Stone Risk Factors Research Articles

Are Pregnant Women More Likely to Develop Kidney Stones

Pregnant women occasionally develop symptomatic kidney stones, but whether pregnancy is a risk factor for symptomatic stones is unclear. In this

Inactivation of the Wnt/β-catenin signaling contributes to the epithelial barrier dysfunction induced by sodium oxalate in canine renal epithelial cells.

High oxalate consumption has been recognized as a risk factor for renal calcium oxalate stones in companion animals (dogs and cats). However, the cellular signaling involved in oxalate-induced dysfunction in renal tubular epithelial cells remains not fully elucidated. In this study, Mardin-Darby canine kidney (MDCK) cells, an epithelial cell line derived from canine kidney tubule, were tested for cell proliferation activity and barrier function after being exposed to sodium oxalate (NaOx). Further, the involvement of Wnt/β-catenin in NaOx-induced renal epithelial barrier dysfunction was evaluated. MDCK cells treated with NaOx exhibited reduction in cell proliferation and migration. Besides, NaOx exposure led to a decrease in transepithelial electrical resistance and an increase in paracellular permeability. The deleterious effects of NaOx on epithelial barrier function were related to the suppressed abundance of tight junction proteins including zonula occludens, occludin, and claudin-1. Of note, protein levels of β-catenin and phosphorylated (p)-β-catenin (Ser552) in MDCK cells were repressed by NaOx, indicating inhibitory effects on Wnt/β-catenin signaling. An inhibition of glycogen synthase kinase-3β (GSK-3β) by SB216763 enhanced the abundance of β-catenin and p-β-catenin (Ser552), and protected against epithelial barrier dysfunction in NaOx-treated MDCK cells. The results revealed a critical role of Wnt/β-catenin signaling in the epithelial barrier function of MDCK cells. Activation of Wnt/β-catenin signaling might be a potential therapeutic target for the treatment of oxalate-linked renal stones.

Incidence and correlation of metabolic syndrome and kidney stones in a healthy screening population.

BackgroundTo study the incidence of metabolic syndrome (MetS) and kidney stones in a healthy screening population and to explore the correlation between them.MethodsThe physical examination data of 11,827 people screened at the First Affiliated Hospital of Soochow University from August 2019 to July 2020 were analyzed. MetS diagnostic criteria were based on the 2004 guidelines of Chinese Diabetes Society (CDS). Multivariate logistic regression was used to analyze the correlation between MetS and various characteristics and kidney stones. Trend analysis was represented by P value, and P<0.05 indicated statistical significance.ResultsThe present study comprised 6,570 males (55.6%, aged 46.15±13.653 years) and 5,257 females (44.4%, aged 41.41±11.712 years). Of these, 1,036 (8.8%) had kidney stones and 1,552 (13.1%) had MetS. Among the MetS patients, 35.1% had a body mass index (BMI) ≥25, 27.7% had hypertension, 10.8% had hyperglycemia, and 31.2% had dyslipidemia. Kidney stone morbidity was 14.5% in the MetS group and 7.9% in the non-MetS group (P<0.05). As the number of MetS characteristics increased, kidney stone morbidity showed a linear increasing trend (P<0.05 for trend). With an increase in BMI and blood triglycerides (TG), and a decrease in lipoprotein cholesterol (HDL-C), the incidence of kidney stones had an increasing trend (P<0.05 for trend). Sex, age and MetS were independent risk factors for the occurrence of kidney stones, with and odds ratio (OR) of 1.493 [95% confidence interval (CI): 1.264–1.763] for MetS. Of the MetS characteristics, BMI ≥25 and blood pressure (BP) ≥140/90 mmHg were independent risk factors for kidney stones, with OR values of 1.209 (95% CI: 1.047–1.396) and 1.248 (95% CI: 1.071–1.453), respectively.ConclusionsMetS is an independent risk factor for kidney stones. Appropriate medication and dietary advice may help to correct urinary metabolic abnormalities and prevent the recurrence of kidney stones.

