Chemical Composition Of Stones Research Articles

Кислотно-щелочное состояние крови у пациентов с мочекаменной болезнью. Исследование I: роль бикарбонатов.

Introduction. Kidneys play a leading role in maintaining acid-base balance. Kidney disorders lead to the acid-base balance violations. Data analysis showed that there are not enough attention to the problem of assessing blood acid-base balance in patients with urolithiasis. The aim of the first stage of this work was to determine the presence and severity of changes in one of the main indicators of acid-base balance - the level of blood bicarbonate in patients with urolithiasis. Materials and methods. We analyzed data from 83 patients: 39 men and 44 women aged 18 to 74 years. All patients were prescribed a biochemical blood test, a biochemical analysis of daily urine, blood acid-base balance and stone chemical composition. We studied the relationship of actual serum bicarbonate (actHCO3 - ) and standard bicarbonate (stdHCO3- ) in urolithiasis patients with level of other blood and urine parameters. Statistical analysis was performed using the methods of descriptive statistics, comparative statistical analysis, calculation of the t-test for independent groups, correlation analysis for two variables using the computer program Statistica 10.0 (StatSoft USA). Results. According to the statistical analysis performed using the calculation of Student's t-test, patients with actual serum bicarbonate [actHCO3- ] <21.0 mmol/l and urine pH>5.8 had lower serum total calcium levels (p<0.05 ), higher serum [Cl-] (p<0.05), higher serum creatinine (p<0.05) and urea (p<0.05), lower serum pH (p<0, 05), serum pCO2 (p<0.05), serum lactate concentration (p<0.05), lower BE (p<0.05) than patients with [actHCO3- ] blood >28.0 mmol/l. Correlation analysis showed that there is a relationship between the level of [actHCO3- ] and indicators of total blood calcium (p <0.05), blood chloride (p<0.05), creatinine and blood urea (p <0.05) and the concentration of calcium and magnesium in the daily urine (p<0.05). There was no statistically confirmed relationship between the level of standard blood bicarbonate [stdHCO3- ] and the concentration of other indicators of blood and daily urine. Conclusion. Determination of the serum bicarbonate level is necessary to clarify the metabolic state in urolithiasis patients. It is necessary to determine the concentration of actual blood bicarbonate (actHCO3- ) in urolithiasis patients.

Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana.

Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.

Evaluation of Ordering Practices, Microbial Yield, and Clinical Utility of Urinary Stone Cultures

Abstract Urinary stones are a global problem. While it has been established that microorganisms can be associated with urinary stone formation, data on best practices for microbial culture and clinical interpretation of microbial culture of urinary stone specimens are limited. Our objective was to investigate the microorganisms present in urinary stone cultures (usc) and companion urine cultures. We conducted a retrospective study at a tertiry hospital examining cultures submitted between October 2018 and October 2021. We collected data from electronic medical records of patients who had at least at least one usc performed. As part of routine clinical workup, all urinary stone specimens submitted for culture were ground using a disposable tissue grinder and inoculated on a tryptic soy agar with 5% sheep blood agar plate (BAP), a chocolate agar plate (CHOC), and a MacConkey agar plate (MAC), streaked for isolation and incubated in 5% CO2 at 35°C for up to three days. Urine cultures were performed using the Kiestra TLA system with 10 µL of inoculum onto each of a BAP and MAC, and plates were examined at 16 and 24 hours of incubation. For urine specimens submitted from a straight or “in and out” catheter, 10,000 CFU/mL was the threshold for workup. From clean-voided, midstream, ileostomy, nephrostomy, or indwelling/Foley catheter specimens, 100,000 CFU/mL was the threshold for workup. The final clinical significance of cultures is determined by evaluating the culture result in light of the patient’s clinical presentation. For usc and urine cultures, clinically insignificant growth was considered no growth or when no pathogens were recovered in culture. Urine cultures with more than 3 species over threshold were considered contaminated. A total of 1,049 usc were performed from 854 patients (55.3% female). The median patient age was 61 years (IQR 49-70). The most frequent microorganisms reported in usc cultures were Proteus mirabilis (N=98), Enterococcus faecalis (N=75), and Escherichia coli (N=73). No pathogen was identified from 57% of usc. 441 usc were performed in a context of urine culture (+/-2 days) in 336 (39.3%) patients. In addition, 138 patients (16.1%) had more than 1 usc, being the maximum as 11 usc performed in one patient. The most common urine/USC concordant result was no growth in 165 of 441 cultures (37.4%), followed by coagulase negative Staphylococcus. Cohen’s kappa obtained from usc and urine culture results was 0.45, which is not the minimum acceptable agreement. A pathogen was identified from usc in 43% of cases. Usc and urine cultures rarely resulted in concordant results, but the most common concordant result was no growth in culture. Additional studies are warranted to evaluate the impact of usc results on patient care, including antimicrobial use and correlation of microbes isolated with stone chemical composition.

