While nephrocalcinosis (kidney stones) is uncommon in wild teleost fish, various environmental and nutritional factors could lead to its occurrence in aquacultured fish. This study presents the first documented case of kidney stones in aquacultured Brazilian sardine (Sardinella brasiliensis). During necropsy, eighteen hard, white kidney stones were found in the posterior kidney, with an average diameter of 3.71 mm and a total length of 16.8 mm. Morphological analysis revealed stones of different sizes and shapes, including elongated and irregular structures. This discovery enhances our understanding of pathological conditions in S. brasiliensis and underscores the importance of further research into the causes, prevalence and potential implications for fish health and fisheries sustainability.

Comprehensive review of heart disease prediction: A comparative study from 2019 onwards.

Unveiling the genus Taraxacum: From folk medicine to chemodiversity-driven pharmacological and toxicological outcomes-A systematic review.

Molecular diagnosis of renal calculi biomarkers based on electrochemical sensors: Correlation analysis with the risk of obstructive sleep apnea

BACKGROUND Anxiety and depression are understudied in kidney calculi despite their inverse correlation with clinical outcomes. AIM To investigate the correlation of anxiety and depression with resilience and quality of life (QoL) in patients with kidney calculi, and to identify contributors to these emotional disorders in such patients. METHODS This study included 119 patients with kidney calculi who visited the First Affiliated Hospital of Xi’an Jiaotong University from May 2022 to March 2025. Patients’ anxiety [Hamilton Self-Rating Anxiety Scale (HAMA)], depression [Hamilton Self-Rating Depression Scale (HAMD)], resilience [Connor-Davidson Resilience Scale (CD-RISC)], and QoL [General QoL Inventory-74 (GQOLI-74)] were assessed. Spearman correlation coefficients were calculated to analyze the correlations of anxiety and depression with resilience and QoL. Multivariate modeling identified anxiety and depression contributors in patients with kidney calculi. RESULTS Anxiety and depressive symptoms affected 49.58% and 64.71% of participants, respectively. Notably lower CD-RISC scores (across tenacity, strength, and optimism dimensions and the global scale) were observed in the anxiety/depression groups vs their corresponding non-anxiety/non-depression groups. The same pattern was observed in GQOLI-74 global and subscale scores. Both HAMA and HAMD correlated inversely with CD-RISC (HAMA: r = -0.194, P = 0.034; HAMD: r = -0.413, P < 0.001) and GQOLI-74 (HAMA: r = -0.394, P < 0.001; HAMD: r = -0.347, P < 0.001). As confirmed by multivariate regression, per capita monthly income [odds ratio (OR) = 0.158, P = 0.002], complications (risk factor, OR = 3.442, P = 0.032), CD-RISC (OR = 0.075, P < 0.001), and GQOLI-74 (OR = 0.081, P < 0.001) each independently affected anxiety risk. Depression-associated independent predictors included income (OR = 0.090, P < 0.001), social support (OR = 0.136, P = 0.003), CD-RISC (OR = 0.060, P < 0.001), and GQOLI-74 (OR = 0.198, P = 0.023). CONCLUSION Anxiety and depression exhibited an intimate connection with resilience and QoL in patients with kidney calculi. High income, great resilience, and superior QoL are protective against psychological distress.

Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disorder of purine metabolism causing 2,8-dihydroxyadenine urinary tract stones and crystal nephropathy. Disease manifestations include acute kidney injury (AKI), progressive chronic kidney disease (CKD), and not infrequently, kidney failure. A significant proportion of affected individuals remainasymptomaticinto adulthood. The diagnosis of APRT deficiency should be considered in all children presenting with renal colic, radiolucent urinary stones and/or AKI, as well as in infants with a history of reddish-brown diaper stain. Indeed, the disorder should be considered in any person with radiolucent urinary stones and in young and middle-aged individuals with progressive CKD, particularly when a kidney biopsy reveals tubulointerstitial nephropathy of unknown cause. The presence of biallelic pathogenic APRT mutations identified through targeted multi-gene panels or single-gene testing confirms the diagnosis of APRT deficiency. As kidney stone analysis can be false-positive, this method can only be considered suggestive of APRT deficiency, and confirmatory testing must be carried out in all cases. Timely diagnosis and treatment with a xanthine oxidoreductase inhibitor, eitherallopurinol or febuxostat, have in several studies, based on different levels of evidence, been found to be both highly effective and safe in APRT deficiency. Appropriate pharmacotherapy significantly reduces kidney stone recurrence, slows CKD progression and appears to prevent the development of kidney failure. The outcome of kidney transplantation in individuals with APRT deficiency is comparable to those withother causes ofkidney failure when allopurinol or febuxostat therapy is initiated before the transplant procedure.

