History Of Urolithiasis Research Articles

CLINICAL-EPIDEMIOLOGICAL PROFILE OF 106 PEDIATRIC PACIENTS WITH UROLITHIASIS IN RIO DE JANEIRO, BRAZIL.

ABSTRACTObjective: To describe the frequency, clinical profile and treatment of patients with urolithiasis in the Pediatric Nephrology Department of a public state hospital in Rio de Janeiro, Brazil.Methods: Retrospective study. Data from pediatric patients (age: 1 month - 18 years) with urolithiasis admitted between January/2012 and December/2014 were reviewed from hospital charts. The studied variables were: demographic and anthropometric data, clinical status, family history of urolithiasis, urinary tract infection and use of lithogenic drugs, diagnostic procedures, associated abnormalities, metabolic disorders, treatment and recurrence.Results: The frequency of urolithiasis was 13.6%. Main characteristics of the patients: male gender, white race, eutrophy, aged between 5 and 10 years, family history of urolithiasis, previous urinary infection and spontaneous stone passage. Abdominal and flank pain and macroscopic hematuria were the most common complaints. The most frequent metabolic disorders were hypercalciuria, hyperuricosuria and hypocitraturia. Hypocitraturia was associated with previous urinary infection (p=0.004). Abdomen/urinary tract ultrasonography was the most commonly used diagnostic test. Hydronephrosis occurred in 54.4% of the cases, 81.1% of the stones were in the kidneys, and bilateral stones were associated to a family history of urolithiasis (p=0.030). Recurrence rate was 29.3% (most patients had a metabolic disorder). In 12.3%, the patients underwent lithotripsy, 24.5% were surgically treated (mainly pyelolithotomy), and only 7.6% had their stones analyzed (calcium oxalate was the main finding in the examined stones).Conclusions: The frequency of urolithiasis in these pediatric patients was similar to that reported by the literature. A metabolic evaluation is required and the composition of stones should be better evaluated.

Comorbidity and socio-demographic factors associated with renal lithiasis in persons aged 40 to 65: A cross-sectional study

Background and objectiveRenal lithiasis is one of the most important urological diseases. It seems to be related to different socio-demographic and climatic factors, lifestyle and pre-existing comorbidity. The aim of this study was to examine the relationship between socio-demographic variables, certain risk factors and chronic diseases and the renal lithiasis. Patients and methodA cross-sectional population-based study was carried out, selecting the Spanish population aged from 40 to 65 years, combining 2 random samples (PreLiRenA and PreLiRenE studies). Data were collected by personal telephone surveys, gathering information on socio-demographic variables and perceived morbidity. Data on annual average temperatures in each Spanish region were also collected. A bivariate and multivariate analysis was performed. ResultsA total of 4894 subjects were surveyed; 51.3% were women; 25% were aged 40–45 years, 36% had primary school education and 31.4% were of low social class. The overall prevalence of renal lithiasis was 15.0% (95% confidence interval [95% CI] 14.5–15.5). By means of multivariate analysis, the variables that showed a strong statistical relationship with the presence of renal lithiasis were: older age (61–65 years; OR=1.39; 95% CI 1.06–1.80), high social class (OR=1.98; 95% CI 1.29–2.62), family history of renal lithiasis (OR=2.22; 95% CI 1.88–2.65), high blood pressure (OR=1.68; 95% CI 1.39–2.02) and overweight/obesity (OR=1.31; 95% CI 1.12–1.54). A correlation was observed between renal lithiasis and average annual temperatures in the Spanish regions (r=0.59; p=0.013). ConclusionsA relationship was observed between renal lithiasis and older age, belonging to higher social classes, the existence of a family history of urolithiasis, and hypertension and overweight or obesity. The prevalence of renal lithiasis is greater in warmer climate zones.

Determinants of calcium and oxalate excretion in subjects with calcium nephrolithiasis: the role of metabolic syndrome traits.

