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Iqbal MS, Duan X, Ali H, Kaoqing P, Liu Z, Sardar N, Alsubki RA, Attia KA, Abushady AM, Gu D, Zeng G. Identification of TIMPs signatures in Randall plaque from single-cell RNA sequencing (scRNA-Seq) analysis. Funct Integr Genomics 2024; 24:11. [PMID: 38225514 DOI: 10.1007/s10142-024-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Muhammad Sarfaraz Iqbal
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaolu Duan
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Habib Ali
- Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Kahn, 64200, Pakistan.
| | - Peng Kaoqing
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zezehun Liu
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nimra Sardar
- Department of Microbiology and Molecular Genetics, School of Applied Biology, University of Okara, Okara, Pakistan
| | - Roua A Alsubki
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Kotb A Attia
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, 11451, Riyadh, Saudi Arabia
| | - Asmaa M Abushady
- Biotechnology School, 26th of July Corridor, Nile University, Sheikh Zayed City, 12588, Giza, Egypt
- Department of Genetics, Agriculture College, Ain Shams University, Cairo, Egypt
| | - Di Gu
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, Guangdong Key Laboratory of Urology, Guangzhou Urology Research Institute, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Liu CJ, Ho KT, Tsai YS, Huang HS. Increased renal uptake and urine excretion of oxidized LDL is possibly associated with formation of large calcium oxalate nephrolithiasis: a preliminary study. World J Urol 2023; 41:1423-1430. [PMID: 36977786 DOI: 10.1007/s00345-023-04360-9] [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: 10/04/2022] [Accepted: 02/09/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Growing evidence have suggested an association between nephrolithiasis and cardiovascular disease (CVD) with unclear mechanism. Oxidized low-density lipoproteins (oxLDL) induces atherosclerosis and was found to be the possible link between these two diseases. Our study aimed to examine the serum, urine and kidney expression of oxLDL in relation to large calcium oxalate (CaOx) renal stone disease. METHODS A total of 67 large CaOx dominant renal stone patients and 31 stone-free controls were enrolled in the prospective case-control study. All participants were without known CVD history. Serum, urine, and kidney biopsy were collected before and during percutaneous nephrolithotomy, respectively. Enzyme-linked immunosorbent assays were used to assess serum and urine oxLDL, lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), and high-sensitivity C-reactive protein (hsCRP). RESULTS There was no significantly difference in circulating oxLDL, but serum hsCRP was significantly near two-fold higher in nephrolithiasis patients. Serum hsCRP was also correlated with stone maximal length. Urine oxLDL was significantly higher in the nephrolithiasis group and correlated with serum hsCRP and stone maximal length. Increased oxLDL uptake in kidney was found in nephrolithiasis patients, whereas no significantly renal expression of oxLDL was observed in controls. CONCLUSIONS The renal uptake of oxLDL with increased oxLDL excretion from large CaOx renal stone formers, independent of increased circulating oxLDL, is a novel pathological finding in kidney stone disease and brings attention to the possible involvement of renal steatosis in the process of urolithiasis formation.
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Affiliation(s)
- Chan-Jung Liu
- Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
| | - Kuan-Ta Ho
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan
| | - Yau-Sheng Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan.
- Clinical Medicine Research Center, National Cheng Kung University Hospital, Tainan, 704302, Taiwan.
| | - Ho-Shiang Huang
- Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan.
- Department of Urology, College of Medicine, National Cheng Kung University, Tainan, 704302, Taiwan.
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Jung HD, Cho S, Lee JY. Update on the Effect of the Urinary Microbiome on Urolithiasis. Diagnostics (Basel) 2023; 13:diagnostics13050951. [PMID: 36900094 PMCID: PMC10001284 DOI: 10.3390/diagnostics13050951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/03/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Microbiota are ecological communities of commensal, symbiotic, and pathogenic microorganisms. The microbiome could be involved in kidney stone formation through hyperoxaluria and calcium oxalate supersaturation, biofilm formation and aggregation, and urothelial injury. Bacteria bind to calcium oxalate crystals, which causes pyelonephritis and leads to changes in nephrons to form Randall's plaque. The urinary tract microbiome, but not the gut microbiome, can be distinguished between cohorts with urinary stone disease (USD) and those without a history of the disease. In the urine microbiome, the role is known of urease-producing bacteria (Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Providencia stuartii, Serratia marcescens, and Morganella morganii) in stone formation. Calcium oxalate crystals were generated in the presence of two uropathogenic bacteria (Escherichia coli and K. pneumoniae). Non-uropathogenic bacteria (S. aureus and Streptococcus pneumoniae) exhibit calcium oxalate lithogenic effects. The taxa Lactobacilli and Enterobacteriaceae best distinguished the healthy cohort from the USD cohort, respectively. Standardization is needed in urine microbiome research for urolithiasis. Inadequate standardization and design of urinary microbiome research on urolithiasis have hampered the generalizability of results and diminished their impact on clinical practice.
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Affiliation(s)
- Hae Do Jung
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Seok Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University, Seoul 03722, Republic of Korea
- Correspondence: ; Tel.: +82-2-2228-2320; Fax: +82-2-312-2538
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Malieckal DA, Ganesan C, Mendez DA, Pao AC. Breaking the Cycle of Recurrent Calcium Stone Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:164-176. [PMID: 36868731 PMCID: PMC9993408 DOI: 10.1053/j.akdh.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 03/05/2023]
Abstract
Calcium stones are common and recurrent in nature, yet few therapeutic tools are available for secondary prevention. Personalized approaches for stone prevention have been informed by 24-hour urine testing to guide dietary and medical interventions. However, current evidence is conflicting about whether an approach guided by 24-hour urine testing is more effective than a generic one. The available medications for stone prevention, namely thiazide diuretics, alkali, and allopurinol, are not always prescribed consistently, dosed correctly, or tolerated well by patients. New treatments on the horizon hold the promise of preventing calcium oxalate stones by degrading oxalate in the gut, reprogramming the gut microbiome to reduce oxalate absorption, or knocking down expression of enzymes involved in hepatic oxalate production. New treatments are also needed to target Randall's plaque, the root cause of calcium stone formation.
