Litiasis urinaria en pediatria / Urinary lithiasis in pediatrics

Resumen La litiasis renal es una entidad infrecuente en la infancia y su incidencia va en aumento en los países desarrollados. Afecta más a los individuos de raza blanca que a los afroamericanos en una proporción 4:1, con predominio del sexo masculino. Existen factores geográficos, raciales, genéticos implicados en su patogenia, que depende también de factores fisicoquímicos (eliminación renal de agua y solutos, pH urinario, equilibrio entre factores estimulantes/inhibidores de la cristalización), alteraciones anatómicas, infecciones y cambios socioeconómicos; los cuales a lo largo del tiempo han producido cambios en los hábitos dietéticos, lo que ha modificado la frecuencia, composición química y localización de los cálculos. A pesar de su rareza se debe pensar en la litiasis, con el fin de evitar un daño renal irreversible. La disponibilidad de terapia menos agresiva ha reducido a un 5% las indicaciones quirúrgicas, abriendo nuevas perspectivas en el tratamiento de la urolitiasis en la infancia.

Abstract Renal lithiasis is an infrequent entity in childhood, and its incidence has decreased in developed countries. Affects white individuals more than African Americans in a 4: 1 ratio, with a predominance of males. There are geographic, racial, genetic factors involved in its pathogenesis, which also depends on physicochemical factors (renal elimination of water and solutes, urinary pH, balance between stimulating factors/inhibitors of crystallization), anatomical alterations, infections and socioeconomic changes. Over time, changes have occurred in dietary habits, which has changed the frequency, chemical composition and location of the stones. Despite its rarity, lithiasis must be considered in order to avoid irreversible kidney damage. The availability of less aggressive therapy has reduced surgical indications to 5%, opening new perspectives in the treatment of urolithiasis in childhood. The present article constitutes a bibliographic review about the organophosphorus intoxication, its clinical manifestations, diagnosis and treatment.

Perfil clínico-epidemiológico de 106 pacientes pediátricos portadores de urolitíase no rio de janeiro / Clinical-epidemiological profile of 106 pediatric pacients with urolithiasis in rio de janeiro, brazil

RESUMO Objetivo: Descrever a frequência, o perfil clínico e condutas adotadas em portadores de urolitíase no setor de nefropediatria do Hospital Federal dos Servidores do Estado na cidade do Rio de Janeiro. Métodos: Estudo retrospectivo dos prontuários de pacientes portadores de urolitíase, atendidos entre janeiro de 2012 e dezembro de 2014, com idade entre 1 mês e 18 anos. Variáveis estudadas: dados demográficos, antropométricos, quadro clínico, história familiar de urolitíase, infecção urinária e uso de medicamentos litogênicos, condutas diagnósticas, anomalias associadas, distúrbios metabólicos, terapêutica e recorrências. Resultados: A frequência de urolitíase no período foi de 13,6%, e as características mais frequentes foram sexo masculino, cor da pele branca, eutrofia, idade entre 5 e 10 anos, história familiar de urolitíase, infecção urinária prévia e eliminação espontânea do cálculo. Dor abdominal, em flanco e hematúria macroscópica foram as queixas mais comuns. Distúrbios metabólicos mais frequentes: hipercalciúria, hiperuricosúria e hipocitratúria. A hipocitratúria foi associada à história de infecção urinária prévia (p=0,004). A ultrassonografia de abdome ou aparelho urinário foi o exame mais utilizado para diagnóstico. Hidronefrose ocorreu em 54,4% dos casos, 81,1% dos cálculos estavam nos rins e os bilaterais eram associados com história familiar de urolitíase (p=0,030). Houve recidiva em 29,3% dos casos (maior parte com distúrbio metabólico); 12,3% submeteram-se à litotripsia; 24,5%, à cirurgia, principalmente pielolitotomia; e apenas 7,6% dos pacientes tiveram cálculos analisados (mais frequente: oxalato de cálcio). Conclusões: A frequência de urolitíase nessa população pediátrica foi próxima à da literatura. Os achados sugerem a necessidade de investigação metabólica mais ampla e a análise mais frequente dos cálculos.