The association of metabolic syndrome (MetS) traits with urinary calcium (UCE) or oxalate excretion (UOE) is uncertain in calcium stone formers (CSFs). Our aim was to investigate this association in a large group of Caucasian CSFs. We retrospectively reviewed data of CSFs evaluated at our Kidney Stone Clinic from 1984 to 2015. Data on body mass index (BMI), MetS traits defined according to international consensus, family history of urolithiasis, anti-hypertensive treatments, calcemia, renal function, and 24-h urinary profile of lithogenic risk were collected. The association between MetS traits and UCE or UOE was tested with multivariate linear regression models accounting for a long list of potential confounders. We included 3003 CSFs, aged 44 ± 14years. The prevalence of hypertension, diabetes, overweight (BMI ≥ 25kg/m2) and dyslipidemia was 17, 2, 42 and 38%, respectively. Median values of UCE and UOE were 211mg/24h (IQR 143-296) and 28mg/24h (IQR 22-34), respectively. At a multivariate model, including age, sex, date of examination, drug treatments, family history, renal function, blood calcium and urinary factors as covariates, hypertension was a significant positive determinant of UCE (β ± SE 0.23 ± 0.07, p = 0.003), but overweight, dyslipidemia and diabetes were not. No MetS trait was significantly associated with UOE in multivariate models. In a large group of Caucasian CSFs, hypertension was the only MetS trait significantly associated with UCE, while no MetS trait was associated with oxalate excretion.

Urolithiasis is Associated with the Increased Risk for Osteoporosis

Objective: We aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease. Materials and Methods: Data were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities. Results: After performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% confidence interval [CI]: 1.15–1.27, P < 0.001). Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age < 40 years, adjusted hazard ratio 1.4, 95% CI: 1.12–1.75, P = 0.003; 40–59 years, adjusted hazard ratio 1.3, 95% CI: 1.20–1.40, P < 0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI: 1.05–1.21, P = 0.001; P = 0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI: 1.20–1.36, P < 0.001; hypertension, adjusted hazard ratio 1.12, 95% CI: 1.03–1.22, P = 0.006, P = 0.020 for interaction). Conclusion: In conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Although the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow-up of bone marrow density.

Urolithiasis is associated with the increased risk for osteoporosis: A nationwide 9-year follow-up study

ObjectiveWe aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease. Materials and methodsData were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities. ResultsAfter performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% CI 1.15–1.27, p < 0.001). Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age <40 years, adjusted hazard ratio 1.4, 95% CI 1.12–1.75, p = 0.003; 40–59 years, adjusted hazard ratio 1.3, 95% CI 1.20–1.40, p < 0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI 1.05–1.21, p = 0.001; p = 0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI 1.20–1.36, p < 0.001; hypertension, adjusted hazard ratio 1.12, 95% CI 1.03–1.22, p = 0.006, p = 0.020 for interaction). ConclusionIn conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Though the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow up of bone marrow density.

Comorbilidad y factores sociodemográficos asociados a litiasis renal en personas de 40 a 65 años: estudio transversal

Background and objectiveRenal lithiasis is one of the most important urological diseases. It seems to be related to different socio-demographic and climatic factors, lifestyle and pre-existing comorbidity. The aim of this study was to examine the relationship between socio-demographic variables, certain risk factors and chronic diseases and the renal lithiasis. Patients and methodA cross-sectional population-based study was carried out, selecting the Spanish population aged from 40 to 65 years, combining 2 random samples (PreLiRenA and PreLiRenE studies). Data were collected by personal telephone surveys, gathering information on socio-demographic variables and perceived morbidity. Data on annual average temperatures in each Spanish region were also collected. A bivariate and multivariate analysis was performed. ResultsA total of 4,894 subjects were surveyed; 51.3% were women; 25% were aged 40-45 years, 36% had primary school education and 31.4% were of low social class. The overall prevalence of renal lithiasis was 15.0% (95% confidence interval [95% CI] 14.5-15.5). By means of multivariate analysis, the variables that showed a strong statistical relationship with the presence of renal lithiasis were: older age (61-65 years; OR=1.39; 95% CI 1.06-1.80), high social class (OR=1.98; 95% CI 1.29-2.62), family history of renal lithiasis (OR=2.22; 95% CI 1.88-2.65), high blood pressure (OR=1.68; 95% CI 1.39-2.02) and overweight/obesity (OR=1.31; 95% CI 1.12-1.54). A correlation was observed between renal lithiasis and average annual temperatures in the Spanish regions (r=0.59; P=.013). ConclusionsA relationship was observed between renal lithiasis and older age, belonging to higher social classes, the existence of a family history of urolithiasis, and hypertension and overweight or obesity. The prevalence of renal lithiasis is greater in warmer climate zones.

