Management Of Kidney Stones Research Articles

An insight on mechanism and management of kidney stones and its recurrence

Kidney stones (calculi) comprise mineral concretions which can form in both renal calyces and pelvis and can be free floating or associated with the renal papillae. It is an emerging urological condition that affects around 12% of the world’s population. Globally, the prevalence and recurrence of kidney stone disease are increasing, and there are limited effective treatment options. I manifest a brief general overview and then concentrate on risk factors, pathophysiology, and medical treatment of kidney stones. The major component of most stones is calcium oxalate, and many of them develop on a foundation of calcium phosphate known as Randall’s plaques, which are located on the renal papillary surface. The mechanism of stone formation is a complicated process that involves multiple physicochemical phenomena such as supersaturation, nucleation, growth, aggregation, and retention of urinary stone ingredients inside tubular cells. Cellular damage is also thought to enhance particle retention on renal papillary surfaces. There is currently no effective treatment or prevention for kidney stone recurrence. Recurrence prevention required behavioral and nutritional interventions, as significantly as pharmaceutical therapies tailored to the kind of stone. There is a great demand for recurrence prevention, which necessitates a deeper knowledge of the processes involved in the development of stones to design more effective medications. Open surgical lithotomy has given way to minimally invasive endourological procedures for the treatment of symptomatic kidney stones, resulting in lower patient morbidity, increased stone-free rates, and enhanced quality of life. As a result, furthering our knowledge of the biology of kidney stone development is a research focus for treating urolithiasis with novel medications.

Imaging urolithiasis: complications and interventions in children

Urolithiasis affects people in all age groups, but over the last decades there has been an increasing incidence in children. Typical symptoms include abdominal or flank pain with haematuria; in acute cases dysuria, fever or vomiting also occur. Ultrasound is considered the modality of choice in paediatric urolithiasis because it can be used to identify most clinically relevant stones. Complementary imaging modalities such as conventional radiographs or non-contrast computed tomography should be limited to specific clinical situations. Management of kidney stones includes dietary, pharmacological and urological interventions, depending on stone size, location or type, and the child’s condition. With a very high incidence of underlying metabolic abnormalities and significant recurrence rates in paediatric urolithiasis, thorough metabolic evaluation and follow-up examination studies are of utmost importance.

Successful management of ectopic kidney stones in a patient with situs inversus totalis: a rare case report

BackgroundSitus inversus totalis is a very rare congenital anatomical variation, in which all thoracic and abdominal organs are right-left inverted. This condition is associated with an increased risk of organ malformations including ectopic kidney, which is a very rare combination.Case presentationA 56-year-old male presented with colicky left iliac pain associated with nausea, vomiting, and irritative lower urinary symptoms. The patient has a medical history of recurrent lower urinary infections and a family history of situs inversus totalis. Radiological images demonstrated dextrocardia, situs inversus totalis of all the abdominal organs, and an ectopic pelvic kidney on the left side, with 4 stones inside it. Left nephrectomy was performed due to extensive renal damage. At discharge and during follow-up, the patient's condition was satisfactory and stable.ConclusionsThe ectopic kidney may present diagnostic and therapeutic challenges when associated with situs inversus.

The complex pathophysiology of urolithiasis (kidney stones) and the effect of combinational drugs

Body organs are very crucial when it comes to homeostatically maintaining them. If any changes occur in their function, it may lead to the development of diseases in the body. The kidney is one of the functionalised organs that is connected with the ureter and urinary bladder, which is basically the lower part of the body. The kidney priorly controls the volume of various body fluids, fluid osmolality, acid-base balance, various electrolyte concentrations, and the removal of toxins. Any dis-balance in the function of the kidney can generate a disease like renal calculi (kidney stone), chronic kidney disease (CKD), polycystic kidney disease (PKD), urinary tract infections (UTI), etc. Kidney stones (KS) are prevalent worldwide, affecting 15% of individuals. A stone arranged into various sizes may be micro, macro, and nano or found as mono or polycrystalline forms. The names of the two most common kidney stones, calcium and non-calcium stones (Uric acid stones, struvite stones, cysteine stones, and drug-induced KS), are determined primarily by their composition. Calcium stones are commonly found in individuals, approximately 80% of KS. This review provided recent details on kidney stone symptoms, etiology, psychophysiology, and management perspective.
 Keywords: Kidney disease, calcium stone, renal calculi, chronic kidney disease, Polycystic kidney disease.

Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience.

Despite the continuous update of guidelines for the management of kidney stones, the ability to predict a successful response to extracorporeal shockwave lithotripsy (SWL) remains a topic of research. This is due to the need to refine the decision making in the context of technological advancements and current pandemics. This study aimed to determine the predictors of stone-free rate (SFR) after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter. A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021. Univariate and multivariate analyses were performed for stone- and patient-related factors, using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables. A total of 138 patients were eligible for this study, including 92 men and 46 women. The mean age was 38.6 ± 12.4 years, and the mean body mass index (BMI) was 25.9 ± 3.4 kg/m2. Four weeks after SWL, 120 patients (87%) were free of stones, and 18 (13%) needed further treatment. Univariate analyses showed that SFR was negatively correlated with increased BMI (p = 0.0001), maximum stone length (p = 0.0001), transverse diameter of the stone (p = 0.0001), number of shocks per session (p = 0.052), and Hounsfield unit (HU) (p = 0.0001). Multivariate analysis revealed that HU (p = 0.009), maximum stone length (p = 0.01), BMI (p = 0.000), and presence of double-J stent (p = 0.034) were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter. The estimated average cost per case was USD 450.5. Increased HU, maximum stone length, BMI, and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter. The cost of SWL remains an advantage in the private sector.

The effectiveness and safety of tubed and tubeless percutaneous nephrolithotomy types in the treatment of preschool-age pediatric kidney stones

The incidence of kidney stones in children has increased in recent years. Unlike adults, the treatment of pediatric kidney stones is more difficult because of the size of the stones and the high risk of recurrence.
 The present study aimed to evaluate the management of pediatric kidney stones with percutaneous nephrolithotomy in general and with both types of percutaneous nephrolithotomy (PCNL).
 Methods. This retrospective cross-sectional study was conducted at Al-Safeer Al-Imam Al-Hussein Hospital from November 1, 2019 to October 31, 2021. A total of 90 children with kidney stones were divided into 45 with tubular PCNL and 45 with tubeless PCNL. The children were followed up for at least six months postoperatively. 
 Results. After PCNL, only 4 children were not stone-free and no injury was noted, whereas sepsis was noted in only one child. Renal status after PCNL was stable renal function in 97.8% of children and improved renal function in 2.2% of children, while no deterioration of renal function was noted. The characteristics of the children, the characteristics of the surgical procedure (except access), and the results of PCNL were not significantly different among the different types of PCNL
 Conclusion. PCNL in both variants (with and without tubing) is a safe and effective surgical option in the treatment of children with renal stones.

Predicting urine culture results in candidates for lithotripsy.

Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.

The Safety and Efficacy of Endoscopic Combined Intrarenal Surgery (ECIRS) versus Percutaneous Nephrolithotomy (PCNL): A Systematic Review and Meta-Analysis.

