Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we "gliflozin" patients with kidney stone disease? / Inibidores de cotransportadores sódio-glicose-2 (SGLT2) na nefrolitíase - devemos "gliflozinar" os litiásicos?

ABSTRACT The prevalence of nephrolithiasis is increasing worldwide. Despite advances in understanding the pathogenesis of lithiasis, few studies have demonstrated that specific clinical interventions reduce the recurrence of nephrolithiasis. The aim of this review is to analyze the current data and potential effects of iSGLT2 in lithogenesis and try to answer the question: Should we also "gliflozin" our patients with kidney stone disease?

RESUMO A prevalência da nefrolitíase está aumentando em todo o mundo. Apesar dos avanços na compreensão da patogênese da doença litiásica, poucos estudos demonstraram que intervenções clínicas específicas diminuem a recorrência da nefrolitíase. O objetivo desta revisão é analisar os dados atuais e efeitos potenciais dos iSGLT2 na doença litiásica e tentar responder à pergunta: devemos também "gliflozinar" os litiásicos?

Urolitiasis en lactantes: un reto diagnóstico y terapéutico. Reporte de un caso

La litiasis urinaria en niños obedece a cambios nutricionales, ambientales, climáticos, predisposición genética, infecciones del tracto urinario, anomalías metabólicas y/o anatómicas subyacentes, su incidencia es de 1-3%, la cual se ha incrementado en la última década. Se presenta lactante masculino de 22 meses, con presencia de cálculos a nivel uretral con proceso infeccioso asociado, quien requirió procedimiento invasivo para la extracción de un cálculo y documentaron hiperuricosuria, hipomagneseuria e hipercalciuria, sin antecedente familiar de litiasis renal. La urolitiasis en lactantes es relevante dado el papel que puede tener en la etiología de la infección urinaria y en el deterioro progresivo de la función renal, abarca un manejo integral multidisciplinario debido a su carácter recurrente y que aún no existe un tratamiento curativo, es importante establecer los factores de riesgo, definir estrategias para el diagnóstico temprano y acciones para su prevención y procedimientos menos invasivos para la extracción de los cálculos.

Urinary lithiasis in children are due to nutritional, environmental, climatic changes, genetic predisposition, urinary tract infections, underlying metabolic and/or anatomical anomalies. Its incidence is 1-3%, which has increased in the last decade. We present the case of a 22-month-old male infant, who presented with stones at the urethral level with an associated infectious process, and who required an invasive procedure for the extraction of a stone. The patient had documented hyperuricosuria, hypomagneseuria and hypercalciuria, without a family history of kidney stones. Urolithiasis in infants is relevant given the role it can play in the etiology of urinary infection and the progressive deterioration of kidney function. Its treatment encompasses comprehensive multidisciplinary management due to its recurrent nature and the fact that there is still no curative treatment. It is important to identify risk factors, define strategies for early diagnosis, preventive measures and less invasive procedures for stone extraction.

Nefrolitotomía Endoscópica ex vivo del injerto renal de donante vivo con instrumento flexible

Introduction: The finding of an asymptomatic stone in the study of a living kidney donor does not necessarily contraindicate donation, however, there is no consensus on the management of these cases. The use of a graft with lithiasis may represent a risk of recurrence in the remaining kidney in the donor and eventual obstructive complications in the transplanted kidney. The objective of this work is to present the usefulness of ureteroscopy (URS) to resolve lithiasis ex vivo before transplantation. Material and Methods: Donors with a small, asymptomatic kidney stone and with an analysis of lithogenic factors without relevant findings were considered to continue in the donation process. The kidney unit with stone was selected for nephrectomy. Results: Four donor kidneys underwent flexible URS after nephrectomy under hypothermic preservation conditions during bench preparation. The average time of the procedure was 35 minutes and the stone was extracted in all cases without incident. The transplant was carried out in the usual way and the evolution of the recipients was without complications and with excellent renal function. During follow-up, no recurrence of lithiasis was observed in donors or recipients. Conclusions: In this experience, the URS of the donor kidney was a feasible procedure and was not associated with adverse consequences for the graft. The main advantage of this procedure is to avoid the potential risk to the recipient of an obstructive graft complication.

