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Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, Davis N, Tzelves L, Geraghty R, Lombardo R, Bezuidenhout C, Gambaro G. Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: An EAU Guidelines Update. Eur Urol 2024; 86:343-363. [PMID: 39069389 DOI: 10.1016/j.eururo.2024.05.029] [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: 02/12/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVE The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. METHODS A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. KEY FINDINGS AND LIMITATIONS For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. CONCLUSIONS AND CLINICAL IMPLICATIONS Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence.
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Affiliation(s)
- Andreas Skolarikos
- National and Kapodistrian University of Athens, 2nd Department of Urology, Sismanogleio Hospital, Athens, Greece.
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Helene Jung
- Urinvejskirurgisk Afdeling, Sygehus Lillebælt, Vejle, Denmark
| | - Alec Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czechia
| | - Thomas Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
| | - Niall Davis
- Department of Urology, Connolly Hospital, Dublin, Ireland
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, 2nd Department of Urology, Sismanogleio Hospital, Athens, Greece
| | - Rob Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | - Carla Bezuidenhout
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
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da Cruz Machado J, Miguel Renteria J, Medeiros do Nascimento M, Ahouagi Cunha AC, Marin Vieira G, Ferreira Manso JE. Association between urinary lithiasis, other than struvite by crystallography and non-ureolytic bacteria. Urolithiasis 2024; 52:28. [PMID: 38244096 DOI: 10.1007/s00240-023-01525-4] [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: 10/17/2023] [Accepted: 12/20/2023] [Indexed: 01/22/2024]
Abstract
The relationship between urinary tract infection caused by urease-producing bacteria and lithiasis due to struvite stones is well established in the literature. However, there is limited knowledge on whether non-urease producing bacteria can also promote crystallization. In our study, we analyzed the association between urinary lithiasis, other than struvite by crystallography and non-ureolytic bacteria, in 153 patients who underwent surgery for urinary stone. The collected samples were sent for crystallographic analysis and culture. Additionally, preoperatory urine culture was collected for combined evaluation with the previous data. Percutaneous nephrolithotomy was the most commonly performed approach (45.8%). Struvite stones were more frequently identified in women (90.3%). Among stones with positive cultures, except struvite, 45.5% were composed of calcium oxalate monohydrate. The difference between urine culture and stone culture was different in 24.8% of the cases. Among stones with positive cultures that did not contain struvite, 86.4% showed non-urease bacteria in their cultures and 47.1% of struvite stones also did not have urease-producing bacteria in their cultures (p < 0.021). Our findings suggest that there is an association between non-ureolytic bacteria and stones that are not composed of struvite.
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Lumbreras J, Madariaga L, Rodrigo MD. Pediatric renal lithiasis in Spain: research, diagnostic and therapeutic challenges, and perspectives. Front Pediatr 2023; 11:1294319. [PMID: 38143536 PMCID: PMC10746353 DOI: 10.3389/fped.2023.1294319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Incidence and prevalence of urolithiasis is apparently increasing worldwide, also among children and adolescents. Nevertheless, robust data have only been obtained in a few countries. In Spain, a voluntary Registry for Pediatric Renal Lithiasis has been active since 2015. Irregular participation limits its applicability, as well as its limitation to patients with a stone available for morphocompositional study, to obtain data about incidence and prevalence. On the other hand, findings about typology of stones and clinical and analytical characteristics of these subjects have been communicated in several meetings. Other valuable efforts in this field are the elaboration of guidelines for the collection and processing of urine samples for the study of urolithiasis in pediatric patients with the consensus of the Spanish Society for Pediatric Nephrology (AENP) as well as the Spanish Society for Laboratory Medicine (SEQC), the collaborative network RenalTube for the diagnosis of primary tubulopathies and the registry of patients with Primary Hyperoxaluria (OxalSpain). In many hospitals from the public healthcare system, pediatric nephrologists are the specialists in charge of the management of children with kidney stones, but there is no formal regulation on this competence. Other specialists, such as urologists, pediatric surgeons or pediatric urologists, in many cases do not offer a complete insight into the etiopathogenic mechanisms and the consequent medical treatment. Access to medication according to standards of treatment is warranted, provided a correct diagnosis is achieved, but criteria for the reimbursement of certain therapies, such as RNAi drugs for primary hyperoxaluria, are arguable.
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Affiliation(s)
- Javier Lumbreras
- Pediatric Nephrology Unit, Department of Pediatrics, Son Espases University Hospital, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Leire Madariaga
- Pediatric Nephrology Department, Cruces University Hospital, IIS Biocruces Bizkaia, University of the Basque Country, CIBERER/CIBERDEM/EndoERN, Barakaldo, Spain
| | - María Dolores Rodrigo
- Pediatric Nephrology Unit, Department of Pediatrics, Son Espases University Hospital, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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Bauzá JL, Calvó P, Julià F, Guimerà J, Martínez AI, Tienza A, Costa-Bauzá A, Sanchís P, Grases F, Pieras E. Relationship between Urinary Parameters and Double-J Stent Encrustation. J Clin Med 2023; 12:5149. [PMID: 37568551 PMCID: PMC10420242 DOI: 10.3390/jcm12155149] [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: 06/19/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: This study aimed to determine the relationship between metabolic urine conditions and the formation, severity, and composition of encrustations in ureteral stents. (2) Methods: Ninety stone-former patients requiring a double-J stent were prospectively enrolled. We collected 24 h metabolic urine samples and demographic data, including indwelling time and previous stone composition. The total deposit weight was obtained, and a macroscopic classification according to the degree of encrustation (null, low, moderate, and high) was created, allowing for intergroup comparisons. Stereoscopic and scanning electron microscopy were performed to identify the type of embedded deposits (calcium oxalate, uric acid, and infectious and non-infectious phosphates). (3) Results: In total, 70% of stents were encrusted; thereof, 42% had a moderate degree of encrustation. The most common encrustation type was calcium oxalate, but infectious phosphates were predominant in the high-encrustation group (p < 0.05). A direct correlation was observed between the purpose-built macroscopic classification and the encrustation weights (p < 0.001). Greater calciuria, uricosuria, indwelling time, and decreased diuresis were observed in stents with a higher degree of encrustation (p < 0.05). The urinary pH values were lower in patients with uric acid encrustations and higher in those with infectious phosphate encrustations (p < 0.05). When compared to non-encrusted stents, patients with calcium-oxalate-encrusted stent showed greater calciuria, phosphaturia, indwelling time, and reduced diuresis; patients with uric-acid-encrusted stent showed greater uricosuria; and patients with infectious and non-infectious phosphate encrustation showed greater urinary pH (p < 0.05). (4) Conclusions: Metabolic urine conditions play a critical role in the formation, composition, and severity of double-J stent encrustation.
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Affiliation(s)
- Jose Luis Bauzá
- Urology Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain (A.I.M.); (A.T.)
- Nefro-Urologic Diseases Research Group, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), 07120 Palma de Mallorca, Spain
| | - Paula Calvó
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain (F.J.)
| | - Francesca Julià
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain (F.J.)
| | - Jorge Guimerà
- Urology Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain (A.I.M.); (A.T.)
- Nefro-Urologic Diseases Research Group, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), 07120 Palma de Mallorca, Spain
| | - Ana Isabel Martínez
- Urology Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain (A.I.M.); (A.T.)
- Nefro-Urologic Diseases Research Group, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), 07120 Palma de Mallorca, Spain
| | - Antonio Tienza
- Urology Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain (A.I.M.); (A.T.)
- Nefro-Urologic Diseases Research Group, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), 07120 Palma de Mallorca, Spain
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain (F.J.)
| | - Pilar Sanchís
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain (F.J.)
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain (F.J.)
| | - Enrique Pieras
- Urology Department, University Hospital Son Espases, 07120 Palma de Mallorca, Spain (A.I.M.); (A.T.)
- Nefro-Urologic Diseases Research Group, Fundación Instituto de Investigación Sanitaria Islas Baleares (IdISBa), 07120 Palma de Mallorca, Spain
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Costa-Bauzá A, Calvó P, Hernández Y, Grases F. Efficacy of Theobromine and Its Metabolites in Reducing the Risk of Uric Acid Lithiasis. Int J Mol Sci 2023; 24:10879. [PMID: 37446053 DOI: 10.3390/ijms241310879] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Uric acid lithiasis accounts for about 10% of all types of renal lithiasis. The most common causes of uric acid lithiasis are low urinary pH, followed by high concentration of urinary uric acid, and low diuresis. Treatment of patients consists of alkalinization of urine, reducing the consumption of purine-rich foods, and administration of xanthine oxidase inhibitors, because there are no established therapeutic inhibitors of uric acid crystallization. We recently found that theobromine inhibited uric acid crystallization in vitro, and that the increased urinary level of theobromine following its oral consumption was associated with the prevention of uric acid crystallization. In this study, we evaluated the inhibitory effects of theobromine metabolites and other methylxanthine-related compounds on uric acid crystallization. We also measured the urinary concentrations of theobromine and its metabolites in samples from healthy individuals and patients with uric acid stones and compared the extent of uric acid supersaturation and uric acid crystal formation in these different samples. Theobromine and other methylxanthines that lacked a substituent at position 1 inhibited uric acid crystallization, but other methylxanthines did not have this effect. Individuals with clinical parameters that favored uric acid crystallization did not develop uric acid crystals when theobromine and its metabolites were in the urine at high levels. Thus, theobromine and its metabolites reduced the risk of uric acid lithiasis.