ABSTRACT Objective: To describe the frequency, clinical profile and treatment of patients with urolithiasis in the Pediatric Nephrology Department of a public state hospital in Rio de Janeiro, Brazil. Methods: Retrospective study. Data from pediatric patients (age: 1 month - 18 years) with urolithiasis admitted between January/2012 and December/2014 were reviewed from hospital charts. The studied variables were: demographic and anthropometric data, clinical status, family history of urolithiasis, urinary tract infection and use of lithogenic drugs, diagnostic procedures, associated abnormalities, metabolic disorders, treatment and recurrence. Results: The frequency of urolithiasis was 13.6%. Main characteristics of the patients: male gender, white race, eutrophy, aged between 5 and 10 years, family history of urolithiasis, previous urinary infection and spontaneous stone passage. Abdominal and flank pain and macroscopic hematuria were the most common complaints. The most frequent metabolic disorders were hypercalciuria, hyperuricosuria and hypocitraturia. Hypocitraturia was associated with previous urinary infection (p=0.004). Abdomen/urinary tract ultrasonography was the most commonly used diagnostic test. Hydronephrosis occurred in 54.4% of the cases, 81.1% of the stones were in the kidneys, and bilateral stones were associated to a family history of urolithiasis (p=0.030). Recurrence rate was 29.3% (most patients had a metabolic disorder). In 12.3%, the patients underwent lithotripsy, 24.5% were surgically treated (mainly pyelolithotomy), and only 7.6% had their stones analyzed (calcium oxalate was the main finding in the examined stones). Conclusions: The frequency of urolithiasis in these pediatric patients was similar to that reported by the literature. A metabolic evaluation is required and the composition of stones should be better evaluated.

Pattern of presentation and management of urolithiasis at federal medical centre, Nguru, Nigeria

Background: Urolithiasis has been with mankind since ancient time. Although it is more common in the developed world, the pattern of presentation in the developing countries is tending towards that of developed countries. Objectives: To evaluate the pattern of presentations and treatments offered to patients with urolithiasis over the last 2 years at Federal Medical Centre (FMC), Nguru.Materials and Methods: The study is a 2-year retrospective review of patients managed for urolithiasis at FMC Nguru. The patients' bio-data, pattern of presentation and radiological features of the stones, as well as the treatment given to the patients, were reviewed.Results: The records of 55 patients were reviewed; the mean age was 24.1 years with a range of 1.5 to 70years. The male to female ratio was 10:1. The most common presenting symptom was painful micturition in 21 patients (38.18%). The total number of stones extracted was 58, one patient had multiple right renal pelvic calculi, another had bilateral renal pelvic stone and the third patient had bladder and distal ureteric stone. Two patients (3.64%) expelled their calculi while awaiting surgery, the remaining 53 patients (96.36%) had opened surgical treatment. Most of the stones are in the bladder in 29 patients (52%). Twenty-one patients (38.18%) had upper urinary tract stones out of which 13 were in the renal pelvis.Conclusion: Urolithiasis is also common in the developing communities. Despite the changing pattern from lower to the upper tract in developed countries, we found lower tract stone dominating as seen in many underdeveloped. This may be attributable to yet to establish environmental or genetic factors

Epidemiology of urolithiasis consultations in the Paraíba Valley / Epidemiologia dos atendimentos por urolitíase no Vale do Paraíba