A 5-day antibiotic course for treatment of intermittent catheter-associated urinary tract infection in patients with spinal cord injury.

This was a retrospective monocentric study conducted at Centre Calvé, France, with the objective of evaluating the effectiveness of a 5-day course of antibiotics for symptomatic (mild urinary tract infection, UTI) or asymptomatic (aBact) bacteriuria in patients with spinal cord injury on intermittent catheterization. This study was conducted from May 2013 to September 2016. Antibiotic selection always followed culture collection and analysis of antibiograms. Patients with febrile UTI (>38°5) or recent history of urolithiasis were excluded. Fifty-seven patients underwent 111 5-day courses of antibiotics. The two main bacteria involved were Escherichia coli and Klebsiella Pneumoniae. Most commonly prescribed antibiotics were cephalosporins, cotrimoxazole, fluoroquinolones and nitrofurantoins. On day 4 of the antibiotic course, bacteria were eradicated in 99% of cases. Clinical cure occurred in all patients by day 5 (end of treatment). After treatment, recurrence of UTI occurred in 16% of patients at week 3, 38% at week 6 and 50% at week 9. This rate was not significantly different from patients initially treated for aBact (20%, 35% and 44%, respectively). The UTI-free period was significantly shorter after treatment for aBact (45.5 days) than after treatment for UTI (53.7 days). None of the following characteristics were found to be risk factors for UTI: level or severity of lesion, gender, voiding mode, use of anticholinergic drugs and time since lesion. Results of this study support the use of a short 5-day course of antibiotics to treat mild UTI in patients with spinal cord injury, and provide further evidence against treatment of aBact.

Prevalence of kidney stones and associated risk factors in the Shunyi District of Beijing, China.

Kidney stone formation is a multifactorial condition that involves interaction of environmental and genetic factors. Presence of kidney stones is strongly related to other diseases, which may result in a heavy economic and social burden. Clinical data on the prevalence and influencing factors in kidney stone disease in the north of China are scarce. In this study, we explored the prevalence of kidney stone and potentially associated risk factors in the Shunyi District of Beijing, China. A population-based cross-sectional study was conducted from December 2011 to November 2012 in a northern area of China. Participants were interviewed in randomly selected towns. Univariate analysis of continuous and categorical variables was first performed by calculation of Spearman's correlation coefficient and Pearson Chi squared value, respectively. Variables with statistical significance were further analysed by multivariate logistic regression to explore the potential influencing factors. A total of 3350 participants (1091 males and 2259 females) completed the survey and the response rate was 99.67%. Among the participants, 3.61% were diagnosed with kidney stone. Univariate analysis showed that significant differences were evident in 31 variables. Blood and urine tests were performed in 100 randomly selected patients with kidney stone and 100 healthy controls. Serum creatinine, calcium, and uric acid were significantly different between the patients with kidney stone and healthy controls. Multivariate logistic regression revealed that being male (odds ratio=102.681; 95% confidence interval, 1.062-9925.797), daily intake of white spirits (6.331; 1.204-33.282), and a history of urolithiasis (1797.775; 24.228-133 396.982) were factors potentially associated with kidney stone prevalence. Male gender, drinking white spirits, and a history of urolithiasis are potentially associated with kidney stone formation.

