Calculi In Patients Research Articles

Prevalence of rapid calculus formers and its associated factors amongst patients visiting a dental hospital: a preliminary investigation

BackgroundThis study focuses on the determination and classification of patients as rapid or slowcalculusformersbasedontherateofcalculusformationafteroralprophylaxis. It also aims to determine the factors that positively impact the formation and deposition of calculus in patients and identify the factors that accelerate or decelerate the deposition of calculus.MethodsThe study was conducted in the Department of Periodontology, Dr Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University Chandigarh, India. We examined 51 patients after a month of the oral prophylaxis, recorded the amount of calculus present in the oral cavity, and then recorded a detailed history which was briefly divided into Age, Sex, Residence, Oral habits, and maintenance of oral hygiene.ResultsAn evident and meaningful link was found between age and the rate at which dental calculus forms. The average age of individuals differed significantly between the rapid and slow calculus formers, which could be ascribed to the decline in manual dexterity as age increases, resulting in less effective oral hygiene habits, including toothbrushing. None of the other factors dietary and oral hygiene related could be identified distinctly, probably owing to the small sample of the study. The oral health status exhibited a significant difference between slow and rapid calculus formers.ConclusionsWithin the limitations of the study, the data analyzed, identified age as a significant determinant that impact the rate of formation of calculus in patients and reported a significant difference in the oral health status of rapid and slow calculus formers.

A comparative study of ultrasonography (USG) and computed tomography for detecting ureteric calculi in patients with acute flank pain, and analysis of factors influencing ultrasound detection rates

Introduction: Urolithiasis, a frequent urologic issue, often relies on computed tomography (CT) scans, the preferred imaging technique. However, in low-income countries like Nepal, access to CT scans is limited. The authors’ study focused on comparing ultrasound (US) and CT for assessing ureteric calculi in patients with acute flank pain and examined factors influencing US detection rates in these patients. Methods: The authors conducted a cross-sectional study using purposive sampling, involving 87 participants who presented with acute flank pain at a tertiary hospital in Nepal. Ethical clearance was obtained from the institutional review board. Results: Among the 87 patients presenting with acute flank pain, the majority were male (51, 58.62%). Of the 78 cases with CT-detected ureteric calculi, the most common locations were distal ureter (23/78, 29.49%), followed by proximal ureter (21/78, 26.92%), and pelvic-ureteric junction (PUJ) (20/78, 25.64%). Ultrasound demonstrated varying sensitivities for detecting ureteric calculi: 95.00% for PUJ, 100.00% for vesicoureteric junction (VUJ), 66.67% for proximal ureter, and 56.52% for distal ureter calculi. The highest sensitivity was observed for calculi greater than 15 mm (100%), followed by 10.1–15 mm (77.7%). Overall, ultrasound exhibited a sensitivity of 76.92%, a specificity of 100%, and an accuracy rate of 79.31% in detecting calculi. Notably, patients with hematuria had significantly higher odds of ultrasound-detected ureteric calculi (odds ratio: 36.68, 4.54–296.26, P<0.01) than those without hematuria. However, age, hydronephrosis, calculi location, and laterality were not found to be significantly associated with ultrasound detection. Conclusions: Due to its good sensitivity, ultrasound can serve as the first-line investigation for individuals experiencing acute flank pain, given its cost-effectiveness and radiation-free nature when compared to CT scans. CT scans should be reserved for patients exhibiting clinical symptoms of severe ureteric colic who have previously undergone a negative ultrasound (USG).

