Risk Factors For Stone Formation Research Articles

Is the "Pandemic Diet" Nonlithogenic?

Introduction and Objective: The COVID-19 pandemic and worldwide quarantine resulted in major changes in individual lifestyles. In New York State, March 16, 2020, marked the end of in-restaurant dining and a reported shift to more cooking at home. We investigated the 24-hour urine of patients with known history of nephrolithiasis to see if changes during COVID-19 pandemic altered the risk of stone disease. Methods: Retrospectively, patients with history of nephrolithiasis seen for an outpatient visit from April 1, 2020, to December 31, 2020, were studied. All patients had a 24-hour urine study "pre-COVID" defined as before March 16, 2020, "during-COVID" from March 16, 2020, to December 31, 2020; if available, "post-COVID" from January 1, 2021, to October 31, 2022, was also included. Mean study values were compared using paired, two-tailed t-tests. Results: Ninety-three patients (M = 54, F = 39) with a mean age of 60 years were evaluated. Twenty-four-hour urine revealed a significant reduction in urinary sodium (uNa) levels from pre-COVID (166.15 ± 7.51 mEq/L) compared with during-COVID (149.09 ± 7.55 mEq/L) (p = 0.015) and urinary calcium (uCa) levels from pre-COVID (214.18 ± 13.05 mg) compared with during-COVID (191.48 ± 13.03 mg) (p = 0.010). Post-COVID 24-hour urine (N = 73) levels for uNa (138.55 ± 6.83 mEq/L, p = 0.0035) and uCa (185.33 ± 12.61 mg, p = 0.012) remained significantly reduced compared with pre-COVID values, but with no difference compared with during-COVID values. Upon age stratification, this significance was found only in patients younger than 65. There were no significant differences in 24-hour urine total volume, magnesium, or citrate levels. Conclusions: During the COVID-19 lockdown, dietary choices limited to home-cooked meals allowed patients to better identify their food choices. This study demonstrates that home-cooked meals improved urinary parameters minimizing lithogenic risk factors for stone formation, including hypernatriuria and hypercalciuria. That these changes persisted into the post-COVID period may indicate improved dietary practices after the lockdown ended.

Clinical characteristics of adult cases with urolithiasis from Türkiye: A regional epidemiological study.

To evaluate the metabolic and clinical characteristics of adult cases with stone disease from a regional part of Türkiye. The study included 2348 adult patients with sonography and/or computed tomography-proven urinary stones. All cases were given a questionnaire about the epidemiological features of urolithiasis. Aside from the type and severity of stoneforming risk factors, both patient (age, gender, BMI, associated comorbidities, first onset of stone disease, positive family history, educational level) and stone-related (size, number, location, chemical composition, previous stone attacks) factors have been thoroughly assessed. The data were evaluated in multiple aspects to outline the epidemiological features. The overall mean age value of the cases was 43.3 years, and the M/F ratio was 1.34. The first onset of the disease was found to vary between 15-57 years, with a mean value of 32.4 years. While most of the stones were located in kidney and ureter, calcium-containing stones constituted the most common type (CaOx 69%, CaOxPO4 7%). More than 42% of the cases suffered from multiple stone attacks; positive family history waspresent in 31.6%. Among the associated comorbidities, hypertension was the most common pathology (45.8%), and the BMI index value was > 30 in 31.3% of the cases. 57.7% of the patients had just one stone attack, and 42.2% had recurrent stone formation. Our findings clearly show that important implications may be extracted from epidemiologic data acquired from local scale research to implement an effective preventative program and closely monitor the patients.

Screening for asymptomatic nephrolithiasis in primary hyperparathyroidism patients is warranted

BackgroundWe aimed to investigate the prevalence, characteristics, and management of nephrolithiasis in primary hyperparathyroidism (PHPT) patients. MethodsMedical records of patients who underwent parathyroidectomy at a tertiary care hospital in British Columbia from January 2016 to April 2023 were retrospectively reviewed. Demographic data, laboratory results, imaging reports, and urologic consultations were examined. Descriptive statistics and relevant statistical tests, including logistic regressions, were utilized for data analysis. ResultOf the 413 PHPT patients included in the study population, 41.9% harbored renal stones, and nearly half (48.6%) required urological interventions. Male sex, elevated preoperative serum ionized calcium (iCa) and 24-h urinary calcium (24 ​h urine Ca) levels were independent risk factors for stone formation. Additionally, male sex, younger age, and lower preoperative serum 25-hydroxyvitamin D (25(OH)D) level were associated with higher odds of requiring urological intervention for stones. ConclusionsThis study identified significant prevalence of asymptomatic renal calcifications in PHPT patients, with a substantial proportion necessitating urological intervention. These findings emphasize the importance of incorporating screening and treatment of renal stones into the management of PHPT patients.

