History Of Kidney Stones Research Articles

7752 Navigating Hypercalcemia in Pregnancy: A Case Report

Abstract Disclosure: J. Gabbay: None. S. Steinmetz-Wood: None. Introduction: Primary hyperparathyroidism (PHPT) in pregnancy is rare but presents many diagnostic and therapeutic challenges. Prompt diagnosis and treatment are important due to associated maternal and fetal risks, however evaluation of urine calcium to differentiate from Familial Hypocalciuric Hypercalcemia (FHH) becomes less reliable due to physiologic changes in pregnancy, sestamibi scans. CT scans require radiation, parathyroidectomy introduces surgical risk, and medical alternatives like bisphosphonates can interfere with fetal skeletal development. Clinical Case: A 24-year-old woman who presented to the emergency room for progressive nausea and abdominal pain was found to be pregnant with elevated serum calculated calcium to 11.4 mg/dL (2.84 mmol/L). She had a history of renal stones, longstanding hypercalcemia of unknown etiology and a remote family history of parathyroid “issues”. Follow up laboratory work showed a PTH of 75.8 pg/ml (8.04 pmol/L) with an elevated 24-hour urine calcium and a low 25OH vitamin D. Given her history of kidney stones and overt symptoms it was our clinical judgement that this was not a case of FHH. She was started on IV fluids twice weekly. After an unrevealing neck ultrasound, an MRI neck showed a 7 mm lesion along the posterior aspect of the left thyroid suggestive of a parathyroid adenoma. Sestamibi scan was avoided due to the risks of radiation to the developing fetus. Given the presumptive diagnosis of parathyroid adenoma, the lack of response to aggressive hydration, and the maternal and fetal risks of hypercalcemia during pregnancy, parathyroidectomy was pursued in her second trimester. Intra-operative inspection and biopsy showed the lesion to be only a lymph node. She underwent 4-gland exploration and the left inferior parathyroid gland, which appeared abnormal and enlarged, was removed. The intra-operative PTH dropped only from 98 to 80 (10.4 to 8.5 pmol/L). She otherwise had an unremarkable hospital course and at discharge her calcium was normal with an undetectable PTH, which can be an expected finding in pregnancy. On follow up she was feeling well with sustained normocalcemia and low PTH levels. Given the age at which her hyperparathyroidism started, she was referred to genetics for further evaluation. Clinical Lessons/Conclusion: There were significant biochemical and radiological limitations in the management of this case. Normally an inappropriately normal PTH with elevated serum calcium and normal urine calcium/creatinine clearance ratio confirms the diagnosis of PHPT, however in pregnancy it should be noted that FHH could also present with normal or elevated urine calcium due to absorptive hypercalciuria in pregnancy. Additional clinical history and reasoning was needed for management as well as a skilled surgeon, where preoperative localization was limited and was not ultimately helpful. Presentation: 6/2/2024

6637 A Rare Case of a Possible Non-functional (Clinically Silent Biochemically Negative) Adrenal Pheochromocytoma

Abstract Disclosure: V.K. Babu: None. M.T. Corwin: None. S.T. Olatunbosun: None. Introduction: Adrenal pheochromocytomas (pheo) are rare neuroendocrine tumors arising from the chromaffin cells of the adrenal medulla. Their incidence is around 0.8 per 100,000 patient years. They are usually sporadic, with about 40% having a pre-existing familial genetic disease. About 3% of adrenal incidentalomas prove to be pheo. They have a heterogenous presentation and are diagnosed by measuring urinary and plasma fractionated metanephrines (met) and catecholamines (catecho). The diagnosis becomes challenging in patients presenting with small tumors and normal levels of biochemical metabolites, as in our patient. Clinical Case: A 32-year-old male with no significant past medical history was referred to us with a left adrenal incidentaloma of 1.2 cm x 1 cm with 23 Hounsfield units during a non-contrast CT scan performed for abdominal pain. He denied spells of headaches, excessive perspiration, palpitations, history of hypertension, hypokalemia, history of kidney stones, fractures, muscle weakness, easy bruisability, new abdominal striae, change in weight, steroid use, or family history of endocrine tumors. MRI with adrenal protocol 3 months later showed a 1.2 cm x 1.4 cm left adrenal nodule that was markedly hyperintense on T2-weighted and hypointense on T1-weighted images without microscopic fat, suspicious for a pheo. It also demonstrated peripheral enhancement with progressive central filling on the delayed images without washout. Plasma met and catecho were normal: normetanephrines (normet) (45.2 pg/mL), met (36.4 pg/mL), epinephrine (epi) (34 pg/mL), norepinephrine (norepi) (295 pg/mL) and dopamine (<30 pg/mL). Subsequent 24-hour urine testing revealed normal met (155 mcg/day, 154 mcg/day), and normal normet (248 mcg/day, 236 mcg/day) on two separate occasions, and normal epi (9 mcg/L), norepi (36 mcg/day), and dopamine (228 mcg/day). The patient was subsequently referred to Endocrine Surgery for evaluation. Conclusion: Our patient likely has a non-functional pheo. Another possibility is an adrenal hemangioma, which would show discontinuous peripheral nodular enhancement in addition to progressive central filling. Patients with pheo less than 2 cm may present with normal biochemical testing. The size of a pheo is usually proportional to the levels of its biochemical metabolites. This case is unique because patients with a similar sized pheo are expected to have 3 times higher levels of plasma met and catecho, even if still within normal limits. It is important to take tumor size into consideration when interpreting labs to determine its functional status. This may help in determining the need for a pre-operative alpha blockade prior to adrenal surgery. A definitive diagnosis of a pheo’s non-functional status can only be confirmed after histopathological examination of the tumor tissue. Presentation: 6/3/2024

