Treatment Of Kidney Stone Disease Research Articles

Book Review: No More Kidney Stones

The book "No more kidney stones" is a significant work for understanding the complex world of kidney stone disease. It provides comprehensive information from the formation of kidney stones to treatment options, offering essential guidance for both patients and healthcare professionals. The book emphasizes the importance of a multidisciplinary approach by detailing modern medications and surgical interventions, as well as the roles of various medical specialties in the treatment of kidney stones. The authors aim to raise awareness and develop more effective methods in the treatment of kidney stone disease. The sections cover the formation, symptoms, and treatment methods of kidney stones, diet and lifestyle changes, risk factors, modern medical interventions, and multidisciplinary treatment approaches. The book presents a comprehensive overview of the pathophysiology, diagnostic methods, and treatment options for kidney stone disease. It offers scientifically based guidance, emphasizing the complexity of the disease and the need for a multidisciplinary approach to its management. The importance of customized diagnostic and treatment approaches according to patients' individual characteristics is detailed in each section. The book serves as a valuable reference for anyone seeking information on kidney stone disease, providing practical information for clinical practice. This work enhances nephrologists' professional competence by offering extensive and in-depth knowledge, allowing them to develop a deeper and more comprehensive understanding of kidney stone disease.

Сравнение мини-перкутанной нефролитотомии с супер-мини-перкутанной нефролитотомией: когортное исследование

Introduction. Over the past 20 years mini-percutaneous nephrolithotomy (mini-PCNL) is remaining an effective method non inferior to standard PCNL with lower rates of serious complication related to bigger nephrotomy tract size like bleeding. However, in comparison to standard PCNL miniPCNL diminishes visualization, leads to increase of intrarenal pressure (IRP), difficulties in stone fragments evacuation, and longer operative time. In 2016 Zeng has developed an innovative aspiration sheath. Novel modification of miniPCNL with suction was called superminiPCNL (SMP) [1]. We have modified this aspiration sheath. There is the lack of data regarding efficacy and safety of this innovative method. Objectives. The aim of the study is to compare efficacy and safety of miniPCNL with SMP using an innovative suction sheath in the treatment of kidney stone disease. Material and methods. Between September 2021 and March 2023, 140 underwent PCNL. Patient were divided into 2 groups 1:1, 70 patients in each group. MiniPCNL was used in control group, SMP using aspiration suction sheath – in intervention group. Operative time, stone-free rate (SFR), bleeding, postoperative complications were compared between two groups. Results. SFR didn`t significantly differ between the groups and was 91.3% and 98.4% respectively (p = 0.117). Mean operative time was less in SMP group with a mean shortening of the procedural time of 13 min (p < 0.001). Hemoglobin drop was comparable between the groups (p = 0.73). Fever was significantly less frequent in SMP group, 11.6% in miniPCNL vs. 1.6% in SMP group (p = 0.042). There were no serious complications (Clavien III and IV) in any group. Discussion. PSMP is not inferior to miniPCNL in terms of efficy and safety. Moreover, it leads to shorter operative ime, decreases complication rates, and thus is a preferable method of renal stone treatment. Keywords: Kidney stone disease, percutaneous nephrolithotomy, surgery, supermini-PCNL.

A hybrid approach in surgical treatment of kidney stone disease

Nephrolithiasis is a disease that occurs with the formation of stones in the urinary tract. The occurrence of such stones depends on geographical, climatic, ethnic, dietary, and genetic factors. Most often, they are seen in countries with warm and dry climates. The Balkans are an endemic area, and 2% of the population is estimated to have the condition annually. The frequency is the same in both sexes. It is relatively rarer in childhood. This study aimed to show the modern possibilities for surgical treatment of kidney stone disease and combinations of different surgical approaches to achieve mini-invasiveness, short-term hospital stay, and reduction of postoperative complications. We present a clinical case of a patient with kidney stone disease with multiple lithiasis with multiple localization found in the left kidney. A combined (hybrid) operative approach was used – combining the laparoscopic technique and flexible renoscopy. We combined the possibilities of the two operative procedures and achieved a one-act cure for the patient. The method was minimally invasive. The hospital stay was shorter, and no postoperative complications occurred.