Curcumin alleviated oxidation stress injury by mediating osteopontin in nephrolithiasis rats

Purpose: To explore the role and mechanism of curcumin (Cur) in reducing oxidative stress damage in rats with nephrolithiasis induced by ethylene glycol (EG). Methods: Thirty male rats were divided into normal control, model, positive (10% potassium citrate), Cur-10 (10 mg/kg curcumin) and Cur-20 (20 mg/kg curcumin) groups. Results: The results of kidney tissue section stained by hematoxylin-eosin and von Kossa showed that curcumin treatment can inhibit the formation of kidney stones. The biochemical test results showed that the urea (Ur), creatinine (Cr), uric acid (UA), inorganic phosphorus and Ca2+ concentrations in urine decreased after being treated with curcumin. There were significant differences between different doses of curcumin (P < 0.05). Compared with the Cur-10 group, Cur-20 had a more significant inhibitory effect on malondialdehyde (MDA) (P < 0.05). In addition, reverse transcription polymerase chain reaction (PCR) detection and immunohistochemical results indicated that the osteopontin (OPN) in the kidney was significantly reduced after curcumin treatment. Conclusion: Curcumin could reduce the oxidative stress damage caused by EG-induced kidney stones.

One case report of patient with repeated kidney stone and urine crystal was cured after strengthening calcium supplementation / 中华内分泌外科杂志

The lifetime prevalence of nephrolithiasis is 15% for men, with a 5-year recurrence rate of 35% to 50% after an initial event. Although it was initially recommended to limit calcium intake in these patients, a number of studies have reported association between lower total dietary calcium intake and increased risk of incident kidney stones, and that increased calcium intake might reduce the risk of incident kidney stones. We report a 35-year-old male who presented recurrent 8-years of nephrolithiasis and urine crystal with calcium intake restriction, and had no recurrence after 5 years of follow-up after intensive calcium and vitamin D supplementation.

Protocolo de manejo metabólico multidisciplinario de la litiasis urinaria

La enfermedad de cálculos renales, (nefrolitiasis) es un problema común en la atención en salud. Entre algunos de los factores que ayudan a la prevalencia de litiasis se encuentra la obesidad, altas temperaturas ambientales, y los climas secos. La frecuencia de las diferentes composiciones de los cálculos es: Oxalato de calcio entre el 70-80 %, fosfato calcico el 15 % (la apatita es más común y la brushita es menos común), Ácido úrico el 8%, cistina entre el 1-2 %, Estruvita -1%, Varios - <1 %3.No existen muchos datos sobre la recurrencia de los mismos, pero se sabe que la tasa de recurrencia de litiasis urinaria es del 10 al 30% a los 5 años en pacientes que tienen cálculos de oxalato de calcio idiopáticos. Se plantea elaborar un protocolo de manejo metabólico multidisciplinario de la litiasis urinaria en base a la bibliografía actual tomando en cuanto los puntos de vistas de las especialidades destinadas al manejo del paciente con litiasis urinaria. Nuestro objetivo es establecer un protocolo de manejo capaz de identificar y establecer una terapia que pueda prevenir los cálculos urinarios de forma eficiente y económica, mejorando el pronóstico y minimizando las complicaciones.

Kidney stone disease is a common problem in health care. Among the factors that contribute to the prevalence of lithiasis are obesity, high environmental temperatures, and dry climates. The frequency of the different stone compositions is: Calcium Oxalate 70-80%, Calcium Phosphate -15% (Apatite is more common and Brushite is less common), Uric Acid 8%, Cystine - 1-2%, Struvite -1%, Various - <1%3. There are not many data on their recurrence, but it is known that the recurrence rate of urinary lithiasis is 10 to 30% at 5 years in patients with idiopathic calcium oxalate stones. It is proposed to develop a multidisciplinary metabolic management protocol for urinary lithiasis based on the current bibliography, taking the point of specialties dedicated to the management of patients with urinary lithiasis. Our goal is to establish a management protocol capable of identifying and establishing a therapy that can efficiently and economically prevent urinary stones, improving prognosis and minimizing complications.