Efficacy and safety of flexible ureteral lithotripsy for upper urinary tract calculi in patients aged 80 years and older

Objective: To assess the efficacy and safety of flexible ureteral lithotripsy (FURL) for treating upper urinary tract calculi in patients ≥80 years. Methods: This study retrospectively analyzed the clinical data of 297 elderly patients who underwent FURL for unilateral upper urinary tract calculi at Beijing Hospital from January 2019 to September 2023. Patients were divided into elderly group (≥80 years) and low-middle aged group (≥60-<80 years). Propensity score matching (PSM) was used to match preoperative clinical data of patients. After PSM, the basic, perioperative and postoperative data of the two groups were compared. Results: After PSM, 116 patients were enrolled, including 58 patients in each group. The age [M (Q1, Q3)] of elderly group was 83.0 (81.0, 86.0) years, which included 29 males. The age of low-middle aged group was 69.5 (64.8, 74.0) years, which included 33 males. The duration of postoperative hospitalization [M (Q1, Q3)] in elderly group was longer than that in low-middle aged group [2 (1, 3) d vs 1 (1, 2) d, P=0.002]. Serious postoperative complications occurred in 3 cases in the elderly group and 1 case in the low-middle aged group, respectively, without surgical intervention. There was no significant statistical difference in stone-free rate (SFR) [79.3% (46/58) vs 84.5% (49/58)], operation time [M (Q1, Q3), 70.0 (48.3, 100.0) vs 65.0 (46.5, 101.2) min] and postoperative complication rate [25.9% (15/58) vs 22.4% (13/58)] between two groups (all P>0.05). Conclusions: In the treatment of upper urinary tract calculi in patients ≥80 years, the SFR, operation time and postoperative complication rate of FURL are comparable to those in low-middle aged elderly patients. FURL has good safety and effectiveness in the treatment of upper urinary tract calculi in patients ≥80 years.

Urolitiáza u pacientů s idiopatickými střevními záněty – možnosti prevence a metabolického ovlivnění

Inflammatory bowel diseases (IBD) are typically accompanied by diarrhoea and frequently by malabsorption, both of which are predisposing factors for the formation of renal calculi. In patients who have not undergone bowel surgery the prevalence of urolithiasis has ranged from 1.5 to 5%, but after surgery, stone prevalence can increase to up to 16%. Enteric hyperoxaluria is a frequent complication of inflammatory bowel diseases after ileal-coecal resection, ileostomy, colostomy resection and bariatric surgery. The excess of oxalate is primarily excreted by the kidneys. Increased urinary excretion of oxalate results in urinary calcium oxalate supersaturation, leading to crystal aggregation, urolithiasis, and/or nephrocalcinosis. Prevention of oxalate lithiasis includes high fluid intake, nutritionally balanced low-oxalate, low-fat, low-salt diet, prescription of oral citrate and magnesium, calcium supplement, and also biological manipulation of intestinal flora (microbiota). In IBD patients, urolithiasis can be associated with serious urinary tract infection – in some cases asymptomatic – which can lead to chronic renal insufficiency and failure. New therapeutic approaches to patients with inflammatory bowel diseases have completely changed the natural history of these diseases with reduced number of bowel surgery. Whether this has changed the prevalence and risk factors for urinary calculi in patients with inflammatory bowel diseases is still unknown.

Contemporary Management of Large and Complex Renal Calculi: Have we found the Perfect Solution Yet?

AbstractThis review provides a thorough overview of contemporary treatment strategies for complex renal calculi, including large-volume stones, stones with increased hardness and greater number, or stones with abnormal anatomy. The development of tailored treatment plans for stone removal is essential for treatment success. A literature search was conducted on PubMed using the Keyword “complex renal calculi” along with “percutaneous nephrolithotomy (PCNL),” “retrograde intrarenal surgery (RIRS),” “endoscopic combined intrarenal surgery (ECIRS),” “stone free rate,” and “complications.” Based on the findings, the use of “minimally invasive PCNL,” “multiple-tract PCNL,” “staged RIRS,” and “ECIRS” is proposed in addition to the traditional PCNL suggested using the European Association of Urology guidelines. Renal calculi in patients with solitary kidneys or who underwent kidney transplants are considered to be complex, and treatment options that allow preservation of their remaining renal function should be considered.

