Upper urinary tract stone compositions: the role of age and gender

ABSTRACT Objective: To analyze the compositions of upper urinary tract stones and investigate their distributions in different gender and age groups. Materials and Methods: Patients diagnosed with upper urinary tract stone disease between December 2014 and March 2018 were retrospectively reviewed. Patient's age, gender, BMI, comorbidities, stone event characteristics, and compositions were collected, and proportions of stone components in different gender and age groups were analyzed. Results: A total of 1532 stone analyses were performed (992 from males and 540 from females). The mean age was younger in males (p <0.001). Males included more cases with larger BMI, hyperuricemia, and obesity, while females had more urinary tract infections. Multiple components were present in 61.8% of stones. Calcium oxalate (CaOx) (67.0%) was the most common component, followed by uric acid (UA) (11.8%), infection stone (11.4%), calcium phosphate (CaP) (8.0%), cystine (1.1%), brushite (0.4%), and 2, 8-dihydroxyadenine (0.2%). Men contributed with more CaOx stones than women at age 30-49 years (all p <0.01) and more UA stones at 30-59 years (all p <0.05). Women contributed with more infection stones than men in age groups 30-49 and 60-69 years (all p <0.05), and more CaP stones at 30-49 years. The prevalence peak was 50-59 years in men and 60-69 years in women. Both genders had the lowest prevalence in adolescence. Prevalence of UA stones increased while that of infection stones decreased with aging in both genders. Conclusions: Age and sex had a strong association with distribution of stone compositions in this Chinese cohort.

A Case of Exercise-induced Acute Renal Failure with G774A Mutation in SCL22A12 Causing Renal Hypouricemia

Acute renal failure with severe loin pain which develops after anaerobic exercise is rare. One of predisposing factors of exercise-induced acute renal failure is renal hypouricemia. Idiopathic renal hypouricemia is a genetic disorder characterized by hypouricemia with abnormally high renal tubular uric acid excretion. The mutation in SCL22A12 gene which encodes renal uric acid transporter, URAT1, is the known major cause of this disorder. We here described a 25-yr-old man showing idiopathic renal hypouricemia with G774A mutation in SCL22A12 who presented exercise-induced acute renal failure. There have been a few reports of mutational analysis in Korean idiopathic renal hypouricemia without acute renal failure. This is the first report of genetically diagnosed idiopathic renal hypouricemia with exercise-induced acute renal failure in Korea.

Calcium; serum and urinary in stone formers and non-stone formers

To evaluate the effects of serum calcium and urinary calcium excretion on upper urinary tract stone diseases in the Peshawar [a high stone incidence belt]. One hundred patients [age 20-60 years] who were suffering severely from upper urinary tract stone disease were selected from LRH and Hayatabad Medical Complex Hospitals of Peshawar, same numbers of healthy controls from the same region were also selected for the study. When results were summed up and test Parameters were compared, it was seen that mean serum calcium in stone formers was greater than that of non-stone formers [P<0.001]. Same pattern was also observed [P< 0.001] in both groups regarding mean urinary calcium excretion. We concluded that calcium is a definitive risk factor in upper urinary tract stone disease. However we suggest further work and research on wide scale population in order to evaluate this relation

Análise química do cálculo em pacientes portadores de litíase do trato urinário / Chemical analysis of stone in patients with nephrolithiasis

Introdução: Nefrolitíase é uma doença multifatorial que se relaciona com desordens genéticas e fatores ambientais. Cálculos são mais comuns em adultos e são associados com diversas desordens metabólicas. Os cálculos de oxalato de cálcio são os mais comuns. O objetivo deste estudo é realizar a análise química dos cálculos urinários em nossa região. Materiais e Métodos: Realizamos um estudo retrospectivo em 1.342 pacientes com evidência recente de formação de litíase urinária. A investigação laboratorial consistiu da análise química dos cálculos que estiveram disponíveis. Resultados: Foram atendidos 1.342 pacientes com nefrolitíase, sendo que somente 109 (8,1%) foram submetidos à análise química do cálculo. Nestes, a idade média era de 38,9 ± 13,4 anos, sendo 55 (50,5%) do sexo masculino. História familiar positiva ocorreu em 65% dos casos. Cálculos de oxalato de cálcio foram encontrados em 87% dos casos analisados. Hipercalciúria foi o distúrbio metabólico mais encontrado nos pacientes com cálculos de oxalato de cálcio (60%). Conclusões: A análise química do cálculo mostrou que o oxalato de cálcio é o constituinte mais encontrado em nossa região, e estes dados estão de acordo com a literatura.

