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Pearce RJ, Sui W, Yang H, Chi T, Stoller M. The yield of genetic testing in management of nephrolithiasis. Urology 2024:S0090-4295(24)00555-7. [PMID: 38992507 DOI: 10.1016/j.urology.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/13/2024] [Accepted: 07/01/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To describe the yield and indications for performing genetic testing in patients with nephrolithiasis. Genetic testing for nephrolithiasis is becoming more accessible and rapid due to technologic advances. This study aimed to determine the diagnostic yield of genetic testing in a cohort of high-risk stone formers and to identify 24-hour urine characteristics to prompt genetic screening. MATERIALS AND METHODS We retrospectively identified patients who underwent genetic testing for nephrolithiasis from 2020-22 at a single institution using a custom PerkinElmer™ genomics panel for nephrolithiasis. We compared characteristics of patients with and without genetic abnormalities. We used receiver operator characteristic (ROC) analysis to identify candidate thresholds for genetic testing. RESULTS Fourteen of 36 patients (39%) who underwent genetic testing had identifiable mutations. Five patients (14%) had known pathogenic mutations, including genes for primary hyperoxaluria (PH2 and PH3), cystinuria, and enamel renal syndrome. The remaining mutations were variants of uncertain significance. Of the 14 patients with identified mutations, only 6 had concordant 24-hour urine abnormalities, including 3/5 with known pathogenic mutations. In patients with urine oxalate ≥40mg/day, 3/29 (10.3%) had PH2 or PH3. ROC analysis showed that an oxalate threshold of ≥80mg/day may have promising screening characteristics. CONCLUSIONS Genetic testing for nephrolithiasis remains controversial due to unknown yield and the time and energy required to discuss results with patients. This preliminary report describes the yield and identifies clinical factors and a potential cut-off that may assist clinicians in deciding when genetic profiling should be pursued.
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Affiliation(s)
- Robert J Pearce
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Wilson Sui
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Heiko Yang
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Thomas Chi
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Marshall Stoller
- Department of Urology, University of California San Francisco, San Francisco, California, USA.
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Dalimov Z, Friedlander JI. Do We Really Need a Stone and Metabolic Urine Analysis? Yes. J Endourol 2024. [PMID: 38874916 DOI: 10.1089/end.2024.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Zafarjan Dalimov
- Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Justin I Friedlander
- Department Urology, Fox Chase Cancer Center/Temple Health, Philadelphia, Pennsylvania, USA
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3
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Cong X, Huang L, Wang X, Li L, Zhang X, Chen X, Xu Y. Comparison of the bone mineral density status of patients with kidney stones stratified by stone composition. World J Urol 2024; 42:42. [PMID: 38244092 DOI: 10.1007/s00345-023-04727-y] [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] [Received: 06/29/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Bone loss has been found to occur frequently in patients with particular metabolic disorders that are likely associated with certain kidney stone composition. Thus, we compared the bone mineral density (BMD) of patients with different kidney stone compositions. PATIENTS AND METHODS A total of 204 consecutive patients who exhibited stone formation with calcium oxalate (CaOx), calcium phosphate (CaP), uric acid (UA), and magnesium ammonium phosphate (MAP) underwent 24 h urine test and BMD measurement. BMD was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). The Z-score was used to express BMD. A BMD Z-score ≤ - 2 was defined as a diagnostic threshold for bone loss. RESULTS Amongst the patients, 38 had an LS BMD Z-score of ≤ - 2, but only 2 had FN BMD Z-score of ≤ - 2. The group with an LS BMD Z-score of ≤ - 2 exhibited significantly larger male - female ratio, higher frequency of hypercalciuria and CaP, and lower frequency of MAP than the group with an LS BMD Z-score of > - 2. Reduced LS BMD was most remarkable in the CaP group, followed by the CaOx, UA, and MAP groups. The LS BMD Z-score of hypercalciuric patients was significantly lower than that of normocalciuric patients only in the CaP group. CONCLUSION Patients with different kidney stone compositions presented different BMD status. Using this information may facilitate medical decision-making in patients with kidney stone who should undergone BMD earlier.
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Affiliation(s)
- Xiaoming Cong
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Lili Huang
- Jiangsu Health Development Research Center, NHC Contraceptives Adverse Reaction Surveillance Center, Nanjing, People's Republic of China
| | - Xingbo Wang
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Liulin Li
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Xin Zhang
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Xuehua Chen
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Yan Xu
- Department of Urology, Jiangsu Province Hospital of TCM, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China.
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4
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Sarwal A, Yamauchi J, Raghavan D, Shihab F, Fornadi K, Rofaiel G, Zimmerman M, Campsen J, Baker N, Akhila Ganireddy Y, Aviles-Ovalle L, Baker T, Hall IE, Molnar MZ. Throwing stones: kidney stone incidence in living kidney donor candidates with increased metabolic risk. Ren Fail 2023; 45:2226763. [PMID: 37357461 PMCID: PMC10294741 DOI: 10.1080/0886022x.2023.2226763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023] Open
Affiliation(s)
- Amara Sarwal
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Junji Yamauchi
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Divya Raghavan
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Fuad Shihab
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Katalin Fornadi
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - George Rofaiel
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Michael Zimmerman
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Jeffrey Campsen
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Nicholas Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Yamini Akhila Ganireddy
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Leonardo Aviles-Ovalle
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Talia Baker
- Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Isaac E. Hall
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Miklos Z. Molnar
- Department of Internal Medicine, Division of Nephrology & Hypertension, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
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Geraghty RM, Wilson I, Olinger E, Cook P, Troup S, Kennedy D, Rogers A, Somani BK, Dhayat NA, Fuster DG, Sayer JA. Routine Urinary Biochemistry Does Not Accurately Predict Stone Type Nor Recurrence in Kidney Stone Formers: A Multicentre, Multimodel, Externally Validated Machine-Learning Study. J Endourol 2023; 37:1295-1304. [PMID: 37830220 DOI: 10.1089/end.2023.0451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Objectives: Urinary biochemistry is used to detect and monitor conditions associated with recurrent kidney stones. There are no predictive machine learning (ML) tools for kidney stone type or recurrence. We therefore aimed to build and validate ML models for these outcomes using age, gender, 24-hour urine biochemistry, and stone composition. Materials and Methods: Data from three cohorts were used, Southampton, United Kingdom (n = 3013), Newcastle, United Kingdom (n = 5984), and Bern, Switzerland (n = 794). Of these 3130 had available 24-hour urine biochemistry measurements (calcium, oxalate, urate [Ur], pH, volume), and 1684 had clinical data on kidney stone recurrence. Predictive ML models were built for stone type (n = 5 models) and recurrence (n = 7 models) using the UK data, and externally validated with the Swiss data. Three sets of models were built using complete cases, multiple imputation, and oversampling techniques. Results: For kidney stone type one model (extreme gradient boosting [XGBoost] built using oversampled data) was able to effectively discriminate between calcium oxalate, calcium phosphate, and Ur on both internal and external validation. For stone recurrence, none of the models were able to discriminate between recurrent and nonrecurrent stone formers. Conclusions: Kidney stone recurrence cannot be accurately predicted using modeling tools built using specific 24-hour urinary biochemistry values alone. A single model was able to differentiate between stone types. Further studies to delineate accurate predictive tools should be undertaken using both known and novel risk factors, including radiomics and genomics.
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Affiliation(s)
- Robert M Geraghty
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Ian Wilson
- Biosciences Institute, Newcastle University, International Centre for Life, Newcastle Upon Tyne, United Kingdom
| | - Eric Olinger
- Translational and Clinical Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Paul Cook
- Department of Biochemistry, University Hospital Southampton, Southampton, United Kingdom
| | - Susan Troup
- Department of Biochemistry, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - David Kennedy
- Department of Biochemistry, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Nasser A Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - John A Sayer
- Translational and Clinical Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle Upon Tyne, United Kingdom
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6
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Zhu W, Zhang X, Zhou Z, Sun Y, Zhang G, Duan X, Huang Z, Ai G, Liu Y, Zhao Z, Zhong W, Zeng G. Predictive value of single-nucleotide polymorphism signature for nephrolithiasis recurrence: a 5-year prospective study. Clin Kidney J 2023; 16:2205-2215. [PMID: 37915892 PMCID: PMC10616432 DOI: 10.1093/ckj/sfad119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 11/03/2023] Open
Abstract
Background Genetic variations are linked to kidney stone formation. However, the association of single nucleotide polymorphism (SNPs) and stone recurrence has not been well studied. This study aims to identify genetic variants associated with kidney stone recurrences and to construct a predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones. Methods We genotyped 49 SNPs in 1001 patients who received surgical stone removal between Jan 1 and Dec 31 of 2012. All patients were confirmed stone-free by CT scan and then received follow-up at least 5 years. SNP associations with stone recurrence were analyzed by Cox proportion hazard model. A predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones was developed by use of LASSO Cox regression. Results The recurrence rate at 3, 5, 7 years were 46.8%, 71.2%, and 78.4%, respectively. 5 SNPs were identified that had association with kidney stone recurrence risk. We used computer-generated random numbers to assign 500 of these patients to the training cohort and 501 patients to the validation cohort. A nomogram that combined the 14-SNPs-based classifier with the clinical risk factors was constructed. The areas under the curve (AUCs) at 3, 5 and 7 years of this nomogram was 0.645, 0.723, and 0.75 in training cohort, and was 0.631, 0.708, and 0.727 in validation cohort, respectively. Results show that the nomogram presented a higher predictive accuracy than those of the SNP classifier or clinical factors alone. Conclusion SNPs are significantly associated with kidney stone recurrence and should add prognostic value to the traditional clinical risk factors used to assess the kidney stone recurrence. A nomogram using clinical and genetic variables to predict kidney stone recurrence has revealed its potential in the future as an assessment tool during the follow-up of kidney stone patients.
