Comparison of the bone mineral density status of patients with kidney stones stratified by stone composition.

PURPOSE: Bone loss has been found to occur frequently in patients with particular metabolic disorders that are likely associated with certain kidney stone composition. Thus, we compared the bone mineral density (BMD) of patients with different kidney stone compositions. PATIENTS AND METHODS: A total of 204 consecutive patients who exhibited stone formation with calcium oxalate (CaOx), calcium phosphate (CaP), uric acid (UA), and magnesium ammonium phosphate (MAP) underwent 24 h urine test and BMD measurement. BMD was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). The Z-score was used to express BMD. A BMD Z-score ≤ - 2 was defined as a diagnostic threshold for bone loss. RESULTS: Amongst the patients, 38 had an LS BMD Z-score of ≤ - 2, but only 2 had FN BMD Z-score of ≤ - 2. The group with an LS BMD Z-score of ≤ - 2 exhibited significantly larger male - female ratio, higher frequency of hypercalciuria and CaP, and lower frequency of MAP than the group with an LS BMD Z-score of > - 2. Reduced LS BMD was most remarkable in the CaP group, followed by the CaOx, UA, and MAP groups. The LS BMD Z-score of hypercalciuric patients was significantly lower than that of normocalciuric patients only in the CaP group. CONCLUSION: Patients with different kidney stone compositions presented different BMD status. Using this information may facilitate medical decision-making in patients with kidney stone who should undergone BMD earlier.

Is Toxoplasma gondii infection a concern in individuals with rheumatic diseases? Evidence from a case-control study based on serological diagnosis.

Toxoplasma gondii infection in clinical cases of rheumatic diseases is increasing, whereas, the relationship between T. gondii infection and rheumatic diseases is still ambiguous and contradictory. Thus, the present case-control study based on serological diagnosis was carried out to identify the underlying relationship between T. gondii infection and rheumatic diseases in China. Serological results showed that rheumatic patients (17.25%, 79/458) had a significantly higher T. gondii seroprevalence than control subjects (10.70%, 49/458) (p = 0.004). However, the difference in T. gondii seroprevalence among clinical rheumatic disease forms was insignificant. Moreover, disease duration not effect the T. gondii seroprevalence in the included clinical rheumatic patients. Three risk factors (presence of cats at home, blood transfusion history, and consumption of raw shellfish) were identified through multivariate analysis to affect the T. gondii seroprevalence in the included clinical rheumatic patients. In conclusion, these results indicate that the latent T. gondii infection in clinical rheumatic patients should cause alarm and attention in the course of future scientific research or clinical treatment.

Hattie and Sammler: Saul Bellow's older woman and older man.

Hattie in Saul Bellow's "Leaving the Yellow House" and Sammler in Bellow's Mr. Sammler's Planet are both elderly characters. This article intends to compare the two characters from a gender perspective, to illustrate how these characters appear to experience and respond to old age and how other characters in these two fictions respond to the old age of their respective elderly characters. The comparison of these two characters in the fiction of Saul Bellow gives rise to the observation that old age is not merely a phase of negative changes but also of positive ones; ageism claims victims among both men and women whose suffering is aggravated by other kinds of injustice, such as racism and sexism.

Comparison of renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China.

PURPOSE: To compare renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China. METHODS: Between 2008 and 2011, thirty cystine stone patients were involved in our study, and an equal number of age- and gender pair-matched patients with calcium oxalate stones. Non-stone forming individuals were elected as controls. The evaluation included blood chemistry studies and 24-h urine collection in both groups of patients. RESULTS: The cystine stone patients had higher mean values of serum blood urea nitrogen, urate and creatinine levels than patients in other two groups. With respect to urine risk factors, cystine stone patients had higher urinary citrate and lower urinary oxalate and creatinine than calcium oxalate stone patients. When compared to non-stone forming individuals, cystine stone patients had higher urinary urate excretion and lower urinary creatinine excretion. Metabolic abnormalities could be demonstrated in 80 % of the cystine stone patients and in 100 % of the calcium oxalate stone patients. We also compared urine risk factors among cystine stone patients with different urine cystine excretion (<1 mmol/24 h, 1-2 mmol/24 h and >2 mmol/24 h). No significant difference was found in urine risk factors among three groups. CONCLUSIONS: This study suggested that cystine stone patients were at greater risk for the loss of renal function than calcium oxalate stone patients, but the risk of the formation of calcium oxalate stones was lower. Our results also indicated that urinary cystine had little or no impact on the excretion of urine chemistries in cystine stone patients.

