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Geraghty R, Lovegrove C, Howles S, Sayer JA. Role of Genetic Testing in Kidney Stone Disease: A Narrative Review. Curr Urol Rep 2024:10.1007/s11934-024-01225-5. [PMID: 39096463 DOI: 10.1007/s11934-024-01225-5] [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] [Accepted: 07/05/2024] [Indexed: 08/05/2024]
Abstract
PURPOSE OF REVIEW Kidney stone disease (KSD) is a common and potentially life-threatening condition, and half of patients experience a repeat kidney stone episode within 5-10 years. Despite the ~50% estimate heritability of KSD, international guidelines have not kept up with the pace of discovery of genetic causes of KSD. The European Association of Urology guidelines lists 7 genetic causes of KSD as 'high risk'. RECENT FINDINGS There are currently 46 known monogenic (single gene) causes of kidney stone disease, with evidence of association in a further 23 genes. There is also evidence for polygenic risk of developing KSD. Evidence is lacking for recurrent disease, and only one genome wide association study has investigated this phenomenon, identifying two associated genes (SLC34A1 and TRPV5). However, in the absence of other evidence, patients with genetic predisposition to KSD should be treated as 'high risk'. Further studies are needed to characterize both monogenic and polygenic associations with recurrent disease, to allow for appropriate risk stratification. Durability of test result must be balanced against cost. This would enable retrospective analysis if no genetic cause was found initially. We recommend genetic testing using a gene panel for all children, adults < 25 years, and older patients who have factors associated with high risk disease within the context of a wider metabolic evaluation. Those with a genetic predisposition should be managed via a multi-disciplinary team approach including urologists, radiologists, nephrologists, clinical geneticists and chemical pathologists. This will enable appropriate follow-up, counselling and potentially prophylaxis.
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Affiliation(s)
- Robert Geraghty
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
- Department of Urology, The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Catherine Lovegrove
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Howles
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John A Sayer
- Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Renal Services, The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
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Zisman AL. Thiazides for Nephrolithiasis Prevention: Written in Stone? Am J Kidney Dis 2024; 84:241-243. [PMID: 38461949 DOI: 10.1053/j.ajkd.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Anna L Zisman
- University of Chicago Pritzker School of Medicine, Chicago, Illinois.
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Skolarikos A, Somani B, Neisius A, Jung H, Petřík A, Tailly T, Davis N, Tzelves L, Geraghty R, Lombardo R, Bezuidenhout C, Gambaro G. Metabolic Evaluation and Recurrence Prevention for Urinary Stone Patients: An EAU Guidelines Update. Eur Urol 2024:S0302-2838(24)02411-4. [PMID: 39069389 DOI: 10.1016/j.eururo.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVE The aim of this review was to define patients who are at high risk of recurrence of urolithiasis, to delineate diagnostic and therapeutic algorithms for each type of stone, and to clarify general guidelines and recommendations for prevention of recurrence. METHODS A professional research librarian carried out literature searches for all sections of the urolithiasis guidelines, covering the timeframe between 1976 and June 2023. KEY FINDINGS AND LIMITATIONS For every patient with urolithiasis, an attempt should be made to analyse the stone. Patients should be given general instructions on how to prevent recurrence, including adequate fluid and calcium intake, and low consumption of sodium and protein. Identifying and correcting the causative factors is a cornerstone in preventing the recurrence of urolithiasis. Diagnostic and therapeutic algorithms by stone composition are available. Every patient should undergo baseline metabolic screening, while patients with calcium stones, who are at high risk of relapse and complications, should undergo extensive metabolic screening with two 24-h urine collections and should receive targeted therapy. Patients with uric acid, infection, or cystine stones are at high risk of relapse. All patients at high risk of recurrence should be closely monitored, especially those not complying with therapy in the long term. CONCLUSIONS AND CLINICAL IMPLICATIONS Metabolic stone evaluation and patient follow-up are highly recommended to prevent urolithiasis recurrence. PATIENT SUMMARY We reviewed the evidence for proper evaluation of patients with urinary and stones and the treatment options for preventing stone recurrence. It is essential to determine the type of stone and to carry out specific blood and urine tests for planning the best treatment course for each patient.
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Affiliation(s)
- Andreas Skolarikos
- National and Kapodistrian University of Athens, 2nd Department of Urology, Sismanogleio Hospital, Athens, Greece.
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Helene Jung
- Urinvejskirurgisk Afdeling, Sygehus Lillebælt, Vejle, Denmark
| | - Alec Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czechia
| | - Thomas Tailly
- Servicio de Urología, Hospital Universitario de Gante, Gante, Belgium
| | - Niall Davis
- Department of Urology, Connolly Hospital, Dublin, Ireland
| | - Lazaros Tzelves
- National and Kapodistrian University of Athens, 2nd Department of Urology, Sismanogleio Hospital, Athens, Greece
| | - Rob Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | | | - Carla Bezuidenhout
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
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Dalimov Z, Friedlander JI. Do We Really Need a Stone and Metabolic Urine Analysis? Yes. J Endourol 2024. [PMID: 38874916 DOI: 10.1089/end.2024.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Affiliation(s)
- Zafarjan Dalimov
- Department of Urology, Jefferson Einstein Healthcare Network, Philadelphia, Pennsylvania, USA
| | - Justin I Friedlander
- Department Urology, Fox Chase Cancer Center/Temple Health, Philadelphia, Pennsylvania, USA
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Yuan D, Yang J, Wu W, Amier Y, Li X, Wan W, Huang Y, Li J, Yu X. The immune factors have complex causal regulation effects on kidney stone disease: a mendelian randomization study. BMC Immunol 2024; 25:34. [PMID: 38877395 PMCID: PMC11177369 DOI: 10.1186/s12865-024-00627-x] [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: 03/18/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024] Open
Abstract
PURPOSE Previous studies have reported the potential impact of immune cells on kidney stone disease (KSD), but definitive causal relationships have yet to be established. The purpose of this paper is to elucidate the potential causal association between immune cells and KSD by Mendelian randomization (MR) analysis. METHODS In our study, a thorough two-sample Mendelian randomization (MR) analysis was performed by us to determine the potential causal relationship between immune cell traits and kidney stone disease. We included a total of four immune traits (median fluorescence intensity (MFI), relative cellular (RC), absolute cellular (AC), and morphological parameters (MP)), which are publicly available data. GWAS summary data related to KSD (9713 cases and 366,693 controls) were obtained from the FinnGen consortium. The primary MR analysis method was Inverse variance weighted. Cochran's Q test, MR Egger, and MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) were used to assess the stability of the results. RESULTS After FDR correction, the CD8 on HLA DR + CD8br (OR = 0.95, 95% CI = 0.93-0.98, p-value = 7.20 × 10- 4, q-value = 0.088) was determined to be distinctly associated with KSD, and we also found other 25 suggestive associations between immune cells and KSD, of which 13 associations were suggested as protective factors and 12 associations were suggested as risk factors. There was no horizontal pleiotropy or significant heterogeneity in our MR analysis, as determined by the p-value results of our Cochrane Q-test, MR Egger's intercept test, and MR-PRESSO, which were all > 0.05. CONCLUSIONS Our study has explored the potential causal connection between immune cells and KSD by Mendelian randomization analysis, thus providing some insights for future clinical studies.
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Affiliation(s)
- Dongfeng Yuan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Junyi Yang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weisong Wu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yirixiatijiang Amier
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xianmiu Li
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenlong Wan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yisheng Huang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jiabo Li
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiao Yu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Liberalization Ave, No. 1095, Wuhan, 430030, China.
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Mavridis C, Bouchalakis A, Tsagkaraki V, Somani BK, Mamoulakis C, Tokas T. Recurrent Urinary Stone Formers: Imaging Assessment and Endoscopic Treatment Strategies: A Systematic Search and Review. J Clin Med 2024; 13:3461. [PMID: 38929988 PMCID: PMC11204450 DOI: 10.3390/jcm13123461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/05/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Nephrolithiasis is a heterogeneous disease with a high prevalence and recurrence rate. Although there has been much progress regarding the surgical treatment of stones, a standardized follow-up, especially in recurrent stone formers (SFs), has yet to be decided. This fact leads to the overuse of computed tomography (CT) scans and many reoperations in patients, thus increasing their morbidity and the financial burden on the health systems. This review systematically searched the literature for original articles regarding imaging strategies and endoscopic treatment for patients with recurrent urolithiasis, aiming to identify optimal strategies to deal with these patients. Methods: We systematically searched the Medline database (accessed on 1 April 2024) for articles regarding imaging modalities and endoscopic treatment for patients with recurrent urinary tract lithiasis. Results: No specific follow-up or endoscopic treatment strategy exists for patients with recurrent urolithiasis. CT scan was the imaging modality most used in the studies, followed by X-ray, ultrasonography, and digital tomosynthesis. A transparent algorithm could not be identified. Percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), and ureteroscopy (URS) were used in the studies for endoscopic treatment. PCNL showed the best stone-free (SFr) rate and lowest hazard ratio (HR) for reoperation. RIRS showed superiority over extracorporeal shockwave lithotripsy for recurrent SFs, but fragments over 4 mm increased the recurrent rate. URS has an increased HR for reoperation for bilateral stones. Conclusions: The heterogeneity of urolithiasis leaves urologists without a standardized plan for recurrent SFs. Thus, each patient's follow-up should be planned individually and holistically. Pre-stenting is not to be avoided, especially in high-risk patients, and SFr status needs to be the aim. Finally, CT scans should not be generally overused but should be part of a patient's treatment plan. Prospective studies are required to define SFr status, the size of significant residual fragments, and the modalities of intervention and follow-up.
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Affiliation(s)
- Charalampos Mavridis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Athanasios Bouchalakis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK
| | - Charalampos Mamoulakis
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
| | - Theodoros Tokas
- Department of Urology, School of Medicine, University General Hospital of Heraklion, 71110 Heraklion, Greece
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, 6060 Hall in Tirol, Austria
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Knoedler MA, Li S, Hirano S, Nakada SY, Penniston KL. Higher Risk of Repeat Stone Surgery in Stone Formers With Concomitant Bowel Disease: Single-Center Long-Term Analysis. Urology 2024; 188:47-53. [PMID: 38648946 DOI: 10.1016/j.urology.2024.04.008] [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: 11/20/2023] [Revised: 03/13/2024] [Accepted: 04/02/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify the need for repeat stone surgery in patients with and without bowel disease. Few studies have compared risks between different types of bowel disease and whether their need for repeat stone surgery differs. METHODS From our IRB-approved study, we identified patients with and without bowel disease. We categorized patients' bowel disease into 4 categories: inflammatory bowel disease (IBD), bypass procedures, bowel resection, and bowel disease not otherwise specified (eg, irritable bowel syndrome, celiac disease). Differences between patient demographics, stone disease, and recurrent stone events for patients with and without bowel disease were compared using univariate and multivariate survival analyses (SPSS 25). RESULTS Of all surgical stone patients (2011), 484 (24%) had some type of bowel disease. Compared to patients without bowel disease, patients with bowel disease presented with stones at an older age (62.2 ± 14.5 vs 58.4 ± 15.3 years; P <.001) and were more likely to be female (56 vs 46%; P <.001). Patients with bowel disease required more repeat stone surgery than those without bowel disease (31% vs 23%, P <.001). In multivariate analysis, patients with bypass and bowel resection were associated with more repeat surgery than patients without bowel disease (P <.001, P = .002, respectively). Patients with IBD and bowel disease not otherwise specified did not have higher risk for repeat surgery than patients without bowel disease. CONCLUSION Surgical stone patients with bowel disease, specifically those with prior bowel resection and bypass, had a higher risk of repeat stone surgery over time than stone formers without bowel disease. DATA AVAILABILITY The data sets generated and analyzed during the current study are available from the corresponding author on reasonable request.
