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Song K, He M, Kong X, Xian Y, Zhang Y, Xie X, Xie S, Jia A, Ren Y. Benefits of uric acid-lowering medication after bariatric surgery in patients with gout. BMC Surg 2024; 24:186. [PMID: 38877436 PMCID: PMC11177500 DOI: 10.1186/s12893-024-02472-6] [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: 01/15/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND/PURPOSE Patients with gout are at risk for increased serum uric acid (SUA) levels and gout attacks in the short term after undergoing bariatric surgery, and the purpose of this study was to evaluate the benefits of short-term treatment with uric acid-lowering medication after bariatric surgery for the control of gout attacks and SUA levels in patients with gout. METHODS 71 patients who underwent SG from January 2020 to December 2022 were prospectively included. These patients were diagnosed with hyperuricemia before surgery and had a history of gout attacks. Patients were classified into a drug-treatment group (DTG, n = 32) and a non-drug-treatment group (NDTG, n = 39) according to whether they took uric acid-lowering medication after surgery. Changes in the number of gout attacks, body mass index (BMI), and SUA levels at 1 week, 1 month, 3 months, and 6 months after bariatric surgery were measured in both groups. RESULTS In the DTG, 22 patients (68.8%) experienced an increase in SUA within 1 week, 3 patients (9.4%) had an acute attack of gout within the first month, and no patients had a gout attack thereafter. In the NDTG, 35 patients (89.7%) experienced an increase in SUA within 1 week, 7 patients (17.9%) had an acute gout attack within the first month, and 4 patients (10.3%) experienced gout attacks between month 1 and month 3 postoperatively. Both groups were free of gout attacks between the 3rd and 6th postoperative month and showed a significant decrease in SUA and BMI by the sixth month. CONCLUSION In patients with gout, continued use of uric acid-lowering medication after bariatric surgery is beneficial in reducing the number of gout attacks and the risk of rising SUA.
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Affiliation(s)
- Ke Song
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Ming He
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Xiangxin Kong
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Yin Xian
- Nanchong Psychosomatic Hospital, Nanchong, 637770, P.R. China
| | - Yuan Zhang
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Xing Xie
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Sijun Xie
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Aimei Jia
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China
| | - Yixing Ren
- Department of General Surgery, the Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, P.R. China.
- Institute of Hepatobiliary Pancreatic Intestinal Diseases, North Sichuan Medical College, Nanchong, 637000, P.R. China.
- Chengdu XinHua Hospital Affiliated to North Sichuan Medical College, Chengdu, 610000, P.R. China.
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Fang D, Hu Y, Wang C, Tang C. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study. Open Med (Wars) 2023; 18:20230848. [PMID: 38025535 PMCID: PMC10656756 DOI: 10.1515/med-2023-0848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
We aimed to investigate the diagnostic value of urinary Tamm-Horsfall protein (THP) and 24 h urine osmolality for recurrent calcium oxalate (CaOx) stones. Clinical data of 120 patients with upper urinary tract stones admitted to our hospital between January 2020 and January 2022 were retrospectively reviewed. Patients were divided into recurrence (53 patients) and non-recurrence (67 patients) groups based on postoperative stone recurrence. Meanwhile, 50 healthy patients were selected as the control group. Urinary THP levels, 24 h urine osmolality, and biochemical indices were compared between the three groups; their diagnostic values for stone recurrence were evaluated using receiver operating characteristic (ROC) curves. Urinary THP, 24 h urine osmolality, and biochemical indices were significantly higher in the recurrence group than in the non-recurrence and control groups (P < 0.05). The 24 h urine osmolality was positively correlated with urinary oxalic acid and calcium excretion. ROC curve analysis showed that optimal cutoff values of urinary THP and 24 h urine osmolality for the diagnosis of stone development were ≥27.01 mg/L and ≥577.69 mOsm/(kg H2O), respectively. Furthermore, these indices combined significantly improved the accuracy of diagnosis. Urinary THP and 24 h urine osmolality were higher in patients with recurrent CaOx stones. Detection of both parameters combined can accurately diagnose stone recurrence.