Could infrared spectroscopy identify melamine-related stone using melamine-contained mixture as a reference?

BACKGROUND: Recently, a method of infrared spectroscopy analysis to identify melamine-contained stone was established by examining melamine powders mixed with true urinary stones. However, several studies demonstrated melamine could be interacted with cyanuric acid or uric acid in water through hydrogen bonds. It presents a hypothesis that the infrared spectrum of melamine-contained stone formed in urine is probably different from melamine-contained dry mixtures. This study is to testify is it true. METHODS: The melamine-related mixtures were, respectively, prepared by mixing powders of melamine with cyanuric acid or uric acid in equimolar ratio. The melamine-related precipitates mimicking its related stone formation were, respectively, prepared by mixing melamine with cyanuric acid or uric acid in water at the given conditions. Subsequently, the melamine-related mixtures and precipitates were analyzed by infrared spectroscopy. RESULTS: The wave-number positions of powder mixtures of melamine-cyanuric acid and melamine-uric acid were a combination of these of their individual ingredients. The typical wave-number positions of melamine were showed in two melamine-contained mixtures. In contrast, these positions were disappeared or shifted greatly in the two melamine-related precipitates. In total, the spectrum of precipitates of melamine with cyanuric acid and uric acid had significantly differences with their powder mixtures. CONCLUSIONS: Our results indicate the identification of melamine-related stone by infrared spectroscopy could not use the infrared spectrum of melamine-contained mixtures as a reference.

Comparison of efficacy and safety of shockwave lithotripsy for upper urinary tract stones of different locations in children: a study of 311 cases.

PURPOSE: To compare the efficacy and safety of Shockwave lithotripsy (SWL) for upper urinary tract stones of various locations in children. METHODS: Between 1997 and 2008, a total of 311 children (average age: 7.9 ± 4.4 years, ranged from 6 months to 16 years) with upper urinary tract stones were treated by SWL using Dornier Compact S lithotripter at our department. Of those patients, 196 had renal stones (pelvic, 53; upper and mid calices, 75; lower calices, 68) with an average size of 9.42 ± 7.1 mm, and 115 had ureteral stones (proximal, 53; mid, 16; distal, 46) with an average size of 7.38 ± 5.87 mm. RESULTS: Overall stone-free rates of renal stones and ureteral stones at 3 months were 95.8% and 94.8% with 83.5% and 79.5% of efficacy quotient (EQ), respectively. In renal stone groups, the EQ for renal pelvic stones was 89.2%, for middle and upper calyx stones was 92.5%, which was higher than 71.9% for lower calices stones. In ureteral stone groups, the 82.3% of EQ for proximal ureteral stones and 83.0% for distal ureteral stones were higher than 63.6% for middle ureteral stones. Patients with larger stones had significant higher re-treatment rate (P < 0.05) and lower EQ than small stone groups. No serious side effect happened in the study. CONCLUSIONS: SWL for both renal stones and ureteral stones in pediatric group have comparable efficacy and safety, except that stones in lower calices and middle ureters have lower EQ than those in other locations.

Infrared spectroscopic analysis of 5,248 urinary stones from Chinese patients presenting with the first stone episode.

