1
|
Bargagli M, Trelle S, Bonny O, Fuster DG. Thiazides for kidney stone recurrence prevention. Curr Opin Nephrol Hypertens 2024; 33:427-432. [PMID: 38606682 PMCID: PMC11139243 DOI: 10.1097/mnh.0000000000000990] [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] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Kidney stones are the most common condition affecting the kidney, and characterized by a high rate of recurrence. Thiazide and thiazide-like diuretics (thiazides) are commonly prescribed to prevent the recurrence of kidney stones. This review offers a comprehensive up-to-date assessment of the evidence supporting the use of thiazides for kidney stone recurrence prevention, highlights potential harms associated with treatment, and identifies areas of knowledge that require further investigation. RECENT FINDINGS The clinical routine to prescribe thiazides for kidney stone prevention has recently been challenged by the findings of the large NOSTONE trial that failed to show superiority of hydrochlorothiazide at doses up to 50 mg daily over placebo in preventing a composite of clinical or radiological recurrence in patients at high risk of recurrence. Yet, adverse events such as new onset diabetes mellitus and gout were more common in patients receiving hydrochlorothiazide compared to placebo. As demonstrated by a novel meta-analysis presented in this review encompassing all randomized placebo-controlled trials with thiazide monotherapy, current trial evidence does not indicate that thiazide monotherapy is significantly better than placebo in preventing kidney stone recurrence. SUMMARY Given the limited efficacy and possible adverse effects, we advocate for a restrictive use of thiazides for kidney stone recurrence prevention. Clearly, there remains a high unmet medical need for effective, targeted therapies to prevent recurrence of kidney stones.
Collapse
Affiliation(s)
- Matteo Bargagli
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital
| | - Sven Trelle
- CTU Bern, Department of Clinical Research, University of Bern, Bern
| | - Olivier Bonny
- Service of Nephrology, Fribourg State Hospital, University of Fribourg, Fribourg, Switzerland
| | - Daniel G. Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital
| |
Collapse
|
2
|
Awuah Boadi E, Shin S, Choi BE, Ly K, Raub CB, Bandyopadhyay BC. Sex-specific Stone-forming Phenotype in Mice During Hypercalciuria/Urine Alkalinization. J Transl Med 2024; 104:102047. [PMID: 38452902 PMCID: PMC11103239 DOI: 10.1016/j.labinv.2024.102047] [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: 07/13/2023] [Revised: 01/31/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Sex differences in kidney stone formation are well known. Females generally have slightly acidic blood and higher urine pH when compared with males, which makes them more vulnerable to calcium stone formation, yet the mechanism is still unclear. We aimed to examine the role of sex in stone formation during hypercalciuria and urine alkalinization through acetazolamide and calcium gluconate supplementation, respectively, for 4 weeks in wild-type (WT) and moderately hypercalciuric [TRPC3 knockout [KO](-/-)] male and female mice. Our goal was to develop calcium phosphate (CaP) and CaP+ calcium oxalate mixed stones in our animal model to understand the underlying sex-based mechanism of calcium nephrolithiasis. Our results from the analyses of mice urine, serum, and kidney tissues show that female mice (WT and KO) produce more urinary CaP crystals, higher [Ca2+], and pH in urine compared to their male counterparts. We identified a sex-based relationship of stone-forming phenotypes (types of stones) in our mice model following urine alkalization/calcium supplementation, and our findings suggest that female mice are more susceptible to CaP stones under those conditions. Calcification and fibrotic and inflammatory markers were elevated in treated female mice compared with their male counterparts, and more so in TRPC3 KO mice compared with their WT counterparts. Together these findings contribute to a mechanistic understanding of sex-influenced CaP and mixed stone formation that can be used as a basis for determining the factors in sex-related clinical studies.
Collapse
Affiliation(s)
- Eugenia Awuah Boadi
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC
| | - Samuel Shin
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC; Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Bok-Eum Choi
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC
| | - Khanh Ly
- Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Christopher B Raub
- Department of Biomedical Engineering, The Catholic University of America, Washington DC
| | - Bidhan C Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, Washington, DC; Department of Biomedical Engineering, The Catholic University of America, Washington DC; Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University, Washington DC.
| |
Collapse
|
3
|
Steely A, Worcester E, Prochaska M. Contrasting Response of Urine Stone Risk to Medical Treatment in Calcium Oxalate versus Calcium Phosphate Stone Formers. KIDNEY360 2024; 5:228-236. [PMID: 38251931 PMCID: PMC10914189 DOI: 10.34067/kid.0000000000000362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Key Points Thiazide treatment successfully lowered urine calcium and both calcium oxalate and calcium phosphate supersaturations in both types of stone formers (SFs). Alkali therapy may not confer the same benefits on calcium phosphate SFs as it does on calcium oxalate SFs. Background Randomized controlled trials have shown that both thiazide diuretics and potassium citrate (K-Cit) can prevent calcium stone recurrence, but most participants formed calcium oxalate (CaOx) stones. While thiazides are expected to lower risk of calcium phosphate (CaP) stone formation, the effect of K-Cit on risk of CaP stone formation is unclear. Methods To study the effect of common calcium stone treatments, we analyzed the 24-hour urines of CaOx and CaP stone formers (SFs) by four treatment types: Lifestyle, K-Cit, Thiazide, or Both medications. Results Patients treated with thiazides reduced urine calcium in both CaOx (M =−74.4, SD =94.6 mg/d) and CaP (M =−102, SD =99.7 mg/d) SFs while those on K-Cit had no change in urine calcium. Among CaOx SFs, urine citrate rose in patients administered K-Cit with or without thiazide, but citrate did not rise significantly in CaP SFs. Urine pH rose in all CaOx SFs, but among CaP SFs, only rose in patients receiving K-Cit. CaOx supersaturation (SS) decreased in all patients who received Thiazide, and decreased among CaOx SFs treated with K-Cit. CaP SS decreased in both CaOx SFs (M =−0.46, SD =0.86) and CaP SFs (M =−0.76, SD =0.85) treated with Thiazide, except CaOx SFs who received Both. Patients treated with K-Cit alone increased CaP SS in CaOx SFs (M =0.25, SD =0.79). Conclusions Patients treated with Thiazide lowered urine calcium and SS in both stone groups. Patients treated with K-Cit had no significant changes in urine calcium and had a decrease in CaOx SS in CaOx SFs. The study raises questions about the best preventive treatment for patients with CaP stones and suggests that K-Cit may not confer the same benefits on CaP SFs as it does on CaOx SFs.
Collapse
Affiliation(s)
- Audrey Steely
- Department of Medicine, University of Chicago, Chicago, Illinois
| | | | | |
Collapse
|
4
|
Zhang Q, Wei H, Huang G, Jin L. CCL7 and olfactory transduction pathway activation play an important role in the formation of CaOx and CaP kidney stones. Front Genet 2024; 14:1267545. [PMID: 38235001 PMCID: PMC10791818 DOI: 10.3389/fgene.2023.1267545] [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: 07/26/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Background: The deposition of calcium oxalate (CaOx) and calcium phosphate (CaP) is the most common cause of kidney stone disease (KSD). Whether KSDs caused by CaOx and CaP have common genetic targets or signaling pathways remained unclear. Methods: The present study utilized public data GSE73680 to analyze differentially expressed genes between CaOx or CaP tissues and normal tissues, respectively. Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of co-DEGs were performed. The protein-protein interaction (PPI) network was constructed to identify hub genes, and the top hub gene was selected for gene set enrichment analysis (GSEA). Finally, real-time PCR of patients' urine was performed to validate the bioinformatic results. Results: In total, 155 significantly co-upregulated DEGs and 64 co-downregulated DEGs were obtained from the datasets. The Gene Ontology analysis showed that DEGs were significantly enriched in chemical stimulus in sensory perception, detection of chemical stimulus in sensory perception of smell, and olfactory receptor activity. The KEGG analysis showed that the olfactory transduction pathway was significantly enriched. According to protein-protein interaction, 10 genes were identified as the hub genes, and CCL7 was the top hub gene. The olfactory transduction, maturity-onset diabetes of the young, linoleic acid metabolism, and fat digestion and absorption were significantly enriched in the high-CCL7 subgroup by GSEA. In total, 9 patients who had primarily CaOx mixed with some CaP stones and 9 healthy subjects were enrolled. The RT-PCR results showed that CCL7 level in the stone group was significantly higher than that in the control group (p < 0.05). For the olfactory transduction pathway, the expression of OR10A5, OR9A2, and OR1L3 was significantly upregulated in the stone group compared with the control group (p < 0.05). Conclusion: CCL7 may play a key role in the development of both CaOx and CaP, and this process may depend on olfactory transduction pathway activation.
Collapse
Affiliation(s)
- Qiankun Zhang
- Division of Nephrology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Hhuiling Wei
- Division of Nephrology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Gang Huang
- Division of Traditional Chinese Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| | - Lie Jin
- Division of Nephrology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui Hospital of Zhejiang University, Lishui, China
| |
Collapse
|
5
|
Siener R, Pitzer MS, Speller J, Hesse A. Risk Profile of Patients with Brushite Stone Disease and the Impact of Diet. Nutrients 2023; 15:4092. [PMID: 37764875 PMCID: PMC10534559 DOI: 10.3390/nu15184092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
This study examined the profile of patients and the impact of diet on the risk of brushite stone formation under controlled, standardized conditions. Sixty-five patients with brushite nephrolithiasis were enrolled in the study. Metabolic, dietary, and 24 h urinary parameters were collected under the habitual, self-selected diet of the patients and the balanced mixed, standardized diet. The [13C2]oxalate absorption, ammonium chloride, and calcium loading tests were conducted. All patients had at least one abnormality on the usual diet, with hypercalciuria (84.6%), increased urine pH (61.5%), and hyperphosphaturia (43.1%) being the most common. Absorptive hypercalciuria was present in 32.1% and hyperabsorption of oxalate in 41.2%, while distal renal tubular acidosis (dRTA) was noted in 50% of brushite stone formers. The relative supersaturation of brushite did not differ between patients with and without dRTA. Among all recent brushite-containing calculi, 61.5% were mixed with calcium oxalate and/or carbonate apatite. The relative supersaturation of brushite, apatite, and calcium oxalate decreased significantly under the balanced diet, mainly due to the significant decline in urinary calcium, phosphate, and oxalate excretion. Dietary intervention was shown to be effective and should be an integral part of the treatment of brushite stone disease. Further research on the role of dRTA in brushite stone formation is needed.