Prevalence and predictors of incidence of urolithiasis in a representative region

BACKGROUND: Domestic and foreign studies have shown the presence of correlations between the prevalence of urolithiasis, anthropogenic factors, and composition of the water consumed by the population. In the Nizhny Novgorod Region, there is a high incidence of urolithiasis; thus, the identification of its causes appears to be an urgent task.&#x0D; AIM: To assess the prevalence and identify predictors of the incidence of urolithiasis in the rural population of the Nizhny Novgorod Region.&#x0D; MATERIALS AND METHODS: The study was conducted in the Nizhny Novgorod Region. Annual reports of patients seeking medical care for urolithiasis for 3 years in 49 central district hospitals and two large regional hospitals were analyzed. The incidence rate of urolithiasis was calculated according to the treatment of patients with urolithiasis also for 3 years in relation to the population of each district. Information about drinking sources was obtained by questioning 800 patients with urolithiasis who were treated at the Nizhny Novgorod Regional Clinical Hospital. The chemical composition of drinking water was assessed in accordance with the requirements for drinking water SanPiN 2.1.4.1074-01. The mineralogical composition of 1000 urinary stones of patients from rural areas of the Nizhny Novgorod Rregion was retrospectively analyzed using a Nicolet iS5 IR-Fourier spectrometer.&#x0D; RESULTS: In this study, 38 (77.5%) districts of the Nizhny Novgorod Region have unfavorable conditions for urolithiasis. Moreover, 59.5% of the rural population are using water from underground sources (wells). Significant correlations were found between the incidence of urolithiasis and the chemical composition of the water consumed, particularly water hardness. The analysis of the mineralogical composition of urinary stones showed their polycomponent composition in 89.5% of the cases. Differences in the chemical composition of stones are associated with the environmental factors of the region, one of which is drinking water.&#x0D; CONCLUSIONS: Most of the rural population of the Nizhny Novgorod Region is at risk for urolithiasis. Significant differences in the incidence of urolithiasis were dependent on the degree of hardness of the groundwater used for drinking. Increased water hardness is a significant risk factor for the development of urolithiasis.

Study on renal stones incidence with regard to age, gender and chemical composition of stones in Western Iraq

This study was done to calculate the incidence of urinary stones in relation to age, gender and chemical composition of urinary stone. Moreover, the study was conducted in the period from the 1st of December 2020 to 1st of December 2021. Hundred patients were included in the study from both sexes, their ages ranged from 24 to 57year whom diagnosed with renal stone. All samples analyzed qualitatively by standard methods. The study showed that renal stones were more in males (80%) than females (20%) with male to female ratio of 4:1 with higher occurrence at the age of 50-57years. The commonest type was the calcium salts (oxalate and non-oxalate). Finally, the researcher concludes that the urinary stones are a common disease in west of Iraq with higher incidence in men than women. The commonest age of occurrence is 50-57 years and the commonest type is calcium oxalate.