Study on Uroliths Composition in Tertiary Care Hospital of Pakistan

Background: Identification of risk factors for urolith stones formed in the urinary tract could help in preventing the recurrence. Urolith stones analysis utilized modern technology which is unfortunately not done in Pakistan on a routine basis. Development of renal failure may occur due to complications and urinary tract affected by uroliths. Objective: The current study aims to determine the composition of urolith stones seen in patients admitted in single Centre in Pakistan. Materials and Methods: This cross-sectional study was carried out on urolithstones composition surgically removed through minimum access procedure at Urology department of Ayub Teaching Hospital, Abbottabad for period of six months from October 2020 to March 2021. Urinary stones composition was measured through qualitative tests such as infrared and crystallography spectroscopy. Statistical analysis was performed in SPSS version 20. Results: A total of 82 patients with mean age ± SD 45.3±11.7 years having urinary stones were investigated in this cross-sectional study. Male to female ratio was 1.9:1. Male patients (54) (65.85%) were dominant over females (28) (34.15%) in term of stones removal. A high occurrence for urinary stones was bladder or upper urinary tract (81.6%) irrespective of their gender. Calcium containing stones were predominant in ureter, urethra and renal followed by struvite stones (56.8%). Two-third stones in struvite stones were in lower tract while uric acid, calcium phosphates and calcium oxalate were found in upper tract. Calcium oxalate account for 92.60% with mixed composition stones. Conclusion: Our study concluded that the majority of uroliths constitute calcium oxalate or phosphates and struvite stones in our setting. Uroliths formation is caused by urinary tract infection as indicated in our study. Calcium oxalate was the most common among these stones. Struvite stones were the least common one. The prevalence of stones was dominant in male patients compared to female patients. The anatomical location for calcium oxalate and struvite stones was lower tract and bladder respectively. Keywords: Uroliths, Composition, Calcium oxalate, Struvite stone

Urinary Tract Stones Risk Factors in Patients with Benign Prostatic Hyperplasia in West Java, Indonesia

Background: Urinary tract stones are common in patients with benign prostatic hyperplasia (BPH); therefore, an imaging test is needed for patients who have risk factors for the formation of urinary tract stones. The purpose of this study was to explore the factors associated with the presence of urinary tract stones in patients with BPH as information to conduct imaging tests.Methods: A cross-sectional quantitative analytic study was conducted on medical records of patients with BPH, both with and without urinary tract stones, or patients with urinary tract stones registered at the Department of Urology, Dr. Hasan Sadikin General Hospital, Indonesia, from 2015 to 2018. Data on age, body mass index, hypertension, use of antihypertensive drugs, diabetes mellitus, and hyperuricemia were collected and analyzed using the Mann-Whitney, Chi-square, Fisher exact test, and multivariate logistic regression statistical test to compare variables between BPH with and without urinary tract stones.Results: In total, 235 BPH patients were registered, of whom 74 (31.5%) had urinary tract stones. The median age was 64 years old. There was a relationship between age (p=0.030), diabetes mellitus (p=0.043), and the occurrence of urinary tract stones in patients with BPH. The most dominant risk factor was diabetes mellitus (OR=3.000, 95%CI 1.03-8.69).Conclusions: Age and diabetes mellitus are the risk factors for urinary tract stones in patients with BPH. BPH patients with diabetes mellitus are at a 3-fold risk for urinary tract stones. Diabetes mellitus in BPH patients is an indication to conduct imaging tests.

Vücut kitle endeksi ile retrograd intrarenal cerrahi sonuçları arasındaki ilişki

Objective: Overweight and obesity increased worldwide over four decades. In 2016, nearly 11% of men and 15% of women over 18 years old were obese. Obesity is accepted as a risk factor for renal stones. The relationship between obesity and urolithiasis is complicated. Various complications can occur during perioperative or postoperative follow-up in obese patients. Minimal invasive nature and high efficacy of Retrograde Intrarenal Surgery (RIRS) present itself as a safe and less morbid treatment option. In this study, we aimed to compare the efficacy and safety of RIRS in the treatment of kidney stones in different BMI levels. Material and Methods: Files of 552 patients who underwent RIRS for renal stones between January 2012 and December 2017 were reviewed. We classified patients according to the World Health Organisation classification. These three groups were compared for stone-free rate, complication rate, operative and fluoroscopy times and length of hospital stay. Results: The stone-free rate (SFR) of the study population was 80.8%. It was 81% for Group 1, 83.7% for Group 2 and 77.7% for Group 3. There was no statistically significant difference between the three groups among SFR (p=0.346). Clinical insignificant residual fragments (CIRF) status was also similar among the three groups (p=0.254). Complication rates between the three groups were statistically similar (p=0.416). Conclusion: In this study, we have shown that RIRS is a suitable option for all urolithiasis patients, even for obese individuals. Stone-free rates, length of hospital stay, operation time and complication rates in obese patients are similar with non-obese patients. Keywords: urolithiasis; obesity; laser lithotripsy