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Affiliation(s)
- Deepa A. Malieckal
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY
| | - Calyani Ganesan
- Stanford University School of Medicine, Department of Medicine, Palo Alto, CA
| | | | - Alan C. Pao
- Stanford University School of Medicine, Department of Medicine, Palo Alto, CA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
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Hong SY, Yang YY, Xu JZ, Xia QD, Wang SG, Xun Y. The renal pelvis urobiome in the unilateral kidney stone patients revealed by 2bRAD-M. J Transl Med 2022; 20:431. [PMID: 36153619 PMCID: PMC9509602 DOI: 10.1186/s12967-022-03639-6] [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: 05/30/2022] [Accepted: 09/14/2022] [Indexed: 11/27/2022] Open
Abstract
Background The pathogenesis of kidney stone disease (KSD) is not fully understood, and potential contributing factors remain to be explored. Several studies have revealed that the urinary microbiome (urobiome) of stone formers was distinct from that of healthy individuals using 16S rRNA gene sequencing, most of which only provided microbial identification at the genus level. 2bRAD sequencing for Microbiome (2bRAD-M) is a novel sequencing technique that enables accurate characterization of the low-biomass microbiome at the species resolution. We aimed to apply 2bRAD-M to profile the renal pelvis urobiome of unilateral kidney stone patients and compared the urobiome with and without stone(s). Method A total of 30 patients with unilateral stones were recruited, and their renal pelvis urine from both sides was collected. A ureteroscope was inserted into the renal pelvis with stone(s) and a ureteral catheter was placed into the ureteroscope to collect renal pelvis urine. This procedure was repeated again with new devices to collect the urine of the other side. 2bRAD-M was performed to characterize the renal pelvis urobiome of unilateral stone formers to explore whether microbial differences existed between the stone side and the non-stone side. Results The microbial community composition of the stone side was similar to that of the non-stone side. Paired comparison showed that Corynebacterium was increased and Prevotella and Lactobacillus were decreased in the stone side. Four species (Prevotella bivia, Lactobacillus iners, Corynebacterium aurimucosum, and Pseudomonas sp_286) were overrepresented in the non-stone side. 24 differential taxa were also identified between two groups by linear discriminant analysis effect size (LEfSe). Extensive and close connections among genera and species were observed in the correlation analysis. Moreover, a random forest classifier was constructed using specific enriched species, which can distinguish the stone side from the non-stone side with an accuracy of 71.2%. Conclusion This first 2bRAD-M microbiome survey gave an important hint towards the potential role of urinary dysbiosis in KSD and provided a better understanding of mechanism of stone formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-022-03639-6.
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Cole E, Shaikh N, Forster CS. The pediatric urobiome in genitourinary conditions: a narrative review. Pediatr Nephrol 2022; 37:1443-1452. [PMID: 34654953 DOI: 10.1007/s00467-021-05274-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 12/19/2022]
Abstract
The microbial ecosystem within the bladder that can be measured within the urine, or urobiome, is an emerging field of study with little published data regarding children. However, investigations into urobiome research have the potential to significantly impact the understanding of the pathophysiology of genitourinary conditions, as well as potentially identify novel therapeutics. Therefore, both researchers and clinicians should be aware of pediatric urobiome research. The purpose of this review is to highlight the literature around urobiome research in urinary tract infections, nephrolithiasis, and neurogenic bladder; comment on pediatric-specific considerations when reading and interpreting the urobiome literature; and to identify new potential areas of research.
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Affiliation(s)
- Elisabeth Cole
- Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - Nader Shaikh
- Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA
| | - Catherine S Forster
- Department of Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
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The Microbiome and Urolithiasis: Current Advancements and Future Challenges. Curr Urol Rep 2022; 23:47-56. [PMID: 35138598 DOI: 10.1007/s11934-022-01088-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to explore the effect of the microbiome on urolithiasis and explore recent advances and challenges in microbiome research for urolithiasis. RECENT FINDINGS Lack of standardization and shortcomings in study design for urinary microbiome research on urolithiasis has hampered the generalizability of results and weakened the impact of findings on clinical practice. Important study limitations include sample heterogenicity, specimen contamination, poor culture yields, and lack of shared datasets for meta-analysis. Contrary to traditional teaching, the genitourinary tract is not a sterile environment. This urinary microbiome may influence the pathogenesis of urolithiasis, although the specific mechanisms are still currently being explored. Successful investigation will depend on consistency in study design and analysis, as well as sharing data and protocols across institutions. Developing an understanding of the relationship between the urinary microbiome and urolithiasis may lead to novel approaches to mitigate stone risk.
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Williams JC, Al-Awadi H, Muthenini M, Bledsoe SB, El-Achkar T, Evan AP, Coe F, Lingeman JE, Worcester EM. Stone morphology distinguishes two pathways of idiopathic calcium oxalate stone pathogenesis. J Endourol 2021; 36:694-702. [PMID: 34915736 PMCID: PMC9145590 DOI: 10.1089/end.2021.0685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction About 1-in-11 Americans will experience a kidney stone, but underlying causes remain obscure. The objective of the present study was to separate idiopathic calcium oxalate stone formers by whether or not they showed positive evidence of forming a stone on Randall's plaque (RP). Materials and Methods In patients undergoing either percutaneous or ureteroscopic procedures for kidney stone removal, all stone material was extracted, and analyzed using micro computed tomographic imaging (micro CT), in order to identify those attached to RP. 24-hour urines were collected weeks after the stone removal procedure and off of medications that would affect urine composition. Endoscopic video was analyzed for papillary pathology (RP, pitting, plugging, dilated ducts, loss of papillary shape) by an observer blinded to the data on stone type. Percent papillary area occupied by RP and ductal plugging was quantified using image analytic software. Results Patients having even 1 stone on RP (N=36) did not differ from Non-RP patients (N=37) in age, sex, BMI, or other clinical characteristics. Compared to the Non-RP group, RP stone formers had more numerous but smaller stones, more abundant papillary RP, and fewer ductal plugs, both by quantitative measurement of surface area (on average, 3 times more plaque area, but only 41% as much plug area as Non-RP) and by semi-quantitative visual grading. Serum and blood values did not differ between RP and Non-RP stone formers by any measure. Conclusions Growth of many small stones on plaque seems the pathogenetic scheme for the RP stone forming phenotype, whereas the Non-RP phenotype stone pathogenesis pathway is less obvious. Higher papillary plugging in Non-RP suggests that plugs play a role in stone formation, and that these patients have a greater degree of papillary damage. Underlying mechanisms that create these distinctive phenotypes are presently unknown.
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Affiliation(s)
- James C Williams
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Haider Al-Awadi
- Indiana University School of Medicine, Department of Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Manognya Muthenini
- Indiana University School of Medicine, Department of Medicine, Indianapolis, Indiana, United States;
| | - Sharon B Bledsoe
- Indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Tarek El-Achkar
- Indiana University School of Medicine, Department of Medicine , Indianapolis, Indiana, United States;
| | - Andrew P Evan
- indiana University School of Medicine, Anatomy, Cell Biology & Physiology, Indianapolis, Indiana, United States;
| | - Fred Coe
- University of Chicago Pritzker School of Medicine, 12246, Medicine, Chicago, Illinois, United States;
| | - James E Lingeman
- Indiana University School of Medicine, Dept. of Urology, Indianapolis, Indiana, United States;
| | - Elaine M Worcester
- The University of Chicago, Section of Nephrology, Chicago, Illinois, United States;
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Li Q, Liu G, Cheng Y, Tang W. Three-channel ion chromatograph for improved metabolic evaluation of urolithiasis. BMC Urol 2021; 21:151. [PMID: 34742263 PMCID: PMC8572504 DOI: 10.1186/s12894-021-00914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Urolithiasis is a multi-etiological disease resulting from a combination of environmental and genetic factors. One of the most challenging aspects of this disease is its high recurrence rate. For most patients, an in-depth metabolic evaluation may reveal the presence of urinary stones. The fact that different urinary stone-related compounds (USRCs) are measured by different methods renders the metabolic evaluation of urolithiasis quite tedious and complex. Methods A three-channel ion chromatograph (IC) that automatically measures the concentration of common metabolic indicators of urolithiasis in urine (i.e., oxalate, citrate, uric acid, calcium, and magnesium) was developed to improve the efficiency. To validate its precision and specificity, standard curves were prepared using working solution of these indicators. 100 standard solutions of these indicators were measured with our new IC and three other ICs as the control instruments; analyte concentrations in 100 24-h urine samples from volunteers and 135 calculi patients were also measured. Results All analytes had good linear relationships in concentration ranges of 0–10 mg/L. The precision experiments in the standard and urine samples showed that the measurement errors of the newly developed IC were all less than 5%. In urine, the recovery rate ranged from 99.6 to 100.4%, the coefficient of variation ranged from 1.39 to 2.99%, and the results matched between our newly developed IC and the control ICs. The results of the efficiency test showed that we can finish the analysis at the average number of 14 people per day with the new IC. While the average number in the control group is 3.85/day (p = 0.000). Conclusions Overall, this multi-channel system significantly improves the efficiency of metabolic evaluation while retaining accuracy and precision. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00914-4.
