Low Urine Volume Research Articles

Stone recurrence among Indonesian kidney stone formers: a comprehensive analysis of genetic polymorphism, demographic, and clinical factors

BACKGROUND The recurrence rate of kidney stone disease (KSD) can exceed 50% within 5 years. This study aimed to investigate factors associated with stone recurrence based on single nucleotide polymorphisms (SNPs) of the calcium-sensing receptor (CaSR) rs1801725 and rs1042636, demographic, and clinical profiles. METHODS We collected data on the demographic and clinical characteristics of 80 adult kidney stone formers from April 2021 to September 2022, including peripheral blood samples, morning and 24-hour urine, and 7-day water intake records. Real-time polymerase chain reaction was used to evaluate SNP. Comparisons were made between patients with recurrent and first-time stones. RESULTS 41% of 80 patients have experienced stone recurrence. Recurrent stone formers exhibited significantly higher 24-hour urine calcium excretion (p = 0.03) and lower serum calcium levels (p = 0.019) than first-time stone formers. Hypocitraturia (100%), low urine volume (78%), and hyperoxaluria (55%) were the main abnormalities of all patients. No significant differences were found in CaSR gene polymorphisms and other demographic, biochemical, or clinical parameters. CONCLUSIONS Recurrent stone formers had higher 24-hour urine calcium excretion and lower serum calcium levels. Other risk factors and CaSR polymorphisms may insignificantly affect KSD recurrence.

Rehydration effect of qingshu buye decoction on exercise and high temperature-induced dehydration.

The aim of this study was to conduct a comprehensive evaluation of the rehydration efficacy of QSBYD and elucidate its potential underlying mechanism. 38 participants were randomly assigned to receive either QSBYD or placebo before and after exercise and heat-induced dehydration. Hydration indicators were measured over time. Blood tests assessed cellular anaerobic respiration metabolites, serum inflammatory markers, and coagulation markers. Perceptual measures of thirst, fatigue, and muscular soreness were also taken. QSBYD consumption resulted in lower urine volume (Control vs. QSBYD: 260.83 ± 167.99 ml vs. 187.78 ± 141.34 ml) and smaller decrease in percentage of nude body weight change from baseline (Control vs. QSBYD: -0.52 ± 0.89% vs. -0.07 ± 0.52%). Although no significant differences in urine specific gravity, QSBYD resulted in reduced urine volume at 120 min, suggesting improved fluid retention. Furthermore, QSBYD resulted in lower levels of IL-1β (Control vs. QSBYD: 2.40 ± 0.68 vs. 1.33 ± 0.66 pg/mL), suggesting QSBYD may provide benefits beyond hydration. Further investigation into the underlying mechanisms and long-term effects of QSBYD on hydration is warranted. QSBYD may be an effective alternative to commercial sports drinks in mitigating dehydration effects.

Diagnostic Ability of Ultrasonography Compared with Computed Tomography for Assessing Rectal Feces.

Chronic constipation is a common gastrointestinal disorder, and management is crucial. Computed tomography (CT) is useful for evaluating rectal fecal mass but limited owing to radiation exposure, cost, and inaccessibility at certain facilities. Ultrasonography (US) avoids these pitfalls, but it is unknown whether it accurately assesses rectal feces. In this study, we evaluated the diagnostic performance of US compared with CT as the gold standard for assessing rectal feces. We prospectively evaluated rectal fecal mass retention using US performed within 1 h of CT to assess the degree of agreement between methodologies. Rectal stool findings were evaluated on three levels: no stool (R1), presence of stool (R2), and hard stool filling (R3). The sample included 100 patients (55 men, 45 women), of whom 47 were constipated. The kappa coefficients for rectal content detection were excellent between US and CT (p <0.001). Eighty-two cases (R1: 46 cases; R2: 28 cases; R3: 8 cases) were matched with CT and US findings, and 18 were not. Cases that did not match had low urine or high gas volumes. CT and US findings showed high agreement in constipation (kappa coefficient 0.674, p <0.001) and non-constipation groups (kappa coefficient 0.677, p <0.001). All cases with R3 on CT were found in the constipation group, while more than half of the cases with R1 on CT were in the non-constipation group. CT and US showed high agreement in evaluating rectal fecal mass retention, indicating that US can substitute CT.

Low daily water intake profile-is it a contributor to disease?

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.

Prevalence Of Metabolic Disorders In Paediatric Age Group with Renal Stone Diseases.

