History Of Urolithiasis Research Articles

Perceptions of Dietary Factors Promoting and Preventing Kidney Stones Among Taif City Population - A Cross-Sectional Study.

Background and Aim:Renal stones are the most common urological disorder resulting in different marked morbidities with different risk factors. This study aimed to assess the perceptions of the general population regarding dietary factors in promoting and preventing nephrolithiasis in the Taif region.Methods:We carried out this cross-sectional study during a period of 4 months. All Taif city population who were ≥18 years old were included in the study regardless of their gender and history of urolithiasis. Participants were excluded if they were <18 years of age, not Taif city residents, and whose primary language was not Arabic. Data were analyzed using SPSS ver. 23.Results:It was found that 68.4% of the participants had poor knowledge of dietary risk factors. Further, 86.4% of the participants thought that their diet could affect the risk of kidney stone formation, and 88.6% believed that water can decrease the risk of kidney stone formation. In addition, 54.5% and 66.3% knew that increased consumption of meat and smoking can increase the risk of kidney stone formation.Conclusion:The knowledge regarding specific dietary risk factors promoting and preventing kidney stones formation was poor among the Taif city population.

MP07-11 OMEPRAZOLE LOWERS 24-HOUR URINARY MAGNESIUM EXCRETION IN PATIENTS WITH A HISTORY OF UROLITHIASIS: SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology (MP07)1 Sep 2021MP07-11 OMEPRAZOLE LOWERS 24-HOUR URINARY MAGNESIUM EXCRETION IN PATIENTS WITH A HISTORY OF UROLITHIASIS: SINGLE CENTER EXPERIENCE Kristina L. Penniston, Shuang Li, Stephen Y. Nakada, and R. Allan Jhagroo Kristina L. PennistonKristina L. Penniston More articles by this author , Shuang LiShuang Li More articles by this author , Stephen Y. NakadaStephen Y. Nakada More articles by this author , and R. Allan JhagrooR. Allan Jhagroo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001980.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urine magnesium (Mg) inhibits calcium oxalate (CaOx) stone formation. While highly variable, 24h urine Mg (UMg) is typically >2-fold higher than oxalate. Proton pump inhibitors, used for gastroesophageal reflux disease and peptic ulcer, inhibit active intestinal Mg absorption by interfering with transcellular cation channels. Alterations in Mg absorption are balanced by changes in renal Mg reabsorption. We hypothesized that patients taking omeprazole (OM) have lower UMg. METHODS: With IRB approval, we evaluated sequential patients with a history of urolithiasis seen in our multidisciplinary stone clinic or individually by the registered dietitian nutritionist (RDN). We documented clinical parameters, and OM dosage and duration of treatment if prescribed. We used 24h urine collections from patients′ initial encounters in stone clinic or with the RDN (ie, collected while naive to preventive therapy). Power analysis demonstrated the need for ≥240 subjects in order to identify significant differences in UMg for patients taking and not taking OM. RESULTS: Between 7/15/2020 and 1/15/2021, 325 patients were seen. We excluded for: no history of urolithiasis (n=9); no 24h urine collection prior to starting prevention (n=15); 24h urine creatinine <500 mg or >3,000 mg; initiation of pharmacological and/or nutrition therapy prior to starting OM (n=20). Patients (n=276) were 43% female and 91% white Caucasian. At their most recent clinical encounters, they were 58±14 y; calculated BMI was 31±8.2. Patients taking OM (OM+) for >3 months (n=45) took 24±8.2 mg/d (median 20 mg) and were taking it for 7.3 (median 6.4) y. Compared to those not taking OM (OM-; n=231), OM+ patients had lower UMg (figure). There were no differences for any other 24h urine stone risk parameters. As bowel disease is known to affect UMg, we examined this as a potential confounder. Though prevalence of bowel disease was different (figure), the prevalence of UMg ≤70 mg/d was not (figure; p=0.39, Chi square), suggesting bowel disease was not a confounder. CONCLUSIONS: Patients taking OM may absorb less Mg and have lower UMg, increasing their risk for CaOx stone recurrence. Studies are needed that investigate whether Mg supplementation reverses low UMg in patients taking OM and whether CaOx stone risk or recurrence is affected. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e143-e143 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristina L. Penniston More articles by this author Shuang Li More articles by this author Stephen Y. Nakada More articles by this author R. Allan Jhagroo More articles by this author Expand All Advertisement Loading ...

MP54-15 IS CANDIDA IN THE URINE OF CLINICAL SIGNIFICANCE IN PATIENTS WITH UROLITHIASIS?

