Effect of a low-calorie diet on 24-hour urinary parameters of obese adults with idiopathic calcium oxalate kidney stones

ABSTRACT Purpose: to evaluate the effect of low-calorie diet on 24-hour urinary metabolic parameters of obese adults with idiopathic calcium oxalate kidney stones. Materials and Methods: Adult idiopathic calcium oxalate stone formers, with body mass index (BMI) ≥30kg/m2 and a known lithogenic metabolic abnormality, were submitted to low-calorie diet for twelve weeks. After enrolment, anthropometric measures, serum exams, 24-hour urinary metabolic parameters and body impedance were collected one month prior to dietary intervention and at the end of twelve weeks. Correlations between weight loss, waist circumference loss, fat loss and variation in 24-hour urinary lithogenic parameters and calcium oxalate urinary supersaturation (CaOx SS) as per Tiselius equation were analysed. Results: From January 2017 to January 2018, 39 patients were enrolled to participate in this study. Median (range) prescribed diet was 1300 (1100-2100) Kcal/day. Mean age was 51.7±11.0 (29-68) years old and 69.2% were female. 30.8% of the participants shifted from obesity to BMI <30kg/m2 and none to BMI <25kg/m2. A significant correlation was found between baseline 24-hour urinary oxalate and weight (p=0.018) and BMI (p=0.026). No correlation was found between variation of weight, waist circumference, fat mass and 24-h urinary stone risk factors or CaOx SS. Conclusions: Short-term modest weight loss induced by twelve weeks of low-calorie diet is not associated with a decrease of 24-hour urinary lithogenic parameters in idiopathic calcium oxalate stone formers. Calcium oxalate urinary stone formation is probably multifactorial and driven by other factors than weight.

Impact of intestinal flora on calcium oxalate stones / 中南大学学报(医学版)

Kidney stone is one of the common diseases of the urinary system. About 80% of kidney stones are mainly composed of calcium oxalate. As a huge bacterial network, the interaction of gut microbes is complex. Intestinal microbes may play a role in the pathogenesis and prevention of kidney stones. The intestinal flora of patients with calcium oxalate stones possess unique distribution of gut microbes.

Seasonal variations in urinary calcium, volume, and vitamin D in kidney stone formers

ABSTRACT Objectives: To investigate the seasonal variations in urinary calcium, serum vitamin D, and urinary volume in patients with a history of nephrolithiasis. Materials and Methods: Patients included were those who completed a 24-hour urine metabolic evaluation on two occasions; one in summer (June-Aug) and one in winter (Nov-Jan), and who had not started any medications or been instructed on dietary modifications in the interval between the two tests that may have impacted the results. Patients were excluded if they were on thiazide diuretics or were taking calcium and / or Vitamin D supplementation. Welch's t-test was used to compare the difference in average summer and winter values. Unpaired Student t-test was used to compare baseline parameters (age, BMI), and Paired Student t-test was used to compare average seasonal measurements in men vs. women. Results: 136 patients were identified who were not taking calcium or vitamin D supplements or thiazide diuretics, and who were not instructed on dietary modifications in the interval between the two measured parameters. No significant differences were observed when comparing male to female baseline parameters of age or BMI (Table-1). Average 24-hour urine calcium was higher (226.60) in the winter than in summer (194.18) and was significant in males (p = 0.014) and females (p < 0.001). No significant seasonal difference was seen in 24-hour urine volume or serum vitamin D levels. Conclusions: Urinary calcium is higher in winter months compared to summer months. As such, tailoring medical preventative strategies to the time of year may be helpful.

Review of post bariatric surgery effects on common genitourinary physiology

ABSTRACT Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.