Kidney stone disease (KSD) is heritable and genetic testing is becoming increasingly relevant to its management. However, it is unclear who should be offered genetic testing and what these investigations should entail. This review gives an overview of the existing evidence and future directions. In highly selected cohorts, genetic testing for monogenic disease can yield high diagnostic rates. These diagnoses can facilitate genetic counselling, familial testing, and targeted medical therapies.Our understanding of the role of rare intermediate effect size and common low effect size genetic variants is evolving. The clinical utility of polygenic risk scores and genetic sequencing in unselected cohorts remains uncertain. Genetic testing for monogenic KSD is advised in individuals with a strong family history and with recurrent stones. There is a need for large-scale studies, including in urology settings, to determine optimal criteria for patient selection in real world settings. Further research is required to define the role of genetic testing, including polygenic risk scores, in risk prediction, personalised management, and disease recurrence.

The optimal treatment for 2-3cm renal stones requires balancing efficacy with minimal invasiveness. While mini-percutaneous nephrolithotomy (mPCNL) is a standard approach, retrograde intrarenal surgery with a Flexible and Navigable Suction Sheath (FANS-RIRS) has emerged as a promising alternative. We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the efficacy and safety of these two procedures. A systematic search of PubMed, Embase, Web of Science, and CENTRAL was conducted through August 2025 to identify RCTs comparing FANS-RIRS and mPCNL for 2-3cm renal stones. Primary outcomes included stone-free rates (SFRs), perioperative variables, and safety profiles, including hemorrhagic and infectious complications. Evidence was synthesized using random-effects models, and certainty was assessed with the GRADE framework. Three high-quality RCTs enrolling 1020 patients were included. Final SFRs were comparable between FANS-RIRS and mPCNL (OR 0.80, 95% CI 0.51-1.24; P = 0.31). However, FANS-RIRS was associated with significant advantages in safety and recovery, including a smaller hemoglobin decline (MD - 5.36g/L), lower rates of hemorrhage (OR 0.08) and blood transfusion (OR 0.14), a shorter hospital stay (MD - 1.75 days), and less postoperative pain (all P < 0.05). Operative time, auxiliary procedure rates, and infectious complications did not differ significantly between groups. The certainty of evidence for outcomes was rated as moderate to low due to the small number of studies and heterogeneity. Current evidence from randomized trials suggests that for 2-3cm renal stones, FANS-RIRS may provide efficacy comparable to mPCNL but with a potentially superior safety profile and faster patient recovery. While promising, these findings are based on a limited number of RCTs, and FANS-RIRS appears to be a viable option, particularly for patients who have a high bleeding risk or prioritize a quicker return to normal activities. This study was prospectively registered in PROSPERO (CRD420251136058).

Pediatric nephrolithiasis continues to pose a substantial clinical challenge in pediatric urology because of its elevated recurrence rate and elevated morbidity with risk of end-stage renal failure. The management of pediatric nephrolithiasis involves dietary modification, pharmacological therapy, and urological intervention, with the choice of treatment guided by stone size, location, and composition. To evaluate the efficacy and safety of mini-percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shock wave lithotripsy (SWL) for the management of renal stones measuring 1-2 cm in pediatrics. This prospective, randomized comparative research was conducted at the Department of Urology, Al-Azhar University Hospital, Assiut, Egypt, between December 2022 and November 2024. Sixty children with single renal stones were enrolled, with 30 undergoing SWL and 30 receiving mini-PCNL. Mini-PCNL achieved a significantly elevated stone-free rate (SFR, 93.33%) in contrast with SWL (33.33%) (p < 0.001). The SWL group also showed a higher rate of auxiliary approaches and retreatment. Overall complication rates were comparable. Mini-PCNL is more effective than SWL for managing renal stones measuring 10-20 mm in children aged 6 months to 6 years. It provides an elevated SFR and lowers the likelihood of retreatment and hospital readmission, with a comparable safety profile.