Inhibition of AT1R/IP3/IP3R-mediated Ca2+ release protects against calcium oxalate crystals-induced renal oxidative stress

Calcium oxalate (CaOx) stones are the most prevalent type of kidney stones. CaOx crystals can stimulate reactive oxygen species (ROS) generation and induce renal oxidative stress to promote stone formation. Intracellular Ca2+ is an important signaling molecule, and an elevation of cytoplasmic Ca2+ levels could trigger oxidative stress. Our previous study has revealed that upregulation of Ang II/AT1R promoted renal oxidative stress during CaOx exposure. IP3/IP3R/Ca2+ signaling pathway activated via Ang II/AT1R is involved in several diseases, but its role in stone formation has not been reported. Herein, we focus on the role of AT1R/IP3/IP3R-mediated Ca2+ release in CaOx crystals-induced oxidative stress and explore whether inhibition of this pathway could alleviate renal oxidative stress. NRK-52E cells were exposed to CaOx crystals pretreated with AT1R inhibitor losartan or IP3R inhibitor 2-APB, and glyoxylic acid monohydrate-induced CaOx stone-forming rats were treated with losartan or 2-APB. The intracellular Ca2+ levels, ROS levels, oxidative stress indexes, and the gene expression of this pathway were detected. Our results showed that CaOx crystals activated AT1R to promote IP3/IP3R-mediated Ca2+ release, leading to increased cytoplasmic Ca2+ levels. The Ca2+ elevation was able to stimulate NOX2 and NOX4 to generate ROS, induce oxidative stress, and upregulate the expression of stone-related proteins. 2-APB and losartan reversed the referred effects, reduced CaOx crystals deposition and alleviated tissue injury in the rat kidneys. In summary, our results indicated that CaOx crystals promoted renal oxidative stress by activating the AT1R/IP3/IP3R/Ca2+ pathway. Inhibition of AT1R/IP3/IP3R-mediated Ca2+ release protected against CaOx crystals-induced renal oxidative stress. 2-APB and losartan might be promising preventive and therapeutic agents for the treatment of kidney stone disease.

Homeopathy as a saviour for urolithiasis: A narrative review shading light on pathophysiology of renal stones and homeopathy drugs

Kidney stone disease is a crystal concretion formed generally within the kidneys. It is an accumulative urological disorder of human health, affecting about 12% of the world population. Higher risk of kidney failure which has been associated with end stage renal failure. Calcium oxalate, which forms at Randall's plaque on the renal papillary surfaces, is the most common type of kidney stone. Stone formation is highly prevalent, with rates of up to 14.8% and increasing, and a recurrence rate of up to 50% within the first 5 years of the initial stone incident. The formation of the stone is a complex process which results from numerous physiochemical events such as, super saturation, nucleation, growth, aggregation, and retention of urinary stone constituents within tubular cells. Several therapies are being performed for kidney stone treatment, including thiazide diuretics, allopurinol, painkillers, dietary changes, shock-wave treatment, ureterenooscopic and percutaneous nephrolithotomy, and ureterenooscopic and percutaneous nephrolithotomy in severe cases. However, the side effects that these treatments possess and reoccurrence of the disease have motivated researchers to search for better and safer options. Homeopathic drugs as well as several medicinal plants display antiurolithiatic activity and thus perform an important role in treatment of kidney stone disease. Therefore, the present review thereby wants to bring to the attention the wonderful results that homeopathy is offering in cases of urolithiasis in a very non-invasive and economical way which is not yet popularized.

A mechanistic journey in shock wave lithotripsy research

As a remarkable engineering innovation, shock wave lithotripsy (SWL) has revolutionized the treatment of kidney stone disease since 1980s with worldwide clinical acceptance. Over the past three decades, the long journey to understand the transient interaction of focused shock waves with kidney stones and soft tissues has propelled fundamental research at multiple fronts, including (1) the generation, propagation, and interaction of various stress waves inside the bulk stone materials, and surface acoustic waves associated with Mach stem formation at the stone boundary; (2) dynamic fracture and comminution processes in relation to lithotripter field characteristics; and (3) cavitation-induced stone surface erosion and vascular injury. In this talk, I will present illustrative examples to highlight chronologically the progressive understanding regarding the mechanisms of stone comminution and tissue injury, and how the acquired knowledge has influenced the technology evolution and clinical practice in SWL. I will also discuss how the fundamental concepts and techniques of SWL have been widely utilized in other therapeutic ultrasound and lithotripsy applications; and future perspectives, especially related to 3D cavitation detection and monitoring, as well as multi-spark shock wave generator development.

