Incidence Of Nephrolithiasis Research Articles

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

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

MP03-07 LIVE IMAGING OF A DROSOPHILA MELANOGASTER MODEL OF NEPHROLITHIASIS WITH PROBIOTIC SUPPLEMENTATION USING CO2 ANESTHESIA AND MICRO-CT

INTRODUCTION AND OBJECTIVES:The incidence of nephrolithiasis in North America is currently around 10%, with rates rising. One of the most well-studied models of nephrolithiasis utilizes Drosophila ...

AB177. 119. Seasonal variation in the acute presentation of nephrolithiasis and its association with meteorological factors

Background: A seasonal variation in the frequency of acute stone presentations has been observed in studies from the US, Africa and Asia. The increased incidence of nephrolithiasis during periods of warm weather has been attributed to both the dehydrating effect of elevated temperatures and the vitamin D related increase in calciuria during periods of increased sunshine. The aim of this study is to establish whether the association between various meteorological parameters and the frequency of nephrolithiasis also exists in a European climate.

Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones.

The incidence of nephrolithiasis in children and adolescents is increasing and appears to double every 10years. The most important role of the pediatric nephrologist is to diagnose and modify various metabolic and non-metabolic risk factors, as well as prevent long-term complications especially in the case of recurrent nephrolithiasis. The purpose of this review is to summarize the existing literature on the etiology and management of pediatric nephrolithiasis. The incidence of kidney stones is increasing; dietary and environmental factors are probably the main causes for this increased incidence. In most pediatric patients, the etiology for the kidney stones can be identified. Metabolic factors, such as hypercalciuria and hypocitraturia, urinary tract infection, and urinary stasis, constitute leading causes. Herein, we review the etiologies, diagnostic work-up, and treatment options for the most prevalent causes of kidney stones. The detrimental effects of excessive dietary sodium, reduced fluid intake, and the benefits of plant-based over animal-based protein consumption on urinary crystal formation are discussed. We also review the long-term complications. Pediatric nephrologists have an important role in the diagnostic work-up and prevention of recurring nephrolithiasis.

The evolution of percutaneous nephrolithotomy: Analysis of a single institution experience over 25 years.

Over time, the incidence of nephrolithiasis has risen significantly, and patient populations have become increasingly complex. Our study aimed to determine the impact of changes in patient demographics on percutaneous nephrolithotomy (PCNL) outcomes. A retrospective analysis of a prospectively collected database was carried out from 1990-2015. Patient demographics, comorbidities, stone and procedure characteristics were analyzed. Multivariate logistic regression was used to evaluate differences in operative duration, complications, stone-free rate, and length of stay. A total of 2486 patients with a mean age of 54±15 years, body mass index (BMI) of 31±8, and stone surface area of 895±602 mm2 were analyzed; 47% of patients had comorbidities, including hypertension (22%), diabetes mellitus (14%), and cardiac disease (13%). Complication rate was 19%, including a 2% rate of major complications (Clavien grade III-V). There was a statistically significant increase in patient age, BMI, and comorbidities over time, which was correlated with an increased complication rate (odds ratio [OR] 1.15; p=0.010). The overall transfusion rate was 1.0% and remained stable (p=0.131). With time, both OR duration (mean Δ 16 minutes; p<0.001) and hospital length of stay (mean Δ 2.4 days; p<0.001) decreased significantly. Stone-free rate of 1873 patients with available three-month followup was 87% and decreased significantly over time (OR 1.09; p<0.001), but was correlated with an increased use of computed tomography (CT) scans for followup imaging. Despite an increasingly complex patient population, PCNL remains a safe and effective procedure with a high stone-free rate and low risk of complications.

Metabolically healthy and unhealthy obesity phenotypes and risk of renal stone: a cohort study.