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Affiliation(s)
- Qiang Li
- Department of Urology, Ningbo First Hospital, Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Guanlin Liu
- Department of Urology, Ningbo First Hospital, Zhejiang University, Ningbo, Zhejiang, People's Republic of China.
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, Zhejiang University, Ningbo, Zhejiang, People's Republic of China
| | - Wenbo Tang
- Department of Gynecology, Ningbo Women and Children's Hospital, Zhejiang University, Ningbo, Zhejiang, People's Republic of China
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Brain E, Geraghty RM, Cook P, Roderick P, Somani B. Risk of UTI in kidney stone formers: a matched-cohort study over a median follow-up of 19 years. World J Urol 2021; 39:3095-3101. [PMID: 33403436 PMCID: PMC8405492 DOI: 10.1007/s00345-020-03564-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe risk of UTI in Stone formers comparing to non-stone formers. METHODS Retrospective cohort study using electronic records for patients across southern England. Stone formers referred to a tertiary referral centre in Southern England, comparator patients were age and sex matched with 3:1 ratio from same database. Those with no documentation were excluded. UTI defined using ICD-10 codes. Risk of UTI presented as hazard ratio with 95% confidence interval, generated using cox regression. Sample size calculated using 80% power and significance set at 0.05. RESULTS Eight hundred and nineteen stone formers were included after 1000 records were screened for inclusion, with 2477 age and sex matched non-stone formers extracted from the same database. Sample size was calculated at 287 per group. Stone formers were at significantly increased risk of developing a UTI (HR 5.67; 95% CI 4.52-7.18, p < 0.001). Median follow-up was 19 years (IQR: 15-22). CONCLUSIONS Kidney stone formers are at increased risk of developing urinary tract infections.
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Affiliation(s)
- Eleanor Brain
- Newcastle University Medical School, Newcastle-upon-Tyne, UK
| | | | - Paul Cook
- Department of Biochemistry, University Hospital Southampton, Southampton, UK
| | - Paul Roderick
- Department of Public Health, University of Southampton, Southampton, UK
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Almeras C, Pradere B, Estrade V, Meria P, French Urological Association OBOTLCOT. Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review. J Clin Med 2021; 10:jcm10132888. [PMID: 34209668 PMCID: PMC8267668 DOI: 10.3390/jcm10132888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: The increasing efficiency of the different lasers and the improved performance of endoscopic devices have led to smaller stone fragments that impact the accuracy of microscopic evaluation (morphological and infrared). Before the stone destruction, the urologist has the opportunity to analyze the stone and the papillary abnormalities endoscopically (endoscopic papillary recognition (EPR) and endoscopic stone recognition (ESR)). Our objective was to evaluate the value for those endoscopic descriptions. Methods: The MEDLINE and EMBASE databases were searched in February 2021 for studies on endoscopic papillary recognition and endoscopic stone recognition. Results: If the ESR provided information concerning the main crystallization process, EPR provided information concerning the origin of the lithogenesis and its severity. Despite many actual limitations, those complementary descriptions could support the preventive care of the stone formers in improving the diagnosis of the lithogenesis mechanism and in identifying high-risk stone formers. Conclusion: Until the development of an Artificial Intelligence recognition, the endourologist has to learn EPSR to minimize the distortion effect of the new lasers on the stone analysis and to improve care efficiency of the stone formers patients.
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Affiliation(s)
- Christophe Almeras
- Department of Urology, La Croix du Sud Clinic-RGDS, UroSud, 52 bis Chemin de Ribaute, Boite 301, 31130 Quint Fonsegrives, France
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Correspondence: ; Tel.: +33-53-202-7202; Fax: +33-53-202-7203
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Vincent Estrade
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, CHU Pellegrin, 33300 Bordeaux, France
| | - Paul Meria
- French Urological Association (AFU), La Maison de l’Urologie, 11 rue Viète, 31017 Paris, France; (V.E.); (P.M.);
- Department of Urology, Saint Louis Hospital, Denis Diderot University, 75010 Paris, France
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Zhang J, Kumar S, Jayachandran M, Herrera Hernandez LP, Wang S, Wilson EM, Lieske JC. Excretion of urine extracellular vesicles bearing markers of activated immune cells and calcium/phosphorus physiology differ between calcium kidney stone formers and non-stone formers. BMC Nephrol 2021; 22:204. [PMID: 34074247 PMCID: PMC8170929 DOI: 10.1186/s12882-021-02417-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUNDS Previous studies have demonstrated that excretion of urinary extracellular vesicles (EVs) from different nephron segments differs between kidney stone formers and non-stone formers (NSFs), and could reflect pathogenic mechanisms of urinary stone disease. In this study we quantified selected populations of specific urinary EVs carrying protein markers of immune cells and calcium/phosphorus physiology in calcium oxalate stone formers (CSFs) compared to non-stone formers (NSFs). METHODS Biobanked urine samples from CSFs (n = 24) undergoing stone removal surgery and age- and sex- matched NSFs (n = 21) were studied. Urinary EVs carrying proteins related to renal calcium/phosphorus physiology (phosphorus transporters (PiT1 and PiT2), Klotho, and fibroblast growth factor 23 (FGF23); markers associated with EV generation (anoctamin-4 (ANO4) and Huntington interacting protein 1 (HIP1)), and markers shed from activated immune cells were quantified by standardized and published method of digital flow cytometry. RESULTS Urine excretion of calcium, oxalate, phosphorus, and calcium oxalate supersaturation (SS) were significantly higher in CSFs compared to NSFs (P < 0.05). Urinary excretion of EVs with markers of total leukocytes (CD45), neutrophils (CD15), macrophages (CD68), Klotho, FGF23, PiT1, PiT2, and ANO4 were each markedly lower in CSFs than NSFs (P < 0.05) whereas excretion of those with markers of monocytes (CD14), T-Lymphocytes (CD3), B-Lymphocytes (CD19), plasma cells (CD138 plus CD319 positive) were not different between the groups. Urinary excretion of EVs expressing PiT1 and PiT2 negatively (P < 0.05) correlated with urinary phosphorus excretion, whereas excretion of EVs expressing FGF23 negatively (P < 0.05) correlated with both urinary calcium and phosphorus excretion. Urinary EVs with markers of HIP1 and ANO4 correlated negatively (P < 0.05) with clinical stone events and basement membrane calcifications on papillary tip biopsies. CONCLUSIONS Urinary excretion of EVs derived from specific types of activated immune cells and EVs with proteins related to calcium/phosphorus regulation differed between CSFs and NSFs. Further validation of these and other populations of urinary EVs in larger cohort could identify biomarkers that elucidate novel pathogenic mechanisms of calcium stone formation in specific subsets of patients.
