Nephrolithiasis in gout: prevalence and characteristics of Brazilian patients

Abstract Background: The aims of this article were to assess the prevalence of nephrolithiasis and the factors associated with nephrolithiasis in Brazilian patients with primary gout. Methods: One hundred twenty-three patients with primary gout were recruited from a tertiary referral hospital in São Paulo, Brazil. All patients underwent ultrasonography and had their clinical and laboratory characteristics assessed. Results: One hundred fifteen (93.5%) patients were male, with a mean age of 62.9 ± 9.4 years. Twenty-three (18.7%) patients had asymptomatic nephrolithiasis (detected only by ultrasonography), 7 (6.0%) had symptomatic nephrolithiasis (detected by ultrasonography and a positive clinical history), and 13 (10.0%) had a history of kidney stones, but ultrasonography at evaluation did not show nephrolithiasis. Therefore, 35.0% of the patients had nephrolithiasis (detected either by ultrasonography and/or a positive clinical history). Nephrolithiasis was associated with male gender (43 [100%] vs 72 [90%], p = 0.049), the use of potassium citrate (13 [30.2%] vs 0, p < 0.001) and the use of medications for diabetes (10 [23.3%] vs 8 [10%], p = 0.047) and dyslipidemia (15 [34.9%] vs 10 [12.5%], p = 0.003); benzbromarone had an inverse association with nephrolithiasis (21 [48.8%] vs 55 [68.8%], p = 0.030). In patients with and without nephrolithiasis, no differences were found in the laboratory and ultrasonography characteristics, including serum uric acid levels, urinary uric acid excretion and urine pH. Conclusions: The prevalence of nephrolithiasis in primary gout was 35.0%, and 18.7% of the patients were asymptomatic. Nephrolithiasis was associated with male gender, diabetes and dyslipidemia. A positive history of nephrolithiasis probably biased the prescription of potassium citrate and benzbromarone.(AU)

Impacto de la profilaxis secundaria en el manejo de pacientes con urolitiasis de alto riesgo de recidiva / Impact of secondary prophylaxis in the management of patients with high recurrence risk of urolithiasis

In a previous study, we showed our experience in a group of 54 patients with a high risk of urolithiasis recurrence, who were subjected to a complete metabolic evaluation. Aim: To report the evolution of these patients after 5 years of follow-up. Patients and Methods: All patients underwent a general management of urolithiasis plus specific treatments for underlying metabolic disorders. Each patient had an annual medical assessment including a clinical examination, urinalysis and imaging studies (non-enhanced computed tomography scan, ultrasonography and plain abdominal Rx rays). In every case, the underlying metabolic disorder, treatment adherence, stones on imaging studies and symptomatology were evaluated. Adherence of general and specific measures were evaluated subjectively. Failure of secondary prevention was defined as the recurrence of clinical or imaging urolithiasis (increase of the number of lithiasis) despite a correct treatment of the metabolic disorders. Results: Twenty nine patients completed the follow-up. Mean age was 45 years old. Nineteen patients (65%) had only one metabolic disorder, three patients (10%) two disorders, one patient (3%) four disorders, and six patients (21%) a normal metabolic study. The median of follow-up was 54 months (45-60). During that period, twenty-three patients (79%) kept the treatment as it was indicated. In this subgroup, 21 had no clinical or imaging recurrence of urolithiasis during follow-up (91%). Total adherence to treatment and follow-up was 42% (23/54) of the initial group of patients. Conclusions: A complete metabolic study allows to identify patients with a high risk of urolithiasis recurrence, enabling a specific treatment of the metabolic disorder. Our experience shows that 75% (21/29) of patients remain free of recurrence at five years of follow-up.