Background: inflammation of the urinary tract and prostatic disease is urolithiasis. The causes are numerous , with metabolic diseases , individual life style and environmental factors all playing a part. In pediatric populations , the prevalence of nephrolithiasis is very low; however, some evidence suggests that children are increasingly likely to get this disease. Kidney stone diseases are becoming more frequent among young people, and although the absolute figure remains smaller than in adults , this complex situation however it is should be stressed that factor consists of metabolic disorders such as hypocitraturia, hypercalciuria, and hyperoxaluria. The process of stone production is subject to several factors , for example genetic predisposition , familial background and dietary habits. A commonly employed approach in the prompt identification and treatment of kidney stones involves implementing a comprehensive strategy that tackles both the stones themselves as well as their underlying metabolic problems. It is still necessary to keep on doing research in the area of Pediatric Urology. Only by continuing to do this work will our understanding be deepened and our treatment methods refined in the dynamic world of modern medical science. Objectives: To find out the prevalence of metabolic abnormalities in young children with urolithiasis . Study design: A Retrospective Study Place and duration of the study : Department Of Urology Main Gul Jehanzeb Hospital Swat In Pakistan From January 2018 To January 2019. Methods: From April 2018 to August 2019, the Department Of Urology Main Gul Jehanzeb Hospital Swat carried out a retrospective study. The retrospective study was aimed at analyzing the medical records of 59 patients under the age of 15-year-old with renal stone disease living in this region. Basic details such as age, sex, body mass index (BMI),creatinine levels, serum calcium, serum phosphate, serum uric acid levels, 24-hour urine volume, urinary sodium potassium and chloride content were all obtained and analyzed carefully. The identifications of metabolic diseases were carried out according to recognized laboratory standards. Data processing was performed using SPSS version 22. Results: A total of fifty-nine people ranging from age 8 to 15 years old underwent this study. Of these 25 (42.4%) were female and 34 (57.6%) were male. The mean BMI which the patients exhibited was 16.68 kg/m2. However according to the investigation results, 32 patients (54.2%) had metabolic abnormalities associated with renal stone disease. Hyperuricemia (22%), hypercalciuria (25.4%) and hypokalemia (40.7%) were the three most common diseases identified. Hyperphosphaturia (1.7%), hypocitraturia (1.7%), hyperoxaluria (3%), low urine volume (6.8%) were also found among other types of metabolic abnormalities discovered. Conclusion: According to this study, a large number of children (54.2%) with stone disease in the kidney also had associated metabolic disorders. Hypokalemia was the most common metabolic abnormality in children (40.7%), followed by hypercalciuria (25.4%) and hyperuricemia (22%). These results suggest that children with stone disease in the kidney should be carefully examined for metabolic defects. Primary and secondary prevention methods must be explored in future in order to reduce the occurrence of these problems. Keywords: children with metabolic disorders, kidney stones, hypercalciuria, hypokalemia, and hyperuricemia are frequently seen

Feeding spent hemp biomass to lactating dairy cows: Effects on performance, milk components and quality, blood parameters, and nitrogen metabolism

The legalization of industrial hemp by the 2018 Farm Bill in the United States has driven a sharp increase in its cultivation, including for cannabinoid extraction. Spent hemp biomass (SHB), produced from the extraction of cannabinoids, can potentially be used as feed for dairy cows; however, it is still illegal to do so in the United States, according to the US Food and Drug Administration Center for Veterinary Medicine, due to the presence of cannabinoids and the lack of data on the effect on animals. To assess the safety of this byproduct as feed for dairy cows, late-lactation Jersey cows (245 ± 37 d in milk; 483 ± 38 kg body weight; 10 multiparous and 8 primiparous) received a basal total mixed ration (TMR) diet plus 13% alfalfa pellet (CON) or 13% pelleted SHB for 4 wk (intervention period [IP]) followed by 4 wk of withdrawal period (WP), where all cows received only the basal TMR during WP. The dry matter intake (DMI), body weight, body condition score, milk yield, milk components, and fatty acid profile, blood parameters, N metabolism, methane emission, and activity were measured. Results indicated that feeding SHB decreased DMI mainly due to the low palatability of the SHB pellet, as the cows consumed only 7.4% of the total TMR with 13.0% SHB pellet offered in the ration. However, milk yield was not affected during the IP and was higher than CON during the WP, leading to higher milk yield/DMI. Milk components were not affected, except for a tendency in decreased fat percentage. Milk fat produced by cows fed SHB had a higher proportion of oleate and bacteria-derived fatty acids than CON. The activity of the cows was not affected, except for a shorter overall lying time in SHB versus CON cows during the IP. Blood parameters related to immune function were not affected. Compared with CON, cows fed SHB had a lower cholesterol concentration during the whole experiment and higher β-hydroxybutyric acid during the WP, while a likely low-grade inflammation during the IP was indicated by higher ceruloplasmin and reactive oxidative metabolites. Other parameters related to liver health and inflammatory response were unaffected, except for a tendency for higher activity of alkaline phosphatase during IP and a lower activity of gamma-glutamyl transferase during WP in the SHB group versus CON. The bilirubin concentration was increased in cows fed SHB, suggesting a possible decrease in the clearance ability of the liver. Digestibility of the dry matter and protein and methane emission were not affected by feeding SHB. The urea, purine derivatives, and creatinine concentration in urine was unaffected, but cows fed SHB had higher N use efficiency and lower urine volume. Altogether, our data revealed a relatively low palatability of SHB affecting DMI with minimal biological effects, except for a likely low-grade inflammation, a higher N use efficiency, and a possible decrease in liver clearance. Overall, the data support the use of SHB as a safe feed ingredient for lactating dairy cows.