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Affiliation(s)
- Jiqing Zhang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti Nanlu,Chaoyang District, 100020, Beijing, China
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA
| | - Sanjay Kumar
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA
- Department of Life Science, School of Basic Science and Research, Sharda University, Knowledge Park III, 201310, UP, Greater Noida, India
| | - Muthuvel Jayachandran
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA
- Department of Internal Medicine, Division of Hematology Research, Mayo Clinic, 55905, Rochester, MN, USA
- Department of Physiology & Biomedical Engineering, Mayo Clinic, 55905, Rochester, MN, USA
| | | | - Stanley Wang
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA
| | - Elena M Wilson
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA
| | - John C Lieske
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, MN, 55905, Rochester, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 55905, Rochester, MN, USA.
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13
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Sabaté Arroyo XA, Grases Freixedas F, Bauzà Quetglas JL, Guimerà Garcia J, Pieras Ayala E. Relationship of endoscopic lesions of the renal papilla with type of renal stone and 24 h urine analysis. BMC Urol 2020; 20:46. [PMID: 32334600 PMCID: PMC7183647 DOI: 10.1186/s12894-020-00615-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023] Open
Abstract
Background Our purpose was to study the relationship of the 3 different types of endoscopic calcifications of the renal papilla (Randall’s plaque, intratubular calcification, papillary crater) with the type of stone and urine analysis. Methods This prospective study examined 41 patients (age range: 18 to 80 years) who received retrograde intrarenal surgery (RIRS) for renal lithiasis (mean stone size: 15.3 ± 7.2 mm). The renal papilla injuries were endoscopically classified as Randall’s plaque, intratubular calcification, or papillary crater. Calculi were classified as uric acid, calcium oxalate monohydrate (COM; papillary and cavity), calcium oxalate dihydrate (COD), or calcium phosphate (CP). A 24 h urine analysis of calcium, oxalate, citrate, phosphate, and pH was performed in all patients. The relationship of each type of papillary injury with type of stone and urine chemistry was determined. Fisher’s exact test and Student’s t-test were used to determine the significance of relationships, and a p value below 0.05 was considered significant. Results The most common injury was tubular calcification (78%), followed by Randall’s plaque (58%), and papillary crater (39%). There was no significant relationship of Randall’s plaque with type of stone. However, endoscopic intratubular calcification (p = 0.025) and papillary crater (p = 0.041) were more common in patients with COD and CP stones. There were also significant relationships of papillary crater with hypercalciuria (p = 0.036) and hyperoxaluria (p = 0.024), and of Randall’s plaque with hypocitraturia (p = 0.005). Conclusions There are certain specific relationships between the different types of papillary calcifications that were endoscopically detected with stone chemistry and urine analysis. COD and CP stones were associated with endoscopic tubular calcifications and papillary craters. Hypercalciuria was associated with tubular calcification, and hypocitraturia was associated with Randall’s plaque.
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Affiliation(s)
- X A Sabaté Arroyo
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain.
| | - F Grases Freixedas
- Universitat de les Illes Balears. IUNICS, Ctra. de Valldemossa, Km. 7.5, Palma de Mallorca, Spain
| | - J L Bauzà Quetglas
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - J Guimerà Garcia
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
| | - E Pieras Ayala
- Hospital Universitari Son Espases, Ctra. Valldemossa, 79, Palma de Mallorca, Spain
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14
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Johnson G, Stark N, Wolfe AJ, Putonti C. Complete Genome Sequence of a Pseudomonas aeruginosa Isolate from a Kidney Stone. Microbiol Resour Announc 2019; 8:e01073-19. [PMID: 31537684 PMCID: PMC6753288 DOI: 10.1128/mra.01073-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 11/20/2022] Open
Abstract
Recently, we isolated a temperate bacteriophage, Pseudomonas phage Dobby, from a calcium oxalate kidney stone. Here, we present the complete genome of the bacterial host harboring this phage, Pseudomonas aeruginosa UMB2738. From the analysis of the genome sequence, five additional prophage sequences were identified.
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Affiliation(s)
- Genevieve Johnson
- Bioinformatics Program, Loyola University Chicago, Chicago, Illinois, USA
| | - Nicole Stark
- Department of Biology, Loyola University Chicago, Chicago, Illinois, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Catherine Putonti
- Bioinformatics Program, Loyola University Chicago, Chicago, Illinois, USA
- Department of Biology, Loyola University Chicago, Chicago, Illinois, USA
- Department of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
- Department of Computer Science, Loyola University Chicago, Chicago, Illinois, USA
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15
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Chirackal RS, Jayachandran M, Wang X, Edeh S, Haskic Z, Perinpam M, Halling TM, Mehta R, Rivera ME, Lieske JC. Urinary extracellular vesicle-associated MCP-1 and NGAL derived from specific nephron segments differ between calcium oxalate stone formers and controls. Am J Physiol Renal Physiol 2019; 317:F1475-F1482. [PMID: 31461349 DOI: 10.1152/ajprenal.00515.2018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Randall's plaque (RP; subepithelial calcification) appears to be an important precursor of kidney stone disease. However, RP cannot be noninvasively detected. The present study investigated candidate biomarkers associated with extracellular vesicles (EVs) in the urine of calcium stone formers (CSFs) with low (<5% papillary surface area) and high (≥5% papillary surface area) percentages of RP and a group of nonstone formers. RPs were quantitated via videotaping and image processing in consecutive CSFs undergoing percutaneous surgery for stone removal. Urinary EVs derived from cells of different nephron segments of CSFs (n = 64) and nonstone formers (n = 40) were quantified in biobanked cell-free urine by standardized and validated digital flow cytometer using fluorophore-conjugated antibodies. Overall, the number of EVs carrying surface monocyte chemoattractant protein (MCP)-1 and neutrophil gelatinase-associated lipocalin (NGAL) were significantly lower in CSFs compared with nonstone former controls (P < 0.05) but did not differ statistically between CSFs with low and high RPs. The number of EVs associated with osteopontin did not differ between any groups. Thus, EVs carrying MCP-1 and NGAL may directly or indirectly contribute to stone pathogenesis as evidenced by the lower of these populations of EVs in stone formers compared with nonstone formers. Validation of EV-associated MCP-1 and NGAL as noninvasive biomarkers of kidney stone pathogenesis in larger populations is warranted.