Although obesity is considered an independent risk factor of nephrolithiasis, little is known about the effect of obesity on nephrolithiasis according to metabolic health status. We investigated the association between body mass index (BMI) category and the incidence of nephrolithiasis in metabolically healthy and unhealthy individuals. The cohort consisted of 270,190 Korean adults free of nephrolithiasis at baseline, who were followed-up annually or biennially for a median of 4.1 years. Nephrolithiasis were determined based on ultrasonographic findings. Being metabolically healthy was defined as not having any metabolic syndrome component. A parametric Cox model was used to estimate the adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). During 1,415,523.0 person-years of follow-up, 13,450 participants developed nephrolithiasis (incidence rate, 9.5 per 1000 person-years). Obesity was positively associated with an increased risk of incident nephrolithiasis in dose-response manner, but the association was stronger in metabolically healthy individuals. Among metabolically healthy individuals, the multivariable-adjusted HRs (95% CIs) for incident nephrolithiasis comparing BMIs 23-24.9, 25-29.9, and ≥30 with a BMI of 18.5-22.9 kg/m2 as the reference were 1.02 (0.95-1.10), 1.12 (1.03-1.22), and 1.72 (1.21-2.44), respectively, whereas corresponding HRs (95% CIs) in metabolically unhealthy individuals were 1.10 (1.04-1.17), 1.27 (1.20-1.34), and 1.36 (1.22-1.51), respectively. The association between obesity and incident nephrolithiasis was stronger in men and current smokers. Obesity was associated with a higher incidence of nephrolithiasis in both metabolically healthy and unhealthy individuals, indicating obesity per se as an independent risk factor for nephrolithiasis.

Oral Antibiotic Exposure and Kidney Stone Disease.

Background Although intestinal and urinary microbiome perturbations are associated with nephrolithiasis, whether antibiotics are a risk factor for this condition remains unknown.Methods We determined the association between 12 classes of oral antibiotics and nephrolithiasis in a population-based, case-control study nested within 641 general practices providing electronic health record data for >13 million children and adults from 1994 to 2015 in the United Kingdom. We used incidence density sampling to match 25,981 patients with nephrolithiasis to 259,797 controls by age, sex, and practice at date of diagnosis (index date). Conditional logistic regression models were adjusted for the rate of health care encounters, comorbidities, urinary tract infections, and use of thiazide and loop diuretics, proton-pump inhibitors, and statins.Results Exposure to any of five different antibiotic classes 3-12 months before index date was associated with nephrolithiasis. The adjusted odds ratio (95% confidence interval) was 2.33 (2.19 to 2.48) for sulfas, 1.88 (1.75 to 2.01) for cephalosporins, 1.67 (1.54 to 1.81) for fluoroquinolones, 1.70 (1.55 to 1.88) for nitrofurantoin/methenamine, and 1.27 (1.18 to 1.36) for broad-spectrum penicillins. In exploratory analyses, the magnitude of associations was greatest for exposure at younger ages (P<0.001) and 3-6 months before index date (P<0.001), with all but broad-spectrum penicillins remaining statistically significant 3-5 years from exposure.Conclusions Oral antibiotics associated with increased odds of nephrolithiasis, with the greatest odds for recent exposure and exposure at younger age. These results have implications for disease pathogenesis and the rising incidence of nephrolithiasis, particularly among children.

Pediatric Ureteroscopy.

In recent years, the incidence of nephrolithiasis in the pediatric population appears to be increasing. 1 This has placed a new emphasis on surgical management of stones in children. In the past, extracorporeal shockwave lithotripsy was the preferred management technique for stones in children. 2 More recently, though, advances in endoscopy have allowed ureteroscopy to be adapted to the pediatric population and this approach has become more frequently utilized not just for lower ureteral calculi but also for proximal ureteral and renal stones.

