Quality of life and urolithiasis: the patient - reported outcomes measurement information system (PROMIS)

ABSTRACT Background: With a high rate of recurrence, urolithiasis is a chronic disease that impacts quality of life. The Patient Reported Outcomes Measurement Information System is an NIH validated questionnaire to assess patient quality of life. We evaluated the impact of urolithiasis on quality of life using the NIH-sponsored PROMIS-43 questionnaire. Materials and Methods: Patients reporting to the kidney stone clinic were interviewed to collect information on stone history and demographic information and were asked to complete the PROMIS-43 questionnaire. Quality of life scores were analyzed using gender and age matched groups for the general US population. Statistical comparisons were made based on demographic information and patient stone history. Statistical significance was P<0.05. Results: 103 patients completed the survey. 36% of respondents were male, the average age of the group was 52 years old, with 58% primary income earners, and 35% primary caregivers. 7% had never passed a stone or had a procedure while 17% passed 10 or more stones in their lifetime. Overall, pain and physical function were worse in patients with urolithiasis. Primary income earners had better quality of life while primary caregivers and those with other chronic medical conditions were worse. Patients on dietary and medical therapy had better quality of life scores. Conclusions: Urolithiasis patients subjectively have worse pain and physical function than the general population. The impact of pain on quality of life was greatest in those patients who had more stone episodes, underscoring the importance of preventive measures. Stone prevention measures improve quality of life.

Forming a stone in pelviureteric junction obstruction: cause or effect?

ABSTRACT Objectives To investigate a possible causal relationship for stone formation in pelviureteric junction obstruction and to outline management options. Materials and Methods A literature search and evidence synthesis was conducted via electronic databases in the English language using the key words pelviureteric junction obstruction; urolithiasis; hyperoxaluria; laparoscopic pyeloplasty; flexible nephroscopy; percutaneous nephrolithotomy, alone or in combination. Relevant articles were analysed to extract conclusions. Results Concomitant pelviureteric junction obstruction (PUJO) and renal lithiasis has been reported only scarcely in the literature. Although PUJO has been extensively studied throughout the years, the presence of calculi in such a patient has not received equal attention and there is still doubt surrounding the pathophysiology and global management. Conclusions Metabolic risk factors appear to play an important role, enough to justify metabolic evaluation in these patients. Urinary stasis and infection are well known factors predisposing to lithiasis and contribute to some extent. The choice for treatment is not always straightforward. Management should be tailored according to degree of obstruction, renal function, patient symptoms and stone size. Simultaneous treatment is feasible with the aid of minimally invasive operative techniques and laparoscopy in particular.

Carga ácida potencial renal de la dieta servida a pacientes en un hospital privado. Caracas, Venezuela / Acid load renal potential of the diet served to patients in a private hospital. Caracas Venezuela

La acidosis metabólica sub clínica resultante de una carga ácida de la dieta puede constituir un factor de riesgo para diversas patologías. El objetivo fue determinar la Carga Acida Potencial Renal (CAPR) de las dietas servidas a pacientes hospitalizados en el Centro Médico Docente La Trinidad. Se analizó el contenido en proteínas, grasas, carbohidratos, kilocalorías y CAPR de cuatro tipos de dietas: completa (C), de protección gástrica (PG), hiposódica (H) y para diabéticos (D). Se calculó la CAPR de los alimentos disponibles, de los ofrecidos en dos menús representativos y de las dietas seleccionadas por los pacientes. Adicionalmente se plantearon tres combinaciones para lograr dietas con baja carga ácida. La CAPR (X mEq/día) fue: 1) alimentos disponibles: C 100,51; PG 57,16; H 82,4; D 73,15. 2) para los menús 1 y 2: C 38,88 y 27,22; PG 48,3 y 24,45; H 21,54 y 8,24; D 36,53 y 46,22. 3) para las dietas elegidas por los pacientes: C 28,27; PG 25,77; H 7,19; D 15,63. 4) para las combinaciones propuestas: C -17,43; PG -24,17; H -15,83; D -16,29. La CAPR se correlacionó directamente con el contenido de proteínas de los cuatro tipos de dietas (p<0.001) e inversamente con el peso en gramos de frutas y hortalizas (p<0.01). La CAPR de las dietas elegidas por los pacientes fue positiva. Sin embargo, es posible lograr combinaciones que resulten en dietas con baja carga ácida. Se recomienda educar a los pacientes en relación a la importancia de evitar dietas de elevado contenido ácido(AU)