Collapse
Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Maria Sofie Pitzer
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Jan Speller
- Department of Medical Biometry, Informatics and Epidemiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Albrecht Hesse
- University Stone Center, Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| |
Collapse
|
6
|
Adomako EA, Li X, Sakhaee K, Moe OW, Maalouf NM. Urine pH and Citrate as Predictors of Calcium Phosphate Stone Formation. KIDNEY360 2023; 4:1123-1129. [PMID: 37307531 PMCID: PMC10476682 DOI: 10.34067/kid.0000000000000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
Key Points The occurrence of calcium phosphate stones has increased over the past five decades, and this is most notable in female stone formers. High urine pH and hypocitraturia are the most discriminatory urine parameters between calcium phosphate and calcium oxalate stone formers. High urine pH in calcium phosphate stone formers is independent of the effect of dietary alkali and acid. Background Urinary parameters, including urine pH and citrate, are recognized as critical in the pathophysiology of calcium-based stones. The factors contributing to variation in these parameters between calcium oxalate (CaOx) and calcium phosphate (CaP) stone formers (SFs) are, however, not well-understood. In this study, using readily available laboratory data, we explore these differences to delineate the odds of forming CaP versus CaOx stones. Methods In this single-center retrospective study, we compared serum and urinary parameters between adult CaP SFs, CaOx SFs, and non–stone formers. Results Urine pH was higher and urine citrate lower in CaP SFs compared with same-sex CaOx SFs and non–stone formers. In CaP SFs, higher urine pH and lower citrate were independent of markers of dietary acid intake and gastrointestinal alkali absorption, suggesting abnormal renal citrate handling and urinary alkali excretion. In a multivariable model, urine pH and urine citrate were most discriminatory between CaP SFs and CaOx SFs (receiver-operating characteristic area under the curve of 0.73 and 0.65, respectively). An increase in urine pH by 0.35, a decrease in urine citrate by 220 mg/d, a doubling of urine calcium, and female sex all independently doubled the risk of CaP stone formation compared with CaOx stones. Conclusions High urine pH and hypocitraturia are two clinical parameters that distinguish the urine phenotype of CaP SFs from CaOx SFs. Alkalinuria is due to intrinsic differences in the kidney independent of intestinal alkali absorption and is accentuated in the female sex.
Collapse
Affiliation(s)
- Emmanuel A. Adomako
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, Texas
| | - Xilong Li
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, Texas
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas
| | - Khashayar Sakhaee
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| | - Orson W. Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
- Department of Physiology, UT Southwestern Medical Center, Dallas, Texas
| | - Naim M. Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, UT Southwestern Medical Center, Dallas, Texas
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
7
|
Boeykens M, Van Haute C, De Coninck V. RE: Removal of small, asymptomatic kidney stones and incidence of relapse. World J Urol 2023; 41:613-614. [PMID: 36571592 DOI: 10.1007/s00345-022-04251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Matthias Boeykens
- Department of Urology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carl Van Haute
- Department of Urology, KU Leuven, Katholieke Universiteit Leuven, University Hospitals Leuven, Louvain, Belgium
| | | |
Collapse
|
8
|
Thongprayoon C, Vuckovic I, Vaughan LE, Macura S, Larson NB, D’Costa MR, Lieske JC, Rule AD, Denic A. Nuclear Magnetic Resonance Metabolomic Profiling and Urine Chemistries in Incident Kidney Stone Formers Compared with Controls. J Am Soc Nephrol 2022; 33:2071-2086. [PMID: 36316097 PMCID: PMC9678037 DOI: 10.1681/asn.2022040416] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The urine metabolites and chemistries that contribute to kidney stone formation are not fully understood. This study examined differences between the urine metabolic and chemistries profiles of first-time stone formers and controls. METHODS High-resolution 1H-nuclear magnetic resonance (NMR) spectroscopy-based metabolomic analysis was performed in 24-hour urine samples from a prospective cohort of 418 first-time symptomatic kidney stone formers and 440 controls. In total, 48 NMR-quantified metabolites in addition to 12 standard urine chemistries were assayed. Analysis of covariance was used to determine the association of stone former status with urine metabolites or chemistries after adjusting for age and sex and correcting for the false discovery rate. Gradient-boosted machine methods with nested cross-validation were applied to predict stone former status. RESULTS Among the standard urine chemistries, stone formers had lower urine oxalate and potassium and higher urine calcium, phosphate, and creatinine. Among NMR urine metabolites, stone formers had lower hippuric acid, trigonelline, 2-furoylglycine, imidazole, and citrate and higher creatine and alanine. A cross-validated model using urine chemistries, age, and sex yielded a mean AUC of 0.76 (95% CI, 0.73 to 0.79). A cross-validated model using urine chemistries, NMR-quantified metabolites, age, and sex did not meaningfully improve the discrimination (mean AUC, 0.78; 95% CI, 0.75 to 0.81). In this combined model, among the top ten discriminating features, four were urine chemistries and six NMR-quantified metabolites. CONCLUSIONS Although NMR-quantified metabolites did not improve discrimination, several urine metabolic profiles were identified that may improve understanding of kidney stone pathogenesis.
Collapse
Affiliation(s)
| | - Ivan Vuckovic
- Metabolomics Core, Mayo Clinic, Rochester, Minnesota
| | - Lisa E. Vaughan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Slobodan Macura
- Metabolomics Core, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Matthew R. D’Costa
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Aleksandar Denic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
9
|
Major and Trace Elements in Human Kidney Stones: A Preliminary Investigation in Beijing, China. MINERALS 2022. [DOI: 10.3390/min12050512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Kidney stone disease affects people globally, with its prevalence on the rise. Given the importance of elements’ function in formation of kidney stones, this study investigated major and trace element content in thirty kidney stone samples from patients in Beijing. The kidney stone samples included inorganic components (calcium oxalate and carbonate apatite) and organic components (uric acid). Results showed that Ca is much higher in inorganic components than organic components. Compared to inorganic components, uric acid has a very low content of elements except for Cu and Se, which may be derived from the liver. Carbonate apatite stones have a higher element content (such as Na, K, Sr, Zn, Rb, Ba, Li, and Ti) than calcium oxalate stones, especially enrichment of Mg. The principal components analysis (PCA) extracted three principal components (PCs) with total variances of 91.91%, including the PC1 (45.08%): Na-Li-Ti-Ba-Sr-Zn, PC2 (30.05%): Rb, K, Mg, and PC3 (16.78%): Cu-Se, indicating that there are co-precipitated processes of these elements by their specific properties. A different distribution of stone types in the three components indicates a significant discrepancy in their element content, which can be an essential reference for patient intake elements.
Collapse
|
10
|
Wang K, Ge J, Han W, Wang D, Zhao Y, Shen Y, Chen J, Chen D, Wu J, Shen N, Zhu S, Xue B, Xu X. Risk factors for kidney stone disease recurrence: a comprehensive meta-analysis. BMC Urol 2022; 22:62. [PMID: 35439979 PMCID: PMC9017041 DOI: 10.1186/s12894-022-01017-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/12/2022] [Indexed: 12/23/2022] Open
Abstract
Background Kidney stone disease (KSD) is a common illness that causes an economic burden globally. It is easy for patients to relapse once they have suffered from this disease. The reported recurrence rate of KSD ranged from 6.1% to 66.9%. We performed this meta-analysis to identify various potential risk factors for the recurrence of KSD. Methods The PubMed, Embase and Web of Science databases were searched using suitable keywords from inception to Mar 2022. A total of 2,663 records were collected initially. After screening the literature according to the inclusion and exclusion criteria, 53 articles (40 retrospective studies; 13 prospective studies) including 488,130 patients were enrolled. The study protocol was registered with PROSPERO (No. CRD42020171771). Results The pooled results indicated that 12 risk factors including younger age (n = 18), higher BMI (n = 16), family history of kidney stones (n = 12), personal history of kidney stones (n = 11), hypertension (n = 5), uric acid stone (n = 4), race of Caucasian (n = 3), suspected kidney stone episode before the first confirmed stone episode (n = 3), surgery (n = 3), any concurrent asymptomatic (nonobstructing) stone (n = 2), pelvic or lower pole kidney stone (n = 2), and 24 h urine test completion (n = 2) were identified to be associated with KSD recurrence. In the subgroup analysis, patients with higher BMI (OR = 1.062), personal history of nephrolithiasis (OR = 1.402), or surgery (OR = 3.178) had a higher risk of radiographic KSD recurrence. Conclusions We identified 12 risk factors related to the recurrence of KSD. The results of this analysis could serve to construct recurrence prediction models. It could also supply a basis for preventing the recurrence of KSD. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01017-4.