Plant-Based Milk Alternatives and Risk Factors for Kidney Stones and Chronic Kidney Disease

Patients with kidney stones are counseled to eat a diet low in animal protein, sodium, and oxalate and rich in fruits and vegetables, with a modest amount of calcium, usually from dairy products. Restriction of sodium, potassium, and oxalate may also be recommended in patients with chronic kidney disease. Recently, plant-based diets have gained popularity owing to health, environmental, and animal welfare considerations. Our objective was to compare concentrations of ingredients important for kidney stones and chronic kidney disease in popular brands of milk alternatives. Sodium, calcium, and potassium contents were obtained from nutrition labels. The oxalate content was measured by ion chromatography coupled with mass spectrometry. The calcium content is highest in macadamia followed by soy, almond, rice, and dairy milk; it is lowest in cashew, hazelnut, and coconut milk. Almond milk has the highest oxalate concentration, followed by cashew, hazelnut, and soy. Coconut and flax milk have undetectable oxalate levels; coconut milk also has comparatively low sodium, calcium, and potassium, while flax milk has the most sodium. Overall, oat milk has the most similar parameters to dairy milk (moderate calcium, potassium and sodium with low oxalate). Rice, macadamia, and soy milk also have similar parameters to dairy milk. As consumption of plant-based dairy substitutes increases, it is important for healthcare providers and patients with renal conditions to be aware of their nutritional composition. Oat, macadamia, rice, and soy milk compare favorably in terms of kidney stone risk factors with dairy milk, whereas almond and cashew milk have more potential stone risk factors. Coconut milk may be a favorable dairy substitute for patients with chronic kidney disease based on low potassium, sodium, and oxalate. Further study is warranted to determine the effect of plant-based milk alternatives on urine chemistry.

Evaluating the understanding about kidney stones among adults in the United Arab Emirates

ObjectivesThe prevalence of kidney stones is increasing worldwide. Multiple risk factors are believed to contribute to the development of kidney stones such as lifestyle, diet, and global warming. In the United Arab Emirates (UAE), there has been limited research exploring the prevalence and risk factors of kidney stones. This study attempts to assess the understanding and prevalence of kidney stones among adults in the UAE. MethodsIn this cross-sectional study, data were collected using a self-administered questionnaire, distributed among 515 participants (20–49 years old) from Abu Dhabi, Dubai, Ajman, and Sharjah states. IBM SPSS version 25 was used for data analysis. ResultsThe mean of knowledge score was 56.4% (n = 500). There was no correlation between the knowledge of those who had experienced kidney stones and those who did not. Furthermore, a family history of kidney stones increased the risk of developing stones by 2.27 times. Among participants reporting signs, symptoms, diagnosis, and the management of kidney stones, the knowledge and understanding about kidney stones was high. However, the perceptions of the same cohort about dietary precautions were limited. While analysing the sources of knowledge, the Internet and mass media were twice as important as physicians in educating the population. ConclusionThis study shows that the study cohort from the UAE population was aware of certain aspects of kidney stones but was quite naïve about its consequential risk factors. This highlights the importance of promoting education about kidney stones through health campaigns.

