Effects of magnesium salts in preventing experimental oxalate urolithiasis in rats.

Magnesium oxide, magnesium hydroxide, magnesium sulfate, magnesium trisilicate, and magnesium citrate were added to a calcium-oxalate lithogenic diet in order to determine their effects in preventing lithogenesis. Male Wistar-strain rats which had been fed the glycolic-acid diet developed marked urinary calculi within four weeks. Rats in the magnesium-hydroxide, magnesium-citrate, and magnesium-trisilicate groups, however, had almost no stones in the urinary system. Rats in the magnesium-oxide and magnesium-sulfate groups showed significantly less effect than those in the former three groups. During the experimental period, the 24-hour urinary oxalate excretion and concentration were higher in the glycolic-acid group than in the other groups. The urinary citrate excretion and concentration were the highest in the magnesium-hydroxide and magnesium-citrate groups and higher in the magnesium-trisilicate and magnesium-oxide groups than in the magnesium-sulfate and glycolic-acid groups. Similar trends were observed in the urinary magnesium excretion and in its concentration. The urinary calcium excretion and concentration were higher in the experimental groups than in the glycolic-acid group. The urinary calcium/magnesium ratio remained mostly unchanged. Therefore, it can be concluded that alkaline magnesium salts increase the urinary calcium and magnesium concentrations, without changing the calcium/magnesium ratio, and inhibit urinary calculi formation, most likely by increasing the urinary citrate concentration.

[Results of various analysis technics in relation to urinary calculi studies]. / De resultaten van verschillende analysetechnieken met betrekking tot urinesteenonderzoek.

The article describes the results of surveys on renal calculi analysis organised by the Dutch Quality Assessment Foundation (SKZL) over the years 1986-1989. Most of the Dutch laboratories apply wet chemistry, some of them infrared spectroscopy, some polarisation microscopy and one X-ray diffraction analysis. The results of the wet chemistry category are poor, the infrared spectroscopy and the polarisation microscopy group score moderately well while the X-ray diffraction analysis laboratory performs well. On the basis of the results it is suggested to promote the physical chemical methods for renal calculi analysis.

Dietary restriction of sodium as a means of reducing urinary cystine.

We assessed 5 patients with recurrent cystine urolithiasis before and after implementation of a low sodium diet. This diet led to a significant decrease in the 24-hour urinary excretion of sodium and cystine. Dietary restriction of sodium should be an important component of the therapeutic strategy of patients with cystinuria.

Identification of urinary stone composition by pulsed dye laser.

Stones were recovered from the urinary tract and their composition determined by X-ray diffraction before exposure to a pulsed dye laser beam. The resultant fluorescent emissions were recorded using a scanning reticon and they appeared to be specifically related to the composition of each stone. This technique has a practical application as it may allow identification of the composition of urinary tract stones in vivo, and so indicate the best mode of lithotripsy.

Epizootiologic evaluation and quantitative analysis of urinary calculi from 150 cats.

One hundred fifty specimens of urinary calculi from 150 cats were analyzed by at least 1 of 4 quantitative methods. Struvite (magnesium ammonium phosphate) was the predominant mineral substance encountered, with 104 (69%) of the calculi being composed entirely of struvite and 23 (15%) being composed partially of struvite. Most (93%) of the calculi were located in the urinary bladder. Growth of bacteria was observed in samples from calculi or urine from 30 (41%) of 74 cats. Coagulase-positive staphylococci were isolated from the urine or calculi from 17 cats (45% of bacteria isolated). Ten other bacterial species were isolated. Median and mean ages of the cats were 5.0 and 5.1 years, respectively. Domestic short-hair and domestic longhair breeds predominated. Fifty-seven percent of the calculi came from females, 43% from males. The distribution by gender did not differ significantly (P greater than 0.2) among the 3 groups (domestic shorthair, domestic longhair, and other). However, the distribution of struvite calculi differed significantly (chi 2 = 15.5, P less than 0.001) by age and gender; among cats less than or equal to 2 years of age, males predominated 2:1 over females, and among cats greater than 2 years of age, females predominated by nearly 3:1 over males. When compared with the general population, females greater than 2 years old were significantly (chi 2 = 15.4, P less than 0.001) overrepresented.

