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Siener R, Stein J, Ritter M. [Prevention of recurrence of urolithiasis]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:387-395. [PMID: 38466398 DOI: 10.1007/s00120-024-02312-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Urolithiasis is one of the most frequent urological diseases. Identifying the causes of stone formation forms the basis for successful prevention of recurrence. Metabolic diagnostics and measures for prevention of recurrence are based on the assignment of the patient to a low-risk or high-risk group. Analysis of the urinary calculi is an essential prerequisite for identifying patients at risk. The general recommendations on diet and lifestyle are considered to be the basis of treatment. Depending on the type of stone and the individual biochemical risk profile of a patient, these general measures should be supplemented by targeted medical nutrition therapy and pharmacological treatment. Mixed stones can pose a challenge for the treatment and prevention of recurrence. A personalized treatment decision that takes the various components of mixed stones into account could further improve the prevention of recurrence of urolithiasis.
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Affiliation(s)
- Roswitha Siener
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - Johannes Stein
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Manuel Ritter
- Universitäres Steinzentrum, Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P. The Saudi urological association guidelines on urolithiasis. Urol Ann 2024; 16:1-27. [PMID: 38415236 PMCID: PMC10896325 DOI: 10.4103/ua.ua_120_23] [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: 12/22/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Aims The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia. Panel The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest. Methods The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.
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Affiliation(s)
- Wissam Kamal
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz H Alathal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alamri
- Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Tarek Alzahrani
- Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia
| | | | - Yasser A Noureldin
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Urology, Faculty of Medicine, Benha University, Egypt
- Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada
| | - Mohammad Alomar
- Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour M Alnazari
- Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia
| | - Majid Alharthi
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
- Seoul National University Hospital, Seoul, South Korea
| | - Mohannad A Awad
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
- Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA
| | - Abdulghafour Halawani
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatem Hamed Althubiany
- Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia
| | | | - Phillipe Violette
- Woodstock General Hospital, London Ontario, Canada
- McMaster University, London Ontario, Canada
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Stamatelou K, Goldfarb DS. Epidemiology of Kidney Stones. Healthcare (Basel) 2023; 11:healthcare11030424. [PMID: 36766999 PMCID: PMC9914194 DOI: 10.3390/healthcare11030424] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
In the past two decades, major breakthroughs that improve our understanding of the pathophysiology and therapy of kidney stones (KS) have been lacking. The disease continues to be challenging for patients, physicians, and healthcare systems alike. In this context, epidemiological studies are striving to elucidate the worldwide changes in the patterns and the burden of the disease and identify modifiable risk factors that contribute to the development of kidney stones. Our expanding knowledge of the epidemiology of kidney stones is of paramount importance and largely upgrades the modern management of the disease. In this paper, we review the variables affecting prevalence and incidence, including age, gender, race, ethnicity, occupation, climate, geography, systemic diseases, diabetes, vascular disease, chronic kidney disease, and dietary risk factors relevant to kidney stones.
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Affiliation(s)
- Kyriaki Stamatelou
- “MESOGEIOS” Nephrology Center, Haidari and Nephros.eu Private Clinic, 11527 Athens, Greece
| | - David S. Goldfarb
- Nephrology Division, NYU Langone Health and NYU Grossman School of Medicine, NY Nephrology Section, NY Harbor VA Healthcare System, New York, NY 10016, USA
- Correspondence: ; Tel.: +1-212-686-7500 (ext. 3877); Fax: +1-212-951-6842
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Siener R, Löhr P, Hesse A. Urinary Risk Profile, Impact of Diet, and Risk of Calcium Oxalate Urolithiasis in Idiopathic Uric Acid Stone Disease. Nutrients 2023; 15:nu15030572. [PMID: 36771279 PMCID: PMC9919786 DOI: 10.3390/nu15030572] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
The role of diet in the pathogenesis of uric acid (UA) nephrolithiasis is incompletely understood. This study investigated the effect of dietary intervention on the risk of UA stone formation under standardized conditions. Twenty patients with idiopathic UA stone disease were included in the study. Dietary intake and 24 h urinary parameters were collected on the usual diet of the patients and a standardized balanced mixed diet. Although urinary UA excretion did not change, the relative supersaturation of UA decreased significantly by 47% under the balanced diet primarily due to the significant increase in urine volume and pH. Urinary pH was below 5.8 in 85% of patients under the usual diet, and in 60% of patients under the balanced diet. The supersaturation of calcium oxalate declined significantly under the balanced diet due to the significant decrease in urinary calcium and oxalate excretion and the increase in urine volume. Dietary intervention is a key component in the management of UA nephrolithiasis. Urinary calcium and oxalate excretion should also be monitored in patients with pure UA calculi to reduce the risk of mixed stone formation with calcium oxalate. Lower urinary pH in UA stone patients can only be partially explained by diet.
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Mechanism Investigation of Wuwei Shexiang Pills on Gouty Arthritis via Network Pharmacology, Molecule Docking, and Pharmacological Verification. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2377692. [PMID: 36248423 PMCID: PMC9568303 DOI: 10.1155/2022/2377692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/15/2022] [Accepted: 09/08/2022] [Indexed: 11/07/2022]
Abstract
Background Gout is a common crystal-related arthritis caused by the deposition of monosodium urates (MSU). Tibetan medicine Wuwei Shexiang Pills (WSP) has been demonstrated to exhibit anti-inflammatory, antihyperuricemia, and antigout activities. However, the underlying mechanism is unknown. Objectives To explore the mechanisms of Wuwei Shexiang Pills on gouty arthritis via network pharmacology, molecule docking, and pharmacological verification. Methods The ingredients and targets of WSP were obtained by searching and screening in BATMAN-TCM and SwissADME. The targets involving the gout were acquired from public databases. The shared targets were put onto STRING to construct a PPI network. Furthermore, Metascape was applied for the GO and KEGG enrichment analysis to predict the biological processes and signaling pathways. And molecular docking was performed to validate the binding association between the key ingredients and the relative proteins of TNF signaling. Based on the serum pharmacology, the predicted antigout mechanism of WSP was validated in MSU-induced THP-1 macrophages. The levels of inflammatory cytokines and mRNA were measured by ELISA and qRT-PCR, respectively, and MAPK, NF-κB, and NLRP3 signaling-associated proteins were determined by western blot and immunofluorescence staining. Results 48 bioactive ingredients and 165 common targets were found in WSP. The data showed that 5-Cis-Cyclopentadecen-1-One, 5-Cis-Cyclotetradecen-1-One, (−)-isoshyobunone, etc. were potential active ingredients. TNF signaling, HIF-1 signaling, and Jak-STAT signaling were predicted to be the potential pathways against gout. The molecule docking analysis found that most ingredients had a high affinity for p65, NLRP3, IL-1β, TNF-α, and p38. The data from in vitro experiment showed that WSP suppressed the production and gene expression of inflammatory cytokines. Furthermore, WSP could inhibit the activation of MAPK, NF-κB, and NLRP3 signaling pathways. Conclusion Our finding suggested that the antigout effect of WSP could be achieved by inhibiting MAPK, NF-κB, and NLRP3 signaling pathways. WSP might be a candidate drug for gouty treatment.