Risk factors in urinary stones: A case–control study

AbstractWhat are the urinary stones risk factors? Is there a relationship between nutritional, clinical and sociodemographic characteristics and urinary stones. The aims of this study are to determine risk factors in urinary stones, to examine the relationship between nutritional, clinical and sociodemographic characteristics and urinary stones and to compare these variables with those of healthy individuals. Urinary stones are multifactorial diseases. Determining the risk factors that cause urinary stones is vital to take preventive measures for urinary stones and avoiding recurrence. A 1:1 matched case–control study was performed and it included 123 cases and control group. The study data were collected with a questionnaire designed by the researchers. The study results suggested that 73.2% (n = 90) of the participants in the case group and 74.8% (n = 92) of the control group were male, the use of vitamin D was higher and the daily fluid consumption was lower in the case groups. The results of logistic regression analysis indicated that the incidence of urinary stones was 3.9 times higher (OR: 3.9, CI: 2.175–7.180) in patients who had a relative with urinary stones and 2.3 times higher in patients with previous urinary infection (OR: 2.309, CI: 1.200–4.443). It was concluded that a relative with urinary stones, prior urinary infection and usage of vitamin D were risk factors for urinary stones. Nurses should determine risk factors for urinary stones among all population groups and inform the public about the prevention of stone development.

Low insertion of cystic duct increases risk for common bile duct stone recurrence.

Common bile duct (CBD) stone is one of the most frequent biliary diseases. Recurrence after the complete removal of CBD stones is high, and we aim to evaluate the rate and risk factors for symptomatic recurrence of CBD stones after endoscopic retrograde cholangiopancreatography (ERCP). We, retrospectively, reviewed the database of patients who underwent ERCP for CBD stones and subsequent cholecystectomy between January 2015 and December 2017 at a tertiary hospital. The recurrence of symptomatic CBD stones was defined as the presence of a CBD stone with related symptoms at least 6months after the ERCP procedure. The primary outcomes were recurrence of symptomatic CBD stones and its risk factors. Among the 362 enrolled patients, 60 experienced a symptomatic recurrence of CBD stones between 6months and 5years after the procedure. The mean duration of follow-up was 32.3 ± 8.1months. The patients with recurrences were older and had a longer follow-up duration. Low insertion of the cystic duct (HR = 2.893, p = 0.016), distal CBD angulation (HR = 1.015, p = 0.034), maximum CBD diameter (HR = 1.070, p = 0.012), number of ERCP sessions at first admission (HR = 1.558, p = 0.032), and cannulation time (HR = 1.030, p = 0.008) were the independent risk factors for symptomatic recurrent CBD stones. Patients with risk factors, especially those with low cystic duct insertion, are more prone to symptomatic recurrent CBD stones and should be followed more carefully.

745 Risk Factors of Incident Renal Stones in Indian Population: A Hospital-Based Case-Control Study

Abstract Introduction Nephrolithiasis is pathological calcification in the excretory passages of the body and is prevalent among 7.6% of Indians. We aimed to study the various risk factors associated with renal stones from India. Method It was a hospital-based case-control study conducted over 18 months in a tertiary hospital in Delhi. Cases were defined as patients with renal stones diagnosed on the basis of history and radiological examination. Controls were similar to cases in all respects except for the diagnosis and selected from the hospital. A total of 18 risk factors, including age, gender, heavy metals, stress, metabolic factors, alcohol intake, dietary habits, co-morbidities, etc. were assessed. Logistic regression analysis was performed to calculate the strength of the risk associations. Results In the analysis of 60 cases and controls, we found 6 times, 5.5 times, and 2.4 times increased odds of renal stones in patients with increased arsenic, cadmium, and lead concentrations in blood, respectively. Similarly, there are 3 times increased odds of renal stones in patients suffering from stress. Conclusions Exposure to smoke, occupation dust, and contaminated water may lead to an increased ingestion/inhalation of heavy metals like cadmium, arsenic, and predisposing people to an increased risk of renal stones.

Predictors of recurrent bile duct stone after clearance by endoscopic retrograde cholangiopancreatography: A case-control study

