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Tian C, Qiao J, An L, Hong Y, Xu Q, Xiong L, Huang X, Liu J. Risk factors and prediction model for postoperative complications in patients with struvite stones after percutaneous nephrolithotomy and flexible ureteroscopy. World J Urol 2024; 42:501. [PMID: 39222253 DOI: 10.1007/s00345-024-05206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE To analyze the risk factors for complications in patients with struvite stones following percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (fURS), and to establish a nomogram for postoperative complications in patients following PCNL. METHODS A retrospective analysis was conducted on patients with struvite stones after PCNL and fURS at the Department of Urology, Peking University People's Hospital, from January 2012 to March 2022. The common pathogens and antimicrobial susceptibilities in preoperative midstream urine culture were analyzed. Logistic regression analyses were used to evaluate the risk factors. Receiver-operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA) were used to assess the discrimination, accuracy, and practicability of the nomogram. RESULTS 332 patients with struvite stones received one-stage PCNL or fURS, including 243 cases of PCNL and 89 cases of fURS. 72 patients (21.69%) developed postoperative complications. The most common pathogens in preoperative urine cultures were Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. Multivariate logistic regression analysis showed that preoperative hemoglobin (OR = 0.981, P = 0.042), staghorn stone (OR = 4.226, P = 0.037), and positive preoperative midstream urine culture (OR = 2.000, P = 0.043) were independent risk factors for postoperative complications in patients following PCNL. The nomogram showed good performance in discrimination, accuracy, and applicability. CONCLUSION Preoperative hemoglobin, staghorn stone, and positive preoperative midstream urine culture were independent risk factors for postoperative complications in patients with struvite stones following PCNL. A nomogram was developed to predict the probability of postoperative complications.
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Affiliation(s)
- Cong Tian
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Jiajia Qiao
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Lizhe An
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Yang Hong
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Qingquan Xu
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Liulin Xiong
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Xiaobo Huang
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China
| | - Jun Liu
- Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China.
- Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China.
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Nguyen LD, Nguyen TT, Mai LV, Bui PV, Nguyen VT, Truong GT, Luu MT, Duong HT, Vu LD, Hoang TT. The first epidemiology of urolithiasis in Northern Vietnam: Urinary stone composition, age, gender, season, and clinical features study. Urologia 2024; 91:42-48. [PMID: 37916769 DOI: 10.1177/03915603231208090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES The aim of this study is to analyze the compositions of urinary stones and investigate their distributions in different ages, genders, seasons, and clinical features of Northern Vietnamese patients. METHODS A total of 231 patients with urinary stones from Northern Vietnam were collected and analyzed composition from 1/2021-12/2022. For all patients, age, sex, stone location, stone side, urine pH, and hospitalized date (month) were collected. RESULTS Kidney stones are more frequently found in men than women with the male: female urinary stones ratio in this study being 1.96:1. The highest stone prevalence appeared between 60 and 69 years old. The most common stone composition was calcium oxalate, followed by calcium phosphate, uric acid, struvite, and cysteine. Mix stones of CaOx and CaP were more prevalent than pure stones. Males submitted more CaOx, CaP, and UA stones, whereas females were susceptible to infectious stones. Stones were more frequently found on the left side of the upper urinary tract (51.9%) than on the right side (27.3%) and lower urinary tract (7.8%). Cultural tendency leads to a smaller number of stones during the Lunar new year (February), and Ghost month (August).
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Affiliation(s)
- Lien D Nguyen
- E Hospital, Hanoi, Vietnam
- University of Medicine and Pharmacy, Vietnam National University, Hanoi-VNU, Hanoi, Vietnam
| | | | | | | | - Van Thi Nguyen
- Institute of Chemistry, Vietnam Academy of Science and Technology, Hanoi, Vietnam
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Giang Tb Truong
- Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam
- College of Education, Vinh University, Nghean, Vietnam
| | - Minh Tn Luu
- Institute of Chemistry, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Hung T Duong
- Institute of Chemistry, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Loi D Vu
- Institute of Chemistry, Vietnam Academy of Science and Technology, Hanoi, Vietnam
- Vietnam - Korea Institute of Science and Technology, Hanoi, Vietnam
| | - Thao Th Hoang
- Institute of Chemistry, Vietnam Academy of Science and Technology, Hanoi, Vietnam
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Segall M, Mousavi A, Eisner BH, Scotland K. Pharmacologic treatment of kidney stones: Current medication and pH monitoring. Actas Urol Esp 2024; 48:11-18. [PMID: 38043680 DOI: 10.1016/j.acuroe.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
Nephrolithiasis is a globally prevalent urologic condition associated with significant morbidity and patient discomfort. Current management of kidney stones includes both surgical and pharmacologic interventions. Though surgery may be necessary under certain circumstances, pharmacologic treatment is a more affordable, readily available, and a less invasive option for patients. A comprehensive scoping review was conducted to summarize the available literature on the pharmacologic strategies for managing the predominant stone types including calcium oxalate, calcium phosphate, uric acid, struvite, and cystine stones. Central to these therapeutic approaches is the regulation of factors such as urine pH, stone crystallization, and patient metabolics that precipitate stone development and growth. This review highlights the pharmacological options available for treating each kidney stone type, emphasizing the importance of patient tailored medical management that should be considered by every physician.