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Affiliation(s)
- Margaret A Knoedler
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shuang Li
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Shuhei Hirano
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Stephen Y Nakada
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Kristina L Penniston
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Arivoli K, Valicevic AN, Oerline MK, Hsi RS, Patel SR, Hollingsworth JM, Shahinian VB. Preventive Pharmacological Therapy and Risk of Recurrent Urinary Stone Disease. Clin J Am Soc Nephrol 2024; 19:565-572. [PMID: 38345854 PMCID: PMC11108239 DOI: 10.2215/cjn.0000000000000428] [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: 09/27/2023] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Urinary stone disease is a prevalent condition associated with a high recurrence risk. Preventive pharmacological therapy has been proposed to reduce recurrent stone episodes. However, limited evidence exists regarding its effectiveness, contributing to its underutilization by physicians. This study aimed to evaluate the association between preventive pharmacological therapy (thiazide diuretics, alkali therapy, and uric acid-lowering medications) and clinically significant urinary stone disease recurrence. METHODS Using data from the Veterans Health Administration, adults with an index episode of urinary stone disease from 2012 through 2019 and at least one urinary abnormality (hypercalciuria, hypocitraturia, or hyperuricosuria) on 24-hour urine collection were included. The primary outcome was a composite variable representing recurrent stone events that resulted in emergency department visits, hospitalizations, or surgery for urinary stone disease. Cox proportional hazards regression was performed to estimate the association between preventive pharmacological therapy use and recurrent urinary stone disease while adjusting for relevant baseline patient characteristics. RESULTS Among the cohort of patients with urinary abnormalities ( n =5637), treatment with preventive pharmacological therapy was associated with a significant 19% lower risk of recurrent urinary stone disease during the 12-36-month period after the initial urine collection (hazard ratio, 0.81; 95% confidence interval, 0.65 to 1.00; P = 0.0496). However, the effectiveness of preventive pharmacological therapy diminished over longer follow-up periods (12-48 and 12-60 months after the urine collection) and did not reach statistical significance. When examining specific urinary abnormalities, only alkali therapy for hypocitraturia was associated with a significant 26% lower recurrence risk within the 12-36-month timeframe (hazard ratio, 0.74; 95% confidence interval, 0.56 to 0.97; P = 0.03). CONCLUSIONS When considering all urinary abnormalities together, this study demonstrates that the use of preventive pharmacological therapy is associated with a lower risk of clinically significant recurrent episodes of urinary stone disease in the 12-36 month timeframe after urine collection, although only the association with the use of alkali therapy for hypocitraturia was significant when individual abnormalities were examined.
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Affiliation(s)
- Kumaran Arivoli
- University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Autumn N. Valicevic
- Veterans Administration, Veterans Affairs Medical Center, Ann Arbor, Michigan
| | - Mary K. Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Ryan S. Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sanjeevkumar R. Patel
- Veterans Administration, Veterans Affairs Medical Center, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Vahakn B. Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Js Medeiros H, Gee E, Pak A, Hu V, Crawford L, Razavi S, Anderson TA, Sabouri AS. The Analgesic Effects of the Thoracic Paravertebral Block on Post-percutaneous Nephrolithotripsy: A Retrospective Study. Cureus 2024; 16:e60272. [PMID: 38872686 PMCID: PMC11170241 DOI: 10.7759/cureus.60272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Percutaneous nephrolithotripsy (PCNL) is a minimally invasive procedure for treating large and complex kidney stones, often resulting in significant post-operative pain and increased opioid use. This study aims to compare pain scores between patients undergoing PCNL who did and did not receive a preoperative single-shot thoracic paravertebral block (PVB) at the post-anesthesia care unit (PACU) as the primary outcome. Secondary outcomes were patient-controlled analgesia (PCA) usage on post-operative day 1 (POD 1), total opioid consumption on PACU and POD 1, and post-operative nausea and vomiting (PONV). METHODS A retrospective cohort study was conducted on the medical records of 341 patients who underwent PCNL from July 2014 to April 2016 in a single major academic center. PVB was administered at thoracic levels T7-9 using a volume of 20 cc of bupivacaine, ranging from 0.25% to 0.5%, to achieve the desired analgesic effect. RESULTS After excluding 34 patients, the study included 123 in the no block (NB) group and 149 in the regional anesthesia (RA) group. There were no differences in demographics, including age, sex, weight and height, BMI, and indication for PCNL. The results revealed that the RA group experienced a statistically significant reduction in PCA usage in both crude and adjusted models (adjusted logistic regression analysis: OR = 0.19, 95% CI = 0.05-0.60; p = 0.008). However, there were no significant changes in total opioid consumption, pain scores, or incidents of PONV. CONCLUSION The retrospective analysis did not reveal any discernible advantage in pain management associated with the use of PVB for post-PCNL analgesia, except for reducing the percentage of PCA narcotics used. Future investigations with larger sample sizes and meticulous control for surgical indications and complexity are imperative to accurately assess the efficacy of this block in the context of post-PCNL surgery.
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Affiliation(s)
- Heitor Js Medeiros
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Erica Gee
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Aimee Pak
- Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Vivian Hu
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Lane Crawford
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Sarah Razavi
- Urology, Massachusetts General Hospital, Boston, USA
| | | | - A Sassan Sabouri
- Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, USA
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Basiri A, Kashi AH, Zahir M, Borumandnia N, Taheri M, Golshan S, Narouie B, Mombeini H. Predictors of Recurrent Urolithiasis in Iran: Findings from a Nationwide Study. ARCHIVES OF IRANIAN MEDICINE 2024; 27:200-205. [PMID: 38685846 PMCID: PMC11097307 DOI: 10.34172/aim.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/24/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Prevention of urinary stone recurrence is the ultimate goal in urolithiasis patients. In this study, we aimed to investigate the national prevalence rate and possible determinants of increased urolithiasis recurrence risk in a nationwide study in Iran. METHODS All data regarding stone occurrence and recurrence episodes were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of recurrence were evaluated in the subset of 2913 patients who had a positive history of at least one episode of urolithiasis. RESULTS The national prevalence rate of recurrent urolithiasis was 2.6% (95% CI: 2.5, 2.8) in Iran. Moreover, the relative ratio of recurrent stone formers to all stone formers was 39.8% (95% CI: 38.0, 41.6). Our univariable truncated negative binomial regressions suggested that a positive history of urolithiasis in the patient's father (prevalence ratio [PR] [95% CI]=1.83 [1.39, 2.41], P<0.001), mother (PR [95% CI]=1.92 [1.39, 2.66], P<0.001) or brother (PR [95% CI]=1.32 [1.03, 1.69], P=0.026); and residence in urban areas (PR [95% CI]=1.27 [1.04, 1.55], P=0.016) were significant predictors of repetitive recurrence episodes. However, when incorporated into a multivariable truncated negative binomial regression model, the only significant predictors of more frequent recurrence episodes were a positive history in father (PR [95% CI]=1.66 [1.24, 2.22], P<0.001) and mother (PR [95% CI]=1.68 [1.20, 2.36], P=0.002); and urban residence (PR [95% CI]=1.24 [1.01, 1.51], P=0.031). CONCLUSION Our results indicate that a positive family history of urolithiasis in mother and father and residence in urban areas are the significant predictors of recurrence risk in urolithiasis patients in Iran.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Kashi
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mazyar Zahir
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabnam Golshan
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hayat Mombeini
- Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Wan MC, Jiao K, Zhu YN, Wan QQ, Zhang YP, Niu LZ, Lei C, Song JH, Lu WC, Liu HJ, Ren ZY, Tay F, Niu LN. Bacteria-mediated resistance of neutrophil extracellular traps to enzymatic degradation drives the formation of dental calculi. Nat Biomed Eng 2024:10.1038/s41551-024-01186-7. [PMID: 38491329 DOI: 10.1038/s41551-024-01186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
Dental calculi can cause gingival bleeding and periodontitis, yet the mechanism underlying the formation of such mineral build-ups, and in particular the role of the local microenvironment, are unclear. Here we show that the formation of dental calculi involves bacteria in local mature biofilms converting the DNA in neutrophil extracellular traps (NETs) from being degradable by the enzyme DNase I to being degradation resistant, promoting the nucleation and growth of apatite. DNase I inhibited NET-induced mineralization in vitro and ex vivo, yet plasma DNases were ineffective at inhibiting ectopic mineralization in the oral cavity in rodents. The topical application of the DNA-intercalating agent chloroquine in rodents fed with a dental calculogenic diet reverted NET DNA to its degradable form, inhibiting the formation of calculi. Our findings may motivate therapeutic strategies for the reduction of the prevalence of the deposition of bacteria-driven calculi in the oral cavity.
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Affiliation(s)
- Mei-Chen Wan
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Kai Jiao
- Department of Stomatology, Tangdu hospital; State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Yi-Na Zhu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Qian-Qian Wan
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Yi-Peng Zhang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Long-Zhang Niu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Chen Lei
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Jing-Han Song
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Wei-Cheng Lu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Hua-Jie Liu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Zhao-Yang Ren
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China
| | - Franklin Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Li-Na Niu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, P.R. China.
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Tamborino F, Cicchetti R, Mascitti M, Litterio G, Orsini A, Ferretti S, Basconi M, De Palma A, Ferro M, Marchioni M, Schips L. Pathophysiology and Main Molecular Mechanisms of Urinary Stone Formation and Recurrence. Int J Mol Sci 2024; 25:3075. [PMID: 38474319 DOI: 10.3390/ijms25053075] [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: 12/22/2023] [Revised: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Kidney stone disease (KSD) is one of the most common urological diseases. The incidence of kidney stones has increased dramatically in the last few decades. Kidney stones are mineral deposits in the calyces or the pelvis, free or attached to the renal papillae. They contain crystals and organic components, and they are made when urine is supersaturated with minerals. Calcium-containing stones are the most common, with calcium oxalate as the main component of most stones. However, many of these form on a calcium phosphate matrix called Randall's plaque, which is found on the surface of the kidney papilla. The etiology is multifactorial, and the recurrence rate is as high as 50% within 5 years after the first stone onset. There is a great need for recurrence prevention that requires a better understanding of the mechanisms involved in stone formation to facilitate the development of more effective drugs. This review aims to understand the pathophysiology and the main molecular mechanisms known to date to prevent recurrences, which requires behavioral and nutritional interventions, as well as pharmacological treatments that are specific to the type of stone.
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Affiliation(s)
- Flavia Tamborino
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Rossella Cicchetti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Marco Mascitti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Giulio Litterio
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Angelo Orsini
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Simone Ferretti
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Martina Basconi
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Antonio De Palma
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy
| | - Michele Marchioni
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
| | - Luigi Schips
- Department of Medical Oral and Biotechnological Science, Università degli Studi "G. d'Annunzio" of Chieti, 66100 Chieti, Italy
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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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14
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Gui Z, Yu L, Chen Y, Zhang M, He J, Hao Y. Study from the United States: increased prevalence of kidney stones in patients with high weight-adjusted waist index. Front Nutr 2024; 10:1171775. [PMID: 38299185 PMCID: PMC10828009 DOI: 10.3389/fnut.2023.1171775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/13/2023] [Indexed: 02/02/2024] Open
Abstract
Objective Using data from NHANES 2007-2018, to examine the association between WWI (weight-adjusted waist index) index and prevalence of kidney stones. Methods Using multiple logistic regression analysis of the National Health and Nutrition Examination Survey (NHANES) 2007-2018, we evaluated the association between WWI index and the prevalence of kidney stones, followed by subgroup analysis of sensitive populations. Smooth curve fitting was used to determine whether there was a non-linear relationship between the WWI index and kidney stone prevalence, and threshold effect analysis was used to test this relationship. Results Among 29,280 participants, 2,760 self-reported renal calculi. After adjustment for all confounders, there was a positive association between WWI and kidney stone prevalence (OR = 1.20, 95% CI: 1.12, 1.28), and this positive association was stronger with increasing WWI (and P = 0.01 for trend). Our results indicate a non-linear positive correlation between WWI index and kidney stones, with the saturation threshold effect analysis and the most important threshold value at 11.02. According to subgroup analysis, WWI showed the strongest association with kidney stone prevalence in participants aged 20-39 years, males, other US ethnic groups, and participants without hypertension and diabetes. Conclusion Increased WWI is positively associated with increased incidence of kidney stones, and increased WWI is a high risk for kidney stones that should be treated with caution. This association should be more pronounced in people between the ages of 20 and 39 years, in men, in other US ethnic populations, and in participants who do not have hypertension or diabetes.