Risk factors for infection development after transrectal prostate biopsy and the role of resistant bacteria in colonic flora.

In this study, we aimed to identify risk factors for the development of infectious complications after prostate biopsy and to investigate the role of intestinal colonization of bacteria that are resistant to prophylactic antibiotics. A total of 168 patients who had undergone transrectal prostate biopsy (TRPB) under ciprofloxacin and gentamycin prophylaxis were included in the study. Stool cultures and subsequent antibiotic susceptibility testing were performed in all patients before the start of antibiotic prophylaxis. Of the 168 patients, 17 (10.1%) developed urinary tract infection (UTI), while 6 (3.57%) developed sepsis within seven days after biopsy. Ciprofloxacin-resistant bacterial colonization was detected in 81 (48.2%) of the patients. None of the patients with ciprofloxacin-sensitive bacteria in intestinal flora developed a UTI. The colonization of intestinal ciprofloxacin-resistant bacteria increased UTI risk significantly after TRPB (p < 0.0001). Urolithiasis history, presence of permanent urinary catheterization, hospitalization history for more than 48 hours in the last year, and recent antibiotic usage significantly increased UTI risk after TRPB. Development of an infection was more frequent in patients with resistant bacterial colonization. We hope to guide more comprehensive studies designed to find a standard prophylactic regimen for TRPB that can be used all over the world.

The relationship between serum and urinary Fetuin-A levels and kidney stone formation among kidney stone patients.

IntroductionMineralization inhibitors are required to prevent the precipitation of minerals and inhibit the formation of kidney stones and other ectopic calcifications. In laboratory studies, Fetuin-A as a glycoprotein has inhibited hydroxyapatite precipitation in calcium and phosphate supersaturated solutions; however, information about patients with kidney stones is limited. The aim of this study was to investigate the association of serum and urinary Fetuin-A levels with calcium oxalate kidney stones.Material and methodsIn this case-control study, 30 patients with kidney stones and 30 healthy individuals without any history of urolithiasis who were referred to the urology ward of Sina Hospital of Tehran, Iran, in 2015 were entered into the study. All patients underwent computerized tomography scans. After collecting demographic information, serum and urine levels of Fetuin-A and some other calcification inhibitors and promoters, were measured and compared using T-test, Mann-Whitney and logistic regression between the two study groups.ResultsPatients with kidney stones, on average, had lower levels of Serum Fetuin-A (1522.27 ±755.39 vs. 1914.64 ±733.76 μg/ml; P = 0.046) as well as lower levels of Urine Fetuin-A (944.62 ±188.5 vs. 1409.68 ±295.26 μg/ml; P <0.001). Multivariate logistic analysis showed that urinary calcium and serum creatinine are the risk factors and Fetuin-A is a urinary protective factor for kidney stones.ConclusionsPFC Our study showed that patients with kidney stones had lower serum and urinary levels of Fetuin-A. In the logistic regression model, urinary Fetuin-A was reported as a protective factor for kidney stones.

Pediatric Urolithiasis in Children: Diagnosis and Management

Introduction: Pediatric urolithiasis remains endemic in low-resource countries affecting children <1 to 15 years. This study aimed to investigate the diagnosis and the treatment options of pediatric urolithiasis and compare that with the literature. Materials and methods: This study retrospectively evaluated patients who had been diagnosed with urolithiasis in the in department of pediatric emergency and reanimation and the department of pediatric surgery in Hedi Chaker hospital in Sfax between 2001 and 2016. Results: Over 16 years period, we diagnosed and managed 78 children with urolithiasis. 44 were male (56%) and 34 were female (44%). The median age was 54 months (4 to 144 months). Family history of urolithiasis was found in 23 patients (29.5%). The diagnosis of urolithiasis was made after Urinary tract infection in 23 (29.5%), abdominal pain in 16 (20.5%), Hematuria in 9 (11.5%), nephritic colic in 8 (10.5%), dysuria in 11(14%) and after antenatal diagnosis of malformative uropathies in 11 (14%) patients. The treatment were surgery in 32, medical in 30, LEC and endoscopy in 8 patients. The mean of follow up was 36 months and we had 11 recurrent urolithiasis. Conclusion: Pediatric urolithiasis remains a devastating health problem. Their management requires more exploration especially in the etiology research for a best management.