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Affiliation(s)
- Robin S Chirackal
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Muthuvel Jayachandran
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.,Division of Hematology Research, Mayo Clinic, Rochester, Minnesota.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Xiangling Wang
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Samuel Edeh
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Zejfa Haskic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Majuran Perinpam
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Ramila Mehta
- Health Sciences Research, 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
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16
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Rao CY, Sun XY, Ouyang JM. Effects of physical properties of nano-sized hydroxyapatite crystals on cellular toxicity in renal epithelial cells. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 103:109807. [PMID: 31349397 DOI: 10.1016/j.msec.2019.109807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/29/2019] [Accepted: 05/26/2019] [Indexed: 12/29/2022]
Abstract
Hydroxyapatite (HAP) is not only a common component of most idiopathic CaOx stones, but also the core of Randall's plaque. HAP is a nest that can induce the formation of Randall's plaques and even kidney stones. We studied the toxic effects and mechanisms of four different types of nano-HAP crystals (H-Sphere, 72.5 nm × 72.5 nm; H-Needle, 37.2 nm × 162.7 nm; H-Rod, 42.3 nm × 115.3 nm; and H-Plate, 145.5 nm × 272.9 nm) on human renal proximal tubular epithelial cells (HK-2). HAP crystals could cause oxidative stress that triggered a series of cell dysfunction problems, resulting in decreased cell viability, loss of cell membrane integrity, cell swelling, and cell necrosis. The toxic effect of HAP was mainly attributed to its entry into cell by endocytosis and its accumulation in the lysosomes, causing the level of intracellular reactive oxygen species (ROS) to rise, the mitochondrial membrane potential (Δψm) to decrease, the lysosomal integrity to be destroyed, and the cell cycle blocked during the G0/G1 phase. The cytotoxicity of the four kinds of HAP crystals was ranked as follows: H-Sphere > H-Needle > H-Rod > H-Plate. The cytotoxicity of each crystal was positively correlated with low absolute zeta potential, conduciveness to internalized morphology, large specific surface area and aspect ratio, and small particle size. These results indicated that nano-HAP could damage HK-2 cells, and the physical properties of HAP crystals play a vital effect in their cytotoxicity.
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Affiliation(s)
- Chen-Ying Rao
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
| | - Xin-Yuan Sun
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China
| | - Jian-Ming Ouyang
- Institute of Biomineralization and Lithiasis Research, Jinan University, Guangzhou 510632, China.
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17
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Johnson G, Wolfe AJ, Putonti C. Characterization of the ϕCTX-like Pseudomonas aeruginosa phage Dobby isolated from the kidney stone microbiota. Access Microbiol 2019; 1. [PMID: 32864566 PMCID: PMC7454045 DOI: 10.1099/acmi.0.000002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Bacteriophages (phages) are vital members of the human microbiota. They are abundant even within low biomass niches of the human body, including the lower urinary tract. While several prior studies have cultured bacteria from kidney stones, this is the first study to explore phages within the kidney stone microbiota. Here we report Dobby, a temperate phage isolated from a strain of Pseudomonas aeruginosa cultured from a kidney stone. Dobby is capable of lysing clinical P. aeruginosa strains within our collection from the urinary tract. Sequencing was performed producing a 37,152 bp genome that closely resembles the temperate P. aeruginosa phage ϕCTX, a member of the P2 phage group. Dobby does not, however, encode for the cytotoxin CTX. Dobby's genome was queried against publicly available bacterial sequences identifying 44 other ϕCTX-like prophages. These prophages are integrated within the genomes of P. aeruginosa strains from a variety of environments, including strains isolated from urine samples and other niches of the human body. Phylogenetic analysis suggests that the temperate ϕCTX phage species is widespread. With the isolation of Dobby, we now have evidence that phages are members of the kidney stone microbiota. Further investigation, however, is needed to determine their abundance and diversity within these communities.
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Affiliation(s)
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL USA
| | - Catherine Putonti
- Bioinformatics Program, Loyola University Chicago, Chicago, IL USA.,Department of Microbiology and Immunology, Loyola University Chicago, Maywood, IL USA.,Department of Biology, Loyola University Chicago, Chicago, IL USA.,Department of Computer Science, Loyola University Chicago, Chicago, IL USA
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18
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Chen J, Zhang D, Ji MF, Liu T, Mei CL, Tang XJ. Activation of liver X receptor suppresses osteopontin expression and ameliorates nephrolithiasis. J Cell Physiol 2019; 234:14109-14122. [PMID: 30623435 DOI: 10.1002/jcp.28101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 12/07/2018] [Indexed: 11/09/2022]
Abstract
Nephrolithiasis is a common disease of the urinary system, of which idiopathic calcium oxalate (CaOx) kidney stones, in particular, are one of the special types. In the initial stages of CaOx kidney stone formation, Randall's plaques (RPs) develop. Liver X receptors (LXRs) inhibit oxidative stress and inflammatory in other diseases; nevertheless, the role of LXRs in nephrolithiasis has yet to be elucidated. In this study, the role of LXRs in the progression of RP formation was investigated. Microarray analysis revealed that LXR/RXR levels were significantly greater in low-plaque tissues (<5%) than in high-plaque tissues (>5%), confirming the link between LXR activation and RP formation. Correspondingly, expression levels of two LXR target genes, LXRα and LXRβ, were lower in high-plaque tissues than in low-plaque tissues. In vitro, LXR agonist alleviated calcium oxalate monohydrate-induced cellular calcium deposits and apoptosis. LXR activation decreased reactive oxygen species production and gene expression of inflammatory mediators, including osteopontin that has recently been demonstrated to correlate with the development of RPs. Moreover, p38 MAPK and JNK signaling may mediate LXR-regulated expression in HK-2 cells. In an animal model, the deposition was reduced by activating LXR, and osteopontin expression was also inhibited. Our findings suggest a role for LXRs in the progression of idiopathic CaOx kidney stones; LXR agonists may have therapeutic potential for the treatment of nephrolithiasis.
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Affiliation(s)
- Jie Chen
- Division of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Di Zhang
- Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ming-Fei Ji
- Division of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Tao Liu
- Division of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Lin Mei
- Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Jing Tang
- Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
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19
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Lieske JC, Wang X. Heritable traits that contribute to nephrolithiasis. Urolithiasis 2018; 47:5-10. [PMID: 30460525 DOI: 10.1007/s00240-018-1095-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55901, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Xiangling Wang
- Genomic Medicine Institute, Department of Nephrology and Hypertension, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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20
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Genetic polymorphisms of human transcription factor-7 like 2 (TCF7L2), β-defensin (DEFB1) and CD14 genes in nephrolithiasis patients. Int J Biol Macromol 2018; 118:610-616. [DOI: 10.1016/j.ijbiomac.2018.06.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/22/2018] [Accepted: 06/23/2018] [Indexed: 11/24/2022]
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21
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Sivaguru M, Saw JJ, Williams JC, Lieske JC, Krambeck AE, Romero MF, Chia N, Schwaderer AL, Alcalde RE, Bruce WJ, Wildman DE, Fried GA, Werth CJ, Reeder RJ, Yau PM, Sanford RA, Fouke BW. Geobiology reveals how human kidney stones dissolve in vivo. Sci Rep 2018; 8:13731. [PMID: 30213974 PMCID: PMC6137216 DOI: 10.1038/s41598-018-31890-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022] Open
Abstract
More than 10% of the global human population is now afflicted with kidney stones, which are commonly associated with other significant health problems including diabetes, hypertension and obesity. Nearly 70% of these stones are primarily composed of calcium oxalate, a mineral previously assumed to be effectively insoluble within the kidney. This has limited currently available treatment options to painful passage and/or invasive surgical procedures. We analyze kidney stone thin sections with a combination of optical techniques, which include bright field, polarization, confocal and super-resolution nanometer-scale auto-fluorescence microscopy. Here we demonstrate using interdisciplinary geology and biology (geobiology) approaches that calcium oxalate stones undergo multiple events of dissolution as they crystallize and grow within the kidney. These observations open a fundamentally new paradigm for clinical approaches that include in vivo stone dissolution and identify high-frequency layering of organic matter and minerals as a template for biomineralization in natural and engineered settings.
