Kidney stone composition in overweight and obese patients: a preliminary report

Prevention and Management of Urolithiasis With Parsley and Barley Among the Hail Population, Saudi Arabia: Is It Fact or Not?

BACKGROUND

Urolithiasis is one of the most common urinary tract diseases. It is a multifactorial condition involving both environmental and metabolic aspects. Dietary changes and lifestyle modifications are crucial for managing and preventing urolithiasis. Barley and parsley have been utilized as a complementary treatment to manage urolithiasis, which may be helpful in managing and preventing this disease.

METHODOLOGY

This was a community-based cross-sectional study conducted to determine the effects of parsley and barley in managing urolithiasis among the population of Hail, Saudi Arabia by an electronic questionnaire. All responses were kept confidential. Statistical analyses were conducted using SPSS version 22 (Chicago, IL: SPSS Inc.).

RESULTS

A total of 395 participants completed the questionnaire, with ages ranging from 18 years to more than 60 years; nearly half of them were females. Only 37 (9.4%) had a history of renal disease but 182 (46.1%) had a family history of renal stones. Regarding the frequency of barley and parsley used in the management of renal stones, 162 (41%) respondents used barley, while 176 (44.6%) of them used parsley to treat or prevent kidney stones. Factors associated with the use of barley and parsley in the management of renal stones were older age, female gender, non-healthcare staff, those with renal disease history, and family history of renal stones.

CONCLUSION

The results showed that among the Hail population, non-conventional therapies are more commonly used for treating renal stones than medical treatment. There were multiple factors associated with using barley and parsley to manage urolithiasis. Additional research is needed to gain a clearer understanding of the safety and effectiveness of non-conventional therapies, such as barley and parsley, in managing urolithiasis.

Utilization of barley and parsley for the management of urolithiasis among the Saudi Arabian population

Objective

To determine the utilization of barley and parsley for managing urolithiasis among the Saudi Arabian population.

Methods

This is a prospective cross-sectional survey-based study. The survey comprised questions about the use of barley, parsley, and other therapies for managing urolithiasis. A WhatsApp® message with the link to the study survey was sent out to family, friends, patients, and other acquaintances residing in the Kingdom of Saudi Arabia (KSA).

Results

A total of 1014 respondents completed the survey, of which 44.8% indicated that they utilized barley, 38.3% stated that they used parsley, and 4.2% indicated that they utilized other non-medical remedies to treat or prevent kidney stones. In contrast, only 29.5% stated that they utilized potassium citrate and/or magnesium citrate, and only 14.4% indicated that they consumed greater amounts of water to treat or prevent kidney stones.

Conclusion

Our study findings indicate that among the Saudi Arabian population, non-conventional therapies such as barley and parsley are more commonly utilized for managing urolithiasis rather than established therapies such as increasing water intake and the use of potassium-citrate/ magnesium-citrate. There is a need to conduct large-scale clinical studies to evaluate the efficacy and safety of barley, parsley, and other non-conventional therapies for treating urolithiasis.

The association of visceral adiposity index with the risk of kidney stone and kidney stone recurrence

AIM

Our aim in this study was primarily to assess the relationship between visceral adiposity index (VAI) and the risk of kidney stones and kidney stone recurrence in US adults.

METHODS

We used data from the National Health and Nutrition Examination Survey (NHANES) 2007-2014 for our analysis. VAI was calculated from waist circumference (WC), body mass index (BMI), triglycerides (TG), and high-density lipoprotein-cholesterol (HDL-C). Kidney stones and recurrence of kidney stones were obtained from questionnaire interview data. We used multivariate logistic regression analysis to explore the correlation between VAI and the risk of kidney stone and kidney stone recurrence. In addition, we performed subgroup analysis, interaction tests, and restricted cubic spline (RCS) analysis.

RESULTS

A total of 9886 participants were included in this study, with a prevalence of 9.24% for kidney stones and 2.97% for recurrence of kidney stones. The prevalence of kidney stones and kidney stone recurrence increased with higher quartiles of VAI. We observed a significantly positive correlation between VAI and the risk of kidney stone and kidney stone recurrence. Participants with the highest VAI quartiles had a 48% (OR: 1.48, 95%CI: 1.08-2.02) and 52% (OR: 1.52, 95%CI: 0.86-2.71) increased risk of kidney stones and kidney stone recurrence, respectively, compared to participants with the lowest VAI quartiles. Subgroup analysis and interaction tests demonstrated this positive association independent of different subgroup factors.

CONCLUSION

Visceral fat accumulation may be associated with an increased risk of kidney stones and kidney stone recurrence.

Ureteroscopy Is Equally Efficient and Safe in Obese and Morbidly Obese Patients: A Systematic Review and Meta-Analysis

Background

Ureteroscopy (URS) has been established as an effective treatment for stones in obese patients (OP). However, recent studies found that the efficacy of the procedure may be lower in patients with higher body mass index (BMI). In the current study, we aim to determine if obesity might influence the effectiveness and safety of URS.