Association of Stone Chemical Composition with the Stone-free Result and Operative Time Following Percutaneous Nephrolithotomy

Background and Objective: The present study aimed to assess the association between stone chemical compositions and Percutaneous Nephrolithotomy (PCNL) outcomes (stone-free result, operative time). Materials and Methods: In this analytical cross-sectional study, the data of 113 patients who underwent PCNL, including stone chemical composition, stone-free result, and operative time, were recorded and analyzed. Results: In univariate analysis, no significant differences were observed between the group with the stone-free result and the group without stone-free result in mean percentages of calcium phosphate, calcium oxalate, uric acid, and the frequency of infectious stones time (P&gt;0.05). Moreover, operative time was not significantly correlated with the percentages of calcium phosphate, calcium oxalate, and uric acid components (P&gt;0.05). In addition, no significant difference was detected between the two groups (with and without infectious stones) in terms of mean operative time (47.00±17.38 vs. 45.99±20.98; P=0.817). In multivariate regression analysis, none of calcium phosphate, calcium oxalate, uric acid, and infectious stone were the predictive factors affecting stone-free result and operative time. Conclusion: As evidenced by the obtained results, the compositions of upper urinary tract stones had no effect on the stone-free result and operative time in PCNL.

The Chemical Compositon of Urinary Stones at the Military Teaching Hospital of Cotonou

The Chemical composition of urinary stones at the Military Teaching Hospital of Cotonou. Objective: To determine the chemical composition of urinary stones in our patients. Patients and method: We collect surgically removed urinary stones from our patients and send them abroad for infrared spectroscopic analysis. Results: The infrared spectroscopic analysis was performed on urinary stones from 26 patients, i.e. 21 males (80.8%) and 5 females (19.2%). Their mean age was 48 years (range: 21-71). The mean proportions of chemical components in the stones were: 40.8% whewellite (0-97), 29.4% weddellite (0-95), 12.7% uric acid (0-90), 5.4% struvite (0-70), 5.2% carbonate apatite (0-20), 1.9% ammonium urate (0-20), 1.7% silicate (0-45), 1.3% protein (0-10), 1.2% whitlockite (0-10) and 0.1% hydroxyapatite (0-2). All stones were a mixture of 2 or 3 of the identified chemical components. Based on the main component, there were 3 groups of stones: the calcium oxalate stones (77%), the uric acid stones (15.4%) and struvite stones (7.7%). One calcium oxalate stone from a female comprised 45% silicate and 5% protein. There was no stone chemical composition difference between males and females. Conclusion: The stones from the 26 patients were mainly non pure calcium oxalate stones (73%), uric acid stones 8%) and struvite stones (4%).

Analysis of clinical manifestations, risk factors and diagnostic procedures in children with urolithiasis

The incidence of urolithiasis in the paediatric population has grown in recent years. Aim: The aim of this study was to analyse clinical symptoms, risk factors and diagnostic procedures in children with urolithiasis. Materials and methods: We conducted a questionnaire study (supplemented with an analysis of medical records) in a group of 49 children diagnosed with urolithiasis, including 17 patients from the department of paediatrics at the time of the first metabolic evaluation, and 32 patients hospitalised in a one-day department of paediatric urology prior to extracorporeal shock wave lithotripsy. Results: Urolithiasis occurred in children in the study group at the age of 9.3 ± 4.9 years and manifested with abdominal pain (69.4%), vomiting (18.4%) and haematuria (10.2%); urolithiasis was diagnosed accidentally in 14.3% of patients. All patients developed renal stones (bilateral in 20.4%); 28.6% of patients additionally presented with ureteral stones, and 6.1% with bladder stones. Urolithiasis was accompanied by urinary tract infection in 44.9% of patients. The most common risk factors for urolithiasis included positive family history (75.5%), low fluid intake (51%), urinary tract infection (42.9%) and overweight/obesity (28.6%). Among patients admitted for extracorporeal shock wave lithotripsy, only 65.6% of children underwent nephrological consultation. Slightly more than a half of these patients underwent metabolic diagnosis, with exhausted evaluation in 7 cases and incomplete metabolic assessment in 5 cases. The chemical composition of stones was analysed in 22.4% of patients. Conclusions: Abdominal pain and vomiting are the most common clinical symptoms in children with urolithiasis. The paper presents modifiable risk factors and shows the need for improvement in metabolic evaluation of urolithiasis.