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Affiliation(s)
- Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Paula Calvó
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain
| | | | - Fèlix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, 07122 Palma de Mallorca, Spain
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Coello I, Sanchis P, Pieras EC, Grases F. Diet in Different Calcium Oxalate Kidney Stones. Nutrients 2023; 15:nu15112607. [PMID: 37299570 DOI: 10.3390/nu15112607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Diet can be a helpful tool to enhance the quality of urine and lower the likelihood and recurrence of kidney stones. This study set out to identify the foods and nutrients that are associated with each type of calcium oxalate kidney stone formation. A single-center, cross-sectional study was conducted. Between 2018 and 2021, a sample of 90 cases (13 cases with papillary COM, 27 with non-papillary COM, and 50 with COD kidney stones), as well as a control group of 50 people, were chosen. A food intake frequency questionnaire was completed by the study's participants, and the results were compared between groups. Additionally, a comparison of the 24 h urine analysis between stone groups was made. Processed food and meat derivatives were linked to COM papillary calculi (OR = 1.051, p = 0.032 and OR = 1.013, p = 0.012, respectively). Consuming enough calcium may offer protection against non-papillary COM stones (OR = 0.997; p = 0.002). Similarly, dairy product consumption was linked to COD calculi (OR = 1.005, p = 0.001). In conclusion, a diet high in animal items may increase the risk of developing papillary COM stones. Consuming calcium may be preventive against non-papillary COM calculi, and dairy product consumption may be a risk factor for COD stones.
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Affiliation(s)
- Iris Coello
- Urology Department, Joan XXIII University Hospital, 43005 Tarragona, Spain
| | - Pilar Sanchis
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), University of the Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Enrique C Pieras
- Urology Department, Son Espases University Hospital, 07120 Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS), Health Research Institute of the Balearic Islands (IdISBa), University of the Balearic Islands, 07122 Palma de Mallorca, Spain
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Costa-Bauzá A, Grases F, Julià F. The power of desktop scanning electron microscopy with elemental analysis for analyzing urinary stones. Urolithiasis 2023; 51:50. [PMID: 36920587 PMCID: PMC10017624 DOI: 10.1007/s00240-023-01424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
The aim of this paper is to present a protocol for the routine morphocompositional study of kidney stones in a clinical setting, and to demonstrate that it is a simple and useful approach that can reliably determine the etiology of all types of kidney stones. Our routine study of kidney stones consists of a combination of stereoscopic microscopy, scanning electron microscopy, and infrared spectroscopy. The usefulness of such a procedure is demonstrated by its application to several illustrating examples. The protocol applied here is reliable and fast, and does not require multiple infrared spectroscopic analyses for most non-homogeneous samples. It also provides the identification of components that are present in very small proportions, the characteristics of internal and external structures, and information about areas with biological structures, such as renal tubules. It should be noted that results are obtained in a relatively short time and with high reliability. The detailed morphocompositional study of a urinary calculus is essential for establishing the diagnosis and etiology and for initiating the treatment of a patient with renal lithiasis, because there is a relationship between the specific characteristics of a stone and the specific etiology of the disease. The increasing number of treatments available for patients with different types of renal calculi makes improvements in diagnosis and determination of stone etiology, such as the procedure described here, more important now than ever.
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Affiliation(s)
- A Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain.
| | - F Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain
| | - F Julià
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain
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Guimerà J, Martínez A, Bauza JL, Sanchís P, Pieras E, Grases F. Effect of phytate on hypercalciuria secondary to bone resorption in patients with urinary stones: pilot study. Urolithiasis 2022; 50:685-690. [PMID: 36087116 PMCID: PMC9584984 DOI: 10.1007/s00240-022-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
The objective is to evaluate the effect of phytate supplements on calciuria in patients with urinary stones and elevated bone resorption. The secondary objective is to analyze the therapeutic effect of phytate based on measurements of serum markers of bone resorption. This is a controlled randomized study included patients according to predefined inclusion and exclusion criteria, and randomized them into two groups. Patients in the phytate group received a 380 mg capsule of calcium-magnesium InsP6 (Salvat Laboratories®) every 24 h for 3 months and patients in the control group received no treatment. All included patients were male or female, 18-65 years old, had hypercalciuria (> 250 mg/24 h), had a ß-Crosslaps level greater than 0.4 ng/mL, and had bone densitometry results indicative of osteopenia or osteoporosis in the femur and/or spine. At study onset, calciuria was 321 ± 52 mg/24 h in the phytate group and 305 ± 57 mg/24 h in the control group (p > 0.05). At 3 months, calciuria was significantly lower in the phytate group than the control group (226 ± 45 mg/24 h vs. 304 ± 58 mg/24 h, p < 0.05). At study onset, the mean ß-CrossLaps level was 1.25 ± 0.72 ng/mL in the phytate group and 0.57 ± 0.13 ng/mL in the control group (p < 0.05). However, at 3 months, the ß-CrossLaps level was significantly lower in the phytate group than in the control group (0.57 ± 0.13 ng/mL vs. 0.77 ± 0.42 ng/mL, p < 0.05). Phytate reduced calciuria in patients with hypercalciuria secondary to bone resorption. The ß-CrossLaps assay was effective for evaluating the efficacy of phytate on hypercalciuria during follow-up.
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Affiliation(s)
- Jordi Guimerà
- Urology Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain.
| | - Ana Martínez
- Urology Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain
| | - Jose Luis Bauza
- Urology Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain
| | - Pilar Sanchís
- University Health Science Research Institute (IUNICS), Science Department, Balearic Islands University, Palma, Spain
| | - Enrique Pieras
- Urology Department, Son Espases University Hospital, Carretera de Valldemossa, 79, 07120, Palma, Balearic Islands, Spain
| | - Felix Grases
- University Health Science Research Institute (IUNICS), Science Department, Balearic Islands University, Palma, Spain
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Michael KGFT, Michael S, Abusada E, Srirangam SJ, Bourdoumis A, Surange R. Does the mineral content of tap water correlate with urinary calculus composition? Urolithiasis 2022; 50:691-699. [DOI: 10.1007/s00240-022-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
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Valido IH, Fuentes-Cebrian V, Boada R, Vallcorba O, Resina-Gallego M, Valiente M, López-Mesas M. Discriminating the origin of calcium oxalate monohydrate formation in kidney stones via synchrotron microdiffraction. Analyst 2021; 147:349-357. [PMID: 34935777 DOI: 10.1039/d1an01703a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nephrolithiasis is a multifactor disease that produces nephrolites in the kidneys. Calcium oxalate hydrate (dihydrated, COD, or monohydrated, COM) stones are the most common ones with more than sixty percent incidence worldwide. They are related to different pathologies, COD with hypercalciuria and COM with hyperoxaluria. COD is an unstable species and transforms into COM (herein named TRA to distinguish the origin of the monohydrated species). TRA and COM are chemically and crystallographically identical leading to misdiagnosis and recurrence increase. In the current study, the composition and crystalline structures of several calcium oxalate stones, classified by morpho-constitutional analysis, were examined by IR and synchrotron through-the-substrate micro-X-ray diffraction (tts-μXRD). Both IR and linear diffractogram studies were able to distinguish between the monohydrated and dihydrated phases but not between COM and TRA, as expected. The analysis of 2D diffraction patterns revealed that TRA showed a lower degree of crystallinity and less texture with respect to COM which can be used as a signature to distinguish between the two. This study confirms that despite the subtle differences between COM and TRA, the origin of the monohydrate oxalates can be unraveled using tts-μXRD. This valuable information should be taken into account in order to improve patients' diagnosis and reduce recurrence by considering and treating the origin of the formed stones.
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Affiliation(s)
- Iris H Valido
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Victor Fuentes-Cebrian
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Roberto Boada
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Oriol Vallcorba
- ALBA Synchrotorn Light Source, Cerdanyola del Vallès, Barcelona, Spain
| | - Montserrat Resina-Gallego
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Manuel Valiente
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Montserrat López-Mesas
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
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Calvó P, Costa-Bauzá A, Grases F, Hernandez Y, Sanchis P. Validation of a novel diagnostic test for assessing the risk of urinary uric acid crystallization. Clin Chim Acta 2021; 519:187-192. [PMID: 33964262 DOI: 10.1016/j.cca.2021.05.001] [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: 03/18/2021] [Revised: 04/15/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Uric acid (UA) kidney stones account for 10 to 11% of all kidney stones, and this percentage has increased over time. An accurate, rapid, simple, and low-cost test is needed to distinguish urine that is susceptible and resistant to the formation of UA crystals. The aim of this paper is to develop a test to assess the risk for UA crystallization (RUAC) and to validate its utility in routine clinical practice by analysis of urine samples of UA stone formers and healthy volunteers. PATIENTS AND METHODS Urine samples of 20 healthy adult volunteers and 54 active formers of UA stones were collected. Three samples were collected from each participant, with at least 7 days between each collection. The main lithogenic parameters for UA stones were determined, and an RUAC test was performed in all urine samples. RESULTS Our RUAC test reliably discriminated urine that was resistant and susceptible to the formation of UA crystals. This test had high specificity (94%) and a low percentage of false negatives. CONCLUSION The RUAC test described here had high diagnostic accuracy, low-cost, and a rapid assay time, that make this test an attractive screening tool for UA stone fomers follow-up.
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Affiliation(s)
- Paula Calvó
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
| | - Yumaira Hernandez
- Urology Service of Manacor Hospital, Manacor 07500, Balearic Islands, Spain.
| | - Pilar Sanchis
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Palma de Mallorca 07122, Spain.
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Adelman A, Shilo Y, Modai J, Leibovici D, Dror I, Berkowitz B. Do organic substances act as a degradable binding matrix in calcium oxalate kidney stones? BMC Urol 2021; 21:46. [PMID: 33765979 PMCID: PMC7995742 DOI: 10.1186/s12894-021-00818-3] [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: 02/10/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Calcium oxalate (CaOx) stones are considered to be highly resistant to chemolysis. While significant organic matter has been identified within these stones, which is presumed to bind (inorganic) CaOx particles and aggregates, most chemolysis efforts have focused on methods to attack the CaOx components of a stone. We examine the feasibility of inducing chemolysis of CaOx kidney stones, within hours, by specifically attacking the organic matrix present in these stones. METHODS In contrast to previous studies, we focused on the possible "brick and mortar" stone configuration. We systematically tested, via in vitro experiments, the ability of an extensive range of 26 potential chemolysis agents to induce relatively fast disintegration (and/or dissolution) of a large set of natural CaOx stone fragments, extracted during endourological procedures, without regard to immediate clinical application. Each stone fragment was monitored for reduction in weight and other changes over 72 h. RESULTS We find that agents known to attack organic material have little, if any, effect on stone chemolysis. Similarly, protein and enzymatic agents, and oral additive medical treatments, have little immediate effect. CONCLUSIONS These findings suggest that the organic and inorganic constituents present in CaOx stones are not structured as "brick and mortar" configurations in terms of inorganic and organic components.
