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Prochaska M, Menezes C, Ko BS, Coe F, Worcester E. Contribution of thick ascending limb and distal convoluted tubule to glucose-induced hypercalciuria in healthy controls. Am J Physiol Renal Physiol 2023; 325:F811-F816. [PMID: 37823200 PMCID: PMC10874680 DOI: 10.1152/ajprenal.00130.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Abstract
Carbohydrates increase kidney stone risk and increase urine calcium and magnesium. We hypothesize that the effects of glucose as an allosteric modulator of calcium-sensing receptors may mediate this effect. Six healthy subjects were on a low-sodium diet before consuming 100 g of glucose beverage. Timed fasting (3) and postglucose (6) urine and blood samples were collected every 30 min. Urine composition and serum markers were measured and microvesicular abundance of tubular transport proteins (NHE3, NKCC2, NCC, and TRPV5) were quantified. Postglucose, serum glucose, and insulin rose rapidly with a parallel increase in calcium and magnesium excretion and no change in fractional excretion of sodium. Both serum parathyroid hormone (PTH) and urine TRPV5 fell in the postglucose periods. The rise in the calcium and magnesium excretion likely occurred primarily in the thick ascending limb where they are both under control of the calcium-sensing receptor. The fall in PTH and TRPV5 support the role of glucose as an allosteric modulator of calcium-sensing receptor.NEW & NOTEWORTHY Sugar increases urine calcium and magnesium as well as kidney stone and bone disease risk. Our study provided new insights into the underlying mechanism as we gave healthy subjects an oral glucose load and used newer tools such as fractional excretion of lithium, serum parathyroid hormone, and microvesicular abundance of tubular transport proteins to characterize the mechanism and identify the thick ascending limb with possible calcium-sensing receptor mediation as a likely contributor to this mechanism.
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Affiliation(s)
- Megan Prochaska
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Cameron Menezes
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Benjamin S Ko
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Fredric Coe
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
| | - Elaine Worcester
- Department of Medicine, Section of Nephrology, University of Chicago, Chicago, Illinois, United States
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Gutbrod J, Keys McKay CC, Coe L, Bergsland K, Coe F, Worcester E, Prochaska M. Clinical Effectiveness of Calcium Oxalate Stone Treatments. Am J Nephrol 2022; 53:761-766. [PMID: 36412567 PMCID: PMC9877156 DOI: 10.1159/000527940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Lowering kidney stone risk and urine calcium oxalate supersaturation is a primary clinical focus for kidney stone prevention and can be achieved with multiple strategies. Common strategies include advice to increase fluid intake, restrict dietary sodium, or prescribing a thiazide-type diuretic. We investigated how physicians make these decisions in real-world practice and evaluate their efficacy based on 24-h urine collections. METHODS We reviewed medical charts for 203 kidney stone formers with idiopathic calcium stones from University of Chicago Kidney Stone Clinic between 2005 and 2020. Patients had three 24-h urines before an initial pre-treatment clinic visit and one follow-up 24-h urine. We analyzed changes in urine composition based on treatment advice using t tests and ANOVA. RESULTS Patients who received advice to increase fluid intake had lower urine volume at baseline (1.5 vs. 2.5 L/day, p < 0.001) and larger increase in urine volume at follow-up (0.6 vs. 0.1 L/day, p < 0.001) compared to those who did not receive the advice. Patients who were advised to restrict dietary sodium had a higher urine sodium at baseline (208 vs. 139 mEq/day, p < 0.001), a larger reduction in urine sodium (-28 vs. 13 mEq/day, p = 0.002), and larger reduction in urine calcium (-74 vs. -28 mg/day, p = 0.005) compared with those not advised to restrict dietary sodium. Patients started on a thiazide had a higher baseline urine calcium (281 vs. 213 mg/day) and larger reduction in urine calcium (-83 vs. -9 mg/day, p < 0.001) compared with patients not started on a thiazide. In combination, thiazide prescriptions with dietary sodium restriction reduced urine calcium by 99 mg/day and reduced calcium oxalate supersaturation from 8.0 to 5.5 and calcium phosphate supersaturation from 1.4 to 1.0. CONCLUSION Providers use 24-h urine data to guide treatment strategy decisions. These strategies achieved the intended effects on urine composition and lowered kidney stone risk.