A series of 5,248 urinary stones was analyzed by Fourier transform infrared spectroscopy between 1999 and 2008. This study evaluated the percentage of each stone type and the association with sex and age in Chinese stone formers presenting with the first stone episode. The overall sex ratio (male:female) was 2.34:1. Results showed that the preponderant type of stone was calcium oxalate, followed by carbapatite, anhydrous uric acid, struvite and cystine. Struvite stones in this study accounted for a relatively low rate compared to that reported by others. Of 5,248 stones, only 38.1% had one component, 42.5% consisted of two components, and 20.4% consisted of three components. Our results also showed the higher percentage of carbapatite stones in females than in males and the increment of anhydrous uric acid stones with age. In addition, the percentage of calcium oxalate stones decreased with increase in the percentage of carbapatite stones over the period.

Greater and lesser ischiadic foramina as path of shock wave lithotripsy for distal ureteral stone in children.

PURPOSE: We evaluated the efficacy and safety of shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as a path of shock wave to treat distal ureteral stones in young children. MATERIALS AND METHODS: We treated 22 young children with distal urinary calculi using the Dornier Compact S lithotriptor between 1997 and 2007. The study population consisted of 15 boys and 7 girls 6 months to 7 years old (mean +/- SD 5.4 +/- 2.1 years). Stone size ranged from 5 to 16 mm (mean 6.8). All patients were treated in the supine position under dissociative anesthesia with ketamine. The focused shock wave targeted the stone in the distal ureter through the greater and lesser ischiadic foramina. RESULTS: Number of shocks ranged from 600 to 3,000 (mean +/- SD 2,346.2 +/- 483.7). Energy per pulse ranged from level 4 to 5 (mean 4.5). Treatment time varied from 20 to 40 minutes (mean 31). Stone-free rate at 2 weeks after lithotripsy was 77.3%, which increased to 100% at 3 months after a single lithotripsy session. No serious side effects were observed. CONCLUSIONS: Shock wave lithotripsy in the supine position through the greater and lesser ischiadic foramina as the path of shock wave treats distal ureteral stones in young children with an excellent success rate and few side effects.

Using thermal energy produced by irradiation of Mn-Zn ferrite magnetic nanoparticles (MZF-NPs) for heat-inducible gene expression.

One of the main advantages of gene therapy over traditional therapy is the potential to target the expression of therapeutic genes in desired cells or tissues. To achieve targeted gene expression, we developed a novel heat-inducible gene expression system in which thermal energy generated by Mn-Zn ferrite magnetic nanoparticles (MZF-NPs) under an alternating magnetic field (AMF) was used to activate gene expression. MZF-NPs, obtained by co-precipitation method, were firstly surface modified with cation poly(ethylenimine) (PEI). Then thermodynamic test of various doses of MZF-NPs was preformed in vivo and in vitro. PEI-MZF-NPs showed good DNA binding ability and high transfection efficiency. In AMF, they could rise to a steady temperature. To analyze the heat-induced gene expression under an AMF, we combined P1730OR vector transfection with hyperthermia produced by irradiation of MZF-NPs. By using LacZ gene as a reporter gene and Hsp70 as a promoter, it was demonstrated that expression of a heterogeneous gene could be elevated to 10 to 500-fold over background by moderate hyperthermia (added 12.24 or 25.81 mg MZF-NPs to growth medium) in tissue cultured cells. When injected with 2.6 or 4.6 mg MZF-NPs, the temperature of tumor-bearing nude mice could rise to 39.5 or 42.8 degrees C, respectively, and the beta-gal concentration could increase up to 3.8 or 8.1 mU/mg proteins accordingly 1 day after hyperthermia treatment. Our results therefore supported hyperthermia produced by irradiation of MZF-NPs under an AMF as a feasible approach for targeted heat-induced gene expression. This novel system made use of the relative low Curie point of MZF-NPs to control the in vivo hyperthermia temperature and therefore acquired safe and effective heat-inducible transgene expression.

Current opinions on nephrolithiasis associated with primary hyperparathyroidism.