Risk factors of bladder stones in neurogenic lower urinary tract dysfunction: A real-world study.

The objective of this study is to investigate the incidence and risk factors for stone formation and recurrence in patients with neurogenic lower urinary tract dysfunction (NLUTD) in a real-world cohort. A retrospective cohort study was conducted on all patients with NLUTD who underwent bladder stone treatment between 2010 and 2022. Univariate and multivariate Cox models were used to identify the potential risk factors for stone recurrence. Among 114 patients included in the study, 30% experienced stone recurrence. The most common stone components were carbonate apatite phosphate and magnesium ammonium phosphate. The overall recurrence rate was 14 cases per 100 patient years. Neurogenic detrusor overactivity had the highest recurrence rate. Risk factors for stone recurrence in the multivariate analysis were intermittent and suprapubic catheterization, and recurrent urinary tract infection (rUTI). Patients experienced multiple bladder stone recurrences. Close monitoring of bladder pressure and UTI with restrictive catheter application may reduce the risk of stone recurrence.

Renal and ureteric colic

Renal and ureteric colic describes acute onset, severe flank pain. It is caused by an obstruction within the renal collecting system or ureter and is primarily precipitated by stones. In this article, our aim is to discuss the etiology of renal colic, its management in primary care, and indications for secondary care referral. We will also discuss risk factors for stone formation and the available prevention advice.

Investigating Risk Factors for Kidney Stones in Department of Nephrology Saidu Teaching Hospital Swat

Objectives: The main objective of this study is to investigate the risk factors associated with kidney stones in the Department of Nephrology, Saidu Teaching Hospital, Swat, from Jan 2021 to Jan 2022. Specific objectives of this study are to: 1. Identify and examine the demographic, medical and lifestyle factors of patients with and without kidney stones. 2. Analyze the risk factors for the different types of kidney stones. 3. Determine the relative risk of each risk factor for kidney stone formation. 4. Make suggestions for prevention and management strategies of kidney stone development. Methods: This study was a retrospective case-control study in the Department of Nephrology, Saidu Teaching Hospital, Swat, from Jan 2021 to Jan 2022. Patient records from this period were reviewed and demographic, medical, and lifestyle factors of patients with and without kidney stones were compared. Risk factors for stone formation were determined using univariate and multivariate analyses. Statistical analysis was conducted using the chi-square test, Fisher’s exact test, and logistic regression. Results: A total of 193 patients of various ages had been admitted to the nephrology department from Jan 2021 to Jan 2022; 10 of these had a kidney stone. Of the kidney stone patients, six (60%) were male and four (40%) were female. The mean age of those with kidney stones was 43.6 years. Of the risk factors analyzed, male sex, family history of stone disease, diabetes, hypertension, and certain lifestyle factors such as drinking soft drinks and eating a diet high in animal proteins were significantly associated with stone formation. Conclusion: This study identified a number of risk factors associated with the formation of kidney stones in the nephrology department of Saidu Teaching Hospital between Jan 2021 to Jan 2022. Male sex, family history of stone disease, diabetes, hypertension, and certain lifestyle factors such as drinking soft drinks and consuming a diet high in animal proteins were found to be significantly associated with stone formation. Further research is needed to gain a better understanding of these risk factors and develop prevention and treatment strategies for kidney stone formation. Keywords: Kidney Stones, Risk Factors, Department of Nephrology, Saidu Teaching Hospital

Is stone free status really necessary for metabolic evaluation following stone removal procedures?