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Affiliation(s)
- Mayandi Sivaguru
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA.
| | - Jessica J Saw
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana- Champaign, Urbana, IL, USA.
- Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amy E Krambeck
- Department of Urology, Mayo Clinic, Rochester, MN, USA
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael F Romero
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Chia
- Department of Physiology & Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
- Department of Individualized Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew L Schwaderer
- Department of Pediatric Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Reinaldo E Alcalde
- Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - William J Bruce
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Derek E Wildman
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Molecular and Integrative Physiology, University of Illinois at Urbana- Champaign, Urbana, IL, USA
| | - Glenn A Fried
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charles J Werth
- Civil, Architectural and Environmental Engineering, University of Texas at Austin, Austin, TX, USA
| | - Richard J Reeder
- Department of Geosciences, Stony Brook University, Stony Brook, NY, 11794, USA
| | - Peter M Yau
- Protein Sciences, Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert A Sanford
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Bruce W Fouke
- Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Carl Zeiss Labs@Location Partner, Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Geology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Department of Microbiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
- Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
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22
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Zeng X, Xi Y, Jiang W. Protective roles of flavonoids and flavonoid-rich plant extracts against urolithiasis: A review. Crit Rev Food Sci Nutr 2018; 59:2125-2135. [DOI: 10.1080/10408398.2018.1439880] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Xiangquan Zeng
- Bioengineering Department, College of Food Science and Nutritional Engineering, China Agricultural University, Qinghua Donglu No. 17, Beijing, PR China
| | - Yu Xi
- Bioengineering Department, College of Food Science and Nutritional Engineering, China Agricultural University, Qinghua Donglu No. 17, Beijing, PR China
| | - Weibo Jiang
- Bioengineering Department, College of Food Science and Nutritional Engineering, China Agricultural University, Qinghua Donglu No. 17, Beijing, PR China
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23
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Gerber D, Forster CS, Hsieh M. The Role of the Genitourinary Microbiome in Pediatric Urology: a Review. Curr Urol Rep 2018; 19:13. [PMID: 29468401 DOI: 10.1007/s11934-018-0763-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In this review, we highlight the effects of the microbiome on urologic diseases that affect the pediatric patient. RECENT FINDINGS Perturbations in the urinary microbiome have been shown to be associated with a number of urologic diseases affecting children, namely urinary tract infection, overactive bladder/urge urinary incontinence, and urolithiasis. Recently, improved cultivation and sequencing technologies have allowed for the discovery of a significant and diverse microbiome in the bladder, previously assumed to be sterile. Early studies aimed to identify the resident bacterial species and demonstrate the efficacy of sequencing and enhanced quantitative urine culture. More recently, research has sought to elucidate the association between the microbiome and urologic disease, as well as to demonstrate effects of manipulation of the microbiome on various urologic pathologies. With an improved appreciation for the impact of the urinary microbiome on urologic disease, researchers have begun to explore the impact of these resident bacteria in pediatric urology.
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Affiliation(s)
- Daniel Gerber
- Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Catherine S Forster
- Children's National Health System, 111 Michigan Avenue NW Suite M4800, Washington, DC, 20010, USA.,Biomedical Research Institute, 9410 Key West Avenue, Rockville, MD, 20850, USA
| | - Michael Hsieh
- Children's National Health System, 111 Michigan Avenue NW Suite M4800, Washington, DC, 20010, USA. .,Biomedical Research Institute, 9410 Key West Avenue, Rockville, MD, 20850, USA.
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24
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Li X, Wang W, Su Y, Yue Z, Bao J. Inhibitory effect of an aqueous extract of Radix Paeoniae Alba on calcium oxalate nephrolithiasis in a rat model. Ren Fail 2017; 39:120-129. [PMID: 28085537 PMCID: PMC6014290 DOI: 10.1080/0886022x.2016.1254658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To examine the effect of an aqueous extract of Radix Paeoniae Alba (RPA) on the formation of calcium oxalate (CaOx) stones and the potential mechanism underlying the effect. Materials and methods: An in vitro assay was used to determine whether the RPA extract prevents the formation of CaOx or promotes CaOx dissolution. We also investigated the efficacy of the extract in vivo as a preventive and therapeutic agent for experimentally induced CaOx nephrolithiasis in rats. Various biochemical, molecular, and histological parameters were assessed in kidney tissue and urine at the end of the in vivo experiment. Results: Significant dissolution of formed crystals (8.99 ± 1.43) and inhibition of crystal formation (2.55 ± 0.21) were observed in vitro after treatment with 64 mg/mL of the RPA extract compared with a control treatment (55.10 ± 4.98 and 54.57 ± 5.84, respectively) (p < .05). In preventive protocols, the RPA extract significantly reduced urinary and renal oxalate levels and increased urinary calcium and citrate levels compared to the control. In addition, the RPA preventive protocol significantly decreased osteopontin expression, renal crystallization, and pathological changes compared to the control. These changes were not observed in rats on the therapeutic protocol. Conclusions: RPA is a useful agent that prevents the formation of CaOx kidney stones.
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Affiliation(s)
- Xiaoran Li
- a Department of Urology , Gansu Nephro-Urological Clinical Center, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital , Gansu , China
| | - Wenyun Wang
- b Department of Pediatric Surgery , Lanzhou University Second Hospital , Gansu , China
| | - Yu Su
- c First Clinical Medical College of Lanzhou University , Gansu Province , China
| | - Zhongjin Yue
- a Department of Urology , Gansu Nephro-Urological Clinical Center, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital , Gansu , China
| | - Junsheng Bao
- a Department of Urology , Gansu Nephro-Urological Clinical Center, Key Laboratory of Gansu Province for Urological Diseases, Lanzhou University Second Hospital , Gansu , China
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25
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Abstract
BACKGROUND Urinary supersaturation is one key determinant of calcium oxalate (CaOx) urinary stone formation, and urinary excretions of oxalate and citrate are two key determinants. Each is influenced by gastrointestinal processes. METHODS Open label and randomized placebo studies have examined the effect of oral probiotic preparations on urinary supersaturation and oxalate excretion. Cross sectional studies in humans have studied the association of Oxalobacter formigenes colonization status and urinary oxalate excretion and prevalence of urinary stones. The intestinal microbiome of representative animals adapted to a high oxalate diet has been defined. RESULTS The fecal content of O. formigenes, the best studied oxalate-degrader, varies depending on stone status. However, trials with probiotics designed to degrade oxalate including those containing O. formigenes, Lactobacillus, and/or Bifidobacterium spp., have been disappointing. Multiple intestinal segments of animals on a high oxalate diet contains diverse communities of microorganisms that can function together to degrade and detoxify a large oxalate load. CONCLUSIONS Although the intestinal microbiome seems likely to play a role to modify gastrointestinal absorption of lithogenic substances and hence urinary stone risk, whether we can develop tools to manipulate it and decrease this kidney stone risk remains to be determined.