[Experience with extracorporeal shock wave lithotripsy for urinary stone. Factors for requiring more than two ESWL treatments and its result].

Extracorporeal shook wave lithotripsy (ESWL) was performed for the treatment of 1277 urolithiasis patients at Osaka City University Hospital from July, 1985 to December, 1988. A total of 1788 ESWL treatments were carried out using Dornier HM3 kidney lithotripter. 964 patients (75.5%) underwent only one ESWL treatment, while 313 patients (24.5%) more than two ESWL treatments. We retrospectively examined the factors for requiring more than two ESWL treatments. Not only stone number, size and location, but fragility were considered to be the main causes for requiring more than two ESWL treatments. According to component analysis of ureteral stones, which were hard and resistant to shock wave, calcium apatite content of these stones turned out to be high (p less than 0.001). As for fragility, the residual stones created by ESWL were more difficult to be disintegrated that the nontreated stones of the same size (p less than 0.05). "Fragility" of the stones before shock wave and residual stones after ESWL are considered to be a major problem in ESWL treatment of urinary stones to be solved in the years to come.

Medical dissolution of feline struvite urocystoliths.

The efficacy of a diet designed to facilitate dissolution of feline magnesium ammonium phosphate (struvite) uroliths was evaluated in 30 cases of urolithiasis, sterile struvite uroliths dissolved in a mean of 36 days after initiation of dietary treatment. In 5 cases of urolithiasis, struvite urocystoliths associated with urease-negative bacterial urinary tract infection dissolved in a mean of 23 days after initiation of dietary and antimicrobial treatment. In 3 cases of urolithiasis, struvite urocystoliths associated with urease-positive staphylococcal urinary tract infection dissolved in a mean of 79 days after initiation of dietary and antimicrobial treatment. Dissolution of uroliths in cats fed the treatment diet was associated with concomitant remission of dysuria, hematuria, and pyuria, and reduction in urine pH and struvite crystalluria. In one case, a urocystolith composed of 100% ammonium urate, and in another case, a urolith composed of 60% calcium phosphate, 20% calcium oxalate, and 20% magnesium ammonium phosphate did not dissolve.

Epidemiological study of urinary tract stones in a northern Italian city.

An epidemiological study of stone disease in a Northern Italian city was carried out by means of a postal questionnaire mailed to 6000 individuals (2.5% of the entire population). It was found that the incidence of stone disease was comparable to that of industrialised Western Europe. There was a relationship between stone disease and gout and stone disease and a positive family history. The frequency of uric acid stones was high (26.5%). Stone-formers showed no alimentary differences from non-stone formers apart from the use of spices and herbs. Stone-formers used less water from public aqueducts and more uncarbonated mineral water, but only 19% of these drank at least 2 litres a day.

Analysis of urinary calculi by infrared spectroscopy.

In the past 4 years, we used infrared spectroscopy to analyze 728 urinary calculi. The most common component of pure urinary calculi was calcium oxalate (whewellite and weddellite) 8.65%, followed by calcium phosphate (carbonate apatite, brushite and amorphous calcium phosphate) 6.87%, uric acid 5.91% and struvite 2.75%. The majority of urinary calculi had mixed components: whewellite/apatite 28.98%, weddellite/apatite 24.31% and whewellite/weddellite/apatite 14.42%. Only 3 cystine stones were found (0.41%). Good correspondence (82.7%) was noted when the results of 110 urinary calculi analyzed by infrared spectroscopy were compared with the results of polarization microscopy. The advantages and disadvantages of infrared spectroscopy are also discussed.

[Clinical study on recurrence of urinary tract lithiasis of ESWL].

