Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group.

Science.gov (United States)

Prezioso, Domenico; Strazzullo, Pasquale; Lotti, Tullio; Bianchi, Giampaolo; Borghi, Loris; Caione, Paolo; Carini, Marco; Caudarella, Renata; Ferraro, Manuel; Gambaro, Giovanni; Gelosa, Marco; Guttilla, Andrea; Illiano, Ester; Martino, Marangella; Meschi, Tiziana; Messa, Piergiorgio; Miano, Roberto; Napodano, Giorgio; Nouvenne, Antonio; Rendina, Domenico; Rocco, Francesco; Rosa, Marco; Sanseverino, Roberto; Salerno, Annamaria; Spatafora, Sebastiano; Tasca, Andrea; Ticinesi, Andrea; Travaglini, Fabrizio; Trinchieri, Alberto; Vespasiani, Giuseppe; Zattoni, Filiberto

2015-07-07

stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. HYPEROXALURIA: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults) reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. HYPERURICOSURIA: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. HYPOCITRATURIA: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content) increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime) and non citrus fruits (melon) are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems reasonable to advice a balanced consumption of fruit and vegetables and a low

Dietary treatment of urinary risk factors for renal stone formation. A review of CLU Working Group

Directory of Open Access Journals (Sweden)

Domenico Prezioso

2015-07-01

different origin decreases calciuria, but their impact on the urinary stone risk profile is uncertain. Sports beverage do not affect the urinary stone risk profile. Hyperoxaluria: A diet low in oxalate and/or a calcium intake normal to high (800-1200 mg/day for adults reduce the urinary excretion of oxalate, conversely a diet rich in oxalates and/or a diet low in calcium increase urinary oxalate. A restriction in protein intake may reduce the urinary excretion of oxalate although a vegetarian diet may lead to an increase in urinary oxalate. Adding bran to a diet low in oxalate cancels its effect of reducing urinary oxalate. Conversely, the addition of supplements of fruit and vegetables to a mixed diet does not involve an increased excretion of oxalate in the urine. The intake of pyridoxine reduces the excretion of oxalate. Hyperuricosuria: In patients with renal calcium stones the decrease of the urinary excretion of uric acid after restriction of dietary protein and purine is suggested although not clearly demonstrated. Hypocitraturia: The administration of alkaline-citrates salts is recommended for the medical treatment of renal stone-formers with hypocitraturia, although compliance to this treatment is limited by gastrointestinal side effects and costs. Increased intake of fruit and vegetables (excluding those with high oxalate content increases citrate excretion and involves a significant protection against the risk of stone formation. Citrus (lemons, oranges, grapefruit, and lime and non citrus fruits (melon are natural sources of dietary citrate, and several studies have shown the potential of these fruits and/or their juices in raising urine citrate levels. Children: There are enought basis to advice an adequate fluid intake also in children. Moderate dietary salt restriction and implementation of potassium intake are useful in limiting urinary calcium excretion whereas dietary calcium restriction is not recommended for children with nephrolithiasis. It seems

EPR of some irradiated renal stones

International Nuclear Information System (INIS)

Koeseoglu, R.; Koeseoglu, E.; Koeksal, F.; Basaran, E.; Demirci, D.

2005-01-01

Some renal stones were investigated by electron paramagnetic resonance of their untreated, UV-photolyzed and gamma-irradiated states. Powder X-ray diffraction technique indicated that the renal stones were made mainly from CaC 2 O 4 , MgC 2 O 4 , MgCO 3 and NH 4 MgPO 4 .6H 2 O. Before radiation treatment, the renal stones yielded a signal that could be attributed to a C 2 O 4 - radical. UV-photolysis seems to slightly increase the intensity of this signal, but does not produce any new centres. Gamma-irradiation initially gives -CH 2 C (CH 3 )-R and CO 2 - radicals, and while the intensity of the -CH 2 C (CH 3 )-R signal decreases, the intensity of the CO 2 - signal increases as time elapses

Renal geology (quantitative renal stone analysis) by 'Fourier transform infrared spectroscopy'.

Science.gov (United States)

Singh, Iqbal

2008-01-01

To prospectively determine the precise stone composition (quantitative analysis) by using infrared spectroscopy in patients with urinary stone disease presenting to our clinic. To determine an ideal method for stone analysis suitable for use in a clinical setting. After routine and a detailed metabolic workup of all patients of urolithiasis, stone samples of 50 patients of urolithiasis satisfying the entry criteria were subjected to the Fourier transform infrared spectroscopic analysis after adequate sample homogenization at a single testing center. Calcium oxalate monohydrate and dihydrate stone mixture was most commonly encountered in 35 (71%) followed by calcium phosphate, carbonate apatite, magnesium ammonium hexahydrate and xanthine stones. Fourier transform infrared spectroscopy allows an accurate, reliable quantitative method of stone analysis. It also helps in maintaining a computerized large reference library. Knowledge of precise stone composition may allow the institution of appropriate prophylactic therapy despite the absence of any detectable metabolic abnormalities. This may prevent and or delay stone recurrence.

21 CFR 876.4650 - Water jet renal stone dislodger system.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Water jet renal stone dislodger system. 876.4650... (CONTINUED) MEDICAL DEVICES GASTROENTEROLOGY-UROLOGY DEVICES Surgical Devices § 876.4650 Water jet renal stone dislodger system. (a) Identification. A water jet renal stone dislodger system is a device used to...

The study on the factors for detection of renal stone on ultrasound

International Nuclear Information System (INIS)

Sim, Hyun Sun; Jung, Hong Ryang; Lim, Cheong Hwan

2006-01-01

Renal stones are common and typically arise within the collecting system. The renal sinus are contains the collection system, the renal vessels, lymphatcs, fat, and fibrous tissue. Because of the compression of all the large echoes in signal processing, the echo from the renal stone generally cannot be distinguished from large echoes emanating from normal structures of the renal sinus. Use of ultrasonography has been difficult for detecting small renal stone without posterior shadowing and chemical composition of stone. The aim of study was measuring for posterior acoustic shadowing to a stone for various scan parameter and it examines a help in renal stone diagnosis. The stone was place on sponge examined in a water bath with a 3.5 MHz or 7.5 HMz transducer (LOGIQ 400, USA). First, tested a variety of gain. Second, tested a variety of dynamic range. Third, tested a variety of focal zone. Fourth, measuring of the echo level for low and high frequency for depth. 1) Average echo level was 98 for low total gain (10 dB) and was 142 for high total gain (40 dB). Posterior acoustic shadowing of renal stone was clear for low gain. 2) Average echo level was 129 for low dynamic range (42 dB) and was 101 for high dynamic range (72 dB). Posterior acoustic shadowing of renal stone was clear for high dynamic range. 3) When stone is in focal zone of transducer, definite posterior acoustic shadow is identified. 4) Stone was clear appeared for high frequency (7.5 MHz) than low frequency (3.5 MHz) and it is not distorted. The demonstration of an posterior acoustic shadow of renal stone dependents on several technical factors such as gain, dynamic range, focus, and frequency. This various factors are a help in renal stone diagnosis

Screening and Management of Asymptomatic Renal Stones in Astronauts

Science.gov (United States)

Reyes, David; Locke, James; Sargsyan, Ashot; Garcia, Kathleen

2017-01-01

Management guidelines were created to screen and manage asymptomatic renal stones in U.S. astronauts. The true risk for renal stone formation in astronauts due to the space flight environment is unknown. Proper management of this condition is crucial to mitigate health and mission risks. The NASA Flight Medicine Clinic electronic medical record and the Lifetime Surveillance of Astronaut Health databases were reviewed. An extensive review of the literature and current aeromedical standards for the monitoring and management of renal stones was also done. This work was used to develop a screening and management protocol for renal stones in astronauts that is relevant to the spaceflight operational environment. In the proposed guidelines all astronauts receive a yearly screening and post-flight renal ultrasound using a novel ultrasound protocol. The ultrasound protocol uses a combination of factors, including: size, position, shadow, twinkle and dispersion properties to confirm the presence of a renal calcification. For mission-assigned astronauts, any positive ultrasound study is followed by a low-dose renal computed tomography scan and urologic consult. Other specific guidelines were also created. A small asymptomatic renal stone within the renal collecting system may become symptomatic at any time, and therefore affect launch and flight schedules, or cause incapacitation during a mission. Astronauts in need of definitive care can be evacuated from the International Space Station, but for deep space missions evacuation is impossible. The new screening and management algorithm has been implemented and the initial round of screening ultrasounds is under way. Data from these exams will better define the incidence of renal stones in U.S. astronauts, and will be used to inform risk mitigation for both short and long duration spaceflights.

[Pharmacotherapy for preventing calcium containing stone formation].

Science.gov (United States)

Nagata, Masao; Takayama, Tatsuya; Mugiya, Souichi; Ohzono, Seiichiro

2011-10-01

Many urinary tract stones consist of calcium, and has high relapse rate. Accordingly, it is very important to prevent calcium-containing stone formation. This paper describes about effects and mechanisms for Xanthine oxidase inhibitor, citrate formulation, magnesium formulation, thiazides, vitamin B(6), extract of Quercus salicina Blume and chorei-to (medical herb) . Recent new drugs and the elucidation of new metabolic pathways may lead to the development of prevention of urolithiasis.

Simplified methods for the evaluation of the risk of forming renal stones and the follow-up of stone-forming propensity during the preventive treatment of stone-formation.

Science.gov (United States)

Grases, Fèlix; Costa-Bauzá, Antonia

2016-02-01

Renal lithiasis is a complex multifactorial disease in which recurrence is common. Thus, simple and reliable procedures are needed to evaluate patients with previous kidney stones to determine the risk of recurrence. In this paper we review simple biochemical procedures that can be used to determine the risk for renal stone formation when the stone is available or unavailable for analysis. Our present knowledge of renal lithiasis indicates that renal stones form due to several well-defined factors. Analysis of the renal stone itself can provide important information about clinical factors that require further investigation. When the stone is unavailable, it is necessary to perform a general evaluation of main urinary risk factors associated to renal stone formation, but this study should be complemented considering information related to direct familial antecedents, recidivant degree, radiological images, medical history, and life style habits. Finally, tools for patient follow-up of stone-forming propensity during the preventive treatment are discussed .

Renal lithiasis and nutrition

Directory of Open Access Journals (Sweden)

Prieto Rafel M

2006-09-01

Full Text Available Abstract Renal lithiasis is a multifactorial disease. An important number of etiologic factors can be adequately modified trough diet, since it must be considered that the urine composition is directly related to diet. In fact, the change of inappropriate habitual diet patterns should be the main measure to prevent kidney stones. In this paper, the relation between different dietary factors (liquid intake, pH, calcium, phosphate, oxalate, citrate, phytate, urate and vitamins and each type of renal stone (calcium oxalate monohydrate papillary, calcium oxalate monohydrate unattached, calcium oxalate dihydrate, calcium oxalate dihydrate/hydroxyapatite, hydroxyapatite, struvite infectious, brushite, uric acid, calcium oxalate/uric acid and cystine is discussed.

Significance of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy in nonobstructive isolated renal pelvic stones.

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Sozen, Sinan; Kupeli, Bora; Acar, Cenk; Gurocak, Serhat; Karaoglan, Ustunol; Bozkirli, Ibrahim

2008-05-01

To investigate the probable effect of lower-pole pelvicaliceal anatomy on stone clearance after shockwave lithotripsy (SWL) in patients with nonobstructive renal pelvic stones. The clinical records of patients with isolated renal pelvic stones who underwent SWL between 1996 and 2005 were reviewed. After excluding patients with obstruction leading to dilatation, major anatomic abnormalities, noncalcium stones, metabolic abnormalities, history of recurrent stone disease, multiple stones, and previous renal surgery, 153 patients were enrolled in the study. Lower pole infundibulopelvic angle (IPA) and infundibular length and width were measured from intravenous urography. Patients were classified into three groups according to stone burden (group 1, renal pelvis, and both in 50 (32.6%), 29 (18.9%), and 8 (5.2%) patients, respectively. There was no statistically significant difference in pelvicaliceal anatomic features except narrower IPA (P=0.02) in group 1 patients with residual stones. The falling of stone fragments to the lower calix in spite of the ureter whether clinically significant or not after SWL of pelvic stones initially seems to be related to stone burden rather than lower caliceal anatomy. However, existence of a more narrow IPA in group 1 patients with residual fragments led us to believe that lower-pole IPA can play a role in stone clearance, especially for smaller stones, probably because of smaller residual fragment size or the more mobile nature of the primary stone.

[Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus].

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Qiao, Mingzhou; Zhang, Haifang; Zhou, Chenlong

2015-11-24

To explore the factors affecting the residual stones after percutaneous nephrolithotomy (PCNL) in patients with renal calculus. A retrospective analysis was performed for 1 200 patients who were affected by renal calculus and treated with PCNL between Jan 2008 and May 2014 in People's Hospital of Anyang City. Among those patients, 16 were diagnosed as bilateral renal stone and had two successive operations. The size, location and number of stones, previous history of surgery, the degree of hydronephrosis, urinary infection were included in the univariate analysis. Significant factors in univariate analysis were included in the multivariate analysis to determine factors affecting stone residual. A total of 385 cases developed stone residual after surgery. The overall residual rate was 31.7%. In univariate analysis, renal pelvis combined with caliceal calculus (P=0.006), stone size larger than 4 cm (P=0.005), stone number more than 4 (P=0.002), the amount of bleeding more than 200 ml (P=0.025), operation time longer than 120 minutes (P=0.028) were associated with an increased rate of stone residual. When subjected to the Cox multivariate analysis, the independent risk factors for residual stones were renal pelvis combined with caliceal calculus (P=0.049), stone size larger than 4 cm (P=0.038) and stone number more than 4 (P=0.018). Factors affecting the incidence of residual stones after PCNL are the size, location and number of stones. Larger size stone and the presence of renal pelvis combined with caliceal calculus are significantly associated with residual stones. Nevertheless, stone number less than 4 indicates an increased stone clearance rate.

Papillary Ductal Plugging is a Mechanism for Early Stone Retention in Brushite Stone Disease

DEFF Research Database (Denmark)

Williams, James C; Borofsky, Michael S; Bledsoe, Sharon B

2018-01-01

PURPOSE: Mechanisms of early stone retention in the kidney are under studied and poorly understood. To date attachment via Randall's plaque is the only widely accepted theory in this regard, which is best described in idiopathic calcium oxalate stone formers. Brushite stone formers are known...... to have distinct papillary morphology relative to calcium oxalate stone formers. As such we sought to determine whether stone attachment mechanisms in such patients may be similarly unique. MATERIALS AND METHODS: Patients undergoing percutaneous and or ureteroscopic procedures for stone removal consented...... to endoscopic renal papillary examination and individual stone collection. Each removed stone was processed using micro computerized tomography to assess the 3-dimensional microstructure and the minerals contained, and search for common structural features indicative of novel mechanisms of early growth...

Percutaneous nephrolithotomy for the treatment of radiolucent renal stones in children: is it different opaque stone treatment?

Science.gov (United States)

Adanur, Şenol; Ziypak, Tevfik; Sancaktutar, Ahmet Ali; Tepeler, Abdülkadir; Reşorlu, Berkan; Söylemez, Haluk; Dağgülli, Mansur; Özbey, İsa; Unsal, Ali

2014-02-01

We aimed to evaluate the effectiveness of percutaneous nephrolithotomy (PNL), stone-free rates, and related complications in children with radiolucent renal stones. A total of 56 patients aged auxillary treatment method was detected as 94.6%. The total complication rate was 19.6% (11 patients). No adjacent organ injury was observed. All of the complications that occurred were minor according to the Clavien classification (Clavien Grades I-II). PNL can be applied to radiolucent pediatric renal stones in children with similar success, and complication rates as noted for radiopaque stones.

Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

International Nuclear Information System (INIS)

Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon; Yoon, Seok Hwan

2006-01-01

We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications

Extracorporeal shock wave lithotripsy for renal stone with infundibular stenosis

Energy Technology Data Exchange (ETDEWEB)

Lee, Won Hong; Son, Soon Yong; Kang, Seong Ho; Lee, Yong Moon [Asan Medical Center, Seoul (Korea, Republic of); Yoon, Seok Hwan [Dongnam Health College, Suwon (Korea, Republic of)

2006-06-15

We analyzed retrospectively our experience to evaluate an effect of extracorporeal shock wave lithotripsy (ESWL) for renal stone with infundibular stenosis. From January 2002 to August 2005, 35 patients with renal stone with infundibular stenosis were treated with ESWL. The diagnosis of infundibular stenosis was made by intravenous pyelography or retrograde pyelography. The final follow-up check was performed by simple abdominal film or computed tomography and interview after 6 months to 24 months (mean 10 months). 7 (20.0%) of 35 patients was freed completely, but Stone free rate including less than 2 mm size was 80% (28/35). 30 (85.7%) patients became asymptomatic, 4 (11.4%) patients were continued, and 1 (2.9%) patient was required the percutaneous nephrostolithotomy. Although ESWL has a low complete stone free rate, We suggest that renal stone with infundibular stenosis should be treated with ESWL, because that is likely to produce a high symptom free and low complications.

Renal pelvic stones: choosing shock wave lithotripsy or percutaneous nephrolithotomy

Directory of Open Access Journals (Sweden)

Robert Marcovich

2003-06-01

Full Text Available Introduction of minimally invasive techniques has revolutionized the surgical management of renal calculi. Extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy are now both well-established procedures. Each modality has advantages and disadvantages, and the application of each should be based on well-defined factors. These variables include stone factors such as number, size, and composition; factors related to the stone's environment, including the stone's location, spatial anatomy of the renal collecting system, presence of hydronephrosis, and other anatomic variables, such as the presence of calyceal diverticula and renal anomalies; and clinical or patient factors like morbid obesity, the presence of a solitary kidney, and renal insufficiency. The morbidity of each procedure in relation to its efficacy should be taken in to account. This article will review current knowledge and suggest an algorithm for the rational management of renal calculi with shock wave lithotripsy and percutaneous nephrolithotomy.

Prevalence of renal uric acid stones in the adult.

Science.gov (United States)

Trinchieri, Alberto; Montanari, Emanuele

2017-12-01

The aim of this study was to estimate uric acid renal stone prevalence rates of adults in different countries of the world. PubMed was searched for papers dealing with "urinary calculi and prevalence or composition" for the period from January 1996 to June 2016. Alternative searches were made to collect further information on specific topics. The prevalence rate of uric acid stones was computed by the general renal stone prevalence rate and the frequency of uric acid stones in each country. After the initial search, 2180 papers were extracted. Out of them, 79 papers were selected after the reading of the titles and of the abstracts. For ten countries, papers relating to both the renal stone prevalence in the general population and the frequency of uric stones were available. Additional search produced 13 papers that completed information on 11 more countries in 5 continents. Estimated prevalence rate of uric acid stones was >0.75% in Thailand, Pakistan, Saudi Arabia, Iran, South Africa (white population), United States and Australia; ranged 0.50-0.75% in Turkey, Israel, Italy, India (Southern), Spain, Taiwan, Germany, Brazil; and uric acid stone formation. A hot and dry climate increases fluid losses reducing urinary volume and urinary pH. A diet rich in meat protein causes low urinary pH and increased uric acid excretion. On the other hand, uric acid stone formation is frequently associated with obesity, metabolic syndrome and diabetes type 2 that are linked to dietary energy excess mainly from carbohydrate and saturated fat and also present with low urine pH values. An epidemic of uric acid stone formation could be if current nutritional trends will be maintained both in developed countries and in developing countries and the areas of greater climatic risk for the formation of uric acid stones will enlarge as result of the "global warming".

Efficacy of the lithotripsy in treating lower pole renal stones.

Science.gov (United States)

Cui, Helen; Thomee, Eeke; Noble, Jeremy G; Reynard, John M; Turney, Benjamin W

2013-06-01

Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

Influence of Pelvicaliceal Anatomy on Stone Clearance After Flexible Ureteroscopy and Holmium Laser Lithotripsy for Large Renal Stones.

Science.gov (United States)

Inoue, Takaaki; Murota, Takashi; Okada, Shinsuke; Hamamoto, Shuzo; Muguruma, Kouei; Kinoshita, Hidefumi; Matsuda, Tadashi

2015-09-01

This study was performed to evaluate the impact of pelvicaliceal anatomy on stone clearance in patients with remnant fragments in the lower pole after flexible ureteroscopy and holmium laser lithotripsy (fURSL) for renal stones >15 mm. This retrospective study included 67 patients with radiopaque residual fragments (>2 mm) in the lower pole after fURSL for large renal stones (>15 mm). The preoperative infundibular length (IL), infundibular width (IW), infundibulopelvic angle (IPA), and caliceal pelvic height (CPH) were measured using intravenous urography. Multivariate analysis was performed to determine whether any of these measurements affected stone clearance. Of the 67 patients, 55 (82.1%) were stone free (SF) 3 months after fURSL. The anatomic factors significantly favorable for an SF status were a short IL, broad IW, wide IPA, and low CPH. On multivariate analysis, the IPA had a significant influence on an SF status after fURSL (p=0.010). An IPA renal stones according to our multivariate analysis. Additional studies are required to further evaluate the characteristics of the pelvicaliceal anatomy influencing stone clearance.

Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study.

Science.gov (United States)

Atalay, Hasan Anıl; Canat, Lutfi; Bayraktarlı, Recep; Alkan, Ilter; Can, Osman; Altunrende, Fatih

2017-06-23

We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.

Renal and prostate stones composition in alkaptonuria: a case report.

Science.gov (United States)

Wolff, Fleur; Biaou, Ibrahim; Koopmansch, Caroline; Vanden Bossche, Marc; Pozdzik, Agnieszka; Roumeguère, Thierry; Cotton, Frédéric

2015-12-01

Alkaptonuria is a genetic disorder characterized by an accumulation of homogentisic acid due to an enzymatic defect of homogentisate 1,2 dioxygenase. The homogentisic acid is excreted exclusively by both glomerular filtration and tubular secretion leading to the renal parenchyma being exposed to high concentrations of homogentisic acid. The alkaptonuric patients are at higher risk of renal stones (and of prostate stones for males), usually in the later stages of the disease. We describe the case of a 51-year-old man whose renal and prostate stones were analyzed by X-ray diffraction and infrared spectroscopy, respectively. We review the cases of alkaptonuria (AKU) patients reported in the literature for whom the composition of kidney or prostate stones was assessed with physical or chemical techniques. In this paper, we also discuss the advantages and drawbacks of the different methodologies.

Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

International Nuclear Information System (INIS)

Wang, Li-Jen; Wong, Yon-Cheong; Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen; See, Lai-Chu

2005-01-01

The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P 3 (P 3 (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

Relationship between the incidence infection stones and the magnesium-calcium ratio of tap water.

Science.gov (United States)

Kohri, K; Ishikawa, Y; Iguchi, M; Kurita, T; Okada, Y; Yoshida, O

1993-01-01

In a previous study we showed that the magnesium-calcium ratio of tap water is negatively correlated with the incidence of calcium-containing urinary stones. In this study we examined the relationship between the incidence of struvite stones, water hardness and the regional geological features on the basis of our previous study and an epidemiological study of urolithiasis performed in Japan. The magnesium-calcium ratio of tap water was found to correlate positively with the incidence of struvite stones. The tap water magnesium-calcium ratio was high in regions of basalt and sedimentary rock and was low in granite and limestone areas. The incidence of struvite stones in the regions of basalt and sedimentary rock was higher than that in the granite and limestone areas. Thus, this study suggested that the incidence of struvite stones is related to the magnesium-calcium ratio of tap water and to the regional geology, as is the case for calcium-containing stones.

Programmatic Considerations to Reduce the Risk of Adverse Renal Stone Events in Spaceflight

Science.gov (United States)

Antonsen, Erik; Pietrzyk, Robert

2017-01-01

Introduction: Microgravity exposure may alter the likelihood that astronauts will experience renal stones. The potential risk includes both acute and chronic health issues, with the potential for significant impact on mission objectives. Methods: To understand the role of the NASA's Human Research Program (HRP) research agenda in both preventing and addressing renal stones in spaceflight, current astronaut epidemiologic data and a summary of programmatic considerations are reviewed. Results: Although there has never been a symptomatic renal stone event in a U.S. crewmember during spaceflight, urine chemistry has been altered - likely due to induced changes in renal physiology as a result of exposure to microgravity. This may predispose astronauts to stone formation, leading the HRP to conduct and sponsor research to: 1) understand the risk of stone formation in space; 2) prevent stones from forming; and 3) address stones that may form by providing novel diagnostic and therapeutic approaches. Discussion: The development of a renal stone during spaceflight is a significant medical concern that requires the HRP to minimize this risk by providing the ability to prevent, diagnose, monitor and treat the condition during spaceflight. A discussion of the risk as NASA understands it is followed by an overview of the multiple mitigations currently under study, including novel ultrasound techniques for stone detection and manipulation, and how they may function as part of a larger exploration medical system.

Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis

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Wang, Li-Jen; Wong, Yon-Cheong [Chang Gung University, Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Taipei (Taiwan); Chuang, Cheng-Keng; Chu, Sheng-Hsien; Chen, Chih-Shou; Chiang, Yang-Jen [Chang Gung University, Department of Urology, Chang Gung Memorial Hospital, Taipei (Taiwan); See, Lai-Chu [Chang Gung University, Department of Biostatistics Center, Chang Gung Memorial Hospital, Taipei (Taiwan)

2005-11-01

The aim of our study is to analyze the relationships between the characteristics of renal stones determined by unenhanced helical computed tomography (UHCT) and their outcomes after extracorporeal shock wave lithotripsy (ESWL) as well as to predict ESWL outcomes of renal stones by their UHCT characteristics with the use of multivariate analysis. During a 7-month period, 80 adult patients with renal stones underwent ESWL as well as UHCT both before and 3 months after ESWL. Of the 80 patients, 42 patients were classified as ESWL successes and 38 as ESWL failures based on their post-ESWL UHCT findings. For pre-ESWL UHCT, a stone number of more than 2 (P=0.0236), a maximal stone size of greater than 12 mm (P<0.0001), a stone burden of more than 700 mm{sup 3} (P<0.0001), a maximal stone density of more than 900 HU (P=0.0008) and nonround/oval stones (P=0.0007) were associated with ESWL failure outcomes. Multivariate analysis demonstrated that a stone burden of more than 700 mm{sup 3} (P=0.0003), the presence of nonround/oval stones (P=0.0072) and a maximal stone density of more than 900 HU (P=0.0430) were statistically significant predictors of a failure outcome for ESWL. Thus, the analysis of stone characteristics of renal stones by UHCT is helpful in selecting appropriate patients undergoing ESWL for favorable outcomes and reduces the overall costs of the treatment of renal stones. (orig.)

Renal stone in crossed fused renal ectopia and its laparoscopic management: Case report and review of literature

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Santosh Agrawal

2016-01-01

Full Text Available Management of renal stone in crossed fused renal ectopia (CFRE is difficult because of abnormal location, malrotation, and its relations with vertebral column and small bowel. Management is not standardized because of the paucity of literature and variable anatomy. We managed an 8-year-old boy with multiple renal stones in right side crossed kidney by laparoscopic pyelolithotomy and nephro pyeloscopy with the help of ureteroscope. Until now, there is only one prior report of laparoscopic pyelolithotomy in CFRE. We share our experience in this case and review the literature regarding the management of kidney stones in this rare anomaly.

Frequency and factors effecting non clearance of lower pole renal stones

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Ullah, A.; Zubair, M.; Khan, N.; Malik, A.

2015-01-01

Renal stone disease is a major health hazard in Pakistan and extra-corporeal shockwave lithotripsy is one of comprehensive method used to treat these stones. The aim of this study is to determine the frequency of factors affecting the non-clearance of stone fragments of lower pole renal stone after extra corporeal shockwave lithotripsy. The study was done with the objective to determine the frequency the spatial anatomical factors which can influence the non-clearance of lower pole stone fragments after ESWL. Methods: One and nineteen (119) patients with lower pole renal stone less than 10 mm were subjected to maximum 3 sessions of extracorporeal shock wave lithotripsy. KUB radiographs, ultrasonography and intravenous urography were used as investigative tools for lower pole renal calyceal anatomy. X ray KUB and ultrasound were done after a week for clearance. Data was analysed with the help of SPSS version 10.0 and presented in the forms of tables and graphs. Results: There were 77 (64.71%) males and 42 (35.29%) females. Infundibulo-pelvic angle (IPA)>40 degree was present in 93 (78.15%), Infundibular length (IL) <22 mm in 107 (89.92%) and Infundibular width (IW) >4 mm was present in 100 (84.03%) patients. The frequency of stone non clearance was noted in 31 (26.05%). Infundibulo-pelvic angle (IPA)>40 degree (p=0.000), Infundibular length (IL)<22 mm (p=0.001) and Infundibular width (IW)>4 mm (p=0.046) were significant variables affecting stone clearance. Conclusion: The frequency of non-clearance of lower calyx of kidney stone is 26.05%. The clearance of fragments of the lower calyx kidney stones is affected by three spatial anatomical factors, i.e., Infundibulopelvic angle, Infundibular width and infundibular length. (author)

Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones.

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Al-Ansari, Abdulla; As-Sadiq, Khalid; Al-Said, Sami; Younis, Nagy; Jaleel, Osama A; Shokeir, Ahmed A

2006-01-01

To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.

Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

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Shahat, Ahmed; Elderwy, Ahmad; Safwat, Ahmed S; Abdelkawi, Islam F; Reda, Ahmed; Abdelsalam, Yasser; Sayed, Mohamed; Hammouda, Hisham

2016-04-01

We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones. A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation. Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649). Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

In vitro dissolution of calcium oxalate stones with ethylenediaminetetraacetic acid and snake venom thrombin-like enzyme.

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Zhou, Xiang-Jun; Zhang, Jie; Zhang, Ci; Xu, Chang-Geng

2014-01-01

The aim of this study was to determine the feasibility of using snake venom thrombin-like enzyme (SVTLE) and/or ethylenediaminetetraacetic acid (EDTA) to dissolve calcium oxalate stones in vitro. Seven calcium oxalate stones were incubated with various chemolytic agents [EDTA, Tris-HCl/EDTA (TE) buffer or SVTLE diluted in TE buffer]. The pH, calcium concentration, stone weight and stone surface integrity were recorded, as well as related pathological changes to bladder mucosae. Compared to all other solutions, those containing SVTLE and buffered EDTA had higher concentrations of mobilized calcium and caused significantly more stone weight loss, stone fragility and gaps in the calcium crystals. Also, there were no adverse pathological effects on rabbit bladder mucosae from any of the solutions. The data indicate that buffered EDTA and SVTLE can be used to dissolve calcium oxalate stones and, at the concentrations used here, do not damage tissue. 2013 S. Karger AG, Basel.

Retroperitoneoscopy for treatment of renal and ureteral stones.

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Soares, Rodrigo S; Romanelli, Pedro; Sandoval, Marcos A; Salim, Marcelo M; Tavora, Jose E; Abelha, David L

2005-01-01

To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42%) had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58%) had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71%) had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26%) also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%), a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days). The mean length of retroperitoneal urinary drainage was 3 days (1-10 days). There were minor complications in 6 (17.6%) patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94%) became stone free. Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

Retroperitoneoscopy for treatment of renal and ureteral stones

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Rodrigo S. Soares

2005-04-01

Full Text Available OBJECTIVE: To assess the efficacy of retroperitoneoscopy for treating stones in the renal pelvis and proximal ureter. MATERIALS AND METHODS: In the period from August 2003 to August 2004, 35 retroperitoneoscopies for treatment of urinary stones were performed on 34 patients. Fifteen patients (42% had stones in the renal pelvis, and in 2 cases, there were associated stones in the upper caliceal group. Twenty patients (58% had ureteral stones, all of them located above the iliac vessel. Twenty-five patients (71% had previously undergone at least one session of extracorporeal lithotripsy and 8 patients (26% also underwent ureteroscopy to attempt to remove the stone. Eight patients underwent retroperitoneoscopy as a primary procedure. Stone size ranged from 0.5 to 6 cm with a mean of 2.1 cm. RESULTS: Retroperitoneoscopy was performed by lumbar approach with initial access conducted by open technique and creation of space by digital dissection. We used a 10-mm Hasson trocar for the optics, and 2 or 3 additional working ports placed under visualization. Following identification, the urinary tract was opened with a laparoscopic scalpel and the stone was removed intact. The urinary tract was closed with absorbable 4-0 suture and a Penrose drain was left in the retroperitoneum. In 17 patients (49%, a double-J stent was maintained postoperatively. Surgical time ranged from 60 to 260 minutes with a mean of 140 minutes. The mean hospital stay was 3 days (1-10 days. The mean length of retroperitoneal urinary drainage was 3 days (1-10 days. There were minor complications in 6 (17.6% patients and 1 case of conversion due to technical difficulty. Thirty-three patients (94% became stone free. CONCLUSION: Retroperitoneoscopy is an effective, low-morbidity alternative for treatment of urinary stones.

Combined retrograde flexible ureteroscopic lithotripsy with holmium YAG laser for renal calculi associated with ipsilateral ureteral stones.

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Cocuzza, Marcello; Colombo, Jose R; Ganpule, Arvind; Turna, Burak; Cocuzza, Antonio; Dhawan, Divyar; Santos, Bruno; Mazzucchi, Eduardo; Srougi, Miguel; Desai, Mahesh; Desai, Mihir

2009-02-01

The purpose of this study was to evaluate the effectiveness of combined ureteroscopic holmium YAG lithotripsy for renal calculi associated with ipsilateral ureteral stones. Between August 2002 and March 2007, retrograde flexible ureteroscopic stone treatment was attempted in 351 cases. Indication for treatment was concurrent symptomatic ureteral stones in 63 patients (group I). Additional operative time and perioperative complication rates were compared to a group of 39 patients submitted to ureteroscopic treatment for ureteral calculi exclusively (group II). Mean ureteral stone size was 8.0 +/- 2.6 mm and 8.1 +/- 3.4 mm for groups I and II, respectively. Mean operative time for group I was 67.9 +/- 29.5 minutes and for group 2 was 49.3 +/- 13.2 minutes (p stone size was 10.7 +/- 6.4 mm, overall stone free rate in group I was 81%. However, considering only patients with renal stones smaller than 15 mm, the stone free rate was 88%. Successful treatment occurred in 81% of patients presenting lower pole stones, but only 76% of patients with multiple renal stones became stone free. As expected, stone free rate showed a significant negative correlation with renal stone size (p = 0.03; r = -0.36). Logistic regression model indicated an independent association of renal stones smaller than 15 mm and stone free rate (OR = 13.5; p = 0.01). Combined ureteroscopic treatment for ureteral and ipsilateral renal calculi is a safe and attractive option for patients presenting for symptomatic ureteral stone and ipsilateral renal calculi smaller than 15 mm.

Obesometric factors associated with increased skin-to-stone distances in renal stone patients.

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Allard, Christopher B; Shuster, Anatoly; Pinthus, Jehonathan H; Farrokhyar, Forough; Raees, A; Patlas, Michael; Matsumoto, Edward D; Whelan, J Paul

2012-12-01

Obese patients are at increased risk for renal stones as well as treatment failures due to increased skin-to-stone distances (SSD) and harder stone compositions. We investigated the relationships between obesometric parameters (body mass index [BMI], body fat distribution and obesity-related hormone levels) with SSD and stone hardness. We prospectively enrolled patients undergoing stone interventions at our institution. Computed tomography (CT) scans were analyzed; adipose tissue was identified according to Hounsfield units (HU) and separated into subcutaneous (SAT) and visceral (VAT) components. The pixels were averaged at three levels to calculate fat distribution: %VAT = (VAT)/(VAT + SAT). SSD was measured and HU were used as a surrogate for stone hardness. Obesity-related hormones leptin and adiponectin were measured by ELISA. Seventy-nine patients were prospectively enrolled. Mean BMI and %VAT were 30.02 kg/m2 and 40.13 kg/m2. Mean leptin and adiponectin levels were 17.5 ng/mL and 7.67 mcg/mL indicating high risk for metabolic consequences of obesity. Females had greater proportions of subcutaneous fat than males (%VAT 28.4 versus 46.94, p r = 0.454, p = 0.008). Obese patients with %VAT > 40 versus stone compositions as measured by HU than non-diabetics (982.86 versus 648.86, p = 0.001). Obesometric parameters such as BMI, body fat distribution, and the presence of diabetes mellitus are important considerations in the management of renal stone disease. A large proportion of subcutaneous fat, which can be estimated by physical examination, predicts SSD among obese patients and may aid treatment decisions in patients, particularly those without pre-treatment CT scans. Further studies are needed to refine the role of obesometrics in personalizing treatment decisions.

Magnesium-to-calcium ratio in tap water, and its relationship to geological features and the incidence of calcium-containing urinary stones.

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Kohri, K; Kodama, M; Ishikawa, Y; Katayama, Y; Takada, M; Katoh, Y; Kataoka, K; Iguchi, M; Kurita, T

1989-11-01

We examined the relationship among magnesium and calcium content in tap water, the geological features and urinary stone incidence in Japan. The magnesium-to-calcium ratio in tap water correlated negatively with the incidence of urolithiasis. There was no correlation between calcium and magnesium concentration in tap water and urinary stone incidence. Geological features in Japan were classified into 5 groups. The magnesium-to-calcium ratio in the basalt areas was higher than in the other areas, while ratio in the granite areas was low. In the sedimentary rock areas calcium and magnesium concentrations were high; the magnesium-to-calcium ratio in these areas was between those of the basalt and granite areas. The limestone areas had a much higher calcium concentration. The incidence of urinary stones in the sedimentary rock and basalt areas was lower than that of the granite areas, while that in the limestone areas was the highest. Thus, the incidence of urinary stone is related to the magnesium-to-calcium ratio in tap water and the geological area.

Influence of nutritional status, laboratory parameters and dietary patterns upon urinary acid excretion in calcium stone formers.

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Carolini Zanette Warmling Tessaro

2018-04-01

Full Text Available ABSTRACT Introduction: Obesity and Metabolic Syndrome (MS are associated with low urinary pH and represent risk factors for nephrolithiasis, especially composed by uric acid. Acidogenic diets may also contribute to a reduction of urinary pH. Propensity for calcium oxalate precipitation has been shown to be higher with increasing features of the MS. Objective: A retrospective evaluation of anthropometric and body composition parameters, MS criteria and the dietary patterns of overweight and obese calcium stone formers and their impact upon urinary pH and other lithogenic parameters was performed. Methods: Data regarding anthropometry, body composition, serum and urinary parameters and 3-days dietary records were obtained from medical records of 102(34M/68F calcium stone formers. Results: A negative correlation was found between urinary pH, waist circumference and serum uric acid levels (males. The endogenous production of organic acids (OA was positively correlated with triglycerides levels and number of features of MS (males, and with glucose, uric acid and triglycerides serum levels, and number of features of MS (females. No significant correlations were detected between Net Acid Excretion (NAE or Potential Renal Acid Load of the diet with any of the assessed parameters. A multivariate analysis showed a negative association between OA and urinary pH. Conclusion: The endogenous production of OA and not an acidogenic diet were found to be independently predictive factors for lower urinary pH levels in calcium stone formers. Hypercalciuric and/or hyperuricosuric patients presented higher OA levels and lower levels of urinary pH.

Role of alpha-1 blocker in expulsion of stone fragments after extracorporeal shock wave lithotripsy for renal stones

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Pirzada, A.J.; Anwar, A.; Javed, A.; Memon, I.; Mohammad, A.

2011-01-01

Background: Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL). Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Patients and Methods: This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1-adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.5-1.5 Cm in size (average size 1.2 Cm) were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic (Drotaverine HCl) as required and Proton Pump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p=0.01). The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group (p=0.002). This difference was statistically significant. Conclusion: Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal

Laparoscopic surgery for renal stones: is it indicated in the modern endourology era?

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Andrei Nadu

2009-02-01

Full Text Available Purpose: To report the outcomes of laparoscopic surgery combined with endourological assistance for the treatment of renal stones in patients with associated anomalies of the urinary tract. To discuss the role of laparoscopy in kidney stone disease. Materials and Methods: Thirteen patients with renal stones and concomitant urinary anomalies underwent laparoscopic stone surgery combined with ancillary endourological assistance as needed. Their data were analyzed retrospectively including stone burden, associated malformations, perioperative complications and outcomes. Results: Encountered anomalies included ureteropelvic junction obstruction, horseshoe kidney, ectopic pelvic kidney, fussed-crossed ectopic kidney, and double collecting system. Treatment included laparoscopic pyeloplasty, pyelolithotomy, and nephrolithotomy combined with flexible nephroscopy and stone retrieval. Intraoperative complications were lost stones in the abdomen diagnosed in two patients during follow up. Mean number of stones removed was 12 (range 3 to 214. Stone free status was 77% (10/13 and 100% after one ancillary treatment in the remaining patients. One patient had a postoperative urinary leak managed conservatively. Laparoscopic pyeloplasty was successful in all patients according to clinical and dynamic renal scan parameters. Conclusions: In carefully selected patients, laparoscopic and endourological techniques can be successfully combined in a one procedure solution that deals with complex stone disease and repairs underlying urinary anomalies.

Effect of animal and vegetable protein intake on oxalate excretion in idiopathic calcium stone disease.

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Marangella, M; Bianco, O; Martini, C; Petrarulo, M; Vitale, C; Linari, F

1989-04-01

Oxalate excretion was measured in healthy subjects and idiopathic calcium stone-formers on dietary regimens which differed in the type and amount of protein allowed; 24-h urine collections were obtained from 41 practising vegetarians and 40 normal persons on a free, mixed, "mediterranean" diet. Twenty idiopathic calcium stone-formers were also studied while on two low calcium, low oxalate diets which differed in that animal protein was high in one and restricted in the other. Vegetarians had higher urinary oxalate levels than controls and although the calcium levels were markedly lower, urinary saturation with calcium/oxalate was significantly higher. This mild hypercalciuria was interpreted as being secondary to both a higher intake and increased fractional intestinal absorption of oxalate. Changing calcium stone-formers from a high to a low animal protein intake produced a significant decrease in calcium excretion but there was no variation in urinary oxalate. As a result, the decrease in calcium oxalate saturation was only marginal and not significant. It was concluded that dietary animal protein has a minimal effect on oxalate excretion. Mild hyperoxaluria of idiopathic calcium stone disease is likely to be intestinal in origin. Calcium stone-formers should be advised to avoid an excess of animal protein but the risks of a vegetable-rich diet should also be borne in mind.

Association of staphylococcus cohnii subspecies urealyticum infection with recurrence of renal staghorn stone.

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Shahandeh, Zahra; Shafi, Hamid; Sadighian, Farahnaz

2015-01-01

Stphylococcus cohnii is an organism of coagulase negative species which is considered as normal flora. However, it has been isolated from urinary tract infections and surgical prostheses but its relation with staghorn stones has not been reported, yet. A 50-years-old woman presented with left renal staghorn stone in June 2014. She had bilateral staghorn stones 7 years ago. Staphylococcus cohnii subspecies urealyticum were detected from a removed stone. After 7 years, recurrence staghorn stone in her left kidney was diagnosed and patient underwent another surgery. The patient had several attacks of cystitis during these 7 years. The results of stone and urine cultures revealed staphylococcus cohnii subspecies urealyticum. This case report emphasizes a possible association between staphylococcus cohnii subspecies urealyticum infection and recurrence renal staghhorn stone.

Efficacy of commercialised extracorporeal shock wave lithotripsy service: a review of 589 renal stones.

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Nielsen, Tommy Kjærgaard; Jensen, Jørgen Bjerggaard

2017-07-27

Extracorporeal shockwave lithotripsy (ESWL) is the management of choice for renal stones 20 mm or smaller, with a stone clearance rate of up to 89%. The purpose of the present is to investigate the efficacy of a commercialised ESWL service, being performed as an outsourced treatment using a mobile lithotripsy system on an outpatient basis. Furthermore, the study aims to evaluate the risk of needing treatment with an internal ureteral double-J stent (JJ) after ESWL treatment. During an eight-year period, 461 patients with a total of 589 renal stones were treated using a mobile lithotripsy system at a single Danish institution. A commercial company performed all treatments using a Storz Modulith SLK® system. Each stone was prospectively registered according to size, intra renal location and the presence of a JJ at the time of treatment. The number of required ESWL treatments and auxiliary procedures were retrospectively evaluated. The success rate after the initial ESWL procedure was 69%, which increased to an overall success rate of 93% after repeated treatment. A negative correlation was found between stone size and the overall success rate (r = -0.2, p ESWL procedure. No significant difference was observed between the stone size or intra renal location and the risk of needing treatment with JJ after ESWL. Commercialised ESWL treatment can achieve an overall success rate of more than 90% using a mobile lithotripsy system. As expected, an inverse relation between stone size and success rate was found. Patients who do not require treatment with a JJ prior to ESWL will only rarely need treatment with a JJ after ESWL, irrespective of stone size and intra renal stone location.

[Clinical study of influential factors on renal scarring after ESWL monotherapy for renal stone disease].

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Ishito, Noritaka; Takamoto, Hitoshi; Kunitomi, Kimito; Satoh, Eiichi; Ishii, Ayano; Shiotuka, Youichi; Sako, Shinichi; Ohta, Naoki; Araki, Tohru

2002-11-01

ESWL is now widely used for the treatment of renal stone disease. Although ESWL has many advantages for patients' quality of life, few reports have demonstrated the long-term outcomes of the alterations of renal morphology after ESWL. We reported renal scarring after ESWL monotherapy in patients with renal calyceal stones. In this study, we evaluated a large series of patients' cohort treated at our institution, and assessed the causal effect of ESWL on the late occurrence of renal scar formation. ESWL was performed with EDAP (LT-01,02) that generates shock wave energy by piezoelectric discharge. We analyzed the records of 285 kidneys treated between Dec. 1986 and Nov. 1998. Renal scarring was noted in 44 kidneys and not in 241 kidneys with periodical ultrasonography. We compared the backgrounds of the two groups using chi-square or non-parametric analysis. The Kaplan-Meier method and Cox regression model determined the analysis of renal scar formation. Univariate and multiple regression analysis revealed that the total amount of ESWL emission and hyperuricemia independently affected the probability of renal scar formation. Over-emission of ESWL (over 10,000 shots) must be care for the prevention of renal scarring in patients with renal calyceal calculi, especially when associated with hyperuricemia. After ESWL, periodical checkups with ultrasonography will provide useful information for the clinical diagnosis of renal scarring.

Testosterone increases urinary calcium excretion and inhibits expression of renal calcium transport proteins.

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Hsu, Y.J.; Dimke, H.; Schoeber, J.P.H.; Hsu, S.C.; Lin, S.H.; Chu, P.; Hoenderop, J.G.J.; Bindels, R.J.M.

2010-01-01

Although gender differences in the renal handling of calcium have been reported, the overall contribution of androgens to these differences remains uncertain. We determined here whether testosterone affects active renal calcium reabsorption by regulating calcium transport proteins. Male mice had

Renal stone characterization using high resolution imaging mode on a photon counting detector CT system

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Ferrero, A.; Gutjahr, R.; Henning, A.; Kappler, S.; Halaweish, A.; Abdurakhimova, D.; Peterson, Z.; Montoya, J.; Leng, S.; McCollough, C.

2017-03-01

In addition to the standard-resolution (SR) acquisition mode, a high-resolution (HR) mode is available on a research photon-counting-detector (PCD) whole-body CT system. In the HR mode each detector consists of a 2x2 array of 0.225 mm x 0.225 mm subpixel elements. This is in contrast to the SR mode that consists of a 4x4 array of the same subelements, and results in 0.25 mm isotropic resolution at iso-center for the HR mode. In this study, we quantified ex vivo the capabilities of the HR mode to characterize renal stones in terms of morphology and mineral composition. Forty pure stones - 10 uric acid (UA), 10 cystine (CYS), 10 calcium oxalate monohydrate (COM) and 10 apatite (APA) - and 14 mixed stones were placed in a 20 cm water phantom and scanned in HR mode, at radiation dose matched to that of routine dual-energy stone exams. Data from micro CT provided a reference for the quantification of morphology and mineral composition of the mixed stones. The area under the ROC curve was 1.0 for discriminating UA from CYS, 0.89 for CYS vs COM and 0.84 for COM vs APA. The root mean square error (RMSE) of the percent UA in mixed stones was 11.0% with a medium-sharp kernel and 15.6% with the sharpest kernel. The HR showed qualitatively accurate characterization of stone morphology relative to micro CT.

Bone Genes in the Kidney of Stone Formers

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Evan, Andrew P.; Bledsoe, Sharon B.

2008-09-01

Intraoperative papillary biopsies from kidneys of idiopathic-calcium oxalate stone formers (ICSF) have revealed a distinct pattern of mineral deposition in the interstitium of the renal papilla. The earliest sites of these deposits, termed Randall's plaque, are found in the basement membrane of thin loops of Henle and appear to spread into the surrounding interstitium down to the papillary epithelium. Recent studies show kidney stones of ICSF patients grow attached to the renal papilla and at sites of Randall's plaque. Together these observations suggest that plaque formation may be the critical step in stone formation. In order to control plaque formation and thereby reduce future kidney stone development, the mechanism of plaque deposition must be understood. Because the renal papilla has unique anatomical features similar to bone and the fact that the interstitial deposits of ICSF patients are formed of biological apatite, this paper tests the hypothesis that sites of interstitial plaque form as a result of cell-mediated osteoblast-like activity.

Quantitative Mineralogical Composition of Calculi and Urine Abnormalities for Calcium Oxalate Stone Formers: A Single-Center Results.