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Affiliation(s)
- Daocheng Fang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Yuanyuan Hu
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Chao Wang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
| | - Chunhua Tang
- Department of Urology, Shanghai Songjiang District Central Hospital, Shanghai, 201600, China
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3
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Zhang C, Qiu S, Bian H, Tian B, Wang H, Tu X, Cai B, Jin K, Zheng X, Yang L, Wei Q. Association between Dietary Inflammatory Index and kidney stones in US adults: data from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Public Health Nutr 2021; 24:6113-6121. [PMID: 33602356 PMCID: PMC11148609 DOI: 10.1017/s1368980021000793] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We evaluate the association between the Dietary Inflammatory Index (DII) and kidney stones. DESIGN We performed a cross-sectional analysis using data from National Health and Nutrition Examination Survey (NHANES). Dietary intake information was assessed using first 24-h dietary recall interviews, and the Kidney Conditions were presented by a questionnaire. The primary outcome was to investigate the association between DII and incidence of kidney stones, and the secondary outcome was to assess the association between DII and nephrolithiasis recurrence. SETTING The NHANES, 2007-2016. PARTICIPANTS The study included 25 984 NHANES participants, whose data on DII and kidney stones were available, of whom 2439 reported a history of kidney stones. RESULTS For the primary outcome, after fully multivariate adjustment, DII score is positively associated with the risk of kidney stones (OR = 1·07; 95 % CI 1·04, 1·10). Then, compared Q4 with Q1, a significant 38 % increased likelihood of nephrolithiasis was observed. (OR = 1·38; 95 % CI 1·19, 1·60). For the secondary outcome, the multivariate regression analysis showed that DII score is positively correlated with nephrolithiasis recurrence (OR = 1·07; 95 % CI 1·00, 1·15). The results noted that higher DII scores (Q3 and Q4) are positively associated with a significant 48 % and 61 % increased risk of nephrolithiasis recurrence compared with the reference after fully multivariate adjustment (OR = 1·48; 95 % CI 1·07, 2·05; OR = 1·61; 95 % CI 1·12, 2·31). CONCLUSIONS Our findings revealed that increased intake of pro-inflammatory diet, as a higher DII score, is correlated with increased odds of kidney stones incidence and recurrence.
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Affiliation(s)
- Chichen Zhang
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
- West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shi Qiu
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
- Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Haiyang Bian
- Institute of Reproductive and Child Health and Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing, People's Republic of China
| | - Bowen Tian
- West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Haoyuan Wang
- West China School of Clinical Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiang Tu
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
| | - Boyu Cai
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
| | - Kun Jin
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
| | - Xiaonan Zheng
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
| | - Lu Yang
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
| | - Qiang Wei
- Department of Urology, Institute of Urology and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, No. 37, Guoxue Lane, Chengdu, Sichuan 610041, People's Republic of China
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Ng DM, Haleem M, Mamuchashvili A, Wang KY, Pan JF, Cheng Y, Ma Q. Medical evaluation and pharmacotherapeutical strategies in management of urolithiasis. Ther Adv Urol 2021; 13:1756287221993300. [PMID: 33708261 PMCID: PMC7907714 DOI: 10.1177/1756287221993300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
Treatment of urolithiasis depends on several important factors which include stone location, size, composition, and patient symptoms. Although significant advancements have been made in the surgical management of urolithiasis in the last decade, pharmacotherapy which can prevent the formation of new stones and decrease the recurrence of urolithiasis has not experienced the same level of success. Currently, urolithiasis is regarded as a complicated syndrome that is determined by numerous factors, and any treatment plan for urolithiasis should be individualized while considering any potential damage arising from stone-forming factors. This review introduces the most popular methods currently used to evaluate urolithiasis and the pharmacotherapy of urolithiasis based on patient-specific factors.
