Renal Stone Disease Research Articles

Frequency of urinary metabolic abnormalities in children with renal stone disease.

Objective: The key to preventing morbidity and long-term renal problems is thorough metabolic examination of every child with renal stones. This is meant to assist doctors in creating management protocols that include urine metabolic tests as a key component in an effort to stop stone recurrence. Study Design: Descriptive Cross Sectional study. Setting: Department of Paediatric, National Institute of Child Health, Karachi. Period: January 2021 to February 2022. Material & Methods: To determine how frequently local children with urolithiasis have metabolic problems. A total of 80 children who were aged 4 to 14 years and who had renal stones were included, while those suffering from chronic kidney diseases, liver and biliary tract diseases and children, receiving vitamin D supplementation are excluded. Urine samples were analyzed urinary uric acid, calcium, Demographics and metabolic abnormalities—hypercalciuria, hyperuricosuria analyzed. Results: The study analysis included 80 patients. Seventy one patients (88.8%) had metabolic abnormalities. Most frequent metabolic abnormality was hypercalciuria 60(75%) followed by hyperuricosuria in 52(65%) of participants. There was no significant association observed between metabolic abnormalities and age, gender and BMI classification. Conclusion: Metabolic abnormalities were found 88.8% of children presenting with urinary lithiasis. The most frequent abnormality observed was hypercalciuria followed by hyperuricosuria. Early identification helps manage such patients appropriately, mitigating long-term sequelae.

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

SAT180 Comparison Between Sporadic Primary Hyperparathyroidism And Multiple Endocrine Neoplasia Type 1 (MEN1)-Associated Primary Hyperparathyroidism: A Retrospective Analysis Of The Indian PHPT Registry

Abstract Disclosure: S. Bhadada: None. A.M. Chakraborty: None. P. Kumari: None. R. Pal: None. A. Sood: None. D. Dahiya: None. S.D. Rao: None. Introduction: Multiple endocrine neoplasia type 1 (MEN1)-associated tumours are located in parathyroid, pituitary and pancreatoduodenal locations. Though heterogenous, the most consistent presentation of MEN1 is primary hyperparathyroidism (PHPT) seen in almost 100% of cases. Comparisons between sporadic and MEN1 PHPT patients are sparse in the literature. Objective: To retrospectively compare the demography, clinical manifestations, management, and outcome of sporadic PHPT and MEN1-associated PHPT patients. Design and setting: A registry-based (www.indianphptregistry.com) retrospective cohort study from a tertiary care hospital in North India. Methods and patients: The medical records and clinical data of sporadic PHPT patients and MEN1-associated PHPT patients registered in the Indian PHPT registry were analysed. Result: A total of 616 PHPT patients have been registered in the electronic registry, 72 of whom (11.68%) were MEN1-associated PHPT. The mean age of sporadic PHPT patients was 43.4 ± 14.3, whereas MEN1-associated PHPT was 35.8 ± 13.5 years (p<0.05). Among MEN1-associated PHPT cases, 66 (90%) were index cases at the time of presentation, and the rest were detected on family screening. For both sporadic PHPT and MEN1-associated PHPT, the most common presenting symptom was bone pain, followed by renal stone disease. Sporadic PHPT and MEN1 PHPT both had comparable mean calcium (11.9 ± 1.5 vs 11.9 ± 1.6 mg/dl), mean phosphate (2.7 ± 1 vs 2.58 ± 0.7 mg/dl), median PTH (314; IQR 161-984 pg/ml vs 292; IQR 180-818 pg/ml) level at presentation. Median 25-hydroxyvitamin D level was 19.3; IQR 10.4-30.4 ng/dl, and 15; IQR 8.1 – 25.1 ng/dl (p<0.05) for sporadic PHPT and MEN1-associated PHPT respectively. Multiglandular disease was common in MEN1-associated PHPT (40.2%) compared to sporadic cases (3%). Median tumour weight was higher in sporadic cases (2.5; IQR 0.8- 7.3 gm) compared to MEN1 cases (1.9; IQR 1.08 – 4.05 gm). Ultrasound neck and Sesta-MIBI concordance rate among sporadic cases was 57%, whereas MEN1 cases were 70.8%. Median post-surgery decline in PTH and calcium was more in the case of sporadic PHPT in comparison to MEN1-associated PHPT 84.81% vs 46.7% and 23.4% vs 16.59 % respectively (p<0.05). Discussion: MEN1-associated PHPT patients presented at an earlier age than sporadic cases. There was no statistical difference in PTH, calcium or phosphate levels between the two cohorts, but 25-hydroxyvitamin D levels were lower in MEN1-associated PHPT. Localisation was better in the case of the MEN-1 cohort as per as the Sesta-MIBI and USG concordance was concerned. Postoperative fall of PTH and calcium was more in sporadic cases than in MEN1 cases. Presentation: Saturday, June 17, 2023