Kidney stones: composition, frequency and relation to metabolic diagnosis

Nephrolithiasis is one of the most frequent urologic diseases. The aim of this paper is to study the composition and frequency of 8854 patient kidney stones and in a subset of them their metabolic risk factors to be related to their type of calculi. Physicochemical and crystallographic methods were used to assess kidney stone composition. In a subset of 715 patients, we performed an ambulatory metabolic protocol with diagnostic purposes. From the total sample 79% of stones were made of calcium salts (oxalate and phosphate), followed by uric acid stones in 16.5%, calcium salts and uric acid in 2%, other salts in 1.9% and cystine in 0.6%. Male to female ratio was almost three times higher in calcium salts and other types of stones, reaching a marked male predominance in uric acid stones, M/F 18.8 /1.0. The major risk factors for calcium stones are idiopathic hypercalciuria, followed by unduly acidic urine pH and hyperuricosuria. In uric acid stones unduly acidic urine pH and less commonly hyperuricosuria are the most frequent biochemical diagnosis. Our results show that analysis of kidney stones composition and the corresponding metabolic diagnosis may provide a scientific basis for the best management and prevention of kidney stone formation, as well as it may help us to study the mechanisms of urine stone formation.

La litiasis renal es una de las enfermedades urológicas más frecuentes. El objetivo de este trabajo fue estudiar la composición y frecuencia de 8854 cálculos renales y evaluar en un subgrupo de ellos la relación de los factores de riesgo metabólicos con el tipo de cálculo hallado. Se utilizaron métodos fisicoquímicos y cristalográficos para evaluar la composición de los cálculos renales. En un subgrupo de 715 pacientes, se pudo realizar un protocolo metabólico ambulatorio con fines diagnóstico. De la muestra total, 79.0% de los cálculos fueron de sales de calcio (oxalato y fosfato), seguido por cálculos de ácido úrico en 16.5%, sales de calcio y ácido úrico en 2.0%, otras sales en 1.9% y cistina en 0.6%. La relación hombre/mujer fue casi tres veces mayor en las sales de calcio y otros tipos de cálculos, alcanzando un marcado predominio en varones con cálculos de ácido úrico, M/F 18.8/1.0. Los principales factores de riesgo para los cálculos de calcio fueron la hipercalciuria idiopática, seguida del pH urinario excesivamente ácido y la hiperuricosuria. En los cálculos de ácido úrico el pH urinario excesivamente ácido y con menor frecuencia la hiperuricosuria fueron los diagnósticos más frecuentes. Nuestros resultados muestran que el análisis de la composición de los cálculos renales y el correspondiente diagnóstico metabólico pueden proporcionar una base científica para el mejor manejo y prevención en la formación de cálculos renales, así como que nos puede ayudar a estudiar los mecanismos de formación de los mismos.

Bone Marrow Oxalosis in a Patient With Pancytopenia Following Bilateral Nephrectomy

No abstract available.

What is the Incidence of Kidney Stones after Chemotherapy in Patients with Lymphoproliferative or Myeloproliferative Disorders?

Introduction This study describes the incidence and risk factors of de novo nephrolithiasis among patients with lymphoproliferative or myeloproliferative diseases who have undergone chemotherapy. Materials and Methods From 2001 to 2011, patients with lymphoproliferative or myeloproliferative disorders treated with chemotherapy were retrospectively identified. The incidence of image proven nephrolithiasis after chemotherapy was determined. Demographic and clinical variables were recorded. Patients with a history of nephrolithiasis prior to chemotherapy were excluded. The primary outcome was incidence of nephrolithiasis, and secondary outcomes were risk factors predictive of de novo stone. Comparative statistics were used to compare demographic and disease specific variables for patients who developed de novo stones versus those who did not. Results A total of 1,316 patients were identified and the incidence of de novo nephrolithiasis was 5.5% (72/1316; symptomatic stones 1.8% 24/1316). Among patients with nephrolithiasis, 72.2% had lymphoproliferative disorders, 27.8% had myeloproliferative disorders, and 25% utilized allopurinol. The median urinary pH was 5.5, and the mean serum uric acid, calcium, potassium and phosphorus levels were 7.5, 9.6, 4.3, and 3.8 mg/dL, respectively. In univariate analysis, mean uric acid (p=0.013), calcium (p<0.001)), and potassium (p=0.039) levels were higher in stone formers. Diabetes mellitus (p<0.001), hypertension (p=0.003), and hyperlipidemia (p<0.001) were more common in stone formers. In multivariate analysis, diabetes mellitus, hyperuricemia, and hypercalcemia predicted stone. Conclusions We report the incidence of de novo nephrolithiasis in patients who have undergone chemotherapy. Diabetes mellitus, hyperuricemia, and hypercalcemia are patient-specific risk factors that increase the odds of developing an upper tract stone following chemotherapy. .