FEATURES OF THE COURSE OF IDIOPATHIC HYPERCALCIURIA IN CHILDREN. ANALYSIS OF CLINICAL AND LABORATORY MANIFESTATIONS

THE AIM: to study clinical and laboratory manifestations of hypercalciuria in children of Barnaul, living in the zone of sharply continental climate of the South of Western Siberia. PATIENTS AND METHODS. The study included 239 children aged from 1 month to 16 years (mean age of 6.6±2,72 years) with idiopathic hypercalciuria (IH), diagnosed according to the level of calcium/creatininemia coefficient (CCC), more than 0.6 mmol/mmol and normal plasma calcium and parathyroid hormone. Conducted physical examination and biochemical blood and urine determination of calcium, phosphorus, creatinine, urea and uric acid, ultrasound of the kidneys and bladder, radiopaque research methods indicated. RESULTS. Family history of urolithiasis have been reported in 56.1% children with hypercalciuria. Analysis of comorbidity showed a combination of IH with urolithiasis in 15.1% patients with urinary system infections(USI) – in 38.5%, with anomalies of the urinary system – 27,2% children with neurogenic disorders of urination – at 9.2 percent. The clinical picture of the disease prevailed dysuric disorders (48,5%) and moderately pronounced edema syndrome (45,6%). In the urinary sediment of children with hypercalciuria, the most frequently recorded crystalluria (31,8%), microhematuria (19,2%) and leukocyturia (13.8%). CONCLUSION. Idiopathic hypercalciuria in children is often combined with such pathological conditions as USI, neurogenic disorders of urination, abnormalities of the urinary system and it is the cause of the development of the urolithiasis already in childhood.

Characterization of Urolithiasis in Patients Following Lower Urinary Tract Reconstruction with Intestinal Segments.

Urinary diversion and augmentation cystoplasty are associated with long-term complications, including metabolic derangements, infectious complications, and urolithiasis. The aim of this series was to characterize upper and lower urinary tract (LUT) calculi in this population. A retrospective chart review was performed on all patients with a history of urinary diversion or augmentation cystoplasty who subsequently underwent treatment for urolithiasis between January 1998 and May 2015. Data collected included demographics, perioperative characteristics, type of reconstructive procedure, urine culture, stone analysis, and metabolic evaluation. A statistical analysis was performed. Ninety-nine patients were identified with a history of urolithiasis and incontinent urinary diversion (28), neobladder (21), continent cutaneous diversion (12), and augmentation cystoplasty (38). LUT stones were more common than upper tract stones in all except for incontinent diversions, which only had one lower tract stone (p = 0.0001). Twenty-three percent of stones were metabolic. Several metabolic derangements were noted, including hypocitraturia (100%), elevated urine pH (100%), low urine volume (70%), and hyperoxaluria (35%). There was a 44% rate of recurrent urolithiasis. Given the high rate of stone recurrence among patients with a history of urinary diversion and augmentation cystoplasty, all measures should be taken to prevent recurrent stones. In addition to actions aimed to prevent infectious stones such as bladder and pouch irrigation, we recommend these patients undergo a full metabolic workup with targeted dietary changes and medical therapies.

Associations between interventions for urolithiasis and urinary tract cancer among patients in Taiwan: The effect of early intervention.