ABSTRACT Objective: to know the epidemiological profile of patients with urolithiasis in the Paraíba Valley region, identifying its prevalence and spatial distribution. Method: we conducted a cross-sectional study, by residence location in the Paraíba Valley, on morbidity data due to urolithiasis obtained from the DATASUS, covering the period between 2010 and 2012. We aimed at identifying the general, male and female prevalence of urolithiasis, the distribution by age, type of visit, year season and spatial distribution. Results: there were 1,901 visits for urolithiasis in the 35 municipalities of the Paraíba Valley in the three years studied, 52.3% of them of female patients. Of the total, 70.1% of the visits were emergency ones. The feminine visits (67.2%) were mostly also urgent (p <0.01). The overall prevalence for urolithiasis was 31.7/100,000. Male prevalence was 30.7/100,000, and the female, 32.7/100,000 (p>0.05). The prevalence ratio was 0.9 men for every woman. The age group with the highest prevalence was between 30 and 39 years, with 23.1%. Warm seasons concentrated 51.6% of cases, while 48.8% occurred in the cold ones (p>0.05) . Conclusion: women are more affected by urolithiasis than the male in the Paraíba Valley region, an unprecedented in the literature. There was no relationship between the year season and the disease. We identified municipalities where preventive actions of urinary lithogenesis are required.

RESUMO Objetivo: conhecer o perfil epidemiológico dos pacientes com urolitíase, na região do Vale do Paraíba, identificando sua prevalência e distribuição espacial. Métodos: estudo transversal com dados de morbidade por local de residência decorrente de urolitíase no Vale do Paraíba, relativos ao período compreendido entre 2010 e 2012, obtidos do DATASUS. Os dados foram analisados para identificar a prevalência geral, masculina e feminina da urolitíase, a distribuição por idade, tipo de atendimento, estação do ano e sua distribuição espacial. Resultados: ocorreram 1901 atendimentos por urolitíase nos 35 municípios do Vale do Paraíba nos três anos estudados, sendo 52,3% dos pacientes do sexo feminino. Do total, 70,1% dos atendimentos foram em caráter de urgência. Os atendimentos femininos, na sua maioria (67,2%), também foram de urgência (p<0,01). A prevalência geral encontrada para a urolitíase foi 31,7/100.000 habitantes. A prevalência masculina foi 30,7/100.000 e a feminina de 32,7/100.000 (p>0,05). A relação de prevalência encontrada foi 0,9 homens para cada mulher. A faixa etária com o maior número de pacientes atendidos foi entre 30 e 39 anos, com 23,1% do total. Nas estações quentes ocorreram 51,6% dos atendimentos, enquanto nas frias 48,8% (p>0,05). Conclusões: foi possível identificar que na região do Vale do Paraíba o sexo feminino é mais acometido pela urolitíase do que o masculino, fato inédito na literatura. Não se encontrou relação entre a estação do ano e a doença. Foram identificados municípios onde ações de prevenção da litogênese urinária são necessárias.

Etiología de la urolitiasis en niños mayores de un mes a dieciocho años de edad, en el período comprendido entre los meses de enero 2008 hasta diciembre 2012, en la consulta externa de nefrología del Hospital Nacional de Niños Benjamín Bloom / Etiology of urolithiasis in children older than one month to eighteen years of age, in the period from January 2008 to December 2012, in the outpatient nephrology consultation of the Benjamín Bloom National Children's Hospital

