Episode Of Urolithiasis Research Articles

Predictors of Recurrent Urolithiasis in Iran: Findings from a Nationwide Study.

Prevention of urinary stone recurrence is the ultimate goal in urolithiasis patients. In this study, we aimed to investigate the national prevalence rate and possible determinants of increased urolithiasis recurrence risk in a nationwide study in Iran. All data regarding stone occurrence and recurrence episodes were extracted from the cross-sectional Iran National Stone Survey (INSS) study, and the possible determinants of recurrence were evaluated in the subset of 2913 patients who had a positive history of at least one episode of urolithiasis. The national prevalence rate of recurrent urolithiasis was 2.6% (95% CI: 2.5, 2.8) in Iran. Moreover, the relative ratio of recurrent stone formers to all stone formers was 39.8% (95% CI: 38.0, 41.6). Our univariable truncated negative binomial regressions suggested that a positive history of urolithiasis in the patient's father (prevalence ratio [PR] [95% CI]=1.83 [1.39, 2.41], P<0.001), mother (PR [95% CI]=1.92 [1.39, 2.66], P<0.001) or brother (PR [95% CI]=1.32 [1.03, 1.69], P=0.026); and residence in urban areas (PR [95% CI]=1.27 [1.04, 1.55], P=0.016) were significant predictors of repetitive recurrence episodes. However, when incorporated into a multivariable truncated negative binomial regression model, the only significant predictors of more frequent recurrence episodes were a positive history in father (PR [95% CI]=1.66 [1.24, 2.22], P<0.001) and mother (PR [95% CI]=1.68 [1.20, 2.36], P=0.002); and urban residence (PR [95% CI]=1.24 [1.01, 1.51], P=0.031). Our results indicate that a positive family history of urolithiasis in mother and father and residence in urban areas are the significant predictors of recurrence risk in urolithiasis patients in Iran.

The correlation between demographic factors and urolithiasis composition in a tertiary hospital

Introduction: Urolithiasis is the formation of biomineral stones in the urinary tract, kidneys, and bladder. The formation of stones (uroliths) is still a multifactorial and complex phenomenon that has not been clearly understood; this cannot be attributed to a multifactorial leading to increased excretion of stone-forming components. Renal stones' etiology is still not well understood. Some studies stated that demographics in the population have a strong correlation as a risk factor for urolithiasis. This study was aimed to know the correlation between demographic factors in society and urolithiasis composition in the Aceh population between the year 2018 to 2020.Methods: This study included 52 patients diagnosed clinically and radiographically with their first episode of urolithiasis at Dr. Zainoel Abidin General Hospital, Aceh, Indonesia, from 2018 to 2020. All samples were first characterized using Fourier Transform Infrared spectroscopy (FTIR) to obtain the mineralogical compositions.Results: Obtained 52 patients diagnosed with urolithiasis were aged 3-67 years, with most patients (27 patients; 51,92%) were aged 45-64 years old. The mean age of the subjects of this study is 45,52 + 13,90. Of the 52 patients included in this study, 37 patients (71,15%) were male, and 15 patients (28,85%) were female. Of 52 patients, 22 (42,31%) presented with one stone only. Of 52 patients, most of the uroliths consisted of Calcium oxalate monohydrate (Whewellite), which is presented in 27 (51,92%) patients, followed by uric acid (Uricite) in 19 (36,54%) patients.Conclusion: most of the urolithiasis patients were aged 45-64 years. The ratio of male to female patients was found to be 2:1. Most of the patients presented with one stone only. Most of the uroliths consisted of Calcium oxalate monohydrate (Whewellite) as the main composition, followed by uric acid (Uricite).