Purpose Our aim is to evaluate the safety and efficacy of endoscopic combined intrarenal surgery compared to percutaneous nephrolithotomy to guide practitioners and inform guidelines. Materials and Methods A detailed database search was performed in PubMed, OVID, Scopus, and Web of Science in October 2021 to identify articles pertaining to ECIRS published between 2001 and 2021. Results Four nonrandomized comparative studies and one RCT were identified, yielding five studies with a total of 546 patients (ECIRS/mini-ECIRS, n = 277; PCNL/mini-PCNL, n = 269). Subjects in these five studies met the predefined inclusion criteria established by two reviewers (J.E.A. and R.L.S.) and were therefore eligible for analysis. The results demonstrated that ECIRS was associated with a higher SFR (OR: 4.20; 95% CI: 2.79, 6.33; p < 0.00001), fewer complications (OR: 0.63; 95% CI: 0.41, 0.97; p=0.04), and a shorter hospital stay (WMD: −1.27; 95% CI: −1.55, −0.98; p < 0.00001) when compared to PCNL. There were no statistically significant differences in blood transfusions (OR: 0.45; 95% CI: 0.12, 1.68; p=0.24), operative time (SMD: −1.05; 95% CI: −2.42, 0.31; p=0.13), or blood loss (SMD: −1.10; 95% CI: −2.46, 0.26; p=0.11) between ECIRS and PCNL. Conclusions ECIRS may be a more suitable approach for the surgical management of large and complex kidney stones currently indicating PCNL due to its superior efficacy with comparable surgical time and complication rate, though it is thought that a lack of resources and properly trained personnel may preclude ECIRS from becoming the standard. It is our impression that ECIRS may become the preferred technique in the endourologic community corresponding to the evolutionary sequence of percutaneous stone surgery.

Efficacy and safety of minimally invasive percutaneous nephrolithotomy in patients with lower pole kidney stones 1-2 cm in diameter

Introduction: Anatomical features of the lower pole calyces plays an important role in the treatment of urolithiasis. The optimal treatment options for lower pole stones with a diameter below 2 cm are controversially discussed. Extracorporeal shock wave lithotripsy (SWL) is non-invasive, but is hampered by low stone-free rates and a significant retreatment rate in patients with unfavourable factors for lithotripsy. Retrograde intrarenal surgery (RIRS) has been demonstrated to have high stone-free rates since the development of modern flexible endoscopes. But the long operative time in the case of a large stone burden, unfavourable anatomy and considerable costs for consumables represent limiting factors for this technique. With the miniaturization of percutaneous approach and decreasing the morbidity, minimally invasive percutaneous nephrolithotomy (miniPCNL) is a promising method for treatment of lower pole stones in one stage procedure. The objective of this study is to investigate the efficacy and safety of mini-PCNL for the treatment of lower pole stones 1-2 cm. Material and methods: The medical records of 54 patients with lower pole kidney stones 1-2 cm, treated at the Clinic of Endurology and SWL, Military Medical Academy, Sofia between January 2020 to January 2022, were retrospectively reviewed. All patients underwent mini-PCNL under spinal anesthesia in prone position with fluoroscopic guidance through 18 Fr sheath using semirigid nephroscope and Ho:YAG laser for lithotripsy. Stone-free rate was defined as absence of residual fragments ≥2 mm. Data on patients’ preoperative characterstics, stone-free rates, operating times, intra- and postoperative complications were analyzed. Results: Patients mean age was 54,68±11,99 years. Mean stone surface was 169,02±57,40mm2 and mean CT stone density was 1112,26±250,47 HU. Stone-free rate after single procedure was 96,3 % (52 patients). 14,8% of patients had preoperative urinary tract infection. Mean operative time was 27,46±12,40 min and mean hospital stay - 2,5±1,17 days. The mean Hgb drop was 11.9±15.6 g/l. Lower pole puncture was performed in all patients. Two tracts were required in 1 (1,9 %) patient. One patient had intraoperative haemorrhage at the end of the procedure. Postoperative complications were observed in 2 (3,8 %) patients: postoperative fever t &gt;38.5o C in 1 patient (1,9%) and postoperative AV-fistula in 1 (1,9%) patient, who needed hemotransfusion and selective embolization. 2 patients required auxiliary procedures: 1 patient needed stent JJ and 1 underwent ureteroscopy for fragments in ureter. Conclusion: Various factors are important for management of lower pole kidney stones and should be taken into consideration, when choosing the optimal treatment modality. The results from this study suggest that mini-PCNL is an effective and safe procedure with high stone free rates and low complication rates in patients with lower pole kidney stones unfavourable for SWL and RIRS. Key words: minimally invasive nephrolithotomy, lower pole kidney, urolithiasis

Incidence and risk factors for urolithiasis recurrence after endourological management of kidney stones: A retrospective single-centre study.