Use of artificial intelligence for sepsis risk prediction after flexible ureteroscopy: a systematic review / Uso da inteligência artificial na predição do risco de sepse pós-ureteroscopia flexível: uma revisão sistemática

ABSTRACT Introduction: flexible ureteroscopy is a minimally invasive surgical technique used for the treatment of renal lithiasis. Postoperative urosepsis is a rare but potentially fatal complication. Traditional models used to predict the risk of this condition have limited accuracy, while models based on artificial intelligence are more promising. The objective of this study is to carry out a systematic review regarding the use of artificial intelligence to detect the risk of sepsis in patients with renal lithiasis undergoing flexible ureteroscopy. Methods: the literature review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The keyword search was performed in MEDLINE, Embase, Web of Science and Scopus and resulted in a total of 2,496 articles, of which 2 met the inclusion criteria. Results: both studies used artificial intelligence models to predict the risk of sepsis after flexible uteroscopy. The first had a sample of 114 patients and was based on clinical and laboratory parameters. The second had an initial sample of 132 patients and was based on preoperative computed tomography images. Both obtained good measurements of Area Under the Curve (AUC), sensitivity and specificity, demonstrating good performance. Conclusion: artificial intelligence provides multiple effective strategies for sepsis risk stratification in patients undergoing urological procedures for renal lithiasis, although further studies are needed.

RESUMO Introdução: a ureteroscopia flexível é uma técnica cirúrgica minimamente invasiva utilizada para o tratamento de litíase renal. A urosepse pós-operatória é uma complicação rara, mas potencialmente fatal. Os modelos tradicionais utilizados para prever o risco dessa condição apresentam precisão limitada, enquanto modelos baseados em inteligência artificial são mais promissores. O objetivo desse estudo é realizar uma revisão sistemática a respeito do uso de inteligência artificial para detecção do risco de sepse em pacientes com litíase renal submetidos à ureteroscopia flexível. Métodos: a revisão de literatura está de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A busca com palavras-chave foi realizada no MEDLINE, Embase, Web of Science e Scopus e resultou no total de 2.496 artigos, dos quais 2 se enquadraram nos critérios de inclusão. Resultados: os dois estudos utilizaram modelos de inteligência artificial para predizer o risco de sepse após utereroscopia flexível. O primeiro teve uma amostra de 114 pacientes e foi baseado em parâmetros clínicos e laboratoriais. O segundo teve uma amostra inicial de 132 pacientes e foi baseado em imagens de tomografia computadorizada no pré-operatório. Ambos obtiveram boas medidas de Area Under the Curve (AUC), sensibilidade e especificidade, demonstrando boa performance. Conclusão: a inteligência artificial fornece múltiplas estratégias eficazes para estratificação do risco de sepse em pacientes submetidos a procedimentos urológicos para litíase renal, ainda que mais estudos sejam necessários.

Complicaciones frecuentes en pacientes con nefrolitotomía percutánea / Common complications in patients with percutaneous nephrolithotomy

RESUMEN La nefrolitotomía percutánea es un procedimiento estandarizado para el tratamiento de la litiasis renal. El objetivo de esta comunicación fue describir las complicaciones que más incidieron en los pacientes que fueron atendidos en el Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro¼, en el servicio de Urología, de enero de 2015 a diciembre de 2019, a los cuales se les realizó nefrolitotomía percutánea, así como el tratamiento que recibieron y su evolución. Este estudio mostró bajo índice de complicaciones, lo que guarda relación con el poco tiempo utilizado para realizar esta técnica. Esto resultó beneficioso ya que contribuyó a la corta estadía hospitalaria y disminuyó el consumo de materiales e insumos médicos. También representa un gran logro para los médicos y sobre todo para el paciente, el cual puede recuperarse en un menor período de tiempo y vincularse rápidamente a su vida diaria.

ABSTRACT Percutaneous nephrolithotomy is a standardized procedure for the treatment of kidney stones. The objective of this communication was to describe complications, treatment and evolution of patients who underwent a percutaneous nephrolithotomy in the Urology service at "Arnaldo Milián Castro" Clinical and Surgical University Hospital from January 2015 to December 2019. This study showed a low rate of complications, which is related to the short time used to perform this technique. This was beneficial since it contributed to the short hospital stay and decreased the consumption of medical materials and supplies. It also represents a great achievement for doctors and above all for the patients, who can recover in a shorter period of time and be quickly returned to their daily life.