Risk factors for recurrent urolithiasis in children

To identify risk factors associated with recurrent kidney stones in a paediatric cohort in a Belgian tertiary centre. Medical records of children with the first episode of urolithiasis between 1998 and 2016, followed at Ghent University Hospital initially and at least one-year follow-up were retrospectively reviewed. Patient characteristics, past medical history, presenting symptoms, the results of laboratory investigations and the applied management strategy were analysed. The significant variables from the univariate analysis were integrated into a backward conditional multivariate model. Ninety-seven children were included in the analysis, of which 33 (34%) presented with at least one episode of stone recurrence. In the univariate analysis, body mass index (BMI)>85th percentile and asymptomatic stones at initial presentation were associated with 1.8 and 0.1 times lower risk of recurrent stones, respectively (p=0.020, 95% confidence interval (CI):0.368-8.749 and p=0.017, 95% CI:0.014-0.921). In contrast, immobilization resulted in a 10-times higher risk (p=0.002, 95% CI:1.968-50.005) and the need for technical intervention was associated with a 3.2- times higher risk (p=0.017, 95% CI:1.297-8.084) of developing recurrent stones. On multivariate analysis only BMI >85th percentile was associated with a 15 times lower risk of stone recurrence (p=0.030, 95% CI:0.006-0.739). A possible explanation of reduced risk in patients with a BMI>85th percentile may lie in a different metabolic profile. Immobilization as a risk factor can be explained by calcium metabolism, which is influenced by immobilization due to fractures, paralysis or motor disability because it causes resorption of the skeleton resulting in elevated blood calcium levels. This study showed that patients who presented without symptoms when the stones first occurred were less likely to have recurring kidney stones compared with patients with symptoms at initial presentation. When technical intervention was needed, we believe this is partly due to a larger stone burden, however we could not find an evidence-based explanation. The institutional protocol, which allowed to create a database with a limited number of patients, was lost to follow-up. Despite the retrospective setting some data were missing. There might also be a bias because the patients were followed-up at a tertiary centre. Possibly, our conclusions cannot be generalized towardthe entire paediatric population. Of all the factors investigated in our cohort, BMI>85th percentile and asymptomatic stones are associated with a lower risk of stone recurrence. Conversely, immobilized patients and those who require technical intervention at initial presentation may benefit from an intense follow-up after the first episode of urolithiasis.

The effect of serum levels of vitamin D in stone recurrencein patients with urinary tract stone

Introduction: The role of vitamin D in kidney stone disease and its effect on stone formation is still controversial. Objectives: To find out the possible role of 25(OH) D3 as an intrinsic factor in urinary calcium stone formers (SFs; individuals with one episode during the last 5 years and individuals with more than one episode during the last 5 years), we investigated the effect of serum levels of vitamin D on recurrence of urinary stones in SFs and control subjects (non-SFs). Patients and Methods: A total of 30 patients with first episode of urolithiasis (group A) and 30 patients with more than one episode of urolithiasis during the last 5 years (group B) aged 18 or older enrolled in this study and underwent metabolic evaluation including the measurement of serum level of 25(OH)D3, parathyroid hormone (PTH), calcium and uric acid. Thirty age and sex-matched patients who had never urinary stone episode (non-SFs) were considered as control group. The patients in this study were selected among those admitted in Urology Department of Kashani hospital during the last year. Individuals excluded from the study were subjects with hyperparathyroidism or with the previous history of hyperparathyroidism. Results: Mean level of 25(OH) D3 was positively correlated with recurrent stone (mean 19.89 ± 7.6 in the control group versus 47.21 ± 19.77 in the group with the recurrent stone disease). The recurrent stone group (SFs) had the higher serum level of 25(OH) D3 than the control. No correlation was observed between the serum levels of PTH and 25(OH) D3 (r = 0. 13, P = 0.11) in both control and urinary SFs group. Conclusion: High serum level of vitamin D has an important effect on the pathogenesis of repeated urolithiasis. High serum levels of 25(OH) D3 were detected in the group with recurrent kidney stone disease. But it seems there was no relation between serum level of vitamin D3 and one episode of urolithiasis. Based on the results of this study, the high level of vitamin D3 may have a significant role in inducing the recurrence of urinary stone.

Metabolic assessment of recurrent and first renal calcium oxalate stone formers.

This study aimed to demonstrate the dominant role of metabolic disorders in the formation of calcium oxalate stones in patients with recurrent urolithiasis, as well as in patients experiencing their first episode of urolithiasis. The records of the patients who attended our kidney stone outpatient clinics between 2008 and 2012 were reviewed, and the data of 318 calcium oxalate stone patients who had undergone a metabolic assessment were retrospectively analysed. The patients were divided in two groups. The first group included the patients who presented with their first episode of urolithiasis (Group 1, n = 170), and the second group included patients with recurrent urolithiasis (Group 2, n = 148); intergroup comparisons of metabolic disorders were performed. A significant difference was found between the two groups in mean urine calcium levels (Group 1, 0.25; Group 2, 0.31; p = 0.001); the mean serum calcium level was found to be significantly higher although at less extent in Group 2 (Group 1, 9.4; Group 2, 9.6); p = 0.04). Significant differences were also found in mean urine citrate (Group 1, 481.9; Group 2, 397.2, p &lt; 0.0001) and oxalate levels (Group 1, 22.1; Group 2, 28.5; p &lt; 0.0001) . This study revealed a metabolic tendency to hypercalciuria in calcium oxalate stone patients, predominantly in those with recurrent calcium oxalate urolithiasis. Urinary oxalate excretion was found to be higher in recurrent urolithiasis in comparison to the first episode of calcium oxalate urolithiasis and urinary citrate excretion lower in recurrent urolithiasis.