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Use of the probability of stone formation (PSF) score to assess stone forming risk and treatment response in a cohort of Brazilian stone formers

Introduction The aim was to confirm that PSF (probability of stone formation) changed appropriately following medical therapy on recurrent stone formers. Materials and Methods Data were collected on 26 Brazilian stone-formers. A baseline 24-hour urine collection was performed prior to treatment. Details of the medical treatment initiated for stone-disease were recorded. A PSF calculation was performed on the 24 hour urine sample using the 7 urinary parameters required: voided volume, oxalate, calcium, urate, pH, citrate and magnesium. A repeat 24-hour urine sample was performed for PSF calculation after treatment. Comparison was made between the PSF scores before and during treatment. Results At baseline, 20 of the 26 patients (77%) had a high PSF score (> 0.5). Of the 26 patients, 17 (65%) showed an overall reduction in their PSF profiles with a medical treatment regimen. Eleven patients (42%) changed from a high risk (PSF > 0.5) to a low risk (PSF < 0.5) and 6 patients reduced their risk score but did not change risk category. Six (23%) patients remained in a high risk category (> 0.5) during both assessments. Conclusions The PSF score reduced following medical treatment in the majority of patients in this cohort. .

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...

Análisis retrospectivo de la asociación de urolitiasis y la cirugía bariátrica comparando la técnica de by-pass gástrico y manga gástrica / Retrospective analysis of the association of urolithiasis ans bariatricsurgery comparing gastric bypass and gastric sleeve techniques

Publicaciones recientes han mostrado la asociación de litiasis urinaria y cirugía bariátrica. La cirugía bariátrica se ha hecho frecuente en los últimos años pero no hemos conocido reportes en nuestro medio, que describan la frecuencia y asociación de esta cirugía con un mayor riesgo de urolitiasis post operatoria. Revisamos la base de datos de cirugía bariátrica de un cirujano (J.A) de pacientes operados de Bypass gástrico y Manga gástrica durante 5 años (2004-2009) y determinamos la frecuencia de litiasis urinaria post operatoria y la relación de cada tipo de cirugía con la aparición de cálculos urinarios. Obtuvimos datos de 366 pacientes con edad promedio de 36 años, IMC preoperatorio de 39 y distribución por sexo de 23 por ciento sexo masculino y 77 por ciento sexo femenino. Luego de una mediana de seguimiento de 328 días (6 d. -1461 d.) se encontraron a I pacientes con urolitiasis cuyo diagnostico se hizo en promedio 213 días posteriores a la cirugía. Dentro de los pacientes diagnosticados con litiasis urinaria, 6 (3,14por ciento) pacientes fueron operados de bypass gástrico y 2 (1 ,32 por ciento) pacientes operados de manga gástrica. La comparación de ambas técnicas quirúrgicas no permitió establecer una diferencia significativa de mayor riesgo de hacer cálculos de una sobre otra (OR: 2,70 lC 0,57-12,8). Los pacientes sometidos a cirugía bariátrica tienen riesgo de presentar litiasis urinaria, por lo que recomendamos tener presente esta complicación en él post operatorio tardío. No se demostró diferencia en cuanto a riesgo de producción cálculos en los pacientes operados de bypass gástrico y los sometidos a manga gástrica...

Recent publications have shown the association of urolithiasis and bariatric surgery. Bariatric surgery has become common in recent years but have not met reports that describe this surgery with an increased risk of postoperative urolithiasis. Methods: We reviewed a database of a bariatric surgeon (JA) of patients who underwent gastric bypass and sleeve gastrectomy for 5 years(2004-2009) and determine the frequency of postoperative urinary stones and relationship of each type surgery with the appearance of urinary calculi. We obtained data from 366 patients with mean age of 36 years, preoperative BMI of 39 and sex distribution: 23 percent mate and 77 percent female. After a median follow up of 328 days (6 -1461) were found 8 patients with urotithiasis wose diagnosis was made on average 213 days after surgery. Among patients diagnosed with urolithiasis, 6 (3.14 percent) patients underwent gastric bypass surgery and 2 (1 .32 percent) patients who underwent gastric sleeve. The comparison of both surgical techniques did not show a significant difference of one over the other (OR: 2.70 Cl 0.57 to 12.8). Patients undergoing bariatric surgery are at risk for urinary stones, we recommend to keep in mind this complication in the late postoperative period. There is no difference in stone risk in patients undergoing gastric bypass or gastric sleeve...

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

Is there an association between urolithiasis and roux-en-y gastric bypass surgery?