Hiperaldosteronismo primario asociado a neoplasia adrenal. Reporte de caso

Se describe el caso de un varón de 68 años con antecedente de hipertensión arterial no tratada, diagnosticada un año antes, que ingresó con un cuadro de anasarca, debilidad muscular y disnea al reposo. Los primeros exámenes realizados mostraron hipopotasemia severa, alcalosis metabólica, litiasis renal y vesical y enfermedad renal crónica. La tomografía abdominal reveló una tumoración suprarrenal derecha, hidronefrosis bilateral y litiasis renal y vesical. Con la sospecha de hiperaldosteronismo primario se completó el estudio, con la determinación de relación aldosterona/concentración de renina directa, que resultó alta. El estudio metabólico arrojó hipercalciuria e hiperuricosuria y la gradiente transtubular de potasio mayor de 7. El paciente fue sometido a tratamiento quirúrgico con nefrectomía derecha, sin embargo, falleció en el postoperatorio inmediato, por shock hipovolémico e insuficiencia respiratoria.

SUMMARY We report the case of a 68-year-old male with a history of non-treated arterial hypertension diagnosed the previous year that was admitted with anasarca, muscle weakness and dyspnea at rest. The first laboratory exams showed severe hypopotassemia, metabolic alkalosis, renal and gallbladder lithiasis and chronic renal disease. The abdominal tomography revealed a right suprarenal tumor, bilateral hydronephrosis and renal and gallbladder lithiasis. Under the suspicion of primary hyperaldosteronism, the diagnosis was confirmed with the determination of the relationship between aldosterone/direct renin concentration, which was high. The metabolic study showed hypercalciuria and hyperuricosuria and the potassium trans tubular gradient was above 7. The patient underwent right nephrectomy, nonetheless, died at the immediate post-operatory period due to a hypovolemic shock and respiratory failure.

Hypoparathyroidism: update of guidelines from the 2022 International Task Force

ABSTRACT The 2022 International Task Force guidelines for chronic hypoparathyroidism will be published within several months in the Journal of Bone and Mineral Research. These guidelines update the original guidelines published in 2016, and include new information from literature published since then. Chronic postsurgical hypoparathyroidism is now defined as lasting for at least 12 months after surgery, rather than 6 months. Chronic postsurgical hypoparathyroidism may be predicted by serum PTH <10 pg/mL in the first 12-24 hours after surgery. The most common symptoms and complications of chronic hypoparathyroidism based on the literature are summarized in detail. How to monitor and manage patients with hypoparathyroidism is described in detail where recommendations can be given. These guidelines are intended to frame the diagnosis and care of patients with chronic hypoparathyroidism for at least the next five years.

Skeletal and nonskeletal consequences of hypoparathyroidism

ABSTRACT Hypoparathyroidism, despite the conventional therapy with calcium and active vitamin D, can lead to skeletal and nonskeletal abnormalities. Chronic hypoparathyroidism is associated with a significant reduction in bone remodeling, increases in areal and volumetric bone density, and improvement in trabecular microarchitecture and in trabecular bone score. Regardless of these advantages in bone mass and microarchitecture, recent data suggest an increased vertebral fracture risk in patients with nonsurgical hypoparathyroidism. Moreover, chronic hypoparathyroidism can lead to abnormalities in multiple organ systems, including the neurological, cardiovascular, renal, neuropsychiatric, ocular, and immune systems. Nephrocalcinosis, nephrolithiasis, and renal insufficiency, as well as decreased quality of life and cataracts, are common in patients with hypoparathyroidism. An increased incidence of hospitalization due to infections and a greater risk of cardiovascular diseases are observed in patients with hypoparathyroidism, particularly in those with nonsurgical disease. All these abnormalities may be because of the disease itself or complications of therapy. We herein reviewed the skeletal and nonskeletal consequences of hypoparathyroidism in patients conventionally managed with calcium and active vitamin D.

Normocalcemic primary hyperparathyroidism

ABSTRACT Normocalcemic primary hyperparathyroidism (PHPT) is a newer phenotype of PHPT defined by elevated PTH concentrations in the setting of normal serum calcium levels. It is increasingly being diagnosed in the setting of evaluation for nephrolithiasis or metabolic bone diseases. It is important to demonstrate that PTH values remain consistently elevated and to measure ionized calcium levels to make the diagnosis. A diagnosis of normocalcemic disease is one of exclusion of secondary forms of hyperparathyroidism, including vitamin D deficiency, renal failure, medications, malabsorption, and hypercalciuria. Lack of rigorous diagnostic criteria and selection bias of the studied populations may explain the different rates of bone and renal complications. The natural history still remains unknown. Caution should be used in recommending surgery, unless clearly indicated. Here we will review the diagnostic features, epidemiology, clinical presentation, natural history, medical and surgical management of normocalcemic PHPT.

