Urinary Saturation Research Articles

Technological Solutions for Urinary Continence Care Delivery for Older Adults: A Scoping Review.

The aim of this scoping review was to examine available evidence regarding use of technology-based continence care delivery for older adults and to identify gaps in knowledge. Scoping review. With the help of a medical librarian, CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, Web of Science, and websites were searched. Search terms included technology, sensors, older adults, urinary incontinence, continence care, nursing homes, long-term care, and continence management. All literature elements except for opinion pieces and case reports written in English within the last 15 years were included. Articles not written in the English language were excluded; our search indicated that less than 6% of returned elements were written in other languages. After duplications were removed, 2146 potential sources were identified. After exclusions, 19 results were included in the review. Review findings suggest positive effects of technology-based continence care on older adults and those involved in their care such as enhanced delivery of a successful toileting program. Information on potential harms, from either the perspective of care provider or recipient, is limited. It is important that needs of older adults and collaborative efforts are considered in the implementation of technology-based continence care. A paucity of guidelines on the use and adoption of technology-based continence care was found; additional research into uptake and sustainability is needed. Technological solutions, such as sensors, need to be accurate in the measurement of urine saturation levels and timely in notifying caregivers for effective delivery of continence care. Adverse consequences of incontinence, such as incontinence-associated dermatitis or urinary tract infection, may potentially be reduced or avoided with technology-based continence care delivery.

A post-market cluster randomized controlled trial of the effect of the TENA SmartCare Change Indicator™ on urinary continence care efficiency and skin health in older nursing home residents

BackgroundUrinary continence care for residents of nursing homes who are unable to communicate their toileting needs usually involves care aides manually checking continence products (pads) to determine the level of urine saturation prior to changing. The TENA SmartCare Change Indicator is a medical device which estimates urine saturation and notifies caregivers of the optimal time for pad changes. This study will seek to examine the effect of the TENA SmartCare Change Indicator on urinary continence care efficiency and skin health, in comparison to usual care.MethodsThis cluster randomized controlled trial (NCT05247047) involving older nursing home residents with urinary incontinence unable to consistently indicate their toileting needs, and their care aides, will compare technology-based and usual continence care over a period of 8 weeks. Co-primary endpoints of superiority in continence care efficiency and non-inferiority in the maintenance of skin health will be assessed. Secondary outcomes will examine the resident quality of life, sleep quality, responsive behaviours, changes in pad use and leakage episodes outside the pad. Change in care aide work engagement, job satisfaction and rushed tasks will be assessed. Benefits and challenges with the use of the device for continence care will be identified from the perspectives of the care staff.DiscussionUrinary continence assessment and care in nursing homes is reported as suboptimal and threatening to dignity. Data on the utility and effect of technological solutions for improving urinary continence care are few and conflicting. If shown effective, this technological solution has the potential to improve the care for older residents and improve the working lives of caregiving staff who look after this most vulnerable section of the population.Trial registrationClinicalTrials.gov NCT05247047. Registration date is Feb 18, 2022

Multiple vesicolithiasis on cystocele and uterine prolapse

Uterine prolapse is a condition where some or all parts of uterus descended into the introitus vagina. Patients usually present with lump, feeling of discomfort, pain, urinary, and defecating disorders. Uterine prolapse happen to almost half of the women population. Almost half of the women who had given birth suffer from pelvic organ prolapse that is diagnosed through physical examination; however, only 5%-20% of patients present with symptoms. Uterine prolapse with vesicolithiasis is a rare case. Uterine prolapse can cause bladder obstruction, urine stasis, and chronic infection, which become the risk factors to the increase of urine saturation that can lead to vesicolithiasis. We present a case of multiple vesicolithiasis on cystocele and uterine prolapse in a 79-year-old female who has difficulty of urinating, feeling of burning in the end of urinating, and a mass that protrudes from the vagina for 33 years ago. The patient underwent pervaginam hysterectomy, anterior and posterior colporrhaphy, open vesicolithotomy, and cystoscopy biopsy of the bladder mucosa. She evolved with good postoperative condition and was then discharged.