Purpose: Several studies have documented high incidence of urinary lithiasis after jejunoileal by-pass. Roux-en-y gastric bypass surgery (RYGB) is currently the most common bariatric procedure. Because of its difficult for absorption, RYGB has a potential risk to increase the incidence of lithiasis. This study was conducted in order to test the hypothesis that RYGB increases the incidence urolithiasis after 50 percent of excessive weight loss. Materials and Methods: We performed a retrospective cohort study to evaluate 58 patients who underwent RYGB at the Obesity Service at Santa Casa de Misericordia de Sao Paulo, between 2000 and 2005, with minimum follow-up of 10 and maximum of 72 months, after the procedure. Results: Forty-five (77.6 percent) patients had ¡Ý 50 percent loss of weight excess. There was no difference between the frequency of urolithiasis before and after the procedure, and nephrolithiasis was observed after surgery in only one patient, however this had been detected before the procedure. Conclusion: In the period studied, RYGB does not seem to affect the incidence of urolithiasis after weight reduction. This may be due to its smaller malabsorptive component as compared with jejunoileal ¡°by-pass¡±, thereby possibly not significantly influencing the oxalate metabolism.

Urolitíase em caprinos e ovinos / Urolithiasis in sheep and goats

A urolitíase é uma doença freqüente no semi-árido em ovinos e caprinos alimentados com grãos, principalmente quando a relação Ca:P não é corrigida e são utilizadas grandes quantidades de concentrado. De 28 ovinos com urolitíase atendidos no Hospital Veterinário da UFCG, 19 morreram e 9 receberam alta, dos 15 caprinos 12 morreram e 3 receberam alta. As alterações mais freqüentes foi presença de cálculos na uretra e bexiga, uretrite hemorrágica difusa severa, uretrite purulenta, ruptura de uretra com presença de urina no tecido subcutâneo, cistite hemorrágica necrosante, ruptura de bexiga, hidronefrose, nefrite necrosante difusa, abscesso renal, pielonefrite, hemorragia renal e ruptura renal. A gravidade das lesões observadas justifica a alta letalidade apesar dos tratamentos medicamentosos e cirúrgicos. A medida preventiva mais importante é a correção dos níveis de Ca e P. Recomenda-se, também, a administração de volumosos em boa quantidade e qualidade e, nos casos em que a quantidade de concentrados seja superior a 1,5 por cento do peso vivo, a administração de cloreto de amônia a 1 por cento no concentrado e a administração de cloreto de sódio em concentrações de 0,5 até 4 por cento. Deve ser administrada água de boa qualidade à vontade. É necessário abolir a prática, extremamente utilizada em caprinos e ovinos, de administrar sal mineral em animais alimentados com grãos e subprodutos dos mesmos.

Urolithiasis is a common disease in the Brazilian semiarid in rams and bucks fed with grains, mainly with low C:P ratio. From 28 rams with urolithiasis sent to the Veterinary Hospital of the Federal University of Campina Grande, Paraíba, 19 died and 9 survived, and from the bucks, 13 died and 3 survived At necropsy the main lesions were presence of calculi in the urethra and urinary bladder, diffuse purulent urethritis, hemorrhagic necrotizing urethritis, rupture of the urethra with presence of urine in the subcutaneous tissue, hydronephrosis, urinary bladder rupture, necrotizing diffuse nephritis, pyelonephritis, renal hemorrhage, and renal rupture. The severity of the lesions is responsible for the high case fatality rate despite medical and chirurgic treatment. The most important preventive measure is the correction of the Ca:P ratio to at least 2:1. The administration of good quality roughage in the food is also necessary. In cases in which the amount of concentrate food is higher than 1.5 percent live weight, the addition of 1 percent ammonium chloride and 0.5-4 percent of sodium chloride in the diet could be also necessary. Water had to be offered ad libitum. It is necessary to abolish the use of ad libitum mineral supplementation in sheep and goats fed grains or their byproducts.