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Affiliation(s)
- Wei Zhu
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Zhang
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen Zhou
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yin Sun
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Guangyuan Zhang
- Department of Urology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Xiaolu Duan
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhicong Huang
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guoyao Ai
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Liu
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhijian Zhao
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wen Zhong
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guohua Zeng
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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7
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Travers S, Bertoye C, Daudon M, Courbebaisse M, Baron S. How to Monitor Hydration Status and Urine Dilution in Patients with Nephrolithiasis. Nutrients 2023; 15:nu15071642. [PMID: 37049482 PMCID: PMC10097240 DOI: 10.3390/nu15071642] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Maintenance of hydration status requires a tight balance between fluid input and output. An increase in water loss or a decrease in fluid intake is responsible for dehydration status, leading to kidney water reabsorption. Thus, urine volume decreases and concentration of the different solutes increases. Urine dilution is the main recommendation to prevent kidney stone recurrence. Monitoring hydration status and urine dilution is key to preventing stone recurrence. This monitoring could either be performed via spot urine or 24 h urine collection with corresponding interpretation criteria. In laboratory conditions, urine osmolality measurement is the best tool to evaluate urine dilution, with less interference than urine-specific gravity measurement. However, this evaluation is only available during time lab examination. To improve urine dilution in nephrolithiasis patients in daily life, such monitoring should also be available at home. Urine color is of poor interest, but reagent strips with urine-specific gravity estimation are currently the only available tool, even with well-known interferences. Finally, at home, fluid intake monitoring could be an alternative to urine dilution monitoring. Eventually, the use of a connected device seems to be the most promising solution.
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8
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Ahmed AE, Abol-Enein H, Awadalla A, Shokeir AA, El-Shehaby OA, Harraz AM. Metabolic stone workup abnormalities are not as important as stone culture in patients with recurrent stones undergoing percutaneous nephrolithotomy. Urolithiasis 2023; 51:47. [PMID: 36913043 PMCID: PMC10011315 DOI: 10.1007/s00240-023-01422-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
To investigate the association between metabolic urinary abnormalities and urinary tract infection (UTI) and the stone recurrence status in patients undergoing percutaneous nephrolithotomy (PCNL). A prospective evaluation was performed for patients who underwent PCNL between November 2019 and November 2021 and met the inclusion criteria. Patients with previous stone interventions were classified as recurrent stone formers. Before PCNL, a 24 h metabolic stone workup and midstream urine culture (MSU-C) were done. Renal pelvis (RP-C) and stones (S-C) cultures were collected during the procedure. The association between the metabolic workup and UTI results with stone recurrence was evaluated using univariate and multivariate analyses. The study included 210 patients. UTI factors that showed significant association with stone recurrence included positive S-C [51 (60.7%) vs 23 (18.2%), p < 0.001], positive MSU-C [37 (44.1%) vs 30 (23.8%), p = 0.002], and positive RP-C [17 (20.2%) vs 12 (9.5%), p = 0.03]. Other factors were mean ± SD GFR (ml/min) (65 ± 13.1 vs 59.5 ± 13.1, p = 0.003), calcium-containing stones [47 (55.9%) vs 48 (38.1%), p = 0.01], median (IQR) urinary citrate levels (mg/day) [333 (123-512.5) vs 221.5 (120.3-412), p = 0.04], and mean ± SD urinary pH (6.1 ± 1 vs 5.6 ± 0.7, p < 0.001). On multivariate analysis, only positive S-C was the significant predictor of stone recurrence (odds ratio: 9.9, 95% confidence interval [CI] (3.8-28.6), p < 0.001). Positive S-C, and not metabolic abnormalities, was the only independent factor associated with stone recurrence. A focus on preventing UTI might prevent further stone recurrence.
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Affiliation(s)
- Asmaa E Ahmed
- Botany Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Omar A El-Shehaby
- Botany Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Ahmed M Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt.
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9
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Alfimov AE, Shaderkina IA, Korolev DO, Gorinova DM, Enikeev ME, Tsarichemko DG, Rapoport LM. Markers of lithogenic activity in kidney stone disease. ANDROLOGY AND GENITAL SURGERY 2023. [DOI: 10.17650/2070-9781-2022-23-4-36-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- A. E. Alfimov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - I. A. Shaderkina
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - D. O. Korolev
- Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - D. M. Gorinova
- Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - M. E. Enikeev
- Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - D. G. Tsarichemko
- Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
| | - L. M. Rapoport
- Institute of Urology and Human Reproductive Health of the I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)
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10
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Hsi RS, Koyama T, Silver HJ, Goldfarb DS. Urinary supersaturation in a Randomized trial among Individuals with Nephrolithiasis comparing Empiric versus selective therapy (URINE): design and rationale of a clinical trial. Urolithiasis 2023; 51:28. [PMID: 36598705 PMCID: PMC9836785 DOI: 10.1007/s00240-022-01400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Clinical guidelines disagree on whether the identification of abnormal urine chemistries should occur before starting diet and medication interventions to prevent the recurrence of kidney stone events. We describe the rationale and design of the Urinary supersaturation in a Randomized trial among Individuals with Nephrolithiasis comparing Empiric versus selective therapy (URINE) study, a randomized trial comparing two multi-component interventions to improve urinary supersaturation. Participants are randomized (1:1 ratio) to the empiric or selective arm. The target sample size is 56 participants. Adults ≥ 18 years of age with idiopathic calcium stone disease and two symptomatic stone events within the previous 5 years. Exclusion criteria include systemic conditions predisposing to kidney stones and pharmacologic treatment for stone prevention at baseline. Participants in the empiric arm receive standard diet therapy recommendations, thiazide, and potassium citrate. Participants in the selective arm receive tailored diet and nutrient recommendations and medications based on baseline and 1-month follow-up of 24-h urine testing results. The primary endpoints are urinary supersaturations of calcium oxalate and calcium phosphate at 2 months of follow-up. Secondary endpoints include side effects, diet and medication adherence, and changes in 24-h urine volume, calcium, oxalate, citrate, and pH. Short-term changes in urinary supersaturation may not reflect changes in future risk of stone events. The URINE study will provide foundational data to compare the effectiveness of two prevention strategies for kidney stone disease.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi J Silver
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David S Goldfarb
- Nephrology Section, New York Harbor VAMC, St. Vincent's Hospital, New York, NY, USA
- NYU Langone Health and NYU Grossman School of Medicine, and New York Harbor VA Healthcare System, New York, NY, USA
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11
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Todorov LG, Sivaguru M, Krambeck AE, Lee MS, Lieske JC, Fouke BW. GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles. Sci Rep 2022; 12:18371. [PMID: 36319741 PMCID: PMC9626463 DOI: 10.1038/s41598-022-23331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022] Open
Abstract
Shock wave lithotripsy (SWL) is an effective and commonly applied clinical treatment for human kidney stones. Yet the success of SWL is counterbalanced by the risk of retained fragments causing recurrent stone formation, which may require retreatment. This study has applied GeoBioMed experimental and analytical approaches to determine the size frequency distribution, fracture patterns, and reactive surface area of SWL-derived particles within the context of their original crystal growth structure (crystalline architecture) as revealed by confocal autofluorescence (CAF) and super-resolution autofluorescence (SRAF) microscopy. Multiple calcium oxalate (CaOx) stones were removed from a Mayo Clinic patient using standard percutaneous nephrolithotomy (PCNL) and shock pulse lithotripsy (SPL). This produced approximately 4-12 mm-diameter PCNL-derived fragments that were experimentally treated ex vivo with SWL to form hundreds of smaller particles. Fractures propagated through the crystalline architecture of PCNL-derived fragments in a variety of geometric orientations to form rectangular, pointed, concentrically spalled, and irregular SWL-derived particles. Size frequency distributions ranged from fine silt (4-8 μm) to very fine pebbles (2-4 mm), according to the Wentworth grain size scale, with a mean size of fine sand (125-250 μm). Importantly, these SWL-derived particles are smaller than the 3-4 mm-diameter detection limit of clinical computed tomography (CT) techniques and can be retained on internal kidney membrane surfaces. This creates clinically undetectable crystallization seed points with extremely high reactive surface areas, which dramatically enhance the multiple events of crystallization and dissolution (diagenetic phase transitions) that may lead to the high rates of CaOx kidney stone recurrence after SWL treatment.