A rare case of reactive arthritis with intermittent hematuria in a young male

Reactive arthritis (ReA) is an inflammatory arthritis that manifests days to weeks after a gastrointestinal or genitourinary infection. It is also described as a classic triad of arthritis, urethritis, and conjunctivitis. Here we discuss the clinical presentation of ReA in a 20-year-old male who presented with typical triad of symptoms. But there was presence of hematuria which couldn't be explained by this single diagnosis. So further investigations where necessary to find the cause of his haematuria. A 20-year-old male student with history of childhood onset renal stone disease presented with complaints of dysuria for 3 days followed by bilateral conjunctival congestion along with pain around right hip joint, painful swelling around right ankle joint for 2 days. All examination were normal except for bilateral conjunctivitis and features of right ankle joint arthritis. His blood investigations showed neutrophilic leucocytosis with raised CRP levels. Chlamydia IgM Antibody was detected positive, which revealed the causative organism being Chlamydia Trachomatis. Urine routine showed 50-55 RBC’S and 2+ proteinuria. Hematuria was attributed to the CT evidence of renal stone and abnormal retroaortic coarse of his left renal vein described as posterior nutcracker syndrome.

Temporal trends of post-contrast acute kidney injury in patients with intravenous administration of iodinated contrast medium

Little is known about whether preventative practices for post-contrast acute kidney injury (PC-AKI) recommended in guidelines have been adopted in clinical practice and translated into a lower incidence of PC-AKI. The aim of this study was to examine the yearly trends in the incidence of PC-AKI, and comorbidities and care practices associated with PC-AKI in hospitalized patients who received intravenous administration of iodinated contrast medium (ICM). Adult patients receiving intravenous ICM at the Second Xiangya Hospital of Central South University in China between 2015 and 2021 were included. Temporal trends in the incidence and risk factors for PC-AKI were evaluated using logistic regression analyses with adjustments for relevant variables. The incidence of PC-AKI has declined significantly from 5.3% in 2015 to 4.1% in 2021 (p < 0.001). This decreasing trend persisted after extensive multivariable adjustments. Of the comorbidities associated with PC-AKI, the proportion of patients with congestive heart failure or hypertension increased, while the proportion of patients older than 75 years, or with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2, diabetic nephropathy, or renal stone disease decreased. Among the care practices associated with PC-AKI, the proportion of patients using nephrotoxic drugs decreased, whereas the proportion of patients receiving intravenous fluids > 1000 mL on the day of ICM administration or using iso-osmolar ICM increased. In conclusion, a declining trend in PC-AKI incidence was observed in patients receiving intravenous ICM between 2015 and 2021, which may be related to increased awareness and efforts to prevent PC-AKI.