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Affiliation(s)
- John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
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Schwaderer AL, Wolfe AJ. The association between bacteria and urinary stones. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:32. [PMID: 28217697 DOI: 10.21037/atm.2016.11.73] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Urinary stone disease (USD) is an increasing clinical problem in both children and adults. One in ten individuals will experience a urinary stone, yet the mechanisms responsible for urinary stones remain largely unknown. Bacteria have long been recognized to contribute to struvite urinary stones; however, the role of bacteria in the development of the more common calcium oxalate (CaOx) and calcium phosphate (CaPhos) stones has not been extensively investigated. However, several findings do indicate a possible association between urinary stones and bacteria, including the high rate of urinary tract infections (UTI) in urinary stone patients and multiple case series of culture-positive urinary stones, including stones composed of CaOx or CaPhos. New technology, such as next generation sequencing, may be used to lend additional insight regarding the association between urinary stones and bacteria. In 2015, we published the initial bacterial sequencing results from five urinary stones, from which we sequenced multiple types of bacterial DNA. Whether these bacteria are causal, disease modifying or passively present remains to be determined. However, initial exploration of underlying mechanisms for this association indicate that bacteria aggregate selectively to crystals, that their presence is associated with increased clumping of crystals, and that they stimulate incorporation of proteins into the stone matrix.
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Affiliation(s)
- Andrew L Schwaderer
- The Research Institute at Nationwide Children's Hospital, Center for Clinical and Translational Research, Columbus, OH, USA;; Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Alan J Wolfe
- Department of Microbiology and Immunology, Loyola University Chicago, Stritch School of Medicine, Chicago, IL, USA
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Gambaro G, Croppi E, Coe F, Lingeman J, Moe O, Worcester E, Buchholz N, Bushinsky D, Curhan GC, Ferraro PM, Fuster D, Goldfarb DS, Heilberg IP, Hess B, Lieske J, Marangella M, Milliner D, Preminger GM, Reis Santos JM, Sakhaee K, Sarica K, Siener R, Strazzullo P, Williams JC. Metabolic diagnosis and medical prevention of calcium nephrolithiasis and its systemic manifestations: a consensus statement. J Nephrol 2016; 29:715-734. [PMID: 27456839 PMCID: PMC5080344 DOI: 10.1007/s40620-016-0329-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently published guidelines on the medical management of renal stone disease did not address relevant topics in the field of idiopathic calcium nephrolithiasis, which are important also for clinical research. DESIGN A steering committee identified 27 questions, which were proposed to a faculty of 44 experts in nephrolithiasis and allied fields. A systematic review of the literature was conducted and 5216 potentially relevant articles were selected; from these, 407 articles were deemed to provide useful scientific information. The Faculty, divided into working groups, analysed the relevant literature. Preliminary statements developed by each group were exhaustively discussed in plenary sessions and approved. RESULTS Statements were developed to inform clinicians on the identification of secondary forms of calcium nephrolithiasis and systemic complications; on the definition of idiopathic calcium nephrolithiasis; on the use of urinary tests of crystallization and of surgical observations during stone treatment in the management of these patients; on the identification of patients warranting preventive measures; on the role of fluid and nutritional measures and of drugs to prevent recurrent episodes of stones; and finally, on the cooperation between the urologist and nephrologist in the renal stone patients. CONCLUSIONS This document has addressed idiopathic calcium nephrolithiasis from the perspective of a disease that can associate with systemic disorders, emphasizing the interplay needed between urologists and nephrologists. It is complementary to the American Urological Association and European Association of Urology guidelines. Future areas for research are identified.
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Affiliation(s)
- Giovanni Gambaro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Fredric Coe
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
| | - Orson Moe
- Department of Internal Medicine, Southwestern Medical Center, University of Texas, Dallas, USA
| | - Elen Worcester
- Department of Nephrology, University of Chicago Medicine, Chicago, USA
| | - Noor Buchholz
- Department of Urological Surgery, Sobeh's Vascular and Medical Center, Dubai, UAE
| | - David Bushinsky
- Department of Nephrology, Medical Center, University of Rochester, Rochester, USA
| | - Gary C Curhan
- Renal Division, Brigham and Women's Hospital, Boston, USA
| | - Pietro Manuel Ferraro
- Department of Nephrology and Dialysis, A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Daniel Fuster
- Department of Nephrology, University of Bern, Bern, Switzerland
| | - David S Goldfarb
- Department of Nephrology, New York Harbor VA Health Care System, New York, USA
| | | | - Bernard Hess
- Department of Internal Medicine and Nephrology, Klinik Im Park Hospital, Zurich, Switzerland
| | - John Lieske
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA
| | - Martino Marangella
- Department of Nephrology, A.S.O Ordine Mauriziano Hospital, Turin, Italy
| | - Dawn Milliner
- Department of Nephrology, Mayo Clinic, Rochester, USA
| | - Glen M Preminger
- Department of Urology, Duke University Medical Center, Durham, USA
| | | | - Khashayar Sakhaee
- Southwestern Medical Center, Mineral Metabolism Research, University of Texas, Dallas, USA
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi KIRDAR Kartal Research and Training Hospital, Istanbul, Turkey
| | | | | | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indiana, USA
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Abstract
The most common presentation of nephrolithiasis is idiopathic calcium stones in patients without systemic disease. Most stones are primarily composed of calcium oxalate and form on a base of interstitial apatite deposits, known as Randall's plaque. By contrast some stones are composed largely of calcium phosphate, as either hydroxyapatite or brushite (calcium monohydrogen phosphate), and are usually accompanied by deposits of calcium phosphate in the Bellini ducts. These deposits result in local tissue damage and might serve as a site of mineral overgrowth. Stone formation is driven by supersaturation of urine with calcium oxalate and brushite. The level of supersaturation is related to fluid intake as well as to the levels of urinary citrate and calcium. Risk of stone formation is increased when urine citrate excretion is <400 mg per day, and treatment with potassium citrate has been used to prevent stones. Urine calcium levels >200 mg per day also increase stone risk and often result in negative calcium balance. Reduced renal calcium reabsorption has a role in idiopathic hypercalciuria. Low sodium diets and thiazide-type diuretics lower urine calcium levels and potentially reduce the risk of stone recurrence and bone disease.
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Affiliation(s)
- Fredric L Coe
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Elaine M Worcester
- Nephrology Section MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, Illinois, 60637 USA
| | - Andrew P Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 635 Barnhill Drive, MS 5055, Indianapolis, IN 46220, Indiana, USA
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Taguchi K, Hamamoto S, Okada A, Unno R, Kamisawa H, Naiki T, Ando R, Mizuno K, Kawai N, Tozawa K, Kohri K, Yasui T. Genome-Wide Gene Expression Profiling of Randall's Plaques in Calcium Oxalate Stone Formers. J Am Soc Nephrol 2016; 28:333-347. [PMID: 27297950 DOI: 10.1681/asn.2015111271] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/04/2016] [Indexed: 12/23/2022] Open
Abstract
Randall plaques (RPs) can contribute to the formation of idiopathic calcium oxalate (CaOx) kidney stones; however, genes related to RP formation have not been identified. We previously reported the potential therapeutic role of osteopontin (OPN) and macrophages in CaOx kidney stone formation, discovered using genome-recombined mice and genome-wide analyses. Here, to characterize the genetic pathogenesis of RPs, we used microarrays and immunohistology to compare gene expression among renal papillary RP and non-RP tissues of 23 CaOx stone formers (SFs) (age- and sex-matched) and normal papillary tissue of seven controls. Transmission electron microscopy showed OPN and collagen expression inside and around RPs, respectively. Cluster analysis revealed that the papillary gene expression of CaOx SFs differed significantly from that of controls. Disease and function analysis of gene expression revealed activation of cellular hyperpolarization, reproductive development, and molecular transport in papillary tissue from RPs and non-RP regions of CaOx SFs. Compared with non-RP tissue, RP tissue showed upregulation (˃2-fold) of LCN2, IL11, PTGS1, GPX3, and MMD and downregulation (0.5-fold) of SLC12A1 and NALCN (P<0.01). In network and toxicity analyses, these genes associated with activated mitogen-activated protein kinase, the Akt/phosphatidylinositol 3-kinase pathway, and proinflammatory cytokines that cause renal injury and oxidative stress. Additionally, expression of proinflammatory cytokines, numbers of immune cells, and cellular apoptosis increased in RP tissue. This study establishes an association between genes related to renal dysfunction, proinflammation, oxidative stress, and ion transport and RP development in CaOx SFs.