6980 A Case Report Of Severe Hypercalcemia In Acute Decompensated Liver Cirrhosis

Abstract Disclosure: M.M. Eid: None. R.M. Sargis: None. Introduction: Hypercalcemia in advanced liver disease in the absence of malignancy is a rare condition. Case: A 26 year old female with history of liver cirrhosis secondary to alcohol use disorder, presented with hematemesis and ascites. She was diagnosed with acute decompensated liver cell failure and transferred to our facility for liver transplantation. On Day 10 of her hospital course, she had an acute rise in serum calcium (Ca) to 10.8 mg/dl (N 8.7-10.5),albumin (Alb) 2.6 g/dl, corrected calcium (CCa) 11.9mg/dl. On day 13 Ca peaked to 13.5 mg/dl, CCa 14 mg/dl, ionized Ca 6.5mg/dl (N 4.2-5.4 mg/dl). Serum Ca was normal on day 9, Ca 8.7mg/dl, Alb 2.5 g/dl and CCa 9.9 mg/dl. She was not taking lithium, vitamin A or antacid. No personal or family history of bone disorder, fracture or kidney stone. On exam, blood pressure 85/45, heart rate 110 bpm, jaundiced with abdominal distension and respiratory distress. Labs: hemoglobin 8.1 g/dl, WBC 32.5K/Ul, platelet 136 K/Ul, serum creatinine 1.82 mg/dl, Na 133 mmol/l, K 3.5 mmol/l, Total/Direct bilirubin 29.9/18.1 mg/dl, alkaline phosphatase 166 U/L, AST/ALT 60/42U/l, Mag 2.3 mg/dl, Phos 5 mg/dl, INR 3, PTT 50 sec, parathyroid hormone (PTH) 12 pg/ml (N12-88), TSH 1.02 mciu/ml (N 0.34-4), 25 hydroxy vitamin D 17 ng/ml (N 20-80), parathyroid related peptide (PTHrP) 3.9 pmol/l (N<3.4), 1,25 di-hydroxy vitamin D 9.8 pg/ml (N 19.9-79.3), alpha fetoprotein 9.1 ng/ml (N <9). Normal anti smooth muscle and anti mitochondrial antibodies. Negative viral hepatitis serology. CT abdomen did not reveal hepatobiliary mass or tumor nor kidney stone. She was intubated and mechanically ventilated. Vasopressor support was initiated. One dose of calcitonin 4 units/kg and zoledronic acid 4 mg were given. Serum Ca decreased to 12 mg/dl, CCa 12.6 mg/dL then to 10.2 mg/dl, CCa 11mg/dl within hrs. Calcium normalized to 8.4mg/dl, CCa 9.2 mg/dl, ionized Ca 4.3 mg/dl within 24 hrs. Her condition deteriorated and withdrawal of care was decided. Conclusion: Our case demonstrates non PTH and non vitamin D mediated severe hypercalcemia in setting of acute decompensated cirrhosis and absence of malignancy. Previous literature has noted poor prognosis of hypercalcemia with acute decompensated cirrhosis. While hypercalcemia in cirrhosis may arise from paraneoplastic processes, in absence of malignancy it is speculated that acute hypercalcemia may arise from the inflammatory mediators inducing osteoclastic bone resorption as osteoclast activating factor, prostaglandin and immobilization. Some reports found an association between hypercalcemia and elevations in bilirubin and creatinine(1). Further research is needed to understand the pathophysiology and the management of hypercalcemia in acute decompensated cirrhosis.

