Urinary tract stone raises subsequent risk for urinary tract cancer: a population-based cohort study.

OBJECTIVE: To evaluate the association between urinary tract stone (UTS) and urinary tract cancer (UTC) in Taiwanese patients, as the results of epidemiological studies about the relationship between UTS and the development of UTC remain inconclusive. PATIENTS/SUBJECTS AND METHODS: We conducted a population-based cohort study using data from the Taiwanese National Health Insurance system. The UTS cohort included 21 862 patients, and each patient was randomly frequency-matched for age, sex, and index year with two insured members of the general population who did not have UTS. Cox proportional hazard regression analysis was performed to estimate the effect of UTS on the risk of UTC. RESULTS: Patients with UTS were at a significantly higher risk of developing UTC compared with the comparison group (adjusted hazard ratio 4.66; 95% confidence interval 2.97-7.30). Women were at higher risk than men. Further analyses showed that the level of UTC was associated with that of UTS, and that the risk for UTC became more divergent for the two groups over time. CONCLUSIONS: Taiwanese patients with UTS, particularly women, had a higher risk for developing UTC than patients without UTS. The risk became more marked over time for this group.

Proteomic analysis of renal calculi indicates an important role for inflammatory processes in calcium stone formation.

Even though renal stones/calculi occur in approximately 10% of individuals, they are an enormous economic burden to the entire US health system. While the relative metabolic composition of renal calculi is generally known, there is no clear understanding of the genetics of renal stone formation, nor are there clear prognostic indicators of renal stone formation. The application of proteomics to the analysis of renal calculi axiomatically holds that insight into renal stone pathobiology can be gained by a more comprehensive understanding of renal calculus protein composition. We analyzed isolated renal stone matrix proteins with mass spectrometric and immunohistochemical methods identifying 158 proteins with high confidence, including 28 common proteins. The abundant proteins included those identified previously in stones and proteins identified here for the first time, such as myeloid lineage-specific, integral membrane and lipid regulatory proteins. Pathway analyses of all proteins identified suggested that a significant fraction of the most abundant matrix proteins participate in inflammatory processes. These proteomic results support the hypothesis that stone formation induces a cellular inflammatory response and the protein components of this response contribute to the abundant stone matrix proteome.

Rat strains differ in susceptibility to Ureaplasma parvum-induced urinary tract infection and struvite stone formation.

Individuals with struvite uroliths are susceptible to recurrent urinary tract infections (UTI), sepsis, and renal disease. Unfortunately, little is known about the host-specific factors that predispose to this disease. In order to develop a rodent model that can address this problem, we inoculated female Fischer 344 (F344), Lewis (LEW), Sprague-Dawley (SD), and Wistar (WIS) rats with a host-adapted strain of Ureaplasma parvum. Animals were necropsied at 2 weeks postinoculation; 100% of F344, 42% of SD, 10% of LEW, and 10% of WIS rats remained infected. Severe bladder lesions and struvite calculi were seen in 64% of F344 rats; in other rat strains, bladder lesions were mild or absent. F344 rats with struvite uroliths had the highest urinary levels of proinflammatory cytokines, such as GRO/KC, interleukin-1alpha (IL-1alpha), and IL-1beta. F344 rats without struvite stones at necropsy had milder bladder lesions and significantly lower urinary levels of proinflammatory cytokines but a more prominent inflammatory response than did other rat strains. Based on our results, struvite stone formation is linked to a robust inflammatory response that does not resolve UTI but instead promotes damage to surrounding tissues.

[Polyoxidonium in the treatment of calculous pyelonephritis].

Efficacy of polyoxidonium was studied in combined therapy of urolithiasis complicated with secondary pyelonephritis. Of 60 patients with secondary pyelonephritis in urolithiasis, 30 received adjuvant polyoxidonium. Phospholipids and cholesterol in cytomembranes were defined with thin-layer chromatography. Humoral immunity was evaluated by the levels of IgA, IgM, IgG, hemolytic activity of the compliment system, the level of circulating immune complexes, activity of lysozyme. Concentrations of IL-1beta, TNF, IL-4, IL-6 were also estimated. Subpopulations of immunocompetent cells were tested on flow cytofluorimeter by immunofluorescence with monoclonal antibodies. Phagocytic component of the immune system was assessed by phagocytic activity of neutrophils, phagocytic count, NBT test. The trial demonstrates that polyoxidonium has a positive action on the disease course, an antiinflammatory, immunomodulating properties, suppresses peroxidation, promotes recovery of structural-functional characteristics of cellular membranes in patients with urolithiasis and secondary pyelonephritis. Polyoxidonium is recommended in secondary pyelonephritis and urolithiasis as adjuvant to basic therapy for anti-inflammatory, detoxication and immunomodulating effect.