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Affiliation(s)
- Zhaohua Gui
- Division of Life Sciences and Medicine, Department of Pathology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Longshan Yu
- Division of Life Sciences and Medicine, Department of Emergency Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Yan Chen
- Department of General Practice, Wuhu City Second People’s Hospital, Wuhu, China
| | - Mingxun Zhang
- Division of Life Sciences and Medicine, Department of Pathology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Jie He
- Division of Life Sciences and Medicine, Department of Pathology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Yunwu Hao
- Department of Urology, Lu’an Hospital Affiliated of Anhui Medical University (Lu an City People’s Hospital), Lu’an, Anhui, China
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15
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Hsi RS, Crivelli JJ, Yan PL, Shahinian V, Hollingsworth JM. Comparison of Class-Specific Side Effects Across Preventative Pharmacologic Therapies for Kidney Stone Disease. UROLOGY PRACTICE 2024; 11:172-178. [PMID: 38117963 PMCID: PMC10751065 DOI: 10.1097/upj.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/25/2023] [Indexed: 12/22/2023]
Abstract
INTRODUCTION Clinical guidelines recommend monitoring for metabolic derangements while on preventive pharmacologic therapy for kidney stone disease. The study objective was to compare the frequency of side effects among patients receiving alkali citrate, thiazides, and allopurinol. METHODS Using claims data from working-age adults with kidney stone disease (2008-2019), we identified those with a new prescription for alkali citrate, thiazide, or allopurinol within 12 months after their index stone-related diagnosis or procedure. We fit multivariable logistic regression models, adjusting for cohort characteristics like comorbid illness and medication adherence, to estimate 2-year measured frequencies of claims-based outcomes of acute kidney injury, falls/hip fracture, gastritis, abnormal liver function tests/hepatitis, hypercalcemia, hyperglycemia/diabetes, hyperkalemia, hypokalemia, hyponatremia, and hypotension. RESULTS Our cohort consisted of 1776 (34%), 2767 (53%), and 677 (13%) patients prescribed alkali citrate, thiazides, or allopurinol, respectively. Comparing unadjusted rates of incident diagnoses, thiazides compared to alkali citrate and allopurinol were associated with the highest rates of hypercalcemia (2.3% vs 1.5% and 1.0%, respectively, P = .04), hypokalemia (6% vs 3% and 2%, respectively, P < .01), and hyperglycemia/diabetes (17% vs 11% and 16%, respectively, P < .01). No other differences with the other outcomes were significant. In adjusted analyses, compared to alkali citrate, thiazides were associated with a higher odds of hypokalemia (OR=2.01, 95% CI 1.44-2.81) and hyperglycemia/diabetes (OR=1.52, 95% CI 1.26-1.83), while allopurinol was associated with a higher odds of hyperglycemia/diabetes (OR=1.34, 95% CI 1.02-1.75). CONCLUSIONS These data provide evidence to support clinical guidelines that recommend periodic serum testing to assess for adverse effects from preventive pharmacologic therapy.
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Affiliation(s)
- Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph J Crivelli
- Department of Urology, University of Alabama at Birmingham School of Medicine and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
| | - Phyllis L Yan
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Vahakn Shahinian
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
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Rodriguez-Alvarez JS, Khooblall P, Brar H, Fedrigon D, Gutierrez-Aceves J, Monga M, De S. Endoscopic Stone Composition Identification: Is Accuracy Improved by Stone Appearance During Laser Lithotripsy? Urology 2023; 182:67-72. [PMID: 37802193 DOI: 10.1016/j.urology.2023.09.025] [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: 06/28/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate if videos during laser lithotripsy increase accuracy and confidence of stone identification by urologists compared to still pictures. METHODS We obtained representative pictures and videos of 4 major stone types from 8 different patients during ureteroscopy with holmium laser lithotripsy. A REDCap survey was created and emailed to members of the Endourological Society. The survey included a picture followed by the corresponding video of each stone undergoing laser lithotripsy and additional clinical information. Each picture and video included multiple-choice questions about stone composition and response confidence level. Accuracy, confidence levels, and rates of rectification (change from incorrect to correct answer) or confounding (correct to incorrect) after watching videos were analyzed. RESULTS One hundred eighty-seven urologists responded to the survey. The accuracy rate of stone identification with pictures was 43.8% vs 46.1% with videos (P = .27). Accuracy for individual stones was low and highly variable. Video only improved accuracy for 1 cystine stone. After viewing videos, participants were more likely to rectify vs confound their answers. Urologists were more likely to be confident with videos than pictures alone (65.4% vs 53.7%, respectively; P <.001); however, confident answers were not more likely to yield accurate predictions with videos vs still pictures. CONCLUSION Stone identification by urologists is marginally improved with videos vs pictures alone. Overall, accuracy in stone identification is low irrespective of confidence level, picture, and lithotripsy video visualization. Urologists should be cautious in using endoscopic stone appearance to direct metabolic management.
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Affiliation(s)
| | - Prajit Khooblall
- Cleveland Clinic Glickman Urological & Kidney Institute, Cleveland, OH
| | | | | | | | - Manoj Monga
- University of California San Diego, San Diego, CA
| | - Smita De
- Cleveland Clinic Glickman Urological & Kidney Institute, Cleveland, OH
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Geraghty RM, Wilson I, Olinger E, Cook P, Troup S, Kennedy D, Rogers A, Somani BK, Dhayat NA, Fuster DG, Sayer JA. Routine Urinary Biochemistry Does Not Accurately Predict Stone Type Nor Recurrence in Kidney Stone Formers: A Multicentre, Multimodel, Externally Validated Machine-Learning Study. J Endourol 2023; 37:1295-1304. [PMID: 37830220 DOI: 10.1089/end.2023.0451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Objectives: Urinary biochemistry is used to detect and monitor conditions associated with recurrent kidney stones. There are no predictive machine learning (ML) tools for kidney stone type or recurrence. We therefore aimed to build and validate ML models for these outcomes using age, gender, 24-hour urine biochemistry, and stone composition. Materials and Methods: Data from three cohorts were used, Southampton, United Kingdom (n = 3013), Newcastle, United Kingdom (n = 5984), and Bern, Switzerland (n = 794). Of these 3130 had available 24-hour urine biochemistry measurements (calcium, oxalate, urate [Ur], pH, volume), and 1684 had clinical data on kidney stone recurrence. Predictive ML models were built for stone type (n = 5 models) and recurrence (n = 7 models) using the UK data, and externally validated with the Swiss data. Three sets of models were built using complete cases, multiple imputation, and oversampling techniques. Results: For kidney stone type one model (extreme gradient boosting [XGBoost] built using oversampled data) was able to effectively discriminate between calcium oxalate, calcium phosphate, and Ur on both internal and external validation. For stone recurrence, none of the models were able to discriminate between recurrent and nonrecurrent stone formers. Conclusions: Kidney stone recurrence cannot be accurately predicted using modeling tools built using specific 24-hour urinary biochemistry values alone. A single model was able to differentiate between stone types. Further studies to delineate accurate predictive tools should be undertaken using both known and novel risk factors, including radiomics and genomics.
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Affiliation(s)
- Robert M Geraghty
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Ian Wilson
- Biosciences Institute, Newcastle University, International Centre for Life, Newcastle Upon Tyne, United Kingdom
| | - Eric Olinger
- Translational and Clinical Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Paul Cook
- Department of Biochemistry, University Hospital Southampton, Southampton, United Kingdom
| | - Susan Troup
- Department of Biochemistry, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - David Kennedy
- Department of Biochemistry, Queen Elizabeth Hospital, Gateshead, United Kingdom
| | - Alistair Rogers
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Nasser A Dhayat
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Daniel G Fuster
- Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - John A Sayer
- Translational and Clinical Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle Upon Tyne, United Kingdom
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Barton MF, Brower CH, Barton BL, Duggan NM, Baugh CW, Haleblian GE, Goldsmith AJ. POCUS-first for nephrolithiasis: A Monte Carlo simulation illustrating cost savings, LOS reduction, and preventable radiation. Am J Emerg Med 2023; 74:41-48. [PMID: 37769445 DOI: 10.1016/j.ajem.2023.09.025] [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: 04/17/2023] [Revised: 08/05/2023] [Accepted: 09/18/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Non-contrast computed tomography (NCCT) is the gold standard for nephrolithiasis evaluation in the emergency department (ED). However, Choosing Wisely guidelines recommend against ordering NCCT for patients with suspected nephrolithiasis who are <50 years old with a history of kidney stones. Our primary objective was to estimate the national annual cost savings from using a point-of-care ultrasound (POCUS)-first approach for patients with suspected nephrolithiasis meeting Choosing Wisely criteria. Our secondary objectives were to estimate reductions in ED length of stay (LOS) and preventable radiation exposure. METHODS We created a Monte Carlo simulation using available estimates for the frequency of ED visits for nephrolithiasis and eligibility for a POCUS-first approach. The study population included all ED patients diagnosed with nephrolithiasis. Based on 1000 trials of our simulation, we estimated national cost savings in averted advanced imaging from this strategy. We applied the same model to estimate the reduction in ED LOS and preventable radiation exposure. RESULTS Using this model, we estimate a POCUS-first approach for evaluating nephrolithiasis meeting Choosing Wisely guidelines to save a mean (±SD) of $16.5 million (±$2.1 million) by avoiding 159,000 (±18,000) NCCT scans annually. This resulted in a national cumulative decrease of 166,000 (±165,000) annual bed-hours in ED LOS. Additionally, this resulted in a national cumulative reduction in radiation exposure of 1.9 million person-mSv, which could potentially prevent 232 (±81) excess cancer cases and 118 (±43) excess cancer deaths annually. CONCLUSION If adopted widely, a POCUS-first approach for suspected nephrolithiasis in patients meeting Choosing Wisely criteria could yield significant national cost savings and a reduction in ED LOS and preventable radiation exposure. Further research is needed to explore the barriers to widespread adoption of this clinical workflow as well as the benefits of a POCUS-first approach in other patient populations.
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Affiliation(s)
- Michael F Barton
- Department of Emergency Medicine, University of Chicago Medicine, Chicago, IL, USA.
| | - Charles H Brower
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Brenna L Barton
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Nicole M Duggan
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - George E Haleblian
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Andrew J Goldsmith
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Moore CD, Azam B, Do H, Williamson K, Chambers AH, Ghani MOAA. Underdiagnosis of Hyperparathyroidism in Patients With Nephrolithiasis in a Community Setting. Cureus 2023; 15:e49290. [PMID: 38143641 PMCID: PMC10748449 DOI: 10.7759/cureus.49290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Untreated primary hyperparathyroidism (PHPT) has wide-ranging multisystemic effects. Recent studies based in the US have shown a less than 25% screening rate for PHPT. Our study aims to detect whether similar deficiencies exist in our community healthcare system while quantifying the prevalence of PHPT underdiagnosis and inadequate surgical referrals. Study design This retrospective quantitative study enrolled patients aged ≥18 years with imaged-confirmed nephrolithiasis at our healthcare facilities from 2017 to the present (n=2021). Patients with documented calcium levels and kidney/ureter stones were included. Descriptive and univariate analyses were performed. Results A total of 2021 subjects met the criteria to be enrolled in the study. 26.6% (n=537) of patients with nephrolithiasis had elevated calcium levels on record. 13.6% (n=73) of hypercalcemic patients were screened for PHPT with an intact parathyroid hormone (PTH). A majority (63%, n=46) of patients with intact PTH had PHPT defined as PTH levels >55 pg/mL. Ultimately, only 19.6% (n=9) of patients with PHPT were referred for surgical intervention, and there was no significant difference in referral rate between patients with PHPT and those without (p=0.913). Conclusions PHPT is underdiagnosed in our community, leading to a significantly low rate of surgical referral and delay in management. Implementation of hospital protocols to aid in improving diagnosis and interventions could improve outcomes for PHPT patients.