Prevalence of urolithiasis in the 40 to 65 year old Spanish population: The PreLiRenE study

Background and objectiveUrolithiasis is a common urologic condition with increasing incidence in the population worldwide. In Andalusia (Spain), the PreLiRenA study showed a high prevalence (16.4%; 95% confidence interval [95% CI] 14.8–17.8) of this condition in population aged between 40 and 65 years. The interesting results reported in that study encouraged us to further investigate the magnitude of this condition at a national level. We aimed to estimate the prevalence of urolithiasis in the Spanish population aged between 40 and 65 years. Patients and methodThis is an observational, cross-sectional, prevalence, stratified sampling study by Spanish region, sex and age. A total of 2444 telephone interviews were conducted using a questionnaire that covered several sociodemographic and clinical variables. Bivariate, descriptive statistical study was performed. The prevalence ratio (PR) with the 95% CI was calculated. ResultsOf the 2444 subjects interviewed, 51.2% (n=1251) were women. The prevalence and incidence of urolithiasis were 14.6% (95% CI 13.1–15.9) and 2.9% (95% CI 2.2–3.6), respectively. Significant differences were found by age, with a higher prevalence in 46–50 years (PR 1.58; 95% CI 1.12–2.21; p<.001) and 61–65 years (PR 1.47; 95% CI 1.02–2.13), and upper-class subjects (PR 1.75; 95% CI 1.07–2.86; p<.024). Of respondents, 52.8% had experienced more than one episode of urolithiasis. A total of 46.9% passed the calculus spontaneously, and 51.1% were diagnosed in the Emergency Unit. ConclusionsThe prevalence of urolithiasis in the Spanish population aged between 40 and 65 years is high; especially among upper-class subjects and in middle-aged. A high recurrence rate is also observed.

Prevalencia de la urolitiasis en la población española de 40 a 65 años: Estudio PreLiRenE

Background and objectiveUrolithiasis is a common urologic condition with increasing incidence in the population worldwide. In Andalusia (Spain), the PreLiRenA study showed a high prevalence (16.4%; 95% confidence interval [95% CI] 14.8-17.8) of this condition in population aged between 40 and 65 years. The interesting results reported in that study encouraged us to further investigate the magnitude of this condition at a national level. We aimed to estimate the prevalence of urolithiasis in the Spanish population aged between 40 and 65 years. Patients and methodThis is an observational, cross-sectional, prevalence, stratified sampling study by Spanish region, sex and age. A total of 2,444 telephone interviews were conducted using a questionnaire that covered several sociodemographic and clinical variables. Bivariate, descriptive statistical study was performed. The prevalence ratio (PR) with the 95% CI was calculated. ResultsOf the 2,444 subjects interviewed, 51.2% (n=1,251) were women. The prevalence and incidence of urolithiasis were 14.6% (95% CI 13.1-15.9) and 2.9% (95% CI 2.2-3.6), respectively. Significant differences were found by age, with a higher prevalence in 46-50 years (PR 1.58; 95% CI 1.12-2.21; P<.001) and 61-65 years (PR 1.47; 95% CI 1.02-2.13), and upper-class subjects (PR 1.75; 95% CI 1.07-2.86; P<.024). Of respondents, 52.8% had experienced more than one episode of urolithiasis. A total of 46.9% passed the calculus spontaneously, and 51.1% were diagnosed in the Emergency Unit. ConclusionsThe prevalence of urolithiasis in the Spanish population aged between 40 and 65 years is high; especially among upper-class subjects and in middle-aged. A high recurrence rate is also observed.

尿沈渣で発見されたAdenine phosphoribosy ltransferase(APRT)欠損症の一例

APRT deficiency is an enzyme disorder which is inherited as an autosomal recessive trait. The use of adenine in purine metabolism is disturbed and it accumulates in the body, where it is oxidised by xanthine oxidase to poorly insoluble 2, 8-dihydroxyadenine (DHA). The dihydroxyadenine forms stones which cause recurrent urolithiasis, frequent episodes of urinary tract infection or interstitial nephritis, and finally renal insufficiency in some cases. We report a case of APRT deficiency discovered by urine examination. The patient was a 33-year-old man who had never had any episodes of urolithiasis. He was admitted to our hospital because of pseudoarthrosis of his left arm caused by a traffic accident. His urinalysis revealed no proteinuria nor hematuria, but disclosed numerous round brown crystals in the sediment. These crystals had the characteristics of 2, 8-DHA. The enzyme activity of APRT in his blood was completely deficient. He was diagnosed as an APRT* QO homozygote. In addition, diagnostic imaging revealed that his right kidney was poorly hypoplastic and the pelvis of his left kidney was extra-renal. The renal function was slightly disturbed. In Japan 6 cases of 2, 8-DHA urolithiasis associated with hypoplastic kidney had been reported by 1989. Theoretically, the incidence of hypoplastic kidney is around 20% of all 2, 8-DHA urolithiasis cases. We suspect a genetic correlation between hypoplastic kidney and APRT deficiency. This patient was treated with Allopurinol, which inhibits the process of xanthine oxidation, after which crystals were no longer detected in his urine.