Subclinical metabolic acidosis as a result of an acid dietary load may represent a risk factor for multiple pathologies. The objective of this study was to determine the Potential Renal Acid Load (PRAL) of diets served to patients hospitalized at the Centro Médico Docente La Trinidad. Protein, fat, carbohydrate, energy and PRAL of four types of diets were analyzed. The four types of diets were the following: complete (C), gastric protection (GP), low sodium (LS) and for diabetic patients (D). PRAL was calculated for available foods, for foods in two types of menus (1 and 2) and for diets selected by patients. Additionally, food combinations for diets with low acid load were proposed. PRAL (X mEq/day) was: 1) for available foods: C 100,51; GP 57,16; LS 82,4; D 73,15. 2); for patients selection: C 28,27; GP 25,77; LS 7,19; D 15,6; 3) for menus 1 and 2: C 38,88 and 27,22; PG 48,3 and 24,45; H 21,54 and 8,24; D 36,53 and 46,22. 4) for proposed combinations: C -17,43; GP -24,17; LS -15,83; D -16,29. There was a direct and significant correlation between PRAL and protein content (p<0.001) and an inverse and significant correlation with fruits and vegetables (p<0.01). PRAL of patient selected diets was positive. However, it is possible to achieve food combinations for diets with a low acid load. Appropriate strategies should be designed in order to educate patients in relation to the importance of avoiding diets with elevated acid load(AU)

Multidrug-resistant Staphylococcus pseudintermedius isolated from dog: case report / Staphylococcus pseudintermedius multirresistente isolado do cão: relato de caso

The zoonotic potential of multidrug resistant (MDR) bacteria is a worldwide concern and companion animals have been implicated in the spread of resistant bacteria. Therefore, surveillance is important, as there are reports of transmission of these bacteria from dog to men, as well as from men to dog. A 5-year-old mixed-breed male dog was admitted with obstructive struvite urolithiasis relapsing for over 18 months, in Botucatu, in the state of São Paulo, Brazil. The strain, biochemically identified as Staphylococcus spp., was MDR and was treated off-label with vancomycin, which resulted in clinical cure. The strain was molecularly identified as Staphylococcus pseudintermedius and the mecA gene was identified. This is the main gene responsible for methicillin-resistant S. pseudintermedius (MRSP), which is often resistant to multiple antimicrobials. The hypotheses for this clinical case are the transmission from man to animal, since the tutor was an intensivist doctor, or the bacterium itself could be part of the animal's microbiota and due to other factors, such as stress or obstructive urinary disease, opened a doorway to infection by S. pseudintermedius. Further studies should elucidate the transmission of MDR bacteria between human and pets.(AU)

O potencial zoonótico de bactérias multirresistentes é uma preocupação global e os animais de companhia têm sido implicados na disseminação de bactérias resistentes; assim, é importante a vigilância, pois já existem relatos de transmissão destas bactérias do cão para o homem e vice-versa. Um cão, sem raça definida e de cinco anos de idade, foi atendido na cidade de Botucatu, São Paulo, Brasil, apresentando urolitíase obstrutiva de estruvita recorrente há um ano e meio. Na urocultura do animal foi isolada uma estirpe de Staphylococcus spp. multirresistente; o tratamento com vancomicina possibilitou acura clínica. A estirpe de Staphylococcus spp. isolada foi identificada molecularmente como S. pseudintermedius e nela foi identificada a presença do gene mecA, o principal responsável por S. pseuidintermedius resistente à meticilina (MRSP), e que é frequentemente resistente à múltiplos antimicrobianos. As hipóteses para este caso clínico são a transmissão do homem para o animal, pois o tutor era um médico intensivista, ou que a própria bactéria fazia parte da microbiota do animal e, devido a outros fatores como estresse e doença urinária obstrutiva, abriu-se uma porta de entrada para a infecção pelo S. pseudintermedius. Mais estudos são necessários para a elucidação da transmissão de bactérias multirresistentes entre animais de companhia e o ser humano.(AU)

Litiasis urinaria en niños hospitalizados. Centro Hospitalario Pereira Rossell 2006-2012 / Urinary stones in hospitalized children. Centro Hospitalario Pereira Rossell 2006-2012