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-15 IS CANDIDA IN THE URINE OF CLINICAL SIGNIFICANCE IN PATIENTS WITH UROLITHIASIS? Erfan Masiha, Fiona Ryan, Matthew Bultitude, Carolyn Hemsley, and Kay Thomas Erfan MasihaErfan Masiha More articles by this author , Fiona RyanFiona Ryan More articles by this author , Matthew BultitudeMatthew Bultitude More articles by this author , Carolyn HemsleyCarolyn Hemsley More articles by this author , and Kay ThomasKay Thomas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Candiduria is a common finding in clinical practice with an incidence of 3.49–10.63% in positive inpatient urinecultures. In many hospitalised patients this may demonstrate colonisation or contamination, with only areported 2-4% being symptomatic of it. However, candiduria remains a risk factor for the development ofcandidemia, with a crude mortality rate ranging from 30-40%. Our department had observed anapparent increased frequency of candiduria in patients with urolithiasis and wanted to assess the potential clinicalimpact. METHODS: Urine culture over a 1-year period (01/01/2019-01/01/2020) amongst urology inpatient/outpatients were analysed. 106 urine cultures (78 patients) were positive for candida. 33/78 patients (42%), 42/106 urine cultures (40%) had urolithiasis – their clinical notes were reviewed. RESULTS: Demographic parameters of the 33 patients with urolithiasis showed a wide range of ages (29y-90yrs) with a mean age of 60.5yrs and predominance of female patients (24F:9M). Almost half of the patients (15/33 =45%) had a form of urological prosthesis in-situ (n=15) the majority were ureteric stents (n=13), nephrostomies (n=2). The location the urine was sent from was mainly the ward (n=33), office (n=5), theatres (n=4). The site of urine collection were mostly mid stream urine (n=21), peri-op bladder / kidney urine (n=14) nephrostomy (n=4), urethral catheter (n=3). Concurrent bacteriuria was present in 8 patients (3 enterococcus, 2 citrobacter, 2 e-coli, 1 proteus). The most common co-morbidities in this patient group were diabetes mellitus (n=11), neurological disorder (n=5) and body mass index (BMI) >35 (n=4). Two thirds of the patients 22/33 (67%) were undergoing an endourology procedure for stone disease (Ureteroscopy n=16, percutaneous nephrolithotomy (PCNL) n=6). 11/33 had an obstructing ureteric stone. Of the 33 patients with urolithiasis, over half were symptomatic 18/33 (54.5%), with the majority showing signs of sepsis (n=17). 12 of the symptomatic cohort received antifungal therapy along with 6 asymptomatic patients (all pre- or intraoperatively) based on pre-operative candiduria. Only 1 patient went onto develop candidemia. 6 patients continued to demonstrate candiduria in subsequent cultures following the index finding. CONCLUSIONS: We have demonstrated the high rate of symptomatic candiduria in our patient population with a history of urolithiasis. As such candiduria in this patient cohort should be carefully assessed and given further consideration for treatment rather than assumed to be an incidental finding. Source of Funding: No Funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e955-e955 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erfan Masiha More articles by this author Fiona Ryan More articles by this author Matthew Bultitude More articles by this author Carolyn Hemsley More articles by this author Kay Thomas More articles by this author Expand All Advertisement Loading ...

MP29-01 PREDICTORS OF SEPSIS OR ACUTE PYELONEPHRITIS DUE TO OBSTRUCTIVE UROLITHIASIS: A 15-YEAR UNITED STATES COHORT STUDY

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II (MP29)1 Sep 2021MP29-01 PREDICTORS OF SEPSIS OR ACUTE PYELONEPHRITIS DUE TO OBSTRUCTIVE UROLITHIASIS: A 15-YEAR UNITED STATES COHORT STUDY Koo Han Yoo, Hyuk Jin Cho, Phil Hyun Song, Jin Kyu Oh, Sang Youn Kim, Wuran Wei, Wansuk Kim, Sinyeong Lee, Jianlin Huang, Shufeng Li, Kyle Spradling, Francesco Del Giudice, Simon Conti, and Benjamin Chung Koo Han YooKoo Han Yoo More articles by this author , Hyuk Jin ChoHyuk Jin Cho More articles by this author , Phil Hyun SongPhil Hyun Song More articles by this author , Jin Kyu OhJin Kyu Oh More articles by this author , Sang Youn KimSang Youn Kim More articles by this author , Wuran WeiWuran Wei More articles by this author , Wansuk KimWansuk Kim More articles by this author , Sinyeong LeeSinyeong Lee More articles by this author , Jianlin HuangJianlin Huang More articles by this author , Shufeng LiShufeng Li More articles by this author , Kyle SpradlingKyle Spradling More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Simon ContiSimon Conti More articles by this author , and Benjamin ChungBenjamin Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002026.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sepsis or acute pyelonephritis (APN) caused by obstructing ureteral calculi can have serious consequences, resulting in inpatient hospitalization or intensive care unit admission. This study aimed to identify the characteristics of patients with sepsis or APN caused by ureteral calculi and to analyze risk factors in its causation. METHODS: We included patients with sepsis or APN caused by ureteral calculi who received treatment in the United States from January 2003 to December 2017 using the Optum® de-identified Clinformatics© Datamart. Demographic factors and risk factors for the receipt of sepsis or APN were subsequently analyzed for statistical significance. RESULTS: A total of 467,502 patients received treatment for urinary stones were analyzed and of these, 25,747 (5.50%) were diagnosed with sepsis or APN. Age-matched multivariate analysis revealed that history of urinary tract infection (OR 11.21, 95% CI 10.58-11.88, p <0.001) and female gender (OR 2.74, 95% CI 2.63-2.85, p <0.001) were significantly related to an increased risk of sepsis or APN. Also, the presence of comorbid conditions, especially 3 or more (OR 2.95 (2.78-3.14), p <0.001) was also a significant predictor of sepsis or APN. Conversely, a previous past medical history of urolithiasis (OR 0.89, 95% CI 0.86-0.93, p <0.0001) and cancer (OR 0.93, 95% CI 0.89-0.97, p=0.0002) were associated with decreased risk of sepsis or APN. CONCLUSIONS: A history of urinary tract infection, female gender, and multiple coexisting comorbid conditions are significant risk factors for sepsis or APN in patients with ureteral calculi. These patients should be strongly advised to undergo active treatment to reduce the incidence of life-threatening infections. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e490-e490 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Koo Han Yoo More articles by this author Hyuk Jin Cho More articles by this author Phil Hyun Song More articles by this author Jin Kyu Oh More articles by this author Sang Youn Kim More articles by this author Wuran Wei More articles by this author Wansuk Kim More articles by this author Sinyeong Lee More articles by this author Jianlin Huang More articles by this author Shufeng Li More articles by this author Kyle Spradling More articles by this author Francesco Del Giudice More articles by this author Simon Conti More articles by this author Benjamin Chung More articles by this author Expand All Advertisement Loading ...