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Affiliation(s)
- Derry Minyao Ng
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Maria Haleem
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Anny Mamuchashvili
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Kai-yun Wang
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Jin-Feng Pan
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China
| | - Qi Ma
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, 59, Liuting Street, Ningbo, Zhejiang 315010, China
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Calcium Oxalate Nephrolithiasis and Gut Microbiota: Not just a Gut-Kidney Axis. A Nutritional Perspective. Nutrients 2020; 12:nu12020548. [PMID: 32093202 PMCID: PMC7071363 DOI: 10.3390/nu12020548] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Recent studies have shown that patients with kidney stone disease, and particularly calcium oxalate nephrolithiasis, exhibit dysbiosis in their fecal and urinary microbiota compared with controls. The alterations of microbiota go far beyond the simple presence and representation of Oxalobacter formigenes, a well-known symbiont exhibiting a marked capacity of degrading dietary oxalate and stimulating oxalate secretion by the gut mucosa. Thus, alterations of the intestinal microbiota may be involved in the pathophysiology of calcium kidney stones. However, the role of nutrition in this gut-kidney axis is still unknown, even if nutritional imbalances, such as poor hydration, high salt, and animal protein intake and reduced fruit and vegetable intake, are well-known risk factors for kidney stones. In this narrative review, we provide an overview of the gut-kidney axis in nephrolithiasis from a nutritional perspective, summarizing the evidence supporting the role of nutrition in the modulation of microbiota composition, and their relevance for the modulation of lithogenic risk.
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Abstract
BACKGROUND Urinary stone disease is a common condition characterised by increasing prevalence and high rates of recurrence. Observational studies have reported that increased water intake played a role in the prevention of urinary stone formation but with limited strength of evidence. OBJECTIVES To compare the effects of increased water intake with standard water intake for the prevention of urinary stone formation in participants with or without a history of urinary stones. SEARCH METHODS We performed a systematic search of PubMed (MEDLINE), EMBASE (Ovid) and the Cochrane Library to 15 October 2019. We handsearched review articles, clinical trial registries, and reference lists of retrieved articles. We did not apply any restrictions to publication language or publication status. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs looking at the benefits and harms of increased water intake versus standard water intake for the prevention of urinary stone formation in participants with or without a history of urinary stones. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias of included studies. We pooled dichotomous outcomes (e.g. incidence/recurrence rate of urinary stones; adverse events) using risk ratios (RRs) with 95% confidence intervals (CIs). We calculated hazard ratio (HRs) and corresponding 95% CIs to assess the intervention effect for time-to-event outcomes. We assessed the certainty of the evidence by using the GRADE criteria. MAIN RESULTS Our search identified no RCTs investigating the role of increased water intake for the prevention of urinary stone formation in participants with no history of urinary stones (primary prevention). We found one RCT assessing the effects of increased water intake versus standard water intake for the prevention of urinary stone formation in people with a history of urinary stones (secondary prevention). This trial randomised 220 participants (110 participants in the intervention group with increased water intake and 110 in the control group with standard water intake). Increased water intake was defined as achieving a urine volume of at least 2.0 L per day by drinking water. Based on this study, increased water intake may decrease stone recurrences (RR 0.45, 95% CI 0.24 to 0.84; 199 participants; low-certainty evidence); this corresponds to 149 fewer (43 fewer to 205 fewer) stone recurrences per 1000 participants with 270 stone recurrence per 1000 participants over five years in the control group. Increased water intake may also prolong the time to urinary stone recurrence compared to standard water intake (HR 0.40, 95% CI 0.20 to 0.79; 199 participants; low-certainty evidence); based on a stone recurrence rate of 270 per 1000 participants over five years, this corresponds to 152 fewer (209 fewer to 50 fewer) recurrences per 1000 participants. For both outcomes we downgraded the certainty of evidence for study limitations and imprecision. We found no evidence for the outcome of adverse events AUTHORS' CONCLUSIONS: We found no RCT evidence on the role of increased water intake for primary prevention of urinary stones. For secondary prevention, increased water intake achieving a urine volume of at least 2.0 L/day may reduce urinary stone recurrence and prolong time to recurrence for people with a history of urinary stone disease. However, our confidence in these findings is limited. We did not find evidence for adverse events.