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Affiliation(s)
- Kazumi Taguchi
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and.,Department of Urology, Social Medical Corporation Kojunkai Daido Hospital, Daido Clinic, Nagoya, Japan
| | - Shuzo Hamamoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Rei Unno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Hideyuki Kamisawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and.,Department of Urology, Social Medical Corporation Kojunkai Daido Hospital, Daido Clinic, Nagoya, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Kentaro Mizuno
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Keiichi Tozawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Kenjiro Kohri
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; and
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Abstract
Kidney stones are mineral deposits in the renal calyces and pelvis that are found free or attached to the renal papillae. They contain crystalline and organic components and are formed when the urine becomes supersaturated with respect to a mineral. Calcium oxalate is the main constituent of most stones, many of which form on a foundation of calcium phosphate called Randall's plaques, which are present on the renal papillary surface. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone episode. Obesity, diabetes, hypertension and metabolic syndrome are considered risk factors for stone formation, which, in turn, can lead to hypertension, chronic kidney disease and end-stage renal disease. Management of symptomatic kidney stones has evolved from open surgical lithotomy to minimally invasive endourological treatments leading to a reduction in patient morbidity, improved stone-free rates and better quality of life. Prevention of recurrence requires behavioural and nutritional interventions, as well as pharmacological treatments that are specific for the type of stone. 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.
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Cheungpasitporn W, Erickson SB, Rule AD, Enders F, Lieske JC. Short-Term Tolvaptan Increases Water Intake and Effectively Decreases Urinary Calcium Oxalate, Calcium Phosphate and Uric Acid Supersaturations. J Urol 2015; 195:1476-1481. [PMID: 26598423 DOI: 10.1016/j.juro.2015.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE Some patients cannot effectively increase water intake and urine volume to prevent urinary stones. Tolvaptan, a V2 receptor antagonist, blocks water reabsorption in the collecting duct and should decrease urinary supersaturation of stone forming solutes, although this action has never been proved. MATERIALS AND METHODS We conducted a double-blind, randomized, placebo controlled, crossover study of 21 calcium urinary stone formers stratified into majority calcium oxalate (10 patients) and calcium phosphate (11) groups. Patients received 45 mg tolvaptan per day or placebo for 1 week, followed by a washout week and crossover to tolvaptan or placebo for week 3. A 24-hour urine sample was collected at the end of weeks 1 and 3. RESULTS Tolvaptan vs placebo decreased urinary osmolality (mean ± SD 204 ± 96 vs 529 ± 213 mOsm/kg, p <0.001) and increased urinary volume (4.8 ± 2.9 vs 1.8 ± 0.9 L, p <0.001). The majority of urinary solute excretion rates, including sodium and calcium, did not change significantly, although oxalate secretion increased slightly (from mean ± SD 15 ± 8 to 23 ± 8 mg per 24 hours, p = 0.009). Mean ± SD urinary calcium oxalate supersaturation (-0.01 ± 1.14 vs 0.95 ± 0.87 dG, p <0.001), calcium phosphate supersaturation (-1.66 ± 1.17 vs -0.13 ± 1.02 dG, p <0.001) and uric acid supersaturation (-2.05 ± 4.05 vs -5.24 ± 3.12 dG, p = 0.04) all dramatically decreased. Effects did not differ between the calcium oxalate and calcium phosphate groups (p >0.05 for all interactions). CONCLUSIONS Tolvaptan increases urine volume and decreases urinary supersaturation in calcium stone formers. Further study is needed to determine if long-term use of V2 receptor antagonists results in fewer stone events.
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Affiliation(s)
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota; Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Felicity Enders
- Department of Health Sciences Research, 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.
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Barr-Beare E, Saxena V, Hilt EE, Thomas-White K, Schober M, Li B, Becknell B, Hains DS, Wolfe AJ, Schwaderer AL. The Interaction between Enterobacteriaceae and Calcium Oxalate Deposits. PLoS One 2015; 10:e0139575. [PMID: 26448465 PMCID: PMC4598009 DOI: 10.1371/journal.pone.0139575] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
Background The role of calcium oxalate crystals and deposits in UTI pathogenesis has not been established. The objectives of this study were to identify bacteria present in pediatric urolithiasis and, using in vitro and in vivo models, to determine the relevance of calcium oxalate deposits during experimental pyelonephritis. Methods Pediatric kidney stones and urine were collected and both cultured and sequenced for bacteria. Bacterial adhesion to calcium oxalate was compared. Murine kidney calcium oxalate deposits were induced by intraperitoneal glyoxalate injection and kidneys were transurethrally inoculated with uropathogenic Escherichia coli to induce pyelonephritis Results E. coli of the family Enterobacteriaceae was identified in patients by calcium oxalate stone culture. Additionally Enterobacteriaceae DNA was sequenced from multiple calcium oxalate kidney stones. E. coli selectively aggregated on and around calcium oxalate monohydrate crystals. Mice inoculated with glyoxalate and uropathogenic E. coli had higher bacterial burdens, increased kidney calcium oxalate deposits and an increased kidney innate immune response compared to mice with only calcium oxalate deposits or only pyelonephritis. Conclusions In a murine model, the presence of calcium oxalate deposits increases pyelonephritis risk, likely due to preferential aggregation of bacteria on and around calcium oxalate crystals. When both calcium oxalate deposits and uropathogenic bacteria were present, calcium oxalate deposit number increased along with renal gene transcription of inner stone core matrix proteins increased. Therefore renal calcium oxalate deposits may be a modifiable risk factor for infections of the kidney and urinary tract. Furthermore, bacteria may be present in calcium oxalate deposits and potentially contribute to calcium oxalate renal disease.
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Affiliation(s)
- Evan Barr-Beare
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Vijay Saxena
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Evann E. Hilt
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Krystal Thomas-White
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Megan Schober
- Nationwide Children’s Hospital, Division of Urology, Columbus, Ohio, United States of America
| | - Birong Li
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
| | - Brian Becknell
- The Research Institute at Nationwide Children’s Hospital, Center for Clinical and Translational Research, Columbus, Ohio, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
| | - David S. Hains
- Lebonheur Children’s Hospital, Division of Nephrology, Memphis, Tennessee, United States of America
| | - Alan J. Wolfe
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
| | - Andrew L. Schwaderer
- Loyola University Chicago, Stritch School of Medicine, Department of Microbiology and Immunology, Chicago, Illinois, United States of America
- Nationwide Children’s Hospital, Division of Nephrology, Columbus, Ohio, United States of America
- * E-mail:
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