analgesics, non-steroidal anti-inflammatory drugs, antidepressants, first-generation antipsychotics (classic neuroleptics) and selected cardiovascular drugs (beta-blockers, thiazides potassium-sparing diuretics, statins), as well as others-may increase the risk of developing urological disorders, such as urinary retention or incontinence, urinary tract infections, urolithiasis, erectile dysfunction in men and retroperitoneal fibrosis. The purpose of this paper is to characterise the abovementioned drug-induced disorders of the lower urinary tract on the basis of a non-systematic literature review.
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Affiliation(s)
- Lukasz Dobrek
- Department of Clinical Pharmacology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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5
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Nephrolithiasis in Two Patients on Iron Chelation Therapy: A Case Report. Transfus Apher Sci 2023:103702. [PMID: 37055329 DOI: 10.1016/j.transci.2023.103702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023]
Abstract
Drug-induced nephrolithiasis can arise from insoluble components within medications or crystallization of metabolites due to changes in metabolism and urinary pH. The connection between drugs utilized for iron chelation therapy (ICT) and nephrolithiasis is not well understood. In this report, we describe two pediatric patients diagnosed with nephrolithiasis while undergoing treatment with the chelating agents deferasirox, deferiprone, and deferoxamine for iron overload secondary to repeat blood transfusion.
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Dobrek L. A Synopsis of Current Theories on Drug-Induced Nephrotoxicity. Life (Basel) 2023; 13:life13020325. [PMID: 36836682 PMCID: PMC9960203 DOI: 10.3390/life13020325] [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: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
The overriding goal of the treatment of patients is its effectiveness and safety. However, all medications currently being used also exert some adverse pharmaceutical reactions, which may be regarded as an unintended but inevitable cost of pharmacotherapy. The kidney, as the main organ that eliminates xenobiotics, is an organ especially predisposed and vulnerable to the toxic effects of drugs and their metabolites during their excretion from the body. Moreover, some drugs (e.g., aminoglycosides, cyclosporin A, cisplatin, amphotericin B, and others) have a "preferential" nephrotoxicity potential, and their use is associated with an increased risk of kidney damage. Drug nephrotoxicity is, therefore, both a significant problem and a complication of pharmacotherapy. It should be noted that, currently, there is no generally recognized definition of drug-induced nephrotoxicity and no clear criteria for its diagnosis. This review briefly describes the epidemiology and diagnosis of drug-induced nephrotoxicity and characterizes its pathomechanisms, including immunological and inflammatory disturbances, altered kidney blood flow, tubulointerstitial injury, increased lithogenesis-crystal nephropathy, rhabdomyolysis, and thrombotic microangiopathy. The study also lists the basic drugs with nephrotoxicity potential and provides a short overview of the preventive methods for reducing the risk of drug-related kidney damage developing.
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Affiliation(s)
- Lukasz Dobrek
- Department of Clinical Pharmacology, Wroclaw Medical University, Wroclaw, Poland
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Chebion G, Bugni E, Gerin V, Daudon M, Castiglione V. Drug-induced nephrolithiasis and crystalluria: the particular case of the sulfasalazine derivatives. CR CHIM 2022. [DOI: 10.5802/crchim.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Zhong J, Huang Z, Yang T, Wang G, Guo H, Li P, Zhang Y, Zhao Y, Liu J. The current status of preventive measures for urinary calculi in children. Ther Adv Urol 2021; 13:17562872211039581. [PMID: 34422114 PMCID: PMC8371722 DOI: 10.1177/17562872211039581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/27/2021] [Indexed: 11/17/2022] Open
Abstract
Urological calculus is a common disease in urology. Urological calculi are
generally more common in adults but have become more common in children in
recent years. Most existing studies focus on the prevention of urinary calculi
in adults; there are relatively few articles on calculi in children. Reported
preventive measures are not comprehensive enough, while the latest research
progress has not been updated. The pathogenesis and preventive measures
associated with urinary calculi have been the focus of research, but many
preventive measures still need further clarification. This article reviews the
progress on preventive measures for urinary calculi in children.
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Affiliation(s)
- Jiao Zhong
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Ziye Huang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Tongxin Yang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Guang Wang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Haixiang Guo
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Pei Li
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yafei Zhang
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Yuan Zhao
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Jianhe Liu
- The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dian-Mian Avenue, Kunming, Yunnan 650101, P.R. China
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Abstract
The prevalence of urolithiasis in humans is increasing worldwide; however, non-surgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins and ferrets, that form calcium oxalate, struvite, uric acid, cystine and other stone types. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.
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Abstract
PURPOSE OF REVIEW As the incidence of nephrolithiasis in children doubles every 10 years it is becoming a common disease associated with significant morbidity along with considerable economic burden worldwide. The aim of this review is to summarize current data on the epidemiology and causes of renal stones in children and to provide a frame for the first clinical evaluation of a child with suspected nephrolithiasis. RECENT FINDINGS Dietary and environmental factors are the driving force of changing epidemiology. Diagnosis should be based on medical history, presenting signs, examination, first laboratory and radiological workup. Ultrasound should be the initial diagnostic imaging performed in pediatric patients while low-dose computed tomography is rarely necessary for management. Metabolic factors including hypercalciuria, hypocitraturia, low fluid intake as well as specific genetic diseases should be explored after the resolution of initial signs and symptoms. SUMMARY Appropriate initial evaluation, imaging technique, identification of risk factors and other abnormalities are essential for early diagnosis and prevention of stone-related morbidity in children with suspected nephrolithiasis.
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