Collapse
Affiliation(s)
- Kai Wang
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jing Ge
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Wenlong Han
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Dong Wang
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Yinjuan Zhao
- Collaborative Innovation Center of Sustainable Forestry in Southern China, College of Forestry, Nanjing Forestry University, Nanjing, 210037, Jiangsu Province, China
| | - Yanhao Shen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jiexun Chen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Dongming Chen
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Jing Wu
- Department of Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China
| | - Ning Shen
- China Exposomics Institute (CEI) Precision Medicine Co. Ltd, Shanghai, 200120, China
| | - Shuai Zhu
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
| | - Bin Xue
- Department of Core Laboratory, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
| | - Xianlin Xu
- Department of Urology, Sir Run Run Hospital, Nanjing Medical University, 109 Longmian Road, Jiangning District, Nanjing, 211100, Jiangsu Province, China.
| |
Collapse
|
11
|
Finger M, Finger E, Bellucci A, Malieckal DA. Medical management for the prevention of kidney stones. Postgrad Med J 2021; 99:postgradmedj-2021-140971. [PMID: 34930814 DOI: 10.1136/postgradmedj-2021-140971] [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] [Received: 08/10/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022]
Abstract
The alarming fact is that approximately one out of every 10 of us will have a kidney stone during our lifetime. The increasing prevalence and associated costs of kidney stones have resulted in it being one of the most commonly encountered and impactful medical conditions. Contributing factors include, but are not limited to, diet, climate, genetics, medications, activity and underlying medical conditions. Symptoms generally parallel stone size. Treatment varies from supportive to procedural (invasive and non-invasive). Prevention remains the best way to avoid this condition especially given the high recurrence rate. First time stone formers require counselling regarding dietary adjustments. Certain risk factors ultimately require a more in-depth metabolic investigation, especially if stones are recurrent. Ultimately, management is defined by stone composition. Where appropriate, we review both pharmacologic and non-pharmacologic options. Pivotal to successful prevention is patient education and the encouragement of compliance with the appropriate regimen.
Collapse
Affiliation(s)
- Mark Finger
- Medicine-Nephrology, Northwell Health, Great Neck, New York, USA
| | - Evan Finger
- Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | | | | |
Collapse
|
12
|
Preliminary Data on Geochemical Characteristics of Major and Trace Elements in Typical Biominerals: From the Perspective of Human Kidney Stones. MINERALS 2021. [DOI: 10.3390/min11121396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The chemical composition of biominerals is essential for understanding biomineral formation and is regarded as an attractive subject in bio-mineralogical research on human kidney stones (urinary calculi). In order to obtain more geochemically interpreted data on biogenic minerals, mineralogical compositions and major and trace element concentrations of sixty-six kidney stone samples derived from kidney stone removal surgeries were measured. Infrared spectroscopy results showed that calcium oxalate monohydrate (COM) and calcium oxalate dihydrate (COD) were the two main mineral components of kidney stones. Geochemical results indicated that major and trace element concentrations were present in the following order: Ca > Mg > Na > K > Zn > Fe > Pb > Ba > Cu > Ti > Mo > Cd > Cr. With the exception of Ca, Mg was the second-most abundant element. Zn exhibited higher concentrations relative to other trace elements, which suggests a potential substitution of calcium by metal ions with a similar charge and radius rather than by metals in kidney stone formation. Pb appeared in significantly higher concentrations than in previous studies, which indicates Pb enrichment in the environment. In order to discern multi-element relationships within kidney stones, principal component analysis was applied. Three principal components (PCs, eigenvalues >1) were extracted to explain 64.4% of the total variance. The first component exhibited positively correlated Na-Zn-Cr-Mo-Cd-Pb, while the second component exhibited more positively weighted Mg-K-Ba-Ti. Fe-Cu demonstrated a positive correlation in the third component. This study suggests that Ca exhibits a preference for uptake by oxalates during human urinary stone crystallization, while other alkali metals and alkaline earth metals precipitate with phosphate.
Collapse
|
13
|
Bergsland KJ, Coe FL, El-Achkar TM, Worcester EM. Increased Urinary Leukocyte Esterase Distinguishes Patients With Brushite Kidney Stones. Kidney Int Rep 2021; 6:1729-1731. [PMID: 34169214 PMCID: PMC8207319 DOI: 10.1016/j.ekir.2021.03.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kristin J. Bergsland
- Department of Medicine, Nephrology Section, University of Chicago, Chicago, Illinois, USA
| | - Fredric L. Coe
- Department of Medicine, Nephrology Section, University of Chicago, Chicago, Illinois, USA
| | - Tarek M. El-Achkar
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elaine M. Worcester
- Department of Medicine, Nephrology Section, University of Chicago, Chicago, Illinois, USA
| |
Collapse
|
14
|
Brinkman JE, Large T, Nottingham CU, Stoughton C, Krambeck AE. Clinical and Metabolic Correlates of Pure Stone Subtypes. J Endourol 2021; 35:1555-1562. [PMID: 33573466 DOI: 10.1089/end.2020.1035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are multiple stone types, with each forming under different urinary conditions. We compared clinical and metabolic findings in pure stone formers (SFs) to understand whether there are consistent factors that differentiate these groups in terms of underlying etiology and potential for empiric treatment. Materials and Methods: Pure SFs based on infrared spectroscopic analysis of stones obtained at our institution between January 2002 and July 2018 with a corresponding 24-hour urinalysis were retrospectively evaluated. Results: One hundred twenty-one apatite (AP), 54 brushite (BRU), 50 calcium oxalate (CaOx) dihydrate, 104 CaOx monohydrate, and 82 uric acid (UA) patients were analyzed. AP, BRU, and CaOx dihydrate patients were younger than CaOx monohydrate and UA patients. The UA patients had the highest male predominance (76.8%), whereas AP patients were predominantly female (80.2%). UA was most associated with diabetes mellitus (45.3%), and CaOx monohydrate with cardiovascular disease (27.2%) and malabsorptive gastrointestinal conditions (19.2%). BRU patients had the highest prevalence of primary hyperparathyroidism (17%). AP, BRU, and CaOx dihydrate patients demonstrated high rates of hypercalciuria (66.1%, 79.6%, 82%). AP and BRU patients had the highest urinary pH. AP patients exhibited the highest rate of hypocitraturia, whereas CaOx dihydrate patients exhibited the lowest (55.4%, 30%). CaOx monohydrate patients had the highest rate of hyperoxaluria (51.9%). UA patients had the lowest urinary pH. There were no observable differences in the rates of hyperuricosuria or hypernatriuria. Conclusions: These results demonstrate that pure stone composition correlates with certain urinary and clinical characteristics. These data can help guide empiric clinical decision making.
Collapse
Affiliation(s)
- John E Brinkman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christa Stoughton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
15
|
Giglio S, Montini G, Trepiccione F, Gambaro G, Emma F. Distal renal tubular acidosis: a systematic approach from diagnosis to treatment. J Nephrol 2021; 34:2073-2083. [PMID: 33770395 PMCID: PMC8610947 DOI: 10.1007/s40620-021-01032-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Renal tubular acidosis (RTA) comprises a group of disorders in which excretion of hydrogen ions or reabsorption of filtered HCO3 is impaired, leading to chronic metabolic acidosis with normal anion gap. In the current review, the focus is placed on the most common type of RTA, Type 1 RTA or Distal RTA (dRTA), which is a rare chronic genetic disorder characterized by an inability of the distal nephron to secrete hydrogen ions in the presence of metabolic acidosis. Over the years, knowledge of the molecular mechanisms behind acid secretion has improved, thereby greatly helping the diagnosis of dRTA. The primary or inherited form of dRTA is mostly diagnosed in infancy, childhood, or young adulthood, while the acquired secondary form, as a consequence of other disorders or medications, can happen at any age, although it is more commonly seen in adults. dRTA is not as “benign” as previously assumed, and can have several, highly variable long-term consequences. The present review indeed reports and summarizes both clinical symptoms and diagnosis, long-term outcomes, genetic inheritance, epidemiology and current treatment options, with the aim of shedding more light onto this rare disorder. Being a chronic condition, dRTA also deserves attention in the transition between pediatric and adult nephrology care, and as a rare disease it has a place in the European and Italian rare nephrological diseases network.
Collapse
Affiliation(s)
- Sabrina Giglio
- Medical Genetics Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Giovanni Montini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Nephrology, Dialysis and PediatricTransplant Unit, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy.,Biogem Research Institute Ariano Irpino, Ariano Irpino, Italy
| | - Giovanni Gambaro
- Nephrology Department of Medicine, University of Verona, Verona, Italy
| | - Francesco Emma
- Division of Nephrology, Department of Pediatric Subspecialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
16
|
Arunkajohnsak N, Taweemonkongsap T, Leewansangtong S, Srinualnad S, Jongjitaree K, Chotikawanich E. The correlation between demographic factors and upper urinary tract stone composition in the Thai population. Heliyon 2020; 6:e04649. [PMID: 32793840 PMCID: PMC7415835 DOI: 10.1016/j.heliyon.2020.e04649] [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: 06/16/2020] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022] Open
Abstract
Objective To identify the correlation between demographic factors and upper urinary tract stone composition in the Thai population. Method A retrospective observational study of first-time upper urinary tract stone former patients aged over 18 years who underwent stone surgery was performed in a tertiary referral university hospital from January 2013 to May 2018. Collected data included demographic information and stone composition information, which were analysed by the Fourier Transform-Infrared Spectroscopy (FTIR) method. The correlation between the demographic factors and major upper urinary tract stone composition was analysed using Fisher's exact test. Results A total of 480 patients were included in this study. The stones were 319 (66.5%) renal calculi and 161 (33.5%) ureteric calculi. There were 248 (51.7%) single composition stones and 232 (48.3%) mixed composition stones. The major stone compositions were 288 (60.0%) calcium oxalate (CaOx), 125 (26.0%) calcium phosphate (CaP), 40 (8.3%) uric acid (UA), 19 (4.0%) magnesium ammonium phosphate (MAP), five (1.0%) cystine, and three (0.6%) ammonium hydrogen urate (AHU). Gender was correlated with the major stone composition. In females, a correlation was found between the major stone composition and age, diabetes mellitus (DM), and glomerular filtration rate (GFR). The study showed no significant correlation between the major stone composition and dyslipidemia (DLP), hypertension (HT), gout, and body mass index (BMI) in both genders. Conclusion Gender, age, DM, and GFR were the factors affecting the stone composition.
