The Possible Beneficial Effect of Breastfeeding on the Clinical Course of Urolithiasis Detected During Infancy.

Aim: To evaluate the possible effect of breastfeeding duration on the clinical course and treatment of stones detected during infancy. Materials and Methods: Forty-eight infants with renal stones diagnosed between 0 and 23 months were included in this retrospective cohort study. The children were called for regular follow-up visits for the evaluation of physical examination findings, renal size and parenchymal thickness measured by ultrasonography, localization, size and number of stones, spot urine analysis data, metabolic evaluation findings, and duration of breastfeeding and formula use. The relationship between the disease course (progression or stability) and the duration of breastfeeding were assessed from different aspects by considering the original characteristics of the stones at the time of first diagnosis. Results: The mean follow-up period was 46.21 ± 23.22 months, and the most important metabolic risk factor was hypercalciuria with a rate of 29.2%. The mean duration of breast milk intake was longer in children with no disease progression and in those with a reduced size and/or number of stones. The children receiving only breast milk for the first 6 months of life required treatment less and had less growth retardation. Conclusions: Our findings suggest that breastfeeding has critical effects on infantile urolithiasis. Breastfeeding should be encouraged in children with stones particularly detected during infancy. Further studies with a larger case series are needed to reveal the positive effects of breast milk on the clinical course of urolithiasis in children.

Evaluation of a dry therapeutic urinary diet and concurrent administration of antimicrobials for struvite cystolith dissolution in dogs.

BACKGROUND: Struvite urolithiasis with bacterial urinary tract infection (UTI) is commonly reported in dogs; few data exist to describe successful dissolution protocols in dogs with naturally occurring disease. We hypothesized that a dry therapeutic urinary diet combined with targeted antimicrobial therapy can effectively dissolve presumptive struvite cystolithiasis in dogs with naturally occurring urease-producing bacterial UTI. RESULTS: Ten dogs with presumed infection-induced struvite cystolithiasis based on lower urinary tract signs (LUTS), radiodense cystoliths, and urease-producing bacterial UTI were enrolled. At enrollment, antimicrobials and dry therapeutic urinary diet were dispensed. In addition to lack of radiographic resolution of urolithiasis, dogs with persistent clinical signs were considered non-responders. There was no significant difference in pH between responders and non-responders; USG was significantly higher in the responder group. Recheck visits continued until radiographic dissolution or failure was documented. Five of the 10 dogs achieved radiographic dissolution of cystolithiasis within a median of 31 days (range 19-103). In the other 5 dogs, surgical urolith removal was necessary due to persistent LUTS (3 dogs within 2 weeks) or lack of continued dissolution noted radiographically (1 dog with numerous cystoliths failed at day 91; 1 dog failed by day 57 with questionable owner compliance). CONCLUSIONS: Dissolution of urinary tract infection induced struvite cystoliths can be accomplished in some dogs fed this dry therapeutic urinary diet in conjunction with antimicrobial therapy. Case selection could increase the likelihood of successful dissolution; however, if calcium phosphate is present, this could also prevent stone dissolution. If clinical signs persist despite diet and antimicrobials, stone removal is advised.

Nutritional Management of Urolithiasis.

Dietary management of urolithiasis in dogs and cats is designed to dissolve calculi when possible and/or reduce the risk of recurrence. The diet must reduce urine relative supersaturation for the particular salt in order to prevent crystallization. To decrease urinary concentrations of crystal precursors, increasing water intake is essential regardless of the stone type. Altering the amounts of dietary precursors of the stone and controlling urine pH is mostly effective for struvite, urate, xanthine, and cystine, but still subject to controversy for calcium oxalate. The investigation of underlying metabolic disorders and close monitoring of animals at risk is recommended.

Diet and stone formation: a brief review of the literature.

PURPOSE OF REVIEW: Urolithiasis is a very common condition, which can be accompanied by serious complications. Diagnosis, treatment, and prevention are of great cost for national health systems. Many studies have been published about the role of diet in both stone formation and prevention. The aim of this review is to summarize the most recent developments that correlate diet to lithiasis. RECENT FINDINGS: Recurrent stone formers should undergo metabolic evaluation and stone chemical analysis. Current evidence propose difference approaches based on the metabolic disorder that is diagnosed. Diet could have a detrimental role in the prevention of recurrences. Prevention advises include increased fluid uptake, vegetables and fruit intake but decreased sugar, salt, and meat consumption. SUMMARY: The analysis of the food contents and their role to lithogenesis prevention are of great importance. Modifying diet to prevent stones could help many people who suffer from lithiasis to avoid recurrence and the consequences. Furthermore, the cost for diagnosis and treatment could be significantly reduced. Therefore, the field of dietary factors in lithogenesis should be further investigated.