Ectopia renal cruzada com fusão: relato de dois casos e revisão da literatura / Crossed renal ectopia with fusion: report of two cases and review of the literature

Ectopia renal é uma das mais comuns anormalidades de desenvolvimento renal. Contudo, somente poucos casos de ectopia renal cruzada com fusão têm sido relatados na literatura. Ectopia renal cruzada, geralmente, é uma entidade clinicamente silenciosa, mas algumas vezes complica com infecção urinária de repetição e nefrolitíase e pode ser associada com uma alta incidência de obstrução da junção ureteropélvica, refluxo vesicoureteral e displasia renal multicística. Os autores relatam dois novos casos de ectopia renal cruzada com fusão diagnosticados em um contexto de infecção urinária e nefrolitíase e fazem uma revisão dos mecanismos e características clínicas desta anormalidade. O nefrologista deve estar familiarizado com esta alteração do desenvolvimento renal, uma vez que muitas complicações podem ocorrer durante o seguimento destes pacientes.

Renal ectopia is one of the most common renal abnormalities of kidney development. However, only a few cases of crossed fused renal ectopia have been reported in the literature. Although crossed renal ectopia is usually clinically silent, they is sometime responsible for infection and urinary stones and may be associated with a high incidence of ureteropelvic junction obstruction, vesicoureteral reflux and renal multicystic dysplasia. We report two new cases of crossed renal ectopia with fusion diagnosed in a context of kidney stones and urinary tract infection and review the mechanism and clinical features of this abnormality. We believe that Nephrologist must be familiar with this abnormality of kidney development, as a number of complications may appear during follow-up.

Microlithiasis and Nephrolithiasis among infants: Is it a new phenomenon?

Although nephrolithiasis is a rare but a serious problem for children's health, recent data has showed that the prevalence of pediatric nephrolithiasis has increased in both developed and developing countries. North and West of Iran, as a country located in Afro-Asian stone-forming belt, has the highest incidence for renal stones among adults. This study aimed to determine the incidence of microlithiasis and nephrolithiasis among infants in a city at North West of Iran. It was a cross-sectional study on infants aged less than one year old, diagnosed as patients with microlithiasis and nephrolithiasis, over three months period [since March 2010] who were referred to pediatrician in a city of East Azerbaijan province. Demographic data [age, sex], number of stones, size of stones, presence of hydronephrosis in kidneys, history of jaundice and family history of stone disease were recorded. Incidence of microlithiasis and nephrolithiasis was 0.04866 and 0.03244, respectively. Fever [30%] was the main cause of complication. Male to female ratio was 4:1, and 20% of our subjects had a positive history of nephrolithiasis in their first degree relatives. This area has the highest incidence of microlithiasis and nephrolithiasis. Emergent population-based and case-control studies are needed to report its incidence/prevalence of nephrolithiasis in other parts of the country as well as to find its etiology

Renal Stone Associated with the Ketogenic Diet in a 5-Year Old Girl with Intractable Epilepsy

In this paper, we report on a 5-year-old girl who developed a renal stone while following the ketogenic diet to treat refractory seizure disorder. Three months after initiating the ketogenic diet, she developed severe abdominal pain and vomiting. The spot urine calcium-to-creatinine (Ca/Cr) ratio and 24-hour urine evaluation showed hypercalciuria. Computed tomography (CT) imaging revealed a stone in the right ureteropelvic junction, resulting in hydronephrosis of the right kidney. The renal stone disappeared 5 days after conservative treatment; the patien's microscopic hematuria resolved concurrently. In light of this case report, we recommend regularly monitoring the urine Ca/Cr ratio with ultrasonography for further development of renal stones in patients following the ketogenic diet. If these patients exhibit evidence of symptomatic hypercalciuria or cyristalluria, liberalization of fluid restriction and urine alkalization using oral potassium citrate should be considered.