Methods

In May 2021, a comprehensive search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to find eligible studies. Stone-free rate (SFR), operative time, length of stay, and complication rate were assessed utilizing RevMan 5.3.

Results

Thirteen studies involving 4,583 normal-weight patients (NWP), 2,465 OP, and 291 morbidly OP (MOP) were included. Pooled results showed that statistically similar SFR existed between OP and NWP [odds ratio (OR): 1.09; 95% CI: 0.79, 1.52; p = 0.59], and between MOP and NWP (OR: 1.03; 95% CI: 0.46, 2.31; p = 0.95). The operation time was similar between OP and NWP [mean difference (MD): −2.27; 95% CI: −8.98, 4.43; p = 0.51], and between MOP and NWP (MD: 4.85; 95% CI: −5.78, 15.47; p = 0.37). In addition, no significant difference regarding length of stay existed between OP and NWP (MD: −0.07; 95% CI: −0.20, 0.07; p = 0.33), and between MOP and NWP (MD: −0.06; 95% CI: −0.25, 0.14; p = 0.58). Furthermore, we observed similar minor complication rate between OP and NWP (OR: 1.04; 95% CI: 0.81, 1.32; p = 0.78), and between MOP and NWP (OR: 1.29; 95% CI: 0.80, 2.08; p = 0.30). The differences concerning major complication rate between OP and NWP (OR: 0.97; 95% CI: 0.39, 2.43; p = 0.95), and between MOP and NWP (OR: 2.01; 95% CI: 0.55, 7.30; p = 0.29) were also not significant.

Conclusions

Our study demonstrated that URS performed in MOP and OP appears to have the same efficacy and safety as well as in NWP group.

Obesity and Kidney Stone Procedures

Obesity is a chronic disease that has increased in prevalence in the United States and is a risk factor for the development of nephrolithiasis. As with other medical conditions, obesity should be considered when optimizing surgical management and choosing kidney stone procedures for patients. In this review, we outline the various procedures available for treating stone disease and discuss any discrepancies in outcomes or complications for the obese cohort.

Heritable traits that contribute to nephrolithiasis

Urinary stones tend to cluster in families. Of the known risk factors, evidence is strongest for heritability of urinary calcium excretion. Recent studies suggest that other stone risk factors may have heritable components including urinary pH, citrate and magnesium excretion, and circulating vitamin D concentration. Several risk factors assumed purely environmental may also have heritable components, including dietary intake and thirst. Thus, future studies may reveal that genetics plays an even stronger role in urinary stone pathogenesis than previously known.

Effect of Calcifications on Breast Ultrasound Shear Wave Elastography: An Investigational Study

Purpose

To investigate the effects of macrocalcifications and clustered microcalcifications associated with benign breast masses on shear wave elastography (SWE).

Methods

SuperSonic Imagine (SSI) and comb-push ultrasound shear elastography (CUSE) were performed on three sets of phantoms to investigate how calcifications of different sizes and distributions influence measured elasticity. To demonstrate the effect in vivo, three female patients with benign breast masses associated with mammographically-identified calcifications were evaluated by CUSE.

Results

Apparent maximum elasticity (E_max) estimates resulting from individual macrocalcifications (with diameters of 2mm, 3mm, 5mm, 6mm, 9mm, 11mm, and 15mm) showed values over 50 kPa for all cases, which represents more than 100% increase over background (~21kPa). We considered a 2cm-diameter circular region of interest for all phantom experiments. Mean elasticity (E_mean) values varied from 26 kPa to 73 kPa, depending on the macrocalcification size. Highly dense clusters of microcalcifications showed higher E_max values than clusters of microcalcification with low concentrations, but the difference in E_mean values was not significant.

Conclusions

Our results demonstrate that the presence of large isolated macrocalcifications and highly concentrated clusters of microcalcifications can introduce areas with apparent high elasticity in SWE. Considering that benign breast masses normally have significantly lower elasticity values than malignant tumors, such areas with high elasticity appearing due to presence of calcification in benign breast masses may lead to misdiagnosis.

SLC2A9 Genotype Is Associated with SLC2A9 Gene Expression and Urinary Uric Acid Concentration

Objectives

SLC2A9 gene variants have been associated with urinary uric acid (UA) concentration, but little is known about the functional mechanism linking these gene variants with UA. SLC2A9 encodes a UA transporter present in the proximal tubule of the kidney, and gene expression levels of SLC2A9 and other genes in the uricosuric pathway (ABCG2, SLC17A1, SLC17A3, and SLC22A12) could potentially mediate the relationship between SLC2A9 gene variants and urinary UA excretion.

Methods

The association between urinary UA concentrations and single nucleotide polymorphisms (SNPs) within the SLC2A9 gene region, expression levels of genes in the uricosuric pathway, and dietary protein intake were analyzed for a sample of non-Hispanic white participants from the Genetic Epidemiology Network of Arteriopathy (GENOA) cohort. The SLC2A9 SNP most significantly associated with urinary UA concentration was then tested for associations with gene expression levels from uric acid absorption/secretion associated genes. Models including interactions between dietary protein (total, animal, and vegetable) and genetic factors were also assessed.