ObjectiveTo evaluate the impact of stone free status on the outcomes of metabolic evaluation in recurrent stone formers after ureteroscopic stone removal. Patients and methodsA total of 78 patients undergoing retrograde intrarenal surgery (RIRS) for renal stones were included and cases were divided into two groups after 4 weeks based on the NCCT findings. While cases in the Group 1 (n = 54) was completely stone free, cases in Group 2 (n = 24) had residual fragments in the kidney. A full 24-h urine analysis for relevant stone forming risk factors has been performed after 4 weeks following the fURS procedures in all patients of both groups. Outcomes of metabolic evaluation (24-h urine and serum) have been comparatively evaluated in both groups. ResultsEvaluation of the preoperative serum and urine stone forming risk factors revelaed no statistical difference in both groups. Comparative evaluation of the 24-h urinary stone forming risk factors also revealed no statistically significant difference between preoperative and postoperative findings in cases of Group 2 with residual stones. Last but not least, no significant difference was observed between the mean preoperative and postoperative serum variables between two groups. ConclusionsOur results show that in the light of the similar metabolic evaluation outcomes obtained in cases with and without residual fragments, ‘stone free status’ may not be an essential factor to perform a detailed metabolic evaluation (24-h urine analysis and serum parameters) after endourological stone removal procedures.

Valoración del impacto de la tasa libre de litiasis en los resultados de la evaluación metabólica

ObjectiveTo evaluate the impact of stone free status on the outcomes of metabolic evaluation in recurrent stone formers after ureteroscopic stone removal. Patients and methodsA total of 78 patients undergoing retrograde intrarenal surgery (RIRS) for renal stones were included and cases were divided into two groups after 4 weeks based on the NCCT findings. While cases in the Group 1 (n=54) was completely stone free, cases in Group 2 (n=24) had residual fragments in the kidney. A full 24-hour urine analysis for relevant stone forming risk factors has been performed after 4 weeks following the fURS procedures in all patients of both groups. Outcomes of metabolic evaluation (24-hour urine and serum) have been comparatively evaluated in both groups. ResultsEvaluation of the preoperative serum and urine stone forming risk factors revelaed no statistical difference in both groups. Comparative evaluation of the 24-hour urinary stone forming risk factors also revealed no statistically significant difference between preoperative and postoperative findings in cases of Group 2 with residual stones. Last but not least, no significant difference was observed between the mean preoperative and postoperative serum variables between two groups. ConclusionsOur results show that in the light of the similar metabolic evaluation outcomes obtained in cases with and without residual fragments, ‘stone free status’ may not be an essential factor to perform a detailed metabolic evaluation (24-hour urine analysis and serum parameters) after endourological stone removal procedures.

Association of Height and Prevalence of Kidney Stones.

Introduction and objectives Nephrolithiasis is universally understood to be a multifactorial disease resulting from genetic and environmental factors including gender, diet, calcium, and uric acid excretion. Notably, several of these factors may be related to body habitus. Because men are more likely to develop kidney stones and on average have a larger body size, height may be an important risk factor for stone formation. Several studies have demonstrated that short adult stature is associated with numerous conditions such as hypertension, hypercholesterolemia, and cardiovascular diseases. However, other studies have demonstrated otherwise. Additionally, stones have been shown to be correlated with a high body mass index (BMI). This is likely due to dietary factors. Although height is a component of BMI, there is minimal literature regarding the relationship of height to stone prevalence adjusting for weight. Methods We aimed to examine whether short adult height is associated with the development of kidney stones using a population-based cohort of the National Center for Health Statistics. Data was gathered from National Health and Nutrition Examination Surveys (NHANES) "Kidney Conditions - Urology" and "Weight History" questionnaire datasets from March 2017 to March 2020 along with demographic data. Logistic regression analysis was used to determine an association between current self-reported height (inches) and if the participant has ever had kidney stones, controlling for weight, gender, age, race, educational level, and marital status. Results We found that those who were shorter had higher odds of reporting a history of stones (OR: 1.017; 95%CI: 1.005-1.028). This association was found after controlling for covariates such as age, gender, race, education, and weight. In addition, the male gender and Hispanic race had higher odds of reporting a history of stones (OR: 1.43 and 1.073, respectively). Conclusion Our results suggest that short height is related to the prevalence of kidney stones independent of weight, age, gender, and race. This supports previous literature indicating height to be a component of renal disease.