MP68-15 THE EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF A SINGLE INSTITUTION EXPERIENCE OVER 25 YEARS

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2018MP68-15 THE EVOLUTION OF PERCUTANEOUS NEPHROLITHOTOMY: ANALYSIS OF A SINGLE INSTITUTION EXPERIENCE OVER 25 YEARS Jennifer Bjazevic, Linda Nott, John Denstedt, and Hassan Razvi Jennifer BjazevicJennifer Bjazevic More articles by this author , Linda NottLinda Nott More articles by this author , John DenstedtJohn Denstedt More articles by this author , and Hassan RazviHassan Razvi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2219AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of nephrolithiasis and the use of percutaneous nephrolithotomy (PCNL) has risen significantly over the years. PCNL aims to achieve a high stone-free rate with a low risk of complications. The objective of our study was to determine the impact of changes in patient demographics and surgical techniques over a 25-year time period, on PCNL outcomes. METHODS A retrospective analysis on a prospectively maintained database, including 2554 consecutive PCNL treatments in 2486 patients from July 1990 to July 2015 was undertaken. Collected data included patient demographics, comorbidities, stone and procedure characteristics, adverse events, and stone-free status at three-month follow-up. Adverse events were categorized according to the Clavien-Dindo classification. Patients were divided into equal terciles, each representing 852 consecutive procedures, ordered chronologically. Chi squared test was used to evaluate changes in patient characteristics and surgical techniques over time. A multivariate logistic regression was used to identify the effect of time on operative duration, adverse events, stone-free rate and hospital length of stay. RESULTS Our cohort had a mean age of 54 ± 15 years, was 66.6% male, had a mean body mass index (BMI) of 31 ± 8, and a mean stone surface area of 895 ± 602 mm2. Medical comorbidities were present in 46.9% of patients, most commonly hypertension (22%), diabetes (14%), and cardiac disease (13%). Overall complication rate was 15.6%, including a 2.5% rate of major complications (Clavien grade 3-5). Three-month follow-up of 1873 available patients showed residual stones in 13.3%. Over time there was a statistically significant increase in patient age, BMI, comorbidities, and ASA score. Over time, both OR duration (mean Δ 16 mins, p<0.001) and hospital length of stay (mean Δ 3 days, p<0.001) decreased significantly. Intra-operatively, there was an increase in the use of the balloon dilator and ultrasonic lithotripter (p<0.001). Stone-free rate decreased significantly over time (OR 1.09, p<0.001), but was correlated with an increased use of CT scans for follow-up imaging. There was an increased complication rate with time (OR 1.15, p=0.010); however, this was correlated with the increased rate of medical comorbidities. The overall transfusion rate was 1.0% and did not change over time (p=0.131). CONCLUSIONS Despite an increasingly complex patient population, PCNL remains a safe and effective procedure for the management of large and complex urolithiasis; resulting in a high stone-free rate and low risk of complications. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e922 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jennifer Bjazevic More articles by this author Linda Nott More articles by this author John Denstedt More articles by this author Hassan Razvi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

P182 EPIDEMIOLOGY OF NEPHROLITHIASIS IN HOSPITALIZED PATIENTS OF INFLAMMATORY BOWEL DISEASE: NATIONAL INPATIENT SAMPLE ANALYSIS 2002-2014

Extraintestinal manifestations (EIMs) are common in Inflammatory bowel disease (IBD), adding to the burden of disease, with a prevalence varying from 6% to 46%. The mechanism of nephrolithiasis is different in Ulcerative Colitis (UC) and Crohn’s disease (CD) but it is the most common renal manifestation in both. We analyzed the National Inpatient Sample (NIS) database for all subjects with discharge diagnosis of IBD (Ulcerative Colitis & Crohn’s disease) with or without Nephrolithiasis as primary or secondary diagnosis via ICD 9 codes during the period from 2002-2014. All analyses were performed with the use of SAS (version 9.4). From 2002-2014 there were total 3359 discharges of Ulcerative Colitis (UC) patients and 9741 discharges of Crohn’s Disease (CD) patients with nephrolithiasis, constituting 1.4% & 2.3% discharges respectively. Most of the patients with Nephrolithiasis were Caucasians (82.1% in UC & 87.8% in CD), with age below 65 (70.2% in UC & 79.9% in CD), males (55.9% in UC & 51.6% in CD). The odds of routine discharge were more and decreased mortality & Charlson index was found in patients with nephrolithiasis. There was a slight rise in incidence of nephrolithiasis in IBD (0.9% of UC discharges & 2.1% of CD discharges in 2002 to 1.8% of UC & 2.6% of CD discharges in 2014). Deficiency anemias, liver disease, arthritis, renal failure, fluid and electrolyte disorders and collagen vascular disorders were the significant predictors of nephrolithiasis in IBD on Multivariate regression analysis. Our analysis concludes that incidence of nephrolithiasis is less than the previously reported figures in some of the population studies, though the incidence is slightly more in CD then UC as previously reported. Our analysis points out an interesting finding that nephrolithiasis in IBD may be predictive of more benign outcome in hospitalized patients of IBD as observed by decreased mortality and more routine discharges.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Non-alcoholic fatty liver disease and the development of nephrolithiasis: A cohort study.