Successful Treatment of Urolith in a Neutered Persian Cat: A Case Report

Introduction: Uroliths or calculi are the formations of stones in the bladder. The formation of stones is influenced by specific metabolic conditions such as nutritional factors (e.g., protein-rich diet), hydration (lack of water), pH modification, low urine volume, hypercalcemia, or hypophosphatemia. In pet medicine, urolithiasis is common, particularly in cats.&#x0D; Case report: In October 2022, a 2-year-old neutered male Persian cat with a weight of 4 kg was referred to Ardebili Veterinary Pet Clinic (Mashhad, Iran) due to urinating outside the litter box, painful urination, and blood in the urine. A physical examination, ultrasonography, and blood analysis were performed. The physical examination included an assessment of the cat’s body temperature, heart rate, respiratory rate, mental state, mucous membrane color, capillary refill time, cardiopulmonary auscultation, and abdominal palpation. The cat appeared to be in good general health. No abnormalities were detected during the palpation of the bladder. Ultrasonography was performed using a real-time scanner with a 7.5-10 MHz broadband curvilinear probe, and the kidney parenchyma was examined. During the examination, a urolith with a size of 1 mm was observed. According to history and ultrasonography, and physical examination, the diagnosis was urolithiasis. To treat intermittent bladder pain, a spasmolytic drug (Prazosin) was administered at a dose of 0.5 mg/kg for 7 days. By the second day, the symptoms of pain had subsided.&#x0D; Additionally, ciprofloxacin at 20 mg/kg was used to combat infections. Fluoxetine at a 1 mg/kg dose was also administered to control inappropriate urination outside the litter box. After 3 days, the owner reported that the pet’s health improved, and most clinical signs disappeared.&#x0D; Conclusion: Administering appropriate medication (spasmolytic drug, antibiotic, and antidepressant in case of depressed animal and behavioral problems) can alleviate the calculi crystals in a cat’s urinary bladder and prevent future recurrences. In this instance, fluoxetine was discovered to be a successful option for managing pain and solving behavioral problems.

Clinical Effectiveness of Calcium Oxalate Stone Treatments

Introduction: Lowering kidney stone risk and urine calcium oxalate supersaturation is a primary clinical focus for kidney stone prevention and can be achieved with multiple strategies. Common strategies include advice to increase fluid intake, restrict dietary sodium, or prescribing a thiazide-type diuretic. We investigated how physicians make these decisions in real-world practice and evaluate their efficacy based on 24-h urine collections. Methods: We reviewed medical charts for 203 kidney stone formers with idiopathic calcium stones from University of Chicago Kidney Stone Clinic between 2005 and 2020. Patients had three 24-h urines before an initial pre-treatment clinic visit and one follow-up 24-h urine. We analyzed changes in urine composition based on treatment advice using t tests and ANOVA. Results: Patients who received advice to increase fluid intake had lower urine volume at baseline (1.5 vs. 2.5 L/day, p < 0.001) and larger increase in urine volume at follow-up (0.6 vs. 0.1 L/day, p < 0.001) compared to those who did not receive the advice. Patients who were advised to restrict dietary sodium had a higher urine sodium at baseline (208 vs. 139 mEq/day, p < 0.001), a larger reduction in urine sodium (−28 vs. 13 mEq/day, p = 0.002), and larger reduction in urine calcium (−74 vs. −28 mg/day, p = 0.005) compared with those not advised to restrict dietary sodium. Patients started on a thiazide had a higher baseline urine calcium (281 vs. 213 mg/day) and larger reduction in urine calcium (−83 vs. −9 mg/day, p < 0.001) compared with patients not started on a thiazide. In combination, thiazide prescriptions with dietary sodium restriction reduced urine calcium by 99 mg/day and reduced calcium oxalate supersaturation from 8.0 to 5.5 and calcium phosphate supersaturation from 1.4 to 1.0. Conclusion: Providers use 24-h urine data to guide treatment strategy decisions. These strategies achieved the intended effects on urine composition and lowered kidney stone risk.