Effect of Two Different Dietary Weight Loss Strategies on Risk Factors for Urinary Stone Formation and Cardiometabolic Risk Profile in Overweight Women

Overweight has been suggested to increase the risk of kidney stone formation. Although weight reduction might affect risk factors for urolithiasis, findings on the impact of different dietary weight loss strategies are limited. This randomized, controlled study evaluated the effect of a conventional energy-restricted modified diet with (MR group) or without meal replacement (C group) on risk factors for stone formation in overweight women without a history of urolithiasis. Of 105 participants, 78 were included into the per-protocol analysis. Anthropometric, clinical, biochemical, and 24 h urinary parameters were collected at baseline and after 12 weeks. Although both dietary interventions resulted in a significant weight reduction, relative weight loss and rate of responders were higher in the MR group. Weight loss improved cardiometabolic risk profile in both groups. Unfortunately, the benefit of decreased GPT activity in the C group was offset by a significant increase in homocysteine and a decline in GFR. While the relative supersaturation of calcium oxalate decreased significantly in both groups, a significant decline in serum uric acid concentration and relative supersaturation of uric acid was observed only in the MR group. Finally, the energy-restricted modified diet with meal replacement showed significant advantages over the energy-restricted modified diet alone.

Defining 24-hour urine parameters and kidney stone risk of student athletes.

Dehydration is a risk factor for kidney stone formation. Studying populations that may experience dehydration without a known increased incidence of stone formation may help understand stone formation and prevention. High-caliber athletes represent such a population. We characterized the urinary environment of high-caliber athletes utilizing 24-hour urine collections with comparison to non-athlete controls. After Institutional Review Board (IRB) and National Collegiate Athletic Association (NCAA) compliance officer approval, 74 college-student athletes and 20 non-athletes were enrolled. Demographics, medical history, and sport of participation were recorded. Participants were asked to provide 24-hour urine collections as well as diet and activity logs at the time of urine collection. Standard stone risk parameters were assessed and compared to litholink reference standards. 34 athletes and 10 non-athletes provided at least one 24-hour urine specimen for evaluation. Athletes had a high prevalence of urinary risks for stone formation including low volume (median 1.46L), low citrate, high sodium, high calcium (females), and high uric acid (males). However, athletes also had a high prevalence of known stone-protective factors such as high urine magnesium. Athletes had a lower urine pH but high supersaturation of uric acid and calcium oxalate compared to non-athletes. Student athletes appear to have a high prevalence of urinary risk factors for stone formation such as dehydration, high calcium, high uric acid, high sodium, and low citrate. Overall stone risk in this population may be offset by increased levels of stone-protective factors such as magnesium. Further study of this population may help generate hypotheses for effective stone prevention strategies in the general population.

Role of Citrus Fruit Juices in Prevention of Kidney Stone Disease (KSD): A Narrative Review.

To explore the relationship between citrus fruit juices (oranges, grapefruits, and lemonades) and kidney stone disease (KSD). Methods: A systematic review was performed using the Medline, EMBASE, and Scopus databases, in concordance with the PRISMA checklist for all English, French, and Spanish language studies regarding the consumption of citrus fruit juices and the relationship to urinary stone disease. The main outcome of interest was the association of citrus fruit juices with KSD. Results: Thirteen articles met the criteria for inclusion in the final review. Three large epidemiological studies found that grapefruit juice was a risk factor for stone formation, while orange juice did not increase the risk for KSD. Ten small prospective clinical studies found that orange, grapefruit, and lemon juices all increased urinary citrate levels. Only orange and grapefruit juices had an alkalinizing effect and while lemon juice has a protective effect by raising urinary citrate levels, it lacked a significant alkalinizing effect on urine pH. Orange juice and grapefruit juices significantly increased urinary oxalate levels, while orange juice also had a high carbohydrate content. Conclusion: While orange juice seems to play a protective role against stone formation, grapefruit was found to raise the risk of KSD in epidemiological studies but had a protective role in smaller clinical studies. Lemon juice had a smaller protective role than orange juice. Larger amounts of, as well as more accurate, data is needed before recommendations can be made and a high carbohydrate content in these juices needs to be taken into consideration.