THE PREVALENCE OF NEGLECTED RENAL STONE AMONG PATIENTS PRESENTED WITH ACUTE KIDNEY INJURY TO A TERTIARY CARE HOSPITAL

Objective: To determine the frequency of neglected renal calculi in patients with acute kidney injury. Material and Methods: This was a descriptive study conducted at the division of nephrology, Lady Reading Hospital Peshawar, from 26/09/2021- 26/03/2022. Data was collected from 214 patients with acute kidney injury (AKI). Detailed clinical history was taken to confirm the patient did not know about the presence of previous stone disease. After confirming the acute kidney injury, bio-chemical investigations including serum urea, serum creatinine, serum calcium, urine analysis, and radiological investigation i.e. ultrasound KUB, X-ray KUB. When needed IUV and CT scan KUB was also done for the confirmation of the renal stones. Results: In this study, the mean age was 52 years ± 13.81. Sixty-seven percent of patients were male, while 33% were female. Twelve percent of patients had neglected renal calculi, while 88% of patients didn’t have neglected renal calculi. Conclusion: Our study concluded that 12% of patients presented with Acute Kidney Injury at a tertiary care hospital had neglected renal stones. Keywords: Neglected renal calculi, Acute Kidney Injury.

Landscape in the gallbladder mycobiome and bacteriome of patients undergoing cholelithiasis with chronic cholecystitis.

Gallstone disease (GSD) is associated with changes in the gut and gallbladder bacterial composition, but there is limited information on the role of the fungal community (mycobiome) in disease development. This study aimed to characterize the gallbladder mycobiome profiles and their interactions with bacteriome in GSD. A total of 136 bile and gallstone samples (34 paired for bacteriome, and 33 paired and extra 2 bile samples for mycobiome) were obtained from calculi patients with chronic cholecystitis. Bile and gallstone bacteriome and mycobiome were profiled by 16S and internal transcribed spacer (ITS) rRNA gene sequencing, respectively. Gallbladder bacteriome, mycobiome, and interkingdom and intrakingdom interactions were compared between bile and gallstone. In general, microbial diversity was higher in bile than in gallstone, and distinct microbial community structures were observed among them. Deep Sea Euryarchaeotic Group, Rhodobacteraceae, and Rhodobacterales were microbial biomarkers of bile, while Clostridiales and Eubacterium coprostanoligenes were biomarkers of gallstone. Five fungal taxa, including Colletotrichum, Colletotrichum sublineola, and Epicoccum, were enriched in gallstone. Further ecologic analyses revealed that intensive transkingdom correlations between fungi and bacteria and intrakingdom correlations within them observed in gallstone were significantly decreased in bile. Large and complex fungal communities inhabit the gallbladder of patients with GSD. Gallstone, compared with bile, is characterized by significantly altered bacterial taxonomic composition and strengthened bacterial-bacterial, fungal-fungal, and bacterial-fungal correlations in the gallbladder of patients with GSD.

Prevalence of Progression Toward Renal Calculi in Patients Suffering from Urinary Tract Infection: A Cross-Sectional Study

Objective: To assess the frequency of renal stones in the patient suffering from urinary tract infection (UTI) Study design: A cross-sectional study Place and Duration: This study was conducted at Northwest General Hospital Peshawar from June 2021 to June 2022 Methodology: A total of 115 patients with the symptoms of recurrent urinary tract infection were included in the study. Those patients who had a positive history of upper and lower urinary tract stones, renal tumors, already present renal calculi, and patients with renal failure, were not added to the present study. A specially designed proforma was filled out by all the patients so that the required data could be acquired and analyzed. Results: The mean age of the patients was 36.1±15.2 years ranging from 15 years to 60 years. Urinary tract infection was confirmed in 92 (80%) patients. The most prevalent organism detected on urine culture was E.Coli (29%). Some of the other organisms majorly detected were Proteus (18%), Pseudomonas (8%), Klebsiella (10%), and Staphylococcus aureus (4%). The renal stone disease was found in 18 (19.56%) patients out of which 12 (13.04%) were male and 6 (6.52%) were female. The mean age of the patients presented with renal stones was 32.65±15.3 years. The male-to-female ratio of the patients with renal stones was 1.5:1. Conclusion: A large number of patients with urinary tract infections can develop the renal stone disease. Certain microorganisms are significant in this progression and resulting in renal stones. Keywords:Urinary tract infection, renal stone disease, Microorganisms, E.Coli

A nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery in upper urinary calculi patients with negative preoperative urine culture

Retrograde intrarenal surgery (RIRS) is one of the main surgical methods for upper urinary calculi, but severe complications of infection may occur after surgery. This study aimed to establish and validate a preoperative nomogram for predicting postoperative urosepsis following retrograde intrarenal surgery to treat upper urinary calculus in patients with a negative preoperative urine culture. We retrospectively recruited 1767 patients with negative preoperative urine cultures who underwent retrograde intrarenal surgery to treat upper urinary calculi from January 2017 to April 2022. The independent risk factors for urosepsis include a solitary kidney, positive urine nitrite, operative time ≥ 75 min, history of recurrent urinary tract infections, and history of diabetes were identified by univariate analysis and multivariate binary logistic regression analysis, which construct a nomogram. The receiver operating characteristic curve of the nomogram for predicting urosepsis was 0.887 in the training cohort and 0.864 in the validation cohort, respectively. The calibration curve and decision curve analysis demonstrated great consistency and clinical utility of the nomogram. Therefore, the nomogram combining preoperative independent risk factors can predict the probability of a postoperative urosepsis following retrograde intrarenal surgery in patients with a negative preoperative urine culture, which could help urologists take preventive measures in advance after surgery to avoid more serious complications of infection.

Predictability of Computerized Tomography as Compared to Ureteroscopy in Detection of Ureteric Stone in Patients with Indwelling Stents

Objective: The current gold standard for the diagnosis of ureteric stones in patients with a stent in situ is ureteroscopy but this study is planned to determine the positive predictive value of computerized tomography (CT) scan among such patients. Methods: This study involved patients who had ureteral stent in situ and were referred for re-evaluation of residual stones after extracorporeal shock wave lithotripsy. These patients underwent CT-scan for detection of ureteric stone. Later on, ureteroscopy was performed and ureteric stone was confirmed on direct visualization. Results: The mean age of the patients was 32.2±8.9 years. Male to female ratio of 1.7:1. CT scan shows a stone in 252 patients (70.2%) out of which 165 (46.0%) were confirmed on ureteroscopy. This yielded a sensitivity of 88.7 %, specificity of 49.7 %, positive predictive value of 65.5%, negative predictive value of 80.4% and diagnostic accuracy of 69.9% of CT&#x0D; for detecting ureteric calculi in patients with ureteric stents (p value &lt; 0.0001). Conclusion: CT scan owing to its limited diagnostic accuracy cannot replace ureteroscopy for detection of ureteric stones in patients with ureteric stents.

Clinical study and management of bladder calculus in patients presenting to VMKVMC hospital

Aim: To study and analyse the clinical findings, pattern, various management and their outcome of bladder calculus in patients visiting VMKVMC hospital. Methodology: In this retrospective study about Fifty patients with bladder calculus were selected and datas like urine examination, ultrasonogram (USG), X ray KUB were noted. The Management performed in those patients were open suprapubic cystolithotomy or transurethral cystolithotripsy or percutaneous cystolithotripsy. Patients’ symptoms, socio- economic status, composition of calculus and post- operative complications were recorded. Results: Out of 50 patients, 30 were male (64%) and 20 were female (36%). Management done was open suprapubic cystolithotomy in 8, transurethral cystolithotripsy in 28 and percutaneous cystolithotripsy in 14 patients. Composition of bladder stones was Caph. CaOx, uric acid in 24, CaOx, uric acid in 3, MAP CaOx uric acid in 16, MAP CaOx in 3, uric acid in 2 and CaOxAmm. Urate in 2 patients. Conclusion: The study revealed that maximum males were affected and transurethral cystolithotripsy was the most common management performed.