PD14-11 MATERNAL FAMILY HISTORY OF UROLITHIASIS IS ASSOCIATED WITH EARLIER ONSET OF URINARY STONE DISEASE: RESULTS FROM ReSKU

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I (PD14)1 Sep 2021PD14-11 MATERNAL FAMILY HISTORY OF UROLITHIASIS IS ASSOCIATED WITH EARLIER ONSET OF URINARY STONE DISEASE: RESULTS FROM ReSKU Rei Unno, Kazumi Taguchi, Manint Usawachintachit, Heiko Yang, Fadl Hamouche, Justin Ahn, David Bayne, Marshall Stoller, and Thomas Chi Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Manint UsawachintachitManint Usawachintachit More articles by this author , Heiko YangHeiko Yang More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , Justin AhnJustin Ahn More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001990.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Family history of urolithiasis is a known risk factor for kidney stones. The direct relationship between family history and the severity of clinical presentation for kidney stone formers is not yet well documented. In this study, we evaluated the impact of family history on the severity of disease and age of onset in patients with urolithiasis. METHODS: This was an analysis of prospectively collected data from Registry for Stones of the Kidney and Ureter (ReSKU) from a single institution between October 2015 and December 2020. Demographics, clinical, and family history information from urolithiasis patients were collected. The family history information was further characterized to highlight the type of relationship (first vs first- and second-degree relatives) as well as the parental sidedness of the relationship (paternal vs maternal). This detailed family history was then linked to patient clinical data, including number of previous stone episodes, bilaterality, age of stone onset, 24-hour urine evaluation, and recurrent stone events during follow-up. Our primary endpoint was the number of patients experiencing at least one recurrent stone event during the study period. RESULTS: A total of 1566 patients were analyzed for this study. 603 patients (38.5%) had a family history of urolithiasis. On univariate analysis, a positive family history was associated with a higher number of recurrent stone events during the follow-up period (38.2% vs 27.6% p=0.001), an earlier onset of kidney stones, a higher percentage of bilateral disease, a higher number of previous stone episodes as well as more significant hypercalciuria on 24 hours urine collections (Table1). On multivariate analysis, any family history was associated with an increased risk of recurrent stone events. The presence of both a first and a second degree relative was associated with the highest odds ratio for recurrent stone event (OR 2.23 p <0.001), while having a maternal side relative conferred a higher odds ratio for a younger onset of stones (OR 2.53 p <0.001). CONCLUSIONS: The presence of any family history of kidney stone disease imparts an increased severity of urinary stone disease on patients. Furthermore, the presence of a maternal side relative with kidney stones may be a predictor for an earlier onset of urolithiasis. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e220-e220 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rei Unno More articles by this author Kazumi Taguchi More articles by this author Manint Usawachintachit More articles by this author Heiko Yang More articles by this author Fadl Hamouche More articles by this author Justin Ahn More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement Loading ...

PD21-12 CLINICAL COMPARISON OF NON-PRESCRIPTION OVER-THE-COUNTER URINARY ALKALINIZING AGENTS: EFFECTS ON URINARY CITRATE EXCRETION AND URINE pH

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-12 CLINICAL COMPARISON OF NON-PRESCRIPTION OVER-THE-COUNTER URINARY ALKALINIZING AGENTS: EFFECTS ON URINARY CITRATE EXCRETION AND URINE pH Kristina L. Penniston, Riley J. Medenwald, Mariana M. Coughlin, Stephen Y. Nakada, and R. Allan Jhagroo Kristina L. PennistonKristina L. Penniston More articles by this author , Riley J. MedenwaldRiley J. Medenwald More articles by this author , Mariana M. CoughlinMariana M. Coughlin More articles by this author , Stephen Y. NakadaStephen Y. Nakada More articles by this author , and R. Allan JhagrooR. Allan Jhagroo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low urine citrate (Cit) and pH increase risk for calcium and uric acid kidney stones, respectively. Prescriptive urinary alkalinizing agents are expensive, and many patients request alternatives. We tested effects of 2 over-the-counter products, baking soda (BS) and Litholyte® (LL) on 24 h urine (24U) Cit and pH in patients with low 24U Cit, pH, or both. We hypothesized they had equivalent effect. METHODS: Patients with a history of urolithiasis participated in this IRB-approved study if 24U Cit was <420 mg and/or pH was <5.9 when evaluated in our clinic. Patients were randomized to 40 mEq of LL taken AM and PM (20 mEq each time) or 40 mEq alkali from BS as follows: 1/4 level tsp in water in AM and 1/2 tsp in PM. During the last 1-2 weeks of the 90-day treatment, patients completed a 24U collection, a side effects survey, and the Wisconsin Stone Quality of Life (QOL) questionnaire. We compared baseline and follow-up measures within and between groups. Patients were excluded from analysis if 24U creatinine between their 24U collections differed by >35%. Outcomes were changes in 24U Cit, pH, and NH4. We measured change in 24U calcium to assess calciuric potential of BS. RESULTS: Patients completing both 24U collections (11 of 13 on BS; 8 of 15 on LL) did not differ at baseline for 24U Cit, pH, NH4, or calcium; for stone-related QOL; nor for prevalence of low 24U Cit (54 vs 50%), pH (69 vs 88%), or both (46 vs 38%). Both treatments increased 24U Cit (median-max, 154 and 589 mg for BS; 96 and 389 mg for LL) and pH (figure), and changes were not different between groups. However, within-group changes in 24U Cit, pH, and NH4 were significant only with BS (p≤0.006, asterisks in figure). Follow-up prevalence of low urine Cit, pH, or both was slightly lower on BS vs LL (27 vs 36% for 24U Cit; and 37 vs 47% for pH). 24U calcium did not change in either group. Stone-related QOL improved by 10% in both groups; the largest improvement was in disease symptoms. Patients on BS tended to more frequently forget a dose than those on LL (50 vs 33%) and were more likely to be concerned about side effects (33 vs. 17%). CONCLUSIONS: BS and LL both increased 24U Cit and pH without increasing calcium. All changes were clinically relevant; within-group changes were significant only in those using BS. Source of Funding: LithoLyte product donated by Dr. Ryan Holland © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e379-e379 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristina L. Penniston More articles by this author Riley J. Medenwald More articles by this author Mariana M. Coughlin More articles by this author Stephen Y. Nakada More articles by this author R. Allan Jhagroo More articles by this author Expand All Advertisement Loading ...