Evaluation of RNA Based Biomarker Expression in Acute Kidney Injury after ESWL

Background Extracorporeal shock wave lithotripsy (ESWL) was introduced more than three decades as an authentic modern modality for the treatment of urinary stone disease. It is considered first choice of treatment for nearly all kinds of urinary tract calculi. Objective To evaluate the damage effect of ESWL on kidney tissue by measuring non-coding lncRNA profile in serum before and after ESWL session and assess their usefulness as diagnostic biomarkers for AKI and the relationship between the selected RNA based biomarker panel and clinicopathological changes of patients. Patients and Methods It is a prospective randomized control study assessing the damage effect of ESWL on kidney tissue by measuring non-coding lnc-RNA profile in serum before and after ESWL session(s) in 20 patients and compare it to control group of 20 healthy persons with no known urogenital disease and no known history of urologic pathology. Results The results favored outcomes of pre procedure lncRNA showed a statistically significant reduction after 48 hours after the procedure (p = 0.017). In comparison with control group the lncRNA showed a statistically significant difference between patients and controls at 2 hours and 48 hours after the procedure (p = 0.03 and 0.01, respectively). Conclusion Although ESWL is considered a safe and effective procedure in the treatment of renal stone disease yet it may cause acute renal injury. In this study, serum lncRNA rises significantly following acute renal injury caused by ESWL. Hence, serum lncRNA together with other kidney function tests as serum urea, creatinine can be used as acute renal injury markers following ESWL in patients with renal stone disease.

Effect of Shock Wave Frequency on Stone Disintegration in Extra Corporeal Shock Wave Lithotripsy

Background The use of Shock Wave Frequency (SWL) for the treatment of renal stones has brought a revolution in the field of urology. Not only has it decreased hospitalization duration and morbidity, but it has also shown to be cost-effective. SWL treatment is noninvasive, doesn't require anesthesia, and may be done in outpatient settings. As a result, when it comes to treating renal and upper and middle ureteric stones, ESWL is still the best option. Objective To evaluate of the effect of shock wave frequency on treatment outcomes in terms of success and complication rates. Methods This is a prospective study conducted on 135 patients with renal stone planned to have ESWL sessions attending urology outpatient clinic in Ain Shams University and Misr University for Science and Technology hospitals. Patients were recruited from the outpatient clinic from age 18 years to 70 years old with renal or upper ureteric stone who are candidate for ESWL. Patients were assigned to 3 equal groups who received the same number of shock waves (3000 shock waves) with different shockwave frequency. Results The results revealed that there was no statistically significant difference found between the three studied groups regarding age, sex, BMI, side, site, size of stone and house field unit (density of stone). As regard sensation of pain during session, there was difference between patients’ groups where pain sensation increases as the frequency rate increase. But there was no statistically significant difference found between frequency 60 and frequency 90 groups regarding pain score. While there was statistically significant increase in the pain score in frequency 120 group than the other both groups 60/min and 90/min. There was no statistically significant difference found between the three studied groups regarding results of stone clearance. Conclusion Extra corporeal shock wave lithotripsy (ESWL) is still one of the most effective methods in treatment of upper urinary tract stones. It also remains the only truly non-invasive treatment in renal and upper ureteric stone diseases. There is evidence that modifying lithotripsy parameters like frequency of disintegration is strongly related to the outcome of the treatment. Intermediate shock wave frequency (90/min) is associated with highest success rate (95.3%) followed by the low frequency group (60 /min) and both are better in outcome than high frequency (120/min). With increasing the frequency of disintegration, duration of session decrease with pain sensation during the treatment increase. Highest shock wave frequency (120/min) is associated with lowest success rate as well as highest pain sensation during session.

The Role of Osteopontin in Respiratory Health and Disease.

The biological functions of osteopontin (OPN) are diverse and specific to physiological and pathophysiological conditions implicated in inflammation, biomineralization, cardiovascular diseases, cellular viability, cancer, diabetes, and renal stone disease. We aimed to present the role of OPN in respiratory health and disease. OPN influences the immune system and is a chemo-attractive protein correlated with respiratory disease severity. There is evidence that OPN can advance the disease stage associated with its fibrotic, inflammatory, and immune functions. OPN contributes to eosinophilic airway inflammation. OPN can destroy the lung parenchyma through its neutrophil influx and fibrotic mechanisms, linking OPN to at least one of the two major chronic obstructive pulmonary disease phenotypes. Respiratory diseases that involve irreversible lung scarring, such as idiopathic pulmonary disease, are linked to OPN, with protein levels being overexpressed in individuals with severe or advanced stages of the disorders and considerably lower levels in those with less severe symptoms. OPN plays a significant role in lung cancer progression and metastasis. It is also implicated in the pathogenesis of pulmonary hypertension, coronavirus disease 2019, and granuloma generation.