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Kustov, Andrey V; Strelnikov, Alexander I

2017-12-26

The paper focuses on the relationship of risk factors and metabolic disorders with mineralogical composition of calculi, age and gender of calcium oxalate stone formers. Stone mineralogical composition, 24 hour biochemistry and pH-profile of urine were examined for sixty four stone formers using powder X-ray diffraction, spectrophotometric and potentiometric techniques. The analysis indicated that 44 % of calculi were composed of pure calcium oxalate monohydrate, whereas other 56 % contained both monohydrate and dihydrate or usually their mixtures with hydroxyl apatite. Hypocitraturia, hypercalciuria and hyperuricosuria were identified as the most frequent disorders. Patients with pure calcium oxalate stones and calcium oxalate mixed with apatite revealed different patterns including age, acid-base balance of urine, calcium, citrate excretion etc. Our results demonstrate that most patients simultaneously reveal several risk factors. The special attention should be paid to normalize the daily citrate, calcium and urate excretion. High risk patients, such as postmenopausal females or stone formers with a high apatite content require a specific metabolic evaluation towards in highlighting abnormalities associated with stone formation.

Quantification of the risk of urinary calcium stone formation in the urine collected at 2 times of the day in a group of children studied to rule out prelithiasis

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Víctor M. García Nieto

2018-05-01

Full Text Available Background: Various genetic and environmental factors are involved in urolithiasis. The 2 most common metabolic abnormalities are the increase in urinary calcium and low urinary citrate excretion. The ratio calculated between the concentrations of both substances is a good risk marker for the formation of calcium stones. Objectives: To determine whether the risk of urinary calcium stone formation changes throughout the day in the same patient. Methods: We studied 56 children (23 V, 33 M to check if they had prelithiasis. Calcium, citrate, and creatinine concentrations were determined in two urine samples collected one before dinner and the other in the morning. It was collected if they had ultrasound stones and if there was a history of urolithiasis in first and/or second degree relatives. Results: In 25 patients (44.6%, renal ultrasound was positive for lithiasis (stones [n = 9] and microlithiasis [n = 16]. Forty of the 56 families (71.4% had a history of urolithiasis. The percentage of abnormal urinary calcium (28.6% concentrations and an abnormal calcium/citrate ratio (69.6% was higher in the first urine of the day. The calcium/citrate ratio was the only studied parameter that was related to a family history of urolithiasis. There were no differences in urinary parameters between patients with and without ultrasound-confirmed kidney stones. Conclusions: Urinary concentrations of calcium and the calcium/citrate ratio vary throughout the day. Urine produced at night has a higher risk of urinary calcium stone formation. Resumen: Antecedentes: En la urolitiasis intervienen diversos factores genéticos y ambientales. Las 2 anomalías metabólicas más frecuentes son el incremento en la eliminación urinaria de calcio y la reducción en la de citrato. El cociente calculado entre las concentraciones de ambas sustancias es un buen marcador de riesgo de formación de cálculos cálcicos. Objetivos: Determinar si el riesgo litógeno en la orina de

Urinary stone composition in Oman: with high incidence of cystinuria.

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Al-Marhoon, Mohammed S; Bayoumi, Riad; Al-Farsi, Yahya; Al-Hinai, Abdullhakeem; Al-Maskary, Sultan; Venkiteswaran, Krishna; Al-Busaidi, Qassim; Mathew, Josephkunju; Rhman, Khalid; Sharif, Omar; Aquil, Shahid; Al-Hashmi, Intisar

2015-06-01

Urinary stones are a common problem in Oman and their composition is unknown. The aim of this study is to analyze the components of urinary stones of Omani patients and use the obtained data for future studies of etiology, treatment, and prevention. Urinary stones of 255 consecutive patients were collected at the Sultan Qaboos University Hospital. Stones were analyzed by Fourier transform infrared spectrophotometer. The biochemical, metabolic, and radiological data relating to the patients and stones were collected. The mean age was 41 years, with M:F ratio of 3.7:1. The common comorbidities associated with stone formation were hypertension; diabetes, benign prostate hyperplasia; urinary tract infection; obesity; and atrophic kidney. The common presentation was renal colic and flank pain (96%). Stones were surgically retrieved in 70% of patients. Mean stone size was 9 ± 0.5 mm (range 1.3-80). Stone formers had a BMI ≥ 25 in 56% (P = 0.006) and positive family history of stones in 3.8%. The most common stones in Oman were as follows: Calcium Oxalates 45% (114/255); Mixed calcium phosphates & calcium oxalates 22% (55/255); Uric Acid 16% (40/255); and Cystine 4% (10/255). The most common urinary stones in Oman are Calcium Oxalates. Overweight is an important risk factor associated with stone formation. The hereditary Cystine stones are three times more common in Oman than what is reported in the literature that needs further genetic studies.

Urinary Exertion Of Calcium By Urinary Stone Disease Patients And ...

African Journals Online (AJOL)

To compare the urinary excretion of calcium by subjects in a known area of high incidence of urinary stone disease, and a known area of low incidence, 12 adult male patients with idiopathic calcigerous urinary stone disease in south-East Nigeria and 55 similar patients from Scotland, United Kingdom were analyzed ...

Flexible Ureterorenoscopy versus Mini-Percutaneous Nephrolithotomy for the Treatment of Renal Stones.

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Ergin, Giray; Kirac, Mustafa; Kopru, Burak; Ebiloglu, Turgay; Biri, Hasan

2018-04-22

To compare the pain status and stone free rates of flexible ureterorenoscopy (F-URS) versus mini-percutaneousnephrolithotomy (mini-PNL) for the treatment of 1-to 2-cm renal stones. This study was retrospectively designed with match paired method. Between January 2013 and December 2016, 387 patients underwent stone surgery for renal stones, 45 patients underwent FURS and 45 patients underwent mini-PNL. 90 patients were divided into two groups according to the surgical procedures. Group 1 patients underwent F-URS, and Group 2 patients underwent mini-PNL. During the intraoperative andpostoperative periods, pain management for all patients was standardized. Pain scores were determined using a visual analogue scale (VAS) completed at 2, 6, 12 and 24 hours postoperatively. The stone free status, hemoglobin levels, fluoroscopy time (FT), operation time (OT), hospitalization time (HT), return to work time (RWT), and complications were noted for each patient. Of all patients, the mean age was 41.1 ± 12.1 years and the mean stone size was 13.9 ± 2.9 mm. The VAS scores were significantly higher in the mini-PNL group at 2, 6, 12 and 24 hours (P .05); however, the hemoglobin decreases and the fluoroscopy, operation, hospitalization and return to work times were higher in the mini-PNL group than in the F-URS group (P work duration. We think that F-URS is more comfortable and less painful than mini-PNL and achieves a similar stone free rate for the treatment of 1- to 2-cm renal stones.

The effect of sodium bicarbonate upon urinary citrate excretion in calcium stone formers.

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Pinheiro, Vivian Barbosa; Baxmann, Alessandra Calábria; Tiselius, Hans-Göran; Heilberg, Ita Pfeferman

2013-07-01

To evaluate the effects of oral sodium bicarbonate (NaBic) supplementation upon urinary citrate excretion in calcium stone formers (CSFs). Sixteen adult calcium stone formers with hypocitraturia were enrolled in a randomized, double-blind, crossover protocol using 60 mEq/day of NaBic during 3 days compared to the same period and doses of potassium citrate (KCit) supplementation. Blood and 24-hour urine samples were collected at baseline and during the third day of each alkali salt. NaBic, similarly to KCit supplementation, led to an equivalent and significant increase in urinary citrate and pH. Compared to baseline, NaBic led to a significant increase in sodium excretion without concomitant increases in urinary calcium excretion, whereas KCit induced a significant increase in potassium excretion coupled with a significant reduction in urinary calcium. Although NaBic and KCit both reduced calcium oxalate supersaturation (CaOxSS) significantly vs baseline, KCit reduced calcium oxalate supersaturation significantly further vs NaBic. Both KCit and NaBic significantly reduced urinary phosphate and increased calcium phosphate supersaturation (CaPSS) compared to baseline. Finally, a significantly higher sodium urate supersaturation (NaUrSS) was observed after the use of the 2 drugs. This short-term study suggests that NaBic represents an effective alternative for the treatment of hypocitraturic calcium oxalate stone formers who cannot tolerate or afford the cost of KCit. In view of the increased sodium urate supersaturation, patients with pure uric acid stones and high urate excretion may be less suited for treatment with NaBic. Copyright © 2013 Elsevier Inc. All rights reserved.

Stone-free-rate after extracorporeal shockwave lithotripsy in the management of pediatric renal stones in lower pole and other locations - a comparative study

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Iqbal, N.; Muhammad, S.; Akhter, S.

2016-01-01

To determine a difference in the stone-free-rate among different renal locations in children after extracorporeal shockwave lithotripsy (ESWL). Study Design: A descriptive study. Place and Duration of Study: Urology Department, Shifa International Hospital, Islamabad, Pakistan, from January 2007 to June 2015. Methodology: The study included children who underwent ESWL, divided into three groups based on location of stones in kidney as group A (lower pole stones), group B (upper and mid pole stones) and group C (renal pelvis stone), respectively. ESWL was done by standard technique using Storz Modulith SLX lithotripter 3rd generation. Data was collected by chart review. SPSS version 16 was used for data analysis. Results: Among 76 children with mean age of 7.55 +-4.16 years, 55 (72.4%) were males whereas 21 (27.6%) were females. Mean stone size was 1.08 +-0.59 cm. There were 34, 17 and 25 cases in groups A, B and C, respectively. PostESWL stone-free-rate was 47% in lower pole stones, 70.58% in upper and mid pole stones, and 68% in renal pelvis stones. Hematuria was seen in one patient from each group, sepsis in two patients from each of the mid pole/upper pole and lower pole group, while Steinstrasse in one patient from each group. (author)

Changes in renal uptake of Tc-99m methylene diphosphonate (MDP) in stone-forming rats

International Nuclear Information System (INIS)

McAfee, J.G.; Thomas, F.D.; Roskopf, M.; Ritter, K.; Lyons, B.; Lilien, O.M.; Schoonmaker, J.E.

1984-01-01

A pyridoxine (vitamin B6)-deficient diet in rats was used as a model of early renal lithiasis to find out if stone-formers could be identified from control animals by differences in the biodistribution of Tc-99m MDP. The mean renal uptake of this agent at 3 hours was about 70% higher in test animals than in controls, but there was considerable overlap between the upper limits of the normal range and lower values in stone-formers. If these results were valid for humans, the metabolic abnormality in males with early stone-forming disease could not be identified with certainty by in vivo measurements of Tc-99m MDP renal uptake alone. However, the skeletal uptake of MDP in the stone-forming animals was depressed by 28 to 35%, compared with control rats. Consequently, the renal to skeletal MDP concentration ratio was invariably elevated in stone-formers beyond the 95 percentile normal range. Unexpectedly, 76% of the pyridoxine-deficient animals had a higher accumulation of MDP in the myocardium than the upper limit of the normal range. The pyridoxine-deficient diet induced no remarkable early changes in the biodistribution or renal clearance of I-131 Hippuran

Treatment options for active removal of renal stones

NARCIS (Netherlands)

Warmerdam, G.J.J.; Laet, De K.; Wijn, R.P.W.F.; Wijn, P.F.F.

2012-01-01

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from

Update on probiotics for the treatment of calcium oxalate stones

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Di ZHANG

2016-09-01

Full Text Available Urolithiasis is one of the common diseases in urinary system, among which calcium oxalate stone is the most common one with a high recurrence rate. An important pathological factor for the formation of calcium oxalate stone is the increased absorption of oxalate from intestine, which leads to a high urine oxalate concentration. Intestinal bacteria known to be able to degrade oxalate includes Oxalobacter formigenes, Enterococcus faecalis, Escherichia coli, Eubacterium lentum, Providencia rettgeri, Lactobacillus and Bifidobacterium species, etc. Among those, Oxalobacter formigenes is the first oxalate-degrading obligate anaerobe found in human, while the rest are just conditioned bacteria with the function to degrade intestinal oxalate. There are three kinds of enzymes in Oxalobacter formigenes involved in the metabolism of oxalate, namely oxalate-formate antiporter (OxlT, formyl-CoA transferase (Frc and oxalyl-CoA decarboxylase (Oxc. Animal experiments have verified that Oxalobacter formigenes could reduce intestinal oxalate absorption by promoting the secretion of oxalate and degradation as well, thus decrease the excretion of urine oxalate. The present review will focus on the research progress of probiotics treatment for the calcium oxalate stones so as to provide reference for further research and development. DOI: 10.11855/j.issn.0577-7402.2016.08.16

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

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Singal, Rikki; Dhar, Siddharth

2018-01-01

The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

Contemporary Management of Medium-Sized (10-20 mm) Renal Stones: A Retrospective Multicenter Observational Study.

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Kiremit, Murat Can; Guven, Selcuk; Sarica, Kemal; Ozturk, Ahmet; Buldu, Ibrahim; Kafkasli, Alper; Balasar, Mehmet; Istanbulluoglu, Okan; Horuz, Rahim; Cetinel, Cihangir Ali; Kandemir, Abdulkadir; Albayrak, Selami

2015-07-01

To evaluate contemporary management approaches to medium-sized (10-20 mm) renal stones. A total of 935 patients treated for medium-sized renal stones (10-20 mm) between July 2012 and March 2014 were included in the study program. Contemporary minimally invasive approaches applied in the management of such stones were evaluated and compared. The cohort consisted of 561 male (60%) and 374 female (40%) patients. Of the 935 patients with medium-sized renal calculi, 535 (57.2%) were treated with shockwave lithotripsy (SWL), 201 (21.4%) with retrograde intrarenal surgery (RIRS), 110 (11.7%) with minimally invasive percutaneous nephrolithotomy (miniperc), and the remaining 89 (11.7%) patients with micropercutaneous nephrolithotomy (microperc). In the SWL group, stones were located mostly in the pelvis (51%), while in the miniperc and microperc groups, they were located mainly in the lower pole (46%, 53%, respectively). Stone-free rates after a single session were 77.2%, 86.1%, 88.8%, and 83.6% in the SWL, RIRS, microperc, and miniperc groups, respectively. Although no serious complications (above Clavien level III) were noted in any of the groups evaluated, Clavien I to II complications were common in the miniperc group. Although SWL is the preferred treatment option for patients with medium-sized (10-20 mm) renal stones, endourologic methods also have been found to have a significant role. Relatively lower complication rates along with higher stone-free status observed with the RIRS technique compared with percutaneous approaches have made this method a valuable option in the management of such stones in recent years.

The composition of urinary stones in central sindh

International Nuclear Information System (INIS)

Memon, J.M.; Naqvi, S.Q.H.

2014-01-01

To determine chemical analysis of urinary stones of central sindh. Study design: Prospective and randomized study. Setting: Department of Surgery and Pathology of Peoples University of Medical and Health Sciences Nawabshah. Duration of study: Three years from May 2008 to May 2011. Material and Methods: Total 106 urolith patients who underwent open stone surgery were included in the study. EDTA Titration used for determination of calcium ions and determination of oxalate, phosphate, magnesium, ammonia, uric acid and cystine stones was carried out using spectrophotometer. These patients were asked to fill out a proforma with parameters of age, sex, radiological location of stone and chemical composition of surgically recovered stones. The stone analysis findings were reviewed and compared with other reported series Results: In this study 75(70.75%) patients were male and 31 (29.25%) female. Male to female ratio was of 2.41:1. The age ranged from 1 to 70 years with the mean of 22.69 years. The peak incidence of upper urinary tract stone in 20-30 years and lower urinary tract stones in both sexes was under 10 years. Anatomical location of stone showed 48(45.29%) renal, 13(12.26%) ureteric and 45(42.45%) bladder calculi. Chemical analysis revealed 56(52.8%) calcium oxalate, 7(6.6%) calcium phosphate, 11(10.3%) ammonium urate, 18(16.9%) uric acid, 13(12.2%) Sturvite and 1(0.9%) cystine calculi. Conclusion: It was concluded that urolithiasis is predominantly male disease. No age group was spared to stone disease. Calcium oxalate, uric acid, ammonium urate and mixed calculi are the main types in our study due to poor nutritional status, poverty and inadequate health facilities. Considering that knowledge of stone composition is of utmost importance to modify the incidence of urolithiasis. (author)

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management.

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Cai, Jian-liang; Zhang, Yi; Sun, Guo-feng; Li, Ning-chen; Yuan, Xue-li; Na, Yan-qun

2013-10-01

Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen. Thirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes. Significant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs

Calcium hypochlorite as a disinfecting additive for dental stone.

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Twomey, Jonathan O; Abdelaziz, Khalid M; Combe, Edward C; Anderson, Dwight L

2003-09-01

Dental casts come into direct contact with impression materials and other items that are contaminated by saliva and blood from a patient's mouth, leaving the casts susceptible to cross-contamination. Topical methods of disinfecting casts are difficult to control, while immersion methods are potentially destructive. Thus, an additional method to control cross-contamination between patients and laboratory personnel is needed. This study was undertaken in an attempt to develop a dental stone with disinfecting properties and adequate compressive and tensile strengths. Calcium hypochlorite [Ca(OCl)(2)] in aqueous solution in concentrations from 0 to 1.5% was tested as a disinfecting additive to type V dental stone. The compressive and tensile strength properties of the modified stone were measured (MPa) using a universal testing machine at a consistency similar to unmodified stone. Strength data were analyzed by 1-way ANOVA and post hoc Tukey-Kramer procedure (alpha CaviCide, and 3 impressions rinsed in water served as controls. In general, the effect of adding the disinfectant to the stone was a decrease in strength. Exceptions were the dry compressive strength, for which there was a significant increase in strength (P=.048) at 0.5%, and the wet compressive and wet tensile strength, which showed no significant difference between the 1.5% and the control. When Ca(OCl)(2) was added at the concentration 0.5% (2765 ppm available chlorine), the gypsum had acceptable mechanical properties; dry compressive strength was 78.86 +/- 4.12 MPa, and dry tensile strength was 10.64 +/- 1.27 MPa, compared to control values of 67.85 +/- 6.28 and 13.41 +/- 1.24 MPa, respectively. At concentrations of 0.3% and higher (36 1650 ppm of available chlorine), calcium hypochlorite was able to completely inactivate phi29. It is possible to prepare a type V dental stone that contains a disinfectant, has adequate mechanical properties, and will reduce numbers of residual microorganisms. For example

Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.

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Wiesenthal, Joshua D; Ghiculete, Daniela; D'A Honey, R John; Pace, Kenneth T

2010-08-01

Shock wave lithotripsy (SWL) is considered the first line treatment for the majority of patients with renal and ureteric calculi, with success rates from contemporary series varying from 60 to 90%. Success is dependent on many patient and stone-related factors. We conducted a retrospective analysis of mean stone CT density (MSD) and skin-to-stone distance (SSD) to determine their influence on the success of SWL of renal and ureteric calculi. Data from all patients treated at the St. Michael's Hospital Lithotripsy Unit from May 2004 to June 2009 were reviewed. Analysis was restricted to those patients with a pre-treatment non-contrast CT scan conducted at our center demonstrating a solitary renal or ureteric calculus 900 HU (OR = 0.49, CI: 0.32-0.75) and SSD >110 mm (OR = 0.49, CI: 0.31-0.78) were both significant predictors of outcome. We have identified in a large series of renal and ureteric calculi that both MSD and SSD can reliably predict SWL outcomes. This data can be used in combination with other patient and stone-related factors to facilitate optimal treatment-based decisions and provide patients with more accurate single-treatment success rates for SWL.

Effects of dietary interventions on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones

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Mustafa Kıraç

2013-02-01

Full Text Available The aim of this study is to investigate the effects of dietary factors on 24-hour urine parameters in patients with idiopathic recurrent calcium oxalate stones. A total of 108 of idiopathic recurrent calcium oxalate stones were included in the study. A 24-hour urinalysis was performed and metabolic abnormalities were measured for all of the patients. All of the patients were given specialized diets for their 24-hour urine abnormalities. At the end of first month, the same parameters were examined in another 24-hour urinalysis. Hyperoxaluria, hypernatruria, and hypercalciuria were found in 84 (77%, 43 (39.8%, and 38 (35.5% of the patients, respectively. The differences between the oxalate, sodium, volume, uric acid, and citrate parameters before and after the dietary intervention were significant (p < 0.05. The calcium parameters were not significantly different before and after the intervention. We found that oxalate, sodium, volume, uric acid, and citrate—but not calcium—abnormalities in patients with recurrent calcium oxalate stones can be corrected by diet. The metabolic profiles of idiopathic calcium oxalate stone patients should be evaluated and the appropriate dietary interventions should be implemented to decrease stone recurrence.

Association between some CT characteristics of renal stones and extracorporeal shockwave lithotripsy success rate

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Saedi D

2012-06-01

Conclusion: We strongly suggest performing densitometry in bone window for renal stones on pre-ESWL NCCT scanning and using an alternative treatment other than ESWL for stone densities greater than 740 HU.

Association of staphylococcus cohnii subspecies urealyticum infection with recurrence of renal staghorn stone

OpenAIRE

Shahandeh, Zahra; Shafi, Hamid; Sadighian, Farahnaz

2015-01-01

Background: Stphylococcus cohnii is an organism of coagulase negative species which is considered as normal flora. However, it has been isolated from urinary tract infections and surgical prostheses but its relation with staghorn stones has not been reported, yet. Case Presentation: A 50-years-old woman presented with left renal staghorn stone in June 2014. She had bilateral staghorn stones 7 years ago. Staphylococcus cohnii subspecies urealyticum were detected from a removed stone. After 7 y...

A paracrine mechanism involving renal tubular cells, adipocytes and macrophages promotes kidney stone formation in a simulated metabolic syndrome environment.

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Zuo, Li; Tozawa, Keiichi; Okada, Atsushi; Yasui, Takahiro; Taguchi, Kazumi; Ito, Yasuhiko; Hirose, Yasuhiko; Fujii, Yasuhiro; Niimi, Kazuhiro; Hamamoto, Shuzo; Ando, Ryosuke; Itoh, Yasunori; Zou, Jiangang; Kohri, Kenjiro

2014-06-01

We developed an in vitro system composed of renal tubular cells, adipocytes and macrophages to simulate metabolic syndrome conditions. We investigated the molecular communication mechanism of these cells and their involvement in kidney stone formation. Mouse renal tubular cells (M-1) were cocultured with adipocytes (3T3-L1) and/or macrophages (RAW264.7). Calcium oxalate monohydrate crystals were exposed to M-1 cells after 48-hour coculture and the number of calcium oxalate monohydrate crystals adherent to the cells was quantified. The expression of cocultured medium and M-1 cell inflammatory factors was analyzed by enzyme-linked immunosorbent assay and quantitative polymerase chain reaction, respectively. The inflammatory markers MCP-1, OPN and TNF-α were markedly up-regulated in cocultured M-1 cells. OPN expression increased in M-1 cells cocultured with RAW264.7 cells while MCP-1 and TNF-α were over expressed in M-1 cells cocultured with 3T3-L1 cells. Coculturing M-1 cells simultaneously with 3T3-L1 and RAW264.7 cells resulted in a significant increase in calcium oxalate monohydrate crystal adherence to M-1 cells. Inflammatory cytokine changes were induced by coculturing renal tubular cells with adipocytes and/or macrophages without direct contact, indicating that crosstalk between adipocytes/macrophages and renal tubular cells was mediated by soluble factors. The susceptibility to urolithiasis of patients with metabolic syndrome might be due to aggravated inflammation of renal tubular cells triggered by a paracrine mechanism involving these 3 cell types. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Histopathology Predicts the Mechanism of Stone Formation

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Evan, Andrew P.

2007-04-01

About 5% of American women and 12% of men will develop a kidney stone at some time in their life and these numbers appear to be on the rise. Despite years of scientific research into the mechanisms of stone formation and growth, limited advances have been made until recently. Randall's original observations and thoughts on the mechanisms for kidney stone formation have been validated for idiopathic calcium oxalate stone formers (ICSF) but not for most other stone forming groups. Our current studies on selected groups of human stone formers using intraoperative papillary biopsies has shown overwhelming evidence for the presence of Randall's plaque in ICSF and that stone formation and growth are exclusively linked to its availability to urinary ions and proteins. Intense investigation of the plaque-stone junction is needed if we are to understand the factors leading to the overgrowth process on exposed regions of plaque. Such information should allow the development of treatment strategies to block stone formation in ICSF patients. Patients who form brushite stones, or who form apatite stones because of distal renal tubular acidosis (dRTA), or patients with calcium oxalate stones due to obesity bypass procedures, or patients with cystinuria, get plugged inner medullary collecting ducts (IMCD) which leads to total destruction of the lining cells and focal sites of interstitial fibrosis. These stone formers have plaque but at levels equal to or below non-stone formers, which would suggest that they form stones by a different mechanism than do ICSF patients.

Genetic polymorphisms in calcitonin receptor gene and risk for recurrent kidney calcium stone disease.

Science.gov (United States)

Shakhssalim, Nasser; Basiri, Abbas; Houshmand, Massoud; Pakmanesh, Hamid; Golestan, Banafsheh; Azadvari, Mohaddeseh; Aryan, Hajar; Kashi, Amir H

2014-01-01

In this study the full sequence of the calcitonin receptor gene (CALCR) in a group of Iranian males suffering from recurrent calcium urinary stones was compared with that of a control group. Serum and urinary biochemistry related to urolithiasis were evaluated in 105 males diagnosed with recurrent kidney calcium stones and 101 age-matched healthy control males. The polymerase chain reaction single-strand conformation polymorphism method was used to detect new polymorphisms in the CALCR. Nine polymorphisms were detected; seven were in the non-coding and two in the coding region. The T allele associated with the 3'UTR+18C>T polymorphism was observed exclusively in the stone formers. The exact odds ratio for the T allele in this locus for those at risk of stone formation was 36.72 (95% CI 4.95-272.0) (p C and IVS1insA polymorphisms in intron 1 were associated with kidney stone disease (p T and intron 1 polymorphisms in the CALCR and the risk of kidney stone disease. 2013 S. Karger AG, Basel.

In vitro differentiation of renal stone composition using dual-source, dual-energy CT

International Nuclear Information System (INIS)

Zhou Changsheng; Zhang Longjiang; Xu Feng; Qi Li; Zhao Yan'e; Zheng Ling; Huang Wei; Liu Youhuang; Lu Guangming

2012-01-01

Objective: To evaluate the ability of dual-source. dual-energy CT in differentiating uric acid stones from non-uric acid stones with infrared spectroscopy as reference standard. Materials and Methods: Urinary calculus from 308 patients were scanned in first generation dual-source CT with dual-energy mode between July 2011 and June 2012. Renal Stone application was used to analyze their composition. The uric acid stones color were coded red and non-uric acid stones were blue. CT values were measured in 60 selective urinary calculus including 30 uric acid stones and 30 non-uric acid stones. The accuracy of dual energy CT to differentiate uric acid and no-uric acid stones was calculated. Results: Of 308 patients, 60 patients had uric acid stones and 248 non-uric acid stones. No difference was found for uric acid stone at 80 kV and 140 kV (375.8±69.2 HU vs. 374.1±69.4 HU; t=-0.217, P=0.830), while CT values of non-uric acid stones were higher at 80 kV than those at 140 kV (1455.1±312.4 HU vs. 1039.6±194.4 HU; t=-12.16. P<0.001). CT values of non-uric acid stones at 80 kV, 140 kV, and average weighted images (1455.1±312.4 HU, 1 039.6±194.4 HU, and 882.0±176.4 HU, respectively) were higher than those of uric acid stones (375.8±69.2 HU, 374.1±69.4 HU, and 366.3±80.1 HU, respectively; P<0.001). With infrared spectrum findings as reference standard, the accuracy of dual energy CT in differentiating uric acid stones from non-uric acid stones was 100%. Conclusions: Dual-source, dual-energy CT can accurately differentiate uric acid stones from non-uric acid stones, and plays an important role in treatment planning of renal stones. (authors)

Stone composition and metabolic status.

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Bibilash, B S; Vijay, Adarsh; Fazil Marickar, Y M

2010-06-01

This paper aims to study the correlation between biochemical risk factors of the stone former and the type of oxalate stone formed, namely calcium oxalate monohydrate (COM) and calcium oxalate dehydrate (COD). A retrospective study of 487 patients who had been attending the urinary stone clinic, Trivandrum during 1998-2007 was conducted. The stones retrieved from them were subjected to chemical analysis and FTIR spectrographic analysis. They were categorized into COM, COD, mixed COM+COD and others. Of 142 pure calcium oxalate stone patients, 87 were predominantly COM stone formers and 55 COD stone formers. Their metabolic status of 24 h urine and serum was assessed. The values of urine calcium, phosphorus, uric acid, magnesium, creatinine, oxalate, citric acid, sodium and potassium, serum values of calcium, phosphorus, uric acid, magnesium and creatinine and calculated values of creatinine clearance, tubular reabsorption of phosphate, calcium magnesium ratio and calcium oxalate ratio were recorded. Comparison was made between the COM stone group and the COD stone group. Patients forming COM stones had significantly higher mean values for urine calcium (P stone forming patients. All other values failed to show significant difference. Patients, with higher urine oxalate, formed COM stones. Those with low magnesium (which is an inhibitor) formed more of COD stones. Urine calcium was high in both groups without showing significant variation from the mean. In patients with high calcium-oxalate and calcium-magnesium ratios, there is higher chance of forming a COD stone than COM. Identification of the crystallization pattern of the calcium stone will help in selecting treatment modalities.

Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone: Technique and outcomes

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Yuh-Shyan Tsai

2015-03-01

Conclusion: Such an ancillary procedure might be suitable for the management of complete staghorn stones or other complex renal stones in patients in whom adequate intracalyceal space was not available for the creation of nephrostomy access.

Calcium and phosphorus regulatory hormones and risk of incident symptomatic kidney stones.

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Taylor, Eric N; Hoofnagle, Andrew N; Curhan, Gary C

2015-04-07

Calcium and phosphorus regulatory hormones may contribute to the pathogenesis of calcium nephrolithiasis. However, there has been no prospective study to date of plasma hormone levels and risk of kidney stones. This study aimed to examine independent associations between plasma levels of 1,25-dihydroxyvitamin D (1,25[OH]2D), 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, fibroblast growth factor 23 (FGF23), parathyroid hormone, calcium, phosphate, and creatinine and the subsequent risk of incident kidney stones. This study was a prospective, nested case-control study of men in the Health Professionals Follow-Up Study who were free of diagnosed nephrolithiasis at blood draw. During 12 years of follow-up, 356 men developed an incident symptomatic kidney stone. Using risk set sampling, controls were selected in a 2:1 ratio (n=712 controls) and matched for age, race, and year, month, and time of day of blood collection. Baseline plasma levels of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, parathyroid hormone, calcium, phosphate, and creatinine were similar in cases and controls. Mean 1,25(OH)2D and median FGF23 levels were higher in cases than controls but differences were small and statistically nonsignificant (45.7 versus 44.2 pg/ml, P=0.07 for 1,25[OH]2D; 47.6 versus 45.1 pg/ml, P=0.08 for FGF23). However, after adjusting for body mass index, diet, plasma factors, and other covariates, the odds ratios of incident symptomatic kidney stones in the highest compared with lowest quartiles were 1.73 (95% confidence interval, 1.11 to 2.71; P for trend 0.01) for 1,25(OH)2D and 1.45 (95% confidence interval, 0.96 to 2.19; P for trend 0.03) for FGF23. There were no significant associations between other plasma factors and kidney stone risk. Higher plasma 1,25(OH)2D, even in ranges considered normal, is independently associated with higher risk of symptomatic kidney stones. Although of borderline statistical significance, these findings also suggest that higher FGF23 may be

Renal Control of Calcium, Phosphate, and Magnesium Homeostasis

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Chonchol, Michel; Levi, Moshe

2015-01-01

Calcium, phosphate, and magnesium are multivalent cations that are important for many biologic and cellular functions. The kidneys play a central role in the homeostasis of these ions. Gastrointestinal absorption is balanced by renal excretion. When body stores of these ions decline significantly, gastrointestinal absorption, bone resorption, and renal tubular reabsorption increase to normalize their levels. Renal regulation of these ions occurs through glomerular filtration and tubular reabsorption and/or secretion and is therefore an important determinant of plasma ion concentration. Under physiologic conditions, the whole body balance of calcium, phosphate, and magnesium is maintained by fine adjustments of urinary excretion to equal the net intake. This review discusses how calcium, phosphate, and magnesium are handled by the kidneys. PMID:25287933

Hyperoxaluria in idiopathic calcium nephrolithiasis--what are the limits?

DEFF Research Database (Denmark)

Osther, P J

1999-01-01

OBJECTIVE: The object of this study was to investigate the role for measurement of 24-h renal oxalate excretion in the evaluation of idiopathic calcium stone formers. MATERIALS AND METHODS: Renal excretion rates of oxalate and creatinine were measured in 24-h urines in 46 consecutive male recurrent...

Has the pelvic renal stone position inside the upper loop of JJ stent any influence on the extracorporeal shock wave lithotripsy results?

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Pricop, Catalin; Serban, Dragomir N; Serban, Ionela Lacramioara; Cumpanas, Alin-Adrian; Gingu, Constantin-Virgil

2016-01-01

JJ stents are often encountered in patients with pelvic renal stones referred for shock wave lithotripsy, most of them being placed either for obstructive renal pelvic stones or for ureteric stones mobilized retrograde during the JJ stent insertion. The aim of the study was to determine whether the relative stone position in the upper loop of the JJ stent during extracorporeal shock wave lithotripsy (SWL) influences the efficiency of the procedure. The study was designed as a prospective cohort study on 162 patients addressing the same urological department, with single renal pelvic stone (primary or mobilized to the renal pelvis during the insertion of JJ stent), smaller than 15 mm, with JJ stent, treated by SWL using a second generation spark gap lithotripter, 18 kV, 3000 waves/session. Patients were divided in three groups according to the relative position of the stone to the upper loop of the JJ stent as appears on plain X-ray: stone-inside-loop, loop-crossing-stone and stone-outside the loop. The SWL success rate was the primary outcome of the study. p Value, Chi square and Kruskal-Wallis tests were used for statistical analysis. For stone-inside-loop cases, SWL efficiency was 22.7 versus 42 % for all the other cases (p = 0.002). Other factors for decreased SWL success rate were: higher stone radio-opacity, larger JJ of stent and obese patients. Study limitation is represented by the relative small study group and by the evaluation of stone density using plain X-ray instead of computer tomography. For pelvic renal stones having the same density characteristics studied by plain X-ray, the SWL efficiency is lower in stone-inside-loop cases comparing with the other positions. The overall stone free rate for renal pelvic stones could be explained by the second generation lithotripter used for all procedures.

Influences of renal stone surgeries on renal function; Evaluation of renal function with sup 99m Tc-DMSA renal scintigraphy

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Katayama, Yasushi (Niigata Univ. (Japan). School of Medicine)

1991-10-01

From 1984 to 1990, {sup 99m}Tc-DMSA renal scintigraphy was performed before and after nephrolithotomy (15 cases), pyelolithotomy (15 cases), percutaneous nephrolithotripsy (PNL: 15 cases) and extracorporeal shock wave lithotripsy (ESWL: 16 cases, 17 kidneys) in order to evaluate of influences of renal stone surgeries on split renal function. DMSA renal uptake change ratio of treated kidneys of nephrolithotomy (-24.94{+-}5.60%) was significantly lower than that of PNL (-0.06{+-}3.92%), pyelolithotomy (-4.08{+-}4.79%) (p<0.01) and ESWL (-7.72{+-}3.87%) (p<0.05). The average change ratios of contralateral kidneys were as follows: PNL 4.80{+-}4.21% nephrolithotomy 4.67{+-}4.73%, pyelolithotomy -1.46{+-}5.39% and ESWL -2.02{+-}4.44%. One to 3 weeks after PNL, the cold area on the renal image was found in 10 (66.7%) of 15 cases. In cases of ESWL, DMSA renal uptake decreased even 4-10 weeks (mean 7 weeks) after treatment. In conclusion, possibility of deterioration of renal function after ESWL was suggested. (author).

[Solitary stones of the lower renal calyx: how to treat?

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Martov, A G; Ergakov, D V; Andronov, A S; Dutov, S V; Takhaev, R A; Kil'chukov, Z I; Moskalenko, S A

2017-06-01

The choice of treatment for the stones of the lower renal calyx is one of the challenging issues of modern urology. The aim of this retrospective and prospective study was to investigate the clinical effectiveness and safety of 3 modern minimally invasive techniques for treating renal stones: percutaneous (PNL) and transurethral (TNL) nephrolithotripsy and extracorporeal shock wave lithotripsy (ESWL) in patients with solitary lower calyx stones sized from 10 to 15 mm. The study included 136 patients with symptomatic stones of the lower calyces, who underwent ESWL, PNL and TNL from November 2010 to the present day. The criteria for inclusion in the study were: the presence of a solitary stone of the lower calyx, the stone size of 10 mm to 15 mm, the performance of the classical (standard) PNL in the prone position (puncture access 28-30 Fr) and the follow-up examination at 3 months after the operation. Forty-six patients underwent ESWL, 49 - PNL, and 41 - TNL. Postoperative follow-up was done at 3 months and included a plain radiography, ultrasound and non-contrast-enhanced computed tomography. The stone free rate (SFR) was used as a criterion for the effectiveness of the intervention, where the stone size of 3 mm was taken as the upper limit for the possible presence of fragments. Besides, the rate of repeat interventions, complications and subjective assessment of patients treatment satisfaction (0 to 10) by using visual analogue scale (VAS) were investigated. The effectiveness analysis of the three methods for treating the lower calyx stones sized 10-15 mm showed that PNL was no more effective than TNL (SFR 95.9% and 85.4%, respectively), but both methods were significantly more effective than ESWL (SFR 69.5%). 29.3% of patients who underwent TNL required repeat interventions (TNL or ESWL), while among those treated with ESWL, 45.6% required repeat ESWL sessions. PNL resulted in stone clearance in one stage. Postoperative inflammatory complications were most

Infusum Daun Alpukat Sebagai Inhibitor Kristalisasi Kalsium Oksalat pada Ginjal (THE AVOCADO LEAVES INFUSUM AS INHIBITOR ON RENAL CALCIUM OXALATE CRYSTALIZATION

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Rini Madyastuti

2016-01-01

Full Text Available Urine crystal is a crystal nucleus which tend to form urine stone. The case of urine stone seems to beincreased every year. Crystallization could induce acute tubular necrosis which impact on renal dysfunction.The signs of this condition are high level of urea, creatinine and decrease glomerulus filtration rate. Theobjective of this research was to evaluate the effects of infusum Persea americana Mill as an inhibitorcrystallization which induced by ethylene glycol on white male rats. 20 male rats were divided into 4groups; K1 as negative group received only distilled water ad libitum, K2 as positive group receiveddistilled water containing ethylene glycol, K3 (dose 5% and K4 (dose 10% as treatment groups receivedwater containing ethylene glycol and avocado leaves infusion. Phytochemsitry screening of infusion avocadoleaves consisted of flavonoid, saponin, tanine and quinone. Result of analysis showed that the level ofureum and creatinine on K2 was higher than K3 and K4 group. The increased level could be inhibited byinfusion avocado leaves. The measurement of glomerular filtration rate in treatment groups wassignificantly different (p<0.05. Descriptive histopathology observation showed that renal lesio in grouptreatment (K3 and K4 were declined. Large crystal calcium oxalate on K2 group was observed by usingpolarized microscope, whereas small crystal calcium oxalate were seen in the infusion of avocado leavesgroups. These result showed the ability of infusion of avocado leaves as an inhibitor on the growth ofcrystallization calcium oxalate

A comparative study of mud-like and coralliform calcium carbonate gallbladder stones.

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Ma, Rui-Hong; Luo, Xiao-Bing; Wang, Xiao-Feng; Qiao, Tie; Huang, Hai-Yi; Zhong, Hai-Qiang

2017-07-01

To gain insight to underlying mechanism of the formation of calcium carbonate (CaCO 3 ) gallbladder stones, we did comparative study of stones with mud appearance and those with coralliform appearance. A total of 93 gallbladder stones with mud appearance and 50 stones with coralliform appearance were analyzed. The appearance, color, texture, and the detection of Clonorchis sinensis eggs by microscopic examination were compared between the two groups. Then, the material compositions of stones were analyzed using Fourier Transform Infrared spectroscopy and the spectrogram characteristics were compared. Moreover, microstructure characteristics of the two kinds of stones were observed and compared with Scanning Electron Microscopy. Mud-like gallbladder stones were mainly earthy yellow or brown with brittle or soft texture, while coralliform stones were mainly black with extremely hard texture, the differences between the two groups was significant (p mud-like gallbladder stones were CaCO 3 stones, and mainly aragonite; while all of the coralliform stones were CaCO 3 stones, and mainly calcite (p mud-like CaCO 3 stones was lower than that in coralliform CaCO 3 stones (p Mud-like CaCO 3 stones mainly happened to patients with cystic duct obstruction. Clonorchis sinensis infection was mainly associated with coralliform (calcite) CaCO 3 stones. Cystic duct obstruction was mainly associated with mud-like (aragonite) CaCO 3 stones. © 2017 Wiley Periodicals, Inc.

Effect of Stone Size and Composition on Ultrasonic Propulsion Ex Vivo.

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Janssen, Karmon M; Brand, Timothy C; Bailey, Michael R; Cunitz, Bryan W; Harper, Jonathan D; Sorensen, Mathew D; Dunmire, Barbrina

2018-01-01

To evaluate in more detail the effectiveness of a new designed more efficient ultrasonic propulsion for large stones and specific stone compositions in a tissue phantom model. In the first clinical trial of noninvasive ultrasonic propulsion, urinary stones of unknown compositions and sizes up to 10 mm were successfully repositioned. The study included 8- to 12-mm stones of 4 different primary compositions (calcium oxalate monohydrate, ammonium acid urate, calcium phosphate, and struvite) and a renal calyx phantom consisting of a 12 mm × 30 mm well in a 10-cm block of tissue-mimicking material. Primary outcome was the number of times a stone was expelled over 10 attempts, with ultrasonic propulsion burst duration varying from 0.5 seconds to 5 seconds. Overall success rate at expelling stones was 95%. All calcium oxalate monohydrate and ammonium acid urate stones were expelled 100% of the time. The largest stone (12 mm) became lodged within the 12-mm phantom calyx 25% of the time regardless of the burst duration. With the 0.5-second burst, there was insufficient energy to expel the heaviest stone (0.88 g), but there was sufficient energy at the longer burst durations. With a single burst, ultrasonic propulsion successfully moved most stones at least 3 cm and, regardless of size or composition, expelled them from the calyx. Ultrasonic propulsion is limited to the stones smaller than the calyceal space, and for each burst duration, related to maximum stone mass. Published by Elsevier Inc.

Rare calcium oxalate monohydrate calculus attached to the wall of the renal pelvis.

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Grases, Felix; Costa-Bauza, Antonia; Prieto, Rafael M; Saus, Carlos; Servera, Antonio; García-Miralles, Reyes; Benejam, Joan

2011-04-01

Most renal calculi can be classified using well-established criteria in a manner that reflects both composition and fine structure under specific pathophysiological conditions. However, when a large patient population is considered, rare renal calculi invariably appear, some of which have never been classified; careful study is required to establish stone etiology in such cases. The patient in the present case report formed two types of calculi. One was attached on the wall of the renal pelvis near the ureter and part of the calculus was embedded inside pelvic renal tissue. The calculus developed on an ossified calcification located in the pelvis tissue. Current knowledge on the development of calcification in soft tissues suggests a pre-existing injury as an inducer of its development. A mechanism of calculus formation is proposed. The second stone was a typical jack-stone calculus. © 2011 The Japanese Urological Association.

Uricosuric effect of Roselle (Hibiscus sabdariffa) in normal and renal-stone former subjects.

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Prasongwatana, Vitoon; Woottisin, Surachet; Sriboonlue, Pote; Kukongviriyapan, Veerapol

2008-05-22

The Roselle (Hibiscus sabdariffa) was investigated for its uricosuric effect. A human model with nine subjects with no history of renal stones (non-renal stone, NS) and nine with a history of renal stones (RS) was used in this study. A cup of tea made from 1.5 g of dry Roselle calyces was provided to subjects twice daily (morning and evening) for 15 days. A clotted blood and two consecutive 24-h urine samples were collected from each subject three times: (1) at baseline (control); (2) on days 14 and 15 during the tea drinking period; and (3) 15 days after the tea drinking was stopped (washout). Serum and 24-h urinary samples were analyzed for uric acid and other chemical compositions related to urinary stone risk factors. All analyzed serum parameters were within normal ranges and similar; between the two groups of subjects and among the three periods. Vis-à-vis the urinary parameters, most of the baseline values for both groups were similar. After taking the tea, the trend was an increase in oxalate and citrate in both groups and uric acid excretion and clearance in the NS group. In the RS group, both uric acid excretion and clearance were significantly increased (pRoselle calyces. Since the various chemical constituents in Roselle calyces have been identified, the one(s) exerting this uricosuric effect need to be identified.

MSCT renal stone protocol; dose penalty and influence on management decision of patients: Is it really worth the radiation dose?

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Ahmed Hamimi

2016-03-01

Conclusions: Considering time is of the essence; MSCT renal stone protocol using low dose technique is crucial in the management of renal stone in acute setting including the diagnosis and management decision.

Clinical observation of calcium dobesilate in the treatment of chronic renal allograft dysfunction

Institute of Scientific and Technical Information of China (English)

Zheng Xue-yang; Han Shu; Zhou Mei-sheng; Fu Shang-xi; Wang Li-ming

2014-01-01

Abstract BACKGROUND: Calcium dobesilate (calcium dihydroxy-2, 5-benzenesulfonate) has been widely used to treat chronic venous insufficiency and diabetic retinopathy, especialy many clinical studies showed that calcium dobesilate as vasoprotective compound ameliorates renal lesions in diabetic nephropathy. However, there are few literatures reported calcium dobesilate in the treatment of chronic renal alograft dysfunction after renal transplantation. OBJECTIVE:To observe the efficacy and safety of calcium dobesilate on chronic renal dysfunction after renal transplantation. METHODS:A total of 152 patients with chronic renal alograft dysfunction after renal transplantation were enroled from the Military Institute of Organ Transplantation, Changzheng Hospital, Second Military Medical University of Chinese PLA. They were randomly divided into the treatment group (n=78) and the control group (n=74). Patients in the treatment group received 500 mg of calcium dobesilate three times daily for eight weeks. Al patients were treated with calcineurin inhibitor-based triple immunosuppressive protocols and comprehensive therapies. RESULTS AND CONCLUSION: For patients receiving calcium dobesilate, serum creatinine, blood urea nitrogen and uric acid decreased significantly at two weeks after treatment and maintained a stable level (P 0.05). Administration of calcium dobesilate did not change the general condition of patients with renal insufficiency, nor did it affect blood concentrations of the immunosuppressive agents. Calcium dobesilate may help to delay the progress of graft injury in patients with chronic renal graft dysfunction by conjugating with creatinine, ameliorating the impaired microcirculation and its antioxidant property. The decline in serum creatinine aleviates patients’ anxiety and concern arising from the elevation of creatinine. However, the negative interference with serum creatinine caused by calcium dobesilate should be cautious in order to avoid

Diagnosis of rare inherited glyoxalate metabolic disorders through in-situ analysis of renal stones

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Jacob, D. E.; Grohe, B.; Hoppe, B.; Beck, B. B.; Tessadri, R.

2012-04-01

The primary hyperoxalurias type I - III constitute rare autosomal-recessive inherited disorders of the human glyoxylate metabolism. By mechanisms that are ill understood progressive nephrocalcinosis and recurrent urolithiasis (kidney stone formation) often starting in early childhood, along with their secondary complications results in loss of nephron mass which progresses to end-stage renal failure over time. In the most frequent form, end-stage renal failure (ESRF) is the rule and combined liver/kidney transplantation respectively pre-emptive liver transplantation are the only causative treatment today. Hence, this contributes significantly to healthcare costs and early diagnosis is extremely important for a positive outcome for the patient. We are developing a stone-based diagnostic method by in-detail multi-methods investigation of the crystalline moiety in concert with urine and stone proteomics. Stone analysis will allow faster analysis at low-impact for the patients in the early stages of the disease. First results from combined spectroscopic (Raman, FTIR)and geochemical micro-analyses (Electron Microprobe and Laser Ablation ICP-MS) are presented here that show significant differences between stones from hyperoxaluria patients and those formed by patients without this disorder (idiopathic stones). Major differences exist in chemistry as well as in morphology and phase composition of the stones. Ca/P ratios and Mg contents differentiate between oxalate-stones from hyperoxaluria patients and idiopathic stones. Results show that also within the different subtypes of primary hyperoxaluria significant differences can be found in stone composition. These imply differences in stone formation which could be exploited for new therapeutic pathways. Furthermore, the results provide important feedback for suspected but yet unconfirmed cases of primary hyperoxaluria when used in concert with the genetic methods routinely applied.

The effects of previous open renal stone surgery types on PNL outcomes.

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Ozgor, Faruk; Kucuktopcu, Onur; Ucpinar, Burak; Sarilar, Omer; Erbin, Akif; Yanaral, Fatih; Sahan, Murat; Binbay, Murat

2016-01-01

Our aim was to demonstrate the effect of insicion of renal parenchyma during open renal stone surgery (ORSS) on percutaneous nephrolithotomy (PNL) outcomes. Patients with history of ORSS who underwent PNL operation between June 2005 and June 2015 were analyzed retrospectively. Patients were divided into two groups according to their type of previous ORSS. Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study. 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%). Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.

Do JJ Stents Increase the Effectiveness of Extracorporeal Shock Wave Lithotripsy for Pediatric Renal Stones?