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Pradhane AP, Methekar RN, Agrawal SG. Batch Crystallization of Uric Acid: Modeling, Simulation, and the Impact of 3,7 – dimethylxanthine. CRYSTAL RESEARCH AND TECHNOLOGY 2022. [DOI: 10.1002/crat.202200125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ashish P. Pradhane
- Department of Chemical Engineering Visvesvaraya National Institute of Technology Nagpur Maharashtra 440010 India
| | - Ravi N. Methekar
- Department of Chemical Engineering Visvesvaraya National Institute of Technology Nagpur Maharashtra 440010 India
- Crystallization Design Institute Molecular Science Research Centre University of Puerto Rico 1390 C. Juan Ponce de Léon San Juan Puerto Rico 00926 USA
| | - Shailesh G. Agrawal
- Department of Chemical Engineering Visvesvaraya National Institute of Technology Nagpur Maharashtra 440010 India
- Crystallization Design Institute Molecular Science Research Centre University of Puerto Rico 1390 C. Juan Ponce de Léon San Juan Puerto Rico 00926 USA
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Mehra S. Role of Dual-Energy Computed Tomography in Urolithiasis. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1749108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objectives The objectives of this study are to describe the role of dual-energy computed tomography (DECT) in evaluation of renal stones in current practice and elaborate the imaging findings that need to be reported to help surgeons make an appropriate management strategy for renal stones.
Background Nephrolithiasis is a global problem, affecting people across geographical, cultural, and economic boundaries. Renal stones can be accurately diagnosed on computed tomography.
Discussion With the development of DECT, renal stones can now be better characterized in terms of stone burden, stone composition, and stone fragility.
Conclusion These parameters are helpful to treating surgeons in not only planning an appropriate management for patient but also in predicting the success of the various procedures such as extracorporeal shock wave lithotripsy, flexible ureterorenoscopy, or percutaneous nephrolithotomy. Familiarity with recent developments will help radiologists give an apt description of renal stone to meet the requirements of treating surgeon.
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Affiliation(s)
- Shibani Mehra
- Department of Radiodiagnosis, RML Hospital, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Li H, Zhang H, Yan F, He Y, Ji A, Liu Z, Li M, Ji X, Li C. Kidney and plasma metabolomics provide insights into the molecular mechanisms of urate nephropathy in a mouse model of hyperuricemia. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166374. [PMID: 35276331 DOI: 10.1016/j.bbadis.2022.166374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/04/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
Hyperuricemia (HUA) is closely associated with kidney damage and kidney diseases in humans; however, the underlying mechanisms of HUA-induced kidney diseases remain unknown. In the present study, we examined the kidney and plasma metabolic profiles in a HUA mouse model constructed by knocking out (Ko) the urate oxidase (Uox) gene. The Uox-Ko mice were characterized by an increase in uric acid, glycine, 3'-adenosine monophosphate, citrate, N-acetyl-l-glutamate, l-kynurenine, 5-hydroxyindoleacetate, xanthurenic acid, cortisol, and (-)-prostaglandin e2 together with a decrease of inosine in the kidneys. These altered metabolites confirmed disturbances of purine metabolism, amino acid biosynthesis, tryptophan metabolism, and neuroactive ligand-receptor interaction in Uox-Ko mice. Betaine and biotin were related to kidney function and identified as the potential plasma metabolic biomarker for predicting urate nephropathy (UN). Taken together, these results revealed the underlying pathogenic mechanisms of UN. Investigating these pathways might provide novel targets for the therapeutic intervention of UN and can potentially lead to new treatment strategies.
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Affiliation(s)
- Hailong Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao 266003, China; Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Hui Zhang
- Institute of Metabolic Diseases, Qingdao University, Qingdao 266003, China; Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Fei Yan
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yuwei He
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Aichang Ji
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Zhen Liu
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Maichao Li
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Xiaopeng Ji
- Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Changgui Li
- Institute of Metabolic Diseases, Qingdao University, Qingdao 266003, China; Shandong Provincial Key Laboratory of Metabolic Disease and Qingdao Key Laboratory of Gout, The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
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Kamphuis GM, van Hattum JW, van Dongen-Lases EC, Henderickx MMEL, Beerlage HP. Introduction of a Standardized Approach of Electronic Urinary pH Monitoring to Assist Alkalization Therapy: A Uric Acid Urolithiasis Patient's Perspective. J Endourol 2021; 35:1563-1570. [PMID: 34210175 DOI: 10.1089/end.2020.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: This study evaluates the introduction of an electronic pH meter to measure the urinary pH in patients with uric acid (UA) urolithiasis and assess patient's perspective. Materials and Methods: Patients known with UA urolithiasis were included in this single-center, nonrandomized, prospective feasibility study, IDEAL stage 2a. Their experience with urolithiasis and satisfaction with the method of urinary pH monitoring before inclusion was evaluated. All patients received an electronic pH meter and standardized instructions. After a period of 6-12 weeks their experience and satisfaction with this pH meter and new regimen was assessed. Patient satisfaction was scored on a Likert scale 1-5. Results: Eighteen patients were included. Median age was 63 years and median body mass index was 30 kg/m2. The cohort consisted of 67% men and 33% women. In their medical history, 55% had unilateral stones, whereas 45% had bilateral stones. The median estimated glomerular filtration rate was 58 mL/minute/1.73 m2. Eighty-nine percent took medication to alkalize their urine, median 3.5 years. Fifteen patients used paper reagent strips and three used an electronic pH meter to assess urinary pH before this study. Satisfaction with the method of urinary pH measurement at inclusion was reasonable (median score 3; interquartile range [IQR] 1-4). Satisfaction with the new electronic pH meter was good (median score 4; IQR 3-5), as was the overall satisfaction (median score 4; IQR 3-5). The new electronic pH meter was slightly easier to use (median 3.5; IQR 1.75-5), as easy in maintenance (median 3; IQR 2-4), and significantly easier to read (median 5; IQR 4-5). The new electronic pH meter was better (median score 4; IQR 2.75-5) than their previous method. Conclusion: The introduction of a standardized approach of urinary pH monitoring for UA urolithiasis patients with an electronic pH meter leads to an easier interpretable outcome and higher patient satisfaction.
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Affiliation(s)
- Guido M Kamphuis
- Department of Urology and Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jons W van Hattum
- Department of Urology and Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Edmée C van Dongen-Lases
- Department of Clinical Chemistry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Harrie P Beerlage
- Department of Urology and Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Xi Y, Yan J, Li M, Ying S, Shi Z. Gut microbiota dysbiosis increases the risk of visceral gout in goslings through translocation of gut-derived lipopolysaccharide. Poult Sci 2020; 98:5361-5373. [PMID: 31250018 DOI: 10.3382/ps/pez357] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/03/2019] [Indexed: 12/22/2022] Open
Abstract
We investigated the gut-kidney interaction in goslings with gout and tried to decipher the probable mechanisms through which gut dysbiosis leads to the progression of renal injury and inflammation. A total of 15 goslings (Anser cygnoides), with typical visceral gout symptoms, were screened and compared with 15 healthy goslings. We determined the signatures of the microbiome in the cecum chyme of goslings in the 2 groups by 16S sequencing, and analyzed the changes in intestinal permeability, levels of serum lipopolysaccharide (LPS), and the induced inflammatory response of Toll-like receptors (TLRs). We found the existence of gut dysbiosis in goslings with gout as a result of interactions among the multitude of bacteria present in the gut, and the proliferation of a specific pathogenic genus, Proteobacteria, played a decisive role in this process. Moreover, the permeability increased not only in the intestinal epithelium but also in the renal endothelium, providing possibilities for gut-derived LPS to enter the blood circulation and damage the kidneys. The systemic LPS concentration was increased in the gout group and exhibited a positive correlation with the degree of renal injury. In addition, we also found that inflammatory disorders concurrently existed in the gut and kidney of goslings with gout, and the LPS/TLR4/MyD88 (Myeloid differentiation primary response gene 88) inflammatory signaling was activated. These results indicate that the loss of intestinal barrier as a result of gut dysbiosis causes the translocation of gut-derived LPS, which can play an important role in the development of gout in goslings through interference with kidney functions.