Almost half of the patients have hadrecurrent nephrolithiasis despite undergoing effective treatment. Our objective is to determine the recurrence rate of lithiasis after endourological management of nephrolithiasis and identify the risk factors for these recurrences. Data were gathered retrospectively from all patients who were treated for nephrolithiasis by endourological management from May 2014 to January 2017 in our university hospital. The patients were devised into two groups: with and without recurrence. Many variables were also compared between these two groups. During this period 265 patients were treated for upper urinary tract stone. A total of 190 patients were included in the study. The median age and median BMI of the patients were 57.5 years and 25.2kg/m2, respectively. A biochemical analysis of the stones was performed in 117 (61.5%) patients. The most common types of stones were calcium oxalate monohydrate stones (n=44, 23.2%), mixed stones (n=39, 20.5%) including mixed calcium oxalate (n=10; 8.5%), calcium oxalate dihydrate stones (n=13, 6.8%) and uric acid stones (n=11, 5.8%). At the end of a median follow-up of 32 months (range, 13-61 monthes), 49 patients (25.8%) had a recurrent stone. In univariate analysis, the risk factors for recurrence were BMI greater than 25kg/m2 (HR: 2; P<0.05), diabetes (HR: 3.73; P<0.008) and smoking (HR: 3.1; P<0.039). However age (HR: 0.96: P<0.003) and high blood pressure (HR: 0.37; P<0.027) were protective factors. In multivariate analysis, diabetes, smoking, hypertension, and age are still risk factors for recurrence. Stone recurrence is common after the management of urinary stones. In this study25.8% of patients had recurred stone disease after endourological management with a median follow-up of 32 months. Our study findings showed that diabetes and smoking are risk factors for recurrence, while age and blood hypertension are protective factors that decreased the risk of recurrence.

Antiurolithiatic Potential of Three Sri Lankan Medicinal Plants by the Inhibition of Nucleation, Growth, and Aggregation of Calcium Oxalate Crystals In Vitro

Background Deposition and formation of stones in any part of the urinary system is called urolithiasis. CaOx is the predominant component of most stones, and the formation of these stones is a multistep process that includes supersaturation, nucleation, aggregation, growth, and retention. In ayurvedic medicine, medicinal plants are used for the management of kidney stones. The objective of this study was to determine the effect of aqueous, ethanol, and hexane extracts of Drymoglossum piloselloides leaves, Kalanchoe laciniata leaves, and Aegle marmelos flowers against CaOx urolithiasis in vitro. Methods The crystallization of CaOx monohydrate (COM) and dihydrate (COD) was induced in a synthetic urine system. The nucleation, growth, and aggregation of crystals were measured using spectrophotometric methods. The results were compared against the polyherbal drug, Cystone, under identical concentrations. Crystals generated in the urine were also observed under light microscopy. Statistical differences and percentage inhibitions were calculated using standard formulae and compared. A preliminary phytochemical screening was also performed to detect active phytoconstituents present in the three plants used in the study. Results The results obtained clearly demonstrated that Kalanchoe laciniata, Aegle marmelos, and Drymoglossum piloselloides have the capacity to inhibit the nucleation, growth, and aggregation of CaOx crystals. Microscopic examination of crystals revealed the presence of more COM than COD crystals but a dose-dependent reduction in crystals was observed in the presence of plant extracts. Hexane, ethanol, and aqueous extracts of all three plants had different capabilities to inhibit nucleation, growth, and aggregation of CaOx crystals but their activities were different at different concentrations. Preliminary phytochemical screening revealed the presence of reducing sugars, proteins, flavonoids, tannins, and polyphenol compound in Kalanchoe laciniata and Drymoglossum piloselloides and reducing sugars, proteins, anthracene glycosides, and saponins in Aegle marmelos. Conclusions This study provided evidence that Kalanchoe laciniata, Aegle marmelos, and Drymoglossum piloselloides have the potential to be developed as inhibitors of nucleation, growth, and aggregation of CaOx crystals in the treatment of urolithiasis.