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Affiliation(s)
- Yige Bao
- West China Hospital, Sichuan UniversityDepartment of UrologyNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Xiang Tu
- Sichuan UniversityWest China School of Clinical MedicineChengduChina
| | - Qiang Wei
- West China Hospital, Sichuan UniversityDepartment of UrologyNo. 37, Guo Xue XiangChengduSichuanChina610041
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Idiopathic calcium nephrolithiasis with pure calcium oxalate composition: clinical correlates of the calcium oxalate dihydrate/monohydrate (COD/COM) stone ratio. Urolithiasis 2019; 48:271-279. [PMID: 31506762 DOI: 10.1007/s00240-019-01156-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/02/2019] [Indexed: 10/26/2022]
Abstract
Pure calcium oxalate is the most frequent type of idiopathic kidney stone composition. Fourier transform infrared spectroscopy (FT-IR) allows to detect the ratio of calcium oxalate dihydrate (COD) and monohydrate (COM) crystals in stones, but the clinical significance of this parameter remains uncertain. The objective of this observational study was to verify the association of clinical and laboratory parameters of kidney stone disease with COD/COM ratio in a group of 465 (322 M, age 46 ± 14) patients suffering from idiopathic calcium nephrolithiasis with pure calcium oxalate stones (≥ 97%). Each participant underwent a complete clinical examination, serum chemistry, 24-h urine collection for the determination of the profile of lithogenic risk, and had stones analyzed by FT-IR. Most (62%) of the stones had a COD/COM ratio ≤ 0.25, and the urine chemistry of the corresponding patients showed a low prevalence of urinary metabolic abnormalities. With increasing COD/COM ratio intervals (0-0.25, 0.26-0.50, 0.51-0.75, 0.76-1), a significant association was observed for the number of urological procedures, serum calcium, 24-h urinary calcium excretion, prevalence of hypercalciuria and relative calcium oxalate supersaturation, and a negative trend was detected for the age of the first stone episode (all p values < 0.05). A linear regression model showed that the only parameters significantly associated with COD/COM ratio were 24-h urinary calcium excretion (standardized β = 0.464, p < 0.001) and urine pH (standardized β = 0.103, p = 0.013). In pure calcium oxalate idiopathic stones, COD/COM ratio may reflect the presence of urinary metabolic risk factors, and represent a guide for the prescription of urinary analyses.
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Kang HW, Seo SP, Ha YS, Kim WT, Kim YJ, Yun SJ, Kim WJ, Lee SC. Twenty-four-hour urine osmolality as a representative index of adequate hydration and a predictor of recurrence in patients with urolithiasis. Int Urol Nephrol 2019; 51:1129-1135. [PMID: 31089946 DOI: 10.1007/s11255-019-02108-2] [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: 12/19/2018] [Accepted: 02/16/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the value of 24-h urine osmolality (UOsm) as a representative index of adequate hydration and predictor of stone recurrence in patients with urolithiasis. METHODS Medical records of consecutive patients presenting with renal or ureteric stones between 1994 and 2017 were retrospectively reviewed. Patients were grouped according to the results of 24-h UOsm (low ≤ 564 mOsm/kg H2O, high > 564 mOsm/kg H2O). Metabolic parameters and risk of stone recurrence were compared between the two groups. RESULTS The low urine concentration group were more likely to be older, to be female, and to have a lower body mass index and higher glomerular filtration rate than the high concentration group (each P < 0.005). A positive correlation was seen between 24-h UOsm and urinary calcium, sodium, uric acid, and magnesium excretion and 24-h specific gravity; a negative correlation was seen with 24-h urine volume. Stone-forming constituents, such as calcium and uric acid, were significantly higher in the high urine concentration group. Kaplan-Meier estimates showed that the low urine concentration group had a significantly longer stone recurrence-free period than the high urine concentration group (log-rank test, P < 0.001). In multivariate Cox regression analyses, 24-h UOsm was seen to be an independent risk factor for stone recurrence. CONCLUSIONS UOsm is a promising approach to assessing hydration and predicting stone recurrence in patients with urolithiasis. Maintaining UOsm < 564 mOsm/kg H2O may reduce the risk of stone recurrence.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Pil Seo
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yong-June Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Seok-Joong Yun
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea.,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang-Cheol Lee
- Department of Urology, College of Medicine and Institute for Tumor Research, Chungbuk National University, 776 1sunhwan-ro, Seowon-gu, Cheonju, 28644, Korea. .,Department of Urology, Chungbuk National University Hospital, Cheongju, Korea.
