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Xu M, Qin Y, Xia Y, Wang G, Xiong Z, Song X, Ai L. Screening of oxalate-degrading probiotics and preventive effect of Lactiplantibacillus plantarum AR1089 on kidney stones. Food Funct 2024. [PMID: 39300803 DOI: 10.1039/d4fo03133d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Calcium oxalate stone is the main type of kidney stone, so far there is no specific drug treatment. Here, we screened for oxalate-degrading probiotics and evaluated the potential preventive effect of lactic acid bacteria in rats with hyperoxaluria-induced kidney stones. The oxalate degradation efficiencies of the probiotics were determined to be 5-20% by in vitro experiments, of which the degradation efficiencies of Lactiplantibacillus plantarum AR342 and L. plantarum AR1089 were 17.32% and 14.15%, respectively. Through animal experiments, we found that L. plantarum AR1089 significantly attenuated kidney injury, as demonstrated by improving renal dysfunction and renal fibrosis, lowering creatinine and urea nitrogen levels. L. plantarum AR1089 was also effective in decreasing the number of calcium oxalate crystals in the urine and kidneys as well as ameliorating oxidative stress as evidenced by lowering the level of MDA and decreasing the level of SOD and CAT. Moreover, supplementation of L. plantarum AR1089 inhibited renal crystalline deposition by down-regulating the expression of KIM-1, OPN and MCP-1, and prevented hyperoxaluria-induced kidney stones by regulating the gut microbiota. Taken together, the present study shows that oral administration of L. plantarum AR1089, by attenuating kidney injury and regulating gut microbiota, is a potential therapy to reduce calcium oxalate crystals and prevent the progression of kidney stones.
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Affiliation(s)
- Mingyue Xu
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Yugang Qin
- Aerospace Center Hospital, Beijing 100049, China
| | - Yongjun Xia
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Guangqiang Wang
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Zhiqiang Xiong
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Xin Song
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
| | - Lianzhong Ai
- Shanghai Engineering Research Center of Food Microbiology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China.
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Le BD, Oh KJ, Le AT, Hoang L, Park I. Investigation and quantification of composition variability in urinary stone analysis. Investig Clin Urol 2024; 65:511-517. [PMID: 39249925 PMCID: PMC11390264 DOI: 10.4111/icu.20240275] [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: 08/06/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/10/2024] Open
Abstract
PURPOSE To investigate the variability in urinary stone composition analysis due to sampling and suggest potential solutions. MATERIALS AND METHODS We collected 1,135 stone fragments from 149 instances that had undergone a stone removal at Hanoi Medical University Hospital from January 2022 to August 2022. Each fragment was ground into fine powder and divided into separate specimens if the amount was abundant. For composition analyzing every specimen, Fourier transform infrared spectroscopy was performed. The composition of a given fragment was the average of its belonging specimens. The variability in composition was assessed on the fragment level (i.e., between fragments of an instance). We defined an instance as "significantly variable" if the maximum difference in any composition across its belonging fragments was equal to or greater than a given threshold. RESULTS On average, there were 7.6±3.3 stone fragments per instance and 2.3±0.5 specimens per fragment. We found that the variability could be substantial on the fragment level. Eighty-nine (69.5%) and 70 (54.7%) out of 128 multiple-component instances were significantly variable if the threshold was set at 20% and 30%, respectively. The variability of an instance on the fragment level was correlated with the size of fragment and the number of components. CONCLUSIONS Our study demonstrated the significant variability in urinary stone composition and showed that it correlated with the size and the impurity of samples. Mapping denotation while sampling and analyzing as well as reporting the composition of individual fragments could be valuable to reduce potential variability.
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Affiliation(s)
- Binh Duy Le
- Department of Biomedical Sciences, Chonnam National University Medical School, Gwangju, Korea
- Department of Urology, Saint Paul Hospital, Hanoi, Vietnam
| | - Kyung-Jin Oh
- Department of Urology, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Anh Tuan Le
- Department of Urology, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Long Hoang
- Department of Urology, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Ilwoo Park
- Department of Radiology, Chonnam National University Medical School and Hospital, Gwangju, Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, Korea
- Department of Data Science, Chonnam National University, Gwangju, Korea.
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Papatsoris A, Alba AB, Galán Llopis JA, Musafer MA, Alameedee M, Ather H, Caballero-Romeu JP, Costa-Bauzá A, Dellis A, El Howairis M, Gambaro G, Geavlete B, Halinski A, Hess B, Jaffry S, Kok D, Kouicem H, Llanes L, Lopez Martinez JM, Popov E, Rodgers A, Soria F, Stamatelou K, Trinchieri A, Tuerk C. Management of urinary stones: state of the art and future perspectives by experts in stone disease. Arch Ital Urol Androl 2024; 96:12703. [PMID: 38934520 DOI: 10.4081/aiua.2024.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
AIM To present state of the art on the management of urinary stones from a panel of globally recognized urolithiasis experts who met during the Experts in Stone Disease Congress in Valencia in January 2024. Options of treatment: The surgical treatment modalities of renal and ureteral stones are well defined by the guidelines of international societies, although for some index cases more alternative options are possible. For 1.5 cm renal stones, both m-PCNL and RIRS have proven to be valid treatment alternatives with comparable stone-free rates. The m-PCNL has proven to be more cost effective and requires a shorter operative time, while the RIRS has demonstrated lower morbidity in terms of blood loss and shorter recovery times. SWL has proven to be less effective at least for lower calyceal stones but has the highest safety profile. For a 6mm obstructing stone of the pelviureteric junction (PUJ) stone, SWL should be the first choice for a stone less than 1 cm, due to less invasiveness and lower risk of complications although it has a lower stone free-rate. RIRS has advantages in certain conditions such as anticoagulant treatment, obesity, or body deformity. Technical issues of the surgical procedures for stone removal: In patients receiving antithrombotic therapy, SWL, PCN and open surgery are at elevated risk of hemorrhage or perinephric hematoma. URS, is associated with less morbidity in these cases. An individualized combined evaluation of risks of bleeding and thromboembolism should determine the perioperative thromboprophylactic strategy. Pre-interventional urine culture and antibiotic therapy are mandatory although UTI treatment is becoming more challenging due to increasing resistance to routinely applied antibiotics. The use of an intrarenal urine culture and stone culture is recommended to adapt antibiotic therapy in case of postoperative infectious complications. Measurements of temperature and pressure during RIRS are vital for