Medical Management of Kidney Stones: a review

The incidence of kidney stone disease has been rising in past decades. The prevalence has doubled in both genders, andthe prevalence ratio is shrinking from 3.4 to 1.3 between males and females. This condition greatly impacts individuals, thehealth care system, and socioeconomic levels. Kidney stone diseases are related to various risk factors and medical conditions.A detailed diagnosis through history taking, urinalysis, metabolic evaluation, and stone analysis is important to direct thetherapy approach. The therapy in managing kidney stone diseases comprises dietary and pharmacological treatment. Inaddition to general advice on sufficient fluid intake, citrate intake, maintaining ideal body weight, and restricting sodium andanimal protein, the therapy should be adjusted based on the specific type of stones.

A0001 - SWL is more cost-effective than fURS for the management of kidney stones: Comparative study in a tertiary care centre

A0001 - SWL is more cost-effective than fURS for the management of kidney stones: Comparative study in a tertiary care centre

Outcomes of Ureterorenoscopy for Lower Pole Kidney Stones (≤3 cm) to the Omar Bongo Ondimba Army Instruction Hospital

Introduction: The management of kidney stones has benefited from endoscopic techniques, in particular the development of flexible ureteroscopy (ureterorenoscopy). This endoscopic treatment has made it possible to treat many upper urinary tract stones, with satisfactory results and less morbidity. This innovative minimally invasive technique was introduced in our country in 2018. It is not practiced in all health structures. We report our experience. Objectives: The aim of our study was to evaluate the place of flexible ureteroscopy laser, its feasibility, and the results on stones up to 30 mm in size only in the lower calicial group, while assessing the postoperative quality of life. Patients and Methods: We conducted a monocentric observational retrospective study at the Omar Bongo Ondimba Army Training Hospital (OBO ATH) on 22 patients with symptomatic inferior caliciel stones, over a period of January 2019 and December 2020 treated by flexible ureteroscopy laser (FUR-L), once or twice depending on the size of the residual fragments. Results: All the patients had symptomatic urolithiasis, diagnosed on the clinical elements, and confirmed in 77% by urinary computed tomography. The average age was 35.47 years ± 12, with a clear female predominance (64%). All the stones sat in the lower chalice. 66.5% of stones were larger than 10 mm. 75% of patients were “stones free” after one FUR-L session, and 100% after the second session. 10% of patients still had residual pain at 01 month which was absent at 03 month. 18% of postoperative urinary tract infections were treated with antibiotics. 90% of the patients had resumed an activity prior to 1 month. At 1 month and 3 months, 82% and 100% respectively were satisfied with the mode of treatment according to self-questioning. Conclusion: FUR-L remains a therapeutic modality for stones in the lower calicial group, for stones whose diameter is close to 30 mm. A sequential approach should be considered for diameter stone up to 30 mm.

MINIMALLY INVASIVE PERCUTANEOUS NEPHROLITHOTRYPSY IN THE TREATMENT OF PATIENTS WITH KIDNEY STONES.

The aim: To evaluate the outcomes and complications rate of minipercutaneous nephrolithotripsy (MPCNL) for renal stones treatment. Materials and methods: MPCNL was performed to 123 patients with kidney stones from January 2020 till November 2021. All operations were performed under endotracheal inhalation anesthesia. After the ureteral catheter was introduced ultrasound controlled punction of kidney collecting system and work channel dilation were performed. Stones were fragmented by holmium laser. The fragments extracted passively with fluid flow through the outer sheath. Operation ended by introduction of nephrostomy tube 14Ch. Results: In total 135 MPCNLs were performed in 123 patients. The average duration of operations was 55±5,4 minutes and stone size was 1,6±0,2 sm. 12 patients were per¬formed simultaneous MPCNL on both sides. The simultaneous MPCNL duration amounted 105±8,1 min. In 3 (2,2%) cases residual stones were observed. The average hospital stay was 1,31±0,2 days. The renal drainage was removed in 24 ± 3,2 hours after operation. Acute pyelonephritis was presented in 4 (3,3%) and postoperative bleeding in 2 (1,6%) patients, which were stopped by antibacterial and hemostatic drugs with drainage occlusion respectively. Conclusions: To advantages of MPCNL belong short hospital stay, high safety level, insignificant intraoperative and postoperative bleeding, good operation field visualization, opportunity of quick removal of renal drainage, ureteral and urethral catheters. Benefit in patients with severe comorbidities, opportunity of simultaneous bilateral MPCNL and almost complete postoperative pain absence allow to consider MPCNL the operation of choice in kidney stone management.