The aim of this study was to investigate cancer risk in patients with a history of urolithiasis and to determine whether intervention for calculi attenuated the risk of subsequent urinary tract cancer (UTC).Using data from the National Health Insurance Research Database in Taiwan, we performed a nationwide cohort study enrolling participants (n = 42,732) aged > 30 years who were diagnosed with urinary tract calculi between 2000 and 2009. Age- and gender-matched insured individuals (n = 213,660) found in the health service records over the same period were recruited as the control group. The Cox proportional hazards model and competing risks regression model were used to examine the relationship between urolithiasis and UTC, as well as whether early intervention for urolithiasis decreased the subsequent cancer risk relative to late intervention.Participants with a previous diagnosis of urolithiasis (n = 695) had a 1.82-fold (95% CI: 1.66-1.99, P < 0.001) increased risk of developing UTC. Furthermore, the risk of UTC associated with urolithiasis was higher in women (adjusted HR: 2.43, 95% CI: 1.94-3.05) than in men (adjusted HR: 1.72, 95% CI: 1.55-1.90). When stratified by cancer site, the adjusted HR for bladder, renal pelvis/ureter, renal, and prostate cancers were 1.94 (95% CI: 1.62-2.33), 2.94 (95% CI: 2.24-3.87), 2.94 (95% CI: 2.29-3.77), and 1.45 (95% CI: 1.27-1.65), respectively. Patients who received interventions for urolithiasis within 3 months of detection had a decreased risk of subsequent UTC (adjusted HR: 0.53, 95% CI: 0.40-0.71, P < 0.001).The present study demonstrated that urolithiasis increased the risk of subsequent UTC, especially upper UTC. Hence, it is recommended that physicians administer the appropriate interventions as early as possible upon diagnosis of urolithiasis.

Unilateral renal agenesis. New arguments about the genetic relationship between kidney malformations and urolithiasis

Abstract Background In few previous studies, it has been reported that hypercalciuria is associated with some types of congenital anomalies of the kidney and urinary tract (CAKUT), namely ureteropelvic junction obstruction, vesicoureteral reflux or simple renal cysts. In addition, one higher prevalence of hypercalciuria and/or urolithiasis has been described in their family members compared to the general population. This study was carried out to find out whether children with unilateral renal agenesis (URA) have these features previously described in other CAKUT types. Methods In a descriptive and multicenter study we studied the prevalence of hypercalciuria, hypocitraturia and urolithiasis in 67 children (43 males and 24 females) with URA and their families. Results The two metabolic anomalies that promote stone formation were observed in 26 children (38.8%), distributed as follows: hypercalciuria in 16, hypocitraturia in 9, and both hypercalciuria and hypocitraturia in 1. Eight children (11.9%) suffered renal colic during follow-up. Familial history of urolithiasis was found in 42/67 children (62.7%): in 12 of the first-degree relatives, in 15 of the second degree relatives and in 15 patients both in the first-degree as in their second degree relatives. In contrast, in historic control group, only in 28.1% of families at least one member had urolithiasis. Conclusion Our results show that the prevalence of hypercalciuria and/or hypocitraturia is greater in pediatric patients with URA than in the general population. Likewise, the prevalence of urolithiasis in the families of these children is also higher than that in the general population.

Metabolic risk factors in pediatric stone formers: a report from an emerging economy.

The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15years. Patients were evaluated for demographics, blood and 24h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50±3.56years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4%), urinary tract infection in 18 (7%) and chronic diarrhea in 75 (30%). Hypercalcemia was seen in 37 (14.8%), hyperuricemia in 23 (9.2%) and hyperphosphatemia in 6 (2.4%). Urinary metabolic abnormalities were identified in 248 (98%) of the cases. Hypocitraturia was found in 207 (82.8%), hyperoxaluria in 62 (26.4%), hyperuricosuria in 82 (32.8%), hypercalciuria in 51 (20.4%), hyperphosphaturia in 46 (18.4%), hyperammonuria in 10 (4%), hypocalciuria in 82 (32.8%), and hypovolemia in 73 (29.2%). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5years (52, 49, 49%) as compared to (18, 21, 12%) those in 11-15years (p<0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98% of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.