Differences of Uric Acid Transporters Carrying Extracellular Vesicles in the Urine from Uric Acid and Calcium Stone Formers and Non-Stone Formers.

Background: Low urine pH and volume are established risk factors for uric acid (UA) stone disease (UASD). Renal tubular epithelial cells exposed to an acidic pH and/or UA crystals can shed extracellular vesicles (EVs) into the tubular fluid, and these EVs may be a pathogenic biomarker of UASD. Methods: Urinary EVs bearing UA transporters (SLC2A9, SLC17A3, SLC22A12, SLC5A8, ABCG2, and ZNF365) were quantified in urine from UA stone formers (UASFs), calcium stone formers (CSFs), and age-/sex-matched non-stone formers (NSFs) using a standardized and published method of digital flow cytometry. Results: Urinary pH was lower (p < 0.05) and serum and urinary UA were greater (p < 0.05) in UASFs compared with NSFs. Urinary EVs carrying SLC17A3 and SLC5A8 were lower (p < 0.05) in UASFs compared with NSFs. Urinary EVs bearing SLC2A9, SLC22A12, SLC5A8, ABCG2, and ZNF365 were lower (p < 0.05) in CSFs than UASFs, while excretion of SLC17A3-bearing EVs did not differ between groups. Conclusion: EVs bearing specific UA transporters might contribute to the pathogenesis of UASD and represent non-invasive pathogenic biomarkers for calcium and UA stone risk.

MP26-02 PREVALENCE OF 24-HOUR URINE ABNORMALITIES AMONG OLDER ADULTS WITH URINARY STONE DISEASE

You have accessJournal of UrologyCME1 May 2022MP26-02 PREVALENCE OF 24-HOUR URINE ABNORMALITIES AMONG OLDER ADULTS WITH URINARY STONE DISEASE Ryan Hsi, Mary Oerline, Joseph Crivelli, Vahakn Shahinian, and John Hollingsworth Ryan HsiRyan Hsi More articles by this author , Mary OerlineMary Oerline More articles by this author , Joseph CrivelliJoseph Crivelli More articles by this author , Vahakn ShahinianVahakn Shahinian More articles by this author , and John HollingsworthJohn Hollingsworth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002569.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While urinary stone disease (USD) is traditionally considered a condition affecting working age adults, its prevalence among the older population is increasing. Given physiologic and lifestyle differences between these two populations, there is reason to believe that the frequency of urine chemistry abnormalities may also differ in older adults. In this context, we characterized 24-hour urine findings in a large convenience sample of Medicare beneficiaries. METHODS: For our study, we analyzed urine chemistry data from Medicare beneficiaries 65 years of age and older with a diagnosis of USD, who had a 24-hour urine specimen processed by a large central laboratory in the U.S. between 2010 to 2019. For beneficiaries with multiple submitted specimens, we extracted analyte values from their first collection. Using laboratory reference ranges, we then determined whether a given beneficiary had evidence of hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, or abnormal urine pH. Finally, we examined the frequency of multiple abnormalities (2, 3, and 4 or more) on a single collection. RESULTS: A total of 196,297 beneficiaries underwent 24-hour urine testing for USD. The tests increased from 24,744 in 2010 to 50,936 in 2019 (Figure 1). The sample adequacy, as determined by urine creatinine per body weight, was normally distributed (mean ± SD, 15.0 ± 4.5 mg/kg). Low urine volume was the most common abnormality (urine output less than 2 L/day in 61.9%), followed by hypocitraturia (43.8%), hyperoxaluria (34.2%), hypercalciuria (25%), and hyperuricosuria (17.3%). Twenty-five percent and 31.4% of beneficiaries had high and low urine pH, respectively. High urine sodium was observed in 17.3%. The percentages of beneficiaries with 2, 3, and 4 or more concurrent abnormalities were 33.9%, 35.2%, and 15.8%, respectively. CONCLUSIONS: Older adults with USD frequently have urine chemistry abnormalities, and often more than one abnormality is present. These data suggest that 24-hour urine testing in this population can help providers select interventions to help reduce future stone risk. Source of Funding: NIDDK R01DK121709 © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e438 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Hsi More articles by this author Mary Oerline More articles by this author Joseph Crivelli More articles by this author Vahakn Shahinian More articles by this author John Hollingsworth More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Randomized Trial Evaluating the Use of a Smart Water Bottle to Increase Fluid Intake in Stone Formers