12372 A Rare Case Of Silicon Granulomatosis Induced Hypercalcemia In A Transgender Female

Abstract Disclosure: O.A. Aluko: None. I. Singh: None. Introduction: Hypercalcemia has been described in patients with most granulomatous disorders, of which sarcoidosis and tuberculosis are the most common. Granuloma formation is a rare, however well known complication of silicon implants and injections. We present a case of silicon granulomatosis induced hypercalcemia in a transgender female. Case Report 60-year-old transgender female, with past medical history of HIV on HAART was referred to Endocrinology for evaluation of hypercalcemia. She Bloodwork done a few weeks prior revealed elevated calcium 12.3 and low PTH of 9. Reported symptoms include worsening abdominal pain similar to prior gastritis flare, insomnia and significant weight loss. Denied any constipation, joint pain, mood changes, no history of bone fractures or kidney stones. Admitted to significant dairy intake - half a gallon of milk within 3 days and daily yogurt consumption. Endorsed inadequate daily fluid intake and she was not taking oral calcium or Vitamin D supplementation. Quit tobacco 9 years ago. Vitals were significant for tachycardia with HR 120/min, BP stable. Patient was referred to the ER for IV hydration and further evaluation with initial suspicion of malignancy. Repeat corrected calcium was 14.7, ionized calcium 6.8, PTHrP undetectable <2, borderline high 1,25 dihydroxyvitamin D 74.5, low vitamin D 17.9 and normal free T4 1.5. ACE, SPEP, UPEP levels within normal limits. Vitamin A low. CT chest/abdomen/pelvis revealed innumerable soft tissue foci in the subcutaneous adipose tissue of the flanks and lateral gluteal areas; nodular liver, suspected cirrhosis and portal hypertension. Imaging findings prompted further discussion regarding prior procedures. She endorsed history of silicone fillers in hips and breast implants 30 years ago. Images reviewed with radiology confirmed calcification around bilateral breast implants, with intracapsular rupture. Calcium improved with IV Fluids, bisphosphonates and steroids. The most probable cause of hypercalcemia was believed to be secondary to silicone granulomatosis. Innumerable granulomas were deemed irresectable, removal of the breast implants considered however not performed. She was later diagnosed with hepatitis B, cirrhosis and succumbed to sepsis and multiorgan failure. Conclusion Eliciting a detailed history, physical exam and correlating with imaging findings is imperative to establishing an uncommon diagnosis. PTHrP was low and there were no bony metastases making the possibility of malignancy related hypercalcemia less likely. FDG-PET if performed would reveal hypermetabolic nodules, often an initial indication to the underlying etiology. Presentation: 6/2/2024

Increased kidney stone risk following total pancreatectomy with islet autotransplantation

Background/objectivesChronic pancreatitis (CP) is associated with increased risk of calcium-oxalate kidney stones, likely due to enteric hyperoxaluria. However, the risk of kidney stones for patients with CP after total pancreatectomy with islet autotransplantation (TPIAT) is unknown. We aimed to evaluate kidney stone risk in patients with CP after TPIAT. MethodsA retrospective analysis of 629 patients who underwent TPIAT was conducted to identify patients who developed kidney stones post-TPIAT. Kaplan-Meier analysis estimated time to first event. An Anderson-Gill proportional-hazards analysis of all kidney stone events described key clinical associations. ResultsMean age at TPIAT was 33 years (SD 15.3, range 3–69); 69.8 % (n = 439) were female. The estimated chance of any kidney stone episodes by 5 years post-TPIAT was 12.8 % (95 % CI: 8.8–16.6 %); by 10 years, 23.2 % (CI: 17.5–28.6 %); by 15 years, 29.4 % (CI: 21.8–36.2 %). Significant associations with kidney stones post-TPIAT included older age (HR 1.25 per 10 years), smoking history (HR 1.72), mild chronic kidney disease (HR 1.96), renal cysts (HR 3.67), pre-TPIAT kidney stones (HR 4.06), family history of kidney stones (HR 4.10), and Roux-en-Y reconstruction (HR 2.68). Of the 77 patients who developed kidney stones, 34 (44.1 %) had recurrent episodes. Of 143 total kidney stone events, 35 (24.5 %) required stone removal, 79 (55.2 %) resolved spontaneously, and 29 (20.3 %) were missing this data. ConclusionsPatients with CP post-TPIAT commonly have kidney stones: nearly 3 in 10 have ≥1 kidney stone episodes within 15 years. Clinicians should be aware of this risk and counsel patients on prevention.

Case Report : Hepatic Cirrhosis and Nephrolithiasis

Liver cirrhosis and nephrolithiasis are significant health problems with different pathophysiological mechanisms. Liver cirrhosis, the final stage of chronic liver disease, is characterized by fibrosis and regenerative nodules, leading to severe complications, including portal hypertension and liver failure. Nephrolithiasis, commonly known as kidney stones, is a common urological condition characterized by the formation of stones in the renal system. Although these conditions are distinct, metabolic and physiological changes in cirrhotic patients may predispose to nephrolithiasis. It was reported that a man came to the emergency room of RSUD Dr. Suhatman MARS with complaints of left-sided low back pain that had been felt for 1 week. The complaint was accompanied by shortness of breath which was getting worse over time. The patient also felt cough, headache, nausea, fatigue, urine slightly coloured like tea, weight loss. The patient has a history of untreated kidney stones. The patient has a history of hepatitis 31 years ago. The main objective of investigating the coexistence of liver cirrhosis and nephrolithiasis is to understand the relationship between these two conditions and to develop effective management strategies that can address their combined impact on patients.