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Gündüz, Metin; Sekmenli, Tamer; Ciftci, İlhan; Elmacı, Ahmet Midhat

2017-01-01

We aimed to evaluate the effects of preoperative urinary catheterization in nephrolithiasis treatment with extracorporeal shock wave lithotripsy (SWL). Patients admitted to the Department of Pediatric Surgery for renal stones between June 2012 and June 2014 were evaluated retrospectively. Patients were divided into 2 groups based on JJ stent placements. Group 1 did not receive JJ stents, while group 2 did. The recorded demographic data for each group included age, gender, stone size, location, sessions, and complications. The Elmed Complit ESWL system was used with 11-13 kV, and 1,000-1,200 shots in patients 2-4 years of age, and 11-14 kV, and 1,000-1,500 shots for patients over 4 years. In group 1, 18 sessions of SWL were performed on 8 female and 2 male children with a mean age of 4.5 (range 2-12) years and stone diameter of 9 (range 7-15) mm. The locations of the renal stones were in the upper pole in 1 patient, 7 in the lower pole, and 2 in the pelvis renalis. Postoperatively, 1 patient had hematuria, 2 had dysuria, and one had a stone in the external urethral meatus. Eighty percent of patients were stone free; there were no fragmentations in 2 patients, and 1 patient discontinued treatment. In group 2, 15 SWL sessions were performed on 5 female and 5 male children aged 4 (range 3-5) and the stone diameter was 9 (range 7-16) mm. The locations of the renal stones were in the upper pole in 6 patients, in the lower pole in 3 patients, and in the ureteropelvic junction in one patient. JJ stents were placed in all patients preoperatively. Postoperatively, 3 patients had hematuria and one had dysuria. At the end of the study, all of the patients were stone free. Statistically, there were no differences in age, gender, stone size, location, and the number of sessions. Our results indicate that SWL without preoperative ureteral stenting is an effective and safe procedure that can be carried out in the pediatric population. Preoperative JJ stenting is unnecessary in

Percutaneous nephrolithotomy vs. extracorporeal shockwave lithotripsy for treating a 20-30 mm single renal pelvic stone.

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Hassan, Mohammed; El-Nahas, Ahmed R; Sheir, Khaled Z; El-Tabey, Nasr A; El-Assmy, Ahmed M; Elshal, Ahmed M; Shokeir, Ahmed A

2015-09-01

To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20-30 mm single renal pelvic stone. The computerised records of patients who underwent PNL or ESWL for a 20-30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged PNL. The re-treatment rate (75% vs. 5%), the need for secondary procedures (25% vs. 4.7%) and total number of procedures (three vs. one) were significantly higher in the ESWL group (P PNL group (95% vs. 75%, P PNL (US$ 1120 vs. 490; P PNL was more effective than ESWL for treating a single renal pelvic stone of 20-30 mm. However, ESWL was associated with fewer complications and a lower cost.

Studying inhibition of calcium oxalate stone formation: an in vitro approach for screening hydrogen sulfide and its metabolites

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S. Vaitheeswari

2015-06-01

Full Text Available ABSTRACTPurpose:Calcium oxalate urolithiasis is one of the most common urinary tract diseases and is of high prevalence. The present study proposes to evaluate the antilithiatic property of hydrogen sulfide and its metabolites like thiosulfate & sulfate in an in vitro model.Materials and Methods:The antilithiatic activity of sodium hydrogen sulfide (NaSH, sodium thiosulfate (Na2S2O3 and sodium sulfate (Na2SO4 on the kinetics of calcium oxalate crystal formation was investigated both in physiological buffer and in urine from normal and recurrent stone forming volunteers. The stones were characterized by optical and spectroscopic techniques.Results:The stones were characterized to be monoclinic, prismatic and bipyramidal habit which is of calcium monohydrate and dihydrate nature. The FTIR displayed fingerprint corresponding to calcium oxalate in the control while in NaSH treated, S=O vibrations were visible in the spectrum. The order of percentage inhibition was NaSH>Na2S2O3>Na2SO4.Conclusion:Our study indicates that sodium hydrogen sulfide and its metabolite thiosulfate are inhibitors of calcium oxalate stone agglomeration which makes them unstable both in physiological buffer and in urine. This effect is attributed to pH changes and complexing of calcium by S2O32-and SO42- moiety produced by the test compounds.

Safety and efficacy of staged retrograde intrarenal surgery for large stone burden of renal stones in selected patients: A single-center experience

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Cheng-Feng Lin

2017-06-01

Conclusion: To the best of our knowledge, RIRS for large renal stone manipulation is an effective and safe treatment modality currently. In our study, the single RIRS SFR was superior to PNL or SWL even when the stone burden was between 2.0 cm and 3.0 cm (80.2%. For those patients whose stone burden was over 3.0 cm or for those with comorbidities, staged RIRS resulted in a lower complication rate, reduced hospital stay, and better SFR (76.5%.

Effects of Orthosiphon grandiflorus, Hibiscus sabdariffa and Phyllanthus amarus extracts on risk factors for urinary calcium oxalate stones in rats.

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Woottisin, Surachet; Hossain, Rayhan Zubair; Yachantha, Chatchai; Sriboonlue, Pote; Ogawa, Yoshihide; Saito, Seiichi

2011-01-01

We evaluated the antilithic effect of Orthosiphon grandiflorus, Hibiscus sabdariffa and Phyllanthus amarus extracts on known risk factors for calcium oxalate stones in rats. We divided 30 male Wistar rats into 5 equal groups. Controls were fed a standard diet and the remaining groups received a 3% glycolate diet for 4 weeks to induce hyperoxaluria. One glycolate fed group served as the untreated group and the others were given oral extracts of Orthosiphon grandiflorus, Hibiscus sabdariffa or Phyllanthus amarus at a dose of 3.5 mg daily. We collected 24-hour urine and blood samples. Kidneys were harvested for histological examination. We measured the renal tissue content of calcium and oxalate. The Hibiscus sabdariffa group showed significantly decreased serum oxalate and glycolate, and higher oxalate urinary excretion. The Phyllanthus amarus group showed significantly increased urinary citrate vs the untreated group. Histological examination revealed less CaOx crystal deposition in the kidneys of Hibiscus sabdariffa and Phyllanthus amarus treated rats than in untreated rats. Those rats also had significantly lower renal tissue calcium content than untreated rats. All parameters in the Orthosiphon grandiflorus treated group were comparable to those in the untreated group. Hibiscus sabdariffa and Phyllanthus amarus decreased calcium crystal deposition in the kidneys. The antilithic effect of Hibiscus sabdariffa may be related to decreased oxalate retention in the kidney and more excretion into urine while that of Phyllanthus amarus may depend on increased urinary citrate. In contrast, administering Orthosiphon grandiflorus had no antilithic effect. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Nephrolithiasis-induced end stage renal disease

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M Ounissi

2010-03-01

Full Text Available M Ounissi¹, T Gargueh², M Mahfoudhi¹, K Boubaker¹, H Hedri¹, R Goucha¹, E Abderrahim¹, F Ben Hamida¹, T Ben Abdallah¹, F El Younsi¹, H Ben Maiz³, A Kheder¹1Internal Medicine Department, 2Pediatric Department, 3Laboratory of Kidney Diseases, Charles Nicolle Hospital, Tunis, TunisiaIntroduction: Nephrolithiasis still remains a too frequent and underappreciated cause of end stage renal disease (ESRD.Methods and patients: Of the entire cohort of 7128 consecutive patients who started maintenance dialysis in our nephrology department between January 1992 and December 2006, a total of 45 patients (26 women, 19 men had renal stone disease as the cause of ESRD. The type of nephrolithiasis was determined in 45 cases and etiology in 42. The treatment and evolution of stone disease and patient’s survival were studied.Results: The overall proportion of nephrolithiasis related ESRD was 0.63%. The mean age was 48.4 years. Infection stones (struvite accounted for 40%, calcium stones, 26.67% (primary hyperparathyroidism:15.56%; familial hypercalciuria: 4.44%, unknown etiology: 6.66%, primary hyperoxaluria type 1, 17.78% and uric acid lithiasis in 15.56% of cases. The mean delay of the evolution of the stone renal disease to chronic renal failure was 85.8 months. The feminine gender, obesity and elevated alkaline phosphatases >128 IU/L were significantly correlated with fast evolution of ESRD. The median evolution to ESRD was 12 months. The normal body mass index (BMI, medical treatment of stone and primary hyperoxaluria type 1 were correlated with fast evolution to ESRD. All patients were treated by hemodialysis during a mean evolution of 60 months. Sixteen patients died. The patient's survival rate at 1, 3 and 5 years was 97.6, 92.8 and 69% respectively. Hypocalcemia, cardiopathy and normal calcium-phosphate product were significantly correlated with lower survival rate.Conclusion: Severe forms of nephrolithiasis remain an underestimated cause of

Furosemide/Fludrocortisone Test and Clinical Parameters to Diagnose Incomplete Distal Renal Tubular Acidosis in Kidney Stone Formers.

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Dhayat, Nasser A; Gradwell, Michael W; Pathare, Ganesh; Anderegg, Manuel; Schneider, Lisa; Luethi, David; Mattmann, Cedric; Moe, Orson W; Vogt, Bruno; Fuster, Daniel G

2017-09-07

Incomplete distal renal tubular acidosis is a well known cause of calcareous nephrolithiasis but the prevalence is unknown, mostly due to lack of accepted diagnostic tests and criteria. The ammonium chloride test is considered as gold standard for the diagnosis of incomplete distal renal tubular acidosis, but the furosemide/fludrocortisone test was recently proposed as an alternative. Because of the lack of rigorous comparative studies, the validity of the furosemide/fludrocortisone test in stone formers remains unknown. In addition, the performance of conventional, nonprovocative parameters in predicting incomplete distal renal tubular acidosis has not been studied. We conducted a prospective study in an unselected cohort of 170 stone formers that underwent sequential ammonium chloride and furosemide/fludrocortisone testing. Using the ammonium chloride test as gold standard, the prevalence of incomplete distal renal tubular acidosis was 8%. Sensitivity and specificity of the furosemide/fludrocortisone test were 77% and 85%, respectively, yielding a positive predictive value of 30% and a negative predictive value of 98%. Testing of several nonprovocative clinical parameters in the prediction of incomplete distal renal tubular acidosis revealed fasting morning urinary pH and plasma potassium as the most discriminative parameters. The combination of a fasting morning urinary threshold pH 3.8 mEq/L yielded a negative predictive value of 98% with a sensitivity of 85% and a specificity of 77% for the diagnosis of incomplete distal renal tubular acidosis. The furosemide/fludrocortisone test can be used for incomplete distal renal tubular acidosis screening in stone formers, but an abnormal furosemide/fludrocortisone test result needs confirmation by ammonium chloride testing. Our data furthermore indicate that incomplete distal renal tubular acidosis can reliably be excluded in stone formers by use of nonprovocative clinical parameters. Copyright © 2017 by the American

Retroperitoneoscopic pyelolithotomy: A minimally invasive alternative for the management of large renal pelvic stone

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Saurabh Sudhir Chipde

2014-01-01

Full Text Available Introduction: Large stones in renal pelvis can be treated with percutaneous nephrolithotomy (PCNL or pyelolithotomy (either by open or laparoscopic techniques. PCNL is difficult in undilated system. For pyelolithotomy, laparoscopy is more preferable over the open surgery. Surgeons are more familiar with the tansperitoneoscopic anatomy than retroperitoneoscopic one, but retroperitoneoscopic approach can be attempted if we anticipate the problems in the transperitoneal route. Case: A fifty years old gentleman presented to us with the complaint of dull aching right flank pain. On ultrasonographic examination, he was found to have a large stone in renal pelvis with minimal hydronephrosis and thickened omentum on right side. Xray KUB showed a large radio-opaque shadow in renal area. We did the CECT-Urogram of the patient to know the detailed anatomy, which showed a stone of 5.3 x 3.7 cm in right extra-rena pelvis without hydronephrosis and a large focal area of marked fat stranding in omentum on the right side in mid and lower abdomen with swirling of fat stranding on the superior aspect suggestive of omental infarction and torsion. Due to undilated caliceal system, we preferred laparoscopic surgery over the PCNL in this patient. As whole of the omental tissue was stuck on right side we decided to proceed with transperitoneoscopic route instead of retroperitoneoscopic one. The DJ stent was inserted preoperatively.The surgery was performed in the flank position with three ports, one 10mm port just antero-inferior to tip of 12th rib for camera and two 5mm working ports, one at anterior axillary line and other at renal angle. We created the retroperitoneal space with the customized balloon, made with the glove-fingure. Results: The operative time was 1 hour 40 minutes, and there were no intra or post-operative complications. The stone was removed in toto. Patient was orally allowed on first postoperative day and foleys was removed on second day. patient

Substituting milk for apple juice does not increase kidney stone risk in most normocalciuric adults who form calcium oxalate stones.

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Massey, L K; Kynast-Gales, S A

1998-03-01

Increasing intake of dietary calcium from less than 400 mg to 800 mg daily may decrease the absorption of dietary oxalate, which in turn would decrease urinary oxalate excretion. The effect of substituting milk for apple juice on urine composition and risk of calcium oxalate precipitability was studied. Twenty-one normocalciuric adults with a history of at least 1 calcium oxalate stone and urinary oxalate excretion exceeding 275 micromol/day on their self-selected diet. Randomized crossover trial. Each participant consumed two moderate-oxalate (2,011 micromol/day) study diets, which were identical except that one contained 360 mL milk and the other contained 540 mL apple juice as the beverage with meals. Four days free-living then 2 days in the metabolic unit of a university nutrition department. Tiselius risk index for calcium oxalate precipitability calculated from urine composition. Paired t tests. Twenty-four hour urinary oxalate excretion was 18% lower (Pjuice diet: 423 vs 514 micromol, respectively. Calcium excretion was 17% higher (Pjuice diet: 4.7 vs 3.9 mmol, respectively. Urinary magnesium and citrate excretion, volume, and Tiselius risk index did not differ between diets. Substituting 360 mL milk daily for apple juice with meals in a diet containing moderate amounts of dietary oxalate from whole grains, legumes, fruits, and vegetables does not increase the risk index of calcium oxalate precipitability in most normocalciuric adults who form stones.

Effects and outcome of Tamsulosin more than just stone clearance after extracorporeal shock wave lithotripsy for renal calculi

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Qadri, S. S. U.; Khalid, S. E.; Mahmud, S. M.

2014-01-01

Objective: To determine the effect of Tamsulosin, as adjunctive medical therapy after Extracorporeal Shock Wave Lithotripsy for renal stones on rate of stone clearance, clearance time, pain intensity during stone clearance, steinstrasse formation and auxiliary surgical intervention required. Method: A prospective randomized controlled study was carried out in 120 patients who underwent ESWL for renal stones of 0.5-2.0 cm. They were randomized into study and control group in which Tamsulosin 0.4mg/day was given in former as an adjunctive medical therapy. All patients underwent ESWL every 2 weeks until complete stone clearance for 8 weeks. The parameters assessed were stone clearance, clearance time, pain intensity and effect on steinstrasse. Results: Of the 120 patients 60 were in each group. The stone clearance rate was greater in study than in control group, 58(96.7%) vs. 48(80%) respectively, (p<0.004). The mean stone clearance time was observed earlier in study group as compared to control group with significant statistical difference in stone size between 0.6-1.5 cm. The mean intensity of pain patients experienced according to Visual analogue scale (VAS) was significantly less in study group (p<0.002). The rate of steinstrasse formation was observed to be higher in control than in study group 15(25%) vs 6(10%) respectively(p<0.003), while its spontaneous clearance was higher in study group than in control group 83.3% vs 33.3% (p<0.03). Conclusion: Tamsulosin significantly increases stone clearance after shock wave lithotripsy for renal stones. It also appeared to facilitate earlier stone clearance, reduces severity of pain, reduces the incidence of steinstrasse formation and tends to facilitate its spontaneous clearance. (author)

Altered Calcium and Vitamin D Homeostasis in First-Time Calcium Kidney Stone-Formers.

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Hemamalini Ketha

Full Text Available Elevated serum 1,25-dihydroxyvitamin D (1,25(OH2D concentrations have been reported among cohorts of recurrent calcium (Ca kidney stone-formers and implicated in the pathogenesis of hypercalciuria. Variations in Ca and vitamin D metabolism, and excretion of urinary solutes among first-time male and female Ca stone-formers in the community, however, have not been defined.In a 4-year community-based study we measured serum Ca, phosphorus (P, 25-hydroxyvitamin D (25(OHD, 1,25(OH2D, 24,25-dihydroxyvitamin D (24,25(OH2D, parathyroid hormone (PTH, and fibroblast growth factor-23 (FGF-23 concentrations in first-time Ca stone-formers and age- and gender frequency-matched controls.Serum Ca and 1,25(OH2D were increased in Ca stone-formers compared to controls (P = 0.01 and P = 0.001. Stone-formers had a lower serum 24,25(OH2D/25(OHD ratio compared to controls (P = 0.008. Serum PTH and FGF-23 concentrations were similar in the groups. Urine Ca excretion was similar in the two groups (P = 0.82. In controls, positive associations between serum 25(OHD and 24,25(OH2D, FGF-23 and fractional phosphate excretion, and negative associations between serum Ca and PTH, and FGF-23 and 1,25(OH2D were observed. In SF associations between FGF-23 and fractional phosphate excretion, and FGF-23 and 1,25(OH2D, were not observed. 1,25(OH2D concentrations associated more weakly with FGF-23 in SF compared with C (P <0.05.Quantitative differences in serum Ca and 1,25(OH2D and reductions in 24-hydroxylation of vitamin D metabolites are present in first-time SF and might contribute to first-time stone risk.

Use of the Escape nitinol stone retrieval basket facilitates fragmentation and extraction of ureteral and renal calculi: a pilot study.

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Kesler, Stuart S; Pierre, Sean A; Brison, Daniel I; Preminger, Glenn M; Munver, Ravi

2008-06-01

Advances in ureteroscope and stone basket design have catapulted ureteroscopy to the forefront of surgical stone management; however, persistent problems such as stone migration continue to challenge urologists. The Escape nitinol stone retrieval basket (Boston Scientific, Natick, MA) is a stone basket designed to capture calculi and facilitate simultaneous laser lithotripsy in situ. We report our initial experience with the Escape basket for the management of urinary calculi and compare the use of this device with other methods of optimizing ureteroscopic stone management. A prospective evaluation of 23 patients undergoing ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy of urinary calculi was performed at two institutions by two surgeons (R.M. and G.M.P). The Escape basket was used to prevent retrograde ureteral stone migration or to facilitate fragmentation and extraction of large renal calculi. Patient demographics and perioperative parameters were assessed. Twenty-three patients (16 men, 7 women), with a mean age of 55.5 years (range 33-74 yrs) were treated for renal (n = 9) or ureteral (n = 14) calculi. The mean stone diameter was 1.4 cm (range 0.4-2.5 cm), mean fragmentation time was 44.1 minutes (range 10-75 min), and mean energy used was 3.1 kJ (range 0.4-10.6 kJ). No complications were encountered. Eighty-seven percent (20/23) of patients were rendered completely stone free after ureteroscopic laser lithotripsy using the Escape basket. Of the three patients with residual calculi, one patient with a 2.5-cm renal calculus had residual fragments larger than 3 mm, and two patients with large renal calculi had residual fragments smaller than 3 mm. The Escape basket appears to be safe and effective in preventing stone migration and facilitating ureteroscopic laser lithotripsy and stone extraction.

Alopecia universalis, renal stones, and hyperuricemia: A familial or an unfamiliar association

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Kalachand Jana

2014-01-01

Full Text Available Alopecia Universalis is an autoimmune disorder which sometimes may be associated with other autoimmune diseases like vitiligo, atopic dermatitis and endocrine disorders like hypothyroidism. In less than 2% of cases it may be associated with nephrotic syndrome although the underlying etiology has not been reported. We report here one similar case that had alopecia universalis beginning at the age of 17 years and simultaneously developed hyperuricemia. His son also developed alopecia universalis and renal stones at an early age of 10 years. The case represents one of the rare forms of alopecia namely alopecia universalis in two generations of the same family. Apart from this the case highlights the presence of renal stones probably due to hyperuricemia in both the generations which invokes a need to investigate any association of hyperuricemia with alopecia universalis.

The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study.

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Mohayuddin, Nazim; Malik, Hamad Afzal; Hussain, Manzoor; Tipu, Salman Ahmed; Shehzad, Asad; Hashmi, Altaf; Naqvi, Syed Ali Anwar; Rizvi, Syed Adibul Hasan

2009-03-01

To compare the outcome of Extra corporeal shockwave lithotripsy for a renal pelvic stone with and without JJ stent. A comparative cross sectional study was carried out at Sindh Institute of Urology and Transplantation from January 2007 to January 2008. Eighty patients with renal pelvic stone measuring 2cm +/- 2mm were selected for treatment with Extra Corporeal Shockwave Lithotripsy (ESWL). All of these patients were adults with normal renal function and had unilateral renal stones with negative urine cultures. Patients with renal failure and children were excluded. They were divided into two groups of 40 each. Group A patients underwent ESWL without a JJ stent and in Group B a JJ stent was placed before ESWL. SLX F2 electromagnetic ESWL machine was used to impart shock waves. 3000 shockwaves were given in a session. Both the groups were compared for renal colic, steinstrasse, fever, lower urinary tract symptoms (LUTS) emergency room visits and hospital admissions, stone clearance, number of ESWL sessions, auxilliary procedures, (percutaneous nephrostomy or ureterorenoscopy) and cost. Ureteric colic occurred in 13 (32.5%) patients in group A and in 3 (7.5%) patient in group B. Steinstrasse developed in 4 (10%) patients with out JJ stent and in 3 (7.5%) patients with JJ stent. Fever was encountered in 1 (2.5%) patient in group A and in 3 (7.5%) patient in group B. Mean emergency room visits were 2.1 per patient in group A and 0.7 per patient in group B. Stone clearance occurred in 33 (82.5%) patients in group A and 31 (77.5%) in group B. In group B lower urinary tract symptoms were found in 50% versus 20% in group A. Auxillary procedure was performed in one (2.5%) patient each in both groups. Pre ESWL JJ stenting for a 2 cm +/- 2 mm renal stone was not beneficial in terms of steinstrasse, fever, stone clearance and number of ESWL sessions. However ureteric colic was significantly less in the stented group. Lower urinary tract symptoms (LUTS) was also significantly

Renal Epithelial Cell Injury Induced by Calcium Oxalate Monohydrate Depends on their Structural Features: Size, Surface, and Crystalline Structure.

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Sun, Xin-Yuan; Ouyang, Jian-Ming; Gan, Qiong-Zhi; Liu, Ai-Jie

2016-11-01

Urinary crystals in normal and kidney stone patients often differ in crystal sizes and surface structures, but the effects of different crystal properties on renal tubular epithelial cells remain unclear. This study aimed to compare the cytotoxicity of micron/nano-calcium oxalate monohydrate (COM) crystals with sizes of 50 nm, 200 nm, 1 μm, 3 μm, and 10 μm to African green monkey renal epithelial (Vero) cells, to reveal the effect of crystal size and surface structure on cell injury, and to investigate the pathological mechanism of calcium oxalate kidney stones. Cell viability, cellular biochemical parameters, and internalized crystal amount in Vero cells were closely associated with the size of COM crystals. At the same concentration (200 μg/mL), COM-1 μm induced the most serious injury to Vero cells and caused the most significant change to cellular biochemical parameters, which were related to the specific porous structure and highest internalized amount in Vero cells. By contrast, COM-50 nm and COM-200 nm crystals lost their small size effect because of serious aggregation and weakened their toxicity to cells. COM-3 μm and COM-10 μm crystals were too large for cells to completely internalize; these crystals also exhibited a low specific surface area and thus weakened their toxicity. The excessive expression of intracellular ROS and reduction of the free-radical scavenger SOD were the main reasons for cell injury and eventually caused necrotic cell death. Crystal size, surface structure, aggregation, and internalization amount were closely related to the cytotoxicity of COM crystals.

Comparison of secondary signs as shown by unenhanced helical computed tomography in patients with uric acid or calcium ureteral stones

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Yii-Her Chou

2012-06-01

Full Text Available Unenhanced helical computed tomography (UHCT has evolved into a well-accepted diagnostic method in patients with suspected ureterolithiasis. UHCT not only shows stones within the lumen of the ureter, it also permits evaluation of the secondary signs associated with ureteral obstruction from stones. However, there we could find no data on how secondary signs might differ in relation to different compositions of ureteral stones. In this study, we compared the degree of secondary signs revealed by UHCT in uric acid stone formers and in patients forming calcium stones. We enrolled 117 patients with ureteral stones who underwent UHCT examination and Fourier transform infra-red analysis of stone samples. Clinical data were collected as follows: age, sex, estimated glomerular filtration rate (eGFR, urine pH, and radiological data on secondary signs apparent on UHCT. The uric acid stone formers had significantly lower urine pH and eGFR in comparison to calcium stone formers, and on UHCT they also had a higher percentage of the secondary signs, including rim sign (78.9% vs. 60.2%, hydroureter (94.7% vs. 89.8%, perirenal stranding (84.2% vs. 59.2% and kidney density difference (73.7% vs. 50.0%. The radiological difference was statistically significant for perirenal stranding (p=0.041. In conclusion, we found that UHCT scanning reveals secondary signs to be more frequent in patients with uric acid ureteral stones than in patients with calcium stones, a tendency that might result from an acidic urine environment.

[The fasting calcium/creatinine ratio in patients with calcium stones and the relation with hypercalciuria and phosphocalcium metabolism].

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Arrabal-Polo, Miguel Ángel; del Carmen Cano-García, María; Arrabal-Martín, Miguel

2016-04-01

To determine the importance of fasting calcium/creatinine ratio in patients with calcium stones and its relation with hypercalciuria and phospho-calcium metabolism. Cross-sectional study including 143 patients divided into two groups according to fasting calcium/creatinine. Group 1: 66 patients (calcium/ creatininecreatinine>0.11). A comparative study is performed between groups including phospho-calcium metabolism parameters and excretion of urinary lithogenic markers. Linear correlation studying calciuria and fasting calcium/ creatinine was performed. SPSS 17.0 statistical analysis software was used, considering p≤0.05. It is noteworthy that group 2 had increased 24 h urine calcium excretion in comparison to group 1 (229.3 vs 158.1; p=0.0001) and calcium/citrate (0.47 vs 0.34; p=0.001). There is a positive and significant correlation between calcium levels in 24 h urine and fasting calcium/creatinine (R=0.455; p=0.0001) and a cutoff is set at 0.127 (sensitivity 72%, specificity 66%) to determine hypercalciuria (>260 mg in 24 h). Increased fasting calcium/creatinine determines increased 24 hours calcium excretion, although the sensitivity and specificity to determine hypercalciuria is not high.

Aromatase deficiency causes altered expression of molecules critical for calcium reabsorption in the kidneys of female mice *.

NARCIS (Netherlands)

Oz, O.K.; Hajibeigi, A.; Howard, K.; Cummins, C.L.; Abel, M. van; Bindels, R.J.M.; Word, R.A.; Kuro-o, M.; Pak, C.Y.; Zerwekh, J.E.

2007-01-01

Kidney stones increase after menopause, suggesting a role for estrogen deficiency. ArKO mice have hypercalciuria and lower levels of calcium transport proteins, whereas levels of the klotho protein are elevated. Thus, estrogen deficiency is sufficient to cause altered renal calcium handling.

ORIGINAL PAPER ORIG ORIG Percutaneous stone removal

African Journals Online (AJOL)

Percutaneous nephrolithotomy (PCNL) is an effective procedure to treat patients with complex renal stones,. e.g. staghorn calculi and stones greater than 20 mm in diameter. The treatment of choice for small, less com- plex renal stones is extracorporeal shock-wave litho- tripsy (ESWL).1 We have treated renal stones mainly.

Phytate (IP6) is a powerful agent for preventing calcifications in biological fluids: usefulness in renal lithiasis treatment.

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Grases, F; Costa-Bauzá, A

1999-01-01

The extraordinary capacity of phytate (myo-inositol hexaphosphate), a substance present in blood, urine, interstitial and intracellular fluids, to inhibit crystallization of calcium salts (oxalate and phosphate) is discussed. Its role in preventing calcium renal stone formation is specifically presented and discussed. "In vitro" and "in vivo" experiments, as well as clinical studies clearly demonstrated that phytate plays an important role as a crystallization inhibitor of calcium salts in biological fluids and becomes a clear alternative in the treatment of calcium oxalate renal lithiasis.

Comparative Study between Slow Shock Wave Lithotripsy and Fast Shock Wave Lithotripsy in the Management of Renal Stone

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AKM Zamanul Islam Bhuiyan

2013-01-01

Full Text Available Background: Renal calculi are frequent causes of ureteric colic. Extracorporeal shock wave lithotripsy is the most common treatment of these stones. It uses focused sound waves to break up stones externally. Objective: To compare the efficiency of slow and fast delivery rate of shock waves on stone fragmentation and treatment outcome in patients with renal calculi. Materials and Methods: This prospective study was done in the department of Urology, National Institute of Kidney diseases and Urology, Sher-e-Bangla Nagar, Dhaka from July 2006 to June 2007. Total 90 patients were treated using the Storz Medical Modulith ® SLX lithotripter. Patients were divided into Group A, Group B and Group C – each group having 30 subjects. Group A was selected for extracorporeal shockwave lithotripsy (ESWL by 60 shock waves per minute, Group B by 90 shock waves per minute and Group C by 120 shock waves per minute. Results: Complete clearance of stone was observed in 24 patients in Group A and 13 patients in both Group B and Group C in first session. In Group A only 3 patients needed second session but in Group B and Group C, 12 and 8 patients needed second session. In Group A only one patient needed third session but third session was required for 3 patients in Group B and 5 patients in Group C for complete clearance of stone. In Group A, subsequent sessions were performed under spinal anesthesia and in Group B under sedation and analgesia (p>0.001. Mean number of sessions for full clearance of stones in group A was 1.37 ± 0.85, in Group B was 1.8 ± 0.887 and in Group C was 2.0 ± 1.083. Significant difference was observed in term of sessions among groups (p>0.05. In first follow-up, complete clearance of stones was seen in 24 patients in Group A and 13 in both Group B and Group C. In second follow-up, 3 patients in Group A, 12 in Group B and 8 in Group C showed complete clearance of stones. It was observed that rate of stone clearance was higher in Group A

A prospective randomized trial of open surgery versus endourological stone removal in patients of staghorn stones with chronic renal failure

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Anant Kumar

2001-01-01

Conclusion: In view of the better clearance rate and lesser cost of treatment, open surgery still has a place in the management of staghorn stones with chronic renal failure even in a tertiary urological center. However postoperative pain and a larger scar cannot be ignored.

Dose Optimization of Calcusol™ and Calcium Oxalate Monohydrate (COM on Primary Renal Epithelial Cells Cultures of Mice ( Mus musculus

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Ahmad Soni

2014-05-01

Full Text Available Kidney stones are one of the urologic diseases that have plagued mankind for centuries. The main constituents of stones in the kidney are calcium oxalate monohydrate (COM crystals. Nowadays, there are varieties of drugs and treatments that can be made to minimize the grievances due to kidney stone disease. The treatment can be done either by using chemicals or traditional medicine. Calcusol™ is one of the popular herbal products that have been used by Indonesian people in curing the kidney stone disease. The main constituent that was contained in Calcusol™ is an extract of the tempuyung leaves (Sonchus arvensis L., which is expected could cure the kidney stone disease. This study used primary cultured renal epithelial cells of mice to determine the optimal dose of Calcusol™ and the optimal dose of COM. The primary Kidney epithelial cell were treated with Calcusol™ and COM at various doses. The analysis of the cell death either by necrosis or apoptosis pathways was analyzed by flow cytometric analysis. The results that were obtained is the percentage of cell death that is then analyzed by using a complete randomized design (CRD One Way Anova. Based on the results that were obtained, it is known that the optimal dose of Calcusol™ in vitro were ranging from 75 ppm to 100 ppm, whereas the optimal dose of COM suggested for 500 ppm.

Advances in percutaneous stone surgery

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Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, ...

Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients

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V. A. Mezentsev

2005-04-01

Full Text Available INTRODUCTION: Management of urolithiasis in morbidly obese patients is usually associated with higher morbidity and mortality compared to non-obese patients. In morbidly obese patients, since the kidney and stone are at a considerable distance from the skin (compared to non-obese patients difficulty may be found in positioning the patient so that the stone is situated at the focal point of the lithotripter. OBJECTIVE: To evaluate the outcomes and cost-efficiency of extracorporeal shock wave lithotripsy (ESWL in the treatment of renal pelvicalyceal stones sized between 6 and 20 mm in morbidly obese patients. MATERIALS AND METHODS: Using various aids, such as mobile overtable module, extended shock pathway and abdominal compression 37 patients with body mass index more than 40 kg/m2 were treated using the Siemens Lithostar-plus third generation lithotripter. The size of renal pelvicalyceal stones was between 6 and 20 mm. Treatment costs for shock wave lithotripsy were calculated. RESULTS: The overall stone free rate at 3 months of 73% was achieved. The mean number of treatments per patient was 2.1. The post-lithotripsy secondary procedures rate was 5.4%. No complications, such as subcapsular haematoma or acute pyelonephritis were recorded. The most effective (87% success rate and cost-efficient treatment was in the patients with pelvic stones. The treatment of the patients with low caliceal stones was effective in 60% only. The cost of the treatment of the patients with low calyceal stones was in 1.8 times higher than in the patients with pelvic stones. CONCLUSION: We conclude that ESWL with the Siemens Lithostar-plus is the most effective and cost-efficient in morbidly obese patients with pelvic stones sized between 6 and 20 mm. 87% success rate was achieved. The increased distance from the skin surface to the stone in those patients does not decrease the success rate provided the stone is positioned in the focal point or within 3 cm of it on the

Main Nutritional Lithogenic Factors in Diets of Polish Patients with Kidney Stones

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Barbara Pyszczuk

2017-10-01

Full Text Available Background. Nutrition is one of the most important determinants of kidney stone formation. This study was designed to evaluate lithogenic factors in diet of patients with renal calculi. Materials and me­thods. 40 stone-formers without metabolic disorders stimulating stone formation (e.g. hyperparatyroidism, primary hyperoxaluria were invited to the study. Antropometric measurements of nutritional status (BMI, WHR, analysis of body composition (BIA, quality and quantitative analysis of patients’ eating habits ­(3-day food records were conducted. Results. Half of patients were overweight or obese. Their diets contained high amounts of protein, fat, phosphorus, vitamin C and low amounts of fluid, calcium, magnesium, potassium, vitamin B6. Protein consumption was positively correlated with uric acid intake in diets (r = 0.78, and body weight with dietary fat intake (r = 0.58 and uric acid intake (r = 0.55. Conclusions. Complete treatment of nephrolithiasis should include nutritional therapy. No change in customary diets of patients with renal calculi can stimulate lithogenesis process.

Doença de Crohn e cálculo renal: muito mais que coincidência? Crohn’s disease and kidney stones: much more than coincidence?

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Maria Lenise Lopes Viana

2007-09-01

hipocitratúria e a hipomagnesiúria, que representam fatores de risco reconhecido para a formação de cálculos, devem ter participação ativa nestes resultados. O impacto dessas alterações, medido pela saturação urinária elevada de oxalato e fosfato de cálcio, representa uma das maneiras de se demonstrar como estes fatores predispõem à nucleação de cristais e, conseqüentemente, à formação de cálculos nas vias urinárias.BACKGROUND: Crohn’s disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30% of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population. AIM: To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn’s disease. METHODS: We evaluated 29 patients with Crohn’s disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrassonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate. RESULTS: Twenty-nine of the evaluated patients were female or 65.5% and 34.5% were males. Among the metabolic urinary studied, we identified the following potential disturbances associated with nephrolithiasis: hypocitraturia in 21 patients (72.4%, hypomagnesuria in 12 (41.4%, hyperoxaluria in 4 (13.6% and urinary volume low in 5 (17.2%. Renal stones were identified in 13 patients (44.8%. Oxalate urinary excretion was higher in patients submitted to bowel surgery and also in patients with ileum resection. The urinary supersaturation of

Preoperative JJ stent placement in ureteric and renal stone treatment: results from the Clinical Research Office of Endourological Society (CROES) ureteroscopy (URS) Global Study.

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Assimos, Dean; Crisci, Alfonso; Culkin, Daniel; Xue, Wei; Roelofs, Anita; Duvdevani, Mordechai; Desai, Mahesh; de la Rosette, Jean

2016-04-01

To compare outcomes of ureteric and renal stone treatment with ureteroscopy (URS) in patients with or without the placement of a preoperative JJ stent. The Clinical Research Office of the Endourological Society (CROES) URS Global Study collected prospective data for 1 year on consecutive patients with ureteric or renal stones treated with URS at 114 centres around the world. Patients that had had preoperative JJ stent placement were compared with those that did not. Inverse-probability-weighted regression adjustment (IPWRA) was used to examine the effect of preoperative JJ stent placement on the stone-free rate (SFR), length of hospital stay (LOHS), operative duration, and complications (rate and severity). Of 8 189 patients with ureteric stones, there were 978 (11.9%) and 7 133 patients with and without a preoperative JJ stent, respectively. Of the 1 622 patients with renal stones, 590 (36.4%) had preoperative stenting and 1 002 did not. For renal stone treatment, preoperative stent placement increased the SFR and operative time, and there was a borderline significant decrease in intraoperative complications. For ureteric stone treatment, preoperative stent placement was associated with longer operative duration and decreased LOHS, but there was no difference in the SFR and complications. One major limitation of the study was that the reason for JJ stent placement was not identified preoperatively. The placement of a preoperative JJ stent increases SFRs and decreases complications in patients with renal stones but not in those with ureteric stones. © 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.

Our experience with percutaneous nephrolithotomy in pediatric renal stone disease.

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Oral, İlknur; Nalbant, İsmail; Öztürk, Ufuk; Can Şener, Nevzat; Yeşil, Süleyman; Göksel Göktuğ, H N; Abdurrahim İmamoğlu, M

2013-03-01

In this paper, we present our experience with percutaneous nephrolithotomy (PNL) in a pediatric patient group. From June 2007 to September 2010, we performed PNL on 57 pediatric patients. children with a mean age of 7.56 (1-15) years. Study population consisted of 30 male, and 27 female children with a mean age of 7.56 (1-5) years. Mean stone burden was calculated to be 312.2 (95-1550) mm(2). Percutaneous access was performed under fluoroscopy. Tract dilatation was accomplished with 20 F Amplatz dilators. Pneumatic lithotripsy was used to fragment the renal calculi. Mean operating time was 34 (3-80) minutes. With a single session of PNL, complete stone-free rates were achieved in 55 (96.4%) patients. Residual fragments were remained in 2 (3.5%) patients. Two patients had a febrile episode without signs and symptoms of bacteremia. Subcostal access was used in all of the patients, and none of the patients had any complications. Based on our experience, we conclude that PNL is a safe and effective method in the management of pediatric stone disease.

Technique and value of three dimensional reconstruction of stones in the renal pelvis using spiral CT

International Nuclear Information System (INIS)

Fink, B.K.; Fink, U.; Pentenrieder, M.; Kohz, P.; Englmeier, H.K.; Schmeller, N.

1994-01-01

5 patients with staghorn calculi in the renal pelvis were examined by spiral CT. From the raw data three dimensional reconstructions of the stones were obtained. In all patients it was possible to compare the three dimensional model with the stone following performance of percutaneous lithopaxy and endoscopic removal of the fragments. In all cases the three dimensional reconstruction provided a realistic image of the stones and was of practical value for the urologist for preoperative diagnosis and intraoperative control. (orig.) [de

Advances in percutaneous stone surgery.

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Hartman, Christopher; Gupta, Nikhil; Leavitt, David; Hoenig, David; Okeke, Zeph; Smith, Arthur

2015-01-01

Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.

The role of imaging in the diagnosis and management of renal stone disease in pregnancy

International Nuclear Information System (INIS)

Masselli, G.; Weston, M.; Spencer, J.

2015-01-01

The distinction of pain in pregnancy due to urolithiasis from that related to physiological dilation of the renal tract is a common conundrum as renal colic is one of the commonest causes for non-obstetric pain in pregnancy. Ultrasound is the first-line imaging test but although it may demonstrate renal dilation, it may not show the cause. Magnetic resonance imaging (MRI) is able to make the distinction. Physiological dilation will show smooth tapering of the ureter in the middle third as it is compressed between the gravid uterus and the retroperitoneum. Obstruction due to calculi causes renal enlargement and perinephric oedema. When a stone is lodged in the lower ureter, a standing column of dilated ureter will be seen below the physiological constriction. The stone itself may be shown. Computed tomography (CT) is an acceptable alternative if there is a contraindication to MRI, but even low-dose regimes involve some ionising radiation. This paper serves to highlight the role of MRI compared to US and CT in the imaging of renal colic in pregnancy. Multidisciplinary collaboration between obstetricians, urologists, and radiologists is required for effective management. - Highlights: • Ultrasound and MR imaging are the preferred investigations for renal colic during pregnancy. • MR imaging helps differentiate physiologic from obstructive hydronephrosis when ultrasound is inconclusive. • If MR imaging cannot be performed, low-dose CT may be necessary.

Biochemical and dietary factors of uric acid stone formation.

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Trinchieri, Alberto; Montanari, Emanuele

2018-04-01

The aim of this study was to compare the clinical characteristics of "pure" uric acid renal stone formers (UA-RSFs) with that of mixed uric acid/calcium oxalate stone formers (UC-RSFs) and to identify which urinary and dietary risk factors predispose to their formation. A total of 136 UA-RSFs and 115 UC-RSFs were extracted from our database of renal stone formers. A control group of 60 subjects without history of renal stones was considered for comparison. Data from serum chemistries, 24-h urine collections and 24-h dietary recalls were considered. UA-RSFs had a significantly (p = 0.001) higher body mass index (26.3 ± 3.6 kg/m 2 ) than UC-RSFs, whereas body mass index of UA-RSFs was higher but not significantly than in controls (24.6 ± 4.7) (p = 0.108). The mean urinary pH was significantly lower in UA-RSFs (5.57 ± 0.58) and UC-RSFs (5.71 ± 0.56) compared with controls (5.83 ± 0.29) (p = 0.007). No difference of daily urinary uric acid excretion was observed in the three groups (p = 0.902). Daily urinary calcium excretion was significantly (p = 0.018) higher in UC-RSFs (224 ± 149 mg/day) than UA-RSFs (179 ± 115) whereas no significant difference was observed with controls (181 ± 89). UA-RSFs tend to have a lower uric acid fractional excretion (0.083 ± 0.045% vs 0.107+/-0.165; p = 0.120) and had significantly higher serum uric acid (5.33 ± 1.66 vs 4.78 ± 1.44 mg/dl; p = 0.007) than UC-RSFs. The mean energy, carbohydrate and vitamin C intakes were higher in UA-SFs (1987 ± 683 kcal, 272 ± 91 g, 112 ± 72 mg) and UC-SFs (1836 ± 74 kcal, 265 ± 117, 140 ± 118) with respect to controls (1474 ± 601, 188 ± 84, 76 ± 53) (p = 0.000). UA-RSFs should be differentiated from UC-RSFs as they present lower urinary pH, lower uric acid fractional excretion and higher serum uric acid. On the contrary, patients with UC-RSFs show urinary risk factors

Pseudomonas, Pantoea and Cupriavidus isolates induce calcium carbonate precipitation for biorestoration of ornamental stone.

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Daskalakis, M I; Magoulas, A; Kotoulas, G; Catsikis, I; Bakolas, A; Karageorgis, A P; Mavridou, A; Doulia, D; Rigas, F

2013-08-01

Bacterially induced calcium carbonate precipitation from various isolates was investigated aiming at developing an environmentally friendly technique for ornamental stone protection and restoration. Micro-organisms isolated from stone samples and identified using 16S rDNA and biochemical tests promoted calcium carbonate precipitation in solid and novel liquid growth media. Biomineral morphology was studied on marble samples with scanning electron microscopy. Most isolates demonstrated specimen weight increase, covering partially or even completely the marble surfaces mainly with vaterite. The conditions under which vaterite precipitated and its stability throughout the experimental runs are presented. A growth medium that facilitated bacterial growth of different species and promoted biomineralization was formulated. Most isolates induced biomineralization of CaCO3 . Micro-organisms may actually be a milestone in the investigation of vaterite formation facilitating our understanding of geomicrobiological interactions. Pseudomonas, Pantoea and Cupriavidus strains could be candidates for bioconsolidation of ornamental stone protection. Characterization of biomineralization capacity of different bacterial species improves understanding of the bacterially induced mineralization processes and enriches the list of candidates for biorestoration applications. Knowledge of biomineral morphology assists in differentiating mineral from biologically induced precipitates. © 2013 The Society for Applied Microbiology.

Mini vs standard percutaneous nephrolithotomy for renal stones: a comparative study.

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ElSheemy, Mohammed S; Elmarakbi, Akram A; Hytham, Mohammed; Ibrahim, Hamdy; Khadgi, Sanjay; Al-Kandari, Ahmed M

2018-03-16

To compare the outcome of mini-percutaneous nephrolithotomy (Mini-PNL) versus standard-PNL for renal stones. Retrospective study was performed between March 2010 and May 2013 for patients treated by Mini-PNL or standard-PNL through 18 and 30 Fr tracts, respectively, using pneumatic lithotripsy. Semirigid ureteroscope (8.5/11.5 Fr) was used for Mini-PNL and 24 Fr nephroscope for standard-PNL. Both groups were compared in stone free rate(SFR), complications and operative time using Student-t, Mann-Whitney, Chi square or Fisher's exact tests as appropriate in addition to logistic regression analysis. P PNL (378) and standard-PNL (151) were nearly comparable in patients and stones criteria including stone burden (3.77 ± 2.21 vs 3.77 ± 2.43 cm 2 ; respectively). There was no significant difference in number of tracts or supracostal puncture. Mini-PNL had longer operative time (68.6 ± 29.09 vs 60.49 ± 11.38 min; p = 0.434), significantly shorter hospital stay (2.43 ± 1.46 vs 4.29 ± 1.28 days) and significantly higher rate of tubeless PNL (75.1 vs 4.6%). Complications were significantly higher in standard-PNL (7.9 vs 20.5%; p PNL (89.9 vs 96%; p = 0.022). This significant difference was found with multiple stones and large stone burden (> 2 cm 2 ), but the SFR was comparable between both groups with single stone or stone burden ≤ 2 cm. Logistic regression analysis confirmed significantly higher complications and SFR with standard-PNL but with significantly shorter operative time. Mini-PNL has significantly lower SFR when compared to standard-PNL (but clinically comparable) with markedly reduced complications and hospital stay. Most of cases can be performed tubeless. The significant difference in SFR was found with multiple stones or large stone burden (> 2 cm 2 ), but not with single stones or stone burden ≤ 2 cm 2 .

The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones.

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Resorlu, Berkan; Oguz, Ural; Resorlu, Eylem Burcu; Oztuna, Derya; Unsal, Ali

2012-01-01

To evaluate the impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery (RIRS) for lower pole renal stones and determine which of these factors can be used to select patients who will benefit from RIRS. We evaluated 67 patients who underwent RIRS between 2009 and 2010 for isolated lower pole renal stones. The infundibular length (IL), infundibular width (IW), pelvicaliceal height (PCH), and infundibulopelvic angle (IPA) were measured by preoperative intravenous urogram. Success was defined as either complete clearance or clearance with insignificant residual fragments≤3 mm in size at 2-months follow-up. Mean IL was 26.7±7.9 and 28.2±5.3 mm, mean PCH was 20.7±6.6 and 23.2±4.9 mm in stone-free and non-stone-free patients, respectively. These were slightly larger in the non-stone-free group but not statistically significant (P=.140 and P=.072, respectively). Mean IW was 5.8±3.5 and 5.6±2.2 mm in stone-free and non-stone-free patients, respectively, which had no significant impact on the stone-free rate (P=.719). There were significant differences between the groups in terms of stone length (P=.001) and IPA (P=.003). The mean IPA was 49.37±11.83 and 37.61±13.22 mm in stone-free and non-stone-free patients, respectively. In addition to the influence of stone size, lower pole anatomy, especially IPA, has a significant impact on stone clearance for lower pole stones after RIRS. Copyright © 2012 Elsevier Inc. All rights reserved.

Stone clearance after extracorporeal shockwave lithotripsy in patients with solitary pure calcium oxalate stones smaller than 1.0 cm in the proximal ureter, with special reference to monohydrate and dihydrate content.

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Ichiyanagi, Osamu; Nagaoka, Akira; Izumi, Takuji; Kawamura, Yuko; Tsukigi, Masaaki; Ishii, Tatsuya; Ohji, Hiroshi; Kato, Tomoyuki; Tomita, Yoshihiko

2013-04-01

The aim of this study was to assess stone-free rates following extracorporeal shockwave lithotripsy (ESWL) of pure calcium oxalate (CaOx) stones in the proximal ureter. The investigators retrospectively examined 53 patients with 5-10 mm pure CaOx stones in the proximal ureter from the medical archives of 593 consecutive patients treated with ESWL. The compositions of calcium oxalate monohydrate (COM) and dihydrate (COD) in a given stone were determined by infrared spectrometry. Stone size, attenuation number and stone-to-skin distance (SSD) were measured using plain radiography and computed tomography (CT). ESWL success was evaluated by stone-free status after the first single session. On average, calculi were 8.0 × 5.3 mm in size, with an SSD of 11.0 cm. The mean CT attenuation value was 740.1 HU. Attenuation numbers correlated significantly with stone diameter (r = 0.49), but had no correlation with the stone content of COM or COD. A negative correlation was observed between COM and COD content (r = -0.925). With regard to patients' physical characteristics and COM and COD content, no differences were found between study subgroups with stone-free and residual status (n = 38 and 15, respectively). There were also no differences in clinical features between patient subgroups with COM- or COD-predominant stones (n = 22 and 31, respectively). The findings indicated that the differences in COM and COD content of CaOx stones had no impact on stone clearance after ESWL and that a favorable stone-free rate of the stones treated with ESWL may be achieved independently of CaOx hydration.

