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Yan YQ, Huang YQ, Feng YQ. Correlation of Great Chinese Famine Exposure During Early Life to Prevalence of Kidney Stone in Adulthood. Int J Gen Med 2023; 16:2013-2022. [PMID: 37251281 PMCID: PMC10225139 DOI: 10.2147/ijgm.s409269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Background The Great Chinese Famine, as the famine of 1959-1961 was often known. Famine exposure during early life was proven to be associated with some kidney diseases but has not been studied with kidney stone. We aimed to investigate the relationship between exposure to the Great Chinese Famine in early life and the incidence of kidney stone in adulthood. Methods From 1 January 2017 to 31 December 2018, a total of 19,658 eligible adults were recruited in a cross-sectional survey who were born between 1 October 1952 and 30 September 1964 in Guangdong, China. Participants were separated into kidney stone and none-kidney stone groups based on kidney stone status. According to birth data, participants were divided into non-exposed, fetal-exposed, early-, mid-, and late-childhood-exposed groups. Multivariate logistic regression, subgroup analysis and interaction test were used to estimate the odds ratios (ORs) and confidence intervals (CIs) between famine exposure and kidney stone. Results In total, 19,658 (12,246 female, mean age 59.31 ± 3.68 years) subjects were enrolled, and 3219 (16.38%) participants with kidney stone. The prevalence of kidney in none-, fetal-, early-, mid-, and late-childhood-exposed groups were 645 (14.9%), 437 (15.9%), 676 (16.3%), 743 (17.0%), and 718 (17.6%), respectively (P<0.001). When compared with the unexposed group, the fully adjusted ORs for kidney stone from fetal-exposed, early-, mid- to late-childhood-exposed groups were 1.37 (95% CI: 1.13, 1.68, P=0.002), 1.98 (95% CI: 1.45, 2.72, P<0.001), 2.94 (95% CI: 1.96, 4.42, P<0.001), and 3.48 (95% CI: 2.11, 5.72, P<0.001), respectively (P for trend<0.001). Subgroup analyses revealed no interactions between the famine effect on kidney stones and body mass index, gender, smoking status, history of diabetes or hypertension (all P for interaction >0.05). Conclusion This study found that exposure to the Great Chinese Famine during early life was independently associated with the increased incidence of kidney stone in adulthood.
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Affiliation(s)
- Yu-Qin Yan
- Department of Cardiology, People’s Hospital of Shenzhen Baoan District, Shenzhen, People’s Republic of China
| | - Yu-Qing Huang
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China
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Yılmaz AÇ, Ünal N. Do dietary factors play a role in infantile urolithiasis? Pediatr Nephrol 2022; 37:3157-3163. [PMID: 35275274 DOI: 10.1007/s00467-022-05501-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Urolithiasis is a significant cause of morbidity that may be diagnosed at a young age. However, there is little research on the role of nutrition in pediatric urolithiasis, and research on the infantile period is extremely rare. The aim of this study is to investigate the effect of dietary factors on those diagnosed with "idiopathic" infantile urolithiasis. METHOD The study group included 44 infants without a proven etiological factor for urolithiasis. The control group consisted of 60 fully healthy infants of matched age and gender. The parents and caregivers of each infant in the patient and control groups were carefully questioned by the same researcher for their dietary characteristics. RESULT The duration of formula usage and daily volume of formula were statistically higher in the study group than the control group (p = 0.041 and p = 0.003, respectively). The urolithiasis group consumed significantly more cow's milk and dairy products (p = 0.033 and p = 0.001). There was no statistically meaningful difference between the two groups in terms of starting age for free water and salty food, as well as daily water intake. CONCLUSION We concluded that dietary conditions could also be a risk factor for idiopathic urolithiasis. We believe that nutritional factors for infantile urolithiasis should be better described, in addition to genetic, anatomical, and metabolic factors. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Aysun Çaltık Yılmaz
- Department of Pediatric Nephrology, Ankara Baskent University, Ankara, Turkey.