MO167AN UNUSUAL COURSE OF A 2,8 DHA CRYSTAL INDUCED NEPHROPATHY

Abstract Background and Aims 2, 8 dihydroxyadenine (DHA) deposition is a less known etiology of crystal-induced nephropathy, caused by a deficiency in a purine salvage enzyme, the adenine phosphoribosyl transferase (APRT). DHA is an insoluble molecule in urine leading to crystal formation, tubular obstruction or stone formation. The disease manifests as a history of urolithiasis, chronic kidney disease and even loss of renal allograft when the disease is undiagnosed in native kidneys. The cornerstone of treatment is the inhibition of xanthine dehydrogenase reducing thus the formation of 2,8-DHA and its renal excretion. Method A 59-year-old obese Lebanese male patient, born to a consanguineously married couple, was admitted to another hospital with desaturation, a history of progressive shortness of breath and a creatinine level of 2,8 mg/dl. He had no hypertension nor diabetes. His family history was positive for a sister with ESRD of unknown etiology. He was discharged on oxygen and continuous airway positive pressure therapy for severe obstructive sleep apnea. His renal function deteriorated leading to a creatinine level of 9.8 mg/dl three months later. There were no signs of systemic disease, no gross hematuria, no fluid overload. His blood pressure was normal. Laboratory work up showed anemia, low grade proteinuria, intermittent microscopic hematuria and negative serological and immunological workup. Kidney ultrasound showed normal size kidneys with no evidence of collecting system dilatation or urolithiasis. Due to this atypical presentation, the patient was admitted for a renal biopsy with a creatinine level of 11 mg/dl upon admission. Results The renal biopsy showed tubulo-interstitial nephritis associated with numerous brown-green crystals by Haematoxylin and eosin of various shapes birefringent under polarized light with the characteristic “maltese cross”. Crystals were found within tubular lumens and cytoplasm, interstitium, and macrophages. These findings were characteristic of 2,8 DHA crystals deposition in the kidney. The patient was started on 120 mg of Febuxostat with a low purine and high fluid diet. A genetic testing showed a pathogenic homozygous variant in the APRT gene which causes an amino acid change from Glycine to Aspartate at position 63. Two weeks later the patient was admitted to the ICU with pneumonia, respiratory failure, a creatinine of 9 mg/dl and severe metabolic encephalopathy. He received 4 sessions of hemodialysis followed by an improvement in his kidney function with a creatinine level down to 3.2 mg/dl a month after his discharge and he remains off dialysis until now. Conclusion Around 400 cases are currently recognized worldwide, emphasizing the under recognition of this autosomal recessive disease. Considering that the homozygoty causing a complete APRT deficiency should range between 1/50 000 and 1/100 000 cases, this would translate in at least 80 000 cases worldwide. The variant found in our patient has previously been described as disease causing for APRT deficiency in four cases. Reviewing the phenotype of these cases we find differences in terms of presentation and evolution, highlighting the variability in the APRT deficiency phenotype and underlining the fact that no correlation between phenotype and genotype was reported to date even for the same type of mutation. This case report shows us that the initiation of an adequate therapy is necessary even at advanced stages of the disease since it can improve our kidney outcome.

Association of CASR, CALCR, and ORAI1 Genes Polymorphisms With the Calcium Urolithiasis Development in Russian Population.

Kidney stone disease is an urgent medical and social problem. Genetic factors play an important role in the disease development. This study aims to establish an association between polymorphisms in genes coding for proteins involved in calcium metabolism and the development of calcium urolithiasis in Russian population. In this case-control study, we investigated 50 patients with calcium urolithiasis (experimental group) and 50 persons lacking signs of kidney stone disease (control group). For molecular genetic analysis we used a previously developed gene panel consisting of 33 polymorphisms in 15 genes involved in calcium metabolism: VDR, CASR, CALCR, OPN, MGP, PLAU, AQP1, DGKH, SLC34A1, CLDN14, TRPV6, KLOTHO, ORAI1, ALPL, and RGS14. High-throughput target sequencing was utilized to study the loci of interest. Odds ratios and 95% confidence intervals were used to estimate the association between each SNP and risk of urolithiasis development. Multifactor dimensionality reduction analysis was also carried out to analyze the gene-gene interaction. We found statistically significant (unadjusted p-value < 0.05) associations between calcium urolithiasis and the polymorphisms in the following genes: CASR rs1042636 (OR = 3.18 for allele A), CALCR rs1801197 (OR = 6.84 for allele A), and ORAI1 rs6486795 (OR = 2.25 for allele C). The maximum OR was shown for AA genotypes in loci rs1042636 (CASR) and rs1801197 (CALCR) (OR = 4.71, OR = 11.8, respectively). After adjustment by Benjamini-Hochberg FDR we found only CALCR (rs1801197) was significantly associated with the risk of calcium urolithiasis development. There was no relationship between recurrent course of the disease and family history of urolithiasis in investigated patients. Thus we found a statistically significant association of polymorphism rs1801197 (gene CALCR) with calcium urolithiasis in Russian population.