Renal hypoxia, vascular calcification and crystalline nephropathy

ABSTRACT
 
 Objective: To emphasize the increase, in the last decades, in the incidence of kidney diseases and associated comorbidities and, within a wide range of kidney injury triggers, it is important to mention the nephropathies caused by crystal and mineral deposition, considering the often slow, gradual and asymptomatic progression of these disorders.
 Methods: This is a literature review based on the search for articles related to the topics ‘Crystalluria and renal hypoxia’, in databases such as Pubmed, Bireme, Web of Science and Google Scholar.
 Results: It can be observed that, of the metabolic processes involved, inflammation and renal hypoxia, which are mutually related, are variables of interest to be considered in this type of injury. Understanding and monitoring the impact of mineral deposition and / or the formation of crystals in the renal parenchyma is an extremely important factor in this context.
 Conclusion: Mineral imbalance and the urinary saturation of some crystallization promoters, such as oxalate, as well as the inflammation and hypoxemia process, make the kidney environment prone to acute or chronic disorders, possibly due to the disconnected of these variables.
 Keywords: Oxalate; hypoxia; vascular calcification; renal failure, chronic; COVID-19

Modern vision on the problem of urolithiasis in children: Epidemiology, etiopathogenesis, clinical, diagnostics, treatment, metaphylaxis

According to the study literature, urolithiasis remains one of the most common nosologies among the child population. In connection with the global changes in the health status of the population of our planet, the social significance of urolithiasis has recently acquired new relevance. The mechanism of stone formation is a complex process; stones are formed as a result of urine saturation with oxalates, calcium, uric acid, cystine. Most stones in children are located in the upper urinary tract. In 15%-25% of cases in children, urolithiasis may be asymptomatic. Diagnostics today are not difficult. If urolithiasis is suspected, first, among the instrumental research methods, ultrasound examination of the urinary tract is used, which identifies both X-ray-positive and X-ray-negative stones. Nowadays, not all standards for treating obstructing stones of the upper urinary tract in children of various sizes and localizations, as well as the type of pelvis structure, have been defined. Simultaneously, new trends in treatment may change already existing standards. It should be noted that in the modern world, and ways of metaphylaxis urolithiasis in children studied insufficiently. In the world literature, there is insufficient information on predicting the occurrence of recurrence of urolithiasis and ways to eliminate them. This literature review examines the epidemiology, etiopathogenesis of urolithiasis, diagnosis, existing treatment standards and metaphylaxis. Methods of active tactics of treatment of obstructive stones of the upper urinary tract are analysed in more detail.

Urine Crystallization in Heat Exposed Workers in Semarang City, Indonesia

Work environment conditions with high temperatures cause workers to experience fluid loss which can cause urine production to decrease so that the urine produced becomes concentrated. If this condition is left for a long time, it can cause saturation of the urine. This study used a cross-sectional design and had 32 respondents as tofu factory workers in Tandang Village, Semarang. The variable most relatedA working environment with high temperatures impacts the employees to encounter fluid loss which leads to the reduction of urine production, thus the urine production becomes concentrated. If this condition lasts for a long time, there will be saturation of the urine. This present study used a cross-sectional design with 32 employees of the tofu factory as the respondent in Tandang Village, Semarang. The most related variable with urine crystallization is water drinking consumption which is the most influential variable in the occurrence of urine crystallization. Employees who consume water drinking insufficient amounts have a probability crystallization of 41.80% compared to employees who consume less water drinking, namely the probability of urine crystallization of 98.81. From this equation, it can be interpreted that employees have a risk of urine crystallization of 0.4230 times. From the eight variables studied, there are four variables (age, water drinking consumption, heat density, and the level of dehydration) that had a statistically significant relationship with urine crystallization. Meanwhile, the most dominant variable based on the logistic regression test is air consumption.to urine crystallization is drinking water consumption which is the most influential variable in the implementation of urine crystallization. Workers who consume enough drinking water have a probability of urine crystallization of 41.80% comA working environment with high temperatures impact on the employees to encounter with the fluid loss which lead to the reduction of urine production, thus the urine production becomes concentrated. If this condition is not taken into account for a long period, it caused the saturation of urine. This present study used a cross-sectional design with 32 employees of the tofu factory as the respondent in Tandang Village, Semarang. The most related variable with urine crystallization is water drinking consumption which is the most influential variable in the occurrence of urine crystallization. Employees who consume water drinking insufficient amounts have a probability crystallization of 41.80% compared to employees who consume less water drinking, namely the probability of urine crystallization of 98.81. From this equation, it can be interpreted that employees have a risk of urine crystallization of 0.4230 times. From the eight variables studied, there are four variables (age, water drinking consumption, heat density, and the level of dehydration) that had a statistically significant relationship with urine crystallization. Meanwhile, the most dominant variable based on the logistic regression test is air consumption paired to workers who consume less drinking water, namely the probability of urine crystallization of 98.81. From this equation, it can be interpreted that workers have a risk of urine crystallization of 0.4230 times. Of the eight types of variables studied, empathy variables (age, air consumption, heat pressure, and degree of dehydration) had a statistically significant relationship with urine crystallization. Meanwhile, the most dominant variable based on the logistic regression test is air consumption.