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Affiliation(s)
- Lauren G. Todorov
- grid.35403.310000 0004 1936 9991Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Mayandi Sivaguru
- grid.35403.310000 0004 1936 9991Cytometry and Microscopy to Omics Facility, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Amy E. Krambeck
- grid.66875.3a0000 0004 0459 167XDepartment of Urology, Mayo Clinic, Rochester, MN USA ,grid.16753.360000 0001 2299 3507Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Matthew S. Lee
- grid.16753.360000 0001 2299 3507Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - John C. Lieske
- grid.66875.3a0000 0004 0459 167XDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN USA
| | - Bruce W. Fouke
- grid.35403.310000 0004 1936 9991Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL USA ,grid.35403.310000 0004 1936 9991Department of Evolution, Ecology and Behavior, University of Illinois at Urbana-Champaign, Urbana, IL USA
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12
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Chen SJ, Tseng CC, Huang KH, Chang YC, Fu LM. Microfluidic Sliding Paper-Based Device for Point-of-Care Determination of Albumin-to-Creatine Ratio in Human Urine. BIOSENSORS 2022; 12:bios12070496. [PMID: 35884299 PMCID: PMC9313340 DOI: 10.3390/bios12070496] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023]
Abstract
A novel assay platform consisting of a microfluidic sliding double-track paper-based chip and a hand-held Raspberry Pi detection system is proposed for determining the albumin-to-creatine ratio (ACR) in human urine. It is a clinically important parameter and can be used for the early detection of related diseases, such as renal insufficiency. In the proposed method, the sliding layer of the microchip is applied and the sample diffuses through two parallel filtration channels to the reaction/detection areas of the microchip to complete the detection reaction, which is a simple method well suited for self-diagnosis of ACR index in human urine. The RGB (red, green, and blue) value intensity signals of the reaction complexes in these two reaction zones are analyzed by a Raspberry Pi computer to derive the ACR value (ALB and CRE concentrations). It is shown that the G + B value intensity signal is linearly related to the ALB and CRE concentrations with the correlation coefficients of R2 = 0.9919 and R2 = 0.9923, respectively. It is additionally shown that the ALB and CRE concentration results determined using the proposed method for 23 urine samples were collected from real suffering chronic kidney disease (CKD) patients are in fine agreement with those acquired operating a traditional high-reliability macroscale method. Overall, for point-of-care (POC) CKD diagnosis and monitoring in clinical applications, the results prove that the proposed method offers a convenient, real time, reliable, and low-spending solution for POC CKD diagnosis.
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Affiliation(s)
- Szu-Jui Chen
- Department of Engineering Science, National Cheng Kung University, Tainan 701, Taiwan; (S.-J.C.); (K.-H.H.); (Y.-C.C.)
| | - Chin-Chung Tseng
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin 640, Taiwan;
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Kuan-Hsun Huang
- Department of Engineering Science, National Cheng Kung University, Tainan 701, Taiwan; (S.-J.C.); (K.-H.H.); (Y.-C.C.)
| | - Yu-Chi Chang
- Department of Engineering Science, National Cheng Kung University, Tainan 701, Taiwan; (S.-J.C.); (K.-H.H.); (Y.-C.C.)
| | - Lung-Ming Fu
- Department of Engineering Science, National Cheng Kung University, Tainan 701, Taiwan; (S.-J.C.); (K.-H.H.); (Y.-C.C.)
- Graduate Institute of Materials Engineering, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
- Correspondence: ; Tel.: +886-6-275-7575 (ext. 63321)
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13
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Li W, Zheng J, Chen M, Liu B, Liu Z, Gong L. Simultaneous determination of oxalate and citrate in urine and serum of calcium oxalate kidney stone rats by IP-RP LC-MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1208:123395. [DOI: 10.1016/j.jchromb.2022.123395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 10/16/2022]
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14
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Zhou Y, Chu X, Jiang D, Wu X, Xu J, Qi H, Tang Y, Dai Y. Development and validation of a nomogram for risk prediction of nephrolithiasis recurrence in patients with primary hyperparathyroidism. Front Endocrinol (Lausanne) 2022; 13:947497. [PMID: 36120445 PMCID: PMC9470877 DOI: 10.3389/fendo.2022.947497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nephrolithiasis is a common complication of primary hyperparathyroidism (PHPT), and the recurrence of nephrolithiasis in patients with PHPT is also an urgent concern. What is worse, there is a scarcity of recommended evaluation to predict the risk of nephrolithiasis recurrence in patients with PHPT. This study was aimed to develop and validate a nomogram to facilitate risk assessment in patients with PHPT. METHODS A total of 197 patients with PHPT were retrospectively included in this study from September 2016 to August 2021. Patients' demographic data, blood test parameters, urinalysis, stone parameters, and surgical intervention were collected. Extracted variables were submitted to a least absolute shrinkage and selection operator (LASSO) regression model. A nomogram was built and validated according to the area under the curve (AUC) value, calibration curve, and decision curve analysis. RESULTS According to the LASSO regression and logistic regression analyses, five predictors were derived from 22 variables: creatinine, uric acid, bilateral stone, multiplicity, and surgery. The AUC and concordance index of the training cohort and validation cohort were 0.829 and 0.856, and 0.827 and 0.877, respectively. The calibration curve analysis and the decision curve analysis showed that the nomogram had an adequate prediction accuracy. CONCLUSION We built a useful nomogram model to predict the risk of nephrolithiasis recurrence in patients with PHPT. This would assist clinicians to provide appropriate advices and managements for these patients.
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Affiliation(s)
- Yihong Zhou
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xi Chu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Dong Jiang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Xiang Wu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Jiarong Xu
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Hao Qi
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Yuxin Tang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
- Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
- *Correspondence: Yingbo Dai, ; Yuxin Tang,
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15
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Lee HY, Kang HW, Kim K, Ha YS, Kim WT, Kim YJ, Yun SJ, Kim WJ, Lee SC. Nutritional status assessed by the Controlling Nutritional Status (CONUT) score as a predictor of recurrence of urolithiasis. Investig Clin Urol 2021; 62:553-559. [PMID: 34387033 PMCID: PMC8421996 DOI: 10.4111/icu.20210031] [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: 01/21/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aimed to determine the influence of nutritional status on urinary metabolic abnormalities and stone recurrence in patients with urolithiasis. MATERIALS AND METHODS We analyzed data for 464 stone-formers and 464 propensity-score-matched control patients that had been collected between 2003 and 2015. Nutritional status was evaluated by use of the Controlling Nutritional Status (CONUT) score, and patients were placed into two CONUT score categories (0-1 and ≥2). Serum and 24-hour urinary metabolites were evaluated in 464 stone-formers. Kaplan-Meier and multivariate Cox regression analyses were performed to assess the influence of nutritional status on stone recurrence. Stone recurrence was defined as radiographic appearance of new stones during the follow-up period. RESULTS Stone-formers showed a higher prevalence of poor nutrition (CONUT score ≥2) than did the propensity-score-matched control patients (p<0.001). Stone-formers who had poor nutritional status had significantly lower 24-hour urinary calcium but higher oxalate excretion (each p<0.05). Kaplan-Meier estimates demonstrated that stone-formers with poor nutritional status also experienced stone recurrence more rapidly (log-rank test, p=0.014). Multivariate Cox regression revealed that poor nutritional status was independently associated with stone recurrence (hazard ratio, 1.736; 95% confidence interval, 1.041-2.896; p=0.034). CONCLUSIONS The CONUT score, an easily measured immunonutritional biomarker, is independently associated with a higher risk for stone recurrence in patients with urolithiasis. This implies that not only dietary excess, but also undernourished status, may be associated with aberrations in urine physicochemistry and stone recurrence.
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Affiliation(s)
- Hee Youn Lee
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyeong Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seok Joong Yun
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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16
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Bamberger JN, Rosen DC, Khusid JA, Kaplan-Marans E, Gallante B, Kapoor A, Paranjpe I, Atashsokhan DJ, Atallah WM, Gupta M. The impact of metabolic syndrome components on urinary parameters and risk of stone formation. World J Urol 2021; 39:4483-4490. [PMID: 34264364 DOI: 10.1007/s00345-021-03790-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the relationship between metabolic syndrome (MS) and urinary abnormalities in stone-forming patients. Additionally, to delineate whether severity of urinary derangements is impacted by the number of co-occurring MS components. METHODS Stone-forming patients who underwent initial metabolic workup prior to medical intervention at a comprehensive stone clinic were retrospectively reviewed and included in the study. Patients were given a six point (0-5) Metabolic Syndrome Severity Score (MSSS) based on the number of co-occurring MS components and split into six respective groups. Baseline clinical characteristics and metabolic profiles were compared between groups. RESULTS Four-hundred-ninety-five patients were included in the study. Median age and median BMI was 58 years and 27.26 kg/m2, respectively. Several significant metabolic differences were noted, most notably a downward trend in median urinary pH (p < 0.001) and an upward trend in median urinary supersaturation uric acid (p < 0.001) across groups as MSSS increased. Multivariate analysis demonstrated an independent association between higher MSSS and increasing number of urinary abnormalities. A second multivariate analysis revealed that all MS components except hyperlipidemia were independently associated with low urinary pH. Additionally, obesity was independently associated with the greatest number of urinary abnormalities and had the strongest association with hyperuricosuria. CONCLUSIONS Prior research has attributed the strong association of nephrolithiasis and MS to high prevalence of UA nephrolithiasis and low urinary pH. Our findings indicate that all MS components with the exception of hyperlipidemia were independently associated with low urinary pH suggesting a mechanism independent from insulin resistance.
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Affiliation(s)
- Jacob N Bamberger
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,SUNY Downstate College of Medicine, Brooklyn, NY, USA.
| | - Daniel C Rosen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johnathan A Khusid
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elie Kaplan-Marans
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Blair Gallante
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arjun Kapoor
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ishan Paranjpe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danie J Atashsokhan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William M Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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Xiang A, Nourian A, Ghiraldi E, Friedlander JI. Improving Compliance with 24-H Urine Collections: Understanding Inadequacies in the Collection Process and Risk Factors for Poor Compliance. Curr Urol Rep 2021; 22:38. [PMID: 34086154 DOI: 10.1007/s11934-021-01057-7] [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] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition. RECENT FINDINGS Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations. Studies show conflicting data of compliance regarding patient age and gender. Physicians must understand the difficulties regarding 24-h urine collections including patient compliance, variability between collections, and complexities with interpretation to best utilize this tool in guiding clinical management for the treatment of nephrolithiasis.