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9
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Ticinesi A, Milani C, Guerra A, Allegri F, Lauretani F, Nouvenne A, Mancabelli L, Lugli GA, Turroni F, Duranti S, Mangifesta M, Viappiani A, Ferrario C, Dodi R, Dall'Asta M, Del Rio D, Ventura M, Meschi T. Understanding the gut-kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers. Gut 2018; 67:2097-2106. [PMID: 29705728 DOI: 10.1136/gutjnl-2017-315734] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The involvement of the gut microbiota in the pathogenesis of calcium nephrolithiasis has been hypothesised since the discovery of the oxalate-degrading activity of Oxalobacter formigenes, but never comprehensively studied with metagenomics. The aim of this case-control study was to compare the faecal microbiota composition and functionality between recurrent idiopathic calcium stone formers (SFs) and controls. DESIGN Faecal samples were collected from 52 SFs and 48 controls (mean age 48±11). The microbiota composition was analysed through 16S rRNA microbial profiling approach. Ten samples (five SFs, five controls) were also analysed with deep shotgun metagenomics sequencing, with focus on oxalate-degrading microbial metabolic pathways. Dietary habits, assessed through a food-frequency questionnaire, and 24-hour urinary excretion of prolithogenic and antilithogenic factors, including calcium and oxalate, were compared between SFs and controls, and considered as covariates in the comparison of microbiota profiles. RESULTS SFs exhibited lower faecal microbial diversity than controls (Chao1 index 1460±363vs 1658±297, fully adjusted p=0.02 with stepwise backward regression analysis). At multivariate analyses, three taxa (Faecalibacterium, Enterobacter, Dorea) were significantly less represented in faecal samples of SFs. The Oxalobacter abundance was not different between groups. Faecal samples from SFs exhibited a significantly lower bacterial representation of genes involved in oxalate degradation, with inverse correlation with 24-hour oxalate excretion (r=-0.87, p=0.002). The oxalate-degrading genes were represented in several bacterial species, whose cumulative abundance was inversely correlated with oxaluria (r=-0.85, p=0.02). CONCLUSIONS Idiopathic calcium SFs exhibited altered gut microbiota composition and functionality that could contribute to nephrolithiasis physiopathology.