The Satisfaction of Patients with the Management of Kidney Stones in Malaysia: A Qualitative Study

<p style="text-align: justify;"><strong>Background: </strong>Kidney stones form by the precipitation or crystallization of minerals and urinary constituents. It is a common problem worldwide manifested with recurrent intermittent pain episodes, surgical interventions, and medication consumption which affect the patients&rsquo; quality of life. The current study explored patients&rsquo; satisfaction with the management of kidney stones disease, along with their experience with the treatment. <strong>Methods:</strong> Qualitative face-to-face semi-structured interviews were conducted with kidney stones patients from Hospital Universiti Sains Malaysia in January 2018. Interviews were verbatim transcribed and thematic content analysis was carried out to understand the phenomena of patients&rsquo; experiences. <strong>Results:</strong> The fifteen patients who were interviewed judged their health and clinical outcomes based on several aspects. They build perceptions and make opinions based on outcomes including whether the disease is cured or not, relief of symptoms, prevention of disease progression, or absence of symptoms relapse, and whether the diagnostic and follow-up tests became normal. Based on the interviews, most patients were more satisfied with medical treatment than interventional treatment. <strong>Conclusion: </strong>The satisfaction towards the management of kidney stones was influenced by the treatment option chosen for each patient, expectations and perceptions of the treatment and disease, and healthcare system-related issues. This understanding could improve targeted support and therapy provided by health care providers so patients can better deal with the many disputes they face during suffering from kidney stones. <p style="text-align: justify;"><strong>Key words: </strong>Satisfaction, Perception, Kidney stones, Interview, Qualitative research.

Social Determinants of Kidney Stone Disease: The Impact of Race, Income and Access on Urolithiasis Treatment and Outcomes

The medical and surgical management of kidney stones is one of the most common functions of the urologist. Management choices are often nuanced, involving the decision to embark on one surgical plan among several options. As the wider medical community critically evaluates the care we provide to an increasingly diverse population, it will be important to examine patient outcomes with a particular focus on ensuring equitable care. This review examines the influence of social parameters on the care of kidney stone patients. The dearth of literature in this area warrants rigorous studies on the relationship between race as well as socioeconomic status and the management of kidney stone disease.

MP18-02 EVALUATING SPONTANEOUS STONE PASSAGE RATES DURING THE COVID-19 PANDEMIC

INTRODUCTION AND OBJECTIVE: During the COVID-19 pandemic our institution limited elective surgery including management of kidney stones. Additionally, patients themselves were reluctant to pursue elective surgery. This presented us a unique opportunity to reassess the natural history of symptomatic nephrolithiasis given potentially prolonged periods of conservative management. METHODS: A retrospective review was performed of patients presenting to the emergency room (ER) with flank pain secondary to nephrolithiasis from March to April of 2020 (COVID peak period of elective surgery limitations), and a comparative cohort from March and April 2019. Assessed outcomes included definitive stone treatment at initial presentation to the ER, rate of spontaneous stone passage, and time to elective surgery from initial ER presentation. Chi-square or Mann-Whitney U tests were utilized for dependent binary variables and continuous variables, respectively. A Kaplan Meier analysis was used to demonstrate differences in time to elective surgery between the two eras. RESULTS: Baseline characteristics did not differ between groups (Table). Patients discharged from the ER were more often offered medical expulsive therapy (71.6% vs 55.0%, p=0.026) during the COVID era. The rate of surgical stone management or stent placement at initial presentation did not differ, however, discharged patients waited longer from initial ER presentation to elective surgery (55.3 vs 33.1 days, p=0.02). Spontaneous stone passage rates were similar between groups despite the delay, and similar stone location and stone size between eras. CONCLUSIONS: During the height of the COVID pandemic, ER patients with symptomatic stones had similar characteristics at presentation but were more often offered MET. Spontaneous stone passage during the pandemic was no different than in 2019, despite a significant difference in time to elective surgery from initial presentation to the ER with flank pain .