Nephrolithiasis is a major global health challenge, with oxidative stress and mitochondrial dysfunction emerging as key drivers of renal injury and stone formation. l-ergothioneine (l-Erg), a naturally occurring antioxidant transported by OCTN1, has shown promising effects in cystinuria models, preventing stone formation. Despite evidence supporting an indirect mechanism of action, key mechanistic aspects have yet to be fully clarified. This study aimed to evaluate whether l-Erg can prevent stone progression in cystinuria and in other types of lithiasis, such as calcium oxalate nephrolithiasis, and to further elucidate its mechanistic basis. Using mouse models, l-Erg significantly reduced cystine stone growth and renal inflammation, and its combination with d-penicillamine enhanced stone dissolution and mitigated drug-related toxicity. In calcium oxalate nephrolithiasis, l-Erg decreased crystal deposition, preserved renal architecture, normalized glutathione levels, and restored mitochondrial respiration. Transcriptomic analysis revealed downregulation of immune pathways and activation of cell cycle genes, suggesting attenuation of inflammation and promotion of tubular repair. This study is the first to demonstrate that l-Erg exerts renoprotective effects through combined antioxidant and mitochondrial mechanisms in two major forms of nephrolithiasis and introduces a dual therapeutic approach combining an antioxidant with a cystine-solubilizing agent. By targeting oxidative stress and mitochondrial dysfunction, l-Erg represents a promising therapeutic strategy for nephrolithiasis, either alone or as an adjunct to current treatments. Antioxid. Redox Signal. 00, 000-000.

The association between ZJU index and kidney stone risk: a machine learning approach on NHANES 2007-2018.

This study aimed to investigate the knowledge, attitudes and practices (KAP) of patients with urinary calculi in China, where prior KAP research on this condition is lacking. A cross-sectional study was conducted. The study was carried out in Jiangsu Province between August and September 2024. Patients diagnosed with urinary calculi were included, with 440 valid questionnaires analysed (65.9% male). Primary outcomes were KAP scores (knowledge: 0-30, attitude: 6-30, practice: 7-35). Secondary outcomes included structural equation modelling (SEM) analysing relationships between KAP domains. Mean scores were 10.63±3.73 (knowledge), 22.37±4.16 (attitude) and 22.40±5.36 (practice). SEM revealed direct effects of knowledge on attitude (β=0.652, p<0.001) and practice (β=0.375, p<0.001), and attitude on practice (β=0.432, p<0.001). Knowledge also indirectly influenced practice via attitude (β=0.281, p<0.001). Patients with urinary calculi tended to demonstrate limited knowledge but moderate attitudes and practices towards their condition. These findings suggest potential gaps in patient understanding and indicate that educational approaches may play a role in supporting urinary calculi management.

Xanthogranulomatous pyelonephritis (XGP) is an infection of the kidney that often results from a chronic obstruction, such as a kidney stone. We present a patient with a massively enlarged left renal pelvis with minimal renal parenchyma presenting as an end stage ureteropelvic junction obstruction (UPJO). The patient was afebrile during his time in the emergency room (ER). Urinalysis was significant for trace leukocyte esterase and 11–20 WBCs. His creatinine during his ER encounter was 1.02. Due to his normal creatinine, a percutaneous nephrostomy tube was not placed. Preoperatively, we did not suspect XGP or pyonephrosis given his prior ER results. Shortly after the patient′s ER presentation he was taken to surgery and final pathology revealed XGP. We were able to successfully perform a robotic‐assisted laparoscopic radical nephrectomy for stage I XGP safely, which included drainage of over two liters of pyogenic urine during the surgery.