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Affiliation(s)
- Alice Xiang
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Alex Nourian
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Eric Ghiraldi
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA
| | - Justin I Friedlander
- Department of Urology, Einstein Healthcare Network, 1200 W. Tabor Road 3 Sley Building/MossRehab, Philadelphia, PA, 19141, USA.
- Division of Urologic Oncology and Urology, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA.
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18
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Carnes K, Howe A, Feustel PJ, Listman JA, White M, Kogan BA. 24-Hour urine collection for first time pediatric stone formers: Is it worth it? J Pediatr Urol 2021; 17:387.e1-387.e7. [PMID: 33762156 DOI: 10.1016/j.jpurol.2020.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/23/2020] [Accepted: 12/02/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/OBJECTIVE 24-h urine collections are recommended for motivated first-time stone formers. Given that children have a lifetime potential for recurrences, metabolic work-up has been recommended. 24-hour urine collections can be problematic, especially in children. We sought to study the benefits of 24-h urine collections in children with stones. STUDY DESIGN We performed a single center, retrospective chart review of the most recent pediatric nephrolithiasis patients under age 18 at our center who supplied their first 24-h urine collection. We assessed whether 24-h urine results led to a change in management and if those patients were adherent to the recommendations. RESULTS Seventy pediatric nephrolithiasis patients who had 24-h urine collection were reviewed. Recommendations other than standard dietary and fluid intake changes were made in 8/70 (11%). A low citrate/calcium ratio (327 vs. 525, p < 0.03) and whether the test was ordered by nephrology vs. urology (26% vs. 2%, p < 0.003) were predictive of an additional recommendation. Of the 8 patients who had changes recommended only 1/8 completed a repeat 24-h urine collection, 3/8 never returned for followed up and 2/8 stopped the medicines prior to follow up. There was no difference in early stone recurrence rates, 55% of the studies were incorrectly collected, and total costs are estimated at $9800. DISCUSSION Our study aimed to evaluate the impact and value of 24-h urine collection in first time pediatric stone formers. We found that 24-h urine collections altered management from standard dietary recommendations in only 11% of cases. These collections were fraught with challenges - 55% of our samples appeared to be incorrectly collected, there was at least one abnormality noted in 100% of collections, these tests are expensive, and patients were poorly compliant with recommendations based on test results. Additionally, changes made based on the 24-h urine results seemed to vary depending on who evaluated the test results. Among cases in which changes were made, nephrologists made alterations at a far greater rate than urologists did. We do acknowledge there are several limitations to our study. First, this is a retrospective chart review. Second, for the urology patients, we were only able to review patient records that were available due to a transition from one electronic medical record to another, resulting in a loss of some earlier patient records. We highly doubt that those records we could not review were significantly different than those we did review. Third, this is a single center design and includes the practice patterns of the providers here. We acknowledge that our local practice patterns may or may not be reflective of national practice patterns, however, most clinicians are likely faced with similar interpretation issues and poor rates of compliance and could benefit from guidelines. CONCLUSION 24-h urine collection for first time pediatric stone formers is expensive, difficult to accomplish and infrequently leads to treatment changes. Our data suggest it adds little for most children with stones and may be better reserved for those children with recurrent stone disease.
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19
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Brinkman JE, Large T, Nottingham CU, Stoughton C, Krambeck AE. Clinical and Metabolic Correlates of Pure Stone Subtypes. J Endourol 2021; 35:1555-1562. [PMID: 33573466 DOI: 10.1089/end.2020.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are multiple stone types, with each forming under different urinary conditions. We compared clinical and metabolic findings in pure stone formers (SFs) to understand whether there are consistent factors that differentiate these groups in terms of underlying etiology and potential for empiric treatment. Materials and Methods: Pure SFs based on infrared spectroscopic analysis of stones obtained at our institution between January 2002 and July 2018 with a corresponding 24-hour urinalysis were retrospectively evaluated. Results: One hundred twenty-one apatite (AP), 54 brushite (BRU), 50 calcium oxalate (CaOx) dihydrate, 104 CaOx monohydrate, and 82 uric acid (UA) patients were analyzed. AP, BRU, and CaOx dihydrate patients were younger than CaOx monohydrate and UA patients. The UA patients had the highest male predominance (76.8%), whereas AP patients were predominantly female (80.2%). UA was most associated with diabetes mellitus (45.3%), and CaOx monohydrate with cardiovascular disease (27.2%) and malabsorptive gastrointestinal conditions (19.2%). BRU patients had the highest prevalence of primary hyperparathyroidism (17%). AP, BRU, and CaOx dihydrate patients demonstrated high rates of hypercalciuria (66.1%, 79.6%, 82%). AP and BRU patients had the highest urinary pH. AP patients exhibited the highest rate of hypocitraturia, whereas CaOx dihydrate patients exhibited the lowest (55.4%, 30%). CaOx monohydrate patients had the highest rate of hyperoxaluria (51.9%). UA patients had the lowest urinary pH. There were no observable differences in the rates of hyperuricosuria or hypernatriuria. Conclusions: These results demonstrate that pure stone composition correlates with certain urinary and clinical characteristics. These data can help guide empiric clinical decision making.
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Affiliation(s)
- John E Brinkman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christa Stoughton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Ito K, Takahashi T, Somiya S, Kanno T, Higashi Y, Yamada H. Predictors of Repeat Surgery and Stone-related Events After Flexible Ureteroscopy for Renal Stones. Urology 2021; 154:96-102. [PMID: 33667526 DOI: 10.1016/j.urology.2021.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the risk of repeat surgery and stone-related events after flexible ureteroscopy (fURS) for renal stones, and to identify their predictive factors. PATIENTS AND METHODS This was a single-center, retrospective cohort study of patients (n = 664) who underwent fURS for renal stones with or without concomitant ureteral stones between January 2012 and December 2019. The primary outcomes were time to ipsilateral stone-related surgical intervention and any stone-related event (including ipsilateral renal colic, symptomatic ureteral calculi, obstructive urinary tract infection, and surgical intervention). RESULTS During median follow-up of 31.1 months, 103 (15.5%) and 135 (20.3%) patients experienced surgical intervention and any stone-related event, respectively. The estimated 2-year intervention-free survival and stone-event-free survival was 86.9% and 81.6%, respectively. On Cox multivariate analysis, younger age (hazard ratio [HR] 0.96), history of stone surgery (HR 2.17), larger preoperative stone burden (HR 1.03), and larger residual fragment (HR 1.09) showed an association with future intervention. Use of the four identified risk factors (age ≤60, history of stone surgery, stone burden ≥20 mm, and residual fragment ≥4 mm) allowed stratification of patients based on the risk of future intervention (low [score: 0-1], intermediate [2], and high [3-4] risk). The estimated 2-year intervention-free survival rates in low-, intermediate-, and high-risk groups were 96.2%, 86.4%, and 71.3%, respectively. CONCLUSION Patients undergoing fURS are at risk of future ipsilateral surgical intervention and stone-related events. Our simple predictive tool can facilitate treatment decision-making by identifying patients who are at high risk of recurrence.
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Affiliation(s)
- Katsuhiro Ito
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan.
| | - Toshifumi Takahashi
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Shinya Somiya
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Toru Kanno
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Yoshihito Higashi
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
| | - Hitoshi Yamada
- Department of Urology, Ijinkai Takeda General Hospital, Ishida Fushimi-ku, Kyoto, Japan
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21
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D'Costa MR, Kausz AT, Carroll KJ, Ingimarsson JP, Enders FT, Mara KC, Mehta RA, Lieske JC. Subsequent urinary stone events are predicted by the magnitude of urinary oxalate excretion in enteric hyperoxaluria. Nephrol Dial Transplant 2020; 36:2208-2215. [PMID: 33367720 DOI: 10.1093/ndt/gfaa281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/12/2022] Open
Abstract
Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. Therefore, we assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. Mean ± standard deviation age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had one or more stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. Thus, these data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group. BACKGROUND Data directly demonstrating the relationship between urinary oxalate (UOx) excretion and stone events in those with enteric hyperoxaluria (EH) are limited. METHODS We assessed the relationship between UOx excretion and risk of kidney stone events in a retrospective population-based EH cohort. In all, 297 patients from Olmsted County, Minnesota were identified with EH based upon having a 24-h UOx ≥40 mg/24 h preceded by a diagnosis or procedure associated with malabsorption. Diagnostic codes and urologic procedures consistent with kidney stones during follow-up after baseline UOx were considered a new stone event. Logistic regression and accelerated failure time modeling were performed as a function of UOx excretion to predict the probability of new stone event and the annual rate of stone events, respectively, with adjustment for urine calcium and citrate. RESULTS Mean ± SD age was 51.4 ± 11.4 years and 68% were female. Median (interquartile range) UOx was 55.4 (46.6-73.0) mg/24 h and 81 patients had ≥1 stone event during a median follow-up time of 4.9 (2.8-7.8) years. Higher UOx was associated with a higher probability of developing a stone event (P < 0.01) and predicted an increased annual risk of kidney stones (P = 0.001). Estimates derived from these analyses suggest that a 20% decrease in UOx is associated with 25% reduction in the annual odds of a future stone event. CONCLUSIONS These data demonstrate an association between baseline UOx and stone events in EH patients and highlight the potential benefit of strategies to reduce UOx in this patient group.