MP37-08 RENAL TRANSPLANT UROLITHIASIS MANAGEMENT: A SYSTEMATIC REVIEW

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-08 RENAL TRANSPLANT UROLITHIASIS MANAGEMENT: A SYSTEMATIC REVIEW Krishna Ravivarapu, Alexander Small, Nir Tomer, Evan Garden, and Michael Palese Krishna RavivarapuKrishna Ravivarapu More articles by this author , Alexander SmallAlexander Small More articles by this author , Nir TomerNir Tomer More articles by this author , Evan GardenEvan Garden More articles by this author , and Michael PaleseMichael Palese More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal transplant urolithiasis is an uncommon but serious issue. Management of these stones is challenging due to the urgency of an obstructed solitary kidney plus technical issues accessing a transplant. Treatments include observation, extracorporeal lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy (PNL), and open surgical pyelotomy. There are currently no established guidelines for the management of transplant stones and comparative effectiveness research is lacking. We performed a critical systematic review of contemporary research to evaluate practice patterns and stone-free rates (SFR) among the interventions. METHODS: A systematic review was conducted for all English-language abstracts and peer-reviewed articles using the Pubmed, MEDLINE, Scopus, and Google Scholar databases from January 2010 to January 2020. Case-reports were excluded from analysis. Two authors independently extracted data on stone location, size, treatment approach, and SFR. RESULTS: 835 publications were screened and 11 were included in this analysis, with a total of 268 renal transplant urolithiasis patients. In 15,624 total transplants, overall urolithiasis incidence was 1.1% (0.4-2.4%). Average stone size was reported in 6 studies and was 12.2 mm (7.4-19.9 mm). Stones were identified in the kidney (51.7%) and ureter (48.3%). Primary treatments included ESWL 27.2%, URS 25.0%, PNL 13.4%, and open pyelotomy 4.5% with SFR 64.1% (0-100%), 87.1% (60-100%), 91.9% (75-100%), and 90.9% (50-100%) respectively. The overall stone-free rate across all first line treatments was 79.1%. Secondary treatments were reported in 41 patients - the approaches were observation (53.7%), PNL (19.5%), URS (14.6%), open pyelotomy (9.8%), and ESWL (2.4%). CONCLUSIONS: Renal transplant urolithiasis poses unique challenges to both patients and providers. This review represents a contemporary snapshot of global treatment strategies and comparative effectiveness. The most common approaches are observation, ESWL and URS, however the most definitive strategies are PNL and open pyelotomy. Ultimately, the approach should be tailored to the individual patient depending on stone size, location, patient anatomy, and surgeon experience. Future prospective studies of renal transplant urolithiasis can shed light on specific risk factors for stone formation as well as optimal treatment protocols. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e648-e648 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Krishna Ravivarapu More articles by this author Alexander Small More articles by this author Nir Tomer More articles by this author Evan Garden More articles by this author Michael Palese More articles by this author Expand All Advertisement Loading ...

Search for Crystalline Species of Urinary Stones by Patients in the Region of Tissemsilt, Algeria

Urinary stones are among the most common diseases in the world and in Algeria as well, because it is a complex and multifactorial disease. The saturation of solutes in the urine is considered as the main stage of the deposition of crystals and their rapid growth and aggregation lead to the formation of stones in different places of the urinary system. It is the consequence of excessive urinary supersaturation causing renal complications such as lithiasis, nephrocalcinosis, acute or chronic renal failure which may progress to the terminal stage. The purpose of the study was to identify the most common different forms of crystals in the urine of patients for further measures to prevent more serious complications of crystalluria. Materials and methods. The study focused on all lithiasis patients of the age group "from 20 years to 84 years". Three-day urine samples were collected at different urology departments which were referred by urologists, during the period from February 06, 2020 to March 21, 2020. Being the best method, crystalluria was used to determine the types of crystals, their number and their growth. Three criteria must be met for the study of crystalluria to be clinically interpretable. They are the choice of patients according to their metabolic state; how long urine is stored after it is released, and the storage temperature. Results and discussion. Thanks to this study it was possible to characterize many types of crystals, including calcium oxalates, in particular monohydrate, which is considered as a risk factor for stone formation. Also, the urinary acid crystals indicate a specific environmental pattern in many patients. In addition to the calcium phosphate crystals resulting from microbial infections, the results showed pure crystalline aggregates which will inevitably lead to lithiasis. The microscopic examination of patient urine samples is the preferred method for optimal patient assurance with the cooperation of therapists and doctors in addition to the epidemiological study. Conclusion. The relatively high rate of recurrent lithiasis illustrates the current limits of preventive measures which can be penalized by the lack of patient attendance but whose reduced effectiveness primarily suggests a lack of knowledge of one or more fundamental determinants of the lithogenic process. The experimental part showed a diversity of crystals in the urine of patients, pure calcium oxalate monohydrate, which was noticed in the majority of the subjects analyzed. The detection, in crystalluria, of a single crystal of whewellite can therefore be considered as a marker for hyperoxaluria. Weddellite was more common in the urine of subjects under analysis

LITHOSCREEN: a comprehensive screening program and database for the assessment and treatment management of patients with kidney stones.