BackgroundNon-alcoholic fatty liver disease (NAFLD), a hepatic manifestation or precursor of metabolic syndrome, may increase nephrolithiasis, a renal manifestation of insulin resistance, but the prospective association between NAFLD and incident nephrolithiasis has not been evaluated. We examined the association of NAFLD with the development of nephrolithiasis in a large cohort of Korean men and women.MethodsWe performed a cohort study of 208,578 Korean adults who underwent a health checkup examination between January 2002 and December 2014 and were followed-up annually or biennially through December 2014. NAFLD was defined as the presence of fatty liver in the absence of excessive alcohol use or other identifiable causes. Fatty liver and nephrolithiasis were determined based on ultrasonographic findings. We used a parametric Cox model to estimate the adjusted hazard ratios (HRs) of nephrolithiasis according to the presence of NAFLD.ResultsDuring 1,054,887.6 person-year of follow-up, 16,442 participants developed nephrolithiasis. After adjusting for age, center, year of screening exam, smoking status, alcohol intake, physical activity, education level, body mass index, history of hypertension and diabetes, HOMA-IR, uric acid and C-reactive protein, male participants with NAFLD had a significantly increased risk of nephrolithiasis than those without NAFLD (adjusted HR 1.17, 95% CI 1.06–1.30). However, no association between NAFLD and nephrolithiasis was observed in women (adjusted HR 0.97, 95% CI 0.81–1.16).ConclusionsIn this large cohort study of young and middle-aged Koreans, NAFLD was significantly associated with an increased incidence of nephrolithiasis in men but not in women.

Whole exome sequencing frequently detects a monogenic cause in early onset nephrolithiasis and nephrocalcinosis

The incidence of nephrolithiasis continues to rise. Previously, we showed that a monogenic cause could be detected in 11.4% of individuals with adult-onset nephrolithiasis or nephrocalcinosis and in 16.7-20.8% of individuals with onset before 18 years of age, using gene panel sequencing of 30 genes known to cause nephrolithiasis/nephrocalcinosis. To overcome the limitations of panel sequencing, we utilized whole exome sequencing in 51 families, who presented before age 25 years with at least one renal stone or with a renal ultrasound finding of nephrocalcinosis to identify the underlying molecular genetic cause of disease. In 15 of 51 families, we detected a monogenic causative mutation by whole exome sequencing. A mutation in seven recessive genes (AGXT, ATP6V1B1, CLDN16, CLDN19, GRHPR, SLC3A1, SLC12A1), in one dominant gene (SLC9A3R1), and in one gene (SLC34A1) with both recessive and dominant inheritance was detected. Seven of the 19 different mutations were not previously described as disease-causing. In one family, a causative mutation in one of 117 genes that may represent phenocopies of nephrolithiasis-causing genes was detected. In nine of 15 families, the genetic diagnosis may have specific implications for stone management and prevention. Several factors that correlated with the higher detection rate in our cohort were younger age at onset of nephrolithiasis/nephrocalcinosis, presence of multiple affected members in a family, and presence of consanguinity. Thus, we established whole exome sequencing as an efficient approach toward a molecular genetic diagnosis in individuals with nephrolithiasis/nephrocalcinosis who manifest before age 25 years.