Collapse
Affiliation(s)
- Noppon Arunkajohnsak
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tawatchai Taweemonkongsap
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sunai Leewansangtong
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sittiporn Srinualnad
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kantima Jongjitaree
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkarin Chotikawanich
- Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
17
|
Patel PM, Kandabarow AM, Druck A, Hart S, Blackwell RH, Kadlec A, Farooq A, Turk TMT, Baldea KG. Association of Impaired Renal Function With Changes in Urinary Mineral Excretion and Stone Composition. Urology 2020; 141:45-49. [PMID: 32294484 DOI: 10.1016/j.urology.2020.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/03/2020] [Accepted: 03/15/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effect of kidney function on stone composition and urinary mineral excretion in patients undergoing surgical intervention for nephrolithiasis. METHODS Using our institutional kidney stone database, we performed a retrospective review of stone patients who underwent surgical intervention between 2004 and 2015. Patients' demographic information, 24-hour urinary mineral excretion, and stone characteristics were reported. The patients' estimated glomerular filtration rates (eGFR) were compared with their stone compositions and 24-hour urine mineral excretions. RESULTS A statistically significant difference was noted between the groups, with uric acid stones being associated with lower eGFR and calcium phosphate stones associated with higher eGFR. No relationship could be demonstrated between eGFR and calcium oxalate or struvite stones. Patients with lower eGFR also demonstrated a statistically significant association with lower urinary pH as well as lower urinary excretion of calcium and citrate. CONCLUSION While various factors have been found to play significant roles in kidney stone formation and composition, our findings demonstrate a definite relationship between these and renal function. This paper highlights the fact that renal function evaluation should be considered an important component in the evaluation, counseling, and management of patients with nephrolithiasis.
Collapse
Affiliation(s)
- Parth M Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL.
| | | | - Aleksander Druck
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL
| | - Spencer Hart
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | | | - Ahmer Farooq
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Thomas M T Turk
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Kristin G Baldea
- Department of Urology, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
18
|
|
19
|
Makki MS, Winfree S, Lingeman JE, Witzmann FA, Worcester EM, Krambeck AE, Coe FL, Evan AP, Bledsoe S, Bergsland KJ, Khochare S, Barwinska D, Williams JC, El-Achkar TM. A Precision Medicine Approach Uncovers a Unique Signature of Neutrophils in Patients With Brushite Kidney Stones. Kidney Int Rep 2020; 5:663-677. [PMID: 32405588 PMCID: PMC7210605 DOI: 10.1016/j.ekir.2020.02.1025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/10/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction We have previously found that papillary histopathology differs greatly between calcium oxalate and brushite stone formers (SF); the latter have much more papillary mineral deposition, tubular cell injury, and tissue fibrosis. Methods In this study, we applied unbiased orthogonal omics approaches on biopsied renal papillae and extracted stones from patients with brushite or calcium oxalate (CaOx) stones. Our goal was to discover stone type-specific molecular signatures to advance our understanding of the underlying pathogenesis. Results Brushite SF did not differ from CaOx SF with respect to metabolic risk factors for stones but did exhibit increased tubule plugging in their papillae. Brushite SF had upregulation of inflammatory pathways in papillary tissue and increased neutrophil markers in stone matrix compared with those with CaOx stones. Large-scale 3-dimensional tissue cytometry on renal papillary biopsies showed an increase in the number and density of neutrophils in the papillae of patients with brushite versus CaOx, thereby linking the observed inflammatory signatures to the neutrophils in the tissue. To explain how neutrophil proteins appear in the stone matrix, we measured neutrophil extracellular trap (NET) formation—NETosis—and found it significantly increased in the papillae of patients with brushite stones compared with CaOx stones. Conclusion We show that increased neutrophil infiltration and NETosis is an unrecognized factor that differentiates brushite and CaOx SF and may explain the markedly increased scarring and inflammation seen in the papillae of patients with brushite stones. Given the increasing prevalence of brushite stones, the role of neutrophil activation in brushite stone formation requires further study.
Collapse
Affiliation(s)
- Mohammad Shahidul Makki
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Seth Winfree
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Frank A Witzmann
- Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elaine M Worcester
- Department of Medicine, Division of Nephrology, University of Chicago, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Fredric L Coe
- Department of Medicine, Division of Nephrology, University of Chicago, Chicago, Illinois, USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sharon Bledsoe
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kristin J Bergsland
- Department of Medicine, Division of Nephrology, University of Chicago, Chicago, Illinois, USA
| | - Suraj Khochare
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daria Barwinska
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tarek M El-Achkar
- Department of Medicine, Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Cellular & Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
20
|
Worcester EM, Bergsland KJ, Gillen DL, Coe FL. Evidence for disordered acid-base handling in calcium stone-forming patients. Am J Physiol Renal Physiol 2020; 318:F363-F374. [PMID: 31790303 DOI: 10.1152/ajprenal.00400.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In stone formers (SFs) with idiopathic hypercalciuria, urine pH governs the mineral phase of stones. Calcium phosphate (CaP) SFs have higher urine pH than calcium oxalate (CaOx) SFs. Normal women have higher urine pH than men on fixed diets, accompanied by greater absorption of food alkali. Female CaP and male CaOx SFs have similar urine pH as same sex normal individuals, but male CaP and female CaOx SFs may have abnormal acid-base handling. We studied 25 normal individuals (13 men and 12 women), 17 CaOx SFs (11 men and 6 women), and 15 CaP SFs (8 men and 7 women) on fixed diets. Urine and blood samples were collected under fasting and fed conditions. Female CaOx SFs had lower urine pH and lower alkali absorption, fed, compared with normal women; their urine NH4 was higher and urine citrate excretion lower than in normal women, consistent with their higher net acid excretion. Male CaOx SFs had higher urine citrate excretion and higher serum ultrafilterable citrate levels than normal men. Both male and female CaP SFs had higher urine pH fasting than same sex normal individuals, but only men were higher in the fed period, and there were no differences from normal in gut alkali absorption. CaP SFs of both sexes had higher urine NH4 and lower urine citrate than same sex normal individuals. The lower urine pH of female CaOx SFs seems related to decreased gut alkali absorption, while the higher pH of CaP SFs, accompanied by higher urine NH4 and lower urine citrate, suggests a proximal tubule disorder.
Collapse
Affiliation(s)
- Elaine M Worcester
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | | | - Daniel L Gillen
- Department of Statistics, University of California, Irvine, California
| | - Fredric L Coe
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
21
|
Rimer JD, Sakhaee K, Maalouf NM. Citrate therapy for calcium phosphate stones. Curr Opin Nephrol Hypertens 2020; 28:130-139. [PMID: 30531474 DOI: 10.1097/mnh.0000000000000474] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Calcium phosphate (CaP) stones represent an increasingly encountered form of recurrent nephrolithiasis, but current prophylactic medical regimens are suboptimal. Although hypocitraturia is a well-described risk factor for CaP stones, strategies that enhance citrate excretion have not consistently been effective at reducing CaP saturation and stone recurrence. This review summarizes the role of citrate therapy in CaP nephrolithiasis. RECENT FINDINGS Citrate in urine inhibits CaP stone formation through multiple mechanisms, including the formation of soluble citrate-calcium complexes, and inhibition of CaP nucleation, crystal growth and crystal aggregation. Recent in-vitro studies demonstrate that citrate delays CaP crystal growth through distinct inhibitory mechanisms that depend on supersaturation and citrate concentration. The impact of pharmacological provision of citrate on CaP saturation depends on the accompanying cation: Potassium citrate imparts a significant alkali load that enhances citraturia and reduces calciuria, but could worsen urine pH elevation. Conversely, citric acid administration results in minimal citraturia and alteration in CaP saturation. SUMMARY Citrate, starting at very low urinary concentrations, can significantly retard CaP crystal growth in vitro through diverse mechanisms. Clinically, the net impact on CaP stone formation of providing an alkali load during pharmacological delivery of citrate into the urinary environment remains to be determined.
Collapse
Affiliation(s)
- Jeffrey D Rimer
- Department of Chemical and Biomolecular Engineering, University of Houston, Houston, Texas
| | - Khashayar Sakhaee
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
22
|
Mirković M, Dosen A, Erić S, Vulić P, Matović B, Rosić A. Phase and microstructural study of urinary stones. Microchem J 2020. [DOI: 10.1016/j.microc.2019.104429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
23
|
Abstract
Infection stones are complex aggregates of crystals amalgamated in an organic matrix that are strictly associated with urinary tract infections. The management of patients who form infection stones is challenging owing to the complexity of the calculi and high recurrence rates. The formation of infection stones is a multifactorial process that can be driven by urine chemistry, the urine microenvironment, the presence of modulator substances in urine, associations with bacteria, and the development of biofilms. Despite decades of investigation, the mechanisms of infection stone formation are still poorly understood. A mechanistic understanding of the formation and growth of infection stones - including the role of organics in the stone matrix, microorganisms, and biofilms in stone formation and their effect on stone characteristics - and the medical implications of these insights might be crucial for the development of improved treatments. Tools and approaches used in various disciplines (for example, engineering, chemistry, mineralogy, and microbiology) can be applied to further understand the microorganism-mineral interactions that lead to infection stone formation. Thus, the use of integrated multidisciplinary approaches is imperative to improve the diagnosis, prevention, and treatment of infection stones.