Therapeutic voyage of synthetic and natural xanthine oxidase inhibitors.

Xanthine oxidase (XO) inhibitors are commonly used to treat gout, nephropathy, and renal stone diseases related to hyperuricemia. However, recent research has shown that these inhibitors may also have potential benefits in preventing vascular diseases, including those affecting the cerebrovasculature. This is due to emerging evidence suggesting that serum uric acid is involved in the growth of cardiovascular disease, and XO inhibition can reduce oxidative stress in the vasculature. There is a great interest in the development of new XO inhibitors for the treatment of hyperuricemia and gout. The present review discusses the many synthetic and natural XO inhibitors that have been developed which are found to have greater potency.

Prediction of Stone Free Rate after Standard Percutaneous Nephrolithotomy using Stone Nephrolithometry Score in Nobel Medical College Teaching hospital – A Prospective Study

Background: Amongst all the modalities of treatment for renal stones, percutaneous nephrolithotomy is preferred treatment for large volume renal stone disease. However, percutaneous nephrolithotomy is associated with the risk of postoperative complications and the problem of stone free status. So, a preoperative classification is necessary to grade the complexity of percutaneous nephrolithotomy and STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is one of such kind.&#x0D; Materials and Methods: This is analytical study conducted at the Department of Urology and Kidney Transplant, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal from January 2020 to July 2020. Total 115 patients were included in the study. These patients were subjected for percutaneous nephrolithotomy. Stone clearance was documented at the end of the surgery; on first postoperative day and at 4 weeks.&#x0D; Results: In our study the stone – free rate was 89.6%. 32 patients experienced complications (27.8%). The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) score correlated with the postoperative stone – free status (P=0.001). The patients rendered stone free had statistically significant lower scores than the patients with residual stones (6.83 ± 1.83 vs 9.83 ± 2.08, P = 0.001).&#x0D; Conclusion: The STONE (stone size, tract length, degree of obstruction, number of involved calices, and stone essence) nephrolithometry score is a simple and easy tool to apply system for predicting complexity in stone clearance with percutaneous nephrolithotomy.

Frequency of Different Metoboloic Abnormalities in Paediatric Age Group with Renal Stone Diseases

Introduction: Up to 15% of children under the age of 15 may have paediatric urolithiasis, which is linked with severe morbidity and high recurrence rates. This condition is still a serious urological concern. In 86% to 96.1% of kids with kidney stone disorders, metabolic abnormalities are one of the most frequent causes of urolithiasis. Hypercalciuria, hyperoxaluria, hyperuricosurea, and hypocitraturea are the most prevalent metabolic disorders. In order to treat and prevent renal stones in children with renal stone disorders, it is crucial to identify several metabolic abnormalities. Materials and Methods: Descriptive Cross-Sectional Study at the IKD, HMC, Urology Department. This research covered paediatric patients with urolithiasis under the age of 15 years. All patients with urolithiasis had a 24-hour urine assay for metabolic abnormalities on their first visit. Results: 119 individuals, or 72.12%, of the total 165 patients, exhibited metabolic disorders. Out of 119 patients, hypercalciurea affected 56 patients (47.05%), hypocitraturea affected 31 patients (26.05%), hyperoxalurea affected 18 patients (15.12%), and hyperuricosurea affected 14 patients (11.65%). 41 patients, or 34.45% of the 119 total patients, were female youngsters, making up 78 patients (65.54%). The most frequent findings were hypocitraturea and hypercalciuria. Conclusion: Urolithiasis in children is often brought on by metabolic disorders, which are curable and avoidable. In order to detect, treat, and prevent urolithiasis recurrence as well as morbidities brought on by urolithiasis in paediatric patients, it is advised that all paediatric patients presenting with urolithiasis for the first time undergo extensive investigation. Keywords: Metabolic Abnormalities, Recurrent Renal Stones, Urolithiasis

Prevalence and Risk Factors of Renal Stones Among the Bisha Population, Saudi Arabia.

