Diagnosis Of Nephrolithiasis Research Articles

Sodium-glucose cotransporter 2 inhibitors and risk of nephrolithiasis.

Sodium-glucose cotransporter 2 inhibitors (SGLT2Is) may reduce nephrolithiasis risk by increasing urine flow. We aimed to investigate whether initiation of SGLT2I was associated with reduced nephrolithiasis risk. We conducted an active-comparator new-user cohort study using the Danish health registries in the period 11 November 2012 to 31 December 2018. Individuals aged ≥40years initiating SGLT2Is or glucagon-like peptide-1 receptor agonists (GLP1 RAs) were followed from treatment initiation until an inpatient or outpatient diagnosis of nephrolithiasis, death, emigration or end of study. New users of SGLT2Is were matched 1:1 on propensity scores to new users of GLP1 RAs. In supplementary analyses, risk of recurrent nephrolithiasis was assessed in individuals with a history of nephrolithiasis before treatment initiation. We identified 24,290 and 19,576 eligible users of SGLT2Is and GLP1 RAs, respectively. After matching, 12,325 patient pairs remained. The median age was 61years and median follow-up was 2.0years. The nephrolithiasis rate was 2.0 per 1000 person-years in SGLT2I initiators compared with 4.0 per 1000 person-years in GLP1 RA initiators, with a rate difference of -1.9 per 1000 person-years (95% CI -2.8, -1.0) and an HR of 0.51 (95% CI 0.37, 0.71). For recurrent nephrolithiasis (n = 731 patient pairs), the rate difference was -17 per 1000 person-years (95% CI -33, -1.5) and the HR was 0.68 (95% CI 0.48, 0.97). Initiation of treatment with SGLT2Is was associated with a clinically significant reduced risk of incident and recurrent nephrolithiasis.

Dual-Energy CT for Urinary Stone Evaluation.

Conventional CT imaging is an excellent tool for the diagnosis of nephrolithiasis however is limited in its ability to detect stone composition. Dual-energy CT (DECT) scans have demonstrated promise in overcoming this limitation. We review the current utility of DECT in nephrolithiasis. DECT is superior to conventional CT in differentiating uric acid stones from non-uric acid stones, with numerous studies reporting sensitivities and specificities approaching > 95%. Dose reduction protocols incorporating low-dose CT scans are commonly used, providing significantly lower effective radiation doses compared to conventional CT. DECT remains an effective diagnostic tool in patients with large body habitus. DECT can accurately detect uric acid stones, which can help guide which stones may be suitable to medical dissolution. Further studies evaluating the effectiveness of DECT in guiding management of patients with nephrolithiasis can help to promote its widespread use.

Evaluation for Primary Hyperparathyroidism in Patients Who Present With Nephrolithiasis

The incidence of primary hyperparathyroidism (PHP) is likely underestimated. Nephrolithiasis may indicate PHP with indication for parathyroidectomy. We sought to determine the proportion of patients with an index diagnosis of nephrolithiasis that have serum calcium levels measured, parathyroid hormone (PTH) levels measured if hypercalcemic, and time to referral for definitive management if PHP is diagnosed. A single-institution retrospective review was performed of adult patients presenting with nephrolithiasis between July 1, 2016 and December 31, 2018. Exclusion criteria included currently admitted patients, prior nephrolithiasis, congenital or acquired urinary tract anomalies, and patients on calciuretics. Records were assessed for serum calcium and PTH measurement, as well as referrals. Univariate statistical analysis was performed. Of 1782 patients with nephrolithiasis screened, 968 met inclusion criteria. Patients were 49.8% female, 88.9% white. Mean age was 53y. Within this cohort, 620 (64.0%) patients had a calcium measured, with a mean elapsed time from presentation of 27d (interquartile range [IQR] 0-8). Twelve patients (1.58%) with calcium measured were hypercalcemic and eight (66.7%) had PTH measured with a mean elapsed time from presentation of 183d (IQR 72-310), all had elevated or non-suppressed PTH. Five (62.5%) were referred to surgeons with mean elapsed referral time of 270d (IQR 95-492). Many with index nephrolithiasis are not assessed for hypercalcemia or hyperparathyroidism. Patients with serum calcium and PTH values indicating PHP diagnosis may have significant delay to parathyroidectomy. Targeted interventions with electronic health record alerts or automated reflex testing may improve care in this domain.