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Affiliation(s)
- Cameron D Moore
- General Surgery, University of Kentucky Bowling Green Campus, The Medical Center, Bowling Green, USA
| | - Bassil Azam
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells NHS Trust, Kent, GBR
| | - Helena Do
- General Surgery, University of Kentucky Bowling Green Campus, The Medical Center, Bowling Green, USA
| | - Kayla Williamson
- Surgery, University of Kentucky Bowling Green Campus, The Medical Center, Bowling Green, USA
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20
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Zhu W, Zhang X, Zhou Z, Sun Y, Zhang G, Duan X, Huang Z, Ai G, Liu Y, Zhao Z, Zhong W, Zeng G. Predictive value of single-nucleotide polymorphism signature for nephrolithiasis recurrence: a 5-year prospective study. Clin Kidney J 2023; 16:2205-2215. [PMID: 37915892 PMCID: PMC10616432 DOI: 10.1093/ckj/sfad119] [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: 03/17/2023] [Indexed: 11/03/2023] Open
Abstract
Background Genetic variations are linked to kidney stone formation. However, the association of single nucleotide polymorphism (SNPs) and stone recurrence has not been well studied. This study aims to identify genetic variants associated with kidney stone recurrences and to construct a predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones. Methods We genotyped 49 SNPs in 1001 patients who received surgical stone removal between Jan 1 and Dec 31 of 2012. All patients were confirmed stone-free by CT scan and then received follow-up at least 5 years. SNP associations with stone recurrence were analyzed by Cox proportion hazard model. A predictive nomogram model using SNPs and clinical features to predict the recurrence risk of kidney stones was developed by use of LASSO Cox regression. Results The recurrence rate at 3, 5, 7 years were 46.8%, 71.2%, and 78.4%, respectively. 5 SNPs were identified that had association with kidney stone recurrence risk. We used computer-generated random numbers to assign 500 of these patients to the training cohort and 501 patients to the validation cohort. A nomogram that combined the 14-SNPs-based classifier with the clinical risk factors was constructed. The areas under the curve (AUCs) at 3, 5 and 7 years of this nomogram was 0.645, 0.723, and 0.75 in training cohort, and was 0.631, 0.708, and 0.727 in validation cohort, respectively. Results show that the nomogram presented a higher predictive accuracy than those of the SNP classifier or clinical factors alone. Conclusion SNPs are significantly associated with kidney stone recurrence and should add prognostic value to the traditional clinical risk factors used to assess the kidney stone recurrence. A nomogram using clinical and genetic variables to predict kidney stone recurrence has revealed its potential in the future as an assessment tool during the follow-up of kidney stone patients.
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Affiliation(s)
- Wei Zhu
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Zhang
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhen Zhou
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yin Sun
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Guangyuan Zhang
- Department of Urology, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Xiaolu Duan
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhicong Huang
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guoyao Ai
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Liu
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhijian Zhao
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Wen Zhong
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guohua Zeng
- Guangdong Key Laboratory of Urology, Department of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Brazier F, Cornière N, Eladari D. Leave NOSTONE unturned: are thiazides useless in preventing kidney stone recurrence? Kidney Int 2023; 104:640-643. [PMID: 37437809 DOI: 10.1016/j.kint.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Affiliation(s)
- François Brazier
- Centre de dépistage et de Médecine de précision des Maladies Rénales, Service de Néphrologie, Centre Hospitalier Universitaire Amiens-Picardie, Université de Picardie Jules Verne, Amiens, France; Réseau F-CRIN: INI-CRCT, Vandœuvre-lès-Nancy, France
| | - Nicolas Cornière
- Centre de dépistage et de Médecine de précision des Maladies Rénales, Service de Néphrologie, Centre Hospitalier Universitaire Amiens-Picardie, Université de Picardie Jules Verne, Amiens, France; Réseau F-CRIN: INI-CRCT, Vandœuvre-lès-Nancy, France
| | - Dominique Eladari
- Centre de dépistage et de Médecine de précision des Maladies Rénales, Service de Néphrologie, Centre Hospitalier Universitaire Amiens-Picardie, Université de Picardie Jules Verne, Amiens, France; Réseau F-CRIN: INI-CRCT, Vandœuvre-lès-Nancy, France.
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22
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Chmiel JA, Stuivenberg GA, Al KF, Akouris PP, Razvi H, Burton JP, Bjazevic J. Vitamins as regulators of calcium-containing kidney stones - new perspectives on the role of the gut microbiome. Nat Rev Urol 2023; 20:615-637. [PMID: 37161031 PMCID: PMC10169205 DOI: 10.1038/s41585-023-00768-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 05/11/2023]
Abstract
Calcium-based kidney stone disease is a highly prevalent and morbid condition, with an often complicated and multifactorial aetiology. An abundance of research on the role of specific vitamins (B6, C and D) in stone formation exists, but no consensus has been reached on how these vitamins influence stone disease. As a consequence of emerging research on the role of the gut microbiota in urolithiasis, previous notions on the contribution of these vitamins to urolithiasis are being reconsidered in the field, and investigation into previously overlooked vitamins (A, E and K) was expanded. Understanding how the microbiota influences host vitamin regulation could help to determine the role of vitamins in stone disease.
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Affiliation(s)
- John A Chmiel
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Gerrit A Stuivenberg
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Kait F Al
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Polycronis P Akouris
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jeremy P Burton
- Department of Microbiology & Immunology, Western University, London, Ontario, Canada
- Canadian Centre for Human Microbiome and Probiotic Research, London, Ontario, Canada
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, Ontario, Canada.
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23
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Xie F, Deng S, Fei K, Xu H, Zhang H. Nomogram to predict the risk of adverse outcomes in patients with residual stones following percutaneous nephrolithotomy. Int Braz J Urol 2023; 49:599-607. [PMID: 37390125 PMCID: PMC10482460 DOI: 10.1590/s1677-5538.ibju.2023.0111] [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: 03/10/2023] [Accepted: 05/28/2023] [Indexed: 07/02/2023] Open
Abstract
PURPOSE To investigate the risk factors associated with adverse outcomes in patients with residual stones after percutaneous nephrolithotomy (PCNL) and to establish a nomogram to predict the probability of adverse outcomes based on these risk factors. METHODS We conducted a retrospective review of 233 patients who underwent PCNL for upper urinary tract calculi and had postoperative residual stones. The patients were divided into two groups according to whether adverse outcomes occurred, and the risk factors for adverse outcomes were explored by univariate and multivariate analyses. Finally, we created a nomogram for predicting the risk of adverse outcomes in patients with residual stones after PCNL. RESULTS In this study, adverse outcomes occurred in 125 (53.6%) patients. Multivariate logistic regression analysis indicated that the independent risk factors for adverse outcomes were the diameter of the postoperative residual stones (P < 0.001), a positive urine culture (P = 0.022), and previous stone surgery (P = 0.004). The above independent risk factors were used as variables to construct the nomogram. The nomogram model was internally validated. The calculated concordance index was 0.772. The Hosmer-Lemeshow goodness-of-fit test was performed (P > 0.05). The area under the ROC curve of this model was 0.772. CONCLUSIONS Larger diameter of residual stones, positive urine culture, and previous stone surgery were significant predictors associated with adverse outcomes in patients with residual stones after PCNL. Our nomogram could help to assess the risk of adverse outcomes quickly and effectively in patients with residual stones after PCNL.
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Affiliation(s)
- Feng Xie
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
- The First Hospital of ChangshaEmergency DepartmentChangshaHunanChinaEmergency Department, The First Hospital of Changsha, Changsha, Hunan, China
| | - Shidong Deng
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Kuilin Fei
- Central South UniversityXiangya HospitalDepartment of ObstetricsChangshaHunanChinaDepartment of Obstetrics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hanfeng Xu
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Huihui Zhang
- University of South ChinaThe First Affiliated HospitalHengyang Medical SchoolHengyangHunanChinaDepartment of Urology, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, China
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24
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Yang J, Wu W, Amier Y, Li X, Wan W, Yu X. Causal relationship of genetically predicted circulating micronutrients levels with the risk of kidney stone disease: a Mendelian randomization study. Front Nutr 2023; 10:1132597. [PMID: 37671199 PMCID: PMC10476526 DOI: 10.3389/fnut.2023.1132597] [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: 12/31/2022] [Accepted: 04/12/2023] [Indexed: 09/07/2023] Open
Abstract
Background Current studies have reported conflicting associations between circulating micronutrient levels and kidney stone disease (KSD). We aimed to elucidate the causal relationship between circulating micronutrient levels and KSD by a two-sample Mendelian randomization (MR) analysis. Methods Total of 36 single nucleotide polymorphisms (SNPs) from published genome-wide association studies (GWAS) significantly associated with eight micronutrients (vitamin B12, folic acid, magnesium, iron, phosphorus, copper, zinc, and selenium) were used as instrumental variables. The GWAS summary data associated with KSD (8,060 cases and 301,094 controls) were obtained from the FinnGen consortium. Inverse variance weighted was the main MR analysis method. MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO), weighted median and MR-Egger were used to assess pleiotropy and heterogeneity. Results Genetically predicted circulating vitamin B12 and zinc levels were causally associated with the risk of KSD (vitamin B12: OR: 1.17, 95% CI: 1.04-1.32, p = 0.008; zinc: OR: 1.15, 95% CI: 1.03-1.28, p = 0.015). We found no evidence that other circulating micronutrients were associated with risk of KSD. p-value for Cochrane Q test, MR Egger intercept test, and MR-PRESSO were >0.05, indicating no significant heterogeneity or horizontal pleiotropy in this MR analysis. Conclusion Increasing circulating zinc levels may increase the risk of KSD. More studies are needed to provide evidence on whether genetically predicted circulating vitamin B12 and zinc levels are a risk factor for KSD.
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Affiliation(s)
| | | | | | | | | | - Xiao Yu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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25
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Yin S, Zhou Z, Zhang F, Wu J, Lin T, Wang X. Treatment of donors' asymptomatic small kidney stones and post-transplant outcomes: a meta-analysis. Urolithiasis 2023; 51:104. [PMID: 37584873 DOI: 10.1007/s00240-023-01476-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: 02/17/2023] [Accepted: 07/31/2023] [Indexed: 08/17/2023]
Abstract
Kidney donors with asymptomatic small kidney stones were increasingly accepted in kidney transplantation (KT) due to organ shortage and advances in endoscopic urology. However, recipients' clinical outcomes using these donors remained unclear. We conducted a meta-analysis to summarize transplant outcomes using these donors with asymptomatic small kidney stones. Finally, 15 retrospective studies were included. The prevalence of asymptomatic small kidney stones was 5.3% (95%CI 3.5-7.8%). After transplantation, low incidence of urinary fistula (0%, 95%CI 0-1.0%), obstruction (0%, 95%CI 0-1.1%), relapse of kidney graft stone (0.3%, 95%CI 0-2.5%), and delayed graft function (0.6%, 95%CI 0-3.5%) was reported. Pooled serum creatinine was 1.3 (95%CI 1.2-1.5) mg/dl and 1.4 (95%CI 1.2-1.6) mg/dl at post-transplant 1 month and 1 year, respectively. Notably, we observed numerically higher relapse rate after conservative management (1.8% [0-9.2%] vs 0% [0-1.8%]) but numerically higher DGF rate after surgical removal of asymptomatic stones (1.8% [0-7.0%] vs 0% [0-1.9%]). Overall, short-term transplant outcomes using kidneys with asymptomatic small stones were acceptable. However, long-term transplant outcomes remained unexplored. Well-designed prospective studies are also needed to compare the efficacy of conservative management with surgical removal of "donors' gifted" asymptomatic kidney stones.