Evaluation of Metabolic and Biochemical Abnormalities in Pediatric Population With Nephrocalcinosis in Southwestern Iran

This retrospective study aimed to evaluate the metabolic and biochemical abnormalities in children with nephrocalcinosis to identify its important risk factors and better understand the disease pathophysiology. Data were collected from the medical records of 163 children diagnosed with nephrocalcinosis. Their clinical and laboratory characteristics at admission were recorded, and a 24-hour urinalysis was performed to measure parameters such as calcium, oxalate, citrate, uric acid, magnesium, and cystine. Family history of kidney stones and parental consanguinity were present in 58.8% and 58.2% of patients, respectively. The most common underlying conditions were hyperparathyroidism (24%), distal renal tubular acidosis (16.6%), and medullary sponge kidney (12.9%). The main abnormalities included hypocitraturia (65.2%), hypercalciuria (51.9%), hypomagnesuria (44.6%), hyperoxaluria (39.1%), hyperuricosuria (31.5%), vitamin D deficiency (30.06%), and metabolic acidosis (27%). Patients with kidney stones and failure to thrive had higher rates of hypercalciuria. Metabolic acidosis was more common in those with parental consanguinity and vitamin D deficiency. Renal failure at final follow-up was more evident in older patients, those with parental consanguinity, hypokalemia, acidosis, and hyperparathyroidism. End-stage renal disease was more frequent in patients with consanguineous parentage, hyperparathyroidism, hypokalemia, and acidosis. Parental consanguinity, family history of kidney stones, and urinary metabolic disorders are important risk factors for pediatric nephrocalcinosis. This highlights the need for genetic counseling, screening, and monitoring of biochemical abnormalities. Early diagnosis and timely treatment are crucial to maintain glomerular function and prevent kidney failure.

Association between the atherogenic index of plasma and kidney stones: a nationally representative study

PurposeThe atherogenic index of plasma (AIP) is a novel comprehensive lipid index. We aimed to investigate a possible relationship between AIP index and kidney stones in US adults.MethodsThis cross-sectional study was conducted among adults with complete AIP index and questionnaire records on kidney stones from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018. The AIP index served as the exposure variable, defined as the logarithm of the ratio between triglycerides (TG, mmol/L) and high-density lipoprotein cholesterol (HDL-c, mmol/L). Self-reported history of kidney stones was utilized as the outcome variable. The independent relationship between AIP index and the risk of kidney stones was fully assessed.ResultsA total of 14,833 participants were included in this study, with an average AIP index of -0.07 ± 0.01. The proportion of kidney stones progressively increased with higher AIP index tertile intervals (7.33% vs. 9.97% vs. 12.57%, P < 0.001). Furthermore, AIP index was found to be independently associated with the risk of kidney stones after adjusting for confounding factors (OR = 1.32, 95% CI 1.08–1.61, P = 0.006). Restricted cubic spline (RCS) analysis confirmed the robustness of our results. There was no significant interaction observed based on subgroup analysis stratified by age, gender, race, body mass index (BMI, kg/m2), smokers, diabetes, hypertension, and cardiovascular disease (P for interaction > 0.05).ConclusionsThe AIP index may be a potential epidemiological tool to quantify the role of dyslipidemia in the risk of kidney stones in US adults.

Association Between Kidney Stone History and Cardiovascular Event Risk in US Adults

ObjectivesTo determine the association between kidney stone history and predicted 10-year risk of atherosclerotic cardiovascular disease events in a nationally representative US adult sample without existing cardiovascular disease. MethodsThis was a cross-sectional study of the 2017-2020 National Health and Nutrition Examination Survey that included a nationally representative sample of 3,842 adults aged 40-79 free from cardiovascular disease. Kidney stone history was assessed through self-reporting. The 10-year risk of an atherosclerotic cardiovascular disease event was predicted using the American College of Cardiology/American Heart Association (ACC/AHA) Pooled Cohort Equations. ResultsThe weighted prevalence of kidney stones was 12.2% (95% CI: 10.5% to 14.1%). In unadjusted analysis, the odds of borderline or higher (≥5%) atherosclerotic cardiovascular disease risk were higher in stone formers (odds ratio=1.56; 95% CI 1.01-2.40; P=0.046). This association persisted after adjustment for demographics and clinical covariates (adjusted odds ratio=1.57; 95% CI=1.02 to 2.43; P=0.04). A significant interaction by biological sex was identified (p=0.002), with excess risk conferred by kidney stones in men but not women. ConclusionsKidney stone history was independently associated with increased 10-year predicted atherosclerotic cardiovascular disease event risk, with excess risk observed among men but not women. Intensified cardiovascular disease screening may be warranted among stone formers given their increased cardiovascular risk.

Causal Effects of Inflammatory Bowel Diseases on the Risk of Kidney Stone Disease.