MP03-06 ASSOCIATION OF URINARY STONE DISEASE WITH KIDNEY FUNCTION DECLINE

INTRODUCTION AND OBJECTIVE: Prior studies have shown significant differences in glomerular filtration rate (GFR) between stone formers and non-stone formers. There is evidence that nephrolithiasis is a risk factor for chronic kidney disease (CKD). The role of kidney function in kidney stone formation however largely remains unexplored. The objective of this study is to investigate differences in kidney function decline between stone formers and non-stone formers over time. METHODS: A retrospective study was undertaken using de-identified patient data at our tertiary care center. Serum creatinine values of adults (age ≥ 18) were used to calculate GFR using the CKD-EPI creatinine equation. The primary outcome was change in GFR per year using an adjusted linear model. An adjusted cox-model was used to calculate the average risk of stone formation associated with GFR decline in stone formers based on date of initial nephrolithiasis diagnosis. Our secondary outcome was GFR change post stone formation stratified by surgical versus non-surgical intervention. RESULTS: Complete data for analysis was obtained from 3,450 stone formers and 112,072 non-stone formers after review of medical record data between 2010 and 2019. Stone formers had an overall GFR decline of 2.8 cc/min per year (p-value < 0.001) compared to a decline of 0.04 cc/min per year (p-value = 0.38) in non-stone forming patients. A fully adjusted cox-model indicated, on average, each 1 cc/min decline in GFR was associated with an increased risk of stone development in the following 2 years by 3.7%. Stone formers who underwent surgical intervention (PNL, URS, or SWL) had stable GFR post-operatively at 1 year. Patients who did not undergo surgical intervention had GFR decline of 0.82 cc/min CI [-1.56, -0.08] at 1 year (p-value = 0.03). CONCLUSIONS: A decline in GFR is associated with risk of kidney stone presentation up to 2 years prior to a stone event. This suggests that upstream changes in the renal papilla which affect GFR also may be contributing to mineralization. Kidney function decline could be used as a possible predictive tool for risk of stone formation. Additionally, surgical intervention is associated with preservation of GFR within one year after stone event. Clinically, unexplained GFR decline should increase suspicion for nephrolithiasis and appropriate evaluation and treatment should be considered.Source of Funding: none

Regional Variation in Shock Wave Lithotripsy Utilization Among Medicare Patients with Nephrolithiasis

To characterize shock wave lithotripsy (SWL) utilization and assess for regional variation in the use of this procedure across the United States. We examined SWL and URS utilization among Medicare Beneficiaries with a diagnosis of nephrolithiasis for the years 2006, 2009, and 2014. Adjusted utilization rates were calculated per 1000 beneficiaries accounting for age, sex, and race. Utilization rates were examined nationally and by hospital referral region (HRR). A total of 511,495, 604,493, and 806,652 Medicare beneficiaries had a diagnosis of nephrolithiasis in 2006, 2009, and 2014, respectively. The adjusted rate of SWL per 1000 beneficiaries with nephrolithiasis decreased from 59.4/1000 in 2006 to 52.2/1000 and 45.5/1000 in 2009 and 2014 (13.9% decrease, P < .001). Variation was observed in SWL utilization; up to a 12-fold difference between HRRs (9.2/1000 in Winchester, VA to 105.8/1000 in Lincoln, NE). The adjusted rate of URS per 1000 beneficiaries increased by 10.2% (P < .001) between 2006 and 2014. However, the percent decrease in SWL utilization did not correlate with the percent increase in URS utilization when examined by HRR (P = .66). Variation exists in the utilization of SWL among Medicare beneficiaries (12-fold difference). This variation is likely secondary to a series of supply, urologist, and patient-specific factors. SWL utilization decreased between 2006 and 2014, while URS increased. Stone procedure type is likely highly dependent on where patients receive their urologic care.