Morphological and immunological characteristics of nanobacteria from human renal stones of a north Indian population.

The aim of this study was to detect, isolate and characterize the nanobacteria from human renal stones from a north Indian population, and to determine their role in biomineralization. Renal stones retrieved from the kidneys of 65 patients were processed and subjected to mammalian cell culture conditions. The isolated bacteria were examined using scanning (SEM) and transmission electron microscopy (TEM). They were characterized for the presence of DNA, proteins and antigenicity. The role of these bacteria in biomineralization was studied by using the (14)C-oxalate based calcium oxalate monohydrate (COM) crystallization assay. We observed the presence of apatite forming, ultrafilterable gram negative, coccoid microorganisms in 62% of the renal stones. SEM studies revealed 60-200 nm sized organisms with a distinct cell wall and a capsule. TEM images showed needle like apatite structures both within and surrounding them. They were heat sensitive, showed antibiotic resistance and accelerated COM crystallization. A potent signal corresponding to the presence of DNA was observed in demineralized nanobacterial cells by flow cytometry. The protein profile showed the presence of several peptide bands of which those of 18 kDa and 39kDa were prominent. Apatite forming nanosized bacteria are present in human renal stones and may play a role in the pathophysiology of renal stone formation by facilitating crystallization and biomineralization. However, further studies are required to establish the exact mechanism by which nanobacteria are involved in the causation of renal stones.

[The role of uric acid in effects of balneotherapy on the phagocytic link of immunity and unspecific defense at the Truskavets health resort]. / Rol' sechovoï kysloty v efektakh bal'neoterapiï na kurorti Truskavets' ta ïï vplyv na fahotsytarnu lanku imunitetu ta nespetsyfichnyi zakhyst.

Revealed in the wake of balneotherapy at the Truskavets health-resort were two opposite types of changes--those in the level of uriacidemia and in the content of theophylline-sensitive lymphocytes that are probably caused by central and peripheral effects of uric acid. In this setting, parameters characterizing the phagocytic link of immunity and unspecific defense are noted to change unidirectionally, in other words, they remain unaffected by changes in uriacidemia.

[The use of laser radiation and sinusoidal modulated currents in the therapy of patients with chronic calculous pyelonephritis]. / Primenenie lazernogo izlucheniia i sinusoidal'nykh modulirovannykh tokov v terapii bol'nykh khronicheskim kal'kuleznym pielonefritom.

The authors present a technique of treating chronic calculous pyelonephritis with laser radiation and sinusoidal modulated currents which promotes a complete elimination of the calculus fragments in 100, 70 and 50% of the patients in the stone size 0.2-0.5 cm, 0.5-0.7 cm and > 7 cm, respectively. This combined therapy had also antiinflammatory, and immunity-stimulating effects.

[The local immunity of the urinary system in patients with recurrent urolithiasis]. / Sostoianie mestnogo immuniteta mochevoi sistemy u bol'nykh s retsidivnym urolitiazom.

51 patients with urolithiasis complicated by pyelonephritis in the active phase of inflammation were studied for the condition of local immunity by determining the urine content of secretory immunoglobulin A (SIgA) under conditions of combined treatment with making use of phlogenzyme, a drug of II-generation systemic enzymotherapy (SE). Recordable in this patients population was a marked increase in the urine level of SIgA. Incorporation in a combined treatment of phlogenzyme results in normalizing the status of the urinary system local immunity. Evidence has been obtained on the lack of parallelism in the dynamics between the serum IgA content and urine concentration of SIgA, which fact suggests independence of local immunity. Our theory is that an appreciable increase in the urine level of SIgA in patients with urolithiasis concurrent with pyelonephritis may have an important part to play in the genesis of nephrolithiasis.

Specific detection of kappa light chain in uric acid stones.

Proteins were extracted from uric acid stones with 6M guanidine chloride (pH 8.5), which were successively developed by 12% polyacrylamide gel electrophoresis in the presence of sodium dodecyl sulfate (SDS-PAGE). Amino acid sequence analysis of each band on SDS-PAGE revealed that major components in uric acid stones were immunoglobulin alpha heavy and kappa light chains. Although immunoglobulin heavy chain (gamma and mu, as well as alpha) and a kappa light chain were clearly detected in uric acid stones by Western blotting using their specific antibodies, no lambda chains whatsoever could be detected. The results suggest that immunoglobulins selectively containing kappa light chain might have specific functions in uric acid stone formation as stone matrices.

Urolithiasis and distal renal tubular acidosis preceding primary Sjögren's syndrome: a retrospective study 5-53 years after the presentation of urolithiasis.

