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Yoo MJ, Pelletier J, Koyfman A, Long B. High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med 2024; 75:137-142. [PMID: 37950981 DOI: 10.1016/j.ajem.2023.10.049] [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: 08/18/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/13/2023] Open
Abstract
INTRODUCTION Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. CONCLUSIONS An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Michael J Yoo
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT, Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Prezioso D, Piccinocchi G, Abate V, Ancona M, Celia A, De Luca C, Ferrari R, Ferraro PM, Mancon S, Mazzon G, Micali S, Puca G, Rendina D, Saita A, Salvetti A, Spasiano A, Tesè E, Trinchieri A. The role of the general practictioner in the management of urinary calculi. Arch Ital Urol Androl 2023; 95:12155. [PMID: 38193217 DOI: 10.4081/aiua.2023.12155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. METHODS a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. RESULTS Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. CONCLUSIONS The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.
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Affiliation(s)
- Domenico Prezioso
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | | | - Veronica Abate
- Department of Clinical Medicine and Surgery, Federico II University, Naples.
| | | | - Antonio Celia
- S.C. Urologia ULSS 7 Pedemontana, Bassano del Grappa (VI).
| | - Ciro De Luca
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Baggiovara (MO).
| | - Pietro Manuel Ferraro
- Sezione di Nefrologia, Dipartimento di Medicina, Università degli Studi di Verona, Verona.
| | - Stefano Mancon
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan.
| | - Giorgio Mazzon
- S.C. Urologia ULSS 7 Pedemontana, Bassano del Grappa (VI).
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Baggiovara (MO).
| | - Giacomo Puca
- Dipartimento Neuroscienze, Scienze della Riproduzione ed Odontostomatologia Università Federico II, Naples.
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, Federico II University, Naples.
| | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan.
| | | | | | - Elisa Tesè
- Società Italiana di Medicina Generale, Florence.
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Dobrek L. Lower Urinary Tract Disorders as Adverse Drug Reactions-A Literature Review. Pharmaceuticals (Basel) 2023; 16:1031. [PMID: 37513941 PMCID: PMC10383968 DOI: 10.3390/ph16071031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
A potential complication of pharmacotherapy for a given patient is the possibility of various side effects of drugs, which are manifested in many ways and constitute iatrogenic causes of diseases. Among the systemic side effects of drugs, there are also those involving the urinary tract, although these are less reported in the literature. The use of numerous drugs-especially of anticholinergics or drugs with anticholinergic potential, opioid analgesics, non-steroidal anti-inflammatory drugs, antidepressants, first-generation antipsychotics (classic neuroleptics) and selected cardiovascular drugs (beta-blockers, thiazides potassium-sparing diuretics, statins), as well as others-may increase the risk of developing urological disorders, such as urinary retention or incontinence, urinary tract infections, urolithiasis, erectile dysfunction in men and retroperitoneal fibrosis. The purpose of this paper is to characterise the abovementioned drug-induced disorders of the lower urinary tract on the basis of a non-systematic literature review.
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Affiliation(s)
- Lukasz Dobrek
- Department of Clinical Pharmacology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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Aihemaitijiang B, Ruotian L, Qi Y, Mahemuti M. Correlation between sKL and Nrf2 plasma levels and calcium oxalate urolithiasis. Int Urol Nephrol 2023:10.1007/s11255-023-03615-z. [PMID: 37198517 DOI: 10.1007/s11255-023-03615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To investigate the relationship between plasma levels of sKL and Nrf2 and calcium oxalate calculi. METHODS The clinical data of 135 patients with calcium oxalate calculi treated in the Department of Urology of the second affiliated Hospital of Xinjiang Medical University from February 2019 to December 2022, and 125 healthy persons who underwent physical examination in the same period were collected and divided into healthy group and stone group. The levels of sKL and Nrf2 were measured by ELISA. Correlation test was used to analyze the risk factors of calcium oxalate stones, logistic regression analysis was used to analyze the risk factors of calcium oxalate stones, and ROC curve was used to evaluate the sensitivity and specificity of sKL and Nrf2 in predicting urinary calculi. RESULTS Compared with the healthy group, the plasma sKL level in the stone group decreased (111.53 ± 27.89 vs 130.68 ± 32.51), while the plasma Nrf2 level increased (300.74 ± 114.31 vs 246.74 ± 108.22). There was no significant difference in