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Affiliation(s)
| | - Junshu Yan
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base of Ministry of Science and Technology, Animal Husbandry Institute, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Mingyang Li
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base of Ministry of Science and Technology, Animal Husbandry Institute, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Shijia Ying
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base of Ministry of Science and Technology, Animal Husbandry Institute, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
| | - Zhendan Shi
- Jiangsu Key Laboratory for Food Quality and Safety-State Key Laboratory Cultivation Base of Ministry of Science and Technology, Animal Husbandry Institute, Jiangsu Academy of Agricultural Sciences, Nanjing 210014, China
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Abstract
The process of kidney stone formation is complex and still not completely understood. Supersaturation and crystallization are the main drivers for the etiopathogenesis of uric acid, xanthine and cystine stones but this physicochemical concept fails to adequately explain the formation of calcium-based nephrolithiasis, which represents the majority of kidney stones. Contemporary concepts of the pathogenesis of calcium-based nephrolithiasis focus on a nidus-associated stone formation of calcium-based nephrolithiasis on Randall's plaques or on plugs of Bellini's duct. Randall's plaques originate from the interaction of interstitial calcium supersaturation in the renal papilla, vascular and interstitial inflammatory processes and mineral deposits of calcifying nanoparticles on the basal membrane of the thin ascending branch of the loop of Henle; however, plugs of Bellini's duct are assumed to be caused by mineral deposits on the wall of the collecting ducts. Aggregation and overgrowth are influenced by the interaction of matrix proteins with calcium supersaturated urine, by an imbalance between promoters and inhibitors of stone formation in the calyceal urine. Current research has elucidated many factors contributing to stone formation by revealing novel insights into the physiology of nephron and papilla, by analyzing vascular, inflammatory and calcifying processes in the renal medulla, by examining the proteome, the microbiome, promoters and inhibitors of stone formation in the urine and by conducting the first genome-wide association studies; however, more future research is mandatory to fill the gap of knowledge and hopefully, to obtain novel prophylactic, therapeutic and metaphylactic tools beyond the current state of knowledge.
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Kaushal N, Vohora D, Jalali RK, Jha S. Review of the Literature Examining the Association of Serum Uric Acid with Osteoporosis and Mechanistic Insights into Its Effect on Bone Metabolism. Endocr Metab Immune Disord Drug Targets 2019; 19:259-273. [DOI: 10.2174/1871530318666181102115106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
Abstract
Background And Objective:Osteoporosis is a common bone disorder that increases susceptibility to fragility bone fractures. The clinical and public health repercussions of osteoporosis are huge due to the morbidity, mortality, and cost of medical care linked with fragility fractures. Clinical assessment of osteoporotic risk factors can help to identify candidates at an early stage that will benefit from medical intervention and potentially lowering the morbidity and mortality seen with fractures and complications. Given this, research is ongoing to evaluate the association of osteoporosis with some novel or less well-studied risk factors/bio-markers such as uric acid (UA).Discussion:Uric acid’s antioxidant activity has been proposed to be one of the factors responsible for increasing longevity and lowering rates of age-related cancers during primate evolution, the level of which increased markedly due to loss of uricase enzyme activity (mutational silencing). Accumulated evidence shows that oxidative stress is the fundamental mechanism of age-related bone loss and acts via enhancing osteoclastic activity and increasing bone resorption. Antioxidant substances such as ascorbic acid scavenge free radicals are positively related to bone health. Thus, it is hypothesized that uric acid holds bone-protective potential owing to its potent antioxidative property. Several correlation studies have been conducted globally to investigate the relationship between serum uric acid with bone mineral density and osteoporosis. Few pre-clinical studies have tried to investigate the interaction between uric acid and bone mineral density and reported important role played via Runt-related transcription factor 2 (RUNX2)/core-binding factor subunit alpha-1 (CBF-alpha-1), Wingless-related integration site (Wnt)-3a/β-catenin signaling pathway and 11β Hydroxysteroid Dehydrogenase type 1.Conclusion:In this review, the authors provided a comprehensive summary of the literature related to association studies reported in humans as well work done until date to understand the potential cellular and molecular mechanisms that interplay between uric acid and bone metabolism.
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Affiliation(s)
- Neelam Kaushal
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rajinder K Jalali
- Medical Affairs & Clinical Research, Sun Pharmaceutical Industries Limited, Gurgaon, India
| | - Sujeet Jha
- Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd, India
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Nicholson K, Chan J, Macklin EA, Levine‐Weinberg M, Breen C, Bakshi R, Grasso DL, Wills A, Jahandideh S, Taylor AA, Beaulieu D, Ennist DL, Andronesi O, Ratai E, Schwarzschild MA, Cudkowicz M, Paganoni S. Pilot trial of inosine to elevate urate levels in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2018; 5:1522-1533. [PMID: 30564619 PMCID: PMC6292193 DOI: 10.1002/acn3.671] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To test the safety, tolerability, and urate-elevating capability of the urate precursor inosine taken orally or by feeding tube in people with amyotrophic lateral sclerosis (ALS). METHODS This was a pilot, open-label trial in 25 participants with ALS. Treatment duration was 12 weeks. The dose of inosine was titrated at pre-specified time points to elevate serum urate levels to 7-8 mg/dL. Primary outcomes were safety (as assessed by the occurrence of adverse events [AEs]) and tolerability (defined as the ability to complete the 12-week study on study drug). Secondary outcomes included biomarkers of oxidative stress and damage. As an exploratory analysis, observed outcomes were compared with a virtual control arm built using prediction algorithms to estimate ALSFRS-R scores. RESULTS Twenty-four out of 25 participants (96%) completed 12 weeks of study drug treatment. One participant was unable to comply with study visits and was lost to follow-up. Serum urate rose to target levels in 6 weeks. No serious AEs attributed to study drug and no AEs of special concern, such as urolithiasis and gout, occurred. Selected biomarkers of oxidative stress and damage had significant changes during the study period. Observed changes in ALSFRS-R did not differ from baseline predictions. INTERPRETATION Inosine appeared safe, well tolerated, and effective in raising serum urate levels in people with ALS. These findings, together with epidemiological observations and preclinical data supporting a neuroprotective role of urate in ALS models, provide the rationale for larger clinical trials testing inosine as a potential disease-modifying therapy for ALS.
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Affiliation(s)
- Katharine Nicholson
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | - James Chan
- MGH Biostatistics CenterBostonMassachusetts
| | | | - Mark Levine‐Weinberg
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | - Christopher Breen
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | - Rachit Bakshi
- MassGeneral Institute for Neurodegenerative DiseaseBostonMassachusetts
| | - Daniela L. Grasso
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | - Anne‐Marie Wills
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | | | | | | | | | - Ovidiu Andronesi
- MGH Department of RadiologyA. A. Martinos Center for Biomedical ImagingBostonMassachusetts
| | - Eva‐Maria Ratai
- MGH Department of RadiologyA. A. Martinos Center for Biomedical ImagingBostonMassachusetts
| | | | - Merit Cudkowicz
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
| | - Sabrina Paganoni
- Neurological Clinical Research Institute (NCRI)Massachusetts General Hospital (MGH)BostonMassachusetts
- Spaulding Rehabilitation HospitalBostonMassachusetts
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Abstract
Uric acid nephrolithiasis appears to increase in prevalence. While a relationship between uric acid stones and low urinary pH has been for long known, additional association with various metabolic conditions and pathophysiological basis has recently been elucidated. Some conditions such as diabetes and metabolic syndrome disease, excessive dietary intake, and increased endogenous uric acid production and/or defect in ammoniagenesis are associated with low urinary pH. In addition, the phenomenon of global warming could result in an increase in areas with greater climate risk for uric acid stone formation. There are three therapeutic steps to be taken for management of uric acid stones: identification of urinary pH profiles, assessment of urinary volume status, and identification of disorders leading to excessive uric acid production. However, the most important factor for uric acid stone formation is acid urinary pH, which is a prerequisite for uric acid precipitation. This article reviews recent insights into the pathophysiology of uric acid stones and their management.