Knowledge, awareness and dietary practice on urolithiasis among general population in Kuantan, Pahang, Malaysia: Preliminary findings.

Background: To date, no studies have been published at evaluating the level of knowledge, awareness and practice of dietary, particularly regarding to urolithiasis in patients or the general population. This study aims to provide basic information on the level of knowledge, awareness and dietary practice among general population in Kuantan, Pahang.Design and Methods: The respondents (n=30) were conveniently recruited within 10 kilometers radius of Kuantan city. The data were obtained using semi-guided administered questionnaires, which consists of four parts: socio-demographic data, lifestyle and clinical history (Part A); attitude and awareness on dietary practice regarding urolithiasis (Part B); food frequency questionnaire on urolithiasis (Part C) and level of knowledge on urolithiasis (Part D).Results: Majority of the respondents were women (70%), Malay (83.3%), mean age of 33.97 (±9.27), married (63.3%), completed higher education level (60%), working with government sector (33.3%) and have fixed monthly income (53.3%). Some of them had hypertension (n=4), diabetes (n=1), gout (n=1) and intestinal problem (n=1). Majority (80%) claimed having no family history of urolithiasis, consumed alcohol (10%), exercise with average frequency 2-3 times/week (46.7%) and heard about urolithiasis from healthcare worker (46.7%). The respondents’ awareness about urolithiasis is considered to be good [81.23 (±9.98)] but having poor knowledge score [2.70 (±1.149)]. Majority preferred whole meal bread, white rice, chicken meat, mackerel fish, chicken egg, apple, carrot, mustard leave and fresh milk in daily intake. Lesser plain water intake than standard requirement was noticed among respondents. Seasoning powder was commonly used for seasoning.Conclusions: Generally, the general population of Kuantan, Pahang was aware of urolithiasis disease but needed more information on dietary aspect in terms of knowledge and food choice.Significance for public healthThe result of this study provided fundamental findings on the level of knowledge, attitude and dietary practice (KAP) among the general population in Malaysia, particular in Kuantan, Pahang. Based on the literature reviews, most of the results focused on the epidemiological findings on the occurrence of urolithiasis. There were limited findings on KAP conducted locally, among the general population, patients alongside the healthcare professionals. Therefore, the self-developed instrument used in the current study has a future potential to be duplicated and utilized in the previously mentioned population.

POS-441 NEPHROCALCINOS IN ADULTS: EPIDIMIOLOGICAL PROFILE

Nephrocalcinosis is defined by the presence of calcium deposits in the renal tubules resulting from an imbalance between lithogenesis promoters and lithogenesis inhibitors. The diagnosis can be made with ultrasonography. We seek to study the particularities of this disorder in adults and its etiologies. This is a retrospective study of the macroscopic nephrocalcinosis cases in adults treated in our department from January 1986 to October 2020 26 cases were diagnosed at a mean age of 35.28 years old with extremes ranging from 11 to 79 years old. The sex ratio M/F was 1. More than half of the patients had a family history of urolithiasis. Nephrocalcinosis was suspected following renal colic in 13 cases, a polyuropolydipsic syndrome in 4 case, a hypokaliemia in 2 case, an urolithiasis in 2 case and a renal impairment in 2 case. In 3 case, the diagnosis was made fortuitly with an ultrasonography. The etiologies found were: familial distal tubular acidosis (6 cases), distal tubular acidosis caused by Sjögren’s syndrome (4 cases), primitive oxalosis (3 case), Cacci Ricci syndrome (3 cases), familial hypomagnesemia hypercalciuria (2 case), Dent syndrome (1 case) and no causes found (7 cases). Follow-up showed stabilization of renal function in 18 cases and the evolution into chronic kidney disease in 6 cases: 2 of them requiring renal replacement therapy after 5 years and the other died. Nephrocalcinosis is prevalent both in children and adults. Its etiologies are numerous. Most of the metabolic disorders are genetic. The diagnosis of nephrocalcinosis requires a deep investigation with a global clinical assessment, laboratory tests and radiological evaluation. The final objective is to prevent ESKD.

Urolithiasis and Its Treatment in Pregnant Women: 10-Year Clinical Experience From a Single Centre.

Introduction: Urolithiasis during pregnancy is an important health concern that can affect maternal and foetal health. If left untreated, it can cause obstetric complications, such as spontaneous abortion and preterm delivery. In this study, we aimed to evaluate urolithiasis and its treatment in pregnant women.Methods: We analysed data of 57 patients diagnosed with urolithiasis during pregnancy between January 2010 and December 2020. Patients’ age, gestational age, urolithiasis history, physical examination findings, laboratory findings, location and size of the stone and applied treatment methods were examined. The effectiveness and complications of the applied treatment methods were evaluated.Results: The mean age of 57 patients included in our study was 27 (27.8 ± 5.6) years and their mean gestational age was 20 (20.3 ± 9.2) weeks. The mean stone size was 9 mm (9.09 ± 4.37). The most common symptom at the time of presentation to the hospital was flank pain (93%). Kidney stones were detected in 34 patients and ureteral stones in 23 patients. Although conservative treatment was sufficient in 26 (45.6%) patients, 31 (54.4%) patients required surgical intervention. Major obstetric complications, such as preterm delivery and abortion, did not occur in any of the patients.Conclusion: The diagnosis and treatment of pregnant women with urolithiasis should be managed in a multidisciplinary manner. While determining the treatment options, foetal and maternal health should be considered.