MO113CALCULATED URINARY CALCIUM-OXALATE SATURATION (ßCAOX) IS NOT SPECIFICALLY ELEVATED IN PATIENTS WITH PRIMARY HYPEROXALURIA

Abstract Background and Aims In the primary hyperoxalurias (PH; types 1-3) recurrent urolithiasis (UL) and/or progressive nephrocalcinosis (NC) are the clinical hallmarks. Three different enzyme defects lead to endogenous oxalate overproduction and to extremely elevated urinary oxalate excretion (UOx). Thus, it seems logical that urine is supersaturated for calcium-oxalate (CaOx). It was, hence, speculated that urinary CaOx saturation (ßCaOx), calculated by computed programs, is significantly higher as compared to that of patients with idiopathic CaOx stones. We now aimed to evaluate and calculate urinary ßCaOx in PH patients according to type, as well as in non-PH patients with UL or NC. Method The computed equilibrium program EQUIL2 was used for the calculation of ßCaOx. For this, 24 h urine specimen of 70 patients with non-PH NC (46 male, 24 female, median age 6.06 (range 0.3-31.4 years)), of 149 idiopathic CaOx UL (90/59 m/f, age 8.5 (0.1-68.6)), of 51 PH 1 patients (31/21, age 12.33 (0.8-63.8)), of 5 PH 2 patients (3/2, age 5.41 (4.3-12.9)) and of 14 PH 3 patients (8/6, age 8.5 (2.9-29.3)) were analyzed for all necessary components. All patients were in stable kidney function (eGFR > 45 ml/min). Results Uox was higher in the PH patients as compared to the non-PH UL or NC patients (p < 0.05). However, there was no statistical difference between the Uox in PH 1 vs PH 2 or PH 3 patients, although, a clear effect of B6 medication was visible in PH1 patients. Urinary calcium excretion was lower (not significant) in PH patients as compared to NC/UL. There was no difference in ßCaOx when PH were compared to non-PH patients and it mostly remained in the normal range. Conclusion Urine ßCaOx is similar in PH and non-PH stone formers. Therefore, calculation of ßCaOx using computed programs is not a reliable parameter to define the definitively extreme CaOx supersaturation of urine from PH patients. This miscalculation is related to a rather lowish urinary calcium excretion in PH as compared to other UL/NC patients. Therefore, we recommend not to use such programs to express the risk of recurrent stone disease or nephrocalcinosis in PH.

Critical Reappraisal of Methods for Measuring Urine Saturation with Calcium Salts.

Background: Metabolic and physicochemical evaluation is recommended to manage the condition of patients with nephrolithiasis. The estimation of the saturation state (β values) is often included in the diagnostic work-up, and it is preferably performed through calculations. The free concentrations of constituent ions are estimated by considering the main ionic soluble complexes. It is contended that this approach is liable to an overestimation of β values because some complexes may be overlooked. A recent report found that β values could be significantly lowered upon the addition of new and so far neglected complexes, [Ca(PO4)Cit]4− and [Ca2H2(PO4)2]. The aim of this work was to assess whether these complexes can be relevant to explaining the chemistry of urine. Methods: The Ca–phosphate–citrate aqueous system was investigated by potentiometric titrations. The stability constants of the parent binary complexes [Cacit]− and [CaPO4]−, and the coordination tendency of PO43− toward [Ca(cit)]− to form the ternary complex, were estimated. βCaOx and βCaHPO4 were then calculated on 5 natural urines by chemical models, including or not including the [CaPO4]− and [Ca(PO4)cit]4− species. Results: Species distribution diagrams show that the [Ca(PO4)cit]4− species was only noticeable at pH > 8.5 and below 10% of the total calcium. β values estimated on natural urine were slightly lowered by the formation of [CaPO4]− species, whereas [Ca(PO4)cit]4− results were irrelevant. Conclusions: While [CaPO4]− species have an impact on saturation levels at higher pHs, the existence of ternary complex and of the dimer is rejected.

