[Urinary calculus protective side effects of anti-rheumatic therapy]. / Harnsteinprotektive Nebeneffekte bei antirheumatischer Therapie.

In a retrospective study two patient groups suffering from recurrent calcium oxalate lithiasis are compared before and after antirheumatic therapy using Diclofenac-Natrium alone or in combination with xanthine oxidase inhibitors and/or hydrochlorothiazides. The examination of concentration and excretion of lithogenic important parameters show a partly significant reduction of the concentration mean values of calcium, oxalic acid and uric acid. The influence of non-steroidal antiphlogistics (NSAP) on calculus recurrence rate in calcium oxalate lithiasis is recognized.

Glycose aminoglycane excretion and concentration in the urine of patients with frequently recurrent calcium-oxalate lithiasis prior to and following Diclofenac-Na therapy.

Excretion and concentration of glycose aminoglycans were measured in 19 patients with frequent relapses of calcium-oxalate lithiasis, prior to and two weeks after onset of Diclofenac-Na therapy. In most patients, markedly enhanced glycose aminoglycan concentration and excretion could be demonstrated. Elevation of the high-molecular inhibitor potential in the urine results in reduced risk of calcium-oxalate lithogenesis, which may explain the therapeutic success of nonsteroidal anti-inflammatory drugs in the treatment of therapy resistant calcium-oxalate lithiasis.

[The prognosis of patients with struvite calculi with remaining/recurrent calculi and treatment refractory urinary tract infections]. / Zur Prognose von Struvitsteinpatienten mit Rest-/Rezidivsteinen und therapieresistenten Harnwegsinfekten.

29 patients suffering from recurrent struvite stones and/or persistent urinary tract infection were analyzed retrospectively with a follow-up time of 10 +/- 6 years. A sanitation of the urease-positive urinary tract infection was possible in 12 patients (41%). After 10 out of 53 operations (19%) rest stones were found. An unilateral nephrectomy was done in 3 cases. Despite rest calculi and persistent urinary tract infection no further calculus growth or deterioration of renal function was found in most patients.

[Non-medicamentous prevention of calcium oxalate urinary calculi]. / Nichtmedikamentöse Prophylaxe beim Calcium-Oxalat-Harnsteinleiden.

In a prospective study the efficacy and actual outcome of non-medicamentous preventive measures with metabolically unremarkable calcium-oxalate urolithiasis were investigated in 49 idiopathic calcium-oxalate stone formers. Overnight urine excretion was not increased. The mean concentration and excretion of essential parameters in terms of lithogenesis were hardly influenced. The obvious reduction of the pelvi-calyceal area in both lithogenous and non-lithogenous kidneys after one year of calculus prophylaxis was striking. By means of a discriminant function including morphological parameters and high-molecular urine components some developments may be verified in the discriminant space suggesting a good prophylactic result in many patients.

Influence of different factors on the formation of calcium oxalate stones. I. Discriminant analytical computations of morphological parameters of the pelvic-calyceal systems of calcium oxalate stone formers and controls.

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study, pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

Influence of different factors on the formation of calcium oxalate stones. II. Discriminant analytical computations of morphological parameters of pelvic-calyceal systems and clinicochemical urine parameters of controls and calcium-oxalate stone formers.

Until now almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation. In part I of this study pelvic-calyceal systems of healthy persons and calcium oxalate stone formers are compared with regard to their morphology, whereas urine parameters will be briefly included in part II. Discriminant functions are given by means of which it is possible to calculate the risk and, e.g. to quantify a follow-up.

[Long-term results of small intestine interpositionplasty]. / Langzeitergebnisse bei Dünndarminterpositionsplastiken.

The results of interposition plastic operations of the small intestine are presented which were performed in 8 patients. The control period comprises 4 to 23 years. The relatively complicationless postoperative course confirms an efficient technique, by means of which the functionless ureter may be bridged over. The function of the kidneys remains compensated and this the technique fulfils the main criterion of an operative technique conserving the organ.

Disturbed urinary transport in the pelvi-calyceal system in calcium-oxalate stone patients.

This study is intended to elucidate the process of urinary transport through the pelvi-calyceal system (PCS). PCS-motility of a total of 28 PCS was qualitatively and quantitatively determined in 9 stone patients and 14 control persons by examination of contrast medium excretion. From X-ray videograms recorded by means of Siemens urography, four different urinary transport types could be distinguished as well as the duration of the contraction periods and the intervals between the PCS-contractions. In stone patients physiological types of urinary transport are less common (33%) than in control subjects (81.25%). In stone patients the PCS is often characterized by reduced or even absent motility. Calyceal reflux is usually found in the systolic phase of PCS-contractions, which may apparently be regarded as a physiological process.