La litiasis renal es definida como la presencia de cálculos en el tracto urinario y es una entidad poco frecuente en la infancia. Su incidencia ha disminuido en los países desarrollados. Consiste en la precipitación de sustancias cristalinas que normalmente están disueltas en la orina, de distinta composición química. Tiene una etiología multifactorial e implica factores genéticos, ambientales, raciales y estructurales además de mecanismos fisicoquímicos complejos, el objetivo del presente estudio se basa en determinar la etiología de urolitiasis en niños mayores de un mes a menores de dieciocho años de edad que se han diagnosticado en la consulta externa del HNNBB, dicho estudio es de importancia ya que no se cuenta con análisis previos sobre el tema en dicho centro. El estudio es de tipo descriptivo, retrospectivo de corte transversal, en el cual se investigó a 59 pacientes con diagnóstico de litiasis renal entre las edades de 1 mes a 18 años, proveyendo datos relevantes sobre la patología, se realizó tabla de vaciamiento de datos en donde se utilizaron variables como: edad, sexo, procedencia, métodos diagnóstico de litiasis renal, así como para conocer la etiología que con mayor frecuencia predispone a la aparición Urolitiasis se utilizaron los parámetros tanto urinarios y sanguíneos que conlleva a la manifestación de la enfermedad. Los resultados que se obtuvieron de los 59 pacientes investigado sobresalen: El género más frecuente afectado es el masculino con una relación M/F: 2.9:1. La edad promedio de los pacientes fue de 5.36 ± 3.6 años, siendo el grupo atareo más afectado para la predisposición de litiasis renal son los preescolares que corresponde a los rangos de edades de 3 a 5 años, siendo un total de 19 pacientes (32.2%). La zona geográfica del país con más predisposición de litiasis renal es la central, el síntoma inicial para la predisposición de la enfermedad es el dolor, el método diagnóstico más utilizado es la USG abdominal, las causas metabólicas que se asocian son la Hipercalciuria y la hipocitraturia, además se encontraran más datos de interés para el lector del presente trabajo. El estudio concluye que la alteración metabólica relacionada al padecimiento de litiasis renal es la hipercalciuria como causa principal para padecer litiasis renal, además el dolor abdominal es considerada en el presente trabajo la razón por la cual consultaron los pacientes a los cuales se le toma USG abdominal para coincidir con diagnóstico de litiasis de la vía urinaria. Datos importantes para evaluar a futuros pacientes que consulten en nuestro hospital

Daily Mean Temperature Affects Urolithiasis Presentation in Seoul: a Time-series Analysis

This study aimed to investigate the overall cumulative exposure-response and the lag response relationships between daily temperature and urolithiasis presentation in Seoul. Using a time-series design and distributing lag nonlinear methods, we estimated the relative risk (RR) of urolithiasis presentation associated with mean daily temperature, including the cumulative RR for a 20 days period, and RR for individual daily lag through 20 days. We analyzed data from 14,518 patients of 4 hospitals emergency department who sought medical evaluation or treatment of urolithiasis from 2005-2013 in Seoul. RR was estimated according to sex and age. Associations between mean daily temperature and urolithiasis presentation were not monotonic. Furthermore, there was variation in the exposure-response curve shapes and the strength of association at different temperatures, although in most cases RRs increased for temperatures above the 13℃ reference value. The RRs for urolothiasis at 29℃ vs. 13℃ were 2.54 in all patients (95% confidence interval [CI]: 1.67-3.87), 2.59 in male (95% CI, 1.56-4.32), 2.42 in female (95% CI, 1.15-5.07), 3.83 in male less than 40 years old (95% CI, 1.78-8.26), and 2.47 in male between 40 and 60 years old (95% CI, 1.15-5.34). Consistent trends of increasing RR of urolithiasis presentation were observed within 5 days of high temperatures across all groups. Urolithiasis presentation increased with high temperature with higher daily mean temperatures, with the strongest associations estimated for lags of only a few days, in Seoul, a metropolitan city in Korea.

Endourology, the initiative

No abstract available.

Litíase urinária e gestação / Urolithiasis and pregnancy

A litíase urinária é frequentemente diagnosticada durante a gestação. O diagnóstico de nefrolitíase assintomática durante a gestação não requer medidas adicionais, apenas o seguimento do pré-natal normal. Contudo, quando ocorre cólica renal ou complicações decorrentes da litíase urinária, medidas adicionais tornam-se necessárias. Nestes eventos, mais comuns nos últimos meses de gestação, há particularidades relacionadas ao quadro clínico, diagnóstico e tratamento específicos para esta população de pacientes. O presente artigo tem como objetivo revisar estes aspectos de litíase urinária na gestação à luz do conhecimento atual e da experiência pessoal dos autores.

The diagnosis of urolithiasis during pregnancy is common, even though no additional measures are required in asymptomatic cases. Renal colic or complications of urinary lithiasis occur more frequently during the last months of pregnancy, and there are several particularities for the diagnosis and treatment of this subset of women. The present manuscript aim to review the current knowledge concerning this subject and present authors personal experience.