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.

P0561ACUTE KIDNEY INJURY AS A RISK FACTOR FOR KIDNEY STONES: A PROPENSITY MATCHED ANALYSIS

Abstract Background and Aims Kidney stones affects 6-9% of the population, with an almost 30% risk of reoccurrence. Factors associated with kidney stone formation include male gender, ethnicity, family history and stone type. The underlying pathology of stone formation is complex and includes increased urine saturation, decreased urine stone inhibitors in addition to metabolic factors. Acute kidney injury (AKI) refers to the abrupt decrease in kidney function, resulting in retention of urea and other waste products and the dysregulation of fluid and electrolyte balance. AKI affects 10-15% of the hospitalised population and is associated with long-term outcomes, such as chronic kidney disease, end-stage kidney disease (ESKD), cardiovascular disease, fractures and earlier mortality. There is evidence that AKI may result in long-term renal damage and fibrosis. A potential effect is impairment in urine concentration which would limit kidney stone formation. However there has been no previous investigation about this potential association. We aim to investigate if there is an association between AKI and kidney stone formation. Method Retrospective clinical data available for all adult (≥18 years of age) hospital admissions to a local health district in Australia between January 2008 and December 2017 was used in the analysis. We excluded 1) non-residents, 2) stone diagnosis pre-AKI, 3) death within 1 month of an AKI episode, 4) dialysis dependent ESKD prior to an AKI episode and 5) incomplete patient information. AKI episode was diagnosed from ICD-10 coding and kidney stone from ICD-10 and SNOMED coding. Our outcome was a kidney stone episode. We examined the entire cohort in addition to propensity score matching (PSM) using 1:1 optimal matching, caliper 0.1 and without replacement based on covariates known to be associated with renal calculi and AKI. Balance before and after PSM was assessed between the groups to evaluate quality using standardised means. Baseline characteristics were compared with chi-square and Mann Whitney U. Multivariate analysis was compared using Logistic regression. Results For the cohort of 180,927 patients, after exclusions, 12,338 (6.8%) patients were diagnosed with an AKI and 4,495 (2.5%) patients with a kidney stone. Patients with an AKI (12,338), compared to patients with no AKI (168,523), were more likely to be older (75.0 vs 50.0 years, p&amp;lt;0.001) with more comorbidities such as hypertension (31.8% vs 12.7%, p&amp;lt;0.001), diabetes (21.5% vs 9.4%, p&amp;lt;0.001), coronary artery disease (14.6% vs 7.0%, p&amp;lt;0.001) and peripheral vascular disease (5.4% vs 1.8%, p&amp;lt;0.001). The risk of kidney stone formation for the entire cohort in patients with a history of AKI was lower when compared to the no AKI patients (1.1% vs 2.6%, Hazard ratio 0.42, 95% confidence interval 0.36- 0.52, p&amp;lt;0.001). After PSM 12,336 patients with AKI were matched with 12,336 patients with no AKI with good balance of covariates. Patients with a history of AKI had a lower risk of kidney stone formation when compared to no AKI patients (Hazard ratio 0.57, 95% Confidence Interval 0.36- 0.51, p&amp;lt;0.001) Conclusion Our findings suggest that patients with AKI appear to be at a significantly lower risk of developing subsequent kidney stone formation when compared to patients with no previous AKI episodes. Further analysis on a greater scale are required to confirm these findings and their implications.

Late onset of glucose-6- phosphate dehydrogenase deficiency with methemoglobinemia: a case report

Background: Glucose-6- phosphate dehydrogenase (G6PD) is an enzyme that plays a vital role in eliminating reactive oxygen species (ROS) which are considered to be toxic to the cells. Deficiency of this enzyme causes hemolysis. This study presents a case of a middle-aged woman with the late onset of G6PD with methemoglobinemia. Case Presentation: A case of 57-year-old female was reported, who was presented to the emergency department with jaundice, dyspnea, dark urine and low oxygen saturation. On further investigation the patient's methemoglobin level reached up to 5.1%. Thus, the patient was diagnosed with the late onset of G6PD with methemoglobinemia. Conclusion: The G6PD deficiency could present late in life especially in areas with mild variants. On rare occasions, it could be present with severe hemolysis associated with methemoglobinemia. In these cases, it is important to find the cause. The use of methylene blue as an antidote is harmful.