Dieta cetogénica en epilepsia refractaria: eficacia, evolución y complicaciones a largo plazo / Ketogenic diet in refractory epilepsy: efficacy, evolution and long-term complications

Background: Ketogenic diet (KD) represents an alternative in treatment of refractory epilepsy (RE). Objective: To evaluate the efficacy of the diet and the frequency of complications in patients belonging to the KD Program from Luis Calvo Mackenna Children's Hospital (HLCM). Methods: Evaluation of all children enrolled in the program between 1999 and 2004, with analysis every 6 months of the diet efficacy, digestive tolerance, nutritional status, cholesterol levels and nephrolithiasis. Results: 21 children were admitted, 14 boys, age between 6 months - 17 years-old. 76 percent, 71 percent and 67 percent of patients followed KD at 6, 12 and 18 months, respectively, with KD efficacy of 67 percent. At 12 months, 24 percent of patients did not present seizures. At 18 months, 85 percent remained close to ideal body weight (15 percent obesity) and height/age Z score decreased (-0,7 +/- 0,4; p < 0,05). Total cholesterol significantly increased at 6 months (64 percent hypercholesterolemia; decreased to 15 percent at 18 months). 2 patients developed nephrolithiasis. Conclusions: The study shows high efficacy of the KD for treatment of refractory epilepsy, with low rate of complications. It should be considered as a therapeutic alternative for these patients.

La dieta cetogénica (DK) es una opción de tratamiento en epilepsia refractaria (ER). En Chile no hay estudios publicados al respecto. Objetivo: Evaluar la eficacia de la dieta en el control de las convulsiones y la frecuencia de complicaciones en los pacientes del programa de DK, para el tratamiento de ER, del Hospital Luis Calvo Mackena (HLCM). Pacientes y Método: Evaluamos todos los niños ingresados al programa entre 1999-2004. Para efectos de este trabajo se consideró el control al ingreso y cada 6 meses, evaluándose: eficacia de la dieta, tolerancia digestiva, evolución nutricional, niveles de colesterol plasmático y litiasis renal. Resultados: Ingresaron 21 niños de 6,2 años (6 meses a 17 años), 14 de sexo masculino. A los 6, 12 y 18 meses, 76 por ciento, 71 por ciento y 67 por ciento de los pacientes, respectivamente, se mantenía en dieta. La eficacia del tratamiento fue 67 por ciento. A los 12 meses, 24 por ciento de los pacientes estaba sin crisis. A los 18 meses 85 por ciento de los pacientes estaba eutrófico y 15 por ciento obeso. Se observó deterioro en la talla (delta zT/E -0,7 +/- 0,4; p < 0,05). El colesterol total aumentó significativamente a los 6 meses, encontrándose el 64 por ciento hipercolesterolémico; a los 18 meses este porcentaje se redujo a 15 por ciento. Dos pacientes presentaron litiasis renal (9 por ciento). Conclusiones: Este estudio muestra una muy buena eficacia de la dieta cetogénica para el tratamiento de la epilepsia refractaria, y una baja frecuencia de complicaciones, por lo que debería ser considerada como alternativa terapéutica en estos pacientes.

Doença de Crohn e cálculo renal: muito mais que coincidência? / Crohn’s disease and kidney stones: much more than coincidence?

RACIONAL: A doença de Crohn é uma doença inflamatória intestinal que pode estar associada a várias complicações e manifestações que são secundárias ao processo inflamatório de base. Em aproximadamente 30 por cento dos pacientes têm sido encontradas manifestações extra-intestinais. A nefrolitíase é uma delas e a formação de cálculos é mais comum nestes pacientes do que na população em geral, principalmente cálculos de oxalato de cálcio. OBJETIVOS: Avaliar os fatores metabólicos urinários potencialmente envolvidos na formação de cálculos renais em pacientes com doença de Crohn. MÉTODOS: Foram avaliados 29 pacientes com doença de Crohn atendidos no Ambulatório de Doenças Inflamatórias do Hospital de Clínicas da Universidade Estadual de Londrina, PR, no período de janeiro a dezembro de 2004. A avaliação metabólica incluiu medidas séricas e urinárias de substâncias relacionadas à litíase renal, ultra-sonografia de rins e vias urinárias e cálculo da supersaturação urinária para o oxalato de cálcio, ácido úrico e fosfato de cálcio. RESULTADOS: Dos 29 pacientes avaliados, 65,5 por cento eram do sexo feminino e 34,5 por cento do masculino. As principais alterações metabólicas urinárias encontradas foram 72,41 por cento de hipocitratúria, 41,4 por cento de hipomagnesiúria, 13,6 por cento de hiperoxalúria e 17,24 por cento de baixo volume urinário. Foram encontrados cálculos renais em 13 pacientes (44,8 por cento). Os pacientes submetidos a cirurgia intestinal, com ressecção ileal, apresentaram alterações na saturação urinária de oxalato e fosfato. Para a comparação das médias, utilizou-se o teste de Mann-Whitney e para determinar a associação entre as variáveis foi utilizado o teste do Qui-quadrado ou o teste exato de Fisher com um nível de significância de 5 por cento. CONCLUSÃO: A freqüência de pacientes com cálculos renais foi maior que a encontrada na população geral e acima do descrito em trabalhos similares. As alterações encontradas como...