Collapse
|
24
|
Abou Chakra M, Dellis AE, Papatsoris AG, Moussa M. Established and recent developments in the pharmacological management of urolithiasis: an overview of the current treatment armamentarium. Expert Opin Pharmacother 2019; 21:85-96. [DOI: 10.1080/14656566.2019.1685979] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Athanasios E. Dellis
- Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Beirut, Lebanon
| |
Collapse
|
25
|
Chandrajith R, Weerasingha A, Premaratne KM, Gamage D, Abeygunasekera AM, Joachimski MM, Senaratne A. Mineralogical, compositional and isotope characterization of human kidney stones (urolithiasis) in a Sri Lankan population. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:1881-1894. [PMID: 30671690 DOI: 10.1007/s10653-018-0237-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 12/20/2018] [Indexed: 05/28/2023]
Abstract
In order to understand the processes of stone formation, compositional, spectroscopic, mineralogical and crystallographic characteristics of human urinary stones collected from patients in Sri Lanka were investigated in detail. The data showed that the majority of urinary calculi were calcium oxalate, either whewellite or weddellite. Other solid phases of stones were composed of struvite, uricite and hydroxylapatite. However, mixed compositions were common except for whewellite stones which occur frequently in pure form. Scanning electron microscope observations and associated energy-dispersive X-ray analyses revealed that whewellite or weddellite was well crystalized compared to other stones types, while phosphate stones were mostly cryptocrystalline. The average δ13C and δ18O of stones were - 32.2‰ (- 37.3 to - 17.4‰) and - 24.2‰ (- 26.7‰ to - 8.9‰), respectively. The δ13C values were highly depleted compared to North American and European urinary stones. This may be due to food habits of Asians who consume rice as the staple food.
Collapse
Affiliation(s)
- Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Anushka Weerasingha
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kusala M Premaratne
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Dhanushke Gamage
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Michael M Joachimski
- GeoZentrum Nordbayern, University of Erlangen-Nürnberg, Schlossgarten 5, 91054, Erlangen, Germany
| | - Atula Senaratne
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
26
|
Thomas L, Xue J, Murali SK, Fenton RA, Dominguez Rieg JA, Rieg T. Pharmacological Npt2a Inhibition Causes Phosphaturia and Reduces Plasma Phosphate in Mice with Normal and Reduced Kidney Function. J Am Soc Nephrol 2019; 30:2128-2139. [PMID: 31409727 DOI: 10.1681/asn.2018121250] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/14/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The kidneys play an important role in phosphate homeostasis. Patients with CKD develop hyperphosphatemia in the later stages of the disease. Currently, treatment options are limited to dietary phosphate restriction and oral phosphate binders. The sodium-phosphate cotransporter Npt2a, which mediates a large proportion of phosphate reabsorption in the kidney, might be a good therapeutic target for new medications for hyperphosphatemia. METHODS The authors assessed the effects of the first orally bioavailable Npt2a inhibitor (Npt2a-I) PF-06869206 in normal mice and mice that had undergone subtotal nephrectomy (5/6 Nx), a mouse model of CKD. Dose-response relationships of sodium, chloride, potassium, phosphate, and calcium excretion were assessed in response to the Npt2a inhibitor in both groups of mice. Expression and localization of Npt2a/c and levels of plasma phosphate, calcium, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF-23) were studied up to 24-hours after Npt2a-I treatment. RESULTS In normal mice, Npt2a inhibition caused a dose-dependent increase in urinary phosphate (ED50 approximately 21 mg/kg), calcium, sodium and chloride excretion. In contrast, urinary potassium excretion, flow rate and urinary pH were not affected dose dependently. Plasma phosphate and PTH significantly decreased after 3 hours, with both returning to near baseline levels after 24 hours. Similar effects were observed in the mouse model of CKD but were reduced in magnitude. CONCLUSIONS Npt2a inhibition causes a dose-dependent increase in phosphate, sodium and chloride excretion associated with reductions in plasma phosphate and PTH levels in normal mice and in a CKD mouse model.
Collapse
Affiliation(s)
- Linto Thomas
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida; and
| | - Jianxiang Xue
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida; and
| | | | - Robert A Fenton
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Jessica A Dominguez Rieg
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida; and
| | - Timo Rieg
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, Florida; and
| |
Collapse
|
27
|
Dong W, Hu R, Wu Q. A New Discovery of Calcium Phosphate Urinary Stones Formation Induced by Melamine: Nanocrystalline Assembly Mechanism. CHINESE J CHEM 2019. [DOI: 10.1002/cjoc.201900124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wenya Dong
- School of Chemical Science and Engineering, Shanghai Key Laboratory of Chemical Assessment and SustainabilityTongji University Shanghai 200092 China
| | - Ruiming Hu
- Huashan HospitalFudan University Shanghai 200040 China
| | - Qingsheng Wu
- School of Chemical Science and Engineering, Shanghai Key Laboratory of Chemical Assessment and SustainabilityTongji University Shanghai 200092 China
| |
Collapse
|
28
|
Abstract
Objectives: The aim of this study was to investigate frequencies of kidney stone constituents in a Norwegian population and examine trends over time by comparing with an earlier study of this population. Materials and methods: Upper urinary tract calculi consecutively collected from patients who underwent stone surgery at Akershus University Hospital from July 2014 to December 2017, in total 1252 calculi, were analysed by infrared spectroscopy. The results were compared with a study of 500 calculi collected from June 1975 to September 1980 at the same hospital. Results: The male:female ratio was 1.83:1. Single-component stones constituted 39%, 35% were binary, and 25% ternary. Main stone component frequencies were oxalate 71.3%, calcium oxalate monohydrate 53.7% with higher occurrence in males, calcium oxalate dihydrate 17.6%, carbonate apatite 10.8% and struvite 5.7%, both with higher occurrence in females, uric acid 8.9% with a non-significant male predominance, brushite 1.6% and cystine about 1%. Over four decades the frequency of UA stones increased by 4.6-times, whereas struvite and pure carbonate apatite stones decreased and no change was observed for brushite stones. Conclusion: Frequencies of kidney stone types in this Norwegian population are mainly in accordance with other studies, except a large increase in UA stones over four decades, partly caused by a particularly low frequency of UA stones in the old study, a decreased carbonate apatite frequency over four decades, and an unaltered brushite frequency. Also, in contrast to other studies, a relatively small and non-significant male UA stone predominance was found.
Collapse
Affiliation(s)
- Gunnhild Kravdal
- a Multidisciplinary Laboratory Medicine and Medical Biochemistry , Akershus University Hospital HF , Lørenskog , Norway
| | - Dan Helgø
- b Department of Urology , Akershus University Hospital HF , Lørenskog , Norway
| | - Morten K Moe
- a Multidisciplinary Laboratory Medicine and Medical Biochemistry , Akershus University Hospital HF , Lørenskog , Norway
| |
Collapse
|
29
|
Ibeh CL, Yiu AJ, Kanaras YL, Paal E, Birnbaumer L, Jose PA, Bandyopadhyay BC. Evidence for a regulated Ca 2+ entry in proximal tubular cells and its implication in calcium stone formation. J Cell Sci 2019; 132:jcs.225268. [PMID: 30910829 DOI: 10.1242/jcs.225268] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/14/2019] [Indexed: 12/14/2022] Open
Abstract
Calcium phosphate (CaP) crystals, which begin to form in the early segments of the loop of Henle (LOH), are known to act as precursors for calcium stone formation. The proximal tubule (PT), which is just upstream of the LOH and is a major site for Ca2+ reabsorption, could be a regulator of such CaP crystal formation. However, PT Ca2+ reabsorption is mostly described as being paracellular. Here, we show the existence of a regulated transcellular Ca2+ entry pathway in luminal membrane PT cells induced by Ca2+-sensing receptor (CSR, also known as CASR)-mediated activation of transient receptor potential canonical 3 (TRPC3) channels. In support of this idea, we found that both CSR and TRPC3 are physically and functionally coupled at the luminal membrane of PT cells. More importantly, TRPC3-deficient mice presented with a deficiency in PT Ca2+ entry/transport, elevated urinary [Ca2+], microcalcifications in LOH and urine microcrystals formations. Taken together, these data suggest that a signaling complex comprising CSR and TRPC3 exists in the PT and can mediate transcellular Ca2+ transport, which could be critical in maintaining the PT luminal [Ca2+] to mitigate formation of the CaP crystals in LOH and subsequent formation of calcium stones.
Collapse
Affiliation(s)
- Cliff-Lawrence Ibeh
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington DC, DC 20422, USA
| | - Allen J Yiu
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington DC, DC 20422, USA.,Department of Medicine, Division of Renal Diseases & Hypertension, The George Washington University, Washington DC, DC 20037, USA
| | - Yianni L Kanaras
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington DC, DC 20422, USA
| | - Edina Paal
- Pathology and Laboratory Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington DC, DC 20422, USA
| | - Lutz Birnbaumer
- Division of Intramural Research, NIEHS, Research Triangle Park, Durham, NC 27709, USA.,Institute for Biomedical Research (BIOMED), Catholic University of Argentina, C1107AFF Buenos Aires, Argentina
| | - Pedro A Jose
- Department of Medicine, Division of Renal Diseases & Hypertension, The George Washington University, Washington DC, DC 20037, USA.,Department of Pharmacology and Physiology, The George Washington University, Washington DC, DC 20037, USA
| | - Bidhan C Bandyopadhyay
- Calcium Signaling Laboratory, Research Service, Veterans Affairs Medical Center, 50 Irving Street, NW, Washington DC, DC 20422, USA .,Department of Medicine, Division of Renal Diseases & Hypertension, The George Washington University, Washington DC, DC 20037, USA.,Department of Pharmacology and Physiology, The George Washington University, Washington DC, DC 20037, USA
| |
Collapse
|
30
|
Kim JC, Cho KS, Kim DK, Chung DY, Jung HD, Lee JY. Predictors of Uric Acid Stones: Mean Stone Density, Stone Heterogeneity Index, and Variation Coefficient of Stone Density by Single-Energy Non-Contrast Computed Tomography and Urinary pH. J Clin Med 2019; 8:jcm8020243. [PMID: 30781839 PMCID: PMC6407098 DOI: 10.3390/jcm8020243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022] Open
Abstract
We analyzed the capacities of pertinent parameters (determined by single-energy non-contrast computed tomography [NCCT]) and urinary pH to predict uric acid stones. We reviewed the medical records of 501 patients whose stones were removed surgically or passed spontaneously between December 2014 and April 2016. Qualifying participants (n = 420) were stratified by the nature of the stone (calcium oxalate, uric acid, or infectious). Based on NCCT, we determined maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) using Hounsfield units (HU) and calculated the variant coefficient of stone density (VCSD = SHI/MSD × 100). Urinary pH was also ascertained. Mean patient age was 55.55 ± 15.46 years. MSD (448.59 ± 173.21 HU), SHI (100.81 ± 77.37 HU), and VCSD (22.58 ± 10.55) proved to be significantly lower in uric acid versus other types of stones, as did urinary pH (5.33 ± 0.56; all p < 0.001). Receiver operating characteristic (ROC) curves depicting predictability of uric acid stones yielded area under ROC curve (AUC) values for MSD, SHI, VCSD, and urinary pH of 0.806 (95% CI: 0.761⁻0.850), 0.893 (95% CI: 0.855⁻0.931), 0.782 (95% CI: 0.726⁻0.839), and 0.797 (95% CI: 0.749⁻0.846), respectively, with corresponding cutpoints of 572.3 HU, 140.4 HU, 25.79, and 6.0. Among these four parameters, SHI was verifiably (DeLong's test) the most effective predictor of uric acid stones (all p < 0.001). Compared with MSD, VCSD, and urinary pH, SHI may better predict uric acid stones, using a cutpoint of 140.4 HU.