| | - Necla Ünal
- Department of Pediatrics, Ankara Kecioren Training and Research Hospital, Ankara, Turkey
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Vrielinck J, Janssens GPJ, Chantziaras I, Cools A, Maes D. Effect of Feed Supplementation with Tripotassium Citrate or Sodium Chloride on the Development of Urinary Calcium Oxalate Crystals in Fattening Pigs. Vet Sci 2022; 9:614. [PMID: 36356091 PMCID: PMC9699466 DOI: 10.3390/vetsci9110614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/22/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
The present study investigated whether dietary supplementation of tripotassium citrate or NaCl reduced the prevalence of calcium oxalate dihydrate (COD) uroliths in fattening pigs on a farm with a high prevalence of COD uroliths. Each group (control, TPC, NaCl) consisted of three batches of approximately 260 fattening pigs each. Performance, water intake, markers for bone resorption (CTX) and bone formation (osteocalcin) and urinalysis from samples taken at the farm and in the slaughterhouse were investigated. Performance parameters, feed and water intake, CTX and osteocalcin were not significantly different between the groups (p > 0.05). The main crystals found were struvite, COD, calcite and amorphous crystals. The prevalence of COD crystals was lower in samples from the slaughterhouse in each group. Microscopic and biochemical examination of urine showed large differences between samples from the farm and the slaughterhouse. In conclusion, there were no beneficial effects of feed supplementation with TPC or NaCl on the prevalence of COD crystals but TPC has a clear promoting influence on the development of alkaline calcite crystals. Urinalysis from samples taken at the slaughterhouse does not fully reflect the situation on the farm.
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Affiliation(s)
- Joris Vrielinck
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium
- Veterinary Practice, Hospitaalstraat 38, 8906 Ieper-Elverdinge, Belgium
| | | | - Ilias Chantziaras
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium
| | - An Cools
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium
| | - Dominiek Maes
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium
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Pozdzik A, Hamade A, Racapé J, Roumeguère T, Wolff F, Cotton F. The epidemiology of kidney stones in Belgium based on Daudon’s morpho-constitutional classification: a retrospective, single-center study. CR CHIM 2022. [DOI: 10.5802/crchim.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Torres JA, Rezaei M, Broderick C, Lin L, Wang X, Hoppe B, Cowley BD, Savica V, Torres VE, Khan S, Holmes RP, Mrug M, Weimbs T. Crystal deposition triggers tubule dilation that accelerates cystogenesis in polycystic kidney disease. J Clin Invest 2019; 129:4506-4522. [PMID: 31361604 PMCID: PMC6763267 DOI: 10.1172/jci128503] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022] Open
Abstract
The rate of disease progression in autosomal-dominant (AD) polycystic kidney disease (PKD) exhibits high intra-familial variability suggesting that environmental factors may play a role. We hypothesized that a prevalent form of renal insult may accelerate cystic progression and investigated tubular crystal deposition. We report that calcium oxalate (CaOx) crystal deposition led to rapid tubule dilation, activation of PKD-associated signaling pathways, and hypertrophy in tubule segments along the affected nephrons. Blocking mTOR signaling blunted this response and inhibited efficient excretion of lodged crystals. This mechanism of "flushing out" crystals by purposefully dilating renal tubules has not previously been recognized. Challenging PKD rat models with CaOx crystal deposition, or inducing calcium phosphate deposition by increasing dietary phosphorous intake, led to increased cystogenesis and disease progression. In a cohort of ADPKD patients, lower levels of urinary excretion of citrate, an endogenous inhibitor of calcium crystal formation, correlated with increased disease severity. These results suggest that PKD progression may be accelerated by commonly occurring renal crystal deposition which could be therapeutically controlled by relatively simple measures.