Time-Driven Activity-Based Costing Analysis of Urological Stone Disease

IntroductionThe documented increasing incidence of nephrolithiasis in the United States will likely be associated with significant economic impact. Time-driven activity-based costing is an analytical method that has been successfully adapted from industrial analysis for use in health care. Using this costing approach we characterized the cost of 4 stone treatment modalities at our academic medical center, including trial of passage, semirigid ureteroscopy, flexible ureteroscopy and extracorporeal shock wave lithotripsy. MethodsWe developed process mapping for urological evaluation, treatment and followup of renal or ureteral stones less than 10 mm in size for each treatment method. We calculated cost of resources, equipment, disposables, personnel and space used for each step in the process. Cost was based on the capacity of each resource and the amount of time required for the treatment process. ResultsThe cost for trial of stone passage, $389, was expectedly lower than for surgical interventions and was mainly driven by clinic visit costs. Extracorporeal shock wave lithotripsy and semirigid and flexible ureteroscopy costs were $4,367, $4,830 and $5,356, respectively. Intraoperative disposables and personnel were the top contributors to overall treatment costs. ConclusionsConservative management is less costly than surgical interventions. Flexible ureteroscopy is the most expensive of surgical interventions. We describe the first time-driven activity-based cost analysis of stone management to our knowledge. Identifying the main drivers of cost can help to improve the value of urological care and improve future cost-effectiveness analyses.

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

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

Prevalence and risk factors for nephrolithiasis among young rural residents

To determine the prevalence of nephrolithiasis, assess the significance of known risk factors, and identify new risk factors for nephrolithiasis among young rural residents. This cross-sectional study was conducted in 5 settlements of the Irkutsk rural district of the Irkutsk region and involved 408 inhabitants (93 men, 315 women) aged from 18 to 47 years. The selection of candidates for the study was randomized. The response of the population was 81.6%. Diagnostic evaluation included clinical examination, renal ultrasound, urinalysis and questionnaires; drinking water hardness was determined. The prevalence of nephrolithiasis was 10.0% (95% CI 7.1-12.9). The men-to-women ratio for the prevalence of nephrolithiasis in was 0.69. No kidney stones were found in participants younger than 20 years, but after 20 years of age, there was a statistically significant (p=0.04) trend in increasing prevalence of nephrolithiasis. Calculi were detected only in participants with acidic urine and were absent in individuals with alkaline urine (p=0.001). A higher prevalence of nephrolithiasis was found in individuals using hard water (12.5%), compared to those using water of medium hardness (1.6%) (p=0.019). The odds ratio of nephrolithiasis in persons using hard water was 8.9 (95% CI 1.2-66.6). and conclusions 1.The incidence of nephrolithiasis in the Irkutsk rural area was 10.0%, which is comparable to that in populations of Europe and North America; 2. The primary risk factors for nephrolithiasis were age, acidic urine and the hardness of drinking water, which is consistent with the data of other authors; 3. Difficulties in measuring, grading and controlling subjective risk factors for nephrolithiasis (fluid intake, diet, heredity, and past diseases) make it difficult to analyze them in cross-sectional studies and prevent direct comparison with other studies.

The Emergence of Kidney Stone Disease During Childhood-Impact on Adults.

The goal of this chapter is to review the recent epidemiologic trends of kidney stone disease and discuss the impact of the increasing incidence of nephrolithiasis among children on adults with respect to extra-renal manifestations, surgical management, and secondary prevention. Among pediatric patients, kidney stone disease has been increasing at a rate of approximately 5-10% annually. Kidney stone disease has been associated with increased risks of coronary heart disease, chronic kidney disease, hypertension, and decreased bone mineral density, which is concerning for patients diagnosed at a young age. Improvements in endo-urology have allowed for less invasive surgical treatment of stones in the pediatric population. However, current guidelines often lack recommendations for evaluation, medical, and surgical management of children with kidney stone disease. Nephrolithiasis is a disorder of mineral metabolism, which is beginning during childhood with increasing frequency. Kidney stone disease often exists over the lifetime and is associated with serious conditions that are important for pediatric and adult urologists to recognize and consider in their evaluation and treatment of patients.