BackgroundRecurrent common bile duct (CBD) stone is a long-term sequalae among patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with CBD stone extraction. Data regarding risk factors for recurrent CBD stone are scarce. We aimed to identify predictors of recurrent CBD stone. MethodsWe performed a retrospective case-controlled study from January 2010 to December 2019. Inclusion criteria included patients who had recurrent CBD stone at least 6 months after the index ERCP, in which complete stone extraction was performed and normal cholangiogram was obtained. Overall, 457 patients were included. Forty-two patients (9.2%) had recurrent CBD stone, and 415 patients (90.8%) did not have recurrent CBD stone. ResultsIn univariate analysis, male sex [odds ratio (OR) = 0.49, P = 0.033] was a protective factor, while endoscopic stone extraction by basket vs. balloon (OR = 2.55, P = 0.005), older age (OR = 1.03, P = 0.003), number of CBD stones (OR = 1.99, P = 0.037), size of CBD stone (OR = 4.06, P = 0.003) and mechanical lithotripsy (OR = 9.22, P = 0.004) were risk factors for recurrent CBD stone. In multivariate logistic regression analysis, mechanical lithotripsy [OR = 9.73, 95% confidence interval (CI): 1.69–55.89, P = 0.010], basket clearance vs. combined basket and balloon (OR = 18.25, 95% CI: 1.05–318.35, P = 0.046) and older age (OR = 1.02, 95% CI: 1.00–1.05, P = 0.023) were risk factors, and male sex (OR = 0.39, 95% CI: 0.19–0.81, P = 0.012) was a protective factor. ConclusionsWe identified modifiable and non-modifiable risk factors for recurrent CBD stone. Taking into consideration those factors might aid in minimizing the CBD stone recurrence risk.

Could saline irrigation clear all residual common bile duct stones after lithotripsy? A self-controlled prospective cohort study

BACKGROUNDA previous study showed that irrigation with 100 mL saline reduced residual common bile duct (CBD) stones, which potentially cause recurrent stones after endoscopic retrograde cholangiopancreatography.AIMTo determine whether saline irrigation can improve CBD clearance after lithotripsy.METHODSThis prospective self-controlled study enrolled patients receiving mechanical lithotripsy for large (> 1.2 cm) CBD stones. After occlusion cholangiography confirmed CBD stone clearance, peroral cholangioscopy (POC) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via POC were graded on a 5-point scale (score 1, worst; score 5, best). Scores were documented after only stone removal (control) and after irrigation with 50 mL and 100 mL saline, respectively. The stone composition was analyzed using infrared spectroscopy.RESULTSBetween October 2018 and January 2020, 47 patients had CBD clearance scores of 2.4 ± 1.1 without saline irrigation, 3.5 ± 0.7 with 50 mL irrigation, and 4.6 ± 0.6 with 100 mL irrigation (P < 0.001). Multivariate analysis showed that CBD diameter > 15 mm [odds ratio (OR) = 0.08, 95% confidence interval (CI): 0.01-0.49; P = 0.007] and periampullary diverticula (PAD) (OR = 6.51, 95%CI: 1.08-39.21; P = 0.041) were independent risk factors for residual stones. Bilirubin pigment stones constituted the main residual stones found in patients with PAD (P = 0.004).CONCLUSIONIrrigation with 100 mL of saline may not clear all residual CBD stones after lithotripsy, especially in patients with PAD and/or a dilated (> 15 mm) CBD. Pigment residual stones are soft and commonly found in patients with PAD. Additional saline irrigation may be required to remove retained stones.

Effect of parathyroidectomy on renal stone recurrence

Parathyroidectomy (PTX) is routinely performed in hypercalciuric renal stone patients with primary hyperparathyroidism (PHPT). However, some data indicate a persistent stone activity following PTX, raising the issue of the link between PHPT and stone disease. We performed an observational study on 30 renal stone patients diagnosed with PHPT. Patients were selected among 1448 hypercalciuric patients referred in our department for a diagnostic evaluation. Patients with no parathyroid surgery or any biological follow-up were excluded. Clinical and biological data (including 24-h urine collection and a calcium load test) were collected before and within 12months following surgery. Stone recurrence was evaluated by direct phone contact (median 43months). Comparison of biological data before and after surgery showed a significant decrease of ionized calcium and serum parathyroid hormone after PTX. All stones contained calcium-dependent species such as carbapatite, brushite or dihydrate calcium oxalate. Urine saturation indexes and calciuria significantly decreased after surgery (from 9.9 to 5.9mmol/d, p < 0.0001), but a persistent hypercalciuria was detected in 47% of patients. The other stone risk factors including diuresis stayed similar. Stone activity that was increasing (from 0.20-0.30 to 0.50-0.75/year) the 2years before PTX, significantly decreased after surgery [0.05-0.15/year (p < 0.001)]. PTX in calcium-dependent renal stone formers with PHPT significantly decreases both stone recurrence and urine saturation indexes. However, PTX unmasked an underlying renal stone disease related to idiopathic hypercalciuria in half of patients with a remaining stone activity, testifying the need for patient's follow-up to prevent stone recurrence.