Cuantificación de cistina en orina espontánea para la detección de cistinuria / Quantitation of urinary cystine for the detection of cystinuria / Determinagáo quantitativa de cistina urinaria para a detecgáo de cistinuria

La cistinuria es un error innato del metabolismo ocasionado por un defecto en el transporte renal de arginina, ornitina, lisina y cistina. La acumulación de este último aminoácido de baja solubilidad ocasiona episodios de urolitiasis característicos de la enfermedad. En el presente estudio se estandarizó un método espectrofotométrico confiable y de fácil ejecución para la determinación cuantitativa de cistina en orina espontánea. Se realizó el análisis en 184 muestras, correspondientes a 104 controles y 80 pacientes con urolitiasis. Con el objeto de validar el método y posteriormente establecer un rango de excreción normal en la población colombiana se evaluaron los siguientes parámetros: exactitud, precisión, linealidad y límite de detección. La técnica mostró coeficientes de variación intra e inter ensayos inferiores al 10% y una excelente linealidad, con un coeficiente r² entre concentraciones conocidas de cistina y absorbancia generada por el método de 0,998. Usando esta técnica se encontró un valor normal de excreción de 1,35 a 110,11 mg cistina/g creatinina. En cinco pacientes, de los 80 con nefrolitiasis, se hallaron valores elevados de cistina, compatibles con cistinuria. El método utilizado puede implementarse en cualquier laboratorio clínico para confirmar el diagnóstico de cistinuria e iniciar un tratamiento oportuno.

Cystinuria is an inborn error of metabolism, caused by a defect in renal tubular transport of the following aminoacids: arginine, ornithine, lysine and cystine. Accumulation of the latter poorly soluble aminoacid leads to the development of kidney stones, characteristic of the disease. In this study, an easy and dependable spectrophotometric method for the quantitative determination of urinary cystine was standardized. The analysis was performed on 184 samples from 104 controls and 80 patients with kidney stones. In order to validate the method and later establish a range of normal urinary cystine excretion in the Colombian population, the following parameters were evaluated: Accuracy, precision, linearity and lower limit of detection. The technique showed intra and intei assay coefficients of variation below 10%, and excellent linearity, with an R square (r²) coefficient between known cystine concentrations and absorbance generated by the method at 0.998. Using this technique, a normal urinary cystine excretion range of 1.35-110.11 mg cystine/g creatinine was found. Among the 80 patients with kidney stones, elevated urinary cystine levels were found in 5 of them, compatible with the presence of cystinuria. This method can be implemented in any clinical laboratory to confirm the diagnosis of cystinuria and provide opportune treatment.

A cistinúria é um erro inato do metabolismo, causado por um defeito no transporte tubular renal de ar-ginina, ornitina, lisina e cistina. A acumulagáo deste último aminoácido, pouco solúvel, provoca episodios de urolitíase, característicos da doenga. No presente estudo, foi padronizado um método espectrofotomé-trico confiável e de fácil execugáo para a determinagáo quantitativa de cistina em urina espontánea. A análise foi realizada em 184 amostras de 104 controles e 80 pacientes com urolitíase. A fim de validar o método e, posteriormente, estabelecer um intervalo de excregao normal na populagao colombiana, foram avaliados os seguintes parámetros: exatidáo, precisáo, linearidade e limite inferior de detecgáo. O método mostrou coeficientes de variagáo intra e inter ensaios inferiores a 10%, e excelente linearidade, com um coeficiente R quadrado (r²) entre concentragoes conhecidas de cistina e absorváncia gerada pelo método de 0,998. Com esta técnica, foi encontrado um valor normal de excregáo de 1,35-110,11 mg cistina/g de creatinina. Entre os 80 pacientes com urolitíase, foram encontrados níveis elevados de cistina em cinco deles, compatíveis com a presenga de cistinúria. Este método pode ser implementado em qualquer laboratorio clínico para confirmar o diagnóstico de cistinúria e proporcionar um tratamento oportuno.