[Unusual case of struvite urolithiasis in a dog. A case report]. / Ungewöhnlicher Fall von Struvit-Urolithiasis bei einem Hund. Ein Fallbericht.

A dog was referred for nutrition consultation after surgical removal of struvite uroliths from the bladder. Inspection of the dog's current ration revealed a pronounced vitamin-A deficiency together with a marked deficiency of protein, phosphorus and magnesium. Therefore, a supersaturation of the urine with ammonium, magnesium and phosphate, the three constituents of struvite, as a cause of struvite calculi formation appears rather unlikely. Vitamin-A deficiency can promote urinary infections and consequently struvite stone formation because of the lack of the protective effect of vitamin A on the epithelia of the urinary tract. Not only common causes for struvite urolith formation, including urinary supersaturation with stone-forming constituents and urinary tract infection, but also less common causes, including vitamin-A deficiency, which was the presumed trigger in the present case study, have to be taken into consideration. Dietetic measures appear to be a useful tool in such cases to prevent uroliths from reoccurring.

[Diet in the lithiasic patient: A practical guide.] / La dieta en el paciente litiásico:una guía práctica.

The incidence and prevalence of lithiasic disease in developed countries has increased over the last years. Being diet one of the risk factors for urolithiasis, and having it evolved in conjunction with lifestyle over the last decades, such changes could explain the increase in lithiasis case-load. In this article, we analyze how the exercise of the urologist has been regarding the preventive role of diet in the lithiasis patient, what are the scientific evidences on the relationship of diet and lithiasis, and, on this base, what general dietetic recommendations we can give currently to our patients.

Evaluation of dogs with genetic hyperuricosuria and urate urolithiasis consuming a purine restricted diet: a pilot study.

BACKGROUND: Urate urolithiasis is a common problem in breed homozygous for the mutation that results in hyperuricosuria. Low purine diets have been recommended to reduce purine intake in these dogs. METHODS: A higher protein, purine restricted diet with water added was evaluated in dogs with genetic hyperuricosuria and a history of clinical urate urolithiasis over a one year time period. Dogs were evaluated at baseline and 2, 6, and 12 months after initiating the test diet. Bloodwork, urinalysis, abdominal ultrasound, body composition, and 24-h urinary purine metabolite analyses were performed. RESULTS: Transient, mild, self-limited lower urinary tract signs were noted in only one dog on a single day, despite variable but usually mild and occasionally moderate amounts of echogenic bladder stones (<2-3 mm in size) in almost every dog at each visit. No significant differences were noted in urine specific gravity, urine pH, lean body condition score or body composition. Urinary uric acid concentration was lower on the test diet (p = 0.008), but 24-h uric acid excretions were similar (p = 0.220) compared to baseline. Significant differences between least squares mean plasma amino acid concentrations measured at the 0 and 12-month visits were found only for valine (p = 0.0119) and leucine (p = 0.0017). CONCLUSION: This study suggests the use of a low purine, higher protein diet with added water may be beneficial as part of the management of dogs with genetic hyperuricosuria and history of clinical urate urolithiasis.

[Metaphylaxis of urolithiasis - a neglected field in medicine?]

Urolithiasis is a common condition linked to lifestyle factors and its prevalence is increasing in Europe and United States. Nevertheless, recurrence of urinary stones can be effectively prevented by dietary and life style changes. The review focuses on general dietary recommendations as well as specific medical therapy for kidney stone formers.

Electronic nutritional intake assessment in patients with urolithiasis: A decision impact analysis.

PURPOSE: To evaluate a physician's impression of a urinary stone patient's dietary intake and whether it was dependent on the medium through which the nutritional data were obtained. Furthermore, we sought to determine if using an electronic food frequency questionnaire (FFQ) impacted dietary recommendations for these patients. MATERIALS AND METHODS: Seventy-six patients attended the Stone Clinic over a period of 6 weeks. Seventy-five gave consent for enrollment in our study. Patients completed an office-based interview with a fellowship-trained endourologist, and a FFQ administered on an iPad. The FFQ assessed intake of various dietary components related to stone development, such as oxalate and calcium. The urologists were blinded to the identity of patients' FFQ results. Based on the office-based interview and the FFQ results, the urologists provided separate assessments of the impact of nutrition and hydration on the patient's stone disease (nutrition impact score and hydration impact score, respectively) and treatment recommendations. Multivariate logistic regressions were used to compare pre-FFQ data to post-FFQ data. RESULTS: Higher FFQ scores for sodium (odds ratio [OR], 1.02; p=0.02) and fluids (OR, 1.03, p=0.04) were associated with a higher nutritional impact score. None of the FFQ parameters impacted hydration impact score. A higher FFQ score for oxalate (OR, 1.07; p=0.02) was associated with the addition of at least one treatment recommendation. CONCLUSIONS: Information derived from a FFQ can yield a significant impact on a physician's assessment of stone risks and decision for management of stone disease.

