Renal Stone Group Research Articles

Evaluation of Serum Procalcitonin and Other Kidney Function Test in Patients with Large Renal Stone

Background: Renal stone disease is a main cause for acute kidney injury . Renal stone can damage the tubular epithelial cells, which can lead to functional loss of the renal parenchyma. Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin . PCT levels are marker for determine if a patient has an infection , bacteria selectively aggregate to crystal and that bacteria are associated with an increased number of crystal-crystal agglomerations. Bacteria-crystal aggregates bind to the tubular epithelium resulting in expression of stone matrix proteins in either renal tubular epithelium or inflammatory cells. Objective: To estimate serum procalcitonin (PCT) in primary renal stone patients and compare it with secondary renal stone group when renal stone size ≥ 1.5 cm. Subjects, Materials and Methods: This Cross-sectional Study was designed incorporation with college of Medicine , Mustansiriya university , chemistry and biochemistry Department . Samples were taken from Al Yarmouk teaching hospital in Bagdad , urology department . A total number of eighty eight (88) patients were registered (44 male ) and (44 female ) aged between (30-40) years. The total subjects were divided into two groups:Group I : Patients with Primary Renal Stone , Group II: Patients with Recurrent(secondary) renal stone . Results: Analysis of variance for serum PCT were significant , p ≤0.0001, indicating there were significant difference in serum PCT among renal stone size in primary renal stone group and recurrent(secondary) renal stone group . Conclusion: Serum procalcitonin increased significantly in patients with recurrent renal stone disease ,therefore, it is considered as a predictor of kidney stone disease. Keywords: Serum Procalcitonin , Primary Renal stone , Secondary Renal stone , Serum uric acid , and Serum Albumin .

Management of complex renal stones by a novel ureterorenoscope with vacuum suctioning system combined with flexible ureteroscope

Objective: To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones. Methods: Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients' information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared. Results: A total of 347 patients were included in the study, with 220 males and 127 females. The age [M(Q1,Q3)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [M(Q1,Q3)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (P=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, P<0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5), P=0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, P=0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, P<0.001), while the difference in complication rate was not statistically significant (P>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm, P<0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm, P=0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, P<0.001) and lower complication rate(10.7% vs 31.6%, P=0.012) compared to those with stone size >40 mm. Conclusion: Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.

Initial clinical experience with the new thulium fiber laser: first 50 cases.

To evaluate the efficacy, safety, and laser settings of thulium fiber laser (TFL) in laser lithotripsy during retrograde intrarenal surgery (RIRS) for ureteral and renal stones. A prospective study of the first 50 patients with ureteral and renal stones who underwent RIRS using TFL (SOLTIVE Premium, Olympus, Japan) was performed. 200 and 150µm laser fibers were used for ureteral and renal stones, respectively. Stone size, stone density, laser-on time (LOT), and laser settings were recorded. We also assessed the ablation speed (mm3/s), laser power (W), and Joules/mm3 values for each lithotripsy. A total of 50 patients were included in the study with a median (IQR) age of 66 (55.5-74) years old for patients with ureteral stones and 55 (44-61.5) years old for patients with renal stones. Most of the patients had a Charlson comorbidity index score of 0. Median (IQR) stone volume for ureteral stones was 486 (332-1250) mm3 and for renal stones was 1800 (682.8-2760) mm3. Median (IQR) stone density for ureteral and renal stones was 998 (776-1300) HU and 1200 (750-1300) HU, respectively. Median (IQR) pulse energy for ureteral stones was 0.4 (0.2-0.4) J; and for renal stones, 0.3 (0.2-0.6) J. Median pulse frequency, laser power, and laser operative time were higher in the renal stones group. The overall complication rate was low in both groups. TFL is a safe and effective modality for lithotripsy during RIRS with minimal complication rates.

A clinical prediction rule for uncomplicated ureteral stone: The STONE score; a prospective observational validation cohort study