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Affiliation(s)
- Adi Adelman
- Department of Urology, Kaplan Medical Center, 7661041, Rehovot, Israel
| | - Yaniv Shilo
- Department of Urology, Kaplan Medical Center, 7661041, Rehovot, Israel
| | - Jonathan Modai
- Department of Urology, Kaplan Medical Center, 7661041, Rehovot, Israel
| | - Dan Leibovici
- Department of Urology, Kaplan Medical Center, 7661041, Rehovot, Israel
| | - Ishai Dror
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, 7610001, Rehovot, Israel
| | - Brian Berkowitz
- Department of Earth and Planetary Sciences, Weizmann Institute of Science, 7610001, Rehovot, Israel.
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Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). Actas Urol Esp 2021; 45:154-159. [PMID: 32854978 DOI: 10.1016/j.acuro.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.
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14
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H Valido I, Resina-Gallego M, Yousef I, Luque-Gálvez MP, Valiente M, López-Mesas M. Calcium oxalate kidney stones, where is the organic matter?: A synchrotron based infrared microspectroscopy study. JOURNAL OF BIOPHOTONICS 2020; 13:e202000303. [PMID: 32892479 DOI: 10.1002/jbio.202000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Kidney stones are collections of microcrystals formed inside the kidneys, which affect 6% to 12% of the population worldwide, with an increasing recurrence (50%-72%) after the first episode. The most abundant type is calcium oxalate (66%), described as monohydrated (COM) and dihydrated (COD). An issue in their chemistry is the transformation process of the metastable specie (COD) into the stable one, which is chemically, and in appearance, monohydrated. Since the origin of these species is different, it is important to differentiate between the transformation stage (and what stabilize COD) to understand the physiopathology and prevent the patients' recurrence. This work focuses on the organic matter distribution along these nephroliths by synchrotron radiation-based infrared microspectroscopy. Differences in the asymmetric stretching of the aliphatic hydrocarbons suggest that lipids may participate in the stabilization of COD and as inhibitors of COM formation/development; however, the presence of proteins in the nucleus could indicate a promoting role.
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Affiliation(s)
- Iris H Valido
- Centre Grup de Tècniques de Separació en Química (GTS), Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Montserrat Resina-Gallego
- Centre Grup de Tècniques de Separació en Química (GTS), Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Ibraheem Yousef
- MIRAS beamline BL01, ALBA-CELLS Synchrotron, Cerdanyola del Vallès, Spain
| | | | - Manuel Valiente
- Centre Grup de Tècniques de Separació en Química (GTS), Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Montserrat López-Mesas
- Centre Grup de Tècniques de Separació en Química (GTS), Departament de Química, Universitat Autònoma de Barcelona, Bellaterra, Spain
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15
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Grases F, Costa-Bauza A, Garcia-Raja A, Rodrigo D. Rare non-papillary lithiasis of calcium oxalate monohydrate generated on a central core of potassium urate. Urol Case Rep 2020; 34:101483. [PMID: 33204645 PMCID: PMC7653282 DOI: 10.1016/j.eucr.2020.101483] [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: 09/29/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 11/24/2022] Open
Abstract
This report describes a patient who developed a spheroidal calculus with a central part composed of potassium urate, surrounded by a continuous layer of calcium oxalate monohydrate with crystals of calcium oxalate dihydrate on the surface. The mechanism of calculus development is also suggested.
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Affiliation(s)
- Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS- IDISBA), University of Balearic Islands, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS- IDISBA), University of Balearic Islands, Spain
| | - Ana Garcia-Raja
- Clinical Analysis Service, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Pediatric Service, Son Espases University Hospital, Palma de Mallorca, Spain
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16
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Rodriguez A, Cunha TDS, Rodgers AL, Gambaro G, Ferraro PM. Comparison of Supersaturation Outputs from Different Programs and Their Application in Testing Correspondence with Kidney Stone Composition. J Endourol 2020; 35:687-694. [PMID: 33050741 DOI: 10.1089/end.2020.0894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Relative supersaturation (SS) for calcium oxalate (CaOx), calcium phosphate (CaP), and uric acid (UA) has been used for assessing urinary crystallization and estimated by programs, including EQUIL, Joint Expert Speciation System (JESS), and Lithorisk. We compared outputs from these programs and their correspondence with stone composition. Materials and Methods: SS of CaOx, CaP, and UA, using EQUIL, JESS, and Lithorisk were calculated from stone-forming patients. Pearson correlation coefficients were used to ascertain the correspondence between the outputs. Fractional regression models evaluated the relationship between SS and the percentage of each compound in the stones. Results: Two hundred eleven patients were included. Pearson correlation coefficients for CaOx (r ≥ 0.96), CaP (r ≥ 0.99), and UA SS (r ≥ 0.99) showed a high correspondence between all programs. We observed a significant correspondence between CaOx SS and the percentage of CaOx dihydrate in the stone (p < 0.001), as well as between the percentage of brushite and apatite and CaP SS. UA SS showed the strongest correspondence with the percentage of UA in the stones (p < 0.001). Conclusions: Good correlation between EQUIL, JESS, and Lithorisk was observed and good correspondence with stone composition. The magnitude of the association demonstrated by fractional regression models supports evidence for applying SS in clinical practice.
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Affiliation(s)
- Adrián Rodriguez
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
| | - Tamara da Silva Cunha
- Division of Nephrology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Allen L Rodgers
- Division of Chemistry, University of Cape Town, Cape Town, South Africa
| | - Giovanni Gambaro
- Renal Unit, Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Pietro Manuel Ferraro
- U.O.C. Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.,Università Cattolica del Sacro Cuore, Roma, Italia
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17
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Urine and stone analysis for the investigation of the renal stone former: a consensus conference. Urolithiasis 2020; 49:1-16. [PMID: 33048172 PMCID: PMC7867533 DOI: 10.1007/s00240-020-01217-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/11/2020] [Indexed: 01/08/2023]
Abstract
The Consensus Group deliberated on a number of questions concerning urine and stone analysis over a period of months, and then met to develop consensus. The Group concluded that analyses of urine and stones should be routine in the diagnosis and treatment of urinary stone diseases. At present, the 24-h urine is the most useful type of urine collection, and accepted methods for analysis are described. Patient education is also important for obtaining a proper urine sample. Graphical methods for reporting urine analysis results can be helpful both for the physician and for educating the patient as to proper dietary changes that could be beneficial. Proper analysis of stones is also essential for diagnosis and management of patients. The Consensus Group also agreed that research has shown that evaluation of urinary crystals could be very valuable, but the Group also recognizes that existing methods for assessment of crystalluria do not allow this to be part of stone treatment in many places.
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18
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Martinez A, Trinh DH, El Beze J, Hubert J, Eschwege P, Estrade V, Aguilar L, Daul C, Ochoa G. Towards an automated classification method for ureteroscopic kidney stone images using ensemble learning. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1936-1939. [PMID: 33018381 DOI: 10.1109/embc44109.2020.9176121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Urolithiasis is a common disease around the world and its incidence has been growing every year. There are various diagnosis techniques based on kidney stone identification aiming to find the formation cause. However, most of them are time consuming, tedious and expensive. The accuracy of the diagnosis is crucial for the prescription of an appropriate treatment that can eliminate the stones and diminish future relapses. This paper presents two effective supervised learning methods to automate and improve the accuracy of the classification of kidney stones; as well as a dataset consisting of kidney stone images captured with ureteroscopes. In the proposed methods, the image features that are visually exploited by urologists to distinguish the type of kidney stones are analyzed and encoded as vectors. Then, the classification is performed on these feature vectors through Random Forest and ensemble K Nearest Neighbor classifiers. The overall classification accuracy obtained was 89%, outperforming previous methods by more than 10%. The details of the classifier implementation, as well as their performance and accuracy, are presented and discussed. Finally, future work and improvements are proposed.
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19
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Cunha TDS, Rodriguez A, Heilberg IP. Influence of socioeconomic disparities, temperature and humidity in kidney stone composition. J Bras Nefrol 2020; 42:454-460. [PMID: 32716471 PMCID: PMC7860642 DOI: 10.1590/2175-8239-jbn-2019-0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Large variations in demographic, economic and environmental factors might influence the worldwide distribution of urolithiasis, but scarce data are available concerning their associations with stone composition. We aimed to evaluate the frequency and composition of kidney stones and their associations with temperature, humidity, and human development index (HDI). MATERIALS AND METHODS A total of 1,158 stones from distinct patients (47±14 years old, male/female 2:1) were included. The mean annual temperature and relative humidity of each town were considered separately. RESULTS Calcium oxalate monohydrate (COM) was disclosed in 38.8% of patients, calcium oxalate dihydrate (COD) in 22.1%, mixed COD/apatite in 9.4%, pure apatite in 1.9%, brushite in 1.8%, struvite in 8.3%, pure uric acid in 11.1%, mixed uric acid/COM in 5.6%, and cystine/rare types in 0.8%. Mean HDI of all pooled cities was 0.780±0.03. However, people living in HDI<0.800 regions had twice the odds of having a struvite stone versus those living in HDI>0.800 (OR=2.14, 95% CI 1.11-4.11). Furthermore, a progressive increase in the struvite stones frequency from 4.5 to 22.8% was detected from HDI>0.800 through HDI<0.700. No significant difference for other stone types was disclosed. Separate logistic regression models assessed the association of each stone composition with gender, temperature, humidity and HDI as covariates. CONCLUSION Patients living in low HDI areas are more prone to develop struvite stones, possibly due to lower access to healthcare. Temperature and humidity did not represent a specific risk factor for any stone type in the present sample.