BACKGROUND: Crohn’s disease is an inflammatory bowel disease associated with a wide variety of complications and manifestations secondary to the effects of underlie inflammatory process. In about 30 percent of the patients with Crohn’s disease can be found extra-intestinals symptoms. Nephrolithiasis is one of them and the appearance of kidney stones, mainly of oxalate of calcium, is more common in these patients than in general population. AIM: To evaluate urinary metabolic factors potentially involved in renal stones formation on patients with Crohn’s disease. METHODS: We evaluated 29 patients with Crohn’s disease followed in the Outpatient Bowel Inflammatory Disease Clinics of State University Hospital, Londrina, PR, Brazil, from January to December of 2004. The metabolic evaluation included measured of blood and urine substances related to renal stones formation, kidneys, ureters and bladder ultrassonography and calculation of urinary supersaturation for calcium oxalate, uric acid and calcium phosphate. RESULTS: Twenty-nine of the evaluated patients were female or 65.5 percent and 34.5 percent were males. Among the metabolic urinary studied, we identified the following potential disturbances associated with nephrolithiasis: hypocitraturia in 21 patients (72.4 percent), hypomagnesuria in 12 (41.4 percent), hyperoxaluria in 4 (13.6 percent) and urinary volume low in 5 (17.2 percent). Renal stones were identified in 13 patients (44.8 percent). Oxalate urinary excretion was higher in patients submitted to bowel surgery and also in patients with ileum resection. The urinary supersaturation of calcium oxalate and brushita in patients with bowels surgery was higher than the other patients not submitted to any surgery. Data to compare patients who underwent to surgery or not were analyzed by Mann-Whitney test (U test), and Qui-square test or the accurate test of Fisher have been used to determine variables association. For all tests 5 percent...

Calcium intake and disease prevention / Ingesta de cálcio e prevenção de doença

While the fundamental metabolic function of calcium is to serve as a second messenger, coupling intracellular responses to extracellular signals, nutritional deficiency of calcium is manifested at a higher level of organization: 1) depletion of the calcium nutrient reserve; 2) inadequate complexation of digestive byproducts; and 3) collateral effects of hormones produced primarily to compensate for low calcium intake. The first mechanism contributes to the osteoporosis problem, the second to kidney stones and colon cancer, and the third to hypertension, preeclampsia, obesity, and insulin resistance, among others. Adequate calcium intakes (1000­1500 mg/d) in adults have been shown in controlled trials to lower the risk of osteoporotic fractures, kidney stones, obesity, and hypertension. The best source of calcium is dairy foods, largely because the disorders concerned depend upon multiple nutrients, not just calcium, and dairy provides a broad array of essential nutrients in addition to calcium, and at low cost.

Enquanto a principal função metabólica do cálcio é atuar como um secundo mensageiro, acoplando as respostas intracelulares aos sinais extracelulares, a deficiência nutricional do cálcio é manifestada num nível mais alto de organização: 1) depleção da reserva de cálcio; 2) inadequada formação em complexo digestivo; 3) efeitos colaterais dos hormônios produzidos para compensar a baixa reserva de cálcio. O primeiro mecanismo contribui para o surgimento da osteoporose, o secundo para cálculos renais e câncer, e o terceiro hipertensão arterial, preeclampsia, obesidade e resistência insulínica, entre outros. Uma adequada ingesta de cálcio (1000­1500 mg/d) tem mostrado em estudos clínicos controlados em adultos, reduzir os riscos de fraturas osteoporóticas, cálculos renais, obesidade e hipertensão. A melhor fonte de cálcio são os laticínios, porque além do cálcio, fornecem múltiplos nutrientes e são de baixo custo.