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Affiliation(s)
- Elisa Cicerello
- Unità Complessa di Urologia, Ospedale Ca' Foncello, Treviso, Italy
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Mediators of the Effects of Gender on Uric Acid Nephrolithiasis: A Novel Application of Structural Equation Modeling. Sci Rep 2018; 8:6077. [PMID: 29666405 PMCID: PMC5904184 DOI: 10.1038/s41598-018-24485-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/04/2018] [Indexed: 11/08/2022] Open
Abstract
Numerous epidemiological studies have shown that male patients with uric acid nephrolithiasis outnumber female patients. To our knowledge, no research exists evaluating the reasons gender affects the development of uric acid nephrolithiasis. We hereby used a novel application of structural equation modeling to analyze the mediators of the effects of gender on uric acid nephrolithiasis. In 1,098 patients with nephrolithiasis between 2012 and 2016, male gender was found to have a statistically significant positive indirect effect on the development of uric acid nephrolithiasis, which was mediated by lower urine pH (estimate: 0.010, standard error: 0.005, critical ratio: 2.135, 95% confidence interval: 0.002–0.023, P = 0.017), lower estimated glomerular filtration rate (estimate: 0.014, standard error: 0.005, critical ratio: 2.993, 95% confidence interval: 0.006–0.025, P < 0.001), and higher incidence rate of gout (estimate: 0.009, standard error: 0.005, critical ratio: 2.028, 95% confidence interval: 0.002–0.021, P = 0.009). We conclude that low urine pH, impaired renal function, and gout are the mediators of the effect of male gender on the development of uric acid nephrolithiasis. The survey, treatment, and follow-up of kidney diseases, acidic urine, and uric acid metabolism disorders should be considered in men with uric acid nephrolithiasis.
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17
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Wu J. Urolithiasis (Kidney and Bladder Stones). Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Zawadzki AD, Cardoso DR, Skibsted LH. Proton-coupled electron transfer promotes the reduction of ferrylmyoglobin by uric acid under physiological conditions. RSC Adv 2017. [DOI: 10.1039/c6ra28314d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Uric acid prevents the oxidative toxic effects of ferrylmyoglobin during red meat digestion.
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Affiliation(s)
- Andressa de Zawadzki
- Instituto de Química de São Carlos
- Universidade de São Paulo
- São Carlos
- Brazil
- Department of Food Science
| | - Daniel R. Cardoso
- Instituto de Química de São Carlos
- Universidade de São Paulo
- São Carlos
- Brazil
| | - Leif H. Skibsted
- Department of Food Science
- University of Copenhagen
- 1958 Frederiksberg C
- Denmark
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Dion M, Ankawi G, Chew B, Paterson R, Sultan N, Hoddinott P, Razvi H. CUA guideline on the evaluation and medical management of the kidney stone patient - 2016 update. Can Urol Assoc J 2016; 10:E347-E358. [PMID: 28096919 DOI: 10.5489/cuaj.4218] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Marie Dion
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ghada Ankawi
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ben Chew
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Paterson
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nabil Sultan
- Division of Nephrology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Patti Hoddinott
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Hassan Razvi
- Division of Urology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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22
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Can the manipulation of urinary pH by beverages assist with the prevention of stone recurrence? Urolithiasis 2015; 44:51-6. [PMID: 26614113 DOI: 10.1007/s00240-015-0844-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
The formation of various types of stones in the urinary tract is strongly influenced by urinary pH. An acidic urinary pH promotes the crystallization of uric acid and cystine, respectively. Moreover, changes in systemic acid-base homeostasis alter urinary excretion of citrate, an important inhibitor of calcium oxalate stone formation. The effect of beverages on urinary pH and citrate excretion is mainly determined by the presence of bicarbonate and citrate. The bicarbonate content of mineral water can replace alkalization therapy with potassium citrate and contribute to urine inhibitory power by increasing urinary pH and citrate excretion. Citrus juices are rich sources of citrate. Oral citrate is absorbed in the intestine and nearly completely metabolized to bicarbonate, providing an alkali load, which in turn increases urinary pH and citrate excretion. However, data from observational and interventional studies on the effect of different types of citrus juices on the risk of urinary stone formation are conflicting. In conclusion, favourable changes in urinary pH and citrate excretion can be attained by various beverages. However, the long-term efficacy of certain beverages for the recurrence prevention of different types of stones has yet to be determined.
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23
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Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional Management of Kidney Stones (Nephrolithiasis). Clin Nutr Res 2015; 4:137-52. [PMID: 26251832 PMCID: PMC4525130 DOI: 10.7762/cnr.2015.4.3.137] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 01/02/2023] Open
Abstract
The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones.
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Affiliation(s)
- Haewook Han
- Department of Nephrology, Harvard Vanguard Medical Associate, Boston, MA 02115, USA
| | - Adam M Segal
- Harvard Vanguard Medical Associate, Clinical Instructor at Harvard Medical School, Boston, MA 02115, USA
| | - Julian L Seifter
- Harvard Vanguard Medical Associates; Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Johanna T Dwyer
- Tufts University Friedman School of Nutrition and School of Medicine, Boston, MA 02111, USA
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24
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Does hypertension impact 24-hour urine parameters in patients with nephrolithiasis? Urology 2015; 85:539-43. [PMID: 25733263 DOI: 10.1016/j.urology.2014.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/20/2014] [Accepted: 12/05/2014] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To examine the differences in 24-hour urine parameters and stone composition between patients with and without systemic hypertension (HTN) in a large cohort of stone formers. MATERIALS AND METHODS We performed a retrospective review over a 10-year period of patients with stone, who had completed a 24-hour urinalysis (Litholink) and for whom demographic information was available, including the presence of HTN. Univariate and multivariate analyses were performed, comparing the 24-hour urinalysis profiles of patients with HTN with that of normotensive patients. RESULTS Of the 1115 patients eligible for inclusion, 442 patients (40%) had HTN and 673 (60%) did not. Patients with HTN were significantly older, had a higher body mass index, and had a greater number of comorbid conditions than normotensive patients. Univariate analysis revealed significantly lower urine pH, calcium, supersaturation (SS) of calcium oxalate (CaOx) and SS calcium phosphate (all P <.05) in patients with HTN. Multivariate analysis showed significantly lower calcium, citrate, and SS CaOx in patients with HTN (all P <.05). CONCLUSION Our results demonstrate lower levels of calcium and SS CaOx on univariate and multivariate analysis, as well as lower levels of citrate on multivariate analysis in patients with HTN. These results suggest that lower levels of citrate may contribute to stone formation to a greater degree in patients with HTN than abnormalities in calcium metabolism.
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25
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Skolarikos A, Straub M, Knoll T, Sarica K, Seitz C, Petřík A, Türk C. Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: EAU Guidelines. Eur Urol 2015; 67:750-63. [DOI: 10.1016/j.eururo.2014.10.029] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 10/16/2014] [Indexed: 12/31/2022]
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26
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Mol M, Raj Bejugam P, Singh S. Synthetic biology at the interface of functional genomics. Brief Funct Genomics 2014; 14:180-8. [PMID: 25212484 DOI: 10.1093/bfgp/elu031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Functional genomics is considered a powerful tool that helps understand the relation between an organism's genotype and possible phenotypes. Volumes of data generated on several 'omics' platforms have revealed the network complexities underlying biological processes. Systems and synthetic biology have garnered much attention because of the ability to infer and comprehend the uncertainties associated with such complexities. Also, part-wise characterization of the network components (e.g. DNA, RNA, protein) has rendered an engineering perspective in life sciences to build modular and functional devices. This approach can be used to combat one of the many concerns of the world, i.e. in the area of biomedical translational research by designing and constructing novel therapeutic devices to intervene network perturbation in a diseased state to transform to a healthy state.