In urolithiasis, urinary calculi are formed in the urinary system. Stone development does not initially result in any symptoms, but later renal colic, flank pain, hematuria, obstruction of urine flow, and/or hydronephrosis may indicate renal stone disease. In addition to age, gender, ethnicity, and local climate, urolithiasis can be caused by several other factors. The prevalence and recurrence rate of kidney stone disease is rising globally, while few effective treatment options currently exist. Between June and October 2022, a cross-sectional study was conducted. An electronic questionnaire subdivided into three categories was used to determine the prevalence and identify the factors that increase the likelihood of developing urolithiasis among the population in Bisha. The collected data werereviewed and analyzed via IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. A total of 1,002 participants filledoutthequestionnaire. The age of the participants ranged from 18 to over 60 years, with an average age of 26.1 ± 13.9 years. There were 451 female participants(45%), and 927 (92.5%) were Saudis. According to the participants' body mass index, 98 (9.8%) were underweight, 388 (38.7%) were normal weight, 300 (29.9%) were overweight, and 216 (21.6%) were obese. The total number of participants with urolithiasis was161(16.1%),and 420 (41.9%) had a family history of renal stones. Urolithiasis was found to be significantly associated with family history, smoking, diabetes, hypertension, hyperthyroidism, gout, and chronic kidney disease. Older age and female gender were also associated with the risk of having urolithiasis. This study found urolithiasis to be highly prevalent among the Bisha population. In terms of risk factors, body mass index, smoking, and diabetes were the most significant. Based on the findings of this study, the authors recommend more public education regarding urolithiasis and its risk factors, emphasizing the importance ofpreventingthe disease and the ways of treating urolithiasis through medical campaigns and social media.

Finding the optimal anesthetic technique during PCNL for renal stone disease: A comparison of general, spinal, and combined spinal epidural anesthesia

Background: Renal stone disease is prevalent worldwide. Percutaneous nephrolithotomy (PCNL) has become an important mode of treatment for large size renal stones. Various anesthetic techniques have described for performing PCNL, with each having its own merits and demerits. There is lacuna in evidence for the ideal mode of anesthesia with best results and least associated complications. Aims and Objectives: PCNL is a common procedure for renal stones. It can be performed under various anesthesia techniques. Selection of an appropriate anesthetic technique is essential for successful outcome. In this study, we compared three anesthesia techniques during PCNL and their outcomes. Materials and Methods: Retrospective and observational study involved all cases of PCNL performed from February 2022 to January 2023. Baseline clinical and anesthesia parameters were recorded. Three groups based on anesthesia method were made; Group A for general anesthesia (GA), B for spinal anesthesia (SA), and C for combined spinal epidural anesthesia (CSEA). Intraoperative variables including heart rate (HR), blood pressure, operation time, and analgesia adequacy were noted. Post-operative pain level, hospital stay, stone free rate (SFR), complications, patient, and surgeon satisfaction were recorded. Results: Seventy-two cases (56 Male and 16 Female) with a mean age of 36.2±15.9 years were included in the study. Age and body mass index were lower in Group A, while ASA status and comorbidities were comparable. Intraoperative HR and mean blood pressure were higher in Group A than in B and C (P=0.000, P=0.003). Hypotension was more frequent in Group B (24.1%, P=0.046). Operation time, hospital stay, transfusion rates, SFR, and overall patient satisfaction were similar. Group A patients experienced more post-procedure pain (Visual analogue scale 4.1 vs. 2.2 vs. 2.1; P=0.001). Nausea-vomiting and shivering episodes were also higher in Group A (P=0.033, P=0.021). Anesthetic effect weaned-off in 6 patients of SA. Post-operative headache was higher but non-significant in Group B and C (P=0.621). Conclusion: CSEA appears a superior alternative to both SA and GA, with additional adequate post-operative comfort.

Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?

Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.