Algorithm for definition of stones components at kidney-stones illness using two-energetic digital roentgen-graphic method

International Nuclear Information System (INIS)

Nedavnij, O.I.; Osipov, S.P.

2001-01-01

Paper presents the algorithm for definition of stone composition in case of kidney-stones using two-energy digital X-ray photography. One calculated the values of p information parameter for the main types of stones within 40-150 keV energy range. It was shown that p parameter dependence on energy was not essential one (maximum 3.5% deviation), p value for various chemical compositions of kidney stones ranged from 15% (calcium phosphate and calcium oxalate) up to 70% (calcium lactate and calcium oxalate). The conducted studies enable to make a conclusion about the possibility to define material representing the heart of kidney stones using two-energy digital X-ray photography. Paper includes recommendations on selection of the optimal energy values [ru

What is the best option for 10-20mm renal pelvic stones undergoing ESWL in the pediatric population: stenting, alpha blockers or conservative follow-up?

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Telli, Onur; Gokce, Mehmet Ilker; Ozturk, Erdem; Suer, Evren; Mermerkaya, Murat; Afandiyev, Faraj; Ozcan, Cihat; Guclu, Adil Gucal; Soygur, Tarkan; Burgu, Berk

2015-09-01

In this study we aimed to identify the effect of three different modalities (stenting, doxazosin and conservative follow-up) on stone free rates and complication rates for 10-20mm renal pelvic stones in pediatric patients who underwent shock wave lithotripsy. In this study data from 241 renal units (RUs) of 195 consecutive patients with 10-20mm renal pelvis stones were analyzed retrospectively. There were 3 groups in the study; 56 (23.2%) RUs with ureteral stenting were categorized as group 1, and 39 (16.2%) RUs that received doxazosin were categorized as group 2. The remaining 146 (60.6%) RUs without history of ureteral stenting or alpha-blockers usage were categorized as group 3. Patient demographics, stone characteristics, stone free rates (SFRs), time to stone expulsion and complications were documented and compared in each group. Mean age of the population was 6.6 years and mean stone size was 13.8 ± 2.9 mm. Demographic characteristics of the 3 groups were not significantly different. SFRs of the three groups were 89.2%, 87.1% and 82.1% (p = 0.275). Mean time to stone expulsion for groups 1 and 2 were 17.4 and 21.8 days respectively and significantly lower than that in group 3 (31.3 days). Ureteral stenting or doxazosin for shockwave lithotripsy (SWL) is not superior to watchful waiting in terms of SFR and complications however both modalities shorten the stone expulsion time for 10-20mm renal pelvis stones in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery.

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Ercil, Hakan; Alma, Ergun; Bas, Okan; Sener, Nevzat Can; Vuruskan, Ediz; Kuyucu, Faruk; Unal, Umut; Gören, Mehmet Resit; Evliyaoglu, Yalcin

2016-03-05

To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. The average stone size for the SWL group was 14.62 ± 2.58 mm and 14.91 ± 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 ± 158.39 HU in the SWL group and 567.74 ± 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 ± 9.71 days in the SWL group and 11.59 ± 7.01 days in the RIRS group (P < .001). One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies. .

Intraperitoneal stone migration during percutaneos nephrolithotomy

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Akif Diri

2014-12-01

Full Text Available Percutaneos nephrolithotomy (PNL is the standard care for renal stones larger than 2 cm. The procedure has some major and minor complications. Renal pelvis laceration and stone migration to the retroperitoneum is one of the rare condition. We report the first case of intraperitoneal stone migration during PNL.

A Giant Ureteral Stone without Underlying Anatomic or Metabolic Abnormalities: A Case Report

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Selcuk Sarikaya

2013-01-01

Full Text Available A 28-year old man presented with left flank pain and dysuria. Plain abdominal film and computed tomography showed a left giant ureteral stone measuring 11.5 cm causing ureteral obstruction and other stones 2.5 cm in size in the lower pole of ipsilateral kidney and 7 mm in size in distal part of right ureter. A left ureterolithotomy was performed and then a double J stent was inserted into the ureter. The patient was discharged from the hospital 4 days postoperatively with no complications. Stone analysis was consistent with magnesium ammonium phosphate and calcium oxalate. Underlying anatomic or metabolic abnormalities were not detected. One month after surgery, right ureteral stone passed spontaneously, left renal stone moved to distal ureter, and it was removed by ureterolithotomy. Control intravenous urography and cystography demonstrated unobstructed bilateral ureter and the absence of vesicoureteral reflux.

Role of cellular oxalate in oxalate clearance of patients with calcium oxalate monohydrate stone formation and normal controls.

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Oehlschläger, Sven; Fuessel, Susanne; Meye, Axel; Herrmann, Jana; Froehner, Michael; Albrecht, Steffen; Wirth, Manfred P

2009-03-01

To examine the cellular, plasma, and urinary oxalate and erythrocyte oxalate flux in patients with calcium oxalate monohydrate (COM) stone formation vs normal controls. Pathologic oxalate clearance in humans is mostly integrated in calcium oxalate stone formation. An underlying cause of deficient oxalate clearance could be defective transmembrane oxalate transport, which, in many tissues, is regulated by an anion exchanger (SLC26). We studied 2 groups: 40 normal controls and 41 patients with COM stone formation. Red blood cells were divided for cellular oxalate measurement and for resuspension in a buffered solution (pH 7.40); 0.1 mmol/L oxalate was added. The supernatant was measured for oxalate immediately and 1 hour after incubation. The plasma and urinary oxalate were analyzed in parallel. The mean cellular oxalate concentrations were significantly greater in the normal controls (5.25 +/- 0.47 micromol/L) than in those with COM stone formation (2.36 +/- 0.28 micromol/L; P stone formation (0.31 +/- 0.02 mmol/L) than in the controls (0.24 +/- 0.02 mmol/L; P r = 0.49-0.63; P r = -0.29-0.41; P r = -0.30; P r = 0.25; P stone formation. Our data implicate the presence of a cellular oxalate buffer to stabilize plasma and urinary oxalate concentrations in normal controls.

Determination of thermodynamic parameters for complexation of calcium and magnesium with chondroitin sulfate isomers using isothermal titration calorimetry: Implications for calcium kidney-stone research

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Rodgers, Allen L.; Jackson, Graham E.

2017-04-01

Chondroitin sulfate (CS) occurs in human urine. It has several potential binding sites for calcium and as such may play an inhibitory role in calcium oxalate and calcium phosphate (kidney stone disease by reducing the supersaturation (SS) and crystallization of these salts. Urinary magnesium is also a role player in determining speciation in stone forming processes. This study was undertaken to determine the thermodynamic parameters for binding of the disaccharide unit of two different CS isomers with calcium and magnesium. These included the binding constant K. Experiments were performed using an isothermal titration calorimeter (ITC) at 3 different pH levels in the physiological range in human urine. Data showed that interactions between the CS isomers and calcium and magnesium occur via one binding site, thought to be sulfate, and that log K values are 1.17-1.93 and 1.77-1.80 for these two metals respectively. Binding was significantly stronger in Mg-CS than in Ca-CS complexes and was found to be dependent on pH in the latter but not in the former. Furthermore, binding in Ca-CS complexes was dependent on the location of the sulfate binding site. This was not the case in the Mg-CS complexes. Interactions were shown to be entropy driven and enthalpy unfavourable. These findings can be used in computational modeling studies to predict the effects of the calcium and magnesium CS complexes on the speciation of calcium and the SS of calcium salts in real urine samples.

Kidney stones - self-care

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... self-care; Nephrolithiasis and self-care; Stones and kidney - self-care; Calcium stones and self-care; Oxalate ... provider or the hospital because you have a kidney stone. You will need to take self-care ...

Kidney Stones and Ceftriaxone

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Murat Dursun

2015-01-01

Full Text Available Metabolic causes such as hypercalciuria, urinary tract infection, and obstruction are the most common aetiologies of urolithiasis, and drugs, although important in this regard, are rarely the cause of urolithiasis. Administration of one of these drugs, ceftriaxone (CTX, has been associated with biliary pseudolithiasis in adult and paediatric patients, and rarely may cause urolithiasis. Several factors, including drug concentration and incubation time, are very important for determining the degree of CTX/calcium (Ca crystallisation in the urine. According to this data, CTX crystallisation was a dose and time-dependent reaction. It is particularly important to monitor patients on high-dose long-term CTX treatment with the urinary Ca to creatinine ratios, ultrasound sonography, and renal function testing, as these individuals may be at greater risk of large stones and renal damage. This type of screening may help prevent permanent complications in the future. This underlying review will help to educate readers on the pathophysiology and interaction between CTX and urolithiasis.

Bariatric Surgery and Stone Disease

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Lieske, John C.; Kumar, Rajiv

2008-09-01

Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

Female stone disease: the changing trend.

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Marickar, Y M Fazil; Vijay, Adarsh

2009-12-01

This paper has attempted to assess the changes noted in the trends in the incidence and biochemical pattern of female urolithiasis patients during the period 1971-2008. A prospective descriptive clinical study was done on 8,590 stone patients belonging to both sexes treated at the urinary stone clinic. The incidence of stone disease among the two sexes was plotted. The various metabolic parameters including 24-h urine volume, urine calcium, phosphorus, uric acid, oxalate, magnesium, creatinine and citrate, serum creatinine, calcium, phosphorus, uric acid and magnesium and calculated parameter calcium:magnesium ratio were studied. The possible causes for the change in incidence of stone disease in the female sex were elucidated. Of the patients studied, 12.7% (1,091) were females. There was a definite increase in the incidence of female urolithiasis over the past 37 years (P stone genesis, together with the increased excretion of calcium and oxalate may have contributed to the increasing incidence of stone disease in females. This might be due to changes in living standards and dietary habits.

Optimum nutrition for kidney stone disease.

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Heilberg, Ita P; Goldfarb, David S

2013-03-01

We summarize the data regarding the associations of individual dietary components with kidney stones and the effects on 24-hour urinary profiles. The therapeutic recommendations for stone prevention that result from these studies are applied where possible to stones of specific composition. Idiopathic calcium oxalate stone-formers are advised to reduce ingestion of animal protein, oxalate, and sodium while maintaining intake of 800 to 1200 mg of calcium and increasing consumption of citrate and potassium. There are few data regarding dietary therapy of calcium phosphate stones. Whether the inhibitory effect of citrate sufficiently counteracts increasing urine pH to justify more intake of potassium and citrate is not clear. Reduction of sodium intake to decrease urinary calcium excretion would also be expected to decrease calcium phosphate stone recurrence. Conversely, the most important urine variable in the causation of uric acid stones is low urine pH, linked to insulin resistance as a component of obesity and the metabolic syndrome. The mainstay of therapy is weight loss and urinary alkalinization provided by a more vegetarian diet. Reduction in animal protein intake will reduce purine ingestion and uric acid excretion. For cystine stones, restriction of animal protein is associated with reduction in intake of the cystine precursor methionine as well as cystine. Reduction of urine sodium results in less urine cystine. Ingestion of vegetables high in organic anion content, such as citrate and malate, should be associated with higher urine pH and fewer stones because the amino acid cystine is soluble in more alkaline urine. Because of their infectious origin, diet has no definitive role for struvite stones except for avoiding urinary alkalinization, which may worsen their development. Published by Elsevier Inc.

Can Hounsfield Unit Value Predict Type of Urinary Stones?

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Alper Gok

2014-03-01

Full Text Available Aim: Aim of this study is to determine the role of Hounsfield unit (HU in predicting results of stone analysis. Material and Method: This study included 199 patients to whom percutaneous nephrolithotomy (PNL procedures were applied between January 2008 and May 2011 in our clinic. Before the procedure HU values of kidney stones were measured using non-contrast computed tomography. After the operation, obtained stone samples were analysed using X-ray diffraction technique. HU values were compared with stone analysis results. Results: Stone analysis revealed eight different stone types. Distribution of stone types and HU value ranges were as follows: 85% calcium oxalate monohydrate, 730-1130 HU; 38% calcium oxalate dihydrate, 510-810 HU; 21% uric acid, 320-550 HU; 23% struvite, 614-870 HU; 7% calcium hydrogene phosphate, 1100-1365 HU; 3% cystine, 630-674 HU; 15% mixed uric acid plus calcium oxalate, 499-840 HU; and 7% mixed cystine plus calcium phosphate, 430-520 HU. HU values of all stone types ranged between 320 and 1365. There was a statistically significant relation between HU values of uric acid and non uric acid stones (p

A low or high BMI is a risk factor for renal hematoma after extracorporeal shock wave lithotripsy for kidney stones.

Science.gov (United States)

Nussberger, Fabio; Roth, Beat; Metzger, Tobias; Kiss, Bernhard; Thalmann, George N; Seiler, Roland

2017-06-01

The purpose of this study was to evaluate risk factors for renal hematoma after extracorporeal shock wave lithotripsy (SWL) for kidney stones in a matched case-control analysis of a subgroup of patients recruited from a prospective randomized cohort. Between 06/2010 and 03/2013, 418 patients underwent SWL with the MODULITH ® -SLX-F2-lithotripter for kidney stones. In 39/418 patients (9 %), ultrasound at post-treatment day 1 revealed renal hematomas. For 37 of these patients, a matched group without hematoma could be selected according to the following matching criteria: age, gender, number and energy of shock waves, stone burden and localization. Risk factors for renal hematoma after SWL were compared between the two groups. The rates of diabetes, stopped anticoagulant/antiplatelet medications and arterial hypertension were not different between the two groups (p > 0.2). The skin-kidney distance was virtually the same in both groups (p = 0.5). In the hematoma group, significantly more patients had a high (>30: n = 16) as well as a low (hematomas after SWL. Patients with a high (>30) or low (<21.5) BMI had a higher risk for renal damage after SWL. Therefore, alternative endoscopic treatment options should be considered in these patients.

Functional Importance of L- and P/Q-Type Voltage-Gated Calcium Channels in Human Renal Vasculature

DEFF Research Database (Denmark)

Hansen, Pernille B; Poulsen, Christian B; Walter, Steen

2011-01-01

Calcium channel blockers are widely used for treatment of hypertension, because they decrease peripheral vascular resistance through inhibition of voltage-gated calcium channels. Animal studies of renal vasculature have shown expression of several types of calcium channels that are involved......-type subtype (Ca(v) 3.1 and Ca(v) 3.2) voltage-gated calcium channels (Ca(v)s), and quantitative PCR showed highest expression of L-type channels in renal arteries and variable expression between patients of subtypes of calcium channels in intrarenal vessels. Immunohistochemical labeling of kidney sections...

CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy.

Science.gov (United States)

Cui, Helen W; Devlies, Wout; Ravenscroft, Samuel; Heers, Hendrik; Freidin, Andrew J; Cleveland, Robin O; Ganeshan, Balaji; Turney, Benjamin W

2017-07-01

Understanding the factors affecting success of extracorporeal shockwave lithotripsy (SWL) would improve informed decision-making on the most appropriate treatment modality for an individual patient. Although stone size and skin-to-stone distance do correlate with fragmentation efficacy, it has been shown that stone composition and architecture, as reflected by structural heterogeneity on CT, are also important factors. This study aims to determine if CT texture analysis (CTTA), a novel, nondestructive, and objective tool that generates statistical metrics reflecting stone heterogeneity, could have utility in predicting likelihood of SWL success. Seven spontaneously passed, intact renal tract stones, were scanned ex vivo using standard CT KUB and micro-CT. The stones were then fragmented in vitro using a clinical lithotripter, after which, chemical composition analysis was performed. CTTA was used to generate a number of metrics that were correlated to the number of shocks needed to fragment the stone. CTTA metrics reflected stone characteristics and composition, and predicted ease of SWL fragmentation. The strongest correlation with number of shocks required to fragment the stone was mean Hounsfield unit (HU) density (r = 0.806, p = 0.028) and a CTTA metric measuring the entropy of the pixel distribution of the stone image (r = 0.804, p = 0.039). Using multiple linear regression analysis, the best model showed that CTTA metrics of entropy and kurtosis could predict 92% of the outcome of number of shocks needed to fragment the stone. This was superior to using stone volume or density. CTTA metrics entropy and kurtosis have been shown in this experimental ex vivo setting to strongly predict fragmentation by SWL. This warrants further investigation in a larger clinical study for the contribution of CT textural metrics as a measure of stone heterogeneity, along with other known clinical factors, to predict likelihood of SWL success.

Influence of substrate mineralogy on bacterial mineralization of calcium carbonate: implications for stone conservation.

Science.gov (United States)

Rodriguez-Navarro, Carlos; Jroundi, Fadwa; Schiro, Mara; Ruiz-Agudo, Encarnación; González-Muñoz, María Teresa

2012-06-01

The influence of mineral substrate composition and structure on bacterial calcium carbonate productivity and polymorph selection was studied. Bacterial calcium carbonate precipitation occurred on calcitic (Iceland spar single crystals, marble, and porous limestone) and silicate (glass coverslips, porous sintered glass, and quartz sandstone) substrates following culturing in liquid medium (M-3P) inoculated with different types of bacteria (Myxococcus xanthus, Brevundimonas diminuta, and a carbonatogenic bacterial community isolated from porous calcarenite stone in a historical building) and direct application of sterile M-3P medium to limestone and sandstone with their own bacterial communities. Field emission scanning electron microscopy (FESEM), atomic force microscopy (AFM), powder X-ray diffraction (XRD), and 2-dimensional XRD (2D-XRD) analyses revealed that abundant highly oriented calcite crystals formed homoepitaxially on the calcitic substrates, irrespective of the bacterial type. Conversely, scattered spheroidal vaterite entombing bacterial cells formed on the silicate substrates. These results show that carbonate phase selection is not strain specific and that under equal culture conditions, the substrate type is the overruling factor for calcium carbonate polymorph selection. Furthermore, carbonate productivity is strongly dependent on the mineralogy of the substrate. Calcitic substrates offer a higher affinity for bacterial attachment than silicate substrates, thereby fostering bacterial growth and metabolic activity, resulting in higher production of calcium carbonate cement. Bacterial calcite grows coherently over the calcitic substrate and is therefore more chemically and mechanically stable than metastable vaterite, which formed incoherently on the silicate substrates. The implications of these results for technological applications of bacterial carbonatogenesis, including building stone conservation, are discussed.

Production of calcium hydroxide from the waste of Cariri stone

International Nuclear Information System (INIS)

Alves, T.M.E.; Santos, A.M.M.; Brasileiro, M.I.; Pinheiro, S.F.L.; Prado, A.C.A.

2016-01-01

The extraction of Cariri stone in the northeast is a frequent activity because of its ornamental application as well as for the construction sector. However, by this extraction, untapped waste formation grows and becomes a problem for the environment. The objective of this work is to produce calcium hydroxide, from this limestone residue, with controlled porosity, solubility and particle size. The waste was characterized with X-Ray Diffraction (XRD), X-Ray Fluorescence (XRF) and thermal analysis (TGA). The limestone was calcined at 850°C and 950°C for 45 minutes and three hours, being characterized by XRD, XRF and TGA. Once calcined, it was hydrated with 17,5g and 22g oxide to 100mL water and manually mixed for 15 and 25 minutes. The calcium hydroxides have been submitted for tests in vivo in rats and will be characterized by XRD, Scanning Electron Microscopy (SEM) and Infrared. (author)

PHOSPHATE CRYSTALLURIA IN VARIOUS FORMS OF UROLITHIASIS AND POSSIBILITIES OF ITS PROGNOSTICATION IN PATIENTS WITH PHOSPHATE STONES

Directory of Open Access Journals (Sweden)

O. V. Konstantinova

2017-01-01

Full Text Available Purpose. Definition of types of crystalluria in various forms of urolithiasis and biochemical signs of phosphate crystals in the urine, while phosphate urolithiasis (infectious origin.Patients and methods. The study involved 144 patients with recurrent urolithiasis — 75 women and 69 men. Of these, 46 — diagnosed calculi with uric acid, 44 — calcium oxalate or mixed with a prevalence of calcium oxalate, in 54 — phosphate rocks (carbonate-apatite and/or struvite. The age of patients ranged from 21 to 74 years. 93 people have been under long-term, within 2–15 years, outpatient observation. The examination included the collection of anamnesis, general and microbiological analysis of urine, biochemical blood serum and urine on 10 indicators, reflecting renal function, state of the protein, water and electrolyte metabolism, uric acid metabolism, the chemical composition of the stone analysis.Results. It was found that in patients with calcium oxalate stones phosphaturia has been diagnosed in 2% of cases. And, along with calcium phosphate crystals they had oxalate crystals. In patients with phosphate urolithiasis phosphaturia observed in 96% of patients, in two patients (4% they determined except phosphates also oxalate salt in urine sediment. Patients with phosphate urolithiasis at occurrence of phosphate crystalluria have metabolic state changes: increased serum uric acid concentration from 0.322 ± 0.009 to 0.367 ± 0.018 mmol/l daily renal excretion of inorganic phosphate 23.94 ± 2.93 mmol/day to 32.12 ± 4.39 mmol/day, and reduced total calcium content in urine 6.61 ± 0.94 mmol/day to 3.37 ± 0.89 mmol/day. The results led to the following conclusion.Conclusion. Biochemical signs of occurrence of phosphate crystalluria in patients with stones of infectious origin can be: the approaching level of excretion in the urine of inorganic phosphates to 32,12 ± 4,39 mmol/day, serum uric acid concentration to 0,367 ± 0,018 mmol/l, and the

Flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stone <2 cm: a meta-analysis.

Science.gov (United States)

Mi, Yuanyuan; Ren, Kewei; Pan, Haiyan; Zhu, Lijie; Wu, Sheng; You, Xiaoming; Shao, Hongbao; Dai, Feng; Peng, Tao; Qin, Feng; Wang, Jian; Huang, Yi

2016-08-01

The objective of the study was to systematically review the efficacy and safety of flexible ureterorenoscopy (F-URS) with holmium laser versus extracorporeal shock wave lithotripsy (ESWL) for the treatment of renal stone ESWL (WMD = 2.13, 95 % CI 1.13-4.00, P = 0.02). F-URS is associated with higher SFR, lower APR and RR than ESWL. F-URS is a safe and effective procedure. It can successfully treat patients with stones for 1-2 cm, especially for lower pole stone, without increasing complications, operative time and hospital stay. F-URS can be used as an alternative treatment to ESWL in selected cases with larger renal stones. However, further randomized trials are needed to confirm these findings.

Instrumental neutron activation analysis of kidney stones

International Nuclear Information System (INIS)

Sarmani, S.; Kuan, L.L.; Bakar, M.A.A.

1990-01-01

Kidney stone samples of the types calcium oxalate, uric acid, and xanthine were analyzed for their elemental contents by neutron activation analysis to study both the elemental correlation and influence of element on stone precipitation processes. Elements, such as Al, Au, Br, Ca, Cl, Co, Cr, Fe,H, I, K, Mg, Na, Sb, Se, Sr, and Zn, were determined quantitatively. Calcium oxalate stones contained higher concentration of all the elements analyzed compared to uric acid or xanthine stones. The concentrations of Cl, Fe, K, Na, Sr, and Zn were relatively higher than Au, Co, Cr, and Sb. A positive correlation exists between Ca and Zn, whereas a negative correlation exists between Sr and Ca. Zinc may play an important role in the formation of calcium oxalate stone

Acute management of stones

DEFF Research Database (Denmark)

Jung, Helene; Osther, Palle J S

2015-01-01

INTRODUCTION: Stone management is often conservative due to a high spontaneous stone passage rate or non-symptomatic calyceal stones that do not necessarily require active treatment. However, stone disease may cause symptoms and complications requiring urgent intervention. MATERIAL AND METHODS: I...... with careful consideration of stone size and location, symptoms, patient comorbidity and radiation dose. CONCLUSION: In case of infective hydronephrosis, compromised renal function or persistent pain despite adequate analgesic treatment acute intervention is indicated....

Inadequate dietary calcium and vitamin D intakes in renal-transplant recipients in Ireland.

LENUS (Irish Health Repository)

Lynch, Irene T

2012-02-03

OBJECTIVE: To quantify the dietary calcium and vitamin D intake in adult renal-transplant recipients attending at a large teaching hospital in Ireland for follow-up. SETTING: Outpatient renal-transplant follow-up clinic. SUBJECTS: Fifty-nine adult renal transplant recipients (58% male) with a mean age of 46 years, a median transplant duration of 6 years, and a mean estimated glomerular filtration rate (eGFR) of 50 mL\\/min per 1.73 m2. Fifty-three percent were at National Kidney Foundation stage 3 chronic kidney disease, and 14% had stage 4 chronic kidney disease. INTERVENTION: This cross-sectional, observational study used a tailored food frequency questionnaire specific for calcium and vitamin D intake in Irish adults, which was completed during a face-to-face interview with each subject. MAIN OUTCOME MEASURE: The main outcome measure was the average daily dietary and supplemented calcium and vitamin D intake. RESULTS: The median interquartile range (IQR) dietary calcium intake was 820 mg\\/day (range, 576-1,177 mg\\/day), and was similar in men and women (recommended intake > or = 1,000 mg\\/day in adult men and nonmenopausal adult women, > or = 1,500 mg\\/day in menopausal women). Five participants received calcium supplementation. Overall, 59% of men and 64% of women had total calcium intakes below the recommended amounts. The median IQR estimated dietary vitamin D intake was 5.2 microg\\/day (range, 2.4-6.4 microg\\/day) in women, and 4.6 microg\\/day (range, 2.2-6.6 microg\\/day) in men (recommended intake, > or = 10 microg\\/day). Six subjects received vitamin D supplementation. Total vitamin D intakes were suboptimal in 91% of men and 87% of women. Dietary calcium and vitamin D intakes significantly correlated with each other, but neither was significantly related to eGFR category, and was similarly low in both presumed menopausal women and in the initial year posttransplantation. CONCLUSION: These findings suggest that dietary and total calcium and

Bladder stones after bladder augmentation are not what they seem.

Science.gov (United States)

Szymanski, Konrad M; Misseri, Rosalia; Whittam, Benjamin; Lingeman, James E; Amstutz, Sable; Ring, Joshua D; Kaefer, Martin; Rink, Richard C; Cain, Mark P

2016-04-01

Bladder and renal calculi after bladder augmentation are thought to be primarily infectious, yet few studies have reported stone composition. The primary aim was to assess bladder stone composition after augmentation, and renal stone composition in those with subsequent nephrolithiasis. The exploratory secondary aim was to screen for possible risk factors for developing infectious stones. Patients treated for bladder stones after bladder augmentation at the present institution between 1981 and 2012 were retrospectively reviewed. Data were collected on demographics, surgeries and stone composition. Patients without stone analysis were excluded. Stones containing struvite, carbonate apatite or ammonium acid ureate were classified as infectious. The following variables were analyzed for a possible association with infectious bladder stone composition: gender, history of cloacal exstrophy, ambulatory status, nephrolithiasis, recurrent urea-splitting urinary tract infections, first vs recurrent stones, timing of presentation with a calculus, history of bladder neck procedures, catheterizable channel and vesicoureteral reflux. Fisher's exact test was used for analysis. Of the 107 patients with bladder stones after bladder augmentation, 85 met inclusion criteria. Median age at augmentation was 8.0 years (follow-up 10.8 years). Forty-four patients (51.8%) recurred (14 multiple recurrences, 143 bladder stones). Renal calculi developed in 19 (22.4%) patients with a bladder stone, and 10 (52.6%) recurred (30 renal stones). Overall, 30.8% of bladder stones were non-infectious (Table). Among patients recurring after an infectious bladder stone, 30.4% recurred with a non-infectious one. Among patients recurring after a non-infectious stone, 84.6% recurred with a non-infectious one (P = 0.005). Compared with bladder stones, renal stones were more likely to be non-infectious (60.0%, P = 0.003). Of patients with recurrent renal calculi after an infectious stone, 40.0% recurred with

Correlation between the development of calcium oxalate stones and polymorphisms in the fibronectin gene in the Uighur population of the Xinjiang region of China.

Science.gov (United States)

Murat, M; Aekeper, A; Yuan, L Y; Alim, T; Du, G J; Abdusamat, A; Wu, G W; Aniwer, Y

2015-10-29

Here, we have investigated the correlation between calcium oxalate stone formation and Fn gene polymorphisms in urinary calculi patients among the Uighur population (Xinjiang region). In this case control study, genomic DNA extracted from the peripheral blood of 129 patients with calcium oxalate stones (patient group) and 94 normal people (control group) was used to genotype polymorphisms in the rs6725958, rs10202709, and rs35343655 sites of the Fn gene by polymerase chain reaction-restriction fragment length polymorphism. Subsequently, the association between different genotypes and susceptibility to calcium oxalate stone formation was compared among the patient and control groups. Single nucleotide polymorphisms (SNPs) were detected in the rs6725958, rs10202709, and rs35343655 sites of the Fn gene among the patient and control groups. The genotype distributions of the three loci complied with the Hardy-Weinberg equilibrium. The results of allele frequencies of the patient/control group for polymorphisms in the rs6725958 site of the Fn gene were C = 179 (69.92%)/119 (63.30%) and A = 77 (30.08%)/69 (36.70%), in the rs10202709 site were C = 245 (95.70%)/176 (93.63%) and T = 11 (4.30%)/12 (6.38%), and in the rs35343655 site of the Fn gene were A = 139 (54.30%)/87 (46.28%) and G = 117 (45.70%)/101 (53.72%). We observed no significant differences between the three SNPs and development of calcium oxalate stones. Polymorphisms in rs6725958, rs10202709, and rs35343655 of the Fn gene had no obvious effect on the susceptibility to the development of calcium oxalate stones in the Uighur population, residing in the Xinjiang region of China.

Retrograde intrarenal surgery versus percutaneous lithotripsy to treat renal stones 2-3 cm in diameter.

Science.gov (United States)

Zengin, Kursad; Tanik, Serhat; Karakoyunlu, Nihat; Sener, Nevzat Can; Albayrak, Sebahattin; Tuygun, Can; Bakirtas, Hasan; Imamoglu, M Abdurrahim; Gurdal, Mesut

2015-01-01

Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P = 0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P = 0.520). RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

International Nuclear Information System (INIS)

Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W.; Sinjab, T.A.; Wlodarczyk, Z.

2009-01-01

Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups

Coronary Artery Calcium Distribution and Interscan Measurement Variability in End-Stage Renal and Coronary Heart Disease Patients

Energy Technology Data Exchange (ETDEWEB)

Serafin, Z.; Laskowska, K.; Marzec, M.; Lasek, W. (Dept. of Radiology and Diagnostic Imaging, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland)); Sinjab, T.A.; Wlodarczyk, Z. (Dept. of Transplantology, Nicolaus Copernicus Univ., Collegium Medicum, Bydgoszcz (Poland))

2009-04-15

Background: Coronary heart disease patients and end-stage renal disease patients have been documented to have an increased amount of coronary artery calcifications (CAC). Purpose: To evaluate the distribution of CAC and its influence on interscan variability of measurement in end-stage renal disease and coronary heart disease patients, proven to have calcifications. Material and Methods: 69 patients having CAC, including 34 with coronary heart disease and 35 with end-stage renal disease, were scanned twice with multidetector-row computed tomography (MDCT). Amount of CAC was determined as the number of calcified lesions (CN), total calcium score (CS), calcium volume (CV), and calcium mass (CM). Distribution of CAC was evaluated on a per-patient basis as the median CS and CM of a single lesion. Density of the calcifications was calculated as the patient's CM divided by CV. Results: The overall median CS was 457.2, and the median CM was 75.6 mg. There were no significant differences in the number of calcified lesions, CS, or CM between the two groups. Both CS and CM of a single lesion, as well as the mean calcium density were lower in renal disease patients (P<0.05) than in coronary heart disease subjects. The relative interscan variability of coronary calcium measurement was higher in the renal disease group (P<0.05). There was a negative correlation between the calcium concentration and the relative interscan variability. Conclusion: The results indicate that the coronary calcium distribution influences the measurement interscan reproducibility, and the distribution may differ between end-stage renal disease patients and coronary heart disease patients, reflecting the dissimilar nature of coronary calcifications in those groups.

Renal protection in diabetes--an emerging role for calcium antagonists

DEFF Research Database (Denmark)

Parving, H H; Tarnow, L; Rossing, P

1997-01-01

The combination of diabetes and hypertension increases the changes of progressive renal disorder and ultimately renal failure. Roughly 40% of all diabetics, whether insulin dependent or not, develop diabetic nephropathy. Diabetic nephropathy is the single most important cause of end-stage renal...... disease in the western world and accounts for more than a quarter of all end-stage renal diseases. It is also a major cause of increased morbidity and mortality in diabetic patients. Increased arterial blood pressure is an early and common phenomenon in incipient and overt diabetic nephropathy...... the ability to retard renal growth and possibly to attenuate mesangial entrapment of macromolecules and to attenuate the mitogenic effects of diverse growth factors. Calcium antagonists (except the old short-acting dihydropyridine drugs) reduce microalbuminuria and preserve kidney function in diabetic...

Hyaluronan Biology and Regulation in Renal Tubular Epithelial Cells and its Role in Kidney Stone Disease

NARCIS (Netherlands)

M. Asselman (Marino)

2008-01-01

textabstractRenal stone disease is a widespread problem afflicting more and more people throughout the world. Epidemiological studies show an increase in incidence and prevalence rates. In North America and Europe the yearly incidence is estimated to be about 0.5% 1, 2. The prevalence of kidney

Analysis of urinary stone based on a spectrum absorption FTIR-ATR

International Nuclear Information System (INIS)

Asyana, V; Haryanto, F; Fitri, L A; Ridwan, T; Anwary, F; Soekersi, H

2016-01-01

This research analysed the urinary stone by measuring samples using Fourier transform infrared-attenuated total reflection spectroscopy and black box analysis. The main objective of this study is to find kinds of urinary stone and determine a total spectrum, which is a simple model of the chemical and mineral composition urinary stone through black box analysis using convolution method. The measurements result showed that kinds of urinary stone were pure calcium oxalate monohydrate, ion amino acid calcium oxalate monohydrate, a mixture of calcium oxalate monohydrate with calcium phosphate, a mixture of ion amino acid calcium oxalate monohydrate and calcium phosphate,pure uric acid, ion amino acid uric acid, and a mixture of calcium oxalate monohydrate with ion amino acid uric acid. The results of analysis of black box showed characteristics as the most accurate and precise to confirm the type of urinary stones based on theregion absorption peak on a graph, the results of the convolution, and the shape of the total spectrum on each urinary stones. (paper)

Frequency of stone clearance after extracorporeal shockwave ...

African Journals Online (AJOL)

Objective: To determine the rate of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for renal stones in adult patients with renal insufficiency. Subjects and methods: This is a cross-sectional descriptive study of 117 adult patients who underwent ESWL. The indications for ESWL were determined by the ...

Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

Directory of Open Access Journals (Sweden)

Kursad Zengin

2015-01-01

Full Text Available Objective. Retrograde intrarenal surgery (RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL. However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter. Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2. Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061. The respective complication rates (evaluated using the Clavien system were 13.5% and 8.8% (P=0.520. Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial.

Science.gov (United States)

Ye, Zhangqun; Zeng, Guohua; Yang, Huan; Tang, Kun; Zhang, Xiaochun; Li, Hong; Li, Weibing; Wu, Zhong; Chen, Lingwu; Chen, Xingfa; Liu, Xiankui; Deng, Yaoliang; Pan, Tiejun; Xing, Jinchun; Wang, Shusheng; Cheng, Yue; Gu, Xiaojian; Gao, Wenxi; Yang, Jianggen; Zhang, Yonghai; Mi, Qiwu; Qi, Lin; Li, Jiongming; Hu, Weilie; Liang, Peiyu; Sun, Zhaolin; Xu, Changbao; Long, Yongfu; Liao, Yongbin; Liu, Siping; Liu, Guoqing; Xu, Xun; He, Wei; Chen, Zhiqiang; Xu, Hua

2017-11-12

Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. Participants were randomly assigned (1:1) into tamsulosin (0.4mg) or placebo groups for 4 wk. The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; ptamsulosin for the treatment of large distal ureteral stones (>5mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (ptamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5mm. In this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

Directory of Open Access Journals (Sweden)

Hidehiro Kakizaki

1996-01-01

Full Text Available Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1 the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2 this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones.

The comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of solitary large renal pelvic stones

NARCIS (Netherlands)

Tefekli, Ahmet; Tepeler, Abdulkadir; Akman, Tolga; Akçay, Muzaffer; Baykal, Murat; Karadağ, Mert Ali; Muslumanoglu, Ahmet Y.; de la Rosette, Jean

2012-01-01

The aim of the study is to investigate whether laparoscopic pyelolithotomy (LPL) could find a place in the management of large renal pelvic stones which are generally considered as excellent indications for percutaneous nephrolithotomy (PNL). Between 2006 and 2009, 26 consecutive patients with large

Is an excretory urogram mandatory in patients with small to medium-sized renal and ureteric stones treated by extra corporeal shock wave lithotripsy?

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Akhtar Sobia

2004-04-01

Full Text Available Abstract Background An intravenous urogram (IVU has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL. This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique. Methods This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i IVU; ii non-contrast enhanced helical computed tomography (UHCT; and iii ultrasound (US + X-ray kidney, ureter and bladder (KUB. The groups were matched in terms of age and gender, as well as location, side and size of stones. Results There was no statistically significantly difference for number of ESWL sessions, number of shock waves and use of ancillary procedures between the three groups. The stone-free rate was 98% for the IVU and UHCT groups, and 97% for the US + X-ray KUB group. Conclusions The complication rate and need for ancillary procedures was comparable across the three groups. Patients imaged by UHCT or US + X-ray KUB prior to ESWL for uncomplicated renal and ureteric stones do not require IVU.

Kidney stone erosion by micro scale hydrodynamic cavitation and consequent kidney stone treatment.

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Perk, Osman Yavuz; Şeşen, Muhsincan; Gozuacik, Devrim; Koşar, Ali

2012-09-01

The objective of this study is to reveal the potential of micro scale hydrodynamic bubbly cavitation for the use of kidney stone treatment. Hydrodynamically generated cavitating bubbles were targeted to the surfaces of 18 kidney stone samples made of calcium oxalate, and their destructive effects were exploited in order to remove kidney stones in in vitro experiments. Phosphate buffered saline (PBS) solution was used as the working fluid under bubbly cavitating conditions in a 0.75 cm long micro probe of 147 μm inner diameter at 9790 kPa pressure. The surface of calcium oxalate type kidney stones were exposed to bubbly cavitation at room temperature for 5 to 30 min. The eroded kidney stones were visually analyzed with a high speed CCD camera and using SEM (scanning electron microscopy) techniques. The experiments showed that at a cavitation number of 0.017, hydrodynamic bubbly cavitation device could successfully erode stones with an erosion rate of 0.31 mg/min. It was also observed that the targeted application of the erosion with micro scale hydrodynamic cavitation may even cause the fracture of the kidney stones within a short time of 30 min. The proposed treatment method has proven to be an efficient instrument for destroying kidney stones.

A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

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Goyal Neeraj

2010-01-01

Full Text Available To compare the accuracy of artificial neural network (ANN analysis and multi-variate regression analysis (MVRA for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL. A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC (r2 . For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL.

A comparative study of artificial neural network and multivariate regression analysis to analyze optimum renal stone fragmentation by extracorporeal shock wave lithotripsy

International Nuclear Information System (INIS)

Neeraj K Goyal, Abhay Kumar; Sameer Trivedi

2010-01-01

To compare the accuracy of artificial neural network (ANN) analysis and multivariate regression analysis (MVRA) for renal stone fragmentation by extracorporeal shock wave lithotripsy (ESWL). A total of 276 patients with renal calculus were treated by ESWL during December 2001 to December 2006. Of them, the data of 196 patients were used for training the ANN. The predictability of trained ANN was tested on 80 subsequent patients. The input data include age of patient, stone size, stone burden, number of sittings and urinary pH. The output values (predicted values) were number of shocks and shock power. Of these 80 patients, the input was analyzed and output was also calculated by MVRA. The output values (predicted values) from both the methods were compared and the results were drawn. The predicted and observed values of shock power and number of shocks were compared using 1:1 slope line. The results were calculated as coefficient of correlation (COC) (r2 ). For prediction of power, the MVRA COC was 0.0195 and ANN COC was 0.8343. For prediction of number of shocks, the MVRA COC was 0.5726 and ANN COC was 0.9329. In conclusion, ANN gives better COC than MVRA, hence could be a better tool to analyze the optimum renal stone fragmentation by ESWL (Author).

Ultrasonic propulsion of kidney stones.

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May, Philip C; Bailey, Michael R; Harper, Jonathan D

2016-05-01

Ultrasonic propulsion is a novel technique that uses short bursts of focused ultrasonic pulses to reposition stones transcutaneously within the renal collecting system and ureter. The purpose of this review is to discuss the initial testing of effectiveness and safety, directions for refinement of technique and technology, and opinions on clinical application. Preclinical studies with a range of probes, interfaces, and outputs have demonstrated feasibility and consistent safety of ultrasonic propulsion with room for increased outputs and refinement toward specific applications. Ultrasonic propulsion was used painlessly and without adverse events to reposition stones in 14 of 15 human study participants without restrictions on patient size, stone size, or stone location. The initial feasibility study showed applicability in a range of clinically relevant situations, including facilitating passage of residual fragments following ureteroscopy or shock wave lithotripsy, moving a large stone at the ureteropelvic junction with relief of pain, and differentiating large stones from a collection of small fragments. Ultrasonic propulsion shows promise as an office-based system for transcutaneously repositioning kidney stones. Potential applications include facilitating expulsion of residual fragments following ureteroscopy or shock wave lithotripsy, repositioning stones prior to treatment, and repositioning obstructing ureteropelvic junction stones into the kidney to alleviate acute renal colic.

RIRS versus mPCNL for single renal stone of 2-3 cm: clinical outcome and cost-effective analysis in Chinese medical setting.

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Pan, Jiahua; Chen, Qi; Xue, Wei; Chen, Yonghui; Xia, Lei; Chen, Haige; Huang, Yiran

2013-02-01

The aim of the study was to compare the clinical outcome and the cost-effectiveness between retrograde intra renal surgery (RIRS) and mini-percutaneous nephrolithotripsy (mPCNL) for the management of single renal stone of 2-3 cm in Chinese medical setting. From May 2005 to February 2011, 115 patients with solitary renal calculi were treated either by RIRS or mPCNL. 56 patients were in RIRS group while 59 were in mPCNL group. Patients' demographics between the two groups, in terms of gender, age, BMI, history of ESWL as well as stone side, stone location and stone size were comparable. Peri-operative course, clinical outcome, complication rates and medical cost were compared. The effective quotient (EQ) of two groups was calculated. Data were analyzed using Fisher's exact test, Chi-square test and Student's t test. EQ for RIRS and mPCNL were 0.52 and 0.90. The initial stone-free rate (SFR) of RIRS group and mPCNL group was 71.4 and 96.6 %, respectively (P = 0.000). The mean procedure number was 1.18 in RIRS group and 1.03 in mPCNL group, respectively (P = 0.035). The operative time for RIRS was longer (P = 0.000) while the mean hospital stay was shorter (P = 0.000). There was no statistical difference in peri-operative complications between the groups. The initial hospitalization cost, laboratory and radiology test cost of RIRS group were lower (P = 0.000). However, counting the retreatment cost in the two groups, the total medical expenditure including the overall hospitalization cost, overall laboratory and radiology test cost and post-operative out-patient department (OPD) visit cost was similar between two groups. In conclusion, with similar total medical cost, mPCNL achieved faster stone clearance and lower retreatment rate without major complications, which implied higher cost-effectiveness for the treatment of single renal stone of 2-3 cm in Chinese medical setting. RIRS is also a safe and reliable choice for patients having contraindications or

The preservation of urine samples for determination of renal stone risk factors

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Nicar, M. J.; Hsu, M. C.; Johnson, T.; Pak, C. Y.

1987-01-01

A preservation technique for urine specimens before determination of stone risk factors was evaluated. The purpose of these experiments was to prove the effectiveness of the preservatives used to prevent changes in the concentrations of those constituents measured. Measured concentrations in fresh specimens were compared with those in the same specimens after storage with the preservatives. Refrigeration at 4 degrees C up to five days was appropriate in a laboratory setting, as no significant changes in urinary concentrations occurred. Refrigeration, however, did not offer a convenient method for shipping. Chemical preservation was found to be an effective alternative to refrigeration. Thymol prevented changes in concentration of pH, citrate, uric acid, sulfate, sodium, potassium, and cyclic AMP, while a mixture of hydrochloric (HCl) acid and boric acid prevented changes in calcium, magnesium, phosphorus, oxalate, ammonium, and creatinine. Thus, the addition of thymol or HCl/boric acid to urine specimens will prevent significant changes in the concentrations of stone risk factors.

Role of Calcium Sensing Receptor in Streptozotocin-Induced Diabetic Rats Exposed to Renal Ischemia Reperfusion Injury

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Bo Hu

2018-02-01

Full Text Available Background/Aims: Renal ischemia/reperfusion (I/R injury (RI/RI is a common complication of diabetes, and it may be involved in altering intracellular calcium concentrations at its onset, which can result in inflammation, abnormal lipid metabolism, the production of reactive oxygen species (ROS, and nitroso-redox imbalance. The calcium-sensing receptor (CaSR is a G-protein coupled receptor, however, the functional involvement of CaSR in diabetic RI/ RI remains unclear. The present study was intended to investigate the role of CaSR on RI/RI in diabetes mellitus (DM. Methods: The bilateral renal arteries and veins of streptozotocin (STZ-induced diabetic rats were subjected to 45-min ischemia followed by 2-h reperfusion with or without R-568 (agonist of CaSR and NPS-2143 (antagonist of CaSR at the beginning of I/R procedure. DM without renal I/R rats served as control group. The expressions of CaSR, calmodulin (CaM, and p47phox in the renal tissue were analyzed by qRT-PCR and Western blot. The renal pathomorphology, renal function, oxidative stress, inflammatory response, and calcium disorder were evaluated by detection of a series of indices by hematoxylin-eosin (HE staining, transmission electron microscope (TEM, commercial kits, enzyme-linked immunosorbent assay (ELISA, and spectrophotofluorometry, respectively. Results: Results showed that the expressions of CaSR, CaM, and p47phox in I/R group were significantly up-regulated as compared with those in DM group, which were accompanied by renal tissue injury, increased calcium, oxidative stress, inflammation, and nitroso-redox imbalance. Conclusion: These results suggest that activation of CaSR is involved in the induction of damage of renal tubular epithelial cell during diabetic RI/RI, resulting in lipid peroxidation, inflammatory response, nitroso-redox imbalance, and apoptosis.

A variant in a Cis-regulatory element enhances claudin-14 expression and is associated with pediatric-onset hypercalciuria and kidney stones

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Ure, Megan E; Heydari, Emma; Pan, Wanling

2017-01-01

The greatest risk factor for kidney stones is hypercalciuria, the etiology of which is largely unknown. A recent genome-wide association study (GWAS) linked hypercalciuria and kidney stones to a claudin-14 (CLDN14) risk haplotype. However, the underlying molecular mechanism was not delineated....... Recently, renal CLDN14 expression was found to increase in response to increased plasma calcium, thereby inducing calciuria. We hypothesized therefore that some children with hypercalciuria and kidney stones harbor a CLDN14 variant that inappropriately increases gene expression. To test this hypothesis, we...... sequenced the CLDN14 risk haplotype in a cohort of children with idiopathic hypercalciuria and kidney stones. An intronic single nucleotide polymorphism (SNP) was more frequent in affected children. Dual luciferase and cell based assays demonstrated increased reporter or CLDN14 expression when...

Emergency management of ureteral stones: Recent advances

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Luis Osorio

2008-01-01

Full Text Available Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators′ experience, patients′ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Emergency management of ureteral stones: Recent advances.

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Osorio, Luis; Lima, Estêvão; Autorino, Riccardo; Marcelo, Filinto

2008-10-01

Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators' experience, patients' preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.

Recurrence rates of urinary calculi according to stone composition and morphology

DEFF Research Database (Denmark)

Daudon, Michel; Jungers, Paul; Bazin, Dominique

2018-01-01

stone event, with these being more frequent in men (44.4%) than in women (38.9%, p acid (62.5 ± 14.9 years), with the average age of first stones of calcium oxalate falling...... in the middle (40.7 ± 14.6 years for calcium oxalate dihydrate, and 48.4 ± 15.1 years for calcium oxalate monohydrate, COM). By composition alone, COM was among the least recurrent of stones, with only 38.0% of COM stones coming from patients who had had a previous episode; however, when the different...

Study of stone composition changes in melamine-related urinary calculi and its clinical significance.