OBJECTIVES: Distal renal tubular acidosis (dRTA) can be associated with autoimmune diseases such as primary Sjögren's syndrome (SS). Our objective was to study SS-associated symptoms, autoantibodies and renal histopathology in patients with urolithiasis and dRTA. SETTING: The patients were from the Departments of Nephrology and Rheumatology. University Hospital of Linköping, which is a tertiary referral hospital, as well as a secondary referral centre for the immediate area around the city of Linköping. SUBJECTS: Ten female patients with dRTA, who presented with urolithiasis and not with subjective sicca symptoms, were from the Department of Nephrology, University Hospital, Linköping. Autoantibodies were detected in eight of these patients, and they were studied with respect to clinical and laboratory evidence of SS (urolithiasis group). Fifteen women with SS, who presented with sicca symptoms and not with urolithiasis or dRTA, served as the reference group. RESULTS: In the urolithiasis group, all of the eight patients had anti-SS-A antibodies, and SS (or possible SS) developed in seven of the eight patients 1-48 (mean 15) years after the onset of urolithiasis. Histological features of tubulointerstitial nephritis were found in four of five biopsied patients in the urolithiasis group, and in two of four patients (with dRTA) in the reference group. CONCLUSIONS: Urolithiasis and dRTA can precede subjective sicca symptoms, and patients with dRTA may have SS in the absence of subjective sicca symptoms. Anti-SS-A antibodies are common in patients with urolithiasis and dRTA. Therefore, we hypothesize the possibility of a Sjögren-related renal disease in these patients.

[The correction of the immune disorders in patients with chronic pyelonephritis and chronic kidney failure]. / Korrektsiia immunnykh narushenii u bol'nykh khronicheskim pielonefritom i khronicheskoi pochechnoi nedostatochnost'iu.

The trial entered 41 patients with chronic renal failure. Group I (15 patients) received conventional therapy involving infusion detoxication, antibiotics, immunostimulators, anabolic agents. 26 patients of group II in addition to standard therapeutic measures underwent plasmapheresis. The effect was assessed by immunological and renal function parameters. Group I patients have benefited from conventional treatment, but signs of immunodeficiency remained: B-lymphocyte, IgG and IgA levels were lowered and elevated, respectively. Patients of group II improved clinically, got rid of uremia and immunodeficiency.

[The characteristics of histocompatibility antigen distribution in urolithiasis patients with a phosphorus metabolic disorder]. / Osobennosti raspredeleniia antigenov gistosovmestimosti u bol'nykh urolitiazom s narusheniem fosfornogo obmena.

Phosphorus metabolic disturbances play a great role in the occurrence of urolithiasis. This study covered 150 patients with urolithiasis to establish correlations between the frequency of histocompatibility antigens and the increase in blood and urinary phosphorus levels. The HLA antigens were identified by the routine microlymphocytotoxic method involving a histotyping serum panel. The ABO antigens and rhesus were determined by the agglutination method by using reference sera. The study revealed specific distribution of histocompatibility antigens in urolithiasis patients with disturbed phosphorus metabolism. Hyperphosphatemia correlated with the higher frequency of HLA-B35 (chi 2 = 9.89) and E/E system rhesus (chi 2 = 8.63); hyperphosphaturia showed a negative association with the HLA-A28 antigens (chi 2 = 9.7), as well as with E/e (chi 2 = 14.69) and e/e (chi 2 = 39.36) and a positive association with HLA-B13 (chi 2 = 5.98) and B35 (chi 2 = 36.58). The highest relative risk for hyperphosphatemia associated with the B27 and B35 antigens was observed with genetic predisposition, being 3.63 and 7.13, respectively. B12- and B35-positive individuals were at higher risk for hyperphosphaturia up to 11.25. There were significant differences in antigen frequency, and sex, genetic predisposition to urolithiasis, association of phosphorus metabolic disturbances with other metabolic disorders, and their effects of parathyroid lesions, etc. The findings reveal the immunogenetically induced risk for the occurrence and development of urolithiasis with disturbed phosphorus metabolism to make goal-oriented prophylactic measures.

[The correction of the humoral and hemodynamic disorders in patients with urolithiasis complicated by chronic kidney failure]. / Korrektsiia gumoral'nykh i gemodinamicheskikh narushenii u bol'nykh mochekamennoi bolezn'iu, oslozhnennoi khronicheskoi poochechnoi nedostatochnost'iu.