Artificial Neural Networks for Diagnosis of Kidney Stones Disease

The foundation of medical care for children with renal stone disease is the assessment of metabolic risk factors, which aims to stop the growth of preexisting calculi and subsequent stone occurrences. In this retrospective analysis, 90 children with kidney stone disease who had been sent to our institution and had undergone clinical testing in accordance with a defined procedure had their metabolic risk factors, clinical histories, and family histories assessed. Our pediatric patients were 10.7 years old on average, with a male to female ratio of 1.14:1.0. In 84.4% of the instances, biochemical abnormalities were discovered. Of the patients, 52.2% (n = 47) had only one urine metabolic risk factor, whereas the remaining 31.1% (n = 28) had several risk factors. Adrenal hypercalciuria. The aim of this work is to compare the performance of all three neural networks on the basis of its accuracy, time taken to build model, and training data set size. We will use Learning vector quantization (LVQ), two layers feed forward perceptron trained with back propagation training algorithm and Radial basis function (RBF) networks for diagnosis of kidney stone disease. In this work we used Waikato Environment for Knowledge Analysis (WEKA) version 3.7.5 as simulation tool which is an open source tool

A narrative review on efficacy of homoeopathic medicine Pareira brava in urolithiasis.

Urolithiasis orNephrolithiasis commonly known as renal calculi, kidney stones, or urine calculi, are terms used to describe the disease of renal stones. Since many years, mankind has been afflicted with this condition, which, if left untreated, may progress to End Stage Renal Disease (ESRD). The multiple aetiology and risk factors of renal stone disease affect about 12% of the world's population. Understanding the process of stone production is extremely difficult because there are many different types of stones, including calcium oxalate and calcium phosphate. The conventional medical system has used a variety of medications and procedures, including PCNL and ESWL, to treat urolithiasis. However, the rate of recurrence is remainshigh. Extracts from plants are now utilized to treat kidney stones. There is evidence that homoeopathic medications are employed as curative therapies as well. One of the treatments that homoeopaths usually recommend for kidney stone disease is Pareira Brava. Therefore, use of homoeopathic intervention is attempted in the current review in an effort to shed insight on the evolutionary changes in stone production technology and to lower the recurrence rate.

Renal stone disease

Renal stone disease (urolithiasis, nephrolithiasis) covers many conditions causing kidney, ureteric or bladder stones. These include metabolic and inherited disorders, anatomical defects of the upper or lower urinary tract, and chronic urinary infection. However, most cases of renal stones are idiopathic. They present with loin or abdominal pain, and visible or non-visible haematuria; this is followed by the eventual passage of a stone and resolution, or the need for further investigation and intervention. Renal stones often recur, and it is important to identify the underlying cause, particularly because the risk can be related to diet and lifestyle, and is often associated with hypertension and/or diabetes mellitus. Although clinical management is largely surgical and can seem straightforward, the increasing prevalence of renal stone disease in developed countries is becoming a significant health and economic burden.

MP10-06 RISK FACTORS FOR NEPHROLITHIASIS IN 24-HOUR URINE STUDIES OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD)

You have accessJournal of UrologyCME1 Apr 2023MP10-06 RISK FACTORS FOR NEPHROLITHIASIS IN 24-HOUR URINE STUDIES OF PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) Michelle Chen, Alex Nourian, Johnathan Drevik, Eric Ghiraldi, and Justin Friedlander Michelle ChenMichelle Chen More articles by this author , Alex NourianAlex Nourian More articles by this author , Johnathan DrevikJohnathan Drevik More articles by this author , Eric GhiraldiEric Ghiraldi More articles by this author , and Justin FriedlanderJustin Friedlander More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003225.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been suggested to be an independent risk factor for renal stone disease by several studies. We aimed to identify abnormalities on 24-hour urine collection in this patient population. METHODS: 24-hour urine collections from a single tertiary care center were retrospectively reviewed from May 2014 to May 2021. Univariate analysis was performed using Chi-square test and unpaired T-test for categorical and continuous variables, respectively. A multivariable logistic regression was performed controlling for age, body mass index (BMI), diabetes mellitus (DM). RESULTS: 98 (24%) of 406 patients who met inclusion criteria were identified to have radiographic hepatic steatosis. There were no differences in baseline characteristics between groups including age, race, and gender. On univariate analysis, patients with NAFLD had decreased urinary pH (5.88 vs 6.06, p=0.02), elevated urinary oxalate (40 vs 36, p=0.04), calcium (219 vs 186, p=0.02) and sodium (185 vs 163, p=0.02) relative to those who did not have fatty infiltration of the liver on imaging. After controlling for DM and obesity as defined as BMI≥30, no 24-hour urine abnormalities were identified. CONCLUSIONS: After adjusting for confounding factors, patients with hepatic steatosis did not have identifiable abnormalities in their 24-hour urine studies. Increased risk of nephrolithiasis in patients with NAFLD is likely related to contributors of metabolic syndrome such as diabetes and obesity. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e116 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michelle Chen More articles by this author Alex Nourian More articles by this author Johnathan Drevik More articles by this author Eric Ghiraldi More articles by this author Justin Friedlander More articles by this author Expand All Advertisement PDF downloadLoading ...