Renal stone disease: causes, evaluation and medical treatment / Calculose renal: causas, avaliação e tratamento médico

The purpose of the present review is to provide an update about the most common risk factors or medical conditions associated with renal stone formation, the current methods available for metabolic investigation, dietary recommendations and medical treatment. Laboratory investigation of hypercalciuria, hyperuricosuria, hyperoxaluria, cystinuria, hypocitraturia, renal tubular acidosis, urinary tract infection and reduction of urinary volume is based on the results of 24-hr urine collection and a spot urine for urinary sediment, culture and pH. Blood analysis for creatinine, calcium and uric acid must be obtained. Bone mineral density has to be determined mainly among hypercalciurics and primary hyperparathyroidism has to be ruled out. Current knowledge does not support calcium restriction recommendation because it can lead to secondary hyperoxaluria and bone demineralization. Reduction of animal protein and salt intake, higher fluid intake and potassium consumption should be implemented. Medical treatments involve the use of thiazides, allopurinol, potassium citrate or other drugs according to the metabolic disturbances. The correction of those metabolic abnormalities is the basic tool for prevention or reduction of recurrent stone formation.

O propósito desta revisão é apresentar uma atualização sobre os fatores de risco ou condições médica comuns associadas com a formação de cálculos renais, os métodos atualmente disponíveis para investigação metabólica, recomendações dietéticas e tratamento médico. A investigação laboratorial para hipercalciúria, hiperuricosuria, hiperoxalúria, cistinúria, hipocitratúria, acidose tubular renal, infecção do trato urinário e redução do volume urinário, é baseada nos resultados das coleções de urina de 24h e amostra isolada para sedimento urinário, cultura e pH. Deve-se obter análises sanguíneas para creatinina, cálcio e ácido úrico. Deve-se determinar a densidade mineral óssea especialmente entre pacientes hipercalciúricos, e o hiperparatiroidismo primário deve ser excluído. O conhecimento atual não endossa as recomendações de restrição de cálcio, já que isto pode levar o hiperaxalúria secundária e desmineralização óssea. Redução da ingesta de proteína animal e de sal deve ser implementada junto com aumento da ingesta de líquidos e do consumo de potássio. Tratamento medicamentoso envolve o uso de tiazídicos, alopurinol, citrato de potássio ou outras drogas, conforme o distúrbio metabólico. A correção dessas anormalidades metabólicas é o instrumento básico para a prevenção ou redução da formação recorrente de cálculos.

The impact of pelvicaliceal anatomical variation between the stone-bearing and normal contralateral kidney on stone formation in adult patients with lower caliceal stones

OBJECTIVE: We aimed to investigate the effect of pelvicaliceal anatomical differences on the etiology of lower caliceal stones. MATERIALS AND METHODS: Records of adult patients between January 1996 and December 2005 with solitary lower caliceal stone were reviewed. After exclusion of patients with hydronephrosis, major renal anatomic anomalies, non-calcium stones, history of recurrent stone disease and previous renal surgery, 78 patients were enrolled into the study. Lower pole infundibulopelvic angle (IPA), infundibulovertebral angle (IVA), infundibular length (IL), width (IW), number of minor calices and cortical thickness of the lower pole together with other caliceal variables obtained from the whole pelvicaliceal anatomy of both stone-bearing and contralateral normal kidneys were measured from intravenous pyelogram of the patients. Total pelvicaliceal volume was also calculated by a previously described formula for both kidneys. RESULTS: There were statistically significant difference between two kidneys in terms of IW (p < 0.001) and IL (p = 0.002) of the upper calyx, IW (p = 0.001) and IVA (p < 0.001) of the lower calyx), pelvicaliceal volume (p < 0.001), IPA of middle calyx (p = 0.006) and cortical thickness over the lower pole (p < 0.001). However there was no difference between stone-bearing and contralateral normal kidneys in terms of lower pole IPA (p = 0.864) and IL (p = 0.568). CONCLUSION: Pelvicaliceal volume but not lower caliceal properties seem to be a risk factor for stone formation in lower calyx.