Renal Stones and Risk Factors in Jeddah and Riyadh.

Saudi Arabia has extremely hot climate for most of the year; this is associated with the risk of developing nephrolithiasis. This retrospective research aimed to investigate the current prevalence, manifestation, mode of treatment, and risk factors of renal stones in Jeddah and Riyadh, Saudi Arabia. A cross-sectional study was conducted from November 2018 to June 2019 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This study included 1031 participants aged ≥18 years from Jeddah (n=652, 63.3%) and Riyadh (n=379, 36.8%). Data were expressed as mean ± standard deviation (minimum-maximum) or number (%). Comparisons between patients with and without renal stones were made using the Chi-square test and unpaired Student's t-test as appropriate. The odds ratio (OR) with a 95% confidence interval (95% CI) was determined for the risk factors of renal stones. The prevalence of renal stones was 16.9% among the participants. A significantly high risk for renal stones was associated with male sex (2.96; 95% CI: 2.08-4.20, P = 0.0001) and age group of 34-40 years (OR: 1.44; 95% CI: 1.005-2.103, P = 0.047). Hypertension was more common in patients with renal stones than those without renal stones (9.5% vs.4.6%, P = 0.013). The percentage of patients who took diuretics was significantly higher among those with renal stones than among those without renal stones (11.2% vs. 3.5%, P = 0.001). Of the 169 patients with renal stones, 58.0% had a positive family history of renal stones, and 23.7% had a history of urinary tract infections (UTIs). The symptoms of renal stones were pain (86.4%), hematuria (11.2%), fever (2.4%), and others (0.6%). Of all the patients, 43.8% took medication. For most patients, the stones passed spontaneously (67.5%), while 23.7% underwent lithotripsy, and 1.5% received stents. In this study, we found a higher prevalence of renal stones two major cities in Saudi Arabia in Jeddah and Riyadh, at 16.4%. Risk factors included male sex and age group of 34-40 years. A significant number of patients with renal stones have a family history of renal stones and a history of UTI. Loin pain and hematuria were the two major clinical presenting symptoms for renal stones. In the majority of patients, the renal stones passed spontaneously without the need for lithotripsy or surgery.

Advances in Risk Factors for Recurrence of Common Bile Duct Stones.

Choledocholithiasis is a chronic common disease. The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis. Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%. The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors. We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.

Risk Factors for Recurrence of Common Bile Duct Stones after Common Bile Duct Exploration Surgery

Purpose: Recurrent common bile duct (CBD) stone is a significant delayed complication after CBD exploration surgery. However, no definite risk factors for recurrence have been established. The aim of this study is to identify the risk factors of recurrent CBD stone following surgical CBD stone removal. Methods: In total, 253 patients who underwent CBD exploration surgery from Jan 2000 to Jan 2018 were identified and included in this study. We retrospectively collected clinical data based on the medical records of the patients and investigated risk factors with logistic regression analysis. Results: A total of 31 patients (12.3%) developed recurrent CBD stones. The median follow-up period was 9.6 months. Univariate analyses showed that the following factors were associated with recurrent CBD stones: delayed diet start after 7 days, longer hospital duration, and preoperative endoscopic sphincterotomy. However, sex, age, gallstone, operation time, transfusion, T-tube insertion, and postoperative complications were not associated with recurrent CBD stone. In multivariate analysis, longer hospital duration and preoperative endoscopic sphincterotomy were associated with recurrent CBD stone (OR = 1.047; CI 1.001 to 1.095; p = 0.048 and OR = 3.615; CI 1.081 to 12.087; p = 0.037, respectively). Conclusion: Recurrent CBD stones can often occur and require regular follow-up although it is safe to remove by surgical CBD exploration. Further investigation is needed on the risk factors of recurrent CBD stones.

Relationship between urine specific gravity and the prevalence rate of kidney stone.