IntroductionRenal colic is one of the most common complaints in patients admitted to Emergency Department (ED). Computed Tomography (CT) is the reference standard for the diagnosis of any stones in the kidneys or ureters. However, CT has classical disadvantages, such as radiation exposure, cost and availability. Recently, STONE clinical prediction criteria were suggested to identify uncomplicated ureteral stone cases among patiens admitted to the ED with abdominal pain. Primary objective of this study was the external validation of the STONE criteria. MethodsThis was a diagnostic accuracy study conducted on a prospective, observational cohort. All consecutive patients who underwent a non-enhanced abdominopelvic CT scan in the ED with an initial diagnosis of ureteral stone disease were enrolled. Using a pre-prepared checklist, all data and the final diagnosis according to the CT scan were recorded. STONE score was calculated for all patients. The area under the curve (AUC) of the STONE Score and the CT, the reference standard, were compared using the ROC curve analysis. ResultsTotally, 237 patients (59.9% male) with an average age of 41.54 years (SD: 13.37) were evaluated, and 156 cases (65.8%) were proved to have renal stone. The mean (SD) STONE scores in the groups of patients with renal stone and in the group of patients without renal stone group were 9.1 (2.6) and 6.0 ( 2.8), respectively (p < 0.001). The area under the curve (AUC) for the STONE score was 0.789 (95% confidence interval (CI) 0.725 to 0.852). The optimum threshold value of the STONE score for the diagnosis of a renal stone was 8 or more, which had a sensitivity of 75.0% and a specificity of 70.4%. ConclusionDespite the acceptable diagnostic accuracy, further modifications and enhancements of the STONE score are needed to differentiate patients with low risk prior to imaging.

Bidirectional association between gallstones and renal stones: Two longitudinal follow-up studies using a national sample cohort

The present study evaluated the associations between gallstones and renal stones using a national sample cohort of the Korean population. The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. We designed two different longitudinal follow-up studies. In study I, we extracted gallstone patients (n = 20,711) and 1:4-matched control I subjects (n = 82,844) and analyzed the occurrence of renal stones. In study II, we extracted renal stone patients (n = 23,615) and 1:4-matched control II subjects (n = 94,460) and analyzed the occurrence of gallstones. Matching was performed for age, sex, income, region of residence, and history of hypertension, diabetes mellitus, and dyslipidemia. Crude and adjusted hazard ratios (HRs) were calculated using a Cox proportional hazards model, and the 95% confidence intervals (CIs) were calculated. Subgroup analyses were performed according to age and sex. The adjusted HR of renal stones was 1.93 (95% CI = 1.75–2.14) in the gallstone group (P < 0.001). The adjusted HR of gallstones was 1.97 (95% CI = 1.81–2.15) in the renal stone group (P < 0.001). The results were consistent in all subgroup analyses. Gallstones increased the risk of renal stones, and renal stones increased the risk of gallstones.

Role of Calcium to Citrate Ratio in Predicting Stone Formation in Idiopathic Hypercalciuria Children (2-12 Years Old)

Considering the predictive role of the relatively low urinary citrate for stone formation, especially in hypercalciuric patients, this study is aimed at comparing urine calcium to citrate (Ca/Cit) ratio in 3 groups of children, including patients with idiopathic hypercalciuria with and without renal stone as well as the healthy children. This study was carried out on 96 children (2 to 12years old) referred to a pediatric nephrology clinic in the city of Ahvaz, Southwest Iran. All the children underwent renal ultrasonography, urinalysis, and measurement of random nonfasting urine Ca, Cr, and citrate. Those with secondary hypercalciuria, urinary tract malformations, and/or functional abnormalities of the gastrointestinal tract were excluded from the study. The mean Ca/Cit. ratio (mg/mg) in the three groups, including children with hypercalciuric with and without renal stones and the healthy children (control group), was 0.44±0.14, 0.39±0.13, and 0.19±0.08, respectively, which showed a significant difference (P<.001). There was also a significant difference in Ca/Cit ratio between the first and the control group by Tukey's range test (P<.001). Mean urinary Ca/Cit ratio in those with a positive family history of urolithiasis within three groups was 0.42±0.17 and in those with a negative family history was 0.32±0.16 (P=.013). Mean Ca/Cit. ratio (mg/mg) of 0.25 showed a sensitivity of 90.6% (confidence interval: 75.7-96.7%) and a specificity of 81.2% (confidence interval: 64.7-91.1%) to differentiate between the renal stone group and the control group. High Ca/Cit ratio can predict stones formation in hypercalciuric patients, especially in those with a positive family history of urolithiasis. The present study found the cutoff level of 0.25 for Ca/Cit. ratio as the highest prognostic value for renal stone formation.