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Li, Yuan; Chen, YiRong; Zhang, Wei; Huang, XiaoGang; Li, WenHui; Ru, XiaoRui; Meng, Min; Xi, Xinsheng; Huang, Gang; Shi, BaoGuang; Liu, Gang; Li, WeiHua; Xu, Hui

2011-08-01

To investigate the composition changes in melamine-related urinary calculi and their clinical significance. A total of 49 melamine-related urinary calculi were included from 49 children (age 4-82 months, mean 22). The qualitative analysis of stone composition was determined using Fourier transform infrared. The quantitative analysis of the stone computed tomography (CT) attenuation value, stone uric acid level, and stone calcium level were measured using spiral CT, high-performance liquid chromatography, and flame atomic absorption spectrum, respectively. Fourier transform infrared showed that 41 (84%) of the 49 stones contained uric acid and 25 (51%) contained calcium compounds. The data from the qualitative and quantitative analysis were available for 15 stones because of sample consumption in the detection process (Fourier transform infrared, atomic absorption spectrum, and high-performance liquid chromatography). A negative correlation was observed between stone uric acid level and stone calcium level (n = 15, r = -0.629, P = .009). A positive correlation was observed between the stone calcium level and stone CT attenuation value (n = 25, r = 0.855, P = .000). Compared with the ≤1-year-age group and the 1-2-year-age group, the stone calcium level in the >2-year-age group was significantly greater (27.51% ± 12.65% vs 1.60% ± 1.68% or 10.12% ± 8.69%, P = .000 and P = .003, respectively). Compared with the alkalization-alone group, the stone calcium level in the nonalkalization-alone group was significant greater (19.83% ± 7.48% vs 1.25% ± 1.43%, n = 19, P = .000). The stones from children >2 years old were not amenable to medical treatment because they contained greater levels of calcium, which can be demonstrated by the radiologic "positive stone image" or stone CT attenuation value. We believe that surgical invention will be the best choice for such patients if extracorporeal shock wave lithotripsy has failed. Copyright © 2011 Elsevier Inc. All rights

Metabolic abnormalities associated with renal calculi in patients with horseshoe kidneys.

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Raj, Ganesh V; Auge, Brian K; Assimos, Dean; Preminger, Glenn M

2004-03-01

Horseshoe kidneys are a complex anatomic variant of fused kidneys, with a 20% reported incidence of associated calculi. Anatomic causes such as high insertion of the ureter on the renal pelvis and obstruction of the ureteropelvic junction are thought to contribute to stone formation via impaired drainage, with urinary stasis, and an increased incidence of infection. In this multi-institutional study, we evaluated whether metabolic factors contributed to stone development in patients with horseshoe kidneys. A retrospective review of 37 patients with horseshoe kidneys was performed to determine if these patients had metabolic derangements that might have contributed to calculus formation. Stone compositions as well as 24-hour urine collections were examined. Specific data points of interest were total urine volume; urine pH; urine concentrations of calcium, sodium, uric acid, oxalate, and citrate; and number of abnormalities per patient per 24-hour urine collection. These data were compared with those of a group of 13 patients with stones in caliceal diverticula as well as 24 age-, race-, and sex-matched controls with stones in anatomically normal kidneys. Eleven (9 men and 2 women) of the 37 patients (30%) with renal calculi in horseshoe kidneys had complete metabolic evaluations available for review. All patients were noted to have at least one abnormality, with an average of 2.68 abnormalities per 24-hour urine collection (range 1-4). One patient had primary hyperparathyroidism and underwent a parathyroidectomy. Low urine volumes were noted in eight patients on at least one of the two specimens (range 350-1640 mL/day). Hypercalciuria, hyperoxaluria, hyperuricosuria, and hypocitraturia were noted in seven, three, six, and six patients, respectively. No patients were found to have gouty diathesis or developed cystine stones. Comparative metabolic analyses of patients with renal calculi in caliceal diverticula or normal kidneys revealed a distinct profile in patients

Renal manifestations of primary hyperparathyroidism

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Anurag Ranjan Lila

2012-01-01

Full Text Available Primary hyperparathyroidism (PHPT is associated with nephrolithiasis and nephrocalcinosis. Hypercalciuria is one of the multiple factors that is implicated in the complex pathophysiology of stone formation. The presence of a renal stone (symptomatic or asymptomatic categorizes PHPT as symptomatic and is an indication for parathyroid adenomectomy. Progression of nephrocalcinosis is largely reversible after successful surgery, but the residual risk persists. PHPT is also associated with declining renal function. In case of asymptomatic mild PHPT, annual renal functional assessment is advised. Guidelines suggest that an estimated glomerular filtration rate (eGFR < 60 ml / minute / 1.73 m 2 is an indication for parathyroid adenomectomy. This article discusses how to monitor and manage renal stones and other related renal parameters in case of PHPT.

Effectiveness of Treatment Modalities on Kidney Stone Recurrence.

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Zisman, Anna L

2017-10-06

Nephrolithiasis is highly prevalent across all demographic groups in the Western world and beyond, and its incidence rates are rising. In addition to the morbidity of the acute event, stone disease often becomes a lifelong problem that requires preventative therapy to diminish ongoing morbidity. Across the majority of stone types, increased fluid intake and targeted dietary modifications are mainstays of therapy. Specific dietary interventions associated with reduced calcium stone risk include adequate dietary calcium intake and restriction of sodium, protein, and oxalate intake, among others. Pharmaceutical therapy may be required if lifestyle changes are insufficient to minimize risk of stone recurrence, and must be targeted to the specific metabolic abnormalities portending risk for a given patient. Therapeutic options for idiopathic calcium stone disease include thiazides, citrate salts, and uric acid-lowering agents. Alkali salts are also the treatment of choice for uric acid stone disease. Management of struvite stone disease is largely surgical, but acetohydroxamic acid is a proven second line therapy. Cystinuria requires lifestyle modifications and may call for thiol-binding agents. Significant heterogeneity of the clinical population with stone disease has previously limited opportunities for large randomized controlled trials. However, as clinical phenotypes and genotypes are increasingly clarified, there are mounting opportunities for targeted randomized controlled trials in stone prevention. In the meantime, the currently available evidence for both lifestyle and pharmacologic interventions is reviewed herein. Copyright © 2017 by the American Society of Nephrology.

The relationship between serum and urinary Fetuin-A levels and kidney stone formation among kidney stone patients.

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Mehrsai, Abdolrasoul; Guitynavard, Fateme; Nikoobakht, Mohammad Reza; Gooran, Shahram; Ahmadi, Ayat

2017-01-01

Mineralization inhibitors are required to prevent the precipitation of minerals and inhibit the formation of kidney stones and other ectopic calcifications. In laboratory studies, Fetuin-A as a glycoprotein has inhibited hydroxyapatite precipitation in calcium and phosphate supersaturated solutions; however, information about patients with kidney stones is limited. The aim of this study was to investigate the association of serum and urinary Fetuin-A levels with calcium oxalate kidney stones. In this case-control study, 30 patients with kidney stones and 30 healthy individuals without any history of urolithiasis who were referred to the urology ward of Sina Hospital of Tehran, Iran, in 2015 were entered into the study. All patients underwent computerized tomography scans. After collecting demographic information, serum and urine levels of Fetuin-A and some other calcification inhibitors and promoters, were measured and compared using T-test, Mann-Whitney and logistic regression between the two study groups. Patients with kidney stones, on average, had lower levels of Serum Fetuin-A (1522.27 ±755.39 vs. 1914.64 ±733.76 μg/ml; P = 0.046) as well as lower levels of Urine Fetuin-A (944.62 ±188.5 vs. 1409.68 ±295.26 μg/ml; P <0.001). Multivariate logistic analysis showed that urinary calcium and serum creatinine are the risk factors and Fetuin-A is a urinary protective factor for kidney stones. PFC Our study showed that patients with kidney stones had lower serum and urinary levels of Fetuin-A. In the logistic regression model, urinary Fetuin-A was reported as a protective factor for kidney stones.

Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones.

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Resorlu, Berkan; Unsal, Ali; Ziypak, Tevfik; Diri, Akif; Atis, Gokhan; Guven, Selcuk; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir; Bozkurt, Omer Faruk; Oztuna, Derya

2013-12-01

To compare the outcomes of shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PNL), and retrograde intrarenal surgery (RIRS) for 10-20 mm radiolucent renal calculi by evaluating stone-free rates and associated complications. A total of 437 patients at 7 institutions who underwent SWL (n = 251), PNL (n = 140), or RIRS (n = 46) were enrolled in our study. Clinical success was defined as stone-free status or asymptomatic insignificant residual fragments PNL, and RIRS (p PNL and RIRS (21.9 vs 5.7 vs 8.7%, respectively; p PNL, and RIRS were 7.6, 22.1, and 10.9%, respectively (p PNL group received blood transfusions, while none of the patients in RIRS and SWL groups transfused. Hospitalization time per patient was 1.3 ± 0.5 days in the RIRS group, while it was 2.6 ± 0.9 days in the PNL group (p PNL group compared to RIRS (145.7 ± 101.7 vs 28.7 ± 18.7 s, and 57.5 ± 22.1 vs 43.1 ± 17 min, respectively). For treatment of moderate-sized radiolucent renal stones, RIRS and PNL provide significantly higher success and lower retreatment rate compared with SWL. Although PNL is effective, its biggest drawback is its invasiveness. Blood loss, radiation exposure, hospital stay, and morbidities of PNL can be significantly reduced with RIRS technique.

A Novel Decision Aid to Support Informed Decision-Making Process in Patients with a Symptomatic Nonlower Pole Renal Stone <20 mm in Diameter.

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Gökce, Mehmet İlker; Esen, Barış; Sancı, Adem; Akpınar, Cağrı; Süer, Evren; Gülpınar, Ömer

2017-07-01

Stone disease is an important health problem, and patients have different treatment choices. Shared decision making is recommended for deciding the treatment type, but patient education is necessary. Decision aids (DAs) are used for this aim, and herein, we developed a novel DA for patients with symptomatic nonlower pole renal stones group assessment resulted in a total score of 50/54. Patient evaluation of the DA resulted in favorable outcomes, and patients generally recommended its use by other patients. This novel DA for patients with a symptomatic nonlower pole renal stone <20 mm showed promising results and was well accepted by the patients. We believe that this DA will have a positive impact on patients' level of knowledge. Increased level of knowledge will also improve the patients' contribution to the shared decision-making process. A further prospective randomized trial to compare with the standard patient informing process is also planned.

[Gallbladder Stone Types in Patients with Cholelithiasis and Clonorchis sinensis Infection in the Endemic Area of Clonorchiasis].

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Ma, Rui-hong; Qiao, Tie; Luo, Zhen-liang; Luo, Xiao-bing; Zheng, Pei-ming; Yang, Liu-qing

2015-06-01

To investigate the relationship between Clonorchis sinensis infection and the gallbladder stone type in patients with cholelithiasis in the endemic area of clonorchiasis. Gallbladder stones were collected from 598 patients with cholelithiasis through minimally invasive gallbladder-preserving cholelithotomy in the Sixth People's Hospital of Nansha District from May 2009 to October 2012. The stone samples were analyzed for composition by Fourier transform infrared spectroscopy to identify their types. The Clonorchis sinensis eggs were detected in the stones by microscopic examination, and the detection rates of eggs were calculated for different stone types. Then the clinical characteristics and biochemical indicators were compared among patients with different types of stones, as well as between Clonorchis sinensis egg-positive and -negative patients with the calcium-carbonate type of stones. Some calcium-carbonate stones positive for Clonorchis sinensis eggs were randomly selected for further scanning electron microscopy (SEM) examination. Of the stones from 598 patients, 234 (39.1%) were cholesterol type, 133 (22.2%) bile pigment type, 112(18.7%) calcium-carbonate type, 86 (14.4%) mixed types and 33(5.5%) were others. The detection rate of Clonorchis sinensis eggs in these types was 6% (15/234), 44% (59/133), 60% (67/112), 36% (31/ 86) and 30% (10/33), respectively, being highest in calcium-carbonate stones while lowest in cholesterol stones. The Co2-combining power of the plasma was higher in patients with calcium-carbonate and mixed stones than in those with cholesterol stones (P Clonorchis sinensis eggs to calcium-carbonate crystals. The infection rate of Clonorchis sinensis is higher in patients with calcium-carbonate gallbladder stones than in those with other types of stones.

Functional importance of T-type voltage-gated calcium channels in the cardiovascular and renal system

DEFF Research Database (Denmark)

Hansen, Pernille B L

2015-01-01

Over the years, it has been discussed whether T-type calcium channels Cav3 play a role in the cardiovascular and renal system. T-type channels have been reported to play an important role in renal hemodynamics, contractility of resistance vessels, and pacemaker activity in the heart. However...

Correlation of radial bone mineral content with total body calcium in chronic renal failure

International Nuclear Information System (INIS)

Cohn, S.H.; Ellis, K.J.; Caselnova, R.C.; Asad, S.N.; Letteri, J.M.

1975-01-01

Loss of bone mineral of the skeleton in renal disease can be measured directly by total body neutron activation analysis (TBNAA), and also by an absorptiometric technique applied to the appendicular skeleton (radius). In the present study the results of these two techniques are compared in 25 patients with renal insufficiency, 53 patients with end-stage renal failure on dialysis, and 24 normal control subjects. It is apparent that there is good correlation between total body calcium (TBCa) and bone mineral content (BMC) in all groups studied. The correlation in the normal contrast group was 0.944 as compared to 0.919 for the renal patients and 0.892 for patients with end-stage renal failure on dialysis. In order to measure the relative deficit in TBCa in individual patients from the absolute Ca measurement, it is necessary to normalize the data for sex, age, and skeletal size. For this purpose, an empirically derived relationship was used to predict the normal skeletal Ca in each subject, based on weight, height, sex, and age. The measured TBCa divided by the predicted TBCa is referred to as the calcium ratio. This ratio is useful in expressing the relative deficit of Ca in individual renal patients. In similar manner, BMC data were normalized, with the same relationship used to obtain BMC ratios. The normalization procedures allow both the TBCa and BMC measurements to be used to quantitate the Ca deficit in individual patients with renal insufficiency

Contribution of stone size to chronic kidney disease in kidney stone formers.

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Ahmadi, Farrokhlagha; Etemadi, Samira Motedayen; Lessan-Pezeshki, Mahbob; Mahdavi-Mazdeh, Mitra; Ayati, Mohsen; Mir, Alireza; Yazdi, Hadi Rokni

2015-01-01

To determine whether stone burden correlates with the degree of chronic kidney disease in kidney stone formers. A total of 97 extracorporeal shockwave lithotripsy candidates aged 18 years and older were included. Size, number and location of the kidney stones, along with cumulative stone size, defined as the sum of diameters of all stones) were determined. Estimated glomerular filtration rate was determined using the Chronic Kidney Disease Epidemiology Collaboration cystatin C/creatinine equation, and chronic kidney disease was defined as estimated glomerular filtration rate chronic kidney disease. The relationship persisted even after adjustment for age, sex, body mass index, C-reactive protein, fasting plasma glucose, thyroid stimulating hormone, presence of microalbuminuria, history of renal calculi, history of extracorporeal shockwave lithotripsy, number and location of the stones (odds ratio 1.24, 95% confidence interval 1.02-1.52). The same was not observed for individuals with a cumulative stone size ≥ 20 mm. In kidney stone formers with a cumulative stone size up to 20 mm, estimated glomerular filtration rate linearly declines with increasing cumulative stone size. Additionally, cumulative stone size is an independent predictor of chronic kidney disease in this group of patients. © 2014 The Japanese Urological Association.

Effect of Dietary Countermeasures and Impact of Gravity on Renal Calculi Size Distributions Predicted by PBE-System and PBE-CFD Models

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Kassemi, M.; Thompson, D.; Goodenow, D.; Gokoglu, S.; Myers, J.

2016-01-01

Renal stone disease is not only a concern on earth but can conceivably pose a serious risk to the astronauts health and safety in Space. In this work, two different deterministic models based on a Population Balance Equation (PBE) analysis of renal stone formation are developed to assess the risks of critical renal stone incidence for astronauts during space travel. In the first model, the nephron is treated as a continuous mixed suspension mixed product removal crystallizer and the PBE for the nucleating, growing and agglomerating renal calculi is coupled to speciation calculations performed by JESS. Predictions of stone size distributions in the kidney using this model indicate that the astronaut in microgravity is at noticeably greater but still subcritical risk and recommend administration of citrate and augmented hydration as effective means of minimizing and containing this risk. In the second model, the PBE analysis is coupled to a Computational Fluid Dynamics (CFD) model for flow of urine and transport of Calcium and Oxalate in the nephron to predict the impact of gravity on the stone size distributions. Results presented for realistic 3D tubule and collecting duct geometries, clearly indicate that agglomeration is the primary mode of size enhancement in both 1g and microgravity. 3D numerical simulations seem to further indicate that there will be an increased number of smaller stones developed in microgravity that will likely pass through the nephron in the absence of wall adhesion. However, upon reentry to a 1g (Earth) or 38g (Mars) partial gravitational fields, the renal calculi can lag behind the urinary flow in tubules that are adversely oriented with respect to the gravitational field and grow agglomerate to large sizes that are sedimented near the wall with increased propensity for wall adhesion, plaque formation, and risk to the astronauts.

Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones.

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Tligui, M; El Khadime, M R; Tchala, K; Haab, F; Traxer, O; Gattegno, B; Thibault, P

2003-05-01

To evaluate emergency treatment of obstructing ureteral stones by in situ extracorporeal shock wave lithotripsy (ESWL) during acute renal colic. From January 1994 to February 2000, 200 patients (mean age: 42 years) were treated by ESWL (EDAP LT-02) for obstructing ureteral stones causing acute renal colic refractory to medical treatment or recurring within 24hours of such treatment. Stones were visualised by fluoroscopic imaging and/or ultrasound. Follow-up included radiological and/or ultrasound examinations and lasted three months. Mean stone size was 7mm (3-20mm). At three months, 164/200 (82%) patients were stone-free. This rate ranged from 79% to 83% according to the location of the stone, and from 75% to 86% according to the size of the stone. These differences in rate were not significant. Two or three ESWL sessions were required in 79 patients. ESWL was well tolerated in 90% of patients. The only complication was a case of pyelonephritis requiring the placement of a JJ stent, administration of antibiotics, and distant ureteroscopy. The 36 patients, in whom ESWL failed, underwent ureteroscopy (n=23) or lithotripsy with a Dornier machine (n=13). Non-deferred ESWL for acute renal colic secondary to obstructing ureteral stones has a satisfactory success rate and very low morbidity.

Clinical experience with EDAP LT-01+ extracorporeal shock wave lithotripsy for radiolucent stones; a report of 27 cases

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Rim, Hee Kwan; Kim, Ho Sung; Rim, Joung Sik

1994-01-01

Between February 1990 and February 1993, Radiolucent stones of 27 renal units in 22 patients were treated by extracorporeal shock wave lithotripsy (ESWL) using the EDAP LT-01+. Intravenous urography was done in all patients for the diagnosis of radiolucent stones. Retrograde pyelography, ultrasonography and/or computed tomography was done, if needed. The locations of stones were kidney in 11(40.7 %), upper ureter in 8(29.6 %), lower ureter in 6(22.2 %), bladder in 1(3.7 %), ureteropelvic junction in 1(3.7 %). The average stone size was 10.9mm with a range of 5 to 32mm in maximum diameter. The average numbers of treatment were 2.7 sessions and average storage required was 34.8 in one session. The average treatment time was 40.4 minutes. All the patients showed complete removal of all calculous materials. Of 17 urinary stones analysed by chemical method, 8(47.1 %) were composed of uric acid, 5(29.4 %) of uric acid and calcium, 3 of phosphate and 1 of carbonate and phosphate. Therefore, we conclude that ESWL with EDAP LT-01+ lithotriptor is considered to be an effective noninvasive procedure for treatment of radiolucent stones. (Author)

Low Bone Density and Bisphosphonate Use and the Risk of Kidney Stones.

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Prochaska, Megan; Taylor, Eric; Vaidya, Anand; Curhan, Gary

2017-08-07

Previous studies have demonstrated lower bone density in patients with kidney stones, but no longitudinal studies have evaluated kidney stone risk in individuals with low bone density. Small studies with short follow-up reported reduced 24-hour urine calcium excretion with bisphosphonate use. We examined history of low bone density and bisphosphonate use and the risk of incident kidney stone as well as the association with 24-hour calcium excretion. We conducted a prospective analysis of 96,092 women in the Nurses' Health Study II. We used Cox proportional hazards models to adjust for age, body mass index, thiazide use, fluid intake, supplemental calcium use, and dietary factors. We also conducted a cross-sectional analysis of 2294 participants using multivariable linear regression to compare 24-hour urinary calcium excretion between participants with and without a history of low bone density, and among 458 participants with low bone density, with and without bisphosphonate use. We identified 2564 incident stones during 1,179,860 person-years of follow-up. The multivariable adjusted relative risk for an incident kidney stone for participants with history of low bone density compared with participants without was 1.39 (95% confidence interval [95% CI], 1.20 to 1.62). Among participants with low bone density, the multivariable adjusted relative risk for an incident kidney stone for bisphosphonate users was 0.68 (95% CI, 0.48 to 0.98). In the cross-sectional analysis of 24-hour urine calcium excretion, the multivariable adjusted mean difference in 24-hour calcium was 10 mg/d (95% CI, 1 to 19) higher for participants with history of low bone density. However, among participants with history of low bone density, there was no association between bisphosphonate use and 24-hour calcium with multivariable adjusted mean difference in 24-hour calcium of -2 mg/d (95% CI, -25 to 20). Low bone density is an independent risk factor for incident kidney stone and is associated with

A pilot study of the effect of sodium thiosulfate on urinary lithogenicity and associated metabolic acid load in non-stone formers and stone formers with hypercalciuria.

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Onyeka W Okonkwo

Full Text Available BACKGROUND AND OBJECTIVES: Sodium thiosulfate (STS reduced calcium stone formation in both humans and genetic hypercalciuric stone forming (GHS rats. We sought to measure urine chemistry changes resulting from STS administration in people. DESIGN SETTING PARTICIPANTS MEASUREMENTS: STS was given to healthy and hypercalciuric stone forming adults. Five normal non-stone forming adults (mean age 33 years, and 5 people with idiopathic hypercalciuria and calcium kidney stones (mean age 66 years participated. Two baseline 24-hour urine collections were performed on days 2 and 3 of 3 days of self-selected diets. Subjects then drank STS 10 mmol twice a day for 7 days and did urine collections while repeating the self-selected diet. Results were compared by non-parametric Wilcoxon signed rank test. The primary outcome was the resulting change in urine chemistry. RESULTS: STS administration did not cause a significant change in urinary calcium excretion in either group. In both groups, 24 hour urinary ammonium (P = 0.005 and sulfate excretion (P = 0.007 increased, and urinary pH fell (P = 0.005; citrate excretion fell (P<0.05 in hypercalciuric participants but not in non-stone formers. Among stone formers with hypercalciuria, 3 of 5 patients had measurement of serum HCO3 concentration after the STS period: it did not change. The net effect was an increase in supersaturation of uric acid, and no change in supersaturation of calcium oxalate or calcium phosphate. CONCLUSIONS: The basis for studies demonstrating that STS prevented stones in rats and people was not reflected by the changes in urine chemistry reported here. Although serum HCO3 did not change, urine tests suggested an acid load in both non-stone forming and hypercalciuric stone-forming participants. The long term safety of STS needs to be determined before the drug can be tested in humans for long-term prevention of stone recurrence.

Calcium source (image)

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Getting enough calcium to keep bones from thinning throughout a person's life may be made more difficult if that person has ... as a tendency toward kidney stones, for avoiding calcium-rich food sources. Calcium deficiency also effects the ...

The increased risk of urinary stone disease in betel quid chewers.

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Allen, Siân E; Singh, Sadmeet; Robertson, William G

2006-08-01

The chewing of betel quid is a common practice in many countries of the world, particularly in Southeast Asia. The quid consists of a preparation of areca nut, betel leaf and calcium hydroxide "lime" paste ("chuna"). For the first time, we present a study that links its use to urinary stone disease. Eight patients (seven male and one female) who presented to our Stone Unit with recurrent urinary stones were included in the study. All were from the Indian subcontinent and were found to regularly chew betel. The patients underwent metabolic screening including blood, random urine and 24-h urine tests, quantitative chemical analysis of their calculi (where possible) and each completed a 7-day Diet Diary on his/her free, home diet. The study demonstrated a high incidence of hypercalciuria, a tendency to pass an alkaline urine and low urinary citrate excretion among the patients. Together these urinary risk factors increase the probability of developing both calcium phosphate-containing and calcium oxalate-containing stones. In support of this hypothesis, the patients were found to form stones consisting mainly of calcium phosphate but mixed with calcium oxalate. It is concluded that the use of calcium hydroxide "chuna" in the betel quid is the major contributor to the cause of urinary stones in its users. Moreover, the development of urinary lithiasis in such patients may be a precursor to milk-alkali syndrome in those individuals whose chewing habit is more extensive than in the patients in this study and who do not seek to decrease their habit over the long term.

Comparative Evaluation of Tensile Strength in Die Stone Incorporated with Sodium and Calcium Hypochlorite as Disinfectants: An in vitro Study.

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Pramodh, N R; Kumar, C N Vijay; Pradeep, M R; Naik, Ravi; Mahesh, C S; Kumari, Manju R

2017-12-01

The aim of this study was to evaluate the tensile strength of die stone incorporated with sodium and calcium hypochlorite as disinfectants. Two commercially available type IV die stone (Kalrock: Kalabhai Karson Pvt., Ltd and Pearlstone: Asian Chemicals) and two commercially available disinfectant solutions (sodium hypochlorite and calcium hypochlorite: Beachem Laboratory Chemical Private Limited, Chennai and Leo Chem Private Limited, Bengaluru) were used in this study, and the tensile strength was measured using Lloyd's Universal Testing Machine. The results show that incorporating the disinfecting solutions decreases the tensile strength of both products. The effect of decreasing tensile strength on type IV gypsum product is seen more in calcium hypochlorite when compared with sodium hypochlorite disinfecting solution, and the tensile strength of Kalrock specimens is higher than Pearlstone specimens after disinfecting with sodium hypochlorite and calcium hypochlorite solution. The statistical results also show significant results in all the groups when compared with the control group. The incorporation of sodium and calcium hypochlorite disinfecting solutions is not an encouraging method for both die materials as it reduces the tensile strength of type IV gypsum product. Tensile strength of Kalstone® die material is superior than Pearlstone® die material after mixing with sodium hypochlorite and calcium hypochlorite. According to the recommendations of Americans with Disability Act (ADA) and the Centers for Disease Control and Prevention, disinfecting the whole cast without or minimal changes in physical and mechanical properties was the motto of the study. The tensile strength in type IV gypsum product plays a most important role in retrieval of cast from impression, especially in narrow tooth preparation. This study reveals that incorporating method of disinfecting solutions is not recommended as it reduces the tensile strength.

Citrate and renal calculi: an update

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Pak, C. Y.

1994-01-01

Citrate is an inhibitor of the crystallization of stone-forming calcium salts. Hypocitraturia, frequently encountered in patients with nephrolithiasis, is therefore an important risk factor for stone formation. Potassium citrate provides physiological and physicochemical correction and inhibits new stone formation, not only in hypocitraturic calcium nephrolithiasis but also in uric acid nephrolithiasis. Inhibition of stone recurrence has now been validated by a randomized trial. Ongoing research has disclosed additional causes of hypocitraturia (sodium excess, low intestinal alkali absorption, but not primary citrate malabsorption). Moreover, new insights on potassium citrate action have been shown, notably that some of absorbed citrate escapes oxidation and contributes to the citraturic response, that ingestion with a meal does not sacrifice physiological or physicochemical action, that orange juice mimics but does not completely duplicate its actions, that potassium citrate may have a beneficial bone-sparing effect, that it may reduce stone fragments following ESWL, and that danger of aluminum toxicity is not great in subjects with functioning kidneys. Finally, the research on potassium citrate has led to two promising products, calcium citrate as an optimum calcium supplement and potassium-magnesium citrate which may be superior to potassium citrate in the management of stone disease.

Quantificação do stone clinic effect em pacientes com nefrolitíase Quantification of the stone clinic effect in patients with nephrolithiasis

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Maurício Carvalho

2004-01-01

Full Text Available O termo stone clinic effect refere-se ao efeito do aumento da ingestão hídrica e aconselhamento dietético na evolução clínica da doença calculosa renal. OBJETIVO: O nosso objetivo foi quantificar esta variável em pacientes portadores de nefrolitíase. MÉTODOS: Vinte e cinco pacientes (11 mulheres e 14 homens; 47,64±10,55 anos com nefrolitíase recorrente foram acompanhados com consultas trimestrais por um ano. Orientações sobre aumento da ingestão hídrica, diminuição do consumo de sal e proteína foram rotineiramente fornecidas. Nenhum paciente foi submetido à terapia farmacológica. Foram coletados no início (S1 e no final do seguimento (S2 os seguintes parâmetros: atividade clínica e radiológica da doença litiásica, urina de 24 horas com dosagem de creatinina, cálcio, sódio, ácido úrico, citrato, oxalato e magnésio. A supersaturação (SS para o oxalato de cálcio foi calculada pelo índice de Tiselius. RESULTADOS: Onze (44% pacientes apresentaram hipocitratúria, nove (36% hipercalciúria e cinco (20% hiperuricosúria. Houve aumento do volume urinário (1903±811 vs 2381±919 ml/dia, pBACKGROUND: The ''stone clinic effect'' refers to the effect of encouraging a high intake of fluid and diet counseling in the clinical evolution of kidney stone disease. Objective: Our objective was to determine the extent of this variable in patients with nephrolithiasis. METHODS: Twenty-five patients (11 female and 14 male; 47.64±10.55 years old with recurrent nephrolithiasis were prospectively followed for one year, with 3-month interval medical evaluation. Patients were advised to increase the fluid intake, and to limit the intake of salt and protein. No patient was submitted to pharmacological therapy. Two 24-hour urine samples were collected at baseline (S1 and in the end of follow-up (S2 for the measurement of creatinine, calcium, sodium, uric acid, citrate, oxalate and magnesium. Metabolic and radiological activity was also

Association Study of Klotho Gene Polymorphism With Calcium Oxalate Stones in The Uyghur Population of Xinjiang, China.

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Ali, Abdusamat; Tursun, Halmurat; Talat, Alim; Abla, Akpar; Muhtar, Erpan; Zhang, Tao; Mahmut, Murat

2017-01-18

The aim of the present study was to investigate the correlation between Klotho gene polymorphisms andcalcium oxalate stones in Xinjiang Uyghur people. We compared 128 patients with calcium oxalate stones (case group) and 94 healthypeople (control group), detected the genotype and allele distributions of single-nucleotide polymorphisms (SNPs)of the Klotho gene (rs3752472, rs650439, and rs1207568) by reverse transcription polymerase chain reaction. The distributions of the genotype and allele frequencies of the SNPs were consistent with the Hardy-Weinberg equilibrium in the two groups. There were statistically significant differences between the genotype andallele distributions of rs3752472 between the case and control groups; the allele frequencies in the case/controlgroups were C = 240 (93.7%)/151 (80.3%) and T = 16 (6.3%)/37 (19.7%). There was no statistically significantdifference in the genotype distribution of rs650439 between the case and control groups, but there was a differencein the allele distribution; the allele frequencies in the case/control groups were A = 202 (78.9%)/143 (57.2%) andT = 54 (21.1%)/107 (42.8%). There were no statistically significant differences in genotype and allele distributionsbetween the case and control groups of rs1207568; the allele frequencies in the case/control groups were C = 194(71.3%)/145 (77.1%) and T = 78 (28.7%)/43 (22.9%). In rs3752472, the risk for patients with the C and A allelesincreased by 3.675 and 2.799 times, respectively. The rs3752472 and rs650439 SNPs are related to the risk of calcium oxalate stones in Xinjiang Uyghurpeople, and might be one of the risk factors.

Metabolic Characteristics and Risks Associated with Stone Recurrence in Korean Young Adult Stone Patients.

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Kang, Ho Won; Seo, Sung Pil; Kim, Won Tae; Kim, Yong-June; Yun, Seok-Joong; Kim, Wun-Jae; Lee, Sang-Cheol

2017-08-01

The aim of this study was to assess the metabolic characteristics and risks of stone recurrence in young adult stone patients in Korea. The medical records of 1532 patients presenting with renal or ureteric stones at our stone clinic between 1994 and 2015 were retrospectively reviewed. Patients were grouped according to age (young adult, 18-29 years; intermediate onset, 30-59 years; old age, ≥60 years) at first presentation, and measurements of clinicometabolic characteristics and risks of stone recurrence were compared. Overall, excretion of urinary stone-forming substances was highest in the intermediate onset group, followed by the young adult and old age groups. Importantly, excretion of urinary citrate was lowest in the young adult group. Kaplan-Meier analyses identified a significant difference between the three age groups in terms of stone recurrence (log rank test, p adult stone patients. Younger age (18-29 years) at first stone presentation was a significant risk factor for stone recurrence, and urinary citrate excretion was an independent risk factor affecting recurrence in this group. Metabolic evaluation and potassium citrate therapy should be considered for young adult stone patients to prevent recurrence.

Anatomy of the collecting system of lower pole of the kidney in patients with a single renal stone: a comparative study with individuals with normal kidneys.

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Zomorrodi, Afshar; Buhluli, Abulfazel; Fathi, Samad

2010-07-01

At least 5% of women and 12% of men during their lives will experience renal colic, at least once. Many theories have been suggested for the etiology of renal stones and variations in the anatomy of the collecting system have been suggested to have a role in stone formation. This study was conducted to examine the role of variation of lower pole collecting system in patients with lower pole kidney stone and compared the same in normal persons (kidney donors). Investigation for the anatomy of the lower pole of the kidney (angle between lower infundibulum and pelvis, length and diameter of the infundibulum and number and pattern distribution of calyces) was carried out using intravenous pyelogram (IVP) in 100 cases with urinary stone (study cases) and 400 persons with normal kidneys (control subjects). The study was a retrospective cross-sectional case control study. Results were analyzed by Mann-Whitney and independent sample chi square tests. The mean infundibulum-pelvic angle (IPA) in control subjects and in patients was 112.5 +/- 10.7 and 96.6 +/- 28.8, respectively. There was significant correlation between reduced angle and stone formation (P= kidney (IPIL) in controls and study patients was 22.5 +/- 4.1 and 27.5 +/- 7.7, respectively, which was statistically significant (Pkidney (LPCN) in controls and study patients was 2.6 +/- 0.6 and 3 +/- 0.9, respectively, which was statistically significant (P = or anatomy was more common in patients with lower pole kidney stone and should be considered a risk factor for forming lower pole kidney stone.

Sensitivity of Non-Contrast Computed Tomography for Small Renal Calculi with Endoscopy as the Gold Standard.

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Bhojani, Naeem; Paonessa, Jessica E; El Tayeb, Marawan M; Williams, James C; Hameed, Tariq A; Lingeman, James E

2018-04-03

To compare the sensitivity of non-contrast CT to endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray (KUB), ultrasound (US), and non-contrast computed tomography (CT). Sensitivities of 58-62% (KUB), 45% (US), and 95-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy (URS) were studied. At the time of surgery, the number and location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. 18 renal units were studied in 11 patients. Average time from CT scan to URS was 28.6 days. The mean number of calculi identified per kidney was 9.2±6.1 for endoscopy and 5.9±4.1 for CT (p<0.004). The mean size of total renal calculi (sum of longest stone diameters) per kidney was 22.4±17.1 mm and 18.2±13.2 mm for endoscopy and CT, respectively (p=0.06). CT scan underreports the number of renal calculi, probably missing some small stones and unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared to that found on endoscopic examination. Copyright © 2018. Published by Elsevier Inc.

High calcium concentration in bones promotes bone metastasis in renal cell carcinomas expressing calcium-sensing receptor.

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Joeckel, Elke; Haber, Tobias; Prawitt, Dirk; Junker, Kerstin; Hampel, Christian; Thüroff, Joachim W; Roos, Frederik C; Brenner, Walburgis

2014-02-28

The prognosis for renal cell carcinoma (RCC) is related to a high rate of metastasis, including 30% of bone metastasis. Characteristic for bone tissue is a high concentration of calcium ions. In this study, we show a promoting effect of an enhanced extracellular calcium concentration on mechanisms of bone metastasis via the calcium-sensing receptor (CaSR) and its downstream signaling molecules. Our analyses were performed using 33 (11/category) matched specimens of normal and tumor tissue and 9 (3/category) primary cells derived from RCC patients of the 3 categories: non-metastasized, metastasized into the lung and metastasized into bones during a five-year period after nephrectomy. Expression of CaSR was determined by RT-PCR, Western blot analyses and flow cytometry, respectively. Cells were treated by calcium and the CaSR inhibitor NPS 2143. Cell migration was measured in a Boyden chamber with calcium (10 μM) as chemotaxin and proliferation by BrdU incorporation. The activity of intracellular signaling mediators was quantified by a phospho-kinase array and Western blot. The expression of CaSR was highest in specimens and cells of patients with bone metastases. Calcium treatment induced an increased migration (19-fold) and proliferation (2.3-fold) exclusively in RCC cells from patients with bone metastases. The CaSR inhibitor NPS 2143 elucidated the role of CaSR on the calcium-dependent effects. After treatment with calcium, the activity of AKT, PLCγ-1, p38α and JNK was clearly enhanced and PTEN expression was almost completely abolished in bone metastasizing RCC cells. Our results indicate a promoting effect of extracellular calcium on cell migration and proliferation of bone metastasizing RCC cells via highly expressed CaSR and its downstream signaling pathways. Consequently, CaSR may be regarded as a new prognostic marker predicting RCC bone metastasis.

In vitro CT evaluation of intrahepatic stones: correlation with chemical composition

International Nuclear Information System (INIS)

Kim, Young Jun; Han, Joon Koo; Jeong, Jun Yong; Lee, Kyoung Ho; Kim, Se Hyung; Kim, Young Il; Lee, Jeong Min; Choi, Byung Ihn; Park, Youn-Chan; Kim, Sun-Whe

2005-01-01

Objective: To describe in vitro CT features of intrahepatic stones and to correlate CT attenuation with chemical composition. Materials and methods: Of the patients who underwent choledochoscopic intrahepatic stone removal between 1998 and 2001, 54 patients with stones larger than 3 mm were enrolled in this study. In each case, a chemical compositional analysis was performed to determine calcium, cholesterol, total bilirubin, and inorganic phosphorus compositions. The three largest stones obtained from each patient were imaged by CT. CT attenuation numbers were measured in the center images of each stone by drawing free-hand region of interest (ROI). The measured CT attenuation numbers were correlated with their chemical composition. Also, CT attenuation numbers of stones were compared with that of the liver on non-contrast CT (50-70 HU). Results: Stone size ranged from 3.1 to 10.5 mm (mean ± S.D.: 6.0 ± 1.4). The CT attenuation numbers (HU) of stones ranged from 36.4 to 410.19 (mean ± S.D.: 94.6 ± 49.9). CT numbers of stones were below 70 HU in 11 patients (20.4%), and below 90 HU in 33 patients (59.3%). The chemical analysis data of the stones were as follows: calcium (0.5-6.5 wt.%; mean ± S.D., 2.6 ± 1.4), total bilirubin (0.45-24.4 wt.%; 13.1 ± 6.2), cholesterol (5.4-73.9 wt.%; 29.3 ± 17.4), phosphorus (0.1-1.2 wt.%; 0.6 ± 0.3), and non-soluble residue (17.6-85.4 wt.%; 57.0 ± 22.6). There was a weak but significant correlation between calcium composition and CT attenuation (r = 0.38, P 0.01; total bilirubin, r = 0.05, P > 0.01; phosphorus, r = 0.01, P > 0.01). Conclusion: On non-contrast CT, intrahepatic stones would not be hyperattenuating with respect to liver parenchyma in about one fifth of patients. The CT attenuation of stones correlates with calcium and does not correlate with any other chemical composition

Uric acid stones increase the risk of chronic kidney disease.

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Li, Ching-Chia; Chien, Tsu-Ming; Wu, Wen-Jeng; Huang, Chun-Nung; Chou, Yii-Her

2018-02-28

The aim of this study was to compare the clinical characteristics of uric acid stones and their potential risk for chronic kidney disease (CKD). A total of 401 patients (196 with uric acid stone and 205 without) were enrolled from our database of patients with urolithiasis. We analyzed the clinical demographic features, stone location, urine chemistries, and renal function. There was a significant difference (p uric acid group. Patients with uric acid stones had much lower pH of urine (p uric acid level (p = 0.002). Notably, those with uric acid stones had worse eGFR than those with non-uric acid stones. Multivariate analysis confirmed that age over 60 years (ORs = 9.19; 95% CI 3.5-24.3), female sex (ORs = 4.01; 95% CI 1.8-9.0), hyperuricemia (ORs = 8.47; 95% CI 1.6-43.5), and uric acid stone (OR = 2.86; 95% CI 1.2-6.7) were the independent predictors of poor prognoses in CKD. Therefore, an association exists between uric acid stones and higher prevalence of CKD. Patients with uric acid stones may need close monitoring of renal function during follow-up.

Hyaluronan and Stone Disease

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Asselman, Marino

2008-09-01

Kidney stones cannot be formed as long as crystals are passed in the urine. However, when crystals are retained it becomes possible for them to aggregate and form a stone. Crystals are expected to be formed not earlier than the distal tubules and collecting ducts. Studies both in vitro and in vivo demonstrate that calcium oxalate monohydrate crystals do not adhere to intact distal epithelium, but only when the epithelium is proliferating or regenerating, so that it possesses dedifferentiated cells expressing hyaluronan, osteopontin (OPN) and their mutual receptor CD44 at the apical cell membrane. The polysaccharide hyaluronan is an excellent crystal binding molecule because of its negative ionic charge. We hypothesized that the risk for crystal retention in the human kidney would be increased when tubular cells express hyaluronan at their apical cell membrane. Two different patient categories in which nephrocalcinosis frequently occurs were studied to test this hypothesis (preterm neonates and kidney transplant patients). Hyaluronan (and OPN) expression at the luminal membrane of tubular cells indeed was observed, which preceded subsequent retention of crystals in the distal tubules. Tubular nephrocalcinosis has been reported to be associated with decline of renal function and thus further studies to extend our knowledge of the mechanisms of retention and accumulation of crystals in the kidney are warranted. Ultimately, this may allow the design of new strategies for the prevention and treatment of both nephrocalcinosis and nephrolithiasis in patients.

Chemical nature and distribution of calcium compounds in radiolucent gallstones

International Nuclear Information System (INIS)

Agarwal, D.K.; Choudhuri, G.; Kumar, J.

1993-01-01

A high failure rate for radiolucent cholesterol gallstones to dissolve with oral bile acids may be due to the presence of insoluble calcium compounds. Twenty sets of radiolucent gallstones, 7-20 mm in diameter, obtained from 20 patients undergoing cholecystectomy, were cut, and the outer surface, outer rim, middle portion, and central core areas were scanned for calcium by energy-dispersive X-ray microanalysis (EDX) and scanning electron microscopy (SEM). Scrapings from the four areas of each stone were analysed by infrared spectroscopy. A sample of the crushed stone was used for chemical estimation of cholesterol. 11 of the 20 cholesterol stones showed presence of calcium by EDX; the distribution was peripheral in 5, homogeneous in 4, and central in 2. The chemical compound was calcium bilirubinate in 10 and calcium carbonate in 8 stones. Calcium compounds are present in a high proportion of radiolucent gallstones considered suitable for chemodissolution by conventional criteria. Their unrecognized presence may explain the high failure rate of such stones to respond to medical therapy. 20 refs., 3 figs

Association of calcitonin receptor gene (CALCR) polymorphism with kidney stone disease in the population of West Bengal, India.

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Mitra, Pubali; Guha, Manalee; Ghosh, Sudakshina; Mukherjee, Sourav; Bankura, Biswabandhu; Pal, Dilip Kumar; Maity, Biswanath; Das, Madhusudan

2017-07-30

Kidney Stone Disease (KSD) is a complex urologic disorder with strong genetic constituent. Earlier association studies have indicated that the genetic polymorphisms are the potential cause of stone materialization; however unfortunately, the actual genetic signature is still unknown. Therefore, present study was aimed to investigate the potential contribution of two important polymorphisms of calcitonin receptor gene (CALCR): (i) rs1801197 (Leu447Pro) and (ii) rs1042138 (3'UTR+18C>T) in renal stone formation. Accordingly, we enrolled 152 patients registered with calcium-rich stone in kidney (case) and 144 corresponding age, sex and ethnicity matched healthy individuals (controls). Epidemiological and clinical data were recorded as well as peripheral blood sample was collected from each individual. Serum creatinine and urinary calcium level was found high in patients, compared to controls. Out of two studied polymorphisms, we have not found any significant association against the rs1042138 with KSD, nonetheless, significant high frequency (p=0.001; Odds ratio=1.81; 95% CI: 1.28-2.55) of risk allele T against the rs1801197 (T>C) in patient was noted. Moreover, significant association with KSD was noted by genotypic analysis of rs1801197 (Leu447Pro) in our population. Interestingly, male patients carrying TT genotype was found to be at high risk of stone formation, while no such association was observed in female patients. Altogether, present study indicated that the rs1042138 might not be used as a useful marker for susceptibility of kidney stone formation, whereas, the rs1801197 could definitely be considered as one of the risk factors for KSD in Indian population at least in West Bengal in particular. Copyright © 2017 Elsevier B.V. All rights reserved.

Prospective comparative study of miniperc and standard PNL for treatment of 1 to 2 cm size renal stone.

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Mishra, Shashikant; Sharma, Rajan; Garg, Chandrapraksh; Kurien, Abraham; Sabnis, Ravindra; Desai, Mahesh

2011-09-01

• To evaluate the results of miniperc vis-à-vis standard PNL in the treatment of stones of 1-2 cm in size. Miniperc may represent a reasonable procedure in patients with nonbulky urolithiasis offering a similar outcome as standard percutaneous nephrolithotomy (PNL) with advantage of reduced morbidity. • 55 procedures including 27 miniperc and 28 standard PNL were performed for renal stones 1-2 cm in size. Pediatric patient, active urinary tract infection, renal malformation, uncorrected coagulopathy and morbid obesity patients were excluded from the study. • The parameters studied were demography, operative time, postoperative analgesic requirement, hemoglobin drop, complications and stone clearance. • Mean tract size was 18.2 ± 2 F (15-20) and 26.8 ± 2 F (24-30), P value PNL, respectively. Holmium LASER and pneumatic lithotripter were the main energy sources used in miniperc and standard PNL, respectively. • Miniperc operative time was longer than that of standard PNL (45.2 ± 12.6 vs 31 ± 16.6 min, P= 0.0008 respectively). • Conversely, there was an advantage of miniperc over standard PNL in terms of a significantly reduced hemoglobin drop (0.8 ± 0.9 vs 1.3 ± 0.4 gram%, P= 0.01), analgesic requirement (55.4 ± 50 vs 70.2 ± 52 mg tramadol, P= 0.29) and hospital stay (3.2 ± 0.8 vs 4.8 ± 0.6 days, P ≤ 0.001), respectively. • Intra- operative conversion of the procedure into a tubeless PNL was significantly more in the miniperc group (P ≤ 0.001). The miniperc and standard PNL group had clearance rates of 96% and 100%, respectively at 1 month follow up. • This study demonstrated significant advantages of the miniperc procedure in terms of reduced bleeding leading to a tubeless procedure and reduced hospital stay. • The stone free rates and the complications were similar in either group. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Growth and characterization of calcium hydrogen phosphate dihydrate crystals from single diffusion gel technique

Energy Technology Data Exchange (ETDEWEB)

Rajendran, K.; Dale Keefe, C. [Department of Chemistry, Cape Breton University, Sydney, Nova Scotia (Canada)

2010-09-15

Calcium hydrogen phosphate dihydrate (CaHPO{sub 4}.2H{sub 2}O, CHPD) a dissolved mineral in urine is known to cause renal or bladder stones in both human and animals. Growth of CHPD or brushite using sodium metasilicate gel techniques followed by light and polarizing microscopic studies revealed its structural and morphological details. Crystal identity by powder x-ray diffraction confirmed the FT-IR and FT-Raman spectroscopic techniques as alternate methods for fast analysis of brushite crystals which could form as one type of renal stones. P-O-P asymmetric stretchings in both FT-IR (987.2, 874.1 and 792 cm{sup -1}) and FT-Raman (986.3 cm{sup -1}, 1057.6 cm{sup -1} and 875.2 cm{sup -1}) were found as characteristics of brushite crystals. Differential Scanning Calorimetry (DSC) analysis revealed brushite crystallization purity using gel method by studying their endothermic peaks. This study incorporated a multidisciplinary approach in characterizing CHPD crystals grown in vitro to help formulate prevention or dissolution strategy in controlling urinary stone growth. Initial studies with 0.2 M citric acid ions as controlling agent in the nucleation of brushite crystals further support the presented approach. (copyright 2010 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim) (orig.)

Extracorporeal shockwave lithotripsy vs. percutaneous nephrolithotomy vs. flexible ureterorenoscopy for lower-pole stones

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Knoll, Thomas; Buchholz, Noor; Wendt-Nordahl, Gunnar

2012-01-01

Objectives To review previous reports and discuss current trends in extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureterorenoscopy (URS). ESWL was recommended as the first-line treatment for small and intermediate-sized stones in the lower pole, while it is the standard treatment for large stones. However, the stone clearance rate after ESWL seems to be lower than that of stones in other locations. This seems to result from a lower rate of fragment passage, due to anatomical factors. Methods Reports on urinary stone disease were reviewed, assessing only publications in peer-reviewed, Medline-listed journals in the English language (publication years 1990–2011). Results Recent experience with flexible URS (fURS) for intrarenal stones showed that excellent stone-free rates can be achieved. With increasing experience and technically improved equipment, fURS has become an alternative to ESWL for small and intermediate-sized renal stones. Furthermore, several authors reported successful retrograde treatment for large renal stones, proposing fURS as an alternative to PCNL. However, the major drawbacks are long operating times and commonly, staged procedures, which is why PCNL remains the method of choice for such stones. Conclusions Considering the currents trends and evidence, the 2012 update of the European Association of Urology Guidelines on Urolithiasis has upgraded the endourological treatment of kidney stones. Individual factors such as body habitus, renal anatomy, costs and patient preference must be considered. PMID:26558046

Obstructive uropathy and acute renal failure due to ureteral calculus in renal graft: a case report.