A clinical pathway to minimize computed tomography for suspected nephrolithiasis in children

Ultrasound (US) imaging is preferred in the initial evaluation for children with suspected nephrolithiasis; however, computed tomography (CT) continues to be used in this setting with resultant unnecessary ionizing radiation exposure. The study institution implemented a standardized clinical pathway to reduce rates of CT utilization for children with nephrolithiasis. The aim of this study was to evaluate the impact of this pathway on initial imaging strategies for children with suspected nephrolithiasis. A standardized pathway was designed and implemented using a systematic quality improvement process. A suspected cohort was created using 'reason for study'search terms consistent with a nephrolithiasis diagnosis. A confirmed cohort of children with a final diagnosis of nephrolithiasis was derived from this suspected cohort. The primary outcome was CT use as the initial imaging study in children with suspected or confirmed nephrolithiasis presenting to the emergency department (ED) between October 2013 and February 2018. Comparisons were made before and after pathway implementation (October 2015). Secondary outcomes included rates of CT scan within 30 days, while balancing measures included rates of admission, ED length of stay, and return visits. A total of 534 children with suspected (220 prepathway; 314 postpathway) and 90 children with confirmed (37 prepathway; 53 postpathway) nephrolithiasis were included. For the suspected cohort, CT scans performed as the initial imaging evaluation (9.2% vs 2.5%, P=0.001) and at any time during the index visit (15.7% vs 5.7%, P=0.001) decreased after pathway implementation. Within the confirmed cohort, a non-significant decrease in initial CT rates was observed after implementation. No differences were observed in admission rates or ED length of stay after implementation. A trend towardlower return visits to the ED was seen after pathway implementation (5.5% vs 2.2%, P=0.058). Within a tertiary care pediatric ED associated with a strong institutional experience with clinical pathways, initial CT rates were decreased after pathway implementation for children with suspected nephrolithiasis. While retrospective assessment of suspected disease is limited, this is one of the first studies to address imaging patterns for nephrolithiasis beyond the final discharge diagnosis, thus capturing a broader cohort of children. Children with suspected nephrolithiasis can be safely managed with an US-first approach, and postvisit CT scans are rarely necessary for management. A standardized clinical pathway for suspected nephrolithiasis can reduce rates of initial and overall CT utilization without adversely impacting downstream care.

Is There Gender Discrimination in Acute Renal Colic Pain Management? A Retrospective Analysis in an Emergency Department Setting

BackgroundPain is a widespread problem, affecting both men and women; studies have found that women in the emergency department receive analgesic medication and opioids less often compared with men. AimsThe aim of this study was to examine the administration and management of analgesics by the medical/paramedical staff in relation to the patients' gender, and thereby to examine the extent of gender discrimination in treating pain. DesignThis is a single-center retrospective cohort study that included 824 patients. SettingsEmergency department of tertiary hospital in Israel. Participants/SubjectsThe patients stratified by gender to compare pain treatments and waiting times between men and women in renal colic complaint. MethodsAs an acute pain model, we used renal colic with a nephrolithiasis diagnosis confirmed by imaging. We recorded pain level by Visual Analog Scale (VAS) scores and number of VAS examinations. Time intervals were calculated between admissions to different stations in the emergency department. We recorded the number of analgesic drugs administered, type of drugs prescribed, and drug class (opioids or others). ResultsA total of 824 patients (414 women and 410 men) participated. There were no significant differences in age, ethnicity, and laboratory findings. VAS assessments were higher in men than in women (6.43 versus 5.90, p = .001, respectively). More men than women received analgesics (68.8% versus 62.1%, p = .04, respectively) and opioids were prescribed more often for men than for women (48.3 versus 35.7%, p = .001). The number of drugs prescribed per patient was also higher in men compared with women (1.06 versus 0.93, p = .03). A significant difference was found in waiting time length from admission to medical examination between non-Jewish women and Jewish women. ConclusionsWe found differences in pain management between genders, which could be interpreted as gender discrimination. Yet these differences could also be attributed to other factors not based on gender discrimination but rather on gender differences.