Results

The most significant SLC2A9 SNP associated with urinary UA (rs12509955, corrected p = 0.001) was also associated with SLC2A9 gene expression levels (corrected p = 0.0084); however, SLC2A9 gene expression levels were not significantly associated with urinary UA concentrations (p = 0.509). The interactions between rs12509955 and total dietary protein, and SLC2A9 gene-level gene expression and dietary vegetable protein on the outcome of urinary UA were marginally significant (p = 0.11 and p = 0.07, respectively). Gene expression level of one SLC2A9 transcript had a significant interaction with dietary animal protein (SLC2A9-001 ENST00000506583, p = 0.01) and a marginally significant interaction with total dietary protein (p = 0.07) on urinary UA.

Conclusion

Our results illustrate that SNPs in the SLC2A9 gene influence SLC2A9 gene expression as well as urinary UA excretion. Evidence is also suggestive that gene-by-diet interactions may disproportionately increase urinary UA in genetically susceptible individuals that consume higher amounts of protein.

Nomogram to predict uric acid kidney stones based on patient's age, BMI and 24-hour urine profiles: A multicentre validation

INTRODUCTION

We performed a multicentre validation of a nomogram to predict uric acid kidney stones in two populations.

METHODS

We reviewed the kidney stone database of two institutions, searching for patients with kidney stones who had stone composition analysis and 24-hour urine collection from January 2010 to December 2013. A nomogram to predict uric acid kidneys stones based on patient age, body mass index (BMI), and 24-hour urine collection was tested. Receiver-operating curves (ROC) were performed.

RESULTS

We identified 445 patients, 355 from Cleveland, United States, and 90 from Sao Paulo, Brazil. Uric acid stone formers were 7.9% and 8.9%, respectively. Uric acid patients had a significantly higher age and BMI, as well as significant lower urinary calcium than calcium stone formers in both populations. Uric acid had significantly higher total points when scored according to the nomogram. ROC curves showed an area under the curve of 0.8 for Cleveland and 0.92 for Sao Paulo. The cutoff value that provided the highest sensitivity and specificity was 179 points and 192 for Cleveland and Sao Paulo, respectively. Using 180 points as a cutoff provided a sensitivity and specificity of 87.5% and 68% for Cleveland, and 100% and 42% for Sao Paulo. Higher cutoffs were associated with higher specificity. The main limitation of this study is that only patients from high volume hospitals with uric acid or calcium stones were included.

CONCLUSION

Predicting uric acid kidneys stone based on a nomogram, which includes only demographic data and 24-hour urine parameters, is feasible with a high degree of accuracy.

Associations between BMI, serum uric acid, serum glucose, and blood pressure with urinary tract stone opacity

Background: Urolithiasis refers to formation of stone in the kidney, ureter, or bladder. Several studies showed metabolic abnormalities were common in urolithiasis patients. The aim of this study was to describe the association between body-mass-index (BMI), serum uric acid, serum glucose, and blood pressure toward stone opacity in urinary tract stone patients.Methods: This study was done retrospectively by reviewing registry data of urinary tract stone patients that had undergone ESWL on January 2008 – December 2013 in Department of Urology Cipto Mangunkusumo Hospital. Data concerning body mass index, serum uric acid, serum glucose, blood pressure, and urinary tract stone opacity were recorded. Associations between body mass index, serum uric acid, serum glucose and blood pressure with urinary tract stone opacity were analyzed using chi-square test.Results: There were 2,889 patients who underwent ESWL on January 2008 – December 2013. We analyzed 242 subjects with complete data. Mean age was ± 12.78 (48.02 years). Male-to-female ratio was 2.27:1. Mean BMI was ± 3.78 (29.91 kg/m2). High risk BMIs were found in 161 patients (66.52%). The proportion of radioopaque stone was 77.69% (188 patients). Twenty two patients (9.1%) had normal blood pressure. Patients with high serum uric acid were 34.30% (83 patients). We found a significant association between random serum glucose level and stone opacity (p < 0.05).Conclusion: There is an association between random serum glucose level and stone opacity in urolithiasis patients. Hyperglycemia patients tend to have radiolucent stone, whereas normoglycemia patients tend to have radioopaque stone.

Environmental and stressful factors affecting the occurrence of kidney stones and the kidney colic

The first renal disease described from Hippocrates is nephrolithiasis with renal colic, which is the pain of stone passage and is also a common renal problem with easily recognizable characteristics. There has been much written about dietary factors, which have unequivocally been proved to play an important role in the formation of kidney stones. In this regard, it is of interest that the contribution of factors such as stressful events, life style, or occupation in the formation of kidney stones has not been well studied. This review examines the clinical evidence of the stressful events and other environmental factors affecting the occurrence of kidney stones.