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance < or =60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

Effect of Renal Insufficiency on Stone Recurrence in Patients with Urolithiasis

The study was designed to assess the relationship between glomerular filtration rate (GFR) and urinary stone-forming constituents, and to assess the effect of renal insufficiency on stone recurrence risk in first stone formers (SF). Baseline serum creatinine levels were obtained, and renal insufficiency was defined as creatinine clearance < or =60 mL/min (Cockroft-Gault). This retrospective case-control study consists of 342 first SF; 171 SF with normal renal function were selected with 1:1 propensity scores matched to 171 SF with renal insufficiency. Urinary metabolic evaluation was compared to renal function. GFR was positively correlated with urinary calcium, uric acid, and citrate excretion. Subjects with renal insufficiency had significantly lower urinary calcium, uric acid, and citrate excretion than those with normal renal function, but not urine volume. With regard to urinary metabolic abnormalities, similar results were obtained. SF with renal insufficiency had lower calcium oxalate supersaturation indexes and stone recurrence rates than SF with normal renal function. Kaplan-Meier curves showed similar results. In conclusion, GFR correlates positively with urinary excretion of stone-forming constituents in SF. This finding implies that renal insufficiency is not a risk factor for stone recurrence.

Litiasis urinaria en niños hospitalizados. Centro Hospitalario Pereira Rossell 2006-2012 / Urinary stones in hospitalized children. Centro Hospitalario Pereira Rossell 2006-2012

La enfermedad litiásica puede comenzar en la infancia con manifestaciones escasas o atípicas. Su incidencia es menor que en adultos y es de difícil diagnóstico. La causa favorecedora (metabólica, infecciosa, malformativa, mixta) se encuentra con mayor frecuencia que en adultos. El objetivo es describir las características clínicas, la evolución y el tratamiento de los niños hospitalizados con litiasis urinaria en el CHPR.Se realizó un estudio descriptivo, retrospectivo entre el 1 de junio de 2006 y el 31 de mayo de 2012. Se incluyeron todos los niños de 1 mes a 14 años hospitalizados con diagnóstico de litiasis urinaria. Se analizó presentación clínica, causas predisponentes, tratamiento y evolución. La fuente de datos fueron las historias clínicas. Se hospitalizaron 20 niños, 12 varones y ocho mujeres, mediana 10,5 años. El dolor fue la presentación clínica más frecuente (n=17). La litiasis fue única en 11 casos y múltiple en 9. Se diagnosticó litiasis coraliforme con pionefrosis en dos niños y en otros dos nefrocalcinosis. Presentaron complicaciones obstructivas (n=15), infecciosas (n=4), insuficiencia renal aguda leve (n=3). Se hallaron causas predisponentes en 13 niños: metabólicas (n=9), infecciosas (n=4), malformativas (n=3); el estudio metabólico se realizó en 10 casos, siendo completo en tres de ellos. Recibieron tratamiento quirúrgico o litotricia 10 pacientes. Los niños con litiasis coraliforme y pionefrosis requirieron nefrectomía. Permanecen en seguimiento seis niños: tres persisten con litiasis y dos tienen nefrocalcinosis, uno de ellos con IRC moderada.Esta constituye la primera comunicación de litiasis urinaria en niños hospitalizados. Aunque se trata de un centro de referencia nacional, conocer la prevalencia y características de esta enfermedad requiere estudios multicéntricos. Una proporción importante de niños presentó complicaciones graves...

Hiperoxaluria primaria en tres hermanos / Primary hyperoxaluria in three brothers