Optimal duration between drainage for obstructing renal or ureteral stones associated with infection and ureteroscopic lithotripsy: a randomized controlled trial.

Kidney stones are a prevalent urological condition with significant global burden, often diagnosed using ultrasound (US) as a first-line modality despite its limitations in sensitivity and operator dependency. Artificial intelligence (AI) and deep learning (DL) algorithms have shown promise in enhancing US-based kidney stone applications, including detection, classification, complication prediction, and procedural guidance, but evidence remains heterogeneous. To systematically review and synthesize the applications of AI and DL algorithms in US-based kidney stone detection, classification, prediction of complications/outcomes, and procedural guidance. This systematic review followed PRISMA guidelines (PROSPERO: CRD420251247650). Databases including PubMed, Embase, Scopus, and others were searched from inception without language restrictions. Eligible studies were original peer-reviewed articles evaluating AI/DL in US for kidney stone diagnostics against reference standards like CT or surgical findings. Two reviewers independently screened, extracted data, and assessed quality using QUADAS-2 with AI extensions. From 1,285 records, 9 studies were included after exclusions. These encompassed DL for image detection/segmentation (n = 3), predictive modeling for complications/outcomes (n = 4), and procedural guidance (n = 2). Methodologies included CNN variants and ML ensembles. Performance metrics were high, with accuracies up to 96.54%, AUCs > 0.90 for predictions, and improved procedural outcomes. Risk of bias was low in most studies (5/9), with some concerns in others. Heterogeneity in datasets and validation limited meta-analysis. AI and DL algorithms demonstrate high diagnostic accuracy and clinical utility in enhancing US for kidney stone management, with stratification by application type revealing high performance across tasks, addressing traditional limitations. However, methodological variability and low to very low certainty of evidence (per GRADE) necessitate standardized external validation and multimodal integration for broader adoption.

Urolithiasis is a prevalent urinary tract disorder marked by the formation of stones in the kidneys or other parts of the urinary system. Its incidence is rising worldwide due to lifestyle changes, dietary habits, climatic factors and metabolic abnormalities. Kidney stones are seen about twice as often in men compared to women. Stone formation is a multifactorial process involving urinary supersaturation, crystal nucleation, growth, aggregation and retention within renal tissues. This review provides a comprehensive overview of the etiology, epidemiology, types of stones and mechanism of stone formation, diagnosis and current alternative treatment approaches for Urolithiasis such as surgical interventions, pharmacotherapy and phytotherapy, in-vivo and in-vitro evaluation models of urolithiasis. Various dietary and lifestyle modifications have potential to prevent urolithiasis and recurrences. The diagnostic methods and preventive approaches along with complete removal of stones will improve the management of urolithiasis. In vitro and in vivo evaluation methods for urolithiasis help researchers better understand stone formation and support the development of effective antiurolithiatic compounds.

Endourologic procedures for ureteral/renal stones traditionally rely on fluoroscopic guidance. The necessity of fluoroscopy for safe and effective stone treatment remains controversial. To perform a systematic review and meta-analysis to evaluate intraoperative, perioperative, and postoperative outcomes of fluoroless vs fluoroscopy-guided endourologic procedures for kidney and/or ureteral stones. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we searched PubMed, Cochrane Central Register, and Scopus on 13th November 2025. Inclusion criterion comprised randomized trials comparing fluoroless with fluoroscopy-guided ureteroscopy (URS) or percutaneous nephrolithotripsy (PCNL). Binary outcomes were assessed using the Cochran-Mantel-Haenszel Method with the random effect model and reported as odds ratio (OR), 95% confidence interval (CI), and p-values. Continuous variables were pooled using the inverse variance of the mean difference with a random effect. Statistical significance was set at p < 0.05. Eighteen randomized studies were included: 7 URS studies (1119 patients) and 11 PCNL studies (1370 patients). For PCNL, fluoroless ultrasound-guided techniques demonstrated superior safety with significantly lower overall complications (OR 0.57, 95% CI 0.42-0.78, p = 0.0004), minor complication- (OR 0.60, 95% CI 0.41-0.86, p = 0.006), and major complication- rates (OR 0.52, 95% CI 0.30-0.88, p = 0.02) compared with fluoroscopy-guided approaches. Stone-free rates (SFRs) were equivalent between groups (OR 1.03, 95% CI 0.77-1.38, p = 0.83). For URS, fluoroless approaches showed comparable overall complications (OR 1.08, 95% CI 0.81-1.45, p = 0.60), major complications, SFR (OR 0.89, 95% CI 0.65-1.19, p = 0.47), and reintervention rates. Flexible fluoroless URS demonstrated fewer minor complications (OR 2.09, 95% CI 1.43-3.06, p < 0.0001). Mean surgical time increased minimally for fluoroless URS (1.60 minutes, p = 0.03). Fluoroless ultrasound-guided PCNL demonstrates superior safety with maintained efficacy compared with fluoroscopy-guided techniques. Fluoroless URS shows equivalent safety and efficacy with minimal operative time differences. These findings support transitioning from fluoroscopy-dependent to fluoroscopy-optional endourology, aligning with radiation safety principles while maintaining optimal patient outcomes.