The Validity of Ultrasound KUB; in the Diagnosis of Ureteric Calculus

Background: Diagnostic techniques have utilized to diagnose ureteric calculus in patients presenting with ureteric calculus. The availability, cost and expertise of these techniques varies greatly from region to region. Among them ultrasound is the widely available, can be rapidly performed and also can be repeated without any exposure to radiation. We conduct this study which helps to establish the level of sensitivity, the specificity level, the value of Positive Prediction and the value of the negative prediction KUB ultrasound in the diagnosis of ureteric calculus. Methods: They collect this data from 193 patients from suspected ureteric calculus. All these 193 patients underwent for Ultrasound KUB followed by non-contrast CT KUB. These results of ultrasound are compared with CT KUB, which helps to report and to determine the accuracy level of ultrasound. Results: The USG enables and helps diagnose 105 number of cases in 193 patients with the accuracy of 62.60%. Number of cases diagnosed as having ureteric calculus on CT KUB, were 171 out of total 193 patients with 22 cases being missed. Conclusions: This ultrasound is a key to the preliminary test for the diagnosis of ureteric calculus. These results show some significant relationship for the last and final CT KUB report. The Professional level of experts used to perform this task.

Comparison of USG KUB Findings with MR Urography (fluid static) in Patients with Obstructive Uropathy- A Cross Sectional Study

Introduction– Obstructive uropathy is one of the most urgent clinical entities that has to be diagnosed and treated on time. Ultrasonography [USG] is cheap and easily accessible for determining the cause of obstructive uropathy. Magnetic Resonance Urography [MRU] has the potential to provide an excellent noninvasive examination of a wide range of urinary tract disorders, congenital anomalies and neoplasms without contrast administration. Aims- To assess the role of USG in obstructive uropathy patients and compare its finding with MRU static fluid. Design- Cross sectional study Materials and methods- This study was conducted on all patients referred to the Radio-Diagnosis department with any clinically suspicious obstructive uropathy symptoms. They underwent USG KUB and those with confirmed obstructive uropathy, underwent static fluid MR urography. Results- The study was conducted in 74 patients; 59.4% patients were males. Hydroureteronephrosis was the most common finding. MRU was superior to USG for diagnosis of stricture ureter and calculus in patients with obstructive uropathy. USG and MRI for diagnosis of VUJ, vesical, renal and pelvis calculus showed perfect agreement (κ=1; p=0.01); moderate for ureteric calculus (0.60-0.79; p less than 0.05) and minimal for ureteric stricture (0.21-0.39; p less than 0.05). MRU was superior in detailing PUJ obstruction as partial and complete. Conclusions- Ultrasound as an initial investigation helped in finding the level and severity of urinary obstruction. However, MRU performed better, in whom ultrasound showed inadequate results. In case of malignant obstruction, it gave precise soft tissue details. MRU appears as a better tool in diagnosing both extrinsic and intrinsic causes of obstructive uropathy.

Assessment of Bacterial Communities Within the Biofilm of Bladder Calculi in the Neurogenic Bladder Rat Model Following Spinal Cord Injury.

PurposeTo develop a rat model of bladder calculi in the neurogenic bladder following spinal cord injury (SCI) and assess bacterial communities within the biofilm of bladder calculi using denaturing gradient gel electrophoresis (DGGE).MethodsThe silk tied to a small segment of the Teflon IV catheter was implanted through the urethra into the bladder of rats with SCI induced by T9 laminectomy. After 6 months, the rats were sacrificed and their bladder calculi were collected by opening the bladders through the low-midline incision. Genomic DNA was extracted from the biofilm of bladder calculi followed by DGGE to obtain bacterial DNA. The DNA sequences were compared and analyzed using BLAST (Basic Local Alignment Search Tool) to identify bacteria.ResultsAfter placing silk nidus in the bladder for 6 months, all 6 rats developed bladder calculi. According to DGGE analysis, Pseudomonas aeruginosa was the most dominant strain, while Clostridium sp. and Lactobacillus sp. were relatively dominant strains within the biofilm of bladder calculi in the rats with SCI.ConclusionsDGGE analysis showed various microorganisms in the biofilm of calculi arising from a neurogenic bladder rat model. This research design can be the basis for clinical studies and may be applied to calculi in patients with neurogenic bladder following SCI.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