CREB1 protects against the renal injury in a rat model of kidney stone disease and calcium oxalate monohydrate crystals-induced injury in NRK-52E cells

Kidney stone disease (KSD) is a common urinary disease with increasing prevalence worldwide. In this study, we investigated the effect of cyclic AMP responsive element binding protein (CREB) 1 in a KSD model of rat and calcium oxalate monohydrate (COM) crystals-treated NRK-52E cells. Rats were pretreated with lentivirus (LV)-CREB1 vector or LV-control vector and administrated with ethylene glycol + ammonium chloride to induce KSD. It was found that CREB1 was activated in the renal tissue of non-treated KSD rats. Pretreating with LV-CREB1 vector significantly enhanced CREB1 expression in KSD rats. Biochemical analysis for serum and urine showed that upregulation of CREB1 could improve the renal function of KSD rats. Histological analysis confirmed that upregulation of CREB1 alleviated the renal injury in KSD rats. Moreover, the upregulation of CREB1 suppressed the apoptosis in renal tissue of KSD rats through regulating apoptosis-associated proteins. Further study showed that the upregulation of CREB1 could attenuate the oxidative stress in KSD rats as well. More interestingly, the upregulation of CREB1 enhanced the activity of complex I and complex III and the expression of mitochondrial cytochrome c, implicating the effect of CREB1 on improving mitochondrial function in KSD rats. In vitro study confirmed that upregulation of CREB1 inhibited the apoptosis and oxidative stress, while improved the mitochondrial function of NRK-52E cells treated with COM crystals, demonstrating the protective effect of CREB1 on COM crystals-induced renal epithelial cell injury. Therefore, CREB1 might be served as a promising target in the prophylaxis and treatment of KSD.

Evaluation of antiurolithiatic activity of moringa leaves by uv spectroscopic method

The effect of M.olifera leaf against Calcium oxalate was tested by uv Spectrscopy method. calcium oxalate crystals were confirmed by UV analysis. Then the sample was treated against leaf extract and again UV analysis was done to confirm presence or absence of crystals. Two type of assay the done to confirming the property Aggression assay and nucleation assay. calcium Oxalate, Phosphate, uric acid and proteins are important markers as well as citrate and magnesium are inhibitors which were tested for the confirmation of the stone. LDH and oxalate are the enzymes of liver and kidneys are having an important role in Urolithiasis were also estimated. After studding the absorbance and turbidity of calcium oxalate solution we concluded the results, studies showed significant data to confirm the efficacy of M.olifera leaf having anti-urolithic activity. The results of present study suggest usefulness of M.olifera in the treatment of kidney stone disease.

Does Sciaena umbra (Linnaeus 1758) otolith protect tissues against nephropathy, oxidative stress and inflammation induced by ethylene glycol?

Sciaena umbra is a species of fish with large otoliths. These otoliths are used for treatment of kidney stone disease with high morbidity among the public. In present study, the first group was determined as a control. Group 2 was applied to rats by adding 1% ethylene glycol to drinking water. Group 3 rats were given 50 mg/kg otolith by gavage daily. Group 4 rats were administered by adding ethylene glycol and otolith was given. Group 5 rats were added ethylene glycol for the first 30 days. Then next 15 days, the rats were given only otolith. the Serum CREA and BUN levels and urine calcium, phosphate and pH levels were determined to be damaged by ethylene glycol. Free radicals and oxidative damage caused by ethylene glycol were determined from oxidative/antioxidative parameters. Ethylene glycol has also been shown to be inflammatory. There is no positive effect on oxidative stress. From the levels of TNF-α and IL-1β in renal tissue, SUO has shown the triggering effect of inflammation. All data indicate that otolith is not an agent that can be used in nephropathy in the kidney. It is thought that caution should be exercised regarding its use.

Flavon Compound from The Ethyl Acetate Extract of The Stem of Supit (Tetracera indica Merr.)

