Urolithiasis Research Articles

Accurate statistical methods to cover the aspects of the increase in the incidence of kidney failure: A survey study in Ha'il -Saudi Arabia.

Chronic kidney disease (CKD) has become more common in recent decades, putting significant strain on healthcare systems worldwide. CKD is a global health issue that can lead to severe complications such as kidney failure and death. The purpose of this study was to investigate the actual causes of the alarming increase of kidney failure cases in Saudi Arabia using the supersaturated design analysis and edge design analysis. A cross-sectional questionnaire was distributed to the general population in the KSA, and data were collected using Google Forms. A total of 401 responses were received. To determine the actual causes of kidney failure, edge and supersaturated designs analysis methods were used, which resulted in statistical significance. All variables were studied from factor h1 to factor h18 related to the causes of kidney failure. The supersaturated analysis method revealed that the reasons for the increase in kidney failure cases are as follows: h9(Bad diet), h8(Recurrent urinary tract infection), h1 (Not drinking fluids), h6 (Lack of exercise), h14 (drinking from places not designated for valleys and reefs), h18 (Rheumatic diseases), h10 (Smoking and alcohol consumption), h13 (Direct damage to the kidneys), h2 (take medications), h17 (excessive intake of soft drinks), h12 (Infection), h5 (heart disease), h3 (diabetes), h4 (pressure disease), h15 (Dyes used in X-rays), and h11 (The presence of kidney stones) are all valid. The design analysis method by edges revealed that the following factors contributed to an increase in kidney failure cases: h8 (Recurrent urinary tract infection), h6 (Lack of exercise), h7 (Obesity), and h11. The findings showed that there were causes of kidney failure that led to the statistical significance, which is h8 (Recurrent urinary tract infection) and h11 (The presence of kidney stones).

Comparative Study Between Percutaneous Nephrolithotomy in Patients with and without History of Open Renal Stone Surgery

Comparative Study Between Percutaneous Nephrolithotomy in Patients with and without History of Open Renal Stone Surgery

The Role of Biochemistry in Understanding Kidney Stone Formation andUrinary Health

Renal illness caused by stones is the term for a solid substance concretion that usually develops inside the kidneys. A rising urological condition influences the well-being of people and affects about 12% of the world's population. An increased chance of ending stage of renal failure and they are closely related. There are several types of kidney stones. The CaC2O4 kidney calculi are the most common type. It appears at Randall plaque's renal papillary surfaces. (1) Several physicochemical mechanisms, such as supersaturating, urinary stone nucleation, growth, aggregation, and retention components found in tubular cells, which aid in the complex process of formation of stones. An inequity between the elements that promote or inhibit the crystallization of urine influences these phases. Moreover, Scientists have noticed that renal injury of cells promotes particle retention reticular body. (2)

Plasma metabolites as potential markers and targets to prevent and treat urolithiasis: a Mendelian randomization study.

Studies on the relationships between diseases of the urinary system and human plasma proteomes have identified several potential biomarkers. However, none of these studies have elucidated the causal relationships between plasma proteins and urolithiasis. The objective of the study was to investigate the potential risks of plasma metabolites in urolithiasis using a two-sample Mendelian randomization (MR) study. A total of 1,400 metabolites were identified in the most comprehensive genome-wide association study (GWAS) of plasma metabolomics in a European population to date, and single-nucleotide polymorphisms (SNPs) were used as the instrumental variables for the plasma metabolites. The European GWAS data for urinary calculi included 482,123 case samples and 6,223 control samples (ebi-a-GCST90018935). The associations between the plasma metabolites and risk of urolithiasis were evaluated by inverse variance weighting (IVW) and supplemented by sensitivity analyses of the MR-Egger and MR-PRESSO tests. For the first time, we found a causal relationship between two plasma metabolites (p < 1.03 × 10-4) and urolithiasis (p < 0.05). The chemical 4-hydroxychlorothalonil, which is an intermediate product of the pesticide hydroxychlorothalonil, could promote urolithiasis (odds ratio (OR) = 1.12) as a risk factor. Moreover, 1-stearoyl-2-arachidonoyl-GPC, which is an important component of phospholipid metabolism in the human body, can inhibit urolithiasis (OR = 0.94). Our results suggest that blood metabolites can be used as blood markers and drug targets in the prevention, diagnosis, and treatment of urolithiasis; furthermore, our results can provide a basis for policy makers to formulate prevention and treatment policies for urolithiasis.