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Affiliation(s)
- M Segall
- Escuela de Medicina Albert Einstein, Bronx, NY, USA
| | - A Mousavi
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA
| | - B H Eisner
- Servicio de Urología, Hospital General de Massachusetts, Boston, MA, USA
| | - K Scotland
- Departamento de Urología, Escuela de Medicina David Geffen, Universidad de California, Los Ángeles, CA, USA.
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Modou N, Mohamed D, Motoula Latou L, Racine K, Lamine N, Dominique D, Mohamed SS. Epidemiology and composition of upper urinary tract lithiasis in Senegalese population: a multicenter retrospective study. Urolithiasis 2023; 52:4. [PMID: 37982903 DOI: 10.1007/s00240-023-01498-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/24/2023] [Indexed: 11/21/2023]
Abstract
Urolithiasis is a major public health issue due to its increasing prevalence. The objective of this study was to describe the spectrophotometric profile of upper urinary tract stones (UTS) in Senegal. We conducted a multicenter retrospective study of all patients treated for upper UTS whose chemical composition was analyzed from January 2014 to January 2020 in eight regions of Senegal. Socio-demographic, clinical, paraclinical, and prognosis data were collected and analyzed. Three hundred and thirty-four patients were included in this study with a mean age of 46.3 ± 18.4 years and a sex ratio of 1.38. About one-third of patients (31.1%) had a body mass index > 25 kg/m2 and 74.2% presented with lumbar pain was the main clinical symptom. Calcium oxalate and calcium phosphate stones were the predominant types found, respectively, in 37.7% and 24.5% of patients. Uric acid was the main stone constituent in 18.6% of patients and struvites represented 14.7% of cases. Stones were located in the renal calyces and pelvis in 71.2% of cases. Surgical lithotomy was performed in 62.7% of patients for UTS extraction. Upper UTS are frequent condition in Senegalese with predominance of males and young adults. Calcium and uric acid stones are the main types. Preventive dietary and lifestyle measures are needed to reduce their burden.
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Affiliation(s)
- Ndongo Modou
- Nephrology and Dialysis, Regional Hospital of Kedougou, Dakar, Senegal
| | - Dahaba Mohamed
- Nephrology and Dialysis Department, Regional Hospital of Ndioum, Dakar, Senegal
| | - L Motoula Latou
- Nephrology and Dialysis Department, Military Hospital of Ouakam, Dakar, Senegal
| | - Kane Racine
- Urology Department, Hopital Principal, Dakar, Senegal
| | - Niang Lamine
- Urology Department, Idrissa Pouye General Hospital, Dakar, Senegal
| | - Doupa Dominique
- Faculty of Health Sciences, IRL-3189/ESS/UGB/CNRS/UCAD/CNRST/USTB, University Gaston Berger, Saint-Louis, Senegal
| | - Seck Sidy Mohamed
- Nephrology and Dialysis, Regional Hospital of Kedougou, Dakar, Senegal.
- Faculty of Health Sciences, IRL-3189/ESS/UGB/CNRS/UCAD/CNRST/USTB, University Gaston Berger, Saint-Louis, Senegal.
- CEA AGIR, Cheikh Anta DIOP University, Dakar, Senegal.
- Nephrology Department, Faculty of Health Sciences, University Gaston Berger, Route de Ngalléle, Sanar, BP 234, Saint-Louis, Sénégal.