Tetracera indica Merr. in Musi Banyuasin, is one of the traditional medicine used by the community for the treatment of kidney stone disease and gout, but this claim is not recorded in the treatment of kidney stones and gout in Indonesia. In this study, isolation of antioxidant compound from ethyl acetate extracts of supit (Tetracera indica) was done. The isolation was carried out through step gradient polarity extraction, and separated and purified by chromatography technique. The determination of the structure of the isolated compound was performed by spectroscopy method including UV, IR, and NMR 1D and 2D, and antoxidant activity was determined by DPPH method. An active antioxidant compound was isolated from ethyl acetate extract in form of yellow solid (15 mg). Based on spectroscopic analysis the isolated compound was 5,8-dihydroxy-7-methoxyflavone. The compound showed strong antioxidant activity (IC50 8.25 μg/mL) higher than standard ascorbic acid (IC50 11.3 μg/mL). This data concluded that efficacy of supit (Tetracera indica) for the treatment related to antioxidant activity (uric acid) is proven by the identification of one antioxidant compound of this plant.

Treatment of Kidney Stone Disease, Benign Prostatic Hyperplasia and Chronic Prostatitis with Thermobalancing Therapy should be listed in the Guidance for Health Professionals

Treatment of Kidney Stone Disease, Benign Prostatic Hyperplasia and Chronic Prostatitis with Thermobalancing Therapy should be listed in the Guidance for Health Professionals

Kidney stone nano-structure - Is there an opportunity for nanomedicine development?

Kidney stone analysis techniques are well-established in the field of materials characterization and provide information for the chemical composition and structure of a sample. Nanomedicine, on the other hand, is a field with an increasing rate of scientific research, a big budget and increasingly developing market. The key scientific question is if there is a possibility for the development of a nanomedicine to treat kidney stones. The main calculi characterization techniques such as X-ray Diffraction and Fourier Transform Infrared Spectroscopy can provide information about the composition of a kidney stone but not for its nanostructure. On the other hand, Small Angle X-ray Scattering and Nitrogen Porosimetry can show the nanostructural parameters of the calculi. The combination of the previously described parameters can be used for the development of nano-drugs for the treatment of urolithiasis, while no such nano-drugs exist yet. In this study, we focus on the most well-known techniques for kidney stone analysis, the urolithiasis management and the search for possible nanomedicine for the treatment of kidney stone disease. We combine the results from five different analysis techniques in order to represent a three dimensional model and we propose a hypothetical nano-drug with gold nanoparticles. This article is part of a Special Issue entitled "Recent Advances in Bionanomaterials" Guest Editor: Dr. Marie-Louise Saboungi and Dr. Samuel D. Bader.

Successful ureteroscopy for kidney stone disease leads to resolution of urinary tract infections: Prospective outcomes with a 12-month follow-up.

IntroductionTo investigate the resolution of urinary tract infection (UTI) with the successful treatment of kidney stone disease (KSD).We reviewed the outcomes of ureteroscopy (URS) and stone treatment for patients with positive urine culture or recurrent UTIs and evaluated whether the infection resolved with the clearance of their urinary stones.Material and methodsBetween March 2012 and July 2016, consecutive patients who underwent URS for stone disease with a history of recurrent UTIs or culture proven UTIs were identified from a prospective database. Data was recorded on stone free rate (SFR) and infection free rate (IFR) during the follow-up period at 3, 6 and 12-months.ResultsDuring the study period, 103 consecutive patients with stone disease and associated UTI underwent URS over a 52-month period (mean age: 60 years, Female: Male ratio of 2:1). The mean cumulative stone size was 16 mm (range: 3–107 mm) and a positive pre-operative urine culture was found in 81 (79%) patients. While the overall SFR was 96%, the total complication rate was 12.6% (n = 13) and these were all Clavien I/II complications.At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI.ConclusionsThe majority of patients will remain infection free at the 12-month follow-up if they are stone free after their initial treatment. Stone recurrence, which is more likely in high-risk patients, is also linked to the recurrence of their UTI.

Is micro-percutaneous nephrolithotomy surgery technically feasible and efficient under spinal anesthesia?