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Affiliation(s)
- Matthew R D'Costa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,USA
| | | | | | | | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - Kristin C Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN,USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN,USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN,USA
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22
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Hsi RS, Yan PL, Goldfarb DS, Egbuji A, Si Y, Shahinian V, Hollingsworth JM. Comparison of Selective Versus Empiric Pharmacologic Preventative Therapy With Kidney Stone Recurrence. Urology 2020; 149:81-88. [PMID: 33352163 DOI: 10.1016/j.urology.2020.11.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/13/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effectiveness of an empiric approach to metabolic stone prevention. METHODS Using medical claims from a cohort of working age adults with kidney stone diagnoses (2008-2017), we identified the subset who were prescribed thiazides, alkali therapy, or allopurinol-collectively known as preventive pharmacologic therapy (PPT). We distinguished between those who had 24-hour urine testing prior to initiating PPT (selective therapy) from those without it (empiric therapy). We conducted a survival analysis for time to first recurrence for stone-related events, including ED visits, hospitalizations, and surgery, up to 2 years after initiating PPT. RESULTS Of 10,125 patients identified, 2744 (27%) and 7381 (73%) received selective and empiric therapy, respectively. The overall frequency of any stone-related event was 11%, and this did not differ between the 2 groups on bivariate analysis (P = .29). After adjusting for sociodemographic factors, comorbidities, medication class, and adherence, there was no difference in the hazard of a stone-related event between the selective and empiric therapy groups (hazard ratio, 0.97; 95% confidence interval, 0.84-1.12). When considered individually, the frequency of ED visits, hospitalizations, and surgeries did not differ between groups. Greater adherence to PPT and older age were associated with a lower hazard of a stone-related event (both P < .05). CONCLUSION Compared to empiric therapy, PPT guided by 24-hour urine testing, on average, is not associated with a lower hazard of a stone-related event. These results suggest a need to identify kidney stone patients who benefit from 24-hour urine testing.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Phyllis L Yan
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David S Goldfarb
- Nephrology Section, VA New York Harbor Healthcare System, New York, NY; Division of Nephrology, New York University Langone Medical Center, New York, NY
| | - Ada Egbuji
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Yajuan Si
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Vahakn Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - John M Hollingsworth
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis 2020; 49:1-16. [PMID: 33048172 PMCID: PMC7867533 DOI: 10.1007/s00240-020-01217-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023]
Abstract
The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.
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24
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Ghiraldi EM, Braitman LE, Friedlander JI. Factors Associated With Compliance With 24-Hour Urine Collection. Urology 2020; 142:65-69. [DOI: 10.1016/j.urology.2020.03.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022]
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25
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Johnson BA, Best SL, Nakada SY, Tracy C, Steinberg RL, Thomas L, Marien T, Miller N, Kolitz E, Cohen A, Pearle MS, Lotan Y, Antonelli JA. Initial Results from the M-STONE Group: A Multi-Center Collaboration to Study Treatment Outcomes in Nephrolithiasis Evaluation. J Endourol 2020; 34:919-923. [PMID: 32660266 DOI: 10.1089/end.2020.0108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Despite proven effectiveness of medications in preventing stone recurrence, compliance with pharmacotherapy (PT) is often poor because of cost, side effects, and impact on lifestyle. We sought to compare the risk of stone recurrence between patients managed with conservative therapy (CT) vs PT controlling for aggressiveness of stone disease. Materials and Methods: The Multi-center collaboration to Study Treatment Outcomes in Nephrolithiasis Evaluation (MSTONE) database contains patient data and outcomes from July 2001 to April 2015 across four centers. The database was queried for patients whose stone disease was managed with CT alone (fluid and dietary recommendations) vs PT. Patients were risk stratified according to number of previous passed stones. Within each risk group, we compared CT vs PT with respect to 2-year stone event rate and stone event-free survival (SEFS) using the Kaplan-Meier method. Results: A total of 245 patients, with a median follow-up of 29 months (interquartile range = 16-44), were identified, including 93 on CT and 152 on PT. The overall 2-year stone event rate was 38% for all patients. Stone events at 2 years occurred less frequently in the PT group compared with the CT group (31% vs 44%, p = 0.043), with the difference most pronounced in the high-risk group (71% vs 32% for CT and PT, respectively, p = 0.058). The 30-month SEFS was significantly higher for PT (58%) than CT (46%) overall. When stratified by risk group, 30-month SEFS was statistically significantly higher for PT than CT in the intermediate risk group (65% vs 45% for PT and CT, respectively). Conclusion: Controlling for aggressiveness of stone disease, PT was more effective than CT in reducing and delaying stone-related events. However, CT appeared to be as effective as PT in low-risk patients. PT is best reserved for recurrent stone formers, regardless of metabolic background.
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Affiliation(s)
- Brett A Johnson
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin, Madison, Wisconsin, USA
| | - Chad Tracy
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Ryan L Steinberg
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA.,Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Lewis Thomas
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | - Tracy Marien
- Department of Urology, Vanderbilt University, Nashville, Tennessee, USA
| | - Nicole Miller
- Department of Urology, Vanderbilt University, Nashville, Tennessee, USA
| | - Elly Kolitz
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Adam Cohen
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jodi A Antonelli
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
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26
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Samson PC, Holt SK, Hsi RS, Sorensen MD, Harper JD. The Association Between 24-Hour Urine and Stone Recurrence Among High Risk Kidney Stone Formers: A Population Level Assessment. Urology 2020; 144:71-76. [PMID: 32540303 DOI: 10.1016/j.urology.2020.05.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if obtaining a 24-hour urine collection (24HU) in stone formers is associated with decreased recurrent stone episodes. METHODS Using the MarketScan database, adults 17-62 years old with nephrolithiasis were identified between 2007 and 2017 with a minimum of 3-year follow up. High-risk stone formers, those undergoing stone surgery, and those with history of recurrent stones were identified. The exposure was a 24HU within 6 months of primary diagnosis. The outcome was recurrent stone episodes-defined by stone-related emergency room visits, hospitalizations, or stone surgery 90 days to 3 years after diagnosis. Logistic regression was used to estimate recurrence risk by 24HU exposure for the overall cohort and sub-cohorts limited to known recurrent stone formers, high-risk subjects, and those having stone surgery. RESULTS Of 434,055 subjects analyzed, 30,153 (6.9%) had a 24HU. An annual decline in 24HU utilization was seen (7.5%-5.8%). Regional variation in usage rate was also observed. On multivariate analysis, completing a 24HU was not associated with risk of recurrence in any of the following cohorts: recurrent stone formers (OR 0.98, 95% CI 0.9-1.07), both high risk and recurrent stone formers (OR 0.95 [0.8-1.13]), those undergoing surgery (OR 1.02 [0.97-1.07]); a positive association with 24HU and recurrence was seen in those labeled high-risk (OR 1.08 [1.01-1.16]) and in all-comers (OR 1.15 [1.12-1.19]). CONCLUSION The 24HU was not associated with decreased recurrence rates in the overall population nor in higher risk sub-cohorts.
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Affiliation(s)
| | - Sarah K Holt
- Department of Urology, University of Washington Medical Center, Seattle, WA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Mathew D Sorensen
- Department of Urology, University of Washington Medical Center, Seattle, WA; Division of Urology, Veterans Affairs Medical Center, Seattle, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington Medical Center, Seattle, WA
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27
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Yang JYC, Sarwal RD, Ky K, Dong V, Stoller M, Sarwal MM, Chi T. Non-radiological assessment of kidney stones using the kidney injury test (KIT), a spot urine assay. BJU Int 2020; 125:732-738. [PMID: 31869527 DOI: 10.1111/bju.14978] [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] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the utility of kidney injury test (KIT) assay urinary biomarkers to detect kidney stones and quantify stone burden. PATIENTS AND METHODS A total of 136 spot urine samples from 98 individuals, with and without kidney stone disease, were processed in a predefined assay to measure six DNA and protein markers in order to generate a risk score for the non-invasive detection of nephrolithiasis. From this cohort, 56 individuals had spot, non-timed urine samples collected at the time of radiographically confirmed kidney stones, and 54 demographically matched, healthy controls without kidney stone disease also provided spot, non-timed urine samples. Sixteen individuals with persistent stone disease had more than one urine sample. Using a proprietary microwell-based KIT assay, we measured cell-free DNA (cfDNA), methylated cfDNA, clusterin, creatinine, protein and CXCL10. A KIT stone score was computed across all markers using the prior locked KIT algorithm. The KIT stone score, with a scale of 0 to 100, was then correlated with demographic variables, kidney stone burden, obstructive kidney stone disease, and urine solutes in 24-h urine collections. RESULTS The scaled KIT stone score, a composite of all six biomarkers, readily discriminated individuals with current or prior radiographically confirmed kidney stones from healthy controls without kidney stone disease (P < 0.001). In individuals with nephrolithiasis, KIT stone score also correlated with radiologically measured stone size (P = 0.017) and differentiated patients with a clinical radiological diagnosis of obstructive nephrolithiasis associated with upper renal tract dilatation (P = 0.001). Stone burden as assessed by KIT stone score, however, did not correlate with the any of the traditional measures of 24-h urine solutes or the 24-h urine supersaturation levels. In patients with persistent stone disease, where multiple urine samples were collected over time and after different interventions, the use of KIT stone score could non-invasively track stone burden over time through a spot urine, non-timed urine sample. CONCLUSIONS A random, spot urine-based assay, KIT stone score, can non-invasively detect, quantify and monitor current stone burden, and may thus minimize radiographic exposure for kidney stone detection. The KIT stone score assay may also help monitor stone recurrence risk for patients with nephrolithiasis, without the requirement for 24-h urine collections.