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Affiliation(s)
- Saifu Yin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zhaoxia Zhou
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Fan Zhang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jiapei Wu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Kidney Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Tao Lin
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Kidney Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China.
| | - Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
- Kidney Transplantation Center, West China Hospital, Sichuan University, Guoxue Alley 37#, Wuhou District, Chengdu, 610041, Sichuan, China.
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26
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Hamamoto S, Inoue T, Okada S, Taguchi K, Yasui T. Application of ultrasound imaging in the treatment of urinary tract stones. J Med Ultrason (2001) 2023:10.1007/s10396-023-01343-6. [PMID: 37572224 DOI: 10.1007/s10396-023-01343-6] [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: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/14/2023]
Abstract
Urinary tract stones are a common clinical condition that affect millions of individuals worldwide. The management of these stones has evolved significantly over the past 70 years, and ultrasound imaging has emerged as a valuable tool for diagnosis, treatment planning, and follow-up. This review aims to provide an overview of the application of ultrasound imaging in the treatment of urinary tract stones, highlighting its advantages, limitations, and current advancements in the field.
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Affiliation(s)
- Shuzo Hamamoto
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
- SMART Study Group, Nagoya, Japan.
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Hyogo, Japan
- SMART Study Group, Nagoya, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Chiba, Japan
- SMART Study Group, Nagoya, Japan
| | - Kazumi Taguchi
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
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Thongprayoon C, Vaughan LE, Barreto EF, Mehta RA, Koo K, Schulte PJ, Lieske JC, Rule AD. Outpatient Antibiotic Use is Not Associated with an Increased Risk of First-Time Symptomatic Kidney Stones. J Am Soc Nephrol 2023; 34:1399-1408. [PMID: 37184480 PMCID: PMC10400106 DOI: 10.1681/asn.0000000000000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/20/2023] [Indexed: 05/16/2023] Open
Abstract
SIGNIFICANCE STATEMENT Antibiotics modify human microbiomes and may contribute to kidney stone risk. In a population-based case-control study using 1247 chart-validated first-time symptomatic kidney stone formers and 4024 age- and sex-matched controls, the risk of kidney stones was transiently higher during the first year after antibiotic use. However, this risk was no longer evident after adjustment for comorbidities and excluding participants with prior urinary symptoms. Findings were consistent across antibiotic classes and the number of antibiotic courses received. This suggests that antibiotics are not important risk factors of kidney stones. Rather, kidney stones when they initially cause urinary symptoms are under-recognized, resulting in antibiotic use before a formal diagnosis of kidney stones ( i.e. , reverse causality). BACKGROUND Antibiotics modify gastrointestinal and urinary microbiomes, which may contribute to kidney stone formation. This study examined whether an increased risk of a first-time symptomatic kidney stone episode follows antibiotic use. METHODS A population-based case-control study surveyed 1247 chart-validated first-time symptomatic kidney stone formers with a documented obstructing or passed stone (cases) in Olmsted County, Minnesota, from 2008 to 2013 and 4024 age- and sex-matched controls. All prescriptions for outpatient oral antibiotic use within 5 years before the onset of symptomatic stone for the cases and their matched controls were identified. Conditional logistic regression estimated the odds ratio (OR) of a first-time symptomatic kidney stone across time after antibiotic use. Analyses were also performed after excluding cases and controls with prior urinary tract infection or hematuria because urinary symptoms resulting in antibiotic prescription could have been warranted because of undiagnosed kidney stones. RESULTS The risk of a symptomatic kidney stone was only increased during the 1-year period after antibiotic use (unadjusted OR, 1.31; P = 0.001), and this risk was attenuated after adjustment for comorbidities (OR, 1.16; P = 0.08). After excluding cases and controls with prior urinary symptoms, there was no increased risk of a symptomatic kidney stone during the 1-year period after antibiotic use (unadjusted OR, 1.04; P = 0.70). Findings were consistent across antibiotic classes and the number of antibiotic courses received. CONCLUSIONS The increased risk of a first-time symptomatic kidney stone with antibiotic use seems largely due to both comorbidities and prescription of antibiotics for urinary symptoms. Under-recognition of kidney stones that initially cause urinary symptoms resulting in antibiotic use may explain much of the perceived stone risk with antibiotics ( i.e. , reverse causality).
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Affiliation(s)
| | - Lisa E. Vaughan
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | | | - Ramila A. Mehta
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - Kevin Koo
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - John C. Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
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Zou B, Zhou Y, He Z, Zhou X, Dong S, Zheng X, Xu R, Duan X, Zeng G. A critical appraisal of urolithiasis clinical practice guidelines using the AGREE II instrument. Transl Androl Urol 2023; 12:977-988. [PMID: 37426603 PMCID: PMC10323444 DOI: 10.21037/tau-22-846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Background The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument was developed to improve the methodological quality of clinical practice guidelines (CPGs). High-quality guidelines can provide reliable recommendations for different clinical issues. Currently, there is no quality appraisal of CPGs for urolithiasis. This study evaluated the quality of evidence-based CPGs for urolithiasis and provided new insights into improving guideline quality on urolithiasis. Methods Systematic reviews were conducted to identify urolithiasis CPGs in PubMed, electronic databases, and websites of medical associations from January 2009 to July 2022. The quality of included CPGs was evaluated by four reviewers using the AGREE II instrument. Subsequently, the scores of all domains in the AGREE II instrument were calculated. Results A total of 19 urolithiasis CPGs were identified for review: seven from Europe, six from USA, three from international union, two from Canada, and one from Asia. The agreement among reviewers was rated good [intraclass correlation coefficient (ICC), 0.806; 95% CI: 0.779-0.831]. The domains with the highest scores were scope and purpose (69.7%, 54.2-86.1%) and clarity of presentation (76.8%, 59.7-90.3%). The domains of stakeholder involvement (44.9%, 19.4-84.7%) and applicability (48.5%, 30.2-72.9%) gained the lowest score. Only five guidelines (26.3%) were considered "strongly recommended". Conclusions The overall quality of the eligible CPGs was relatively high; however, future work is still needed in the domains of rigor of development, editorial independence, applicability, and stakeholder involvement.
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Affiliation(s)
- Bangyu Zou
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuhao Zhou
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiqing He
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Zhou
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Sicheng Dong
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaopeng Zheng
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ran Xu
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaolu Duan
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Doyle P, Gong W, Hsi R, Kavoussi N. Machine Learning Models to Predict Kidney Stone Recurrence Using 24 Hour Urine Testing and Electronic Health Record-Derived Features. RESEARCH SQUARE 2023:rs.3.rs-3107998. [PMID: 37461654 PMCID: PMC10350114 DOI: 10.21203/rs.3.rs-3107998/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective To assess the accuracy of machine learning models in predicting kidney stone recurrence using variables extracted from the electronic health record (EHR). Methods We trained three separate machine learning (ML) models (least absolute shrinkage and selection operator regression [LASSO], random forest [RF], and gradient boosted decision tree [XGBoost] to predict 2-year and 5-year symptomatic kidney stone recurrence from electronic health-record (EHR) derived features and 24H urine data (n = 1231). ML models were compared to logistic regression [LR]. A manual, retrospective review was performed to evaluate for a symptomatic stone event, defined as pain, acute kidney injury or recurrent infections attributed to a kidney stone identified in the clinic or the emergency department, or for any stone requiring surgical treatment. We evaluated performance using area under the receiver operating curve (AUC-ROC) and identified important features for each model. Results The 2- and 5- year symptomatic stone recurrence rates were 25% and 31%, respectively. The LASSO model performed best for symptomatic stone recurrence prediction (2-yr AUC: 0.62, 5-yr AUC: 0.63). Other models demonstrated modest overall performance at 2- and 5-years: LR (0.585, 0.618), RF (0.570, 0.608), and XGBoost (0.580, 0.621). Patient age was the only feature in the top 5 features of every model. Additionally, the LASSO model prioritized BMI and history of gout for prediction. Conclusions Throughout our cohorts, ML models demonstrated comparable results to that of LR, with the LASSO model outperforming all other models. Further model testing should evaluate the utility of 24H urine features in model structure.
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Affiliation(s)
| | - Wu Gong
- Vanderbilt University Medical Center
| | - Ryan Hsi
- Vanderbilt University Medical Center
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30
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Kavoussi NL, Da Silva A, Floyd C, McCoy A, Koyama T, Hsi RS. Feasibility of stone recurrence risk stratification using the recurrence of kidney stone (ROKS) nomogram. Urolithiasis 2023; 51:73. [PMID: 37067633 DOI: 10.1007/s00240-023-01446-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Abstract
This study seeks to evaluate the recurrence of kidney stones (ROKS) nomogram for risk stratification of recurrence in a retrospective study. To do this, we analyzed the performance of the 2018 ROKS nomogram in a case-control study of 200 patients (100 with and 100 without subsequent recurrence). All patients underwent kidney stone surgery between 2013 and 2015 and had at least 5 years of follow-up. We evaluated ROKS performance for prediction of recurrence at 2- and 5-year via area under the receiver operating curve (ROC-AUC). Specifically, we assessed the nomogram's potential for stratifying patients based on low or high risk of recurrence at: a) an optimized cutoff threshold (i.e., optimized for both sensitivity and specificity), and b) a sensitive cutoff threshold (i.e., high sensitivity (0.80) and low specificity). We found fair performance of the nomogram for recurrence prediction at 2 and 5 years (ROC-AUC of 0.67 and 0.63, respectively). At the optimized cutoff threshold, recurrence rates for the low and high-risk groups were 20 and 45% at 2 years, and 50 and 70% at 5 years, respectively. At the sensitive cutoff threshold, the corresponding recurrence rates for the low and high-risk groups were of 16 and 38% at 2 years, and 42 and 66% at 5 years, respectively. Kaplan-Meier analysis revealed a recurrence-free advantage between the groups for both cutoff thresholds (p < 0.01, Fig. 2). Therefore, we believe that the ROKS nomogram could facilitate risk stratification for stone recurrence and adherence to risk-based surveillance protocols.
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Affiliation(s)
- Nicholas L Kavoussi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA.
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA.