Collapse
Affiliation(s)
- Jong Chan Kim
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin 17046, Korea.
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| |
Collapse
|
31
|
Stone-free Outcomes of Flexible Ureteroscopy for Renal Calculi Utilizing Computed Tomography Imaging. Urology 2019; 124:52-56. [DOI: 10.1016/j.urology.2018.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 12/15/2022]
|
32
|
Melamine promotes calcium crystal formation in three-dimensional microfluidic device. Sci Rep 2019; 9:875. [PMID: 30696888 PMCID: PMC6351636 DOI: 10.1038/s41598-018-37191-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023] Open
Abstract
Melamine, which induces proximal tubular (PT) cell damage has a greater nephrotoxic effect when combined with cyanuric and uric acids; however, it is unknown whether such effect can stimulate calcium phosphate (CaP)/calcium oxalate (CaOx) stone formation. Here, we show that melamine acts as an inducer of CaP, CaOx and CaP + CaOx (mixed) crystal formations in a time and concentration-dependent manner by stabilizing those crystals and further co-aggregating with melamine. To explore the physiological relevance of such melamine-augmented calcium crystal formation, we used 2-dimensional (2D) and 3D microfluidic (MF) device, embedded with PT cells, which also resembled the effect of melamine-stimulated CaP, CaOx and mixed crystal formation. Significantly, addition of preformed CaP and/or CaOx crystal in the presence of melamine, further potentiated those crystal formations in 3D MFs, which helped the growth and aggregation of mixed crystals. Our data show that the mechanism of such predisposition of stone formation could be largely due to co-crystallization between melamine and CaP/CaOx and pronounced effect on induction of stone-forming pathway activation in 3D MF. Taken together, melamine-induced CaP and/or CaOx crystal formation ex-vivo will help us in understanding the larger role of melamine as an environmental toxicant in producing the pathology in similar cellular microenvironments.
Collapse
|
33
|
Dhayat NA, Faller N, Bonny O, Mohebbi N, Ritter A, Pellegrini L, Bedino G, Schönholzer C, Venzin RM, Hüsler C, Koneth I, Del Giorno R, Gabutti L, Amico P, Mayr M, Odermatt U, Buchkremer F, Ernandez T, Stoermann-Chopard C, Teta D, Rintelen F, Roumet M, Irincheeva I, Trelle S, Tamò L, Roth B, Vogt B, Fuster DG. Efficacy of standard and low dose hydrochlorothiazide in the recurrence prevention of calcium nephrolithiasis (NOSTONE trial): protocol for a randomized double-blind placebo-controlled trial. BMC Nephrol 2018; 19:349. [PMID: 30526528 PMCID: PMC6288917 DOI: 10.1186/s12882-018-1144-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Nephrolithiasis is a global healthcare problem with a current lifetime risk of 18.8% in men and 9.4% in women. Given the high cost of medical treatments and surgical interventions as well as the morbidity related to symptomatic stone disease, medical prophylaxis for stone recurrence is an attractive approach. Thiazide diuretics have been the cornerstone of pharmacologic metaphylaxis for more than 40 years. However, evidence for benefits and harms of thiazides in the prevention of calcium containing kidney stones in general remains unclear. In addition, the efficacy of the currently employed low dose thiazide regimens to prevent stone recurrence is not known. Methods The NOSTONE trial is an investigator-initiated 3-year prospective, multicenter, double-blind, placebo-controlled trial to assess the efficacy of standard and low dose hydrochlorothiazide treatment in the recurrence prevention of calcium containing kidney stones. We plan to include 416 adult (≥ 18 years) patients with recurrent (≥ 2 stone episodes in the last 10 years) calcium containing kidney stones (containing ≥50% of calcium oxalate, calcium phosphate or a mixture of both). Patients will be randomly allocated to 50 mg or 25 mg or 12.5 mg hydrochlorothiazide or placebo. The primary outcome will be incidence of stone recurrence (a composite of symptomatic or radiologic recurrence). Secondary outcomes will be individual components of the composite primary outcome, safety and tolerability of hydrochlorothiazide treatment, changes in urinary biochemistry elicited by hydrochlorothiazide treatment and impact of baseline disease severity, biochemical abnormalities and stone composition on treatment response. Discussion The NOSTONE study will provide long-sought information on the efficacy of hydrochlorothiazide in the recurrence prevention of calcium containing kidney stones. Strengths of the study include the randomized, double-blind and placebo-controlled design, the large amount of patients studied, the employment of high sensitivity and high specificity imaging and the exclusive public funding support. Trial registration ClinicalTrials.gov, NCT03057431. Registered on February 20 2017.
Collapse
Affiliation(s)
- Nasser A Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Faller
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier Bonny
- Department of Nephrology, CHUV, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland
| | - Nilufar Mohebbi
- Department of Nephrology, University Hospital Zurich, Zürich, Switzerland
| | - Alexander Ritter
- Department of Nephrology, University Hospital Zurich, Zürich, Switzerland
| | - Lisa Pellegrini
- Department of Nephrology, Regional Hospital Lugano, Lugano, Switzerland
| | - Giulia Bedino
- Department of Nephrology, Regional Hospital Lugano, Lugano, Switzerland
| | - Carlo Schönholzer
- Department of Nephrology, Regional Hospital Lugano, Lugano, Switzerland
| | - Reto M Venzin
- Department of Nephrology, Cantonal Hospital Chur, Chur, Switzerland
| | - Carina Hüsler
- Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Irene Koneth
- Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Rosaria Del Giorno
- Department of Nephrology, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - Luca Gabutti
- Department of Nephrology, Regional Hospital Bellinzona, Bellinzona, Switzerland
| | - Patrizia Amico
- Medical Outpatient Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Mayr
- Medical Outpatient Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Urs Odermatt
- Department of Nephrology, Cantonal Hospital Luzern, Luzern, Switzerland
| | - Florian Buchkremer
- Division of Nephrology, Dialysis and Transplantation, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas Ernandez
- Department of Nephrology, HUG, University Hospital Geneva, University of Geneva, Geneva, Switzerland
| | | | - Daniel Teta
- Service de Nephrology, Centre Hospitalier du Valais Romand (CHVR), Sion, Switzerland
| | - Felix Rintelen
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Marie Roumet
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | | | - Sven Trelle
- Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Luca Tamò
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Beat Roth
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bruno Vogt
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| |
Collapse
|
34
|
Daudon M, Jungers P, Bazin D, Williams JC. Recurrence rates of urinary calculi according to stone composition and morphology. Urolithiasis 2018; 46:459-470. [PMID: 29392338 PMCID: PMC6711148 DOI: 10.1007/s00240-018-1043-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/24/2018] [Indexed: 12/13/2022]
Abstract
Few studies have examined the relative risk of recurrence of different stone types. The object of the present study was to evaluate the tendency for stone recurrence as a function of major mineral composition of the stones and morphological characteristics of the stones. This study was carried out using 38,274 stones for which we had data available to specify if the stone was from the first or a subsequent urinary stone episode. Stones were analyzed for morphology by stereomicroscope and for composition by infrared spectroscopy. Overall, 42.7% of stones were from patients who had had a previous stone event, with these being more frequent in men (44.4%) than in women (38.9%, p < 0.0001). Age of first stone occurrence was lowest for dihydroxyadenine (15.7 ± 16.6 years) and highest for anhydrous uric acid (62.5 ± 14.9 years), with the average age of first stones of calcium oxalate falling in the middle (40.7 ± 14.6 years for calcium oxalate dihydrate, and 48.4 ± 15.1 years for calcium oxalate monohydrate, COM). By composition alone, COM was among the least recurrent of stones, with only 38.0% of COM stones coming from patients who had had a previous episode; however, when the different morphological types of COM were considered, type Ic-which displays a light color, budding surface and unorganized section-had a significantly greater rate of recurrence, at 82.4% (p < 0.0001), than did other morphologies of COM. Similarly, for stones composed of apatite, morphological type IVa2-a unique form with cracks visible beneath a glossy surface-had a higher rate of recurrence than other apatite morphologies (78.8 vs. 39-42%, p < 0.0001). Stone mineral type alone is insufficient for identifying the potential of recurrence of the stones. Instead, the addition of stone morphology may allow the diagnosis of highly recurrent stones, even among common mineral types (e.g., COM) that in general are less recurrent.
Collapse
Affiliation(s)
- Michel Daudon
- Laboratoire des Lithiases, Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, APHP, 4, rue de la Chine, 75970, Paris Cedex 20, France.