Evaluation of the Hazards of Flexible Ureteroscope for the Treatment of Renal and Ureteral Calculi during the Learning Curve

AbstractBackground: Management of urolithiasis varies from simple clinical observation and medical expulsive therapy to the use of refined endourologic techniques to extract the stone. The therapeutic technique currently available comprises ureteroscopy with or without the need for intracorporeal lithotripsy, percutaneous therapy, (PCNL) Extracorporeal Shock Wave Lithotripsy (ESWL), and surgical modalities (4,5).Objective: Urolithiasis (UL) is one of the most common diseases, with worldwide increasing incidence and prevalence.Aim of the Work: Was to report the hazards of Flexible Ureteroscopy (FURS), the re-treatment rate and its complica-tion outcomes for the treatment of renal and ureteral calculi during the learning curve.Patients and Methods: This study was conducted prospec-tively on forty patients divided into two groups; Group I (ureteric stone group) and Group II (renal stone group)to compare the complications after the introduction of FURS. They underwent FURS and Holmium: YAG laser lithotripsy. The complications were classified using modified stave and the Clavien system (I-IV).Results: The mean patient age in the total procedures was 45.63±10.98 years (range 27.0-62.0 years), and the mean stone size was 1.36±0.37cm (range 0.6-2cm). Group I: Mean stone size 1.36±0.37cm, the stone free rate for all cases was 77.3% (100% for stones <1.5cm and 50% for stones ³1.5cm). The overall intra-operative complications rate in all cases was 27.2% (8.3% for stones <1.5 and 50% for stone size ³1.5cm). The overall post-operative complications rate was 27.4% (9% for stones <1.5cm and 60% for stones ³1.5cm.Group II: The mean stone size 1.46±0.31, the stone free for all cases was 44.4% (70.0% for stones <1.5cm and 12.5%. for stones ³1.5cm. The overall intra-operative complications rate in all cases was 72.2% (52% for stones <1.5cm and 100% for stones size ³1.5cm. The overall post-operative complications rate was 77.7% (60% for stones <1.5cm and 100% for stones ³1.5cm was.Conclusions: The results of the current study indicated that stone size, stone site and surgeon experience were factors affecting complication rates after FURS.

Buccal mucosa urethroplasty for female urethral stricture—Report of two cases and literature review

s / Urological Science 26 (2015) 301e310 308 regression for all patients, only stone size, BMI and ureter or renal stone got statistically significant. In univariate analysis of the renal stone group, we can find that age BMI and stone size showed statistically significant to influence the success rate. In the multivariate logistic regression of the renal stone group, BMI and stone size are the independent factors which affect the success rate. In univariate analysis of the ureteral stone group, only the stone size showed statistically significant. In the multivariate logistic regression of the stone length and stone width of the ureteral stone, only stone length is the independent factor. Conclusion: Stone size is the most important factors influencing the outcome of ESWL both in renal stone and ureteral stone. In the ureteral stone group, the stone length is the more important factor than stone width. NDP23: BUCCAL MUCOSA URETHROPLASTY FOR FEMALE URETHRAL STRICTUREdREPORT OF TWO CASES AND LITERATURE REVIEW Kuan-Jung Lin , Chi-Cheh Lin , Alex Tong-Long Lin , Kuang-Kuo Chen . Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3 Shu-Tien Urological Science Research Center,

Comparative study of percutaneous nephrolithotomy versus open stone surgery for management of patients with large staghorn calculi

s / Urological Science 26 (2015) S50eS81 S75 success rate. In the multivariate logistic regression of the renal stone group, stone width is the independent factor which affects the success rate. In univariate analysis of the ureteral stone group, only the stone size showed statistically significant. In the multivariate logistic regression of the stone length and stone width of the ureteral stone, only stone length is the independent factor. Conclusion: Stone size is the most important factors influencing the outcome of ESWL both in renal stone and ureteral stone. In renal stone group, the stone width is the major character to affect post-ESWL stone free rate and in the ureteral stone group, the stone length is the major character. NDP096: COMPARATIVE STUDY OF PERCUTANEOUS NEPHROLITHOTOMY VERSUS OPEN STONE SURGERY FOR MANAGEMENT OF PATIENTS WITH LARGE STAGHORN CALCULI Friedrich Bo-Yuan Zhang, Wun-Rong Lin, Jong-Ming Hsu, Huang-Kuang Chang, Wen-Chou Lin, Marcelo Chen. Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan Purpose: Advances in shock wave lithotripsy and endourological procedures have further limited the need for open surgery in the treatment of renal stones. We reviewed our experience of percutaneous nephrolithotomy (PNL)-based therapy with open stone surgery (OSS) to determine the clinical outcomes of these therapeutic modalities. Materials and methods: This retrospective study was conducted at Mackay Memorial Hospitals (Taipei and Tamsui), Taiwan. Hospital and office charts, operative records, and pertinent radiographic studies of all patients undergoing OSS (11 patients) and PNL (61 patients) for the treatment of large staghorn calculi from December 2007 through June 2013 were reviewed. Only patients with stones 10 cm2 or greater were included. Patient characteristics, stone burden, indications, surgical outcomes, and differences between the two procedures were compared and analyzed. Stone-clearance status was confirmed with postoperative kidney, ureter, bladder X-rays. Results: There were no differences between the two groups in patient demographics, stone size, estimated blood loss and mean renal function level change. However, there were statistically significant differences between the groups in mean operative time (282.1± 54.5 [range: 187-340] vs. 156.6± 41.2 [range: 85-285] minutes), mean hospital stay (10.27± 1.79 [range: 8-14] vs. 6.18± 2.71 [range: 2-17] days), postoperative stoneclearance rate (97.5 vs. 76.1%) and number of procedures per patient (1.55 vs. 2.77). Conclusion: In our experience, OSS should still be considered a valid and efficient treatment option for patients with complete staghorn calculi, although PNL is the standard treatment for most cases of renal stones. NDP097: THE USE AND THE PRESCRIPTION PATTERN OF TRADITIONAL CHINESE MEDICINE AMONG UROLITHIASIS PATIENTS IN TAIWAN: A POPULATION-BASED STUDY Jui-Ming Liu , Po-Hung Lin , Shun-Ku Lin . Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; 3 Institute of Traditional Medicine, School of Medicine, National Yang-Ming University,