MO118ROLE OF DUAL ENERGY COMPUTED TOMOGRAPHY IN PREDICTING THE CHEMICAL COMPOSITION OF STONES

Abstract Background and Aims Dual-energy CT (DECT) has shown excellent outcomes in differentiating the chemical composition of the urinary stones with a great accuracy. A reliable determination of the chemical type of the stone help the clinician to better satisfy treatment options for the patient- medical versus surgery We used the DECT in our study to assess the accuracy of non-invasive differentiation of renal stones using the 3rd generation dual-source computed tomography (CT) scanner in determining the chemical composition of renal stones and to determine appropriate management based on DECT determined chemical composition of stones. Method This prospective study was conducted in the Department of surgery and radiodiagnosis and Imaging, Era Medical College and RML institute of Medical Sciences , Lucknow over the study period, i.e., November 2016 to May 2018 . The patients were those referred for non-contrast/contrast CT for the diagnosis/evaluation of urolithiasis from the department of Surgery admitted for PCNL/ESWL/therapeutic ureterorenoscopy. DECT ratios of the various stones were noted and compared with the post extraction analysis of stones for composition. A total of 100 patients were included in the study, and their DECT results were compared with the post-extraction analysis (by infrared spectroscopy as the standard comparative method). Results Mean age of patients was 41.15+/- 10.08 years with 64% being males. DECT was highly sensitive and specific in the diagnosis of various types of calculi based on their dual-energy ratio. It was found to be 100% sensitivity and 97.2% specificity for differentiating UA stones with level of agreement between chemical and DECT was almost perfect (k= .951) .However for hydroxyapatite stones was substantial (k=.889). Most of the stones belonged to non-UA category (72%), and only 28% were UA calculi. The sensitivity and specificity in differentiating a calcium oxalate from non-calcium oxalate calculus was 94.1% and 95.5%, respectively. Conclusion DECT highly sensitive and effective in characterizing chemical composition of the urinary stones and can help in determining the management plan and reduce the unnecessary burden of surgical interventions.

Weathering of stone monuments: Damage assessment of basalt and laterite

Most heritage monuments in India are made of stones, representing the rich cultural traditions of the region. Due to human interventions and natural causes these monuments are undergoing deterioration and need effective intervention. The weathering of stone monuments can be attributed to stone characteristics and also to the environment. This study attempts to investigate and assess extent of deterioration in two monuments, Khidrapur temple and Panhala Fort. Engineering properties and chemical composition of stones were determined. XRD analysis revealed the presence of minerals, pyroxene and olivine. SEM images show the formation of detritus minerals indicating the intrinsic weathering of rock. These studies reveal that agents of weathering have deteriorated the building stones from outside and inside also. Micro structural analysis also helped to identify the intrinsic characteristics of stone, which will aid in formulating preservative treatments and procedures. This study forms a base for sustainable conservation of these heritage monuments. The outcome of the study will be applicable for determining conservation strategies for the monuments built in basalt and laterite.

Определение химического состава мочевого камня in vivo по профилю потребления нутриентов

Introduction. Сurrently, existing methods for determining the chemical composition of the stone in vivo do not have the necessary accuracy. In this regard, the development of methods for high-precision determination of the chemical nature of urinary stones using modern technologies is relevant for modern urology. Materials and methods. 72 patients with urolithiasis who were treated at the Institute of urology and interventional radiology. N.A. Lopatkin – a branch of the Federal state budgetary institution «NMIC of radiology» of the Ministry of health of Russia, along with standard methods of examination, performed the determination of the chemical composition of urinary stones using infrared spectroscopy. Urinary stones were classified according to the predominant mineral component into six main types (calcium-oxalate, uric acid, calcium phosphate, magnesium-ammonium-phosphate, urate–ammonium and mixed), as well as determining the nutrition stereotype for 25 nutrients using an electronic questionnaire. The classification model was built using the tools of a modern set of Data mining methods-IBM SPSS Modeler 18.0 (IBM Corporation, USA). Results. the data set includes the results of the survey of pattern of food and chemical composition analysis of urinary stones on the basis of which a model was produced, allowing high-precision to predict in vivo chemical type of urinary stones. The constructed machine-learning model (C5.0 algorithm) has high predictive accuracy (98.6-100%), specificity (98.2-100%), and sensitivity (100% for the main types of stones and 75.0% for mixed ones). Conclusions. the Developed method for determining the chemical composition of urinary calculus in vivo based on the indicators of the patients nutrition stereotype has a high specificity, sensitivity and accuracy, which allows using this prognostic model in clinical practice.