Clinical results in the treatment of therapy-resistant calcium-stone formers with non-steroidal anti-inflammatory drugs.

Long-lasting success was obtained in the treatment of 8 therapy-resistant, frequently relapsing calcium-stone formers with non-steroidal anti-inflammatory drugs (NSAIDs). Over the period of treatment the rate of stone formation decreased markedly in these patients. Until now 3 test persons have exhibited only partial success with NSAID treatment. Diclofenac-Na as single-drug therapy or in combination with thiazide preparations or indomethacin is presented as a novel therapeutic possibility, the influence of NSAID on pathomechanism of calcium-stone formation is discussed.

[Simple rapid test with carbonate/nitroprusside for the semiquantitative determination of cysteine in the urine--possible use for control of ascorbic acid therapy in cystine urolithiasis]. / Einfacher Schnelltest mit Karbonat/Nitroprussid zur semiquantitativen Bestimmung von Zystein im Urin--Möglichkeit einer Verlaufskontrolle unter Askorbinsäuretherapie beim Zystinsteinleiden.

In this paper a method of semiquantitative cysteine determination is presented, which is based on the formation of a red cysteine-Na-nitroprusside salt. The method is a suitable rapid test for checking the process of ascorbic acid therapy in cystinuria and cystine urolithiasis patients. It guarantees acceptable reproducibility of values and can be easily carried out in every clinicochemical laboratory. With the K2CO3/nitroprusside test described and an additional cystine rapid test (Ni2+/S2O4(2-) tablet reagency) a separate semiquantitative differentiation of cysteine and cystine in fresh (!) urine is possible.

[Diclofenac-Na--an alternative treatment possibility in therapy-resistant calcium oxalate urolithiasis?]. / Diclofenac-Na--eine alternative Behandlungsmöglichkeit beim therapieresistenten Kalzium-Oxalat-Harnsteinleiden?

In a prospective study, the influence of sole Diclofenac-Na therapy (3 X 25 mg Rewodina, Voltaren) on the calculus recurrence rate of eight frequently relapsing and therapy resistant calcium-oxalate stone patients is analysed. During a period of one year's treatment, the recurrence rate could be reduced by 73.2%, from 123 to 33 calculi. Serious side effects, changes in blood serological parameters and various urine components were not observed. The course of passages of calculi was improved by reduced pain and rapid passage. The paper summarizes all results of calcium-oxalate stone treatments with nonsteroidal antiphlogistics known so far. In the opinion of the authors, the present successful Diclofenac-Na treatment offers a novel possibility of influencing therapy resistant stone-formers over long periods.

[Modified rapid test for the semiquantitative determination of cystine in the urine]. / Modifizierter Schnelltest zur semiquantitativen Bestimmung von Cystin im Urin.

The present study describes a modified method of the semiquantitative determination of cystine in the urine which is based on the decomposition of cystine by dithionite ions and formation of a mixed nickel/cystein/sulfide-complex. The method is suitable as rapid and search test, it guarantees an acceptable reproducibility as well as the exactness of the values and is simply to be performed in every clinical-chemical laboratory. The criteria of analytic applicability are confirmed in comparisons of methods. It must be urged to treat fresh urines.

[Possibilities and limits in the treatment of cystine calculus diathesis with high-dose ascorbic acid. Results of a combined study with 17 patients]. / Möglichkeiten und Grenzen bei der Behandlung der Zystinsteindiathese mit hochdosierter Ascorbinsäure. Ergebnisse einer Verbundstudie mit 17 Patienten.

17 cystine stone patients were treated with high doses of ascorbic acid (5 g p. d.). During the observation period, a total of only two natural passages of cystine stones could be observed. For five patients the therapeutic strategy was altered because the recurrence rate did not change and the cystine concentration in the urine was enhanced. One mixed calcium-oxalate/cystine stone had to be resected. In this case as well as on the occasion of further medical check-ups of other patients, an increased risk of calcium-oxalate stone formation was signalled by an enhanced oxalic-acid concentration in the 24-hour urine. Changes in blood serum and impairment in hepatic and renal functions were not observed. With three patients, the therapy had to be interrupted because of gastritis symptoms. The use of high-dose ascorbic acid therapy is recommended and is continued. In special cases, an additive of low do ses of alpha-mercaptopropionyl-glycine is recommended.