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27
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Hartman C, Friedlander JI, Moreira DM, Elsamra SE, Smith AD, Okeke Z. Differences in 24-h urine composition between nephrolithiasis patients with and without diabetes mellitus. BJU Int 2014; 115:619-24. [DOI: 10.1111/bju.12807] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher Hartman
- Hofstra North Shore-LIJ School of Medicine; The Arthur Smith Institute for Urology; New Hyde Park NY USA
| | - Justin I. Friedlander
- The Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Daniel M. Moreira
- Hofstra North Shore-LIJ School of Medicine; The Arthur Smith Institute for Urology; New Hyde Park NY USA
| | - Sammy E. Elsamra
- Hofstra North Shore-LIJ School of Medicine; The Arthur Smith Institute for Urology; New Hyde Park NY USA
| | - Arthur D. Smith
- Hofstra North Shore-LIJ School of Medicine; The Arthur Smith Institute for Urology; New Hyde Park NY USA
| | - Zeph Okeke
- Hofstra North Shore-LIJ School of Medicine; The Arthur Smith Institute for Urology; New Hyde Park NY USA
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28
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Cai X, Zhou Q, Yu J, Xian Z, Feng Y, Yang W, Mo X. Impact of reduced-radiation dual-energy protocols using 320-detector row computed tomography for analyzing urinary calculus components: initial in vitro evaluation. Urology 2014; 84:760-5. [PMID: 25096333 DOI: 10.1016/j.urology.2014.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/15/2014] [Accepted: 05/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the impact of reduced-radiation dual-energy (DE) protocols using 320-detector row computed tomography on the differentiation of urinary calculus components. MATERIALS AND METHODS A total of 58 urinary calculi were placed into the same phantom and underwent DE scanning with 320-detector row computed tomography. Each calculus was scanned 4 times with the DE protocols using 135 kV and 80 kV tube voltage and different tube current combinations, including 100 mA and 570 mA (group A), 50 mA and 290 mA (group B), 30 mA and 170 mA (group C), and 10 mA and 60 mA (group D). The acquisition data of all 4 groups were then analyzed by stone DE analysis software, and the results were compared with x-ray diffraction analysis. Noise, contrast-to-noise ratio, and radiation dose were compared. RESULTS Calculi were correctly identified in 56 of 58 stones (96.6%) using group A and B protocols. However, only 35 stones (60.3%) and 16 stones (27.6%) were correctly diagnosed using group C and D protocols, respectively. Mean noise increased significantly and mean contrast-to-noise ratio decreased significantly from groups A to D (P <.05). In addition, the effective dose decreased markedly from groups A to D at 3.78, 1.81, 1.07, and 0.37 mSv, respectively. CONCLUSION Decreasing the DE tube currents from 100 mA and 570 mA to 50 mA and 290 mA resulted in 96.6% accuracy for urinary calculus component analysis while reducing patient radiation exposure to 1.81 mSv. Further reduction of tube currents may compromise diagnostic accuracy.
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Affiliation(s)
- Xiangran Cai
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Qingchun Zhou
- Department of Urology, Nanhua Affiliated Hospital, Nanhua University, Hengyang, China
| | - Juan Yu
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Zhaohui Xian
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Youzhen Feng
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wencai Yang
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xukai Mo
- Medical Imaging Center, First Affiliated Hospital, Jinan University, Guangzhou, China
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Abstract
OBJECTIVE Recent technologic advances in MDCT have led to the introduction of dual-energy CT (DECT). The basic principle of DECT is to acquire images at two different energy levels simultaneously and to use the attenuation differences at these different energy levels for deriving additional information, such as virtual monochromatic images, artifact suppression, and material composition of various tissues. CONCLUSION A variety of image reconstruction and postprocessing techniques are available for better demonstration and characterization of pathologic abnormalities. DECT can provide both anatomic and functional information of different organ systems. This article focuses on the main applications of DECT in emergency radiology.
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Schwarzschild MA, Ascherio A, Beal MF, Cudkowicz ME, Curhan GC, Hare JM, Hooper DC, Kieburtz KD, Macklin EA, Oakes D, Rudolph A, Shoulson I, Tennis MK, Espay AJ, Gartner M, Hung A, Bwala G, Lenehan R, Encarnacion E, Ainslie M, Castillo R, Togasaki D, Barles G, Friedman JH, Niles L, Carter JH, Murray M, Goetz CG, Jaglin J, Ahmed A, Russell DS, Cotto C, Goudreau JL, Russell D, Parashos SA, Ede P, Saint-Hilaire MH, Thomas CA, James R, Stacy MA, Johnson J, Gauger L, Antonelle de Marcaida J, Thurlow S, Isaacson SH, Carvajal L, Rao J, Cook M, Hope-Porche C, McClurg L, Grasso DL, Logan R, Orme C, Ross T, Brocht AFD, Constantinescu R, Sharma S, Venuto C, Weber J, Eaton K. Inosine to increase serum and cerebrospinal fluid urate in Parkinson disease: a randomized clinical trial. JAMA Neurol 2014; 71:141-50. [PMID: 24366103 DOI: 10.1001/jamaneurol.2013.5528] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Convergent biological, epidemiological, and clinical data identified urate elevation as a candidate strategy for slowing disability progression in Parkinson disease (PD). OBJECTIVE To determine the safety, tolerability, and urate-elevating capability of the urate precursor inosine in early PD and to assess its suitability and potential design features for a disease-modification trial. DESIGN, SETTING, AND PARTICIPANTS The Safety of Urate Elevation in PD (SURE-PD) study, a randomized, double-blind, placebo-controlled, dose-ranging trial of inosine, enrolled participants from 2009 to 2011 and followed them for up to 25 months at outpatient visits to 17 credentialed clinical study sites of the Parkinson Study Group across the United States. Seventy-five consenting adults (mean age, 62 years; 55% women) with early PD not yet requiring symptomatic treatment and a serum urate concentration less than 6 mg/dL (the approximate population median) were enrolled. INTERVENTIONS Participants were randomized to 1 of 3 treatment arms: placebo or inosine titrated to produce mild (6.1-7.0 mg/dL) or moderate (7.1-8.0 mg/dL) serum urate elevation using 500-mg capsules taken orally up to 2 capsules 3 times per day. They were followed for up to 24 months (median, 18 months) while receiving the study drug plus 1 washout month. MAIN OUTCOMES AND MEASURES The prespecified primary outcomes were absence of unacceptable serious adverse events (safety), continued treatment without adverse event requiring dose reduction (tolerability), and elevation of urate assessed serially in serum and once (at 3 months) in cerebrospinal fluid. RESULTS Serious adverse events (17), including infrequent cardiovascular events, occurred at the same or lower rates in the inosine groups relative to placebo. No participant developed gout and 3 receiving inosine developed symptomatic urolithiasis. Treatment was tolerated by 95% of participants at 6 months, and no participant withdrew because of an adverse event. Serum urate rose by 2.3 and 3.0 mg/dL in the 2 inosine groups (P < .001 for each) vs placebo, and cerebrospinal fluid urate level was greater in both inosine groups (P = .006 and <.001, respectively). Secondary analyses demonstrated nonfutility of inosine treatment for slowing disability. CONCLUSIONS AND RELEVANCE Inosine was generally safe, tolerable, and effective in raising serum and cerebrospinal fluid urate levels in early PD. The findings support advancing to more definitive development of inosine as a potential disease-modifying therapy for PD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00833690.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - David Oakes
- University of Rochester, Rochester, New York
| | | | | | | | | | | | - Albert Hung