Objective: The optimal surgical approach for 1.0-2.0 cm renal stones in solitary kidney patients remains controversial. This retrospective study compared mini-percutaneous nephrolithotomy (mPCNL) and flexible ureteroscopy (f-URS) outcomes in this vulnerable population. Methods: Between June 2018 and April 2024, 50 patients with solitary kidneys and 1.0-2.0 cm renal stones underwent either mPCNL (n = 26) or f-URS (n = 24). Outcomes included 3-month stone-free rate (SFR), complications (Clavien-Dindo classification), and renal function (serum creatinine, eGFR by CKD-EPI equation) at the baseline, 72 h, and 1 month. Results: Stone-free rates were comparable (mPCNL 96.2% vs. f-URS 91.7%, p = 0.157). The f-URS group demonstrated significantly less hemoglobin decline (2.2 ± 0.9 vs. 5.7 ± 2.4 g/dL, p < 0.001) and shorter hospitalization (4.1 ± 1.1 vs. 7.8 ± 1.6 days, p < 0.001). All Grade II complications (8.3%, requiring transfusion) occurred in the mPCNL group. At 1 month, serum creatinine decreased more with f-URS (15.4 ± 7.96 vs. 8.7 ± 4.23 μmol/L, p < 0.001), with greater eGFR improvement (16.7 ± 4.7 vs. 15.4 ± 5.2 mL/min/1.73 m2, p = 0.023). Conclusions: In this retrospective cohort, f-URS achieved comparable stone clearance to mPCNL alongside a superior early safety profile and better short-term renal functional preservation. These preliminary findings suggest that f-URS represents a viable nephron-sparing option for this high-risk population. However, these results are considered hypothesis-generating, and further prospective, long-term studies are required to evaluate the durability of these functional benefits.

Rationale:Verrucous carcinoma (VC) of the upper urinary tract is an extremely rare disease, with only 7 cases reported in the literature to date. We report a successfully treated case of VC involving the renal pelvis and ureter, along with a literature review to explore its pathogenesis and optimal treatment strategies.Patient concerns:A 79-year-old male presented with “recurrent right flank pain for over 10 years and fever for 1 week.”Diagnoses:VC of the right renal pelvis and ureter (pT1N0M0); right renal and ureteral calculi and right pyonephrosis.Interventions:After initial percutaneous nephrostomy to manage the infection, the patient underwent nephrectomy and partial ureterectomy.Outcomes:Histopathological analysis revealed VC in the renal pelvis and ureter, with no muscular invasion or lymph node metastasis. Postoperative recovery was uneventful, and at the 3-month follow-up, no recurrence or residual disease was observed on imaging and cystoscopy.Lessons:patients with long-standing renal calculi and chronic inflammation should be carefully monitored for potential malignant transformation. Early treatment of predisposing factors is essential. Contrast-enhanced imaging and thorough pathological evaluation can aid in diagnosis.

Clusterin elaborated by renal tubular epithelial cells under high oxalate stress serves as a matrix protein to facilitate kidney stone formation.