Anomalías metabólicas en las nefrolitiasis: manejo clínico y tratamientos en una población pediátrica hospitalaria

RESUMEN Introducción: La litiasis urinaria en los niños es multifactorial y con tendencia a recurrir. Las anomalías metabólicas son factores de riesgo importante. Objetivo: Describir las anomalías metabólicas, el manejo clínico y el tratamiento de la nefrolitiasis en una población pediátrica. Materiales y métodos: Estudio observacional descriptivo de corte transverso retrospectivo. Por muestreo de casos consecutivos fueron incluidos pacientes de 0 a 18 años del Servicio de Nefrología Pediátrica del Hospital General Pediátrico Niños de Acosta Ñu en el periodo de enero del 2020 a diciembre del 2021, con diagnóstico de nefrolitiasis, Variables: datos demográficos, estado nutricional, sintomatología, presencia de factores de riesgo y resultado del estudio de anomalías metabólicas. Los datos fueron recogidos en un formulario de Google y analizados en con el SPSSv21, utilizando estadísticas descriptivas. El protocolo fue aprobado por el comité de ética de la investigación con liberación del consentimiento informado. Resultados: Fueron incluidos 112 pacientes con edad mediana de 13 años, el 61,6% de sexo femenino, los síntomas más frecuentes fueron dolor lumbar, abdominal y hematuria. En 54,5% (n=61) se realizó el estudio metabólico. Se detectó anomalías metabólicas en el 90% (55/61). Las más frecuentes fueron la combinación de hipocitraturia e hipomagnesuria (34,4%). El tratamiento consistió en medidas dietéticas e individualizado de acuerdo a las anomalías detectadas. Conclusiones: La frecuencia de anomalías metabólicas en los pacientes sometidos a estudio fue del 90%. Las más frecuentes fueron la combinación de hipocitraturia e hipomagnesuria. El tratamiento consistió en medidas dietéticas y tratamiento específico de las anomalías detectadas.

ABSTRACT Introduction: Urolithiasis in children is multifactorial and tends to recur. Metabolic abnormalities are important risk factors. Objective: To describe the metabolic abnormalities, clinical management, and treatment of nephrolithiasis in a pediatric population. Materials and methods: This was a retrospective, cross-sectional, descriptive and observational study, performed by sampling of consecutive cases. Patients aged 0 to 18 years with a diagnosis of nephrolithiasis from the Pediatric Nephrology Service of the Children's General Pediatric Hospital of Acosta Ñu were included during the period from January 2020 to December 2021. Variables: Demographic data, nutritional status, symptoms, presence of risk factors and results of the study of metabolic abnormalities. The data was collected in a Google form and analyzed with SPSSv21, using descriptive statistics. The protocol was approved by the research ethics committee with the release of informed consent. Results: A total of 112 patients were included with a median age of 13 years, 61.6% female, the most frequent symptoms were lumbar and abdominal pain and haematuria. In 54.5% (n=61) metabolic studies were performed. Metabolic abnormalities were detected in 90% (55/61). The most frequent were the combination of hypocitraturia and hypomagnesuria (34.4%). The treatment consisted of individualized dietary measures, according to the abnormalities detected. Conclusions: The frequency of metabolic abnormalities in the patients studied was 90%. The most frequent were the combination of hypocitraturia and hypomagnesuria. The treatment consisted of dietary measures and specific treatment of the abnormalities detected.