the distribution of age and sex between the healthy group and the stone group, but there were significant differences in plasma levels of WBC, NEUT, CRP, BUN, BUA, SCr, BMI, and eating habits. The results of correlation test showed that the level of plasma Nrf2 was positively correlated with SCr (r = 0.181, P < 0.05) and NEUT (r = 0.144 P < 0.05). Plasma sKL was not significantly correlated with Nrf2 (r = 0.047, P > 0.05), WBC (r = 0.108, P > 0.05), CRP (r = - 0.022, P > 0.05), BUN (r = - 0.115, P > 0.05), BUA (r = - 0.139, P > 0.05), SCr (r = 0.049, P > 0.05), and NEUT (r = 0.027, P > 0.05). Plasma Nrf2 was not significantly correlated with WBC (r = 0.097, P > 0.05), CRP (r = 0.045, P > 0.05), BUN (r = 0.122, P > 0.05), and BUA (r = 0.122, P > 0.05); (r = 0.078, P > 0.05) had no significant correlation. Logistic regression showed that elevated plasma sKL (OR 0.978, 95% CI 0.969 ~ 0.988, P < 0.05) was a protective factor for the occurrence of calcium oxalate stones, BMI (OR 1.122, 95% CI 1.045 ~ 1.206, P < 0.05), dietary habit score (OR 1.571, 95% CI 1.221 ~ 2.020, P < 0.05), and WBC (OR 1.551, 95% CI 1.423 ~ 1.424, P < 0.05). Increased NEUT (OR 1.539, 95% CI 1.391 ~ 1.395, P < 0.05) and CRP (OR 1.118, 95% CI: 1.066 ~ 1.098, P < 0.05) are risk factors for the occurrence of calcium oxalate stones. CONCLUSION Plasma sKL level decreased and Nrf2 level increased in patients with calcium oxalate calculi. Plasma sKL may play an antioxidant role in the pathogenesis of calcium oxalate stones through Nrf2 antioxidant pathway.
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Affiliation(s)
- Baihetiyaer Aihemaitijiang
- Urology Department, Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, Xinjiang, China
| | - Liu Ruotian
- Department of Urology, The Second People's Hospital of Henan Province, Zhengzhou, 450000, Henan Province, China
| | - Yang Qi
- Department of Surgery, Neijiang Traditional Chinese Medicine Hospital, Neijiang, 641099, Sichuan, China
| | - Mulati Mahemuti
- Urology Department, Second Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, Xinjiang, China.
- Department of Urology, The Second People's Hospital of Henan Province, Zhengzhou, 450000, Henan Province, China.
- Department of Surgery, Neijiang Traditional Chinese Medicine Hospital, Neijiang, 641099, Sichuan, China.
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Zhu W, Qiong D, Yanli G, Min L, Ying Z, Qiyi H, Shenping Z, Xisheng W, Hui L. Proteomics and transcriptomics profiling reveals distinct aspects of kidney stone related genes in calculi rats. BMC Genomics 2023; 24:127. [PMID: 36932340 PMCID: PMC10024419 DOI: 10.1186/s12864-023-09222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUNDS Kidney stone also known as urolithiasis or nephrolithiasis, is one of the oldest diseases known to medicine, however, the gene expression changes and related kidney injury remains unclear. METHODS A calculi rat model was developed via ethylene glycol- and ammonium chloride-induction. Integrated proteomic and transcriptomic analysis was performed to characterize the distinct gene expression profiles in the kidney of calculi rat. Differential expressed genes (DEGs) were sub-clustered into distinct groups according to the consistency of transcriptome and proteome. Gene Ontology and KEGG pathway enrichment was performed to analyze the functions of each sub-group of DEGs. Immunohistochemistry was performed to validated the expression of identified proteins. RESULTS Five thousand eight hundred ninety-seven genes were quantified at both transcriptome and proteome levels, and six distinct gene clusters were identified, of which 14 genes were consistently dysregulated. Functional enrichment analysis showed that the calculi rat kidney was increased expression of injured & apoptotic markers and immune-molecules, and decreased expression of solute carriers & transporters and many metabolic related factors. CONCLUSIONS The present proteotranscriptomic study provided a data resource and new insights for better understanding of the pathogenesis of nephrolithiasis, will hopefully facilitate the future development of new strategies for the recurrence prevention and treatment in patients with kidney stone disease.
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Affiliation(s)
- Wang Zhu
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Deng Qiong
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Gu Yanli
- Central Laboratory, People's Hospital of Longhua Shenzhen, Southern Medical University, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Li Min
- Department of Pathology, People's Hospital of Longhua Shenzhen, Southern Medical University, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Zhang Ying
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Hu Qiyi
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Zhang Shenping
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China
| | - Wang Xisheng
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China.
| | - Liang Hui
- Department of Urology, People's Hospital of Longhua Shenzhen, Southern Medical University, 38 Jinglong Jianshe Road, Shenzhen, Guangdong, 518109, People's Republic of China.