Science.gov (United States)

Lusenti, T; Fiorini, F; Barozzi, L

2009-09-01

Obstructive uropathy caused by kidney stones is quite rare in transplant kidneys. The authors report the case of a patient, previously gastrectomized for gastric carcinoma. He underwent renal transplantation using uretero-ureterostomy, and presented an episode of acute renal failure 7 years after surgery. Ultrasound (US) examination showed no sign of rejection but allowed detection of moderate hydronephrosis in the transplant kidney. Subsequent computed tomography (CT) revealed a kidney stone in the middle ureter at the crossing of the iliac vessels. The patient therefore urgently underwent percutaneous nephrostomy of the graft and recovered diuresis and renal function. The patient was transferred to the Transplant Center where he underwent ureterotomy with removal of the stone and subsequent ureteropyelostomy. Also transureteral resection of the prostate (TURP) was performed due to urinary retention of prostatic origin. Histological examination showed prostate carcinoma, Gleason stage 3, which was treated conservatively using radiotherapy without suspension of the administered low dose of immunotherapy. Calculosis is one of the least common causes of obstructive uropathy in transplant kidneys. In the described case, US examination performed after onset of renal insufficiency led to subsequent radiological investigation and resulting interventional procedures (nephrostomy and surgical removal of the stone) with complete recovery of pre-existing renal function.

Experience of extracorporeal shock wave lithotripsy for kidney and upper ureteric stones by electromagnetic lithotripter

International Nuclear Information System (INIS)

Wazir, B.G.; Haq, M.I.H.; Faheem-ul-Haq; Nawaz, A.; Nawaz, A.; Ikramullah; Jamil, M.

2010-01-01

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive treatment of urinary stones which breaks them, by using externally applied, focused, high intensity acoustic pulse, into smaller pieces so that they can pass easily through ureter. Shock wave generation, focusing, coupling and stone localisation by fluoroscope or ultrasound are the basic components of ESWL. ESWL has some complications and is contraindicated in certain situations. The aim of this study was to evaluate the effectiveness and safety of ESWL in kidney and upper ureteric stones by Electromagnetic Lithotriptor. Methods: All adult patients with renal and upper ureteric stones having a diameter of up to 1 Cm were included in the study. Basic evaluation such as history, examination, ultrasound and excretory urography were performed. Electromagnetic lithotripsy was done and data were collected on a printed proforma from January 1, 2008 to March 30, 2009 in Institute of Kidney Diseases, Peshawar. Results: Out of a total of 625 patients 463 were male and 162 were female; 67.36% of patients were having renal stones, 23.84% upper ureteric and 8.8% both renal and ureteric stones. Complications noted were renal colic in 9.76%, haematuria in 3.2%, stein strasse in 2.72%, and fever in 1.12% of patients. The stone free rate was 89% and 7% of patients were having stone fragments <4 mm. ESWL failed in 4% of patients. Conclusion: ESWL is a safe and effective way of treating kidney and upper ureteric stones. (author)

Worldwide Impact of Warmer Seasons on the Incidence of Renal Colic and Kidney Stone Disease: Evidence from a Systematic Review of Literature.

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Geraghty, Robert M; Proietti, Silvia; Traxer, Olivier; Archer, Matthew; Somani, Bhaskar K

2017-08-01

Several studies have examined the link between temperature or monthly seasonal variations and urolithiasis. The majority of these studies have demonstrated a link between higher ambient monthly temperatures and the incidence of renal colic and kidney stone disease (KSD). However, a worldwide trend on this association has not been explored and we perform a systematic review to examine the effect of seasonal variations on renal colic and KSD. A systematic review of the literature for a 26-year period (1990-2017) was conducted on all studies reporting on the effect of seasonal variations and its link to KSD. Two reviewers independently extracted the data from each study, which were analyzed using SPSS version 24. A total of 59 studies were identified, and after screening, 13 were included in this review. The studies ranged in duration from 1 to 9 years (mean: 5.5 years) and included seasonal/monthly variations for proven stones or lithotripsy treatments or emergency department presentations with renal colic. Except for one study, there was a statistically significant association between higher monthly mean temperatures and the incidence of KSD-related events reported from the United Kingdom, South Korea, the United States, Saudi Arabia, Italy, Spain, Taiwan, Japan, and New Zealand. Worldwide trends on the incidence of renal colic and KSD seem be affected by seasonal variation favoring warmer months, with data suggesting that higher ambient temperature has an association with KSD.

Should flexible ureteroscope be added to our armamentarium to treat stone disease?

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Anand Dharaskar

2008-01-01

Full Text Available The field of Urology in Medicine has witnessed tremendous advancement in technology and in accordance with it. Endourology has taken a leap ahead in terms of stone management. Most of the stones could be treated with semi-rigid ureteroscopy, percutaneous nephrolithotomy (PNL and ESWL and some would need Flexible ureteroscopy. Flexible ureteroscopy has been primarily indicated to treat ESWL resistant renal stones but with changes in the technology of incorporating secondary active deflection and availability of laser fibres, its horizon for indications to treat stones is being widened. Though Flexible ureteroscopy is being used to treat stones of various sizes and locations, its cost effectiveness is debatable. Should it be used ubiquitously to treat stones amenable to PNL or ESWL is a big question we need to answer. As of now true indications of Flexible ureteroscopy are limited and there is an urgent need for a randomized trial to compare its efficacy with ESWL and PNL for renal and upper ureteric stones.

Can ureteral stones cause pain without causing hydronephrosis?

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Song, Yan; Hernandez, Natalia; Gee, Michael S; Noble, Vicki E; Eisner, Brian H

2016-09-01

While computerized tomography (CT) is the gold standard for diagnosis of ureterolithiasis, ultrasound is a less costly and radiation-free alternative which is commonly used to evaluate patients with ureteral colic. The purpose of this study was to evaluate the frequency with which patients with ureteral stones and renal colic demonstrate hydronephrosis in order to better understand the evaluation of these patients. Two hundred and forty-eight consecutive patients presenting with ureteral colic and diagnosed with a single unilateral ureteral stone on CT scan in an urban tertiary care emergency department were retrospectively reviewed. Radiology reports were reviewed for stone size, diagnosis, and degree of hydronephrosis. Of the 248 patients evaluated for suspected ureteral stone, 221 (89.1 %) demonstrated any hydronephrosis, while 27 (10.9 %) did not. Hydronephrosis grade, available in 194 patients, was as follows: mild-70.6 %, moderate-27.8 %, and severe-1.5 %. Mean patient age was 47.0 years (SD 15.5), gender distribution was 35.9 % female and 64.1 % male, and mean stone axial diameter was 4.1 mm (SD 2.4). Stone location was as follows: ureteropelvic junction-4.1 %, proximal ureter-21 %, distal ureter-24.9 %, and ureterovesical junction-47.1 %. Axial stone diameter and coronal length (craniocaudal) were both significant predictors of degree of hydronephrosis (ANOVA, p hydronephrosis. In patients with ureteral stones and colic, nearly 11 % do not demonstrate any hydronephrosis and a majority (nearly 71 %) will demonstrate only mild hydronephrosis. Stone diameter appears to be related to degree of hydronephrosis, whereas age, gender, and stone location are not. The lower incidence of hydronephrosis for small stones causing renal colic may explain the lower diagnostic accuracy of ultrasound when compared to CT for detecting ureteral stones.

Dual-source dual-energy CT for the differentiation of urinary stone composition: preliminary study

International Nuclear Information System (INIS)

Yang Qifang; Zhang Wanshi; Meng Limin; Shi Huiping; Wang Dong; Bi Yongmin; Li Xiangsheng; Fang Hong; Guo Heqing; Yan Jingmin

2011-01-01

Objective: To evaluate dual-source dual-energy CT (DSCT) for the differentiation of' urinary stone composition in vitro. Methods: Ninety-seven urinary stones were obtained by endoscopic lithotripsy and scanned using dual-source dual-energy CT. The stones were divided into six groups according to infrared spectroscopy stone analysis: uric acid (UA) stones (n=10), cystine stones (n=5), struvite stones (n=6), calcium oxalate (CaOx) stones (n=22), mixed UA stones (n=7) and mixed calcium stones (n=47). Hounsfield units (HU) of each stone were recorded for the 80 kV and the 140 kV datasets by hand-drawing method. HU difference, HU ratio and dual energy index (DEI) were calculated and compared among the stone groups with one-way ANOVA. Using dual energy software to determine the composition of all stones, results were compared to infrared spectroscopy analysis. Results: There were statistical differences in HU difference [(-17±13), (229±34), (309±45), (512±97), (201±64) and (530±71) HU respectively], in HU ratio (0.96±0.03, 1.34±0.04, 1.41±0.03, 1.47±0.03, 1.30±0.07, and 1.49±0.03 respectively), and DEI (-0.006±0.004, 0.064±0.007, 0.080± 0.007, 0.108±0.011, 0.055±0.014 and 0.112±0.008 respectively) among different stone groups (F= 124.894, 407.028, 322.864 respectively, P<0.01). There were statistical differences in HU difference, HU ratio and DEI between UA stones and the other groups (P<0.01). There were statistical differences in HU difference, HU ratio and DEI between CaOx or mixed calcium stones and the other four groups (P< 0.01). There was statistical difference in HU ratio between cystine and struvite stones (P<0.01). There were statistical differences in HU difference, HU ratio and DEI between struvite and mixed UA stones (P< 0.05). Dual energy software correctly characterized 10 UA stones, 4 cystine stones, 22 CaOx stones and 6 mixed UA stones. Two struvite stones were considered to contain cystine. One cystine stone, 1 mixed UA stone, 4

The Role of Non-Steroidal Anti-Inflammatory Drugs in Renal Colic

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Elizabeth Waine

2010-04-01

Full Text Available NSAIDs provide optimal analgesia in renal colic due to the reduction in glomerular filtration and renal pelvic pressure, ureteric peristalsis and ureteric oedema. Prevention of glomerular afferent arteriolar vasodilatation renders these patients at risk of renal impairment. NSAIDs have the additional benefit of reducing the number of new colic episodes and preventing subsequent readmission to hospital. Despite recent work promoting the use of pharmacological agents to improve stone passage rates, NSAIDs do not appear to reduce the time to stone passage or increase the likelihood of stone passage in renal colic.

Vitamin D-dependent rat renal calcium-binding protein: development of a radioimmunoassay, tissue distribution, and immunologic identification

International Nuclear Information System (INIS)

Sonnenberg, J.; Pansini, A.R.; Christakos, S.

1984-01-01

A sensitive double antibody RIA has been developed for the 28,000 mol wt rat renal vitamin D-dependent calcium-binding protein. Using this assay, concentrations of calcium-binding protein (CaBP) as low as 30 ng can be measured. The assay is precise (intraassay variability, 5.0%) and reproductible (interassay variability, 8.2%). Measurements of renal CaBP by RIA showed a good correlation with measurements of CaBP by the chelex resin assay and by polyacrylamide gel analysis by densitometric tracing using a purified CaBP marker. The concentration of CaBP in the vitamin D-replete rat kidney is 7.3 +/- 1.0 (mean +/- SEM) micrograms/mg protein. In vitamin D-deficient rats the level of renal CaBP is 2.6 +/- 0.3 micrograms/mg protein. Tissue distribution of immunoreactive rat renal CaBP showed the highest concentration of CaBP in the rat cerebellum (38.3 +/- 5.1 micrograms/mg protein). Lower concentrations of immunoreactive CaBP were detected in several other rat tissues. No immunoreactive CaBP was detected in rat or human serum. In necropsy human kidney and cerebellum, high levels of immunoreactive CaBP were also detected (1.5 +/- 0.1 and 27.3 +/- 2.1 micrograms/mg protein, respectively). When extracts of rat kidney and brain and human cerebellum and kidney were assayed at several dilutions, immunodisplacement curves parallel to that of pure renal CaBP were observed, indicating immunochemical similarity. Fractionation of extracts of rat cerebellum, human kidney, and human cerebellum on Sephadex G-100 revealed immunoreactivity and calcium-binding activity in the 28,000 mol wt region similar to rat kidney

Accurately Diagnosing Uric Acid Stones from Conventional Computerized Tomography Imaging: Development and Preliminary Assessment of a Pixel Mapping Software.

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Ganesan, Vishnu; De, Shubha; Shkumat, Nicholas; Marchini, Giovanni; Monga, Manoj

2018-02-01

Preoperative determination of uric acid stones from computerized tomography imaging would be of tremendous clinical use. We sought to design a software algorithm that could apply data from noncontrast computerized tomography to predict the presence of uric acid stones. Patients with pure uric acid and calcium oxalate stones were identified from our stone registry. Only stones greater than 4 mm which were clearly traceable from initial computerized tomography to final composition were included in analysis. A semiautomated computer algorithm was used to process image data. Average and maximum HU, eccentricity (deviation from a circle) and kurtosis (peakedness vs flatness) were automatically generated. These parameters were examined in several mathematical models to predict the presence of uric acid stones. A total of 100 patients, of whom 52 had calcium oxalate and 48 had uric acid stones, were included in the final analysis. Uric acid stones were significantly larger (12.2 vs 9.0 mm, p = 0.03) but calcium oxalate stones had higher mean attenuation (457 vs 315 HU, p = 0.001) and maximum attenuation (918 vs 553 HU, p uric acid stones. A combination of stone size, attenuation intensity and attenuation pattern from conventional computerized tomography can distinguish uric acid stones from calcium oxalate stones with high sensitivity and specificity. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Family history and biochemical diagnosis in 1948 kidney stone formers

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Francisco R. Spivacow

2016-12-01

Full Text Available Introduction: The presence of family history of nephrolithiasis is associated with an increased risk of renal lithiasis. Different epidemiological studies have shown a family component in the incidence of it, which is independent of dietary and environmental factors. The role of heredity is evident in monogenic diseases such as cystinuria, Dent’s disease or primary hyperoxaluria, while a polygenic inheritance has been proposed to explain the tendency to form calcium oxalate stones. Objective: Our objective was to evaluate the family history of patients with renal lithiasis and the correlation of family history with its corresponding biochemical alteration, considering only those with a single metabolic alteration. Methods: a prospective and retrospective observational and analytical study that included 1948 adults over 17 years of age and a normal control group of 165 individuals, all evaluated according to an ambulatory protocol to obtain a biochemical diagnosis. They were asked about their family history of nephrolithiasis and classified into five groups according to the degree of kinship and the number of people affected in the family. Results: a positive family history of nephrolithiasis was found in 27.4% of renal stone formers, predominantly in women, compared to 15.2% of normal controls. The family history of nephrolithiasis was observed especially in 31.4% of patients with hypomagnesuria and in 29.6% of hypercalciuric patients. The rest of the biochemical alterations had a positive family history between 28.6% in hyperoxaluria and 21.9% in hypocitraturia. The highest percentage of family history of nephrolithiasis was found in cystinuria (75% although there were few patients with this diagnosis. Conclusions: the inheritance has a clear impact on urolithiasis independently of the present biochemical alteration. Family history of nephrolithiasis of the first and second degree was observed between 21 and 32% of patients with renal

Idiopathic recurrent calcium urolithiasis (IRCU: pathophysiology evaluated in light of oxidative metabolism, without and with variation of several biomarkers in fasting urine and plasma - a comparison of stone-free and -bearing male patients, emphasizing mineral, acid-base, blood pressure and protein status*

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Schwilie PO

2011-08-01

Full Text Available Abstract Background IRCU is traditionally considered as lifestyle disease (associations with, among others, overweight, obesity, hypertension, type-2 diabetes, arising from excess, in 24 h urine, of calcium (Ca salts (calcium oxalate (CaOx, calcium phosphate (CaPi, supersaturation of, and crystallization in, tubular fluid and urine, causing crystal-induced epithelial cell damage, proteinuria, crystal aggregation and uroliths. Methods Another picture emerges from the present uncontrolled study of 154 male adult IRCU patients (75 stone-bearing (SB and 79 age-matched stone-free (SF, in whom stone-forming and other parameters in fasting urine and plasma were contrasted with five biomarkers (see footnote of oxidative metabolism (OM, without and with variation of markers. Results 1 In SB vs. SF unstratified OM biomarkers were statistically unchanged, but the majority of patients was overweight; despite, in SB vs. SF urine pH, total and non-albumin protein concentration were elevated, fractional urinary uric acid excretion and blood bicarbonate decreased, whereas urine volume, sodium, supersaturation with CaOx and CaPi (as hydroxyapatite were unchanged; 2 upon variation of OM markers (strata below and above median numerous stone parameters differed significant!', among others urine volume, total protein, Ca/Pi ratio, pH, sodium, potassium, plasma Ca/Pi ratio and parathyroid hormone, blood pressure, renal excretion of non-albumin protein and other substances; 3 a significant shift from SF to SB patients occurred with increase of urine pH, decrease of blood bicarbonate, and increase of diastolic blood pressure, whereas increase of plasma uric acid impacted only marginally; 4 in both SF and SB patients a strong curvilinear relationship links a rise of urine Ca/Pi to urine Ca/Pi divided by plasma Ca/Pi, but in SB urine Ca/Pi failed to correlate significantly with urine hydroxyapatite supersaturation; 5 also in SB, plasma Ca/Pi and urinary nitrate were

Extracorporeal shock wave lithotripsy for urinary stones

International Nuclear Information System (INIS)

Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun

1988-01-01

Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization was

Extracorporeal shock wave lithotripsy for urinary stones

Energy Technology Data Exchange (ETDEWEB)

Shinn, Kyung Sub; Kim, Hyun; Byun, Jae Young; Lee, Myung Hee; Bahk, Yong Whee; Park, Yong Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical College, Seoul (Korea, Republic of)

1988-06-15

Extracorporeal shock wave lithotripsy (ESWL) is a new noninvasive treatment modality for urinary stones, and it sometimes is to necessitate endourologic techniques. ESWL with an Edap lithotripter which uses piezo-electric elements, was performed in 142 cases (130 patients) with urinary stones including 68 in calices, 30 in pelves, and 44 in ureters. Technical factors were 100 storages at 5 to 10 pulse rates/sec and 70-100% adjustable power for about 60 minutes (15-90) for renal stones, and 200 storages at 20 pulse rates/sec and 100% adjustable power for about 60 minutes for ureteral stones in a single treatment under stone localization by 5 MHz ultrasonic sector scanner. All patients were treated at Kangnam St.Mary's Hospital of Catholic University Medical College during the 5 months period from May 1, 1987. Every patient had pre-treatment chest, plain abdomen, intravenous urogram and ultrasonogram studies and post-treatment follow-up abdominal radiograms in 1 to 3 months after ESWL.The overall success rate of ESWL in 142 cases was 94.4%. Eight out of 142 cases were successful. Thus, 134 cases were analysed. Of these, 58 cases (43.3%) received one treatment, 33 cases (24.6%) two treatments, 16 cases (11.9%) three treatments and 27 cases (20.2%) more than four treatments. Renal stones were more successfully treated (98.0%) than ureteral stones (88.1%), and calyceal stones presented the highest success rate (98.5%). The stones as small as 5 to 10 mm in size were easily fragmented and the stones of round of oval shape were more easily pulverized than those of staghorn or amorphous shape. The adjunctive endourlogic techniques such as percutaneous nephrostomy, ureteral catheterization or internal ureteral stenting with a double pigtail catheter were required in 17 cases (11.9%). Complications of ESWL for urolithiasis included hematuria (84.5%), flank pain (8.5%) and fever (5.6%), which were controlled without specific treatment. ESWL using ultrasonic localization

Fasting urinary calcium-to-creatinine and oxalate-to-creatinine ratios in dogs with calcium oxalate urolithiasis and breed-matched controls.

Science.gov (United States)

Furrow, E; Patterson, E E; Armstrong, P J; Osborne, C A; Lulich, J P

2015-01-01

Hypercalciuria and hyperoxaluria are risk factors for calcium oxalate (CaOx) urolithiasis, but breed-specific reports of urinary metabolites and their relationship with stone status are lacking. To compare urinary metabolites (calcium and oxalate) and blood ionized calcium (iCa) concentrations between CaOx stone formers and breed-matched stone-free controls for the Miniature Schnauzer, Bichon Frise, and Shih Tzu breeds. Forty-seven Miniature Schnauzers (23 cases and 24 controls), 27 Bichons Frise (14 cases and 13 controls), and 15 Shih Tzus (7 cases and 8 controls). Prospective study. Fasting spot urinary calcium-to-creatinine and oxalate-to-creatinine ratios (UCa/Cr and UOx/Cr, respectively) and blood iCa concentrations were measured and compared between cases and controls within and across breeds. Regression models were used to test the effect of patient and environmental factors on these variables. UCa/Cr was higher in cases than controls for each of the 3 breeds. In addition to stone status, being on a therapeutic food designed to prevent CaOx stone recurrence was associated with higher UCa/Cr. UOx/Cr did not differ between cases and controls for any of the breeds. Blood iCa was higher in cases than controls in the Miniature Schnauzer and Bichon Frise breeds and had a moderate correlation with UCa/Cr. Hypercalciuria is associated with CaOx stone status in the Miniature Schnauzer, Bichon Frise, and Shih Tzu breeds. UOx/Cr did not correlate with stone status in these 3 breeds. These findings may influence breed-specific stone prevention recommendations. Copyright © 2015 by the American College of Veterinary Internal Medicine.

Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL)

DEFF Research Database (Denmark)

Anastasiadis, Anastasios; Onal, Bulent; Modi, Pranjal

2013-01-01

were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups. Results. Retreatment for residual stones...... was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment...

Differential expression of T- and L-type voltage-dependent calcium channels in renal resistance vessels

DEFF Research Database (Denmark)

Hansen, Pernille B. Lærkegaard; Jensen, Boye L.; Andreasen, D

2001-01-01

The distribution of voltage-dependent calcium channels in kidney pre- and postglomerular resistance vessels was determined at the molecular and functional levels. Reverse transcription-polymerase chain reaction analysis of microdissected rat preglomerular vessels and cultured smooth muscle cells...... on vascular diameter in the afferent arteriole. We conclude that voltage-dependent L- and T-type calcium channels are expressed and of functional significance in renal cortical preglomerular vessels, in juxtamedullary efferent arterioles, and in outer medullary vasa recta, but not in cortical efferent...

H+, Water and Urea Transport in the Inner Medullary Collecting Duct and Their Role in the Prevention and Pathogenesis of Renal Stone Disease

Science.gov (United States)

Wall, Susan M.; Klein, Janet D.

2008-09-01

The inner medullary collecting duct (IMCD) is the final site within the kidney for the reabsorption of urea, water and electrolytes and for the secretion of H+ before the luminal fluid becomes the final urine. Transporters expressed in the IMCD contribute to the generation of the large ion gradients that exist between the interstitium and the collecting duct lumen. Thus, the luminal fluid within the human IMCD can reach an osmolality of 1200 mOsm/kg H2O and a pH of 4. This ability of the human nephron to concentrate and acidify the urine might predispose to stone formation. However, under treatment conditions that predispose to stone formation, such as during hypercalciuria, the kidney mitigates stone formation by reducing solute concentration by reducing H2O reabsorption. Moreover, the kidney attenuates stone formation by tightly controlling acid-base balance, which prevents the bone loss, hypocitraturia and hypercalciuria observed during metabolic acidosis by augmenting net H+ excretion by tightly regulating H+ transporter function and through luminal buffering, particularly with NH3. This article will review the ion transporters present in the mammalian IMCD and their role in the prevention and in the pathogenesis of renal stone formation.

Accuracy of endoscopic intraoperative assessment of urologic stone size.

Science.gov (United States)

Patel, Nishant; Chew, Ben; Knudsen, Bodo; Lipkin, Michael; Wenzler, David; Sur, Roger L

2014-05-01

Endoscopic treatment of renal calculi relies on surgeon assessment of residual stone fragment size for either basket removal or for the passage of fragments postoperatively. We therefore sought to determine the accuracy of endoscopic assessment of renal calculi size. Between January and May 2013, five board-certified endourologists participated in an ex vivo artificial endoscopic simulation. A total of 10 stones (pebbles) were measured (mm) by nonparticipating urologist (N.D.P.) with electronic calibers and placed into separate labeled opaque test tubes to prevent visualization of the stones through the side of the tube. Endourologists were blinded to the actual size of the stones. A flexible digital ureteroscope with a 200-μm core sized laser fiber in the working channel as a size reference was placed through the ureteroscope into the test tube to estimate the stone size (mm). Accuracy was determined by obtaining the correlation coefficient (r) and constructing an Altman-Bland plot. Endourologists tended to overestimate actual stone size by a margin of 0.05 mm. The Pearson correlation coefficient was r=0.924, with a p-valuestones (stones (≥4 mm), r=0.911 vs r=0.666. Altman-bland plot analysis suggests that surgeons are able to accurately estimate stone size within a range of -1.8 to +1.9 mm. This ex vivo simulation study demonstrates that endoscopic assessment is reliable when assessing stone size. On average, there was a slight tendency to overestimate stone size by 0.05 mm. Most endourologists could visually estimate stone size within 2 mm of the actual size. These findings could be generalized to state that endourologists are accurately able to intraoperatively assess residual stone fragment size to guide decision making.

Vitamin D, calcium, and cardiovascular mortality: a perspective from a plenary lecture given at the annual meeting of the American Association of Clinical Endocrinologists.

Science.gov (United States)

Miller, Paul D

2011-01-01

To examine data showing associations between serum 25-hydroxyvitamin D levels and calcium intake and cardiovascular mortality. The articles reviewed include those published from 1992-2011 derived from search engines (PubMed, Scopus, Medscape) using the following search terms: vitamin D, calcium, cardiovascular events, cardiovascular mortality, all-cause mortality, vascular calcification, chronic kidney disease, renal stones, and hypercalciuria. Because these articles were not weighted (graded) on the level of evidence, this review reflects my own perspective on the data and how they should be applied to clinical management. For skeletal health, vitamin D and calcium are both needed to ensure proper skeletal growth (modeling) and repair (remodeling). Nutritional deficiencies of either vitamin D or calcium may lead to a spectrum of metabolic bone disorders. Excessive consumption of either nutrient has been linked to a variety of medical disorders, such as hypercalcemia or renal stones. There have also been associations between vitamin D or calcium intake and cardiovascular disease. However, neither of these associations have established evidence nor known causality for increasing cardiovascular risk or all-cause mortality in patients with creatinine clearances greater than 60 mL/min. In patients with more severe chronic kidney disease, stronger data link excess calcium (or phosphorus) intake and increase in vascular calcification, but not mortality. The safe upper limit for vitamin D intake is at least 4000 IU daily and probably 10 000 IU daily; for calcium, the safe upper limit is between 2000 and 3000 mg daily. While no solid scientific evidence validates that serum vitamin D levels between 15 and 70 ng/mL are associated with increased cardiovascular disease risk, stronger but inconsistent evidence shows an association between calcium supplementation greater than 500 mg daily and an increase in cardiovascular disease risk. Most professional societies suggest that

External Validation and Evaluation of Reliability and Validity of the Modified Seoul National University Renal Stone Complexity Scoring System to Predict Stone-Free Status After Retrograde Intrarenal Surgery.

Science.gov (United States)

Park, Juhyun; Kang, Minyong; Jeong, Chang Wook; Oh, Sohee; Lee, Jeong Woo; Lee, Seung Bae; Son, Hwancheol; Jeong, Hyeon; Cho, Sung Yong

2015-08-01

The modified Seoul National University Renal Stone Complexity scoring system (S-ReSC-R) for retrograde intrarenal surgery (RIRS) was developed as a tool to predict stone-free rate (SFR) after RIRS. We externally validated the S-ReSC-R. We retrospectively reviewed 159 patients who underwent RIRS. The S-ReSC-R was assigned from 1 to 12 according to the location and number of sites involved. The stone-free status was defined as no evidence of a stone or with clinically insignificant residual fragment stones less than 2 mm. Interobserver and test-retest reliabilities were evaluated. Statistical performance of the prediction model was assessed by its predictive accuracy, predictive probability, and clinical usefulness. Overall SFR was 73.0%. The SFRs were 86.7%, 70.2%, and 48.6% in low-score (1-2), intermediate-score (3-4), and high-score (5-12) groups, respectively (pR revealed an area under the curve (AUC) of 0.731 (95% CI 0.650-0.813). The AUC of the three-titered S-ReSC-R was 0.701 (95% CI 0.609-0.794). The calibration plot showed that the predicted probability of SFR had a concordance comparable to that of observed frequency. The Hosmer-Lemeshow goodness of fit test revealed a p-value of 0.01 for the S-ReSC-R and 0.90 for the three-titered S-ReSC-R. Interobserver and test-retest reliabilities revealed an almost perfect level of agreement. The present study proved the predictive value of S-ReSC-R to predict SFR following RIRS in an independent cohort. Interobserver and test-retest reliabilities confirmed that S-ReSC-R was reliable and valid.

Detection of Asymptomatic Renal Calcifications in Astronauts Using a Novel Ultrasound Protocol

Science.gov (United States)

Garcia, Kathleen; Sargsyan, Ashot; Reyes, David; Locke, James

2017-01-01

Ultrasound (US) specifically looking for asymptomatic renal calcifications that may be renal stones is typically not done in the terrestrial setting. Standard abdominal US without a renal focus may discover incidental, mineralized renal material (MRM); however punctate solid areas of MRM is less than 3 mm are usually considered subclinical. Detecting these early calcifications before they become symptomatic renal stones is critical to prevent adverse medical and mission outcomes during spaceflight.

Relation of Aortic Valve and Coronary Artery Calcium in Patients With Chronic Kidney Disease to the Stage and Etiology of the Renal Disease

NARCIS (Netherlands)

Piers, Lieuwe H.; Touw, Hugo R. W.; Gansevoort, Ron; Franssen, Casper F. M.; Oudkerk, Matthijs; Zijlstra, Felix; Tio, Rene A.

2009-01-01

Patients with chronic renal failure have increased cardiac calcium loads. Previous studies have investigated the prevalence and quantitative extent of aortic valve calcium (AVC) and coronary artery calcium (CAC) in patients with various stages of chronic kidney disease (CKD). However, the impact of

Lessons from a Stone Farm

Science.gov (United States)

Kavanagh, John P.; Rao, P. Nagaraj

2007-04-01

The stone farm is a system for measuring macroscopic stone growth of 12 calcium stones simultaneously. It is based on mixed suspension, mixed product removal continuous crystallization principles and the stones are grown continuously for about 500 hours or more. The growth of the stones follows a surface area dependent pattern and the growth rate constants are very similar irrespective of whether the stating materials are fragments of human stone or pieces of marble chip. Increasing citrate from 2mM to 6mM caused a significant growth inhibition which persisted in the presence of urinary macromolecules. Phytate was a very effective inhibitor (about 50% at sub-μM concentrations) but the effective concentration was increased by an order of magnitude in the presence of urinary macromolecules. The effective concentration for inhibition in a crystallization assay was a further two orders of magnitude higher. Urinary macromolecules or almost whole urine were also strongly inhibitory although neither human serum albumin nor bovine mucin had any great effect. The relationship between the size distribution of crystals in suspension and the stone enlargement rate suggests that the primary enlargement mechanism for these in vitro stones is through aggregation. The stone farm is a powerful tool with which to study crystallization inhibitors in a new light. Some differences between inhibition of crystallization and inhibition of stone growth have emerged and we have obtained quantitative evidence on the mechanism of stone enlargement in vitro. Our findings suggest that the interface between crystals in suspension and the stone surface is the key to controlling stone enlargement.

Measuring stone volume - three-dimensional software reconstruction or an ellipsoid algebra formula?

Science.gov (United States)

Finch, William; Johnston, Richard; Shaida, Nadeem; Winterbottom, Andrew; Wiseman, Oliver

2014-04-01

To determine the optimal method for assessing stone volume, and thus stone burden, by comparing the accuracy of scalene, oblate, and prolate ellipsoid volume equations with three-dimensional (3D)-reconstructed stone volume. Kidney stone volume may be helpful in predicting treatment outcome for renal stones. While the precise measurement of stone volume by 3D reconstruction can be accomplished using modern computer tomography (CT) scanning software, this technique is not available in all hospitals or with routine acute colic scanning protocols. Therefore, maximum diameters as measured by either X-ray or CT are used in the calculation of stone volume based on a scalene ellipsoid formula, as recommended by the European Association of Urology. In all, 100 stones with both X-ray and CT (1-2-mm slices) were reviewed. Complete and partial staghorn stones were excluded. Stone volume was calculated using software designed to measure tissue density of a certain range within a specified region of interest. Correlation coefficients among all measured outcomes were compared. Stone volumes were analysed to determine the average 'shape' of the stones. The maximum stone diameter on X-ray was 3-25 mm and on CT was 3-36 mm, with a reasonable correlation (r = 0.77). Smaller stones (15 mm towards scalene ellipsoids. There was no difference in stone shape by location within the kidney. As the average shape of renal stones changes with diameter, no single equation for estimating stone volume can be recommended. As the maximum diameter increases, calculated stone volume becomes less accurate, suggesting that larger stones have more asymmetric shapes. We recommend that research looking at stone clearance rates should use 3D-reconstructed stone volumes when available, followed by prolate, oblate, or scalene ellipsoid formulas depending on the maximum stone diameter. © 2013 The Authors. BJU International © 2013 BJU International.

SYNTHESIS OF EXPANDER TO PREVENT CONTRACTION OF CEMENT STONE

Directory of Open Access Journals (Sweden)

Elenova Aurika Almazovna

2017-03-01

Full Text Available This article contains the results of studies of the use of additives containing crystallization components significantly affecting the curing of cement, improving the structure of cement stone and concrete. The crystalline component is obtained using the rotary-pulse unit, which provides not only the grinding of agents, but their interaction with each other as well in order to accelerate the hydration and structure formation in cement stone. The degree, and kinetics of hydration, the composition of hydrated phases, the structure of the additives and cement stone was studied using the following methods: x-ray diffraction (XRD, differential thermal analysis (DTA, scanning electron microscope (SEM. Mechanical properties of cement were determined by standard methods and techniques. The expander produced by means of hydrodynamic activation of the sulfoaluminate clinker (SAC consists of ettringite and hydrated calcium silicates, which are characterized by high dispersion rate (less than 10 µm and reactivity as the seed for the crystallization of hydrated compounds. The introduction of the ultrafine additives of the crystalline SAC (within 1-5% was discovered to cause expansion of the cement stone. Implementation of the additives increases cement hydration and contributes to the formation of active centers of crystallization that lead to the fast formation of ettringite, hydrated calcium aluminates and calcium silicates. The activated crystalline additive provides for significant reduction of porosity, initial curing, and high strength of cement stone. In addition, the additive is an expansive component, forming needle-like crystals of ettringite during hydration. These microcrystals grow in the capillaries of cement stone, filling them, and create conditions for improving the crack resistance of cement concrete.

Can a dual-energy computed tomography predict unsuitable stone components for extracorporeal shock wave lithotripsy?

Science.gov (United States)

Ahn, Sung Hoon; Oh, Tae Hoon; Seo, Ill Young

2015-09-01

To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (penergy values (p<0.001). DECT improved the characterization of urinary stone components and was a useful method for identifying uric acid and calcium oxalate monohydrate stones, which are unsuitable for ESWL.

Efficacy of surgical techniques and factors affecting residual stone rate in the treatment of kidney stones.

Science.gov (United States)

Aydemir, Hüseyin; Budak, Salih; Kumsar, Şükrü; Köse, Osman; Sağlam, Hasan Salih; Adsan, Öztuğ

2014-09-01

In this study, we aimed to evaluate, the efficacy of surgical methods and the factors affecting the residual stone rate by scrutinizing retrospectively the patients who had undergone renal stone surgery. Records of 109 cases of kidney stones who had been surgically treated between January 2010, and July 2013 were reviewed. Patients were divided into three groups in terms of surgical treatment; open stone surgery, percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgery (RIRS). Patients' history, physical examination, biochemical and radiological images and operative and postoperative data were recorded. The patients had undergone PNL (n=74; 67.9%), RIRS (n=22;20.2%), and open renal surgery (n=13; 11.9%). The mean and median ages of the patients were 46±9, 41 (21-75) and, 42 (23-67) years, respectively. The mean stone burden was 2.6±0.7 cm(2) in the PNL, 1.4±0.1 cm(2) in the RIRS, and 3.1±0.9 cm(2) in the open surgery groups. The mean operative times were 126±24 min in the PNL group, 72±12 min in the RIRS group and 82±22 min in the open surgery group. The duration of hospitalisation was 3.1±0.2 days, 1.2±0.3 days and 3.4±1.1 days respectively. While the RIRS group did not need blood transfusion, in the PNL group blood transfusions were given in the PNL (n=18), and open surgery (n=2) groups. Residual stones were detected in the PNL (n=22), open surgery (n=2), and RIRS (n=5) groups. PNL and RIRS have been seen as safe and effective methods in our self application too. However, it should not be forgotten that as a basical method, open surgery may be needed in cases of necessity.

An association between urinary cadmium and urinary stone disease in persons living in cadmium-contaminated villages in northwestern Thailand: A population study

International Nuclear Information System (INIS)

Swaddiwudhipong, Witaya; Mahasakpan, Pranee; Limpatanachote, Pisit; Krintratun, Somyot

2011-01-01

Excessive urinary calcium excretion is the major risk of urinary stone formation. Very few population studies have been performed to determine the relationship between environmental cadmium exposure and urinary stone disease. This population-based study examined an association between urinary cadmium excretion, a good biomarker of long-term cadmium exposure, and prevalence of urinary stones in persons aged 15 years and older, who lived in the 12 cadmium-contaminated villages in the Mae Sot District, Tak Province, northwestern Thailand. A total of 6748 persons were interviewed and screened for urinary cadmium and urinary stone disease in 2009. To test a correlation between urinary excretion of cadmium and calcium, we measured urinary calcium content in 1492 persons, who lived in 3 villages randomly selected from the 12 contaminated villages. The rate of urinary stones significantly increased from 4.3% among persons in the lowest quartile of urinary cadmium to 11.3% in the highest quartile. An increase in stone prevalence with increasing urinary cadmium levels was similarly observed in both genders. Multiple logistic regression analysis revealed a positive association between urinary cadmium levels and stone prevalence, after adjusting for other co-variables. The urinary calcium excretion significantly increased with increasing urinary cadmium levels in both genders, after adjusting for other co-variables. Elevated calciuria induced by cadmium might increase the risk of urinary stone formation in this environmentally exposed population. - Research highlights: → Excessive calciuria is the major risk of urinary stone formation. → We examine cadmium-exposed persons for urinary cadmium, calcium, and stones. → The rate of urinary stones increases with increasing urinary cadmium. → Urinary calcium excretion increases with increasing urinary cadmium. → Elevated calciuria induced by cadmium may increase the risk of urinary stones.

Use of flexible ureteroscopy in the clinical practice for the treatment of renal stones: results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis.

Science.gov (United States)

Sanguedolce, F; Liatsikos, E; Verze, P; Hruby, S; Breda, A; Beatty, J D; Knoll, T

2014-08-01

Treatment of renal stones using flexible ureteroscopy (fURS) is increasingly common despite the poor evidence in literature supporting its use and indications. With this study, we wanted to investigate the current use and indication of fURS for the treatment of renal stones in the clinical practice across the European countries. A survey was conducted using an emailed questionnaire consisting of 21 items; 2,894 recipients were selected via the EAU membership database. The questionnaires were collected through the SurveyMonkey system and the data were processed with the SPSS statistical package. Frequencies, cross tabs and Pearson correlation coefficients were applied as appropriate. 1,168 questionnaires were collected (response rate 40.4%). fURS was performed in 72.9% of the respondents' institutions, and 54.2% of the respondents were performing the procedure. For 95% of the users, fURS was considered first-line treatment, for stone of lower pole stone (45.9%) and <1 cm (44.2%) and 2 cm (43.8%) in size. The ureteral access sheaths were used routinely by more than 70% of the respondents. Lower pole stone repositioning technique was routinely performed by 45.9% of the surgeons. After fragmentation, 47.2% of the responders preferred to retrieve only the bigger fragments. At the end of fURS, lower volume surgeons were more likely to place routinely a double-J stent (p = 0.001). Higher volume surgeons estimated a higher durability of devices, both optical and digital ones (p < 0.001), and were more prone to consider fURS cost-effective when compared to other treatment modalities (p < 0.001). fURS is widely used for the treatment of renal stones and its use and indication can vary according to the age and surgeons' case volume. Higher volume surgeons are more prompt to extend international guidelines indications and to consider the technology cost-effective.

Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for renal calculi between 20-30 mm: a multivariate analysis model.

Science.gov (United States)

El-Assmy, Ahmed; El-Nahas, Ahmed R; Abo-Elghar, Mohamed E; Eraky, Ibrahim; El-Kenawy, Mahmoud R; Sheir, Khaled Z

2006-03-23

The first-line management of renal stones between 20-30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL) stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20-30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis. Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%. Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20-30 mm. High probability of stone clearance is obtained with single stone ESWL in such controversial groups and can define patients who would need other treatment modality.

Functional and pharmacological consequences of the distribution of voltage-gated calcium channels in the renal blood vessels

DEFF Research Database (Denmark)

Hansen, P B L

2013-01-01

Calcium channel blockers are widely used to treat hypertension because they inhibit voltage-gated calcium channels that mediate transmembrane calcium influx in, for example, vascular smooth muscle and cardiomyocytes. The calcium channel family consists of several subfamilies, of which the L......-type is usually associated with vascular contractility. However, the L-, T- and P-/Q-types of calcium channels are present in the renal vasculature and are differentially involved in controlling vascular contractility, thereby contributing to regulation of kidney function and blood pressure. In the preglomerular...... vascular bed, all the three channel families are present. However, the T-type channel is the only channel in cortical efferent arterioles which is in contrast to the juxtamedullary efferent arteriole, and that leads to diverse functional effects of L- and T-type channel inhibition. Furthermore...

Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

Energy Technology Data Exchange (ETDEWEB)

Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Radiology, Jerusalem (Israel); Katz, Ran [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Urology, Jerusalem (Israel); Salama, Shaden [Hadassah Mount Scopus - Hebrew University Medical Center, Department of Emergency Medicine, Jerusalem (Israel)

2010-05-15

To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: {<=}5 mm, 6-9 mm and {>=}10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

Coronal reconstruction of unenhanced abdominal CT for correct ureteral stone size classification

International Nuclear Information System (INIS)

Berkovitz, Nadav; Simanovsky, Natalia; Hiller, Nurith; Katz, Ran; Salama, Shaden

2010-01-01

To determine whether size measurement of a urinary calculus in coronal reconstruction of computed tomography (CT) differs from stone size measured in the axial plane, and whether the difference alters clinical decision making. We retrospectively reviewed unenhanced CT examinations of 150 patients admitted to the emergency room (ER) with acute renal colic. Maximal ureteral calculus size was measured on axial slices and coronal reconstructions. Clinical significance was defined as an upgrading or downgrading of stone size according to accepted thresholds of treatment: ≤5 mm, 6-9 mm and ≥10 mm. There were 151 stones in 150 patients (male:female 115:34, mean age 41 years). Transverse stone diameters ranged from 1 to 11 mm (mean 4 mm). On coronal images, 56 (37%) stones were upgraded in severity; 46 (30%) from below 5 mm to 6 mm or more, and ten (7%) from 6-9 mm to 10 mm or more. Transverse measurement on the axial slices enabled correct categorization of 95 stones (63%). Transverse calculus measurement on axial slices often underestimates stone size and provides incorrect clinical classification of the true maximal stone diameter. Coronal reconstruction provides additional information in patients with renal colic that may alter treatment strategy. (orig.)

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

Science.gov (United States)

Chung, Ho Seok; Jung, Seung Il; Yu, Ho Song; Hwang, Eu Chang; Oh, Kyung Jin; Kwon, Dong Deuk; Park, Kwangsung

2016-01-01

We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications. To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1. Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

Determination of cholesterol, calcium carbonate and bilirubinate of gallstone

International Nuclear Information System (INIS)

Iqbal, Y.; Nazneen, B.I.

2004-01-01

Gallstones of seven patients were collected from different parts of North West Frontier and Punjab provinces. These stones were analyzed using Liebermann-Burchard method, estimation technique and Microlab-200 for cholesterol, calcium carbonate (CaCO/sub 3/) and bilirubinate respectively. The levels of cholesterol bilirubinate and CaCO/sub 3/ were found in the ranges of 50-81, 12-40 and 7-19% respectively. All of the stones were found to be mixed type stones that contain cholesterol, bilirubinate and calcium carbonate. The structures of the stones are also shown in the picture, which confirm our analysis data. Possible reasons, which cause formation of gallstones, are discussed in this paper. (author)

[Ultraminipercutaneous nephrolithotripsy in treating kidney stones].

Science.gov (United States)

Martov, A G; Dutov, S V; Andronov, A S

2016-04-01

Percutaneous nephrolithotripsy (PNL) is the recommended method of surgical treatment of kidney stones of size greater than 2 cm. Trends in the development of modern urology have been steadily toward less traumatic method to treat nephrolithiasis - minimally invasive PNL. The present work aimed to explore of the possibilities of one of the modern variants of minimally invasive PNL - ultra-mini-PNL in treating nephrolithiasis. The study included 60 patients (mean age 45.6+/-7.2 years) with isolated kidney calculus, up to 2.0 cm or several stones with a total size of up to 2.5 cm. All patients were found to have 77 kidney stones, six of which had a size of 10 mm, 51 had a size of 11-15 mm and 20 had a size of 16-20 mm. 45% of patients had isolated renal pelvic stones and 28.3% had stones in the renal pelvis and lower calyx. All patients underwent ultra-mini-PNL using nephroscope size 7.5 Ch and tube size 12 Fr. The average duration of surgery from the moment of the puncture of the pyelocaliceal system to installing the nephrostomy tube was 65.4 minutes. Complete clearance of stones after single-stage ultra-mini-PNL was observed in 80% of cases. Nephrostomy tube was removed on days 2-3. The average postoperative hospital stay was 5.1 days. The most common complication was postoperative exacerbation of pyelonephritis (13.3% of patients), successfully treated with conservative measures. There were no cases of postoperative bleeding, accompanied by anemia and needed a blood transfusion. Considering high effectiveness and low rate of complications of ultra-mini-PNL, it can be successfully used in treating nephrolithiasis among a wide group of patients.

Determination of urinary stone composition using dual-energy spectral CT: Initial in vitro analysis

International Nuclear Information System (INIS)

Li, X.-H.; Zhao, R.; Liu, B.; Yu, Y.-Q.

2013-01-01

Aim: To evaluate the feasibility of determining the chemical composition of urinary stones using computed tomography (CT) spectral imaging (SI) Materials and methods: Two hundred and ten urinary stones were scanned in vitro using the SI mode and conventional polychromatic imaging (CPI; 120 kVp) mode. The radiodensity at 50 keV and 120 kVp, the mean calcium density (CD), and the water density (WD) were measured using the 50 keV images, 120 kVp images, calcium-based images, and water-based images, respectively. These parameters and the calcium–water ratio (CWR) were compared between different types of stones. CWR was defined as: CWR = ‌calcium density/water density‌. Results: According to the results determined by infrared spectroscopy, 116 pure urinary stones were divided into five groups: uric acid (UA, n = 16), struvite (STR, n = 23), cystine (CYS, n = 10), calcium phosphate (CaP, n = 29), and calcium oxalate (COX, n = 38). CD, CWR, and the radiodensity of stones at 50 keV CT imaging of each group were as follows: UA (−3.55 ± 10.85 mg/ml, 0.03 ± 0.05, 510.08 ± 157.29 HU); STR (224.99 ± 64.28 mg/ml, 0.19 ± 0.07, 1058.58 ± 260.13 HU); CYS (139.67 ± 34.66 mg/ml, 0.13 ± 0.03, 725.75 ± 142.35 HU); CaP (619.39 ± 26.13 mg/ml, 0.69 ± 0.11, 2617.46 ± 186.22 HU); COX (518.61 ± 95.5 mg/ml, 0.58 ± 0.1, 2247.47 ± 379.51 HU). The differences in the CD, CRW, and radiodensity of stones at 50 keV CT imaging among the groups were statistically significant by binary comparison (p < 0.05). There were no significant differences in the radiodensity of stones at 120 keV CT imaging between UA and CYS (p = 0.267), CaP and COX (p = 0.065), and in the WD between STR and CYS (p = 0.108). Conclusion: SI provides a novel method to better characterize pure urinary stones using the mean CD, CWR, and the radiodensity of stones at 50 keV CT imaging

Ultrasonographic diagnosis of ureteral stones: Accuracy and factors influencing on diagnostic sensitivity

Energy Technology Data Exchange (ETDEWEB)

Park, Young Mi; Han, Sang Seok; Chang, Seung Kuk; Joo, Sang Hoo; Lee, Jeong Sik; Eun, Choong Ki [Pusan Paik Hospital, Inje University College of Medicine, Pusan (Korea, Republic of)

1999-12-15

To determine the accuracy of ultrasonographic diagnosis in patients with clinically suspected ureteral stones and to evaluate the factors influencing on the diagnostic sensitivity for the detection of ureteral stone. The patients (115 cases) with proven presence or absence of ureteral stones were included in the study. At first, both sided kidney and proximal ureters were examined on each decubitus position and then middle ureters were done if proximal ureters were visualized. On the supine view, distal ureters and UVJ were scanned through the acoustic window of the filled bladder. KUB (20 cases), IVU (62 cases), AGP (7 cases), RGP (3 cases), ESWL (9 cases), CT (9 cases), and patients' history of spontaneous passage of stones (5 cases) were included as confirmation methods. The sensitivity, specificity, and accuracy of the ultrasonographic diagnosis of ureteral stones were calculated and the factors influencing on the sensitivity on the focus of the position and size of ureteral stone, visibility of ureter, the presence or absence of renal stone and hydronephrosis were analyzed. Of 82 cases with proven ureteral stone, 72 cases were revealed on ultrasonography and there was one false positive examination among 33 cases with proven absence of ureteral stone. The overall diagnostic accuracy was 90%. The ultrasonographic detection rates of ureteral stones as correlated with their locations were 83% (24/29), 100% (11/11), 80% (16/20), and 100% (21/21) of each group of proximal, middle, distal ureter, and UVJ stones. Of 61 stones, those as correlated with their sizes, were 82% (37/45) and 94% (15/16) of each group less than 10 mm and more than 11 mm. Those as correlated with the presence or absence of ureteral visualization on ultrasonography were 92% (69/75) and 43% (3/7) of each group. Those as correlated with presence of absence of renal stones were 85% (41/48) and 91% (31/34) of each group. Those as correlated with presence or absence of hydronephrosis were 89

The effect of inclined position on stone free rates in patients with lower caliceal stones during SWL session

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Basri Cakiroglu

2015-03-01

Full Text Available Objective: To compare the outcomes of shock wave lithotripsy (SWL combined with inclined position and SWL alone in patients with lower pole calyx stones. Methods: Seven hundred forty patients who underwent SWL treatment for lower pole renal stones with a total diameter of 2 cm or less were prospectively randomized into two groups. They were comparable in terms of age, sex, and stone diameters. Patients with lower calyceal stones (4-20 mm were randomized to SWL (368 patients or SWL with simultaneous inclination (372 patients with 30o head down Trendelenburg position. Shock wave and session numbers were standardized according to stone size. Additional standardized shock waves were given to patients with stone fragments determined by kidney urinary bladder film and ultrasound at weeks 1, 4, 10. Results: The overall stone free rate (SFR was 73% (268/368 in patients with SWL alone and 81% (300/372 in SWL with inclination at the end of 12th week (p = 0.015. No significant adverse events were noted in both treatment groups. Conclusion: Simultaneous inclination of patients during SWL session increase SFR in lower caliceal stones significantly compared to SWL treatment alone.