Modeling the Incidence of Secondary Malignancy Related to Ionizing Radiation Use in the Management of Nephrolithiasis

ObjectiveTo model the risk of secondary malignancy and associated mortality due to ionizing radiation from the evaluation and management of nephrolithiasis. MethodsA PUBMED-based literature search was performed to identify model inputs, specifically annual incidence of nephrolithiasis sub-stratified by age and gender and radiation exposure associated with nephrolithiasis episodes. Estimates of age and gender specific radiation-induced malignancy and mortality rates were obtained from the BEIR VII Phase 2 report with dose extrapolation using the linear no-threshold model. ResultsIncidence of new diagnoses of nephrolithiasis ranged from 42/100,000 in males 20-30 years old to 248/100,000 in males 60-70 years old. Radiation exposure per nephrolithiasis episode was 37.3 mSv over a 2-year period. Data regarding average stone episodes per patient with nephrolithiasis was limited and conservatively estimated at 1.5. Modeled lifetime attributable risk of secondary malignancy and subsequent mortality in individual stone patients ranged from 0.096% and 0.085%, respectively, in males over the age of 70 to 0.59% and 0.39% in females 20-30 years old. In the USA, overall incidence of secondary malignancy and associated mortality related to nephrolithiasis management was calculated to be 862.7 and 545.3 cases/year, respectively. ConclusionThis model suggests that ionizing radiation from the management of nephrolithiasis carries a small but significant risk of causing secondary malignancy. This knowledge must be considered when using modalities that involve radiation in the diagnosis and therapeutic management of nephrolithiasis.

Nephrocalcinosis and Nephrolithiasis in X-Linked Hypophosphatemic Rickets: Diagnostic Imaging and Risk Factors.

ContextNephrocalcinosis (NC) and nephrolithiasis (NL) are described in hypophosphatemic rickets, but data regarding their prevalence rates and the presence of metabolic risk factors in X-linked hypophosphatemic rickets (XLH) are scarce.ObjectiveTo determine the prevalence rates of NC and NL and their risk factors in patients with XLH with confirmed PHEX mutations.MethodsRenal ultrasonography (US) and CT were performed in 16 children and 23 adults. The images were evaluated by two blinded radiologists specializing in US and two specializing in CT. Confirmation of NC was determined with a positive result on both US and CT, whereas the diagnosis of NL was confirmed by CT alone. The presence of hypercalciuria, hypocitraturia, and hyperoxaluria was determined from 24-hour urinary samples from each patient. The glomerular filtration rate was estimated.ResultsNC was identified in 15 patients (38.4%), and stratification by age group showed a higher prevalence of NC in children than in adults (56.2% vs 26.1%). CT identified NL in four adults (10.2%). Patients in the pediatric group required intensive use of phosphate, started treatment earlier, and presented greater phosphaturia than those in the adult group (P < 0.01). In addition to hyperphosphaturia, which was present in all patients with XLH, hypocitraturia was the most common metabolic factor (28.2%), whereas hypercalciuria occurred in two patients (5.1%). None had hyperoxaluria. Most patients had normal renal function.ConclusionsNC was more prevalent than NL. The main metabolic factor was hyperphosphaturia, and intensive phosphate treatment appears to be a worsening factor for kidney calcification.

Can urine osteopontin levels, which may be correlated with nutrition intake and body composition, be used as a new biomarker in the diagnosis of nephrolithiasis?