MiR-148b-5p regulates hypercalciuria and calcium-containing nephrolithiasis

Calcium-containing stones represent the most common form of kidney calculi, frequently linked to idiopathic hypercalciuria, though their precise pathogenesis remains elusive. This research aimed to elucidate the molecular mechanisms involved by employing urinary exosomal microRNAs as proxies for renal tissue analysis. Elevated miR-148b-5p levels were observed in exosomes derived from patients with kidney stones. Systemic administration of miR-148b-5p in rat models resulted in heightened urinary calcium excretion, whereas its inhibition reduced stone formation. RNA immunoprecipitation combined with deep sequencing identified miR-148b-5p as a suppressor of calcitonin receptor (Calcr) expression, thereby promoting urinary calcium excretion and stone formation. Mice deficient in Calcr in distal epithelial cells demonstrated elevated urinary calcium excretion and renal calcification. Mechanistically, miR-148b-5p regulated Calcr through the circRNA-83536/miR-24-3p signaling pathway. Human kidney tissue samples corroborated these results. In summary, miR-148b-5p regulates the formation of calcium-containing kidney stones via the circRNA-83536/miR-24-3p/Calcr axis, presenting a potential target for novel therapeutic interventions to prevent calcium nephrolithiasis.Graphical abstract

Association between the atherogenic index of plasma and kidney stones: a nationally representative study

PurposeThe atherogenic index of plasma (AIP) is a novel comprehensive lipid index. We aimed to investigate a possible relationship between AIP index and kidney stones in US adults.MethodsThis cross-sectional study was conducted among adults with complete AIP index and questionnaire records on kidney stones from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018. The AIP index served as the exposure variable, defined as the logarithm of the ratio between triglycerides (TG, mmol/L) and high-density lipoprotein cholesterol (HDL-c, mmol/L). Self-reported history of kidney stones was utilized as the outcome variable. The independent relationship between AIP index and the risk of kidney stones was fully assessed.ResultsA total of 14,833 participants were included in this study, with an average AIP index of -0.07 ± 0.01. The proportion of kidney stones progressively increased with higher AIP index tertile intervals (7.33% vs. 9.97% vs. 12.57%, P < 0.001). Furthermore, AIP index was found to be independently associated with the risk of kidney stones after adjusting for confounding factors (OR = 1.32, 95% CI 1.08–1.61, P = 0.006). Restricted cubic spline (RCS) analysis confirmed the robustness of our results. There was no significant interaction observed based on subgroup analysis stratified by age, gender, race, body mass index (BMI, kg/m2), smokers, diabetes, hypertension, and cardiovascular disease (P for interaction > 0.05).ConclusionsThe AIP index may be a potential epidemiological tool to quantify the role of dyslipidemia in the risk of kidney stones in US adults.

Role of the Gut Microbiota in the Development of Urolithiasis

This article aims to review the literature regarding assessment of the gut microbiota effect on kidney stone formation. We sought to determine whether several specific gut bacteria or a wider number of members of the gut microbiota are responsible for this association based on the literature data. We conducted an extensive literature search (publications on kidney stones and gut microbiota dated 2013-2023) in PubMed, Cochrane CENTRAL, and Web of Science Core Collection.A large number of earlier studies were focused on physical and chemical properties of crystals formed by kidney stones. In recent years as diagnostic technologies advance, there has been a tendency to study the association of the gut microbiota and the development of other unrelated diseases. Studies have emerged showing the gut microbiota effect on the development of urolithiasis, which suggests that stone formation can be prevented or caused by changing the structure of the gut microbiome. However, further research is needed to identify which genera or types of the gut microbiota break down oxalate and reduce the risk of kidney stone formation.

