The relationship between visceral fat area and uric acid stone formation / 中华泌尿外科杂志

Objective To investigate the relationship between uric acid stone formation and visceral fat area based on computed tomography.Methods As many as 247 patients admitted to our hospital were retrospectively reviewed from January 2017 to January 2018.There were 161 males (65.2％) and 86 females (34.8％).The average age was 51 (20-88 years).According to the results of stone analysis after surgery,the patients were divided into uric acid stone group and non-uric acid stone group.According to the abdominal CT scan,Image J software was used to measure the anthropometric measurements like waist circumference,total fat area (TFA),and visceral fat area (VFA),and subcutaneous fat area (SFA).The clinical characteristics of different stone components were compared.An univariate and multivariate logistic regression analysis was used to identify the independent factors associated with uric acid stone formation.Different anthropometric measurements were compared by using the area under receiver operating characteristic curve.Results The uric acid stones in high VFA group (28/110;25.5％) were obviously more frequent than that in the low VFA group (7/137;5.1％) (P ＜ 0.05).The results of the univariate logistic regression analysis showed that age,diabetes,hyperlipidemia,TFA,waist circumference,body mass index (BMI),VFA,uric acid,and urine pH were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis revealed that diabetes (OR =3.408,95％ CI 1.123-10.340,P =0.030),VFA (OR =6.740,95％ CI 1.95 1-23.279,P =0.003),uric acid (OR =3.182,95 ％ CI 1.120-9.040,P =0.030) and urine pH (OR =4.052,95％ CI 1.095-14.989,P =0.036) were independent factors associated with uric acid stone formation.The area under the curve of TFA,waist circumference,BMI,VFA,and SFA were 0.659,0.665,0.632,0.723 and 0.544,respectively.Conclusions Diabetes,VFA,uric acid and urine pH are independent factors influencing the formation of uric acid stones.Compared with other anthropometric measurements such as TFA,waist circumference,BMI,and SFA,VFA can better assess abdominal obesity and predict the formation of uric acid stones.

Nutritional Management of Kidney Stones (Nephrolithiasis)

The incidence of kidney stones is common in the United States and treatments for them are very costly. This review article provides information about epidemiology, mechanism, diagnosis, and pathophysiology of kidney stone formation, and methods for the evaluation of stone risks for new and follow-up patients. Adequate evaluation and management can prevent recurrence of stones. Kidney stone prevention should be individualized in both its medical and dietary management, keeping in mind the specific risks involved for each type of stones. Recognition of these risk factors and development of long-term management strategies for dealing with them are the most effective ways to prevent recurrence of kidney stones.

Management of Complicated Gout / 대한내과학회지

Chronic tophaceous gout results from long-term uncontrolled hyperuricemia with accumulation of urate crystals in joints, soft tissues, tendon sheaths and bony prominence. Urate-lowering agents should be administered to reduce serum uric acid level to less than 5 mg/dL for tophi reabsorption. Surgical indications include restoration of joint and tendon dysfunction, nerve decompression, debridement of septic joints, pain relief and cosmesis. Gout patients are at greater risk of forming uric acid stones. The renal tubular abnormality related to gout and metabolic syndrome leads to excretion of acidic urine, which favors formation of the relatively insoluble uric acid than more soluble urate. The corner stone of treatment of uric acid stone is urine alkalinization. Lowering serum uric acid with allopurinol and increasing urine volume are also important. Allopurinol is poorly tolerated and ineffective or contraindicated in some patients. Benzbromarone, a uricosuric agent is a useful alternative but possible hepatotoxicity should be monitored. Desensitization of allopurinol can be attempted to patients with mild cutaneous hypersensitivity. For gout patients with chronic renal failure, allopurinol dose need to be adjusted and nonsteroidal anti-inflammatory drugs and colchicine may be contraindicated.

A Case of Partial Hypoxanthine-Guanine Phosphoribosyltransferase Deficiency Presenting as Uric Acid Lithiasis / 소아과

The deficiency of enzyme hypoxanthine-guanine phosphoribosyltransferase(HPRT) results in hyperuricemia and subsequently manifests in diverse symptoms. Lesch-Nyhan syndrome is a disorder characterized by hyperuricemia, mental retardation, choreoathetosis, spasticity and self-mutilation, resulting from complete deficiency of the enzyme, whereas partial deficiency of the enzyme shows symptoms of milder forms more often without abnormal neurologic signs. A 7-year-old boy with normal growth and psychomotor development presented with a uric acid stone accompanied by a disproportionate increase of serum/urine uric acid level. The stone was removed by nephrolithotomy and further enzymatic study on lysed erythrocytes showed less than 1% of the normal HPRT activity. After initiation of treatment with allopurinol, the uric acid level was rapidly decreased to a normal range and the patient has not shown hyperuricemia or nephropathy since. Although partial HPRT deficiency is not commonly seen, this possibility should be considered whenever urolithiasis is accompanied by disproportionately high levels of serum uric acid.

Ureteral Stone in an Infant / 대한비뇨기과학회지

Pediatric urolithiasis is a rare disease. Although the causes of pediatric urolithiasis are unknown, the metabolic conditions account for more than 50% of diagnoses. Because pain originating from stones may mimic a colic in infants, it is difficult to diagnose a stone in pediatrics. To our knowledge there is no case of urolithiasis reported in Korean infants. Here we report a case of a calcium-uric acid urolithiasis in an infant.