Influence of clinical therapy and nutritional counseling on the recurrence of urolithiasis.

PURPOSE: To evaluate the influence of combined clinical therapy and nutritional guidance on the recurrence of urolithiasis. METHODS: From our registry of patients with recurrent urolithiasis we selected 57 who had at least 5-years of follow-up. We collected 24h urine samples in order to analyze Ca, Na, uric acid, citrate, oxalate, and Mg concentrations and to assess urine volume. Patients filled out a clinical questionnaire before treatment, and abdominal radiographs and/or ultrasound were performed both before treatment and during the follow-up period. During follow-up, specific and individualized dietary advice was given based on the individual's metabolic disorders. Patients also received specific pharmacological treatment for their metabolic alterations. Outcome measures were metabolites in urine and the urolith recurrence rate. Pre- and post- intervention values were compared using tests as appropriate. RESULTS: Fifty six of the patients were male and the majority of patients were overweight. The mean BMI was 27 kg/m(2). Urinary excretion of calcium, uric acid and sodium decreased significantly over the five year follow-up period. The number of uroliths that formed during the 5-year follow-up also decreased significantly compared to pre-treatment values. CONCLUSION: Individualized dietary advice combined with pharmacological treatment significantly reduces long-term urolithiasis recurrence.

Influence of clinical therapy and nutritional counseling on the recurrence of urolithiasis

PURPOSE: To evaluate the influence of combined clinical therapy and nutritional guidance on the recurrence of urolithiasis. METHODS: From our registry of patients with recurrent urolithiasis we selected 57 who had at least 5-years of follow-up. We collected 24h urine samples in order to analyze Ca, Na, uric acid, citrate, oxalate, and Mg concentrations and to assess urine volume. Patients filled out a clinical questionnaire before treatment, and abdominal radiographs and/or ultrasound were performed both before treatment and during the follow-up period. During follow-up, specific and individualized dietary advice was given based on the individual's metabolic disorders. Patients also received specific pharmacological treatment for their metabolic alterations. Outcome measures were metabolites in urine and the urolith recurrence rate. Pre- and post- intervention values were compared using tests as appropriate. RESULTS: Fifty six of the patients were male and the majority of patients were overweight. The mean BMI was 27 kg/m2. Urinary excretion of calcium, uric acid and sodium decreased significantly over the five year follow-up period. The number of uroliths that formed during the 5-year follow-up also decreased significantly compared to pre-treatment values. CONCLUSION: Individualized dietary advice combined with pharmacological treatment significantly reduces long-term urolithiasis recurrence. .

Efficacy of two commercially available, low-magnesium, urine-acidifying dry foods for the dissolution of struvite uroliths in cats.

OBJECTIVE: To compare the efficacy and safety of using 2 commercially available, low-magnesium, urine-acidifying dry foods to dissolve sterile struvite uroliths in cats. DESIGN: Prospective, multicenter, randomized clinical trial . SAMPLE: 37 cats with presumed struvite uroliths. PROCEDURES: Cats were randomly assigned to be fed 1 of 2 low-magnesium, urine-acidifying dry foods (food A or B). For each cat, physical examination, urinalysis, and abdominal radiography were performed weekly to assess treatment response. RESULTS: 32 cats had complete urolith dissolution. Mean ± SD times for a 50% reduction in urolith size (0.69 ± 0.1 weeks) and complete urolith dissolution (13.0 ± 2.6 days) were significantly shorter for cats fed food A, compared with those (1.75 ± 0.27 weeks and 27.0 ± 2.6 days, respectively) for cats fed food B. At study termination, mean ± SD urine pH (6.083 ± 0.105) for cats fed food A was lower than that (6.431 ± 0.109) for cats fed food B. In 5 cats, uroliths did not dissolve and were subsequently determined to be composed of 100% ammonium urate (n = 4) or 100% calcium oxalate (1). Adverse events associated with diet were not observed in any of the cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that dietary dissolution is safe and effective for eradication of sterile struvite uroliths in cats. Cats fed food A had faster urolith dissolution than did cats fed food B. Lack of a reduction in urolith size at 2 weeks after diet initiation was indicative of misdiagnosis or noncompliance.