Despistaje de acidosis tubular renal distal en preescolares del jardín de infancia Guiri Guire La Guardia, Estado Nueva Esparta: mayo 2005 / Search of acidosis renal distal in preeschool of the childhood garden Guiri Guire La Guardia, Nueva Esparta: may 2005

La acidosis tubular renal distal es un trastorno congénito o adquirido de la acidificación renal consecuencia de disfunción tubular, no presenta manifestaciones clínicas evidentes. Realizar despistaje en preescolares del Jardín de infancia Guiri Guire, La Guardia, Estado Nueva Esparta, en mayo 2005. Estudio Transversal mixto, muestra de 104 preescolares, se tallaron, pesaron, se llenó cuestionario respecto a hábitos alimentarios. Se realizó examen simple de primera orina en ayunas. Aquellos cuyo pH urinario resultó alcalino y/o presentaban cristales de oxalato de calcio pasaron a segunda etapa del estudio que consistió en recolectar muestra de 1ª y 2ª orina en ayunas, 2 muestras de sangre (en ayunas, post prandial) para determinar electrolitos séricos, urinarios, calcio, creatinina séricos, urinarios, y equilibrio ácido base. Los que presentaron acidosis metabólica hiperclorémica con hiato aniónico urinario positivo, se diagnósticaron como acidosis tubular renal distal. La incidencia es de 1,9 por ciento. Se evidenció alta prevalencia de cristales de oxalato de calcio en orina (26,92 por ciento). Del total se encontró un caso con acidosis metabólica hiperclorémica con hiato aniónico urinario negativo. La asociación entre talla baja y acidosis no fue estadísticamente significativa (p=0,906). La asociación entre déficit ponderal y acidosis no fue significativa (p=0,799). La prevalencia de esta patología (2/104) es significativamente mayor que la mundial (1/10000) (Probabilidad de Poisson = 0,00005352). Se recomienda realizar estudios con muestras de mayor tamaño para resultados más precisos del comportamiento de la enfermedad a nivel estatal.

Sonographic evaluation of the relationship between rheumatoid arthritis and renal stones

Considering the different renal manifestations of rheumatoid arthritis [RA], we carried out this study to investigate the prevalence of renal stones in patients with RA compared to general population. From January 2000 to March 2001, 74 patients with RA and 58 healthy individuals as the control group were evaluated for kidney stones with sonography. All patients were diagnosed on the basis of 1987 criteria of American College of Rheumatology [ACR].1 In the group of patients with RA, 6 out of 74 subjects [8.1%] had renal stones. The prevalence of renal stones in the control group was 8.6% [5 out of 58 persons]. The difference in the incidence of renal stones in the two groups was not statistically significant. The size of renal stones in the two groups was not significantly different. We did not find any relationship between the duration of RA or its various symptoms and the incidence of renal stones. Although RA involves kidneys and in previous studies it was mentioned that the incidence of renal stones in the patients with RA is higher than general population, we did not find any significant statistical correlation between RA and the incidence of renal stones in our study

Biochemical and bacteriological study on renal stone

Results of studying 203 calculi taken from 203 patients showed that the males are more affected than females with a proportion of 1.7:1. The age group [40 - 49 yrs] was the most affected followed by age group [50-59 yrs]. Calcium calculi made the greatest constitution of calculi in proportion of 89.63% of the renal stones. Six bacterial species were isolated from culture of 203 stones comprised the following: Proteus mirabilis, Escherichia coli, Staphylococciis aureus, Psendomonas aeruginosa, Klebsiella pneumonia, and Citrobacter freundii. However, P.aeruginosa made the greatest proportion about 67.97% of the total stones number, while 40 stones did not yield a growth of any bacteria. Even though external layers and nidi of the stones showed the same bacterial species, culture of pelvis urine did not yield bacterial growth.