- Unité INSERM UMRS 1155, UPMC, Hôpital Tenon, Paris, France.
| | - Paul Jungers
- Département de Néphrologie, Hôpital Necker, APHP, Paris, France
| | - Dominique Bazin
- LCMCP, UPMC, CNRS, Collège de France, Paris, France
- Laboratoire de Physique des Solides, Université Paris Sud, Orsay, France
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University, Indianapolis, IN, USA
| |
Collapse
|
35
|
Conversion from Cystine to Noncystine Stones: Incidence and Associated Factors. J Urol 2018; 200:1285-1289. [PMID: 30059686 DOI: 10.1016/j.juro.2018.07.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE Patients with cystinuria are often treated with medical alkalization and shock wave lithotripsy, although each treatment is hypothesized to increase the risk of calcium phosphate stones. We performed a multicenter retrospective review to evaluate whether stones of another composition develop in patients with cystinuria and with what frequency. MATERIALS AND METHODS We retrospectively reviewed the records of a multi-institutional cohort of patients with cystinuria. We assessed medications, stone analyses, 24-hour urinalyses and types of procedures. We compared patients who formed only cystine stones vs those with noncystine stones. RESULTS We identified 125 patients from a total of 5 institutions who were followed a mean of 5.2 years (range 0 to 26). Stones with noncystine components were submitted by 37 patients (29.6%). Potassium citrate medication was not associated with a noncystine composition (p = 0.1877). Regarding surgical management 18 patients (13%) underwent at least 1 shock wave lithotripsy session (range 0 to 9) and 79 (63%) underwent percutaneous nephrolithotomy at least once (range 0 to 10). When stratified based on pure cystine vs converted stones, the average total number of shock wave lithotripsy and percutaneous nephrolithotomy procedures was higher in the group with cystine and subsequent noncystine stone compositions (0.94 vs 0.10, p <0.0001, and 1.7 vs 1.5, p = 0.0053, respectively). On logistic regression male gender (OR 3.1, p = 0.0280) and the number of shock wave lithotripsy sessions (OR 3.0, p = 0.0170) were associated with an increased likelihood of the development of stones with a noncystine composition. CONCLUSIONS Stones with noncystine components develop in more than 25% of patients with cystinuria, underscoring the importance of continued stone analysis. In this study prior shock wave lithotripsy was associated with conversion to a noncystine stone composition while urinary alkalization therapy was not associated.
Collapse
|
36
|
Doizi S, Poindexter JR, Pearle MS, Blanco F, Moe OW, Sakhaee K, Maalouf NM. Impact of Potassium Citrate vs Citric Acid on Urinary Stone Risk in Calcium Phosphate Stone Formers. J Urol 2018; 200:1278-1284. [PMID: 30036516 DOI: 10.1016/j.juro.2018.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To our knowledge no medication has been shown to be effective for preventing recurrent calcium phosphate urinary stones. Potassium citrate may protect against calcium phosphate stones by enhancing urine citrate excretion and lowering urine calcium but it raises urine pH, which increases calcium phosphate saturation and may negate the beneficial effects. Citric acid can potentially raise urine citrate but not pH and, thus, it may be a useful countermeasure against calcium phosphate stones. We assessed whether these 2 agents could significantly alter urine composition and reduce calcium phosphate saturation. MATERIALS AND METHODS In a crossover metabolic study 13 recurrent calcium phosphate stone formers without hypercalciuria were evaluated at the end of 3, 1-week study phases during which they consumed a fixed metabolic diet and received assigned study medications, including citric acid 30 mEq twice daily, potassium citrate 20 mEq twice daily or matching placebo. We collected 24-hour urine specimens to perform urine chemistry studies and calculate calcium phosphate saturation indexes. RESULTS Urine parameters did not significantly differ between the citric acid and placebo phases. Potassium citrate significantly increased urine pH, potassium and citrate compared to citric acid and placebo (p <0.01) with a trend toward lower urine calcium (p = 0.062). Brushite saturation was increased by potassium citrate when calculated by the relative supersaturation ratio but not by the saturation index. CONCLUSIONS Citric acid at a dose of 60 mEq per day did not significantly alter urine composition in calcium phosphate stone formers. The long-term impact of potassium citrate on calcium phosphate stone recurrence needs to be studied further.
Collapse
Affiliation(s)
- Steeve Doizi
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John R Poindexter
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Margaret S Pearle
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Francisco Blanco
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Orson W Moe
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Physiology, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Khashayar Sakhaee
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Naim M Maalouf
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Mineral Metabolism, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
37
|
Abstract
Staghorn stones are large branching stones that fill part of all of the renal pelvis and renal calyces and they can be complete or partial depending on the level of occupancy of the collecting system. Although kidney stones are commoner in men, staghorn stones are less often reported in men compared to women and they are usually unilateral. Due to the significant morbidity and potential mortality attributed to staghorn stones, prompt assessment and treatment is mandatory. Conversely, conservative treatment has been shown to carry a mortality rate of 28% in 10-year period and 36% risk of developing significant renal impairment. Staghorn stones are, therefore, significant disease entity that should be managed aggressively and effectively. Generally, the gold standard treatment for staghorn stones is surgical with a view to achieve stone-free collecting system and preserve renal function. Percutaneous nephrolithotomy should be the recommended first-line treatment for staghorn stones. Other non-surgical options are usually considered in combination with surgery or as monotherapy only if patients are surgically unfit. The decision for optimal treatment of staghorn stones should be individualized according to the circumstances of the patient involved and in order to do so, a closer look at the advantages and disadvantages of each option is necessary.
Collapse
Affiliation(s)
- Akif Diri
- a Faculty of Medicine , Aksaray University , Aksaray , Turkey
| | - Banu Diri
- b Department of Urology and Nephrology , Aksaray University , Aksaray , Turkey
| |
Collapse
|
38
|
Worcester EM, Bergsland KJ, Gillen DL, Coe FL. Mechanism for higher urine pH in normal women compared with men. Am J Physiol Renal Physiol 2017; 314:F623-F629. [PMID: 29357436 DOI: 10.1152/ajprenal.00494.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Regulation of acid-base metabolism maintains the pH of body fluids within a tight range. Urine pH (UpH) is also regulated under normal conditions. Median pH of 24-h urines is ~6, but others have noted that UpH in women is higher than men, which has been attributed to differences in diet. If true, it would help to explain the fact that calcium phosphate stones, which form at higher urine pH, are much more common in women than in men. We studied 14 normal subjects (7 men and 7 women) fed identical meals in a Clinical Research Center. Urine and blood samples were collected during fasting and after meals. UpH of women (6.74 ± 0.11) exceeded that of men (6.07 ± 0.17) fed, but not fasting, and UpH rose significantly with meals in women but not men. Serum and urine total CO2 rose with meals in women but not men, and in women net acid excretion fell to zero during the fed period. In a general linear model adjusted for age, sex, and weight, net gastrointestinal anion uptake was the main predictor of UpH and was significantly higher in women (3.9 ± 0.6) than men (1.8 ± 0.7) in the fed period. Urine citrate, an anion absorbed by the gastrointestinal tract, was higher in women than men in the fed state, and fractional excretion of citrate was higher in women than men. The higher fed UpH in women is related to a greater absorption of food anions and raises 24-h UpH.
Collapse
Affiliation(s)
- Elaine M Worcester
- Department of Medicine, University of Chicago Medicine , Chicago, Illinois
| | | | - Daniel L Gillen
- Department of Statistics, University of California , Irvine, California
| | - Fredric L Coe
- Department of Medicine, University of Chicago Medicine , Chicago, Illinois
| |
Collapse
|
39
|
Abstract
Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein.
Collapse
Affiliation(s)
- Anna L Zisman
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
40
|
Handa RK, Territo PR, Blomgren PM, Persohn SA, Lin C, Johnson CD, Jiang L, Connors BA, Hutchins GD. Development of a novel magnetic resonance imaging acquisition and analysis workflow for the quantification of shock wave lithotripsy-induced renal hemorrhagic injury. Urolithiasis 2017; 45:507-513. [PMID: 28074231 DOI: 10.1007/s00240-016-0959-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Abstract
The current accepted standard for quantifying shock wave lithotripsy (SWL)-induced tissue damage is based on morphometric detection of renal hemorrhage in serial tissue sections from fixed kidneys. This methodology is time and labor intensive and is tissue destructive. We have developed a non-destructive magnetic resonance imaging (MRI) method that permits rapid assessment of SWL-induced hemorrhagic lesion volumes in post-mortem kidneys using native tissue contrast to reduce cycle time. Kidneys of anesthetized pigs were targeted with shock waves using the Dornier Compact S lithotripter. Harvested kidneys were then prepared for tissue injury quantification. T1 weighted (T1W) and T2 weighted (T2W) images were acquired on a Siemens 3T Tim Trio MRI scanner. Images were co-registered, normalized, difference (T1W - T2W) images generated, and volumes classified and segmented using a Multi-Spectral Neural Network (MSNN) classifier. Kidneys were then subjected to standard morphometric analysis for the measurement of lesion volumes. Classifications of T1W, T2W and difference image volumes were correlated with morphometric measurements of whole kidney and parenchymal lesion volumes. From these relationships, a mathematical model was developed that allowed predictions of the morphological parenchymal lesion volume from MRI whole kidney lesion volumes. Predictions and morphology were highly correlated (R = 0.9691, n = 20) and described by the relationship y = 0.84x + 0.09, and highly accurate with a sum of squares difference error of 0.79%. MRI and the MSNN classifier provide a semi-automated segmentation approach, which provide a rapid and reliable means to quantify renal injury lesion volumes due to SWL.