Introduction: Nephrolithiasis is a multifactorial disease and it has relation with genetic disorders and environmental factors. Stones are most common in adults and are associated with several metabolic disorders. Calcium oxalate is the most common type of stone. The objective of this study is to evaluate chemical analysis of calculi in our region. Methods: We made a retrospective study on 1,342 patients with evidence of recent formation of renal stones. Laboratory investigation included chemical analysis when the stones were available. Results: 1,342 patients with nephrolithiasis were consulted, among whom only 109 (8.1%) were submitted to chemical analysis of stones. Mean age of those patients were 38.9+13.4 years, and 55 (50.5%) were male. Familial history occurred in 65% of the cases. Calcium oxalate stones were found in 87% of the cases. Hypercalciuria and hyperuricosuria were the most associated metabolic disturb in patients with calcium oxalate and uric acid in the stones (60%). Conclusions: Chemical analysis has demonstrated that calcium oxalate is the most common component found in our region, according to the literature.

Experimental supratrigonal cystectomy: evaluation of long-term complications

OBJECTIVE: The present study aims at assessing the occurrence of pyelonephritis and long-term complications in rats submitted to surgical reduction of bladder capacity. MATERIALS AND METHODS: Sprague-Dawley rats were submitted to supratrigonal cystectomy (29 animals) or sham operation (15 animals) and sacrificed 2, 4 and 6 months after the surgical procedure. The arterial blood pressure and serum creatinine levels were assessed before the surgery and at the time of the sacrifice. After the sacrifice a careful inspection of the urinary apparatus was performed to the characterization of the hydronephrosis and for the detection of the presence of calculi. With sterile technique, the urine was aspirated from the bladder and the kidneys removed and sent to a microbiologic study. RESULTS: Pyelonephritis was frequent in animals submitted to supratrigonal cystectomy. The most frequent and isolated microorganisms were Staphylococcus sp. and E. coli. The presence of urinary calculi was correlated significantly to the presence of urinary tract infection (p < 0.003). Arterial hypertension was frequent amongst animals submitted to supratrigonal cystectomy. Serum creatinine was high in 72.4 percent of the animals in the group submitted to supratrigonal cystectomy. The presence of calculi and pyelonephritis were frequent in rats presenting renal insufficiency and in hypertensive rats. CONCLUSIONS: The long-term course of urinary infection in rats submitted to supratrigonal cystectomy was characterized by a high incidence of renal insufficiency and arterial hypertension that seem to be related to dysfunction and bladder obstruction induced by an extensive surgical procedure and the presence of urolithiasis and pyelonephritis.

Prevalence and etiology of urinary stones in hospitalized patients in Baghdad

Epidemiology and pathogenesis in urinary stones diagnosed in 184 patients were studied. Mean age was 38.3 years. Male to female ratio was 2.5: 1. Stones were predominantly of mixed type: calcium oxalate was the commonest compound. Anatomical distribution of urinary stones was 67.4% renal, 12.5% ureteric and 14.6% bladder. Recurrence rate following previous surgical removal was 15.0%. Bacteria were isolated from 19 [24.4%] of 78 urinary stones: 14 were urea splitting and 5 non-urea splitting. Females had a greater chance of having infected stones. All bacteria isolated were sensitive to gentamicin and nalidixic acid. All isolates were resistant to amoxicillin and erythromycin. Multiple resistance to 6 antimicrobial agents was common [58.8%]

Role of bacteria in Urolithiasis [in vivo study]

The different bacterial species that were isolated from human renal stones: Pseudomonas aerugniosa [urease +ve], Proteus mirabilis, Citrohacler freundii, Klebsiella pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, [urease -ve], and Escherichia coli, succeeded in stone formation in rats' kidneys, this was determined by examining tissue sections of the kidneys. However, urease producing bacteria revealed more severe than non-urease ones, which influenced, markedly, in increasing urine volume after 10 days of bacterial injecting followed by a decline after 20 - 30 days, however, pH was acidic during the first ten days of injection, changed to alkalinity later, whereas those had been injected with non-urease producers, did not show such changes in their urine.