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Affiliation(s)
- Joseph Gutbrod
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Lillian Coe
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kristin Bergsland
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Fredric Coe
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elaine Worcester
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Megan Prochaska
- Department of Medicine, Section of Nephrology, University of Chicago Medicine, Chicago, Illinois, USA
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Bianco J, Chu F, Bergsland K, Coe F, Worcester E, Prochaska M. What treatments reduce kidney stone risk in patients with bowel disease? Urolithiasis 2022; 50:557-565. [PMID: 35976425 PMCID: PMC9972896 DOI: 10.1007/s00240-022-01352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
We examined how physicians made therapeutic choices to decrease stone risk in patients with bowel disease without colon resection, many of whom have enteric hyperoxaluria (EH), at a single clinic. We analyzed clinic records and 24-h urine collections before and after the first clinic visit, among 100 stone formers with bowel disease. We used multivariate linear regression and t tests to compare effects of fluid intake, alkali supplementation, and oxalate-focused interventions on urine characteristics. Patients advised to increase fluid intake had lower initial urine volumes (L/day; 1.3 ± 0.5 vs. 1.7 ± 0.7) and increased volume more than those not so advised (0.7 ± 0.6 vs. 0.3 ± 0.6 p = 0.03; intervention vs. non-intervention). Calcium oxalate supersaturation (CaOx SS) fell (95% CI -4.3 to -0.8). Alkali supplementation increased urine pH (0.34 ± 0.53 vs. 0.22 ± 0.55, p = 0.26) and urine citrate (mg/d; 83 ± 256 vs. 98 ± 166, p = 0.74). Patients advised to reduce oxalate (mg/day) absorption had higher urine oxalate at baseline (88 ± 44 vs. 50 ± 26) which was unchanged on follow-up (88 (baseline) vs. 91 (follow-up), p = 0.90). Neither alkali (95% CI -1.4 to 2.1) nor oxalate-focused advice (95% CI -1.2 to 2.3) lowered CaOx SS. Physicians chose treatments based on baseline urine characteristics. Advice to increase fluid intake increased urine volume and decreased CaOx SS. Alkali and oxalate interventions were ineffective.
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Affiliation(s)
- Julianna Bianco
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Francesca Chu
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Kristin Bergsland
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Fredric Coe
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Elaine Worcester
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Megan Prochaska
- Department of Medicine, Nephrology Section/MC 5100, University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Huo J, Li D, McKay C, Hoke M, Worcester E, Coe F. Relative contributions of urine sulfate, titratable urine anion, and GI anion to net acid load and effects of age. Physiol Rep 2021; 9:e14870. [PMID: 34042292 PMCID: PMC8157790 DOI: 10.14814/phy2.14870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Models of acid–base balance include acid production from (1) oxidation of sulfur atoms on amino acids and (2) metabolically produced organic acid anions. Acid load is balanced by alkali from metabolism of GI anions; thus, net acid production is equivalent to the sum of urine sulfate and organic anion (measured by titration in urine), minus GI anion. However, the relative contributions of these three sources of acid production in people eating free choice diets, and presumably in acid–base balance, have not been well studied. We collected 26 urines from 18 normal subjects (10 male) and 43 urine samples from 34 stone formers (17 male) and measured sulfate, organic anion, and components of GI anion and acid excretion in each; values were expressed as mEq/mmol creatinine. Mean values of the urine components, except creatinine and pH, did not differ between the sexes or groups. Urine organic acid and acid production varied directly with age (p ≤ 0.03). In a general linear model of acid excretion, the coefficients for sulfate, organic anion, and GI anion were 0.34 ± 0.09, 0.49 ± 0.12, and −0.51 ± 0.06, respectively, p ≤ 0.005, and the model accounted for 54% of the variance. A model for urine ammonia gave similar results. Urine organic anion is a significant contributor to total acid production and may be responsible for an increase in acid production with age.