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Muacevic A, Adler JR, Alzaidi MA, Asiri AF, Fatani MO, Alahmadi AH, Alnefaie Z, Hamoda TA. Influence of BMI on the Recurrence Rate of Nephrolithiasis in the Adult Population of Saudi Arabia: A Retrospective Study. Cureus 2023; 15:e33539. [PMID: 36779090 PMCID: PMC9907171 DOI: 10.7759/cureus.33539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives Nephrolithiasis is a common disease, and Saudi Arabia is among the countries with the highest prevalence of nephrolithiasis. Obesity is one of the risk factors associated with the increased formation of renal calculi. We aimed to assess whether obesity also increases the recurrence rate of nephrolithiasis. Methods We retrospectively identified and collected data of 283 adult patients with renal stones who were managed at our hospital from November 2018 to November 2021. The demographic information, comorbidities, stone burden, and treatment methods related to them were identified, collected, and analyzed. Moreover, we performed the chi-squared test (χ2) and multivariate logistic regression analysis in order to assess the risk factors (i.e., independent predictors) of recurrence among the studied patients. Additionally, the odds ratio (OR) was calculated at a confidence interval (CI) of 95%. A p-value of less than 0.05 was considered statistically significant. Results Of the 283 adult patients we analyzed, 35 did not meet the criteria of our study and, consequently, were excluded. Therefore, we ended up with 248 patients, of whom 179 (68.1%) were males, 131 (52.8%) had a previous history of renal stones, and 90 (36.3%) had chronic illnesses. Moreover, the mean age of the studied patients was 48.91 ± 14.51 years, and the mean BMI was 29.44 ± 6.1 kg/m2. It was found that most of the patients (35.5%) had only one stone, while 23.4% of them had more than 5 stones. Furthermore, the majority of the stones (35.9%) were medium size (with a stone diameter of 10-19 mm [1-1.9 cm]). We did not find a relationship between obesity and the recurrence rate of renal stones. However, there was a significant association (p < 0.05) between the recurrence rate and Saudi nationality, chronic diseases (more specifically, HTN), unilateral stones, and a stone diameter of 10-19 mm (1-1.9 cm). Additionally, we identified diabetes and the kidney as stone location factors that are associated with less recurrence. Conclusion Although obesity was reported to increase the risk of renal stone formation, we did not find it to be associated with an increased recurrent rate of the disease in the Saudi Arabian population, which is inconsistent with other studies conducted in this area in other countries. Therefore, larger studies are needed to prove this finding.
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Rodríguez Maruri G, Merayo Cano J, Gálvez García L, Álvarez García-Rovés B, Martínez Estrada E, Beldarrain Belderrain P. Urolitiasis en Atención Primaria: comparación de un seguimiento sistemático frente a la práctica habitual. Semergen 2022; 48:174-180. [DOI: 10.1016/j.semerg.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/09/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022]
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Thongboonkerd V, Yasui T, Khan SR. Editorial: Immunity and Inflammatory Response in Kidney Stone Disease. Front Immunol 2021; 12:795559. [PMID: 34790209 PMCID: PMC8591093 DOI: 10.3389/fimmu.2021.795559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Visith Thongboonkerd
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Saeed R Khan
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
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Khamchun S, Yoodee S, Thongboonkerd V. Dual modulatory effects of diosmin on calcium oxalate kidney stone formation processes: Crystallization, growth, aggregation, crystal-cell adhesion, internalization into renal tubular cells, and invasion through extracellular matrix. Biomed Pharmacother 2021; 141:111903. [PMID: 34328112 DOI: 10.1016/j.biopha.2021.111903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/25/2021] [Accepted: 07/06/2021] [Indexed: 01/26/2023] Open
Abstract
Diosmin is a natural flavone glycoside (bioflavonoid) found in fruits and plants with several pharmacological activities. It has been widely used as a dietary supplement or therapeutic agent in various diseases/disorders. Although recommended, evidence of its protective mechanisms against kidney stone disease (nephrolithiasis/urolithiasis), especially calcium oxalate (CaOx) monohydrate (COM) that is the most common type, remained unclear. In this study, we thus systematically evaluated the effects of diosmin (at 2.5-160 nM) on various stages of kidney stone formation processes, including COM crystallization, crystal growth, aggregation, crystal-cell adhesion, internalization into renal tubular cells and invasion through extracellular matrix (ECM). The results showed that diosmin had dose-dependent modulatory effects on all the mentioned COM kidney stone processes. Diosmin significantly increased COM crystal number and mass during crystallization, but reduced crystal size and growth. While diosmin promoted crystal aggregation, it inhibited crystal-cell adhesion and internalization into renal tubular cells. Finally, diosmin promoted crystal invasion through the ECM. Our data provide evidence demonstrating both inhibiting and promoting effects of diosmin on COM kidney stone formation processes. Based on these dual modulatory activities of diosmin, its anti-urolithiasis role is doubtful and cautions should be made for its use in kidney stone disease.
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Affiliation(s)
- Supaporn Khamchun
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Department of Medical Technology, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; Unit of Excellence in Integrative Molecular Biomedicine, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Sunisa Yoodee
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Visith Thongboonkerd
- Medical Proteomics Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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