Diagnostic Accuracy of Ultrasonography in Detecting Ureteric Calculi in Patients with Renal Colic Taking Non-Contrast Multidetector Computerized Tomography of Kidney, Ureter, and Bladder (CT KUB) as the Gold Standard

Introduction: The goal of this study is to find the sensitivity, specificity, and diagnostic accuracy of ultrasonography in detecting ureteric calculi in patients with renal colic taking NECT KUB as the gold standard.&#x0D; Methods: All patients with acute renal colic presenting in the radiology department for ultrasonography and NECT KUB were enrolled in the study. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of ultrasonography in detecting ureteric calculi were calculated by taking NECT KUB as the gold standard test.&#x0D; Results: A total of 88 patients were enrolled in the study. The mean age was 37 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of ultrasonography for the detection of ureteric calculi were found to be 85.8 %, 80 %, 97.1 %, 42.1 %, and 85.2 % respectively in the present study.&#x0D; Conclusion: Ultrasonography shows high sensitivity and specificity for the diagnosis of ureteric calculi. It is a cheap, non-invasive, and easily available modality and there is no risk of radiation exposure. NECT KUB should be reserved for that patient for whom ultrasonography is not able to give a diagnosis.

Is percutaneous nephrolithotomy safe in chronic kidney disease patients!!!

Management of renal calculus in a patient of chronic kidney disease (CKD) is always challenging. Treatment options include extracorporeal shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy (PCNL). With PCNL being gold standard for renal calculus ≥1.5 cm in normal kidneys, we aimed to analyze the safety and efficacy of PCNL in CKD patients with calculus ≥1.5 cm. Sixty patients of CKD with renal calculus were included in the study: Group A with glomerular filtration rate (GFR) ≤30 ml/min/m2 and Group B with GFR >30 <60 ml/min/m2. The estimated GFR (eGFR) pre-PCNL, peak eGFR on follow-up, and eGFR at last follow-up, stone free rates, and complications were recorded. The CKD stage before and after PCNL were also compared at the last follow-up. The mean age of patients was 52 years. A mean of 1.14sittings per renal unit was required for PCNL. Complete clearance was 94% after all auxiliary procedures. The mean prePCNL eGFR was 26.5 ± 4.01 and 43.6 ± 9l. 14 ml/min/1.73 m2 in Groups A and B, respectively. The mean post-PCNL eGFR was 32 ± 9.94 and 51 ± 8.85 ml/minute/1.73 m2, respectively, in Groups A and B. At a mean follow-up of 180 days, deterioration with the migration of CKD stage was seen in 13 patients (21.6%) out of which 10 patients were of Groups A and 3 in Group B. Six patients (10%) required maintenance hemodialysis. Postoperative bleeding complication requiring blood transfusions was seen in 12 (20%) and 3 (5%) required intensive care unit care postoperatively. No mortality was observed in our study. PCNL is an effective management strategy for renal calculus in patients with CKD with an acceptable stone clearance rates and manageable complications. Peak eGFR <30 ml/min/m2 and postprocedure complications predict deterioration and need for RRT.

Validation of the infrared spectroscopy method for analysis of the composition of urine concretes.

The aim of this study was to validate the method for analyzing the composition of calculus using infrared (IR) spectroscopy by studying model mixtures of salts. Study was made with an ALPHA-P IR Fourier spectrometer with OPUS software (Bruker, Germany). The samples of pure chemical salts manufactured by Sigma-Aldrich USA were used to validate the method. Salt mixtures were prepared in ratios of 10/90, 50/50 and 90/10. To assess the effect of the fraction size on the calculus component results, were used calculi of patients with urolithiasis. For each mixture were used 10 repeated measurements. Analysis of the composition of model salts showed that in the study of pure cystine salt CV(%) was 0,79%, calcium carbonate - 0,92%, sodium urate - 0,97%, calcium oxalate monohydrate - 4,94%, magnesium ammonium phosphate - 5,59%. And the most common components were analyzed in the composition of complex mixtures, including 90%, 50% and 10% of the investigated component. Calcium oxalate monohydrate has CV(%) 5.70% in mixture 9 part of it to one part of impurities, in mixture 50/50 - 21.57% and in 10/90 - 5.70%. For uric acid in 90/10 - 2.20%, in 50/50 - 10.09%, in 10/90 - 31.94%. For calcium carbonate in 90/10 - 9.02%, in 50/50 - 11.98%, in 10/90 - 24.70%. The dispersion analysis showed that the weighed portions of salts with a particle diameter of more than 0.8 mm provide reproducibility with a CV - 11.48%, with a diameter of 0.2-0.8 mm - 5.35%, and finally less than 0.1 mm - 2.28%. The accuracy of the method is high, but the reproducibility of the IR-spectroscopy method is relatively low in the analysis of stones of mixed composition, due to the greater error in the determination of impurities. Laboratories should pay special attention to optimizing sample preparation to ensure particle fineness less than 0.1 mm.