During the 4 year period from September 1, 1984 through August 31, 1988, a total of 1,866 patients with calculi of the urinary tract (125 patients had bilateral calculi) were subjected to extracorporeal shock wave lithotripsy (ESWL) with a DORNIER HM3 ESWL apparatus. Follow-up was performed factor 1,056 cases 3 or more months after complete elimination of the calculi, and data were obtained for 343 of them. Lithiasis was found to have recurred after ESWL in 30 cases, with a recurrence rate of 11.1%. Recurrence was seen in 16.9% of cases with multiple calculi and 6.5% of cases with a single calculus. The difference was statistically significant. Surgical removed of calculi or spontaneous discharge of calculi had been experienced in 50.0% of the recurrent cases and 27.8% of the non recurrent cases. The difference was also statistically significant. Stone size, stone location and urinary tract infection were unrelated to the recurrence.

Metabolic evaluation of urolithiasis.

The relatively simple scheme described here should become part of the urologist's stone evaluation plan. It allows for the rapid identification of the metabolic disorders and the prompt implementation of appropriate therapy. With a stone remission rate of 70 to 90 per cent and a reduction in the stone formation rate of 88 to 100 per cent, an overwhelming incentive exists to master this evaluation scheme.

Alkali citrate for preventing recurrence of calcium oxalate stones.

The use of alkali citrates for preventing the recurrence of calcium oxalate stones was investigated in two trials. In trial I, alkali citrates were given continuously for 18 months to 8 patients who had shown a tendency to recurrent stone formation. In trial II, 12 similar patients were given intermittent therapy for 12 months. The expected changes in urine chemistry were checked at intervals of 3 months. Recurrent stone formation (2 episodes) was observed in only 1 patient (in trial II) during alkali citrate administration; before therapy this patient had suffered an average of 10 attacks of stone formation annually. In the light of the experience gained in these trials, continuous administration of alkali citrates is recommended; the duration of treatment should be tailored to individual needs, but it should not be prolonged indefinitely. Besides having well-attested effectivity of stone prevention, this mode of therapy carries a relatively low incidence of side effects.

[2,8-dihydroxyadenine lithiasis. 2 new pediatric cases of an unknown metabolic deficit. The use of extracorporal lithotripsy]. / La lithiase 2,8-dihydroxyadéninique. 2 nouvelles observations pédiatriques d'un déficit métabolique méconnu. Apport de la lithotrypsie extra-corporelle.

Inherited adenine phosphoribosyltransferase (APRT) has a recessive transmission. When it is very important, adenine can't be restored into nucleic acids pool and will changed into 2,8-dihydroxyadenine (2,8-DHA) by xanthine oxidase. To date in all countries but Japan, 2,8-DHA urolithiasis is observed only into homozygotic subjects with complete APRT deficiency Commonly, its onset is observed in childhood often dramatically. The authors report two new pediatric cases into new french families. First a 8 years old boy with spontaneous elimination of two lithiasis after right lumbar pain. Secondly an infant (nineteen months) who has presented an acute renal failure with anuria. Bilateral lithiasis included into pyelourectal junctions have been pulled out by bilateral surgical pyelotomy. In each case, lithiasis were radiolucent and diagnosis made by ultrasonography. The uric acid metabolism was normal and it is the infra red spectrophotometric study of stones that had recognised the 2,8-DHA component. In the second case, bilateral residual lithiasis have been broken by piezoelectric extra-corporeal lithotripsy with good tolerance and favorable result. The two children received preventive treatment. After 36 and 19 months they have no recurrence. In the literature, the frequency of 2,8-DHA lithiasis is very more low than the theoretical of homozygotics in population (1/100,000). The common confusion with uric lithiasis is one possible explanation. So spectrophotometric study of radiolucent stones was meant to be realised when uric metabolism is not disturbed.(ABSTRACT TRUNCATED AT 250 WORDS)

Epidemiology of urolithiasis in Japan: a chronological and geographical study.