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Affiliation(s)
- Jacob A. Torres
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Mina Rezaei
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Caroline Broderick
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Louis Lin
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
| | - Xiaofang Wang
- Mayo Clinic College of Medicine, Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Bernd Hoppe
- University Children’s Hospital Bonn, Division of Pediatric Nephrology, Bonn, Germany
| | - Benjamin D. Cowley
- University of Oklahoma Health Sciences Center, Department of Medicine, Section of Nephrology, Oklahoma City, Oklahoma, USA
| | - Vincenzo Savica
- University of Messina, Department of Clinical and Experimental Medicine, Messina, Italy
| | - Vicente E. Torres
- Mayo Clinic College of Medicine, Division of Nephrology and Hypertension, Rochester, Minnesota, USA
| | - Saeed Khan
- University of Florida, Department of Pathology, Gainesville, Florida, USA
| | | | - Michal Mrug
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Thomas Weimbs
- University of California Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, and Neuroscience Research Institute, Santa Barbara, California, USA
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Wu J. Urolithiasis (Kidney and Bladder Stones). Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dessombz A, Coulibaly G, Kirakoya B, Ouedraogo RW, Lengani A, Rouziere S, Weil R, Picaut L, Bonhomme C, Babonneau F, Bazin D, Daudon M. Structural elucidation of silica present in kidney stones coming from Burkina Faso. CR CHIM 2016. [DOI: 10.1016/j.crci.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ahmed MM, Andleeb S, Saqib F, Hussain M, Khatun MN, Ch BA, Rahman H. Diuretic and serum electrolyte regulation potential of aqueous methanolic extract of Solanum surattense fruit validates its folkloric use in dysuria. Altern Ther Health Med 2016; 16:166. [PMID: 27255699 PMCID: PMC4891924 DOI: 10.1186/s12906-016-1148-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/27/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Solanum surattense Burm. (Solanaceae) is traditionally used for management of various ailments. The study was conducted for provision of pharmacological justification for folkloric uses of Solanum surattense in the treatment of dysuria. METHODS Rats were randomly divided into 5 groups, each of (n = 6). Aqueous methanolic fruit extract of S. surattense were also administered intraperitoneally to the rats at doses of 50, 70 and 100 mg/kg. Furosemide (10 mg/kg i.p) was used as standard drug whereas controls were given saline solution (40 mL/kg i.p). The electrolytes in urine were measured using a flame photometer whereas serum sodium, potassium, calcium, bicarbonate and blood urea nitrogen (BUN) were determined by using an automatic analyzer. Urine osmolality was assayed by the micro-osmometer. RESULTS The extract S. surattense induced diuretic effects in a dose-dependent manner as compared with control. Upon administration of extract (70 and 100 mg/kg), we observed the prominent (p < 0.01) increase in the urine volume and osmolality in comparison to control group. However, plant extract (100 mg/kg) significantly increase the urinary electrolyte excretion especially calcium (p < 0.05) to that of the furosemide whereas level of magnesium remains constant. Moreover, our results showed a decrease in serum levels of sodium, potassium, calcium and blood urea nitrogen (BUN), but concentration dependent increase in bicarbonate was found in the test groups. There was no substantial change in the pH of urine samples of the extract-treated groups. CONCLUSION These results indicate that S. surattense investigated exert its action by causing diuresis in the treatment of dysuria.
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Urolithiasis. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00111-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wallace RB, Wactawski-Wende J, O'Sullivan MJ, Larson JC, Cochrane B, Gass M, Masaki K. Urinary tract stone occurrence in the Women's Health Initiative (WHI) randomized clinical trial of calcium and vitamin D supplements. Am J Clin Nutr 2011; 94:270-7. [PMID: 21525191 PMCID: PMC3127502 DOI: 10.3945/ajcn.110.003350] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Women's Health Initiative (WHI) randomized clinical trial (RCT) of calcium plus vitamin D (CaD) supplements found a 17% excess in urinary tract stone incidence in the supplemented group. This study evaluated whether this risk is modified by participant characteristics. OBJECTIVE We examined the correlates of urinary tract stone occurrence in the CaD arm of the WHI trial. DESIGN We analyzed an RCT involving 36,282 postmenopausal women aged 50-79 y from 40 WHI centers: 18,176 women received 500 mg calcium carbonate plus 200 IU vitamin D(3) twice daily (1000 mg and 400 IU daily, respectively), and 18,106 women received a matching placebo for an average of 7.0 y. The incidence of urinary tract stones was determined. RESULTS The incidence of self-reported clinically diagnosed urinary tract stones was more common in the active CaD medication group than in the placebo group (hazard ratio: 1.17; 95% CI: 1.02, 1.34): 449 women in the CaD group and 381 women in the placebo group reported a stone during the trial. The rates of self-reported stones did not differ between various demographic, anthropomorphic, dietary, and other hypothesized risk factors according to randomization assignment. Neither the total calcium intake nor the use of calcium supplements at baseline was associated with the risk of stones. In sensitivity analyses that censored participants who were below 80% adherence, the findings were similar. CONCLUSIONS Daily supplementation with CaD for 7 y was associated with an increase in the number of self-reported urinary tract stones. These findings have implications for CaD supplement use. This trial was registered with the WHI at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA.