Usefulness of technetium-99m-meth-oxyisobutylisonitrile imaging and intraoperative staining technique using methylene blue for localization: Two cases of hyperfunctioning parathyroid lesions.

Two patients with primary hyperparathyroidism in whom it was difficult to search the location of abnormal parathyroid tissues are presented. Both patients, 35-year-old woman and 49-year-old man, had experienced several episodes of urolithiasis. A right lower (the former case) or right upper (the latter) parathyroid tumor was suspected by ultrasonography, but 201Tl-Cl and 99mTc-pertechnetate subtraction scintigraphy (TTSS) demonstrated no abnormal accumulation in the thyroid bed or mediastinum. At operation, no abnormal parathyroid gland was found in both patients. 99mTc-methoxyisobutylisonitrile scintigraphy revealed the presence of elusive parathyroid lesion in the mediastinum or at the lower position of the left thyroid lobe. At reoperation, intraoperative staining with methylene blue was useful to find out the lesions in both patients. The histological diagnosis was hyperplasia of the parathyroid in both. The normal calcium level was obtained promptly after the removal of these tissues.

Obstructive Fibrin Clot in the Peritoneal Catheter

Editar: We read with interest the observation reported by Twardowski and Pasley (1), and we wish to report a similar case, in which the shape of the clot is even more evocative. A 65-year-old woman had a Swan neck continuous ambulatory peritoneal dialysis (CAPD) catheter surgically implanted (right transrectal) on 2 August 1994. Her underlying renal disease was hypertension and noninsulindependent diabetes, the evolution of which has been speeded up by infectious episodes of urolithiasis and dehydration with rhabdomyolysis. Following implantation, the catheter was rinsed until the dialysate was bloodfree; then a stopper was put onto the titanium connector after injection of 2 mL (5000 U/mL) heparin. The patient left the department on the third day and returned on the tenth day for a check of the catheter position by x-ray and its pattern. The abdominal x-ray radiograph showed the catheter tip placed in the Douglas cul-de-sac. However, there was a two-way obstruction. An energetic suction aspirated a long fibrin clot which moulded perfectly the catheter lumen, particularly the side orifices ofits distal portion (Figure 1). Peritoneal dialysis was initiated, but on 8 September 1994 a new obstruction occurred. She was treated successfully by intraperitoneal infusion of 75 000 U urokinase in 40 mL isotonic saline solution, contact during 60 min, then rinsed with 2 L isotonic dialysate. She remained on CAPD until June 1995 without further episodes of catheter clotting. This observation has many features in common with those of Twardowski and Pasley: clotting occurred in the absence of any infection, on a catheter recently implanted without any difficulty, the use of which had been delayed; the clot was easily aspirated with a syringe, and the molding was perfect. Other maneuvers are sometimes necessary in case of obstruction, including the classical use of fibrinolytics or even resorting to mechanical intervention (2).

Çocukluk Çağında Üriner Sistem Taş Hastalığından Korunma

SummaryUrolithiasis is a common condition in pediatric population The risk of recurrence in an individual who had a single episode of urolithiasis has been estimated to be 20 50 Identification of the specific stone type and etiological factor makes it easier for physicans and patients to prevent recurrence To increase urine volume is the most efficacious means of descreasing the concentration of the various substances Appropriate metabolic study will allow rational management of children with urinary stones and reduction of the morbidity and mortality Key words: nbsp;Urolithiasis Metabolic Evaluation Prevention

Thiazides in the Prophylactic Treatment of Recurrent Idiopathic Kidney Stones

In a double-blind prospective clinical study patients with at least two verified episodes of urolithiasis, but stone-free at the time of inclusion in the study, were subjected to prophylactic treatment with either bendroflumethiazide (2.5 mg)+573 mg potassium chloride 3 times a day, or placebo. The material included a total of 22 patients, all males, aged 20–49 years. We found a clear tendency to reduced stone formation in the group treated with the active drug (P<0.1). Calcium excretion was reduced by 25–50% in 7 of 12 patients treated with thiazide.