Densitometric density of urinary stones as a predictive factor demonstrating their efficiency of disintegration in treatment of urolithiasis

Urolithiasis is one of the most common urological diseases, occurring in at least 3% of the human population and 34.2% of the Russian population. Data from the Ministry of Health of the Russian Federation show that in the past 4 years, the incidence of urolithiasis has increased from 405.2 to 460.3 patients per 100,000 population. The purpose of this study was to assess the significance of determining the density of urinary stones via computed tomography, as well as the chemical composition of urinary stones, in order to choose an optimal treatment strategy for patients with urolithiasis. The results of treatment of 108 patients with stones of different localization and sizes were investigated. The patients were subjected to laboratory examination to determine the urinary salt environment; moreover, the levels of electrolytes were examined in blood samples from the patients, and computed tomography densitometry was performed to determine the density of the detected stones. The qualitative chemical compositions of urinary stones in patients with urolithiasis were determined. The density of urinary stones was evaluated by computed tomography densitometry in these patients. The relationship was determined between the chemical compositions of stones and their corresponding densitometric densities. The densitometric density of urinary stones, as determined by computed tomography, can serve as a predictor of the effectiveness of stone disintegration, because it allows selection of the best method to destroy stones for treatment of urolithiasis.

Using computed tomography to predict in vivo stone chemical composition

OBJECTIVES. Several authors hypothesized the usefulness of the non-contrast helical computed tomography (NCHCT) with the determination of stone Hounsfield Unit (HU) values in order to predict urinary stone compositions. Preoperative knowledge of stone composition might be interesting in pre-operative decision-making process. The aim of this study was to evaluate the possible correlation between stone chemical composition and correspondent stone HU value in an in-vivo experience. METHODS. Forty patients with urinary stones were preoperatively studied with abdominal NCHCT, where stone HU values were reported. Stone chemical composition was obtained in each patient, using the colorimetric method. The HU value of each stone was compared with the correspondent chemical analysis. Results. The median HU values of calcium oxalate (n=10), mixed calcium oxalate and phosphate (n=19), calcium phosphate (n=2), uric acid (n=6) and mixed uric acid and calcium oxalate (n=3) stones were 1060 HU [interquartile range (IQR) 743.75-1222.5]; 900 HU (IQR 588.5-1108.5); 774 HU (range 720-828); 371 HU (IQR 361.25-436.25) and 532 HU (range 476-626), respectively. CONCLUSIONS. Our results confirmed a statistically significant difference of the HU values between calcium and pure uric acid calculi, suggesting a correlation between stone chemical composition and CT-density. Hounsfield unit.

Staghorn stones’ composition analysis features

The lack of standards in the analysis of the chemical composition of the staghorn stones leads to a decrease in the effectiveness of metaphylaxis, and especially in those cases where the volume of the stone is much larger than the volume of the stone fragment being studied. The aim of this study was to develop standards in order to determine the composition of the staghorn calculi. In the Institute of urology from 2015 to 2016, we identified patients with urolithiasis, staghorn-stone nephrolithiasis who were eventually hospitalized. All patients underwent percutaneous nephrolithotripsy, and fragments of the stone were taken in order to analyze its chemical composition. An analysis of the composition of various fragments taken from different zones of the same calculus was made. Patients were divided into 4 groups depending on the composition of the stone. The first group included patients with a predominance of phosphate in the internal layer of the pelvic fragment of the stone, the second group – with a predominance of oxalates, the third – with a predominance of urates, the fourth – with cystine stones. Our experience, while doing stone analysis, showed that the composition did not coincide in 77% of cases, and in 41,6% of cases a new component in the chemical composition of the stone appeared. Complete coincidence of the composition in the cortical and internal layer of the stone was detected in 35% of the cases, and component coincidence in 58% of cases. In the cortical and internal layers of the pelvic fragments, the total and component coincidence of the composition was 38% and 58%, respectively. Thus, we show the importance of chemical analysis of stones and that the composition of the stone may vary, depending on its location. Timely detection of changes in the nature of the stone allows an adequate treatment of urolithiasis.

Composition of urinary calculi in infants: a report from an endemic country.