The aim of this study is to evaluate if the use of a smart water bottle improves urine volume in stone forming patients. Adults with nephrolithiasis and low urine volume (<1.5L) documented on a 24-hour urinalysis (24hr U) were randomized to receive either standard dietary recommendations to increase fluid intake (DR arm), or DR and a smart water bottle (HidrateSpark®; Hydrate Inc., Minneapolis, MN) that recorded fluid intake, synced to the user's smartphone, and provided reminders to drink (SBarm). Participants completed baseline surveys assessing barriers to hydration. They then repeated a 24hr U and survey at 6 and 12weeks, respectively. Eighty-five subjects (44 DR, 41 SB) were enrolled. The main baseline factor limiting fluid intake was not remembering to drink (60%). Follow-up 24hr Us were available for 51 patients. The mean increase in volume was greater in the SB arm (1.37L, 95% confidence interval -0.51 to 3.25) than the DR arm (0.79L, 95% confidence interval -1.15 to 2.73) (P=.04). A smaller percentage of subjects in the SB arm reported not remembering to drink as the main factor limiting fluid intake in the follow-up questionnaire compared to baseline (45.4% vs. 68.4%, P<.05). This was not true for the DR arm (40.0% vs. 51.2%, P=.13). Difficulty remembering to drink is a barrier to achieving sufficient fluid intake in stone formers. The use of a smart bottle was associated with greater increases in 24hr U volumes and less difficulty remembering to drink.

Galectin-9 deficiency exacerbates lipopolysaccharide-induced hypothermia and kidney injury.

Galectin-9 (Gal-9) is a multifunctional lectin that moderates inflammation and organ damage. In this study, we tested whether Gal-9 has a protective role in the pathogenesis of endotoxemic acute kidney injury. We examined the levels of Gal-9 in control mice after lipopolysaccharide (LPS) administration. We developed Gal-9 knockout (KO) mice that lack Gal-9 systemically and evaluated the role of Gal-9 in LPS-induced proinflammatory cytokines, vascular permeability, and renal injury. Gal-9 levels were increased in the plasma, kidney, and spleen within 4h after LPS administration to wild-type mice. Gal-9 deficiency did not affect the LPS-induced increase in plasma tumor necrosis factor-α levels at 1h or vascular permeability at 6h. Lower urine volume and reduced creatinine clearance were observed in Gal-9-KO mice compared with wild-type mice after LPS administration. Gal-9-KO mice had limited improvement in urine volume after fluid resuscitation compared with wild-type mice. LPS reduced the body temperature 12h after its administration. Hypothermia had disappeared in wild-type mice by 24h, whereas it was sustained until 24h in Gal-9-KO mice. Importantly, maintaining body temperature in Gal-9-KO mice improved the response of urine flow to fluid resuscitation. Deficiency in Gal-9 worsened LPS-induced hypothermia and kidney injury in mice. The accelerated hypothermia induced by Gal-9 deficiency contributed to the blunted response to fluid resuscitation.

Sensitive detection of testosterone and testosterone prohormone administrations based on urinary concentrations and carbon isotope ratios of androsterone and etiocholanolone.

The testing strategy for the detection of testosterone (T) or T-prohormones is based on the longitudinal evaluation of urinary steroid concentrations accompanied by subsequent isotope ratio mass spectrometry (IRMS)-based confirmation of samples showing atypical concentrations or concentration ratios. In recent years, the IRMS methodology focussed more and more on T itself and on the metabolites of T, 5α- and 5β-androstanediol. These target analytes showed the best sensitivity and retrospectivity, but their use has occasionally been challenging due to their comparably low urinary concentrations. Conversely, the carbon isotope ratios (CIR) of the main urinary metabolites of T, androsterone (A) and etiocholanolone (EITO), can readily be measured even from low urine volumes; those however, commonly offer a lower sensitivity and shorter retrospectivity in uncovering T misuse. Within this study, the CIRs of A and ETIO were combined with their urinary concentrations, resulting in a single parameter referred to as 'difference from weighted mean' (DWM). Both glucuronidated and sulfated steroids were investigated, encompassing a reference population (n = 110), longitudinal studies on three individuals, influence of ethanol in two individuals, and re-analysis of several administration studies including T, dihydrotestosterone, androstenedione, epiandrosterone, dehydroepiandrosterone, and T-gel. Especially DWM calculated for the sulfoconjugated steroids significantly prolonged the detection time of steroid hormone administrations when individual reference ranges were applied. Administration studies employing T encompassing CIR common for Europe (-23.8‰ and -24.4‰) were investigated and, even though for a significantly shorter time period and less pronounced, DWM could demonstrate the exogenous source of T metabolites.