Shock Wave Lithotripsy for Renal Stones Is Not Associated with Hypertension and Diabetes Mellitus

To clarify the influences of shock wave lithotripsy (SWL) treatments for renal and ureteropelvic junction stones on new onsets of hypertension and diabetes mellitus (DM). We compared the new onsets of hypertension and DM after SWL in renal and ureteral stone groups. The renal stone group consisted of 772 patients treated with SWL, who had a possibility of renal and pancreatic shock wave damage. The ureteral stone group consisted of 505 patients treated with SWL, who were unlikely to have suffered SWL damage in the kidney and pancreas areas. Both treatment groups received SWL between 1984 and 1994. The rates of new onset of hypertension in the renal stone and ureteral stone groups were 22.8% and 20.0% in men and 23.1% and 20.5% in women, respectively. The rates of new onset of DM in the renal stone and ureteral stone groups were 7.4% and 11.0% in men and 8.7% and 8.7% in women, respectively. There was no significant difference in the new onsets of hypertension and DM between renal and ureteral stone groups depending on each age decade or sex. Treatment for renal stone was not a significant risk factor for new onsets of hypertension and DM by logistic regression analysis. Our findings suggest that SWL treatment for renal and UPJ stones might not be associated with new onset of hypertension or DM.

Uricosuric effect of Roselle ( Hibiscus sabdariffa) in normal and renal-stone former subjects

Aim of the study The Roselle ( Hibiscus sabdariffa) was investigated for its uricosuric effect. Materials and methods A human model with nine subjects with no history of renal stones (non-renal stone, NS) and nine with a history of renal stones (RS) was used in this study. A cup of tea made from 1.5 g of dry Roselle calyces was provided to subjects twice daily (morning and evening) for 15 days. A clotted blood and two consecutive 24-h urine samples were collected from each subject three times: (1) at baseline (control); (2) on days 14 and 15 during the tea drinking period; and (3) 15 days after the tea drinking was stopped (washout). Serum and 24-h urinary samples were analyzed for uric acid and other chemical compositions related to urinary stone risk factors. Results All analyzed serum parameters were within normal ranges and similar; between the two groups of subjects and among the three periods. Vis-à-vis the urinary parameters, most of the baseline values for both groups were similar. After taking the tea, the trend was an increase in oxalate and citrate in both groups and uric acid excretion and clearance in the NS group. In the RS group, both uric acid excretion and clearance were significantly increased ( p < 0.01). When the fractional excretion of uric acid (FEUa) was calculated, the values were clearly increased in both the NS and SF groups after the intake of tea and returned to baseline values in the washout period. These changes were more clearly observed when the data for each subject was presented individually. Conclusions Our data demonstrate a uricosuric effect of Roselle calyces. Since the various chemical constituents in Roselle calyces have been identified, the one(s) exerting this uricosuric effect need to be identified.