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Affiliation(s)
- Jenny Huo
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Daniel Li
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Charles McKay
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Madeleine Hoke
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Elaine Worcester
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Fredric Coe
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
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Betz M, Coe F. Correlation Between Dietary Components Measured in 24-hour Urine Tests and Food Records in Nephrology Patients. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The surgical creation of an artery-vein connection via a Brachicephalic fistula (BCF) in patients with end stage renal disease (ESRD) provides a unique opportunity to study blood vessel response mechanisms to extreme hemodynamic conditions in relatively short timeframes. After BCF creation, the flow rate in the vein increases by an order of magnitude leading to separated flows and corresponding abnormally low, or negative, wall shear stress (WSS) in the curved arch segment of the cephalic vein. Locations of abnormally low WSS are shown to correlate with development of neointimal hyperplasia (NH) and subsequent stenosis. It is found that the stenosis, prior to a surgical intervention, restores the normal physiological WSS in the vein. As a result, this investigation provides evidence that the adaptation principle, known to apply in the arterial system, is also valid in the venous system. A novel graphical method is developed that combines clinical and computational data to assist in interpreting these physiological mechanisms including adaptation that lead to changes in vein geometry over time.
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Affiliation(s)
- M E Boghosian
- a Fluid Dynamic Research Center, Department of Mechanical , Materials, and Aerospace Engineering, Illinois Institute of Technology , Chicago , IL , USA
| | - M S Hammes
- b Section of Nephrology, Department of Medicine , University of Chicago , Chicago , IL , USA
| | - K W Cassel
- a Fluid Dynamic Research Center, Department of Mechanical , Materials, and Aerospace Engineering, Illinois Institute of Technology , Chicago , IL , USA
| | - S M J Akherat
- a Fluid Dynamic Research Center, Department of Mechanical , Materials, and Aerospace Engineering, Illinois Institute of Technology , Chicago , IL , USA
| | - F Coe
- b Section of Nephrology, Department of Medicine , University of Chicago , Chicago , IL , USA
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Armstrong A, Coe F, Frank S, Howell S, Wright P, Mccabe Y, Morris D, Wardley A. (Neo)Adjuvant Carboplatin-Based Chemotherapy in the Treatment of Triple Negative Early Breast Cancer – Experience at a single UK Institution. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30543-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cohen A, Adamsky M, McGinnis J, Bergsland K, Coe F, Worcester E, Zisman A. MP95-16 RACIAL DIFFERENCES IN URINARY METABOLIC RISK FACTORS FOR NEPHROLITHIASIS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Williams J, Borofsky M, Evan A, Coe F, Worcester E, Lingeman J. MP19-12 PAPILLARY DUCTAL PLUGGING AS A MECHANISM FOR EARLY STONE RETENTION IN BRUSHITE STONE DISEASE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hammes M, Boghosian M, Cassel K, Watson S, Funaki B, Doshi T, Mahmoudzadeh Akherat SMJ, Hines J, Coe F. Increased Inlet Blood Flow Velocity Predicts Low Wall Shear Stress in the Cephalic Arch of Patients with Brachiocephalic Fistula Access. PLoS One 2016; 11:e0152873. [PMID: 27074019 PMCID: PMC4830603 DOI: 10.1371/journal.pone.0152873] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/21/2016] [Indexed: 11/24/2022] Open
Abstract
Background An autogenous arteriovenous fistula is the optimal vascular access for hemodialysis. In the case of brachiocephalic fistula, cephalic arch stenosis commonly develops leading to access failure. We have hypothesized that a contribution to fistula failure is low wall shear stress resulting from post-fistula creation hemodynamic changes that occur in the cephalic arch. Methods Twenty-two subjects with advanced renal failure had brachiocephalic fistulae placed. The following procedures were performed at mapping (pre-operative) and at fistula maturation (8–32 weeks post-operative): venogram, Doppler to measure venous blood flow velocity, and whole blood viscosity. Geometric and computational modeling was performed to determine wall shear stress and other geometric parameters. The relationship between hemodynamic parameters and clinical findings was examined using univariate analysis and linear regression. Results The percent low wall shear stress was linearly related to the increase in blood flow velocity (p < 0.01). This relationship was more significant in non-diabetic patients (p < 0.01) than diabetic patients. The change in global measures of arch curvature and asymmetry also evolve with time to maturation (p < 0.05). Conclusions The curvature and hemodynamic changes during fistula maturation increase the percentage of low wall shear stress regions within the cephalic arch. Low wall shear stress may contribute to subsequent neointimal hyperplasia and resultant cephalic arch stenosis. If this hypothesis remains tenable with further studies, ways of protecting the arch through control of blood flow velocity may need to be developed.