SLC26A6 and NADC‑1: Future direction of nephrolithiasis and calculus‑related hypertension research (Review).

Nephrolithiasis is the most common type of urinary system disease in developed countries, with high morbidity and recurrence rates. Nephrolithiasis is a serious health problem, which eventually leads to the loss of renal function and is closely related to hypertension. Modern medicine has adopted minimally invasive surgery for the management of kidney stones, but this does not resolve the root of the problem. Thus, nephrolithiasis remains a major public health issue, the causes of which remain largely unknown. Researchers have attempted to determine the causes and therapeutic targets of kidney stones and calculus‑related hypertension. Solute carrier family 26 member 6 (SLC26A6), a member of the well‑conserved solute carrier family 26, is highly expressed in the kidney and intestines, and it primarily mediates the transport of various anions, including OXa2‑, HCO3‑, Cl‑ and SO42‑, amongst others. Na+‑dependent dicarboxylate‑1 (NADC‑1) is the Na+‑carboxylate co‑transporter of the SLC13 gene family, which primarily mediates the co‑transport of Na+ and tricarboxylic acid cycle intermediates, such as citrate and succinate, amongst others. Studies have shown that Ca2+ oxalate kidney stones are the most prevalent type of kidney stones. Hyperoxaluria and hypocitraturia notably increase the risk of forming Ca2+ oxalate kidney stones, and the increase in succinate in the juxtaglomerular device can stimulate renin secretion and lead to hypertension. Whilst it is known that it is important to maintain the dynamic equilibrium of oxalate and citrate in the kidney, the synergistic molecular mechanisms underlying the transport of oxalate and citrate across kidney epithelial cells have undergone limited investigations. The present review examines the results from early reports studying oxalate transport and citrate transport in the kidney, describing the synergistic molecular mechanisms of SLC26A6 and NADC‑1 in the process of nephrolithiasis formation. A growing body of research has shown that nephrolithiasis is intricately associated with hypertension. Additionally, the recent investigations into the mediation of succinate via regulation of the synergistic molecular mechanism between the SLC26A6 and NADC‑1 transporters is summarized, revealing their functional role and their close association with the inositol triphosphate receptor‑binding protein to regulate blood pressure.

Complementary and Alternative Medicine Use in First-time and Recurrent Kidney Stone Formers

To describe the patterns of complementary and alternative medicine (CAM) among patients with kidney stones and analyze the alkali content of commonly used CAM therapies. We prospectively conducted structured interviews with patients who presented to a specialty stone clinic for the management of kidney stones. Open-ended questions were used to elicit information regarding CAM knowledge, formulation/dosing, and patterns of use. Several common CAM therapies were then analyzed for their alkali, organic anion, and sugar content. Of 103 subjects, 82 (80%) patients reported knowledge of CAM and 52 (50%) reported using CAM. Patients with recurrent kidney stones were more likely to report using CAM than patients with first-time episodes (56% vs 26%, P = 0.04). Some respondents reported their condition decreased in severity or frequency since starting CAM therapy (17%) and improvements in pain (12%). Total alkali content per serving of the tested supplements was 0 mEq (Stonebreaker), 1.5 mEq (Ocean Spray Cranberry Juice Cocktail), 4.7 mEq (Lakewood Pure Cranberry Juice), 0.6 mEq (Braggs Apple Cider Vinegar), 11.9 mEq (LithoBalance), 9.5 mEq (Simply Grapefruit Juice), 19.8 mEq (KSP-Key Lime), and 20.2 mEq (KSP-Very Berry). Patients with kidney stones may use CAM to alleviate symptoms or prevent recurrence. Commercially available CAM therapies may contain comparable alkali content to commonly prescribed citrate therapy. These data suggest that providers should be prepared to discuss the role of CAM with their patients.