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Alexandre Da Silva
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chase Floyd
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Allison McCoy
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN, 37212, USA
- School of Medicine, Columbia-University of South Carolina, Columbia, SC, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
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Wong DG, Monda S, Vetter J, Lai H, Olsen MA, Keller M, Desai A. Time Course and Risk Factors for Repeat Procedures After Ureteroscopy or Shockwave Lithotripsy. Urology 2023; 174:42-47. [PMID: 36574909 PMCID: PMC10494519 DOI: 10.1016/j.urology.2022.12.014] [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: 09/19/2022] [Revised: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine risk factors and time course for repeat procedures after ureteroscopy (URS) or shockwave lithotripsy (SWL) procedure using a large employer-based claims database. METHODS We identified all patients who underwent treatment for ureteral or renal stone with URS or SWL from January 1, 2007 to December 31, 2014 using the IBM MarketScan Commercial Database. Repeat stone procedure was evaluated after a 90-day grace period from the index procedure. Patients were followed until December 31, 2017. We performed multivariate analyses using Cox proportional hazards to determine independent risk factors for repeat procedure after the initial stone removal. RESULTS A total of 189,739 patients underwent a SWL or URS and were included in the study. The incidence of repeat procedure per 100 person years was 6.8, and 4.4 after SWL and URS, respectively. The median time to reoperation was 12.5 months for SWL and 14.6 months for URS. On multivariable analysis, SWL was associated with an increased risk of repeat procedure compared to URS. (HR = 1.63). Paralysis, neurogenic bladder and inflammatory bowel disease were also associated with an increased risk of repeat procedure (HR = 1.66, 1.40, and 1.36 respectively) CONCLUSION: In a large national cohort, patients with paralysis and neurogenic bladder had a significantly higher risk of repeat stone procedure. SWL was associated with higher risk of repeat procedure than URS. Urologists can use these data to identify and counsel patients at high risk for need for recurrent procedure.
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Affiliation(s)
- Daniel G Wong
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Steve Monda
- Department of Urologic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Joel Vetter
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Henry Lai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Margaret A Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Matthew Keller
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alana Desai
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
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Messa P, Castellano G, Vettoretti S, Alfieri CM, Giannese D, Panichi V, Cupisti A. Vitamin D and Calcium Supplementation and Urolithiasis: A Controversial and Multifaceted Relationship. Nutrients 2023; 15:nu15071724. [PMID: 37049567 PMCID: PMC10096570 DOI: 10.3390/nu15071724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Patients with urolithiasis, and particularly those with hypercalciuria, frequently have a marked reduction of bone mineral content up to the levels of osteoporosis, with a significant increase in bone fracture risk. For these reasons, the indication to prescribe vitamin D and/or calcium supplementations is very frequent in such patients. On the other hand, both calcium supplementation, and even more vitamin D therapy, can worsen the risk of developing urolithiasis by increasing calcium, phosphate, and oxalate urinary excretion. Despite the clinical and practical relevance of this issue, the evidence on this topic is scarce and contradictory. Therefore, some concerns exist about how and whether to prescribe such supplements to a patient with a history of kidney stones. In this narrative review, we resume some pivotal pathophysiological concepts strictly related to the dealt topic, and we draw some considerations and personal opinions on the pros and cons of such prescriptions. Finally, we share with the reader our pragmatic algorithm for handling the urolithiasis risk in patients who have strong indications to be prescribed vitamin D and calcium supplementations.
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Affiliation(s)
- Piergiorgio Messa
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, 20122 Milan, Italy
| | - Giuseppe Castellano
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Simone Vettoretti
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, 20122 Milan, Italy
| | - Carlo Maria Alfieri
- Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Policlinico Milan, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vincenzo Panichi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Ahmed AE, Abol-Enein H, Awadalla A, Shokeir AA, El-Shehaby OA, Harraz AM. Metabolic stone workup abnormalities are not as important as stone culture in patients with recurrent stones undergoing percutaneous nephrolithotomy. Urolithiasis 2023; 51:47. [PMID: 36913043 PMCID: PMC10011315 DOI: 10.1007/s00240-023-01422-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023]
Abstract
To investigate the association between metabolic urinary abnormalities and urinary tract infection (UTI) and the stone recurrence status in patients undergoing percutaneous nephrolithotomy (PCNL). A prospective evaluation was performed for patients who underwent PCNL between November 2019 and November 2021 and met the inclusion criteria. Patients with previous stone interventions were classified as recurrent stone formers. Before PCNL, a 24 h metabolic stone workup and midstream urine culture (MSU-C) were done. Renal pelvis (RP-C) and stones (S-C) cultures were collected during the procedure. The association between the metabolic workup and UTI results with stone recurrence was evaluated using univariate and multivariate analyses. The study included 210 patients. UTI factors that showed significant association with stone recurrence included positive S-C [51 (60.7%) vs 23 (18.2%), p < 0.001], positive MSU-C [37 (44.1%) vs 30 (23.8%), p = 0.002], and positive RP-C [17 (20.2%) vs 12 (9.5%), p = 0.03]. Other factors were mean ± SD GFR (ml/min) (65 ± 13.1 vs 59.5 ± 13.1, p = 0.003), calcium-containing stones [47 (55.9%) vs 48 (38.1%), p = 0.01], median (IQR) urinary citrate levels (mg/day) [333 (123-512.5) vs 221.5 (120.3-412), p = 0.04], and mean ± SD urinary pH (6.1 ± 1 vs 5.6 ± 0.7, p < 0.001). On multivariate analysis, only positive S-C was the significant predictor of stone recurrence (odds ratio: 9.9, 95% confidence interval [CI] (3.8-28.6), p < 0.001). Positive S-C, and not metabolic abnormalities, was the only independent factor associated with stone recurrence. A focus on preventing UTI might prevent further stone recurrence.
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Affiliation(s)
- Asmaa E Ahmed
- Botany Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amira Awadalla
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt
- Center of Excellence for Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Omar A El-Shehaby
- Botany Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Ahmed M Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, 35516, Egypt.
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Göger YE, Özkent MS, Kılınç MT, Erol E, Taşkapu HH. Influencing factors of acute kidney injury following retrograde intrarenal surgery. World J Urol 2023; 41:857-864. [PMID: 36719465 DOI: 10.1007/s00345-023-04301-6] [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: 09/20/2022] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To investigate the influencing factors of acute kidney injury (AKI) following retrograde intrarenal surgery (RIRS). METHODS The data of patients who underwent RIRS for kidney stones between January 2018 and June 2022 at two tertiary centers were retrospectively analyzed. Demographic data of patients were obtained. According to kidney disease: Improving Global Outcomes (KDIGO) criteria, those with and without AKI were divided into two groups. Preoperative, intraoperative, and postoperative predictive factors of patients were investigated between the groups. In addition, the influencing factors of AKI were examined by multivariate analysis. RESULTS This study included 295 (35.7%) women and 532 (64.3%) men. The mean age was 50.03 ± 15.4 years (range 18-89), and mean stone size was 15.5 ± 6.1 mm (range 6-47). Overall, 672 of patients (81.3%) were stone-free after the initial treatment. According to KDIGO, 110 of patients (13.3%) had AKI during the postoperative period. Univariate analysis showed that stone size (P = .003), previous stone surgery (P = .010), renal malformations (P = .017), high operative time (P = < .001), high preoperative creatinine value (P = .036), intraoperative complications (P = .018), and postoperative urinary tract infection (P = .003) had significant influence on the AKI after RIRS. Multivariate analysis excluded previous stone surgery, high preoperative creatinine value, renal malformations, and intraoperative complications from the logistic regression model, whereas other factors maintained their statistically significant effect on AKI, indicating that they were independent predictors. CONCLUSIONS Stone size, operative time, postoperative urinary tract infection, and diabetes mellitus are significant predictors of AKI. During RIRS, urologists should consider the factors that increase the risk of AKI and evaluate the treatment outcomes based on these factors.
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Affiliation(s)
- Yunus Emre Göger
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | | | - Eren Erol
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Hakan Hakkı Taşkapu
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Parajuli P, Luitel BR, Pradhan MM, Chapagain S, Poudyal S, Chalise PR, Sharma UK, Gyawali PR. Metabolic evaluation of high-risk stone formers: a retrospective study. AFRICAN JOURNAL OF UROLOGY 2023. [DOI: 10.1186/s12301-023-00336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
The purpose of this study was to assess the metabolic abnormalities in high-risk stone formers.
Methods
This was a retrospective observational study done at Tribhuvan University Teaching Hospital, Nepal, over 1-year period. High-risk stone formers were identified and were evaluated with serum chemistries and 24-h urinary chemical evaluation. Stone analysis was also included whenever available. Common metabolic abnormalities and stone analysis results were reported and compared with different studies. Continuous variables were expressed as mean ± SD. Categorical variables were expressed as percentage and proportions.
Results
During 1 year of period, sixty-five patients had undergone extensive metabolic evaluation, but complete data were available for only forty-six patients. Of the total patients (n = 46), 63% were male (n = 29) and rest (36.9%) were female. Mean age of patients was 34.4 ± 15.1 years. Common reasons for metabolic evaluation were multiple stones (40%), bilateral stones (27%), recurrent stones (17%) and others (16%). Most common stone type was mixed stone with predominant composition being calcium oxalate mono- and dihydrate (62.9%). Twenty-four-hour urinary metabolic evaluation showed hyperoxaluria (32.6%) as most common abnormalities followed by hypocitraturia (21.7%) and hypocalciuria (21.7%).
Conclusion
Hyperoxaluria and hypocitraturia are common metabolic abnormalities in our patients. These findings help in counselling dietary measures to patients.
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Fluid intake recommendations in urolithiasis and general advice to patients without metabolic risk factors. World J Urol 2023; 41:1251-1259. [PMID: 36692534 DOI: 10.1007/s00345-023-04285-3] [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: 12/04/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
Urolithiasis is a highly prevalent global disease with substantially increasing incidence in the last two decades. Data from the literature suggests that 26%-50% of patients will have a recurrence within 10 years after an initial symptomatic stone episode. Therefore, interest has been raised in preventive strategies, aiming to modify the risk factors of stone recurrence by implementing dietary and lifestyle changes and specific medical treatments for stone formers, depending on their recurrence risk factors. Certain dietary factors are thought to contribute significantly to the increased incidence of urolithiasis, particularly a diet low in fiber and high in animal protein, fat, and sodium. Fluid intake is perhaps the most important and modifiable step in the prevention of urolithiasis, irrespective of stone composition. However, the amount of fluid to be consumed and the implications of various fluid types on stone formation are still controversial. In this article, the relationship between fluid intake, beverage types and stone formation-prevention will be discussed. Moreover, general dietary recommendations for patients without metabolic risk factors will be reviewed based on the current literature.
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Cheikh Hassan HI, Murali K, Lambert K, Lonergan M, McAlister B, Suesse T, Mullan J. Acute kidney injury increases risk of kidney stones-a retrospective propensity score matched cohort study. Nephrol Dial Transplant 2023; 38:138-147. [PMID: 35108386 DOI: 10.1093/ndt/gfac023] [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: 10/07/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common. An episode of AKI may modify the risk of developing kidney stones by potential long-term effects on urine composition. We aimed to investigate the association between AKI and the risk of kidney stone presentations. METHODS The retrospective cohort study used patient data (1 January 2008-31 December 2017), from an Australian Local Health District, which included AKI diagnosis, demographics, comorbidities and kidney stone admissions. Time-varying Cox proportional hazards and propensity-matched analysis were used to determine the impact of AKI on the risk of kidney stones. To address possible population inhomogeneity in comparisons between no AKI and hospitalized AKI, sub-group analysis was done comparing inpatient and outpatient AKI versus no AKI, to assess consistency of association with future stones. Sensitivity analysis was undertaken to capture the impact of a known AKI status and AKI severity. RESULTS Out of 137 635 patients, 23 001 (17%) had an AKI diagnosis and 2295 (2%) had kidney stone presentations. In the unadjusted analysis, AKI was associated with kidney stones, with AKI used as a time-varying exposure, [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.16-1.50)]. Both inpatient-AKI (HR 1.19, 95% CI 1.01-1.39) and outpatient-AKI (HR 1.59, 95% CI 1.30-1.94) were significantly associated with future stones compared to no AKI subjects. This association persisted in the adjusted analysis (HR 1.45, 95% CI 1.26-1.66), propensity-matched dataset (HR 1.67, 95% CI 1.40-1.99) and sensitivity analysis. There was a dose-response relationship with higher stages of AKI being associated with a greater risk of kidney stones. CONCLUSIONS In a large cohort of patients, AKI is associated with a greater risk of kidney stones, which increases with higher stages of AKI. This association should be examined in other cohorts and populations for verification.