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Affiliation(s)
- Mary Hammes
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, United States of America
- * E-mail:
| | - Michael Boghosian
- Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Kevin Cassel
- Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Sydeaka Watson
- Department of Public Health Sciences, Biostatistics Laboratory, The University of Chicago, Chicago, IL, United States of America
| | - Brian Funaki
- Department of Radiology, The University of Chicago, Chicago, IL, United States of America
| | - Taral Doshi
- Department of Radiology, The University of Chicago, Chicago, IL, United States of America
| | - S. M. Javid Mahmoudzadeh Akherat
- Department of Mechanical, Materials and Aerospace Engineering, Illinois Institute of Technology, Chicago, IL, United States of America
| | - Jane Hines
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, United States of America
| | - Fredric Coe
- Department of Medicine, Nephrology Section, The University of Chicago, Chicago, IL, United States of America
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Williams JC, Borofsky MS, Evan AP, Coe F, Worcester E, Lingeman JE. MP58-02 NOVEL INSIGHT INTO STONE FORMATION MECHANISMS USING MICRO CT: VERIFICATION THAT RANDALL’S PLAQUES AND DUCTAL PLUGS CAN PRODUCE CLINICALLY SIGNIFICANT STONES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ennis J, Gillen D, Rubenstein A, Worcester E, Brecher ME, Asplin J, Coe F. Clinical decision support improves physician guideline adherence for laboratory monitoring of chronic kidney disease: a matched cohort study. BMC Nephrol 2015; 16:163. [PMID: 26471846 PMCID: PMC4608162 DOI: 10.1186/s12882-015-0159-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/05/2015] [Indexed: 01/12/2023] Open
Abstract
Background Guidelines exist for chronic kidney disease (CKD) but are not well implemented in clinical practice. We evaluated the impact of a guideline-based clinical decision support system (CDSS) on laboratory monitoring and achievement of laboratory targets in stage 3–4 CKD patients. Methods We performed a matched cohort study of 12,353 stage 3–4 CKD patients whose physicians opted to receive an automated guideline-based CDSS with CKD-related lab results, and 42,996 matched controls whose physicians did not receive the CDSS. Physicians were from US community-based physician practices utilizing a large, commercial laboratory (LabCorp®). We compared the percentage of laboratory tests obtained within guideline-recommended intervals and the percentage of results within guideline target ranges between CDSS and non-CDSS patients. Laboratory tests analyzed included estimated glomerular filtration rate, plasma parathyroid hormone, serum calcium, phosphorus, 25-hydroxy vitamin D (25-D), total carbon dioxide, transferrin saturation (TSAT), LDL cholesterol (LDL-C), blood hemoglobin, and urine protein measurements. Results Physicians who used the CDSS ordered all CKD-relevant testing more in accord with guidelines than those who did not use the system. Odds ratios favoring CDSS ranged from 1.29 (TSAT) to 1.88 (serum phosphorus) [CI, 1.20 to 2.01], p < 0.001 for all tests. The CDSS impact was greater for primary care physicians versus nephrologists. CDSS physicians met guideline targets for LDL-C and 25-D more often, but hemoglobin targets less often, than non-CDSS physicians. Use of CDSS did not impact guideline target achievement for the remaining tests. Conclusions Use of an automated laboratory-based CDSS may improve physician adherence to guidelines with respect to timely monitoring of CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0159-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer Ennis
- Litholink Corporation®, A LabCorp Company, Chicago, IL, USA.
| | - Daniel Gillen
- University of California at Irvine, Irvine, CA, USA.
| | | | | | - Mark E Brecher
- Laboratory Corporation of America® Holdings, Burlington, NC, USA.
| | - John Asplin
- Litholink Corporation®, A LabCorp Company, Chicago, IL, USA.