MP02-10 MENHEALTH UROFLOWMETRY APP IS EQUIVALENT TO STANDARD OFFICE UROFLOWMETRY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-10 MENHEALTH UROFLOWMETRY APP IS EQUIVALENT TO STANDARD OFFICE UROFLOWMETRY Michal Tavrovsky, and Roger E. Schultz Michal TavrovskyMichal Tavrovsky More articles by this author , and Roger E. SchultzRoger E. Schultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We compared standard Prometheus Office Uroflowmetry (POU) against the results obtained by a new MenHealth Uroflowmetry App (MUA). The MenHealth Uroflowmetry App (MUA) is a smart phone app that acquires and analyzes the sound of urine voided into a water filled commode. The program calculates maximum and average flow rates as well as volume voided. MUA can be downloaded by patients to their phones for use at home. METHODS: Only men were tested and all were older than 18 years. Group 1 included 47 volunteers with voiding symptoms suggesting overactive bladder and/or outlet obstruction. Group 2 included 15 men with no urinary complaints. Each participant conducted minimum 10 MUA measurements at home and two standard POU tests in our office. Maximum and average flow rates were recorded, as well as voided volume.A comparison of averaged results of MUA and POU was performed using a Bland-Altman analysis and a Passing-Bablok non-parametric regression analysis. Eight participants were excluded from this analysis - four men who did not operate the MUA properly (data was uninterpretable) and four men who could not properly perform the standard POU. A total of 54 participants (43 in Group 1 and 11 in Group 2) were reviewed. RESULTS: Pearson Correlation coefficient R and correlation coefficient R2 during regression data analysis indicated a very strong correlation and fit between Max Flow rate and Average Flow rate when comparing MUA to POU. Slope value close to 1 indicates practically identical sensitivity to flow using both methods. Insignificant difference in mean Max and Average flow rates for Groups 1 and 2 (<0.5ml/s) also proves strong correlation between the two methods and the accuracy of MUA. Statistical analysis also shows no significant difference between the two measurement methods. Figure comparing Max flow rate between the two methods is shown. CONCLUSIONS: The “at home” use of MUA is equivalent to PUO for men with and without voiding symptoms. MUA may be advantageous for the study of men who may not void well in the office because of low urine volume or bashful bladder. MUA permits repetitive measurements without the need for an office visit. Data can be easily transmitted by phone. A few men are challenged by the use of this smart phone App, but more detailed instruction should help minimize any confusion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e15-e15 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michal Tavrovsky More articles by this author Roger E. Schultz More articles by this author Expand All Advertisement Loading ...

MO790PREDICTORS OF ERYTHROPOIETIN HIPORESPONSIVENESS IN PREVALENT PATIENTS ON PERITONEAL DIALYSIS: A CROSS-SECTIONAL STUDY