- Massachusetts General Hospital, Boston, Massachusetts
| | - Grace Bwala
- Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Lenehan
- Scott & White Memorial Hospital/Texas A&M University, Temple
| | | | - Melissa Ainslie
- Scott & White Memorial Hospital/Texas A&M University, Temple
| | | | | | - Gina Barles
- University of Southern California, Los Angeles
| | | | - Lisa Niles
- Butler Hospital, Providence, Rhode Island
| | | | | | | | - Jeana Jaglin
- Rush University Medical Center, Chicago, Illinois
| | | | - David S Russell
- Institute of Neurodegenerative Disorders, New Haven, Connecticut
| | - Candace Cotto
- Institute of Neurodegenerative Disorders, New Haven, Connecticut
| | | | | | | | - Patricia Ede
- Struthers Parkinson's Center, Golden Valley, Minnesota
| | | | | | | | | | | | | | | | | | - Stuart H Isaacson
- Parkinson's Disease & Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | - Lisbeth Carvajal
- Parkinson's Disease & Movement Disorder Center of Boca Raton, Boca Raton, Florida
| | | | - Maureen Cook
- Ochsner Clinic Foundation, New Orleans, Louisiana
| | | | - Lauren McClurg
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Daniela L Grasso
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Robert Logan
- Administrative Coordination Center, Massachusetts General Hospital, Boston
| | - Constance Orme
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Tori Ross
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Alicia F D Brocht
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | | | - Saloni Sharma
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Charles Venuto
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Joseph Weber
- Clinical Coordination Center, University of Rochester, Rochester, New York
| | - Ken Eaton
- Clinical Coordination Center, University of Rochester, Rochester, New York
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Sattui SE, Singh JA, Gaffo AL. Comorbidities in patients with crystal diseases and hyperuricemia. Rheum Dis Clin North Am 2014; 40:251-78. [PMID: 24703346 DOI: 10.1016/j.rdc.2014.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Crystal arthropathies are among the most common causes of painful inflammatory arthritis. Gout, the most common example, has been associated with cardiovascular and renal disease. In recent years, evidence for these associations and those involving other comorbidities, such as the metabolic syndrome, have emerged, and the importance of asymptomatic hyperuricemia has been established. In this review, an update on evidence, both experimental and clinical, is presented, and associations between hyperuricemia, gout, and several comorbidities are described. Causality regarding calcium pyrophosphate arthropathy and associated comorbidities is also reviewed.
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Affiliation(s)
- Sebastian E Sattui
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Faculty Office Tower 813, 510 20th Street South, Birmingham, AL 35294, USA
| | - Jasvinder A Singh
- Medicine Service, Center for Surgical Medical Acute Care Research and Transitions (C-SMART), 700 19th Street South, Birmingham VA Medical Center, Birmingham, AL 35233, USA; Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Faculty Office Tower 805B, 200 First Street South West, Rochester, MN 55905, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Angelo L Gaffo
- Section of Rheumatology, Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL 35233, USA; Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, University of Alabama, Shelby Building 201, 1825 University Boulevard, Birmingham, AL 35294, USA.
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Ingale KG, Thakurdesai PA, Vyawahare NS. Effect of Hygrophila spinosa in ethylene glycol induced nephrolithiasis in rats. Indian J Pharmacol 2013; 44:639-42. [PMID: 23112429 PMCID: PMC3480800 DOI: 10.4103/0253-7613.100402] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 06/14/2012] [Accepted: 07/01/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Hygrophila spinosa (Acanthaceae) is traditionally used to treat urinary calculi. The present study aimed to evaluate the antiurolithiatic activity of methanolic extract of Hygrophila spinosa (Acanthaceae) in ethylene glycol induced nephrolithiasic rats. MATERIALS AND METHODS Methanolic extract of Hygrophila spinosa (HSME) (250 and 500 mg/ kg body weight) was administered orally to male Wistar albino rats. Ethylene glycol (EG) was used to induce nephrolithiasis. The parameters studied included water intake, urinary volume, urinary pH, urinary and kidney oxalate and calcium, urinary magnesium and serum uric acid. RESULTS Ethylene glycol feeding resulted in hyperoxaluria as well as increased renal excretion of calcium and serum uric acid along with decreased excretion of urinary magnesium. Treatment with HSME significantly reduced the elevated urinary oxalate, urinary calcium and serum uric acid with increase in reduced urinary magnesium. Ethylene glycol feeding also resulted in increased levels of calcium and oxalate in kidney which was decreased after the treatment with HSME. The increased deposition of stone forming constituents in the kidneys of ethylene glycol treated rats was significantly lowered by treatment with HSME. CONCLUSION The results indicate that the aerial parts of Hygrophila spinosa are endowed with antiurolithiatic activity, thereby justifying its traditional claim.
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Affiliation(s)
- Kundan G Ingale
- Department of Pharmacology, KYDSCT's College of Pharmacy, Sakegaon, Bhusawal, India
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Li X, Zhao R, Liu B, Yu Y. Gemstone Spectral Imaging Dual-energy Computed Tomography: A Novel Technique to Determine Urinary Stone Composition. Urology 2013; 81:727-30. [DOI: 10.1016/j.urology.2013.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 12/17/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
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Childs MA, Mynderse LA, Rangel LJ, Wilson TM, Lingeman JE, Krambeck AE. Pathogenesis of bladder calculi in the presence of urinary stasis. J Urol 2013; 189:1347-51. [PMID: 23159588 PMCID: PMC3777386 DOI: 10.1016/j.juro.2012.11.079] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Although minimal evidence exists, bladder calculi in men with benign prostatic hyperplasia are thought to be secondary to bladder outlet obstruction induced urinary stasis. We performed a prospective, multi-institutional clinical trial to determine whether metabolic differences were present in men with and without bladder calculi undergoing surgical intervention for benign prostatic hyperplasia induced bladder outlet obstruction. MATERIALS AND METHODS Men who elected surgery for bladder outlet obstruction secondary to benign prostatic hyperplasia with and without bladder calculi were assessed prospectively and compared. Men without bladder calculi retained more than 150 ml urine post-void residual urine. Medical history, serum electrolytes and 24-hour urinary metabolic studies were compared. RESULTS Of the men 27 had bladder calculi and 30 did not. Bladder calculi were associated with previous renal stone disease in 36.7% of patients (11 of 30) vs 4% (2 of 27) and gout was associated in 13.3% (4 of 30) vs 0% (0 of 27) (p <0.01 and 0.05, respectively). There was no observed difference in the history of other medical conditions or in serum electrolytes. Bladder calculi were associated with lower 24-hour urinary pH (median 5.9 vs 6.4, p = 0.02), lower 24-hour urinary magnesium (median 106 vs 167 mmol, p = 0.01) and increased 24-hour urinary uric acid supersaturation (median 2.2 vs 0.6, p <0.01). CONCLUSIONS In this comparative prospective analysis patients with bladder outlet obstruction and benign prostatic hyperplasia with bladder calculi were more likely to have a renal stone disease history, low urinary pH, low urinary magnesium and increased urinary uric acid supersaturation. These findings suggest that, like the pathogenesis of nephrolithiasis, the pathogenesis of bladder calculi is likely complex with multiple contributing lithogenic factors, including metabolic abnormalities and not just urinary stasis.