Distribution of APOE gene polymorphism in the Chinese Uyghur children & its association with urolithiasis.

Background & objectives:This study was to survey the apolipoprotein E (APOE) gene polymorphism distribution among Chinese Uyghur children and to explore the relationship between APOE gene polymorphism and the occurrence of urolithiasis.Methods:A total of 144 Uyghur children with urolithiasis and 274 without the history of urolithiasis were enrolled in this study. Venous blood samples were collected from all participants, and APOE genotyping, derived from rs429358 and rs7412, was performed using Sanger sequencing.Results:Among the 418 children, the most prevalent genotype was E3/3, accounting for 71.3 per cent in the urolithiasis group and 71.4 per cent in the control group, followed by E3/4 and E2/3. Higher frequencies of the ɛ2 and ɛ4 alleles and lower frequencies of the ɛ3 allele were observed in the test group, and the unusual allele ɛ1 was also found in them. However, there were no significant differences between cases and controls at both rs429358 and rs7412 genotype and allele frequencies [odds ratio (OR)=0.98, 95% confidence interval (CI): 0.57-1.67; 0.98 (0.59-1.63); 1.43 (0.75-2.74) and 1.40 (0.74-2.62), respectively]. Likewise, none of significant differences was found between cases and controls at both APOE genotype and allele frequencies [OR=0.88, 95% CI: 0.51-1.53; 0.74 (0.33-1.64); 1.10 (0.73-1.66); 1.13 (0.76-1.67) and 1.14 (0.76-1.70), respectively].Interpretation & conclusions:The present study does not support any association between APOE genotyping and urolithiasis in Uyghur children.

Prevalence of Urolithiasis by Ultrasonography Among Patients with Gout: A Cross-Sectional Study from the UP-Philippine General Hospital.

ContextWhile urolithiasis is epidemiologically and mechanistically linked to gout, urologic stone disease is not actively investigated in gout patients. Prevalence estimates on the coexistence of urolithiasis in gout have mostly relied on clinical history alone.PurposeTo estimate the prevalence of urolithiasis among adult Filipinos with primary gout through clinical history and ultrasonography.Patients and MethodsPatients diagnosed with primary gout were consecutively enrolled from outpatient clinics of the University of the Philippines Manila-Philippine General Hospital. Clinical data including sex; current age; age at diagnosis, duration of and attack frequency of gout; comorbidities such as hypertension, chronic kidney disease, type 2 diabetes mellitus, and dyslipidemia; personal history of urolithiasis; family history of gout; presence of tophus and laboratory samples to assess general kidney function, serum uric acid level, and urine pH were obtained from each patient who was subsequently subjected to ultrasonographic examination for urolithiasis. Lithiasic and non-lithiasic patients were identified and compared aggregately in terms of the aforementioned features.ResultsWe recruited 121 patients, 86.8% of whom are male, and 37 (30.6%; 95% CI=23.1–39.3%) were identified to have urolithiasis of which only 12 (9.9%) had history consistent with urolithiasis and 30 (24.8%) were diagnosed solely through ultrasonography. None of the variables of interest were found to be statistically associated (P>0.05) with urologic stone formation.ConclusionUrolithiasis among adult Filipino patients with primary gout was found to be more prevalent in this study than previous estimates, which were based only on clinical history. We discovered that 25/37 (67.6%) of patients with urolithiasis denied history of urologic stone.

Osteopontin promoter polymorphisms and risk of urolithiasis: a candidate gene association and meta-analysis study

BackgroundUrolithiasis is a worldwide urological problem with significant contribution of genetic factors. Pakistan, which resides within the Afro-Asian stone belt, has a high reported prevalence (12%) of urolithiasis. Osteopontin (SPP1) is a urinary macromolecule with a suggested critical role in modulating renal stone formation, genetic polymorphisms of which may determine individual risk of developing urolithiasis. However, results of previous studies regarding SPP1 polymorphisms and susceptibility to urolithiasis have apparent inconsistencies with no data available for local population.MethodsA total of 235 urolithiasis patients and 243 healthy controls, all of Pakistani ancestry, underwent genotyping for six SPP1 genetic polymorphisms in an effort to investigate potential association with urolithiasis using indigenous candidate gene association study design. Further, a comprehensive meta-analysis following a systematic literature search was also done to ascertain an evidence based account of any existent association regarding SPP1 promoter polymorphisms and risk of developing urolithiasis.ResultsThree SPP1 promoter polymorphisms, rs2853744:G > T, rs11730582:T > C and rs11439060:delG>G, were found to be significantly associated with risk of urolithiasis in indigenous genetic association study (OR = 3.14; p = 0.006, OR = 1.78; p = 0.006 and OR = 1.60; p = 0.012, respectively). We also observed a 1.68-fold positive association of a tri-allelic haplotype of these SPP1 promoter polymorphisms (G-C-dG) with risk of urolithiasis (OR = 1.68; p = 0.0079). However, no association was evident when data were stratified according to gender, age at first presentation, stone recurrence, stone multiplicity, parental consanguinity and family history of urolithiasis. The overall results from meta-analysis, which included 4 studies, suggested a significant association of SPP1 rs2853744:G > T polymorphism with susceptibility of urolithiasis (OR = 1.37; p = 0.004), but not for other SPP1 polymorphic variants analyzed.ConclusionsIn conclusion, we report significant association of 3 SPP1 polymorphisms with urolithiasis for the first time from South Asia, however, this association persisted only for SPP1 rs2853744:G > T polymorphism after meta-analysis of pooled studies. Further studies with a larger sample size will be required to validate this association and assess any potential usefulness in diagnosis and prognosis of renal stone disease.