Three-channel ion chromatograph for improved metabolic evaluation of urolithiasis

BackgroundUrolithiasis is a multi-etiological disease resulting from a combination of environmental and genetic factors. One of the most challenging aspects of this disease is its high recurrence rate. For most patients, an in-depth metabolic evaluation may reveal the presence of urinary stones. The fact that different urinary stone-related compounds (USRCs) are measured by different methods renders the metabolic evaluation of urolithiasis quite tedious and complex.MethodsA three-channel ion chromatograph (IC) that automatically measures the concentration of common metabolic indicators of urolithiasis in urine (i.e., oxalate, citrate, uric acid, calcium, and magnesium) was developed to improve the efficiency. To validate its precision and specificity, standard curves were prepared using working solution of these indicators. 100 standard solutions of these indicators were measured with our new IC and three other ICs as the control instruments; analyte concentrations in 100 24-h urine samples from volunteers and 135 calculi patients were also measured.ResultsAll analytes had good linear relationships in concentration ranges of 0–10 mg/L. The precision experiments in the standard and urine samples showed that the measurement errors of the newly developed IC were all less than 5%. In urine, the recovery rate ranged from 99.6 to 100.4%, the coefficient of variation ranged from 1.39 to 2.99%, and the results matched between our newly developed IC and the control ICs. The results of the efficiency test showed that we can finish the analysis at the average number of 14 people per day with the new IC. While the average number in the control group is 3.85/day (p = 0.000).ConclusionsOverall, this multi-channel system significantly improves the efficiency of metabolic evaluation while retaining accuracy and precision.

Effect of alkalized urine on renal calculi in patients with gout: a protocol for a placebo-controlled, double-blinded randomized controlled trial

BackgroundThe prevalence of renal calculi in patients with gout is high. Alkalized urine has been recommended by the 2020 European Association of Urology (EAU) guidelines to promote calculus dissolution. However, randomized controlled trials are lacking.MethodsIn the protocol of this randomized, placebo-controlled, double-blinded trial, patients with gout combined with renal calculi are randomized (1:1) to the placebo and sodium bicarbonate groups. The intervention would be performed for 24 weeks, the 1–12 weeks are double-blinded, and the 13–24 weeks are open-labeled. Sodium bicarbonate (1 g tid) will be performed for 24 weeks in the sodium bicarbonate group. The placebo will be performed for 12 weeks and not be performed from 13 weeks to 24 weeks in the placebo group. All subjects will be administered febuxostat (40 mg/day) for 24 weeks and receive concomitant anti-inflammatory prophylaxis therapy for 12 weeks. The primary outcome is the proportion of patients whose renal calculus volume will be reduced after 12 weeks of treatment. The secondary outcomes include the volume changes of renal calculi, uric acid changes, the proportion of patients with serum uric acid (sUA) levels < 360 μmol/L, the changes in estimated glomerular filtration rate (eGFR), the pH value of urine, and the incidence of adverse events after treatment for 12 and 24 weeks.DiscussionThis study will evaluate the efficacy and safety of sodium bicarbonate-alkalized urine on renal calculi in patients with gout.Trial registrationClinicalTrials.gov ChiCTR2100045183. Registered on April 7, 2021, with ChiCTR.