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Ortiz-Alvarado O, Miyaoka R, Kriedberg C, Moeding A, Stessman M, Anderson JK, Monga M. Impact of dietary counseling on urinary stone risk parameters in recurrent stone formers. J Endourol 2011; 25:535-40. [PMID: 21361824 DOI: 10.1089/end.2010.0241] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the current impact of dietary counseling on the risk for urolithiasis. METHODS A retrospective cohort study of the patients treated in our stone clinics from July 2007 to February 2009 was carried out. Patients' urinary risk factors for stone disease were evaluated with pre- and postintervention 24-hour urine collections. All patients received dietary recommendations from a registered dietician at each visit. RESULTS One hundred thirty-seven subjects were identified and managed initially with only dietary interventions to address their urinary stone risk parameters. Average follow-up for this group was 15.19 ± 13.7 months. Subjects showed significant changes in urine volume (71.1%, 1.68 ± 0.68 to 2.59 ± 0.80 L/day, p < 0.0001), urine sodium (58.1%, 229.68 ± 72.51 to 144.65 ± 52.70 mmol/day, p < 0.0001), urine calcium (43.8%, 314.33 ± 95.75 to 216.81 ± 80.90 mg/day, p < 0.0001), urinary uric acid (50%, 0.821 ± 0.210 to 0.622 ± 0.128 g/day, p < 0.0001), urinary citrate (50.7%, 583.19 ± 330.86 to 797.36 ± 412.31, p < 0.0001), and urine oxalate (55.5%, 46.28 ± 10.31 to 32.56 ± 9.02 mg/day, p < 0.0001). The supersaturation for calcium oxalate also decreased significantly from baseline (9.34-5.03, p < 0.0001). CONCLUSION Urolithiasis is a multifactorial disease requiring a multidisciplinary approach. Our results support the use of dietary counseling by a registered dietician in the management of urolithiasis.
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Affiliation(s)
- Omar Ortiz-Alvarado
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, Ohio 44195, USA
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Composition and morphology of phosphate stones and their relation with etiology. ACTA ACUST UNITED AC 2010; 38:459-67. [DOI: 10.1007/s00240-010-0320-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 09/29/2010] [Indexed: 11/25/2022]
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Edvardsson VO, Palsson R, Indridason OS, Thorvaldsson S, Stefansson K. Familiality of kidney stone disease in Iceland. ACTA ACUST UNITED AC 2010; 43:420-4. [PMID: 19921989 DOI: 10.3109/00365590903151479] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aetiology of kidney stones is multifactorial, with environmental and genetic factors contributing to the pathogenesis. The aim of this study was to assess the role of genetic factors in kidney stone disease by examining the heritability of the trait in Icelandic patients. MATERIAL AND METHODS Medical records at all major hospitals and imaging centres in Iceland were searched for diagnostic codes indicative of kidney stones, yielding a cohort of 5954 incident patients with kidney stone disease. The list of patients was cross-matched with a genealogy database that covers the entire Icelandic nation. The risk ratio (RR) and kinship coefficient (KC) were calculated to determine the risk of kidney stones in relatives of stone formers and the relatedness among kidney stone patients. RESULTS The risk of kidney stones among family members of stone formers was significantly higher than in the general population. In 2959 patients with radiopaque stones, the RR ranged from 2.25 (p<0.001) for first degree relatives of probands (such as parents or siblings) to 1.07 (p<0.01) in fifth degree relatives. Moreover, for confirmed recurrent stone formers the RR of kidney stones in parents and offspring was in excess of 10 (p<0.001). The KC analysis shows that Icelandic patients with kidney stone disease are significantly more related to each other than is the average Icelander, even when considering only relatives separated by four meioses or more (p<0.05). CONCLUSIONS The results suggest that genetic factors may substantially influence the risk of kidney stone disease in Iceland.
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Affiliation(s)
- Vidar O Edvardsson
- Children's Medical Center, Landspitali University Hospital, Reykjavik, Iceland
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Oxalate-Degrading Bacteria of the Human Gut as Probiotics in the Management of Kidney Stone Disease. ADVANCES IN APPLIED MICROBIOLOGY 2010; 72:63-87. [DOI: 10.1016/s0065-2164(10)72003-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Wei CC, Chang MS. Mouse interleukin-20 receptor 1a targets renal epithelial cells and is associated with renal calcium deposition. Genes Immun 2008; 10:237-47. [DOI: 10.1038/gene.2008.93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Lieske JC, Peña de la Vega LS, Slezak JM, Bergstralh EJ, Leibson CL, Ho KL, Gettman MT. Renal stone epidemiology in Rochester, Minnesota: an update. Kidney Int 2006; 69:760-4. [PMID: 16518332 DOI: 10.1038/sj.ki.5000150] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Studies in Western countries have suggested an increasing incidence of nephrolithiasis (NL) in the latter part of the 20th century. Therefore, we updated NL epidemiology data for the Rochester population over the years 1970-2000. All Rochester residents with any diagnostic code that could be linked to NL in the years of 1970, 1980, 1990, and 2000 were identified, and the records reviewed to determine if they met the criteria for a symptomatic kidney stone as defined in a previous Rochester, MN study. Age-adjusted incidence (+/-s.e.) of new onset symptomatic stone disease for men was 155.1 (+/-28.5) and 105.0 (+/-16.8) per 100,000 per year in 1970 and 2000, respectively. For women, the corresponding rates were 43.2 (+/-14.0) and 68.4 (+/-12.3) per 100,000 per year, respectively. On average, rates for women increased by about 1.9% per year (P=0.064), whereas rates for men declined by 1.7% per year (P=0.019). The overall man to woman ratio decreased from 3.1 to 1.3 during the 30 years (P=0.006). Incident stone rates were highest for men aged 60-69 years, whereas for women, they plateaued after age 30. Therefore, since 1970 overall NL incidence rates in Rochester have remained relatively flat. However, NL rates for men have declined, whereas rates for women appear to be increasing. The reasons remain to be determined.