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Subramaniyan Y, Khan A, Fathima F, Rekha PD. Differential expression of urease genes and ureolytic activity of uropathogenic Escherichia coli and Pseudomonas aeruginosa isolates in different nutritional conditions. Arch Microbiol 2023; 205:383. [PMID: 37973630 DOI: 10.1007/s00203-023-03722-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
Uropathogens have adaptation strategies to survive in the host urinary tract by efficiently utilizing and tolerating the urinary metabolites. Many uropathogens harbour the enzyme urease for the breakdown of urea and the enzymatic breakdown of urea increases the pH and facilitate the struvite crystallization. In this study, the differential urease activity of uropathogenic Escherichia coli and Pseudomonas aeruginosa strains was investigated under different nutritional conditions. The experiments included measurement of growth, pH, urease activity, NH4-N generation and urease gene (ureC) expression among the bacterial strains under different conditions. Further, the implications of urea breakdown on the struvite crystallization in vitro and biofilm formation were also assessed. The study included urease positive isolates and for comparison urease negative isolates were included. Compared to the urease negative strains the urease positive strains formed higher biofilms and motility. The urease positive P. aeruginosa showed significantly higher (p < 0.01) pH and urease activity (A557-A630) compared to E. coli under experimental conditions. Further, supplementation of glucose to the growth media significantly increased the urease activity in P. aeruginosa and in contrast, it was significantly lower in E. coli. The expression profile of urease gene (ureC) was significantly higher (p < 0.001) in P. aeruginosa compared to E. coli and was consistent with the biochemical results of the urease activity under the nutritional conditions. The differential urease activity under two nutritional conditions influenced the biogenic struvite crystallization. It correlated with the urease activity showing higher crystallization rate in P. aeruginosa compared to E. coli. The results highlight the differential urease activity in two common uropathogens under different nutritional conditions that may have significant role on the regulation of virulence, pathogenicity and in the kidney stone disease.
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Affiliation(s)
- Yuvarajan Subramaniyan
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to Be University), University Road, Deralakatte, Mangalore, 575018, India
| | - Altaf Khan
- Department of Urology, Yenepoya Medical College and Hospital, Yenepoya (Deemed to Be University), University Road, Deralakatte, Mangalore, 575018, India
| | - Fida Fathima
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to Be University), University Road, Deralakatte, Mangalore, 575018, India
| | - Punchappady Devasya Rekha
- Division of Microbiology and Biotechnology, Yenepoya Research Centre, Yenepoya (Deemed to Be University), University Road, Deralakatte, Mangalore, 575018, India.
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Young R, Damasco M, Chen Z. A new method for trans-vaginal extraction of an impacted vaginal calculus: A case report. Int J Surg Case Rep 2023; 110:108742. [PMID: 37657383 PMCID: PMC10509865 DOI: 10.1016/j.ijscr.2023.108742] [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: 07/29/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION Vaginal stones are a rare pathology, with no clear guidelines on management and optimal removal techniques. PRESENTATION OF CASE We report a novel surgical technique, leading to safe transvaginal extraction of the largest reported impacted vaginal stone. In this case we removed an 11 cm struvite stone transvaginally from a 46 year old patient. This was achieved by hollowing it out with surgical drills, allowing safe collapse of the outer cortex and complete removal. DISCUSSION Our technique allowed for the safe, minimally invasive removal of the largest stone to be reported so far in the literature, preventing further complications for the patient. A full description of our technique is outlined to allow other clinicians utilisation of this for similar cases in the future. CONCLUSION Future vaginal calculi could be managed using this technique, preventing the need for laparotomy or vaginal trauma.
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Affiliation(s)
- R Young
- Pelvic Floor Unit, St George Hospital, Sydney, Australia.
| | - M Damasco
- Pelvic Floor Unit, St George Hospital, Sydney, Australia
| | - Z Chen
- Pelvic Floor Unit, St George Hospital, Sydney, Australia
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Wallace B, Chmiel JA, Al KF, Bjazevic J, Burton JP, Goldberg HA, Razvi H. The Role of Urinary Modulators in the Development of Infectious Kidney Stones. J Endourol 2023; 37:358-366. [PMID: 36562270 DOI: 10.1089/end.2022.0458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: The pathogenesis of infectious kidney stones is poorly understood. Bacteria have been implicated in promoting infectious stones via urease production; however, there is mounting evidence indicating the relationship is more complex. The aim of our study was to characterize suspected biotic and abiotic extrinsic factors that may modulate the formation of infectious stones. Materials and Methods: A high-throughput experimental model with Griffith's artificial urine was used to test a wide variety of urinary modulators and cytoplasmic enzymes present in crude cell-free extracts (CFEs) from bacterial strains to investigate how they impact struvite and calcium (Ca) phosphate crystal production. Crystal formation was evaluated with spectrophotometry and growth curve analysis. Light microscopy and scanning electron microscopy/X-ray diffraction was used for crystal structure and composition identification. Results: The acidic urinary modulators used in this study prevented crystal formation, whereas osteopontin had a significant inhibitory effect. Addition of CFEs from Proteus mirabilis 175A and 177A resulted in Ca phosphate and struvite crystals. Of interest, Klebsiella pneumoniae and Klebsiella oxytoca produced crystals including Ca phosphate and Ca oxalate, respectively. Pseudomonas aeruginosa had no urease production detected and produced Ca phosphate crystals. Discussion: Urinary modulators can have a wide variety of effects on infectious stone formation and the role of pH is important but does not guarantee robust crystal formation. Bacterial strains can produce Ca oxalate, Ca phosphate, and struvite stones with and without urease activity. Conclusion: Various urinary modulators appear to influence the process and are worthy of further evaluation as a potential therapeutic strategy to prevent infection-related urinary stone formation. Stones formed from urinary tract infections may be a result of multiple encoded metabolic pathways and discovering these would improve our understanding of the stone-bacterial relationship.
