Urinary lithiasis and idiopathic hypercalciuria: the importance of dietary intake evaluation

PUSPOSE: To evaluate food intake of patients with urinary lithiasis and idiopathic hypercalciuria (IH). MATERIALS AND METHODS: Between August 2007 and June 2008, 105 patients with lithiasis were distributed into 2 groups: Group 1 (n = 55) - patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50) - normocalciuria (NC) patients . Inclusion criteria were: age over 18, normal renal function (creatinine clearance = 60 mL/min), absent proteinuria and negative urinary culture. Pregnant women, patients with some intestinal pathology, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated through the quantitative method of Dietary Register of three days. RESULTS: Urinary excretion of calcium (433.33 ± 141.92 vs. 188.93 ± 53.09), sodium (280.08 ± 100.94 vs. 200.44.93 ± 65.81), uric acid (880.63 ± 281.50 vs. 646.74 ± 182.76) and magnesium (88.78 ± 37.53 vs. 64.34 ± 31.84) was significantly higher in the IH group in comparison to the NC group (p < 0.05). As regards the nutritional composition of food intake of IH and NC groups, there was no statistical significant difference in any nutrient evaluated. CONCLUSION: In our study, no difference was observed in the food intake of patients with urinary lithiasis and IH or NC.

Expression of Epidermal Growth Factor Receptor, ErbB2 and Matrix Metalloproteinase-9 in Hepatolithiasis and Cholangiocarcinoma / 대한소화기학회지

BACKGROUND/AIMS: Hepatolithiasis is a common disease in East Asia and presents as a histological feature of proliferative glands containing mucin. 5-10% of hepatolithiasis is known to be associated with cholangiocarcinoma. Recent studies reported that epidermal growth factor receptor (EGFR) could be activated through heparin binding- EGF cleavage by metalloproteinases. Matrix metalloproteinases (MMPs) which digest the extracellular matrix are required for cancer cell invasion and the expression of MMP-9 is known to be increased in cholangiocarcinoma. However, there has been few studies on the expressions and roles of EGFR and MMP in hepatolithiasis. This study was performed to clarify and compare the expressions of EGFR, erbB2 and MMP-9 in hepatolithiasis and cholangiocarcinoma. METHODS: Surgically resected liver tissues with hepatolithiasis (n=14), cholangiocarcinoma (n=20) and trauma (n=2 as controls) were included. The expressions of EGFR, erbB2 and MMP-9 in tissue samples were examined by immunohistochemistry using respective monoclonal antibodies. RESULTS: In traumatic livers, the expressions of EGFR, erbB2 and MMP-9 were all negative. The expression of EGFR was increased in hepatolithiasis group (79%, 11/14) compared with cholangiocarcinoma group (25%, 5/20) (p0.05). CONCLUSIONS: EGFR expression appears to be the dominant component in periductular hyperplasia of hepatolithiasis and MMP-9 is upregulated not only in cholangiocarcinoma but also in hepatolithiasis. This study suggests that EGFR and MMP-9 are associated with cholangiocarcinoma and hepatolithiasis.

Alteraciones metabólicas en 2612 pacientes con litiasis renal / Metabolic changes in 2612 patients with nephrolithiasis

La litiasis renal constituye por su frecuencia la 3ra alteración de las vías urinarias. La prevalencia en la Ciudad de Buenos Aires es del 4 por ciento, según estudios recientes. Se presentan los resultados metabólicos de 2612 pacientes estudiados con un mismo protocolo ambulatorio para estudio bioquímico de litiasis renal. Se encontraron alteraciones en 2423 pacientes (92.8 por ciento). El 61.5 por ciento como única alteración y 31.2 por ciento en forma asociada. No pudimos obtener diagnóstico en 189 pacientes (7.2 por ciento). Los diagnósticos más frecuentes como única alteración fueron la hipercalciuria idiopática en el 31.2 por ciento, la hiperuricosuria y diátesis gotosa en el 9.4 y 5.4 por ciento respectivamente. Otros diagnósticos fueron hipomagnesuria (6.7 por ciento), hiperparatiroidismo primario (2.6 por ciento), hiperoxaluria (1.3 por ciento) y cistinuria (0.45 por ciento). La hipercalciuria asociada a otros diagnósticos se observó en el 58.1 por ciento y los trastornos del ácido úrico en el 36.8 por ciento. Además de los trastornos metabólicos descriptos observamos un 12 por ciento de pacientes com bajo volumen urinario. Estos datos están en concordancia con la mayoría de las series publicadas y resaltan la importancia de encontrar un diagnóstico bioquímico en estos pacientes que permita el tratamiento específico que evite la recurrencia.

Contribuiçäo do laboratório de análises clínicas no diagnóstico metabólico da litíase renal / The importance of laboratory tests in the metabolic evaluation of nephrolithiasis

Cerca de 5 porcento da populaçäo brasileira é portadora de litíase renal, o que corresponde a cerca de 7 milhöes de litiásicos brasileiros. É uma patologia que acomete indivíduos jovens, geralmente na terceira década de vida, nos seus anos mais produtivos, além de sua recorrência ser muito elevada. Apesar do avanço no tratamento da litíase renal nos últimos anos, através de técnicas näo invasivas, estes métodos só servem para retirar o cálculo, ou seja, eliminam a consequência da doença e näo a sua causa. Desta forma, todo paciente com urolitíase ou que já apresentou cálculo e, principalmente, aquele com história de múltiplos cálculos devem submeter-se a realizaçäo de um estudo metabólico. Com este objetivo, 73 indivíduos com litíase renal recorrente foram estudados. Destes, apenas 1 (1,4 porcento) näo apresentou alteraçäo em nenhum dos parâmetros analisados. Os principais distúrbios metabólicos encontrados foram hipercalciúria, hipernatriúria, hipocitratúria, hipomagnesúria e hiperuricosúria. Este tipo de estudo é importante e o laboratório de análises clínicas contribui na elucidaçäo dos mecanismos fisiopatogênicos responsáveis pela formaçäo de cálculos e na indicaçäo de uma terapêutica mais racional, adequada e eficaz