ensuring patient safety and optimizing surgical outcomes although techniques of measurements and methods for data analysis are still to be refined. Ureteral stents were improved by the development of new biomaterials, new coatings, and new stent designs. Topics of current research are the development of drug eluting and bioresorbable stents. Complications of endoscopic treatment: PCNL is considered the most invasive surgical option. Fever and sepsis were observed in 11 and 0.5% and need for transfusion and embolization for bleeding in 7 and 0.4%. Major complications, as colonic, splenic, liver, gall bladder and bowel injuries are quite rare but are associated with significant morbidity. Ureteroscopy causes less complications, although some of them can be severe. They depend on high pressure in the urinary tract (sepsis or renal bleeding) or application of excessive force to the urinary tract (ureteral avulsion or stricture). Diagnostic work up: Genetic testing consents the diagnosis of monogenetic conditions causing stones. It should be carried out in children and in selected adults. In adults, monogenetic diseases can be diagnosed by systematic genetic testing in no more than 4%, when cystinuria, APRT deficiency, and xanthinuria are excluded. A reliable stone analysis by infrared spectroscopy or X-ray diffraction is mandatory and should be associated to examination of the stone under a stereomicroscope. The analysis of digital images of stones by deep convolutional neural networks in dry laboratory or during endoscopic examination could allow the classification of stones based on their color and texture. Scanning electron microscopy (SEM) in association with energy dispersive spectrometry (EDS) is another fundamental research tool for the study of kidney stones. The combination of metagenomic analysis using Next Generation Sequencing (NGS) techniques and the enhanced quantitative urine culture (EQUC) protocol can be used to evaluate the urobiome of renal stone formers. Twenty-four hour urine analysis has a place during patient evaluation together with repeated measurements of urinary pH with a digital pH meter. Urinary supersaturation is the most comprehensive physicochemical risk factor employed in urolithiasis research. Urinary macromolecules can act as both promoters or inhibitors of stone formation depending on the chemical composition of urine in which they are operating. At the moment, there are no clinical applications of macromolecules in stone management or prophylaxis. Patients should be evaluated for the association with systemic pathologies. PROPHYLAXIS Personalized medicine and public health interventions are complementary to prevent stone recurrence. Personalized medicine addresses a small part of stone patients with a high risk of recurrence and systemic complications requiring specific dietary and pharmacological treatment to prevent stone recurrence and complications of associated systemic diseases. The more numerous subjects who form one or a few stones during their entire lifespan should be treated by modifications of diet and lifestyle. Primary prevention by public health interventions is advisable to reduce prevalence of stones in the general population. Renal stone formers at "high-risk" for recurrence need early diagnosis to start specific treatment. Stone analysis allows the identification of most "high-risk" patients forming non-calcium stones: infection stones (struvite), uric acid and urates, cystine and other rare stones (dihydroxyadenine, xanthine). Patients at "high-risk" forming calcium stones require a more difficult diagnosis by clinical and laboratory evaluation. Particularly, patients with cystinuria and primary hyperoxaluria should be actively searched. FUTURE RESEARCH Application of Artificial Intelligence are promising for automated identification of ureteral stones on CT imaging, prediction of stone composition and 24-hour urinary risk factors by demographics and clinical parameters, assessment of stone composition by evaluation of endoscopic images and prediction of outcomes of stone treatments. The synergy between urologists, nephrologists, and scientists in basic kidney stone research will enhance the depth and breadth of investigations, leading to a more comprehensive understanding of kidney stone formation.
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Affiliation(s)
- Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens; U-merge Scientific Office.
| | - Alberto Budia Alba
- Urology Department, La Fe University and Polytechnic Hospital, Valencia.
| | | | | | | | | | | | - Antònia Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Sciences Research (IUNICS-IdISBa), University of Illes Balears, Palma de Mallorca.
| | - Athanasios Dellis
- 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens.
| | | | - Giovanni Gambaro
- Division of Nephrology, Department of Medicine, University Hospital of Verona.
| | - Bogdan Geavlete
- "Carol Davila" University of Medicine and Pharmacy & "Saint John" Emergency Clinical Hospital, Bucharest.
| | - Adam Halinski
- Private Medical Center "Klinika Wisniowa" Zielona Gora.
| | - Bernhard Hess
- Internal Medicine & Nephrology, KidneyStoneCenter Zurich, Klinik Im Park, Zurich.
| | | | - Dirk Kok
- Saelo Scientific Support, Oegstgeest.
| | | | - Luis Llanes
- Urology Department, University Hospital of Getafe, Getafe, Madrid.
| | | | - Elenko Popov
- Department of Urology, UMHAT "Tzaritza Yoanna-ISUL", Medical University, Sofia.
| | | | - Federico Soria
- Experimental Surgery Department, Ramón y Cajal University Hospital, Madrid.
| | - Kyriaki Stamatelou
- MESOGEIOS Nephrology Center, Haidari Attica and NEPHROS.EU Private Clinic, Athens.
| | | | - Christian Tuerk
- Urologic Department, Sisters of Charity Hospital and Urologic Praxis, Wien.
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Li X, Wang Q, Hu S, Zhang C, Zhu Z, Wang L, Chen R, Song Z, Liao H, Liu Q, Zhu WH. Dual-Responsive and Aggregation-Induced-Emission Probe for Selective Imaging of Infectious Urolithiasis. Adv Healthc Mater 2024:e2401347. [PMID: 38819639 DOI: 10.1002/adhm.202401347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 05/26/2024] [Indexed: 06/01/2024]
Abstract
Identifying infected stones is crucial due to their rapid growth and high recurrence rate. Here, the calcium-magnesium dual-responsive aggregation-induced emission (AIE)-active probe TCM-5COOH (Tricyano-methlene-pyridine-5COOH), distinctively engineered to distinguish high-threat infection calculi from metabolic stones, is presented. Upon incorporation of flexible alkyl carboxyl group, TCM-5COOH featuring five carboxyl moieties demonstrates excellent water solubility and enhanced penetration into porous infectious stones. The robust chelation of TCM-5COOH with stone surface-abundant Ca2+ and Mg2+ inhibits vibrational relaxation, thus triggering intense AIE signals. Remarkably, the resulting complex exhibits high insolubility, effectively anchoring within the porous structure of the infection calculi and offering prolonged illumination. Jobs' plot method reveals similar response characteristics for Ca2+ and Mg2+, with a 1:2 coordination number for both ions. Isothermal titration calorimetry (ITC) results demonstrate higher enthalpy change (ΔH) and lower entropy change (ΔS) for the reaction, indicating enhanced selectivity compared to TCM-4COOH lacking the alkyl carboxyl group. Synchrotron X-ray absorption fine spectroscopy (XAFS) validates TCM-5COOH's interaction with Ca2+ and Mg2+ at the microlevel. This dual-responsive probe excels in identifying infectious and metabolic calculi, compatible with endoscopic modalities and laser excitation, thereby prompting clinical visualization and diagnostic assessment.