A nationwide survey on urolithiasis in Japan between 1965 through 1987 was carried out, succeeding the previous 1955 and 1966 studies, in an effort to evaluate chronological and geographical changes in urolithiasis among the Japanese people who are relatively racially homogenous and living with similar customs and habits, which have changed dramatically from the old Japanese to westernized modes in a very short period after the Second World War. Incidence of calcium-containing urinary stones in the upper urinary tract has been increasing in Japan since the Second World War with increasing westernization of life-style and industrialization, with the annual incidence of urolithiasis steadily increasing from 53.8/100,000 general population in 1965 to 92.5 in 1985. According to the data, 5.4% of the population may be expected to develop a urinary calculus at least once in their life time. Analysis of 69,949 stones obtained during the years from 1978 to 1987 with infrared analysis showed that 79.4% were calcium oxalate and/or calcium phosphate stones, 7.4% were struvite with or without carbonate apatite, 5.2% were uric acid or urate, and 1.0% were cystine. In the era of new treatment modalities such as the endourological surgery and the extracorporeal shock wave lithotripsy, open surgical treatments were replaced with new types of treatment in about 75% of the cases in 1985.

Childhood urolithiasis in Iran with special reference to staghorn calculi.

Between 1972 and 1984 148 children with urolithiasis were studied and managed at the University Clinic Children's Hospital of Teheran. In 125 children the calculi were in the upper and in 23 children in the lower urinary tract. The maximum incidence was between the ages of 5-8 and 12 years. 25 children had malformations and 16 had metabolic disorders. Cystinuria was observed in 6 and xanthinuria in 3 cases. The main constituents of calculi analyses in the upper urinary tract were calcium oxalate followed by ammonium acid urate. In the lower urinary tract ammonium acid urate and oxalate were seen with equal frequency, followed by uric acid. 16 children had staghorn calculi with an age profile of 5-13 years. Predominant symptoms were flank pain and gross hematuria. In 4 cases the calculi were bilateral. The calculi were removed successfully by pyelotomy and extensive pyelolithotomy. In 2 cases with more branched-out staghorn calculi and separate fragments, a logitudinal extensive nephrotomy was performed. In the absence of recurrent stones, renal growth and function were satisfactory postoperatively. In the majority of the cases the analyses of the staghorn calculi revealed phosphate.

[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.

Urolithiasis in Saudi Arabia.

In a retrospective study, 760 Saudi patients with urolithiasis were epidemiologically and metabolically studied (41% were from the Central region, 32% South, 14% West, 9% North, and 1% East; the remaining 3% were Saudi but of unknown region). The male to female ratio was 5:1; 87 percent of the patients were aged thirty to sixty years and 11 patients were under age fourteen. There was no clear relation of stone formation to occupation. Sixty-nine percent of calculi were renal, 29 percent ureteric, and only 3 percent were bladder calculi. Two hundred seventy-eight operative procedures were done (36.5% of all patients), including pyelolithotomy, nephrolithotomy, ureterolithotomy, ESWL, cystolithotomy, and extractions by basket. Infection was a rarity (6%) and urinary schistosomiasis was found in 33 patients (4.3%), 24 of whom were from a schistosoma-infested region. Raised serum calcium was found in only 5.7 percent and raised serum urate in 13 percent. Increased urinary excretion of urate was found in 60 percent and hypercalciuria in 9 percent. Seventy-six percent of stones analyzed (239) were calcium oxalate, 20.5 percent urate, and 3.3 percent phosphate.

Iron, copper, cadmium, zinc and magnesium contents of urinary tract stones and hair from men with stone disease.

Forty-seven urinary tract stones consisting of 5 pure magnesium ammonium phosphate (subgroup 1), 5 mixed calcium oxalate-magnesium ammonium phosphate (subgroup 2), 8 mixed calcium oxalate-calcium phosphate (subgroup 3), 6 mixed calcium oxalate-uric acid (subgroup 4) and 23 pure calcium oxalate stones (subgroup 5) and hair from these patients and control subjects were analyzed for iron, copper, cadmium, zinc and magnesium content by atomic absorption spectroscopy. Mean values +/- SD for each group were determined and statistical correlations were made to establish differences among the stone elements themselves, the hair elements themselves, and the stone and hair elements for group 5 (calcium oxalate stone group). We found significant differences among the element levels of the stones, patient hair and control hair. In particular, hair magnesium and cadmium levels of control and patient groups appear to have promising features for future work concerning urinary tract stone disease.