Background and aimThe nephrolithiasis has a multifactorial etiology resulting from the interaction of metabolic, genetic and environmental factors. Parameters such as nutrition and urinary osteopontin (OPN) level may affect kidney stone formation. The purpose of this study is to evaluate the correlation between urinary OPN level and kidney stone formation and effect of nutrition on OPN level in nephrolithiasis. Materials and methodsThis study was conducted on 88 volunteers including 44 healthy individuals and 44 patients diagnosed with nephrolithiasis and aging between 20 and 65 years. Some serum parameters and urinary OPN levels of the individuals were analyzed. Several anthropometric measurements of the individuals were taken and calculated their body mass index. Additionally, 24-hour dietary recall and water intakes were recorded and the participants completed food-frequency questionnaire for the evaluation of their nutritional status. ResultsUrinary OPN (ng/mL) levels of patients were lower than that of control group (p<0.05). Dietary energy, carbohydrate, poly-unsaturated fatty acid (PUFA) and n-6 fatty acids intakes and urinary OPN levels of male patients were positively correlated (p<0.05). Additionally, there was a negative correlation between their urinary OPN (ng/mL) and serum creatinine (mg/dL) levels of female patients (p<0.05). Body weight, waist circumference, hip circumference and body muscle mass values of healthy males were positively correlated with their urinary OPN levels (p<0.05). ConclusionsResults of the study showed that low urinary OPN levels were correlated with increased kidney stone risk, and dietary habits can affect urinary OPN level.

2514 Disparities in care among patients presenting to the emergency department for nephrolithiasis

OBJECTIVES/SPECIFIC AIMS: The prevalence of kidney stone disease has increased significantly in the United States in the last 2 decades. While several studies have reported that disparities in access to and quality of medical care exist, there is a need for a more thorough investigation of factors that negatively impact patients seeking care specifically for kidney stone disease. We sought to examine whether kidney stone patients received different standard of care in the emergency department (ED) according to their race/ethnicity, gender, age, body mass index, socioeconomic status (SES), and insurance status. METHODS/STUDY POPULATION: We conducted a retrospective study of patients presenting to the ED at Montefiore Medical Center between January 1, 2014 and December 31, 2016. Patients with a diagnosis of nephrolithiasis were identified using ICD-9/10 codes and electronic chart review was used to assess each patient’s ED course as well as to gather sociodemographic information. The primary outcomes of interest were administration of pain medication, prescription of alpha-1 antagonists to facilitate stone passage and whether or not patients received CT scan or ultrasound. Associations of these outcomes with age categories, sex, race/ethnicity, body mass index category, SES and insurance status were examined using multivariate logistic regression models. RESULTS/ANTICIPATED RESULTS: A total of 1200 patients were included in this analysis of which 616 (51%) were women. A large proportion of patients were minorities (40% Hispanic and 15% non-Hispanic African-American), whereas 21% were Caucasian and 24% declined to report race/ethnicity. Patients between the ages of 55–64 and those older than 65 were less likely to receive pain medication compared to younger patients aged &lt;35 years (OR=0.48, 95% CI: 0.27–0.86 and OR=0.46, 95% CI: 0.21–1.00, respectively). Women were less likely than men to undergo any form of diagnostic imaging (OR=0.52, 95% CI: 0.35–0.76) including CT scan (OR=0.50, 95% CI: 0.35–0.72). Similarly, patients in the lowest quintile of SES received less imaging than patients in higher SES categories (OR=0.50; 95% CI: 0.27–0.90). Furthermore, African Americans (both genders) and women were less likely to be prescribed an alpha antagonist medication (e.g., tamsulosin) to facilitate stone passage compared with White patients (OR=0.61, 95% CI 0.36–1.03) and men (OR=0.68, 95% CI: 0.49–0.92), respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: We found that multiple disparities exist among patients presenting to the ED for nephrolithiasis. A more thorough investigation into the causes of these disparities is warranted to limit their impact on patient care.

Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management

To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. A total of 3800 patients presented with ureteral calculi including 42 (1.1%) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2%) were considered emergent due to metabolic (5 of 11, 45.5%), infectious (1 of 11, 9.1%), or both metabolic and infectious indications (5 of 11, 45.5%). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy.

Risk of Nephrolithiasis in Patients With Sleep Apnea: A Population-Based Cohort Study.