MP75-04 VARIATION IN NATIONAL OPIOID PRESCRIBING PATTERNS FOLLOWING OUTPATIENT NEPHROLITHIASIS PROCEDURES

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-04 VARIATION IN NATIONAL OPIOID PRESCRIBING PATTERNS FOLLOWING OUTPATIENT NEPHROLITHIASIS PROCEDURES Tudor Borza, Rodney L. Dunn, Yongmei Qui, Tyler N. Winkelman, Ted A. Skolarus, David C. Miller, Brent K. Hollenbeck, and Gregory B. Auffenberg Tudor BorzaTudor Borza More articles by this author , Rodney L. DunnRodney L. Dunn More articles by this author , Yongmei QuiYongmei Qui More articles by this author , Tyler N. WinkelmanTyler N. Winkelman More articles by this author , Ted A. SkolarusTed A. Skolarus More articles by this author , David C. MillerDavid C. Miller More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , and Gregory B. AuffenbergGregory B. Auffenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2152AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Opioid abuse has become an epidemic in the United States. Surgical episodes account for 40% of all opioids prescribed and thus, surgeons are uniquely positioned to control the supply of available opioids. Given the high incidence of nephrolithiasis, we sought to characterize the variation in opioid prescribing among a national cohort following extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy with lithotripsy (URS). METHODS We identified patients who underwent outpatient ESWL and URS between 2012 and 2014 using the de-identified ClinformaticsTM Data Mart Database (OptumInsight, Eden Prairie, MN). The database contains administrative health and pharmacy claims from a large, national US health insurer. We limited our cohort to patients that had no concurrent procedures and had not filled an opioid prescription in the 6 months prior to their procedure. We calculated the dose and type of opioids, standardized to morphine milligram equivalents (MME), prescribed within 7 days of the procedure. For urologists with a minimum of 10 cases and 3 opioid prescriptions we quantified the variation in surgeon prescribing patterns. RESULTS We identified 22,577 patients (12,942 ESWL, 9,635 URS) treated during our study period. Forty percent of ESWL and 43% of URS patients filled an opioid prescription following their procedure. Among those patients, the median dose was 150 MME (interquartile range [IQR] 128-225). This corresponds to twenty 5mg oxycodone tablets with a range of 17 to 30 tablets. Hydrocodone (57%) was the most frequently prescribed opioid for ESWL and oxycodone (59%) for URS. Surgeons varied widely in the average dose of opioids prescribed, ranging from 89 to 675 MME (p<0.001), or eleven to ninety 5mg oxycodone tablets (Figure). CONCLUSIONS Most patients did not fill an opioid prescription after ESWL or URS. There was no significant difference between ESWL and URS in terms of frequency or amount of opioids prescribed. There was wide variation in opioid prescribing at both the patient and urologist level. Given that these patients were opioid naive, patient variables are not likely to account for this variation. As such, urologists appear to be well positioned to reduce excess opioid prescribing. © 2017FiguresReferencesRelatedDetailsCited byCarpinito G, Shepherd S, Wang D, Katz M and Wason S (2020) Opioid Prescribing Practices of U.S. Urology Trainees after Urological SurgeryUrology Practice, VOL. 8, NO. 2, (277-283), Online publication date: 1-Mar-2021. Volume 197Issue 4SApril 2017Page: e1004-e1005 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Tudor Borza More articles by this author Rodney L. Dunn More articles by this author Yongmei Qui More articles by this author Tyler N. Winkelman More articles by this author Ted A. Skolarus More articles by this author David C. Miller More articles by this author Brent K. Hollenbeck More articles by this author Gregory B. Auffenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The risk of nephrolithiasis is causally related to inactive matrix Gla protein, a marker of vitamin K status: a Mendelian randomization study in a Flemish population.