Inflammatory bowel diseases (IBDs), including Crohn's disease and ulcerative colitis, have been increasingly associated with kidney stone disease, posing significant health challenges globally. This research sought to determine the causal relationship between kidney stone disease risk and inflammatory bowel disorders. This retrospective cohort study included patients with IBDs, such as ulcerative colitis or Crohn's disease, who were diagnosed at least 18 years of age. Information was gathered with an emphasis on patients having comprehensive medical histories and confirmed cases of kidney stone disease from Januaryto December 2022. Medical records were retrospectively evaluated by trained staff to extract treatment information and clinical, radiological, and demographic data. To evaluate relationships, statistical analysis was carried out in SPSS software version 23 using Chi-square tests and descriptive statistics. The study included 320 patients diagnosed with IBDs, among which 198 (61.87%) had Crohn's disease, and 122 (38.13%) were diagnosed with ulcerative colitis. The cohort consisted of 140 females (43.75%) and 180 men (56.25%), with a mean age of 45.5 years. Regarding smoking, 113 people (35.31%) reported being smokers, whereas 207 people (64.69%) did not smoke. Additionally, 18 (5.62%) of the population had an underweight BMI, 136 (42.50%) had a normal BMI, 119 (37.19%) had an overweight BMI, and 47 (14.69%) had an obese BMI. Of the patients, 86 (26.88%) had a prior history of kidney stone disease, while 194 (60.62%) did not. Aminosalicylates were the most often used therapy modality for IBDin 189 (58.97%) of cases, followed by corticosteroids in 117 (36.56%) and immunomodulators in 93 (28.94%). Radiological examinations showed that renal calculi were present in 60 (18.75%) of patients, and kidney stones occurred in 40 (12.50%) of patients throughout the research period. The smoking status (p=0.006) and prior history of kidney stones (p<0.001) were the corresponding p-values for the significant results. The study highlights an increased risk of kidney stone disease in IBD patients, particularly among smokers and those with a recurrent history of kidney stones. Of the 320 patients, 198 (61.87%) had Crohn's disease and 122 (38.13%) had ulcerative colitis, with a significant relationship found between kidney stones and both smoking (113 patients, 35.31%, p=0.006) and a prior history of kidney stones (86 patients, 26.88%, p<0.001). The findings emphasize the need for targeted preventive measures and close monitoring of these high-risk groups.

Risk Factors of Kidney Stones in Khyber Pakhtunkhwa, Pakistan: A Descriptive Cross-Sectional Study.

Introduction Renal calculi, commonly known as kidney stones, affect approximately 12% of the global population, often resulting in mild to severe pain and complications such as infection and renal failure. The causes are multifactorial, involving lifestyle factors, genetic predisposition, and various medical conditions. Despite advancements in treatment, the incidence of kidney stones is on the rise, especially in regions like Asia's stone belt, which includes Pakistan as well. This study investigates the risk factors associated with kidney stones in patients at the Hayatabad Medical Complex, Peshawar, Pakistan, with the goal of informing healthcare policymakers and educating patients to reduce the prevalence and economic burden of the disease in the region. Methods Over a four-month period, 173 patients admitted to the department with confirmed urolithiasis were recruited using a consensus sampling technique. Inclusion criteria were adults aged 18 or older residing in Khyber Pakhtunkhwa, Pakistan. Exclusion criteria included pregnancy, incomplete medical records, secondary causes of renal stones, and unwillingness to participate. Data on socio-demographic factors, clinical history, and lifestyle habits were collected through structured interviews. Descriptive analysis was performed using SPSS software version 23 (IBM Inc, Armonk, New York). Results The study findings indicate that kidney stones were notably prevalent among patients aged 31 to 45 years, with 85 cases identified, comprising 49.1% of the study participants. Furthermore, a significant proportion of affected individuals were males, accounting for 94 cases (54.3%). Those with primary schooling or lower education comprised 106 cases (61.3%), and 124 individuals (71.7%) had lower socioeconomic status. Overweight individuals constituted 81 cases (45.8%) of the total. The study also found a considerable prevalence among residents of rural areas, with 128 cases identified (74.0%). Additionally, 104 cases (60.1%) had a personal history of renal stones. Insufficient water intake was prevalent among 122 individuals (70.5%), while daily consumers of more than one cup of tea also exhibited a higher prevalence, with 97 cases identified (56.1%). Lastly, individuals with a high sodium diet were notably affected, with 112 cases (64.7%) recorded. Conclusion In summary, individuals aged 31-45, males, those residing in rural areas, with lower educational and socioeconomic status, insufficient water intake, a diet high in sodium, personal history of kidney stones, and overweight are at higher risk of urolithiasis. Public education on preventive measures is essential to decrease the incidence of kidney stones and enhance quality of life.