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Affiliation(s)
- Joshua Y C Yang
- Department of, Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Reuben D Sarwal
- Department of, Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Karina Ky
- Urology, University of California San Francisco, San Francisco, CA, USA
| | - Vivian Dong
- Department of, Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Marshall Stoller
- Urology, University of California San Francisco, San Francisco, CA, USA
| | - Minnie M Sarwal
- Department of, Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Thomas Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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28
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Linking 24-h urines to clinical phenotypes: what alternatives does the future bring? Curr Opin Urol 2019; 30:177-182. [PMID: 31834081 DOI: 10.1097/mou.0000000000000702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The 24-h urine test is recommended as part of the metabolic evaluation for patients with nephrolithiasis to guide preventive interventions. However, this test may be challenging to interpret and has limits in its predictive ability. In this review, we summarize and discuss the most recent research on the opportunities and challenges for utilizing urinary biomarkers for kidney stone prevention. RECENT FINDINGS Contemporary studies utilizing the 24-h urine test have improved our understanding of how to better administer testing and interpret test results. Beyond the standard panel of 24-h urine parameters, recent applications of proteomics and metabolomics have identified protein and metabolic profiles of stone formers. These profiles can be assayed in future studies as potential biomarkers for risk stratification and prediction. Broad collaborative efforts to create large datasets and biobanks from kidney stone formers will be invaluable for kidney stone research. SUMMARY Recent advances in our understanding of kidney stone risk have opened opportunities to improve metabolic testing for kidney stone formers. These strategies do not appear to be mutually exclusive of 24-h urine testing but instead complementary in their approach. Finally, large clinical datasets hold promise to be leveraged to identify new avenues for stone prevention.
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29
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Hsi RS, Hollingsworth JM. Gaps in Care among Veterans with Urinary Stone Disease. Clin J Am Soc Nephrol 2019; 14:1690-1691. [PMID: 31811085 PMCID: PMC6895489 DOI: 10.2215/cjn.12131019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - John M Hollingsworth
- Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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30
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Gasparini ME, Chang TW, St Lezin M, Skerry JE, Chan A, Ramaswamy KA. Feasibility of a Telemedicine-Administered, Pharmacist-Staffed, Protocol-Driven, Multicenter Program for Kidney Stone Prevention in a Large Integrated Health Care System: Results of a Pilot Program. Perm J 2019; 23:19.023. [PMID: 31702984 DOI: 10.7812/tpp/19.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.
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Affiliation(s)
| | | | | | | | - Andy Chan
- South San Francisco Medical Center, CA
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31
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Ganesan C, Thomas IC, Song S, Sun AJ, Sohlberg EM, Kurella Tamura M, Chertow GM, Liao JC, Conti S, Elliott CS, Leppert JT, Pao AC. Prevalence of twenty-four hour urine testing in Veterans with urinary stone disease. PLoS One 2019; 14:e0220768. [PMID: 31393935 PMCID: PMC6687143 DOI: 10.1371/journal.pone.0220768] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/23/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The American Urological Association guidelines recommend 24-hour urine testing in patients with urinary stone disease to decrease the risk of stone recurrence; however, national practice patterns for 24-hour urine testing are not well characterized. Our objective is to determine the prevalence of 24-hour urine testing in patients with urinary stone disease in the Veterans Health Administration and examine patient-specific and facility-level factors associated with 24-hour urine testing. Identifying variations in clinical practice can inform future quality improvement efforts in the management of urinary stone disease in integrated healthcare systems. MATERIALS AND METHODS We accessed national Veterans Health Administration data through the Corporate Data Warehouse (CDW), hosted by the Veterans Affairs Informatics and Computing Infrastructure (VINCI), to identify patients with urinary stone disease. We defined stone formers as Veterans with one inpatient ICD-9 code for kidney or ureteral stones, two or more outpatient ICD-9 codes for kidney or ureteral stones, or one or more CPT codes for kidney or ureteral stone procedures from 2007 through 2013. We defined a 24-hour urine test as a 24-hour collection for calcium, oxalate, citrate or sulfate. We used multivariable regression to assess demographic, geographic, and selected clinical factors associated with 24-hour urine testing. RESULTS We identified 130,489 Veterans with urinary stone disease; 19,288 (14.8%) underwent 24-hour urine testing. Patients who completed 24-hour urine testing were younger, had fewer comorbidities, and were more likely to be White. Utilization of 24-hour urine testing varied widely by geography and facility, the latter ranging from 1 to 40%. CONCLUSIONS Fewer than one in six patients with urinary stone disease complete 24-hour urine testing in the Veterans Health Administration. In addition, utilization of 24-hour urine testing varies widely by facility identifying a target area for improvement in the care of patients with urinary stone disease. Future efforts to increase utilization of 24-hour urine testing and improve clinician awareness of targeted approaches to stone prevention may be warranted to reduce the morbidity and cost of urinary stone disease.
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Affiliation(s)
- Calyani Ganesan
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - I-Chun Thomas
- Department of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Shen Song
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Andrew J. Sun
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Ericka M. Sohlberg
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Manjula Kurella Tamura
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Geriatric Research and Education Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Glenn M. Chertow
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, United States of America
| | - Joseph C. Liao
- Department of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Simon Conti
- Department of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Christopher S. Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California, United States of America
| | - John T. Leppert
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Urology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Alan C. Pao
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Urology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States of America
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32
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Wang X, Wang M, Ruan J, Zhao S, Xiao J, Tian Y. Identification of urine biomarkers for calcium-oxalate urolithiasis in adults based on UPLC-Q-TOF/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2019; 1124:290-297. [DOI: 10.1016/j.jchromb.2019.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 01/01/2023]
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33
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Iremashvili V, Li S, Best SL, Hedican SP, Nakada SY. Clinical and demographic predictors of repeat stone surgery. BJU Int 2019; 124:836-841. [PMID: 31166648 DOI: 10.1111/bju.14844] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify the clinical and demographic predictors of repeat stone surgery. MATERIALS AND METHODS We retrospectively analysed 1496 consecutive patients, aged > 18 years, who underwent stone surgery at our institution in the period from January 2009 to May 2017 and who had at least 12 months of postoperative follow-up. We defined surgical recurrence as repeat surgery on the same renal unit or on the opposite renal unit if the original imaging did not demonstrate significant stones on that side. Characteristics associated with the risk of surgical recurrence in univariate Cox regression analysis were entered into a multivariate model. RESULTS Most patients underwent ureteroscopy and laser lithotripsy (83.0%). Approximately 60% of the patients had a personal history of stone disease and 50% were obese. Over a mean (median; interquartile range) follow-up of 4.1 (3.9; 2.4-5.9) years, 24.5% of patients had surgical recurrence, with 82% of repeat surgeries performed for symptomatic nephrolithiasis. The factors associated with increased risk of surgical recurrence in the multivariate model were: age <60 years, female gender, malabsorptive gastrointestinal disease, diabetes, recurrent urinary tract infections, personal history of nephrolithiasis, renal stones and bilateral nephrolithiasis. The hazard ratios for these variables ranged within an interval of <0.5 (from 1.30 to 1.71). CONCLUSION We identified eight demographic and clinical factors associated with increased risk of repeat renal stone surgery. These factors could be combined as a numerical count that allows stratification of patients into low-, intermediate- and high-risk subgroups.
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Affiliation(s)
- Viacheslav Iremashvili
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shuang Li
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sara L Best
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sean P Hedican
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Taguchi K, Cho SY, Ng AC, Usawachintachit M, Tan YK, Deng YL, Shen CH, Gyawali P, Alenezi H, Basiri A, Bou S, Djojodemedjo T, Sarica K, Shi L, Singam P, Singh SK, Yasui T. The Urological Association of Asia clinical guideline for urinary stone disease. Int J Urol 2019; 26:688-709. [PMID: 31016804 DOI: 10.1111/iju.13957] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/04/2019] [Indexed: 12/12/2022]
Abstract
The Urological Association of Asia, consisting of 25 member associations and one affiliated member since its foundation in 1990, has planned to develop Asian guidelines for all urological fields. The field of stone diseases is the third of its guideline projects. Because of the different climates, and social, economic and ethnic environments, the clinical practice for urinary stone diseases widely varies among the Asian countries. The committee members of the Urological Association of Asia on the clinical guidelines for urinary stone disease carried out a surveillance study to better understand the diversity of the treatment strategy among different regions and subsequent systematic literature review through PubMed and MEDLINE database between 1966 and 2017. Levels of evidence and grades of recommendation for each management were decided according to the relevant strategy. Each clinical question and answer were thoroughly reviewed and discussed by all committee members and their colleagues, with suggestions from expert representatives of the American Urological Association and European Association of Urology. However, we focused on the pragmatic care of patients and our own evidence throughout Asia, which included recent surgical trends, such as miniaturized percutaneous nephrolithotomy and endoscopic combined intrarenal surgery. This guideline covers all fields of stone diseases, from etiology to recurrence prevention. Here, we present a short summary of the first version of the guideline - consisting 43 clinical questions - and overview its key practical issues.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea.,Seoul National University Hospital, Seoul, Korea
| | - Anthony Cf Ng
- SH Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Manint Usawachintachit
- Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Yung-Khan Tan
- Urohealth Medical Clinic, Mt Elizabeth Hospital, Singapore
| | - Yao Liang Deng
- Department of Urology, Langdong Hospital and The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Cheng-Huang Shen
- Department of Urology, Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Prem Gyawali
- Department of Urology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Abbas Basiri
- Department of Urology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sopheap Bou
- Department of Urology, Royal Phnom Penh Hospital, Phnom Penh, Cambodia
| | - Tarmono Djojodemedjo
- Department of Urology, Soetomo General Academia Hospital/Faculty of Medicine, Airlangga University, Surabaya, Indonesia
| | - Kemal Sarica
- Department of Urology, Kafkas University Medical School, Kars, Turkey
| | - Lei Shi
- Department of Urology, Yantai Yuhuangding Hospital and Medical School, Qingdao University, Yantai, China
| | | | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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35
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Nguyen MTJP, Carpenter D, Tadros J, Mathur A, Sandoval PR, Woodle ES, Diwan T, Ratner LE. Bariatric surgery prior to living donor nephrectomy: a solution to expand the living donor kidney pool - a retrospective study. Transpl Int 2019; 32:702-709. [PMID: 30721545 DOI: 10.1111/tri.13408] [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: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 01/05/2023]
Abstract
Most transplant centers decline morbidly obese people for living kidney donation. Their inclusion in the living donor pool after weight loss and reversal of comorbidities by bariatric surgery could reverse the downward living donation trend. We investigated whether bariatric surgery in the morbidly obese altered their candidacy for donation, complicated their subsequent donor nephrectomy, and impacted their early postoperative outcomes in a series of 22 donors who had bariatric surgery 0.7-22 years prior to laparoscopic living donor nephrectomy. Eighteen would have been excluded from donation prior to bariatric surgery based on a body mass index (BMI) > 40. Seventeen reached a BMI < 35 after bariatric surgery. One had hypertension that resolved after bariatric surgery. Prior bariatric surgery did not influence port placement and laterality of donor nephrectomy. None required open conversion or blood transfusion. In an exploratory comparison with 37 donors with a BMI 35-40, length of stay and warm ischemic time were shorter, blood loss and postoperative complications were similar, and operative time was longer. We therefore advocate the consideration of bariatric surgery in preparation for donation in morbidly obese people since it positively alters their candidacy without major impact on the subsequent living donor nephrectomy and early outcomes.