P124 - Computer-derived methods for estimating urinary saturation of stone formers: Comparison of EQUIL2, JESS and Lithorisk

P124 - Computer-derived methods for estimating urinary saturation of stone formers: Comparison of EQUIL2, JESS and Lithorisk

Prevention of Calcium Nephrolithiasis: The Influence of Diuresis on Calcium Oxalate Crystallization in Urine.

A high fluid intake is still the most evidence-based measure for the prevention of idiopathic stone disease. The recommendation of current guidelines on urolithiasis to increase diuresis to 2–2.5 L/day is mainly based on a single clinical study. The present paper shows the influence of diuresis on calcium oxalate (CaOx) crystallization and especially aggregation (AGN) which can explain the initial development of Ca stones on papillary calcifications as well as stone growth in the renal pelvic system. Diuresis determines the urinary transit time (UT) through the kidney and together with the afflux of Ca and Ox the state of urinary saturation with respect to CaOx being the most frequent stone mineral. High supersaturation inducing crystallization during UT and a high urinary ion concentration interfering with the inhibition of crystal AGN by urinary macromolecules seem to be critical parameters for stone formation. Using data from the literature the influence of diuresis on these parameters is evaluated for short-term recurrent stone formers (RSF), idiopathic stone patients, and healthy controls, the latter two collectives with and without excessive oxalate ingestion. This investigation suggests that a diuresis of 2 L/day may protect from stone formation even after dietary Ox excesses and in RSF. However, in RSF with a continuously high Ca and Ox afflux into urine a permanent high diuresis is required which is difficult to sustain over 24 hours.

Impact of food quantity and quality on the biochemical risk of renal stone formation

Objective: This study evaluated the role of body mass index (BMI) and dietary potential renal acid load (PRAL) with urinary saturation for calcium oxalate (US-CaOx), calcium phosphate (US-CaP) and uric acid (US-UA) in renal stone formers.Materials and methods: A retrospective analysis was conducted of laboratory data collected on 442 renal stone-forming patients. Demographic information, BMI and 24 h urinary samples were collected from patients on their regular diets. PRAL was calculated as the Load of Acid to Kidney Evaluation (LAKE) score through a short questionnaire.Results: Urinary risk factors, but also inhibitors of calcium stone formation such as magnesium, tended to increase in relation to BMI (p = .000). Urinary pH (p = .002) and ammonium/sulfate ratio (p = .000) were negatively related to BMI. This resulted in a positive correlation between BMI and US-UA (p = .000), whereas US-CaOx and US-CaP were not influenced by BMI. LAKE score was positively correlated with US-CaOx (p = .022) and US-CaP (p = .000) as a consequence of the inverse relationship between LAKE score and citrate (p = .000). Multiple linear regression analysis identified BMI (p = .009) and male gender (p = .002) as independent predictors of US-UA, and LAKE score (p = .004) and age (p = .001) as independent predictors of US-CaP.Conclusions: BMI, which depends on excessive intake of energy from food, is not related to an increased biochemical risk of calcium stone formation, which is more dependent on the renal acid load of the diet. In contrast, obesity is associated with an increased risk of uric acid stone formation due to insulin resistance, impaired ammoniagenesis and low urinary pH.

Evaluation of three herbal compounds used for the management of lower urinary tract disease in healthy cats: a pilot study.

Lower urinary tract disease (LUTD) occurs commonly in cats, and idiopathic cystitis (FIC) and urolithiasis account for >80% of cases in cats <10 years of age. Although several strategies have been recommended, a common recommendation is to induce dilute urine resulting in more frequent urination and to dilute calculogenic constituents. In addition to conventional therapy using modified diets, traditional Chinese and Western herbs have been recommended, although only one - choreito - has published data available. We evaluated three commonly used herbal treatments recommended for use in cats with LUTD: San Ren Tang, Wei Ling Tang and Alisma. We hypothesized that these three Chinese herbal preparations would induce increased urine volume, decreased urine saturation for calcium oxalate and struvite, and differences in mineral and electrolyte excretions in healthy cats. Six healthy spayed female adult cats were evaluated in a placebo-controlled, randomized, crossover design study. Cats were randomized to one of four treatments, including placebo, San Ren Tang, Wei Ling Tang or Alisma. Treatment was for 2 weeks each with a 1 week washout period between treatments. At the end of each treatment period, a 24 h urine sample was collected using modified litter boxes. Body weights were not different between treatments. No differences were found in 24 h urinary analyte excretions, urine volume, urine pH or urinary saturation for calcium oxalate or struvite between treatments. The results of this study do not support the hypothesis; however, evaluation of longer-term and different dosage studies in cats with LUTD is warranted.