BackgroundThe purpose of this study was to evaluate the relationship between urine specific gravity (USG) and the prevalence rate of kidney stone.MethodsWe conducted a cross-sectional study of adult participants (≥20 years) of the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2008. The USG was divided into three groups: <1.008, 1.008–1.020 and >1.020. Univariate and multivariate logistic regression analysis was used to determine the effect of USG on the prevalence rate of kidney stone.ResultsA total of 4,791 patients were included in this study, of which 464 (9.7%) reported a history of kidney stone. Univariate logistic regression analysis showed that age, gender, race, hypertension, diabetes, body mass index (BMI), estimated glomerular filtration rate (eGFR), USG and urine creatinine were closely related to the prevalence of kidney stones. After adjusting for known confounding factors, multivariate logistic regression showed that the prevalence rate of kidney stone increased with the increase of USG (1.008–1.020 vs. <1.008, OR =1.31, 95% CI, 0.09–1.91, P=0.155; >1.020 vs. <1.008, OR =1.71, 95% CI, 1.16–2.54, P=0.007).ConclusionsThe increase of USG was significantly correlated with self-reported kidney stone. This finding helps to identify risk factors for kidney stones as early as possible in the United States.

Postoperative infective complications following percutaneous nephrolithotomy.

Introduction:Percutaneous nephrolithotomy (PCNL) is recommended as the first choice of therapeutic strategy for patients with renal stones larger than 2 cm. It is reported that up to one-third of patients might have some perioperative complications, especially fever and urinary tract infections, which constitutes about 21%–39.8% of all the complications.Primary and Secondary:The primary aim of the study was to study about the proportion of patients getting post-operative infective complications following PCNL. The secondary aim was to study the patient, stone and procedure related risk factors associated with the infective complications.Settings and Design:This is an institution-based observational study.Materials and Methods:All patients who underwent PCNL in the Department of Urology, Medical College, Thiruvananthapuram, during 3 years from September 2016– to August 2019, were included in the study. In this study, the demographic factors and factors related to the patient, stone, and the procedure were collected and analyzed.Statistical Analysis Used:Data analysis was performed using SPSS version 22.0.Results:During the 3-year period, a total of 201 patients with renal stones were treated with PCNL in our hospital. Of this 190 cases were taken for analysis. The mean age of patients was 47.7 years, 148 (77.9%) were male, 42 (22.1%) were female, The final outcomes evaluated were episodes of fever, documented urinary tract infection (UTI), pyelonephritis, and sepsis. Thirty-six (18.9%) patients had fever, of which 21 (11.1%) had UTI, 6 (3.1%) had pyelonephritis and 5 (2.6%) developed sepsis.Conclusions:Post-PCNL complications are more commonly found in patients with history of preoperative UTI, previous history of renal surgeries, large stone burden, operative procedure more than 90 min, and presence of residual calculi.

Study of urinary stone composition in a university-based hospital

Objective: Knowing the composition of a urinary stone is valuable in its treatment, helping to define stone etiology, guide management, and prevent stone recurrence. This study aims to identify the incidence of various stone compositions in a university-based, tertiary care hospital. Material and Method: This retrospective study was conducted at King Chulalongkorn Memorial Hospital. Data of stone composition by infrared spectroscopy were collected from all patients undergoing upper urinary tract stone removal surgery from January 2015 to December 2018. Demographic data including age, gender, comorbidities, and stone characteristics were also collected. Results: A total of 173 stone analyses were included in this study. The main stone composition was calcium oxalate monohydrate (whewellite 49.7%), calcium carbonate apatite (dahllite 34.1%), calcium oxalate dihydrate (weddellite 5.2%), magnesium ammonium phosphate (struvite 4%), and ammonium hydrogen urate (2.9%). A small proportion of uric acid (1.7%), cystine (1.7%), and calcium phosphate (brushite 0.6%) was also found. No correlation was found between stone composition and age, gender or occupation. Multivariate analysis revealed that calcium oxalate stones were more common in males than females (odds ratio=2.21, 95%CI: 1.91-4.12; p-value=0.01). Phosphate-containing stones (struvite, dahllite and brushite) were more common in patients with a history of urinary tract infection (odds ratio=3.06, 95%CI: 1.18-7.92; p-value=0.02). Conclusion: Calcium oxalate and calcium carbonate apatite were the most common stone compositions found in this study. Male gender was a risk factor for oxalate stone, and a history of urinary tract infection was a risk factor for phosphate-containing stones.