The aim of the LITHOSCREEN project was to construct a comprehensive screening program and database for recording and assessing the various risk factors for stone-formation in patients with urolithiasis. It is intended for use in Stone Clinics and is now being made available free of charge to researchers in the field who wish to maintain a comprehensive record of their patients' medical histories, demographic backgrounds, lifestyle activities, metabolic abnormalities, biochemical risk of forming stones of various types, diet histories, stone analysis and long-term treatment records. From the recorded data for each patient, the program automatically calculates numerous functions important in the understanding of the clinical and chemical risk factors for stone-formation, including the renal handling of the ions involved, various metabolic functions, the biochemical risk of forming kidney stones (PSF), the Tiselius Indices of the supersaturation of urine with respect to calcium oxalate and calcium phosphate, the projected effects of changing the composition of each patient's urinary composition on the risk of stone recurrence, and a program for analysing the diet of patients. It automatically produces one-page Summaries of each patient's biochemical and dietary records with abnormal values highlighted according to a "traffic-light" colour-coding system and generates charts designed to improve patient compliance with treatment in the form of colour-coded "Target Diagrams" showing (a) the patient's 24-h urine composition, (b) the patient's biochemical risk of forming stones of different types and (c) the composition of the patient's diet. The Summary pages and "Target Diagrams" are suitable for inclusion in the patient's Case Notes. LITHOSCREEN also produces charts projecting the effect of changing the composition of urine on the patient's biochemical risk of forming further stones. These graphs provide clues as to which urinary risk factors to target to reduce the patient's risk of stone recurrence.

The Possible Role of Urinary Tract Infection in Urinary Stone Formation in Children

Background and Aim: The aim of this study was to evaluate urinary metabolic features as a risk factor in stone formation. Methods: In this case-control study, 222 children ranging from 6 months to 16 years old suffering from urolithiasis in our university hospitals in Iran in 2019-2020 were selected through random sampling and were subsequently evaluated. The research group were cchildren with urinary stones and urinary tract infection and the control group encompassed children with urinary stones and without urinary tract infection. Data was analyzed using statistical package for social sciences (SPSS) version 16 (SPSS Inc. Chicago, IL) for windows. Results: The ratio of average amounts of calcium, magnesium, oxalate, cystine, uric acid, and citrate to creatinine showed no significant differences between the two groups. Conclusion: Urinary tract infection cannot be considered as a factor for stone formation in the urinary tract due to changes in urinary biochemical characteristics.

Changing in gender prevalence of nephrolithiasis.

Although nephrolithiasis is a more common disease in men rather than women, several studies over the last decades show that the male to female ratio 3:1 is narrowing. These finding may be associated to modified risk factors for stone formation between females and males. Changes in lifestyle and increasing obesity in women may play a role in shifting of gender disparity. Furthermore, recent studies have demonstrated an increase of kidney stones in women which have necessitated emergency department visits (ED). Therefore, females show a greater percentage of mortality rate if compared to males, especially if stone disease is associated to urosepsis and requires the admission to the Intensive Care Unit (ICU). This article reviews recent insights into changing gender prevalence in urinary calculi and into identifying the relation between gender and risk factors for stone disease, that in case of severe urosepsis might also lead to mortality.

Establishment and primary clinical application of metabolic evaluation database of urolithiasis

Objective: To establish the metabolic evaluation database of urolithiasis, perform metabolic evaluation, and provide instructions for treatment and prevention of urolithiasis. Methods: This metabolic evaluation database was developed by JAVA and was established by Oracle11g database and Browser/Server framework. We extracted the clinical data of all patients who had complete information, and analyzed their risk factors of stone formation, stone-related medical history, blood and urine tests results and 24-hour urine analysis. Results: A total of 360 patients diagnosed as urolithiasis were included in this research. Male to female ratio was 1.9∶1, and the urolithiasis was first diagnosed at (35.5±13.5) years old. Family history was positive in 39.7% of patients. Metabolic syndrome occurred in 35.0% of patients. Overweight or obesity occurred in 73.2% and 50.0% of male patients, respectively. Abdominal obesity in 62.3% and 56.1% of male and female patients, respectively. Among all patients, 67.5% had high urine sodium, 53.6% had hypercalciuria, 41.1% had hypocitraturia, 29.7% had hyperuricosuria, 22.5% had hypomagnesuria, 15.8% had hyperoxaluria, 11.7% had hyperphosphoraturia, and 36.4% had low urinary volume. Conclusions: The prevalence of overweight or obesity, abdominal obesity, hypertension, diabetes, and metabolic syndrome in stone patients were significantly higher than those in general population. The number of 24-hour urinary abnormalities was positively associated with body mass index. The interventions on high urinary sodium, low urinary volume, obesity and metabolic syndrome were important to the treatment of urolithiasis. This database would facilitate the metabolic evaluation, provide evidence for the treatment and prevention of urolithiasis, and lay foundation for finding important controllable risk factors of urinary stone.