Abstract Background and Aims Anemia resistant to recombinant human erythropoietin (EPO) is a risk factor for mortality in dialyzed patients with chronic kidney disease. Identifying the causes of hyporesponsiveness may help overcome this resistance. The aim of this study was to investigate the risk factors of EPO hyporesponsiveness in a prevalent population of patients on peritoneal dialysis (PD). Method Cross-sectional study involving 50 prevalent DP patients. To evaluate the dose–response effect of EPO therapy, we used the erythropoietin resistance index (ERI), calculated as the average weekly weight-adjusted dose of EPO (U/Kg per week) divided by the average hemoglobin level (g/dL), over a 3-month period. Patients were classified in two groups according to ERI: ERI ≤ 10 and ERI &amp;gt; 10. We compared clinical, analytical and demographic data among groups. Body composition and fluid volume were evaluated by bioimpedance using the body composition monitor (BCM). Logist regression analysis was performed to identify predictors of EPO hyporesponsiveness. Statistical analysis was executed using SPSS (Version 23 for Mac OSX). Results The average age of 50 prevalent DP patients was 52.04 ± 15.98 years, 29 (58%) were male, 29 (58%) were diabetic and 31 (64%) were treated with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). Average hemoglobin level (Hb) was 10.99 ± 0.81g/dL and average ERI was 7.64 ± 7.25. Eleven patients (22%) had hyporesponsiveness to EPO therapy (ERI&amp;gt;10). There was no age, gender, cause of chronic kidney disease or PD modality difference among groups. There was also no difference in the use of ACEIs or ARBs. Hyporesponsive patients had lower body mass index (BMI) (22.94 ± 2.89 vs 26.74 ± 4.53Kg/m2, p=0.01) and lower lean tissue index (LTI) (9.96 ± 1.94 vs 16.23 ± 18.51Kg/m2, p=0.02), but not fat tissue index (FTI). Weekly creatinine clearance (peritoneal plus urinary), but not Kt/V, was also significantly lower in this group (68.76 ± 37.29 vs 87.84 ± 35.35L/1.73m2, p=0.028). Hyporesponsive patients had lower urine volume (0.73 ± 0.63 vs 1.39 ± 0.67L, p=0.005) and residual kidney function (3.43 ± 3.04 vs 6.13 ± 3.69mL/min/1.73m2, p=0.044). The proportion of patients with fluid overload, defined as overhydration (OH)/extracellular water (ECW) &amp;gt; 15%, was significantly higher in this group (p=0.04). No difference was observed in albumin, c-reactive protein, serum iron, serum ferritin, transferrin saturation index or parathormone among groups. In a logist regression analysis, BMI [(OR) 0.56 (CI: 0.364-0.849)] and LTI [(OR) 0.315 (CI: 0.130-0.767)] were predictors of hyporesponsiveness to EPO therapy. Conclusion Lower BMI and lower LTI were predictors of resistance to EPO therapy in our study. Body composition, fluid status and residual kidney function seem to be the main factors influencing the response to EPO therapy in prevalent patients on PD, emphasizing the importance of strategies oriented to preserve residual kidney function in these patients.

Investigating Fluid Intake in an Underserved Community: What Factors Are Associated with Low Urine Volume on 24-Hour Urine Collection?

Background: Stone prevention is dependent on high fluid intake, with evidence that low urine volume (LUV) can promote nephrolithiasis in the absence of other metabolic abnormalities. Herein, we investigate patient-related factors associated with LUV on initial 24-hour urine collection in an underserved population. Materials and Methods: A retrospective chart review was performed of patients treated by a single surgeon for nephrolithiasis from August 2014 to January 2019. Patients who submitted 24-hour urine samples were divided into two groups based on whether their initial collection was >2 L or not. Factors associated with 24-hour urine volume were analyzed using bivariate and multivariate analyses. As a secondary outcome, we investigated factors associated with corrected 24-hour urine volume on repeat 24-hour urine collection. Results: Two hundred eight patients (45.1%) submitted 24-hour urine collections, 63.9% (133/208) of which demonstrated a urine volume of <2 L. LUV was more common in female patients (77.1% vs 49.5%; p = 0.001) and patients with no insurance and Medicaid (no insurance [100%] vs Medicaid [74.1%] vs Medicare/private [58.6%]; p = 0.02). Female gender and insurance status were independent predictors of LUV in the multivariable analysis. Seventeen of 43 patients (39.5%) with LUV who provided a subsequent collection were able to correct their urine volume. Patients who improved their LUV were older (58.5 vs 45.9 years, p = 0.0149) and more likely to have surgical intervention for their kidney stones (94.1% vs 53.8%, p = 0.006). In our multivariable analysis, surgical intervention was associated with correcting urine volume. Conclusions: Female patients and those with no insurance or Medicaid were more likely to have LUV on an initial 24-hour urine collection. Further research into barriers to fluid intake is important for these two groups, along with directed patient education on strategies for increasing fluid intake.

Sex Differences of Kidney Stone Urine Risk Factors after Roux-en-Y Gastric Bypass

Introduction: Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure that is associated with higher risk of kidney stones after surgery. We examined urine composition in 18 men and women before and after RYGB to examine differences in kidney stone risk. Methods: Three 24-h urine collections were performed before and 1 year after RYGB. We analyzed mean urinary values for pre- and post-RYGB collections and compared men and women. Results: Seven men and eleven women completed pre- and post-RYGB urine collections. Pre-RYGB, men had higher calcium oxalate supersaturation (CaOx SS) (7.0 vs. 5.0, p = 0.04) compared with women. Post-RYGB, women had higher urine CaOx SS (13.1 vs. 4.6, p = 0.002), calcium phosphate supersaturation (1.04 vs. 0.59, p = 0.05), and lower urine volumes (1.7 vs. 2.7L, p < 0.001) compared with men. Discussion/Conclusion: There are important differences in urine composition by sex that may contribute to higher kidney stone risk in women after RYGB compared with men.