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Affiliation(s)
- Brendan Wallace
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - John A Chmiel
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Kait F Al
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Jeremy P Burton
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Harvey A Goldberg
- Department of Dentistry and Biochemistry, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Hassan Razvi
- Division of Urology, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Lemberger U, Pjevac P, Hausmann B, Berry D, Moser D, Jahrreis V, Özsoy M, Shariat SF, Veser J. The microbiome of kidney stones and urine of patients with nephrolithiasis. Urolithiasis 2023; 51:27. [PMID: 36596939 PMCID: PMC9810570 DOI: 10.1007/s00240-022-01403-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
The incidence of nephrolithiasis is rising worldwide. Although it is a multifactorial disease, lifestyle plays a major role in its etiology. Another considerable factor could be an aberrant microbiome. In our observational single-center study, we aimed to investigate the composition of bacteria in kidney stones and urine focusing on patients with features of metabolic syndrome. Catheterized urine and kidney stones were collected prospectively from 100 consecutive patients undergoing endoscopic nephrolithotomy between 2020 and 2021 at our clinic. Microbiome composition was analyzed via 16S rRNA gene amplicon sequencing. Detection of bacteria was successful in 24% of the analyzed kidney stones. These patients had a prolonged length of stay compared to patients without verifiable bacteria in their stones (2.9 vs 1.5 days). Patients with features of metabolic syndrome were characterized by kidney stones colonized with classical gastrointestinal bacteria and displayed a significant enrichment of Enterococcaceae and Enterobacteriaceae. Stones of patients without features of metabolic syndrome characterized by Ureaplasma and Staphylococcaceae. Patients with bacteria in their kidney stones exhibit a longer length of stay, possibly due to more complex care. Patients presenting with features of metabolic syndrome displayed a distinct stone microbiome compared to metabolically fit patients. Understanding the role of bacteria in stone formation could enable targeted therapy, prevention of post-operative complications and new therapeutic strategies.
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Affiliation(s)
- Ursula Lemberger
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria.
| | - Petra Pjevac
- Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, Vienna, Austria
- Division of Microbial Ecology, Department of Microbiology and Ecosystem Science, Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria
| | - Bela Hausmann
- Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, Vienna, Austria
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - David Berry
- Joint Microbiome Facility of the Medical University of Vienna and the University of Vienna, Vienna, Austria
- Division of Microbial Ecology, Department of Microbiology and Ecosystem Science, Centre for Microbiology and Environmental Systems Science, University of Vienna, Vienna, Austria
| | - Daniel Moser
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria
| | - Victoria Jahrreis
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria
| | - Mehmet Özsoy
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria
| | - Shahrokh F Shariat
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology, University of Jordan, Amman, Jordan
| | - Julian Veser
- Research Laboratory, Department of Urology, Medical University of Vienna, Waeringerguertel 18-20, 1090, Vienna, Austria
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Spectrum of Bacterial Pathogens from Urinary Infections Associated with Struvite and Metabolic Stones. Diagnostics (Basel) 2022; 13:diagnostics13010080. [PMID: 36611372 PMCID: PMC9818859 DOI: 10.3390/diagnostics13010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The purposes of this multi-center study were to evaluate the rate of infection stones and to evaluate the urine cultures of patients with infection stones. MATERIALS Charts of adulpatients with urinary stones were reviewed and data on stone analyses and urine cultures were collected. RESULTS In total, 1204 renal stone formers (RSFs) from 10 countries were included (776 males, 428 females). Fifty-six patients (4.6%) had struvite stones. The highest frequency of struvite stones was observed in India (23%) and Pakistan (18%). Lower rates were reported in Canada (2%), China (3%), Argentina (3%), Iraq (3%), Italy (3.5%) and Poland (3%), and intermediate rates in Egypt (5.5%) and Bulgaria (5.4%). Urine cultures were retrieved from 508 patients. Patients with struvite stones had a positive culture in 64.3% of the samples and patients with other stones, in 26.7%. In struvite stones, the most common isolates were Escherichia coli (27.7%) and Proteus spp. (27.7%), followed by Klebsiella spp. (16.7%); in other types of stone, it was Escherichia coli (47.6%), followed by Gram-positive bacteria (14.0%) Conclusions: The struvite stone composition was associated with a urinary infection, although an infection was not demonstrable with a conventional midstream urine culture in about 30%.