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Affiliation(s)
- Hicham I Cheikh Hassan
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Karumathil Murali
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, Australia
| | - Maureen Lonergan
- Department of Nephrology, Illawarra and Shoalhaven Local Health District, Wollongong, NSW, Australia.,Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Brendan McAlister
- Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
| | - Thomas Suesse
- National Institute of Applied Statistics Research Australia, School of Mathematics and Applied Statistics, University of Wollongong, NSW, Australia
| | - Judy Mullan
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Centre for Health Research Illawarra Shoalhaven Population (CHRISP), University of Wollongong, Wollongong, NSW, Australia
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Muacevic A, Adler JR, Alzaidi MA, Asiri AF, Fatani MO, Alahmadi AH, Alnefaie Z, Hamoda TA. Influence of BMI on the Recurrence Rate of Nephrolithiasis in the Adult Population of Saudi Arabia: A Retrospective Study. Cureus 2023; 15:e33539. [PMID: 36779090 PMCID: PMC9907171 DOI: 10.7759/cureus.33539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Objectives Nephrolithiasis is a common disease, and Saudi Arabia is among the countries with the highest prevalence of nephrolithiasis. Obesity is one of the risk factors associated with the increased formation of renal calculi. We aimed to assess whether obesity also increases the recurrence rate of nephrolithiasis. Methods We retrospectively identified and collected data of 283 adult patients with renal stones who were managed at our hospital from November 2018 to November 2021. The demographic information, comorbidities, stone burden, and treatment methods related to them were identified, collected, and analyzed. Moreover, we performed the chi-squared test (χ2) and multivariate logistic regression analysis in order to assess the risk factors (i.e., independent predictors) of recurrence among the studied patients. Additionally, the odds ratio (OR) was calculated at a confidence interval (CI) of 95%. A p-value of less than 0.05 was considered statistically significant. Results Of the 283 adult patients we analyzed, 35 did not meet the criteria of our study and, consequently, were excluded. Therefore, we ended up with 248 patients, of whom 179 (68.1%) were males, 131 (52.8%) had a previous history of renal stones, and 90 (36.3%) had chronic illnesses. Moreover, the mean age of the studied patients was 48.91 ± 14.51 years, and the mean BMI was 29.44 ± 6.1 kg/m2. It was found that most of the patients (35.5%) had only one stone, while 23.4% of them had more than 5 stones. Furthermore, the majority of the stones (35.9%) were medium size (with a stone diameter of 10-19 mm [1-1.9 cm]). We did not find a relationship between obesity and the recurrence rate of renal stones. However, there was a significant association (p < 0.05) between the recurrence rate and Saudi nationality, chronic diseases (more specifically, HTN), unilateral stones, and a stone diameter of 10-19 mm (1-1.9 cm). Additionally, we identified diabetes and the kidney as stone location factors that are associated with less recurrence. Conclusion Although obesity was reported to increase the risk of renal stone formation, we did not find it to be associated with an increased recurrent rate of the disease in the Saudi Arabian population, which is inconsistent with other studies conducted in this area in other countries. Therefore, larger studies are needed to prove this finding.
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Dai JC, Maalouf NM, Hill K, Antonelli JA, Pearle MS, Johnson BA. Alkali Citrate Content of Common Over-the-Counter and Medical Food Supplements. J Endourol 2023; 37:112-118. [PMID: 35972746 DOI: 10.1089/end.2022.0274] [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: 01/10/2023] Open
Abstract
Objective: Potassium citrate effectively decreases kidney stone recurrence, but it is costly and associated with side effects. While several over-the-counter supplements and medical foods purport to provide sufficient citrate to prevent recurrent stones, corroborating data on their actual citrate content is limited. Materials and Methods: Nine common nonprescription products were purchased online. Reported citrate content was obtained from packaging, promotional materials, or ingredient labels. Using a single serving of each product, actual citrate, sodium, potassium, calcium, magnesium, and oxalate content was measured using spectrophotometry and chromatography. Total alkali citrate, cost, and amounts of each component per 10 mEq of alkali citrate were also calculated. Results: Nearly all products contained more citrate than advertised, except for Litholyte® powder, Litholyte® Coffee, and Horbäach® potassium citrate. Per serving, Moonstone® powder, LithoBalance™, and KSP tabs™ contained the most citrate (means of 63.9, 33.5, and 26.9 mEq, respectively). Moonstone and LithoBalance had the greatest discrepancy between total citrate and alkali citrate (15.7 and 11.8 mEq per serving, respectively). NOW® potassium citrate was least expensive ($0.04/10 mEq alkali citrate). KSP tabs delivered the most daily sodium (mean 158 mg/10 mEq alkali citrate, Litholyte Coffee provided the most potassium (mean of 13 mEq/10 mEq alkali citrate), and Kidney COP® provided the most calcium (mean 147 mg/10 mEq alkali citrate). Conclusion: Some common over-the-counter products contain sufficient alkali to potentially promote a citraturic response; Moonstone provides the most alkali citrate, but at a higher cost than other products. Sodium, potassium, and calcium from these products must also be considered in daily consumption.
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Affiliation(s)
- Jessica C Dai
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Naim M Maalouf
- Department of Internal Medicine, The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, Dallas, Texas, USA
| | - Kathy Hill
- Department of Internal Medicine, The Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, Dallas, Texas, USA
| | - Jodi A Antonelli
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Margaret S Pearle
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brett A Johnson
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
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Tzelves L, Geraghty R, Lombardo R, Davis NF, Petřík A, Neisius A, Gambaro G, Türk C, Thomas K, Somani B, Skolarikos A. Duration of Follow-up and Timing of Discharge from Imaging Follow-up, in Adult Patients with Urolithiasis After Surgical or Medical Intervention: A Systematic Review and Meta-analysis from the European Association of Urology Guideline Panel on Urolithiasis. Eur Urol Focus 2023; 9:188-198. [PMID: 35851252 DOI: 10.1016/j.euf.2022.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022]
Abstract
CONTEXT No algorithm exists for structured follow-up of urolithiasis patients. OBJECTIVE To provide a discharge time point during follow-up of urolithiasis patients after treatment. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline, EMBASE, Cochrane Library, clinicaltrials.gov, and reference lists according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Fifty studies were eligible. EVIDENCE SYNTHESIS From a pooled analysis of 5467 stone-free patients, we estimated that for a safety margin of 80% for remaining stone free, patients should be followed up using imaging, for at least 2 yr (radiopaque stones) or 3 yr (radiolucent stones) before being discharged. Patients should be discharged after 5 yr of no recurrence with a safety margin of 90%. Regarding residual disease, patients with fragments ≤4 mm could be offered surveillance up to 4 yr since intervention rates range between 17% and 29%, disease progression between 9% and 34%, and spontaneous passage between 21% and 34% at 49 mo. Patients with larger residual fragments should be offered further definitive intervention since intervention rates are high (24-100%). Insufficient data exist for high-risk patients, but the current literature dictates that patients who are adherent to targeted medical treatment seem to experience less stone growth or regrowth of residual fragments, and may be discharged after 36-48 mo of nonprogressive disease on imaging. CONCLUSIONS This systematic review and meta-analysis indicates that stone-free patients with radiopaque or radiolucent stones should be followed up to 2 or 3 yr, respectively. In patients with residual fragments ≤4 mm, surveillance or intervention can be advised according to patient preferences and characteristics, while for those with larger residual fragments, reintervention should be scheduled. PATIENT SUMMARY Here, we review the literature regarding follow-up of urolithiasis patients. Patients who have no stones after treatment should be seen up to 2-3 yr, those with large fragments should be reoperated, and those with small fragments could be offered surveillance with imaging.
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Affiliation(s)
- Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK; Institute of Genetic Medicine, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Niall F Davis
- Department of Urology, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Ales Petřík
- Department of Urology, Region Hospital, Ceske Budejovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Andreas Neisius
- Department of Urology, Hospital of the Brothers of Mercy Trier, Medical Campus University Mainz, Trier, Germany
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, University of Verona, Verona, Italy
| | - Christian Türk
- Department of Urology, Hospital of the Sisters of Charity, Vienna, Austria; Urologische Praxis, Vienna, Austria
| | - Kay Thomas
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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İbrahim A, Esra GT, Burcu GY, Burhanettin Y, Emrah Y, Şahin Ç. The effect of ALPL gene polymorphism on the development of urolithiasis in the Turkish population. Urolithiasis 2022; 51:23. [PMID: 36571714 DOI: 10.1007/s00240-022-01396-1] [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: 09/06/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022]
Abstract
Urinary system stones have a complex pathophysiology affected by environmental and genetic factors. To confirm whether ALPL gene polymorphisms are an effective universal risk factor for the development of urolithiasis, we aimed to investigate ALPL gene polymorphism in Turkish population. Our study was carried out with 187 patients with urolithiasis and 92 healthy volunteers (control group) who were not diagnosed with urolithiasis either in themselves or in their families, applied to Emergency Medicine Clinic of Health Sciences University Haydarpasa Numune Training and Research Hospital in Istanbul, Turkey between November 2021 and February 2022, prospectively. In order to evaluate the relationship between ALP gene (rs1256328) polymorphism and urolithiasis, blood samples were analyzed by quantitative Real Time PCR (qPCR) method. Male gender (OR:3.785; 95% CI:2.118-6.763; p<0.001), increased BUN level (OR:1.082; 95% CI:1.013-1.156; p=0.019), increased NLR level (OR:1.149; 95 %CI:1.033-1.277; p=0.011) and heterozygous genotype (OR:2.353; 95% CI:1.31-4.225; p=0.004) were determined as independent risk factors for the development of urolithiasis. The presence of heterozygous (CT) genotype in the ALPL rs1256328 gene region in the Turkish population is associated with an increased risk of urolithiasis. This suggests that ALPL rs1256328 gene polymorphism can be used as a genetic marker in the Turkish population.
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Affiliation(s)
- Altundag İbrahim
- Department of Emergency Medicine, Başakşehir Çam and Sakura City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Guzel Tanoglu Esra
- Department of Molecular Biology and Genetics, University of Health Sciences, Institute of Health Sciences, Istanbul, Turkey
| | - Genc Yavuz Burcu
- Department of Emergency Medicine, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Tıbbiye Caddesi Üsküdar, Istanbul, Turkey.
| | | | - Yürek Emrah
- Department of Emergency Medicine Kanuni Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çolak Şahin
- Department of Emergency Medicine, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Tıbbiye Caddesi Üsküdar, Istanbul, Turkey
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42
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The New Lithotripsy Index predicts success of shock wave lithotripsy. World J Urol 2022; 40:3049-3053. [DOI: 10.1007/s00345-022-04215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
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43
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Johnston SS, Chen BPH, Rai P, Grange P, Dwarakanathan HR, Amos T, Johnson BH, Ghosh SK, Buchholz N. Incremental Healthcare Cost Implications of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Upper Urinary Tract Stones: A Population-Based Study of Commercially-Insured US Adults. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:371-384. [DOI: 10.2147/mder.s384823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/28/2022] [Indexed: 11/10/2022] Open
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The Impact of Radiographic, Metabolic and Demographic Characteristics on Kidney Stone Recurrence. J Pers Med 2022; 12:jpm12101632. [PMID: 36294771 PMCID: PMC9604730 DOI: 10.3390/jpm12101632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022] Open
Abstract
Urolithiasis is a frequent disease with cited rates of recurrence after initial diagnosis that vary widely and range between 35% and 50%. We assessed the radiographic recurrence rate in patients with urinary stones and its risk factors. We retrospectively identified patients who were diagnosed with urinary stones on non-contrast computed tomography from 2010 to 2011, and underwent another imaging examination at least six months afterwards. We collected patient demographic, clinical, laboratory and radiologic data and compared patients with and without urinary stone recurrence. Ultimately, 237 patients were included in the study; the mean follow-up was 6.7 years; 88 patients (37.1%) had recurrence based on our recurrence criteria. On univariate analysis, the significant parameters for recurrence were baseline serum calcium and uric acid, stone location in the kidney, surgical intervention and stone burden volume. On multivariate analysis, surgical intervention (OR 3.07, p = 0.001), baseline calcium (OR 2.56, p = 0.011), baseline uric acid (OR 1.30, p = 0.021) and stone location in the kidney (OR 2.16, p = 0.012) were associated with higher risk of recurrence. These findings may guide personalized follow-up protocols for patients with urolithiasis based on their risk factors.