Collapse
Affiliation(s)
- Rajash K Handa
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA.
| | - Paul R Territo
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, USA
| | - Philip M Blomgren
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Scott A Persohn
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, USA
| | - Chen Lin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, USA
| | - Cynthia D Johnson
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Lei Jiang
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, USA
| | - Bret A Connors
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN, 46202, USA
| | - Gary D Hutchins
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, USA
| |
Collapse
|
41
|
Risk of Chronic Kidney Disease in Brushite Stone Formers Compared With Idiopathic Calcium Oxalate Stone Formers. Urology 2017; 99:23-26. [DOI: 10.1016/j.urology.2016.08.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022]
|
42
|
Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29:715-734. [PMID: 27456839 PMCID: PMC5080344 DOI: 10.1007/s40620-016-0329-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
Collapse
Affiliation(s)
- Giovanni Gambaro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Fredric Coe
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - Orson Moe
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, USA
| | - Elen Worcester
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - Noor Buchholz
- Department of Urological Surgery, Sobeh's Vascular and Medical Center, Dubai, UAE
| | - David Bushinsky
- Department of Nephrology, Medical Center, University of Rochester, Rochester, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, USA
| | - Pietro Manuel Ferraro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniel Fuster
- Department of Nephrology, University of Bern, Bern, Switzerland
| | - David S Goldfarb
- Department of Nephrology, New York Harbor VA Health Care System, New York, USA
| | | | - Bernard Hess
- Department of Internal Medicine and Nephrology, Klinik Im Park Hospital, Zurich, Switzerland
| | - John Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Martino Marangella
- Department of Nephrology, A.S.O Ordine Mauriziano Hospital, Turin, Italy
| | - Dawn Milliner
- Department of Nephrology, Mayo Clinic, Rochester, USA
| | - Glen M Preminger
- Department of Urology, Duke University Medical Center, Durham, USA
| | | | - Khashayar Sakhaee
- Southwestern Medical Center, Mineral Metabolism Research, University of Texas, Dallas, USA
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indiana, USA
| |
Collapse
|
43
|
Pedro RN, Das K, Buchholz N. Urolithiasis in pregnancy. Int J Surg 2016; 36:688-692. [PMID: 27816709 DOI: 10.1016/j.ijsu.2016.10.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/29/2016] [Indexed: 11/27/2022]
Abstract
Urolithiasis in pregnancy is a major health concern and can potentially affect the well-being of both mother and foetus. Management of this condition often entails simultaneous multidisciplinary involvement of obstetrician, radiologist and urologist. Additionally, adverse effects with usage of anaesthesia, radiation, medications and surgery on mother and foetus, limit utilisation of the full armamentarium of diagnostic and therapeutic modalities that are commonly used in non-pregnant women. This review was conducted using an electronic literature search of peer reviewed journal articles. Clinical studies were identified in the bibliographic database- PubMed (Medline), Ovid and eMedicine(WebMD) using the keywords: hydronephrosis, urolithiasis, kidney stone, urinary tract infection, pregnancy and ultrasound, incidence and epidemiology of renal stones.
Collapse
Affiliation(s)
- Renato N Pedro
- U-merge (Urology in Emerging Countries), London, UK; Faculdade Medicina Sao Leopoldo Mandic, Brazil
| | - Krishanu Das
- U-merge (Urology in Emerging Countries), London, UK; Royal Endourology & Robotic Fellow Adelaide Hospital, Australia
| | - Noor Buchholz
- U-merge (Urology in Emerging Countries), London, UK.
| |
Collapse
|
44
|
Castañeda-Argáiz R, Cloutier J, Villa L, Traxer O. Evolution of endourology and flexible ureterorenoscopy, can they be useful to urologists to clarify stone composition and morphology? CR CHIM 2016. [DOI: 10.1016/j.crci.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Daudon M, Dessombz A, Frochot V, Letavernier E, Haymann JP, Jungers P, Bazin D. Comprehensive morpho-constitutional analysis of urinary stones improves etiological diagnosis and therapeutic strategy of nephrolithiasis. CR CHIM 2016. [DOI: 10.1016/j.crci.2016.05.008] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Letavernier E, Verrier C, Goussard F, Perez J, Huguet L, Haymann JP, Baud L, Bazin D, Daudon M. Calcium and vitamin D have a synergistic role in a rat model of kidney stone disease. Kidney Int 2016; 90:809-17. [DOI: 10.1016/j.kint.2016.05.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
|
47
|
Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
Collapse
Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
| |
Collapse
|
48
|
Molecular modifiers reveal a mechanism of pathological crystal growth inhibition. Nature 2016; 536:446-50. [PMID: 27501150 DOI: 10.1038/nature19062] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/20/2016] [Indexed: 11/08/2022]
Abstract
Crystalline materials are crucial to the function of living organisms, in the shells of molluscs, the matrix of bone, the teeth of sea urchins, and the exoskeletons of coccoliths. However, pathological biomineralization can be an undesirable crystallization process associated with human diseases. The crystal growth of biogenic, natural and synthetic materials may be regulated by the action of modifiers, most commonly inhibitors, which range from small ions and molecules to large macromolecules. Inhibitors adsorb on crystal surfaces and impede the addition of solute, thereby reducing the rate of growth. Complex inhibitor-crystal interactions in biomineralization are often not well elucidated. Here we show that two molecular inhibitors of calcium oxalate monohydrate crystallization--citrate and hydroxycitrate--exhibit a mechanism that differs from classical theory in that inhibitor adsorption on crystal surfaces induces dissolution of the crystal under specific conditions rather than a reduced rate of crystal growth. This phenomenon occurs even in supersaturated solutions where inhibitor concentration is three orders of magnitude less than that of the solute. The results of bulk crystallization, in situ atomic force microscopy, and density functional theory studies are qualitatively consistent with a hypothesis that inhibitor-crystal interactions impart localized strain to the crystal lattice and that oxalate and calcium ions are released into solution to alleviate this strain. Calcium oxalate monohydrate is the principal component of human kidney stones and citrate is an often-used therapy, but hydroxycitrate is not. For hydroxycitrate to function as a kidney stone treatment, it must be excreted in urine. We report that hydroxycitrate ingested by non-stone-forming humans at an often-recommended dose leads to substantial urinary excretion. In vitro assays using human urine reveal that the molecular modifier hydroxycitrate is as effective an inhibitor of nucleation of calcium oxalate monohydrate nucleation as is citrate. Our findings support exploration of the clinical potential of hydroxycitrate as an alternative treatment to citrate for kidney stones.
Collapse
|
49
|
Ghorbani M, Oral O, Ekici S, Gozuacik D, Kosar A. Review on Lithotripsy and Cavitation in Urinary Stone Therapy. IEEE Rev Biomed Eng 2016; 9:264-83. [PMID: 27249837 DOI: 10.1109/rbme.2016.2573381] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cavitation is the sudden formation of vapor bubbles or voids in liquid media and occurs after rapid changes in pressure as a consequence of mechanical forces. It is mostly an undesirable phenomenon. Although the elimination of cavitation is a major topic in the study of fluid dynamics, its destructive nature could be exploited for therapeutic applications. Ultrasonic and hydrodynamic sources are two main origins for generating cavitation. The purpose of this review is to give the reader a general idea about the formation of cavitation phenomenon and existing biomedical applications of ultrasonic and hydrodynamic cavitation. Because of the high number of the studies on ultrasound cavitation in the literature, the main focus of this review is placed on the lithotripsy techniques, which have been widely used for the treatment of urinary stones. Accordingly, cavitation phenomenon and its basic concepts are presented in Section II. The significance of the ultrasound cavitation in the urinary stone treatment is discussed in Section III in detail and hydrodynamic cavitation as an important alternative for the ultrasound cavitation is included in Section IV. Finally, side effects of using both ultrasound and hydrodynamic cavitation in biomedical applications are presented in Section V.
Collapse
|
50
|
Rivera M, Cockerill PA, Enders F, Mehta RA, Vaughan L, Vrtiska TJ, Herrera Hernandez LP, Holmes DR, Rule AD, Lieske JC, Krambeck AE. Characterization of Inner Medullary Collecting Duct Plug Formation Among Idiopathic Calcium Oxalate Stone Formers. Urology 2016; 94:47-52. [PMID: 27210573 DOI: 10.1016/j.urology.2016.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/05/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To study the prevalence of, risk factors for, and renal functional consequences of ductal plug formation in idiopathic calcium oxalate (iCaOx) stone formers (SF). PATIENTS AND METHODS Accessible renal papillae were videotaped to determine the percent surface area (SA) occupied by plaque and ductal plug in a consecutive cohort of iCaOx SF undergoing percutaneous nephrolithotomy for stone removal. RESULTS Between 2009 and 2014, iCaOx SF comprised 96 of 240 enrolled patients. Of these, 41 (43%) had ductal plugs. Mean plaque SA did not differ between the low and high % plug groups (2.1% vs 3.4%, respectively). The amounts of mean % SA plaque and ductal plug were not strongly correlated (Spearman's ρ = 0.12, P = .3). Patients with >1% mean SA plug had a higher urinary pH (median 6.5 vs 6.0, P = .02) and elevated urinary hydroxyapatite supersaturation (median 5.4 vs 3.7 delta G; P = .04). Those with >1% plugging had more extensive ductal dilation (P = .002) compared to those with ≤1%. However, estimated glomerular filtration rate was the same (median 75.4 mL/min/1.73 m(2) vs 74.7 mL/min/1.73 m(2)). Number of prior stone events was associated with mean and maximum papillary SA occupied by plug (P < .05 for both), but not plaque (P = .3 and p = .5, respectively). CONCLUSION Within a cohort of iCaOx SF, macroscopic plaque and ductal plugs often coexist. Intraluminal features known to favor calcium phosphate crystallization appear to play a role in plug formation. The pathogenic significance of these plugs remains to be established, although their extent appears to correlate with stone burden.
Collapse
Affiliation(s)
| | | | - Felicity Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ramila A Mehta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Lisa Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - David R Holmes
- Department of Physiology and Biomedical Engineering, Biomedical Imaging Resource Core, Mayo Clinic, Rochester, MN
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | |
Collapse
|