The objective of the study was to present the clinical and operative effects of two types of anesthesia on micro-percutaneous nephrolithotomy ("microperc"). We retrospectively reviewed 116 patients who underwent microperc between August 2011 and September 2013. Patients were sorted into one of the two groups according to the type of anesthesia received: general (Group 1, n:53) or spinal (Group 2, n:63). Perioperative variables (age, stone size, location) and outcomes (operation time, success, complication rate) were evaluated and compared. Although there was a statistically significant difference in the mean age of patients (30.3 ± 22.1 vs. 45.8 ± 14.6, respectively, p < 0.001), mean body mass indexes were similar (p = 0.689). There was no substantial difference in terms of sizes and localizations of stones in the two groups (p = 0.970 and p = 0.795). While a significant difference was found in comparison of operative times (59.62 ± 32.56 vs. 40.98 ± 26.45 min, p < 0.001), there was no statistically significant difference in mean fluoroscopy times (124.92 ± 84.2 vs. 105.2 ± 61.0 s, p = 0.441). Stone-free rates were similar (90.5% vs. 93.6%, p = 0.297). We found no statistical differences between the two groups with respect to mean hemoglobin drop and hospitalization time (p = 0.015 and p = 0.917, respectively). The complication rates and analog pain scores were also similar (p = 0.543 and p = 0.365). Our results show that microperc is a feasible surgical modality in the treatment of kidney stone disease under both spinal and general anesthesia. Spinal anesthesia may be considered for patients at a high risk for general anesthesia, and also may be an alternative for patients who are concerned about and/or fearful of general anesthesia.

What have we learned about shock wave lithotripsy in the past thirty years?

Shock wave lithotripsy (SWL) has revolutionized the treatment of kidney stone disease since its introduction in the early 1980s. Considering the paucity of knowledge about the bioeffects of shockwaves in various tissues and renal concretions 30 years ago, the success of SWL is a truly remarkable fest on its own. We have learned a lot since then. New technologies have been introduced for shock wave generation, focusing, and measurement, among others. In parallel, new knowledge has been acquired progressively about the mechanisms of stone comminution and tissue injury. Yet there are still outstanding issues that are constantly debated, waiting for resolution. In this talk, the quest for a better understanding of the shockwave interaction with stones and renal tissue in the field of SWL will be reviewed in chronological order. Focus will be on stress waves and cavitation for their distinctly different (for their origin), yet often synergistically combined (in their action), roles in the critical processes of SWL. This historical review will be followed by a discussion of the recent development and future prospects of SWL technologies that may ultimately help to improve the clinical performance and safety of contemporary shock wave lithotripters. [Work supported by NIH through 5R37DK052985-18.]

Comparison of Shockwave Lithotripsy and Microperc for Treatment of Kidney Stones in Children

We aimed to compare the outcomes of microperc and shockwave lithotripsy (SWL) for treatment of kidney stones in children. The medical records of 145 patients under the age of 15 years with opaque and single kidney stones treated with either SWL or microperc were retrospectively reviewed. Both groups were compared in terms of fluoroscopy and operative time, re-treatment, complications, success rate, and secondary and total number of procedures. Microperc and SWL were performed on 37 and 108 pediatric patients, respectively. The mean age of the patients was 5.91±4.03 years (1-15) and 8.43±4.84 (1-15) years in the SWL and microperc groups, respectively (P=0.004). The mean stone size was 11.32±2.84 (5-20) mm in the SWL group and 14.78±5.39 (6-32) mm in the microperc group (P<0.001). In the SWL group, 31 (28.7%) patients underwent a second SWL session and 6 (5%) had a third session. Finally, 95 (88%) patients were stone free at the end of the SWL sessions. In the microperc group, the stone-free rate was 89.2% in a single session (P=0.645). The mean duration of hospitalization was 49.2±12.3 (16-64) hours in the microperc group and 8.4±2.3 (6-10) hours per one session in the SWL group (P<0.001). The fluoroscopy time was significantly longer in the microperc group compared with the SWL group (147.3±95.3 seconds vs 59.6±25.9 seconds, P<0.001). The rate of requirement for an auxiliary procedure was higher in the SWL group than in the microperc group. The overall complication rates for the microperc and SWL groups were 21.6% and 16.7%, respectively (P=0.498). The results of our study demonstrate that microperc provides a similar stone-free rate and a lower additional treatment rate compared with SWL in the treatment of kidney stone disease in children.

Is there still a need for open/laparoscopic surgery for urinary stones?