Stones: Predicting stone episodes using cystine capacity.

Cystine capacity is an assay for assessing urinary cystine saturation and risk of a stone episode in patients with cystinuria. Lowering the threshold for this test improves its sensitivity, potentially enabling relaxation of follow-up regimens for patients at lowest risk of stone episodes and dose modification of medications for those at highest risk.

Easy-to-use equations for the estimation of urine relative saturation in the assessment of risk of recurrence in urinary stones formers

It is a fact that recurrence of urinary stones is a common medical problem. One of the key factors used in determining the risk of urinary stone-formation is the urine relative saturation in the major constituents of lithiasis. Nomograms were developed in the 1970's to estimate the relative saturation of urine. We present here easy-to-use mathematical equations derived from these nomograms. These equations can be integrated directly in the LIS of any laboratories, and can be used as a tool in the treatment and prevention of recurrent stone-formation.

Whey protein and albumin effects upon urinary risk factors for stone formation.

Protein supplements are consumed for an expected increase in muscle mass and improved exercise performance, but as their impact on lithogenic parameters are unknown, we aimed to evaluate the effects of Whey protein (WP) and Albumin upon the risk factors for nephrolithiasis. WP or Albumin supplements (one scoop/day) were administered for 3days to 18 healthy volunteers, with 1-week washout period between them. Serum and 24-h urine samples were collected at baseline and after completing each intervention. All participants were asked to replicate their baseline diet during the subsequent urine collection. After WP or albumin, mean protein equivalent of nitrogen appearance (PNA) was significantly higher (p < 0.001), as the result of the consumption of each of the supplements, but mean urinary calcium, phosphorus, sodium, potassium, uric acid, citrate, oxalate, magnesium, creatinine, pH, and urinary saturation indices did not differ from baseline. However, individual increases higher than 50% in urinary calcium were observed in 39% of the individuals and variable decreases in urinary pH in 44 and 67% of them, respectively, after WP or Albumin. Increases higher than 50% in urinary sodium occurred in one-third of them after Albumin. A short-term consumption of WP or albumin by healthy subjects, under controlled diet, did not significantly change the mean lithogenic parameters. Nevertheless, the wide individual variation and relevant increases/decreases observed for urinary calcium, sodium, and pH suggest the need of a closer surveillance of these parameters and adequacy of diet in case of supplementation by stone formers.

Feline Calcium Oxalate Urolithiasis: Risk factors and rational treatment approaches.

Uroliths occur commonly in the bladder and/or urethra of cats and can be lifethreatening if urethral obstruction occurs. Calcium oxalate accounts for 40-50% of urocystoliths and these stones are not amenable to medical dissolution; therefore, removal by surgery or minimally invasive techniques is required if uroliths must be treated. Medical protocols for prevention involve decreasing urine saturation for minerals that form uroliths. Formation of uroliths is not a disease, but rather a complication of several disorders. Some disorders can be identified and corrected (such as infection-induced struvite urolith formation); others can be identified but not corrected (such as idiopathic hypercalcemia). In most cats with calcium oxalate urolith formation the underlying etiopathogenesis is not known. A common denominator of all these disorders is that they can from time to time create oversaturation of urine with one or more crystal precursors, resulting in formation of crystals. In order to develop rational and effective approaches to treatment, abnormalities that promote urolith formation must be identified, with the goal of eliminating or modifying them. It is important, therefore, to understand several basic concepts associated with urolithiasis and the factors that promote urolith formation that may be modified with medical treatment; for example, the state of urinary saturation, modifiers of crystal formation, potential for multiple crystal types, and presence of bacterial infection or urinary obstruction.

Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. To determine the lithogenic risk profile in patients with urolithiasis. Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.