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Affiliation(s)
- Andrea Ticinesi
- Microbiome Research Hub, University of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Christian Milani
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Franca Allegri
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Antonio Nouvenne
- Microbiome Research Hub, University of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Leonardo Mancabelli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Gabriele Andrea Lugli
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Francesca Turroni
- Microbiome Research Hub, University of Parma, Parma, Italy.,Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Sabrina Duranti
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Marta Mangifesta
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy.,GenProbio S.r.l., Parma, Italy
| | | | - Chiara Ferrario
- Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Rossella Dodi
- Department of Food and Drugs, University of Parma, Parma, Italy
| | | | - Daniele Del Rio
- Microbiome Research Hub, University of Parma, Parma, Italy.,Department of Veterinary Science, University of Parma, Parma, Italy
| | - Marco Ventura
- Microbiome Research Hub, University of Parma, Parma, Italy.,Laboratory of Probiogenomics, Department of Chemistry, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Tiziana Meschi
- Microbiome Research Hub, University of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dipartimento Medico-Geriatrico-Riabilitativo, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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10
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Tana C, Busetto L, Di Vincenzo A, Ricci F, Ticinesi A, Lauretani F, Nouvenne A, Giamberardino MA, Cipollone F, Vettor R, Meschi T. Management of hyperuricemia and gout in obese patients undergoing bariatric surgery. Postgrad Med 2018; 130:523-535. [PMID: 29888674 DOI: 10.1080/00325481.2018.1485444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hyperuricemia and gout represent important issues in the obese patients. Considering the epidemic trend of overweight and obesity in developed countries, the impact of these conditions is likely to increase. At present, bariatric surgery represents the most effective treatment for the management of severe obesity for reducing weight and the impact of associated comorbidities, but its effects on hyperuricemia and gout have not been fully elucidated. METHODS In this narrative review, we discuss the current knowledge about hyperuricemia and gout in obese patients undergoing bariatric surgery. We also suggest a useful approach to prevent gouty attacks in the perioperative period. RESULTS Weight loss seems to reduce hyperuricemia in the long-term follow-up, but there is evidence also of a high frequency of acute attacks early after surgery in patients with a diagnosis of gout. CONCLUSION Bariatric surgery has a high impact on hyperuricemia and gout. A perioperative approach is suggested, based on appropriate hydration, early physical resumption, urate lowering drugs and nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine and corticosteroids if NSAIDs are ineffective or not tolerated.
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Affiliation(s)
- Claudio Tana
- a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy
| | - Luca Busetto
- b Center for the Study and the Integrated Treatment of Obesity, Department of Medicine , University of Padova , Padova , Italy
| | - Angelo Di Vincenzo
- b Center for the Study and the Integrated Treatment of Obesity, Department of Medicine , University of Padova , Padova , Italy
| | - Fabrizio Ricci
- c Institute of Cardiology , University "G. d'Annunzio" , Chieti , Italy
| | - Andrea Ticinesi
- a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy
| | - Fulvio Lauretani
- a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy
| | - Antonio Nouvenne
- a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy
| | - Maria Adele Giamberardino
- d Geriatrics Clinic, Department of Medicine and Science of Aging and Ce.S.I.-MeT , "G. d'Annunzio" University of Chieti , Chieti , Italy
| | - Francesco Cipollone
- e European Center of Excellence on Hypertension, Dyslipidemia and Atherosclerosis, and Department of Medicine and Science of Aging , "G. d'Annunzio" University , Chieti , Italy
| | - Roberto Vettor
- b Center for the Study and the Integrated Treatment of Obesity, Department of Medicine , University of Padova , Padova , Italy
| | - Tiziana Meschi
- a Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, and Department of Medicine and Surgery , University-Hospital of Parma , Parma , Italy
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11
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Abstract
PURPOSE OF REVIEW Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.
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12
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Abstract
PURPOSE OF REVIEW Urinary risk factors, such as hypercalciuria, hypocitraturia, and hyperoxaluria, either in combination or alone, are associated with calcium stones. Dietary habits as well as underlying medical conditions can influence urinary risk factors. Evaluation of the conglomerate of patients' stone risks provides evidence for individualized medical management, an effective and patient-supported approach to prevention. RECENT FINDINGS Many patients with stones desire prevention to avoid repeated surgical interventions. Yet, recent practice pattern assessments and health care utilization data show that many patients are rarely referred for metabolic evaluation or management. Innovations in metabolic management over the past decade have improved its effectiveness in reducing risk and preventing calcium stones. Although no new pharmacologic agents for calcium stone prevention have recently become available, there is relatively new thinking about some diet-based approaches. This review will synthesize current evidence to support individualized metabolic management of calcium stones.
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Affiliation(s)
- Kristina L Penniston
- Clinical Nutrition Services, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI, 53792, USA. .,Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3258 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA.