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Affiliation(s)
- Minh-Tri J P Nguyen
- Department of Surgery, Columbia University, New York, NY, USA.,Department of Surgery, Saint Louis University, Saint Louis, MO, USA
| | | | - Joseph Tadros
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Abhishek Mathur
- Department of Surgery, Columbia University, New York, NY, USA
| | | | - E Steve Woodle
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Tayyab Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University, New York, NY, USA
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36
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Boyd C, Wood K, Ashorobi O, Harvey L, Oster R, Holmes RP, Assimos DG. An Intervention to Increase 24-Hour Urine Collection Compliance. UROLOGY PRACTICE 2019. [DOI: 10.1016/j.urpr.2018.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Carter Boyd
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kyle Wood
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Omotola Ashorobi
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa Harvey
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert Oster
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ross P. Holmes
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dean G. Assimos
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
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37
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Rodriguez A, Saez-Torres C, Mir C, Casasayas P, Rodriguez N, Rodrigo D, Frontera G, Buades JM, Gomez C, Costa-Bauza A, Grases F. Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children. BMC Urol 2018; 18:116. [PMID: 30567525 PMCID: PMC6299942 DOI: 10.1186/s12894-018-0430-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
Background The diagnosis and follow-up of stone forming patients is usually performed by analysis of 24-h urine samples. However, crystallization risk varies throughout the day, being higher at night. The main objective of this study is to evaluate the urinary crystallization risk in adults and children by calculating risk indexes based on different collection periods. Methods The study included 149 adults (82 healthy and 67 stone-formers) and 108 children (87 healthy and 21 stone-formers). 24-h urine was collected, divided into 12-h daytime sample (8 am to 8 pm), and 12-h overnight sample (8 pm to 8 am next morning). Solute concentrations, the calcium to citrate ratio (Ca/Cit), and the ion activity product of calcium oxalate (AP[CaOx]) and calcium phosphate (AP[CaP]) were calculated in each 12-h sample and in overall 24-h urine. Assessments were also related to stone type. Results Ca/Cit and AP(CaOx) were significantly higher in stone forming patients than in healthy subjects. The 12-h overnight samples had the highest values for both risk indexes, confirming a greater risk for crystallization at night. The AP(CaP) index was significantly higher in patients with pure hydroxyapatite stones than healthy controls, but was not significantly different between stone-formers overall and healthy controls. Conclusions The calculation of risk indexes is a simple method that clinicians can use to estimate crystallization risk. For this purpose, the use of 12-h overnight urine may be a reliable alternative to 24-h collections.
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Affiliation(s)
- Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.
| | - Concepcion Mir
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Paula Casasayas
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Nuria Rodriguez
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Juan Manuel Buades
- Department of Nephrology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Cristina Gomez
- Clinical Analysis Service, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
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38
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Goldfarb DS. Empiric therapy for kidney stones. Urolithiasis 2018; 47:107-113. [PMID: 30478476 DOI: 10.1007/s00240-018-1090-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
Careful phenotyping of patients to classify those with kidney stones has a long and important history in revealing the chemical basis for stone formation. Advances in our genetic understanding of kidney stones will lead to incredible insights regarding the pathophysiology of this common disorder. At this time, both evaluation of urine chemistry and genotyping of patients are extremely useful in the setting of a university and research-based kidney stone clinic. For much of the world, in a more clinically focused setting, these techniques are neither available nor absolutely necessary. Careful implementation of an empiric prescription based on stone composition would have an important effect to reduce stone recurrence in the world's many stone formers. Increased fluid intake, generic dietary manipulations, and prescription of potassium citrate and thiazides are all appropriate empiric therapies for people with calcium and uric acid kidney stones.
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Affiliation(s)
- David S Goldfarb
- Nephrology Division, NYU Langone Health, New York, NY, USA. .,NYU School of Medicine, Nephrology Section/111G, New York DVAMC, 423 E. 23 St., New York, NY, 10010, USA.
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39
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Guerra A, Ticinesi A, Allegri F, Nouvenne A, Prati B, Pinelli S, Merli R, Tana C, Lauretani F, Aloe R, Borghi L, Meschi T. Insights about urinary hippuric and citric acid as biomarkers of fruit and vegetable intake in patients with kidney stones: The role of age and sex. Nutrition 2018; 59:83-89. [PMID: 30471528 DOI: 10.1016/j.nut.2018.07.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/04/2018] [Accepted: 07/19/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Urinary hippuric acid (HA) and citrate can represent useful biomarkers of fruit and vegetable (FAV) intake in nephrolithiasis. However, their clinical significance across the life span has been poorly investigated. The aim of this study was to investigate the association between the two biomarkers with FAV intake across different age groups and sexes in a large group of stone formers (SFs). METHODS SFs undergoing baseline 24-h urinary collection for metabolic profile of lithogenic risk at our institution were consecutively enrolled for a 6-y time span (N = 1185; 625 men). HA and citrate excretions were determined by ion chromatography and ultraviolet method, respectively. SFs completed a food frequency questionnaire on the intake of FAV. Stepwise logistic regression was applied to investigate factors associated with very low FAV (≤1 servings/d) and analysis of covariance to compare citrate and HA excretion across age groups and sexes. RESULTS Very low FAV intake prevalence declined with age (Ptrend < 0.001), and was inversely associated with HA and citrate excretion (P < 0.001) in a stepwise logistic regression model. A significant increasing trend was verified for both biomarkers across age groups until the age of 65 for HA (P < 0.001) and 55 for citrate (P < 0.001). Citrate excretion significantly declined after the age of 65, and was higher in women than men in adult age groups, regardless of FAV intake. CONCLUSIONS Both urinary citrate and HA were positively associated with FAV intake in SFs. However, unlike HA, citrate excretion was significantly influenced by the female sex and by older age.
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Affiliation(s)
- Angela Guerra
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Ticinesi
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Franca Allegri
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Antonio Nouvenne
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Beatrice Prati
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Silvana Pinelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberta Merli
- Diagnostic Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Claudio Tana
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Fulvio Lauretani
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Rosalia Aloe
- Diagnostic Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Loris Borghi
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Tiziana Meschi
- Kidney Stone Clinic, Medical-Geriatric-Rehabilitation Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
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40
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Hill F, Sayer JA. Precision medicine in renal stone-formers. Urolithiasis 2018; 47:99-105. [PMID: 30460526 PMCID: PMC6373186 DOI: 10.1007/s00240-018-1091-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/08/2018] [Indexed: 12/22/2022]
Abstract
Here we define precision medicine approaches and discuss how these may be applied to renal stone-formers to optimise diagnosis and a management. Using the gene discovery of monogenic stone disorders as examples, we discuss the benefits of personalising therapies for renal stone-formers to provide improved prevention and treatment of these disorders.
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Affiliation(s)
- Fay Hill
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle, NE1 3BZ, UK
| | - John A Sayer
- Institute of Genetic Medicine, Newcastle University, Central Parkway, Newcastle, NE1 3BZ, UK. .,Renal Services, Newcastle upon Tyne NHS Foundation Trust, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK. .,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, NE4 5PL, UK.