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Affiliation(s)
- Tamara da Silva Cunha
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil.,Universidade Federal do Rio de Janeiro, Divisão de Nefrologia, Rio de Janeiro, RJ, Brazil
| | - Adrian Rodriguez
- Universita Cattolica del Sacro Cuore, Department of Medical Sciences, Rome, Italy
| | - Ita Pfeferman Heilberg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil
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20
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Torrecilla C, Fernández-Concha J, Cansino JR, Mainez JA, Amón JH, Costas S, Angerri O, Emiliani E, Arrabal Martín MA, Arrabal Polo MA, García A, Reina MC, Sánchez JF, Budía A, Pérez-Fentes D, Grases F, Costa-Bauzá A, Cuñé J. Reduction of ureteral stent encrustation by modulating the urine pH and inhibiting the crystal film with a new oral composition: a multicenter, placebo controlled, double blind, randomized clinical trial. BMC Urol 2020; 20:65. [PMID: 32503502 PMCID: PMC7275439 DOI: 10.1186/s12894-020-00633-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Encrustation of ureteral double J stents is a common complication that may affect its removal. The aim of the proposed study is to evaluate the efficacy and safety of a new oral composition to prevent double J stent encrustation in indwelling times up to 8 weeks. METHODS A double-blinded, multicenter, placebo-controlled trial was conducted with 105 patients with indwelling double J stents enrolled across 9 public hospitals in Spain. The patients were randomly assigned (1:1) into intervention (53 patients) or placebo (52 patients) groups for 3 to 8 weeks and both groups self-monitored daily their morning urine pH levels. The primary outcome of analysis was the degree of stent ends encrustation, defined by a 4-point score (0 - none; 3 - global encrustation) using macroscopic and electron microscopy analysis of crystals, after 3 to 8-w indwelling period. Score was exponentially transformed according to calcium levels. Secondary endpoints included urine pH decrease, stent removal, and incidence of adverse events. RESULTS The intervention group benefits from a lower global encrustation rate of stent ends than placebo group (1% vs 8.2%; p < 0.018). Mean encrustation score was 85.12 (274.5) in the placebo group and 18.91 (102.27) in the intervention group (p < 0.025). Considering the secondary end points, treated patients reported greater urine pH decreases (p = 0.002). No differences in the incidence of adverse events were identified between the groups. CONCLUSIONS Our data suggest that the use of this new oral composition is beneficial in the context of ureteral double J indwelling by decreasing mean, as well as global encrustation. TRIAL REGISTRATION This trial was registered at www.clinicaltrials.gov under the name "Combined Use of a Medical Device and a Dietary Complement in Patient Urinary pH Control in Patients With an Implanted Double J Stent" with date 2nd November 2017, code NCT03343275, and URL.
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Affiliation(s)
| | | | | | | | - José H Amón
- Rio Hortega University Hospital, Valladolid, Spain
| | | | | | | | | | | | - Ana García
- Virgen de Valme University Hospital, Sevilla, Spain
| | | | | | - Alberto Budía
- University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Daniel Pérez-Fentes
- University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Félix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS- IDISBA), University of Balearic Islands (UIB), Palma de Mallorca, Spain.
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS- IDISBA), University of Balearic Islands (UIB), Palma de Mallorca, Spain
| | - Jordi Cuñé
- Devicare S.L., Cerdanyola del Vallès, Spain
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21
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Sabaté Arroyo XA, Grases Freixedas F, Bauzà Quetglas JL, Guimerà Garcia J, Pieras Ayala E. Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis. BMC Urol 2020; 20:46. [PMID: 32334600 PMCID: PMC7183647 DOI: 10.1186/s12894-020-00615-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023] Open
Abstract
Background Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis. Methods This prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall’s plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher’s exact test and Student’s t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant. Results The most common injury was tubular calcification (78%), followed by Randall’s plaque (58%), and papillary crater (39%). There was no significant relationship of Randall’s plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall’s plaque with hypocitraturia (p = 0.005). Conclusions There are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall’s plaque.
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Affiliation(s)
- X A Sabaté Arroyo
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain.
| | - F Grases Freixedas
- Universitat de les Illes Balears. IUNICS, Ctra. de Valldemossa, Km. 7.5, Palma de Mallorca, Spain
| | - J L Bauzà Quetglas
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - J Guimerà Garcia
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - E Pieras Ayala
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
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Prieto RM, Rodriguez A, Sanchis P, Morey M, Fiol M, Grases F, Castañer O, Martínez-González MA, Salas-Salvadó J, Romaguera D. Association of Adherence to The Mediterranean Diet with Urinary Factors Favoring Renal Lithiasis: Cross-Sectional Study of Overweight Individuals with Metabolic Syndrome. Nutrients 2019; 11:nu11081708. [PMID: 31344950 PMCID: PMC6723981 DOI: 10.3390/nu11081708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/21/2019] [Accepted: 07/21/2019] [Indexed: 11/16/2022] Open
Abstract
Our purpose was to study the relationship of adherence to the Mediterranean diet (MedDiet) with urinary factors that favor the formation of renal calcium and uric acid stones in overweight and obese participants who had metabolic syndrome. This cross-sectional study examined 267 participants. A well-known MedDiet score (range 0–9) was calculated for each patient, and patients were then categorized has having low (≤3), medium (4–5), or high (≥6) adherence to the MedDiet. Baseline characteristics and urinary parameters were also analyzed. High calcium salt urinary crystallization risk (CaUCR) and high uric acid urinary crystallization risk (UrUCR) were calculated from urinary parameters using pre-defined criteria. More than half of patients with MedDiet scores ≤3 had high UrUCR (55.4%) and high CaUCR (53.8%). In contrast, fewer patients with high adherence (≥6) to the MedDiet had high UrUCR (41.2%) and high CaUCR (29.4%). Relative to those with low adherence, individuals with high adherence had a prevalence ratio (PR) of 0.77 for a high UrUCR (95% CI: 0.46–1.12; p for trend: 0.069) and a PR of 0.51 for a high CaUCR (95% CI: 0.26–0.87; p for trend: 0.012) after adjusting for age, sex, body mass index, type 2 diabetes, and total energy intake. Our findings indicate that greater adherence to the MedDiet was associated with a reduced CaUCR and a reduced UrUCR. This suggests that adequate dietary management using the MedDiet patterns may prevent or reduce the incidence and recurrence of calcium salt and uric acid renal stones.
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Affiliation(s)
- Rafael M Prieto
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain.
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
| | - Pilar Sanchis
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Margalida Morey
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Miquel Fiol
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa). University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
| | - Olga Castañer
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Cardiovascular Risk and Nutrition (Regicor Study Group), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain
| | - Miguel A Martínez-González
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, 31009 Pamplona, Spain
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Jordi Salas-Salvadó
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Human Nutrition Unit, University Hospital of Sant Joan de Reus, 43204 Reus, Spain
- Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Rovira i Virgili University, 43003 Tarragona, Spain
| | - Dora Romaguera
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdISBa), University Hospital Son Espases, 07120 Palma de Mallorca, Spain
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Prevalence of distal renal tubular acidosis in patients with calcium phosphate stones. World J Urol 2019; 38:789-794. [PMID: 31079188 DOI: 10.1007/s00345-019-02804-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND PURPOSE Distal renal tubular acidosis (DRTA) is a metabolic disorder that associates urolithiasis and urinary pH > 6. The prevalence of DRTA in patients with calcium phosphate stones is not well known. The objective is to determine the prevalence of DRTA in patients with calcium phosphate stones and urinary pH above 6 based on the furosemide test. METHODS A total of 54 patients with calcium phosphate stones and urinary pH above 6.0 were submitted to the furosemide test. The association of DRTA with age, sex, type of stone, stone recurrence, stone bilaterality, 24-h urine biochemistry, and adverse effects of the furosemide test were examined. RESULTS The furosemide test indicated that 19 of 54 patients (35.2%) had DRTA. The sex ratio was similar in the two groups (p < 0.776). The DRTA group was significantly younger (p < 0.001), and had a higher prevalence of bilateral stones (p < 0.001), a higher prevalence of recurrent stones (p < 0.04), a lower plasma potassium level (p < 0.001), a higher urinary Ca level (p ≤ 0.05), and a lower urinary citrate level (p < 0.001). None of the patients reported adverse effects from the furosemide test. CONCLUSIONS There was a high prevalence of DTRA in patients with urinary pH above 6 and calcium phosphate stones. Young age, bilateral stones, stone recurrence, hypercalciuria, hypocitraturia, and plasma hypokalemia were associated with DRTA. None of the patients reported adverse effects of the furosemide test.
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Rodriguez A, Saez-Torres C, Mir C, Casasayas P, Rodriguez N, Rodrigo D, Frontera G, Buades JM, Gomez C, Costa-Bauza A, Grases F. Effect of sample time on urinary lithogenic risk indexes in healthy and stone-forming adults and children. BMC Urol 2018; 18:116. [PMID: 30567525 PMCID: PMC6299942 DOI: 10.1186/s12894-018-0430-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/10/2018] [Indexed: 11/12/2022] Open
Abstract
Background The diagnosis and follow-up of stone forming patients is usually performed by analysis of 24-h urine samples. However, crystallization risk varies throughout the day, being higher at night. The main objective of this study is to evaluate the urinary crystallization risk in adults and children by calculating risk indexes based on different collection periods. Methods The study included 149 adults (82 healthy and 67 stone-formers) and 108 children (87 healthy and 21 stone-formers). 24-h urine was collected, divided into 12-h daytime sample (8 am to 8 pm), and 12-h overnight sample (8 pm to 8 am next morning). Solute concentrations, the calcium to citrate ratio (Ca/Cit), and the ion activity product of calcium oxalate (AP[CaOx]) and calcium phosphate (AP[CaP]) were calculated in each 12-h sample and in overall 24-h urine. Assessments were also related to stone type. Results Ca/Cit and AP(CaOx) were significantly higher in stone forming patients than in healthy subjects. The 12-h overnight samples had the highest values for both risk indexes, confirming a greater risk for crystallization at night. The AP(CaP) index was significantly higher in patients with pure hydroxyapatite stones than healthy controls, but was not significantly different between stone-formers overall and healthy controls. Conclusions The calculation of risk indexes is a simple method that clinicians can use to estimate crystallization risk. For this purpose, the use of 12-h overnight urine may be a reliable alternative to 24-h collections.