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

Descripción de las características sociodemográficas y clínicas de pacientes con litiasis renal

Contexto: los cálculos renales son cúmulos o depósitos de minerales que se forman en los cálices, la pelvis renal o el tracto urinario. Objetivo: describir las características sociodemográficas y clínicas de una muestra de pacientes con litiasis renal, mayores de 18 años. Metodología: estudio observacional descriptivo de pacientes atendidos en una consulta ambulatoria de Nefrología en Manizales en el periodo 2010-2020, donde se contaba con estudios en sangre, orina de 24 horas y estudio fisicoquímico del cálculo, además de datos sociodemográficos y clínicos relacionados. Se fragmentaron en grupos, de acuerdo con los hallazgos encontrados en los cálculos disponibles, dividiéndose en oxalato de calcio en su totalidad, calcio mixto con otro compuesto y el último grupo de cálculo no calcio. Resultados: se identificaron 54 pacientes con nefrolitiasis, de los cuales 14 de ellos fueron excluidos. Finalmente, 40 pacientes cumplieron con los criterios de inclusión. La mediana de edad fue 52,5 años, predominio del sexo masculino (55 %), donde se encontró en 20,5 % hiperuricemia, hipercalcemia en 17,6 %, hiperfosfatemia en 5 % e hipercaliemia en 7,5 %. En orina se encontró: hipocitraturia en el 71,1 %, seguido de hipercalciuria (12,5 %), hiperuricosuria (10 %) e hiperoxaluria (5 %). En 17 de los pacientes (42,5 %) se logró el estudio de la composición fisicoquímica del cálculo, en ellos la variedad de calcio mixto fue la más frecuente (55,5 %). Conclusiones: este estudio describe las características de pacientes con cálculos renales, mostrando que la mayoría tiene alteraciones metabólicas asociadas a nefrolitiasis, siendo la hipocitraturia el hallazgo más frecuente y que la mayoría de los cálculos tiene calcio en su composición.

Background: Kidney stones are accumulations or mineral deposits that form in the calyces, renal pelvis, or urinary tract. Purpose: To describe the sociodemographic and clinical characteristics of a sample of patients with kidney stones over 18 years of age. Methodology: Descriptive observational study. Patients treated in an outpatient nephrology and urology consultation in Manizales during the years 2010 to 2020, in which there were studies in blood, 24-hour urine, and a physicochemical study of the stone, as well as related sociodemographic and clinical data. They were divided into groups, according to the findings found in the available stones, dividing into calcium oxalate in its entirety, calcium mixed with another compound and the last group of non-calcium stone. Results: 54 patients with nephrolithiasis were identified, 14 of them were excluded. Finally, 40 patients met the inclusion criteria. Median age was 52.5 years, male predominance (55%), hyperuricemia was found in 20.5%, hypercalcemia in 17.6%, hyperphosphatemia in 5% and hyperkalemia in 7.5%. In urine, hypocitraturia was found in 71.1%, followed by hypercalciuria (12.5%), hyperuricosuria (10%), and hyperoxaluria (5%). In 17 patients (42.5%) there was a result of the physicochemical composition of the stone, in them the mixed calcium variety was the most frequent (55.5%). Conclusions: This study describes the characteristics of patients with kidney stones, showing that the majority have metabolic alterations associated with nephrolithiasis, hypocitraturia being the most frequent finding, and that most stones have calcium in their composition.

Dose-dependent effect of Scolymus hispanicus L. (sevketibostan) on ethylene glycol-induced kidney stone disease in rats

Kidney stone, also known as calcium oxalate nephrolithiasis, is one of the most common diseases worldwide. Calculi usually forms when urine becomes supersaturated with particular calcium salts such as calcium oxalate. In the present study, we investigated the ameliorative potential of the root extract of the Common golden thistle, Scolymus hispanicus L. (SH) on rats with ethylene glycol (EG) induced kidney stone disease. Sprague-Dawley rats, each weighing 250-300 g, were divided into three groups (n=6 per group): (i) Control (C); (ii) EG; and (iii) EG+SH. To induce nephrolithiasis, the rats received 1% of EG with drinking water, while the C group received normal drinking water during the study. SH extract 2 g/kg was added to the treatment from the 4th week onwards in EG+SH group. At the end of each experiment, rats were decapacitated and serum levels of calcium, magnesium, phosphorus, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were assessed in all groups at 0, 4, and 8 weeks. Oxalic acid and creatininelevels were measured in urine samples collected at 24 h in metabolic cages. Renal tissues were evaluated histopathologically at the end of the experiment. After 8 weeks, serum creatinine levels were found decreased in the SH group while increased in the EG group. Serum magnesium and AST levels were also found decreased in the EG group, however, SH treatment reversed these values. The SH treatment also increased urinary oxalic acid levels. When the kidney tissue of EG group was examined, there was a high level of crystal/stone, especially in the renal cortex. In kidney tissues of the SH group, only small amounts of crystal/stone were observed. Our experimental findings have demonstrated the ameliorative potential of the aqueous extracts of S. hispanicus roots and shells on EG-induced in the kidney stones in rats. Isolation of active compounds of SH would be desirable to understand the biochemical mechanism behind the process better.