Nephrolithiasis is a common urological disease and could be secondary to primary hyperparathyroidism (PHPT). PHPT is traditionally characterised with hypercalcaemia. Recently, a normocalcemic PHPT has been officially recognised at the International Workshops. Regarding this new phenotype, nephrolithiasis is frequently found in studies that evaluate low bone mass. However, until now, no study on aetiology of nephrolithiasis considered normocalcemic PHPT. Hypercalciuria related to PHPT is considered as an important risk factor of stone formation in hypercalcemic PHPT, but the precise relationships between hypercalcemic PHPT and nephrolithiasis and between normocalcemic PHPT and nephrolithiasis remain unclear. In patients with hypercalcemic PHPT, after a surgical cure of PHPT, the renal calcium excretion and stone recurrence rate reduce but remain higher above health controls. This finding implies that abnormalities not caused by PHPT also probably affect stone formation. According to the new guideline, the presence of stones indicates the need for parathyroidectomy in patients with either hypercalcemic or normocalcemic PHPT unless contraindications exist. Patients with contraindications for parathyroidectomy or those who do not want to receive parathyroidectomy should be monitored for signs of disease progression and given of medical management. Moreover, due to decreased but significantly higher frequency of nephrolithiasis above those of healthy controls, patients with nephrolithiasis associated with PHPT after parathyroidectomy still should be motivated to explore strategies to prevent stone occurrence.

Clinical and genetic characterization of Chinese pediatric cystine stone patients.

INTRODUCTION: Cystine stone is the only clinical manifestation in patients with cystinuria, which is an autosomal recessive inheritable disease. However, clinical and genetic data vary among patients in different countries. OBJECTIVE: To investigate the characteristics of Chinese pediatric cystine stone patients. PATIENTS AND METHODS: Thirteen pediatric patients with cystine stones were evaluated in our clinic between 2012 and 2015. Gene mutations in SLC3A1 and SLC7A9 were investigated. Metabolic evaluation was also performed. Thirteen pediatric patients with calcium oxalate stones were selected as controls. RESULTS: Of these patients, eight were males and five were females. Average age at detection of the first stone was 6.8 ± 5.2 years. Urinary stones in three of the 13 cystine patients were composed of cystine and calcium oxalate. The 63.6% of patients with upper urinary stones had bilateral stones. A total of 17 different missense mutations were identified, and 12 of these mutations were first reported in this study. Metabolic abnormalities could be detected in 77% of cystine stone patients. The most common metabolic abnormality was hyperoxaluria, followed by hypercalciuria and hypocitraturia. Compared with calcium stone patients, our cystine stone patients had a higher rate of bilateral stones, larger stone size, higher levels of serum BUN and Cr, urine citrate excretion (Table), and higher mean value of surgeries per patient. By contrast, the opposite was true for urine oxalate excretion and AP (CaOx) index EQ. The urine excretion of cystine was not correlated with other urinary constituents. DISCUSSION: Patients with cystinuria frequently suffer recurrent renal stones and may subsequently need a series of stone removal procedures during their lifetime. This condition is likely to affect their overall renal function. SLC3A1 and SLC7A9 have been extensively investigated, but a detection rate of 100% in cystinuric patients has yet to be obtained. In our study, we found 14 missense mutations in 18 of 26 alleles except four mutation polymorphisms. Most of the gene mutations found in our study were their first reports. Metabolic abnormalities were frequently found in cystine stone patients, but their risk of calcium oxalate stone formation was relatively lower than that of patients with calcium oxalate stones. CONCLUSIONS: Cystine stone patients are at risk of impaired renal function and the formation of calcium oxalate stones. Most of the gene mutations identified in our patients were first reported in this study. Therefore, cystinuria possibly exhibits genetic and allelic heterogeneity in Chinese pediatric cystine stone patients.

Characterizing ceftriaxone-induced urolithiasis and its associated acute kidney injury: an animal study and Chinese clinical systematic review.