[Modification of the risk of urolithiasis by changes in magnesium and calcium concentrations in the urine as affected by stress conditions]. / Uber die Beeinflussung des Harnsteinbildungsrisikos durch Veränderungen der Magnesium- und Calciumkonzentration im Urin unter Stressbedingungen.

Under defined stress conditions, a slight decrease in the calcium concentration in the urine of calcium oxalate stone patients on the first and second experimental days was observed. Taking simultaneously recorded calcium concentrations into consideration, Ca/Mg quotients, were calculated, which, at least in single cases, exceed the limiting range, thus signalling an increased risk of calculus formation.

[Rhythm of diurnal and seasonal urine excretion in calcium oxalate-urinary calculi patients and healthy humans and its effect on the incidence of calculi]. / Zur Rhythmik der tages- und jahreszeitlichen Harnausscheidung bei Kalziumoxalat-Harnsteinpatienten und Gesunden und deren Einfluss auf die Steinfrequenz.

Distinct sinus-like variations in the production of urine - with regard to diurnal as well as seasonal rhythms - result in an increased risk of stone formation in the months of May, June, September and November (concerning seasonal rhythm) and between midnight and 6 a.m. (concerning diurnal rhythm). Other data of importance influencing urinary excretion are sex, age and supply of fluid.

[Effect of proteolytic enzymes, electrolytes and other factors on the crystallization of calcium oxalate in the urine]. / Uber den Einfluss proteolytischer Fermente, Elektrolyte und anderer Faktoren auf die Kristallisation von Kalziumoxalat im Urin.

On the basis of 18 discriminance-analytically balanced urine parameters of patients with recidive calcium-oxalate nephrolithiasis and control subjects without urological complaints, it is shown in this article that the concentration of proteolytic activity, of enzyme inhibitors, of acid mucopolysaccharides and inhibition indices do not give better separation between the control group and recidive calcium-oxalate lithiasis patients than the usually measured urine parameters.

Prevention of recurrent uric acid and calcium oxalate stones by administration of the xanthine oxidase inhibitors Milurit 100 and Milurit 300.

Disturbances in purine metabolism with hyperuricaemia and/or hyperuricosuria are a risk factor in uric acid and Ca oxalate stone formation. By way of a competitive xanthine oxidase inhibition, the formation of uric acid is reduced by allopurinol. In investigations on two groups of patients, Milurit could be demonstrated to decrease the uric acid levels in serum and urine. No differences could be seen in the dosages of 3 x 100 mg or 1 x 300 mg Milurit. Therefore, in stone recurrence prevention, the administration of Milurit 300 is recommended.

Possibilities of computing urine parameters as a means of classification of normals and patients suffering from calcium oxalate lithiasis.

By the use of simple quotients consisting of the lithogenic variables in the numerator and the litholytic ones in the denominator as well as of complex chemical and discriminant analytical computational use of urine parameters, it is possible to distinguish significantly between groups of control persons and recurrent calcium oxalate stone formers and to obtain a relative prediction concerning the risk of stone formation. In discriminant analytical computation, in our opinion, it is most convincing to make use of variables which have been checked multivariately concerning their separating properties with regard to their mutual correlations and their measure of indispensability.

[Personal experiences in the long-term treatment of cystine lithiasis with high-dose ascorbic acid]. / Unsere Erfahrungen bei der Langzeitbehandlung des Zystinsteinleidens mit hochdosierter Askorbinsäure.

We report on our experience with 9 cystine-lithiasis patients who were treated with large doses of ascorbic acid (5 g/day) for periods ranging from 6-27 months. We observed recidive lithogenesis in only 3 patients during this time. The influence of ascorbic acid on the excretion of cystine and oxalate in the urine is discussed. A lack of side effects and the significantly lower frequency of recidivation justify the further use of ascorbic as an alternative medication in cystine lithiasis.

Biological rhythmicity and crystallization--urine profiles and Se-studies on calcium oxalate stone genesis.

In profile urines from oxalate stone patients and normal persons the progress of concentration and excretion of 10 urine parameters was investigated. For the majority of lithogenic and litholytic urine substances, especially for oxalic acid, a day-and-night rhythm was proven. This may be transferred to a principle of zonary structure of weddellite crystals, explaining the periodically recurring change of weddellite layers of different dissolution resistances arising from different growth rates due to different concentrations of supersaturated urine.