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Affiliation(s)
- J C Lieske
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Straub M, Strohmaier WL, Berg W, Beck B, Hoppe B, Laube N, Lahme S, Schmidt M, Hesse A, Koehrmann KU. Diagnosis and metaphylaxis of stone disease. Consensus concept of the National Working Committee on Stone Disease for the upcoming German Urolithiasis Guideline. World J Urol 2005; 23:309-23. [PMID: 16315051 DOI: 10.1007/s00345-005-0029-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Accepted: 10/04/2005] [Indexed: 10/25/2022] Open
Abstract
This review draws the recent state of the art in metabolic diagnosis and metaphylaxis of stone disease. It is the basis for the consensus approval with the other medical societies and institutions in Germany involved in the guideline process of the new "Urolithiasis Guideline". The German Working Committee on Stone Disease reviewed critically the current literature in the field of urolithiasis-including the existing German and EAU-Guidelines as well as the Conference Book of the First International Consultation on Stone Disease. As far as possible the references were rated according to the EBM criteria. On this basis the expert group discussed all pathways and statements regarding the management of stone disease. The present review coincides with the consented guideline draft of the German Working Committee on Stone Disease. Occurrence of stone disease in the western world increases seriously. Modern lifestyle, dietary habits and overweight-problems of the affluent societies-emerge to be the important promoters of the "stone-boom" in the new millennium. This even affects children, whose stone prevalence is otherwise significantly less than that of adults. Criteria for the high risk group of stone formers were clearly defined. A diagnostic standard is formulated for the basic and the elaborate metabolic evaluation of a stone patient. Approximately 75% of all stone patients could anticipate stone recurrence with elementary reorientation of their lifestyle and dietary habits, summarized as general metaphylaxis. About 25% of the stone formers require additional pharmacological intervention to normalize their individual biochemical risk, precisely compiled for each stone type as specific metaphylaxis.
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Affiliation(s)
- M Straub
- Urolithiasis Research Group, Department of Urology and Pediatric Urology, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany.
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Abstract
PURPOSE OF REVIEW This review focuses on new developments in stone prevention. Unfortunately, no major progress in this field has happened. There is a worldwide lack of randomized and controlled trials, which could confirm our theoretical assumptions and preventive concepts in stone disease. With these preconditions in mind, this review presents the current knowledge of metabolic influences causing the symptom "stone" and the effective measures against it. RECENT FINDINGS Modern lifestyle, dietary habits and obesity emerge to be the promoters of idiopathic stone disease. Cross-sectional studies showed significant correlations between these factors and kidney stones with direct implications on our preventive concepts: normalization of body mass index, adequate physical activity, balanced nutrition and sufficient circadian fluid intake. Modern diets containing a lot of animal protein, refined carbohydrates and salt act on the metabolism like an acid load. To overcome these disadvantageous effects, a sufficient supply of potassium and alkali is required. Last but not least, calcium should not be restricted. There is clear evidence from clinical and experimental research that a normal or a high calcium supply is appropriate in calcium stone disease. Only in absorptive hypercalciuria calcium restriction remains beneficial in combination with thiazide and citrate therapy. SUMMARY Up to 85% of all stone patients could anticipate lower risk of stone recurrence with elementary reorientation of their lifestyle and dietary habits. Normalizing the major risk factors is easy and cheap. About 15% of patients forming stones require additional specific pharmacological prevention. The specific measures to avoid recurrence of the stone disease are precisely defined.
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Affiliation(s)
- Michael Straub
- Urolithiasis Research Group, Department of Urology and Pediatric Urology, University of Ulm, Prittwitzstrasse 43, D-89075 Ulm, Germany.
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