La hiperoxaluria es responsable de 2%-20% de las causas metabólicas de litiasis en niños y adolescentes. Esta puede ser secundaria o primaria(HP), en este último caso es tipo I o tipo II, de herencia autosómica recesiva. El objetivo es analizar diagnóstico y evolución en dos hermanos con HP tipo I y un tercero con alta probabilidad. El primer caso presentó a los 9 años un cólico nefrítico con litiasis múltiples bilaterales y una IRA leve. Presentaba hiperoxaluria de 214 mg/1,73 m2. Se descartaron causas secundarias. El estudio genético demostró dos copias de la mutación IIe244Thr. Los otros dos pacientes se presentaron en forma similar, a edades de 8 y 17 años. La piridoxina a altas dosis descendió los niveles de oxaluria como está descrito en un tercio de los casos. El tiempo de evolución es 7,3 y 1 año respectivamente. Persisten actualmente con litiasis bilaterales, sin nefrocalcinosis ni alteraciones del medio interno. La severidad de la HP tipo I es variable, hay formas de presentación temprana con litiasis recurrente y falla renal crónica en la infancia o en la adolescencia; otras de inicio tardío en edad adulta. Se trata de una enfermedad grave, progresiva, cuyo diagnóstico temprano con estudio metabólico completo puede mejorar el pronóstico,fundamentalmente en aquellos que responden a la piridoxina. El manejo de la litiasis y sus complicaciones es fundamental para evitar la IRC. Cuando ésta se desarrolla, la diálisis agresiva y el trasplante hepatorrenal son las opciones terapéuticas. Es el primer informe de casos confirmados de hiperoxaluria primaria en nuestro país...

A Case of Zollinger-Ellison Syndrome in Multiple Endocrine Neoplasia Type 1 with Urolithiasis as the Initial Presentation / 대한소화기학회지

Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.

Presentaciones efectivas en medicina El arte de comunicar y transmitir: diez recomendaciones / Effective Presentations in Medicine. The Art of Communication and Transmission: Ten Recommendations

Para lograr una comunicación efectiva durante una conferencia o presentación, es necesario seguir reglas simples, que incluyen la preparación de la conferencia con el auditorio en mente y con la definición de un mensaje específico para dejar a la audiencia. Debe capturarse pronto la atención del público y todas las acciones posteriores deben ir encaminadas a mantenerla. Los textos deben ser precisos y con tamaños fácilmente visibles, las diapositivas deben ofrecer buen contraste, con fondos sólidos y simples y deben evitarse las animaciones excesivas. Al cierre de la conferencia, las conclusiones y la sesión de preguntas ofrecen la oportunidad invaluable de reforzar el mensaje que se quería dejar.

To communicate effectively during a lecture or presentation it is necessary to follow simple rules, including the preparation of the conference with the audience in mind and with the definition of a specific message to leave the audience. The public's attention should be quickly captured and all subsequent actions should aim to keep it. The text must be accurate and sizes easily visible, the slides should provide good contrast with solid and simple backgrounds and should avoid excessive animations. At the close of the conference, the conclusions and question session offers the invaluable opportunity to reinforce the desired message.

Urolitíase por cistina em cães no Brasil / Canine cystine urolithiasis in Brazil

O presente trabalho tem como objetivo relatar três casos de urolitíase canina por cistina, atendidos no Hospital Veterinário da Universidade Estadual de Londrina entre o período de 2007 a 2009. O diagnóstico de urolitíase foi baseado na anamnese, no exame físico e nos exames laboratoriais e radiográficos, e a confirmação do tipo de urólito envolvido foi realizada no Centro de Urólitos de Minnesota-USA, por meio de análise quantitativa, revelando cálculos puros de cistina. A terapia instituída incluiu a remoção cirúrgica dos urólitos e a prevenção de recidivas, por meio do aumento da solubilidade da cistina na urina com dieta comercial própria, aumento da ingestão hídrica e alcalinização medicamentosa da urina.

Three cases of canine cystine urolithiasis were reported at the Veterinary Hospital of Londrina State University in the period from 2007 to 2009. The diagnosis of urolithiasis was based on clinical history, physical examination, laboratory tests and radiographs, and the confirmation of the urolith type was performed at the Minnesota Urolith Center - USA, trough quantitative analysis, showing pure cystine uroliths. The therapy administered in both cases included surgical removal of the uroliths and prevention of recurrence by increasing the solubility of cystine in the urine with a commercial diet, increased fluid intake and alkalinization of the urine.