Bedside Sonography in the Assessment of Suspected Nephrolitiasis

Background: Nephrolithiasis, commonly referred to as kidney stones, is a prevalent urological condition frequently encountered in emergency settings. Rapid and accurate diagnosis is critical for effective management. Bedside sonography has emerged as a valuable diagnostic tool for assessing renal colic and detecting kidney stones due to its non-invasive nature and immediate availability. Objective: To evaluate the diagnostic accuracy and practicality of bedside sonography in suspected cases of nephrolithiasis, particularly in emergency department settings, and to assess its impact on patient management. Methods: A cross-sectional study was conducted at Mahaban Medical and Research Hospital, Swabi, KP, Pakistan, including 72 patients with suspected nephrolithiasis. Bedside sonography was performed using a Toshiba prime ultrasound machine with convex (3.0-5.0 MHz) and linear (7.0-14.0 MHz) transducers. Clinical data, including patient history and symptomatology, were collected and analyzed using SPSS version 25.0. The study focused on identifying the presence, location, and size of kidney stones and correlating these findings with clinical outcomes. Results: Among the 72 participants, 42 (58.3%) had a history of kidney stones. Bedside sonography revealed stone locations as follows: bilateral in 5 (6.9%), left kidney in 27 (37.5%), right kidney in 36 (50.0%), and no stones in 4 (5.6%). The high prevalence of kidney stones, particularly in the right kidney, highlights the importance of BUS in initial evaluations. Conclusion: Bedside sonography is an effective diagnostic tool for nephrolithiasis, providing immediate and detailed information without patient discomfort. Its implementation in emergency settings can enhance patient management, allowing for timely diagnosis and treatment. Further research is warranted to explore the broader applications and long-term outcomes associated with BUS.

The Impact of Kidney Stones on Congestive Heart Failure Risk.

Introduction Heart failure (HF) represents a substantial global health concern, evidenced by its high prevalence, significant mortality rates, and considerable economic impact worldwide. Within this broader context, congestive heart failure (CHF) emerges as a critical subset, affecting millions and leading to high rates of morbidity and mortality. Recent explorations have started to uncover a potential link between kidney stonesand broader systemic health problems, including coronary artery disease. This association suggests that kidney stones might also indicate an increased risk for cardiovascular diseases such as CHF. However, the exploration into the direct relationship between kidney stones and CHF is still in its nascent stages, creating a significant gap in understanding the full cardiovascular implications of kidney stone disease. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES) for the period of March 2017 to March 2020, we conducted a logistic regression analysis to assess the relationship between kidney stones and CHF. This analysis adjusted for key variables such as age, gender, race, and educational attainment, aiming to isolate the impact of kidney stones on CHF risk among 8,521 participants. Results Our findings revealed a higher incidence of CHF among individuals with a history of kidney stones (7%) compared to those without (3%). Logistic regression analysis further highlighted kidney stones as an independent risk factor for CHF, with an odds ratio (OR) of 1.857, significant at p < 0.01. These results underline the importance of considering kidney stones in the broader context of cardiovascular health risks, particularly CHF, as their presence significantly elevates the risk compared to the general population without kidney stones. Additional demographic analyses indicated significant influences of age, gender, race, and educational level on the risk of CHF, emphasizing the complex interplay between these factors and heart health. Conclusion The study confirms the association between a history of kidney stones and an increased risk of CHF, suggesting the need for heightened cardiovascular monitoring for patients with such a history. It also brings to light the significant role demographic factors play in CHF risk, advocating for targeted interventions to mitigate these disparities. Our research supports a broader view of patient care that includes consideration of urological conditions as potential risk factors for heart failure. Further exploration into the mechanisms linking kidney stones and cardiovascular health is recommended to inform more effective prevention and treatment strategies.

Association between monocyte to high-density lipoprotein cholesterol ratio and kidney stone: insights from NHANES.

The ratio of monocyte to high-density lipoprotein cholesterol (MHR) has surfaced as a novel biomarker indicative of inflammation and oxidative stress. The aim of our study was to evaluate the association between MHR and the risk of kidney stones. This study analyzed data from individuals aged 20-79 who participated in the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The MHR was assessed as the exposure variable, while a self-reported history of kidney stones was used as the outcome variable. The independent relationship between MHR and the risk of kidney stones was thoroughly evaluated. This study included 28,878 participants, and as the quartile range of the MHR increased, the proportion of kidney stones also rose progressively (7.20% to 8.89% to 10.88% to 12.05%, P<0.001). After adjusting for confounding factors, MHR was independently associated with an increased risk of kidney stones (OR=1.31, 95%CI=1.11-1.54, P=0.001), also independent of some common inflammatory indices. Subgroup analysis suggested that the relationship between MHR and kidney stones was more pronounced in female and individuals aged 20-49. Further restricted cubic spline (RCS) analysis indicated a nonlinear relationship between MHR and the risk of kidney stones. Our results indicate a positive correlation between MHR and an increased risk of kidney stones in US adults, underscoring the need for further large-scale prospective cohort studies to validate these findings.