Blood pressure and urolithiasis in children

Urolithiasis is a condition that is most commonly found in adults, but is becoming increasingly prevalent in children. Little is known about the relationship between blood pressure (BP) and urolithiasis in children. The aim was to evaluate the relationship between urolithiasis and BP, and to determine the association of BP with 24-h urine parameters in children. We retrospectively analyzed BP and 24-h urine data from children <18 years with and without urolithiasis from 2004 to 2015at a single tertiary center. Children with a diagnosis of non-glomerular hematuria without history of urolithiasis were chosen as the control group. Non-stone formers were excluded if they presented with any abnormal 24-h urine data or kidney disease. Casual BP, BP index (BPi), and 24-h urine parameters were compared between groups using t-tests. Multiple regression analyses adjusting for age, sex and body mass index (BMI) z-score evaluated the association of BP with urolithiasis and urine electrolytes. The urolithiasis group (N=71) was significantly older, taller and heavier than the non-stone former group (N=53) (Table). Systolic BP and diastolic BP in stone formers were significantly greater than in non-stone formers, respectively (p=0.019). Additionally, systolic BPi was significantly higher in the urolithiasis group (p=0.03) but there was no significant difference in diastolic BPi (p=0.45). Urolithiasis was a significant predictor of systolic BPi in the adjusted model (β=0.04, 95% CI 0.001-0.07). In stone formers, systolic BP and systolic BPi were directly associated with 24-h urine sodium, oxalate/1.73m2, and uric acid (all p<0.05). Urine calcium was not associated with any BP parameter. The findings are consistent with previous studies in adults that examined the correlation between blood pressure and kidney stones. The results of this study also showed that blood pressure was positively associated with urine sodium, oxalate, and uric acid. Interestingly, contrary to adult literature, our hypothesis which postulated that blood pressure would be associated with an increase in urine calcium was not supported by our findings. The small sample size is a study limitation and the use of healthy controls as a comparison would have been ideal. Blood pressure was directly associated with urolithiasis children. Greater BP values were also associated with abnormalities in 24-h urine oxalate, uric acid, and sodium values. Interestingly, BP was not associated with urine calcium in this population.

Ureteroscopy versus Shock Wave Lithotripsy: Factors Influencing Patient Treatment Preferences

IntroductionShock wave lithotripsy and ureteroscopy are considered first line treatment options for patients with urolithiasis. However, these interventions have significant variation in rates of stone-free success, procedure related complications and need for reoperation. We examined patient preferences in treatment selection for urolithiasis and factors associated with choice of treatment. MethodsPatients with a history of urolithiasis were self-administered or mailed a questionnaire with a clinical scenario of a stone in the ureter and outcome statistics derived from a Cochrane Review for ureteroscopy and shock wave lithotripsy comparing stone-free success rates, complication rates, need for ureteral stent placement and need for additional surgery. Subjects were asked to choose ureteroscopy or shock wave lithotripsy and to indicate the relative importance that each of the 4 outcome parameters had on their treatment selection. ResultsA total of 163 patients returned complete surveys and a majority preferred ureteroscopy to shock wave lithotripsy (63% vs 37%, p=0.001) for the clinical scenario presented. For factors influencing procedure preference success was indicated as extremely important by 94% (152 of 163) of respondents, followed by complications, need for second surgery and, finally, need for stent. ConclusionsA majority of patients preferred ureteroscopy to shock wave lithotripsy after reviewing the evidence-based rates of stone-free success, complications and need for second surgery. Shared decision making and patient centered care should be the focus of surgical treatment selection when there is no consensus regarding a superior treatment for urolithiasis.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis.

ABSTRACTPurpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not.Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine.Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001).Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. To determine the lithogenic risk profile in patients with urolithiasis. Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.