Sepsis complicated by brain abscess following ESWL of a caliceal kidney stone: a case report.

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Capitanini, Alessandro; Rosso, Luca; Giannecchini, Laura; Meniconi, Ophelia; Cupisti, Adamasco

2016-01-01

A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL) of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU). Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT). Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscesso (55x75mm) in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors). The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate. Copyright® by the International Brazilian Journal of Urology.

Sepsis complicated by brain abscess following ESWL of a caliceal kidney stone: a case report

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Alessandro Capitanini

Full Text Available ABSTRACT A 47-year old, Caucasian man underwent extracorporeal shock wave lithotripsy (ESWL of a 14mm calcium stone in the right renal pelvis, without urinary tract obstruction or sepsis. 24 hours after ESWL septic shock occurred and the patient was admitted to the Intensive Care Unit (ICU. Escherichia coli emerged from the blood and urine culture. The patient developed acute renal failure and it was necessary to start a continuous renal replacement therapy (CRRT. Infection was successfully treated, patient recovered renal function and an improvement of general condition occurred. The patient was then discharged but three day later the patient returned to the hospital to seek treatment for left facial hemiparesis and hypotonia of his left arm. The brain computed tomography showed a wide abscess (55×75mm in the frontal right parietal region. A neurosurgical intervention was then performed and the culture of the drained material resulted positive for Escherichia coli. The guidelines of European and American Associations of Urology do not suggest a prophylactic antibiotic therapy for pre-ESWL (except in the presence of risk factors. The serious complication that occurred in the described low risk patient raises the question of whether routine culture and/or antibiotic prophylaxis, is appropriate.

Effect of calcium intake on urinary oxalate excretion in calcium stone-forming patients

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Nishiura J.L.

2002-01-01

Full Text Available Dietary calcium lowers the risk of nephrolithiasis due to a decreased absorption of dietary oxalate that is bound by intestinal calcium. The aim of the present study was to evaluate oxaluria in normocalciuric and hypercalciuric lithiasic patients under different calcium intake. Fifty patients (26 females and 24 males, 41 ± 10 years old, whose 4-day dietary records revealed a regular low calcium intake (<=500 mg/day, received an oral calcium load (1 g/day for 7 days. A 24-h urine was obtained before and after load and according to the calciuria under both diets, patients were considered as normocalciuric (NC, N = 15, diet-dependent hypercalciuric (DDHC, N = 9 or diet-independent hypercalciuric (DIHC, N = 26. On regular diet, mean oxaluria was 30 ± 14 mg/24 h for all patients. The 7-day calcium load induced a significant decrease in mean oxaluria compared to the regular diet in NC and DIHC (20 ± 12 vs 26 ± 7 and 27 ± 18 vs 32 ± 15 mg/24 h, respectively, P<0.05 but not in DDHC patients (22 ± 10 vs 23 ± 5 mg/24 h. The lack of an oxalate decrease among DDHC patients after the calcium load might have been due to higher calcium absorption under higher calcium supply, with a consequent lower amount of calcium left in the intestine to bind with oxalate. These data suggest that a long-lasting regular calcium consumption <500 mg was not associated with high oxaluria and that a subpopulation of hypercalciuric patients who presented a higher intestinal calcium absorption (DDHC tended to hyperabsorb oxalate as well, so that oxaluria did not change under different calcium intake.

Discriminative power of three indices of renal calcium excretion for the distinction between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism

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Christensen, Signe Engkjær; Nissen, Peter H; Vestergaard, Peter

2008-01-01

Background: Familial hypocalciuric hypercalcaemia (FHH) must be differentiated from primary hyperparathyroidism (PHPT) since prognosis and treatment differ. In daily practice this discrimination is often based on the renal calcium excretion or the calcium/creatinine clearance ratio (CCCR). However......, the diagnostic performance of these variables is poorly documented. Aim: To appraise the power of various simple biochemical variables to differentiate between FHH and PHPT using calcium sensing receptor (CASR) gene analysis and histopathological findings as gold standards. Design: Follow-up approach (direct...

Renal calculus

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Pyrah, Leslie N

1979-01-01

Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long an...

Diglycolic acid, the toxic metabolite of diethylene glycol, chelates calcium and produces renal mitochondrial dysfunction in vitro.

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Conrad, Taylor; Landry, Greg M; Aw, Tak Yee; Nichols, Royce; McMartin, Kenneth E

2016-07-01

Diethylene glycol (DEG) has caused many cases of acute kidney injury and deaths worldwide. Diglycolic acid (DGA) is the metabolite responsible for the renal toxicity, but its toxic mechanism remains unclear. To characterize the mitochondrial dysfunction produced from DGA by examining several mitochondrial processes potentially contributing to renal cell toxicity. The effect of DGA on mitochondrial membrane potential was examined in normal human proximal tubule (HPT) cells. Isolated rat kidney mitochondria were used to assess the effects of DGA on mitochondrial function, including respiratory parameters (States 3 and 4), electron transport chain complex activities and calcium-induced opening of the mitochondrial permeability transition pore. DGA was compared with ethylene glycol tetraacetic acid (EGTA) to determine calcium chelating ability. DGA cytotoxicity was assessed using lactate dehydrogenase leakage from cultured proximal tubule cells. DGA decreased the mitochondrial membrane potential in HPT cells. In rat kidney mitochondria, DGA decreased State 3 respiration, but did not affect State 4 respiration or the ADP/O ratio. DGA reduced glutamate/malate respiration at lower DGA concentrations (0.5 mmol/L) than succinate respiration (100 mmol/L). DGA inhibited Complex II activity without altering Complex I, III or IV activities. DGA blocked calcium-induced mitochondrial swelling, indicating inhibition of the calcium-dependent mitochondrial permeability transition. DGA and EGTA reduced the free calcium concentration in solution in an equimolar manner. DGA toxicity and mitochondrial dysfunction occurred as similar concentrations. DGA inhibited mitochondrial respiration, but without uncoupling oxidative phosphorylation. The more potent effect of DGA on glutamate/malate respiration and the inhibition of mitochondrial swelling was likely due to its chelation of calcium. These results indicate that DGA produces mitochondrial dysfunction by chelating calcium to

Predictors of Success after Extracorporeal Shock Wave Lithotripsy (ESWL for Renal Calculi Between 20—30 mm: A Multivariate Analysis Model

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Ahmed El-Assmy

2006-01-01

Full Text Available The first-line management of renal stones between 20—30 mm remains controversial. The Extracorporeal Shock Wave Lithotripsy (ESWL stone-free rates for such patient groups vary widely. The purpose of this study was to define factors that have a significant impact on the stone-free rate after ESWL in such controversial groups. Between January 1990 and January 2004, 594 patients with renal stones 20—30 mm in length underwent ESWL monotherapy. Stone surface area was measured for all stones. The results of treatment were evaluated after 3 months of follow-up. The stone-free rate was correlated with stone and patient characteristics using the Chi-square test; factors found to be significant were further analyzed using multivariate analysis.Repeat ESWL was needed in 56.9% of cases. Post-ESWL complications occurred in 5% of cases and post-ESWL secondary procedures were required in 5.9%. At 3-month follow-up, the overall stone-free rate was 77.2%. Using the Chi-square test, stone surface area, location, number, radiological renal picture, and congenital renal anomalies had a significant impact on the stone-free rate. Multivariate analysis excluded radiological renal picture from the logistic regression model while other factors maintained their statistically significant effect on success rate, indicating that they were independent predictors. A regression analysis model was designed to estimate the probability of stone-free status after ESWL. The sensitivity of the model was 97.4%, the specificity 90%, and the overall accuracy 95.6%.Stone surface area, location, number, and congenital renal anomalies are prognostic predictors determining stone clearance after ESWL of renal calculi of 20—30 mm. High probability of stone clearance is obtained with single stone ≤400 mm2 located in renal pelvis with no congenital anomalies. Our regression model can predict the probability of the success of ESWL in such controversial groups and can define patients who

[Clinical analysis of percutaneous nephrolithotomy for staghorn calculi with different stone branch number].

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Qi, Shi-yong; Zhang, Zhi-hong; Zhang, Chang-wen; Liu, Ran-lu; Shi, Qi-duo; Xu, Yong

2013-12-01

To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL). From January 2009 to January 2013, the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study. All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging. The computerized database of the patients had been reviewed. Our exclusion criterion was patients with congenital renal anomalies, such as horse-shoe and ectopic kidneys. And borderline stones that branched to one major calyx only were also not included. From 3-DR images, the number of stone branching into minor renal calices was recorded. We made "3" as the branch breakdown between groups. And the patients were divided into four groups. The number of percutaneous tract, operative time, staged PNL, intra-operative blood loss, complications, stone clearance rate, and postoperative hospital day were compared. The 371 patients (386 renal units) underwent PNL successfully, included 144 single-tract PNL, 242 multi-tract PNL, 97 staged PNL. The average operative time was (100 ± 50) minutes; the average intra-operative blood loss was (83 ± 67) ml. The stone clearance rate were 61.7% (3 days) and 79.5% (3 months). The postoperative hospital stay was (6.9 ± 3.4) days. A significantly higher ratio of multi-tract (χ(2) = 212.220, P PNL (χ(2) = 49.679, P PNL for calculi with stone branch number ≥ 5. There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P = 0.460). The possibility of multi-tract and staged PNL, lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.

A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi.

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Wiesenthal, Joshua D; Ghiculete, Daniela; Ray, A Andrew; Honey, R John D'A; Pace, Kenneth T

2011-08-01

Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3±39.3 mm2 for ureteral stones and 78.9±77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p=0.01), body mass index (p=0.01), stone size (pstone density (pstone distance (pstone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Estimation of urinary stone composition by automated processing of CT images.

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Chevreau, Grégoire; Troccaz, Jocelyne; Conort, Pierre; Renard-Penna, Raphaëlle; Mallet, Alain; Daudon, Michel; Mozer, Pierre

2009-10-01

The objective of this article was developing an automated tool for routine clinical practice to estimate urinary stone composition from CT images based on the density of all constituent voxels. A total of 118 stones for which the composition had been determined by infrared spectroscopy were placed in a helical CT scanner. A standard acquisition, low-dose and high-dose acquisitions were performed. All voxels constituting each stone were automatically selected. A dissimilarity index evaluating variations of density around each voxel was created in order to minimize partial volume effects: stone composition was established on the basis of voxel density of homogeneous zones. Stone composition was determined in 52% of cases. Sensitivities for each compound were: uric acid: 65%, struvite: 19%, cystine: 78%, carbapatite: 33.5%, calcium oxalate dihydrate: 57%, calcium oxalate monohydrate: 66.5%, brushite: 75%. Low-dose acquisition did not lower the performances (P < 0.05). This entirely automated approach eliminates manual intervention on the images by the radiologist while providing identical performances including for low-dose protocols.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision.

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Nakamura, Kogenta; Tobiume, Motoi; Narushima, Masahiro; Yoshizawa, Takahiko; Nishikawa, Genya; Kato, Yoshiharu; Katsuda, Remi; Zennami, Kenji; Aoki, Shigeyuki; Yamada, Yoshiaki; Honda, Nobuaki; Sumitomo, Makoto

2011-12-12

The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL Sonolith vision

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Nakamura Kogenta

2011-12-01

Full Text Available Abstract Background The aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004. Methods The subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment. Results At 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]. Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each. Conclusions ESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.

Forty-five-year follow-up on the renal function after spinal cord injury

DEFF Research Database (Denmark)

Elmelund, M; Oturai, P S; Toson, B

2016-01-01

rate (GFR) ⩽75% of expected according to age and gender) was 58%. The cumulative risk of severe renal deterioration (functional distribution outside 30-70% on renography or relative GFR⩽51%) was 29% after 45 years postinjury. Only dilatation of UUT and renal/ureter stone requiring removal significantly...... increased the risk of moderate and severe renal deterioration. CONCLUSION: Renal deterioration occurs at any time after injury, suggesting that lifelong follow-up examinations of the renal function are important, especially in patients with dilatation of UUT and/or renal/ureter stones....

Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?

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Ho Seok Chung

2016-12-01

Full Text Available Introduction: We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL without indwelling ureteral stent would minimize postoperative discomfort without complications. Aim : To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL. Material and methods: From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL. Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups. Results: There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001. Group 2 and group 3 had a lower analgesic requirement (p = 0.010. Immediate postoperative hemoglobin change (p = 0.001 and tube site complications (p = 0.001 were more common in group 1. Conclusions : Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.

Effect of acute acid loading on acid-base and calcium metabolism

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Osther, Palle J

2006-01-01

OBJECTIVE: To investigate the acid-base and calcium metabolic responses to acute non-carbonic acid loading in idiopathic calcium stone-formers and healthy males using a quantitative organ physiological approach. MATERIAL AND METHODS: Five-h ammonium chloride loading studies were performed in 12...... male recurrent idiopathic calcium stone-formers and 12 matched healthy men using a randomized, placebo-controlled, cross-over design. Arterialized capillary blood, serum and urine were collected hourly for measurement of electrolytes, ionized calcium, magnesium, phosphate, parathyroid hormone and acid-base...... status. Concentrations of non-metabolizable base (NB) and acid (NA) were calculated from measured concentrations of non-metabolizable ions. RESULTS: The extracellular acid-base status in the stone-formers during basal conditions and acid loading was comparable to the levels in the healthy controls...

Calcium - ionized

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... diuretics Thrombocytosis (high platelet count) Tumors Vitamin A excess Vitamin D excess Lower-than-normal levels may be due to: Hypoparathyroidism Malabsorption Osteomalacia Pancreatitis Renal failure Rickets Vitamin D deficiency Alternative Names Free calcium; Ionized calcium ...

Dual-layer spectral detector CT: non-inferiority assessment compared to dual-source dual-energy CT in discriminating uric acid from non-uric acid renal stones ex vivo.

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Ananthakrishnan, Lakshmi; Duan, Xinhui; Xi, Yin; Lewis, Matthew A; Pearle, Margaret S; Antonelli, Jodi A; Goerne, Harold; Kolitz, Elysha M; Abbara, Suhny; Lenkinski, Robert E; Fielding, Julia R; Leyendecker, John R

2018-04-07

To assess the non-inferiority of dual-layer spectral detector CT (SDCT) compared to dual-source dual-energy CT (dsDECT) in discriminating uric acid (UA) from non-UA stones. Fifty-seven extracted urinary calculi were placed in a cylindrical phantom in a water bath and scanned on a SDCT scanner (IQon, Philips Healthcare) and second- and third-generation dsDECT scanners (Somatom Flash and Force, Siemens Healthcare) under matched scan parameters. For SDCT data, conventional images and virtual monoenergetic reconstructions were created. A customized 3D growing region segmentation tool was used to segment each stone on a pixel-by-pixel basis for statistical analysis. Median virtual monoenergetic ratios (VMRs) of 40/200, 62/92, and 62/100 for each stone were recorded. For dsDECT data, dual-energy ratio (DER) for each stone was recorded from vendor-specific postprocessing software (Syngo Via) using the Kidney Stones Application. The clinical reference standard of X-ray diffraction analysis was used to assess non-inferiority. Area under the receiver-operating characteristic curve (AUC) was used to assess diagnostic performance of detecting UA stones. Six pure UA, 47 pure calcium-based, 1 pure cystine, and 3 mixed struvite stones were scanned. All pure UA stones were correctly separated from non-UA stones using SDCT and dsDECT (AUC = 1). For UA stones, median VMR was 0.95-0.99 and DER 1.00-1.02. For non-UA stones, median VMR was 1.4-4.1 and DER 1.39-1.69. SDCT spectral reconstructions demonstrate similar performance to those of dsDECT in discriminating UA from non-UA stones in a phantom model.

Role of ultrasonography in percutaneous renal access in patients with renal anatomic abnormalities.

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Penbegul, Necmettin; Hatipoglu, Namik Kemal; Bodakci, Mehmet Nuri; Atar, Murat; Bozkurt, Yasar; Sancaktutar, Ahmet Ali; Tepeler, Abdulkadir

2013-05-01

To present our experience regarding the feasibility, safety, and efficacy of ultrasound (US)-guided percutaneous nephrolithotomy in anatomically abnormal kidneys. We performed US-guided percutaneous nephrolithotomy in 15 patients with anatomically abnormal kidneys and renal calculi. Of the 15 patients, 5 had horseshoe kidneys, 5 had rotation anomalies, 2 had kyphoscoliosis, and 3 had scoliosis. The stone size, number of access tracts, operative time, hospitalization duration, rate of stone clearance, and complication rate were recorded. Percutaneous access was achieved with US guidance in the operating room by the urologist. Successful renal access was obtained by the surgeon using US guidance in all patients, and a single access was obtained in all cases. Of the 15 patients, 8 were females, and 7 were males; 8 patients had solitary stones, and 7 had multiple calculi. The renal calculi were on the right in 7 patients and on the left in 8. Three patients had previously undergone unsuccessful shock wave lithotripsy. Complete stone clearance was achieved in 13 patients. The mean operative time was 54.2 minutes. No patient required a blood transfusion because of bleeding. Urinary tract infections occurred in 2 patients, who were treated with antibiotics. A double-J catheter was not inserted in any patient; however, a ureteral catheter was used in 3 patients for 1 day. None of the patients had any major complications during the postoperative period. The stone-free rate was 87%, and 2 patients had clinically insignificant residual fragments. Our results have demonstrated that US-guided percutaneous nephrolithotomy can be performed feasibly, safely, and effectively in anatomically abnormal kidneys. Copyright © 2013 Elsevier Inc. All rights reserved.

Mammary-Specific Ablation of the Calcium-Sensing Receptor During Lactation Alters Maternal Calcium Metabolism, Milk Calcium Transport, and Neonatal Calcium Accrual

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Mamillapalli, Ramanaiah; VanHouten, Joshua; Dann, Pamela; Bikle, Daniel; Chang, Wenhan; Brown, Edward

2013-01-01

To meet the demands for milk calcium, the lactating mother adjusts systemic calcium and bone metabolism by increasing dietary calcium intake, increasing bone resorption, and reducing renal calcium excretion. As part of this adaptation, the lactating mammary gland secretes PTHrP into the maternal circulation to increase bone turnover and mobilize skeletal calcium stores. Previous data have suggested that, during lactation, the breast relies on the calcium-sensing receptor (CaSR) to coordinate PTHrP secretion and milk calcium transport with calcium availability. To test this idea genetically, we bred BLG-Cre mice with CaSR-floxed mice to ablate the CaSR specifically from mammary epithelial cells only at the onset of lactation (CaSR-cKO mice). Loss of the CaSR in the lactating mammary gland did not disrupt alveolar differentiation or milk production. However, it did increase the secretion of PTHrP into milk and decreased the transport of calcium from the circulation into milk. CaSR-cKO mice did not show accelerated bone resorption, but they did have a decrease in bone formation. Loss of the mammary gland CaSR resulted in hypercalcemia, decreased PTH secretion, and increased renal calcium excretion in lactating mothers. Finally, loss of the mammary gland CaSR resulted in decreased calcium accrual by suckling neonates, likely due to the combination of increased milk PTHrP and decreased milk calcium. These results demonstrate that the mammary gland CaSR coordinates maternal bone and calcium metabolism, calcium transport into milk, and neonatal calcium accrual during lactation. PMID:23782944

Protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms

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Ling Zhang

2017-06-01

Full Text Available Objective: To explore the protective effect of calcium dobesilate combined with benazepril therapy on renal injury in patients with early diabetic nephropathy and the possible molecular mechanisms. Methods: A total of 50 patients with early diabetic nephropathy treated in our hospital between May 2012 and January 2016 were collected, and according to the random number table, the patients were divided into observation group (n=25 and control group (n=25. On the basis of conventional treatment, control group of patients received benazepril therapy, observation group of patients received calcium dobesilate combined with benazepril therapy, and the treatment lasted for 3 months. Before and after treatment, automatic biochemical analyzer was used to detect the levels of renal injury indexes in peripheral blood, RIA method was used to detect the levels of renal injury indexes in urine, ELISA method was used to detect the levels of renal fibrosis indexes and Western-blot method was used to detect the protein expression of TGF-β1/BMP-7 and Smad signaling pathway molecules in renal tissue. Results: Before treatment, differences in renal injury index levels, renal fibrosis index levels and signaling pathway molecule protein expression were not statistically significant between two groups of patients. After treatment, BUN, SCr and β-TP levels in the peripheral blood as well as KIM-1 level in urine of observation group were lower than those of control group; renal fibrosis indexes TGF-β1, CTGF, TIMP-1, LN and HA levels in serum of observation group were lower than those of control group; TGF-β1 and Smad2/3 protein expression in renal tissue of observation group were lower than those of control group while Smad7 and BMP-7 protein expression were higher than those of control group. Conclusion: Calcium dobesilate combined with benazepril therapy can reduce the renal injury and inhibit the fibrosis process in patients with early diabetic nephropathy, and it

Association between polymorphism at 3 ׳UTR of urokinase gene and risk of calcium

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S. Morovvati

2016-06-01

Full Text Available Background: Kidney stone is a common multifactorial disease in Iran. Environmental and genetic factors including single nucleotide polymorphism (SNP affect the incidence of kidney stones. Objective: The aim of this study was to determine the association of +4065 T/C polymorphism at 3′untranslated region (3'UTR of urokinase gene and calcium kidney stones. Methods: This case-control study was conducted on 70 patients with history of calcium kidney stones as case group and 70 healthy subjects as control group in the Baqiyatallah hospital in 2013. The polymorphism was assessed using the Allele Specific PCR (AS-PCR method. Allele and genotype frequencies of the two groups were compared using 2x2 contingency tables. Hardy-Weinberg equilibrium was compared between the two groups using Chi-square test. Findings: Of 70 cases, 10 (15% were heterozygous and 24 (34% were homozygous for the polymorphism. Of 70 controls, 25 (35% were heterozygous for the polymorphism. The frequency of mutant T allele was 41% in the case group and 18% in the control group. The frequency of mutant C allele was 59% in the case group and 82% in the control group. The risk of calcium kidney stones in carriers of the mutant allele was 1.7 times higher than non-carriers (OR: 1.7. Conclusion: With regards to the results, it seems that there is a significant association between the polymorphism at 3 ׳UTR of urokinase gene and formation of calcium kidney stones. Urokinase gene polymorphism may be introduced as a candidate gene involved in calcium stone formation.

[Massive residual stones after ESWL for staghorn cystine calculi were completely dissolved by oral administration of alkaline citrate: a case report].

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Nagashima, Masazumi; Udagawa, Koichi; Fujinami, Kiyoshi; Murai, Tetsuo; Noguchi, Kazumi

2007-11-01

A 62-year-old woman was referred to our hospital for bilateral renal stones. Ultrasonography (US) and computed tomography (CT) revealed bilateral staghorn calculi and atrophic left kidney. She had extracorporeal shock-wave lithotripsy (ESWL) for right renal stone during the first 6 months. However, ESWL was not effective and the patient did not want to continue this treatment. Her stone was composed of cystine. We started oral administration of alkaline citrate. Then massive residual stones were completely dissolved during the next 32 months.

A huge bladder calculus causing acute renal failure.

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Komeya, Mitsuru; Sahoda, Tamami; Sugiura, Shinpei; Sawada, Takuto; Kitami, Kazuo

2013-02-01

A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

Trends in urological stone disease.

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Turney, Benjamin W; Reynard, John M; Noble, Jeremy G; Keoghane, Stephen R

2012-04-01

To summarize the changes in prevalence and treatment of upper urinary tract stone disease in the UK over the last 10 years. Data from the Hospital Episode Statistics (HES) website (http://www.hesonline.nhs.uk) were extracted, summarized and presented. The number of upper urinary tract stone hospital episodes increased by 63% to 83,050 in the 10-year period. The use of shock wave lithotripsy (SWL) for treating all upper tract stones increased from 14,491 cases in 2000-2001 to 22,402 cases in 2010 (a 55% increase) with a 69% increase in lithotripsy for renal stones. There was a 127% increase in the number of ureteroscopic stone treatments from 6,283 to 14,242 cases over the 10-year period with a 49% increase from 2007/2008 to 2009/2010. There was a decline in open surgery for upper tract stones from 278 cases in 2000/2001 to 47 cases in 2009/2010 (an 83% reduction). Treatment for stone disease has increased substantially in comparison with other urological activity. In 2009/2010, SWL was performed almost as frequently as transurethral resection of the prostate or transurethral resection of bladder tumour, ureteroscopy for stones was performed more frequently than nephrectomy, radical prostatectomy and cystectomy combined, and percutaneous nephrolithotomy was performed more frequently than cystectomy. The present study highlights the increase in prevalence and treatment of stone disease in the UK over the last 10 years. If this trend continues it has important implications for workforce planning, training, service delivery and research in the field of urolithiasis. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers.

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Turney, Benjamin; Robertson, William; Wiseman, Oliver; Amaro, Carmen Regina P R; Leitão, Victor A; Silva, Isabela Leme da; Amaro, João Luiz

2014-01-01

The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers. Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF 0.5) during both assessments. The PSF score reduced following medical treatment in the majority of patients in this cohort.

Use of the probability of stone formation (PSF score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

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Benjamin Turney

2014-08-01

Full Text Available Introduction The aim was to confirm that PSF (probability of stone formation changed appropriately following medical therapy on recurrent stone formers. Materials and Methods Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. Results At baseline, 20 of the 26 patients (77% had a high PSF score (> 0.5. Of the 26 patients, 17 (65% showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42% changed from a high risk (PSF > 0.5 to a low risk (PSF 0.5 during both assessments. Conclusions The PSF score reduced following medical treatment in the majority of patients in this cohort.

Management of complete staghorn stone in a developing country

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Anant Kumar

2002-01-01

Renal failure patients had higher clearance rates with open procedures compared to PNL (80% vs 62.5% respec-tively. Moreover these patients had higher incidence of major bleeding with PNL compared to open procedures (31.3% vs 10%. Conclusions: Advantages of endourological procedures in the management of staghorn stones is offset by the need of ancillary treatments, which are expensive and which require frequent visits to the hospital. In view of high clear-ance rates, lesser treatment cost and lesser incidence of complications, open surgery still has a place in the man-agement of staghorn renal stones in patients who have economic constraints and live in remote areas where medi-cal facilities are not freely available. These advantages are also seen in the renal failure patients where complica-tions with endourologic procedures were significantly more than that with open surgery. However postoperative mor-bidity and larger scar should be discussed with the pa-tients.

Evaluating factors that dictate struvite stone composition: A multi-institutional clinical experience from the EDGE Research Consortium

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Battison, Andrew; De, Shubha; Humphreys, Mitchell R.; Bader, Markus; Lellig, Ekaterina; Monga, Manoj; Chew, Ben H.; Lange, Dirk

2018-01-01

Introduction Struvite stones account for 15% of urinary calculi and are typically associated with urease-producing urinary tract infections and carry significant morbidity. This study aims to characterize struvite stones based on purity of stone composition, bacterial speciation, risk factors, and clinical features. Methods Retrospective data was collected from patients diagnosed with infection stones between 2008 and 2012. Stone analysis, perioperative urine cultures, bacterial speciation, and clinical data were collected and analyzed. The purity of struvite stones was determined. Statistical comparisons were made among homogeneous and heterogeneous struvite stones. Results From the four participating centres, 121 struvite stones were identified. Only 13.2% (16/121) were homogenous struvite. Other components included calcium phosphate (42.1%), calcium oxalate (33.9%), calcium carbonate (27.3%), and uric acid (5.8%). Partial or full staghorn calculi occurred in 23.7% of cases. Urease-producing bacteria were only present in 30% of cases. Proteus, E. coli, and Enterococcus were the most common bacterial isolates from perioperative urine, and percutaneous nephrolithotomy was the most common modality of treatment. Only 40% of patients had a urinalysis that was nitrite-positive, indicating that urinalysis alone is not reliable for diagnosing infection stones. The study’s limitation is its retrospective nature; as such, the optimal timing of cultures with respect to stone analysis or treatment was not always possible, urine cultures were often not congruent with stone cultures in the same patient, and our findings of E. coli commonly cultured does not suggest causation. Conclusions Struvite stones are most often heterogeneous in composition. Proteus remains a common bacterial isolate; however, E. coli and Enterococcus were also frequently identified. This new data provides evidence that patients with struvite stones can have urinary tract pathogens other than urease

Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy.

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Ozgor, Faruk; Kucuktopcu, Onur; Sarılar, Omer; Toptas, Mehmet; Simsek, Abdulmuttalip; Gurbuz, Zafer Gokhan; Akbulut, Mehmet Fatih; Muslumanoglu, Ahmet Yaser; Binbay, Murat

2015-11-01

In this study, we aim to evaluate the effectiveness and safety of PNL in patients with a history of open renal surgery or PNL by comparing with primary patients and to compare impact of previous open renal surgery and PNL on the success and complications of subsequent PNL. Charts of patients, who underwent PNL at our institute, were analyzed retrospectively. Patients were divided into three groups according to history of renal stone surgery. Patients without history of renal surgery were enrolled into Group 1. Other patients with previous PNL and previous open surgery were categorized as Group 2 and Group 3. Preoperative characteristic, perioperative data, stone-free status, and complication rates were compared between the groups. Stone-free status was accepted as completing clearance of stone and residual fragment smaller than 4 mm. Eventually, 2070 patients were enrolled into the study. Open renal surgery and PNL had been done in 410 (Group 2) and 131 (Group 3) patients, retrospectively. The mean operation time was longer (71.3 ± 33.5 min) in Group 2 and the mean fluoroscopy time was longer (8.6 ± 5.0) in Group 3 but there was no statistically significant difference between the groups. Highest stone clearance was achieved in primary PNL patients (81.62%) compared to the other groups (77.10% in Group 2 and 75.61% in Group 3). Stone-free rate was not significantly different between Group 2 and Group 3. Fever, pulmonary complications, and blood transfusion requirement were not statically different between groups but angioembolization was significantly higher in Group 2. Percutaneous nephrolithotomy is a safe and effective treatment modality for patients with renal stones regardless history of previous PNL or open renal surgery. However, history of open renal surgery but not PNL significantly reduced PNL success.

A multi-reader in vitro study using porcine kidneys to determine the impact of integrated circuit detectors and iterative reconstruction on the detection accuracy, size measurement, and radiation dose for small (<4 mm) renal stones.

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Wells, Michael L; Froemming, Adam T; Kawashima, Akira; Vrtiska, Terri J; Kim, Bohyun; Hartman, Robert P; Holmes, David R; Carter, Rickey E; Bartley, Adam C; Leng, Shuai; McCollough, Cynthia H; Fletcher, Joel G

2017-08-01

Background Detection of small renal calculi has benefitted from recent advances in computed tomography (CT) scanner design. Information regarding observer performance when using state-of-the-art CT scanners for this application is needed. Purpose To assess observer performance and the impact of radiation dose for detection and size measurement of <4 mm renal stones using CT with integrated circuit detectors and iterative reconstruction. Material and Methods Twenty-nine <4 mm calcium oxalate stones were randomly placed in 20 porcine kidneys in an anthropomorphic phantom. Four radiologists used a workstation to record each calculus detection and size. JAFROC Figure of Merit (FOM), sensitivity, false positive detections, and calculus size were calculated. Results Mean calculus size was 2.2 ± 0.7 mm. The CTDI vol values corresponding to the automatic exposure control settings of 160, 80, 40, 25, and 10 Quality Reference mAs (QRM) were 15.2, 7.9, 4.2, 2.7, and 1.3 mGy, respectively. JAFROC FOM was ≥ 0.97 at ≥ 80 QRM, ≥ 0.89 at ≥ 25 QRM, and was inferior to routine dose (160 QRM) at 10 QRM (0.72, P < 0.05). Per-calculus sensitivity remained ≥ 85% for every reader at ≥ 25 QRM. Mean total false positive detections per reader were ≤ 3 at ≥ 80 QRM, but increased substantially for two readers ( ≥ 12) at ≤ 40 QRM. Measured calculus size significantly decreased at ≤ 25 QRM ( P ≤ 0.01). Conclusion Using low dose renal CT with iterative reconstruction and ≥ 25 QRM results in high sensitivity, but false positive detections increase for some readers at very low dose levels (≤ 40 QRM). At very low doses with iterative reconstruction, measured calculus size will artifactually decrease.

Disappearing renal calculus.

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Cui, Helen; Thomas, Johanna; Kumar, Sunil

2013-04-10

We present a case of a renal calculus treated solely with antibiotics which has not been previously reported in the literature. A man with a 17 mm lower pole renal calculus and concurrent Escherichia coli urine infection was being worked up to undergo percutaneous nephrolithotomy. However, after a course of preoperative antibiotics the stone was no longer seen on retrograde pyelography or CT imaging.

Expression of Trans- and Paracellular Calcium and Magnesium Transport Proteins in Renal and Intestinal Epithelia During Lactation

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Beggs, Megan R; Appel, Ida; Svenningsen, Per

2017-01-01

Significant alterations in maternal calcium (Ca2+) and magnesium (Mg2+) balance occur during lactation. Ca2+ is the primary divalent cation mobilized into breast milk by demineralization of the skeleton and alterations in intestinal and renal Ca2+ transport. Mg2+ is also concentrated in breast milk...

Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy.

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Lin, Chih-Chieh; Hsu, Yen-Shen; Chen, Kuang-Kuo

2008-10-01

This study was carried out to determine whether or not there is a significant relationship between the radiologic anatomy of the lower calyx, as seen on preoperative intravenous urography (IVU), and the outcome of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for lower renal calyceal stones. Between June 1998 and April 2007, 112 patients with a solitary lower renal calyceal stone measuring 20 mm or less in size were enrolled in this retrospective study. Pretreatment IVU was reviewed for measuring the anatomical predictors, such as lower pole infundibular length, infundibular width (IW) and infundibulopelvic angle, while the stone location and size were determined on plain abdominal X-ray. All patients were treated with ESWL using a Siemens Lithostar Plus lithotriptor and were followed-up for the outcome of stone clearance 3 months after ESWL with plain abdominal X-ray films and ultrasonography. Three months after ESWL, only 49 (43.7%) patients were stone-free. Under multivariate analysis with logistic regression, smaller stone size (10 mm or less, p = 0.005) and greater IW (4 mm or more, p = 0.029) were significant favourable predictors for better stone clearance. In addition to the influence of stone size, lower pole anatomy, especially IW, has a significant impact on stone clearance for lower calyceal stone after ESWL.

Chemical composition and binary mixture of human urinary stones using FT-Raman spectroscopy method.

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Selvaraju, R; Raja, A; Thiruppathi, G

2013-10-01

In the present study the human urinary stones were observed in their different chemical compositions of calcium oxalate monohydrate, calcium oxalate dihydrate, calcium phosphate, struvite (magnesium ammonium phosphate), uric acid, cystine, oxammite (ammonium oxalate monohydrate), natroxalate (sodium oxalate), glushinkite (magnesium oxalate dihydrate) and moolooite (copper oxalate) were analyzed using Fourier Transform-Raman (FT-Raman) spectroscopy. For the quantitative analysis, various human urinary stone samples are used for ratios calculation of binary mixtures compositions such as COM/COD, HAP/COD, HAP/COD, Uric acid/COM, uric acid/COD and uric acid/HAP. The calibration curve is used for further analysis of binary mixture of human urinary stones. For the binary mixture calculation the various intensities bands at 1462 cm(-1) (I(COM)), 1473 cm(-1) (I(COD)), 961 cm(-1) (I(HAP)) and 1282 cm(-1) (I(UA)) were used. Copyright © 2013 Elsevier B.V. All rights reserved.

Evolution of stone management in Australia.

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Lee, Ming-Chak; Bariol, Simon Virgil

2011-11-01

What's known on the subject? and What does the study add? There is very little contemporary data regarding stone management in Australia. This study assesses the impact of technological advances on stone management practises, and raises questions as to why there is an increasing rate of intervention for stone disease in Australia. Knowledge of management trends as demonstrated in this paper give individual surgeons a guideline for contemporary practise in this country. • To examine trends in the operative management of upper urinary tract stone disease in Australia over the past 15 years. • The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of renal colic presentations and procedural interventions undertaken for stone disease. • In Australia over the past 15 years, the annual number of procedural interventions for upper urinary tract stones has increased, primarily due to the rising number of endoscopic procedures performed. • During this period, shock wave lithotripsy numbers have remained steady whilst open and percutaneous procedures have been in decline. • The introduction of and subsequent preference for less invasive techniques has changed the management pathway of patients presenting with stone disease in Australia. • Further studies are necessary to determine whether this escalation in endoscopic procedures is due to an increase in the incidence of stone disease, earlier detection, a lower intervention threshold or a higher retreatment rate. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Shock wave lithotripsy outcomes for lower pole and non-lower pole stones from a university teaching hospital: Parallel group comparison during the same time period

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Geraghty, Robert; Burr, Jacob; Simmonds, Nick; Somani, Bhaskar K.

2015-01-01

Introduction: Shock wave lithotripsy (SWL) is a treatment option for all locations of renal and ureteric stones. We compared the results of SWL for lower pole renal stones with all other non-lower pole renal and ureteric stones during the same time period. Material and Methods: All SWL procedures were carried out as day case procedures by a mobile lithotripter from January 2012 to August 2013. The follow-up imaging was a combination of KUB X-ray or USS. Following SWL treatment, the stone free rate (SFR) was defined as ≤3 mm fragments. Results: A total of 148 patients with a mean age of 62 years underwent 201 procedures. Of the 201 procedures, 93 (46%) were for lower pole stones. The non-lower pole stones included upper pole (n = 36), mid pole (n = 40), renal pelvis (n = 10), PUJ (n = 8), mid ureter (n = 3), upper ureter (n = 5) and a combination of upper, middle and/or lower pole (n = 6). The mean stone size for lower pole stones (7.4 mm; range: 4-16 mm) was slightly smaller than non-lower pole stones (8 mm; range: 4-17 mm). The stone fragmentation was successful in 124 (62%) of patients. However, the SFR was statistically significantly better (P = 0.023) for non-lower pole stones 43 (40%) compared to lower pole stones 23 (25%). There were 9 (4%) minor complications and this was not significantly different in the two groups. Conclusions: Although SWL achieves a moderately high stone fragmentation rate with a low complication rate, the SFR is variable depending on the location of stone and the definition of SFR, with lower pole stones fairing significantly worse than stones in all other locations. PMID:25657543

Calcium and vitamin D in post menopausal women

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Sameer Aggarwal

2013-01-01

Full Text Available Calcium and Vitamin D are widely used therapies for Osteoporosis. Vitamin D is not a vitamin in true sense since it is produced in response to the action of sunlight on skin. Vitamin D has multiple roles in the body, not all of them well-understood. Vitamin D supplementation must be considered a form of hormone replacement therapy. Therefore it raises all the questions about efficacy, dose, and side effects. The Efficacy of use of Calcium and Vitamin D in all post menopausal women in terms of the prevention of fracture is uncertain. The Annual worldwide sales of these supplements have been several billion dollars. The variation of the results from various studies of Calcium and Vitamin D supplementation in elderly women suggest that benefit of calcium plus vitamin D on bone mineral density or the risk of fracture is small and may vary from group to group and baseline Vitamin D status. Women taking supplemental vitamin D and calcium have a statistically increased incidence of renal stones, according to evidence from the Women′s Health Initiative. Studies have shown association between calcium use and increased risk for cardiovascular disease. In a recent review of evidence from 6 randomized trials evaluating the use of vitamin D and calcium to prevent fractures in postmenopausal women who are not living in a nursing home or other institution, the United States Preventive Task Force (USPTF found no evidence of a benefit from supplementation with 400 IU or less of vitamin D3 and 1000 mg or less of calcium. Also in a report from institute of Medicine Committee, there was insufficient evidence, particularly from randomized trials, that vitamin D treatment affected the risk of non skeletal outcomes like risk of cancer, cardiovascular disease, diabetes, infections, autoimmune disease, and other extra skeletal outcomes.

Combined use of flexible ureteroscopic lithotripsy with micro-percutaneous nephrolithotomy in pediatric multiple kidney stones.

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Li, Jun; Wang, Wenying; Du, Yuan; Tian, Ye

2018-03-28

We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1-8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F "all-seeing needle" with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30-70 min). The mean volume of irrigation fluid used was 480 mL (range 300-1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0-0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2-5 days). Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases. Copyright © 2018

Meier–Gorlin syndrome: An additional Egyptian patient with gastroesophageal reflux, hydronephrosis, renal stones and hypoplastic labia majora and minora with clitromegaly

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Rabah M. Shawky

2016-10-01

Full Text Available We report a 4.5 year old female child with the classical triad of Meier–Gorlin syndrome (microtia, absent patella and short stature with normal mentality. She had small triangular face, long peaked nose, high nasal bridge, bilateral low set very small ears (microtia, retromicrognathia, high arched palate, maxillary hypoplasia, decayed teeth, and bilateral partial syndactyly between 2nd and 3rd toes. Our patient had a gastroesophageal reflux, renal stones, hydronephrosis and hypoplastic labia majora and minora with clitromegaly.

Effects of dietary carbohydrates on metabolism of calcium and other minerals in normal subjects and patients with noninsulin-dependent diabetes mellitus.

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Garg, A; Bonanome, A; Grundy, S M; Unger, R H; Breslau, N A; Pak, C Y

1990-04-01

Transient hypercalciuria has been noted after high carbohydrate meals which is independent of dietary calcium and is probably due to impaired renal calcium reabsorption mediated by an increase in plasma insulin levels. Based on these observations, some investigators believe that long term intake of high carbohydrate diets may increase the risk of nephrolithiasis and possibly osteoporosis. Using a randomized cross-over design, we compared high carbohydrate diets (60% carbohydrate and 25% fat) with high fat diets (50% fat and 35% carbohydrate) for effects on metabolism of calcium and other minerals in eight normal subjects and eight euglycemic patients with noninsulin-dependent diabetes mellitus. All other dietary constituents, such as protein, fiber, fluid, minerals (including Ca, Mg, Na, K, and P), and caffeine intake, were kept constant. Despite higher daylong levels of plasma insulin on the high carbohydrate diets compared to the high fat diet in both normal and noninsulin-dependent diabetic subjects, no changes in daily urinary excretion of calcium or other constituents, associated with renal stone risk, were observed. Furthermore, there was no change in fractional intestinal 47Ca absorption. Although hypercalciuria may ensue transiently after high carbohydrate meals, we conclude that substitution of simple or complex carbohydrates for fats in an isocaloric manner for a longer duration does not result in significant urinary calcium loss, and therefore, high intakes of digestible carbohydrates may not increase the risk of nephrolithiasis or osteoporosis via this mechanism.

Effects of acid deposition on dissolution of carbonate stone during summer storms in the Adirondack Mountains, New York, 1987-89

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Schuster, Paul F.; Reddy, Michael M.; Sherwood, S.I.

1994-01-01

This study is part of a long-term research program designed to identify and quantify acid rain damage to carbonate stone. Acidic deposition accelerates the dissolution of carbonate-stone monuments and building materials. Sequential sampling of runoff from carbonate-stone (marble) and glass (reference) microcatchments in the Adirondack Mountains in New York State provided a detailed record of the episodic fluctuations in rain rate and runoff chemistry during individual summer storms. Rain rate and chemical concentrations from carbonate-stone and glass runoff fluctuated three to tenfold during storms. Net calcium-ion concentrations from the carbonatestone runoff, a measure of stone dissolution, typically fluctuated twofold during these storms. High net sulfate and net calcium concentrations in the first effective runoff at the start of a storm indicated that atmospheric pollutants deposited on the stone surface during dry periods formed calcium sulfate minerals, an important process in carbonate stone dissolution. Dissolution of the carbonate stone generally increased up to twofold during coincident episodes of low rain rate (less than 5 millimeters per hour) and decreased rainfall (glass runoff) pH (less than 4.0); episodes of high rain rate (cloudbursts) were coincident with a rapid increase in rainfall pH and also a rapid decrease in the dissolution of carbonate-stone. During a storm, it seems the most important factors causing increased dissolution of carbonate stone are coincident periods of low rain rate and decreased rainfall pH. Dissolution of the carbonate stone decreased slightly as the rain rate exceeded about 5 millimeters per hour, probably in response to rapidly increasing rainfall pH during episodes of high rain rate and shorter contact time between the runoff and the stone surface. High runoff rates resulting from cloudbursts remove calcium sulfate minerals formed during dry periods prior to storms and also remove dissolution products formed in large

A case–control study on environmental and biological risk factors for renal calculi persisting in a coastal Union Territory, India

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Prakash Mathiyalagen

2017-01-01

Full Text Available Background and Objectives: Renal stone disease is a common disorder of the urinary tract and also a significant problem because of incidence, recurrence, and severe consequences. The complex pathogenetic mechanisms of renal stone formation involve both biologic and environmental risk factors. The present study was performed to identify the role of these parameters among renal stone patients and normal individuals from a coastal union territory region in South India. Methods: The authors conducted a case–control study of renal stone disease among outpatient department patients more than 30 years of age using systematic random sampling procedure with 100 study participants (50 subjects for each group. A questionnaire to explore some relevant history as well as to note general examination findings was used along with a house visit to collect a sample of water. Analysis was undertaken using appropriate statistical techniques. Results: The study showed statistically significant association for renal stones with female sex, illiteracy, body mass index (BMI (>25 kg/m2, sodium (>50 mg/L, water consumption (<1.5 L/day, water source being borewell, consuming soft drink, sedentary work, and family history of renal stones. The adjusted odds ratios (ORs were significantly higher for consuming soft drink (OR: 8.19; 95% confidence interval: 1.99–33.69, sedentary work (10.01; 1.27–78.91, and water consumption < 1.5 L/day (7.73; 2.24–26.69. Interpretation and Conclusions: We conclude that in this part of India, female gender, illiteracy, high BMI, high sodium in drinking water, inadequate water consumption, borewell drinking water, soft-drink consumption, sedentary work, and family history of renal stones can lead to a significant increase in the risk of renal stone disease.

Renal rickets-practical approach

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Sahay, Manisha; Sahay, Rakesh

2013-01-01

Rickets/osteomalacia is an important problem in a tropical country. Many cases are due to poor vitamin D intake or calcium deficient diets and can be corrected by administration of calcium and vitamin D. However, some cases are refractory to vitamin D therapy and are related to renal defects. These include rickets of renal tubular acidosis (RTA), hypophosphatemic rickets, and vitamin D dependent rickets (VDDR). The latter is due to impaired action of 1α-hydroxylase in renal tubule. These varieties need proper diagnosis and specific treatment. PMID:24251212

Vitamin D receptor gene Alw I, Fok I, Apa I, and Taq I polymorphisms in patients with urinary stone.

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Seo, Ill Young; Kang, In-Hong; Chae, Soo-Cheon; Park, Seung Chol; Lee, Young-Jin; Yang, Yun Sik; Ryu, Soo Bang; Rim, Joung Sik

2010-04-01

To evaluate vitamin D receptor (VDR) gene polymorphisms in Korean patients so as to identify the candidate genes associated with urinary stones. Urinary stones are a multifactorial disease that includes various genetic factors. A normal control group of 535 healthy subjects and 278 patients with urinary stones was evaluated. Of 125 patients who presented stone samples, 102 had calcium stones on chemical analysis. The VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms were evaluated using the polymerase chain reaction-restriction fragment length polymorphism analysis. Allelic and genotypic frequencies were calculated to identify associations in both groups. The haplotype frequencies of the VDR gene polymorphisms for multiple loci were also determined. For the VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms, there was no statistically significant difference between the patients with urinary stones and the healthy controls. There was also no statistically significant difference between the patients with calcium stones and the healthy controls. A novel haplotype (Ht 4; CTTT) was identified in 13.5% of the patients with urinary stones and in 8.3% of the controls (P = .001). The haplotype frequencies were significantly different between the patients with calcium stones and the controls (P = .004). The VDR gene Alw I, Fok I, Apa I, and Taq I polymorphisms does not seem to be candidate genetic markers for urinary stones in Korean patients. However, 1 novel haplotype of the VDR gene polymorphisms for multiple loci might be a candidate genetic marker. Copyright 2010 Elsevier Inc. All rights reserved.

Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic.