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Affiliation(s)
- Xiangyu Li
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Qi Wang
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Shanshan Hu
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Cuiyun Zhang
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Zhirong Zhu
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Liyang Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Ruoyang Chen
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Zhiyin Song
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430074, China
| | - Hongze Liao
- Research Center for Marine Drugs, State Key Laboratory of Oncogene and Related Genes, Department of Pharmacy, RenJi Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Qiang Liu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Wei-Hong Zhu
- Key Laboratory for Advanced Materials and Joint International Research Laboratory of Precision Chemistry and Molecular Engineering, Shanghai Key Laboratory of Functional Materials Chemistry, Frontiers Science Center for Materiobiology and Dynamic Chemistry, Institute of Fine Chemicals, School of Chemistry and Molecular Engineering, East China University of Science and Technology, Shanghai, 200237, China
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5
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Yin K, Yin Z, Liu Z, Yao J, Wu Y, Su S. Exploring the association between multiple factors and urolithiasis: A retrospective study and Mendelian randomization analysis. Medicine (Baltimore) 2024; 103:e37968. [PMID: 38701290 PMCID: PMC11062715 DOI: 10.1097/md.0000000000037968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/29/2024] [Indexed: 05/05/2024] Open
Abstract
To investigate the relationship between several factors and urinary stone as well as different stone compositions. To guide the diagnosis, treatment, and prevention of urinary stone recurrence. We used bidirectional Mendelian randomization to analyze the causal relationship between hypertension and urinary stones, diabetes and urinary stones, and body mass index (BMI) and urinary stones. We retrospectively analyzed the medical records of patients with urinary stones admitted to a tertiary care hospital in Chongqing, China, from July 2015 to October 2022. Patients were included when they were first diagnosed with urinary stones. The odds ratio of calculi on hypertension estimated by inverse variance weighted was 8.46 (95%CI: 4.00-17.90, P = 2.25 × 10-8). The stone composition analysis showed that there were 3101 (67.02%) mixed, 1322 (28.57%) calcium oxalate monohydrate, 148 (3.20%) anhydrous uric acid, 16 (0.35%) magnesium ammonium phosphate hexahydrate, 11 (0.24%) dicalcium phosphate dihydrate, 10 (0.22%) carbonate apatite, 8 (0.17%) L-cystine, 4 ammonium uric acid (0.09%), and 7 other stone types (0.15%). Mendelian randomization studies have proven that urinary stones may be a potential risk factor for hypertension, while there is no causal relationship between diabetes and stones, BMI, and stones. Our retrospective study has shown that urinary stone components are closely associated with sex, age, hypertension, diabetes, and BMI. It is reasonable to suspect that treating a single stone component is ineffective in preventing recurrence. We also found that the peak incidence of urinary stones was at the most active stage of most people's working lives.
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Affiliation(s)
- Kexin Yin
- The First Clinical College of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhikang Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhenyu Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Junjie Yao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yuzhou Wu
- The First Clinical College of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Shuai Su
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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De Coninck V, Skolarikos A, Juliebø-Jones P, Joris M, Traxer O, Keller EX. Advancements in stone classification: unveiling the beauty of urolithiasis. World J Urol 2024; 42:46. [PMID: 38244083 DOI: 10.1007/s00345-023-04746-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/02/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Urolithiasis has become increasingly prevalent, leading to higher disability-adjusted life years and deaths. Various stone classification systems have been developed to enhance the understanding of lithogenesis, aid urologists in treatment decisions, and predict recurrence risk. The aim of this manuscript is to provide an overview of different stone classification criteria. METHODS Two authors conducted a review of literature on studies relating to the classification of urolithiasis. A narrative synthesis for analysis of the studies was used. RESULTS Stones can be categorized based on anatomical position, size, medical imaging features, risk of recurrence, etiology, composition, and morphoconstitutional analysis. The first three mentioned offer a straightforward approach to stone classification, directly influencing treatment recommendations. With the routine use of CT imaging before treatment, precise details like anatomical location, stone dimensions, and Hounsfield Units can be easily determined, aiding treatment planning. In contrast, classifying stones based on risk of recurrence and etiology is more complex due to dependencies on multiple variables, including stone composition and morphology. A classification system based on morphoconstitutional analysis, which combines morphological stone appearance and chemical composition, has demonstrated its value. It allows for the rapid identification of crystalline phase principles, the detection of crystalline conversion processes, the determination of etiopathogenesis, the recognition of lithogenic processes, the assessment of crystal formation speed, related recurrence rates, and guidance for selecting appropriate treatment modalities. CONCLUSIONS Recognizing that no single classification system can comprehensively cover all aspects, the integration of all classification approaches is essential for tailoring urolithiasis patient-specific management.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, Augustijnslei 100, Klina, 2930, Brasschaat, AZ, Belgium.
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands.
| | - Andreas Skolarikos
- Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Manu Joris
- Faculty of Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Olivier Traxer
- GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Arnhem, The Netherlands
| | - Etienne Xavier Keller
- Young Academic Urologists (YAU), Urolithiasis and Endourology Working Party, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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7
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Mohammadi A, Farabi H, Baghdadabad LZ, Narouie B, Reis LO, Aghamir SMK. Serum and 24-hour urinary tests cost-effectiveness in stone formers. BMC Urol 2023; 23:141. [PMID: 37635222 PMCID: PMC10464256 DOI: 10.1186/s12894-023-01310-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVE To assess the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. METHODS This study analyzes the routine serum and 24-hour urine tests proficiency in diagnosing the baseline metabolic abnormality of kidney stone formers. The sensitivity and specificity, false positive, and negative results of the tests are extracted from diagnostic kits used in the laboratories of the target community. To accurately infer the results, a simulation based on 1000 people was used through 22 standard laboratory tests (Additional File 2), including calcium, oxalate, phosphate, uric acid, sulfate, potassium, sodium, citrate, and magnesium in 24-hour urine; and calcium, creatinine, Vit D, uric acid, and intact parathyroid hormone (PTH) in serum. The incremental cost-effectiveness ratio (ICER) was calculated and compared for each diagnostic test versus other diagnostic tests according to the incremental cost required for correct diagnoses of stone causes. RESULTS Urinary uric acid, citrate, and serum potassium constitute the cost-effectiveness boundary curve in this study. This means that other diagnostic tests are not cost-effective compared to these three tests in terms of indexing at least one item of cost and effectiveness. The ICER index for each correct diagnosis with the urinary uric acid test was $ 1.25 per diagnosis, the most cost-effective test compared to serum potassium and urinary citrate. CONCLUSION The simplified blood and 24-hour urine metabolic evaluation, including urinary uric acid, citrate, and serum potassium, constitute the cost-effectiveness boundary curve. The most cost-effective test was urinary uric acid measurement.
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Affiliation(s)
- Abdolreza Mohammadi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hiro Farabi
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Barts the London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, London, UK
| | | | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Leonardo Oliveira Reis
- Department of Urology, UroScience, Unicamp and Pontifical, State University of Campinas, Catholic University of Campinas, PUC-Campinas, Campinas, Brazil
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8
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Costa-Bauzá A, Grases F, Julià F. The power of desktop scanning electron microscopy with elemental analysis for analyzing urinary stones. Urolithiasis 2023; 51:50. [PMID: 36920587 PMCID: PMC10017624 DOI: 10.1007/s00240-023-01424-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
The aim of this paper is to present a protocol for the routine morphocompositional study of kidney stones in a clinical setting, and to demonstrate that it is a simple and useful approach that can reliably determine the etiology of all types of kidney stones. Our routine study of kidney stones consists of a combination of stereoscopic microscopy, scanning electron microscopy, and infrared spectroscopy. The usefulness of such a procedure is demonstrated by its application to several illustrating examples. The protocol applied here is reliable and fast, and does not require multiple infrared spectroscopic analyses for most non-homogeneous samples. It also provides the identification of components that are present in very small proportions, the characteristics of internal and external structures, and information about areas with biological structures, such as renal tubules. It should be noted that results are obtained in a relatively short time and with high reliability. The detailed morphocompositional study of a urinary calculus is essential for establishing the diagnosis and etiology and for initiating the treatment of a patient with renal lithiasis, because there is a relationship between the specific characteristics of a stone and the specific etiology of the disease. The increasing number of treatments available for patients with different types of renal calculi makes improvements in diagnosis and determination of stone etiology, such as the procedure described here, more important now than ever.