Absceso perinefrítico, revisión de casos. Servicio de Urología HEALF 1992- 2003 / Abscess perinefrítico, revision of cases. Service of Urología HEALF 1992 - 2003

,l presente estudio es una revisión de 34 casos de pacientes con abscesos perinefríticos, manejados por el servicio de urología del Hospital Escuela Antonio Lenin Fonseca, entre enero de 1992 y diciembre del 2003. Los resultados del estudio se discuten con relación a los hallazgos de revisiones de casos expuestos en la literatura internacional. El objetivo general del estudio es: Describir las características generales de:Epidemiología, cuadro clínico, agentes etiológicos, diagnostico, tratamiento y evolución de los pacientes con absceso perinefrítico, manejados por el servicio de urología del Hospital Escuela Antonio Lenin Fonseca entre 1992 y el 2003. La edad promedio de los pacientes estudiados fue de 45.9 años, oscilando entre 28 y 73 años. La relación entre hombres y mujeres es de 1:1.2. difiriendo significativamente de la mayoría de los reportes que es de 3:1. (7, 9,11 y 13) La litiasis urinaria y la diabetes mielitus figuran como los principales factores que favorecen la aparición del absceso perinefrítico con 72 porciento, asociadas a obstrucción urinaria que representó el 62.5 porciento de los pacientes. Los signos y síntomas, fueron de tipo general e inespecíficos, dificultando él diagnostico clínico y retrasando el tratamiento. El diagnostico bacteriológico del absceso perinefrítico es infrecuente, al 43.7 porciento de los pacientes no se les practico ningún tipo de estudios bacteriológicos. Las bacterias aisladas tanto de urocultivos, como de cultivos del pus fueron: Klepsiela, E. Coli y Proteus

Urolitíase no alotransplante renal / Urinary lithiasis in renal allografts

OBJETIVO: A litíase urinária é uma complicação incomum no alotransplante renal, a incidência varia de 0,02 a 3,4 por cento. A maioria dos cálculos forma-se após o transplante, porém alguns podem ser transferidos junto com o enxerto para o hospedeiro. O tratamento desta complicação está baseado em alguns casos descritos na literatura. O objetivo deste trabalho é o de relatar a incidência da litíase renal no paciente com transplante renal, assim como a conduta adotada no HCFMRPUSP. MÉTODOS: Foram analisados 953 pacientes submetidos a transplante renal no HCFMRPUSP, de fevereiro 1968 a maio de 2003. A idade média foi de 47,2 anos (35 a 63 anos). Em 09 pacientes, o rim foi proveniente de doador cadáver e apenas 01 doador vivo. RESULTADOS:Foram diagnosticados 10 casos de litíase (1,05 por cento). Em 02 pacientes (20 por cento) o cálculo foi diagnosticado no intraoperatório, em 01 (10 por cento) no peri-operatório (5º. dia), os 07 restantes (70 por cento) no pós-operatório tardio. Em 04 pacientes (57 por cento) não havia sintomatologia específica, 02 (29 por cento) apresentaram ITU, em 03 (43 por cento) ocorreu elevação da creatinina sérica. De 8 pacientes com litíase no pós-operatorio, em 06 os cálculos estavam localizados no rim e 02 no ureter. Dos pacientes com cálculos renais, 02 foram observados, 02 submetidos a LECO, 01 a nefrolitripsia percutânea, 01 à pielolitotomia. Em 01 paciente com cálculo ureteral foi realizada pielovesicostomia (cálculo + estenose), no outro paciente foi feita a ureterorrenoscopia retrógrada. CONCLUSAO: A urolitíase é complicação rara no transplante renal, a conduta terapêutica no pós-operatório tardio é semelhante à da população geral.

Manifestaciones extraintestinales de la enfermedad de Crohn / Crohnïs disease extraintestinal manifestations

La Enfermedad de Crohn es una inflamación intestinal crónica cuyos síntomas comprometen el tracto intestinal desde la boca hasta el ano. Hay algunas manifestaciones extraintestinales en alrededor del 25 al 30 por ciento de los pacientes, las que son más comunes en enfermedad de colon, en comparación con las que afectan el intestino delgado. En este artículo se revisan los distintos síntomas y signos de varios órganos afectados, como la piel, articulaciones, tracto biliar, ojos y otras manifestaciones menos comunes. Es frecuente que varios órganos se vean afectados simultáneamente. El curso de las manifestaciones extraintestinales sigue generalemente el de la enfermedad intestinal, tanto en las crisis, remisiones y la respuesta a esteroides. En algunas ocasiones raras, las manifestaciones extraintestinales de la Enfermedad de Crohn y la colitis ulcerosa se presentan con mayor severidad y anterioridad que las manifestaciones intestinales, lo que hace indispensable considerarlas en el diagnóstico diferencial