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Leo, Megan M; Langlois, Breanne K; Pare, Joseph R; Mitchell, Patricia; Linden, Judith; Nelson, Kerrie P; Amanti, Cristopher; Carmody, Kristin A

2017-06-01

Supporting an "ultrasound-first" approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events. This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed. We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis ( x 2 =51.7, pHydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR- 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03). Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

Laterality of Symptomatic Recurrent Calcium Nephrolithiasis | Ketata ...

African Journals Online (AJOL)

Objective: Although it is presumed that both kidneys excrete similar urinary constituents, it is a general observation that the majority of patients present with unilateral stone disease. The aim of this work was to study the laterality of recurrence in calcium stone formers. Patients and Methods: In a retrospective study of 154 ...

Renal manifestations of primary hyperparathyroidism

OpenAIRE

Lila, Anurag Ranjan; Sarathi, Vijaya; Jagtap, Varsha; Bandgar, Tushar; Menon, Padma S.; Shah, Nalini Samir

2012-01-01

Primary hyperparathyroidism (PHPT) is associated with nephrolithiasis and nephrocalcinosis. Hypercalciuria is one of the multiple factors that is implicated in the complex pathophysiology of stone formation. The presence of a renal stone (symptomatic or asymptomatic) categorizes PHPT as symptomatic and is an indication for parathyroid adenomectomy. Progression of nephrocalcinosis is largely reversible after successful surgery, but the residual risk persists. PHPT is also associated with decli...

Effect of diuretics on renal tubular transport of calcium and magnesium.

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Alexander, R Todd; Dimke, Henrik

2017-06-01

Calcium (Ca 2+ ) and Magnesium (Mg 2+ ) reabsorption along the renal tubule is dependent on distinct trans- and paracellular pathways. Our understanding of the molecular machinery involved is increasing. Ca 2+ and Mg 2+ reclamation in kidney is dependent on a diverse array of proteins, which are important for both forming divalent cation-permeable pores and channels, but also for generating the necessary driving forces for Ca 2+ and Mg 2+ transport. Alterations in these molecular constituents can have profound effects on tubular Ca 2+ and Mg 2+ handling. Diuretics are used to treat a large range of clinical conditions, but most commonly for the management of blood pressure and fluid balance. The pharmacological targets of diuretics generally directly facilitate sodium (Na + ) transport, but also indirectly affect renal Ca 2+ and Mg 2+ handling, i.e., by establishing a prerequisite electrochemical gradient. It is therefore not surprising that substantial alterations in divalent cation handling can be observed following diuretic treatment. The effects of diuretics on renal Ca 2+ and Mg 2+ handling are reviewed in the context of the present understanding of basal molecular mechanisms of Ca 2+ and Mg 2+ transport. Acetazolamide, osmotic diuretics, Na + /H + exchanger (NHE3) inhibitors, and antidiabetic Na + /glucose cotransporter type 2 (SGLT) blocking compounds, target the proximal tubule, where paracellular Ca 2+ transport predominates. Loop diuretics and renal outer medullary K + (ROMK) inhibitors block thick ascending limb transport, a segment with significant paracellular Ca 2+ and Mg 2+ transport. Thiazides target the distal convoluted tubule; however, their effect on divalent cation transport is not limited to that segment. Finally, potassium-sparing diuretics, which inhibit electrogenic Na + transport at distal sites, can also affect divalent cation transport. Copyright © 2017 the American Physiological Society.

Impact of stone branch number on outcomes of percutaneous nephrolithotomy for treatment of staghorn calculi.

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Qi, Shiyong; Li, Li; Liu, Ranlu; Qiao, Baomin; Zhang, Zhihong; Xu, Yong

2014-02-01

To determine the impact of staghorn calculi branch number on outcomes of percutaneous nephrolithotomy (PNL). Retrospectively, we evaluated 371 patients (386 renal units) who underwent PNL for staghorn calculi. All calculi were showed with CT three-dimensional reconstruction (3DR) imaging preoperatively. From 3DR images, the number of stone branching into minor renal calices was recorded. According to the number, patients were divided into four groups. Group 1: the branch number 2-4; Group 2: the branch number 5-7; Group 3: the branch number 8-10; Group 4: the branch number >10. The number of percutaneous tract, operative time, staged PNL, intraoperative blood loss, postoperative hospital stay, complications, main stone composition, and stone clearance rate were compared. A significantly higher ratio of multitract (pPNL (pPNL for calculi with a stone branch number ≥5. There was no statistical difference in intraoperative blood loss (p=0.101) and main stone composition (p=0.546). There was no statistically meaningful difference among the four groups based on the Clavien complication system (p=0.46). With the stone branch number more than five, the possibility of multitract and staged PNL, lower rate of stone clearance, and a longer postoperative hospital stay increases for staghorn calculi.

Ultrasound vs. Computed Tomography for Severity of Hydronephrosis and Its Importance in Renal Colic

Directory of Open Access Journals (Sweden)

Megan M. Leo

2017-05-01

Full Text Available Introduction: Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP ultrasound to computed tomography (CT detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events. Methods: This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed. Results: We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis ( x 2=51.7, p5mm less likely (NPV 89%; LR− 0.39. Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03. Conclusion: Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

Nanoscale observations of the effect of citrate on calcium oxalate precipitation on calcite surfaces.

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Burgos-Cara, Alejandro; Ruiz-Agudo, Encarnacion; Putnis, Christine V.

2016-04-01

Calcium oxalate (CaC2O4ṡxH2O) minerals are naturally occurring minerals found in fossils, plants, kidney stones and is a by-product in some processes such as paper, food and beverage production [1,2]. In particular, calcium oxalate monohydrate phase (COM) also known as whewellite (CaC2O4ṡH2O), is the most frequently reported mineral phase found in urinary and kidney stones together with phosphates. Organic additives are well known to play a key role in the formation of minerals in both biotic and abiotic systems, either facilitating their precipitation or hindering it. In this regard, recent studies have provided direct evidence demonstrating that citrate species could enhance dissolution of COM and inhibit their precipitation. [3,4] The present work aims at evauate the influence of pH, citrate and oxalic acid concentrations in calcium oxalate precipitation on calcite surfaces (Island Spar, Chihuahua, Mexico) through in-situ nanoscale observation using in situ atomic force microscopy (AFM, Multimode, Bruker) in flow-through experiments. Changes in calcium oxalate morphologies and precipitated phases were observed, as well as the inhibitory effect of citrate on calcium oxalate precipitation, which also lead to stabilization an the amorphous calcium oxalate phase. [1] K.D. Demadis, M. Öner, Inhibitory effects of "green"additives on the crystal growth of sparingly soluble salts, in: J.T. Pearlman (Ed.), Green Chemistry Research Trends, Nova Science Publishers Inc., New York, 2009, pp. 265-287. [2] M. Masár, M. Zuborová, D. Kaniansky, B. Stanislawski, Determination of oxalate in beer by zone electrophoresis on a chip with conductivity detection, J. Sep. Sci. 26 (2003) 647-652. [3] Chutipongtanate S, Chaiyarit S, Thongboonkerd V. Citrate, not phosphate, can dissolve calcium oxalate monohydrate crystals and detach these crystals from renal tubular cells. Eur J Pharmacol 2012;689:219-25. [4] Weaver ML, Qiu SR, Hoyer JR, Casey WH, Nancollas GH, De Yoreo JJ

Packing of Renal Fossa: Useful Technique for Intractable Bleeding ...

African Journals Online (AJOL)

There is no documented study to indicate the role of prolonged packing of renal fossa (24 to 48 hours) to control bleeding in life threating haemorrhage following open pyelolithotomy without compromise in the renal functions. On the contrary emergency nephrectomy was performed for intractable bleeding during renal stone ...

Single Large Bladder Stone in a Young Male Adult with Primary Hyperparathyroidism

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Omar Halalsheh

2017-07-01

Full Text Available Bladder stones are caused when minerals are built up in the bladder, especially if the bladder is incompletely emptied. These stones will pass while they are small. Otherwise, they get stuck to the bladder wall or ureter. If this happens, they gradually gather more mineral crystals, becoming larger over time. Primary hyperparathyroidism is usually caused by a tumor within the parathyroid gland, and elevated calcium levels can cause digestive symptoms, psychiatric abnormalities, bone disease and multiple kidney stones.

Childhood bladder stones-an endemic disease of developing countries

International Nuclear Information System (INIS)

Lal, B.

2015-01-01

Bladder calculi are one of the commonest health problems in young children especially in rural and underprivileged areas. Methods: All children of bladder stones operated at District Headquarter Hospital Mithi from July 2009 to June 2012 were included in this cross-sectional study. Data was collected regarding age, sex, address (rural or urban), body weight, duration of breast feeding, weaning, detailed dietary history regarding milk type, volume, amount of water intake, recurrent diarrhoea, urinary tract infection (UTI), family history, and socioeconomic history. Urine analysis, complete blood count (CBC), renal function, ultra sound abdomen, X-ray kidney, ureter, and bladder (KUB) was done in all patients. All patients had cystolithotomy and were followed up till complete recovery. Results: A total of 113 children (97 males and 16 females) operated at District Headquarter Hospital Mithi Tharparker were included in study. All patients belonged to local desert areas of Tharparker. Age ranged from 18 months to 14 year (mean age 8.6 year). Most frequent symptom was difficulty in micturition in 76 (67.25%) patients, urinary retention in 18 (15.9%) and stone with pyuria and fever in 12 (10.6%) patients. Recurrent episodes of diarrhoea (more than 3 episodes per year) in 73(65%) patients, recurrent UTI in 51 (45.6%), family history of stone disease in 6 (5%) and associated rectal prolapse in 3(2.6%) patients. On x-ray KUB 111 (98%) patients had single stone in bladder, 2 (2%) had multiple stones and an associated renal and ureteric stone in 5 (4.5%). Mild anaemia (Hb 7-10 gm%) was seen in 35 (39.55%) patients, moderate anaemia (Hb 5-7 gm %) was seen in 21(24%) and severe anaemia (Hb less than 5 gm%) was seen in 14 (16%) patients. All patients had open cystolithotomy for removal of stones under general anaesthesia. Conclusion: Bladder stones are public health problem. Majority of affected patients were less than 5 years old. Low protein diet, dehydration, use of goat milk

The Effect of Tamsulosin in the Medical Treatment of Distal Ureteral Stones

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Alizadeh, M.; Magsudi, M.

2014-01-01

Introduction: Renal stones are common disorders that affect approximately 5% to 10% of the population and the incidence of renal stones is rising. Treatment of ureteral stones is an important part of urologists and minimally invasive procedures such as ESWL and ureteroscopy effectiveness has been proven in various studies. However, these methods are not completely safe and are expensive and can be complicated. Purpose of this study is to evaluate the effectiveness of tamsulosin in the medical treatment of distal ureteral stones. Patients and methods: A total of 96 patients with distal ureteral stones or UVj are randomly divided into two study group (50 patients) and control group (46 patients). Patients in the control group allowed to freely consuming fluids (hydration) and indomethacin 100 mg PRN. Study group in addition to indomethacin and daily analgesic 0.4 mg tamsulosin was administered. All subjects in terms of analgesic dose, duration of expulsion and expulsion were studied. Results: Spontaneous expulsion of stone was occurred in 62.5% (30 patients out of 46) of control group patients and 82% (41 patients out of 50) that there was no significant difference (P>0.05). Average time to fix the stone in control group 4.7±8.03 days (range 2 to 28 days) and in the study group, 3.7±5.70 days (range 1 to 23 days) is significantly different (P>0.05). The average amount of analgesic consumption in the control group was 2.3±4.31and in the study group was 1.48±2.15 that showed significant differences (Ptamsulosin to conservative treatment of distal ureteral stones in the distal ureteral stone expulsion showed no significant difference between the two groups, but the reduction in the duration of expulsion, reduce pain and reduce the need for analgesic has been beneficial. PMID:25363178

Clinical experience for radiolucent stones; A report of 27 cases

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Kim, Hyung Jee; Lee, Gil Ho [Dankook University, Seoul (Korea, Republic of)

1997-02-01

The cause of radiolucent filling defects in the upper urinary tract are malignant tumor, radiolucent stones, blood clots, air bubbles, congenital deformities of renal parenchyme, and various specific and non-specific infection and their sequence. So the differential diagnosis between malignancy and radiolucent stones is very important, and the exact and fast diagnosis of radiolucent stones is useful in excluding the possibility of malignancy. 27 cases with radiolucent stones were evaluated retrospectively for exact diagnosis and appropriate treatment method. Intravenous urography was done in all cases, and retrograde pyelography, ultrasonography, computed tomography and/or ureterorenoscopy were performed for diagnosis, if needed. Size of stones were measured below 10mm by transverse length in 19 cases (70.4%) with a range of 3 to 30mm. The locations of stones were pelvicalyceal system in 8 cases (29.6%) and ureter in 19 cases (70.4%). Among the diagnostic methods, computed tomography was used most frequency. ESWL with retrograde pyelography was most frequent used method of treatment, also simple hydration to small stone was effective. (author).

Clinical experience for radiolucent stones; A report of 27 cases

International Nuclear Information System (INIS)

Kim, Hyung Jee; Lee, Gil Ho

1997-01-01

The cause of radiolucent filling defects in the upper urinary tract are malignant tumor, radiolucent stones, blood clots, air bubbles, congenital deformities of renal parenchyme, and various specific and non-specific infection and their sequence. So the differential diagnosis between malignancy and radiolucent stones is very important, and the exact and fast diagnosis of radiolucent stones is useful in excluding the possibility of malignancy. 27 cases with radiolucent stones were evaluated retrospectively for exact diagnosis and appropriate treatment method. Intravenous urography was done in all cases, and retrograde pyelography, ultrasonography, computed tomography and/or ureterorenoscopy were performed for diagnosis, if needed. Size of stones were measured below 10mm by transverse length in 19 cases (70.4%) with a range of 3 to 30mm. The locations of stones were pelvicalyceal system in 8 cases (29.6%) and ureter in 19 cases (70.4%). Among the diagnostic methods, computed tomography was used most frequency. ESWL with retrograde pyelography was most frequent used method of treatment, also simple hydration to small stone was effective. (author)

Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants.

Science.gov (United States)

Younesi Rostami, Mehdi; Taghipour-Gorgikolai, Mehrdad; Sharifian, Rayka

2012-01-01

Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

Greco-Roman Stone Disease

Science.gov (United States)

Moran, Michael E.; Ruzhansky, Katherine

2008-09-01

Greek and Roman thought had a profound influence upon Western medical practice. From the fall of the Greek civilization to the fall of the Roman, remarkable progress of our understanding of human anatomy and physiology occurred. Here we review the attempts of Greek and Roman thinkers to develop the first understanding of the pathophysiology of urolithiasis, its epidemiology, differential diagnosis of renal versus bladder stones, medications for both colic and prevention, the role of familial syndromes, and dietary management.

[A case of ammonium urate urinary stones with anorexia nervosa].

Science.gov (United States)

Komori, K; Arai, H; Gotoh, T; Imazu, T; Honda, M; Fujioka, H

2000-09-01

A 27-year-old woman had been suffering from bulimia and habitual vomiting for about 7 years and was incidentally found to have right renal stones by computed tomography. She was referred to our hospital for the treatment of these caluculi. On admission, she presented with hypokalemia, hypochloremia and metabolic alkalosis and was diagnosed with anorexia nervosa. Following successful removal by percutaneous nephrolithotripsy and extracorporeal shockwave lithotripsy the stones were found to consist of pure ammonium urate. Since the urine of an anorexia nervosa patient tends to be rich in uric acid and ammonium, anorexia nervosa seems to be associated with ammonium urate urinary stones.

Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.

Directory of Open Access Journals (Sweden)

Mingchao Li

Full Text Available Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL, the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31, significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53, significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04, significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39. Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77, anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99 and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72 in the α-blocker group was associated with a higher incidence.Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.

Renal tissue damage induced by focused shock waves

Science.gov (United States)

Ioritani, N.; Kuwahara, M.; Kambe, K.; Taguchi, K.; Saitoh, T.; Shirai, S.; Orikasa, S.; Takayama, K.; Lush, P. A.

1990-07-01

Biological evidence of renal arterial wall damage induced by the microjet due to shock wave-cavitation bubble interaction was demonstrated in living dog kidneys. We also intended to clarify the mechanism of renal tissue damage and the effects of different conditions of shock wave exposure (peak pressure of focused area, number of shots, exposure rate) on the renal tissue damage in comparison to stone disintegration. Disruption of arterial wall was the most remarkable histological change in the focused area of the kidneys. This lesion appeared as if the wall had been punctured by a needle. Large hematoma formation in the renal parenchym, and interstitial hemorrhage seemed to be the results of the arterial lesion. This arterial disorder also led to ischemic necrosis of the tubules surrounding the hematoma. Micro-angiographic examination of extracted kidneys also proved such arterial puncture lesions and ischemic lesions. The number of shots required for model stone disintegration was not inversely proportional to peak pressure. It decreased markedly when peak pressure was above 700 bar. Similarly thenumber of shots for hematoma formation was not inversely proportional to peak pressure, however, this decreased markedly above 500 bar. These results suggested that a hematoma could be formed under a lower peak pressure than that required for stone disintegration.

COMPARATIVE STUDY OF CULTURE AND SENSITIVITY PATTERNS OF PRE OPERATIVE MID STREAM URINE WITH RENAL PELVIC URINE AND STONE TO PREDICT UROSEPSIS FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE CLINICAL STUDY

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Bhargava Vardhana Reddy

2015-11-01

Full Text Available INTRODUCTION : Percutaneous nephrolithotomy (PCNL is the most frequently performed surgery for stone disease at our institution. Nearly 100 PCNL procedures are being performed in a year at our institution. Septicemia following PCNL can be catastrophic despite sterile preoperative urine and prophylactic antibiotics. Infected stones, obstructed kidneys , and comorbidit y have been held responsible. In this study we analyzed various culture specimens, namely Mid - stream urine (MSU, renal pelvic urine and crushed stones. MATERIALS AND METHODS : We performed a prospective clinical study in all our patients undergoing PCNL b etween January 2013 and December 2014. MSU was sent for culture and sensitivity testing (C&S one day prior to surgery. Percutaneous access into the ipsilateral pelvicaliceal system is achieved under image intensification using a fine, 14 gauge Kellet need le. Urine from the pelvicaliceal system is first aspirated and sent as pelvic urine C&S. Stone fragments are collected to be proces0sed for C&S. The data collected were divided into 3 main groups, that is MSU C&S, pelvic urine C&S and stone C&S. RESULTS : A total of 83 patients were included in the study, of this MSU C&S was positive in 9/83 (10.8% patients, Pelvic C&S in 10 /73 (13.7% patients and Stone C&S in 25/83 (30.1% patients. Out of 25 cases of stone culture positive patients 17 patients develope d Systemic Inflammatory Response Syndrome (SIRS but only 2 patients developed SIRS in MSU C & S positive patients. CONCLUSIONS: The results of our study suggest that positive stone C&S is the better predictor of potential urosepsis than MSU. Stone cultur e is available only after surgery but appears to be the best guide for antibiotic therapy in case of sepsis. So the routine collection of stone for C&S will be beneficial

Predicting stone composition before treatment – can it really drive clinical decisions?

Science.gov (United States)

Bres–Niewada, Ewa; Radziszewski, Piotr

2014-01-01

Introduction Determination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL). Material and methods This short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings. Results Stone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques such as Dual–Energy CT or analysis of shape, density and homogeneity of stones on plain X–rays are used as promising methods of predicting stone composition and ESWL outcome. Conclusions New imaging techniques facilitate the identification of uric acid stones and ESWL–resistant stones. Therefore, they may help in selecting the best therapeutic option. PMID:25667761

Renal Osteodystrophy

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Aynur Metin Terzibaşoğlu

2004-12-01

Full Text Available Chronic renal insufficiency is a functional definition which is characterized by irreversible and progressive decreasing in renal functions. This impairment is in collaboration with glomeruler filtration rate and serum creatinine levels. Besides this, different grades of bone metabolism disorders develop in chronic renal insufficiency. Pathologic changes in bone tissue due to loss of renal paranchyme is interrelated with calcium, phosphorus vitamine-D and parathyroid hormone. Clinically we can see high turnover bone disease, low turnover bone disease, osteomalacia, osteosclerosis and osteoporosis in renal osteodystropy. In this article we aimed to review pathology of bone metabolism disorders due to chronic renal insufficiency, clinic aspects and treatment approaches briefly.

Parathyroid hormone secretion in chronic renal failure

DEFF Research Database (Denmark)

Madsen, J C; Rasmussen, A Q; Ladefoged, S D

1996-01-01

The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during....../ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure....

Parathyroid hormone secretion in chronic renal failure

DEFF Research Database (Denmark)

Madsen, J C; Rasmussen, A Q; Ladefoged, S D

1996-01-01

/ionized calcium curves were constructed, and a mean calcium set-point of 1.16 mmol/liter was estimated compared to the normal mean of about 1.13 mmol/liter. In conclusion, we demonstrate that it is important to use a standardized method to evaluate parathyroid hormone dynamics in chronic renal failure. By the use...... of a standardized method we show that the calcium set-point is normal or slightly elevated, indicating normal parathyroid reactivity to calcium in chronic renal failure.......The aim of study was to introduce and evaluate a method for quantifying the parathyroid hormone (PTH) secretion during hemodialysis in secondary hyperparathyroidism due to end-stage renal failure. We developed a method suitable for inducing sequential hypocalcemia and hypercalcemia during...

Depression of calcium pump activity in renal cortex of vitamin D-deficient rats with secondary hyperparathyroidism

International Nuclear Information System (INIS)

Tsukamoto, Yusuke; Saitoh, Michiyo; Takita, Yumiko; Nakano, Toshiaki; Tamura, Teiichi

1990-01-01

To examine the hormonal regulation of the ATP-dependent Ca 2+ pump in the kidneys, the ATP-dependent Ca 2+ uptake by the basolateral membrane vesicles in the renal cortex was measured using radioactive calcium ( 45 Ca 2+ ) in rats with vitamin D deficiency or rats undergoing thyroparathyroidectomy. The V max of the Ca 2+ pump activity was increased not only by administering calcitriol, but also by normalizing the serum calcium level in vitamin D-deficient rats. PTH suppressed the Ca 2+ pump activity in normocalcemic vitamin D-deficient rats. Thyroparathyroidectomy did not affect the Ca 2+ pump activity in the kidneys of normal rats. It was concluded that the ATP-dependent Ca 2+ pump activity was depressed by secondary hyperparathyroidism in vitamin D-deficient rats. (author)

Effect of immobilization on urine calcium excretion in orthopedic patients with pelvic fracture treated by skin traction.

Science.gov (United States)

Derakhshan, Ali; Derakhshan, Nima; Namazi, Hamid; Ghaffarpasand, Fariborz

2015-03-31

To determine the effects on urine calcium excretion of immobilization by skin traction in patients with pelvic fracture. In a prospective study, a consecutive series of patients with pelvic fracture treated by skin traction were enrolled. Serum (calcium, phosphorous, alkaline phosphatase, sodium, potassium, uric acid, BUN, creatinine) and fasting urine calcium, creatinine, sodium, potassium and uric acid were checked within 48 hours of hospitalization and at 7, 14 and 21 days of immobilization and then after 3 months of mobilization. Trends in changes of variables were recorded. Fifty five patients were enrolled in this study; they were 45 (81.8%) males and 10 (18.2%) females with a mean age 19.4 ± 12.7 years. We found that serum levels of calcium (p = 0.004), phosphorous (p = 0.047) and alkaline phosphatase (p = 0.001) increased significantly during the 3 weeks of immobilization. In the same way, urine calcium/ urine creatinine ratio increased significantly in the study period (p = 0.004). No symptomatic renal stone formation was observed during the study period. Immobilization even in short term causes hypercalciuria in orthopedic patients. Although it is transient and improves with subsequent mobilization, it is needed to be considered specifically by the team caring for this group of patients.

Evaluation of post-ESWL renal sequelae using quantitative radionuclide studies

International Nuclear Information System (INIS)

Moustafa, H.; Elhaddad, SH.; Ziada, G.; El-Tawil, A.; Hegazi, A.; Fawzy, K.

1995-01-01

45 adult patients with single, unilateral renal stones without back pressure change attended to Cairo University Hospital during 1990 and 1991 were treated with ESWl. All cases were subjected to radionuclide renal studies using 131 I-OIH and 99 mTc-DTPA done pre-, immediate post- and 3 months post-ESWL. No significant changes of total renal ERPF and GFR could be detected. Treated kidneys GFR, GFR%, ERPE and T max showed no significant changes after ESWL except for a transient significant improvement of their T 1/2 (P 3500 shocks caused the reverse (P 55000 caused deterioration of their GFR that persisted up to 3 months (P<0.03). Conclusion: ESWL therapy is safe method for treatment of renal stones with no significant functional changes. 6 tabs

Flexible ureteroscopy versus percutaneous nephrolithotomy as primary treatment for renal stones 2 cm or greater

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Akar EC

2013-01-01

Full Text Available Erin Akar, Bodo E KnudsenDepartment of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USAAbstract: The purpose of this review, based on the current evidence in the literature, is whether ureteroscopy (URS is a comparable primary treatment option to the current gold standard of percutaneous nephrolithotomy (PCNL for the treatment of large kidney stones 2 cm or greater. The lack of prospective randomized trials directly comparing URS and PCNL makes comparison challenging. The numerous studies are not standardized in terms of their definition of stone-free or how stone size is reported. In order to standardize comparison of results, we used a stone-free definition of <4 mm after one procedure per imaging of the author’s choice, since how each patient was imaged postoperatively was not reported. The results from the literature show that moderately large stones from 2 to 3 cm treated ureteroscopically have similar outcomes to PCNL. Stone-free rates with URS decrease when stone size is above 3 cm. Our interpretation of the literature suggests that a current limitation of URS is that multiple procedures for URS would be required to achieve comparable stone-free rates to PCNL, particularly for stones greater than 4 cm.Keywords: ureteroscopy, percutaneous nephrolithotomy, lithotripsy, urinary calculi

Delay in onset of metabolic alkalosis during regional citrate anti-coagulation in continous renal replacement therapy with calcium-free replacement solution

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See Kay

2009-01-01

Full Text Available Regional citrate anti-coagulation for continuous renal replacement therapy chelates calcium to produce the anti- coagulation effect. We hypothesise that a calcium-free replacement solution will require less citrate and produce fewer metabolic side effects. Fifty patients, in a Medical Intensive Care Unit of a tertiary teaching hospital (25 in each group, received continuous venovenous hemofiltration using either calcium-containing or calcium-free replacement solutions. Both groups had no significant differences in filter life, metabolic alkalosis, hypernatremia, hypocalcemia, and hypercalcemia. However, patients using calcium-containing solution developed metabolic alkalosis earlier, compared to patients using calcium-free solution (mean 24.6 hours,CI 0.8-48.4 vs. 37.2 hours, CI 9.4-65, P = 0.020. When calcium-containing replacement solution was used, more citrate was required (mean 280ml/h, CI 227.2-332.8 vs. 265ml/h, CI 203.4-326.6, P = 0.069, but less calcium was infused (mean 21.2 ml/h, CI 1.2-21.2 vs 51.6ml/h, CI 26.8-76.4, P ≤ 0.0001.

Evaluation of post-ESWL renal sequelae using quantitative radionuclide studies

Energy Technology Data Exchange (ETDEWEB)

Moustafa, H; Elhaddad, SH; Ziada, G; El-Tawil, A [Nuclear medicine (Egypt); Hegazi, A; Fawzy, K [Urology departments Faculty of medicine, Cairo university, Cairo, (Egypt)

1995-10-01

45 adult patients with single, unilateral renal stones without back pressure change attended to Cairo University Hospital during 1990 and 1991 were treated with ESWl. All cases were subjected to radionuclide renal studies using 131 I-OIH and 99 mTc-DTPA done pre-, immediate post- and 3 months post-ESWL. No significant changes of total renal ERPF and GFR could be detected. Treated kidneys GFR, GFR%, ERPE and T max showed no significant changes after ESWL except for a transient significant improvement of their T 1/2 (P<0.04); that occurred immediately after ESWL. Contralateral kidneys showed only transient statistically significant improvement of both %GFR and T 1/2 (P<0.02 and <0.04 respectively) Regional evaluation of the stone bearing zones revealed transient significant deterioration of their regional ERPF (P<0.03). We found that shocks <3500 caused transient significant improvement of treated side ERPF, whereas >3500 shocks caused the reverse (P<0.05). Moreover, power index (number of shocks X KV) >55000 caused deterioration of their GFR that persisted up to 3 months (P<0.03). Conclusion: ESWL therapy is safe method for treatment of renal stones with no significant functional changes. 6 tabs.

Bacteriological study and structural composition of staghorn stones removed by the anatrophic nephrolithotomic procedure

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Hamid Shafi

2013-01-01

Full Text Available This study was conducted to determine the composition of staghorn stones and to assess the proportion of infected stones as well as the correlation between infection in the stones and bacteria grown in urine. Samples of 45 consecutive stones removed through anatrophic nephrolithotomic procedures were taken from the operation site and samples of urine were obtained by simultaneous bladder catheterization. The frequency of infection in the stones and correlation between infection of stone and urine samples were determined with respect to the composition of the stones. Twenty-two males and 23 females, with respective mean ages of 48.3 ± 15.6 years and 51 ± 7.4 years, were studied. The stone and urine cultures yielded positive results in ten and 16 patients, respectively, of a total of 45 patients (22.2% and 35.5%, respectively. Calcium oxalate was the main constituent of staghorn stones, seen in 31 patients (68.8%, uric acid in 12 patients (26.6% and struvite and/or calcium phosphate in 11 patients (24.4%. In seven of ten stones with bacterial growth, bacteria were isolated from urine cultures as well, which accounted for a concordance rate of 70%. The bacteria grown in the stone were the cause of urinary tract infection (UTI in 43.5% of the cases. Stone infection was significantly associated with UTI (OR = 6.47; 95% CI 1.43-31.7, P = 0.021 and presence of phosphate in the stones (OR = 18, 95% CI 3.28-99.6, P = 0.0006. E. coli was the most common bacteria grown from the stones, and was isolated in 50% of the cases; Ureaplasma urealyticum was the most common organism causing UTI, grown in 62.5% of the urine samples. There was a high concordance rate between bacteria in the stones and urine. These findings indicate that the urine culture can provide information for selection of an appropriate anti-microbial agent for stone sterilization. In addition, preventing re-growth or recurrence of stones and treatment of post-surgical infections would be

Evidence suggesting a genetic contribution to kidney stone in northeastern Thai population.

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Sritippayawan, Suchai; Borvornpadungkitti, Sombat; Paemanee, Atchara; Predanon, Chagkrapan; Susaengrat, Wattanachai; Chuawattana, Duangporn; Sawasdee, Nunghathai; Nakjang, Sirintra; Pongtepaditep, Suttikarn; Nettuwakul, Choochai; Rungroj, Nanyawan; Vasuvattakul, Somkiat; Malasit, Prida; Yenchitsomanus, Pa-thai

2009-06-01

Genetic factor may play a role in the pathogenesis of kidney stone that is found in the northeastern (NE) Thai population. Herein, we report initial evidence suggesting genetic contribution to the disease in this population. We examined 1,034 subjects including 135 patients with kidney stone, 551 family members, and 348 villagers by radiography of kidney-ureter-bladder (KUB) and other methods, and also analyzed stones removed by surgical operations. One hundred and sixteen of 551 family members (21.05%) and 23 of the 348 villagers (6.61%) were affected with kidney stone. The relative risk (lambda(R)) of the disease among family members was 3.18. Calcium stones (whewellite, dahllite, and weddellite) were observed in about 88% of stones analyzed. Our data indicate familial aggregation of kidney stone in this population supporting that genetic factor should play some role in its pathogenesis. Genetic and genomic studies will be conducted to identify the genes associated with the disease.

Factors affecting lower calyceal stone clearance after Extracorporeal ...

African Journals Online (AJOL)

Objective: Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi. Patients and ...

Evaluation of Extracorporeal Shock Wave Lithotripsy (ESWL): Efficacy in Treatment of Urinary System Stones.

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Junuzovic, Dzelaludin; Prstojevic, Jelena Kovacevic; Hasanbegovic, Munira; Lepara, Zahid

2014-10-01

Elimination of stone is determined by size and its localization. Stone from the ureter in 80% of cases can be eliminated spontaneously. If the stone by its characteristics is not spontaneously eliminated, taken are further steps and therapeutic protocols to solve this problem. The study was prospective, open and comparative. It was conducted at the Urology Clinic Clinical Center of Sarajevo University in the period from 2007 to 2013. The study included 404 patients with urinary tract lithiasis treated by ESWL. ESWL treatment is performed on the machine Siemens Model Lithostar Multiline, which has a combined ultrasonographic and fluoroscopic display, large energy density in order to obtain optimum focus (without damaging surrounding tissue) and minimal pain that on rare occasions requires for mild sedation-sedation. From a total of 404 patients included in the study there were 234 (57.92%) male and 170 (42.08%) female patients. The most common type of stone both in female and male patients was calcium type. From a total of 262 calcium stones, 105 of them (40.07%) was present in female patients and 157 (59.92%) in male. Share of infectious type of stone in female patients was 63 (49.60%) and 64 among males (50.39%). Other stones were less abundant in both the gender groups and their total number was only 17. In women their frequency was 2 (13.33%) and 13 among males (86.67%). There was a significant difference in the frequency of different types of stones by gender (x2 = 11.47, p = 0.009). There was no statistically significant correlation between the number of treatments and localization of stones in the ureter, as well as a statistically significant correlation between the size of the stone and the localization of calculus in the ureter.

Changes of renal blood flow after ESWL: assessment by ASL MR imaging, contrast enhanced MR imaging, and renal resistive index.

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Abd Ellah, Mohamed; Kremser, Christian; Pallwein, Leo; Aigner, Friedrich; Schocke, Michael; Peschel, Reinhard; Pedross, Florian; Pinggera, Germar-Michael; Wolf, Christian; Alsharkawy, Mostafa A M; Jaschke, Werner; Frauscher, Ferdinand

2010-10-01

The annual incidence of stone formation is increased in the industrialised world. Extracorporeal shockwave lithotripsy is a non-invasive effective treatment of upper urinary tract stones. This study is aimed to evaluate changes of renal blood flow in patients undergoing extracorporeal shock wave lithotripsy (ESWL) by arterial spin labeling (ASL) MR imaging, contrast enhanced dynamic MR imaging, and renal resistive index (RI). Thirteen patients with nephrolithiasis were examined using MR imaging and Doppler ultrasound 12h before and 12h after ESWL. ASL sequence was done for both kidneys and followed by contrast enhanced MR imaging. In addition RI Doppler ultrasound measurements were performed. A significant increase in RI (pESWL causes changes in RI and ASL MR imaging, which seem to reflect changes in renal blood flow. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Characterization of kidney stones using NAA and other techniques

International Nuclear Information System (INIS)

Srivastava, A.; Bhardwaj, S.; Vashisht, B.; Swain, K.K.; Ajith, Nicy; Chavan, T.; Wagh, D.N.; Reddy, A.V.R.; Mete, U.; Acharya, R.

2014-01-01

Six kidney stone samples were collected from patients treated in the Advance Urology Centre of PGIMER, Chandigarh. The samples were characterized using neutron activation analysis (NAA), Energy dispersive X-ray fluorescence (EDXRF), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) techniques. For NAA, samples were irradiated in Tray rod facility of Dhruva reactor, Mumbai. Radioactive assay was carried out using high purity germanium detector coupled to 8k channel analyzer. The elements determined in the samples by NAA are Zn, Sr, Co, Fe, Cr, Sc, Se and Th. ED-XRF was used for quantification of Ca. The concentrations of trace elements like Zn, Sr, Fe and Cr were found to be lower in uric acid composite stones as compared to calcium based stones. (author)

Production of calcium hydroxide from the waste of Cariri stone; Producao de hidroxido de calcio a partir de residuo da pedra Cariri

Energy Technology Data Exchange (ETDEWEB)

Alves, T.M.E.; Santos, A.M.M.; Brasileiro, M.I.; Pinheiro, S.F.L.; Prado, A.C.A., E-mail: tiagomaiaea@gmail.com [Universidade Federal do Cariri (UFCA), Juazeiro do Norte, CE (Brazil)

2016-07-01

The extraction of Cariri stone in the northeast is a frequent activity because of its ornamental application as well as for the construction sector. However, by this extraction, untapped waste formation grows and becomes a problem for the environment. The objective of this work is to produce calcium hydroxide, from this limestone residue, with controlled porosity, solubility and particle size. The waste was characterized with X-Ray Diffraction (XRD), X-Ray Fluorescence (XRF) and thermal analysis (TGA). The limestone was calcined at 850°C and 950°C for 45 minutes and three hours, being characterized by XRD, XRF and TGA. Once calcined, it was hydrated with 17,5g and 22g oxide to 100mL water and manually mixed for 15 and 25 minutes. The calcium hydroxides have been submitted for tests in vivo in rats and will be characterized by XRD, Scanning Electron Microscopy (SEM) and Infrared. (author)

Frequency of metabolic abnormalities in urinary stones patients.

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Ahmad, Iftikhar; Pansota, Mudassar Saeed; Tariq, Muhammad; Tabassum, Shafqat Ali

2013-11-01

To determine the frequency of metabolic abnormalities in the serum and urine of patients with urinary stones disease. Two hundred patients with either multiple or recurrent urolithiasis diagnosed on ultrasonography and intravenous urography were included in this study. 24 hour urine sample were collected from each patient and sent for PH, specific gravity, Creatinine, uric acid, calcium, phosphate, oxalate, citrate and magnesium. In addition, blood sample of each patient was also sent for serum levels of urea, creatinine, uric acid, phosphate and calcium. Mean age of patients was 38 ± 7.75 years with male to female ratio of 2:1. The main presenting complaint was lumber pain and 82.5% patients were found to have calcium oxalate stones on chemical analysis. Metabolic abnormalities were found in 90.5% patients, whereas there were no metabolic abnormalities in 19 (9.5%) patients. Forty patients (21.5%) only had one metabolic abnormality and 157 (78.5%) patients had multiple metabolic abnormalities. Hyperoxaluria was the most commonly observed metabolic abnormality and was found in 64.5% patients. Other significant metabolic abnormalities were hypercalciuria, Hypercalcemia, hypocitraturia and hyperuricemia. This study concludes that frequency of metabolic abnormalities is very high in patients with urolithiasis and hyperoxaluria, hypercalciuria and hypocitraturia are the most important metabolic abnormalities observed in these patients.

Renal papillary calcification and the development of calcium oxalate monohydrate papillary renal calculi: a case series study.

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Grases, Fèlix; Costa-Bauzá, Antonia; Prieto, Rafel M; Conte, Antonio; Servera, Antonio

2013-03-11

The objective of this study is to determine in a case series (four patients) how calcified deposits in renal papillae are associated with the development of calcium oxalate monohydrate (COM) papillary calculi. From the recently collected papillary calculi, we evaluated retrospectively patients, subjected to retrograde ureteroscopy, with COM papillary lithiasis. The COM papillary calculi were found to result from subepithelial injury. Many of these lesions underwent calcification by hydroxyapatite (HAP), with calculus morphology and the amount of HAP in the concave zone dependent on the location of the calcified injury. Most of these HAP deposits grew, eroding the epithelium covering the renal papillae, coming into contact with urine and starting the development of COM calculi. Subepithelial HAP plaques may alter the epithelium covering the papillae, resulting in the deposit of COM crystals directly onto the epithelium. Tissue calcification depends on a pre-existing injury, the continuation of this process is due to modulators and/or crystallization inhibitors deficiency. Since calculus morphology and the amount of detected HAP are dependent on the location and widespread of calcified injury, all types of papillary COM calculi can be found in the same patient. All patients had subepithelial calcifications, with fewer papillary calculi, demonstrating that some subepithelial calcifications did not further evolve and were reabsorbed. A high number of subepithelial calcifications increases the likelihood that some will be transformed into COM papillary calculi.

Spiral CT in kidney: assumption of renal function by objective evaluation of renal cortical enhancement

International Nuclear Information System (INIS)

Choi, Bo Yoon; Lee, Jong Seok; Lee, Joon Woo; Myung, Jae Sung; Sim, Jung Suk; Seong, Chang Kyu; Kim, Seung Hyup; Choi, Guk Myeong; Chi, Seong Whi

2000-01-01

To correlate the degree of renal cortical enhancement, objectively evaluated by means of spiral CT with the serum level of creatinine, and to determine the extent to which this degree of enhancement may be used to detect renal parenchymal disease. Eighty patients (M:F = 50:30; age + 25-19, (mean 53) years) with available serum level of creatinine who underwent spiral CT between September and October 1999 were included in this study. In fifty patients the findings suggested hepatic or biliary diseases such as hepatoma, biliary cancer, or stone, while in thirty, renal diseases such as cyst, hematoma, or stone appeared to be present. Spiral CT imaging of the cortical phase was obtained at 30-40 seconds after the injection of 120 ml of non-ionic media at a rate of 3 ml/sec. The degree of renal cortical enhancement was calculated by dividing the CT attenuation number of renal cortex at the level of the renal hilum by the CT attenuation number of aorta at the same level. The degree of renal cortical enhancement was compared with the serum level of creatinine, and the degree of renal cortical enhancement in renal parenchymal disease with that of the normal group. Among eighty patients there were five with renal parenchymal disease and 75 with normal renal function. The ratio of the CT attenuation number of renal cortex to that of aorta at the level of the renal hilum ranged between 0.49 and 0.99 (mean, 0.79; standard deviation, 0.15). while the serum level of creatinine ranged between 0.6 and 3.2 mg/dl. There was significant correlation (coefficient of -0.346) and a statistically significant probability of 0.002 between the ratio of the CT attenuation numbers and the serum level of creatinine. There was a significant difference (statistically significant probability of less than 0.01) between those with renal parenchymal disease and the normal group. The use of spiral CT to measure the degree of renal cortical enhancement provides not only an effective index for

Retrograde Ureteroscopic Management of Large Renal Calculi: A Single Institutional Experience and Concise Literature Review.

Science.gov (United States)

Scotland, Kymora B; Rudnick, Benjamin; Healy, Kelly A; Hubosky, Scott G; Bagley, Demetrius H

2018-06-06

Advances in flexible ureteroscope design and accessory instrumentation have allowed for more challenging cases to be treated ureteroscopically. Here, we evaluate our experience with ureteroscopy (URS) for the management of large renal calculi (≥2 cm) and provide a concise review of recent reports. A retrospective review was undertaken of all URS cases between 2004 and 2014 performed by the endourologic team at a single academic tertiary care institution. We identified patients with at least one stone ≥2 cm managed with retrograde URS. Stone size was defined as the largest linear diameter of the index stone. Small diameter flexible ureteroscopes were used primarily with holmium laser. Patient demographics, intraoperative data, and postoperative outcomes were evaluated. We evaluated 167 consecutive patients who underwent URS for large renal stones ≥2 cm. The initial reason for choosing URS included patient preference (29.5%), failure of other therapies (8.2%), anatomic considerations/body habitus (30.3%), and comorbidities (28.8%). Mean patient age was 55.5 years (22-84). The mean stone size was 2.75 cm with mean number of procedures per patient of 1.65 (1-6). The single session stone-free rate was 57.1%, two-stage procedure stone-free rate was 90.2% and three-stage stone-free rate was 94.0%. Access sheaths were used in 47% of patients. An association was identified between stone size and patient outcomes; smaller stones correlated with decreased number of procedures. Postoperative complications were minor. Single or multi-stage retrograde ureteroscopic lithotripsy is a safe and effective mode of surgical management of large renal calculi. Total stone burden is a reliable predictor of the need for a staged procedure and of stone-free rate.

Pattern of urinary tract stone diseases in Mekelle, Ethiopia.

Science.gov (United States)

Alemu, Mekonnen Hagos

2008-07-01

To evaluate and analyze the pattern of patients with urinary stone diseases admitted to Mekelle Hospital. Between Sept 2003 to Sept 2006, 102 patients with urinary stone disease were admitted to Mekelle Hospital. In this descriptive retrospective audit, case notes were obtained from medical record office and were analyzed for age, sex, localization of the stone disease and the geographic back grounds. Seventy six (74.5%) of the patients were males and 26 (25.5%) were females. There were 102 (13.6%) cases of urinary stone disease admitted to Mekelle Hospital out of 750 total admissions for urological disease for intervention in the surgical ward during the study period. There were 76 (74.5%) males and 26 (25.5%) females and the sex ratio was (M: F: 2.9:1). Most (46.0%) of the urinary stone diseases were between 0-19 year age group both in males and females. The median age was 20 years (range from 2-74 years) and the mean was 25.4 years. Urinary bladder stones were the most common urinary tract stone diseases accounting for 47 (46.0%) followed by renal stones 29 (28.4%), ureteric 16 (15.6%) and urethral 10 (9.8%) stone disease; in that order of frequency. The geographical back ground of the patients with urinary tract stone disease in this report has shown that majorities (53.7%) were from urban and the remaining (44.2%) were from the rural areas. This study has depicted that urinary bladder stone diseases are the most common stone diseases affecting the younger age group. Since this is an institutional based study, it underestimates the magnitude and the pattern of urinary stone diseases at all level. Nevertheless, the audit provides useful information on the socio demographic variables, localization and the geographic back ground of the patients.

Differential effect of T-type voltage-gated calcium channel disruption on renal plasma flow and glomerular filtration rate in vivo

DEFF Research Database (Denmark)

Thuesen, Anne D; Andersen, Henrik; Cardel, Majken

2014-01-01

Voltage-gated calcium channels (Cav) play an essential role in regulation of renal blood flow and GFR. Because T-type Cavs are differentially expressed in pre- and postglomerular vessels it was hypothesized that they impact renal blood flow and GFR differentially. The question was addressed by use...... of two T-type Cav knock-out mice strains. Continuous recordings of blood pressure and heart rate, and para-aminohippurate clearance (renal plasma flow) and inulin clearance (GFR) were performed in conscious, chronically catheterized, wild type and Cav 3.1-/- and Cav 3.2-/- mice. Contractility of afferent...... and efferent arterioles was determined in isolated perfused blood vessels. Efferent arterioles from Cav 3.2-/- mice constricted significantly more in response to a depolarization compared to Wt mice. GFR was increased in Cav 3.2-/- mice with no significant changes in renal plasma flow, heart rate and blood...

Diagnosis of obstruction and stone passage after extracorporeal shock-wave lithotripsy (ESWL)

Energy Technology Data Exchange (ETDEWEB)

Vorwerk, D.; Auffermann, W.; Fischer, N.

1987-09-01

78 patients with ureteral formations of stone fragments after ESWL therapy have been controlled by both ultrasound and plain abdominal films. Detection of renal stone fragments was possible similarly by sonography or radiographs. The plain films demonstrated well location and length of the 'Steinstrasse', which did not necessarily cause obstruction. Combination of sonography and plain abdominal film allows an easy follow-up after ESWL therapy, so i.v. urogramm is not acquired routinely.

Is the gravity effect of radiographic anatomic features enough to justify stone clearance or fragments retention following extracorporeal shock wave lithotripsy (SWL).

Science.gov (United States)

Mustafa, Mahmoud

2012-08-01

We determined whether the gravity effect of radiographic anatomic features on the preoperative urography (IVP) are enough to predict fragments clearance after shock wave lithotripsy (SWL). A Total of 282 patients with mean age 45.8 ± 13.2 years (189 male, 93 female), who underwent SWL due to renal calculi between October 2005 and August 2009 were enrolled. The mean calculi load was 155.72 ± 127.66 mm². The patients were stratified into three groups: patients with pelvis calculi (group 1); patients with upper or middle pole calculi (group 2) and patients with lower pole calculi (group 3). Three angles on the pretreatment IVP were measured: the inner angle between the axis of the lower pole infundibular and ureteropelvic axis (angle I); the inner angle between the lower pole infundibular axis and main axis of pelvis-ureteropelvic (UP) junction point (angle II) and the inner angle between the lower pole infundibular axis and perpendicular line (angle III). Multivariate analysis was used to define the significant predictors of stone clearance. The overall success rate was 85.81%. All angles, sessions number, shock waves number and stone burden were significant predictors of success in patients in group 1. However, in group 2 only angle II and in group 3 angles I and II had significant effect on stone clearance. Radiographic anatomic features have significant role in determining the stone-free rate following satisfactory fragmentation of renal stones with SWL. The measurement of infundibulopelvic angle in different manner helps to predict the stone-free status in patients with renal calculi located not only in lower pole, but also in renal pelvis and upper or middle pole. Gravity effect is not enough to justify the significant influence of the radiographic anatomic features on the stone clearance and fragments retention after SWL.

Anti-miss-shot control device for selective stone disintegration in extracorporeal shock wave lithotripsy

Science.gov (United States)

Kuwahara, M.; Ioritani, N.; Kambe, K.; Orikasa, S.; Takayama, K.

1991-06-01

A new device to prevent erroneously focused shock waves to the renal parenchyma during extracorporeal shock wave lithotripsy (ESWL) has been developed; an anti-miss-shot control device (AMCD) and experiments have been conducted to evaluate its effectiveness. For shock wave generation and stone localization, piezoceramic elements (PSE) and ultrasound localization, respectively were used. After stone localization, probing ultrasounds (PU) were emmitted from the PSE towards the focal region and the reflected sound levels (RSL) were monitored by the PSE which also functioned as a microphone. A direct hit by the PU to the stone or a miss was judged from the RSL, i.e. a high RSL indicates a direct hit and a low RSL indicates a miss. Shock waves were generated only when the RSL exceeded the level which indicated a direct hit. The experimental results showed that the injury to the renal parenchyma was decreased by using the AMCD. Clinical application of the AMCD is expected to increase the safety of ESWL.