Pediatric urolithiasis remains endemic in low-resource countries where infants constitute 17-40% of all children with urolithiasis. This study reports socio-economic factors, medical history and chemical composition of urinary stones in 976 infants of up to 2years of age. Between 1992 and 2016, 976 infants presented to our institute with 1038 stones. Chemical composition of stones was analyzed by Fourier transformation infrared spectroscopy (FTIR). The mean age of infants was 19.5±5.74months with a M:F ratio of 5.5:1. Half (50%) of the infants were rural dwellers, 90% belonged to low socio-economic class and 70% were malnourished. A history of chronic diarrhoea was reported in 13% and urinary tract infections in 5%. The anatomic location was bladder in 487 (46.9%), kidney in 246 (23.6%), ureter in 142 (13.6%), urethra in 2 (0.2%) and 161 (15.5%) were passed spontaneously. Overall frequency of compounds in stones showed ammonium acid urate (AAU) in 772 (74.37%), calcium oxalate (CaOx) in 410 (39.5%). Uric acid (UA) in 119 (11.46%), calcium phosphate apatite (CaP) in 96 (9.25%), magnesium ammonium phosphate (Struvite) in 45 (4.34%), cystine in 12 (1.16%) and xanthine in 40 (3.85%). Frequency of compounds was similar in genders. Infants of age 0-6months had higher frequency of UA (28%), CaOx (50%) and low AAU (61%) as compared to 11, 39 and 75%, respectively, in 7-24months (p<0.049) (p<0.002) (p<0.001). Nucleus of stones showed pure AAU in 63 and 43% on the surface due to addition of CaOx, struvite and CaP. Our study has shown that AAU is a major component of stones in infants where the main risk factors are poverty, malnutrition, diarrheal diseases and dehydration.

Dual energy computed tomography in diagnosis of urolithiasis: a new method for determining the chemical composition of urinary stones

The "gold standard" for the diagnosis and evaluation of urinary stones is native computed tomography, which allows determining stone localization and size of with high accuracy. However, this imaging technique has limited diagnostic usefulness in determining the stone chemical composition. The newly introduced method of dual-energy computed tomography, based on obtaining images at two different energy levels is highly effective in determining the composition of urinary stones. The review outlines the principles and methods of performing dual-energy computed tomography using various scanners. The authors analyze the results of using this method for diagnosing urolithiasis, determining the stone chemical composition and point out the limitations and difficulties encountered in its application.

Study on Chemical Composition of Urinary and Salivary Gland Stones in Relationship with Laboratory Parameters and Lifestyle Habits of Patients with Lithiasis

Lithiasis is a disease with increasing incidence, may occur in the urinary tract, salivary glands and bile ducts. Genetic susceptibility, diet, low fluid intake, endocrine disorders, infections and other factors can influence the development of the disease and its recurrences. The aim of the study was to reveal the relationship between chemical composition of the stones, lifestyle and dietary habits and the results of laboratory analysis in patients with urinary tract and salivary gland lithiasis. The data of 258 patients with urinary tract and salivary gland lithiasis collected between September 2009 � May 2016 were studied. The subjects were from the Urology and Oral Surgery Hospital, and from the Marmed and Procardia medical units in Tirgu Mures. We evaluated the lifestyle habits using a questionnaire, microscopical examination, size measurement and chemical analysis of the stones were made and we processed the results of urinary strip analysis and sediment. In a subgroup of patients (48 samples) calciuria, phosphaturia, serum uric acid, calcium, phosphate, alkaline phosphatase and parathormone (PTH) levels were determined; in case of pathological values calcitonin measurement and endocrinology consultation were performed. The most frequent composition was the combination of calcium oxalate and phosphate in case of both urinary and salivary gland stones, in several uroliths we detected uric acid/xanthine crystals, rarely cystine and carbonate were found. The incidence of hematuria and leukocyturia exceeded 70%. Excessive calcium intake was observed in the diet of the several patients having calcium oxalate stones. In the subgroup tested for biochemical and hormonal analyses we found increased serum PTH concentration in 20.83% of the patients. Some of the subjects had pathological serum calcium, uric acid and alkaline phosphatase results, or the elimination of minerals in the urine was out of the normal range. We found pathological laboratory results in several patients suffering from lithiasis. Proper diet and medical treatment in many cases could prevent the recurrences of stone formation, but first a complex investigation of the patients is necessary to adapt the treatment plan to individual requirements.