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Kim US, Kwon HS, Yang W, Lee W, Choi C, Kim JK, Lee SH, Rim D, Han JH. Prediction of the composition of urinary stones using deep learning. Investig Clin Urol 2022; 63:441-447. [PMID: 35670006 PMCID: PMC9262483 DOI: 10.4111/icu.20220062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/31/2022] [Accepted: 04/17/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study aimed to predict the composition of urolithiasis using deep learning from urinary stone images. MATERIALS AND METHODS We classified 1,332 stones into 31 classes according to the stone composition. The top 4 classes with a frequency of 110 or more (class 1: calcium oxalate monohydrate [COM] 100%, class 2: COM 80%+struvite 20%, class 3: COM 60%+calcium oxalate dihydrate [COD] 40%, class 4: uric acid 100%) were selected. With the 965 stone images of the top 4 classes, we used the seven convolutional neural networks (CNN) to classify urinary stones and compared their classification performances. RESULTS Among the seven models, Xception_Ir0.001 showed the highest accuracy, precision, and recall and was selected as the CNN model to predict the stone composition. The sensitivity and specificity for the 4 classes by Xception_Ir0.001 were as follows: class 1 (94.24%, 91.73%), class 2 (85.42%, 96.14%), class 3 (86.86%, 99.59%), and class 4 (94.96%, 98.82%). The sensitivity and specificity of the individual components of the stones were as follows. COM (98.82%, 94.96%), COD (86.86%, 99.64%), struvite (85.42%, 95.59%), and uric acid (94.96%, 98.82%). The area under the curves for class 1, 2, 3, and 4 were 0.98, 0.97, 1.00, and 1.00, respectively. CONCLUSIONS This study showed the feasibility of deep learning for the diagnostic ability to assess urinary stone composition from images. It can be an alternative tool for conventional stone analysis and provide decision support to urologists, improving the effectiveness of diagnosis and treatment.
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Affiliation(s)
- Ui Seok Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Hyo Sang Kwon
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Wonjong Yang
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Wonchul Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Changil Choi
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Jong Keun Kim
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Seong Ho Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Dohyoung Rim
- Department of Cognitive Science, Yonsei University, Seoul, Korea
| | - Jun Hyun Han
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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Popovtzer B, Khusid JA, Bamberger JN, Lundon D, Gallante B, Sadiq AS, Atallah W, Lifshitz D, Gupta M. Do Infection-Associated Stone Subtypes Behave the Same Clinically? A Retrospective Bi-center Study. J Endourol 2021; 36:688-693. [PMID: 34913732 DOI: 10.1089/end.2021.0460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives Infection associated renal stones are commonly composed of magnesium-ammonium-phosphate (MAP) and carbonate apatite (CA). The clinical implications of these two different, but closely related stone types, are unknown. We sought to compare the clinical, microbiologic, and metabolic characteristics of patients with MAP and CA stone types. Methods We retrospectively reviewed the medical records of patients from two centers (one in the USA and one in Israel) who underwent ureteroscopy or percutaneous nephrolithotomy between 2012 and 2020 and identified patients with a predominant stone analysis component of CA or MAP and clinical data supporting an infection stone. We analyzed and compared demographic data, medical history, post-operative fever, stone and urinary microbiology, and 24-hour urine studies. Results A total of 79 and 75 patients met the inclusion criteria for the MAP and CA cohorts, respectively. No significant difference was found in patient demographics or comorbidities between the MAP and CA cohort. Female predominance was noted in both. Though there were no significant differences in 24-hour urine parameters between the cohorts, hypercalciuria was common in both cohorts (38% and 32% of patients in the MAP and CA cohorts, respectively). Gram negative bacteria were more common in the MAP stone cultures. Post-operative fever was significantly more common in the MAP cohort (14.7% vs 3.8%, p<0.016). Conclusions: MAP and CA stone formers share similar demographic characteristics with a clear female predominance. MAP stones patients appear more likely to develop postoperative fever, possibly related to a higher occurrence of gram-negative bacteria in the stone cultures of the MAP cohort. Although there were no significant differences amongst metabolic parameters, hypercalciuria was noted in approximately a third of the cohort. The clinical significance of this finding is yet to be determined.