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Anderson B, Pearce S, Zisman A, Worcester E, Coe F, Gerber G. MP80-10 URETEROSCOPIC GRADING SYSTEM FOR RENAL PAPILLAE: IMPLICATIONS ON ETIOLOGY OF STONE FORMATION AND RECURRENCE. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.2846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ennis J, Worcester E, Coe F. Contribution of calcium, phosphorus and 25-hydroxyvitamin D to the excessive severity of secondary hyperparathyroidism in African-Americans with CKD. Nephrol Dial Transplant 2012; 27:2847-53. [DOI: 10.1093/ndt/gfs080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evan A, Lingeman J, Coe F, Sommer A, Williams J, Worcester E. 2075 CHARACTERISTICS AND METABOLIC CORRELATIONS OF A NOVEL INTERSTITIAL DEPOSIT IN PATIENTS WHO FORM HYDROXY-APATITE STONES. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ennis J, Asplin J, Donahue S, Worcester E, Coe F. 88: Physicians Using a Computer Guidance System Based on KDOQI Guidelines Appear to Regulate Systolic Blood Pressure Around the Recommended Target of 130 mmHg. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ennis J, Asplin J, Donahue S, Worcester E, Coe F. 87: Corrected Serum Calcium but not Phosphate Correlates With Change in Serum PTH in Treatment of Stages 3-5 CKD. Am J Kidney Dis 2010. [DOI: 10.1053/j.ajkd.2010.02.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Evan AP, Lingeman J, Coe F, Shao Y, Miller N, Matlaga B, Phillips C, Sommer A, Worcester E. Renal histopathology of stone-forming patients with distal renal tubular acidosis. Kidney Int 2007; 71:795-801. [PMID: 17264873 DOI: 10.1038/sj.ki.5002113] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.
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Affiliation(s)
- A P Evan
- Department of Anatomy and Cell Biology, Indiana University, School of Medicine, and Department of Urology, Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46223, USA.
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Worcester E, Evan A, Bledsoe S, Lyon M, Chuang M, Orvieto M, Gerber G, Coe F. Pathophysiological correlates of two unique renal tubule lesions in rats with intestinal resection. Am J Physiol Renal Physiol 2006; 291:F1061-9. [PMID: 17028259 DOI: 10.1152/ajprenal.00033.2006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rats with small bowel resection fed a high-oxalate diet develop extensive deposition of calcium oxalate (CaOx) and calcium phosphate crystals in the kidney after 4 mo. To explore the earliest sites of renal crystal deposition, rats received either small bowel resection or transection and were then fed either standard chow or a high-oxalate diet; perfusion-fixed renal tissue from five rats in each group was examined by light microscopy at 2, 4, 8, and 12 wk. Rats fed the high-oxalate diet developed birefringent microcrystals at the brush border of proximal tubule cells, with or without cell damage; the lesion was most common in rats with both resection and a high-oxalate diet (10/19 with the lesion) and was significantly correlated with urine oxalate excretion (P < 0.001). Rats with bowel resection fed normal chow had mild hyperoxaluria but high urine CaOx supersaturation; four of these rats developed birefringent crystal deposition with tubule plugging in inner medullary collecting ducts (IMCD). Two rats fed a high-oxalate diet also developed this lesion, which was correlated with CaOx supersaturation, but not oxalate excretion. Tissue was examined under oil immersion, and tiny birefringent crystals were noted on the apical surface of IMCD cells only in animals with IMCD crystal plugging. In one animal, IMCD crystals were both birefringent and nonbirefringent, suggesting a mix of CaOx and calcium phosphate. Overall, these animals demonstrate two distinct sites and mechanisms of renal crystal deposition and may help elucidate renal lesions seen in humans with enteric hyperoxaluria and stones.
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Affiliation(s)
- Elaine Worcester
- Nephrology Section/MC 5100, Univ. of Chicago, 5841 South Maryland Ave., Chicago, IL 60637, USA.