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Affiliation(s)
- Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.
| | - Concepcion Mir
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Paula Casasayas
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Nuria Rodriguez
- Department of Urology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain.,Department of Pediatric Nephrology, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Juan Manuel Buades
- Department of Nephrology, Son Llatzer Hospital, 07198, Palma de Mallorca, Spain
| | - Cristina Gomez
- Clinical Analysis Service, Son Espases Universitary Hospital, 07020, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra Valldemossa, km 7.5, 07122, Palma de Mallorca, Spain
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Costa-Bauza A, Grases F, Calvó P, Rodriguez A, Prieto RM. Effect of Consumption of Cocoa-Derived Products on Uric Acid Crystallization in Urine of Healthy Volunteers. Nutrients 2018; 10:E1516. [PMID: 30332783 PMCID: PMC6213556 DOI: 10.3390/nu10101516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study was to determine the effects of consumption of different cocoa-derived products on uric acid crystallization in urine of 20 healthy volunteers. Participants were requested to select the specific diet that they wished to follow during the 12 h prior to collection of urine. The only restriction was that the diet could not include any product with cocoa, coffee, or caffeine. On the first day, each volunteer followed their selected diet, and an overnight 12 h urine sample was collected as the baseline urine. After seven days on an unrestricted diet, each volunteer repeated the same diet with 20 g of milk chocolate, chocolate powder, or dark chocolate during breakfast and another 20 g during dinner. Overnight 12 h urine samples were then collected. Urine volume, pH, oxalate, creatinine, uric acid, theobromine, and a uric acid crystallization test were determined for each sample. The results for all 20 patients show that uric acid crystallization was significantly lower following the consumption of chocolate powder or dark chocolate relative to baseline or following the consumption of milk chocolate. The results indicated that increased concentrations of urinary theobromine reduced the risk of uric acid crystallization.
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Affiliation(s)
- Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain.
| | - Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain.
| | - Paula Calvó
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain.
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain.
| | - Rafael M Prieto
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. Valldemossa km 7.5, 07122 Palma de Mallorca, Spain.
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26
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Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
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Castiglione V, Sacré PY, Cavalier E, Hubert P, Gadisseur R, Ziemons E. Raman chemical imaging, a new tool in kidney stone structure analysis: Case-study and comparison to Fourier Transform Infrared spectroscopy. PLoS One 2018; 13:e0201460. [PMID: 30075002 PMCID: PMC6075768 DOI: 10.1371/journal.pone.0201460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The kidney stone's structure might provide clinical information in addition to the stone composition. The Raman chemical imaging is a technology used for the production of two-dimension maps of the constituents' distribution in samples. We aimed at determining the use of Raman chemical imaging in urinary stone analysis. MATERIAL AND METHODS Fourteen calculi were analyzed by Raman chemical imaging using a confocal Raman microspectrophotometer. They were selected according to their heterogeneous composition and morphology. Raman chemical imaging was performed on the whole section of stones. Once acquired, the data were baseline corrected and analyzed by MCR-ALS. Results were then compared to the spectra obtained by Fourier Transform Infrared spectroscopy. RESULTS Raman chemical imaging succeeded in identifying almost all the chemical components of each sample, including monohydrate and dihydrate calcium oxalate, anhydrous and dihydrate uric acid, apatite, struvite, brushite, and rare chemicals like whitlockite, ammonium urate and drugs. However, proteins couldn't be detected because of the huge autofluorescence background and the small concentration of these poor Raman scatterers. Carbapatite and calcium oxalate were correctly detected even when they represented less than 5 percent of the whole stones. Moreover, Raman chemical imaging provided the distribution of components within the stones: nuclei were accurately identified, as well as thin layers of other components. Conversion of dihydrate to monohydrate calcium oxalate was correctly observed in the centre of one sample. The calcium oxalate monohydrate had different Raman spectra according to its localization. CONCLUSION Raman chemical imaging showed a good accuracy in comparison with infrared spectroscopy in identifying components of kidney stones. This analysis was also useful in determining the organization of components within stones, which help locating constituents in low quantity, such as nuclei. However, this analysis is time-consuming, making it more suitable for research studies rather than routine analysis.
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Affiliation(s)
- Vincent Castiglione
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Pierre-Yves Sacré
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Philippe Hubert
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Romy Gadisseur
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Eric Ziemons
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
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Chatterjee P, Chakraborty A, Mukherjee AK. Phase composition and morphological characterization of human kidney stones using IR spectroscopy, scanning electron microscopy and X-ray Rietveld analysis. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 200:33-42. [PMID: 29660680 DOI: 10.1016/j.saa.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
Pathological calcification in human urinary tract (kidney stones) is a common problem affecting an increasing number of people around the world. Analysis of such minerals or compounds is of fundamental importance for understanding their etiology and for the development of prophylactic measures. In the present study, structural characterization, phase quantification and morphological behaviour of thirty three (33) human kidney stones from eastern India have been carried out using IR spectroscopy (FT-IR), powder X-ray diffraction (PXRD) and scanning electron microscopy (SEM). Quantitative phase composition of kidney stones has been analyzed following the Rietveld method. Based on the quantitative estimates of constituent phases, the calculi samples have been classified into oxalate (OX), uric acid (UA), phosphate (PH) and mixed (MX) groups. Rietveld analysis of PXRD patterns showed that twelve (36%) of the renal calculi were composed exclusively of whewellite (calcium oxalate monohydrate, COM). The remaining twenty one (64%) stones were mixture of phases with oxalate as the major constituent in fourteen (67%) of these stones. The average crystallite size of whewellite in oxalate stones, as determined from the PXRD analysis, varies between 93 (1) nm and 202 (3) nm, whereas the corresponding sizes for the uric acid and struvite crystallites in UA and PH stones are 79 (1)-155 (4) nm and 69 (1)-123(1) nm, respectively. The size of hydroxyapatite crystallites, 10 (1)-21 (1) nm, is smaller by about one order of magnitude compared to other minerals in the kidney stones. A statistical analysis using fifty (50) kidney stones (33 calculi from the present study and 17 calculi reported earlier from our laboratory) revealed that the oxalate group (whewellite, weddellite or mixture of whewellite and weddellite as the major constituent) is the most prevalent (82%) kidney stone type in eastern India.
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Affiliation(s)
- Paramita Chatterjee
- Department of Physics, Jadavpur University, Kolkata 700032, India; Department of Physics, Lady Brabourne College, Kolkata 700017, India
| | - Arup Chakraborty
- Department of Community Medicine, Medical College, Kolkata 700073, India
| | - Alok K Mukherjee
- Department of Physics, Jadavpur University, Kolkata 700032, India.
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Grases F. Epidemiology of renal lithiasis and associated factors. Med Clin (Barc) 2017; 149:397-398. [PMID: 28545951 DOI: 10.1016/j.medcli.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Felix Grases
- Laboratorio de Investigación en Litiasis Renal, Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS-IDISBA), Universidad de las Islas Baleares, Palma de Mallorca, España.
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30
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Trinchieri A, Montanari E. Prevalence of renal uric acid stones in the adult. Urolithiasis 2017; 45:553-562. [PMID: 28258472 DOI: 10.1007/s00240-017-0962-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/28/2017] [Indexed: 01/25/2023]
Abstract
The aim of this study was to estimate uric acid renal stone prevalence rates of adults in different countries of the world. PubMed was searched for papers dealing with "urinary calculi and prevalence or composition" for the period from January 1996 to June 2016. Alternative searches were made to collect further information on specific topics. The prevalence rate of uric acid stones was computed by the general renal stone prevalence rate and the frequency of uric acid stones in each country. After the initial search, 2180 papers were extracted. Out of them, 79 papers were selected after the reading of the titles and of the abstracts. For ten countries, papers relating to both the renal stone prevalence in the general population and the frequency of uric stones were available. Additional search produced 13 papers that completed information on 11 more countries in 5 continents. Estimated prevalence rate of uric acid stones was >0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population), United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India (Southern), Spain, Taiwan, Germany, Brazil; and <0.50% in Tunisia, China, Korea, Japan, Caribe, South Africa (blacks), India (Northern). Climate and diet are major determinants of uric acid stone formation. A hot and dry climate increases fluid losses reducing urinary volume and urinary pH. A diet rich in meat protein causes low urinary pH and increased uric acid excretion. On the other hand, uric acid stone formation is frequently associated with obesity, metabolic syndrome and diabetes type 2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat and also present with low urine pH values. An epidemic of uric acid stone formation could be if current nutritional trends will be maintained both in developed countries and in developing countries and the areas of greater climatic risk for the formation of uric acid stones will enlarge as result of the "global warming".