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Affiliation(s)
- A Costa-Bauzá
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain.
| | - F Grases
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain
| | - F Julià
- Laboratory of Renal Lithiasis Research, University Institute of Health Science Research (IUNICS-IdISBa), University of Balearic Islands, Ctra. de Valldemossa Km 7.5, 07122, Palma, Spain
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9
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Quantitative analysis of calcium oxalate monohydrate and dihydrate for elucidating the formation mechanism of calcium oxalate kidney stones. PLoS One 2023; 18:e0282743. [PMID: 36893192 PMCID: PMC9997882 DOI: 10.1371/journal.pone.0282743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
We sought to identify and quantitatively analyze calcium oxalate (CaOx) kidney stones on the order of micrometers, with a focus on the quantitative identification of calcium oxalate monohydrate (COM) and dihydrate (COD). We performed Fourier transform infrared (FTIR) spectroscopy, powder X-ray diffraction (PXRD), and microfocus X-ray computed tomography measurements (microfocus X-ray CT) and compared their results. An extended analysis of the FTIR spectrum focusing on the 780 cm-1 peak made it possible to achieve a reliable analysis of the COM/COD ratio. We succeeded in the quantitative analysis of COM/COD in 50-μm2 areas by applying microscopic FTIR for thin sections of kidney stones, and by applying microfocus X-ray CT system for bulk samples. The analysis results based on the PXRD measurements with micro-sampling, the microscopic FTIR analysis of thin sections, and the microfocus X-ray CT system observation of a bulk kidney stone sample showed roughly consistent results, indicating that all three methods can be used complementarily. This quantitative analysis method evaluates the detailed CaOx composition on the preserved stone surface and provides information on the stone formation processes. This information clarifies where and which crystal phase nucleates, how the crystals grow, and how the transition from the metastable phase to the stable phase proceeds. The phase transition affects the growth rate and hardness of kidney stones and thus provides crucial clues to the kidney stone formation process.
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Estrade V, Denis de Senneville B, Facq L, Daudon M. Endoscopic in-situ recognition of urinary stones during LASER-induced stone fragmentation: a modern, effective and essential approach in the diagnostic process in urolithiasis. CR CHIM 2022. [DOI: 10.5802/crchim.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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11
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Siener R, Herwig H, Rüdy J, Schaefer RM, Lossin P, Hesse A. Urinary stone composition in Germany: results from 45,783 stone analyses. World J Urol 2022; 40:1813-1820. [PMID: 35666268 PMCID: PMC9236976 DOI: 10.1007/s00345-022-04060-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/16/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Stone composition can provide valuable information for the diagnosis, treatment and recurrence prevention of urolithiasis. The aim of this study was to evaluate the distribution of urinary stone components and the impact of different crystal forms according to gender and age of patients in Germany. METHODS A total of 45,783 urinary stones submitted from 32,512 men and 13,271 women between January 2007 and December 2020 were analyzed by infrared spectroscopy. Only the first calculus obtained per patient was included in the analysis. RESULTS The most common main stone component was calcium oxalate (CaOx) (71.4%), followed by carbonate apatite (CA) (10.2%) and uric acid (UA) (8.3%). Struvite (2.1%), brushite (1.3%), protein (0.5%) and cystine (0.4%) stones were only rarely diagnosed. CaOx (75%) and UA stones (81%) were more frequently obtained from men than women (p < 0.001). Weddellite (COD) and uric acid dihydrate (UAD) were more common in younger ages than whewellite (COM) and anhydrous uric acid (UAA), respectively, in both men and women. The ratios of COM-to-COD and UAA-to-UAD calculi were approximately 4:1 and 8:1, respectively. The peak of stone occurrence was between the ages of 40 and 59 years. CONCLUSION Stone composition is strongly associated with gender and age. The peak incidence of calculi in both women and men was in the most active phase of their working life. The distinction between different crystal forms could provide clues to the activity and mechanisms of lithogenesis. Further research is needed in understanding the causative factors and the process of stone formation.
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Affiliation(s)
- Roswitha Siener
- Department of Urology, University Stone Center, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Helena Herwig
- Department of Urology, University Stone Center, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Jakob Rüdy
- Department of Urology, University Stone Center, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Valido IH, Fuentes-Cebrian V, Boada R, Vallcorba O, Resina-Gallego M, Valiente M, López-Mesas M. Discriminating the origin of calcium oxalate monohydrate formation in kidney stones via synchrotron microdiffraction. Analyst 2021; 147:349-357. [PMID: 34935777 DOI: 10.1039/d1an01703a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Nephrolithiasis is a multifactor disease that produces nephrolites in the kidneys. Calcium oxalate hydrate (dihydrated, COD, or monohydrated, COM) stones are the most common ones with more than sixty percent incidence worldwide. They are related to different pathologies, COD with hypercalciuria and COM with hyperoxaluria. COD is an unstable species and transforms into COM (herein named TRA to distinguish the origin of the monohydrated species). TRA and COM are chemically and crystallographically identical leading to misdiagnosis and recurrence increase. In the current study, the composition and crystalline structures of several calcium oxalate stones, classified by morpho-constitutional analysis, were examined by IR and synchrotron through-the-substrate micro-X-ray diffraction (tts-μXRD). Both IR and linear diffractogram studies were able to distinguish between the monohydrated and dihydrated phases but not between COM and TRA, as expected. The analysis of 2D diffraction patterns revealed that TRA showed a lower degree of crystallinity and less texture with respect to COM which can be used as a signature to distinguish between the two. This study confirms that despite the subtle differences between COM and TRA, the origin of the monohydrate oxalates can be unraveled using tts-μXRD. This valuable information should be taken into account in order to improve patients' diagnosis and reduce recurrence by considering and treating the origin of the formed stones.
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Affiliation(s)
- Iris H Valido
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Victor Fuentes-Cebrian
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Roberto Boada
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Oriol Vallcorba
- ALBA Synchrotorn Light Source, Cerdanyola del Vallès, Barcelona, Spain
| | - Montserrat Resina-Gallego
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Manuel Valiente
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
| | - Montserrat López-Mesas
- GTS Research Group, Department of Chemistry, Faculty of Science, Universitat Autònoma de Barcelona, 08193 Bellaterra, Cerdanyola del Vallès, Spain.