SUMMARY Over the past 30 years the treatment of renal calculous disease has changed dramatically. With the advent of extracorporeal lithotripsy and the advances in ureteroscopy, and percutaneous nephrolithotomy, the need for both open and laparoscopic treatments for renal stone disease has been virtually eliminated. In spite of these advances in technology and technique there still remains a small but crucial role for open and laparoscopic treatments for renal stones. The goal of this article is to identify specific clinical scenarios that would require an open/laparoscopic approach for the treatment of kidney stone disease.

Kidney Stones 2012: Pathogenesis, Diagnosis, and Management

The pathogenetic mechanisms of kidney stone formation are complex and involve both metabolic and environmental risk factors. Over the past decade, major advances have been made in the understanding of the pathogenesis, diagnosis, and treatment of kidney stone disease. Both original and review articles were found via PubMed search reporting on pathophysiology, diagnosis, and management of kidney stones. These resources were integrated with the authors' knowledge of the field. Nephrolithiasis remains a major economic and health burden worldwide. Nephrolithiasis is considered a systemic disorder associated with chronic kidney disease, bone loss and fractures, increased risk of coronary artery disease, hypertension, type 2 diabetes mellitus, and the metabolic syndrome. Further understanding of the pathophysiological link between nephrolithiasis and these systemic disorders is necessary for the development of new therapeutic options.

Nonlinear pharmacokinetics of visnagin in rats after intravenous bolus administration

Ammi visnaga L. (syn. Khella, Apiaceae) preparations have traditionally been used in the Middle East for the treatment of kidney stone disease. Visnagin, a furanocoumarin derivative, is one of the main compounds of Ammi visnaga with potential effects on kidney stone prevention. To date, no information is available about the pharmacokinetic (PK) properties of visnagin. It was the aim of the study to characterize the PK properties of visnagin after intravenous (i.v.) bolus administration in rats and to develop an adequate model for the description of the observed data, including model parameter estimates. Therefore, three doses of visnagin (1.25, 2.5, and 5 mg/kg) solubilized in 25% Captisol® were administered by i.v. bolus injection to male Sprague–Dawley rats. Plasma samples were extracted and subsequently analyzed using a validated LC–MS/MS method. Both non-compartmental and compartmental PK analyses were performed. A stepwise model building approach was applied including nonlinear mixed effect modeling for final model selection and to obtain final model estimates in NONMEM VI. The average areas under the curve (AUC 0–last) after doses of 1.25, 2.5, and 5 mg/kg were 1.03, 3.61, and 12.6 mg∗h/l, respectively. The shape of the plasma concentration-time profiles and the observed disproportionate increase in AUC 0–last with increasing dose suggested nonlinearity in the elimination of visnagin. A two-compartment Michaelis–Menten model provided the best fit with following typical values of the parameter estimates: 2.09 mg/(l∗h) ( V max), 0.08 mg/l ( K M), 0.175 l ( V C), 1.0 h −1 ( k 12), and 1.22 h −1 ( k 21). Associated inter-subject variability estimates (% CV) for V max, K M and V C were 21.8, 70.9, and 9.2, respectively. Intra-subject variability (constant CV error model) was estimated to be 7.0%. The results suggest the involvement of a saturable process in the elimination of visnagin, possibly an enzyme or transporter system.

The mechanism of hypocalciuria with NaCl cotransporter inhibition

Thiazide diuretics are used to prevent the recurrence of calcium-containing kidney stones. The ability of these drugs to reduce urinary calcium excretion has a key role in this process. Although studies have shown a reduction in the recurrence rate of calcium-containing stones in patients treated with thiazides, whether hypocalciuria results from increased calcium reabsorption in the proximal or distal nephron is still unclear. When extracellular fluid volume is considerably reduced, the proximal tubule is likely to have a major role in thiazide-induced hypocalciuria. This process frequently occurs when high doses of thiazides and sodium restriction are prescribed for the treatment of kidney stone disease. The distal tubule is predominantly involved in NaCl cotransporter inhibition-induced hypocalciuria when the extracellular fluid volume is not reduced, a clinical scenario observed in patients with Gitelman syndrome. In this Perspectives article, we discuss the evidence supporting the hypocalciuric effects of NaCl cotransporter inhibition in the proximal and distal nephron.