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Affiliation(s)
- Alberto Trinchieri
- Urology Unit, Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Emanuele Montanari
- IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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31
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Trinchieri A, Montanari E. Biochemical and dietary factors of uric acid stone formation. Urolithiasis 2017; 46:167-172. [PMID: 28246885 DOI: 10.1007/s00240-017-0965-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/30/2017] [Indexed: 11/30/2022]
Abstract
The aim of this study was to compare the clinical characteristics of "pure" uric acid renal stone formers (UA-RSFs) with that of mixed uric acid/calcium oxalate stone formers (UC-RSFs) and to identify which urinary and dietary risk factors predispose to their formation. A total of 136 UA-RSFs and 115 UC-RSFs were extracted from our database of renal stone formers. A control group of 60 subjects without history of renal stones was considered for comparison. Data from serum chemistries, 24-h urine collections and 24-h dietary recalls were considered. UA-RSFs had a significantly (p = 0.001) higher body mass index (26.3 ± 3.6 kg/m2) than UC-RSFs, whereas body mass index of UA-RSFs was higher but not significantly than in controls (24.6 ± 4.7) (p = 0.108). The mean urinary pH was significantly lower in UA-RSFs (5.57 ± 0.58) and UC-RSFs (5.71 ± 0.56) compared with controls (5.83 ± 0.29) (p = 0.007). No difference of daily urinary uric acid excretion was observed in the three groups (p = 0.902). Daily urinary calcium excretion was significantly (p = 0.018) higher in UC-RSFs (224 ± 149 mg/day) than UA-RSFs (179 ± 115) whereas no significant difference was observed with controls (181 ± 89). UA-RSFs tend to have a lower uric acid fractional excretion (0.083 ± 0.045% vs 0.107+/-0.165; p = 0.120) and had significantly higher serum uric acid (5.33 ± 1.66 vs 4.78 ± 1.44 mg/dl; p = 0.007) than UC-RSFs. The mean energy, carbohydrate and vitamin C intakes were higher in UA-SFs (1987 ± 683 kcal, 272 ± 91 g, 112 ± 72 mg) and UC-SFs (1836 ± 74 kcal, 265 ± 117, 140 ± 118) with respect to controls (1474 ± 601, 188 ± 84, 76 ± 53) (p = 0.000). UA-RSFs should be differentiated from UC-RSFs as they present lower urinary pH, lower uric acid fractional excretion and higher serum uric acid. On the contrary, patients with UC-RSFs show urinary risk factors more similar to those for calcium oxalate stones. The dietary approach in patients forming uric acid stones should be reconsidered with more attention to the quantity and quality of carbohydrate intake.
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Affiliation(s)
- Alberto Trinchieri
- Urology Unit, Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Emanuele Montanari
- IRCCS Ca' Granda Ospedale Maggiore Policlinico-University of Milan, Milan, Italy
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Grases F, Costa-Bauzá A. Simplified methods for the evaluation of the risk of forming renal stones and the follow-up of stone-forming propensity during the preventive treatment of stone-formation. Urolithiasis 2015; 44:77-82. [PMID: 26614111 DOI: 10.1007/s00240-015-0838-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Abstract
Renal lithiasis is a complex multifactorial disease in which recurrence is common. Thus, simple and reliable procedures are needed to evaluate patients with previous kidney stones to determine the risk of recurrence. In this paper we review simple biochemical procedures that can be used to determine the risk for renal stone formation when the stone is available or unavailable for analysis. Our present knowledge of renal lithiasis indicates that renal stones form due to several well-defined factors. Analysis of the renal stone itself can provide important information about clinical factors that require further investigation. When the stone is unavailable, it is necessary to perform a general evaluation of main urinary risk factors associated to renal stone formation, but this study should be complemented considering information related to direct familial antecedents, recidivant degree, radiological images, medical history, and life style habits. Finally, tools for patient follow-up of stone-forming propensity during the preventive treatment are discussed .
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Affiliation(s)
- Fèlix Grases
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, 07122, Palma de Mallorca, Spain.
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, 07122, Palma de Mallorca, Spain
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33
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Grases F, Rodriguez A, Costa-Bauza A, Saez-Torres C, Rodrigo D, Gómez C, Mir-Perello C, Frontera G. Factors Associated With the Lower Prevalence of Nephrolithiasis in Children Compared With Adults. Urology 2015; 86:587-92. [PMID: 26144339 DOI: 10.1016/j.urology.2015.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the reasons behind the lower prevalence of kidney stones in children by assessing urinary lithogenic parameters in healthy children, healthy adults, and 3 groups of stone-former patients. METHODS The study subjects included 75 healthy adults, 105 healthy children, 62 patients with previous calcium oxalate monohydrate papillary stones, 120 patients with previous calcium oxalate monohydrate unattached stones, and 248 patients with previous calcium oxalate dihydrate stones. Twenty-four-hour urine samples were collected, and the urinary lithogenic parameters were measured. RESULTS Calcium, magnesium, and phosphorous concentration differed significantly between healthy children and adults. Except citrate, all solute/creatinine ratios differed between healthy children and adults. However, these differences were much more important in the cases of calcium and magnesium. The calcium/creatinine ratio was 2-fold lower, whereas the magnesium/creatinine ratio was 2-fold higher, in healthy children than that in healthy adults (P <.001 each). The calcium/creatinine ratio was higher and the citrate/creatinine ratio lower in calcium oxalate dihydrate stone formers than that in healthy adults. CONCLUSION Ratios of calcium and magnesium to creatinine, as well as morphoanatomic factors and lifestyle habits, may explain the lower prevalence of nephrolithiasis in children than those in adults.
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Affiliation(s)
- Felix Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain.
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Concepcion Saez-Torres
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain
| | - Dolores Rodrigo
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain; Department of Pediatric Nephrology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Cristina Gómez
- Laboratory Department, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Concepcion Mir-Perello
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Palma de Mallorca, Spain; Department of Pediatric Nephrology, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Guiem Frontera
- Research Unit, Son Espases University Hospital, Palma de Mallorca, Spain
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Blanco F, Ortiz-Alías P, López-Mesas M, Valiente M. High precision mapping of kidney stones using μ-IR spectroscopy to determine urinary lithogenesis. JOURNAL OF BIOPHOTONICS 2015; 8:457-465. [PMID: 25091212 DOI: 10.1002/jbio.201300201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 03/13/2014] [Accepted: 07/02/2014] [Indexed: 06/03/2023]
Abstract
Evolution of urinary lithiasis is determined by the metabolism and life-style of the related patient. The appropriate classification of the stone is mandatory for the identification of the lithogenic process. In this study, cros-sections from a single stone of each of the most frequent urolithiasis types (calcium oxalate mono and dihydrate and carbonate apatite) have been selected and imaged using IR microspectroscopy. Moreover, the use of high definition sFTIR (synchrotron source) has revealed hidden information to the conventional FTIR. This work has demonstrated that minor components become key factors on the description of the stages of stone formation. Intensity map for COM (1630 cm(-1) peak). The high spatial definition achieved is key for the precise description of the kidney stone history.
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Affiliation(s)
- Francisco Blanco
- Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Pilar Ortiz-Alías
- Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
| | - Montserrat López-Mesas
- Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
| | - Manuel Valiente
- Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain
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35
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Non-invasive differentiation of kidney stone types using X-ray dark-field radiography. Sci Rep 2015; 5:9527. [PMID: 25873414 PMCID: PMC4397641 DOI: 10.1038/srep09527] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/11/2015] [Indexed: 02/01/2023] Open
Abstract
Treatment of renal calculi is highly dependent on the chemical composition of the stone in question, which is difficult to determine using standard imaging techniques. The objective of this study is to evaluate the potential of scatter-sensitive X-ray dark-field radiography to differentiate between the most common types of kidney stones in clinical practice. Here, we examine the absorption-to-scattering ratio of 118 extracted kidney stones with a laboratory Talbot-Lau Interferometer. Depending on their chemical composition, microscopic growth structure and morphology the various types of kidney stones show strongly varying, partially opposite contrasts in absorption and dark-field imaging. By assessing the microscopic calculi morphology with high resolution micro-computed tomography measurements, we illustrate the dependence of dark-field signal strength on the respective stone type. Finally, we utilize X-ray dark-field radiography as a non-invasive, highly sensitive (100%) and specific (97%) tool for the differentiation of calcium oxalate, uric acid and mixed types of stones, while additionally improving the detectability of radio-lucent calculi. We prove clinical feasibility of the here proposed method by accurately classifying renal stones, embedded within a fresh pig kidney, using dose-compatible measurements and a quick and simple visual inspection.
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Effects of polyphenols from grape seeds on renal lithiasis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:813737. [PMID: 25883748 PMCID: PMC4389982 DOI: 10.1155/2015/813737] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 01/15/2023]
Abstract
Nephrolithiasis is a complex disease that results from a combination of factors related to both urine composition and kidney morphoanatomy. Development of calcium oxalate monohydrate papillary calculi is linked to initial subepithelial calcification of renal papilla. Progressive tissue calcification depends on preexisting injury and involves reactive oxygen species. Many plant extracts that protect against oxidative stress manifest antilithiasic activity. Our study focused on determining the effects of polyphenols on a lithiasis rat model. Rats were pretreated with polyphenols and grape seed extracts, followed by posterior induction of hyperoxalosis via treatment with ethylene glycol plus NH4Cl. The concentrations of calcium and other elements in kidney were determined, along with histological examination of kidney and 24 h urine analysis. Significant differences were observed in the renal calcium content between the control plus ethylene glycol-treated group and the epicatechin plus ethylene glycol-treated, red grape seed extract plus ethylene glycol-treated, and white grape seed extract plus ethylene glycol-treated groups, with reductions of about 50%. The antioxidant activity of polyphenols extracted from red and white grape seeds may be critical in the prevention of calcium oxalate monohydrate papillary calculus formation, particularly if calculi are induced by lesions caused by cytotoxic compounds with oxidative capacity.
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Cloutier J, Villa L, Traxer O, Daudon M. Kidney stone analysis: "Give me your stone, I will tell you who you are!". World J Urol 2014; 33:157-69. [PMID: 25465911 PMCID: PMC4308647 DOI: 10.1007/s00345-014-1444-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Stone analysis is an important part in the evaluation of patients having stone disease. This could orientate the physician toward particular etiologies. MATERIAL AND METHODS Chemical and physical methods are both used for analysis. Unfortunately, chemical methods often are inadequate to analyze accurately urinary calculi and could fail to detect some elements into the stone. Physical methods, in counterpart, are becoming more and more used in high-volume laboratories. The present manuscript will provide a review on analytic methods, and review all the information that should be included into an appropriate morpho-constitutional analysis. CONCLUSION This report can supply an excellent summarization of the stone morphology and give the opportunity to find specific metabolic disorders and different lithogenic process into the same stone. Here, specific chemical types with their different crystalline phases are shown in connection with their different etiologies involved.