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Popovtzer B, Khusid JA, Bamberger JN, Lundon D, Gallante B, Sadiq AS, Atallah W, Lifshitz D, Gupta M. Do Infection-Associated Stone Subtypes Behave the Same Clinically? A Retrospective Bi-center Study. J Endourol 2021; 36:688-693. [PMID: 34913732 DOI: 10.1089/end.2021.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives Infection associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods We retrospectively reviewed the medical records of patients from two centers (one in the USA and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, post-operative fever, stone and urinary microbiology, and 24-hour urine studies. Results A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Though there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram negative bacteria were more common in the MAP stone cultures. Post-operative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p<0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences amongst metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined.
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Affiliation(s)
- Baruch Popovtzer
- Rabin Medical Center, 36632, Urology, Zeev Jabotinsky St 39, Petah Tikva, Israel, 49100;
| | - Johnathan Alexander Khusid
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574;
| | - Jacob N Bamberger
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W 59th St, Suite 4F, New York, New York, United States, 10029-6574;
| | - Dara Lundon
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019;
| | - Areeba Setara Sadiq
- Mount Sinai Health System, 5944, Urology, 425 W59th Street, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - David Lifshitz
- Rabin medical center, urology, Keren kayemet st, Petach Tikva, Israel, 65222;
| | - Mantu Gupta
- Mount Sinai Health System, 5944, Urology, 425 W. 59th Street, New York, New York, United States, 10019;
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Halinski A, Bhatti KH, Boeri L, Cloutier J, Davidoff K, Elqady A, Fryad G, Gadelmoula M, Hui H, Petkova K, Popov E, Rawa B, Saltirov I, Spivacow FR, Belthangady Monu Zeeshan Hameed, Trinchieri A, Buchholz N. Stone composition of renal stone formers from different global regions. Arch Ital Urol Androl 2021; 93:307-312. [PMID: 34839635 DOI: 10.4081/aiua.2021.3.307] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To study urinary stone composition patterns in different populations around the world. MATERIALS AND METHODS Data were collected by reviewing charts of 1204 adult patients of 10 countries with renal or ureteral stones (> 18 years) in whom a stone analysis was done and available. Any method of stone analysis was accepted, but the methodology had to be registered. RESULTS In total, we observed 710 (59%) patients with calcium oxalate, 31 (1%) with calcium phosphate, 161 (13%) with mixed calcium oxalate/calcium phosphate, 15 (1%) with carbapatite, 110 (9%) with uric acid, 7 (< 1%) with urate (ammonium or sodium), 100 (9%) with mixed with uric acid/ calcium oxalate, 56 (5%) with struvite and 14 (1%) with cystine stones. Calciumcontaining stones were the most common in all countries ranging from 43 to 91%. Oxalate stones were more common than phosphate or mixed phosphate/oxalate stones in most countries except Egypt and India. The rate of uric acid containing stones ranged from 4 to 34%, being higher in Egypt, India, Pakistan, Iraq, Poland and Bulgaria. Struvite stones occurred in less than 5% in all countries except India (23%) and Pakistan (16%). Cystine stones occurred in 1% of cases. CONCLUSIONS The frequency of different types of urinary stones varies from country to country. Calcium-containing stones are prevalent in all countries. The frequency of uric acid containing stones seems to depend mainly on climatic factors, being higher in countries with desert or tropical climates. Dietary patterns can also lead to an increase in the frequency of uric acid containing stones in association with high obesity rates. Struvite stones are decreasing in most countries due to improved health conditions.
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Affiliation(s)
- Adam Halinski
- Private Medical Center "Klinika Wisniowa" Zielona Gora.
| | | | - Luca Boeri
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan.
| | | | | | | | | | | | - Hongyi Hui
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai.
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | | | - Bapir Rawa
- Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia.
| | - Francisco R Spivacow
- Instituto de Investigaciones Metabólicas (IDIM Department of Urology), Buenos Aires.
| | | | | | - Noor Buchholz
- U-merge Ltd (Urology for emerging countries), London.
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Siener R. Nutrition and Kidney Stone Disease. Nutrients 2021; 13:1917. [PMID: 34204863 PMCID: PMC8229448 DOI: 10.3390/nu13061917] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
The prevalence of kidney stone disease is increasing worldwide. The recurrence rate of urinary stones is estimated to be up to 50%. Nephrolithiasis is associated with increased risk of chronic and end stage kidney disease. Diet composition is considered to play a crucial role in urinary stone formation. There is strong evidence that an inadequate fluid intake is the major dietary risk factor for urolithiasis. While the benefit of high fluid intake has been confirmed, the effect of different beverages, such as tap water, mineral water, fruit juices, soft drinks, tea and coffee, are debated. Other nutritional factors, including dietary protein, carbohydrates, oxalate, calcium and sodium chloride can also modulate the urinary risk profile and contribute to the risk of kidney stone formation. The assessment of nutritional risk factors is an essential component in the specific dietary therapy of kidney stone patients. An appropriate dietary intervention can contribute to the effective prevention of recurrent stones and reduce the burden of invasive surgical procedures for the treatment of urinary stone disease. This narrative review has intended to provide a comprehensive and updated overview on the role of nutrition and diet in kidney stone disease.