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Affiliation(s)
- Baruch Popovtzer
- Rabin Medical Center, 36632, Urology, Zeev Jabotinsky St 39, Petah Tikva, Israel, 49100;
| | - Johnathan Alexander Khusid
- Icahn School of Medicine at Mount Sinai, 5925, Urology, 1 Gustave Levy Pl., New York, New York, United States, 10029-6574;
| | - Jacob N Bamberger
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W 59th St, Suite 4F, New York, New York, United States, 10029-6574;
| | - Dara Lundon
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, New York, New York, United States;
| | - Blair Gallante
- Icahn School of Medicine at Mount Sinai, 5925, Department of Urology, 425 W. 59th Street, Suite 9F, New York, New York, United States, 10019;
| | - Areeba Setara Sadiq
- Mount Sinai Health System, 5944, Urology, 425 W59th Street, New York, New York, United States, 10019;
| | - William Atallah
- Icahn School of Medicine at Mount Sinai, Urology, New York, New York, United States;
| | - David Lifshitz
- Rabin medical center, urology, Keren kayemet st, Petach Tikva, Israel, 65222;
| | - Mantu Gupta
- Mount Sinai Health System, 5944, Urology, 425 W. 59th Street, New York, New York, United States, 10019;
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12
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Shen C, Zhu Q, Dong F, Wang W, Fan B, Li K, Chen J, Hu S, He Z, Li X. Identifying Two Novel Clusters in Calcium Oxalate Stones With Urinary Tract Infection Using 16S rDNA Sequencing. Front Cell Infect Microbiol 2021; 11:723781. [PMID: 34869053 PMCID: PMC8635737 DOI: 10.3389/fcimb.2021.723781] [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: 06/11/2021] [Accepted: 10/25/2021] [Indexed: 02/01/2023] Open
Abstract
Urinary stones and urinary tract infection (UTI) are the most common diseases in urology and they are characterized by high incidence and high recurrence rate in China. Previous studies have shown that urinary stones are closely associated with gut or urine microbiota. Calcium oxalate stones are the most common type of urinary stones. However, the profile of urinary tract microorganisms of calcium oxalate stones with UTI is not clear. In this research, we firstly found two novel clusters in patients with calcium oxalate stones (OA) that were associated with the WBC/HP (white blood cells per high-power field) level in urine. Two clusters in the OA group (OA1 and OA2) were distinguished by the key microbiota Firmicutes and Enterobacteriaceae. We found that Enterobacteriaceae enriched in OA1 cluster was positively correlated with several infection-related pathways and negatively correlated with a few antibiotics-related pathways. Meantime, some probiotics with higher abundance in OA2 cluster such as Bifidobacterium were positively correlated with antibiotics-related pathways, and some common pathogens with higher abundance in OA2 cluster such as Enterococcus were positively correlated with infection-related pathways. Therefore, we speculated that as a sub-type of OA disease, OA1 was caused by Enterobacteriaceae and the lack of probiotics compared with OA2 cluster. Moreover, we also sequenced urine samples of healthy individuals (CK), patients with UTI (I), patients with uric acid stones (UA), and patients with infection stones (IS). We identified the differentially abundant taxa among all groups. We hope the findings will be helpful for clinical treatment and diagnosis of urinary stones.
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Affiliation(s)
- Chen Shen
- Departmant of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qianhui Zhu
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Fan Dong
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Wei Wang
- Departmant of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Bo Fan
- Departmant of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Kexin Li
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Jun Chen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States
| | - Songnian Hu
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zilong He
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Interdisciplinary Innovation Institute of Medicine and Engineering, Beihang University, Beijing, China.,School of Engineering Medicine, Beihang University, Beijing, China
| | - Xiancheng Li
- Departmant of Urology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
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13
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Undie CU, Nnana EI, Torporo KR. Composition of Uroliths seen in patients in Abuja, Nigeria: a single centre retrospective analysis of 155 stones. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Uroliths are stones formed in the urinary tract. Analysis of stones helps to identify risk factors for their development and prevention of recurrence. Standard stone analysis using modern technology is not routinely done in Nigeria. This study sought to determine the chemical composition of urinary stones seen in Abuja, Nigeria.
Methods
This was a retrospective study on composition of uroliths. Urinary stones surgically removed from 155 patients through minimal access surgical procedures between January 2015 and August 2019 were analysed. Optical crystallography and infrared spectroscopy were used to determine the chemical composition of the urinary stones.
Results
A total of 155 urinary stones were assembled from the patients. More stones were removed from male patients and the male to female ratio was 1.9:1. Stones were rare in the extremes of age. The predominant location (89.7%) of stones was in the upper urinary tract. All stones were of mixed composition with calcium oxalate accounting for 93.55%. Calcium oxalate, calcium phosphate and uric acid stones were more common in the upper tract, while 2 of the 3 struvite stones were found in the lower tract.
Conclusion
Stones found in this study were of mixed composition with the most common constituent being Calcium oxalate and the least common, struvite.