Sustained estradiol valerate delivery by microneedles: A new effective platform to construct estrogen-dependent tumor model

The establishment of an estrogen receptor-positive (ER+) breast tumor model plays a crucial role in the preliminary screening of anticancer drugs and understanding disease mechanism. However, the construction of this model requires exogenous estrogen supplementation. The current method of estrogen supplementation was limited by its high cost and potential side effects. Herein, we utilized Poly D, L-lactic-co-glycolic acid (PLGA) as substrate to develop the estradiol valerate microneedle patch (EVMP). The EVMP exhibited excellent drug loading capacity (46 μg/needle) and good mechanical strength (>0.2 N/needle). Importantly, the EVMP exhibited favorable sustained release of estradiol valerate ability in vitro. Subsequently, the EVMP successfully achieved sustained release in Balb/c nude mice, resulting in an average MCF-7 (ER+) tumor volume of approximately 300 mm3 at day 35. In addition, no significant inflammatory reaction or urinary calculi were observed during this process, which further demonstrated the efficacy and safety of the EVMP. Overall, these findings suggested that the EVMP held great potential as a safe and animal-friendly alternative platform for constructing the ER + breast cancer model.

Homoeopathic dilution of Berberis vulgaris and Urinary calculi: A Case Series

Introduction- Consequent upon the changing lifestyle the incidence of urinary calculus is emerging as one of the alarming problems around the globe. Apart from modern management, homoeopathy provides an alternative and effective means for its management. In this case series Six successfully treated cases of urinary calculi are presented which shows how potentized homoeopathic medicine Berberis vulgaris (Berb-v) is effective in expelling and mitigating urinary calculi. Case summary- After proper case taking Berb-v in diluted and potentised form was prescribed specifically in pre-diagnosed six cases. They were followed up for varied periods of time at 15 to 20 days intervals after first enrolment. Calculi were expelled with diminution of symptoms. However, more and more randomized control trials and other basic researches are needed to evaluate and explore the effectiveness of Berb-v in urinary calculi.

The interactions of protein-calcium oxalate in crystallization process

Understanding the pathogenic crystallization of calcium oxalate (CaOx), a major constituent of kidney stones, is crucial in developing effective treatment strategies. In this work, the interactions between lysozyme and CaOx during crystallization have been investigated. Further investigations into the crystal morphology, size, quantity, and nucleation time of the lysozyme have been designed. The results reveal that CaCl2 could act as an effective precipitant for lysozyme crystallization. The formation process and structure of the distinctive composite CaOx-lysozyme crystal has been investigated. The addition of lysozyme promoted the formation of individual CaOx crystals by preventing the crystal aggregation in the solution. The presence of lysozyme induced a transformation in the CaOx crystals from calcium oxalate monohydrate to calcium oxalate dihydrate. These findings contribute to a better understanding of protein-CaOx interactions and their implications in kidney stone pathogenesis.

Effect of Delayed Parathyroidectomy on Risk of Future Cardiovascular and Nephrolithiasis Interventions in Adults with Primary Hyperparathyroidism [Original Study