Клиническое значение применения препарата Канефрон® Н у больных МКБ после оперативного лечения

The drug Canephron N is a combination of extracts of centaury, lovage and rosemary. Moderate antispasmoic, anti-inflammatory, antioxidant, diuretic and antimicrobial effects are of great interest for urological practice. The optimal combination of components that were made of herbal medicine allows to use their synergistic effect for prevention of recurrence of urinary stone disease. The experience of using the drug Canephron in clinical practice is of great interest. to clarify the clinical efficiency of Canephron N in patients with urinary stone disease after surgical treatment and to evaluate the changes in diuresis and calcium excretion. The results of using the drug Canephron after surgical treatment of urinary stone disease are provided. The changes in diuresis and calcium excretion in 75 patients undergone surgical treatment of urinary stone disease were studied. Patients after ureteroscopy, percutaneous nephrolithotomy and extracorporeal shock-wave lithotripsy were prescribed treatment to prevent stone formation including herbal drug Canephron N. At baseline, there was negative correlation between 24-hours diuresis and calcium excretion in all groups. During follow-up, a positive correlation between 24-hours diuresis and calcium excretion was found in patients receiving Canephron N and other types of treatment. The average follow-up was 390 days. During this period, recurrence was noted in 1 patient receiving Canephron, 4 patients in patients who took other drugs and in 5 patients who didnt receive any treatment. Risk factors of stone formation persist after surgical treatment of urinary stone disease. This is reflected in a negative correlation between 24-hour diuresis and calcium excretion. During treatment, a positive correlation between diuresis and calcium excretion was noted in patients with urinary stone disease. The use of drugs that affect stone formation as well as herbal medicine Canephron N allow to obtain comparable ratio of diuresis and calcium excretion.

Assessment of conservative dietary management as a method for normalization of 24-h urine pH in stone formers.

Low urine pH is a metabolic risk factor for stone formation. While medical therapy is typically prescribed (as urinary alkalinization), patients typically prefer dietary modifications. We aimed to assess capacity to alter urine pH with dietary management alone. We analyzed a retrospective cohort of stone formers seen between 2000 and 2015 with multiple 24-h urine collections (24hUC). Patients ≥ 18years old with low urine pH (< 6.0) were included; those prescribed alkalinizing agents or thiazides were excluded. Demographic data, 24hUC parameters, and medications were abstracted. 24hUC was utilized to calculate gastrointestinal alkali absorption (GIAA). The primary outcome was urine pH ≥ 6.0 on second 24hUC. Predictors were selected utilizing multivariable logistic regression. The database consisted of 2197 stone formers; 224 of these met inclusion criteria. On second 24hUC, 124 (55.4%) achieved a favorable pH ≥ 6.0. On univariable analysis, a second pH ≥ 6.0 was associated with high initial pH, low initial sulfate, younger age, increase in citrate/GIAA/urine volume, and decrease in ammonium (P < 0.02). On multivariable analysis, high initial pH (OR = 23.64, P < 0.001), high initial GIAA (OR = 1.03, P = 0.001), lower initial sulfate (OR = 0.95, P < 0.001), increase in urine volume (OR = 2.19, P = 0.001), increase in GIAA (OR = 8.6, P < 0.001), increase in citrate (OR = 2.7, P = 0.014), decrease in ammonium (OR = 0.18, P < 0.001), and younger age (OR = 0.97, P = 0.025) were associated with a second pH ≥ 6.0. The analysis demonstrated a corrected AUC of 0.853. These data suggest that certain dietary recommendations (increases in urine volume, citrate, GIAA, and decreased acid load) may normalize urine pH in a select group of patients. This may allow urologists to counsel patients with low urine pH on possibility of success with dietary modification alone.