Cólico renal en el embarazo: experiencia en Complejo Asistencial Barros Luco / Symptomatic urolithiasis in pregnancy: a Barros Luco Health Complex experience

Objetivos: Revisar nuestra experiencia en el diagnóstico y manejo de la patología litiásica urinaria sintomática durante el embarazo y exponer una revisión actualizada de la literatura. Materiales y métodos: Se realizó un estudio descriptivo retrospectivo que incluyó a 37 pacientes. Se revisaron fichas clínicas de las pacientes embarazadas con diagnóstico de egreso hospitalario correspondiente a cólico renal, urolitiasis, nefrolitiasis o ureterolitiasis de la Unidad de Medicina Materno Fetal del Hospital Barros Luco, entre los años 2005 y 2007. Las variables extraídas y analizadas fueron: edad, paridad, la edad gestacional, el tipo de parto, prematuridad, antecedentes de urolitiasis, presentación clínica, lateralidad, laboratorio, imagenología, confirmación litiásica, ubicación del cálculo, tratamiento inicial y manejo posparto. Resultados: La edad promedio de las pacientes fue de 27,2 años. La edad gestacional promedio fue de 20 semanas. Multiparidad fue del 62 por ciento y el 35 por ciento tenía antecedentes de urolitiasis previa. El 97 por ciento de las pacientes presentó dolor lumbo-abdominal tipo cólico al ingreso, en 56,8 por ciento de casos al lado derecho. El 73 por ciento de los embarazos estaban en el 2° o 3er trimestre. El 8 por ciento presentó parto prematuro. El estudio imagenológico fue requerido en 24 pacientes (65 por ciento) incluyó a la ultrasonografía y una paciente además requirió de radiografía abdominal simple y RNM. De éstas se confirmó litiasis en el 30 por ciento (62,5 por ciento en el riñón, 25 por ciento uréter distal y 12,5 por ciento en ambas ubicaciones). Todas las pacientes se manejaron inicialmente con tratamiento médico. Una paciente requirió un catéter doble “J”, y sólo 2 pacientes requirieron ureterolitotomía después del parto. Conclusiones: La litiasis urinaria sintomática durante el embarazo, a pesar de un enfrentamiento multidisciplinario, continúa siendo un desafío diagnóstico y terapéutico. Los síntomas y...

Objectives: To review our experience in diagnosis and management of symptomatic urolithiasis during pregnancy and present an updated review of the literature. Materials and methods: A retrospective descriptive study including 37 patients was made. We reviewed medical records of pregnant patients with hospital discharge diagnosis of renal colic, urolithiasis, nephrolithiasis or ureterolithiasis from the Maternal Fetal Medicine Unit of Barros Luco Hospital, between 2005 and 2007. Extracted and analyzed variables were age, parity, gestational age, type of delivery, prematurity, history of urolithiasis, clinical presentation, laterality, laboratory findings, imaging, urolothiasis confirmation, location of calculi, initial treatment and postpartum management. Results: Patients average age was 27.2 years. Average gestational age was 20 weeks. Multiparity was 62 percent and 35 percent had prior history of urolithiasis. At admission, 97 percent of patients had lumbo-abdominal colic pain and 56.8 percent of cases was on the right side. 73 percent of pregnancies were in the 2nd or 3rd trimester. 8% had preterm labor. Imaging studies were required in 24 patients (65 percent) and included ultrasonography. Simple abdominal radiography and MRI were requires in one patient. Of these patients, calculi was confirmed in 30 percent (62.5 percent in the kidney, 25 percent distal ureter and 12.5 percent in both locations). All patients were managed initially with medical treatment. One patient required a double J stent and only 2 patients required ureterolithotomy after delivery. Conclusions: Symptomatic urolithiasis during pregnancy, despite multidisciplinary assess, remains a diagnostic and therapeutic challenge. Symptoms and signs are still the most important elements for establishing the diagnosis. If suspected, ultrasound evaluation is recommended. Conservative management is still the first choice of treatment because most cases resolve spontaneously. Installation of a...