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Affiliation(s)
- Jonathan Cloutier
- Urology Department, Tenon University Hospital, 4 rue de la Chine, 75970, Paris Cedex 20, France
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Blanco F, Lumbreras F, Serrat J, Siener R, Serranti S, Bonifazi G, López-Mesas M, Valiente M. Taking advantage of hyperspectral imaging classification of urinary stones against conventional infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:126004. [PMID: 25478869 DOI: 10.1117/1.jbo.19.12.126004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 10/24/2014] [Indexed: 05/15/2023]
Abstract
The analysis of urinary stones is mandatory for the best management of the disease after the stone passage in order to prevent further stone episodes. Thus the use of an appropriate methodology for an individualized stone analysis becomes a key factor for giving the patient the most suitable treatment. A recently developed hyperspectral imaging methodology, based on pixel-to-pixel analysis of near-infrared spectral images, is compared to the reference technique in stone analysis, infrared (IR) spectroscopy. The developed classification model yields >90% correct classification rate when compared to IR and is able to precisely locate stone components within the structure of the stone with a 15 µm resolution. Due to the little sample pretreatment, low analysis time, good performance of the model, and the automation of the measurements, they become analyst independent; this methodology can be considered to become a routine analysis for clinical laboratories.
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Affiliation(s)
- Francisco Blanco
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
| | - Felipe Lumbreras
- Universitat Autònoma de Barcelona, Computer Vision Center & Department of Computer Science, 08193 Bellaterra, Spain
| | - Joan Serrat
- Universitat Autònoma de Barcelona, Computer Vision Center & Department of Computer Science, 08193 Bellaterra, Spain
| | - Roswitha Siener
- University Stone Centre, Department of Urology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Silvia Serranti
- Sapienza-Università di Roma, Dipartimento di Ingegneria Chimica Materiali Ambiente (DICMA), 00184 Roma, Italy
| | - Giuseppe Bonifazi
- Sapienza-Università di Roma, Dipartimento di Ingegneria Chimica Materiali Ambiente (DICMA), 00184 Roma, Italy
| | - Montserrat López-Mesas
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
| | - Manuel Valiente
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
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Grases F, Costa-Bauzá A, Bonarriba CR, Pieras EC, Fernández RA, Rodríguez A. On the origin of calcium oxalate monohydrate papillary renal stones. Urolithiasis 2014; 43 Suppl 1:33-9. [PMID: 25086903 DOI: 10.1007/s00240-014-0697-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
Abstract
Calcium oxalate monohydrate (COM) papillary calculi can be initiated by subepithelial calcification of the renal papillae. Hydroxyapatite disruption of the papillary epithelial layer can become the nidus of a COM papillary calculus. This study evaluated the causes of papillary tissue calcifications in 60 patients with calcium oxalate lithiasis, 30 with COM papillary and 30 with calcium oxalate dihydrate (COD) calculi. Urinary redox potential was higher in the COM than the COD group, suggesting that the former is more deficient in antioxidants due to increased oxidative stress. Urinary calcium was significantly higher in the COD group, whereas urinary oxalate was significantly higher in the COM group, suggesting a greater degree of oxidative injury of renal cells. Evaluations of their diets showed that both groups consumed low amounts of phytate-rich products. Of chronic diseases possibly associated with urolithiasis, only the prevalence of gastroduodenal ulcer differed significantly, being higher in the COM group and suggesting that epithelial lesions are common to gastroduodenal ulcers and COM papillary renal stones. Occupational exposure to cytotoxic products occurred in 47 % of the COM and 27 % of the COD group, but this difference was not statistically significant. These findings indicate that oxidative stress is associated with injury to papillary tissue and that this is the origin of intrapapillary calcifications. The continuation of this process is due to modulators and/or deficiencies in inhibitors of crystallization. Identifying and eliminating the causes of injury may prevent recurrent episodes in patients with papillary COM calculi.
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Affiliation(s)
- Fèlix Grases
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, 07122, Palma de Mallorca, Spain,
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Friedlander JI, Moreira DM, Hartman C, Elsamra SE, Smith AD, Okeke Z. Comparison of the metabolic profile of mixed calcium oxalate/uric acid stone formers to that of pure calcium oxalate and pure uric acid stone formers. Urology 2014; 84:289-94. [PMID: 24929942 DOI: 10.1016/j.urology.2014.04.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 04/07/2014] [Accepted: 04/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the metabolic profile of patients who form mixed calcium oxalate (CaOx)/uric acid (UA) stones to those of pure CaOx and pure UA stone formers. METHODS We performed a retrospective review of 232 patients, with both stone composition analysis and 24-hour urine collection, seen between March 2002 and April 2012. Analysis of 24-hour urine constituents across the 3 stone groups (pure UA, pure CaOx, and mixed CaOx/UA) was performed using univariate analysis of variance and multivariate linear regression models adjusting for clinical and demographic factors and 24-hour urine collection elements. RESULTS A total of 27 patients (11.6%) had mixed CaOx/UA, 122 (52.6%) had pure CaOx, and 83 (35.8%) had pure UA calculi. Univariate analysis demonstrated significant differences between mixed CaOx/UA patients and pure CaOx patients for urine pH (mixed, 5.63 ± 0.49 vs pure, CaOx 5.93 ± 0.51; P = .009) and supersaturation (SS) UA (mixed, 1.84 ± 1.09 vs pure, CaOx 1.26 ± 0.93; P = .01), and a significant difference between mixed CaOx/UA patients and pure UA patients for SS CaOx (mixed, 7.18 ± 4.23 vs pure, UA 4.90 ± 2.96; P = .005). Multivariate analysis demonstrated that mixed CaOx/UA patients had no significant difference in SS CaOx as compared with pure CaOx patients (difference, -0.27; P = .66), whereas at the same time had no significant difference in SS UA as compared with pure UA patients (-0.07; P = .69). CONCLUSION The metabolic profile of patients who form mixed CaOx/UA stones demonstrates abnormalities that promote both CaOx and UA stone formation. Dietary and medical management for this group of patients should address treatment of both defects.
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Affiliation(s)
- Justin I Friedlander
- Department of Urology, UT Southwestern Medical Center, Dallas, TX; The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY.
| | - Daniel M Moreira
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Christopher Hartman
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Sammy E Elsamra
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Arthur D Smith
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
| | - Zeph Okeke
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine at Hofstra University, New Hyde Park, NY
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Grases F, Rodriguez A, Berga F, Costa-Bauza A, Prieto RM, Burdallo I, Cadarso A, Jimenez-Jorquera C, Baldi A, Garganta R. A new device for simple and accurate urinary pH testing by the Stone-former patient. SPRINGERPLUS 2014; 3:209. [PMID: 24839588 PMCID: PMC4022968 DOI: 10.1186/2193-1801-3-209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/23/2014] [Indexed: 11/24/2022]
Abstract
Purpose Urinary pH is an important factor linked to renal stone disease and a useful marker in the treatment of urolithiasis. Although the gold standard for measuring urinary pH utilizes a glass electrode and a pH meter, at present dipstick testing is largely used to estimate urinary pH. However, the accuracy and precision of this method may be insufficient for making clinical decisions in patients with lithiasis. The aim of this study is to describe a new device for urinary pH testing. Methods The device includes a pH sensor based on differential measurement of an ISFET-REFET pair. The drawbacks associated with this type of configuration, namely short lifetime and manual fabrication, have been overcome in the prototype. An automatic one point calibration is performed when turning on the system. Two buffer solutions were utilized to determine the intra- and inter-day precision of the device. The pH of 30 fresh human urine samples was measured using a pH-meter, a dipstick and the new electronic device. Results In some cases, dipstick measurements differed from those of the pH meter by more than 0.40 units, a clinically relevant discrepancy, whereas none of the measurements made with the new electronic device differed from the results of the pH-meter by more than 0.1 pH units. Conclusions This new electronic device has the possibility to be used by stone-formers to control their urinary pH at home, increasing the tools available for stone prevention and prophylaxis.
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Affiliation(s)
- Felix Grases
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Ctra. de Valldemossa, km 7.5, 07122 Palma de Mallorca, Spain
| | - Adrian Rodriguez
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Ctra. de Valldemossa, km 7.5, 07122 Palma de Mallorca, Spain
| | - Francisco Berga
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Ctra. de Valldemossa, km 7.5, 07122 Palma de Mallorca, Spain
| | - Antonia Costa-Bauza
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Ctra. de Valldemossa, km 7.5, 07122 Palma de Mallorca, Spain
| | - Rafael Maria Prieto
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, University Institute of Health Sciences Research (IUNICS-IdISPa), University of Balearic Islands, Ctra. de Valldemossa, km 7.5, 07122 Palma de Mallorca, Spain
| | - Isabel Burdallo
- Instituto de Microelectrónica de Barcelona, IMB-CNM (CSIC), Campus UAB, E-08193 Cerdanyola, Spain
| | - Alfredo Cadarso
- Instituto de Microelectrónica de Barcelona, IMB-CNM (CSIC), Campus UAB, E-08193 Cerdanyola, Spain
| | - Cecilia Jimenez-Jorquera
- Instituto de Microelectrónica de Barcelona, IMB-CNM (CSIC), Campus UAB, E-08193 Cerdanyola, Spain
| | - Antonio Baldi
- Instituto de Microelectrónica de Barcelona, IMB-CNM (CSIC), Campus UAB, E-08193 Cerdanyola, Spain
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Grases F, Costa-Bauzá A, Prieto RM, Servera A. Internalization of Calcium Oxalate Calculi Developed in Narrow Cavities. Urol Case Rep 2014; 2:51-3. [PMID: 26955544 PMCID: PMC4733024 DOI: 10.1016/j.eucr.2013.12.011] [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: 12/13/2013] [Revised: 12/23/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022] Open
Abstract
We describe the case of a patient with calcium oxalate monohydrate and calcium oxalate dihydrate calculi occluded in cavities. All those calculi were located inside narrow cavities covered with a thin epithelium that permits their visualization. Urinary biochemical analysis showed high calciuria, not hypercalciuria, hypocitraturia, and a ratio [calcium]/[citrate] >0.33. The existence of cavities of very low urodynamic efficacy was decisive in the formation of such calculi. It is important to emphasize that we observed a thin epithelium covering such cavities, demonstrating that this epithelium may be formed after the development of the calculi through a re-epithelialization process.