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Asplin J, Parks J, Lingeman J, Kahnoski R, Mardis H, Lacey S, Goldfarb D, Grasso M, Coe F. Supersaturation and stone composition in a network of dispersed treatment sites. J Urol 1998; 159:1821-5. [PMID: 9598467 DOI: 10.1016/s0022-5347(01)63164-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We determined the validity of urine supersaturation assessed from 2, 24-hour urine collections from outpatients eating uncontrolled diets and receiving care at a network of treatment sites that uses a central laboratory. We compared supersaturation to stone composition to determine whether supersaturation values correlate with composition. MATERIALS AND METHODS Two 24-hour urine samples collected from 183 patients at 6 treatment sites were shipped to a single central laboratory. Complexations and crystallizations in vitro from aging during the transport step were interrupted by pH change in acid and alkaline directions. Relevant analytes were measured, and supersaturation was calculated for calcium oxalate, calcium phosphate as brushite and uric acid. Stone analysis was done at various laboratories. RESULTS Urine supersaturation values correlated well with stone composition. Higher calcium phosphate and uric acid supersaturation was noted when stones contained higher amounts of calcium phosphate and any uric acid, respectively. In a validation study values of relevant urine materials were unchanged after 48 hours of aging. CONCLUSIONS Despite the need for sample transport, resulting in the inevitable aging of samples, and variations in diet and details of sample collection, supersaturation values measured in only 2, 24-hour urine collections accurately reflected stone composition. This finding indicates that supersaturation values are reasonably stable in most patients during the months to years required for stones to form. In addition, samples collected in standard practice settings and sent to a central laboratory may accurately reflect these supersaturation values.
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Affiliation(s)
- J Asplin
- Renal Section, University of Chicago, Illinois, USA
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Abstract
Although the anatomical and physiological changes of normal pregnancy may predispose to kidney stone formation, it remains an uncommon occurrence. Correct diagnosis is often difficult. Ultrasonography has become the primary radiological diagnostic tool, with a limited excretory urogram only necessary in complicated cases. Nephrolithiasis during pregnancy occurs more frequently during the later stages of gestation, in multiparas, and without a difference in laterality. Conservative management with bed rest, hydration and analgesia can result in spontaneous passage of most stones in gravidas. Past experience of several groups suggests that cystoscopy and/or surgery can usually be done safely when absolutely necessary. Pre-existing stone disease can increase the incidence of maternal urinary tract infections by 10-20%. The most common obstetric complications of stones during gestation is premature labour induced by renal colic. Most drugs normally used to treat stone disease are contraindicated in gestation. Known inhibitors of stone formation are present in gestation and may partially explain why the incidence of stones is not increased in this hypercalciuric state.
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Affiliation(s)
- P Maikranz
- Indiana University School of Medicine, Indianapolis 46219
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Affiliation(s)
- F Coe
- Nephrology Section, University of Chicago, Illinois
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Parks J, Coe F, Favus M. Hyperparathyroidism in nephrolithiasis. Arch Intern Med 1980; 140:1479-81. [PMID: 7436644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We found primary hyperparathyroidism in 56 of 1,132 consecutive patients with nephrolithiasis. We describe 48 of these patients who have undergone curative parathyroidectomy. Thirty of the 48 patients had extremely mild hypercalcemia (serum calcium level, 10.15 to 10.95 mg/dL), often accompanied by very substantial hypercalciuria. Stone disease was of equal severity in these 30 patients and in the 18 with more pronounced hypercalcemia (serum calcium level above 11 mg/dL). In all 48 patients, recurrent stone formation was virtually abolished by parathyroidectomy.
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Sitrin MD, Rosenberg IH, Chawla K, Meredith S, Sellin J, Rabb JM, Coe F, Kirsner JB, Kraft SC. Nutritional and metabolic complications in a patient with Crohn's disease and ileal resection. Gastroenterology 1980; 78:1069-79. [PMID: 7380180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Gaeke RF, Kaplan EL, Lindheimer MD, Coe F, Shen KL. Maternal primary hyperparathyroidism of pregnancy. Successful treatment by parathyroidectomy. JAMA 1977; 238:508-9. [PMID: 577577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Primary hyperparathyroidism of pregnancy may result in spontaneous abortion, neonatal hypocalcemia, or neonatal tetany if appropriate treatment is not instituted. Of great importance in prevention of these complications is an awareness by physicians that this disease exists and is of clinical importance. Parathyroidectomy performed during the second trimester of pregnancy offers the best chance for fetal and neonatal survival. This operation results in little risk to either the mother or the fetus. Normal calcium homeostasis is restored to the fetus and the risk of hypocalcemia in the neonatal period is virtually eliminated.
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