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Affiliation(s)
- Roswitha Siener
- University Stone Center, Department of Urology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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16
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Taguchi K, Okada A, Unno R, Hamamoto S, Yasui T. Macrophage Function in Calcium Oxalate Kidney Stone Formation: A Systematic Review of Literature. Front Immunol 2021; 12:673690. [PMID: 34108970 PMCID: PMC8182056 DOI: 10.3389/fimmu.2021.673690] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background The global prevalence and recurrence rate of kidney stones is very high. Recent studies of Randall plaques and urinary components in vivo, and in vitro including gene manipulation, have attempted to reveal the pathogenesis of kidney stones. However, the evidence remains insufficient to facilitate the development of novel curative therapies. The involvement of renal and peripheral macrophages in inflammatory processes offers promise that might lead to the development of therapeutic targets. The present systematic literature review aimed to determine current consensus about the functions of macrophages in renal crystal development and suppression, and to synthesize evidence to provide a basis for future immunotherapy. Methods We systematically reviewed the literature during February 2021 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles investigating the relationship between macrophages and urolithiasis, particularly calcium oxalate (CaOx) stones, were extracted from PubMed, MEDLINE, Embase, and Scopus. Study subjects, languages, and publication dates were unrestricted. Two authors searched and screened the publications. Results Although several studies have applied mixed modalities, we selected 10, 12, and seven (total, n = 29) of 380 articles that respectively described cultured cells, animal models, and human samples. The investigative trend has shifted to macrophage phenotypes and signaling pathways, including micro (m)-RNAs since the discovery of macrophage involvement in kidney stones in 1999. Earlier studies of mice-associated macrophages with the acceleration and suppression of renal crystal formation. Later studies found that pro-inflammatory M1- and anti-inflammatory M2-macrophages are involved. Studies of human-derived and other macrophages in vitro and ex vivo showed that M2-macrophages (stimulated by CSF-1, IL-4, and IL-13) can phagocytose CaOx crystals, which suppresses stone development. The signaling mechanisms that promote M2-like macrophage polarization toward CaOx nephrocalcinosis, include the NLRP3, PPARγ-miR-23-Irf1/Pknox1, miR-93-TLR4/IRF1, and miR-185-5p/CSF1 pathways. Proteomic findings have indicated that patients who form kidney stones mainly express M1-like macrophage-related proteins, which might be due to CaOx stimulation of the macrophage exosomal pathway. Conclusions This systematic review provides an update regarding the current status of macrophage involvement in CaOx nephrolithiasis. Targeting M2-like macrophage function might offer a therapeutic strategy with which to prevent stones via crystal phagocytosis.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Endoscopic identification of urinary stone composition: A study of South Eastern Group for Urolithiasis Research (SEGUR 2). Actas Urol Esp 2021; 45:154-159. [PMID: 32854978 DOI: 10.1016/j.acuro.2020.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the surgeon's ability to evaluate the composition of the stone by observation of endoscopic images. MATERIALS AND METHODS A series of 20 video clips of endoscopic treatments of urinary stones of which was also available the result of infrared spectroscopy was uploaded to a YouTube site accessible only to members of the South Eastern Group for Urolithiasis Research (SEGUR) who were asked to identify the composition of the stones. RESULTS A total of 32 clinicians from 9 different countries participated in the study. The average number of correct detections of participants was 7.81 ± 2.68 (range 1-12). Overall accuracy was 39% (250 out of 640 predictions). Calcium oxalate dihydrate stones have been correctly detected in 69.8%, calcium oxalate monohydrate in 41.8%, uric acid in 33.3%, calcium oxalate/uric acid in 34.3% and cystine in 78.1%. Precision rates for struvite (15.6%), calcium phosphate (0%) and mixed calcium oxalate/calcium phosphate (9.3%) were quite low. CONCLUSIONS Observation of the stone during the endoscopic procedure was not reliable to identify the composition of most stones although it gave some information allowing to identify with a good sensitivity calcium oxalate dihydrate and cystine stones. Nevertheless, photo or video reporting of the intact stone and its internal structure could should be encouraged to implement results of still mandatory post-operative stone analysis. Endourologists should improve their ability of visual identification of the different types of stones.
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Servais A, Thomas K, Dello Strologo L, Sayer JA, Bekri S, Bertholet-Thomas A, Bultitude M, Capolongo G, Cerkauskiene R, Daudon M, Doizi S, Gillion V, Gràcia-Garcia S, Halbritter J, Heidet L, van den Heijkant M, Lemoine S, Knebelmann B, Emma F, Levtchenko E. Cystinuria: clinical practice recommendation. Kidney Int 2020; 99:48-58. [PMID: 32918941 DOI: 10.1016/j.kint.2020.06.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
Cystinuria (OMIM 220100) is an autosomal recessive hereditary disorder in which high urinary cystine excretion leads to the formation of cystine stones because of the low solubility of cystine at normal urinary pH. We developed clinical practice recommendation for diagnosis, surgical and medical treatment, and follow-up of patients with cystinuria. Elaboration of these clinical practice recommendations spanned from June 2018 to December 2019 with a consensus conference in January 2019. Selected topic areas were chosen by the co-chairs of the conference. Working groups focusing on specific topics were formed. Group members performed systematic literature review using MEDLINE, drafted the statements, and discussed them. They included geneticists, medical biochemists, pediatric and adult nephrologists, pediatric and adult urologists experts in cystinuria, and the Metabolic Nephropathy Joint Working Group of the European Reference Network for Rare Kidney Diseases (ERKNet) and eUROGEN members. Overall 20 statements were produced to provide guidance on diagnosis, genetic analysis, imaging techniques, surgical treatment (indication and modalities), conservative treatment (hydration, dietetic, alkalinization, and cystine-binding drugs), follow-up, self-monitoring, complications (renal failure and hypertension), and impact on quality of life. Because of the rarity of the disease and the poor level of evidence in the literature, these statements could not be graded. This clinical practice recommendation provides guidance on all aspects of the management of both adults and children with cystinuria, including diagnosis, surgery, and medical treatment.
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Affiliation(s)
- Aude Servais
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France.
| | - Kay Thomas
- Stone Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luca Dello Strologo
- Renal Transplant Clinic, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - John A Sayer
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Central Parkway, Newcastle upon Tyne, UK; The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France
| | - Aurelia Bertholet-Thomas
- Centre de Référence des Maladies Rénales Rares, Filière ORKID, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Giovanna Capolongo
- Unit of Nephrology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Michel Daudon
- UMR S 1155 and Physiology Unit, AP-HP, Hôpital Tenon, Sorbonne Université and INSERM, Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Service d'Urologie, Hôpital Tenon, AP-HP, Paris, France
| | - Valentine Gillion
- Département de Néphrologie adulte, Cliniques universitaires Saint Luc, Bruxelles, Belgium
| | - Silvia Gràcia-Garcia
- Laboratory of Renal Lithiasis, Clinical Laboratories, Fundació Puigvert, Barcelona, Spain
| | - Jan Halbritter
- Division of Nephrology, Department of Endocrinology, Nephrology, and Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Laurence Heidet
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital universitaire Necker-Enfants Malades, Paris, France
| | - Marleen van den Heijkant
- Pediatric Renal Center, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sandrine Lemoine
- Nephrology and Renal Function Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; University of Lyon, Lyon, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, Centre de Référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Université de Paris, Paris, France
| | - Francesco Emma
- Division of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Elena Levtchenko
- Division of Pediatric Nephrology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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A quick stone component analysis matters in postoperative fever: a propensity score matching study of 1493 retrograde intrarenal surgery. World J Urol 2020; 39:1277-1285. [PMID: 32448970 DOI: 10.1007/s00345-020-03268-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To evaluate the role of stone components in postoperative fever following RIRS, and to investigate the role of quick stone component analysis during RIRS procedure. PATIENTS AND METHODS 1493 patients with RIRS were retrospectively reviewed. Propensity score matching (PSM) analysis was performed as infection stones (IS) vs. calcium-containing stones (CS) and IS vs. other compositions (OS). Independent risk factors of postoperative fever were identified by logistic analysis and nomogram was constructed. RESULTS A total of 73 patients suffered postoperative fever (4.9%), 8 patients with sepsis (0.5%), 4 patients with septic shock (0.3%). In IS vs. CS, the incidence of positive urine test (28.4% vs. 14.7%, p = 0.001), residual stone (48.2% vs. 37.6%, p = 0.04), and postoperative fever (9.1% vs. 2.0%, p = 0.004) was significantly higher in IS. In IS vs. OS, IS had a higher incidence of positive urine test (30.9% vs. 9.3%, p < 0.001) and residual stone (47.4% vs. 18.6%, p < 0.001), while there was no significant difference in postoperative fever (10.3% vs. 4.1%, p = 0.17). Multivariate regression analysis revealed that gender (OR 1.82, CI 1.09-3.07, p < 0.001), stone components (OR 0.6, CI 0.37-0.97, p = 0.038), urine test (OR 3.72, CI 2.23-6.20, p < 0.001), and neutrophil ratio > 75% (OR 5.17, CI 3.03-9.16, p < 0.001) were independent risk factors for postoperative fever. A nomogram with moderate discriminative ability (c-index: 0.813) was constructed to predict postoperative fever. CONCLUSION Infection stones were closely associated with postoperative fever following RIRS, as well as female gender, preoperative positive urine test, and postoperative neutrophil ratio > 75%. A quick stone component analysis would help in prevention of infectious complications. Early and longer duration of antimicrobial therapy was recommended for patients with infection stones.