Urolithiasis analysis in a multiethnic population at a tertiary hospital in Nairobi, Kenya

BackgroundUrolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used.MethodsThis was a retrospective study which utilized patients’ clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confirmed urolithiasis formed the study. This study aimed to describe the clinical characteristics of patients, modalities of treatment as well as the chemical composition of renal stones from patients diagnosed and managed for urolithiasis during a duration spanning 17 months. Wet chemistry was utilized for analyzing the chemical composition of the urinary calculi. Data on age, sex, symptoms, radiological investigations done, location of the calculi, chemical composition of calculi and therapeutic procedures instituted were extracted and analyzed.ResultsAges ranged from 3 to 87 years with a median of 42; males were the majority (79%) and the commonest presenting symptoms were flank pain (91%) and dysuria (19%). The majority of the stones were located in the ureters (46%) and at the pelvi-ureteric junction (25%). A statistically significant difference in frequency of lodgment at the pelvi-ureteric site between males and females was noted. However, the number of female patients in this study was small and studies with larger numbers of female participants are required to confirm this observation. All stones contained calcium and oxalate, often as the only constituents (72%). In the remainder of the stones, other constituents such bicarbonate, ammonium, phosphorous, magnesium, uric acid and cystine occurred in varying combinations with calcium oxalate. Laser lithotripsy was the most performed therapeutic procedure (77.6%).ConclusionsMales formed the majority of patient with urolithiasis. Overall, most of the calculi were located in the ureters except in women where the pelviureteric location was commoner. Stones containing calcium oxalate only were predominant across the age groups and in both sexes. Lithotripsy was the commonest mode of management.

Association of body mass index, urinary pH and urolithiasis

Background: Urinary stones have afflicted mankind since antiquity, with earliest recorded being bladder and kidney stones detected in Egyptian mummies dated 4800 BC. In our study we aimed to determine the association of BMI, urinary pH and urolithiasis. Methods: The study was conducted in the department of surgery, Gandhi Medical College, Bhopal. A total of 100 patients who underwent open surgical procedures for urolithiasis were included in the study. The study was carried out from October 2013 to October 2014. The data collected was analyzed for association of BMI with urinary pH, serum creatinine, serum uric acid and serum calcium. Also the effect of body mass index BMI on the chemical composition of stone was studied. Results: A total of 100 patients of urolithiasis undergoing nephrolithotomy, pyelolithotomy or ureterolithotomy were included in the study. The patients were divided into three groups according to BMI as stated above. The result of inter group comparison showed a statistically significant increase in presence of calcium oxalate and uric acid stones with increasing BMI. The presence of calcium phosphate stone did not indicate any significant change with changing BMI. Conclusions: Hyperinsulinemia and insulin resistance play an important role in etiology of uric acid stones, hence all patients with uric acid stones should be screened for diabetes.

Interconversion of stone composition profiles from two recurrent stone episodes in stone formers

The aim of the study was to investigate the interconversion of the stone chemical composition of two recurrent stone episodes in stone formers. The data of 1098 stones analyses from 549 patients with a history of two renal stone episodes were selected and reviewed. The stone composition between the two recurrent episodes of stones was compared. The percent occurrences of stones caused by infection, known as infection stones, in new episodes of stones significantly increased by 7% and uric acid stones increased by 3.8% while the calcium oxalate stones decreased by 13.1% (each p<0.05). The mean recurrent interval of new episodes of stones was 34.2 months. Infection stones had a significant shorter interval time compared to calcium oxalate stones (p<0.001). On a patient-by-patient investigation, 32.9% of patients underwent conversions of stone compositions, with 31.9% and 34.1% in men and female, respectively (p=0.590). The mutual conversion of infection stones to calcium oxalate stones was most common. The 61.1% of patients with uric acid recurrent stones were composed of calcium oxalate in the previous episode of stones, and 5% and 51.7% of patients with infection stones developed stones of uric acid or calcium oxalate in the new episode, respectively. Alterations of stone components during follow-up were found in as high as 32.9% of patients with no gender difference. The impetus of these shifts is not readily apparent. Accurate and repeated stone analyses throughout the course of recurrent stone disease are highly warranted, which may be useful to prevent recurrence of composition-specific stones.