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14
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Van de Perre E, Reichman G, De Geyter D, Geers C, Wissing KM, Letavernier E. Encrusted Uropathy: A Comprehensive Overview-To the Bottom of the Crust. Front Med (Lausanne) 2021; 7:609024. [PMID: 33553205 PMCID: PMC7858656 DOI: 10.3389/fmed.2020.609024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/14/2020] [Indexed: 12/14/2022] Open
Abstract
Encrusted uropathy is a rare subacute to chronic inflammatory disorder caused by infection with urease-producing bacteria, mainly Corynebacterium urealyticum. The disorder is characterized by urothelial deposition of struvite and carbonated apatite, resulting in encrustations and ulceronecrotic inflammation of the urothelium and surrounding tissues. Most commonly, encrusted uropathy is encountered in patients with predisposing conditions. The disease remains underdiagnosed. High urinary pH and negative conventional urine cultures should raise suspicion of the diagnosis. Prognosis is dependent on timely diagnosis and treatment installment, which consists of urological removal of encrustations in combination with urinary acidification and long-term antibiotic therapy.
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Affiliation(s)
- Els Van de Perre
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gina Reichman
- Urology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deborah De Geyter
- Microbiology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Geers
- Pathology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karl M Wissing
- Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emmanuel Letavernier
- Service des Explorations Fonctionnelles Multidisciplinaires, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche S 1155, Paris, France
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15
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Ng DM, Haleem M, Mamuchashvili A, Wang KY, Pan JF, Cheng Y, Ma Q. Medical evaluation and pharmacotherapeutical strategies in management of urolithiasis. Ther Adv Urol 2021; 13:1756287221993300. [PMID: 33708261 PMCID: PMC7907714 DOI: 10.1177/1756287221993300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 11/17/2022] Open
Abstract
Treatment of urolithiasis depends on several important factors which include stone location, size, composition, and patient symptoms. Although significant advancements have been made in the surgical management of urolithiasis in the last decade, pharmacotherapy which can prevent the formation of new stones and decrease the recurrence of urolithiasis has not experienced the same level of success. Currently, urolithiasis is regarded as a complicated syndrome that is determined by numerous factors, and any treatment plan for urolithiasis should be individualized while considering any potential damage arising from stone-forming factors. This review introduces the most popular methods currently used to evaluate urolithiasis and the pharmacotherapy of urolithiasis based on patient-specific factors.
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Affiliation(s)
- Derry Minyao Ng
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Maria Haleem
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Anny Mamuchashvili
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Kai-yun Wang
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Jin-Feng Pan
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yue Cheng
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang 315010, China
| | - Qi Ma
- Translational Research Laboratory for Urology, The Key Laboratory of Ningbo City, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Department of Urology, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, China
- Comprehensive Urogenital Cancer Center, Ningbo First Hospital, The Affiliated Hospital of Ningbo University, 59, Liuting Street, Ningbo, Zhejiang 315010, China
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16
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Recurrent pain in a child with cerebral palsy: Answers. Pediatr Nephrol 2021; 36:4063-4065. [PMID: 34324051 PMCID: PMC8599261 DOI: 10.1007/s00467-021-05156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022]
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17
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Abstract
The prevalence of urolithiasis in humans is increasing worldwide; however, non-surgical treatment and prevention options remain limited despite decades of investigation. Most existing laboratory animal models for urolithiasis rely on highly artificial methods of stone induction and, as a result, might not be fully applicable to the study of natural stone initiation and growth. Animal models that naturally and spontaneously form uroliths are an underused resource in the study of human stone disease and offer many potential opportunities for improving insight into stone pathogenesis. These models include domestic dogs and cats, as well as a variety of other captive and wild species, such as otters, dolphins and ferrets, that form calcium oxalate, struvite, uric acid, cystine and other stone types. Improved collaboration between urologists, basic scientists and veterinarians is warranted to further our understanding of how stones form and to consider possible new preventive and therapeutic treatment options.
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18
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Rekha PD, Hameed A, Manzoor MAP, Suryavanshi MV, Ghate SD, Arun AB, Rao SS, Athmika, Bajire SK, Mujeeburahiman M, Young CC. First Report of Pathogenic Bacterium Kalamiella piersonii Isolated from Urine of a Kidney Stone Patient: Draft Genome and Evidence for Role in Struvite Crystallization. Pathogens 2020; 9:E711. [PMID: 32872396 PMCID: PMC7558591 DOI: 10.3390/pathogens9090711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 01/01/2023] Open
Abstract
Uropathogenic bacteria are widely distributed in the environment and urinary tract infection is implicated in kidney stone disease. Here, we report on a urease negative bacterium Kalamiella piersonii (strain YU22) isolated from the urine of a struvite stone (MgNH4PO4·6H2O) patient. The closest species, K. piersonii IIIF1SW-P2T was reported from International Space Station samples. However, there are no earlier reports on its human association. Using whole genome and experimental analysis, its involvement in urinary tract colonization and struvite crystallization was explored. The strain YU22 showed many virulence factors that are needed for host cell invasion and colonization including cell adhesion factors, swimming and swarming motilities, biofilm and siderophore among others. In vitro infection studies in HEK-293T cells demonstrated the host cell attachment and killing. It was able to utilize amino acids as sole carbon source and showed growth in synthetic and healthy urine establishing metabolic adaptation to urinary tract. Increased pH and availability of ammonium ions from amino acid breakdown promoted struvite crystallization. The results from this study support the involvement of urease negative uropathogen in the struvite lithogenesis. Further studies on other isolates of K. peirsonii are warranted to assess its health risks.