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Analysis of stones formed in the human gall bladder and kidney using advanced spectroscopic techniques. Biophys Rev 2020; 12:647-668. [PMID: 32410185 DOI: 10.1007/s12551-020-00697-2] [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] [Received: 11/29/2019] [Accepted: 04/30/2020] [Indexed: 02/07/2023] Open
Abstract
Stone diseases (gallstones and kidney stones) are extremely painful and often cause death. The prime aim of biomedical research in this area has been determination of factors resulting in stone formation inside the gallbladder and urinary tract. Many theories have been put forward to explain the mechanism of stone formation and their growth; however, their complete cycle of pathogenesis is still under debate. Several factors are responsible for stone formation; however, much emphasis is placed on the determination of elemental and molecular composition of the stones. In the present review article, we describe different kinds of spectroscopic techniques such as Fourier transform infrared spectroscopy (FTIR), X-ray fluorescence (XRF) spectroscopy, time-of-flight secondary ion mass spectrometry (TOF-SIMS), and laser-induced breakdown spectroscopy (LIBS) and highlight their use in the analysis of stone diseases. We have summarized work done on gallstones and kidney stones using these advanced techniques particularly over the last 10 years. We have also briefly elaborated the basics of stone formations inside the human body and their complications for a better understanding of the subject.
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Runolfsdottir HL, Lin TL, Goldfarb DS, Sayer JA, Michael M, Ketteridge D, Rich PR, Edvardsson VO, Palsson R. Are conventional stone analysis techniques reliable for the identification of 2,8-dihydroxyadenine kidney stones? A case series. Urolithiasis 2020; 48:337-344. [PMID: 32399606 DOI: 10.1007/s00240-020-01187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
We have recently encountered patients incorrectly diagnosed with adenine phosphoribosyltransferase (APRT) deficiency due to misidentification of kidney stones as 2,8-dihydroxyadenine (DHA) stones. The objective of this study was to examine the accuracy of stone analysis for identification of DHA. Medical records of patients referred to the APRT Deficiency Research Program of the Rare Kidney Stone Consortium in 2010-2018 with a diagnosis of APRT deficiency based on kidney stone analysis were reviewed. The diagnosis was verified by measurement of APRT enzyme activity or genetic testing. Attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectra of pure crystalline DHA and a kidney stone obtained from one of the confirmed APRT deficiency cases were generated. The ATR-FTIR spectrum of the kidney stone matched the crystalline DHA spectrum and was used for comparison with available infrared spectra of stone samples from the patients. Of 17 patients referred, 14 had sufficient data available to be included in the study. In all 14 cases, the stone analysis had been performed by FTIR spectroscopy. The diagnosis of APRT deficiency was confirmed in seven cases and rejected in the remaining seven cases. Comparison of the ATR-FTIR spectrum of the DHA stone with the FTIR spectra from three patients who did not have APRT deficiency showed no indication of DHA as a stone component. Misidentification of DHA as a kidney stone component by clinical laboratories appears common among patients referred to our program. Since current clinical protocols used to interpret infrared spectra for stone analysis cannot be considered reliable for the identification of DHA stones, the diagnosis of APRT deficiency must be confirmed by other methods.
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Affiliation(s)
- Hrafnhildur L Runolfsdottir
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Tzu-Ling Lin
- Department of Renal Medicine, University College London, London, UK
| | - David S Goldfarb
- Nephrology Section, VA New York Harbor Healthcare System, and Division of Nephrology, New York University Langone Medical Center, New York, NY, USA
| | - John A Sayer
- Renal Services, The Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - Mini Michael
- Renal Section, Department of Pediatrics, Texas Children's Hospital, and Baylor College of Medicine, Houston, TX, USA
| | - David Ketteridge
- Department of Genetics and Molecular Pathology, Women's and Children's Hospital, Adelaide, Australia
| | - Peter R Rich
- Department of Structural and Molecular Biology, University College London, London, UK
| | - Vidar O Edvardsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Children's Medical Center, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland.
| | - Runolfur Palsson
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. .,Division of Nephrology, Landspitali-The National University Hospital of Iceland, Hringbraut, 101, Reykjavik, Iceland.
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Meeting report of the "Symposium on kidney stones and mineral metabolism: calcium kidney stones in 2017". J Nephrol 2019; 32:681-698. [PMID: 30680550 DOI: 10.1007/s40620-019-00587-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
A symposium on kidney stones and mineral metabolism held on December 2017 in Brussels, Belgium was the first international multidisciplinary conference of the International Collaborative Network on Kidney Stones and Mineral Metabolism. This meeting addressed epidemiology, underlying pathophysiological mechanisms, genetics, pathological, as well as clinical and research topics. The participants included clinicians and recognized experts in the field from Europe and the United States interacted closely during the symposium which promoted a chance to explore new frontiers in the field of kidney stone disease. This manuscript summarizes some of the major highlights of the meeting.
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Ananthakrishnan L, Duan X, Xi Y, Lewis MA, Pearle MS, Antonelli JA, Goerne H, Kolitz EM, Abbara S, Lenkinski RE, Fielding JR, Leyendecker JR. Dual-layer spectral detector CT: non-inferiority assessment compared to dual-source dual-energy CT in discriminating uric acid from non-uric acid renal stones ex vivo. Abdom Radiol (NY) 2018; 43:3075-3081. [PMID: 29626256 DOI: 10.1007/s00261-018-1589-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the non-inferiority of dual-layer spectral detector CT (SDCT) compared to dual-source dual-energy CT (dsDECT) in discriminating uric acid (UA) from non-UA stones. METHODS Fifty-seven extracted urinary calculi were placed in a cylindrical phantom in a water bath and scanned on a SDCT scanner (IQon, Philips Healthcare) and second- and third-generation dsDECT scanners (Somatom Flash and Force, Siemens Healthcare) under matched scan parameters. For SDCT data, conventional images and virtual monoenergetic reconstructions were created. A customized 3D growing region segmentation tool was used to segment each stone on a pixel-by-pixel basis for statistical analysis. Median virtual monoenergetic ratios (VMRs) of 40/200, 62/92, and 62/100 for each stone were recorded. For dsDECT data, dual-energy ratio (DER) for each stone was recorded from vendor-specific postprocessing software (Syngo Via) using the Kidney Stones Application. The clinical reference standard of X-ray diffraction analysis was used to assess non-inferiority. Area under the receiver-operating characteristic curve (AUC) was used to assess diagnostic performance of detecting UA stones. RESULTS Six pure UA, 47 pure calcium-based, 1 pure cystine, and 3 mixed struvite stones were scanned. All pure UA stones were correctly separated from non-UA stones using SDCT and dsDECT (AUC = 1). For UA stones, median VMR was 0.95-0.99 and DER 1.00-1.02. For non-UA stones, median VMR was 1.4-4.1 and DER 1.39-1.69. CONCLUSION SDCT spectral reconstructions demonstrate similar performance to those of dsDECT in discriminating UA from non-UA stones in a phantom model.