Ochratoxin A in human serum samples collected in Isparta-Turkey from healthy individuals and individuals suffering from different urinary disorders

Ochratoxin A (OA) is a nephrotoxic fungal metabolite (mycotoxin) occurring in foodstuffs. The compound is causally associated with mycotoxin porcine nephropathy, a disease comparable with a human kidney disease called endemic nephropathy. In this paper OA levels in the human serum samples collected from healthy individuals and individuals suffering from different urinary disorders in Isparta-Turkey are presented. OA was measured in serum samples of 40 healthy people and a total of 93 patients with different kinds of urinary disorders. Four different kinds of urinary disorders were represented: chronic renal failure treated by hemodialysis (35), chronic renal failure treated by peritoneal dialysis (28), patients with bladder cancer (15), patients with renal stones (15). Analysis of OA in human blood samples was performed using an analytical method based on the measurement of fluorescence spectra. The mean concentration of OA in the healthy group was 0.4±0.28 ng/ml. The highest mean concentration was found in the group of patients treated by hemodialysis, 2.1±1.2 ng/ml. The mean concentrations of the toxin in all patients groups were higher compared to the control group. Also, a significant difference was found between the mean concentrations of the groups of patients treated by dialysis (hemodialysis or peritoneal dialysis) and of the patients with renal stones or bladder cancer, only with the exception of the difference between peritoneal dialysis and renal stones group. No other significant differences were found when comparing the two groups. The findings indicate that OA may have a role in the human urinary pathology considered herein. A higher level of OA in dialysis groups compared to the control, renal stones and bladder cancer groups could probably be explained by the reduced glomerular filtration rate of these patients.

Clinical significance of urinary enzymes and beta 2-microglobulin following ESWL.

To examine the renal damage caused by shock waves, urinary excretion of enzymes and beta 2-microglobulin were determined before and after ESWL. Urine samples were obtained from 35 patients with renal stone and 26 patients with ureteric stone treated with ESWL. Urinary lactate dehydrogenase (LDH) levels significantly increased on day 0, just after ESWL, in both groups. In the ureteric stone group the kidneys received less shock waves than in the renal stone group. Increased urinary lactate dehydrogenase was considered to have derived from erythrocytes in urine. Elevated urinary N-acetyl-beta-D-glucosaminidase (NAG) levels were also observed on day 0 after ESWL in both groups, due to unknown reasons. Indirect effect of ESWL through the sympathetic nervous system or humoral factors may contribute to increases in the urinary excretion of NAG. No significant increase was found in urinary gamma-glutamyl-transpeptidase (GGTP) levels for 5 days after ESWL. Urinary beta 2-microglobulin (BMG) levels increased on day 0 in the renal stone group alone. In our present study, the clinical significance of urinary enzymes and BMG was not well evaluated, because urinary excretion of these indicators following ESWL were transient and mild.

Renal mass and reserve of vitamin D: Determinants in primary hyperparathyroidism

We studied circulating 1,25(OH)2D3 and its determinants in 102 patients with primary hyperparathyroidism (PHPT), 33 of them with recurrent renal stones, 60 with non-specific symptoms, and nine with overt bone disease. Means for serum 1,25(OH)2D3 and intestinal absorption of calcium were abnormally high in the renal stone group, slightly elevated in the non-specific group, and low-normal in the bone disease group. In the whole population of patients, we found a positive correlation between circulating 1,25(OH)2D3 and creatinine clearance (taken as an index of the functional renal mass). Negative correlations were observed between 1,25(OH)2D3 and age, and between creatinine clearance and age, the latter being not different from that observed in a normal large population. In the renal stone group, means for the determinants of the renal 1 alpha hydroxylase activity, that is, PTH activity expressed as nephrogenous cyclic AMP (NcAMP), serum phosphate and calcium were identical to those of the group with non-specific symptoms. However means for age were lower and functional renal mass significantly higher in the renal stone group, which may account for the higher value of circulating 1,25(OH)2D3. In the bone disease group, means for age, renal mass and serum calcium were identical to those of the group with non-specific symptoms, and NcAMP was far higher and hypophosphatemia more marked, which may not account for the lower value of circulating 1,25(OH)2D3. However, in the bone disease group, serum 25(OH)D was abnormally low, which may limit the renal production of 1,25(OH)2D3 and explain the low-normal circulating values.(ABSTRACT TRUNCATED AT 250 WORDS)

A Control Study of Dietary Factors in Renal Stone Formation

Summary— Fifty-one first admission renal stone patients and an equal number of controls were interviewed and a dietary history of the average weekly intake was collected from each participant. A comparison of the dietary intake per kilogram body weight in each group was made using standard statistical procedures. None of the nutrient intakes showed a significant difference, but dietary fibre intake and the percentage of energy provided by carbohydrate were consistently higher in the control group, whereas the percentage of energy provided by fat was consistently higher in the renal stone group.