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Li H, Zhou Y, Xu W, Liu J, Wang S, Jiang H. The role of autophagy in calcium oxalate kidney stone: A systematic review of the literature. Front Physiol 2022; 13:1008264. [PMID: 36213233 PMCID: PMC9533137 DOI: 10.3389/fphys.2022.1008264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Calcium oxalate kidney stone is one of the common diseases in the urinary system and has a high recurrence rate. Currently, the pathogenesis of kidney stone and the methods to prevent recurrence are still being investigated. Autophagy, as an event of cellular self-repair, has received attention in the field of kidney stone in recent years. In some current studies, autophagy has shown destructiveness and protectiveness in the pathogenesis of kidney stone. The inhibition or promotion of autophagy may be a key target for future kidney stone therapy. This systematic literature review discusses the function of autophagy in kidney stone pathogenesis in the context of current research and synthesizes the evidence analysis to provide a basis for new future therapies. Method: We systematically reviewed the literature during September 2021 according to the Preferred Reporting Items for Systematic Evaluation and Meta-Analysis (PRISMA) guidelines. Articles on studying the role of autophagy in the pathogenesis of calcium oxalate kidney stone were extracted from PubMed, MEDLINE, Embase and Scopus, including in vivo versus in vitro experiments. The study topic, language and publication date were not restricted. Two authors (Li and Zhou) searched and screened the literature. Results: We screened 18 articles from the 33 collected articles, of which 6 conducted in vitro cellular studies, four conducted animal studies, eight conducted cellular studies with animal studies, and five studied human specimens. In early studies, the literature generally concluded that autophagy is deleterious in the development of kidney stone. In 2020, the idea of the protectiveness of autophagy associated with kidney stone was first proposed and focused on targeting transcription factor EB. In addition, the interaction of autophagy with other cellular events and the regulation of signaling molecules are focused on in this paper. Conclusion: This systematic review provides advances in research on the role of autophagy in renal calculi. The current studies suggest that both upregulation and downregulation of autophagy may ameliorate injury in kidney stone models. The authors prefer the upregulation of autophagy as a future research direction for kidney stone treatment.
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Affiliation(s)
- Hao Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yingjian Zhou
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenchao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Jiang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongyang Jiang,
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Bervinova AV, Palikov VA, Mikhailov ES, Palikova YA, Borozdina NA, Kazakov VA, Rudenko PA, Tukhovskaya EA, Dyachenko IA, Slashcheva GA, Goryacheva NA, Sadovnikova ES, Kravchenko IN, Kalabina EA, Shinelev MV, Wu P, Murashev AN. Efficacy of Ficus tikoua Bur. extract in ethylene glycol-induced urolithiasis model in SD rats. Front Pharmacol 2022; 13:974947. [PMID: 36105205 PMCID: PMC9464938 DOI: 10.3389/fphar.2022.974947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
The development of new herbal preparations for the treatment of urolithiasis is an urgent task of medical science. Ficus have attracted the attention of pharmacologists due to a wide range of biological properties, including antioxidant, anti-inflammatory, antibacterial and antifungal activity. We studied the effectiveness of Ficus tikoua Bur. in SD rats in which urolithiasis was induced by 6 weeks of oral administration of ethylene glycol 0.5% ad libitum instead of drinking water. Administration of the extract of Ficus tikoua Bur., as well as comparative drug Cystone® after modeling of urolithiasis lead to the restoration of diuresis and the concentration of inorganic phosphates starting from the 6th week of the experiment. The use of the Ficus tikoua Bur. extract for 6 weeks, both during the modeling of urolithiasis and during the recovery period, led to the restoration of the percentage of lymphocytes in the blood, content of sodium, chlorine and inorganic phosphates in the blood to the control level. Thus, the extract of Ficus tikoua Bur. seems to be a promising drug for effective treatment of the initial stages of the development of urolithiasis.
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Affiliation(s)
- Arina V. Bervinova
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- Pushchino State Institute of Natural Sciences, Pushchino, Russia
| | - Viktor A. Palikov
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Evgeny S. Mikhailov
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- Pushchino State Institute of Natural Sciences, Pushchino, Russia
| | - Yulia A. Palikova
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Natalya A. Borozdina
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- Pushchino State Institute of Natural Sciences, Pushchino, Russia
| | - Vitaly A. Kazakov
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Pavel A. Rudenko
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Elena A. Tukhovskaya
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- *Correspondence: Elena A. Tukhovskaya,
| | - Igor A. Dyachenko
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Gulsara A. Slashcheva
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Natalya A. Goryacheva
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- Pushchino State Institute of Natural Sciences, Pushchino, Russia
| | - Elena S. Sadovnikova
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Irina N. Kravchenko
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Elena A. Kalabina
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
| | - Maksim V. Shinelev
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
- Pushchino State Institute of Natural Sciences, Pushchino, Russia
| | - Peng Wu
- Chengdu Sino PharmTech Co., Ltd., Chengdu, China
| | - Arkady N. Murashev
- Branch of Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Pushchino, Russia
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47
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Dai JC, Pearle MS. Diet and Stone Disease in 2022. J Clin Med 2022; 11:jcm11164740. [PMID: 36012979 PMCID: PMC9410446 DOI: 10.3390/jcm11164740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Diet plays a central role in the development and prevention of nephrolithiasis. Although pharmacologic treatment may be required for some patients who are resistant to dietary measures alone, dietary modification may be sufficient to modulate stone risk for many patients. While there is no single specialized diet for stone prevention, several dietary principles and recommendations for stone prevention are supported by practice guidelines, including adequate fluid intake, modest calcium intake, low dietary sodium, and limited animal protein. In this review, we summarized the evidence supporting these dietary recommendations and reviewed the current literature regarding specific dietary components and comprehensive diets for stone prevention.
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48
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Chewcharat A, Thongprayoon C, Vaughan LE, Mehta RA, Schulte PJ, O'Connor HM, Lieske JC, Taylor EN, Rule AD. Dietary Risk Factors for Incident and Recurrent Symptomatic Kidney Stones. Mayo Clin Proc 2022; 97:1437-1448. [PMID: 35933132 DOI: 10.1016/j.mayocp.2022.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/01/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare dietary factors between incident symptomatic stone formers and controls, and among the incident stone formers, to determine whether dietary factors were predictive of symptomatic recurrence. PATIENTS AND METHODS We prospectively recruited 411 local incident symptomatic kidney stone formers (medical record validated) and 384 controls who were seen at Mayo Clinic in Minnesota or Florida between January 1, 2009, and August 31, 2018. Dietary factors were based on a Viocare, Inc, food frequency questionnaire administered during a baseline in-person study visit. Logistic regression compared dietary risk factors between incident symptomatic stone formers and controls. Incident stone formers were followed up for validated symptomatic recurrence in the medical record. Cox proportional hazards models estimated risk of symptomatic recurrence with dietary factors. Analyses adjusted for fluid intake, energy intake, and nondietary risk factors. RESULTS In fully adjusted analyses, lower dietary calcium, potassium, caffeine, phytate, and fluid intake were all associated with a higher odds of an incident symptomatic kidney stone. Among incident stone formers, 73 experienced symptomatic recurrence during a median 4.1 years of follow-up. Adjusting for body mass index, fluid intake, and energy intake, lower dietary calcium and lower potassium intake were predictive of symptomatic kidney stone recurrence. With further adjustment for nondietary risk factors, lower dietary calcium intake remained a predictor of recurrence, but lower potassium intake only remained a predictor of recurrence among those not taking thiazide diuretics or calcium supplements. CONCLUSION Enriching diets in stone formers with foods high in calcium and potassium may help prevent recurrent symptomatic kidney stones.
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Affiliation(s)
- Api Chewcharat
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Lisa E Vaughan
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Ramila A Mehta
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Phillip J Schulte
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Helen M O'Connor
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Eric N Taylor
- Division of Nephrology, VA Maine Healthcare System, Augusta, ME
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
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Cadamuro J, Decho C, Frans G, Auer S, von Meyer A, Kniewallner KM, Drerup M, Heinrich E, Keppel MH, Mrazek C, Felder TK, Oberkofler H, Haschke-Becher E, Kipman U, Salek T, Vermeersch P. Acidification of 24-hour urine in urolithiasis risk testing: An obsolete relic? Clin Chim Acta 2022; 532:1-9. [PMID: 35597305 DOI: 10.1016/j.cca.2022.05.010] [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: 04/07/2022] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recommendations on the optimal preservation of 24 h urine for the metabolic work-up in urolithiasis patients are very heterogeneous. In case two such tests with different storage condition recommendations are being analysed, multiple collections would be needed, challenging especially elderly and very young patients. We therefore aimed to evaluate the stability of urine constituents under different storage conditions. MATERIAL AND METHODS We collected urine samples from ten healthy volunteers and prepared aliquots to be stored either at room temperature or 4 °C. Some aliquots were preserved using hydrochloric acid prior to storage, some thereafter, some using the BD Urine preservation tube and some were not preserved at all. Storage duration was 0, 24, 48 or 72 h. In all samples calcium, magnesium, phosphorus, creatinine, oxalate, citrate and uric acid were measured and compared to the according reference sample. RESULTS We could not find any significant deviation for any of the analytes and preanalytical treatment conditions compared to the associated reference sample. CONCLUSION Preservation of 24 h urine for the metabolic evaluation in stone formers might not be necessary for sample storage up to 72 h.
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Affiliation(s)
- Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Cosima Decho
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Glynis Frans
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Simon Auer
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Alexander von Meyer
- Institute for Laboratory Medicine and Medical Microbiology, Medizet, München-Klinik, Munich, Germany
| | - Kathrin M Kniewallner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TreCS), Paracelsus Medical University, Salzburg, Austria
| | - Martin Drerup
- Department of Urology, Barmherzige Brüder Hospital, Salzburg, Austria
| | - Elmar Heinrich
- Department of Urology, Barmherzige Brüder Hospital, Salzburg, Austria
| | - Martin H Keppel
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Cornelia Mrazek
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Thomas K Felder
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Hannes Oberkofler
- Department of Laboratory Medicine, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Tomas Salek
- Department of Clinical Biochemistry and Pharmacology, The Tomas Bata Hospital in Zlín, Havlíčkovo nábřeží 600, 76275 Zlín, The Czech Republic
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven Belgium
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50
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Spradling K, Ganesan C, Conti S. Medical Treatment and Prevention of Urinary Stone Disease. Urol Clin North Am 2022; 49:335-344. [PMID: 35428438 DOI: 10.1016/j.ucl.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The pathophysiology underlying urinary stone formation remains an area of active investigation. There are many pharmacotherapies aimed at optimizing metabolic factors and reducing urinary supersaturation of stone components that play an important role in urinary stone prevention. In addition, medical expulsive therapy for ureteral stones and medical dissolution therapy for uric acid-based urinary stones are helpful treatment tools and are used alongside surgical treatments in the management of urinary stones.
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Affiliation(s)
- Kyle Spradling
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Calyani Ganesan
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
| | - Simon Conti
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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