La enfermedad litiásica puede comenzar en la infancia con manifestaciones escasas o atípicas. Su incidencia es menor que en adultos y es de difícil diagnóstico. La causa favorecedora (metabólica, infecciosa, malformativa, mixta) se encuentra con mayor frecuencia que en adultos. El objetivo es describir las características clínicas, la evolución y el tratamiento de los niños hospitalizados con litiasis urinaria en el CHPR.Se realizó un estudio descriptivo, retrospectivo entre el 1 de junio de 2006 y el 31 de mayo de 2012. Se incluyeron todos los niños de 1 mes a 14 años hospitalizados con diagnóstico de litiasis urinaria. Se analizó presentación clínica, causas predisponentes, tratamiento y evolución. La fuente de datos fueron las historias clínicas. Se hospitalizaron 20 niños, 12 varones y ocho mujeres, mediana 10,5 años. El dolor fue la presentación clínica más frecuente (n=17). La litiasis fue única en 11 casos y múltiple en 9. Se diagnosticó litiasis coraliforme con pionefrosis en dos niños y en otros dos nefrocalcinosis. Presentaron complicaciones obstructivas (n=15), infecciosas (n=4), insuficiencia renal aguda leve (n=3). Se hallaron causas predisponentes en 13 niños: metabólicas (n=9), infecciosas (n=4), malformativas (n=3); el estudio metabólico se realizó en 10 casos, siendo completo en tres de ellos. Recibieron tratamiento quirúrgico o litotricia 10 pacientes. Los niños con litiasis coraliforme y pionefrosis requirieron nefrectomía. Permanecen en seguimiento seis niños: tres persisten con litiasis y dos tienen nefrocalcinosis, uno de ellos con IRC moderada.Esta constituye la primera comunicación de litiasis urinaria en niños hospitalizados. Aunque se trata de un centro de referencia nacional, conocer la prevalencia y características de esta enfermedad requiere estudios multicéntricos. Una proporción importante de niños presentó complicaciones graves...

Hiperoxaluria primaria en tres hermanos / Primary hyperoxaluria in three brothers

La hiperoxaluria es responsable de 2%-20% de las causas metabólicas de litiasis en niños y adolescentes. Esta puede ser secundaria o primaria(HP), en este último caso es tipo I o tipo II, de herencia autosómica recesiva. El objetivo es analizar diagnóstico y evolución en dos hermanos con HP tipo I y un tercero con alta probabilidad. El primer caso presentó a los 9 años un cólico nefrítico con litiasis múltiples bilaterales y una IRA leve. Presentaba hiperoxaluria de 214 mg/1,73 m2. Se descartaron causas secundarias. El estudio genético demostró dos copias de la mutación IIe244Thr. Los otros dos pacientes se presentaron en forma similar, a edades de 8 y 17 años. La piridoxina a altas dosis descendió los niveles de oxaluria como está descrito en un tercio de los casos. El tiempo de evolución es 7,3 y 1 año respectivamente. Persisten actualmente con litiasis bilaterales, sin nefrocalcinosis ni alteraciones del medio interno. La severidad de la HP tipo I es variable, hay formas de presentación temprana con litiasis recurrente y falla renal crónica en la infancia o en la adolescencia; otras de inicio tardío en edad adulta. Se trata de una enfermedad grave, progresiva, cuyo diagnóstico temprano con estudio metabólico completo puede mejorar el pronóstico,fundamentalmente en aquellos que responden a la piridoxina. El manejo de la litiasis y sus complicaciones es fundamental para evitar la IRC. Cuando ésta se desarrolla, la diálisis agresiva y el trasplante hepatorrenal son las opciones terapéuticas. Es el primer informe de casos confirmados de hiperoxaluria primaria en nuestro país...

Presentaciones efectivas en medicina El arte de comunicar y transmitir: diez recomendaciones / Effective Presentations in Medicine. The Art of Communication and Transmission: Ten Recommendations

Para lograr una comunicación efectiva durante una conferencia o presentación, es necesario seguir reglas simples, que incluyen la preparación de la conferencia con el auditorio en mente y con la definición de un mensaje específico para dejar a la audiencia. Debe capturarse pronto la atención del público y todas las acciones posteriores deben ir encaminadas a mantenerla. Los textos deben ser precisos y con tamaños fácilmente visibles, las diapositivas deben ofrecer buen contraste, con fondos sólidos y simples y deben evitarse las animaciones excesivas. Al cierre de la conferencia, las conclusiones y la sesión de preguntas ofrecen la oportunidad invaluable de reforzar el mensaje que se quería dejar.