To determine whether the timing of parathyroid surgery impacts the risk of renal stone retreatment and cardiovascular interventions. Long-term, untreated primary hyperparathyroidism is associated with significant morbidity including nephrolithiasis and cardiovascular disease. We conducted a Population-based Cohort study of New York and California state-wide data from 2000-2020. Adult patients who underwent renal stone treatment and subsequently diagnosed with primary hyperparathyroidism (pHPT) and underwent parathyroidectomy (PTX) were included. Patients were excluded if PTX was prior to index stone procedure, they underwent second stone treatment within 6 months, with stage V CKD, with secondary or tertiary hyperparathyroidism, with prior kidney transplant or hemodialysis, or with prior cancer diagnosis. Rate of renal stone retreatment and cardiovascular interventions after PTX in pHPT patients with nephrolithiasis who underwent parathyroid surgery at ≤ 2 years and >2 years after index stone procedure was measured. We identified 2,093 patients who underwent first-time stone treatment and subsequent PTX. The median time to PTX was 560 days (IQR 187-1477) and follow-up was 7.4 years (IQR 4.5-13.1). Delaying PTX for more than 2 years increased the risk of renal stone retreatment by 59% (HR 1.59; P<0.001), increased the risk of experiencing coronary disease or associated interventions by 118% (HR=2.18; P=0.01), and increased the risk of experiencing an overall cardiovascular event by 52% (HR 1.52; P<0.01). In symptomatic pHPT, delaying PTX significantly increases the risk of requiring future stone retreatment and cardiac/vascular surgical interventions. This highlights the importance of early surgical referral and multidisciplinary approaches to optimize outcomes and resource utilization in pHPT.

Label-free detection of kidney stones urine combined with SERS and multivariate statistical algorithm

Kidney stones are a common urological disease with an increasing incidence worldwide. Traditional diagnostic methods for kidney stones are relatively complex and time-consuming, thus necessitating the development of a quicker and simpler diagnostic approach. This study investigates the clinical screening of kidney stones using Surface-Enhanced Raman Scattering (SERS) technology combined with multivariate statistical algorithms, comparing the classification performance of three algorithms (PCA-LDA, PCA-LR, PCA-SVM). Urine samples from 32 kidney stone patients, 30 patients with other urinary stones, and 36 healthy individuals were analyzed. SERS spectra data were collected in the range of 450–1800 cm−1 and analyzed. The results showed that the PCA-SVM algorithm had the highest classification accuracy, with 92.9 % for distinguishing kidney stone patients from healthy individuals and 92 % for distinguishing kidney stone patients from those with other urinary stones. In comparison, the classification accuracy of PCA-LR and PCA-LDA was slightly lower. The findings indicate that SERS combined with PCA-SVM demonstrates excellent performance in the clinical screening of kidney stones and has potential for practical clinical application. Future research can further optimize SERS technology and algorithms to enhance their stability and accuracy, and expand the sample size to verify their applicability across different populations. Overall, this study provides a new method for the rapid diagnosis of kidney stones, which is expected to play an important role in clinical diagnostics.

MOF-818 Nanozyme Suppresses Calcium Oxalate Kidney Stones by Alleviating Oxidative Stress and Inflammatory Injury.

There remains a lack of effective drugs to alleviate the kidney stones caused by oxidative stress and inflammatory damage. The MOF-818 nanozyme is utilized to lessen the generation of reactive oxygen species (ROS) effectively, restore the membrane potential of mitochondria, regulate the cell cycle, decrease cell death, hinder the recruitment of macrophages, and mitigate the release of inflammatory factors in macrophages. These effects are attributed to the nanozyme's ability to mimic the enzyme properties of catalase (CAT) and superoxide dismutase (SOD). It is demonstrated that this nanozyme can reduce kidney calcium oxalate crystal deposition by reducing the renal injury caused by high concentration oxalate, upregulate the expression levels of SOD and CAT in tissues, downregulate adhesion proteins and inflammatory factor IL-6 and TNF-α, and promote the polarization of macrophages from M1 to M2 phenotype in the rat model induced by ethylene glycol. Overall, MOF-818 has the potential to effectively suppress oxidative stress and inflammatory harm caused by high levels of oxalate, hence lowering the likelihood of stone formation. MOF-818 nanozyme is also expected to be used as an alternative drug for the treatment of calcium oxalate kidney stones and provide an experimental theoretical basis for the development of new nanomedicines.

Trajectories of body mass index and incident kidney stone disease: a prospective cohort study in Chinese young adults.