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3258 Medical Foundation Centennial Building, Madison, WI, 53705-2281, USA.,Department of Medicine, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA.,Department of Radiology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, Madison, WI, 53705-2281, USA
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13
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The kidney stone and increased water intake trial in steel workers: results from a pilot study. Urolithiasis 2016; 45:177-183. [PMID: 27228999 DOI: 10.1007/s00240-016-0892-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
Preventing dehydration in subjects at risk may provide a means of primary prevention of kidney stones. The purpose of this pilot study was to assess the hydration status of an at-risk group of steel plant workers based on end-of-shift ('post-shift') spot urine osmolality and 24-h urinary stone risk parameters. 100 volunteers were recruited from Gerdau Midlothian steel mill in Texas on 11/14/14 and 12/5/14. Clinical data were recorded and post-shift spot urine sample was used to measure urine osmolality. Participants were invited to submit a 24-h urine sample within 4 weeks of enrollment. The mean age was 41 years and 95 % were men. The majority of subjects were white (75 %), followed by 10 % Hispanic and 9 % black. The mean body mass index was 30.1 kg/m2 and overall 16 % had a past history of stone disease. Mean post-shift urine spot osmolality was 704.5 mOsm (169-1165 mOsm) and was >800 and >700 mOsm in 39 and 57 %, respectively. Among 59 24-h urines samples, the mean volume was 1.89 ± 0.92 l/day, with 56 % < 2 L and 17 % < 1 L. Elevated levels of urinary analytes were found in 29 % of subjects for calcium (>250 mg/TV), 39 % for uric acid (>700 mg/TV), 25 % for oxalate (>45 mg/TV) and 50 % for sodium (>200 meq/TV). The prevalence of stone disease in this population of steel workers was higher than the published prevalence of stone disease in the general population. A significant number of workers had concentrated post-shift and 24-h urines and elevated levels of urinary analytes.
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14
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Dietary recommendations and treatment of patients with recurrent idiopathic calcium stone disease. Urolithiasis 2015; 44:9-26. [PMID: 26645870 DOI: 10.1007/s00240-015-0849-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/05/2015] [Indexed: 10/22/2022]
Abstract
This review describes the various dietary regimens that have been used to advise patients on how to prevent the recurrence of their calcium-containing kidney stones. The conclusion is that although there is some general advice that may be useful to many patients, it is more efficacious to screen each patient individually to identify his/her main urinary, metabolic, nutritional, environmental, and lifestyle risk factors for stone-formation and then tailor specific advice for that particular patient based on the findings from these investigations. If the patient can be motivated to adhere strictly to this conservative approach to the prophylactic management of their stone problem over a long time period, then it is possible to prevent them from forming further stones. This approach to stone management is considerably less expensive than any of the procedures currently available for stone removal or disintegration. In the UK, for each new stone episode prevented by this conservative approach to prophylaxis it is calculated to save the Health Authority concerned around £2000 for every patient treated successfully. In the long term, this accumulates to a major saving within each hospital budget if most stone patients can be prevented from forming further stones and when the savings are totalled up country-wide saves the National Exchequer considerable sums in unclaimed Sick Pay and industry a significant number of manpower days which would otherwise be lost from work. It is also of immense relief and benefit to the patients not to have to suffer the discomfort and inconvenience of further stone episodes.
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15
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Han H, Segal AM, Seifter JL, Dwyer JT. Nutritional Management of Kidney Stones (Nephrolithiasis). Clin Nutr Res 2015; 4:137-52. [PMID: 26251832 PMCID: PMC4525130 DOI: 10.7762/cnr.2015.4.3.137] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 01/02/2023] Open
Abstract
The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones.
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Affiliation(s)
- Haewook Han
- Department of Nephrology, Harvard Vanguard Medical Associate, Boston, MA 02115, USA
| | - Adam M Segal
- Harvard Vanguard Medical Associate, Clinical Instructor at Harvard Medical School, Boston, MA 02115, USA
| | - Julian L Seifter
- Harvard Vanguard Medical Associates; Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Johanna T Dwyer
- Tufts University Friedman School of Nutrition and School of Medicine, Boston, MA 02111, USA
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