OBJECTIVE: To investigate the pathophysiological process of ceftriaxone-induced urolithiasis and its associated acute kidney injury (AKI) based on an animal study and summarize the main clinical characteristics based on a Chinese clinical systematic review. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomly divided into five groups of six each according to different treatments including control; ceftriaxone; ceftriaxone with calcium; calcium; and ceftriaxone, calcium with citrate, respectively. The 24-h urine volume, serum creatinine (Scr) and blood urea nitrogen (BUN) were measured; kidney histological examination and stone analysis were performed. Systematic searches of the Chinese Knowledge Database were conducted for reports on ceftriaxone-induced urolithiasis and AKI. The eligibility of each full-text publication was accessed, and qualified data were extracted and reviewed. RESULTS: Kidney stones and a significantly low 24-h urine volume with increased high Scr and BUN levels were found in the group that received ceftriaxone combined with calcium. Citrate was able to inhibit these biochemical changes and stone formations. A total of 161 qualified patients were included in the Chinese clinical systematic review: The proportion of ceftriaxone-induced urolithiasis was 21.1, 19.3, 19.3, 39.1 and 1.2 % for ages <3, 3-6, 7-17, 18-60 and >60 years. 72.7 % developed acute kidney injury eventually. CONCLUSION: Ceftriaxone-induced urolithiasis was associated with a high risk of AKI. The pathophysiological process may be related to urinary obstruction and crystalline nephropathy. Citrate was able to inhibit stone formation and prevent further kidney injury.

The true stone composition and abnormality of urinary metabolic lithogenic factors of rats fed diets containing melamine.

To better understand the toxicity of melamine to humans, the stone composition and urinary metabolic lithogenic factors of rats fed diets containing melamine including the infant's melamine-induced stone composition were studied. Sixty 4-week-old male rats divided into three groups were, respectively, fed diets containing no melamine (control), 0.1% melamine, and 1% melamine for 4 weeks. At the end of experiment, the collected stones and 24-h urines from rats were, respectively, measured with compositions and metabolic lithogenic parameters. The stone from an infant who ingested melamine-adulterated formula was also included in compositional analysis. Across three groups, the stone was only detected in 1% melamine group, with composition of almost melamine different from the affected infant's stone composed of melamine and uric acid with a ratio of 1:2. Compared with control group, urine calcium and phosphate excretions were significantly increased in 1% melamine group. Urine uric acid excretion was significantly increased but citrate excretion was significantly decreased in 0.1% and 1% melamine groups. Urine oxalate excretion and pH were indicated without any significant difference. In addition based on urine physicochemical characters, melamine-uric acid stone seems difficult to be formed in the rats due to their characters of urine high-pH and low-uric acid. These results demonstrated that (1) the stone composition of rats fed melamine was not and could not be as that of infants fed melamine-adulterated formula, two species had a different mechanism of melamine-induced stone formation; (2) the exposure of melamine could result in abnormalities of urine metabolic lithogenic factors to rats, perhaps as well as human beings.

Possible function of urinary pH and citrate on the ceftriaxone-induced nephrolithiasis.

OBJECTIVE: To test whether urinary pH and citrate is associated with ceftriaxone-induced kidney stone formation and if acidified urine could dissolve this kind of stone using an in vitro crystallization model. METHODS: Crystallization was induced by mixing ceftriaxone at the standard therapeutic urinary concentration to artificial urine. The response of different physiological pH and citrate on ceftriaxone-induced crystallization was measured by the depletion ratio of ceftriaxone in the process. Compositions of formed crystals were qualitatively and quantitatively analyzed. The effect of acidifying urine on dissolving of ceftriaxone-induced crystal was determined by the surplus ratio of ceftriaxone in the process. RESULTS: Compositional analysis showed that ceftriaxone-induced crystals were composed of calcium and ceftriaxone with a ratio of 1:1. Compared to the response to pH 6.0, ceftriaxone-induced crystallizations in artificial urine at pH 4.5 and 5.0 for 4 hours were significantly decreased, and more acid urine resulted in less crystallization. However, it made no significant change when pH increased to 6.5 and 7.0. In addition, ceftriaxone-induced crystals formed at pH 6.0 for 4 hours could be dissolved significantly when artificial urine was acidified to pH 5.0 and 4.5 for 1, 2, and 4 hours; and more time of dissolution and more degree of acidifying resulted in more dissolution. CONCLUSION: Our study suggests that urinary pH and citrate are probable factors associated with ceftriaxone-induced nephrolithiasis. On one hand, alkaline urine and hypocitraturia predispose ceftriaxone nephrolithiasis, and vice versa. On the other hand, acidifying urine could dissolve ceftriaxone-induced stones.