Nutritional chemoprevention of urinary tract tumors (UTT) induced by lithogenic agents: risk for UTT in children exposed to melamine-contaminated milk formulas.

Urinary tract tumors are tenth in frequency, and many environmental carcinogens are excreted by urine. Interplay between chronic inflammatory urolithiasis and urothelial carcinogenesis is not well understood. Experimental evidences show that dietary melamine induce these events even at low concentrations. This is important because thousands of children were exposed to melamine through intentionally contaminated milk formula worldwide. We propose that an increased risk for urinary tumors in adult life may occur and screenings for early urinary signs may be necessary. Therefore, urothelial biology, melamine carcinogenic potential, and related epidemiology are discussed, recommending a preventive dietary polyunsaturated fatty acid-based supplementation, since they modulate such interplay in rodents.

Effects of a urolith prevention diet on urine compositions of glycosaminoglycans, Tamm-Horsfall glycoprotein, and nephrocalcin in cats with calcium oxalate urolithiasis.

OBJECTIVE: To evaluate urine concentrations of glycosaminoglycans, Tamm-Horsfall glycoprotein, and nephrocalcin in cats fed a diet formulated to prevent calcium oxalate uroliths. ANIMALS: 10 cats with calcium oxalate urolithiasis. PROCEDURES: In a previous study conducted in accordance with a balanced crossover design, cats were sequentially fed 2 diets (the diet each cat was consuming prior to urolith detection and a diet formulated to prevent calcium oxalate uroliths). Each diet was fed for 8 weeks. At the end of each 8-week period, a 72-hour urine sample was collected. Concentrations of glycosaminoglycans, Tamm-Horsfall glycoprotein, and the 4 isoforms of nephrocalcin in urine samples collected during that previous study were measured in the study reported here. RESULTS; Diet had no effect on the quantity of Tamm-Horsfall glycoprotein and nephrocalcin in urine. However, the urine concentration of glycosaminoglycans was significantly higher during consumption of the urolith prevention diet. CONCLUSIONS AND CLINICAL RELEVANCE: Feeding a urolith prevention diet increased the urine concentration of glycosaminoglycans, which are glycoprotein inhibitors of growth and aggregation of calcium oxalate crystals.

Omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid in the management of hypercalciuric stone formers.

OBJECTIVE: To investigate the use of fish oil in the dietary management of hypercalciuric stone formers. Prostaglandins have been linked to urinary calcium excretion, suggesting a role for omega-3 fatty acids in the treatment of hypercalciuric urolithiasis. METHODS: We retrospectively studied a cohort of patients treated at our stone clinics from July 2007 to February 2009. Patients' urinary risk factors for stone disease were evaluated with pre- and post-intervention 24-hour urine collections. All patients received empiric dietary recommendations for intake of fluids, sodium, protein, and citric juices. All subjects with hypercalciuria (urinary calcium>250 mg/d for males or >200 mg/d for females) on at least two 24-hour urine collections were counseled to supplement their diet with fish oil (1200 mg/d). RESULTS: Twenty-nine patients were followed for 9.86±8.96 months. The mean age was 43.38±13.78 years. Urinary calcium levels decreased in 52% of patients, with 24% converting to normocalciuria. The average urinary calcium (mg/d) decreased significantly from baseline (329.27±96.23 to 247.47±84.53, P<.0001). Urinary oxalate excretion decreased in 34% of patients. The average urinary oxalate (mg/d) decreased significantly from baseline (45.40±9.90 to 32.9±8.21, P=.0004). Urinary citrate (mg/d) increased in 62% of subjects from baseline (731.67±279.09 to 940.22±437.54, P=.0005). Calcium oxalate supersaturation decreased in 38% of the subjects significantly from baseline (9.73±4.48 to 3.68±1.76, P=.001). CONCLUSION: Omega-3 fatty acids combined with empiric dietary counseling results in a measurable decrease in urinary calcium and oxalate excretion and an increase in urinary citrate in hypercalciuric stone formers.

Management of struvite uroliths in dogs.