Prevalence of Metabolic Risk Factors Affecting Childhood Nephrolithiasis: A Report from a University Hospital in West of Iran

Background The prevalence of urolithiasis in both infants and children is increasing. The metabolic features contributing to urolithiasis formation in children may vary from those in adult patients. The purpose of this study is to determine the prevalence of urinary metabolic abnormalities and related factors in infants and children with urolithiasis in Kermanshah, West of Iran. Materials and Methods: In this cross-sectional study, 104 children and infants with urolithiasis who were admitted to the Pediatrics Nephrology Clinic of Imam Reza Hospital in Kermanshah, Iran in 2018 were investigated. Urinary metabolic abnormalities, including hypercalciuria, hyperuricosuria, hyperoxaluria, and hypocitraturia and cystinuria, were examined using random urine samples. Results: Of the 104 children (66 boys and 38 girls) examined, 64 (61.5%) had at least one urinary metabolic abnormality. Hypercalciuria was the most common (31 patients, 29.8%), followed by hyperuricosuria (27 patients, 26%), hyperoxaluria (20 patients, 19.2%), hypocitraturia (13 patients, 12.5%), and cystinuria (one patient, 0.96%). Hyperuricosuria (88.9%) and hypocitraturia (46.2%) were more common in infants younger than 12 months old compared to those older. No statistically significant association was observed between the frequency of urinary metabolic abnormalities with gender and family history of urolithiasis, but a significant relationship was found between age and prevalence of urinary metabolic abnormalities. Conclusion Hypercalciuria was the most common metabolic abnormality in the urine. Although detection of urinary metabolic abnormalities is important, the role of other variables, like nutritional and climatic factors in the development of childhood nephrolithiasis should be considered too, since no metabolic disorder have been found in more than a third of patients.

Urolithiasis, growth and blood pressure in childhood: A case-control study

Kidney stone is a life-threatening disease with subsequent complications, especially in children who overtake this disease in early ages. This study assessed the effect of kidney stone history on current blood pressure and growth parameters of children. A two hundred children with (n=100) and without (n=100) a history of urolithiasis from Pediatric Urology clinics at the Aliasghar hospital, Tehran, Iran, participated in this case-control study. Several demographic data, height, weight, body mass index (BMI), BMI for age and blood pressure index were measured as the primary outcomes. type of birth and infancy feeding, carbohydrate and energy intake were significantly different between the two groups (P=0.008, 0.002, 0.03 and<0.001 respectively). Ordinal logistic regression analysis showed that the current weight (P=0.001) and BMI for age (P=0.02) of the stone formers were lower than the non-stone formers, while no significant association found between the blood pressure or current height and the history of urolithiasis. Our findings suggest that childhood urolithiasis has no significant effect on growth failure and blood pressure in childhood but it has a little impact on weight and BMI for age in older ages.

P0132DIAGNOSIS OF HYPEROXALURIA FROM RENAL BIOPSY

Abstract Background and Aims Crystal-induced kidney disease refers to kidney injury caused by intratubular crystal deposition. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. The purpose of our study is to determine the epidemiological and clinical characteristics of hyperoxaluria diagnosed from renal biopsy. Method We retrospectively reviewed all kidney biopsy specimens evaluated at renal pathology laboratory, from 1976 to 2019. The biopsy specimens were received from multiple medical department and medical centers. We studied 8900 biopsy specimens and we were focused on patients whose diagnosis of hyperoxaluria was made from renal biopsy Results We identified 25 cases (15 children and 10 adults) with a sex ratio H / F of 0.9. Mean age at diagnosis was 17.2 years old [4 months-73 years old]. Most patients were offspring of consanguineous mating (14 of 25) with intermarriage of first-degree cousins being the most common pattern. A family history of chronic kidney disease was found in 13 patients: indeterminated nephropathy (n = 6) and renal stone (n = 5) and primary hyperoxaluria (n=2). Among our patients, five had a history of urolithiasis. One patient had a history of chronic diarrhea related to Crohn's disease and one patient had a history of cephalic pancreatectomy and ileal resection. Initial symptoms and signs were dominated by renal failure (n = 25) with mean creatinine of 789.5 μmol / l [306-1832μmol / l], associated with proteinuria in 10 patients and hematuria in 11 patients. Arterial hypertension was present in 4 patients. Oligo anuria was reported in 4 patients without dilation of the urinary excretory pathways. In our patients, the diagnosis of crystalin nephropathy was revealed by renal biopsy. In one case, the diagnosis was made after renal transplant. In 4 cases the diagnosis was made by postmortem kidney biopsy. In all cases, the kidney biopsy specimen showed extensive intratubular crystal deposition and tubulointerstitial mononuclear cell infiltration with features of tubular injury and interstitial fibrosis. Examination of histologic slides showed colorless refractile crystals of polygonal appearance. Multicolored birefringence under polarized light identified these crystals as calcium oxalate. After different investigations (genetic and biological analysis), the diagnosis of hyperoxaluria was confirmed. Hyperoxaluria was primary in 23 patients and secondary in 2 patients. Conclusion Hyperoxaluria is a rare condition, often serious, involving renal prognosis and sometimes life-threatening, especially in early-onset forms. Early diagnosis and treatment should be done as soon as possible to slow the progression to end-stage renal failure. In patients with renal insufficiency, the diagnosis of hyperoxaluria is difficult. Renal biopsy can help when clinical and radiological data are not sufficient.