Comparison of efficacy of German and Chinese electromagnetic shock wave lithotripters: Dornier Compact S vs Huikang MZ-SWL-V.

OBJECTIVES: To compare the treatment efficacy of Dornier Compact S and a Chinese electromagnetic shock wave lithotripter (Huikang MZ-SWL-V) in a large series. METHODS: We retrospectively reviewed the outcome of shock wave lithotripsy (SWL) in 13,954 consecutive patients with upper urinary tract stones from December 1996 to December 2008 with Dornier Compact S (9124 cases) and Huikang MZ-SWL-V (4830 cases). An intramuscular injection of 50 mg pethidine was given to the patients with Dornier Compact S but not to those with Huikang MZ-SWL-V. Treatment outcomes were assessed by the stone-free rate at three months, the retreatment rate, the auxiliary procedure rate, and the effectiveness quotient. The pain scores were evaluated by visual analog scales, where 0 = pain and 10 = unbearable pain. RESULTS: The overall stone-free rate at 3 months, retreatment rate, and ancillary procedure rate for Dornier Compact S were 95.9%, 13.4%, and 2.2%, respectively, and they were 85%, 29.6%, and 10.2%, respectively, for Huikang MZ-SWL-V. The overall efficiency quotients of Dornier Compact S and Huikang MZ-SWL-V were 83% and 60.8%, respectively. However, the pain scores in the Dornier group (6-10) were higher than those in the Huikang group (1-5). Three clinically significant subcapsular hematomas were detected in the Dornier group but there were none in the Huikang group. CONCLUSIONS: Dornier Compact S is more effective than Huikang MZ-SWL-V, but SWL with Huikang machine could be performed with milder pain and without analgesia, and a lower significant hematoma rate was observed in Huikang group.

Infrared spectroscopic analysis of urinary stones (including stones induced by melamine-contaminated milk powder) in 189 Chinese children.

AIM: The aim of the study was to investigate the composition of the stones in Chinese children with urolithiasis, including peculiar stones induced by melamine-contaminated milk powder. MATERIALS AND METHODS: Between 1999 and 2009, 189 urinary stones from children of East China were received at our institution. Among them, 12 stones were received from pediatric stone formers with a history of consuming melamine-contaminated milk powder in 2008; and the remaining stones were defined as "natural" stones. All stones were analyzed by Fourier transform infrared spectroscopy. RESULTS: Among 177 "natural" stones, whewellite stone (49.72%) was observed most frequently followed by weddellite stone (15.25%), uric acid anhydrous stone (9.6%), carbapatite stone (9.04%), cystine stone (9.04%), ammonium acid urate stone (4.52%), struvite stone (2.26%), and sodium urate stone (0.56%). Twelve young children who consumed melamine-contaminated milk powder were younger than 3 years, and their stones were composed of a mixture of uric acid dihydrate and ammonium acid urate based on Fourier transform infrared spectroscopy. In addition, the stones were radiolucent and could be dissolved by urine alkalinization. CONCLUSIONS: Our study emphasizes the relatively high rate of calcium oxalate stones and cystine stones, and the relatively low rate of struvite stones in Chinese children with urolithiasis. The stones caused by melamine-contaminated milk powder are composed of the mixture of uric acid dihydrate and ammonium acid urate.