Urolithiasis is a common clinical problem in dogs. Struvite and calcium oxalate are the predominant mineral types in dog urolithiasis. The aim of the present study was to compare the effect of two commercial dry foods formulated for the management of struvite urolithiasis with different anion-cation balance on urinary pH. For the trial, twelve privately owned adult dogs showing struvite urolithiasis were studied. The dogs were randomly divided into two groups (A and B) and fed two dissolving diets for 3 months. The analyses of urine were repeated six times. In both diets, the anion-cation balance was negative ( - 203 and - 192 for diets A and B, respectively). At the first urine analysis, pH values of all the dogs were close to 8.0, and bacteria were present in about 70 % of the samples and thus an antimicrobial was administered for 1 week. Both groups showed a progressive decrease in pH values, and after 2 months, in both cases, the recommended pH values for stone dissolution were achieved. From the sampling at 30 d, group A showed pH values significantly (P < 0.05) lower than group B, probably due to the lower anion-cation balance of diet A. The combination of antimicrobial and dietary therapy allowed the dissolution of struvite uroliths in both groups, even if the utilisation of the diet characterised by the lower anion-cation balance seems to decrease the urinary pH more rapidly. In this case, it seems necessary to interrupt the dietary treatment in order to avoid the risk of other diseases.

Urolitíase por cistina em cães no Brasil / Canine cystine urolithiasis in Brazil

O presente trabalho tem como objetivo relatar três casos de urolitíase canina por cistina, atendidos no Hospital Veterinário da Universidade Estadual de Londrina entre o período de 2007 a 2009. O diagnóstico de urolitíase foi baseado na anamnese, no exame físico e nos exames laboratoriais e radiográficos, e a confirmação do tipo de urólito envolvido foi realizada no Centro de Urólitos de Minnesota-USA, por meio de análise quantitativa, revelando cálculos puros de cistina. A terapia instituída incluiu a remoção cirúrgica dos urólitos e a prevenção de recidivas, por meio do aumento da solubilidade da cistina na urina com dieta comercial própria, aumento da ingestão hídrica e alcalinização medicamentosa da urina.

Three cases of canine cystine urolithiasis were reported at the Veterinary Hospital of Londrina State University in the period from 2007 to 2009. The diagnosis of urolithiasis was based on clinical history, physical examination, laboratory tests and radiographs, and the confirmation of the urolith type was performed at the Minnesota Urolith Center - USA, trough quantitative analysis, showing pure cystine uroliths. The therapy administered in both cases included surgical removal of the uroliths and prevention of recurrence by increasing the solubility of cystine in the urine with a commercial diet, increased fluid intake and alkalinization of the urine.

Results of medical treatment and metabolic risk factors in children with urolithiasis.

Data on conservative treatment in children with urolithiasis are limited. The aim of the study was to determine the metabolic etiology and results of conservative treatment in children with urolithiasis. We evaluated the clinical presentation and metabolic features of 112 children with urolithiasis. The mean age at diagnosis of urolithiasis was 3.9 (range 0.1-18) years, and follow-up duration was 16.7 (range 1-36) months. The most common presenting symptoms were flank or abdominal pain and restlessness (25%). Urine analysis revealed metabolic abnormalities in 92% of cases, including hypocitraturia (42%), hyperoxaluria (32.1%), hypercalcuria (25%), hyperuricosuria (9.8%), and cystinuria (2.7%). Patients who had metabolic risk factors were treated according to underlying metabolic abnormalities. About half of these patients were stone free or stones were diminished in size. These results showed that early recognition and treatment of urinary metabolic abnormalities will reduce the number of invasive procedures and renal damage in children with urolithiasis.

Trends in the medical management of urolithiasis: a comparison of general urologists and endourology specialists.

OBJECTIVES: To determine whether there are differences in the medical and dietary recommendations given to stone formers between urologists that subspecialize in endourology and general urologists. METHODS: A 10 question on-line survey was sent via e-mail to members of the North Central Section (NCS) of the American Urological Association and the Endourological Society (ES). RESULTS: A total of 206 surveys were completed by members of the NCS and 122 surveys were completed by members of the ES. Of the ES members, 75% were in academic practice versus 21% of NCS members (P < .01). Urologists in both groups performed their own medical management (88% ES, 83% NCS) and believed that they were able to provide effective dietary recommendations (73% ES, 72% NCS). Most urologists in both groups performed 24-hour urine and serum studies in recurrent stone formers (68% ES, 73% NCS) as opposed to all stone formers (17% ES, 18% NCS). Members of both groups recommended low salt intake to all stone formers (68% ES, 61% NCS) or only calcium stone formers (18% ES, 29% NCS; P = .03). A higher percentage of urologists from the ES recommended low animal protein intake to all stone formers than urologists from the NCS (69% ES, 47% NCS; P < .05). CONCLUSIONS: Urologists from both the NCS and the ES, despite differences in the type of practice, subspecialty interest in endourology and geographic location of practice, have similar medical and nutritional practices when counseling patients in the prevention of stone disease.