To delineate the relationship between sleep apnea and subsequent risk of nephrolithiasis. We conducted a retrospective cohort analysis of a general population sample from Taiwan National Health Insurance Research Database (NHIRD) from January 1, 2000 to December 31, 2012. Patients with sleep apnea without prior diagnosis of nephrolithiasis (n = 7,831) were identified and subsequent development of nephrolithiasis was compared to an age- and sex-matched control group (n = 31,293) without sleep apnea. The Cox proportional hazard regression models were used to evaluate the association between sleep apnea and subsequent nephrolithiasis development. After adjusting for age, sex, and comorbidities, the risk of nephrolithiasis remained significantly increased in the sleep apnea group (hazard ratio [HR] = 1.35; 95% confidence interval [CI] = 1.23-1.48; P < .001). Compared to controls, elevated HRs of nephrolithiasis were observed for male patients (HR = 1.22; 95% CI 1.09-1.36; P < .001) and those aged 20-39 years (HR = 1.28; 95% CI 1.09-1.49; P < .01) and 40-59 years (HR = 1.17, 95% CI 1.03-1.34, P < .05) in the sleep apnea cohort. Risk of nephrolithiasis in patients with sleep apnea increased significantly with concomitant metabolic-related comorbidities, gouty arthritis, and urinary tract infection. Sleep apnea is associated with an increased subsequent risk of the development of nephrolithiasis. Young male patients with sleep apnea and concomitant comorbidities are at the greatest risk for nephrolithiasis formation.

The Accuracy and Prognostic Value of Point-of-care Ultrasound for Nephrolithiasis in the Emergency Department: A Systematic Review and Meta-analysis.

Point-of-care ultrasound (POCUS) has been suggested as an initial investigation in the management of renal colic. Our objectives were: 1) to determine the accuracy of POCUS for the diagnosis of nephrolithiasis and 2) to assess its prognostic value in the management of renal colic. The review protocol was registered to the PROSPERO database (CRD42016035331). An electronic database search of MEDLINE, Embase, and PubMed was conducted utilizing subject headings, keywords, and synonyms that address our research question. Bibliographies of included studies and narrative reviews were manually examined. Studies of adult emergency department patients with renal colic symptoms were included. Any degree of hydronephrosis was considered a positive POCUS finding. Accepted criterion standards were computed tomography evidence of renal stone or hydronephrosis, direct stone visualization, or surgical findings. Screening of abstracts, quality assessment with the QUADAS-2 instrument, and data extraction were performed by two reviewers, with discrepancies resolved by consensus with a third reviewer. Test performance was assessed by pooled sensitivity and specificity, calculated likelihood ratios, and a summary receiver operator curve (SROC). The secondary objective of prognostic value was reported as a narrative summary. The electronic search yielded 627 unique titles. After relevance screening, 26 papers underwent full-text review, and nine articles metall inclusion criteria. Of these, five high-quality studies (N=1,773) were included in the meta-analysis for diagnostic accuracy and the remaining yielded data on prognostic value. The pooled results for sensitivity and specificity were 70.2% (95% confidence interval [CI]=67.1%-73.2%) and 75.4% (95% CI=72.5%-78.2%), respectively. The calculated positive and negative likelihood ratios were 2.85 and 0.39. The SROC generated did not show evidence of a threshold effect. Two of the studies in the meta-analysis found that the finding of moderate or greater hydronephrosis yielded a specificity of 94.4% (95% CI=92.7%-95.8%). Four studies examining prognostic value noted a higher likelihood of a large stone when positive POCUS findings were present. The largest randomized trial showed lower cumulative radiation exposure and no increase in adverse events in those who received POCUS investigation as the initial renal colic investigation. Point-of-care ultrasound has modest diagnostic accuracy for diagnosing nephrolithiasis. The finding of moderate or severe hydronephrosis is highly specific for the presence of any stone, and the presence of any hydronephrosis is suggestive of a larger (>5mm) stone in those presenting with renal colic.

Adherence to the Mediterranean Dietary Pattern and Incidence of Nephrolithiasis in the Seguimiento Universidad de Navarra Follow-up (SUN) Cohort