#2228 Hypocitraturia is the main factor associated with proteinuria in patients with kidney stones

Abstract Background and Aims Patients with kidney stones (KS) are at increased risk for chronic kidney disease. Research published so far has focused on factors associated with low glomerular filtration rate in KS patients, however, factors associated with proteinuria have not been fully described. The aim of this retrospective study was to assess the presence of proteinuria in our cohort of patients with known or presumed calcium KS and to analyze which common clinical and metabolic variables might be associated with proteinuria. Method We performed a retrospective cross-sectional study in patients (pts) treated at our stone clinic at the University Medical Centre Ljubljana in the ten-year period from January 1st 2010 to December 31st 2019. We excluded patients who did not have 24-hour proteinuria determined and patients with known urate, struvite or cystine stones. We noted the presence of arterial hypertension (AH), diabetes mellitus, a family history of kidney stones, age, sex, eGFR, body mass index, history of renal colic events and urological procedures for kidney stones, and 24-hour urine measurements (calcium, urate, oxalate, citrate, sodium, and proteinuria). Categorical variables were analyzed with Chi-Square test, normally distributed numerical values with Student's t-test and non-normally distributed with Mann-Whitney U test. P-values &amp;lt; 0.05 were considered statistically significant. Associations with p-values &amp;lt; 0.1 were included into a binary logistic regression analysis to determine the probability of predicting the presence of 24-hour proteinuria, defined as &amp;gt; 0.25 g/day in our laboratory. Results In the allocated time period 335 pts were examined. After exclusion, 251 pts were included into the analysis (mean age 49.5 ± 14.2 years, 116 (46.2%) males, 135 (53.8%) females). Complete 24-hour urine metabolic analysis was available for 238 pts. Proteinuria was present in 40 pts (15.9%) and was significantly more common in pts with AH compared to normotensive pts (18/77 (23.4%) vs. 22/174 (12.6%), p 0.027) and more common in males compared to females (23/116 (19.8%) vs. 17/135 (12.6%), p 0.083). Numerical variables with a p-value &amp;lt; 0.1 regarding the association with the presence of proteinuria are presented in Table 1. In regression analysis the model significantly predicted the presence of proteinuria (χ2 20.738, p 0.014, R2 0.343) and was able to predict the result overall in 85.2% of cases. Of all the variables included only citrate significantly predicted the presence of proteinuria (OR 1.732; 95% CI 1.009, 2.972; p 0.046). Proteinuria was significantly more common in pts with hypocitraturia (&amp;lt;1.67 mmol/day) compared to pts with normal urinary citrate (29/116 (25%) vs. 9/122 (7.4%), p &amp;lt; 0.001) and in pts with immeasurably low urinary citrate (&amp;lt;0.2 mmol/day) compared to higher citrate (15/27 (55.6%) vs. 23/211 (10.9%), p &amp;lt; 0.001). Conclusion Proteinuria was relatively common in our cohort. The main factor associated with proteinuria was urinary citrate. Proteinuria was significantly more common in pts with hypocitraturia compared to pts with normal urinary citrate and was present in the majority of pts with immeasurably low urinary citrate. Further studies are warranted to clarify the clinical relevance and implications of this findings.

Association between daily sitting time and kidney stones based on the National Health and Nutrition Examination Survey (NHANES) 2007-2016: a cross-sectional study.

Kidney stones are among the most common urological conditions affecting ~9% of the world population. Although some unhealthy diets and unhealthy lifestyles are reportedly risk factors for kidney stone, the association between daily sitting time and kidney stone has not been explored. This large-scale, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) database 2007-2016. Kidney stone history and daily sitting time were retrieved from the questionnaire and 24hour (h) recall interviews. Logistic regression and subgroup analysis were conducted to investigate the association. The analysis was further stratified by vigorous recreational activity. A total of 19188 participants aged ≥20 years with complete information were included in this study. The overall prevalence of kidney stone was 9.6%. Among participants without vigorous recreational activity, a trend towards an increasing prevalence of kidney stone was observed with increased daily sitting time. However, the trend was not observed in individuals who participated in vigorous recreational activity, as they experienced a decreased risk of kidney stone despite having a daily sitting time of 6-8h (crude model OR=0.659, 95% CI: 0.457-0.950, P =0.028), indicating that vigorous recreational activity may partially attenuate the detrimental effect of prolonged sitting time. Our study revealed an increasing trend of prevalence of kidney stone with increased daily sitting time among the population not performing vigorous recreational activity despite the difference was nonsignificant. Vigorous recreational activity may modify the association between daily sitting time and kidney stone. More prospective cohort studies are warranted to further examine this association.

Association between body roundness index and prevalence of kidney stone in the U.S: a study based on the NHANES database

ObjectiveThis study aimed to evaluate the potential association between the body roundness index (BRI) and kidney stone prevalence in adults in the United States.MethodsA cohort of participants from the National Health and Nutrition Examination Survey (NHANES) database spanning 2007–2018 were gathered for analysis. Logistic regression analyses, subgroup assessments, and calculations were employed to examine the potential link between BRI and kidney stone prevalence.ResultsThe study included 30,990 participants aged > 20 years, of which 2,891 declared a kidney stone history. After modulating all relevant confounding factors, each unit increase in the BRI was linked to a 65% increase in kidney stone prevalence (OR = 1.65, 95% CI: 1.47, 1.85). Sensitivity analyses conducted by categorizing the BRI into three groups revealed a 59% increase in kidney stone prevalence in the highest tertile BRI group compared to the lowest one (OR = 1.59, 95% CI: 1.42, 1.79). Furthermore, dose-response curves depicted a positive near-linear correlation between the BRI and the risk of kidney stone prevalence.ConclusionThese findings suggest a clinically noteworthy positive correlation between higher BRI values and kidney stone prevalence among the studied US adult population. However, it is essential to acknowledge that the observed relationship does not establish a causal link.