To communicate effectively during a lecture or presentation it is necessary to follow simple rules, including the preparation of the conference with the audience in mind and with the definition of a specific message to leave the audience. The public's attention should be quickly captured and all subsequent actions should aim to keep it. The text must be accurate and sizes easily visible, the slides should provide good contrast with solid and simple backgrounds and should avoid excessive animations. At the close of the conference, the conclusions and question session offers the invaluable opportunity to reinforce the desired message.

Metabolic assessment of elderly men with urolithiasis

OBJECTIVE: To assess the presence of metabolic disorders in elderly men with urolithiasis. METHODS: We performed a case-control study. The inclusion criteria were as follows: (1) men older than 60 years of age and either (2) antecedent renal colic or an incidental diagnosis of urinary lithiasis after age 60 (case arm) or (3) no antecedent renal colic or incidental diagnosis of urolithiasis (control arm). Each individual underwent an interview, and those who were selected underwent all clinical protocol examinations: serum levels of total and ionized calcium, uric acid, phosphorus, glucose, urea, creatinine and parathyroid hormone, urine culture, and analysis of 24-hour urine samples (levels of calcium, citrate, creatinine, uric acid and sodium, pH and urine volume). Each case arm patient underwent two complete metabolic urinary investigations, whereas each control arm individual underwent one examination. ClinicalTrials.gov: NCT01246531. RESULTS: A total of 51 subjects completed the clinical investigation: 25 in the case arm and 26 in the control arm. In total, 56% of the case arm patients had hypocitraturia (vs. 15.4% in the control arm; p = 0.002). Hypernatriuria was detected in 64% of the case arm patients and in 30.8% of the controls (p = 0.017). CONCLUSION: Hypocitraturia and hypernatriuria are the main metabolic disorders in elderly men with urolithiasis.

Calculus anuria and its remedy

Urinary lithiases have been a major urological problem. The objective was to determine the out come of treatment for patients with calculus anuria. A descriptive study was conducted at Department of Urology Chandka Medical College Hospital, Larkana from March 2007 to April 2009. All patients with a diagnosis of calculus anuria of all ages and either sex were included in the study. Detailed history, physical examination and examination of genitourinary tract was performed. Investigations included complete blood examination, blood urea, serum creatinine, ultrasonography of KUB area, and X-Ray KUB. Among the 66 patients the cause of anuria was bilateral obstruction by the calculi in 46 cases, unilateral obstruction with small/absent/nephrectomised contralateral kidney in 20 cases. In most of the cases, ureteric catheterisation was done to relieve the obstruction. Five deaths were observed, despite emergency urinary diversion and appropriate treatment. Calculus anuria is a urological emergency. Prompt and early intervention can save the life of patient and prevent to develop chronic renal failure

Paediatric urolithiasis in northern Nigeria

Background. The incidence of paediatric urolithiasis varies according to geographic areas. In Nigeria, there is paucity of literature on urinary stone diseases in childhood. Materials and Methods. In the period between January 1993 and December 2003, 67 Nigerian children with urinary stones were retrospectively reviewed. Results. There were 63 (94.0%) boys and 4 (6.0%) girls. The mean age at presentation was 6.9 years. Thirty one (46.3%) were in the age group less than 5 years. The commonest presenting symptoms were dysuria 42 (62.7%) and abdominal pain in 30 (44.8%). Pulling on the penis is characteristically present in 26 (38.8%) patients. The stones were located in the lower tract in 57 (85.1%) cases. Anatomic obstruction along the urinary tract was responsible for stone formation in 12 (17.9%) patients. Sixteen (23.9%) patients had associated urinary tract infection. All the stones analyzed were mixed and 75% contained urate. In 7 (10.4%) patients the stones were passed spontaneously. Open surgical technique was employed in the remaining 60 patients. There was no death recorded. Post-operative complications occurred in 15 (25.0%) of the operated patients. The commonest complications were wound infection 3 (5.0%) and vesicocutaneous fistula in 3 (5.0%) patients. The average duration of hospital stay was 16.0 days. Conclusion. In our practice lower tract stones are common and congenital urinary tract obstruction is the commonest identifiable cause for stones. The age and sex distribution and chemical composition are in keeping with historic and endemic stones. Early detection and treatment of urinary tract obstruction will further reduce the durden of stones disease