The paper presents the analysis of 52 cases of urolithiasis complicated by chronic renal failure in the intermittent stage. The patients were examined for renal blood flow, central hemodynamics, myocardial function, factors of humoral regulation of the circulation kallikrein-kinin, sympathoadrenal systems, renin activity, renal function. The test were performed preoperatively and 1, 3, 7, 14 days after surgery. The patients entered two groups. 24 patients of group I received routine symptomatic treatment, 28 patients of group II were treated with regard to the changes revealed and underwent preoperative enterosorption. Group I demonstrated severe shifts in renal and central hemodynamics, reduction of renal circulation, hypokinetic circulatory syndrome, phasic syndrome of myocardial hypodynamics, hypoactivity of kallikrein-kinin and sympathoadrenal systems, hyperactivity of renin. The disturbances aggravated postoperatively and disappeared only on day 14 since the operation. having been corrected by cardiac glycosides, desaggregants, hypotensive drugs diuretics. Group II patients developed increased renal circulation, weak activation of humoral blood regulation factors. Hemodynamic disorders showed no progression. As a results, renal postoperative function improved.

[The immunological indices in different types of gouty nephropathy and the degree of renal structure involvement]. / Immunologicheskie pokazateli pri razlichnykh tipakh podagricheskoi nefropatii i stepeni porazheniia pochechnykh struktur.

Patients with different types of podagric nephropathy were examined for 21 indicators of the functional activity of T and B lymphocytes and neutrophils. The data obtained were compared to the degree of impairment of the basic renal structures. Among the study immunologic indicators to estimate the gravity of morphological alterations in the glomeruli, the decrease of the titers of antibodies to DNA is of definite specificity, whereas the fall of the concentration of circulating immune complexes is of definite specificity in the assessment of alteration in the stroma.

[The immunogenetic associations in hereditary forms of urolithiasis]. / Immunogeneticheskie assotsiatsii pri nasledstvennykh formakh mochekamennoi bolezni.

A distribution rate of the leukocytic histocompatibility antigens of HLA loci, A, B, C and basic erythrocytic blood groups of the ABO system, rhesus, P, Duffy, Kell was investigated among people of Azerbaijani nationality suffering from the familial forms of urolithiasis. A practical value of the investigation is to directly use the obtained data during a prophylactic medical survey of population, specific therapeutic management and prognosis, detection of high risk groups and prenosologic diagnosis.

[The enzyme function of cationic transmembrane transport and its relationship to the homeostatic indices of patients with chronic pyelonephritis]. / Funktsional'noe sostoianie fermentov kationnogo transmembrannogo transporta i ikh vzaimosviaz' s nekotorymi pokazateliami gomeostaza u bol'nykh khronicheskim pielonefritom.

The paper examines the relationship between the clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane erythrocyte transport (Mg(2+)-, N(+)-K(+)-, Ca(2+)-ATPases). An individual analysis ascertained that the patients who showed a low Ca(2+)-ATPase activity had marked signs of inflammation in the body, as evidenced by ESR, seromucoid and fibrinogen concentrations. These patients had more significantly depressed immune defense mechanisms as reflected by the levels of immunoglobulins, T-lymphocytes, complement, the neutrophil phagocytosis, and urinary IgA concentrations). Variations were also found in examining the excretion of a number of metabolites. There was a substantial decrease in urea, creatinine, titrated acid, phosphorus excretions in patients with deficient Ca(2+)-ATPase activity than in those with its high activity. It was concluded that there was a relationship between some clinical manifestations of pyelonephritis and the functional activity of enzymes of cation transmembrane transport. To treat metabolic disorders, membrane-protective agents are recommended to include into combined therapy.

[The role of immunologic factors in the pathogenesis of urolithiasis]. / Rol' immunologicheskikh faktorov v patogeneze urolitiaza.

The role of thrombin, fibrinogen, specific and unspecific immunological reactions in the pathogenesis of urolithiasis were evaluated. It was found in the urine of patients with urolithiasis and concomitant pyelonephritis that most bacteria, leucocytes and organic substances fixed on crystalloids contained on their surfaces immunoglobulins M, G and A. The mechanisms of the possible participation of immune reactions in the pathogenesis of urolithiasis are discussed.

[Prostatic specific antigen in the serum in prostatic cancer].

Prostatic specific antigen (PA) level was determined with a Wako test kit (Japan) for prostatic cancer and others. The incidence of abnormal values of PA in untreated prostatic cancer, was 50, 50, 80, and 100% for stage A1, C (pN0, NX), D1 and D2 cancers, respectively. Grade was not related to the level of PA. Prostatic hypertrophy, prostatitis and urinary stone showed a false positive rate of 52, 18 and 0%, respectively. The level of PA was not correlated to those of prostatic acid phosphatase (RIA). In 31% of the cases, the elevated PA decreased 4 weeks after start of endocrine treatment. Elevated PA in low grade cancer was not normalized as much as that in high and moderate grade cancers. The positive rate of PA in the serum of reactivated patients was significantly higher than that of the patients with cancer under good control by endocrine treatment.