Increased renal uptake and urine excretion of oxidized LDL is possibly associated with formation of large calcium oxalate nephrolithiasis: a preliminary study

Growing evidence have suggested an association between nephrolithiasis and cardiovascular disease (CVD)with unclear mechanism. Oxidized low-density lipoproteins (oxLDL) induces atherosclerosis and was found to be the possible link between these two diseases. Our study aimed to examine the serum, urine and kidney expression of oxLDL in relation to large calcium oxalate (CaOx) renal stone disease. A total of 67 large CaOx dominant renal stone patients and 31 stone-free controls were enrolled in the prospective case-control study. All participants were without known CVD history. Serum, urine, and kidney biopsy were collected before and during percutaneous nephrolithotomy, respectively. Enzyme-linked immunosorbent assays were used to assess serum and urine oxLDL, lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1), and high-sensitivity C-reactive protein (hsCRP). There was no significantly difference in circulating oxLDL, but serum hsCRP was significantly near two-fold higher in nephrolithiasis patients. Serum hsCRP was also correlated with stone maximal length. Urine oxLDL was significantly higher in the nephrolithiasis group and correlated with serum hsCRP and stone maximal length. Increased oxLDL uptake in kidney was found in nephrolithiasis patients, whereas no significantly renal expression of oxLDL was observed in controls. The renal uptake of oxLDL with increased oxLDL excretion from large CaOxrenal stone formers, independent of increased circulating oxLDL, is a novel pathological finding in kidney stone disease and brings attention to the possible involvement of renal steatosis in the process of urolithiasis formation.

Epidemiology and demography of Chronic Kidney Disease in Pakistan- A review of Pakistani literature

Background:&#x0D; CKD is spreading like an epidemic. There is a dire need to understand the true prevalence as well as the causes of CKD in both urban and rural areas of Pakistan in relevance to age and gender. In this background, there is a need to know what has been done so far to understand the status of CKD in Pakistan.&#x0D; Materials and Methods:&#x0D; We selected the articles published through PubMed and Google scholar and the following keyword were used, epidemiology, demography, prevalence, chronic kidney disease, chronic renal insufficiency, etiology, and causes of CKD, Pakistan. We found four articles that evaluated the prevalence and five articles that dealt with the causes of CKD. We included all articles in our analysis.&#x0D; Results:&#x0D; The overall prevalence among all age groups was found to be 21.2%. The highest CKD prevalence was reported as 29.9% and the lowest at 12.5%. The highest prevalence was found in patients more than 50 years of age (43.6%). Two studies showed male predominance (62% and 54.4%), while two showed a female majority (64%,52%). The most common cause of CKD was found to be Diabetic nephropathy (27.1%), followed by CKD of unknown etiology (16.6%) and renal stone disease (12.4%)&#x0D; Conclusion:&#x0D; The prevalence of CKD is high, especially in the older population. Similarly, the leading causes of CKD are also different in all studies due to center dependence, hospital-specific and urban locations. DM, CKDu, and renal stone disease are common causes of CKD&#x0D; &#x0D; Keywords: Pakistan, chronic kidney disease, prevalence, epidemiology,