The present study aims to explore the potential changing trajectory patterns of body mass index(BMI) for Chinese young adults and identify the relationship of BMI trajectory patterns with kidney stone disease(KSD) incidence. Latent class growth analysis was used to identify distinct trajectories of BMI during young adulthood. Cox proportion hazard models were conducted to explore the association between the BMI trajectory group memberships and incident KSD. Subgroup and sensitivity analyses were undertaken to test the robustness of the findings. In total, 2,966 young adults who attended at least three annual check-ups from 2014 to 2021 without KSD at baseline were enrolled in the cohort analysis. Three district BMI trajectories were identified for young adults, labeled as low-stable in normal BMI (28.5%), medium-rising to high BMI (67.4%), and rapid-rising to high BMI (4.1%). Compared with the low-stable in normal BMI group, Hazard ratios(HRs) of the rapid-rising and medium-rising to high BMI groups were 3.19 (95% CI: 1.54-6.63) and 1.78 (95% CI: 1.08-2.92) after adjusting the covariates. The cumulative incidence curves likewise illustrated that young adults in the rapid-rising to high BMI group had the highest risk of developing KSD compared to the other two groups. The rapid BMI growth trajectories during young adulthood were identified to be independently associated with a higher risk of KSD. The findings supplied novel insights that monitoring the BMI changing pattern may be favorable to early intervention of KSD during young adulthood.

A novel infrared spectroscopy marker for assessing the postoperative infection risk in patients with upper urinary tract calculus

The aim of this study is to evaluate the ability of infrared wavenumber of calculus to predict postoperative infection in patients with upper urinary tract calculus (UUTC), and to establish a predictive model based on this. From March 2018 to March 2023, 480 UUTC patients from Fujian Provincial Hospital were included in this study. The infrared-wavenumbers related infection score (IR-infection score) was constructed by univariate analysis, multicollinearity screening, and Lasso analysis to predict postoperative infection. Continually, the Delong test was used to compare the predictive power between the IR-infection score and traditional indicators. Afterward, we performed urine metagene sequencing and stone culture to prove the correlation between calculus toxicity and IR-infection score. Finally, logistic regression was used to build a nomogram. IR-infection score composed of four independent wavenumbers could precisely predict postoperative infection (AUCvalidation cohort = 0.707) and sepsis (AUCvalidation cohort = 0.824). IR-infection score had better predictive ability than commonly used clinical indicators. Moreover, metagenomics sequencing and calculus culture confirmed the correlation between IR-infection score and calculus toxicity (all P < 0.05). The nomogram based on the IR-infection score had high predictive power (all AUCs > 0.803). Our study first developed a novel infrared spectroscopy marker and nomogram, which can help urologists better predict postoperative infection in UUTC patients.

Oral Dissolution Therapy of Uric Acid Stones: A Systematic Review

Background/Objectives: Uric acid stones are the second most common type of kidney stones worldwide. Despite being cost-effective and widely available, pharmacological management for these stones is less utilized compared to surgical approaches. Therefore, we conducted a systematic review of the literature to assess the efficacy and shortcomings of oral dissolution therapy for uric acid stones. Methods: Embase, Scopus, PubMed, and Cochrane library databases were searched for English language studies on adults who were diagnosed with uric acid kidney stones and treated with oral dissolution therapy. Results: Twelve studies met our inclusion criteria. Potassium citrate was the primary agent used for dissolution in 10 of the studies and demonstrated a 50% or higher success rate for complete dissolution of uric acid stones. Treatment time for successful dissolution varied, with an average of 3 months minimum and an average of 2.78 years maximum. Overall, 11 of the studies recommended that oral dissolution therapy should be used for either treatment or prevention of uric acid stones. Conclusions: The available evidence demonstrates benefit of oral dissolution therapy for patients with uric acid stones. However, future rigorous studies are required to determine the optimal treatment regimen.

Cost-effectiveness and health economics for ureteral and kidney stone disease: a systematic review of literature.