Kidney stones and dietary intake in adults: a population-based study in southwest Iran

BackgroundThe prevalence of kidney stones is on the rise globally. Several risk factors, including lifestyle, contribute to the formation of kidney stones. Nevertheless, there is a contentious debate about the relationship between diet and kidney stones. Therefore, our study aimed to assess the relationship between macronutrients and micronutrients and the formation of kidney stones.MethodsThis population-based cross-sectional study was conducted in the baseline phase of the Hoveyzeh Cohort Study, focusing on adults aged 35–70 in southwest Iran. The information on demographic characteristics, anthropometrics, kidney stone history, and food frequency was collected. Chi-square and t-tests were utilized to assess the relationship between categorical and numerical variables with kidney stones. The ANCOVA and logistic regression models were used to evaluate the relationships while controlling for confounding factors.ResultsAmong 10,009 participants, the overall prevalence of kidney stones was 18.77% (95% CI: 17.99–19.53). A higher intake of carbohydrates [OR = 1.02 (95% CI:1.002–1.03), p = 0.026] and copper [OR = 1.04 (95% CI:1.01–1.09), p = 0.025] were found to be associated with kidney stones. No associations were found between the other assessed macronutrients or micronutrients and kidney stones (p-tvalues > 0.05).ConclusionOur study’s findings indicate a correlation between diet and the formation of kidney stones. However, the relationship between dietary factors and kidney stones is complex, and further research is needed.

Association between DCP levels and kidney stone prevalence in US female adults based on NHANES data

Our study aimed to evaluate the correlation between levels of 2,4-DCP(2,4-Dichlorophenol) and 2,5-DCP(2,5-Dichlorophenol) and the prevalence of kidney stones in US female adults. Participants were chosen from the National Health and Nutrition Examination Survey database, spanning the years 2007–2016. Dose–response curves were analyzed using logistic regression, subgroup analyses, and other statistical methods to evaluate the relationship between 2,4-DCP and 2,5-DCP levels and the prevalence of kidney stones. The final study included 3220 participants aged over 20 years, with 252 females reporting a history of kidney stones. After accounting for all interfering variables, we found that every 0.1 ug/ml increase in 2.4-DCP correlated with a 1% rise in kidney stone prevalence (OR = 1.01, 95% CI 1.00, 1.01), whereas the same increase in 2.5-DCP was linked to a 27% growth in prevalence (OR = 1.27, 95% CI 1.01, 1.61). Sensitivity analysis was performed by triangulating 2,4-DCP and 2,5-DCP levels. The dose–response curves demonstrated a linear positive relationship between 2,4-DCP and 2,5-DCP levels and the risk of stone development. Our findings indicate a positive correlation between 2,4-DCP and 2,5-DCP levels and the prevalence of kidney stones in US female adults. This association is of clinical significance; however, a direct causal relationship cannot be definitively established.

INCIDENCE OF KIDNEY STONES IN KIDNEY TRANSPLANT RECIPIENTS

The incidence of kidney stones in kidney transplant recipients is a significant concern within the realm of post-transplant complications. The study's main objective is to find the incidence of kidney stones in kidney transplant recipients. This retrospective study was conducted at the Institute of Kidney Diseases Peshawar from 2017 to 2023. Data was collected from 420 kidney transplant patients. All patients above 18 years with available medical records who underwent renal transplants in IKD and outside IKD and who presented to IKD for follow-up were included in the study—patients with a history of kidney stones before the transplant process were excluded. Demographic information, including age, gender, and pre-transplant comorbidities, was recorded for each patient. Data were collected from 420 patients with kidney transplants. Out of 420 patients, 35 patients developed kidney stones after transplantation. The mean age of the patients who developed stones was 48.7 ± 10.2 years. There were 45.7% male and 54.3% female patients in the kidney stone group. 25.7% of patients had pre-transplant DM. Most kidney stones analyzed in the study comprised calcium oxalate, representing 18 cases, followed by calcium phosphate with eight instances. The correlation analysis revealed that age and gender did not significantly correlate with kidney stone formation in transplant patients, with p-values of 0.32 and 0.17, respectively. It is concluded that kidney transplant recipients exhibit a notable incidence of kidney stone formation, with tacrolimus-based immunosuppressive regimens potentially contributing to this risk. While age and pre-transplant diabetes show trends toward association with kidney stone development.