Short-term outcome of kidney transplantation from deceased donors with nephrolithiasis / 中南大学学报(医学版)

Objective: Shortage of kidney allografts is a major barrier to end-stage renal disease patients receiving kidney transplantation, and it is necessary to enlarge the donor pool and find better ways of using available allografts. The global incidence of nephrolithiasis is increasing, nephrolithiasis affects approximately 10％ of adults worldwide, and it also affects the kidney donors. However, there is little information about the use of cadaveric kidney allografts with nephrolithiasis. This study aims to evaluate the safety and outcome of kidney transplantation with allografts from the deceased donors with nephrolithiasis. Methods: A total of 520 deceased donors who was at least 10 years old, and 945 adult recipients with single kidney transplantation at the Department of Kidney Transplantation, the Second Xiangya Hospital from 2016 to 2020 were included in this study. The donors were divided into 2 groups according to nephrolithiasis diagnoses: The donors with nephrolithiasis (D+) and the donors without nephrolithiasis (D?). The recipients were assigned into 3 groups according to their donors and the allografts they received: The allografts from donors without nephrolithiasis (D?K?), the allografts without nephrolithiasis from donors with nephrolithiasis (D+K?), and the allografts with nephrolithiasis (D+K+). The demographic and clinical data of enrolled subjects were retrospectively analyzed. The allograft discard ratio between different donors were analyzed. The one-year survival of allografts and recipients, as well as the allograft function and the complications of kidney transplantation were compared. Results: Fifty out of 520 donors had nephrolithiasis, and the nephrolithiasis incidence was 9.6％. We recovered 1040 kidneys, and total discard rate was 4.4％ (46/1040). The D+ group had a rate of 7％ discard. The donors with kidney discard accounted for 12％ in the D+ group, and this was higher than that of donors in the D? group (5.1％, P<0.05). The total incidence of delayed graft function (DGF) was 7.5％, and there were no significant differences in the incidence of DGF in recipients among the D?K?, D+K?, and D+K+ group (7.5％ vs 6.5％ vs 8.2％, P>0.05). During the one-year follow-up, 8 allografts lost function and 19 recipients died with a functional allograft. Recipients in the D?K?, D+K?, and D+K+ groups also had no significant difference between a one-year allograft and patient survival rate (P>0.05). However, recipients in the D+K+ group had a higher level of serum creatinine [(139.2±62.46) μmol/L vs (117.19±51.22) μmol/L, P<0.05] and lower estimated glomerular filtration rate [eGFR; (56.67±23.31) mL/(min·1.73 m?2) vs (66.86±21.90) mL/(min·1.73 m?2), P<0.05] compared with recipients in the D?K? group at 12 months after transplantation. During the first year after transplantation, 4 recipients developed urolithiasis, and recipients who received allografts from the D+ group donors had a higher incidence of urolithiasis than those who received allografts from the D? group donors (2.2％ vs 0.2％, P<0.05). There were no significant differences in the incidence of urinary tract infections and ureteral strictures at 1 year between recipients of D+ and D? donors (both P>0.05).Conclusion: The cadaveric kidney allografts with nephrolithiasis could be safely used for transplantation, and the short-term outcome is acceptable. However, nephrolithiasis in donors may increase the rate of kidney discard, disturb the short-term function of allografts, and increase the risk of urolithiasis in recipients. Further research with a long-term study is needed to verify the long-term outcome of kidney transplantation using cadaveric kidney allografts with nephrolithiasis.