Multidrug-resistant Escherichia coli isolated from a dog with a history of urolithiasis: case report

ABSTRACT Bacterial resistance is a reality in both human and veterinary health, it limits the therapeutic arsenal and raises the costs of the patient’s treatment. A dog with signs of cystitis received treatment with 5mg/kg enrofloxacin at three consecutive times, with low effectiveness. The presence of urethral uroliths was identified and urohydropulsion was done. The animal presented a new obstruction, for which a cystotomy was performed, but continued with signs of infection. Uroculture and antimicrobial susceptibility test were then performed. Escherichia coli was identified, which was resistant to 13 antibiotics, being sensitive only to piperacillin-tazobactam and amikacin. In the screening test for β-lactamase, the production of ESβL was detected. The qPCR indicated the presence of the bla CTXm, bla DHA, bla OXA, bla IMP, bla TEM, bla GIM, bla SIM, bla SPM and bla SME genes, which may lead to a phenotypic resistance profile for ampicillin, amoxicillin-clavulanate, aztreonam, cefepime cefoxitin, cefuroxime, ceftazidime, ceftriaxone, imipenem, and piperacillin-tazobactam. This case reaffirms the value that laboratory analysis adds to the diagnosis and treatment of cystitis and urolithiasis, which can define the direction of evolution of the prognosis and the speed at which the patient's health will be restored.

Relationship Between the Wisconsin Stone Quality of Life (WISQOL) and Preference-Based/Health Utility Measures of Health-Related Quality of Life (HRQoL) in Kidney Stone Patients

ObjectiveTo determine preference-based (utility) assessments of health-related quality of life (HRQoL) in kidney stone patients, and evaluate the association between these and disease specific, psychometric health status-based HRQoL scores (obtained via the Wisconsin Stone Quality of Life [WISQOL]). MethodsOne hundred four adults with urolithiasis, as well as 78 young healthy adults without history of urolithiasis (controls) were consecutively enrolled, meeting the predetermined recruitment goal. Each participant completed the SF-36 v2 (from which SF-6D utility is calculated) and EQ-5D questionnaires, while urolithiasis patients additionally completed the WISQOL. Relationship between health utility and WISQOL scores was evaluated using Pearson's test and multivariable linear regression analysis (MVA). Construct validity of the utilities for urolithiasis was assessed by comparing utilities for patients vs controls, and for symptomatic vs asymptomatic patients. ResultsMean (SD) WISQOL standard score, SF-6D, and EQ-5D utilities in stone patients respectively were 63 (29.1), 0.68 (0.16), and 0.83 (0.17). SF-6D and EQ-5D utilities significantly correlated with WISQOL standard score (Pearson's r = 0.87 and 0.58, respectively; each P <.0001). On MVA, WISQOL standard score was a significant predictor of SF-6D and EQ-5D utilities, explaining 72.1% and 33.9% of the respective variances in the utilities. Median SF-6D and EQ-5D utility were significantly lower in patients vs controls (each P ≤.0009), and in symptomatic vs asymptomatic patients (each P ≤ .0002). ConclusionSF-6D, more so than EQ-5D utilities in urolithiasis patients are strongly associated with disease-specific WISQOL scores, suggesting they are optimal for preference-based HRQoL assessment in this population. Construct validity of the utilities in stone disease was demonstrated.

SAT-460 HISTOLOGICAL DIAGNOSIS OF HYPEROXALURIA FROM RENAL BIOPSY

Crystal-induced kidney disease refers to kidney injury caused by intratubular crystal deposition. The most common forms of crystalline nephropathy encountered in renal pathology are nephrocalcinosis and oxalate nephropathy. The purpose of our study is to determine the epidemiological and clinical characteristics of hyperoxaluria diagnosed from renal biopsy. We retrospectively reviewed all kidney biopsy specimens evaluated at renal pathology laboratory, from 1976 to 2018. The biopsy specimens were received from multiple medical department and medical centers. We studied 8900 biopsy specimens and we were focused on patients whose diagnosis of hyperoxaluria was made from renal biopsy. We identified 25 cases (15 children and 10 adults) with a sex ratio H / F of 0.9. Mean age at diagnosis was 17.2 years old [4 months-73 years old]. Most patients were offspring of consanguineous mating (14 of 25) with intermarriage of first-degree cousins being the most common pattern. A family history of chronic kidney disease was found in 13 patients: indeterminated nephropathy (n = 6) and renal stone (n = 5) and primary hyperoxaluria (n=2). Among our patients, five had a history of urolithiasis. One patient had a history of chronic diarrhea related to Crohn's disease and one patient had a history of cephalic pancreatectomy and ileal resection. Initial symp­toms and signs were dominated by renal failure (n = 25) with mean creatinine of 789.5 μmol / l [306-1832μmol / l], associated with proteinuria in 10 patients and hematuria in 11 patients. Arterial hypertension was present in 4 patients. Oligo anuria was reported in 4 patients without dilation of the urinary excretory pathways. In our patients, the diagnosis of crystalin nephropathy was revealed by renal biopsy. In one case, the diagnosis was made after renal transplant. In 4 cases the diagnosis was made by postmortem kidney biopsy. In all cases, the kidney biopsy specimen showed extensive intratubular crystal deposition and tubulointerstitial mononuclear cell infiltration with features of tubular injury and interstitial fibrosis. Examination of histologic slides showed colorless refractile crystals of polygonal appearance. Multicolored birefringence under polarized light identified these crystals as calcium oxalate. After different investigations (genetic and biological analysis), the diagnosis of hyperoxaluria was confirmed. Hyperoxaluria was primary in 23 patients and secondary in 2 patients. Hyperoxaluria is a rare condition, often serious, involving renal prognosis and sometimes life-threatening, especially in early-onset forms. Early diagnosis and treatment should be done as soon as possible to slow the progression to end-stage renal failure. In patients with renal insufficiency, the diagnosis of hyperoxaluria is difficult. Renal biopsy can help when clinical and radiological data are not sufficient.