Twenty six-week repeat dose oral rat toxicity study of cizolirtine, a substance-P and calcitonin gene-related peptide release modulator

Cizolirtine, a substance-P and calcitonin gene-related peptide release modulator developed for the treatment of pain and urinary incontinence, was orally administered for 26-weeks to rats at dosages of 20, 60 and 200 mg/kg/day. Clinical signs were limited to post-dosing salivation and brown staining on head and muzzle. There were slight decreases in bodyweight gain and slight increases in water consumption among cizolirtine-treated animals. Slight increases in plasma alkaline phosphatase activity, and cholesterol and phospholipid concentrations were observed in mid- and/or high-dose animals. Low urinary volume, pH and sodium and potassium outputs were observed after 12-weeks, and low urinary pH, low sodium and high potassium outputs at end of treatment. Increased relative (to bodyweight) liver weight was observed in high-dose animals. Treated males and high-dose females showed a dose-related increase in the incidence and severity of periacinar hepatocytic hypertrophy and midzonal/periacinar hepatocytic fat vacuolization. Increased incidences of hepatic clear cell foci were observed in all cizolirtine-treated male groups and, to a lesser extent, in treated females. Ovaries of treated females showed a dose-dependent increased incidence of absent corpora lutea and, occasionally, follicular cysts. The dosages of 20 and 60 mg/kg/day were considered as the No-Observed-Adverse-Effect Levels for males and females, respectively.

Frequency of Metabolic Abnormalities in Pakistani Children With Renal Stones

Objective: To determine the frequency of various metabolic abnormalities in children with urinary lithiasis. Methods: This cross-sectional study was conducted at the Armed Forces Institute of Urology, Rawalpindi, from 30 January 2017 to 1 February 2020. A total of 1355 children who were aged 4 to 14 years and who had renal stones were included, while those with urinary tract infections, posterior urethral valve, pelvi-ureteric junction obstruction, reflux disease, and chronic renal failure were excluded. Twenty-four-hour urine samples were analyzed for urinary uric acid, calcium, oxalate, citrate, and magnesium. Demographics and metabolic abnormalities—hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, and hypomagnesuria—were noted and analyzed. Results: The study analysis included 1355 patients. Low urine volume was observed in 465 (34.3%) of the patients. Three hundred nine patients (22.8%) had metabolic abnormalities, the most common being hypocitraturia (184, 59.5%) followed by hypercalciuria (136, 44%) and hypomagnesuria (126, 40.8%). Mean age of presentation, disease duration, recurrent bilateral stones were found significantly different in those having metabolic abnormalities (7.81±2.25 versus 8.76±2.50 P &lt; 0.001, 7.73±1.50 versus 8.43±1.54 P &lt; 0.001, 19.4 versus 2.4% P &lt; 0.001 respectively). No significant difference was found in frequency of abnormal urinary metabolic parameters between boys and girls (P &gt; 0.05) or, upon data stratification, on the basis of disease duration, stone laterality, and recurrence. Conclusion: Metabolic abnormalities were found in 22.8% % of children presenting with urinary lithiasis. The most frequent abnormality observed was hypocitraturia followed by hypercalciuria and hypomagnesuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae.

Risk factors for delayed elimination of high-dose methotrexate in childhood acute lymphoblastic leukemia and lymphoma.

High-dose methotrexate (HD-MTX) therapy is widely used in patients with acute lymphoblastic leukemia (ALL) and lymphoma. However, some patients experience delayed MTX elimination, which requires treatment suspension or dose reduction to avoid organ damage. This single-center retrospective analysis reviewed the clinical data of 88 children with ALL or non-Hodgkin lymphoma who received a total of 269 courses of HD-MTX therapy between April 2008 and April 2019. HD-MTX was defined as MTX administration at 2.0, 3.0, or 5.0g/m2 over a 24-h period, and delayed MTX elimination was defined as a serum MTX concentration ≥ 1.0µmol/L at 48h after the start of HD-MTX. Clinical factors were compared between courses with and without delayed MTX elimination. MTX elimination was delayed in 21 of the 269 courses (7.8%). Multivariate analysis showed that first HD-MTX course (OR 4.04), lower urine volume per BSA on the first day of HD-MTX administration (< 2,675mL/m2, OR 5.10), higher total bilirubin (> 0.5mg/dL, OR 5.11), lower eGFR (< 136mL/min/1.73m2, OR 3.90), higher dose of MTX(> 3.0g/m2, OR 10.8), and lower urine volume per BSA on the next day of starting HD-MTX (< 2,107mL/m2, OR 3.43) were independent risk factors for delayed MTX elimination.