Biochemical and Clinical Comparison of Gouty Diathesis with Uric Acid and Calcium Stone / 대한비뇨기과학회지

PURPOSE: We compared the biochemical and clinical presentation of gouty diathesis in patients with uric acid and calcium nephrolithiasis MATERIALS AND METHODS: We retrospectively reviewed biochemical and clinical data from 69 gouty diathesis patients(48 with uric acid stones and 21 with calcium stones) and 57 normal subjects were performed at our institution. RESULTS: Demographic similarity between two groups was a male predominance. Gouty diathesis patients in both groups showed abnormally low urinary pH(<5.5) and propensity for hyperuricemia and hypertriglyceridemia. Gouty arthritis and hyperuricemia was found in 31% and 44% of those with uric acid stones whereas 9.5% and 23.8% in those with calcium stone respectively. In control group, 1 case presented with hyperuricemia and urinary pH at 6.3. Both urinary pH and citrate increased after potassium citrate treatment in both groups. CONCLUSIONS: The two groups of gouty diathesis with either uric acid stone or calcium stones have similar biochemical and clinical features that are characteristic of primary gout. Calcium stone formation in patients with hyperuricemia or persistent acidic urine may represent a latent form of gout. Patients with calcium stones and biochemical feature of gouty diathesis may manifest primary gouty. Both groups are responsive to potassium citrate treatment.

Medical Treatment for Uric Acid Calculi / 대한비뇨기과학회지

While surgical intervention may occasionally be indicated for the relief of pain or urinary obstruction, many uric acid stones can be treated medically. We have analysed 27 patients with uric acid stone treated at Soonchunhyang University Hospital from January 1991 to September 1994. Major clinical complaints were presented with flank pain(93%) and gross hematuria(33%). On the urinalysis, urinary pH was 5.0 in 21 patients(78%) , 5.5 in 4 patients(15%), and 6.0 in 2 patients(7%). The urate crystals were found in 11/27 patients(41%). Mean serum uric acid level was 6.5+/-3.2mg% and mean uric acid amount of 24hrs urine was 301+/-188mg. Intravenous urography, retrograde urography, antegrade urography, ultrasonography and computed tomography were used for the diagnosis of uric acid stone. Systemic medical therapy was performed in all patients using hydration, sodium bicarbonate, and allopurinol. Systemic medical therapy and local chemolysis with alkaline irrigating solution were performed in 6 patients(22%) when the stone size was large (.>2cm) or urinary obstruction existed. The uric acid stone, in whom treated with only systemic medical therapy(21), were to be dissolved and passed during 1-24weeks, whereas the other patients(6) with systemic medical therapy and local chemolysis due to complete obstruction or large stone( >=2cm) had taken 2-32weeks. Successful dissolution was obtained in all patients, however, most significant problem of uric acid stone chemolysis is that it takes a long time. Nevertheless, these results demonstrate that the medical treatment could ordinally be considered to the treatment of choice for removal of uric acid calculi before surgical intervention or extracorporeal shock wave lithotripsy.

16 Cases of Uric Acid Stone / 대한비뇨기과학회지

Herein we have analysed retrospectively 16 patients with uric acid stone treated at Chung-Ang University Hospital during one and half year period from January 1987 to June 1988. Major presentation were flank pain(94%) and gross hematuria(44%). On urinalysis, all the patients shows microscopic hematuria and urinary pH were 5.0(8.1%) and 6.0(19%). Urate crystals were found in 44%. Mean serum uric acid level was 8.3 +/- 2.8mg% and mean uric acid amount of 24hr urine was 395 +/- 255mg. IVP, RGP, ultrasonography and CT were done for the diagnosis of uric acid stone. Medical treatment only was done in 7 patients(44%) using sodium bicarbonate and allopurinal. Surgical treatment was done in 6 patients(38%) when the stone size was large and urinary obstruction existed. ESWL was done in 3 patients(19 %). We think the medical treatment is an effective method for the removal of uric acid stone.

Multiple Calcium-Uric acid Urolithiasis in a Child: Report of a Case / 대한비뇨기과학회지

Uric acid, pure or admixed, calculous disease during childhood is uncommon. We recently encountered a case of multiple calcium-uric acid urolithiasis in a l7-month-old male patient presented with anuria owing to bilateral complete obstruction of the ureteropelvic junction in which acute renal failure developed following emergency removal of the stones.

A Uric Acid Stone Radiographically Simulating Renal Pelvis Tumor / 대한비뇨기과학회지

Since the development of ultrasonography and computerized topography scanning, the diagnosis of uric acid stone the urinary system has not been difficult. But recently, we experienced a case of uric acid stone that was misdiagnosed as renal pelvis tumor.

Three Cases of Uric Acid Stone / 대한비뇨기과학회지

We experienced three cases of uric acid stone. We treated all these cases sodium bicarbon with nate for systemic alkalization, 1/10 Molar sodium bicarbonate solution for direct irrigation through urethral & ureteral catheter and allopurinol for decreasing uric acid level and combined surgery was done in two cases, including upper ureteral stone & UVJ stone.