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41
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Patel ND, Ward RD, Calle J, Remer EM, Monga M. CT-Based Diagnosis of Low Vertebral Bone Mineral Density Is Associated with Hypercalciuria and Hypocitraturia on Opportunistic Imaging. J Endourol 2018; 32:878-883. [PMID: 29954225 DOI: 10.1089/end.2018.0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Studies have demonstrated associations between nephrolithiasis and systemic conditions, including low bone mineral density (BMD), which may correlate with hypercalciuria in kidney stone formers (KSFs). Traditionally, low BMD is diagnosed with dual-energy X-ray absorptiometry. As a noncontrast CT (NCCT) scan is typically part of a stone evaluation, our objective was to evaluate the association of NCCT-based vertebral BMD with 24-hour urine parameters in KSF. MATERIALS AND METHODS This is a retrospective analysis of 99 KSFs who had CT imaging and 24-hour urine studies. For each patient, BMD was estimated at the L1 vertebral body and CT attenuation measured in HU. A threshold of 160 HU was chosen to distinguish normal from low BMD. Univariate and multivariate logistic regression analysis was performed to compare patients with low and normal BMD. Multivariate linear regression was performed to assess for variables associated with 24-hour urine parameters. RESULTS Patients with low BMD had higher 24-hour urine calcium (219 vs 147 mg/day, p < 0.0001) and larger stone volume (259 vs 78.4 mm3, p = 0.009). Multivariate analysis demonstrated age >60 years (odds ratio [OR] 9.3, p < 0.0001) and hypercalciuria (OR 4.34, p = 0.004) correlated with low BMD. Linear regression demonstrated that lower BMD was associated with higher urinary calcium (β-coefficient -0.268, p = 0.009) and lower urinary citrate (β-coefficient 0.332, p = 0.01). CONCLUSIONS CT-based diagnosis of low mineral bone density is associated with derangement in 24-hour urine calcium and citrate in KSFs, as well as larger stone volumes.
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Affiliation(s)
- Nishant D Patel
- 1 Department of Urology, UCLA Health System , Los Angeles, California
| | - Ryan D Ward
- 2 Imaging Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Juan Calle
- 3 Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erick M Remer
- 2 Imaging Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manoj Monga
- 3 Glickman Urological and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
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Sorokin I, Pearle MS. Medical therapy for nephrolithiasis: State of the art. Asian J Urol 2018; 5:243-255. [PMID: 30364650 PMCID: PMC6197179 DOI: 10.1016/j.ajur.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/08/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
The prevalence of nephrolithiasis is increasing worldwide. Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition. Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance. Insights into occupational exposures and antibiotic use may help uncover individual risk factors. Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.
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Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Massachusetts, Worcester, MA, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.,Charles and Jane Pak Center for Mineral Metabolism and Bone Research, UT Southwestern Medical Center, Dallas, TX, USA
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43
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Boyd C, Wood K, Whitaker D, Ashorobi O, Harvey L, Oster R, Holmes RP, Assimos DG. Accuracy in 24-hour Urine Collection at a Tertiary Center. Rev Urol 2018; 20:119-124. [PMID: 30473637 PMCID: PMC6241899 DOI: 10.3909/riu0807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a paucity of studies addressing the accuracy of 24-hour urine collection for assessing stone risk parameters. Collection accuracy is thought to be essential for assigning optimal therapy for stone prevention. The objective of this study was to determine factors associated with accurate and inaccurate collections. During a 2-year period (2015-2016), 241 stone formers completed 24-hour urine collections. They were divided into accurate collectors (AC), defined as at least one accurate urine collection, and inaccurate collectors (IC). Accuracy was assessed by 24-hour urine creatinine (Cr) excretion indexed to body weight (normal: males, 20-25 mg Cr/kg; females, 15-20 mg Cr/kg). Demographic data analyzed included age, gender, race, insurance status, partner status, income, and education. Statistical analysis methods included the chi-square test, Fisher's exact test, and the two-group t-test. Average age was 50.7 years at the time of collection; 50.2% were men, 86% were white, and 14% were black. Overall, 51.0% of collections were inaccurate. There was no statistical significance between AC and IC for gender (P = 0.85), race (P = 0.90), insurance status (P = 0.85), recurrence (P = 0.87), stone type (P = 0.57), education (P = 0.35), income (P 5 0.42), or poverty (P = 0.35). Older age (P = 0.017) and having a partner (P = 0.022) were significantly associated with AC. The high rate of inaccurate 24-hour urine collections is a concern. The only factors we identified as influencing collection accuracy were age and partner status. These results underscore the importance of developing methods to improve the accuracy of collecting 24-hour urine samples.
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Affiliation(s)
- Carter Boyd
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Kyle Wood
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Dustin Whitaker
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Omotola Ashorobi
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Lisa Harvey
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Robert Oster
- Department of Medicine, University of Alabama-Birmingham Birmingham, AL
| | - Ross P Holmes
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Dean G Assimos
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
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Miller NL. Editorial Comment on: Age, Body Mass Index, and Gender Predict 24-Hour Urine Parameters in Recurrent Idiopathic Calcium Oxalate Stone Formers by Otto et al. (From: Otto BJ, Bozorgmehri S, Kuo J, et al. J Endourol 2017;31:1335-1341). J Endourol 2017; 32:76. [PMID: 29239224 DOI: 10.1089/end.2017.0872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nicole L Miller
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville, Tennessee
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45
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Policastro LJ, Saggi SJ, Goldfarb DS, Weiss JP. Personalized Intervention in Monogenic Stone Formers. J Urol 2017; 199:623-632. [PMID: 29061541 DOI: 10.1016/j.juro.2017.09.143] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Treatment of a first-time renal stone consists of acute management followed by medical efforts to prevent stone recurrence. Although nephrolithiasis is roughly 50% heritable, the presence of a family history usually does not affect treatment since most stone disease is regarded as polygenic, ie not attributable to a single gene. Recent evidence has suggested that single mutations could be responsible for a larger proportion of renal stones than previously thought. This intriguing possibility holds the potential to change the management paradigm in stone prevention from metabolically directed therapy to more specific approaches informed by genetic screening and testing. This review synthesizes new findings concerning monogenic kidney stone disease, and provides a concise and clinically useful reference for monogenic causes. It is expected that increased awareness of these etiologies will lead to increased use of genetic testing in recurrent stone formers and further research into the prevalence of monogenic stone disease. MATERIALS AND METHODS We assembled a complete list of genes known to cause or influence nephrolithiasis based on recent reviews and commentaries. We then comprehensively searched PubMed® and Google Scholar™ for all research on each gene having a pertinent role in nephrolithiasis. We determined which genes could be considered monogenic causes of nephrolithiasis. One gene, ALPL, was excluded since nephrolithiasis is a relatively minor aspect of the disorder associated with the gene (hypophosphatasia). We summarized selected studies and assembled clinically relevant details. RESULTS A total of 27 genes were reviewed in terms of recent findings, mode of inheritance of stone disease, known or supposed prevalence of mutations in the general population of stone patients and specific therapies or considerations. CONCLUSIONS There is a distinct opportunity for increased use of genetic testing to improve the lives of pediatric and adult stone patients. Several genes first reported in association with rare disease may be loci for novel mutations, heterozygous disease and forme frustes as causes of stones in the broader population. Cases of idiopathic nephrolithiasis should be considered as potentially having a monogenic basis.
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Affiliation(s)
- Lucas J Policastro
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York.
| | - Subodh J Saggi
- Department of Nephrology, SUNY Downstate Medical Center, Brooklyn, New York
| | - David S Goldfarb
- Nephrology Section, NY Harbor VA Medical Center, New York, New York; Nephrology Division, New York University School of Medicine, New York, New York
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, New York; Urology Service, NY Harbor VA Medical Center, New York, New York
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46
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Patel ND, Ward RD, Calle J, Remer EM, Monga M. Vascular Disease and Kidney Stones: Abdominal Aortic Calcifications Are Associated with Low Urine pH and Hypocitraturia. J Endourol 2017; 31:956-961. [PMID: 28605936 DOI: 10.1089/end.2017.0350] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Vascular calcifications are associated with nephrolithiasis. Although studies have demonstrated correlations with vascular disease and calcium stones in kidney stone formers (KSF), an etiologic link has remained elusive. As a noncontrast CT (NCCT) scan is typically part of a stone evaluation, our objective was to evaluate the association of NCCT-based assessment of abdominal aortic calcifications (AACs) with 24-hour urine parameters and stone composition. MATERIALS AND METHODS Ninety-seven KSF were included with CT imaging and 24-hour urine studies. For each patient, semi-automated CT software was utilized to provide an AAC Agatston score from the celiac axis to the aortic bifurcation. Univariate analysis was performed to compare patients with or without AAC. Multivariate logistic regression was performed to assess for variables associated with 24-hour urine parameters and stone composition. RESULTS The presence of AAC was associated with hypertension, diabetes, peripheral vascular disease, and coronary artery disease. Patients with any AAC showed lower 24-hour urine citrate (399 vs 593 mg/day, p < 0.001) and lower 24-hour urine pH (5.862 vs 6.328, p = 0.003). When controlling for age, system comorbidities, the presence of AAC was associated with low urine pH <6 (odds ratio [OR] 2.86, p = 0.032) and hypocitraturia <320 mg/day (OR 4.37, p = 0.005). The receiver operating characteristic curve showed that increasing AAC was associated with low urine pH (area under the curve [AUC] 0.683, p = 0.002) and uric acid stone formation (AUC 0.698, p = 0.045). CONCLUSIONS NCCT-based diagnosis of AAC is associated with low urine pH, hypocitraturia, and uric acid stone formation. The presence of AAC could be considered an additional prognosticator for the utility of alkalinization therapy.
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Affiliation(s)
- Nishant D Patel
- 1 Department of Urology, Glickman Urology and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Ryan D Ward
- 2 Imaging Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Juan Calle
- 1 Department of Urology, Glickman Urology and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Erick M Remer
- 2 Imaging Institute , Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manoj Monga
- 1 Department of Urology, Glickman Urology and Kidney Institute , Cleveland Clinic Foundation, Cleveland, Ohio
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Complete Metabolic Evaluation is Indicated after a First Stone Event. J Urol 2017; 197:545-547. [DOI: 10.1016/j.juro.2016.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/23/2022]
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