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Affiliation(s)
- Fèlix Grases
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Antonia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Rafel M Prieto
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Antonio Servera
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain; Hospital de Manacor, IB-Salut, Manacor, Spain
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High-throughput powder X-ray diffraction, IR-spectroscopy and ion chromatography analysis of urinary stones: A comparative study. OPEN CHEM 2013. [DOI: 10.2478/s11532-013-0335-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe instrumental qualitative analysis of urinary stones is a critical step in clinical practice and urological research. A powder X-ray diffraction, IR-spectroscopy and ion chromatography have been applied for the qualitative analysis of 20 urinary stones. Suggestions for a sample preparation and an optimal measurement strategy were formulated. The main difficulties for the powder X-ray diffraction qualitative analysis are a limiting amount of the sample and a preferential orientation of crystals, both issues should be minimized by the special sample preparation. Urinary stones samples have been clustered into four groups using different sets of numerical input data (cation and anion content, phase composition). At the same time a high-throughput multivariate clustering has been applied for powder X-ray diffraction and IR-spectroscopy data. The multivariate whole-profile approach can be used as a tool for a high-throughput time reducing technique for clinical practice, when a quick and stable classification of samples is required. All three sets of the data can be automatically separated into three clusters: oxalate-reach, oxalate-pure and non-oxalate samples. Uricite-pure and uricite-rich samples can be easily clustered.
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Moreira DM, Friedlander JI, Hartman C, Elsamra SE, Smith AD, Okeke Z. Differences in 24-Hour Urine Composition Between Apatite and Brushite Stone Formers. Urology 2013; 82:768-72. [DOI: 10.1016/j.urology.2013.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/30/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Duan X, Qu M, Wang J, Trevathan J, Vrtiska T, Williams JC, Krambeck A, Lieske J, McCollough C. Differentiation of calcium oxalate monohydrate and calcium oxalate dihydrate stones using quantitative morphological information from micro-computerized and clinical computerized tomography. J Urol 2013; 189:2350-6. [PMID: 23142201 PMCID: PMC3966517 DOI: 10.1016/j.juro.2012.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2012] [Indexed: 11/24/2022]
Abstract
PURPOSE We differentiated calcium oxalate monohydrate and calcium oxalate dihydrate kidney stones using micro and clinical computerized tomography images. MATERIALS AND METHODS A total of 22 calcium oxalate monohydrate and 15 calcium oxalate dihydrate human kidney stones were scanned using a commercial micro-computerized tomography scanner with a pixel size of 7 to 23 μm. Under an institutional review board approved protocol, image data on 10 calcium oxalate monohydrate and 9 calcium oxalate dihydrate stones greater than 5 mm were retrieved from a total of 80 patients who underwent clinical dual energy computerized tomography for clinical indications and had stones available for infrared spectroscopic compositional analysis. Micro and clinical computerized tomography images were processed using in-house software, which quantified stone surface morphology with curvature based calculations. A shape index was generated as a quantitative shape metric to differentiate calcium oxalate monohydrate from calcium oxalate dihydrate stones. Statistical tests were used to test the performance of the shape index. RESULTS On micro-computerized tomography images the shape index of calcium oxalate monohydrate and calcium oxalate dihydrate stones significantly differed (ROC curve AUC 0.92, p <0.0001). At the optimal cutoff sensitivity was 0.93 and specificity was 0.91. On clinical computerized tomography images a significant morphological difference was also detected (p = 0.007). AUC, sensitivity and specificity were 0.90, 1 and 0.73, respectively. CONCLUSIONS On micro and clinical computerized tomography images a morphological difference was detectable in calcium oxalate monohydrate and calcium oxalate dihydrate stones larger than 5 mm. The shape index is a highly promising method that can distinguish calcium oxalate monohydrate and calcium oxalate dihydrate stones with reasonable accuracy.
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Affiliation(s)
- Xinhui Duan
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Mingliang Qu
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | | | - James Trevathan
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Terri Vrtiska
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - James C. Williams
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Amy Krambeck
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - John Lieske
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
| | - Cynthia McCollough
- Departments of Radiology (XD, MQ, JW, JT, TV, CM), Urology (AK), Internal Medicine (JL) and Laboratory Medicine and Pathology (JL), Mayo Clinic, Rochester and Department of Physics, Gustavus Adolphus College (JT), St. Peter, Minnesota, and Department of Anatomy and Cell Biology, Indiana University School of Medicine (JCW), Indianapolis, Indiana
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Giannossi ML, Summa V, Mongelli G. Trace element investigations in urinary stones: a preliminary pilot case in Basilicata (Southern Italy). J Trace Elem Med Biol 2013; 27:91-7. [PMID: 23141501 DOI: 10.1016/j.jtemb.2012.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 04/13/2012] [Accepted: 09/27/2012] [Indexed: 11/22/2022]
Abstract
The role of trace elements in the lithogenesis of urinary stones is still debated. However, it is generally appreciated that urinary stones are one of the most common health problems in the world and are strongly associated with environmental factors. It is important to highlight that urinary stones containing trace elements could be considered a marker of environmental pollution. A large set of urinary stones (48), collected among the Basilicata (southern Italy) inhabitants, was analysed by AAS and ICP for the content of specific chemical elements that were either involved in the crystallisation process of kidney stones (Ca, Mg, K, Zn, Fe, Cu, and Mn) or which were potentially toxic (Pb, Cr). Three main findings emerge from the results: Furthermore, the results showed that the concentrations of Zn, Cu, Fe, Pb and Cr were greater than that of ingested from a standard diet. Consequently, varying amounts of these elements may have been attributed to their enrichment in the diet of the inhabitants of polluted areas.
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Grases F, Costa-Bauzá A, Prieto RM, Conte A, Servera A. Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study. BMC Urol 2013; 13:14. [PMID: 23497010 PMCID: PMC3599710 DOI: 10.1186/1471-2490-13-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. METHODS From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. RESULTS The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. CONCLUSIONS Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi.
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Affiliation(s)
- Fèlix Grases
- Laboratory of Renal Lithiasis Research, Faculty of Sciences, Universitary Institute of Health Sciences Research (IUNICS), University of Balearic Islands, Palma de Mallorca, 07122, Spain.
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Jarolímová Z, Lubal P, Kanický V. Analysis of renal stones by capillary isotachophoresis. Talanta 2012; 98:49-53. [DOI: 10.1016/j.talanta.2012.06.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 06/09/2012] [Accepted: 06/15/2012] [Indexed: 11/16/2022]
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Bandyopadhyay BC, Swaim WD, Sarkar A, Liu X, Ambudkar IS. Extracellular Ca(2+) sensing in salivary ductal cells. J Biol Chem 2012; 287:30305-16. [PMID: 22778254 DOI: 10.1074/jbc.m112.394122] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ca(2+) is secreted from the salivary acinar cells as an ionic constituent of primary saliva. Ions such as Na(+) and Cl(-) get reabsorbed whereas primary saliva flows through the salivary ductal system. Although earlier studies have shown that salivary [Ca(2+)] decreases as it flows down the ductal tree into the oral cavity, ductal reabsorption of Ca(2+) remains enigmatic. Here we report a potential role for the G protein-coupled receptor, calcium-sensing receptor (CSR), in the regulation of Ca(2+) reabsorption by salivary gland ducts. Our data show that CSR is present in the apical region of ductal cells where it is co-localized with transient receptor potential canonical 3 (TRPC3). CSR is activated in isolated salivary gland ducts as well as a ductal cell line (SMIE) by altering extracellular [Ca(2+)] or by aromatic amino acid, L-phenylalanine (L-Phe, endogenous component of saliva), as well as neomycin. CSR activation leads to Ca(2+) influx that, in polarized cells grown on a filter support, is initiated in the luminal region. We show that TRPC3 contributes to Ca(2+) entry triggered by CSR activation. Further, stimulation of CSR in SMIE cells enhances the CSR-TRPC3 association as well as surface expression of TRPC3. Together our findings suggest that CSR could serve as a Ca(2+) sensor in the luminal membrane of salivary gland ducts and regulate reabsorption of [Ca(2+)] from the saliva via TRPC3, thus contributing to maintenance of salivary [Ca(2+)]. CSR could therefore be a potentially important protective mechanism against formation of salivary gland stones (sialolithiasis) and infection (sialoadenitis).
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Affiliation(s)
- Bidhan C Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC 20422, USA.
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Blanco F, López-Mesas M, Serranti S, Bonifazi G, Havel J, Valiente M. Hyperspectral imaging based method for fast characterization of kidney stone types. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:076027. [PMID: 22894510 DOI: 10.1117/1.jbo.17.7.076027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The formation of kidney stones is a common and highly studied disease, which causes intense pain and presents a high recidivism. In order to find the causes of this problem, the characterization of the main compounds is of great importance. In this sense, the analysis of the composition and structure of the stone can give key information about the urine parameters during the crystal growth. But the usual methods employed are slow, analyst dependent and the information obtained is poor. In the present work, the near infrared (NIR)-hyperspectral imaging technique was used for the analysis of 215 samples of kidney stones, including the main types usually found and their mixtures. The NIR reflectance spectra of the analyzed stones showed significant differences that were used for their classification. To do so, a method was created by the use of artificial neural networks, which showed a probability higher than 90% for right classification of the stones. The promising results, robust methodology, and the fast analytical process, without the need of an expert assistance, lead to an easy implementation at the clinical laboratories, offering the urologist a rapid diagnosis that shall contribute to minimize urolithiasis recidivism.
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Affiliation(s)
- Francisco Blanco
- Universitat Autònoma de Barcelona, Centre Grup de Tècniques de Separació en Química (GTS), Unitat de Química Analítica, Departament de Química, 08193 Bellaterra, Spain
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