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Affiliation(s)
- Punchappady Devasya Rekha
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Asif Hameed
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
- Department of Soil and Environmental Sciences, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung 40227, Taiwan;
| | - Muhammed A. P. Manzoor
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Mangesh V. Suryavanshi
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Sudeep D. Ghate
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - A. B. Arun
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Sneha S. Rao
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Athmika
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - Sukesh Kumar Bajire
- Yenepoya Research Centre, Yenepoya Deemed to be University, Mangalore 575018, India; (A.H.); (M.A.P.M.); (M.V.S.); (S.D.G.); (A.B.A.); (S.S.R.); (A.); (S.K.B.)
| | - M. Mujeeburahiman
- Department of Urology, Yenepoya Medical College and Hospital, Yenepoya Deemed to be University, Mangalore 575018, India;
| | - C.-C. Young
- Department of Soil and Environmental Sciences, College of Agriculture and Natural Resources, National Chung Hsing University, Taichung 40227, Taiwan;
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Cunha TDS, Rodriguez A, Heilberg IP. Influence of socioeconomic disparities, temperature and humidity in kidney stone composition. J Bras Nefrol 2020; 42:454-460. [PMID: 32716471 PMCID: PMC7860642 DOI: 10.1590/2175-8239-jbn-2019-0206] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Large variations in demographic, economic and environmental factors might influence the worldwide distribution of urolithiasis, but scarce data are available concerning their associations with stone composition. We aimed to evaluate the frequency and composition of kidney stones and their associations with temperature, humidity, and human development index (HDI). MATERIALS AND METHODS A total of 1,158 stones from distinct patients (47±14 years old, male/female 2:1) were included. The mean annual temperature and relative humidity of each town were considered separately. RESULTS Calcium oxalate monohydrate (COM) was disclosed in 38.8% of patients, calcium oxalate dihydrate (COD) in 22.1%, mixed COD/apatite in 9.4%, pure apatite in 1.9%, brushite in 1.8%, struvite in 8.3%, pure uric acid in 11.1%, mixed uric acid/COM in 5.6%, and cystine/rare types in 0.8%. Mean HDI of all pooled cities was 0.780±0.03. However, people living in HDI<0.800 regions had twice the odds of having a struvite stone versus those living in HDI>0.800 (OR=2.14, 95% CI 1.11-4.11). Furthermore, a progressive increase in the struvite stones frequency from 4.5 to 22.8% was detected from HDI>0.800 through HDI<0.700. No significant difference for other stone types was disclosed. Separate logistic regression models assessed the association of each stone composition with gender, temperature, humidity and HDI as covariates. CONCLUSION Patients living in low HDI areas are more prone to develop struvite stones, possibly due to lower access to healthcare. Temperature and humidity did not represent a specific risk factor for any stone type in the present sample.
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Affiliation(s)
- Tamara da Silva Cunha
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil.,Universidade Federal do Rio de Janeiro, Divisão de Nefrologia, Rio de Janeiro, RJ, Brazil
| | - Adrian Rodriguez
- Universita Cattolica del Sacro Cuore, Department of Medical Sciences, Rome, Italy
| | - Ita Pfeferman Heilberg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Divisão de Nefrologia, São Paulo, SP, Brazil
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Abstract
Infection stones are complex aggregates of crystals amalgamated in an organic matrix that are strictly associated with urinary tract infections. The management of patients who form infection stones is challenging owing to the complexity of the calculi and high recurrence rates. The formation of infection stones is a multifactorial process that can be driven by urine chemistry, the urine microenvironment, the presence of modulator substances in urine, associations with bacteria, and the development of biofilms. Despite decades of investigation, the mechanisms of infection stone formation are still poorly understood. A mechanistic understanding of the formation and growth of infection stones - including the role of organics in the stone matrix, microorganisms, and biofilms in stone formation and their effect on stone characteristics - and the medical implications of these insights might be crucial for the development of improved treatments. Tools and approaches used in various disciplines (for example, engineering, chemistry, mineralogy, and microbiology) can be applied to further understand the microorganism-mineral interactions that lead to infection stone formation. Thus, the use of integrated multidisciplinary approaches is imperative to improve the diagnosis, prevention, and treatment of infection stones.
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