Principais distúrbios metabólicos em adolescentes portadores de nefrolitíase / Main metabolic disorders in adolescents with nephrolithiasis

Introdução: Os cálculos renais compreendem uma das mais comuns patologias do trato urinário e têm apresentado maior incidência em adolescentes nos últimos anos. Objetivos: Identificar os distúrbios metabólicos causadores de cálculo renal mais prevalentes em adolescentes. Métodos: Foram analisados os prontuários de 135 indivíduos portadores de nefrolitíase, com idade entre 12 e 18 anos, de ambos os sexos. Na análise laboratorial, incluiu-se: duas amostras de urina de 24 horas, contendo cálcio, citrato, oxalato e ácido úrico; uma amostra sanguínea, contendo creatinina, paratormônio, ácido úrico e cálcio; pH urinário após 12 horas de restrição hídrica e jejum; urocultura e cistinúria qualitativa. Resultados: 88 pacientes apresentaram hipercaIciúria (65,2%), 42 apresentaram hipocitratúria (31,1%) e 29 hiperuricosúria (21,5%). As demais alterações observadas foram: volume urinário reduzido (14,8%), infecções do trato urinário (9,6%), hiperoxalúria (5,2%), hiperparatireoidismo (1,5%) e acidose tubular renal (1,5%). Os distúrbios metabólicos mais frequentemente observados nos adolescentes portadores de cálculo renal foram hipercalciúria, hipocitratúria e hiperuricosúria

Introduction: Kidney stones are one of the most common pathologies of the urinary tract and have had a higher incidence in adolescents in recent years. Objectives: To identify the most prevalent metabolic disorders that cause kidney stones in adolescents. Methods: The medical records of 135 individuals with nephrolithiasis, aged between 12 and 18 years, of both sexes, were analyzed. The laboratory analysis included: two 24-hour urine samples containing calcium, citrate, oxalate and uric acid; a blood sample, containing creatinine, parathyroid hormone, uric acid, and calcium; urinary pH after 12 hours of fluid restriction and fasting; uroculture and qualitative cystinuria. Results: 88 patients had hyperuricosuria (65.2%), 42 had hypocitraturia (31.1%) and 29 had hyperuricosuria (21.5%). The other changes observed were: reduced urinary volume (14.8%), urinary tract infections (9.6%), hyperoxaluria (5.2%), hyperparathyroidism (1.5%) and renal tubular acidosis (1.5 %). Conclusions: The metabolic disorders most frequently observed in adolescents with kidney stones were hypercalciuria, hypocitraturia and hyperuricosuria.

The learning curve for retrograde intrarenal surgery: A prospective analysis / A curva de aprendizado em cirurgia retrógrada intrarrenal: Uma análise prospectiva

ABSTRACT Introduction: retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. Material and Methods: a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. Results: there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. Discussion: the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. Conclusions: we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.

RESUMO Introdução: a cirurgia retrógrada intrarrenal (CRIR) é ferramenta em evolução. Sua curva de aprendizado não está bem estabelecida, apesar do uso comum dos ureteroscópios flexíveis atualmente. O objetivo é estimar o número de procedimentos necessários para se realizar CRIR consistentemente. Material e Métodos: Um residente de urologia teve suas primeiras 80 CRIR para tratamento de nefrolitíase analisadas quantitativa e qualitativamente. Os procedimentos foram divididos em 4 grupos contendo 20 cirurgias cada (I a IV), de acordo com sua ordem, para comparação. Resultados: Não houve diferença nos tamanhos dos cálculos entre grupos. Todas as variáveis qualitativas apresentaram variação significativa entre os grupos (p<0,001), exceto entre III e IV. Na análise quantitativa houve diferença entre os grupos I e IV no tempo de colocação do cateter duplo J (p=0,012). Houve uma diferença crescente no tempo de colocação da bainha (p<0,001) e no tempo operatório total (p=0,004). O tempo para o tratamento do cálculo (p=0,011) foi significativo apenas entre os grupos I, II e III. Houve diferença no tempo total de bainha apenas entre os grupos I e III (p=0,023). Taxa livre de cálculos não se alterou entre os grupos. Discussão: as diferenças observadas entres as variáveis qualitativas e quantitativas evidenciam a relação entre o número de cirurgias realizadas e a proficiência no procedimento. As comparações intergrupo mostram otimização sequencial dos parâmetros. Conclusões: estima-se que 60 é um número razoável de cirurgias para que se atinja o platô da curva de aprendizado.

Calcified intrarenal aneurysm simulating urinary lithiasis

ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.