Diet plays an important role in the pathogenesis of nephrolithiasis. Limited data are available to investigate the association between a Mediterranean dietary pattern and risk for nephrolithiasis. Prospective cohort study. 16,094 men and women without a history of nephrolithiasis who participated in the Seguimiento Universidad de Navarra Follow-up (SUN) Project. A validated 136-item food frequency questionnaire was used to assess baseline adherence to a Mediterranean dietary pattern that is high in fruits, vegetables, nuts, fish, and legumes, but moderate in alcohol and low in meats, saturated fats, and sugars. A Mediterranean dietary pattern score was calculated and categorized into 3 groups (0-3, 4-6, and 7-9 points). Additional factors included in statistical models were sex, age, body mass index, smoking, physical activity, time spent watching television, following a medical nutritional therapy, water and energy intake, calcium and vitamin D supplementation, and history of hypertension or diabetes. Incidence of nephrolithiasis. Participants were classified as having incident nephrolithiasis if they reported a physician-made diagnosis of nephrolithiasis during follow-up. After a mean follow-up of 9.6 years, 735 new cases of nephrolithiasis were identified. The multivariable HRs of nephrolithiasis for the 2 highest categories of adherence to the Mediterranean dietary pattern, using the lowest category as the reference, were 0.93 (95% CI, 0.79-1.09) and 0.64 (95% CI, 0.48-0.87); P for trend=0.01. The risk for nephrolithiasis was lower with greater consumption of dairy products and vegetables and greater with higher monounsaturated fatty acid to saturated fatty acid ratio. No information for kidney stone composition. Greater adherence to a Mediterranean dietary pattern was associated with reduced risk for incident nephrolithiasis. Additional longitudinal studies are needed.

Association Between Sonographically Diagnosed Nephrolithiasis and Subclinical Coronary Artery Calcification in Adults

Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored. Cross-sectional study. 62,091 asymptomatic adults without known coronary heart disease who underwent a screening health examination that included cardiac tomography. Nephrolithiasis. Coronary artery calcification (CAC). Nephrolithiasis assessed using ultrasonography of the abdomen. CAC scoring assessed using cardiac computed tomography. The prevalence of CAC scores > 0 was 13.1% overall. Participants with nephrolithiasis had a higher prevalence of coronary calcification than those without (19.1% vs 12.8%). In Tobit models adjusted for age and sex, the CAC score ratio comparing participants with nephrolithiasis with those without nephrolithiasis was 1.56 (95%CI, 1.19-2.05). After further adjustment for screening center, year of screening examination, physical activity, alcohol intake, smoking status, education level, body mass index, family history ofcardiovascular disease, total energy intake, glucose concentration, systolic blood pressure, triglyceride concentration, high-density lipoprotein cholesterol concentration, uric acid concentration, and estimated glomerular filtration rate, the CAC score ratio was attenuated, but remained significant (CAC score ratio, 1.31; 95% CI, 1.00-1.71). Computed tomographic diagnosis of nephrolithiasis was unavailable. Nephrolithiasis was associated with the presence of CAC in adults without known coronary heart disease, supporting the hypothesis that these 2 health conditions share a common pathophysiology.

Hiperparatiroidismo primário em idade pediátrica: uma causa rara de litíase renal

Introduction: Primary hyperparathyroidism is a rare disease in the pediatric age group and a rare cause of nephrolithiasis. It results from an excessive production of the parathyroid hormone due to abnormalities within the parathyroid glands.Case report: The patient was a twelve-year-old male admitted in the paediatrics emergency department with intermitent flank pain and dysuria. An abdominal ultrassound identified nephrolithiasis. Laboratorial tests showed hypercalcemia, an increased serum level of parathyroid hormone and hypercalciuria. A primary hyperparathyroidism was diagnosed and the ultrassound plus scintigraphy of both thyroid and parathyroid glands revealed a right lower parathyroid adenoma. A right lower parathyroidectomy was performed with regularization of the calcium and parathyroid hormone levels. The histopathology revealed main cells hyperplasia and genetic tests were negative.Conclusion: Primary hyperparathyroidism should be considered in the differential diagnosis of nephrolithiasis to allow an early intervention and prevent organ damage.

Preventing the Forgotten Ureteral Stent by Using a Mobile Point-of-Care Application.