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Castiglione V, Sacré PY, Cavalier E, Hubert P, Gadisseur R, Ziemons E. Raman chemical imaging, a new tool in kidney stone structure analysis: Case-study and comparison to Fourier Transform Infrared spectroscopy. PLoS One 2018; 13:e0201460. [PMID: 30075002 PMCID: PMC6075768 DOI: 10.1371/journal.pone.0201460] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 07/15/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The kidney stone's structure might provide clinical information in addition to the stone composition. The Raman chemical imaging is a technology used for the production of two-dimension maps of the constituents' distribution in samples. We aimed at determining the use of Raman chemical imaging in urinary stone analysis. MATERIAL AND METHODS Fourteen calculi were analyzed by Raman chemical imaging using a confocal Raman microspectrophotometer. They were selected according to their heterogeneous composition and morphology. Raman chemical imaging was performed on the whole section of stones. Once acquired, the data were baseline corrected and analyzed by MCR-ALS. Results were then compared to the spectra obtained by Fourier Transform Infrared spectroscopy. RESULTS Raman chemical imaging succeeded in identifying almost all the chemical components of each sample, including monohydrate and dihydrate calcium oxalate, anhydrous and dihydrate uric acid, apatite, struvite, brushite, and rare chemicals like whitlockite, ammonium urate and drugs. However, proteins couldn't be detected because of the huge autofluorescence background and the small concentration of these poor Raman scatterers. Carbapatite and calcium oxalate were correctly detected even when they represented less than 5 percent of the whole stones. Moreover, Raman chemical imaging provided the distribution of components within the stones: nuclei were accurately identified, as well as thin layers of other components. Conversion of dihydrate to monohydrate calcium oxalate was correctly observed in the centre of one sample. The calcium oxalate monohydrate had different Raman spectra according to its localization. CONCLUSION Raman chemical imaging showed a good accuracy in comparison with infrared spectroscopy in identifying components of kidney stones. This analysis was also useful in determining the organization of components within stones, which help locating constituents in low quantity, such as nuclei. However, this analysis is time-consuming, making it more suitable for research studies rather than routine analysis.
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Affiliation(s)
- Vincent Castiglione
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Pierre-Yves Sacré
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Etienne Cavalier
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Philippe Hubert
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
| | - Romy Gadisseur
- Department of Clinical Chemistry, CHU of Liège, University of Liège, Liège, Belgium
| | - Eric Ziemons
- University of Liege (ULiege), CIRM, VibraSante Hub, Laboratory of Pharmaceutical Analytical Chemistry, Liège, Belgium
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Abstract
Renal stone disease is a worldwide problem which carries significant morbidity. It frequently requires specialist urology intervention. Patients with recurrent disease and those at high risk require specialist investigations and review. Certain cases benefit from medical and surgical intervention. In this review, we discuss the pathophysiology, risk assessment, specialist investigations and various interventions, their rationale and evidence base. This review aims to provide an update of the previous publication in 2001 in this journal on this topic.
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Affiliation(s)
- Adie Viljoen
- Department of Chemical Pathology, Lister Hospital, Stevenage UK
| | - Rabia Chaudhry
- Department of Chemical Pathology, Lister Hospital, Stevenage UK
| | - John Bycroft
- Department of Urology, Lister Hospital, Stevenage, UK
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Urolithiasis: evaluation, dietary factors, and medical management: an update of the 2014 SIU-ICUD international consultation on stone disease. World J Urol 2017; 35:1331-1340. [DOI: 10.1007/s00345-017-2000-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/02/2017] [Indexed: 01/13/2023] Open
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Mandel NS, Mandel IC, Kolbach-Mandel AM. Accurate stone analysis: the impact on disease diagnosis and treatment. Urolithiasis 2016; 45:3-9. [PMID: 27915396 DOI: 10.1007/s00240-016-0943-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022]
Abstract
This manuscript reviews the requirements for acceptable compositional analysis of kidney stones using various biophysical methods. High-resolution X-ray powder diffraction crystallography and Fourier transform infrared spectroscopy (FTIR) are the only acceptable methods in our labs for kidney stone analysis. The use of well-constructed spectral reference libraries is the basis for accurate and complete stone analysis. The literature included in this manuscript identify errors in most commercial laboratories and in some academic centers. We provide personal comments on why such errors are occurring at such high rates, and although the work load is rather large, it is very worthwhile in providing accurate stone compositions. We also provide the results of our almost 90,000 stone analyses and a breakdown of the number of components we have observed in the various stones. We also offer advice on determining the method used by the various FTIR equipment manufacturers who also provide a stone analysis library so that the FTIR users can feel comfortable in the accuracy of their reported results. Such an analysis on the accuracy of the individual reference libraries could positively influence the reduction in their respective error rates.
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Affiliation(s)
- Neil S Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA.
| | - Ian C Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA
| | - Ann M Kolbach-Mandel
- Division of Nephrology, Mandel International Stone and Molecular Analysis Center, Medical College of Wisconsin, Clement J. Zablocki Department of Veterans Affairs Medical Center, Research Service/151, 5000 W. National Avenue, Milwaukee, WI, 53295, USA
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Vibrational spectroscopies to investigate concretions and ectopic calcifications for medical diagnosis. CR CHIM 2016. [DOI: 10.1016/j.crci.2016.05.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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[Stone treatment tomorrow and the day after]. Urologe A 2016; 55:1309-1316. [PMID: 27620184 DOI: 10.1007/s00120-016-0227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urological and surgical treatment of urinary stones are highly technological and technology-driven disciplines in present-day surgery. German medical engineering has always been recognized for its technical innovations in endoscopic surgery. Current and future trends are indicative of further miniaturization and automation of surgical instruments and assist systems to facilitate endourological procedures as well as improvements in the quality of results and ergonomics. These technologies include, e. g. 3D-tracking to facilitate access to the pelvicaliceal system for percutaneous nephrolithotomy (PNL) or robotic master-slave systems for endourology. The aim of all future stone treatment should be complete stone removal. This could be achieved by improved stone fragmentation ("micron-sized debris") or complete removal of fragments (e. g. using a "stone glue"). Integration of diagnostic procedures and treatments will constitute a key aspect of future developments in medical engineering. Intelligent laser systems may be capable of distinguishing stones from mucosa and artificial surfaces and may be used for immediate stone analysis during surgery. A simpler and faster availability of metabolic ("metabolomics") and genetic ("genomics") diagnostics will help to facilitate and improve individual metaphylaxis, e. g. in patient self-management. Nanotechnology and microrobots that may be used for endoluminal diagnostics and treatment of the urinary tract are already in development.
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