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Affiliation(s)
- M. Adam Childs
- Departments of Urology (MAC, LAM, TMW, AEK) and Health Sciences Research (LJR), Mayo Clinic, Rochester, Minnesota, and Indiana Clinic Urology, Indiana University School of Medicine (JEL), Indianapolis, Indiana
| | | | - Laureano J. Rangel
- Departments of Urology (MAC, LAM, TMW, AEK) and Health Sciences Research (LJR), Mayo Clinic, Rochester, Minnesota, and Indiana Clinic Urology, Indiana University School of Medicine (JEL), Indianapolis, Indiana
| | - Torrence M. Wilson
- Departments of Urology (MAC, LAM, TMW, AEK) and Health Sciences Research (LJR), Mayo Clinic, Rochester, Minnesota, and Indiana Clinic Urology, Indiana University School of Medicine (JEL), Indianapolis, Indiana
| | | | - Amy E. Krambeck
- Departments of Urology (MAC, LAM, TMW, AEK) and Health Sciences Research (LJR), Mayo Clinic, Rochester, Minnesota, and Indiana Clinic Urology, Indiana University School of Medicine (JEL), Indianapolis, Indiana
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Abstract
OBJECTIVE The purpose of this article is to give a brief overview of the technical background of dual-energy CT (DECT) imaging and to review various DECT applications in the abdomen that are currently available for clinical practice. In a review of the recent literature, specific DECT applications available for abdominal organs, liver, pancreas, kidneys including renal stones, and adrenal glands, will be discussed in light of reliability and clinical usefulness in replacing true unenhanced imaging, increased lesion conspicuity, iodine extraction, and improved tissue/material characterization (e.g., renal stone composition). Radiation dose considerations will be addressed in comparison with standard abdominal imaging protocols. CONCLUSION Modern DECT applications for the abdomen expand the use of CT and enable advanced quantitative methods in the clinical routine on the basis of differences in material attenuation observed by imaging at two different distinct photon energies.
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Wieland M, Fussenegger M. Reprogrammed cell delivery for personalized medicine. Adv Drug Deliv Rev 2012; 64:1477-87. [PMID: 22721864 DOI: 10.1016/j.addr.2012.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 06/01/2012] [Accepted: 06/13/2012] [Indexed: 11/29/2022]
Abstract
In most approaches, personalized medicine requires time- and cost-intensive characterization of an individual's genetic background in order to achieve the best-adapted therapy. For this purpose, cell-based drug delivery offers a promising alternative. In particular, synthetic biology has introduced the vision of cells being programmable therapeutic production facilities that can be introduced into patients. This review highlights the progress made in synthetic biology-based cell engineering toward advanced drug delivery entities. Starting from basic one-input responsive transcriptional or post-transcriptional gene control systems, the field has reached a level on which cells can be engineered to detect cancer cells, to obtain control over T-cell proliferation, and to restore blood glucose homeostasis upon blue light illumination. Furthermore, a cellular implant was developed that detects blood urate level disorders and acts accordingly to restore homeostasis while another cellular implant was engineered as an artificial insemination device that releases bull sperm into bovine ovarian only during ovulation time by recording endogenous luteinizing hormone levels. Soon, the field will reach a stage at which cells can be reprogrammed to detect multiple metabolic parameters and self-sufficiently treat any disorder connected to them.
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Affiliation(s)
- Markus Wieland
- ETH Zurich, Department of Biosystems Science and Bioengineering (D-BSSE), Mattenstrasse 26, CH-4058 Basel, Switzerland
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Wieland M, Fussenegger M. Engineering Molecular Circuits Using Synthetic Biology in Mammalian Cells. Annu Rev Chem Biomol Eng 2012; 3:209-34. [DOI: 10.1146/annurev-chembioeng-061010-114145] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Markus Wieland
- Department of Biosystems Science and Bioengineering, ETH Zurich, CH-4058 Basel, Switzerland; ,
| | - Martin Fussenegger
- Department of Biosystems Science and Bioengineering, ETH Zurich, CH-4058 Basel, Switzerland; ,
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Ausländer S, Wieland M, Fussenegger M. Smart medication through combination of synthetic biology and cell microencapsulation. Metab Eng 2012; 14:252-60. [DOI: 10.1016/j.ymben.2011.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 05/11/2011] [Accepted: 06/09/2011] [Indexed: 01/05/2023]
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Hasegawa EM, Fuller R, Chammas MC, de Mello FM, Goldenstein-Schainberg C. Increased prevalence of simple renal cysts in patients with gout. Rheumatol Int 2012; 33:413-6. [PMID: 22453524 DOI: 10.1007/s00296-012-2380-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 03/11/2012] [Indexed: 11/24/2022]
Abstract
The aim of this study was to determine the prevalence of simple renal cysts in gout patients and evaluate associated risk factors for its development. Hundred and forty-six patients followed at our outpatient Gout Unit and 47 sex- and age-matched healthy kidney donors who had undergone routine renal ultrasonography, using a static gray scale and real-time B-mode units with a 3.5- or 5.0-MHz transducer, were evaluated for the presence of renal cysts. Demographic and clinical characteristics of gout patients were evaluated considering possible risk factors for the occurrence of simple renal cysts such as age, male gender, hypertension, and renal impairment. The prevalence of simple renal cyst was 26.0 % in gout patients and 10.6 % in control group (P = 0.045). Gout patients with simple renal cysts presented less renal lithiasis than those without this complication (5.2 vs 25.9 %; P = 0.003) in spite of an overall higher frequency of renal stones in gout patients compared to control group (20.5 vs. 6.3 %, P = 0.025). The presence of simple renal cyst in gout was not associated with previously reported factors such as age (P = 0.296), male predominance (P = 0.688), hypertension (P = 0.314), and renal impairment (P = 254). Moreover, no association with disease duration (P = 0.843) or tophi (P = 0.616) was observed. In conclusion, gout patients have an increased prevalence of simple renal cysts associated with a lower occurrence of nephrolithiasis. Whether renal cysts have any protective effect in the development of nephrolithiasis in gout remains to be determined.
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Affiliation(s)
- Eduardo Massato Hasegawa
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3142, São Paulo, SP 01246-903, Brazil
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40
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Urolithiasis. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Difference in urinary stone components between obese and non-obese patients. ACTA ACUST UNITED AC 2010; 39:283-7. [PMID: 21161648 DOI: 10.1007/s00240-010-0344-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 11/08/2010] [Indexed: 01/08/2023]
Abstract
The prevalence and incidence of urinary stone disease have been reported to be associated with body weight and body mass index (BMI). The aim of the study was to determine the difference in stone components among different BMI groups in patients with urolithiasis. Between Dec 2005 and Jan 2008, 907 urinary calculi were collected and analyzed by infrared spectroscopy. Most of the stones had been passed spontaneously, and some were collected during surgical manipulations. The data on patients' gender, age, BMI at diagnosis, and stone composition were collected. The patients were classified as normal weight (18.5≤ BMI <24), overweight (24≤ BMI <27), or obese (BMI ≥27). Of the 907 patients with urinary stone disease, 27.7% had normal weight, 33.5% were overweight, and 38.8% were obese. The prevalence of calcium oxalate stones in the normal weight, overweight, and obese groups were 23.1, 30.6, and 34.9%, respectively (P = 0.002), and the prevalence of uric acid stones in the different groups was 2.8, 7.2, and 7.7%, respectively (P = 0.002). The prevalence of calcium oxalate and uric acid stones, but not that of calcium phosphate stones, increased with body size. There was a significant correlation between BMI and uric acid stones in the overweight and obesity groups, with odds ratios of 3.28 and 4.35, respectively. The prevalence and incidence of urinary stone disease were found to be associated with BMI. The percentage of uric acid and calcium oxalate stones was higher in obese than in non-obese patients. There was no apparent difference in the prevalence of calcium phosphate stones between obese and non-obese patients.