Estudio metabólico en pacientes con urolitiasis de alto riesgo de recurrencia / Metabolic study in patients with urinary lithiasis at high risk of recurrence

Introducción: La urolitiasis es considerada actualmente una enfermedad metabólica con tendencia ala recurrencia. El objetivo de este trabajo es evaluar la prevalencia de alteraciones metabólicas en pacientes de alto riesgo y su impacto según sexo y edad. Materiales y métodos: Es un estudio descriptivo de 36 pacientes (25 hombres y 11 mujeres), portadores de patología litiásica con alto riesgo de recurrencia. El estudio metabólico consistió en: calcemia, uricemia, fosfemia, PTH sérica, calciuria/24 hrs, uricosuria/24 hrs, fosfaturia/24 hrs, oxalaturia/24 hrs,citraturia/24 hrs y creatininuria/24 hrs. Los valores obtenidos fueron ajustados de acuerdo a la creatininuria y peso. Para el análisis estadístico se utilizó t-student (STATA 7.0). Se consideró significativo p<0,05.Resultados: En el 69 por ciento (25/36) se observó alguna alteración metabólica; el 36 por ciento (13/36) presentó 2 omás alteraciones metabólicas. Las alteraciones más frecuentes fueron la hipercalciuria (30,6 por ciento; 11/36), la hipocitraturia (30,6 por ciento; 11/36), la hiperuricemia (19,4 por ciento; 7/36) y la hiperoxalaturia (13, por ciento; 5/36).No se observó diferencias significativas de edad o sexo entre los grupos con y sin alteración metabólica. Conclusiones: La mayoría de los pacientes con patología litiásica recurrente o de alto riesgo presentan una o más alteraciones metabólicas, predominando la hipercalciuria y la hipocitraturia. En este estudio no hubo diferencias entre ambos sexos en la mayoría de las alteraciones metabólicas, ni tampoco en su distribución etaria. Estos resultados demuestran la necesidad de realizar estudios metabólicos en pacientes de alto riesgo, dado que existen herramientas terapéuticas que permiten un manejo médico de las alteraciones metabólicas y de esta forma reducir la recurrencia de litiasis.

Introduction: Urolithiasis is a metabolic disorder with a tendency to relapse. The aim of this study was to assess the prevalence of metabolic abnormalities in patients at high risk and the impact of sex and age. Materials and methods: Descriptive study of 36 patients (25 men and 11 women),with lithiasic pathology at high risk of recurrence. The metabolic study included the measurement of calcemia, uricemia, fosfemia, parathormone, calciuria/24hrs, uricosuria/24hrs, fosfaturia/24hrs, oxalaturia/24hrs, citraturia/ 24hrs and creatinine/24hrs. The values obtained were corrected according to weight and creatinine. The test used for statistical analysis was t-student (STATA 7.0). It was considered significant p <0.05.Results: In 69 percent (25/36) of the cases a metabolic abnormality was observed and in 36 percent (13/36) there was 2 or more alterations present. The metabolic disorders most frequently observed were hypercalciuria (30.6 percent; 11/36), hypocitraturia (30.6 percent; 11/36), hyperuricemia (19.4 percent; 7/36) and hyperoxaluria (13.9 percent; 5/36). There was no significant difference in age or sex between the groups with and without metabolic abnormality. Conclusions: Most patients with recurrent lithiasic pathology or at high-risk display one or more metabolic disorders, being hypercalciuria and hypocitraturia the most frecuently encountered. In this study, there was no difference between sexes in most of the metabolic disorders, nor in its age distribution. These results demonstrate the need for metabolic studies in high-risk patients, since there are tools that allow therapeutic medical management of metabolic disorders and thus reduce the recurrence of lithiasis.

outbreak of urolithiasis [gout] in a commercial layers flock: diagnosis and control

This study was conducted during an outbreak of urolithiasis of [gout] in a flock of caged layers. The clinical findings of the condition were depression, emaciation, dehydration and decrease in egg production 13%. Mortality rate was 15%. The necropsy findings of dead birds showed white chalk-like deposits covering the surface of various abdominal organs as well as the pericardium kidney tissue swollen and covered with white urate. Diagnosis was made by feed analysis which showed excess of calcium 4.27%, characteristic necropsy findings, and response to the treatment