ABSTRACT
Background: Uric acid nephrolithiasis is characteristically a manifestation of a systemic metabolic disorder. It has a prevalence of about 10% among all stone formers, the third most common type of kidney stone. Uric acid stones form primarily due to an unduly acid urine; less deciding factors are hyperuricosuria and a low urine volume. Aim and objectives: To study and analyze the age and sex distribution of uric acid urolithiasis, to study and identify the predisposing and causative factors and treatment of uric acid urolithiasis. Methods and materials: The materials for the clinical study on radiolucent (uric acid) stones were selected from the cases presenting with pain in loin attended to urology department in King George Hospital, Visakhapatnam from October 2015 to December 2017. The selection of cases was based on clinical symptoms and radiological findings. The number of cases studied was 50. A detailed history, physical examination, blood and urinary examination were done. X-ray KUB, ultrasound KUB, plain CT KUB was done. Patients were treated either medically or surgically depending upon their condition. Results: Out of the 50 patients enrolled, there were 36(72%) male and 14 (28%) female patients. Most of the patients (40%) were in the age group 41-50 years. Pain was the most common symptom (100%) followed by nausea and vomiting. Serum creatinine was normal in 84% of cases. Serum uric acid and Serum electrolytes were normal in all the 50 patients. Urine volume was normal (> 2 litres/24 hrs) in 44% of cases. Urine pH was < 5.5 in 92% and urine uric acid is normal in 100% of cases. In the present study, out of 50 patients, 38(76%) were managed conservatively with potassium citrate and 12 patients were treated with various surgical interventions. Conclusions: Uric acid calculi are more common in men (M: F ratio 2.5:1). Uric acid calculi are caused mostly due to low urinary pH and low urine volume. Type 2 diabetes mellitus and high body Dandamudi Vijay Krishna, Immadi Chandrasekhar. A clinical study on radiolucent (uric acid) stones in tertiary care centre. IAIM, 2019; 6(1): 89-95. Page 90 mass index (BMI) are independent risk factors for uric acid stones. Most of the uric acid calculi can be treated conservatively with potassium citrate (30-40 meq/day) in two divided doses.
ABSTRACT
Objective To study the relationship between metabolic syndromes and uric acid calculi.Methods We retrospectively analyzed medical records of 640 adult patients,who were diagnosed as renal calculi and finished the stone composition analysis.Among them,394 cases were male and 246 were female.The averagc age was (50.9 ± 12.8) years old.According to the diagnostic criteria of the MS,the patients were divided as metabolic syndrome group (metabolic syndrome group /MS group and non-metabolic syndrome group (non MS group);the MS group had a total of 238 cases including 151 males and 87 females.The average age was (54.1 ± 11.0) years old.There were 402 cases in non MS group,including 243 males and 159 females,with an average age of (49.1 ± 13.4) years old.We obtained corresponding metabolic indices.By comparing the differences between each group,the statistic were analyzed with SPSS.Results In the MS group,42 cases was diagnosed with uric acid stones,and the nonMS group with 8 cases diagnose with uric acid stones.The MS included obesity,elevated blood pressure,elevated fasting plasma glucose,high serum triglycerides.In the patients obtained,123 had the 4 kinds of metabolic diseases at a time,and 23 (18.7％) cases were diagnosed as uric acid stones.115 patients had the 3 kinds of metabolic diseases in which 19 (16.5％) cases were uric acid stones.190 patients had 2 kinds of metabolic diseases and 5(2.6％) cases were uric acid stones.137 patients had only one kinds of metabolic disease in which 3 were uric acid stones.The multivariate Logistic regression analysis showed that,after the correction of gender and age,obesity patients own the OR as 1.10(0.98-1.24)(P =0.018),high blood sugar had the OR as 1.72(1.19-1.92) (P =0.006),high glycerin three fat had the OR as 0.71(0.48-1.09) (P =0.032) and high HDL-C was 0.15(0.03-0.65) (P =0.01).Conclusions The metabolic syndromes including obesity,hyperglycemia and dyslipidemia obviously might influenced the formation of uric acid calculi.
ABSTRACT
Summary: This study was designed to evaluate the efficacy of local litholytic irrigation (LLI) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB),retrograde urography,ultrasonography(B-mode ultrasound),spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy. LLI with tromethamine-E(THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antibiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones,13 cases within 10 days and 1 within 12 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case,with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost,less physical suffering and no severe complications.
ABSTRACT
We treated 4 patients with uric acid calculi in the renal pelvis or ureter with alkaline fluid irrigation through percutaneous nephrostomy (PCN) tube. Initial presentations were anuria or severe flank discomfort, we performed PCN to relieve such obstructive symptoms caused by uric acid calculi. We tried to dissolve uric acid calculi with normal saline mixed to sodium bicarbonate through a PCN tube. The success of therapy is believed to be related to the direct and constant urinary alkalinization effect obtained with irrigation compared to be the intermittent alkalization that occurs when oral agent are used.