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Hidas G, Eliahou R, Duvdevani M, Coulon P, Lemaitre L, Gofrit ON, Pode D, Sosna J. Determination of Renal Stone Composition with Dual-Energy CT: In Vivo Analysis and Comparison with X-ray Diffraction. Radiology 2010; 257:394-401. [PMID: 20807846 DOI: 10.1148/radiol.10100249] [Citation(s) in RCA: 149] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Guy Hidas
- Department of Urology, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel
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Kenny JES, Goldfarb DS. Update on the pathophysiology and management of uric acid renal stones. Curr Rheumatol Rep 2010; 12:125-9. [PMID: 20425021 DOI: 10.1007/s11926-010-0089-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Idiopathic uric acid nephrolithiasis appears to be increasing in prevalence. While it has long been known that low urine pH is associated with uric acid stones, only recently has the pathophysiological basis for this disease emerged. Excessively acidic urine is the decisive risk for uric acid lithogenesis, and patients with diabetes and the metabolic syndrome often hold the company of low urine pH. While association does not imply causation, interesting insights have been made regarding insulin's influence on acid-base physiology. We review recent evidence from both the molecular and clinical realms to underline the importance of [H+] in the development and treatment of uric acid nephrolithiasis.
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Affiliation(s)
- Jon-Emile S Kenny
- Department of Medicine, NYU Langone Medical Center, New York, NY, USA.
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Liu Y, Mo L, Goldfarb DS, Evan AP, Liang F, Khan SR, Lieske JC, Wu XR. Progressive renal papillary calcification and ureteral stone formation in mice deficient for Tamm-Horsfall protein. Am J Physiol Renal Physiol 2010; 299:F469-78. [PMID: 20591941 DOI: 10.1152/ajprenal.00243.2010] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mammalian urine contains a range of macromolecule proteins that play critical roles in renal stone formation, among which Tamm-Horsfall protein (THP) is by far the most abundant. While THP is a potent inhibitor of crystal aggregation in vitro and its ablation in vivo predisposes one of the two existing mouse models to spontaneous intrarenal calcium crystallization, key controversies remain regarding the role of THP in nephrolithiasis. By carrying out a long-range follow-up of more than 250 THP-null mice and their wild-type controls, we demonstrate here that renal calcification is a highly consistent phenotype of the THP-null mice that is age and partially gene dosage dependent, but is gender and genetic background independent. Renal calcification in THP-null mice is progressive, and by 15 mo over 85% of all the THP-null mice develop spontaneous intrarenal crystals. The crystals consist primarily of calcium phosphate in the form of hydroxyapatite, are located more frequently in the interstitial space of the renal papillae than intratubularly, particularly in older animals, and lack accompanying inflammatory cell infiltration. The interstitial deposits of hydroxyapatite observed in THP-null mice bear strong resemblances to the renal crystals found in human kidneys bearing idiopathic calcium oxalate stones. Compared with 24-h urine from the wild-type mice, that of THP-null mice is supersaturated with brushite (calcium phosphate), a stone precursor, and has reduced urinary excretion of citrate, a stone inhibitor. While less frequent than renal calcinosis, renal pelvic and ureteral stones and hydronephrosis occur in the aged THP-null mice. These results provide direct in vivo evidence indicating that normal THP plays an important role in defending the urinary system against calcification and suggest that reduced expression and/or decreased function of THP could contribute to nephrolithiasis.
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Affiliation(s)
- Yan Liu
- Dept. of Urology, New York Univ. School of Medicine, NY 10010, USA
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45
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Sinha T, Karan SC, Kotwal A. Increased urinary uric acid excretion: a finding in Indian stone formers. UROLOGICAL RESEARCH 2010; 38:17-20. [PMID: 19921166 DOI: 10.1007/s00240-009-0236-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
Abstract
Many studies have been done to determine the risk factors associated with urolithiasis so that preventive measures can be undertaken to prevent stone formation. However the exact aetiology of urinary stones still remains elusive. A prospective control study of epidemiological factors that influence urinary stone formation was done to determine the aetiology of urinary stones. Patients with stone disease had a significantly higher body mass index. 24-h urine excretion of uric acid and phosphate was found to be significantly higher in stone patients as compared to controls. The intake of non-vegetarian food was significantly higher amongst stone formers. Stone patients had a significantly higher consumption of curd and cheese as compared to controls. There was a significant correlation noted between stone formation and a positive family and past history of stone disease. The results indicate that obese patients, especially those with a family history of stone disease, should be counselled on weight loss. Individuals with a past history of stone disease should be advised to reduce their dietary intake of foods rich in uric acid (meat, liver and beans).
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Affiliation(s)
- Tapan Sinha
- Department of Urology, Army Hospital (R&R), Delhi Cantt., Delhi 110010, India.
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Sighinolfi M, Micali S, Grande M, Mofferdin A, Stefani SD, Bianchi G. Extracorporeal Shock Wave Lithotripsy in an Elderly Population: How to Prevent Complications and Make the Treatment Safe and Effective. J Endourol 2008; 22:2223-6. [PMID: 18937586 DOI: 10.1089/end.2008.9704] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M.C. Sighinolfi
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
| | - S. Micali
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
| | - M. Grande
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
| | - A. Mofferdin
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
| | - S. De Stefani
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
| | - G. Bianchi
- The Department of Urology, University of Modena and Reggio Emilia, Italy Policlinico di Modena, Modena Italy
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Bobulescu IA, Dubree M, Zhang J, McLeroy P, Moe OW. Effect of renal lipid accumulation on proximal tubule Na+/H+ exchange and ammonium secretion. Am J Physiol Renal Physiol 2008; 294:F1315-22. [PMID: 18417539 DOI: 10.1152/ajprenal.00550.2007] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Patients with metabolic syndrome have increased risk of uric acid nephrolithiasis due to lower urinary pH and impaired ammonium excretion. The pathophysiology underlying these urinary changes is unknown. We used two animal models and a cell culture model to study whether the alteration in renal acidification is associated with renal fat infiltration (steatosis). Compared with pair-fed lean control rats, Zucker diabetic fatty rats have higher renal triglyceride content, decreased urinary ammonium and pH, and lower levels of brush border membrane Na(+)/H(+) exchanger-3 (NHE3), a major mediator of ammonium excretion. High-fat feeding in Sprague-Dawley rats results in transient lowering of urinary ammonium and pH, with all parameters returning to normal when the animals resumed eating normal chow. This is consistent with an absence of diet-induced renal steatosis in these animals. To examine the direct effect of fat accumulation, we incubated opossum kidney (OKP) cells with a mixture of long-chain fatty acids and found accumulation of intracellular lipids with concomitant dose-dependent decrease in NHE3 activity, surface biotin-accessible NHE3 protein, and ammonium secretion. A lower dose of fatty acids that leads to intracellular lipid accumulation but does not change baseline NHE3 is sufficient to abolish the stimulation of NHE3 by insulin and to partially block the stimulation of NHE3 by glucocorticoid hormones; acid regulation of NHE3 in lipid-loaded OKP cells is not affected. These findings suggest that renal steatosis decreases ammonium secretion in the proximal tubule, in part by reducing NHE3 activity and by impairing the regulation of NHE3 by specific agonists.
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Affiliation(s)
- I Alexandru Bobulescu
- Dept. of Internal Medicine, Univ. of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-8856, USA
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