The forgotten ureteral stent (FUS) can lead to patient morbidity. To date, tracking ureteral stents is a cumbersome task, given their high frequency of insertion and variable indwelling times. To simplify this process, an application was developed to track patients with indwelling ureteral stents. We report our initial user experience and clinical outcomes with this application. Ureteral Stent Tracker™ (UST) is a secure, Health Insurance Portability and Accountability Act (HIPPA)-compliant, cloud-based point-of-care application. It is designed for logging stent insertion, scheduling the date of anticipated stent extraction, and confirming stent removal. It is accessible via a mobile phone application or web browser interface. We consecutively enrolled all patients who underwent ureteral stent insertion for any indication by two urologists from January 10, 2015, to October 10, 2016. A retrospective chart review was performed of all patients included in the UST database. Data extracted included patient demographics, diagnosis, procedure, and stent characteristics. A total of 115 patients were included with a mean age of 52.4 years; 54% (62/115) were male and 58% (67/115) were Caucasian. This cohort represented 146 ureteral stent care plans with 23 patients (23/115; 20%) having more than one care plan during the study period. The most common procedure performed was ureteroscopy (70/146; 48%) for a diagnosis of nephrolithiasis (108/146; 74%). The median indwelling ureteral stent time was 14 days (interquartile range: 7-45 days). A total of three patients (3/115; 3%) did not return for their scheduled extraction, but were identified only through the application. Each patient was contacted, resulting in effective removal of all three stents in the office. Tracking of ureteral stents is critical to prevent the patient safety issue of the FUS. The UST is a secure, HIPPA-compliant, cloud-based application, which once incorporated into the workflow of a urologic practice can prevent the FUS.

Metabolic and Anatomic Abnormalities Associated with Pediatric Nephrolithiasis: a Cross-Sectional Study

Background Pediatric nephrolithiasis is a condition the prevalence of which varies geographically with multiple etiologies. The aim of this study was to determine possible concomitant anatomic and metabolic disturbances in children with nephrolithiasis and to answer the questions regarding the role of each metabolic and anatomic abnormality. Materials and Methods Between 2007 and 2015, 1,080 patients referred to our pediatric hospital of Hazrat Masumeh in Qom city, with the diagnosis of nephrolithiasis. Complete history from each eligible patient has taken using a prespecified data extraction form. Then, each child was referred for metabolic and anatomical evaluation using laboratory and imaging tests. Results According to the extracted data, 92% of our patients had at least one concomitant metabolic disorder and 12.5% had an anatomic abnormality. Recorded metabolic disorders in our series were hypocitraturia (56.9%), hyperuricosuria (21.4%), hypercalciuria (19.3%), hyperoxaluria (14.7%), phosphaturia (11.4%), and cystinuria (1.4%). According to data analysis, 12.5% of patients had an anatomical abnormality of which the ureteropelvic junction obstruction and vesicoureteral reflux were the most common. Conclusion The current study showed that the most common abnormalities in association with nephrolithiasis were metabolic disturbances, which highlight the importance of further metabolic study, even in patients with anatomical abnormalities.

Relationship between urinary reflux and nephrolithiasis in children- a cross-sectional study

Aim: Urinary reflux is a probable reason of nephrolithiasis among children. This study aimed to assess the relationship between urinary reflux and other reason of stone formation in children.Methods: This cross-sectional study was carried out with 199 children diagnosed with nephrolithiasis using ultrasonography. They were hospitalized in a referral children hospital in an urban area of in Iran. This study was conducted between 2014 and 2016. The presence of urinary reflux was assessed and graded by using the voiding cystourthrography modality.Results: Overall, 83.9% of the children had normal conditions regarding urinary reflux, while 1.5% had reflux grade I, 5.5% reflux grade II, 8.1% reflux grade III, and 1% reflux grade IV with the total urinary reflux rate of 16.1%. The most prevalent observed clinical manifestation was irritability (45.2%) followed by fever (45.2%), and dysuria (19.6%). Also, no relationship was reported between the size of stones in both kidneys and the presence of reflux and its reflux. Furthermore, the size of stones in left and right kidneys was not related to hematuria, pyuria, and urinary tract infection.Conclusion: Vesicoureteral reflux and kidney stones in children may have interdependent identities. Therefore, the presence of reflux may not be a decisive reason for the diagnosis of nephrolithiasis.