To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: 'costs of different procedures: SWL, URS, PCNL', 'costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices', 'costs of KSD treatment in the emergency setting: emergency stenting versus primary URS'. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS. Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays' practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.

Taking measurement in every direction: Implicit scene representation for accurately estimating target dimensions under monocular endoscope

Background and objectives:In endoscopy, measurement of target size can assist medical diagnosis. However, limited operating space, low image quality, and irregular target shape pose great challenges to traditional vision-based measurement methods. Methods:In this paper, we propose a novel approach to measure irregular target size under monocular endoscope using image rendering. Firstly synthesize virtual poses on the same main optical axis as known camera poses, and use implicit neural representation module that considers brightness and target boundaries to render images corresponding to virtual poses. Then, Swin-Unet and rotating calipers are utilized to obtain maximum pixel length of the target in image pairs with the same main optical axis. Finally, the similarity triangle relationship of the endoscopic imaging model is used to measure the size of the target. Results:The evaluation is conducted using renal stone fragments of patients which are placed in the kidney model and the isolated porcine kidney. The mean error of measurement is 0.12 mm. Conclusions:The approached method can automatically measure object size within narrow body cavities in any visible direction. It improves the effectiveness and accuracy of measurement in limited endoscopic space.

Three-dimensional super-resolution passive cavitation mapping in laser lithotripsy.

Kidney stone disease is a major public health issue. By breaking stones with repeated laser irradiation, laser lithotripsy (LL) has become the main treatment for kidney stone disease. Laser-induced cavitation is closely associated with the stone damage in LL. Monitoring the cavitation activities during LL is thus crucial to optimizing the stone damage and maximizing LL efficiency. In this study, we have developed three-dimensional super-resolution passive cavitation mapping (3D-SRPCM), in which the cavitation bubble positions can be localized with an accuracy of 40 μm, which is 1/10th of the acoustic diffraction limit. Moreover, the 3D-SRPCM reconstruction speed has been improved by 300 times by adopting a GPU-based sparse-matrix beamforming approach. Using 3D-SRPCM, we studied LL-induced cavitation activities on BegoStones, both in free space of water and confined space of a kidney phantom. The dose-dependence analysis provided by 3D-SRPCM revealed that accumulated impact pressure on the stone surface has the highest correlation with the stone damage. By providing high-resolution cavitation mapping during LL treatment, we expect that 3D-SRPCM may become a powerful tool to improve the clinical LL efficiency and patient outcome.

Establishment of a diagnostic model for urinary calculi in pregnant women: A retrospective cohort study.

The diagnosis of symptomatic urinary stones during pregnancy is challenging; ultrasonography has a low specificity and sensitivity for diagnosing urinary stones. This study aimed to develop a clinical diagnostic model to assist clinicians in distinguishing symptomatic urinary stones in pregnant women. In this retrospective cohort study, we consecutively collected clinical data from pregnant women who presented with acute abdominal, lumbar, and lumbar and abdominal pain at the emergency department of our hospital between January 1, 2017, and December 31, 2019. To distinguish patients with urinary calculi from those without, we reviewed the follow-up records within 2 weeks post-consultation, ultrasonography results within 2 weeks, or self-reports of stone passage within 2 weeks. We selected risk factors from the baseline clinical and laboratory data of patients to establish a diagnostic model. Of the total patients included in the study, 105 patients were diagnosed as having symptomatic urinary stones and 126 were determined to have abdominal pain for reasons other than urinary stones. The initial model had an area under the curve (AUC) of 0.9966. The No-Lab Model had an AUC of 0.9856. The Lab Model had an AUC of 0.832. The Stone Model had an AUC of 0.9952. The simplified Stone Model did not show a decrease in discriminative ability. Of the four diagnostic models that we established for preliminary diagnosis of symptomatic urinary tract stones in pregnant women, the simplified Stone Model demonstrated excellent performance. Users can scan quick response codes to access web-based diagnostic model interfaces, facilitating easy clinical operation.