Vitamin K (VK)-dependent γ-glutamate carboxylation and serine phosphorylation activate matrix Gla protein (MGP) to a potent locally acting inhibitor of calcification. Nephrolithiasis represents a process of unwanted calcification associated with substantial mortality and high recurrence rates. We hypothesized that the risk of nephrolithiasis increases with VK shortage, as exemplified by higher plasma levels of desphospho-uncarboxylated MGP (dp-ucMGP). In 1748 randomly recruited Flemish individuals (51.1% women; mean age 46.8 years), we determined dp-ucMGP and the prevalence of nephrolithiasis at baseline (April 1996-February 2015) and its incidence during follow-up until March 2016. We estimated the multivariable-adjusted relative risk associated with the doubling of dp-ucMGP, using logistic or Cox regression. We did a Mendelian randomization analysis using four MGP genotypes as instrumental variables. With adjustments applied for sex, age and 24-h urinary volume and calcium excretion, the odds of having prevalent nephrolithiasis [n = 144 (8.2%)] associated with dp-ucMGP was 1.31 [95% confidence interval (CI) 1.04-1.64; P = 0.022]. dp-ucMGP levels were associated (P ≤ 0.001) with MGP variants rs2098435, rs4236 and rs2430692. In the Mendelian analysis, the causal odds ratio was 3.82 (95% CI 1.15-12.7; P = 0.029). The incidence of nephrolithiasis over 12.0 years (median) was 37 cases (0.2%). With similar adjustments as before, the hazard ratio in relation to dp-ucMGP was 2.48 (95% CI 1.71-3.61; P < 0.001). Additional adjustment for a nephrolithiasis propensity score produced consistent results. Higher levels of inactive dp-ucMGP may be causally associated with the risk of nephrolithiasis. Whether or not VK deficiency plays a role in these observations remains to be firmly established.

A 10-Year Retrospective Review of Nephrolithiasis in the Navy and Navy Pilots

Little is known about the incidence of nephrolithiasis in the United States Navy. Navy pilots must be kidney stone-free and are often referred for treatment of small asymptomatic stones. The primary objectives of this study were to determine the incidence of nephrolithiasis and computerized tomography, proportion undergoing treatment and incidence of stone related mishaps in Navy pilots compared with other Navy personnel. We retrospectively studied the records of all Navy service members from 2002 to 2011 for nephrolithiasis based on ICD-9 stone codes to determine the mentioned rates. We also reviewed NSC (Naval Safety Center) data for a history of accidents associated with nephrolithiasis. Rates of disease were calculated using person-years of followup and inferential statistics were done using univariable and multivariable analyses. We evaluated 667,840 Navy personnel with a total of 3,238,331 person-years of followup. The annual incidence of nephrolithiasis was 240/100,000 person-years with a 5-year recurrence rate of 35.3%. On multivariable analysis pilots had nephrolithiasis incidence and treatment rates similar to those of the overall Navy population. Women had a higher incidence of nephrolithiasis compared with men (OR 1.17, p <0.0001). The rate of computerized tomography was lower in pilots than in the rest of the Navy (39 vs 66/10,000 person-years, p<0.0001). No recorded accidents were associated with kidney stones. Navy pilots had a similar incidence of nephrolithiasis and were no more likely to undergo a surgical procedure. Given that no accidents were associated with nephrolithiasis, this study suggests reconsidering current military policies necessitating pilots to be completely stone-free.

Progress in Understanding the Genetics of Calcium-Containing Nephrolithiasis.

Renal stone disease is a frequent condition, causing a huge burden on health care systems globally. Calcium-based calculi account for around 75% of renal stone disease and the incidence of these calculi is increasing, suggesting environmental and dietary factors are acting upon a preexisting genetic background. The familial nature and significant heritability of stone disease is known, and recent genetic studies have successfully identified genes that may be involved in renal stone formation. The detection of monogenic causes of renal stone disease has been made more feasible by the use of high-throughput sequencing technologies and has also facilitated the discovery of novel monogenic causes of stone disease. However, the majority of calcium stone formers remain of undetermined genotype. Genome-wide association studies and candidate gene studies implicate a series of genes involved in renal tubular handling of lithogenic substrates, such as calcium, oxalate, and phosphate, and of inhibitors of crystallization, such as citrate and magnesium. Additionally, expression profiling of renal tissues from stone formers provides a novel way to explore disease pathways. New animal models to explore these recently-identified mechanisms and therapeutic interventions are being tested, which hopefully will provide translational insights to stop the growing incidence of nephrolithiasis.