Artritis reumatoídea y riñón: ¿existe la nefropatía reumatoídea?: caso clínico / Rheumatoid arthritis and kidney: does rheumatoid arthritis nephropathy exist?: a clinical case

Se presenta el caso de una mujer de 50 años de edad con artritis reumatoídea de larga data y con manifestaciones renales no completamente explicables por el tratamiento de base. Al revisar la literatura correspondiente, se detecta que en ella se describen los fármacos asociados a daño renal y sus probables mecanismos fisiopatológicos. En segundo término y brevemente se presenta la amiloidosis como causa fundamental de mortalidad de origen renal en la artritis reumatoídea. Finalmente se profundiza en las nefropatías relacionadas directamente con esta enfermedad reumatológica tan común

Estudo da ação dos fios de categute cromado e poliglecaprone 25, na ileocistoplastia em ratos, destacando a formação de cálculos / Study of the action of chromed catgut and polyglecaprone 25 of the threads in the ileocystoplasty in rats, highlighting the formation of stone

Realizou-se um estudo da ação dos fios de categute cromado 6-0 e de poliglecaprone 25, 5-0, para determinar o fio ideal na ileocistoplastia em ratas. O maior objetivo, foi a profilaxia litiásica. Utilizaram-se 51 ratos de Wistar, que participaram de dois grupos experimentais: grupo do plano piloto (27 ratos), que foi o grupo categute (GC) e grupo da tese do mestrado (24 ratos), que foi o grupo poliglecaprone (GP). Sob anestesia intraperitonial com pentobarbital sódico a 3 por cento, todos os animais foram submetidos a ileocistoplastia, após laparotomia mediana longitudinal. Nos ratos do GC, a anastomose da bexiga urinária (aberta 0,5 cm sagitalmente no seu ápice), com a extremidade distal do segmento ileal ,era realizada por meio de pontos separados em plano único, com fio de categute cromado 6-0, e nas ratas do GP, com fio de poliglecaprone 25, 5-0. Seguiu-se a síntese da parede abdominal e recuperação anestésica. O estudo era realizado em 27, 42 e 57 dias nos animais do GC, que eram divididos em 3 subgrupos de 9 ratos. No GP, os animais eram analisados em 28 e 84 dias, por subgrupos de 12 animais. Transcorrido o tempo determinado para cada subgrupo, eram reoperados e observados os aspectos macroscópicos da cicatrização, aderências e formação de cálculos. A bexiga urinária ampliada pelo segmento ileal, era ressecada, aberta, lavada em solução salina isotônica, fixada no Líquido de Boüin, e processada, para histologia. A eutanásia era consumada com dose mínima letal anestésica. Os resultados apresentados, foram 29,6 por cento de litíase, nas ratas do GC: 5,4 por cento em 27 dias; 10 por cento em 42 dias e 14,25 em 57 dias do pós operatório (p.o.). Nas ratas do GP, não foram encontrados cálculos. Os estudos microscópicos, foram submetidos à análise estatística (a ú a 0,05), e utilizados para outro trabalho científico. Conclui-se: na ileocistoplastia com categute cromado 6-0, há 29,6 por cento de cálculos, do 27o ao 57o dia p.o. e com o uso do fio de poliglecaprone 25, 5-0, até o 84o p.o.,não há presença de litíase.

Importance comparative respective de l'analyse infra rouge et de l'analyse chimique classique dans le diagnostic etiologique de la lithiase urinaire

Analysis of the nature of calculi provides a valuable mean for the differential diagnosis of urinary lithiasis. In this work, we report a comparative study of the nature of 31 calculi performed by infra red and the classical chemical techniques. Our results showed that the chemical techniques give false positives for the struvite, whewellite and false negatives for the weddellite, the amorphus calcium phosphate, the whitlockite, the ammonium urate, the uric acid and the proteins 83,9% of the cases assessed clinically were not confirmed by the infra red analysis. We concluded that the chimical techniques are not inacurate and not adapted to the study of the chemical nature of urinary calculi